Alcohol misuse and psychosocial outcomes in young adulthood: Results from a longitudinal birth cohort studied to age 30

Purpose

This study examined the associations between measures of alcohol abuse/dependence symptoms and a range of psychosocial outcomes from ages 21 to 30 in a New Zealand birth cohort.

Methods

Outcome measures included measures of: criminal offending, family violence and relationship instability, sexual risk-taking and consequences, mental health, and other adverse health and adjustment outcomes. Bivariate associations between a three-level classification of alcohol misuse (no symptoms, subclinical level of symptoms, met criteria for alcohol dependence) and each outcome during the period 21–30 years were computed using Generalised Estimating Equation models. These associations were then adjusted for non-observed sources of confounding using conditional fixed effects regression modelling, augmented by time-dynamic covariate factors. For both sets of models estimates of the attributable risk (AR) were computed.

Results

There were statistically significant (p < .05) bivariate associations between alcohol misuse and each of the fifteen outcome measures, with estimates of the AR ranging from 7.4% to 46.5%. Adjustment for non-observed fixed effects generally reduced the magnitude of these associations; however, after adjustment, 12 of the 15 associations remained statistically significant (p < .05). Estimates of the AR after adjustment for fixed effects ranged from 3.6% to 44.3%.

Conclusions

The results suggest that there are pervasive and persistent linkages between alcohol misuse and a range of adverse psychosocial outcomes. A reduction in levels of alcohol misuse amongst individuals of this age group could reduce substantially the overall level of personal and societal cost of hazardous levels of alcohol consumption.     

Symptoms of alcohol dependence and smoking initiation and persistence: A longitudinal study among US adults

Background

A large number of adults report symptoms of, but do not meet diagnostic criteria for, an alcohol use disorder. Yet, little is known about the relationship between symptoms of alcohol use disorders and the initiation and persistence of smoking. This study prospectively examines the relationship between having 1–2 symptoms of alcohol dependence (without abuse) and smoking initiation and persistence as well as nicotine dependence over a 3-year period among adults in the United States.

Methods

Data were drawn from Wave 1 (2001–2002) and Wave 2 (2004–2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Relationships between Wave 1 symptoms of alcohol dependence, alcohol abuse, and alcohol dependence and initiation and persistence of cigarette smoking and nicotine dependence at Wave 2 were examined using logistic regression analyses. Analyses were adjusted for demographics, mood and anxiety disorders.

Results

Symptoms of alcohol dependence were associated with smoking initiation at Wave 2. There was no association between symptoms of alcohol dependence and smoking persistence. Symptoms of alcohol dependence predicted incident and persistent nicotine dependence. Findings persisted after adjusting for demographic characteristics and mood/anxiety disorders.

Conclusions

Even 1–2 symptoms of alcohol dependence are associated with increased vulnerability to smoking initiation and onset and persistence of nicotine dependence at a similar strength as alcohol use disorders. Efforts at smoking cessation must address problematic alcohol use, even at the subclinical level, in order to improve efficacy.     

Transition to parenthood and substance use disorders: Findings from a 30-year longitudinal study

Background

This study examined the associations between the transition to parenthood and substance use disorders from ages 18 to 30 in a New Zealand birth cohort.

Methods

Outcomes included: DSM-IV criteria for: (a) alcohol abuse/dependence (AAD) and (b) illicit substance abuse/dependence. The study also used measures transition to parenthood during the period 18–30 years; and observed covariate factors including: family socio-economic status; family functioning; childhood abuse exposure; childhood personal and behavioural characteristics; and psychosocial adjustment in adolescence. Data were analysed using repeated measures Generalised Estimating Equation models, and conditional fixed effects regression modelling to control for confounding. Gender interactions were examined using moderated regression analyses.

Results

Those who became parents had unadjusted odds of substance use disorder outcomes that were approximately 50% lower than those who had not become parents. Adjustment of the associations for both: (a) observed confounding factors and (b) non-observed fixed effects; strengthened the associations between parenthood status and substance use disorders. Custodial parents had odds of substance use disorders that were 57–78% lower than those who did not become parents after adjusting for non-observed fixed effects. Additional analyses suggested these effects were confined to custodial parents only. There was also evidence for gender × parenthood status interactions for AAD, with the effects of parenthood on AAD being stronger for females.

