Loosening the Grip: a handbook of Alcohol Information 9th

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Chapter 7 The Behavior of Dependence

Johnson V. I’ll Quit Tomorrow, rev. edition. New York: Harper & Row, 1983.

This work introduced the technique of "the intervention", a method to initiate treatment. The use of "interventions" promoted earlier treatment and prompted care for those previously seen as either "unready" or "inaccessible". The adoption of this clinical approach dispelled the myth that a patient's apparent motivation to cease use is a significant factor in determining treatment outcome, thus revolutionizing alcohol treatment, and by example, drug abuse treatment as well. This work also introduced the concept of "enabling", i.e. the interactions of the family and the alcoholic which unwittingly support the continuation of drinking or drug use. Efforts to counter these behaviors, tied to the framework of the "intervention", offer family a constructive role, beyond "detachment with love", the primary orientation of Al Anon, the self-help group for family members. Copyright 1990, Project Cork Institute.

Schuckit MA, Smith TL, Anthenelli R, et al. Clinical course of alcoholism in 636 male inpatients. American Journal of Psychiatry 150(5): 786–792, 1993. (27 refs)

Objective: This study was undertaken to determine the relative order of appearance of symptoms in alcohol dependence. Method: The age at which 21 alcohol-related major life events first occurred was investigated in 636 male alcohol-dependent inpatients through a standardized, structured personal interview with each subject and at least one resource person. Results: A general pattern of first occurrence of these events was observed. Heavy drinking escalated further when the subjects were in their late 20s, followed by evidence of interference with functioning in multiple life areas in the early 30s, a subsequent perception of loss of control, and then an intensification of social and job-related problems, along with evidence of deterioration in body systems, in the mid- to late 30s. Similar patterns of problems emerged when the alcoholic subjects were divided into subgroups based on onset of alcohol dependence before or after age 30, presence or absence of a family history of alcoholism, and presence or absence of additional psychiatric disorders. Conclusions: These data indicate that there is a typical progression of events related to alcohol dependence. This information can be useful for clinicians in their work with patients and for teachers and researchers as well. Copyright 1993, American Psychiatric Association

Jellinek EM. The Disease Concept of Alcoholism New Haven CT: Hill House Press, 1960.

This is a classic work addressing the notion of alcoholism (alcohol dependence) as a disease, and setting forth the presumed stages and types alcoholism.

Penick EC, Nickel EJ, Powell BJ, Liskow BI, Campbell J, Dale TM, Hassanein RE, et al. The comparative validity of eleven alcoholism typologies. Journal of Studies on Alcohol 60(2): 188-202, 1999. (75 refs.)

Objective: This study directly compared the clinical validity of 11 empirically defined alcoholism typologies to determine whether some typologies are clinically more valid than others. Method: A sample of 360 hospitalized alcoholic men were extensively evaluated at entry into the study and again 1 year later. Twenty-three measures of clinical validity were employed; 15 were postdictive and 8 were predictive. Postdictive retrospective measures obtained at entry into the study included family history, age of onset and lifetime course characteristics associated with alcoholism severity, general psychopathology and psychosocial functioning. Predictive outcome measures drawn from information obtained during the 1-year follow-up included: abstinence, alcoholism severity and clinician ratings of outcome. The measures were subjected to various statistical analyses, including factor analysis. Results: We found that all of the alcoholism typologies met at least 7 of the 23 a priori measures of clinical validity. The correlations between these conceptually and methodologically disparate typologies were often striking. Exploratory factor analysis, which explained 35% of the variance. suggested three possible underlying dimensions to account for the overlap among typologies: (1) age and its correlates, including age- of-alcoholism onset; (2) "pure" alcoholism versus psychiatrically heterogeneous alcoholism that encompassed antisocial personality disorder; and (3) current severity of psychiatric distress, impairment and dysfunction. Conclusions: No single method of subtyping alcoholics clearly emerged as superior. All demonstrated some degree of predictive and postdictive clinical validity. Most methods of subtyping correlated positively with each other at moderate, but typically significant, levels. Copyright 1999, Alcohol Research Documentation, Inc.

Rinaldi RC, Steindler EM, Wilford BB, Goodwin D. Clarification and standardization of substance abuse terminology, JAMA. Journal of the American Medical Association 259(4): 555–557, 1988. (9 refs)

A four-stage Delphi survey of substance abuse experts was conducted to help achieve greater clarity and uniformity in terminology associated with alcohol and other drug-related problems. This multidisciplinary group of experts was asked to reach a consensus on alcohol and other drug-related terms and definitions. Results produced a list of 50 substance abuse terms deemed important, along with the most agreed on definition for each term. Copyright 1987. American Medical Association.

Satel SL. The fallacies of no-fault addiction . Public Interest. 134: 52-67, 1999

On November 20, 1995, more than one hundred substance-abuse experts gathered in Chantilly, Virginia, for a meeting organized by the government's top research agency on drug abuse. One topic for discussion was whether the agency, the National Institute on Drug Abuse (NIDA), which is part of the National Institutes of Health, should declare drug addiction a disease of the brain. Overwhelmingly, the assembled academics, public-health workers, and state officials declared that it should. At the time, the answer was a controversial one, but, in the three years since, the notion of addiction as a brain disease has become widely accepted, thanks to a full blown public education campaign by NIDA. However, politicians, including President Clinton's drug czar, General Barry McCaffrey, should resist this medicalized portrait. First, it reduces a complex human activity to a slice of damaged brain tissue. Second, and more importantly, it vastly underplays the paradoxically voluntary nature of addictive behavior. Copyright 1999, National Affairs, Inc.

