Pubertal development, sleep problems, and alcohol use: a commentary

Background: This commentary discussed the study conducted by Pieters et al. (2010 Alcohol Clin Exp Res in press) on the relationships among puberty dependent, sleep regulation, and alcohol use in adolescents. The goal of this commentary is to underscore the significance of the study and discuss some of the unaddressed questions in the area. Methods: The significance of the study and unaddressed questions are discussed. Results: Pieters et al. (2010 Alcohol Clin Exp Res in press) provided valuable data to understanding the relationships among puberty, sleep problems, and alcohol use. Questions regarding the relationship between puberty and sleep problems, the possible reciprocal relationships among circadian phase preference, sleep problems and alcohol use, mediators and moderators of such relationships, as well as potential gender differences on these relationships were discussed. Conclusions: To understand the relationships among pubertal development, sleep problems, and alcohol use, researchers need to be aware of the physiological changes that take place in puberty, as well as the psychosocial factors that are associated with such changes. Important mediators and moderators of the relationships among these constructs also need to be identified. Longitudinal design may be useful in this regard.     

Alcohol-related problems, drug use, and male intimate partner violence severity among US couples

BACKGROUND: Particularly for women, level of intimate partner violence (IPV) severity is associated with risk of injury. Previous research suggests that male drinking problems and drug use are key risk factors. Few studies, however, have examined the associations between male and female alcohol problems and drug use and risk of moderate and severe male IPV in general household population samples. METHODS: A multiethnic sample of 1615 married and cohabiting couples was obtained from the 1995 National Study of Couples, a cross-sectional study on alcohol and IPV. We assessed the contribution of past year male and female alcohol-related problems (i.e., drinking consequences and alcohol-dependence symptoms) and illicit drug use to the risk of moderate and severe male IPV. A series of generalized multinomial logit models, with adjustment for sociodemographic and psychosocial covariates, was constructed to assess these associations. RESULTS: Female and male alcohol-related problems and female drug use, were associated with increased risk of moderate and severe male IPV. Contrary to our expectation, male drug use was not associated with elevated risk for either type of male IPV. Compared with couples residing in low-unemployment neighborhoods, couples residing in high-unemployment neighborhoods were at greater risk for severe, but not moderate, male IPV. CONCLUSIONS: Alcohol-related problems among men and women and drug use among women, appear to be important correlates of male IPV severity among couples in the general population. These findings can aid in IPV screening efforts, the formulation of prevention strategies, and help inform batterer and victim treatment programs.     

Parallels to early onset alcohol use in the relationship of early onset smoking with drug use and DSM-IV drug and depressive disorders: findings from the National Longitudinal Epidemiologic Survey

This paper endeavored to determine (1) if early onset of regular tobacco use is as predictive of drug use and depressive disorders as it is of alcohol use disorders; and (2) if a biological commonality, as measured by a family history of alcoholism and both early onset and severity of disease, among all three disorders can be evidenced in a large nationally representative sample. Prevalences of lifetime drug use, drug abuse and dependence, and major depressive disorders, as well as indices of their severity, were compared among smoking groups defined by age at onset of regular tobacco use and among nonsmokers. Linear logistic regression analyses, controlling for important covariates, including a family history positive for alcoholism, were conducted to assess the relationship between age at smoking onset and drug use, abuse and dependence, as well as depressive disorders. Both objectives were met. Moreover, results suggest that smoking may play an equally, if not even more, insidious role than drinking in the use and development of dependence on illicit substances and depression.     

Childhood Sleep Problems,Response Inhibition,and Alcohol and Drug Outcomes in Adolescence and Young Adulthood