Conclusions

The results suggest that the transition to custodial parenthood may result in reduced risks of substance use disorder, particularly amongst female cohort members.     

Common and unique parenting predictors of adolescent tobacco and alcohol use

Aim

The current study sought to identify unique and common demographic and parental predictors of adolescent tobacco and alcohol initiation behaviors.

Methods

A total of 1023 middle school students (Grades 6–8) and their parents from six Rhode Island schools were enrolled in a larger study on substance use initiation and progression, with the current sample representing those dyads with data at baseline and at a 12-month follow-up (n = 814 dyads). There was a relatively even split with regard to adolescent sex (n_females = 444; 55%). Comparisons were made between covariate and predictor associations with corresponding substance use behaviors (e.g., ever puffed a cigarette vs. ever sipped an alcoholic drink; ever smoked a whole cigarette vs. ever drank a full alcoholic drink).

Results

At the bivariate level, a host of demographic and parent-related variables were associated with each adolescent substance use behavior. Adolescent reports of parental monitoring variables were consistently more related to use than parent reports. In multivariate logistic regression analyses, adolescent reports of parental monitoring variables were more frequently associated with tobacco use behaviors than alcohol use behaviors. Tobacco use behaviors were more strongly predicted by perceived availability of tobacco than alcohol use behaviors were predicted by perceived availability of alcohol.

Conclusions

The distinctive predictors observed for cigarette versus alcohol use make it problematic for new and existing programs to assume that efforts targeting specific individual or parental characteristics will impact both substances with equivalent efficacy.     

Implicit alcohol cognitions in risky drinking nicotine users with and without co-morbid major depressive disorder

Objective

Alcohol consumption, nicotine use, and major depressive disorder (MDD) are highly co-morbid. The negative reinforcement model of addiction would suggest that smokers may consume alcohol to relieve negative affective symptoms, such as those associated with MDD and withdrawal from nicotine. Over time, these behaviors may become so strongly paired together that they automatically activate a desire to use alcohol, even in the absence of conscious or deliberate intention. This study examined implicit alcohol cognitions in 146 risky drinking nicotine users (n = 83) and non-users (n = 63), to help uncover cognitive mechanisms that link drinking, nicotine use, and depression together. We proposed that nicotine users with a history of MDD would have stronger implicit motivations to drink than non-nicotine users without MDD.

Method

Participants were assessed on lifetime MDD (n = 84) or no MDD (n = 62), and then completed an Implicit Association Task designed to test the strength of associations between alcohol pictures and “approach” words.

Results

Regression analyses showed that implicit alcohol–approach attitudes were stronger among risky drinking nicotine users than non-users. Alcohol–approach motivations were also stronger among risky drinking nicotine users compared to non-users with a history of MDD; nicotine use was unrelated to implicit alcohol cognitions for risky drinkers without MDD.

Conclusions

Implicit cognitive processes may be targeted in behavioral and pharmacological treatments in risky drinking nicotine users, particularly those with depression comorbidity.     

The mediating role of depression in the relationship between anxiety sensitivity and alcohol dependence

Background

Many studies have reported that Anxiety Sensitivity (AS) is positively associated with alcohol use or other alcohol-related variables. More recent mediator and moderator models have shown promise in elucidating mechanisms within this relationship; the literature to date suggests that the relationship between AS and alcohol is likely mediated by problematic coping motives. However, few studies have considered the effects of depression within the AS–alcohol use relationship, despite a strong body of evidence linking AS to subsequent depression and depression to subsequent alcohol use problems, independently. Therefore, the current study assessed depression as a potential mediator of this relationship.

Method

Participants were 418 sequential admissions to a substance abuse treatment facility. A mediation analysis using bootstrapping was utilized in order to estimate indirect effects of AS on alcohol dependence through depression.