Saunders JB; Schuckit MA, eds. Diagnostic issues in substance use disorders. Addiction 101(Supplement 1): entire issues, 2006.

The special supplement on Diagnostic Issues in Substances Use Disorder has 18 articles ranging from considering diagnostic criteria, comparing diagnostic criteria of the APA's Diagnostic and Statistical Manual and the International Classification of Disease, to examining the whether addictive disorders should include non-substance related conditions, such as gambling. (Copyright 2006, Project Cork)

Stepney R. The concept of addiction: Its use and abuse in the media and science Human Psychopharmacology 11(Supplement 1): S15–S20, 1996. (18 refs.)

Since it relates to common and frequently troublesome aspects of human behaviour, the concept of addiction is of considerable interest to the media, as it is to the health sciences and medicine. With some exceptions, the problems that emerge from the media's use of the concept are similar to those evident in the scientific literature. The term is sometimes used simply to draw attention to a behaviour which evokes disapproval, and the concept may be applied so broadly that sight of its core meaning is lost. However, the fact that there are problems in the way we employ the concept of addiction does not mean that there is no problem of addiction. Important aspects of human experience are well captured by much lay and scientific usage of the term. These experiences involve a range of appetitive behaviours (frequently but not exclusively drug-related) which the person concerned finds genuinely difficult to control and which are the source of conflict both within and between individuals. Among drug-related behaviours, opiate use can be considered the paradigm of addiction; and it is meaningful, even if not always appropriate, to consider the addictive potential of other psychoactive drugs in relation to this standard. Copyright 1996, John Wiley & Sons, Ltd.

Vaillant GE. The Natural History of Alcoholism, revisited. Cambridge MA: Harvard University Press, 1996.

This volume represents both a "re-printing", as well an up-dating and reflection on a now classic work in the alcohol field, one published fifteen year ago. Drawing upon the analysis of two major longitudinal studies, that work described the natural history of alcoholism (alcohol dependence.) The "new" edition is structured as a "reprint" of the previous edition, with new sections interspersed -- clearly denoted -- providing a commentary on the earlier work, drawing upon new research in the field, further follow-up of subjects, and the author's reflections. Copyright 1996, Project Cork Institute

Woody G, Schuckit M, Weinrieb R, Yu E: A review of the substance use disorder section of the DSM-IV, Psychiatric Clinics of North America 16(1): 21–32, 1993.

In 1988 the Board of Trustees of the American Psychiatric Association (APA) appointed as Task Force on DSM-IV to revise the Diagnostic and Statistical Manual (DSM) to be compatible with the World Health Organization's (WHO) International Classification of Diseases tenth edition. The Substance Use Disorders work group was formed to assist in the effort. A three-step process included literature reviews on selected topics; re-analysis of several pre-existing data sets, and conduct of field trials in America and Europe to determine the best way to diagnose abuse and dependence. Reports from the work group suggested significant alterations to DSM-IV in several areas: the optimal criteria for abuse; modifications in the criteria for dependence; diagnostic guidelines for dealing with psychiatric syndromes in individuals with substance use disorders; further scrutiny for diagnostic criteria for remission; the need to define severity more clearly; reorganization in the notation of some substance use disorders; handling of nicotine withdrawal; and inclusion/exclusion of alcohol idiosyncratic intoxication. In addition, other reports suggested no change for DSM-IV with regard to inclusion of caffeine abuse and dependence; highlighting anabolic steroid dependence; relevance of protracted abstinence (withdrawal) syndromes; a new subtype of dependence based on familial pattern of the disorder; and combination of amphetamines and cocaine into a large category, stimulants. Copyright 1993, Project Cork Institute

Chapter 8 Effects of Alcohol Problems on the Family

Alcohol Health and Research World. Special issue on children of alcoholics 21(3): entire issue, 1997.

Avenevoli S, Merikangas KR. Familial influences on adolescent smoking (review). Addiction 98 (Supplement): 1–20, 2003. (152 refs.)

The family unit is the primary source of transmission of basic social, cultural, genetic, and biological factors that may underlie individual differences in smoking. Existing information on the role of familial factors in tobacco use is characterized by two separate. but somewhat Overlapping, lines of research: genetic epidemiological studies and risk-factor research. The present paper summarizes and evaluates studies assessing the association between adolescent smoking and parent and sibling smoking behaviors. A review of 87 studies reveals that methods are limited by a lack of standardized instruments, failure to measure important confounding and mediating factors, reliance on cross-sectional designs and the use of inconsistent definitions of tobacco-related behavior and assessment procedures. Moreover, there are no systematic family studies of the acquisition and continuation of smoking that have employed contemporary methodological standards for examining familial aggregation of tobacco behaviors among adolescents. Findings across studies show weak and inconsistent associations between parent and adolescent smoking. Inconsistent findings may be attributed to methodological issues or associated factors that may complicate the relation between parent and adolescent smoking. Sibling and peer smoking show greater associations with adolescent smoking. Suggestions for future research include contemporary family studies that delineate meaningful phenotypes of tobacco use and prospective work on the later stages of tobacco use and the timing of the influence and valence of parent and family factors. Integration of the risk factor approach within the family study design may enrich both approaches to elucidate familial influences on smoking. (Copyright 2003, Society for the Study of Addiction to Alcohol and Other Drugs)

Barnard M. Between a rock and a hard place: The role of relatives in protecting children from the effects of parental drug problems. Child & Family Social Work 8(4): 291–299, 2003. (21 refs.)

