Adolescent Children of Alcoholics: Vulnerable or Resilient?

BACKGROUND: Children of alcoholics (COAs) have been described as both vulnerable and resilient. Although identified as at-risk for mental and physical health problems, chemical dependency, and child abuse and neglect, many go on to lead successful lives.

OBJECTIVE: The relationship between COA status and various adolescent risk behaviors, such as drug and alcohol abuse and sexual precocity, was assessed by addressing the following research question: Could parental alcoholism be a risk factor for teens engaging in problem behaviors?

STUDY DESIGN: A secondary analysis of a Wyoming high-risk youth data set was conducted (N _ 1632). Werner’s (1992) core resiliency factors provided the conceptual frame for the study.

RESULTS: Adolescent COAs scored significantly (p < .000) lower on all psychosocial factors of family/personal strengths and school bonding and significantly higher on all factors of at-risk temperament, feelings, thoughts, and behaviors than non-COAs.

CONCLUSIONS: Adolescent COAs are at risk for depression, suicide, eating disorders, chemical dependency, and teen pregnancy. It has been proposed that mental health professionals teach core resiliency factors to promote healthy behaviors for this vulnerable population.

Children of addicted parents are the highest risk group of children to become alcohol and drug abusers because of both genetic and family environment factors.

Twenty-two percent (n _ 352) of the combined sample identified themselves as a child of an alcoholic. This is consistent with current estimates of children of parental period alcoholics, which is calculated to be 22% (Eigen & Rowden, 2000). Rodney and Mupier (1997), in a recent study among 595 African American boys age 13 to 17 years, identified that 23% of the participating teens were COAs. The National Association of Children of Alcoholics (NACOA, n.d.) estimates that there are 11 million COAs under 18 years of age.

COA’s scored lower on psychosocial factors;

• Family cohesion
• Self-esteem
• Education and school bonding
• Family adaptability

COA’s scored higher on risk factors;

• Negative temperament
• Negative self directed feelings, thoughts and behaviours
• Drug and alcohol use
• Sexual behaviours

COA’s scored higher on negative self directed feelings, thoughts and behaviours

• Depression and hopelessness
• Takes physical risks
• Feels excited doing risky things
• Thought of suicide in last year
• Tried suicide in last year

Research; Adolescent Children of Alcoholics: Vulnerable or Resilient? MaryLou Mylant, Bette Ide, Elizabeth Cuevas, and Maurita Meehan. J Am Psychiatr Nurses Assoc 2002; 8; 57.

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Students with a dense family history of alcoholism are most at risk of alcohol-use disorders

This study looks at first-, second- and third-degree relatives instead of just one parent, usually paternal

Not all university students will “mature out” of their heavy-drinking habits.

A new study examines the density of college students’ family history of alcoholism.

This type of measure – looking at first-, second- and third-degree relatives – identified a significant number of at-risk individuals who would have been missed using regular family-history measures.

While many university students tend to “mature out” of heavy-drinking behavior by the time they become young adults, some go on to develop alcohol-use disorders (AUDs). Most genetic research on an individual’s family history of alcoholism (FHA) has looked at the parents’ – usually paternal – alcohol use. New findings indicate that looking at the density of FHA – including first-, second- and third-degree relatives – is much more telling.

Results will be published in the August issue of Alcoholism: Clinical & Experimental Research.

“Using a density measure of FHA can identify a greater number of individuals who may be at risk for developing an alcohol problem,” said Christy Capone. “The greater number of affected relatives … the greater the potential risk of developing an AUD. Ours is the first published study to examine this measure among college students.”

“Family density appears to be a promising method to identify a higher percentage of at-risk individuals,” agreed John Hustad, research associate at Brown University. “For example, in this study, approximately 44 percent of the at-risk participants would have been missed if a typical family-history measure had been used instead of the family-history density approach.”

The study population for this research consisted of 408 undergraduate students (293 females, 115 males) from a northeastern U.S. university who were asked to complete an anonymous survey for course credit during the 2005-2006 academic year.

“Our use of a density measure identified a large proportion of students, about 29 percent, who are at potentially greater risk for development of AUDs based on their report of alcoholism among first- and second-degree relatives,” said Capone. “Our other key finding was the relationship between FHA and other potential risk factors – behavioral undercontrol, age of onset of drinking (AOD), and cigarette use.”

