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CORK Bibliography: Children of Alcoholics

87 citations. January 2003 to present

Prepared: June 2007

Andreas JB; O'Farrell TJ; Fals-Stewart W. Does individual treatment for alcoholic fathers benefit their children? A longitudinal assessment. Journal of Consulting and Clinical Psychology 74(1): 191-198, 2006. (21 refs.)

Psychosocial adjustment in children of alcoholics (COAs; N = 125) was examined before and at 3 follow-ups in the 15 months after their fathers entered alcoholism treatment. Before their fathers' treatment, COAs exhibited greater overall and clinical-level symptomatology than children from the demographically matched comparison sample, but they improved significantly following their fathers' treatment. Children of stably remitted fathers were similar to their demographic counterparts from the comparison sample and had fewer adjustment problems than children of relapsed fathers, even after accounting for children's baseline adjustment. Thus, COAs' adjustment improved when their fathers received treatment for alcoholism, and fathers' recovery from alcoholism was associated with clinically significant reductions in child problems.

Andreas JB; O'Farrell TJ. Longitudinal associations between fathers' heavy drinking patterns and children's psychosocial adjustment. Journal of Abnormal Child Psychology 35(1): 1-16, 2007. (37 refs.)

Psychosocial adjustment in children of alcoholics (N = 114) was examined in the year before and at three follow-ups in the 15 months after their alcoholic fathers entered alcoholism treatment, testing the hypothesis that children's adjustment problems will vary over time as a function of their fathers' heavy drinking patterns. Three unique patterns of heavy drinking in alcoholic fathers were identified through cluster analysis. The results demonstrated significant and meaningful associations between these drinking patterns in fathers and adjustment problems in children over time. Overall, children whose fathers remained mostly abstinent following their treatment showed lowest and decreasing adjustment problems, while children whose fathers continued and increased heavy drinking following their treatment showed greatest and increasing adjustment problems over time.

Barnow S; Schuckit M; Smith T; Spitzer C; Freyberger HJ. Attention problems among children with a positive family history of alcohol abuse or dependence and controls: Prevalence and course for the period from preteen to early teen years. European Addiction Research 13(1): 1-5, 2007. (59 refs.)

This longitudinal study investigated the scope and course of attention problems over a period of time from preteen (ages 7-12 years) to early teen years (ages 13-17 years). We compared symptoms in subjects with and without a family history (FH) of alcohol abuse or dependence from among families without evidence of antisocial personality disorder. Evaluations of attention problems for the offspring were based on the Child Behavior Checklist and a validated semistructured interview carried out with the mother. The findings indicate no higher risk for attention problems and attention-deficit hyperactivity disorder (ADHD)-like symptoms in the children of families with an alcohol use disorder. Regarding the course of problems, the ADHD symptom count tended to decrease over time, especially for children without a FH of alcohol abuse or dependence. Further research will be needed to determine whether results can be replicated with families from different social strata and including subjects with the antisocial personality disorder.

Barrera M; Hageman DN; Gonzales NA. Revisiting Hispanic adolescents' resilience to the effects of parental problem drinking and life stress. American Journal of Community Psychology 34(1/2): 83-94, 2004. (40 refs.)

Two previous studies found that life stress and parental alcoholism were not as highly related to distress for Hispanic adolescents as they were for European American adolescents (M. Barrera Jr., S.A. Li, and L. Chassin, 1993, 1995). Those findings could be interpreted as evidence of Hispanic youths' resilience, but limitations of the stress measure and the homogeneity of the Hispanic sample threatened this interpretation. The present study improved on those previous studies by using a new measure of uncontrollable stressors and a more heterogeneous Mexican American sample. Participants in this study were 175 Mexican American and 59 European American adolescents and their parents. Unlike the previous studies, results did not show that Mexican American adolescents were more resilient to parental problem drinking or life stress than were European American adolescents. Overall, life stress was related to adolescents', mothers', and fathers' reports of adolescents' psychological distress above and beyond the effects of ethnicity and socioeconomic factors.

Berman SM; Ozkaragoz T; Noble EP; Antolin T; Sheen C; Siddarth P et al. Differential associations of sex and D-2 dopamine receptor (DRD2) genotype with negative affect and other substance abuse risk markers in children of alcoholics. (review). Alcohol 30(3): 201-210, 2003. (117 refs.)

Children of alcoholics have increased risk for substance abuse problems. Self-medication of negative affect may be one developmental path to future substance abuse. Because the 146 young (adolescent) children of alcoholics in the current sample had not used enough abused substances to study substance use directly, the relation of substance abuse risk markers to negative affect was assessed. Because the D-2 dopamine receptor (DRD2) A(1) allele has been associated with alcoholism and other substance use disorders, negative affect, measured by the Beck Depression Inventory (BDI), was determined in four groups of children: boys and girls with the A(1)(+) allele (A(1)A(1) and A(1)A(2) genotypes) and with the A(1)(-) allele (A(2)A(2) genotype). The other risk markers were stress, low amplitude of the P300 evoked potential, poor visuospatial functioning, novelty seeking (NS), and harm avoidance (HA). Stress was correlated with BDI scores in all groups. In contrast, low P300 was associated with BDI scores only in boys with the A(1)(+) allele (P = .04), NS was associated with BDI scores only in girls with the A(1)(+) allele (P = .02), and HA was associated with BDI scores only in boys with the A(1)(-) allele (P = .01). In addition, boys with the A(1)(+) allele had lower BDI (P = .05) and HA (P = .005) scores than the respective scores for boys with the A(1)(-) allele. Girls with the A(1)(-) allele had lower HA scores compared with scores for boys with the A(1)(-) allele (P = .02). Girls with the A(1)(+) allele had lower visuospatial functioning than that of boys with the A(1)(+) allele, (P < .001). Results indicate that both sex and DRD2 genotype modify associations between negative affect and other substance abuse risk markers.

Bijttebier P; Goethals E; Ansoms S. Parental drinking as a risk factor for children's maladjustment: The mediating role of family environment. Psychology of Addictive Behaviors 20(2): 126-130, 2006. (30 refs.)

In the present study, the relationships among parental drinking, family environment, and child adjustment is investigated in a community sample of 207 10-14-year-olds. Multiple aspects of perceived family environment (e.g., cohesion, organization, conflict) as well as multiple indicators of adjustment (e.g., negative affect, feelings of competence, self-esteem) are taken into consideration. Parental alcohol problems are found to be associated with low family cohesion, poor family organization, and low global self-worth of the child. A mediational analysis reveals that the relation between parental drinking and low global self-worth is mediated by family cohesion.