Using qualitative data gathered from 62 problem drug using parents in Glasgow, Scotland, this paper explores the role played by the extended family in protecting children from some of the negative effects of parental drug use. However, the data also indicated that the intervention of the extended family, whilst often critical, was not without its tensions and difficulties for parents, for the extended family and for the children too. What seemed to obtain in most cases was a complex and volatile mix of practical and emotional concerns over children's appropriate care and issues of responsibility and obligation to the child. These in turn were overlaid by expressions of anxiety, worry, anger and disappointment over both the parent's drug problem and its profound effect on the family. In a worst case scenario it can lead to a breakdown of these care arrangements, leaving these already vulnerable children exposed to further rupture, emotional damage and instability. If we are to avoid such outcomes it is crucial that we first identify and then work to rectify those factors that compromise the abilities of extended family carers to look after these children both in the short and the longer term. (Copyright 2003, Blackwell Publishing)

Barrett AE, Turner J. Family structure and substance use problems in adolescence and early adulthood: Examining explanations for the relationship. Addiction 101(1): 109–120, 2006. (63 refs.)

Aims: Our study has two goals: to evaluate variation in symptoms of substance abuse/dependence by family structure and to examine several potential explanations for this association, including differences in socio-economic status, social support, social stress and perceived approval and use of substances by family and friends. Design: Ordinary least squares (OLS) regression is used to examine the association between family type and problematic substance use and to assess the hypothesized mediators. Setting: Data were collected between 1998 and 2000 as part of a study of the prevalence and social distributions of psychiatric and substance use disorders. The study involved face-to-face interviews with a representative sample of young adults in a South Florida community. Participants: Respondents (n = 1760) were between 18 and 23 years of age. Approximately 25% were of Cuban origin, 25% other Caribbean basin Hispanic, 25% African American and 25% non-Hispanic white. Measurements: Four family types are examined: mother-father families, single-parent families. single-parent families that include other adult relative(s) and stepfamilies. Problematic substance use is measured by a set of 22 substance abuse/dependence symptoms. Findings: Controlling for race-ethnicity and gender, respondents from single-parent families report a significantly higher level of problematic substance use than those from mother-father families. Although nearly all explanations receive support, we find the strongest evidence for differential association with deviant peers and exposure to stress. Conclusions: Our findings suggest that -- rather than representing a unique and independent predictor of substance use problems -- family structure can be viewed as a marker of the unequal distribution of factors influencing the risk of problematic substance use. (Copyright 2006, Society for the Study of Addiction to Alcohol and Other Drugs)

Batra V, Patkar AA, Berrettini, WH, Weinstein, SP, Leone FT. The genetic determinants of smoking. Chest 123(5): 1730–1739, 2003. (92 refs.)

Dependence on tobacco, like many other drug dependencies, is a complex behavior with both genetic and environmental factors contributing to the variance. The heritability estimates for smoking in twin studies have ranged from 46 to 84%, indicating a substantial genetic component to smoking. Candidate gene studies have detected functional polymorphisms in genes coding for the cytochrome P450 enzymes, and variations in these genes that lead to more rapid nicotine metabolism have been implicated in smoking. Similarly, smoking has been associated with polymorphisms in dopaminergic genes that may influence the dopamine receptor number and/or function. Animal experiments have localized specific subunits of the nicotinic receptors that may mediate the reinforcing properties of nicotine and have investigated their role in nicotine dependence. However, environmental factors have also been found to contribute to the risk of initiation and persistence of smoking. We review the scientific evidence that supports a role for genetic influences on smoking, discuss the specific genetic and neurobiological mechanisms that may mediate susceptibility to nicotine dependence, identify possible gene/environmental interactions that may be important in understanding smoking behavior, and suggest directions for future research. Insights into the genetic contributions to smoking can potentially lead to more effective strategies to reduce smoking. (Copyright 2003, The American College of Chest Physicians)

Beidler RJ. Adult children of alcoholics: Is it really a separate field of study? Drugs and Society 3(3/4): 133–141, 1989. (16 refs)

This article delineates a number of the core issues involved in understanding the process of adjustment of adult children of alcoholics. In doing so it draws upon representative work in the field as well as relevant work in related fields. The focus is upon identifying a number of core issues. Thus, this article deals with knowledge development and theory and includes the following sections: (1) children of alcoholics, a diagnostic label or category for study?; (2) adult children of alcoholics and individual adjustment; (3) the family, alcoholism, and the adult child; (4) general theory on adult adjustment and the adult children of alcoholics; and (5) the interaction of alcoholism and sociopathy and its possible relationship to adjustment. Copyright 1989, The Haworth Press, Inc.