All of these risks factors are inter-related, added Hustad. “First, family-history density was related to AOD, behavioral undercontrol, and current cigarette use which, in turn, are related to alcohol use and/or alcohol-related problems in this sample of college students. Second, behavioral undercontrol was associated with alcohol problems but not the degree of alcohol consumption; this suggests that individuals with a family-history density of AUDs and behavioral undercontrol are more likely to behave irresponsibly when drinking.”

“The importance of identifying these risk factors is the idea that they can be useful markers of at-risk status and can help us to develop appropriate intervention strategies,” said Capone. “Although, given the fact that many students come to college already having experience with alcohol, I believe that preventive interventions should begin early in the high-school years or during the transition from middle school to high school.”

Hustad agreed. “Due to the relationship between earlier AOD and more alcohol-related problems during college, it is clear that education and prevention efforts should begin well before the college years,” he said. “Until that happens, the risk factors identified in this research can be easily implemented in any screening and brief intervention for incoming college students. For example, these results suggest that effective interventions addressing tobacco use may have a positive influence on both smoking and alcohol-related consequences.”

“It is important to remember that not everyone with density of familial alcoholism will go on to develop a long-term problem with alcohol themselves,” said Capone. “Alcohol dependence is a very complex disorder and FHA is but one influence on its development. However, college students who are heavy drinkers and have a greater density of familial alcoholism are certainly at higher risk of continuing to drink in a problematic fashion after the college years.”

See also;

• 12-Step Treatment More Effective than Alternative
• AA and Treatment Work Better Together
• AA Offers Recovery Not Religion
• Twelve Step Facilitation
• Subscribe to BriefTSF by e-Mail

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Prevalence of positive substance abuse screen results among adolescent primary care patients

Objectives; To measure the prevalence of positive substance use screen results among adolescent primary care patients and to estimate the prevalence of substance-related problems and disorders.

Results; Overall, 14.8% of adolescents had positive results on the CRAFFT screen.

Prevalence rates differed significantly across practices (P < .001) after adjusting for demographic factors.

The highest positive rates on the CRAFFT screen were at

• School-based health centers (29.5%) and
• Rural family practice (24.2%),
• Middle rate was at the adolescent clinic (16.6%), and
• Lowest rates were at the health maintenance organization (14.1%) and
• Pediatric clinic (8.0%).
• Sick visits had the highest rate (23.2%).
• Well-child care visits had a significantly lower rate (11.4%, P < .001).

Statistical modeling estimated that 11.3% of all patients had problematic use,

• 7.1% had abuse, and
• 3.2% had dependence.

Conclusion; Substance abuse screening should occur whenever the opportunity arises, not at well-child care visits only.

Arch Pediatr Adolesc Med. 2007;161(11):1035-1041.

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• AA And Al-Anon
• AA And The Disease Concept Of Alcoholism
• Adolescent Children Of Alcoholics
• Al-Anon Offers New Life
• Alcohol Consumption In Patients Pancreatitis
• Alcohol Metabolization
• Alcohol Related Brain Injury
• Alcoholic Brain Damage And Thiamine
• Alcoholic Jealousy
• Alcoholics Anonymous
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• Alcoholism And Personality Disorders
• Alcoholism Is Also Genetic
• Alcoholism Myths
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• Benefits Of Alcoholics Anonymous
• Beyond Codependency
• Brief-TSF Description
• Children With Alcohol Dependent Fathers
• Counselor Characteristics
• Craving Reduction
• Effective Professional Interventions
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• Free Inhalant Abuse Education
• Just For Today Card
• Mindfulness Can Help Recovery
• Prescription Drug Overdose Becomes Big Killer
• Process Of Recovery For Alcoholic Women
• Research Evidence For TSF  .
• Return To Drinking After Liver Transplantation For Alcoholic Liver Disease
• Role Of Significant Others
• Screening Can Decrease Teen Risk Behaviour
• Sleep Problems Affect Alcoholism Recover
• Spirituality And Helping In Alcoholics Anonymous
• Strategies For Dealing With Common Problems
• Strategies For Dealing With Denial
• Sweet Tooth And Alcoholism
• Symptoms Of Alcoholism
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Researchers say that the reward center in an adolescent’s brain isn’t as fully developed or responsive as an adult’s, which could explain why teens tend to engage in risky behaviors such as consuming alcohol, using drugs, or having unsafe sex, Health Day News reported Feb. 26.