Bletzer KV. Sex workers in agricultural areas: Their drugs, their children. Culture, Health & Sexuality 7(6): 543-555, 2005. (31 refs.)

Most research on female sex workers is urban-based, emphasizing economic necessity and risk-taking. Few authors discuss sex workers and their children. The objective of the present study was to ethnographically explore the influence of street life on childrearing by women involved in sex work in agricultural areas of the southeastern USA. Interviews took place with 38 women. Findings suggest that the sampled women followed the usual paths into substance use. Most began using substances before they began sex work, at which time use escalated to crack-cocaine. Children of 32 of the 34 women who were mothers were living separately from their mothers. None the less, mothers took an interest in children's wellbeing, and many visited them whenever possible. Their principal concern was assuring that children were raised in the best way available. One daughter followed her mother into sex work, and a few older children drank moderately. Several children had experienced abuse from persons other than parents, but the long-term effects of this abuse are unknown.

Braun PA; Beaty BL; DiGuiseppi C; Steiner JF. Recurrent early childhood injuries among disadvantaged children in primary care settings. Injury Prevention 11(4): 251-255, 2005. (20 refs.)

Objective: To examine differences in social risk factors and health care use between young children with and without recurrent injuries. Design: Retrospective cohort study using administrative claims and medical records. Children with no, one, or more than one injury were compared. Setting: Integrated public healthcare system. Subjects: All children born at Denver Health Medical Center (DHMC) in 1993 who continued care there beyond 15 months of age. Children were followed to 36 months. Outcome measures: Sociodemographic information, service use, injury episodes, cause of injury, and social risk factors. Results: 371 injury episodes occurred among 817 children. In the study cohort, 7% had > 1 injury episode, 26% had one injury, and 67% had none. Among children with > 1 injury episode, 78% had at least one social risk factor compared with 63% of children with one injury and 52% of children with none (p < 0.0001). Risk factors for > 1 injury included maternal substance abuse (p = 0.0003), maternal age under 18 years (p = 0.04), a primary caregiver who was single (p < 0.0001) or mentally ill (p = 0.03), and a history of family violence (p = 0.01). Multiple injury episodes were associated with increased non-injury service use, including primary care visits (p < 0.0001), emergency department visits (p < 0.0001), and total non-injury encounters (p < 0.0001). Conclusions: Children with recurrent injury were more likely to have social risk factors, and used DHMC more frequently, than children with one or no injuries. Children with risk factors for recurrent injury can be identified and injury prevention counseling can be delivered to their families at their multiple visits to the system.

Burden MJ; Jacobson SW; Sokol RJ; Jacobson JL. Effects of prenatal alcohol exposure on attention and working memory at 7.5 years of age. Alcoholism: Clinical and Experimental Research 29(3): 443-452, 2005. (50 refs.)

Background: A broad range of attentional and neuropsychological impairments have been demonstrated in children with fetal alcohol exposure. This study was designed to investigate which specific aspects of attentional function are most directly affected by moderate to heavy doses of prenatal alcohol exposure. Methods: A total of 337 black children who were aged 7.5 years and recruited prospectively to over-represent prenatal alcohol exposure at moderate to heavy levels were assessed on a diverse battery of neuropsychological tests. Principal components analyses were used to replicate and extend Mirsky et al.'s (1991) four-component model of attention. The relation of prenatal alcohol exposure to empirically derived attentional constructs was examined. Results: Both the replicated and the extended attentional. models produced solutions similar to the original Mirsky et al. model, reflecting elements of encode (working memory), shift, and focused and sustained attention, as well as a distinct component reflecting impulsivity. Adverse effects of maternal drinking across pregnancy were found primarily for working memory, and these effects were exacerbated when mothers were aged 30 or older at the time of the child's birth. Conclusions: These data confirm previous studies using diverse methods that suggest that working memory may be the most important aspect of attention that is adversely affected by prenatal alcohol exposure.

Campbell-Heider N; Tuttle J; Bidwell-Cerone S; Richeson GT; Collins SE. The buffering effects of connectedness: Teen Club intervention for children of substance abusing families. Journal of Addictions Nursing 14(4): 175-182, 2003. (38 refs.)

This paper will trace the clinical evolution and demonstrated efficacy of Teen Club--a community-based nursing intervention designed to reduce high-risk behaviors in female teens who are children of substance abusing families. Special emphasis is on the relevance of connectedness as a theoretical underpinning for support group interventions. The paper also describes the clinical applications of this research for practice and the team's plans for further testing the Teen Club program in other inner city high-risk adolescent populations.

Carle AC; Chassin L. Resilience in a community sample of children of alcoholics: Its prevalence and relation to internalizing symptomatology and positive affect. Journal of Applied Developmental Psychology 25(5): 577-595, 2004. (54 refs.)

Data from an ongoing longitudinal study examined resilience (competent performance under adverse conditions) in a community sample of children of alcoholics (COAs n = 216) and matched controls (n = 201). The study examined the prevalence of competence and whether the relation of competence to internalizing and positive affect differed for COAs and controls. COAs were less likely to be highly competent in the conduct/rule-abiding and academic domains and more likely to be low competent. Controlling for previous levels of internalizing, highly competent children in the conduct/rule-abiding and overall competence domains endorsed significantly lower levels of internalizing symptomatology. For the social, conduct/rule-abiding, and overall competence domains, competence was associated with increased positive affect. The relation between competence and internalizing, and competence and positive affect did not differ for COAs and controls. Results suggested that behavioral resilience is not associated with psychological costs but is associated with decreased internalizing and increased positive affect.

Chalder M; Elgar FJ; Bennett P. Drinking and motivations to drink among adolescent children of parents with alcohol problems. Alcohol and Alcoholism 41(1): 107-113, 2006. (30 refs.)

Aims: To study the influences of parental alcohol problems on adolescents' alcohol consumption and motivations to drink alcohol. Methods: A community sample of 1744 adolescents from schools in South Wales completed the 6-item Children of Alcoholics Screening Test, Drinking Motives Questionnaire, and survey measures of alcohol consumption. Results: Children of parents with alcohol problems constituted almost one-fifth of the sample group and were found to drink more frequently, more heavily, and more often alone than children of parents without alcohol problems. Parental alcohol problems were also related to internal motives to drink (e.g. coping) in their adolescent children. Across the entire sample, internal motives to drink interacted with parental alcohol problems in predicting alcohol consumption and drinking frequency. Conclusion: Parental alcohol problems appeared to co-exist with an asocial pattern of alcohol consumption in adolescents that involves drinking alone and drinking to feel intoxicated or to forget about problems. In addition to the external, social motives to drink, which are shared by most adolescents, nearly one in five of the adolescents studied reported salient internal motives to drink that tended to coexist with alcohol problems in their parents.