Dishion TJ, Nelson SE, Bullock BM. Premature adolescent autonomy: Parent disengagement and deviant peer process in the amplification of problem behaviour. Journal of Adolescence 27(5): 515–530, 2004. (39 refs.)

Premature autonomy describes a developmental dynamic where parents of high-risk adolescents reduce their involvement and guidance when confronted with challenges of problem behaviour and the influence of deviant friendships. This dynamic was tested on the sample of Oregon Youth Study boys (N = 206), whose family management practices and friendships were observed on videotaped interaction tasks. Latent growth curve models were used to examine longitudinal trends between deviant friendship interactions and family management. Direct observations of deviant friendship process at age 14 were associated with degradation in family management during adolescence. A comparison of antisocial and well-adjusted boys clarified that parents of antisocial boys (started early and persisted) decreased family management around puberty, in comparison to parents of well-adjusted boys who maintained high levels of family management through adolescence. In predicting late adolescent problem behaviour, there was a statistically reliable interaction between family management degradation and deviant peer involvement in adolescence in support of the premature autonomy hypothesis. Adolescent males involved in deviant friendships, and whose parents decreased their family management, were most likely to use marijuana and commit antisocial acts at age 18. The implications for interventions that target adolescents are discussed. (Copyright 2004, The Association for Professionals in Services for Adolescents)

Eiden RD; Edwards EP; Leonard KE. Children's internalization of rules of conduct: Role of parenting in alcoholic families. Psychology of Addictive Behaviors 20(3): 305-315, 2006. (84 refs.)

This study examined the association between fathers' alcoholism and children's internalization of rules of conduct at 2 to 3 years of age. The sample consisted of 220 families (102 without alcoholism, 118 with alcoholism). Results indicated that there was no direct association between fathers' alcoholism and children's internalization measured with a behavioral paradigm at age 3 years. However, the indirect association between fathers' alcoholism and children's behavioral internalization was significant through fathers' sensitivity during play interactions at age 2 years. Children of fathers with alcoholism were rated by their mothers as having lower internalized conduct over the 2- to 3-year period. This direct association was not mediated by parental sensitivity. (Copyright 2006, American Psychological Association)

Eiden RD; Leonard KE; Hoyle RH; Chavez F. A transactional model of parent-infant interactions in alcoholic families. Psychology of Addictive Behaviors 18(4): 350–361, 2004. (66 refs.)

This study examined the transactional nature of parent-infant interactions over time among alcoholic and nonalcoholic families. The sample consisted of 222 families assessed at 12, 18, and 24 months of child age. Results indicated that infant behavior did not influence parental behavior across time, but parental behavior was longitudinally predictive of infant behavior during play interactions. Higher paternal alcohol consumption at 12 months was longitudinally predictive of negative parental behavior at 24 months. Other significant risk factors included marital conflict, fathers' depression, and fathers' education. Results highlight the nested nature of risk in alcoholic families and the direction of influence from parent to child during interactions and suggest that 1 pathway to risk among these children is through negative parent-infant interactions. (Copyright 2004, Educational Publishing Foundation)

Fuller JA, Warner RM. Family stressors as predictors of codependency. Genetic, Social, and General Psychology Monographs 126(1): 5–22, 2000. (41 refs.)

Codependency has been defined as an extreme focus on relationships, caused by a stressful family background (J. L. Fischer, L. Spann, & D. W. Crawford, 1991). In this study the authors assessed the relationship of the Spann-Fischer Codependency Scale (J. L. Fischer et al., 1991) and the Potter-Efron Codependency Assessment (L. A. Potter-Efron & P. S. Potter-Efron, 1989) with self-reported chronic family stress and family background, Students (N = 257) completed: existing self-report codependency measures and provided family background information. Results indicated that women had higher codependency scores than men on the Spann-Fischer scale. Students with a history of chronic family stress (with an alcoholic, mentally ill, or physically ill parent) had significantly higher codependency scores on both scales. The findings suggest that other types of family stressors, not solely alcoholism, may be predictors of codependency. Copyright 2000, Heldref Publications

George WH, La Marr J, Barrett K, McKinnon T. Alcoholic parentage, self-labeling, and endorsement of ACOA-codependent traits. Psychology of Addictive Behaviors 13(1): 39–48, 1999. (50 refs.)

Traits reputed to characterize adult children of alcoholics (ACOAs) and codependent individuals were assessed among psychology undergraduates (n = 281). Students self-reporting alcoholic parentage were no different from controls on these traits or on self-reported drinking. Null effects are attributed to sample characteristics and to systematic inattention to discriminant validity concerns in the original trait formulations. Alcoholic parentage did affect willingness to self-label as ACOA and codependent. Also, regardless of parentage, participants who self-labeled as codependent scored higher on the signature traits than participants who did not self-label as codependent. This result is discussed with respect to recruitment pressures and self-fulfilling-prophecy effects engendered by the widespread dissemination of the ACOA and codependency concepts. Copyright 1999, American Psychological Association

Goldfarb B. Counting the drug war’s female casualties. The Journal of Gender, Race & Justice 6(Fall): 227+, 2002. (177 refs.)