Using magnetic resonance imaging (MRI), researchers scanned the brains of 12 teens aged 12 to 17 and 12 young adults aged 22 to 28. During the scan, participants played a game that involved monetary risk and reward.

In comparing the scans, the researchers found that the ventral stratium, the section of the brain known as the reward center, showed increased activity as the reward increased for both groups. However, the right ventral stratium, which is responsible for motivation, showed more activation in adult participants than in the teens.

“That region of the brain controls how much an organism is willing to work to get a reward,” Bjork said. “The data show that adolescents are just as happy and excited at the prospect of winning as adults, but they differed in the expenditure of effort for that reward.”

The researchers concluded that adolescents are more likely to engage in risky behaviors, such as alcohol and other drug use, because they involve little effort but provide a greater reward in return.

The research also may explain why teens sometimes seem unmotivated to adults. “Adults have readily active motivation in the brain,” said study co-author James Bjork, a research fellow in the Laboratory of Clinical Studies at the National Institute on Alcohol Abuse and Alcoholism. “But it may take exceptionally strong incentives to get kids jazzed up.”

The study’s findings are published in the Feb. 25 issue of the Journal of Neuroscience.

Creative Interventions for Troubled Children & Youth by Liana Lowenstein Read more about this title…

Simple Screening Can Help Decrease Teen Risk Behaviors

Research shows that adolescents who engage in one form of risky behavior, like drug or alcohol use, are likely to engage in other risky behaviors like self-harm, or having unprotected sex, but often times these behaviors are not discussed during a medical or mental health exam. Now, a new study shows that a simple and brief screening measure called the adolescent risk inventory (ARI) can quickly identify the broad range of risk behaviors found among adolescents.

“This constellation of behavior problems is really the thing we are trying to avoid. So, identifying early that a teen is engaging in a risky behavior may prevent that behavior from being the gateway to further risky behaviors,” says lead author Celia Lescano, PhD with the Bradley Hasbro Children’s Research Center and The Warren Alpert Medical School of Brown University.

This research study appeared in the April 2007 issue of the journal Child Psychiatry and Human Development.

Prior research indicates that teenagers who engage in one risky behavior are more likely to be involved in others and that this has an additive effect. The authors note that risk behaviors among teens are prevalent and can lead to increased morbidity, mortality, and health care costs, so identifying and dealing with problematic issues as they arise can help teens be safer and healthier.

Researchers studied 134 youth ages 12 to 19 with psychiatric disorders. Each study participant was given the adolescent risk inventory (ARI) (a paper and pencil measure). The ARI included questions about sexual history (have you ever been pregnant or been a dad?), self-harm (have you ever attempted suicide?), and attitudes towards acting out (do you break rules for no reason?).

“We found that the ARI is reliable and comprehensive and can be useful in quickly identifying a wide range of teen risk behaviors,” says Lescano.

This is important, the authors say, because when teens are seen for medical and/or mental health care, risk behavior issues are often neglected. Time and relevance are often seen as barriers that prevent providers from obtaining this important information.

“Given that the ARI is brief and broad in it assessment of behaviors, these barriers can be overcome and allow pediatricians, family doctors and mental health professionals to make referrals based on the information they get from the teen,” explains Lescano.

The analyses also provided intriguing data on the relationship between sex risk, psychopathology, and behavior in that abuse or self-harm behaviors were highly predictive of sex risk. This is important because while many clinicians are aware of the sexual risks that aggressive youths take, many are unaware of the association between risky sexual behavior and emotional distress, abuse and self-harm. Behaviors like self-cutting thoughts, suicidal thoughts or attempts, or a history of sexual abuse should alert clinicians to the potential for significant sexual risk, the authors say.

Oftentimes, research programs that target the identified risk behavior can be found in nearby communities or even through the medical or mental health offices in which the teens are being seen.

“Referral to these programs, as well as to mental health professionals to help treat the negative emotions that can precipitate risk behaviors may be useful avenues to decreasing risky behaviors in teens,” says Lescano.

Research report from; Lifespan

Twelve Step Facilitation (TSF)

Twelve-Step Facilitation (TSF) consists of a structured, and manual-driven approach to facilitating early recovery from alcohol abuse/alcoholism and other drug abuse/addiction. It is intended to be implemented on an individual basis in 12 to 15 sessions and is based in behavioural, spiritual, and cognitive principles that form the core of 12-step fellowships such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). It is suitable for problem drinkers and other drug users and for those who are alcohol or other drug dependent.