Chen YY; Weitzman ER. Depressive symptoms, DSM-IV alcohol abuse and their comorbidity among children of problem drinkers in a national survey: Effects of parent and child gender and parent recovery status. Journal of Studies on Alcohol 66(1): 66-73, 2005. (36 refs.)

Objective: The purpose of this study was to estimate the risk of depressive symptoms, DSM-lV alcohol abuse and their comorbidity among children of problem drinkers (COPDs) in college and the effects of parent and child gender and parent drinking status on outcomes and on COPDs' treatment utilization. Method: The study population was a nationally representative sample of 27,430 college students from 119 4-year colleges who completed survey questionnaires for the Harvard College Alcohol Study in 1997 and 1999. Logistic regression was used to estimate the psychiatric outcomes and patterns of treatment/counseling. Results: COPDs who reported that their parents were active problem drinkers were at increased risk of depressive symptoms, DSM-lV alcohol abuse and their comorbidity. Female children of active problem drinkers (CAPDs) were at increased risk of depressive symptoms (odds ratio [OR] = 1.57,p <.01) and comorbidity of depressive symptoms and alcohol abuse (OR = 2.09, p <.01). Male CAPDs were at risk of depressive symptoms (OR = 1.69, p <.05) only. Stratified analysis by both parent and child gender revealed that depressive symptoms among female COPDs were affected by both paternal and maternal drinking, whereas among their male counterparts depressive symptoms were present only when the affected parent was the father. Male children of recovered problem drinkers were more likely to seek and receive psychiatric treatment/counseling than male CAPDs. Conclusions: The psychiatric risk of COPDs varied by respondent and parent gender, and by whether the affected parent was reported to be actively disordered or in recovery. The results highlight the importance of early and gender-specific interventions for COPDs.

Chiu TM; Mendelson JH; Sholar MB; Mutschler NH; Wines JD; Hesselbrock VM et al. Brain alcohol detectability in human subjects with and without a paternal history of alcoholism. Journal of Studies on Alcohol 65(1): 16-21, 2004. (36 refs.)

Objective: This study examined the putative effects of a paternal history of alcoholism on the apparent detectability of brain alcohol in human subjects. Method: Brain to blood ethanol ratios in two cohorts of men were determined, using proton magnetic resonance spectroscopic imaging in a brain voxel (2 x 2 x 2 cm) containing the putamen. The men were light drinkers with a positive (n = 8) or a negative (n = 8) paternal history of alcoholism and were given an alcohol dose of 0.8 g/kg body weight. Results: In both groups, brain alcohol detectability was less than 100%. No significant difference (p = .37) was found in the brain/blood ethanol ratios of the two groups. However, subjective assessments of feeling the extreme effects of alcohol and the extent of intoxication ("how drunk") were highly correlated with a paternal history of alcoholism, with the paternal history negative group reporting significantly more intense feelings of intoxication. Conclusions: A review of existing literature evidence and data obtained in this study indicate that brain alcohol detectability via magnetic resonance spectroscopic imaging is less than 100%. There were no significant differences in brain alcohol detectability between paternal history positive and paternal history negative men. Differences in the Subjective High Assessment Scale ratings between the two groups, however, indicate the importance of a genetic influence on the subjective response to alcohol.

Christoffersen MN; Francis B; Soothill K. An upbringing to violence? Identifying the likelihood of violent crime among the 1966 birth cohort in Denmark. Journal of Forensic Psychiatry & Psychology 14(2): 367-381, 2003. (34 refs.)

Why do some boys develop into troublesome youths who eventually get sentenced for violent crimes? In planning a strategy to fight violent crime, it is important to identify significant risk factors for violent criminal behaviour among adolescents and young men. In this study information from population-based registers covers various aspects both for children, aged between 15 and 27 years, and their parents: health (mental and physical), education, social networks, family violence, self-destructive behaviour, parental alcohol or drug abuse, and unemployment. First-time convicted offenders have an increased risk of coming from seriously disadvantaged families; they also seem to be characterized by unstable education and employment records (e.g. not graduating, no vocational training), occasional work, or long-term unemployment.

Christoffersen MN; Soothill K. The long-term consequences of parental alcohol abuse: A cohort study of children in Denmark. Journal of Substance Abuse Treatment 25(2): 107-116, 2003. (40 refs.)

The aim of this study is to consider whether parents' abuse of alcohol has an impact on children during their formative years. The research is based on data from 84,765 children born in Denmark in 1966. These children and their parents were followed between 1979 and 1993. Information was analyzed from government registers covering health, education, family separation, suicidal behavior, criminality, and unemployment, using a discrete time Cox-regression model. Results showed that the parents' alcohol abuse may frame the childhood with parental violence, very high occurrence of family separations, and often foster care. The parental abuse of alcohol may influence several long-term consequences for their 15- to 27-year-old children such as increased mortality, self-destructive behaviors (e.g. attempted suicide or drug addiction). Hospitalization due to violence, an increased risk of teenage pregnancy and unemployment were also seen more frequently among cases where the parents were alcohol abusers. Mothers' alcohol abuse seemed to be associated with higher occurrences of all the mentioned disadvantages.

Coffelt NL; Forehand R; Olson AL; Jones DJ; Gaffney CA; Zens MS. A longitudinal examination of the link between parent alcohol problems and youth drinking: The moderating roles of parent and child gender. Addictive Behaviors 31(4): 593-605, 2006. (40 refs.)

The unique and interactive effects of paternal and maternal alcohol problems on the drinking behavior of adolescent girls and boys were investigated. A prospective design was employed to examine changes in youth drinking behavior over a 3-year period in a community-based sample of 695 families. Results revealed that, as maternal alcohol problems increased, the likelihood of adolescent alcohol use increased. Paternal alcohol problems were associated with an increased likelihood of alcohol use for girls only. Findings point to the need for future research to investigate both maternal and paternal alcohol problems in community samples and with a sample size large enough to examine both parent and adolescent gender. Implications for preventive and interventive efforts are considered.

Conner BT; Noble EP; Berman SM; Ozkaragoz T; Ritchie T; Antolin T; Sheen C. DRD2 genotypes and substance use in adolescent children of alcoholics. Drug and Alcohol Dependence 79(3): 379-387, 2005. (69 refs.)