A women, who despite having only a minor involvement in her boyfriend's drug transactions, is serving a sentence of 34.5 years in federal prison. This is not an isolated case. This article explores the impact of the drug war on women's lives. In Part I, the author examines the usage of the word "war" and its connotations. Part II, illustrates the impact of the drug war on women's lives by detailing a dozen federal cases in which women have served -- or, in several instances continue to serve -- long mandatory sentences for drug offenses. Part III explores gender issues that emerge from these cases. In the final part, the consequences of long-term incarceration of tens of thousands of women, prisoners of the drug war's politics and policies are considered. In summary, the author notes that it is not only long term incarceration, but also banning welfare, eliminating student financial aid, evicting families into homelessness and excluding them from public housing for life for the conduct of a single family member -- that has a deep impact on whole families. It is not uncommon that women and children are pressed more deeply into poverty, thereby creating greater public health problems, more desperation, and arguably more crime. If policymakers can be persuaded that removing primary caretakers is criminogenic in the way that it traumatizes children and disrupts families for generations into the future, and that parenting paired with education and treatment, not long prison terms, reduces violence, then the drug war as we know it will have come to an end long overdue. Copyright 2002, University of Iowa School of Law

Harrington CM, Metzler AE. Are adult children of dysfunctional families with alcoholism different from adult children of dysfunctional families without alcoholism? A look at committed, intimate relationships. Journal of Counseling Psychology 44(1): 102–107, 1997.

Investigating the validity of classifying adult children of dysfunctional families with alcoholism (ACDFAs) as a unique population, this study compared ACDFAs with adult children of dysfunctional families without alcoholism (ACDFs) and adult children of functional families (ACFFs) on current relationship satisfaction. Participants (N = 126) were from a community sample. No significant difference between the ACDFAs and the ACDFs was found; however, both ACDFAs and ACDFs displayed significantly more difficulty with problem-solving communication than the ACFFs. Regression results indicated that dysfunction in the family of origin is significantly related to global distress and difficulties with problem-solving communication in current intimate relationships. Results do not lend support to the utility of classifying ACDFAs as a unique population. Copyright 1997, American Psychological Association, Inc.

Harter SL. Psychosocial adjustment of adult children of alcoholics: A review of the recent empirical literature. Clinical Psychology Review 20(3): 311–337, 2000. (120 refs.)

This review examines controlled studies of the psychosocial adjustment of adult children of alcoholics (ACOAs) published since 1988. ACOAs appear at increased risk for a variety of negative outcomes, including substance abuse, antisocial or undercontrolled behaviors, depressive symptoms, anxiety disorders, low self-esteem, difficulties in family relationships, and generalized distress and maladjustment. However, none of these outcomes are uniformly observed in ACOAs and none are specific to ACOAs. Comorbid parental pathology, childhood abuse, family dysfunction, and other childhood stressors may contribute to or produce similar outcomes. There is little empirical support for "ACOA syndromes" described in the clinical literature. Copyright 2000, Pergamon Press

Haugland BSM. Recurrent disruptions of rituals and routines in families with paternal alcohol abuse. Family Relations 54(2): 225–241, 2005. (47 refs.)

Changes in rituals and routines between drinking and sobriety were examined in families in treatment due to paternal alcohol abuse. Information was gathered through a semistructured family interview. Recurrent disruptions of rituals and routines were found between different phases in the drinking cycle. Disruptions were found typically with regard to the fathers' participation in rituals and routines, the parental roles and responsibility, the affective quality of the rituals, and the general family climate. Four categories of families were distinguished based on amount and type of disruptions in family rituals and routines (i.e., protecting, emotional disruptive, exposing, and chaotic families). Implications for intervention are described. (Copyright 2005, National Council on Family Relations)

Hudson CR, Kirby KC, Firely ML, Festinger DS, Marlowe DB. Social adjustment of family members and significant others (FSOs) of drug users. Journal of Substance Abuse Treatment 23(3): 171–181, 2003. (48 refs.)

This study investigated the social adjustment of female family members and significant others (FSOs) of illicit drug users in order to gain insight into the impact of drug use upon those close to the user. Using the Social Adjustment Scale-Self Report (SAS-SR), we examined the social adjustment self-ratings (overall and in seven specific role areas) of 41 female partners and 24 mothers of drug users. We compared these ratings to the ratings they reported for their drug-using partners or children, to each other, and to self-ratings drawn from community comparison samples. As expected, results showed that the female FSOs reported significantly better social adjustment than the drug users in most role areas. However, their social adjustment was compromised relative to the community samples. Partners of drug users reported poorer adjustment than parents of drug users overall and in the specific areas of marital and economic functioning. Further inquiry is needed to improve our understanding of the impact of drug use on the users' family members. copyright 2004, Elsevier Science

Hunt ME. A comparison of family of origin factors between children of alcoholics and children of non-alcoholics in a longitudinal panel. American Journal of Drug and Alcohol Abuse 23(4): 597–613, 1997. (43 refs.)