Results

Results reveal an indirect effect suggesting that the effects of anxiety sensitivity on alcohol dependence are mediated by symptoms of depression. More specifically, the effects of AS total score and AS somatic sensations on alcohol dependence were mediated by symptoms of depression. Lastly, a dual mediator model demonstrated that both depression and problematic coping uniquely mediate the relationship between AS and alcohol dependence.

Conclusions

While preliminary in nature, the current study provides evidence supporting the hypothesis that depression is an important factor to consider when examining the relationship between AS and alcohol dependence.     

Longitudinal associations between depressive symptoms and alcohol problems: The influence of comorbid delinquent behavior

Objective

Although numerous studies have demonstrated a positive association between depressive symptoms and alcohol problems and related disorders, it remains unclear whether this link can be explained by the joint co-occurrence of these disorders with delinquent behavior. This study examined the longitudinal associations between depressive symptoms and alcohol problems from early adolescence through early adulthood, while accounting for delinquent behavior and the potential interaction effects between delinquent behavior and each of these problems.

Method

The National Longitudinal Study of Adolescent Health sample of 20,728 adolescents, followed for 6 years, was used. Males and females were examined separately. Multilevel modeling was used to predict both initial levels and rate of change in alcohol problems based on levels of depressive symptoms and delinquent behavior (and their interaction), and initial level and rate of change in depressive symptoms based on alcohol problems and delinquent behavior (and their interaction).

Results

Once delinquent behavior was included in the model, the reciprocal positive associations between alcohol problems and depressive symptoms tended to remain significant. Some interactive effects between delinquent behavior and these problems were found, mainly in females. Conclusions: The reciprocal positive associations between alcohol problems and depressive symptoms over time are not fully due to their joint co-occurrence with delinquent behavior, though delinquent behavior does moderate these links in some cases.     

The association between partner and non-partner aggression and suicidal ideation in patients seeking substance use disorder treatment

Objective

The present study was designed to examine the relationship between prior partner and non-partner aggression and suicidal ideation in patients seeking drug and alcohol treatment.

Method

Patients entering drug and alcohol treatment (n = 488) were screened for prior partner and non-partner aggression as well as recent suicidal thoughts. We examined the association between aggression and suicidal ideation in bivariate and multivariate models.

Results

Within the past two weeks, 33% (159/488) of the sample reported suicidal ideation. In bivariate analyses, neither psychological nor physical aggression towards a non-partner was related to suicidal ideation. Partner psychological aggression was related to suicidal ideation in bivariate but not multivariate analyses. Physical aggression towards a partner was consistently related to higher rates of suicidal ideation even after controlling for other known risk factors (OR = 1.8; CI = 1.1–2.7). Mediational analyses indicate that this relationship was no longer significant after accounting for current negative affect.

Conclusion

Suicidal ideation is common in patients seeking drug and alcohol treatment and particularly likely in those who report prior aggression towards a partner.     

The association of puberty and young adolescent alcohol use: Do parents have a moderating role?

Purpose

To explore the extent to which parent–adolescent emotional closeness, family conflict, and parental permissiveness moderate the association of puberty and alcohol use in adolescents (aged 10–14).

Methods

Cross-sectional survey of 7631 adolescents from 231 Australian schools. Measures included pubertal status, recent (30 day) alcohol use, parent–adolescent emotional closeness, family conflict, parental permissiveness of alcohol use and peer alcohol use. The analysis was based on a two-level (individuals nested within schools) logistic regression model, with main effects entered first, and interaction terms added second.

Results

The interaction of family factors and pubertal stage did not improve the fit of the model, so a main effect model of family factors and pubertal stage was adopted. There were significant main effects for pubertal stage with boys in middle puberty at increased odds of alcohol use, and girls in advanced puberty at increased odds of alcohol use.

Conclusions

Puberty and family factors were strong predictors of adolescent alcohol use, but family factors did not account for variation in the association of pubertal stage and alcohol use.     

Alcohol use disorders and acute alcohol use preceding suicide in China

Objectives

Identify distinguishing characteristics of subgroups of suicides classified according to different patterns of alcohol use prior to death.

Methods

Three groups of suicide decedents from a representative sample of 454 male suicides in China identified in a national psychological autopsy study were classified and compared: decedents with an alcohol use disorder during the year prior to death, those without an alcohol use disorder who used alcohol acutely at the time of suicide, and those with neither an alcohol use disorder nor acute use.