Research has identified children of alcoholics (COAs) as a population at increased risk for developing substance use problems. Genetic studies support the Al allele of the D2 dopamine receptor gene (DRD2) as a risk marker for alcoholism and substance use disorders. In this study, substance use was assessed in 48 adolescent boys of alcoholics with the DRDR A1+ allele (A1A1/A1A2 genotypes) or the A1- allele (A2A2 genotype). The results revealed that boys with the A1+ allele tried (p = 0.0001) and got intoxicated on alcohol more often (p = 0.009) than boys with the A1- allele. Boys with the A1+ allele tried more (p = 0.004) and used more substances overall (p = 0.008) than boys with the A1- allele. Boys with the A1+ allele developed a tobacco habit more often (p = 0.03) and experienced marijuana high at an earlier age (p = 0.001) than boys with the A1- allele. The best predictors of substance use severity in boys with the A1+ allele were Psychoticism (p = 0.01) and Negative Affect (p = 0.04). The results provide support for the DRD2 A1 allele as a marker identifying a subgroup of COAs at high risk for developing substance use problems.

Conners NA; Bradley RH; Mansell LW; Liu JY; Roberts TJ; Burgdorf K et al. Children of mothers with serious substance abuse problems: An accumulation of risks. American Journal of Drug and Alcohol Abuse 29(4): 743-758, 2003. (17 refs.)

This study examines the life circumstances and experiences of 4084 children affected by maternal addiction to alcohol or other drugs. The paper will address the characteristics of their caregivers, the multiple risk factors faced by these children, their health and development, and their school performance. Data were collected from mothers at intake into 50 publicly funded residential substance abuse treatment programs for pregnant and parenting women. Findings from this study suggest that children whose mothers abuse alcohol or other drugs confront a high level of risk and are at increased vulnerability for physical, academic, and socioemotional problems. Children affected by maternal addiction are in need of long-term supportive services.

Cooke CG; Kelley ML; Fals-Stewart W; Golden J. A comparison of the psychosocial functioning of children with drug-versus alcohol-dependent fathers. American Journal of Drug and Alcohol Abuse 30(4): 695-710, 2004. (54 refs.)

The present study compared the psychosocial functioning of children whose fathers primarily abused illicit drugs other than alcohol (n = 5 1) to children from a demographically matched sample of families whose fathers abused alcohol (n = 5 1). Children with drug-abusing (DA) fathers exhibited significantly more negative child behaviors on a standardized child-rating scale than did children from homes with alcohol-abusing fathers. In addition, a significantly greater proportion of children with DA fathers met clinical cutoffs indicative of psychosocial impairment (n = 23; 45%) than did children whose fathers abused alcohol (n = 5; 10%). Mediation analyses indicated that severity of drug, legal, medical, employment, and family problems partially mediated the relationship between type of family (i.e., families with fathers who had an alcohol problem versus families with fathers who had a drug problem) and children's psychosocial adjustment.

Crespi TD; Rueckert QH. Family therapy and children of alcoholics: Implications for continuing education and certification in substance abuse practice. Journal of Child & Adolescent Substance Abuse 15(3): 33-44, 2006. (35 refs.)

Clinicians involved in family therapy are increasingly concerned with the impact of parental alcoholism on individual development and family functioning. With more than 20 million adults raised within an alcoholic family, and with widespread problems associated with parental alcoholism, clinicians providing family treatment have a potentially large number of clients impacted by substance abuse. However, many clinicians lack specialty training. This article reviews the problems associated with parental substance abuse and examines substance abuse certification standards as a blueprint for continuing education and specialty credentialing.

Duncan AE; Scherrer J; Fu Q; Bucholz KK; Heath AC; True WR et al. Exposure to paternal alcoholism does not predict development of alcohol-use disorders in offspring: Evidence from an offspring-of-twins study. Journal of Studies on Alcohol 67(5): 649-656, 2006. (44 refs.)

Objective: Using an offspring-of-twins design, we tested the hypothesis that exposure to paternal alcoholism during the child's first 12 years will increase offspring risk for subsequent alcohol-use disorders (AUD). Method: Structured psychiatric interviews assessed history of psychiatric and substance-use disorders in Vietnam Era Twin Registry fathers (n = 512), their offspring (n = 877), and mothers of the offspring (n = 507). Exposure was defined as the fathers' endorsement of any Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, AUD symptom, according to the Lifetime Drinking History assessment (administered in 1999), at any time between offspring ages 0-12 years; all fathers had satisfied DSM, Third Edition, Revised (DSM-III-R), criteria for alcohol dependence in a 1992 diagnostic interview. Cox proportional hazards models were fit to predict time to first symptom of abuse/dependence in offspring. Results: Offspring exposed to paternal alcoholism were significantly more likely to develop an AUD when compared with offspring of nonalcoholic fathers (hazard ratio [HR] = 1.51; 95% confidence interval [CI]: 1.10-2.07). Although offspring unexposed to paternal alcoholism did not significantly differ from control offspring (HR = 1.50, 95% CI: 0.93-2.41), the magnitude of association was similar to that in the exposed offspring. There were no significant differences in AUD between offspring of alcoholics who were exposed and those who were not exposed to paternal alcoholism, as long as fathers had satisfied DSM-III-R criteria for alcohol dependence at some point in their lives. Conclusions: There does not appear to be a relationship between exposure to paternal alcoholism during childhood and development of an AUD in offspring. Genetic and high-risk environmental factors that are correlated with lifetime paternal alcoholism may be stronger predictors of offspring AUD than fathers' problem drinking. Future research should be encouraged, using more comprehensive analyses, to examine the role of family genetic influences and other family environmental influences on offspring alcohol outcomes.

Duncan A; Thomas JC; Miller C. Significance of family risk factors in development of childhood animal cruelty in adolescent boys with conduct problems. Journal of Family Violence 20(4): 235-239, 2005. (12 refs.)

The literature suggests that physical child abuse, sexual child abuse, paternal alcoholism, paternal unavailability, and domestic violence may be significant in development of childhood animal cruelty. Two groups of early- to late adolescent boys (CTA and N-CTA) in residential treatment for conduct disorder were compared in the current study on histories of these family risk factors. The adolescents in Group I were comprised of boys who had conduct problems with documented histories of animal cruelty (n = 50; CTA). Group 2 consisted of adolescent boys (n = 50; N-CTA) with conduct problems, but without documented histories of animal cruelty. Results showed that children in the CTA group had significantly greater histories of physical and/or sexual child abuse and domestic violence in comparison to children in the N-CTA group. These results suggest that physical and/or sexual abuse to a child, and exposure to domestic violence, may be significant in the development of childhood animal cruelty.