Secondary analysis of longitudinal panel data reveals minimal differences in family of origin factors between children of alcoholics (COAs) and children of non-alcoholics (non-COAs). From 220 subjects, 37 parents were identified as alcoholic. The COA subjects' retrospective reports about family of origin factors were compared to those of non-COAs. Contrary to the assertions of the COA clinical literature, few differences were found between the two groups. However, these differences are congruent with the findings of other panel studies which have investigated family of origin factors and adult outcome among COAs. Copyright 1997, Marcel Dekker, Inc. Used with permission

Hussong AM, Chassin L. Parent alcoholism and the leaving home transition. Development and Psychopathology 14(1): 139–157, 2002 (44 refs.)

This study examined individual differences in the experience of leaving home during the transition from adolescence to young adulthood within a high-risk sample of children of alcoholics (COAs). Adolescent precursors and indicators of young adult adjustment that might account for the differences were analyzed. A sample of young adult COAs (n = 227) and matched controls with no alcoholic parent were interviewed at ages 18 through 23 in regard to their experiences prior to leaving home. Findings indicate that COAs had greater difficulty in negotiating the transition, fewer positive feelings about it, and different reasons for leaving home compared to controls. COA risk for having difficulty in the transition was partly accounted for by adolescent risk behaviors, family conflict, and family disorganization. For COAs, the transition also included less consultation with parents, and younger age of departure. Difficulties in the transition of leaving home were predictive of greater adjustment problems in young adulthood. Copyright 2002, Cambridge University Press

Jackson JK. The adjustment of the family to the crisis of alcoholism. Quarterly Journal of Studies on Alcohol 15(4): 562–586, 1954.

Johnson V. I’ll Quit Tomorrow, rev. ed. New York: Harper & Row, 1980.
This work introduced the technique of "the intervention", a method to initiate treatment. The use of "interventions" promoted earlier treatment and prompted care for those previously seen as either "unready" or "inaccessible". The adoption of this clinical approach dispelled the myth that a patient's apparent motivation to cease use is a significant factor in determining treatment outcome, thus revolutionizing alcohol treatment, and by example, drug abuse treatment as well. This work also introduced the concept of "enabling", i.e. the interactions of the family and the alcoholic which unwittingly support the continuation of drinking or drug use. Efforts to counter these behaviors, tied to the framework of the "intervention", offer family a constructive role, beyond "detachment with love", the primary orientation of Al Anon, the self-help group for family members. Copyright 1990, Project Cork Institute.

Kreek MJ, Nielsen DA, LaForge KS. Genes associated with addiction: Alcoholism, opiate, and cocaine addiction (review). Neuromolecular Medicine 5(1): 85–108, 2004. (172 refs.)

Drug addiction is a complex disorder that has a large spectrum of causes. Vulnerability to addiction has been shown in twin studies to have a robust genetic component. This genetic basis for addiction has general and specific components for each drug abused. Although many genes have been implicated in drug addiction, only a handful have either been replicated to have an association or to have an identified functional mechanism related to specific effects of abused drugs. A few selected genetic variants that currently look promising for the study of alcohol, opiate, and cocaine addiction are discussed in this article. (Copyright 2004, Humana Press)

Melchert TP. Clarifying the effects of parental substance abuse, child sexual abuse, and parental caregiving on adult adjustment. Professional Psychology: Research and Practice 31(1): 64–69, 2000. (39 refs.)

Parental alcoholism, childhood sexual abuse, and other forms of child maltreatment are generally viewed as contributing to adult adjustment problems. The long-term effects of these various factors, however, are actually not well understood. The present study found that the largest amount of variance in college students' psychological distress was explained by parental emotional abuse and neglect, with child sexual abuse, parental substance abuse, and other factors explaining additional but smaller amounts of variance in distress. This suggests that comprehensive conceptualizations of family influences on development will result in a more complete understanding of long-term adjustment outcomes than merely focusing on particular childhood risk factors.

Menees MM, Segrin C. The specificity of disrupted processes in families of adult children of alcoholics. Alcohol and Alcoholism 35(4): 361–367, 2000. (46 refs.)

Children of alcoholics (COAs) have been characterized as an at-risk population in part, because of the dysfunctional family environments that disrupt psychosocial development among offspring exposed to parental alcoholism. This study examined the specificity of problematic family environments to children of alcoholics vs children exposed to other significant family stressors that included parental death, unemployment, separation, divorce, or major illness. University students completed self-report measures of family stressors, family relationship problems, family communication quality, family conflict, and relationship with parents. Based on a family stressor checklist, 20 students exposed only to parental alcoholism and no other family stressors were compared to several other groups exposed to specific family stressors, and to 50 control subjects who had reported no family stressors. Results showed that students from families where a parent is or was an alcoholic, and where there were no other family stressors, recall disturbed family relations no more commonly than students specifically exposed to other family stressors such as parental divorce, death, or major illness, and no more commonly than those who reported no family stressors. Further analyses suggest that the disruption of COAs' family environments may be explained by their increased likelihood of experiencing additional family stressors that can have a disruptive effect, such as parental separation, divorce and unemployment. Copyright 2000, Medical Council on Alcoholism

Room R, Matzger H, Weisner C. Sources of informal pressure on problematic drinkers to cut down or seek treatment. Journal of Substance Use 9(6): 280–295, 2004. (43 refs.)