TSF seeks to facilitate two general goals in individuals with alcohol or other drug problems: acceptance (of the need for abstinence from alcohol or other drug use) and surrender, or the willingness to participate actively in 12-step fellowships as a means of sustaining sobriety. These goals are in turn broken down into a series of cognitive, emotional, relationship, behavioural, social, and spiritual objectives.

The theoretical rationale is based in the 12 steps and 12 traditions of AA and includes the need to accept that willpower alone is not sufficient to achieve sustained sobriety, that self-contredanses must be replaced by surrender to the group conscience, and that long-term recovery consists of a process of spiritual renewal. The primary mechanism action is active participation and a willingness to accept a higher power as the locus of change in one’s life.

The facilitator in the TSF treatment model is more truly a facilitator of change than an agent of change. The true agent of change (i.e., sustained sobriety) lies in active participation in 12-step fellowships like AA and NA along with the principles set forth in the 12 steps and 12 traditions that guide these fellowships.

Alcoholism and other drug addiction are considered illnesses that affect individuals both mentally and physically in such a way that they are unable to control their use of alcohol or other drugs. Viewed from this perspective, the concept of controlled use of alcohol or other drugs amounts to denial of the primary problem, that is, loss of control. Specific causative factors are of less relevance in recovery than is acceptance of both the loss of control and the need for abstinence and a willingness to follow the pathway laid out in the 12 Steps.

After Nowinski J. NIDA, 2000.

Adolescents’ participation in Alcoholics Anonymous and Narcotics Anonymous: review, implications and future directions.

Youth treatment programs frequently employ 12-Step concepts and encourage participation in Alcoholics Anonymous (AA) and Narcotics Anonymous (NA).

Since AA/NA groups are easily accessible at no charge and provide flexible support at times of high relapse risk they hold promise as a treatment adjunct in an increasingly cost-constricting economic climate.

Yet, due to concerns related to adolescents’ developmental status, skepticism exists regarding the utility of AA/NA for youth.

This review evaluates the empirical evidence in this regard, identifies and discusses knowledge gaps, and recommends areas for future research.

Findings suggest youth may benefit from AA/NA participation following treatment, but conclusions are limited by four important factors:

• a small number of studies;
• no studies with outpatients;
• existing evidence is solely observational; and
• only partial measurement of the 12-Step construct.

While surveys of adolescent SUD treatment programs indicate widespread clinical interest and application of adult-derived 12-Step approaches this level of enthusiasm has not been reflected in the research community.

Qualitative research is needed to improve our understanding of youth-specific AA/NA barriers, and efficacy, comparative effectiveness, and process studies are still needed to inform clinical practice guidelines for youth providers.

Research; Kelly JF, Myers MG. Adolescents’ participation in Alcoholics Anonymous and Narcotics Anonymous: review, implications and future directions. J Psychoactive Drugs. 2007 Sep;39(3):259-69.

See also;

• Brief-TSF is designed to address these issues.
• Twelve Step Facilitation

Alcoholics Anonymous and Narcotics Anonymous Benefit Adolescents Who Attend

While Alcoholics Anonymous (AA) has existed for more than 70 years, and is the most commonly sought source of help for alcohol-related problems, there is little “hard scientific evidence” showing that AA and Narcotics Anonymous (NA) can improve substance-use outcomes.  This study examined how helpful AA and NA may be for adolescents, finding long-term benefits even though many youth discontinue attendance after time.

“It is difficult to evaluate the efficacy of mutual-help organizations like AA through randomized controlled experiments because the AA ‘intervention,’ being a community organization based on anonymity, cannot be directly under the control of the researcher in the usual way,” explained John F. Kelly, associate director of the MGH-Harvard Center for Addiction Medicine at Massachusetts.

Yet their popularity and cost-effectiveness cannot be denied, added Kelly, also the study’s corresponding author.

“AA and NA are explicitly focused on abstinence and addiction recovery, they are widely available across most communities, they provide entry to a social network of recovery-specific support and sober events that can be accessed ‘on demand’ – particularly at times of high-relapse risk such as evenings and weekends, the services are free, and AA/NA can be attended as intensively, and for as long, as individuals desire,” he said.