Background: To our knowledge, no prospective studies examine the relationships among childhood sleep problems, adolescent executive functioning, and substance outcomes (i.e., substance use and substance‐related problems). In this study, we examined whether childhood sleep problems predicted adolescent sleep problems and response inhibition. We also tested whether adolescent sleep problems and poor response inhibition mediated the relationship between childhood sleep problems and substance (alcohol and drug) outcomes in young adulthood. Methods: Study participants were 292 boys and 94 girls (M = 4.85, SD = 1.47) from a community sample of high‐risk families and controls. Results: When compared to their counterparts, those with trouble sleeping in childhood were twice as likely to have the same problem in adolescence. Childhood overtiredness predicted poor response inhibition in adolescence. Persistent trouble sleeping from childhood to adolescence and response inhibition in adolescence mediated the relationship between childhood sleep problems and drug outcomes in young adulthood, whereas overtiredness in childhood directly predicted alcohol use outcomes and alcohol‐related problems in young adulthood. Conclusions: This is the first study showing a long‐term relationship between childhood sleep measures and subsequent alcohol and drug outcomes. The developmental and clinical implications of these findings were discussed. Prevention and intervention programs may want to consider the role of sleep problems and response inhibition on substance use and abuse.     

Puberty‐Dependent Sleep Regulation and Alcohol Use in Early Adolescents

Background: Research has shown a bi‐directional relation between alcohol use and sleep regulation in adults. Much less is known about this association in early adolescents, while profound puberty‐dependent transitions regarding sleep patterns take place in early adolescence. Moreover, puberty has been associated with an increase in alcohol use of adolescents. Methods: In this study, we investigated the associations between pubertal development, sleep preference, sleep problems, and alcohol use in 431 early adolescents (mean age: 13.66). Second, it was studied whether the associations changed when controlling for adolescent internalizing and externalizing problems. Furthermore, we included gender as a moderator on all the associations. Results: Results showed that pubertal development was positively associated with sleep problems and more evening‐type tendencies (e.g., favoring later bedtimes), which in turn were positively related to alcohol use. Underlying psychopathology, gender and educational level did not change these relationships. Conclusions: From this study, it can be concluded that both puberty and sleep regulation are important factors in explaining alcohol use in early adolescence.     

A social learning perspective: a model of parenting styles, self-regulation, perceived drinking control, and alcohol use and problems

BACKGROUND: This investigation sought to determine how different parenting styles are related to general self-regulatory processes that are linked to alcohol use and abuse. Self-regulation and, more specifically, thoughts of control over drinking are forms of positive self-control mechanisms. Parenting styles are known determinants of both negative and positive self-control mechanisms in offspring. According to social learning theory, stronger relationships between parenting style and self-regulatory processes would be expected from the parent who is the same sex as the respondent. METHODS: A total of 144 female and 107 male college students currently using alcohol were administered a questionnaire on their alcohol use and problems, perceived style of parenting (authoritarian, permissive, or authoritative) of their parents, self-regulation, and perceived control of drinking. A model linking parenting styles, self-regulatory processes, and control over drinking with alcohol use and alcohol problems was tested across sex groups by using structural equation modeling. RESULTS: In general, the parenting style of the parent of the same sex as the respondent's was found to be significantly related to self-regulation, which is known to be protective against alcohol use and abuse. A permissive parent of the same sex as the respondent was negatively associated with good self-regulatory processes for both men and women. Having an authoritative mother was also shown to be related to higher levels of self-regulation for women. CONCLUSIONS: Self-regulation mediated the pathway from a permissive parenting style to perceived drinking control, which, in turn, mediated the pathway from self-regulation to alcohol use and problems. Finally, self-regulation mediated the positive pathway from an authoritative mother to perceived control over drinking for women.     

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.     

Geographic and maternal characteristics associated with alcohol use in pregnancy

Background: To date, no studies have used population‐level data to investigate whether maternal location of residence (metropolitan vs. regional/remote populations) is associated with alcohol use in pregnancy. This information has important implications for appropriate service provision. Methods: Information on all live births in New South Wales Australia was linked to records of alcohol‐related admissions for mothers of these births over a 6‐year period (2000 to 2006). Cases were women who had at least 1 alcohol‐related hospital admission during pregnancy or at birth. Controls were women who had at least 1 live birth over that same time period but no alcohol‐related hospital admissions during that time. Admissions were considered to be alcohol‐related based on the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD‐10‐AM) code. Demographic, obstetric, and neonatal variables were compared. Results: A total of 417,464 singleton birth records were analyzed, 488 of which were coded positive for at least 1 alcohol‐related ICD‐10‐AM diagnosis. Characteristics associated with alcohol‐related admissions in pregnancy were residence in a remote/very remote area, being Australian‐born, having had a previous pregnancy, smoking in the current pregnancy, and presenting late to antenatal care. Alcohol‐exposed pregnancies were associated with a range of poor obstetric and neonatal outcomes, with no geographic differences noted. However, women in regional/remote areas were less likely to attend specialist obstetric hospitals. Conclusions: This study shows the need for standardized screening programs for alcohol use in pregnancy and where problematic use is detected, for clear clinical guidelines on management and referral.     