Results

Compared with suicides unrelated to alcohol, those with an alcohol use disorder were more likely to have made previous suicide attempts (adjusted OR, 95%CI = 1.94, 1.07–3.53), and suicides with acute alcohol use were less likely to have poor overall functioning in the month before death (0.36, 0.20–0.63).

Conclusions

The characteristics of male suicide decedents with an alcohol use disorder, using alcohol acutely but without an alcohol use disorder, and with no alcohol involvement are somewhat different, suggesting the potential value of tailored prevention strategies.     

Alcohol and sexual risk: An event–level analysis in commercial sex setting

Objective

To assess the episodic relationship between alcohol and sexual risk in multiple-client occasions among female sex workers (FSWs).

Methods

Data on alcohol use and sexual episodes with clients from the past two days were collected among FSWs in Guangxi, China (N = 336 for yesterday, and N = 299 for the day before yesterday). Logistic regression using generalized estimating equations with robust variance estimation was used to assess the alcohol–sexual risk relationship, controlling for contextual variables salient in the setting of commercial sex.

Results

Alcohol use among FSWs was associated with a higher likelihood of unprotected sex with clients during both days. This relationship was modified by the number of clients received within a day. Additionally, having a larger number of drinks was associated with higher odds of unprotected sex, but the association was not consistent across the two days.

Conclusion

Findings from the study support an association between alcohol use and sexual risk among FSWs. The design of alcohol and sexual risk reduction intervention among FSWs in China may take advantage of the interaction between contextual factors and alcohol use on sexual risk.     

Social desirability biases in self-reported alcohol consumption and harms

Aims

Self-reports remain the most common means of assessing alcohol consumption despite concern for their validity. The objective of this research is to assess the extent to which social desirability biases relate to self-reported consumption, hazardous use, and harms.

Methods

In each of two studies presented, undergraduate students (N = 391 and N = 177) who reported that they had consumed alcohol in the past year completed online confidential surveys.

Results

Both studies show consistent associations between impression management bias and self-reported consumption such that high impression managers report 20 to 33% less consumption and are about 50% less likely to report risky drinking. No significant correlations involving consumption were found for self-deception bias. Study 2 also indicated that high impression managers report 30–50% fewer acute harms following a drinking episode, and that these effects are maintained after controlling statistically for trait impulsivity/constraint.

Conclusions

Impression management bias represents a significant threat to the validity of self-reported alcohol use and harms. Such bias may lead to misspecification of models and under-estimates of harmful or hazardous use.     

Children's exposure to parental conflict after father's treatment for alcoholism

Objective

This study investigated children of alcoholics' (COAs) exposure to inter-parental conflict before and after their fathers received alcohol treatment and compared exposure levels to a community comparison sample.

Method

This study included 67 couples with a treatment-seeking male alcoholic partner and children aged 4–16. The alcoholic fathers and their relationship partners provided data at baseline and at six and twelve month follow-ups. A community comparison sample of 78 couples with children in the target age range completed similar longitudinal assessments. It was hypothesized that treatment of paternal alcoholism would be associated with a decrease in COAs' exposure to conflict, and that among remitted patients exposure to conflict would decrease to the level found in the community sample.

Results

Prior to the father's alcohol treatment, the children of the treatment sample were exposed to significantly more conflict between their parents than in the community comparison sample. After the fathers received alcohol treatment, COAs' exposure to conflict significantly decreased at both the six and twelve month follow-ups compared to baseline. Children of remitted alcoholics did not differ significantly in levels of exposure to conflict at six months follow-up compared to the community sample as predicted. However, at twelve months remitted alcoholics reported significantly more exposure to conflict compared to the community sample.

Conclusions

Decreased child exposure to parental conflict is a benefit associated with the father's treatment for alcoholism, and it may lead to improvements in COAs' functioning after parental treatment.     

Attention-deficit/hyperactivity disorder subtypes and substance use and use disorders in NESARC

Background

Attention-deficit/hyperactivity disorder (ADHD) is associated with substance use and substance use disorders (SUD). However, relatively little is known about the relationship between DSM-IV ADHD subtypes and substance use or DSM-IV abuse/dependence in epidemiological samples.

