Long-term psychosocial effects of childhood exposure to parental problem drinking

The effect of a computer-based intervention on adult children of alcoholics

OBJECTIVES

People who grow up with a family member who has a substance use disorder (SUD) are at risk for serious problems, and yet support for family members focuses mainly on the individual with the SUD. Technology may offer a way to make support widely available to family members of those with SUDs. This small randomized trial examined an online system of resources called CHESS (Comprehensive Health Enhancement Support System) for adult children of alcoholics (ACOAs), a population at greater risk for SUDs, depression, and other difficulties than adults whose parents were not alcoholics.

METHODS

The study randomized 23 self-identified ACOAs to 3 interventions for 8 weeks. The goal was to increase participants' treatment compliance and psychological health. The interventions were therapy only, CHESS only, and CHESS plus therapy. We used 2 measures: compliance with treatment, gauged by attendance in group therapy for the 2 groups assigned to therapy, and aspects of psychological health or distress, measured by a survey with items from 7 scales.

RESULTS

The CHESS-plus-therapy group had an attendance rate in group therapy of 81.5% compared to 42.8% for the therapy-only group. The CHESS-only intervention had the largest effect size on 5 of the 7 measures of psychological health or distress. In 4 of the 5 cases, the effect size was large; in 1 case, it was moderate.

CONCLUSIONS

The findings of this pilot study are based on a small sample, but they suggest the need for more research and the potentially important role of technology in behavioral health treatment.

Work stress and alcohol use: Examining the tension-reduction model as a function of worker's parent's alcohol use

In an effort to identify groups who may be more vulnerable to tension-reduction drinking [Frone, M. (2003). Predictors of overall and on-the-job substance use among young workers. Journal of Occupational Health Psychology, 8, 39-54.], we examine whether drinking alcohol in response to work stress varies as a function of whether workers were raised in homes where (a) both parents abstained from alcohol, (b) at least one parent drank nonproblematically, (c) at least one parent drank problematically, or (d) both parents drank problematically. Employees participating in a large, longitudinal study who reported using alcohol in the previous year (N=895) completed various measures of work stressors, alcohol use, and alcohol problems. We found few mean group differences for either the work stressor or alcohol measures, but we did find a greater number of significant and moderate correlations between work stressors and alcohol for those reporting that both parents drank alcohol problematically. Interestingly, a number of significant correlations were found for those reporting that both parents abstained from alcohol; few were found for the two groups reporting that at least one parent drank with or without alcohol problems. Results are interpreted in light of where and how alcohol expectancies and other coping methods are learned.

Factors associated with alcohol consumption, problem drinking, and related consequences among high school students in Taiwan

This research evaluated the risk factors associated with alcohol consumption, problem drinking, and related consequences among high school students in Taiwan. A total of 779 10th grade students from four randomly selected high schools in eastern Taiwan were included in the survey. Survey data were self-reported by students and analyzed using logistic regression methods. The results showed that alcohol consumption and problem drinking was 2.22-2.71-fold greater in male than in female adolescents. Parents and peer groups were the determinants influencing alcohol consumption, and these influences could be enhanced particularly by the drinking behaviors of fathers and peer groups, and the relationship of students with their peer groups. The probability of developing adolescent problem drinking was fourfold greater in students whose fathers had habits of drinking. Ethnicity had a notable impact on the risk of problem drinking. The occurrence of problem drinking among indigenous adolescents was 2.98-fold higher than among Hans, indicating a diversity of biological factors, social norms, and expectation for alcohol drinking between these two ethnic groups. This study suggests that a policy for preventing alcohol abuse among high school students should start by addressing the two major associated problems: a need to earn peer group recognition, and the lack of family support among at-risk students.

Assessing parental alcoholism: a comparison of the family history research diagnostic criteria versus a single-question method

This study compares two methods of determining parental alcoholism: (1) a single question asking whether one of the subject's parents had alcohol problems; (2) the Family History Research Diagnostic Criteria (FH-RDC), which require at least one alcohol-related problem in addition to parental problem drinking. We sought first to determine the level of agreement between the single-question approach and the full FH-RDC for parental alcoholism, and then to gauge how much bias will be introduced by using the single question rather than the FH-RDC-method in assessing the risk for psychiatric disorders. Data were taken from the National Comorbidity Survey (NCS), a nationwide survey of the noninstitutionalized US civilian population aged 15 to 54. Parental alcoholism was assessed both by the single question and by the full FH-RDC. Psychiatric disorders were assessed with the Composite International Diagnostic Interview (CIDI). Good agreement was found between the single-question approach and the FH-RDC (kappa = 0.83). The single-question method introduces only a small downward bias when it comes to assessing the risk for psychiatric disorders in children of alcoholic probands. This underestimation does not reach statistical significance. When a questionnaire needs to be shortened, a single question on parental problem drinking is a good alternative to checking all individual FH-RDC items.

Exposure to parental tobacco and alcohol use: effects on children's health and development

This review examines three ways in which parental tobacco and alcohol use compromises the physical and mental health of children: 1) direct exposure to the substances; 2) living with parents who may become ill from using these substances; and 3) children's modeling of parental substance use. Implications for prevention, intervention, and public education are discussed, and a reframing of the national dialogue on youth substance abuse is called for.

Economic evaluations and interventions for children and adolescents with mental health problems

Economic evaluations of interventions for children and adolescents with mental health problems are comparatively rare, although the growing need for them is now quite widely recognized. This review paper first explains how demands for such evaluations have built up, and for what reasons, and then considers the response from evaluators. The various modes of economic evaluation are introduced and illustrated. Previous and current research is discussed by reference to five generic research questions commonly addressed in the wider health economics field: What treatment should be provided? When? Where? To whom? How? The review concludes with recommendations as to how economic evaluations should be taken forward in this increasingly important area of intervention.