Parental drug use, early adversities, later childhood problems and children's use of tobacco and alcohol at age 10: birth cohort study

Aims To estimate the prevalence of alcohol and tobacco use among children at age 10 years and to investigate possible influences on this. Design Birth cohort study. Setting England. Participants A total of 6895 children provided data at age 10. Measurements Parental tobacco, alcohol and cannabis use, parental social position, children's intelligence, behavioural and emotional problems, children's tobacco and alcohol use at age 10. Findings A total of 1.3% of children reported smoking and 1.8% reported drinking alcohol, with boys reporting higher use than girls. Parental social disadvantage was the strongest predictor of children's smoking and also predicted children's alcohol use. Some of this association appeared to be mediated through the greater experience of childhood behavioural and cognitive problems among the disadvantaged. Parental smoking and paternal alcohol use had little independent influence on offspring drug use. Postnatal, rather than prenatal, maternal alcohol use predicted children's alcohol use. Conclusions Strategies to prevent early initiation of tobacco and alcohol use should focus upon the reduction of childhood social disadvantage and the behavioural and cognitive problems associated with this.     

Parenting mechanisms in links between parents' and adolescents' alcohol use behaviors

Background: Adolescence has been identified as a critical period with regard to the initiation and early escalation of alcohol use. Moreover, research on familial risk and protective processes provides independent support for multiple domains of parental influence on adolescent drinking; including parents’ own drinking behaviors, as well as the practices they employ to socialize their children. Despite this prevalence of findings, whether and how these distinct associations are related to one another is still not entirely clear. Methods: The present study used data from 4,731 adolescents and their parents to test the nature of associations between (a) parents’ frequencies of alcohol use and intoxication, and lifetime alcohol‐related problems, (b) adolescents’ perceptions of the parenting that they receive, and (c) adolescents’ prevalence of alcohol use and intoxication at 14 and 17½ years of age. As such, multiple mediation modeling was used to assess whether parental alcohol use behaviors influence adolescent alcohol use directly, or if they operate through indirect associations with various aspects of parenting that subsequently influence adolescent use. Results: Examination of simple associations demonstrated that maternal and paternal alcohol use behaviors were positively linked with adolescent use behaviors at 14 and 17½ years of age. Likewise, several parenting behaviors were independently associated with both parental and adolescent drinking. Examined collectively, multivariate path analyses indicated that associations between parents’ and adolescents’ alcohol‐related behaviors were mediated, in part, by adolescents’ perceptions of the parenting that they received, especially at 14 years of age. Furthermore, perceived parental monitoring and discipline had unique mediating capabilities, net the effects of all other parenting behaviors. Conclusions: This study demonstrates that parenting is an important mediator of the association between parental and adolescent drinking practices. An important area for future research will be to study how adolescents can avoid alcohol‐related problems despite being reared within a risk laden parenting environment and/or having parents who drink frequently.     

Diffusion tensor measures of the corpus callosum in adolescents with adolescent onset alcohol use disorders

