The contribution of parental alcohol use disorders and other psychiatric illness to the risk of alcohol use disorders in the offspring

Background: Few population‐based studies have investigated associations between parental history of alcoholism and the risk of alcoholism in offspring. The aim was to investigate in a large cohort the risk of alcohol use disorders (AUD) in the offspring of parents with or without AUD and with or without hospitalization for other psychiatric disorder (OPD). Methods: Longitudinal birth cohort study included 7,177 men and women born in Copenhagen between October 1959 and December 1961. Cases of AUD were identified in 3 Danish health registers and cases of OPD in the Danish Psychiatric Central Register. Offspring registration with AUD was analyzed in relation to parental registration with AUD and OPD. Covariates were offspring gender and parental social status. Results: Both maternal and paternal registration with AUD significantly predicted offspring risk of AUD (odds ratios 1.96; 95% CI 1.42 to 2.71 and 1.99; 95% CI 1.54 to 2.68, respectively). The association between maternal, but not paternal, OPD and offspring AUD was also significant (odds ratios 1.46; 95% CI 1.15 to 1.86 and 1.26; 95% CI 0.95 to 1.66, respectively). Other predictors were male gender and parental social status. A significant interaction was observed between paternal AUD and offspring gender on offspring AUD, and stratified analyses showed particularly strong associations of both paternal and maternal AUD with offspring AUD in female cohort members. Conclusions: Parental AUD was associated with an increased risk of offspring AUD independent of other significant predictors, such as gender, parental social status, and parental psychiatric hospitalization with other diagnoses. Furthermore, this association appeared to be stronger among female than male offspring. The results suggest that inherited factors related to alcoholism are at least as important in determining the risk of alcoholism among daughters as among sons.     

Maudsley Hospital Survey: prevalence of alcohol problems and other psychiatric disorders in a hospital population

This study, the first of its kind in the United Kingdom, reports on the prevalence of alcohol problems and other psychiatric disorders in the Joint Maudsley and Bethlem Royal Hospital population over a 12 year period. The steady 9–11% of the total number of diagnoses that are alcoholic, forces home the realization of the significant contribution of drinking problems to the work load of the hospital. The consistency of the percentage of alcoholics who receive an additional diagnosis, 30–40%, has considerable implications for treatment, treatment service planning and the understanding of aetiological factors.     

Interpersonal group psychotherapy for comorbid alcohol dependence and non-psychotic psychiatric disorders

Alcohol-dependent patients (N = 15) with comorbid non-psychotic psychiatric disorders were treated with Modified Interpersonal Group Therapy (MIGT) for eight weeks, 16 sessions, in a pilot intervention trial. Analysis of the group participants demonstrated that they achieved statistically significant improvements at post-treatment in four of five self-report outcome measures: number of drinking days, number of heavy drinking days, the Brief Symptom Inventory, and the Beck Depression Inventory. Furthermore, the improvements in heavy drinking days and the Brief Symptom Inventory were maintained at two and eight months post-treatment. This study yields preliminary evidence in support of MIGT as a useful treatment approach for an alcohol-dependent population with psychiatric comorbidity.     

Intergenerational effects--a review of environmentally oriented studies concerning the relationship between parental alcohol problems and family disharmony in the genesis of alcohol and other problems. I: The intergenerational effects of alcohol problems.

This paper is the first in a two-part series. In this paper the literature on the intergenerational transmission of alcohol problems is reviewed from an environmental perspective. It is concluded that there are effects of problem drinking on children, but that the long-term effects of parental problem drinking on the offspring once they reach adulthood are not so well documented. It is suggested that whether or not intergenerational continuities are found depends largely upon the source of the sample, that very little is known about adulthood outcomes other than drinking status, and that there is a striking sex bias in the literature, with most research examining the effects of problem-drinking fathers upon their male offspring. Possible mechanisms whereby parental problem drinking could affect adjustment are outlined and discussed. The notion of disturbed family relationships acting as a possible mediator for the transmission of problems is raised.     

The Relationship between parental alcohol use, early and late adolescent alcohol use, and young adult psychological symptoms: a longitudinal study

We tested the hypothesis that there is a mediational pathway from parental alcohol use during the participants' adolescence to the participants' psychological symptoms in young adulthood. This pathway includes the participants' alcohol use and their psychological symptoms, both during adolescence. The participants are inner city African American and Puerto Rican early adolescents followed until young adulthood. They reported their own and their parents' behavior. Structural equation modeling showed that parental alcohol use was related to early adolescent alcohol use, which was associated with late adolescent alcohol use. Late adolescent alcohol use was related to psychological symptoms in late adolescence, which predicted young adult psychological symptoms. Males reported more alcohol use and more psychological symptoms than females in late adolescence and more psychological symptoms in young adulthood. Findings suggest that parents' and adolescents' alcohol use should be a focus in interventions designed to prevent or treat psychological symptoms in late adolescence and young adulthood.     