Dwyer SB; Nicholson JM; Battistutta D; Oldenburg B. Teachers' knowledge of children's exposure to family risk factors: accuracy and usefulness. Journal of School Psychology 43(1): 23-38, 2005. (38 refs.)

Teachers' knowledge of children's exposure to family risk factors was examined using the Family Risk Factor Checklist-Teacher. Data collected for 756 children indicated that teachers had accurate knowledge of children's exposure to factors such as adverse life events and family socioeconomic status, which predicted children's mental health problems at 1 year follow-up. For children at high teacher-rated risk, odds ratios ranged from 3.04 to 7.46, after adjusting for prior mental health problems. Teachers had poor knowledge of internal family functioning, such as conflict, parenting practices, or parental drug abuse. The findings suggest that asking teachers to report children's exposure to particular family risk factors is a feasible method for identifying children for selective interventions, but improved family-school communication may further enhance this process.

Edwards EP; Eiden RD; Leonard KE. Impact of fathers' alcoholism and associated risk factors on parent-infant attachment stability from 12 to 18 months. Infant Mental Health Journal 25(6): 556-579, 2004. (92 refs.)

This study examined short-term attachment stability and sought to identify predictors of stability and change within a sample characterized by fathers' alcoholism. Results suggest moderate stability of attachment classifications (60% for mothers, 53% for fathers) from 12 to 18 months. Higher paternal and maternal alcohol symptoms, maternal depression, and maternal antisocial behavior were found in families with stable insecure mother-infant attachment compared to those who were stable secure. Mother-infant stable insecurity was associated with higher levels of maternal negative affect expression during play. Father-infant stable insecurity was associated with lower levels of paternal positive affect expression and decreased sensitivity during play. Stable insecure children also had higher levels of negative affect during parent-infant interactions and higher negative emotionality during other episodes compared to stable secure children. Results indicate that infants who were insecure at both time points had the highest constellation of family risk characteristics.

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

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

Eiden RD; Edwards EP; Leonard KE. Predictors of effortful control among children of alcoholic and nonalcoholic fathers. Journal of Studies on Alcohol 65(3): 309-319, 2004. (68 refs.)

Objective: The purpose of this study was (1) to examine the association between fathers' alcoholism and children's effortful control and (2) to examine the role of parental warmth and toddler temperament as mediators or moderators of this relationship. Method: Families were recruited through New York State birth records when their infant was age 12 months. The final sample consisted of 226 families (116 boys) constituting two major groups: a nonalcoholic group consisting of parents with no or few current alcohol problems (n = 102) and a father alcoholic group (it = 124). Families were assessed when their child was ages 12. 18. 24 and 36 months. Results: Results indicate that boys of alcoholic fathers exhibit lower overall levels of effortful control than boys of nonalcoholic fathers. For boys, fathers' warmth over the second year of life mediated the association between fathers' alcoholism and effortful control. Maternal warmth was a unique predictor of effortful control for boys. For girls, fathers' alcoholism was associated with lower paternal warmth, which was in turn a significant predictor of effortful control. Child activity level and negative affect were associated with effortful control for boys but did not account for significant variance when entered in regression models with fathers' alcoholism and parenting variables. Conclusions: Sons of alcoholic fathers are at an increased risk of problems in self-regulation when they are ages 2 to 3 years. Paternal warmth mediates the association between fathers' alcoholism and self-regulation for both boys and girls, although the nature of mediation may vary by child gender.

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

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

Elkins IJ; McGue M; Malone S; Iacono WG. The effect of parental alcohol and drug disorders on adolescent personality. American Journal of Psychiatry 161(4): 670-676, 2004. (36 refs.)

Objective: The relationship of parental alcohol or drug diagnosis to offspring personality was examined in a population-based sample of 17-year-old twins (568 girls and 479 boys) participating in the Minnesota Twin Family Study. Whether offspring personality characteristics 1) are specific to the type of substance use disorder in parents (alcohol versus drug) and 2) are found in high-risk offspring without substance use disorders as well as in offspring with substance use disorders was investigated. Method: Personality was assessed with the Multidimensional Personality Questionnaire; substance use disorders were assessed in person through diagnostic interviews. Results: In both male and female offspring, parental history of alcohol dependence was associated with greater negative emotionality, aggression, stress reaction, and alienation but lower well-being; parental history of drug disorders was associated with lower constraint, control, harm avoidance, and traditionalism but higher social potency. Excluding offspring with a substance use disorder had virtually no effect on the statistical significance of these findings. Conclusions: In contrast to findings in some adult samples, personality characteristics associated with a family history of substance use disorders are found even in adolescent offspring who have not yet developed these disorders themselves, suggesting that personality might be one indicator of familial risk for substance use disorders during this developmental stage. Personality profiles of offspring of parents with substance use disorders also show some diagnostic specificity, with constraint associated with parental drug abuse and negative emotionality with parental alcoholism.

El-Sheikh M. Does poor vagal tone exacerbate child maladjustment in the context of parental problem drinking? A longitudinal examination. Journal of Abnormal Psychology 114(4): 735-741, 2005. (45 refs.)

Children's vagal tone was examined as a vulnerability factor in the longitudinal relation between mothers' (MPD) and fathers' (FPD) problem drinking and children's adjustment. At T1, MPD and FPD were examined, and children's vagal tone was assessed. Two years following initial participation, child adjustment problems were evaluated. A lower level of vagal tone was a vulnerability factor for internalizing problems associated with MPD and FPD and for externalizing difficulties associated with MPD. In the context of a higher level of MPD or FPD, a lower level of vagal tone was a vulnerability factor for increases in externalizing problems over time. Results are supportive of the importance of biopsychosocial perspectives in which child characteristics interact with family risk to predict psychopathology.

Erblich J; Earleywine M; Erblich B; Bovbjerg DH. Biphasic stimulant and sedative effects of ethanol: Are children of alcoholics really different? Addictive Behaviors 28(6): 1129-1139, 2003. (30 refs.)