Objective: To examine how patterns of expressions of concern about drinking from family members and friends differ according to the demographic characteristics of the drinker. Method: A probability sample of adult treated (n=926) and untreated (n=672) problem-drinking individuals from a Northern California county. Logistic regression analysis was used to predict having received pressure about drinking from a specific family member or friend. Results: Spouses and significant others were the most common relations to have said anything about the respondent's drinking, suggested they cut down or given an ultimatum to enter treatment. When controlling for severity, the respondent's degree of dependence and number of social consequences strongly predicted pressure from all sources. Having a higher income remained a strong predictor of pressure by a spouse, while having a lower income was significant in receiving pressure from siblings and other relatives and friends. Younger respondents were more likely to be pressed by a father or mother, while older respondents were more likely to be pressed by sons and daughters. Conclusions: Results show the importance of family relationships other than that with a spouse or significant other, in the efforts at informal control of drinking and efforts to seek treatment. (Copyright 2004, Taylor & Francis Press)

Rotskoff LE. Sober husbands and supportive wives: Marital dramas of alcoholism in post World War II America. IN: Tracy SW; Acker CJ, eds. Altering American Consciousness: The History of Alcohol and Drug Use in the United States, 1800-2000. Amherst MA: University of Massachusetts Press, 2004. pp. 298-326. (74 refs.)

This chapter explores scientific and popular discourses of alcoholism in the 1940s and 1950s. Implicitly, "alcoholic" meant male. It was not uncommon in the period to view the marriages of alcoholics and see wives as involved in a pathological relationship, and that the typical wife had a need to punish herself or control another person, selecting a passive marriage partner, which predisposed him to alcoholism. The chapter has sections devoted to diagnosing the alcoholic marriage, efforts to rehabilitate the alcoholic marriage and the emergence of Al-Anon, and the use of alcoholism to explore the cultural history of marriage. Copyright 2005, Project Cork

Rotunda RJ, Scherer DG, Imm PS. Family systems and alcohol misuse: Research on the effects of alcoholism on family functioning and effective family interventions (review). Professional Psychology: Research and Practice 26(1): 95–104, 1995. (106 refs.)

This article reviews the most prominent research at the interface between studies of alcohol addiction and family systems psychology. The review addresses the general effects of alcohol misuse on family functioning as determined in empirical studies comparing healthy families, alcohol afflicted families, and otherwise troubled families. Three factors ("dry" versus "wet" families, family development and the progression of alcoholism, and family structure) are identified as particularly relevant to understanding the treatment needs of families affected by alcohol misuse. Research examining the general efficacy of family interventions in the treatment of alcoholism and specific treatment considerations unique to treating families coping with alcohol misuse are reviewed. Copyright 1995, American Psychological Association, Inc.

Saatcioglu O, Erim R, Cakmak D. Role of family in alcohol and substance abuse (review). Psychiatry and Clinical Neurosciences 60(2): 125–132, 2006. (48 refs.)

Abuse is a family disease, which requires joint treatment of family members. Family is an important part of the diagnosis and treatment chain of alcohol and substance abuse. Abuse of alcohol and substance is a response to fluctuations in the family system. In consideration of interactions within the system, it seems an important requirement that the clinician involves, and maintains the presence of, the family in its entirety in the treatment process. A family often needs as much treatment as the family member who is the abuser of alcohol or a substance. In this regard, participation of the family in the treatment process as group members and by assuming a supportive role are assets in terms of preventing relapse, and extending clean time, and also very important for solving conflicts that give rise to abuse of alcohol or substances. Accordingly, it is important to know the family structure and its role in the treatment process. This article covers a review of family systems separately in terms of alcoholism and substance abuse. (Copyright 2006, Blackwell Publishing)

Tyndale RF. Genetics of alcohol and tobacco use in humans (review). Annals of Medicine 35(2): 94–121, 2003. (352 refs.)

The field of genetics holds great promise for furthering our understanding of the etiology of drug dependence and for identifying novel targets for treatment. Genetic studies utilizing twins and families have demonstrated a considerable role for genetics in nicotine and/or alcohol dependence. Risk for alcoholism or nicotine dependence is likely to be the result of a large number of genes, each contributing a small fraction of the overall risk. While this review will focus on studies in humans, many of the candidate genes for human nicotine and alcohol dependence listed here were originally postulated to be important, based on data from animal studies. The review will briefly summarize the results from twin and adoption studies that provide estimations of heritability, the results from chromosomal linkage studies that identify regions of chromosomes that may contain relevant genes, and the results of candidate gene studies. For each topic the data will be presented for nicotine dependence, alcohol dependence, and for nicotine and alcohol dependence together. In addition, each section will review briefly some of the confounding issues in the specific type of approach utilized. (Copyright 2003, Finnish Medical Society)

Vail MO, Protinsky H, Prouty A. Sampling issues in research on adult children of alcoholics: Adolescence and beyond. Adolescence 35(137): 113–119, 2000. (19 refs.)

A critical examination of 98 studies on adult children of alcoholics, published from 1986 to 1995, was prompted by suggestions that sampling issues confound research findings. Over half of the studies that were reviewed involved college students. It is important to understand the methodology used in creating a knowledge base that relies heavily on late adolescent and young adult offspring of alcoholics. Thus, two main questions were asked when reviewing these studies: What methods were employed to classify offspring as being children of alcoholics? To what extent does our knowledge about adult children of alcoholics depend on college student samples and clinical samples? Copyright Libra Publishing

Vink JM, Willemsen G, Engels RCME, Boomsma DI. Smoking status of parents, siblings and friends: Predictors of regular smoking? Findings from a longitudinal twin-family study. Twin Research 6(3): 209–217, 2003. (38 refs.)