However, he added, despite growing evidence that adults benefit from AA and NA, little is known about how these abstinence-focused organizations help youth, and what is known lacks scientific rigor.  

“This knowledge gap is particularly noteworthy given that adolescents and young adults face more barriers to AA and NA than older adults and yet appear to be referred there just as frequently by treatment providers,” said Kelly.  “Youth tend to have less severe addiction problems, on average, and consequently do not feel a strong need to stop using alcohol and/or drugs.  ‘Why should they bother to go to abstinence-oriented organizations like AA and NA, and would they benefit even if they did go?’”  These are the questions Kelly and his colleagues wanted to address.

The researchers recruited 160 adolescent inpatients (96 males, 64 females), with an average age of 16 years, who were enrolled at two treatment centers in California having a focus on abstinence and based on a 12-step model.  The study participants’ length of stay ranged from four to six weeks, after which they were re-assessed on a number of clinical variables at six months, and one, two, four, six, and eight years.

“We found that most of the youth attended at least some AA/NA meetings post-treatment,” said Kelly.  “Those patients with severe addiction problems and those who believed they could not use alcohol/drugs in moderation attended the most.  The NA and AA focus on abstinence/recovery probably resonates better with these more severely dependent individuals who also typically need ongoing support.”

Even though many of the youth discontinued AA/NA after time, they nonetheless appeared to benefit from attendance. 

“We found that patients who attended more AA and/or NA meetings in the first six months post-treatment had better longer term outcomes, but this early participation effect did not last forever – it weakened over time,” said Kelly.  “The best outcomes achieved into young adulthood were for those patients who continued to go to AA and/or NA. In terms of a real-world recovery metric, we found that for each AA/NA meeting that a youth attended they gained a subsequent two days of abstinence, independent of all other factors that were also associated with a better outcome.”

A little can go a long way, he added.  “During the first six months post-treatment,” said Kelly, “even small amounts of AA/NA participation – such as once per week – was associated with improved outcome, and three meetings per week was associated with complete abstinence.  This suggests youth may not need to attend as frequently as every day, sometimes recommended clinically, to achieve very good outcomes.”

Kelly believes that part of the reason for the success of AA/NA among adolescents who attend meetings is related to their developmental needs.

“Given the need for social affiliation and peer-group acceptance outside of the family at this stage of life, peers can exert strong influence on the behavior of young people,” he noted.  “When you couple this fact with the reality that most adolescents and young adults are experimenting with, or heavily using, alcohol and other drugs, it may be hard to find suitable peer contexts that can facilitate recovery.  In fact, we know that most youth relapses are connected with social contexts where alcohol/drugs are present; unlike adults, youth rarely relapse alone.  So, organizations such as AA/NA may provide support, and encourage and provide alternatively rewarding sober social activities.”

Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center National Office, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA.

Articles were written based on the following published research:

Sandra A. Brown, Mark Myers, Ana Abrantes, Christopher W. Kahler.  (August 2008).  Social recovery model: an 8-year investigation of adolescent 12-step group involvement following inpatient treatment.  Alcoholism: Clinical & Experimental Research (ACER).  31(8).

See also;

1. 12-Step Treatment More Effective than Alternative
2. A Problem Shared is a Problem Halved
3. Alcoholic Family Roles
4. Subscribe to BriefTSF by e-Mail

Coping Strategies of Female Victims of Child Abuse in Treatment for Substance Abuse Relapse: Their Advice to Other Women and Healthcare Professionals,

Abstract

This study was a part of a larger qualitative descriptive study designed to explore chronic sorrow as a relapse trigger among female victims of child abuse who were currently enrolled in substance abuse treatment for relapse.

The purpose of this study was to identify coping strategies and other factors these women perceived as helpful to their recovery. A purposive sample of twelve women participated in interviews using a semistructured interview schedule.

The advice the participants offered to women in similar situations reflected interpersonal, cognitive and action-focused positive coping strategies.

They encouraged clinicians in primary care facilities to approach persons suspected of substance abuse in a nonjudgmental manner. Healthcare professionals should be more assertive in recommending resources for substance abuse treatment.

Research; Cheryl Slaughter Smith. Coping Strategies of Female Victims of Child Abuse in Treatment for Substance Abuse Relapse: Their Advice to Other Women and Healthcare Professionals, Journal of Addictions Nursing, Volume 18, Issue 2 April 2007 , pages 75 – 80