Methods

Data were obtained from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC, N = 33,588). Respondents reported on ADHD symptoms (DSM-IV) for the period of time when they were 17 years or younger. Lifetime use and DSM-IV abuse/dependence of alcohol, nicotine, cannabis, cocaine, sedatives, stimulants and heroin/opiates were compared across those with ADHD symptoms but no diagnosis (ADHDsx; N = 17,009), the Combined (ADHD-C; N = 361), Predominantly Inattentive (ADHD-I; N = 325), and the Predominantly Hyperactive-Impulsive (ADHD-HI; N = 279) ADHD subtypes. Taking a more dimensional approach, inattentive and hyperactive-impulsive symptom counts and their associations with substance use and misuse were also examined.

Results

After adjustments for conduct disorder, major depressive disorder, any anxiety disorder and other socio-demographic covariates, substance use and SUD were associated with ADHDsx, ADHD-C, ADHD-I and ADHD-HI. Overall, substance use and SUD were more weakly associated with the ADHDsx group compared to the three ADHD diagnostic groups.Statistically significant differences were not evident across the three diagnostic groups. Hyperactive–impulsive symptoms were more consistently associated with substance use and SUD compared to inattentive symptoms.

Conclusions

ADHD subtypes are consistently associated with substance use and SUD. The relatively stronger association of hyperactive/impulsive symptoms with substance use and abuse/dependence is consistent with the extant literature noting impulsivity as a precursor of substance use and SUD.     

Acculturation and perceived discrimination: Predictors of substance use trajectories from adolescence to emerging adulthood among Hispanics

Purpose

Previous studies have documented associations between cultural factors and substance use among Hispanic adolescents. Negative cultural experiences such as discrimination have been associated with an increased risk of substance use among Hispanic adolescents, whereas positive cultural resources, such as maintenance of Hispanic cultural orientations, have shown protective effects. However, few studies have examined the continuing influence of cultural factors on substance use from adolescence to emerging adulthood.

Methods

We surveyed a cohort of Hispanic adolescents in Southern California in 9th, 10th, and 11th grades, and 3–4 years after high school. Growth curve analyses were conducted to examine the effects of U.S. acculturation, Hispanic acculturation, ethnic identity, and perceived discrimination on change in tobacco, alcohol, and marijuana use over time.

Results

Higher perceived discrimination at baseline was significantly associated with a higher intercept (initial level) of tobacco, alcohol, and marijuana use. Higher initial level of Hispanic acculturation was significantly associated with a lower slope of tobacco, alcohol, and marijuana use.

Conclusions

Cultural phenomena such as acculturation and perceived discrimination can continue to affect substance use through the transition to emerging adulthood. Health education interventions are needed to help Hispanics navigate this developmental transition without engaging in substance use.     

Alcohol mixed with energy drinks: Are there associated negative consequences beyond hazardous drinking in college students?

Objective

The consumption of alcohol mixed with energy drinks (AmED) is prevalent among college students as is hazardous drinking, a drinking pattern that places one at risk for alcohol-related harm. The present study, therefore, examined associations between AmED use, hazardous drinking, and alcohol-related consequences in college students.

Methods

Based on a probability sample conducted in 2010, participants were 606 undergraduate students aged 18–25. AmED consumption included lifetime and past year use. Hazardous drinking and alcohol-related consequences were measured during the past year. Point prevalence was used to estimate rates of AmED use, and chi-square, ANOVA, and logistic regression were used to examine associations between AmED use, hazardous drinking, and alcohol-related consequences.

Results

Lifetime and past year AmED use prevalence rates were 75.2% and 64.7%, respectively. Hazardous drinkers who engaged in AmED use were significantly more likely than past year hazardous drinkers who did not engage in AmED use to have had unprotected sex (OR = 2.35, CI 1.27–4.32).

Conclusions

AmED use appears to be highly prevalent among college students, and AmED use may confer additional risk for unprotected sex beyond hazardous drinking. Unprotected sex has implications for public health, and students who drink hazardously and consume AmED may be at greater risk.     