Cigarette smoking and the risk for alcohol use disorders among adolescent drinkers

BACKGROUND: Cigarette smoking and alcohol use disorders (AUDs) are closely linked, but it is not clear whether higher rates of AUD among smokers are solely attributable to heavier drinking or, alternatively, whether smokers are more vulnerable to alcohol abuse and dependence than nonsmokers who drink comparable quantities. We sought to address this issue using data from a nationally representative U.S. sample of adolescents and young adults. Specifically, we analyzed the relationship between cigarette smoking, drinking, and AUDs. METHODS: Data were from the aggregated 2002 through 2004 U.S. National Survey on Drug Use and Health. Participants were randomly selected, household-dwelling adolescents and young adults (ages 12-20) from the noninstitutionalized, civilian population of the United States (N=74,836). Measurements included current DSM-IV alcohol abuse or dependence, number of drinks in the past 30 days, and past-year cigarette smoking, defined as having smoked more than 100 cigarettes across the lifetime and having smoked during the past year. RESULTS: Past-year smokers (prevalence=16.0%) drank in higher quantities than never-smokers, but were also at elevated risk for AUD when compared with never-smokers who drank equivalent quantities. The effect was observed across age groups, but was more prominent among younger adolescents. After adjusting for drinking quantity and sociodemographic variables, smokers had 4.5-fold higher odds of AUD than never-smokers [95% confidence interval (95% CI), 3.1-6.6]. Youths who reported smoking but did not cross the 100-cigarette threshold were at intermediate risk [odds ratio (OR), 2.3; 95% CI, 1.7-3.3]. Differences in AUD between smokers and never-smokers were most pronounced at lower levels of drinking. CONCLUSIONS: The results are consistent with a higher vulnerability to AUDs among smokers, compared with nonsmokers who drink equivalent quantities.     

The effects of parental diagnosis and changing family norms on alcohol use and related problems among urban American Indian adolescents

This study investigated the role of parental diagnosis of alcohol abuse/dependence and perceived family norms for adolescent drinking on alcohol use and alcohol-related problems among urban American Indian youth. A total of 251 urban, American Indian youth and their parents/caregivers were followed from ages 13 to 18. Perceived family norms against alcohol decreased and alcohol use increased from ages 13 to 18. Relative to no parental diagnosis, youth with one or two parents diagnosed with alcohol abuse/dependence were less likely to perceive family norms against alcohol use. Youth with two parents diagnosed were more likely to report alcohol-related problems at age 18 compared to no parental diagnosis. Faster rates of decrease in perceived family norms against alcohol use were associated with faster increases in alcohol use over time. Higher rates of perceived family norms against alcohol use protected youth from high rates of use at age 13, but higher rates of alcohol use at age 13 predicted more alcohol-related problems at age 18. These results suggest that both family history and family behaviors in the form of communication of norms for adolescent alcohol use are likely to impact both rates of use and eventual alcohol-related problems.     

Five-year outcomes of a brief alcohol intervention for adult in-patients with psychiatric disorders

Aims To compare 5 year outcomes (general hospital and mental health morbidity and mortality) among general hospital psychiatric in‐patients randomized to receive either an alcohol reduction motivational interview (MI) or information pack (IP), and compare these to matched controls. Design We recruited 120 patients aged 18–64 years who scored ≥8 on the Alcohol Use Disorders Identification Test (AUDIT). We selected matched controls from in‐patients not recruited but who reached the same AUDIT threshold. At 5 years, follow‐up data were collected via a state‐wide hospital record system. Findings There were no significant differences between the MI and IP groups in terms of ‘survival’ to their first alcohol‐related, other general hospital or mental health admission over 5 years. Matched controls had significantly more mental health in‐patient episodes (F[1,226] 4.4, P < 0.05) and greater length of hospital stay (F[1,226] 4.8, P < 0.05) than the combined MI‐IP group. Furthermore, the MI‐IP group had longer ‘survival’ times to both first general hospital (mean 583 versus 392 days) and mental health in‐patient (mean 788 versus 580 days) events. Collapsed across groups, dependent and harmful consumers had shorter ‘survival’ times than hazardous consumers (AUDIT classifications). Conclusions Alcohol interventions have medium‐term health benefits for those with mental health and alcohol use problems. Importantly, there were no differences in outcome between the intervention groups. The low cost of providing an IP makes it attractive as an alcohol intervention. The AUDIT provided an effective means of identifying those who are at risk of subsequent alcohol‐related admissions and may benefit from intervention.     

The role of psychiatric disorders in fibromyalgia

The cardinal features of fibromyalgia are chronic widespread pain in the presence of widespread tenderness as measured by multiple tender points. Despite extensive investigations, the etiology of this syndrome remains unclear. Increased rates of psychiatric disorders, particularly depressive, anxiety, and somatoform disorders, are apparent in clinic populations. Epidemiologic evidence suggests that this is also true for community subjects. Depression, generalized psychological distress, and other psychological factors have been shown to be associated with the onset and persistence of fibromyalgia symptoms. However, the bodily processes through which such factors may lead to the onset of fibromyalgia are unclear. Recent investigations have demonstrated altered stress system responsiveness, most notably the hypothalamic-pituitary-adrenal stress axis, in patients with fibromyalgia. These findings, and one promising avenue for investigating the interaction between psychological and biological factors in the onset of chronic pain syndromes including fibromyalgia, are discussed.     

The effect of parents' alcohol problems on children's behaviour as reported by parents and by teachers

Associations between parents' alcohol problems when children were aged 9 and children's behaviour at ages 9 and 13 as reported by parents and teachers were investigated. The sample consisted of participants in a multidisciplinary longitudinal study, data were collected by face-to-face interview. When compared to children with no or mild parental alcohol problems, children classified as having severe parental alcohol problems were more likely to display high levels of problem behaviour at age 9 as reported by teachers and at age 13 as reported by parents. Poorer family relationships, lower verbal and reading proficiency and being male were also associated with high levels of behaviour problems.