Children of alcoholics (COAs) have an increased risk of developing alcoholism themselves. The mechanisms responsible are not yet known. One compelling theory postulates that COAs may have an increased sensitivity to the stimulant effects of alcohol during the ascending limb of the blood alcohol curve combined with a decreased sensitivity to the putatively undesirable sedative effects of the drug during the descending limb, providing a particularly strong motivation to drink. Consistent with this theory, we hypothesized that compared to children of nonalcoholics (CONAs), COAs would display higher levels of ascending limb stimulation and lower levels of descending limb sedation. In the present study, 100 college students, who were either COAs (n=18) or CONAs (n=82), completed the Biphasic Alcohol Effects Scale (a self-report measure of stimulation and sedation): (1) before consuming 0.85n ml/kg ethanol; (2) during the ascending limb of their BAC, and; (3) during the descending limb of their BAC. Although findings indicated that COAs and CONAs had comparable levels of sedation at each time point, a significant Group-Time interaction (P<.02) indicated that COAs had greater increases in stimulation from baseline than CONAs, providing partial support for our hypothesis. Interestingly, simple effects analyses revealed that COAs had lower baseline levels of stimulation but almost identical levels of ascending and descending limb stimulation as CONAs, suggesting that increased sensitivity to alcohol among COAs may be the result of baseline understimulation. Overall, findings suggest that theorized differences between COAs and CONAs may be due in part to broader trait differences or other nonpharmacological factors.

Fisher GL; Harrison TC. Substance Abuse: information for School Counselors, Social Workers, Therapists, and Counselors, 3rd edition. Boston: Pearson/Allyn and Bacon, 2005. (650 book refs.)

This volume is directed not to those who work in the substance abuse field, but to the range of mental health professionals who while not exclusively involved with substance abuse can anticipate a significant proportion of their clients to have substance abuse problems. The first chapter provides an overview of the book, and considers the need for generalist training. Chapter 2 deals with the major drug classes, the acute and chronic effects, with sections on central nervous system depressants, central nervous system stimulants, opioids, hallucinogens, cannabis, inhalants, steroids, and club drugs. Chapter 3 focuses upon different models of addiction: the moral model, sociocultural and psychological models, the disease concept, and the biopsychosocial model. Chapter 4 considers the major cultural and ethnic groups in the US -- Native Americans and Alaska natives, Asian Americans, African Americans, Latino and Hispanics -- and general principles in working with culturally and ethnically diverse populations. Chapter 5 addresses assessment and diagnosis; Chapter 6, engaging the client and brief interventions; and Chapter 7 treatment approaches and settings, principles of effective treatment, and client-treatment matching. Chapter 8 focuses upon relapse prevention and the process of recovery. Chapter 9 deals with Twelve-Step programs as well as other types of support groups. Chapters 10 and 11 consider the family and children in the family, and adult children. Chapter 12 focuses upon HIV/AIDS. Chapter 13 provides an overview of a variety of other addictions including gambling. The final chapters deal with prevention and confidentiality and ethical concerns.

Flora DB; Chassin L. Changes in drug use during young adulthood: The effects of parent alcoholism and transition into marriage. Psychology of Addictive Behaviors 19(4): 352-362, 2005. (52 refs.)

The present study examined the changes in drug use during the transition from emerging adulthood into young adulthood among a community sample of children of alcoholics (COAs) and demographically matched non-COAs. Consistent with national data, the non-COAs significantly decreased their drug use during this time, but the COAs did not significantly decrease their use. On the basis of role compatibility theory, the authors next examined whether marital status mediated or moderated this difference between COAs and non-COAs in linear drug use growth trajectories. In support of mediation, the authors found that COAs were significantly less likely than non-COAs to be currently married and that, for male participants, marriage was significantly associated with greater decreases in drug use during the mid to late 20s.

Fraser JJ; Mcabee GN; Commission on Medical Liability. Dealing with the parent whose judgment is impaired by alcohol or drugs: Legal and ethical considerations. Pediatrics 114(3): 869-873, 2004. (16 refs.)

An estimated 11 to 17.5 million children are being raised by a substance-abusing parent or guardian. The importance of this statistic is undeniable, particularly when a patient is brought to a pediatric office by a parent or guardian exhibiting symptoms of judgment impairment. Although the physician-patient relationship exists between the pediatrician and the minor patient, other obligations (some perceived and some real) should be considered as well. In managing encounters with impaired parents who may become disruptive or dangerous, pediatricians should be aware of their responsibilities before acting. In addition to fulfilling the duty involved with an established physician-patient relationship, the pediatrician should take reasonable care to safeguard patient confidentiality; protect the safety of the patient and other patients, visitors, and employees; and comply with reporting mandates. This clinical report identifies and discusses the legal and ethical concepts related to these circumstances. The report offers implementation suggestions when establishing anticipatory office procedures and training programs for staff on what to do (and not do) in such situations to maximize the patient's wellbeing and safety and minimize the liability of the pediatrician.

Fuller BE; Chermack ST; Cruise KA; Kirsch E; Fitzgerald HE; Zucker RA. Predictors of aggression across three generations among sons of alcoholics: Relationships involving grandparental and parental alcoholism, child aggression, marital aggression and parenting practices. Journal of Studies on Alcohol 64(4): 472-483, 2003. (84 refs.)

Objective: This longitudinal study uses a three-generation database involving measures of grandparental and parental alcohol use disorder (AUD), marital aggression and aggression to offspring to predict early and later childhood aggression of third generation offspring. Given the importance of aggressive, undercontrolled behavior in the etiology of alcoholism, the purpose of this study was to construct a statistical model of intergenerational aggression and alcoholism among family members. Method: Participants were a population-based sample of 186 young sons of alcoholics and both biological parents and 120 nonsubstance abusing families and their age-matched sons drawn from the same neighborhoods. Extensive family data were collected at baseline and at 6 years postbaseline. Structural equation modeling evaluated retrospective and prospective relationships between grandparental and parental predictors of the sons' childhood aggression when they were 3-5 and 9-11 years of age. Results: The final model showed that grandparental marital aggression predicted development of parental antisocial behavior, which predicted parental alcoholism and marital aggression and partially mediated level of child aggression among their sons as preschoolers. Significant autostabilities in level of child aggression, parental AUD and marital aggression were present in families over the 6-year interval. Marital aggression was a more important predictor of son's preschool aggression; direct parental aggression to the child was more important at 9-11. Child aggression at 3-5 also was a partial mediator of level of parent-to-child aggression at 9-11. Conclusions: Results indicate continuity of aggression across three generations and also indicate that the child's pathway into risk for later AUD is not simply mediated by parental alcoholism, but is carried by other comorbid aspects of family functioning, in particular aggression.

Furtado EF; Laucht M; Schmidt MH. Gender-related pathways for behavior problems in the offspring of alcoholic fathers. Brazilian Journal of Medical and Biological Research 39(5): 659-669, 2006. (40 refs.)