C-reactive protein and substance use disorders in adolescence and early adulthood: A prospective analysis

Background

Dysregulated immune function and elevated inflammation markers are seen in adults with chronic diseases, including some psychiatric disorders, but evidence on inflammation in the case of drug abuse is conflicting.

Objective

To test the concurrent and predictive relations between C-reactive protein (CRP) and use and abuse of alcohol, nicotine and cannabis in a longitudinal, population sample of adolescents and young adults, at the period of highest increase in drug use.

Methods

Data from the prospective population-based Great Smoky Mountains Study (N = 1420) were used, covering children in the community assessed at ages 9–16, 19, and 21. Structured interviews were used to assess substance abuse symptoms and DSM-IV substance use disorders. Bloodspots were collected at each assessment and assayed for CRP.

Results

CRP levels were higher in the presence of nicotine, alcohol, and cannabis use and nicotine dependence. In prospective analyses, higher CRP levels predicted cannabis use and nicotine dependence, and nicotine use predicted higher CRP levels, once covariates were included in the models. Significant covariates were age, race (American Indian), and obesity.

Conclusions

The inter-relationship of CRP and substance abuse has implications for the later health risks associated with early drug and alcohol use and abuse.     

Test–retest reliability of an online measure of past week alcohol consumption (the TOT-AL), and comparison with face-to-face interview

Objective

This paper reports on the development of a new online measure of beverage-specific past week alcohol consumption (the TOT-AL), its test–retest reliability, and comparability with the face-to-face approach of ascertaining alcohol intake.

Methods

University students participating in the reliability study completed the TOT-AL twice on the same day with at least 3 h apart. Students in the comparability study attended a face-to-face interview and completed the TOT-AL on the same day, in a randomised order, at least 3 h apart.

Results

There was a strong correlation between the repeated measurements of the TOT-AL (r = 0.99; 95% CI: 0.98, 0.99) and between the units calculated by the TOT-AL and the face-to face interview (r = 0.97; 95% CI: 0.95, 0.99). A high level of agreement between measurements was also observed in a Bland–Altman analysis.

Conclusions

The TOT-AL is a reliable, time efficient means of ascertaining alcohol intake, equivalent to that obtained face-to-face. These findings support the use of this approach to online alcohol assessment in populations with access to the Internet.     

Brief motivational enhancement intervention to prevent or reduce postpartum alcohol use: A single-blinded,randomized controlled effectiveness trial

Aims

The aim of this study is to assess the effect of brief motivational enhancement intervention postpartum alcohol use.

Design

This study is a single-blinded, randomized controlled effectiveness trial in which pregnant women were assigned to receive usual care or up to 5 face-to-face brief motivational enhancement sessions lasting 10–30 minutes each and occurring at study enrollment, 4 and 8 weeks after enrollment, 32 weeks of gestation, and 6 weeks postpartum.

Setting

The setting is in a large, urban, obstetrics clinic.

Participants

Participants were women who were ≥ 18 years old, < 20 weeks of gestation, and consumed alcohol during pregnancy. Of 3438 women screened, 330 eligible women were assigned to usual care (n = 165) or intervention (n = 165). Due to missing data, we analyzed 125 in the intervention group and 126 in the usual care group.

Measurements

The measurements were the proportion of women with any alcohol use and the number of drinks per day, reported via follow-up telephone interviews at 4 and 8 weeks after enrollment, 32 weeks of gestation, and 6 weeks, 6 months, and 12 months postpartum.

Findings

In random effects models adjusted for confounders, the intervention group was less likely to use any alcohol (odds ratio 0.50; 95% confidence interval [CI], 0.23–1.09; P = 0.08) and consumed fewer drinks per day (coefficient − 0.11; 95% CI − 0.23–0.01; P = 0.07) than, the usual care group in the postpartum period but these differences were non-significant. Missing data during the prenatal period prevented us from modeling prenatal alcohol use.

Conclusions

Brief motivational enhancement intervention delivered in an obstetrical outpatient setting did not conclusively decrease alcohol use during the postpartum period.