Background: In adults, myelination injury is associated with alcoholism. Maturation of the corpus callosum is prominent during adolescence. We hypothesized that subjects with adolescent‐onset alcohol use disorders (AUD; defined as Diagnostic and Statistical Manual of Mental Disorders‐IV alcohol dependence or abuse) would have myelination mircostructural differences compared to controls. Methods: Adolescent subjects (25 males, 7 females) with an AUD (16.9 ± 1.2 years), who were recruited from substance abuse treatment programs and had co‐morbid mental disorders, and 28 sociodemographically similar healthy controls (17 males, 11 females; 15.9 ± 1.1 years) underwent a 3.0 T MRI diffusion tensor imaging scan. Results: Measures of rostral body fractional anisotropy (FA) were higher in the AUD group than in the control group. Compared to controls, mean diffusivity (MD) was lower, while FA was higher, in the AUD group in the isthmus region. Anterior corpus callosum mircostructural development differed in adolescents with AUD, as age was positively (not negatively) associated with rostrum MD and age was negatively (not positively) associated with rostrum FA. There were sex by group interactions in that control females had higher posterior midbody FA when compared to female adolescents with AUD. Conclusions: Lower MD and higher FA values in the AUD group suggest pre‐morbid vulnerability for accelerated prefrontal and temporo‐parietal myelin maturation that may enhance the risk for adolescent AUD. Significant (and opposite to developmentally expected) correlations were seen between anterior corpus callosum MD and FA measures and age in the AUD group, suggesting neurotoxic effects of alcohol on adolescent corpus callosum microstructure. As seen in adults, female adolescents with AUD may be especially vulnerable to corpus callosum mircostructural injury. Further diffusion tensor imaging studies of corpus callosum maturation in children at familial risk for alcoholism, and in those with AUD, need to be done to elucidate these mechanisms.     

Health problems in adolescents with alcohol use disorders: self-report, liver injury, and physical examination findings and correlates

BACKGROUND: Although adolescent alcohol consumption has been found to be positively correlated with self-reported health problems, few studies have examined other health indicators. This study compared adolescents with alcohol use disorders (AUDs) and a community reference group on self-reported health problems, serum liver enzymes, and physical examination findings. The relevance of negative emotionality to understanding these health problems was also investigated. METHODS: The subjects were adolescents with AUDs recruited from clinical programs and classified as having DSM-IV alcohol dependence (n = 71) or alcohol abuse (n = 57) and reference adolescents without AUDs recruited from community sources (n = 131). The assessment of health status included self-reported health problems in 15 areas; serum liver enzyme assays, including gamma-glutamyl transpeptidase, alanine aminotransferase, and aspartate aminotransferase; and physical examination findings. Negative emotionality was determined by systematically combining scores from the Hamilton Anxiety Rating Scale, the Beck Depression Inventory, the Child Behavior Checklist, and the Multidimensional Personality Questionnaire. RESULTS: Adolescent AUDs were associated with more self-reported health problems, higher gamma-glutamyl transpeptidase and alanine aminotransferase levels, and more physical examination abnormalities. Negative emotionality was highly correlated with self-reported health problems, mediated the relationship between AUDs and self-reported health problems, and was not correlated with serum liver enzyme levels or physical examination abnormalities. CONCLUSIONS: These results indicated that AUDs during adolescence were associated with health problems, including modest but demonstrable liver injury. Self-reported health problems were probably best understood, in this context, as a negative emotionality manifestation.     

Age at first intoxication and alcohol use disorders in Southwest California Indians

BACKGROUND: In several national surveys, a younger age of onset of first drink and/or regular drinking has been associated with a higher likelihood of the development of alcohol dependence. Some studies have suggested that age at first drink is primarily an environmentally driven variable whereas others suggest that it may be partially mediated by a general vulnerability to exhibit problem behaviors. Although Native Americans, overall, have the highest prevalence of alcohol dependence of any U.S. ethnic group, the relationship of age of onset of intoxication with alcohol dependence in Native American populations is relatively unknown. METHODS: Demographic information and DSM-III-R diagnoses were obtained from 525 Southwest California (SWC) Indian adults residing on contiguous reservations. Survival analyses and Cox and logistic regression were used to investigate the relationship between age of onset of first intoxication and the development of alcohol dependence. Heritability of the age of onset of first intoxication was also determined using SOLAR. RESULTS: Age at first intoxication was not found to be heritable in this population. Early onset of intoxication, however, was found to be significantly associated with both a shorter time to onset of alcohol dependence and increased prevalence in this population, even on taking into account several other risk factors including externalizing diagnoses. CONCLUSIONS: These data suggest that effective environmental prevention efforts at reducing underage drinking may be an important strategy to lower the prevalence of alcohol dependence in this high-risk population.