The objective of the present study was to examine gender differences in the influence of paternal alcoholism on children's social-emotional development and to determine whether paternal alcoholism is associated with a greater number of externalizing symptoms in the male offspring. From the Mannheim Study of Risk Children, an ongoing longitudinal study of a high-risk population, the developmental data of 219 children [193 (95 boys and 98 girls) of non-alcoholic fathers, non-COAs, and 26 (14 boys, 12 girls) of alcoholic fathers, COAs] were analyzed from birth to the age of I I years. Paternal alcoholism was defined according to the ICD-10 categories of alcohol dependence and harmful use. Socio-demographic data, cognitive development, number and severity of behavior problems, and gender-related differences in the rates of externalizing and internalizing symptoms were assessed using standardized instruments (IQ tests, Child Behavior Checklist questionnaire and diagnostic interviews). The general linear model analysis revealed a significant overall effect of paternal alcoholism on the number of child psychiatric problems (F = 21.872, d.f. = 1.217, P < 0.001). Beginning at age 2, significantly higher numbers of externalizing symptoms were observed among COAs. In female COAs, a pattern similar to that of the male COAs emerged, with the predominance of delinquent and aggressive behavior. Unlike male COAs, females showed an increase of internalizing symptoms up to age 11 years. Of these, somatic complaints revealed the strongest discriminating effect in 11-year-old females. Children of alcoholic fathers are at high risk for psychopathology. Gender-related differences seem to exist and may contribute to different phenotypes during development from early childhood to adolescence.

Godsall RE; Jurkovic GJ; Emshoff J; Anderson L; Stanwyck D. Why some kids do well in bad situations: Relation of parental alcohol misuse and parentification to children's self-concept. Substance Use & Misuse 39(5): 789-809, 2004. (46 refs.)

Between 1991 and 1994 a sample of high- and low-functioning 10-18-year-old children of alcohol misusing and nonalcohol misusing parents were assessed on degree of problematic parental role functioning (parentification) and global self-concept. The high functioning children had been chosen by their teachers to receive training as peer counselors, whereas the low functioning children were in either psychiatric facilities or the custody of family and children services. The parentification scores of the latter significantly exceeded those of the former. Children of alcoholic parents also scored higher on the parentification measure than did those with nonalcoholic parents. Within the high functioning group hierarchical regression analysis revealed that while parental alcohol misuse status accounted for a small but significant amount of the variance in self-concept, the effect of this variable was substantially reduced after entering level of parentification into the equation. By contrast, within the low functioning group parental alcohol misuse status was not significantly related to self-concept whereas level of parentification was. The results are discussed within a family systems framework.

Gogineni A; King S; Jackson K; Kramer J; Bucholz K; Chan G et al. Female offspring of alcoholic individuals: Recent findings on alcoholism and psychopathology risks: Symposium presented at the Research Society on Alcoholism, 2004, Vancouver Aruna Gogineni, chair. (editorial). Alcoholism: Clinical and Experimental Research 30(2): 377-387, 2006. (58 refs.)

Grekin ER; Brennan PA; Hammen C. Parental alcohol use disorders and child delinquency: The mediating effects of executive functioning and chronic family stress. Journal of Studies on Alcohol 66(1): 14-22, 2005. (62 refs.)

Objective: This study examines the relationship between parental alcohol use disorders (AUDs) and child violent and nonviolent delinquency. It also explores the mediating effects of executive functioning and chronic family stress on the parental AUD/child delinquency relationship. Method: Participants were 816 families with children (414 boys and 402 girls) born between 1981 and 1984 at Mater Misericordiae Mother's Hospital in Brisbane, Australia. Parents and children completed semistructured inter-views, questionnaires and neuropsychological tests that assessed parental alcohol use, family psychiatric history, chronic family stress, child delinquency and child executive functioning. Results: Paternal (but not maternal) AUDs predicted child violent and nonviolent delinquency. Executive functioning mediated the relationship between paternal AUDs and violent delinquency, whereas family stress mediated the relationship between paternal AUDs and both violent and nonviolent delinquency. Conclusions: Results: support a biosocial conceptualization of the paternal AUD/delinquency relationship. They suggest that paternal AUDs may be associated with child executive functioning and family stress, which may in turn lead to child delinquency.

Griffin ML; Amodeo M; Fassler I; Ellis MA; Clay C. Mediating factors for the long-term effects of parental alcoholism in women: The contribution of other childhood stresses and resources. American Journal on Addictions 14(1): 18-34, 2005. (79 refs.)

The primary aim of this study was to identify the stresses and resources in childhood that mediate the relationship between parental alcoholism and adult outcomes in women. Adult outcomes included alcohol problems and measures of psychosocial adjustment. Standardized measures and a face-to face interview were used to collect data on 290 community-dwelling women, with siblings as collateral informants. Mediation analysis showed that the effect of parental alcoholism on several adult outcomes teas indirect, mediated by the other stresses and resources examined. Contextual models such as those presented here are helpful in understanding the long-term effects of childhood environment on women.

Haatainen KM; Tanskanen A; Kylma J; Honkalampi K; Koivumaa-Honkanen H; Hintikka J et al. Gender differences in the association of adult hopelessness with adverse childhood experiences. Social Psychiatry and Psychiatric Epidemiology 38(1): 12-17, 2003. (35 refs.)

Background: The impact of childhood traumatic events on long- term psychological development has been widely studied. Nevertheless, little research has been carried out on possible associations between adverse childhood experiences (ACEs) and hopelessness in adulthood, and whether any gender differences exist. Aim The aim of this study was to examine the association between ACEs (poor relationship between parents, unhappiness of childhood home, hard parenting, physical punishment, domestic violence, alcohol abuse in primary family) and current hopelessness without any mental disorder in a general population sample. Method: 1598 adults (43% were men), aged 25- 64 years, completed self-report measures to assess ACEs and hopelessness by means of the Beck Hopelessness Scale (HS). Logistic regression was used to adjust for the effects of sociodemographic factors on the association between the cumulative number of ACEs and hopelessness. Results: Whereas several bivariate associations were found between ACEs and hopelessness, none of them remained significant in multivariate analysis. However, men who reported three or more ACEs were 2.79 times (95% CI 1.17-6.63) and women 2.19 times (95% CI 1.04-4.65) more likely to be hopeless compared with those without any ACEs. In women (OR 2.25, 95% CI 1.01-5.00), but not in men, this relationship remained significant after adjusting for several current covariates. Conclusion: Clustering of ACEs may have long-lasting effects by increasing the risk of hopelessness in adulthood, especially in women. Increased awareness of the frequency of ACEs and their subsequent consequences, such as hopelessness, may encourage health care professionals to undertake preventive work in primary and mental health care.

Haber JR; Jacob T; Heath AC. Paternal alcoholism and offspring conduct disorder: Evidence for the 'common genes' hypothesis. Twin Research and Genetics 8(2): 120-131, 2005. (43 refs.)