In contrast to other aspects of smoking behavior, little attention has been paid to the genetics of nicotine dependence. In this paper, three models (single liability dimension, independent liability dimension and combined model) have been applied to data on smoking initiation and nicotine dependence (n = 1572 Dutch twin pairs, mean age 30.5). A combined model best described the data. This model postulates a smoking initiation dimension and a nicotine dependence dimension, which are not independent. For both males and females, individual differences in smoking initiation were explained by genetic (44%), shared environmental (51%) and unique environmental (5%) influences. The nicotine dependence dimension was influenced only by genetic (75%) and unique environmental (25%) factors. The substantial impact of genetic factors on nicotine dependence emphasizes the need for further research to localize and identify specific genes and pathways involved in nicotine dependence. (Copyright 2003, Springer Publishing)

Walker JP, Lee RE. Uncovering strengths of children of alcoholic parents (review). Contemporary Family Therapy 20(4): 521–538, 1998.

Being a child of an alcoholic (COA) is neither a diagnosis nor a psychosocial death sentence. Neither alcoholic families nor COAs are monolithic. A variety of factors converge in developmental trajectories resulting in diverse individual outcomes. Supportive relationships with non-substance using parents and siblings and appropriate levels of parentification all may enable a significant proportion of COAs to enjoy high self-esteem, lack of problematic substance use, and good adaptive capability. Therapists and clients should refrain from looking at COAs through a deficit framework and instead should look for evidence of relational resilience in alcoholic families of origin. Such strengths-based assessments will increase therapeutic leverage with COAs seeking treatment for a range of presenting problems. Copyright 1998, Human Sciences Press, Inc.

Werner EE. Resilient offspring of alcoholics: A longitudinal study from birth to age 18. Journal of Studies on Alcohol 47(1): 34–40, 1986.

This study focuses on child characteristics and on the qualities of the caregiving environment that differentiated between offspring of alcoholics who did and those who did not develop serious coping problems by age 18. The 49 subjects (22 male) are members of a multiracial cohort of 698 children born in 1955 on the island of Kauai, Hawaii, who were followed at ages 1, 2, 10 and 18. In this group, males and the offspring of alcoholic mothers had higher rates of psychosocial problems in childhood and adolescence than females and the offspring of alcoholic fathers. Children of alcoholics who developed no serious coping problems by age 18 differed from those who did in characteristics of temperament, communication skills, self-concept and locus of control. They had also experienced fewer stressful life events disrupting their family unit in the first two years of life. Results of the study support a transactional model of human development and demonstrate bidirectionality of child-caregiver effects. Copyright 1986, Project Cork

Woititz J. Adult children of alcoholics. Hollywood, FL: Health Communications, 1983

Wolstein J, Rosinger C, Gastpar M. Children and families in substance misuse. Current Opinion in Psychiatry 11(3): 279–283, 1998. (45 refs.)
The consequences of parental substance misuse on children of all age groups is discussed in this review. Current issues related to substance misuse in children and adolescents are also presented. Several interesting, mainly longitudinal studies offer new insights into both fields. Copyright 1998, Rapid Science Publishers

Xian H, Scherrer JF, Madden PAF, Lyons MJ, Tsuang M, True WR, et al. The heritability of failed smoking cessation and nicotine withdrawal in twins who smoked and attempted to quit. Nicotine & Tobacco Research 5(2): 245–254, 2003. (49 refs.)

The magnitude of the association between nicotine withdrawal and failed smoking cessation remains uncertain, and the potential genetic contribution to that relationship is unknown. We used a twin design study to test if genetic and environmental risk factors contribute to nicotine withdrawal and failed cessation. We then estimated the magnitude of genetic and environmental risk factors and the associated correlations. Cigarette consumption data were obtained in 1992 from 4,112 (1,806 pairs, 496 singletons) male twin pairs from the Vietnam Era Twin Registry. Participants responded to a telephone administration of the Diagnostic Interview Schedule. Odds ratios were computed for failed smoking cessation as a function of 12 individual nicotine withdrawal symptoms. Genetic model fitting was performed on a, sample of 1818 twin pairs, all of whom were lifetime smokers; both twins of the pairs had made at least one quit attempt. After adjustment for cigarette consumption, odds of failed smoking cessation ranged from .87 (95% CI .76-.99) for "increased appetite/weight gain" to 1.85 (95% CI 1.55-2.22) for "depressed." Genetic influences accounted for 54% and 29.7% of the variance in risk for failed smoking cessation and nicotine withdrawal, respectively. The correlation between genetic influences was significant (r=.31, 95% CI.17-.45). The magnitude of the association between failed cessation and nicotine withdrawal varied by symptom. The risk of experiencing nicotine withdrawal after a quit attempt was related partly to genetic vulnerability; lifetime risk for both failed cessation and nicotine withdrawal was related partly to genetic factors that were correlated. (Copyright 2003, Carfax Publishing)

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