Not only are alcoholism and externalizing disorders frequently comorbid, they often co-occur in families across generations; for example, paternal alcoholism predicts offspring conduct disorder just as it does offspring alcoholism. To clarify this relationship, the current study examined the 'common genes' hypothesis utilizing a children-of-twins research design. Participants were male monozygotic NZ) and dizygotic (DZ) twins from the Vietnam Era Twin Registry who were concordant or discordant for alcohol dependence together with their offspring and the mothers of those offspring. All participants were conducted through a structured psychiatric interview. Offspring risk of conduct disorder was examined as a function of alcoholism genetic risk (due to paternal and co-twin alcohol dependence) and alcoholism environmental risk (due to being reared by a father with an alcohol dependence diagnosis). After controlling for potentially confounding variables, the offspring of alcohol-dependent fathers were significantly more likely to exhibit conduct disorder diagnoses than were offspring of nonalcohol-dependent fathers, thus indicating diagnostic crossover in generational family transmission. Comparing offspring at high genetic and high environmental risk with offspring at high genetic and low environmental risk indicated that genetic factors were most likely responsible for the alcoholism-conduct disorder association. The observed diagnostic crossover (from paternal alcoholism to offspring conduct disorder) across generations in the context of both high and low environmental risk (while genetic risk remained high) supported the common genes hypothesis.

Habeych ME; Folan MM; Luna B; Tarter RE. Impaired oculomotor response inhibition in children of alcoholics: The role of attention deficit hyperactivity disorder. Drug and Alcohol Dependence 82(1): 11-17, 2006. (61 refs.)

Objective: The aim of the project was to determine whether children at high risk for alcohol use disorder (AUD) are impaired at performing oculomotor response inhibition tasks sensitive to detecting prefrontal cortex dysfunction. Methods: Three antisaccade tasks were administered to 67 10-12-year-old children having fathers with AUD and 12 children whose fathers had no psychiatric disorder. Results: Children of AUD+ fathers performed similar to children of AUD- fathers on measures of response latency and gain to target. Peak velocity discriminated the two groups On Only one task. Children of AUD+ fathers exhibited a higher rate of prosaccade errors on the most difficult antisaccade task. Within the AUD+ group of men, offspring who qualified for attention deficit hyperactivity disorder (ADHD; N = 13) exhibited more response suppression errors than children Without ADHD on two of three tasks. No differences were observed between children without ADHD whose fathers either qualified for AUD+ or had no psychiatric disorder. Conclusion: Inhibiting a response to a prepotent stimulus in children of AUD+ fathers is circumscribed to ADHD youths. These findings suggest that frontal-striatal mechanisms may underlie the risk for AUD among ADHD children.

Hanson RF; Self-Brown S; Fricker-Elhai A; Kilpatrick DG; Saunders BE; Resnick H. Relations among parental substance use, violence exposure and mental health: The national survey of adolescents. Addictive Behaviors 31(11): 1988-2001, 2006. (42 refs.)

Objective: To study the relations among parental substance use, violence exposure and psychopathology in a nationally representative sample of adolescents. Method: Random digit dialing methodology was used to obtain a nationally representative sample of 4023 adolescents, ages 12-17. Telephone surveys, conducted in 1995, assessed demographics, parental substance use, violence exposure, and three psychiatric disorders: major depressive disorder (MDE), posttraumatic stress disorder (PTSD), and substance abuse/dependence (SA/D). Results: Obtained prevalence rates included: 8.2% for sexual assault, 22.5% for physical assault, and 39.7% for witnessing violence at home or in the community. Substance use by a family member was reported by 18.4% (n = 721) of adolescents, with 50.6% reporting parental alcohol use and 19.1% (n = 138) reporting parental drug use. Consistent with hypotheses, violence exposure and parental substance use, particularly parental alcohol abuse, were independently associated with outcomes. Additionally, parental substance use emerged as a moderator for MDE, PTSD, and SA/D; however, the moderating relations varied according to the outcome variable investigated. Conclusions: Violence-exposed adolescents reporting parental alcohol or drug use had the highest rates of psychiatric diagnoses.

Haugland BSM. Paternal alcohol abuse: Relationship between child adjustment, parental characteristics, and family functioning. Child Psychiatry & Human Development 34(2): 127-146, 2003. (68 refs.)

This study examines possible risk factors associated with child adjustment in a sample of children with alcohol abusing fathers in Norway (N = 37). Factors included are socio-economic status, severity of the fathers' alcohol abuse, parental psychological problems, and family functioning. Children of alcohol abusing fathers were found to have more adjustment problems assessed by CBCL compared to a general population sample. The findings further suggest that child adjustment in families with paternal alcohol abuse is the result of an accumulation of risk factors rather than the effects of the paternal alcohol abuse alone. Both general environmental risk factors (psychological problems in the fathers, family climate, family health and conflicts) and environmental factors related to the parental alcohol abuse (severity of the alcohol abuse, the child's level of exposure to the alcohol abuse, changes in routines and rituals due to drinking) were related to child adjustment. The results indicate the need to obtain both parents' assessments of child adjustment, as the fathers' assessment was associated with different risk factors compared to the mothers.

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

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

Hennigan KM; O'Keefe M; Noether CD; Rinehart DJ; Russell LA. Through a mother's eyes: Sources of bias when mothers with co-occurring disorders assess their children. Journal of Behavioral Health Services & Research 33(1): 87-104, 2006. (64 refs.)

Mothers are the principal informants on children's emotional and behavioral functioning. Maternal assessments of child functioning can be influenced by a mother's own psychological state. The magnitude and valence of distortion in maternal assessments associated with current maternal mental health and substance abuse symptoms were explored in a clinical sample of 253 mothers with co-occurring disorders and histories of trauma. Analyses estimated the correlation between current maternal symptoms and child assessments after controlling for maternal history of disorders, child's history of service utilization for emotional and behavioral problems, and demographic characteristics. Current maternal psychological distress was associated with more pessimistic assessments on the problem-focused Child Behavior Checklist, whereas current maternal substance abuse problems were associated with more optimistic assessments on both problem-focused and strength-based measures. Clinicians and researchers may choose to take distortion into account when treatment plans or measures of change are based on maternal assessments.

Hussong AM; Chassin L. Stress and coping among children of alcoholic parents through the young adult transition. Development and Psychopathology 16(4): 985-1006, 2004. (66 refs.)

The transition to young adulthood is both a time when risky health behaviors such as substance misuse peak and a time of opportunity for growth and development through the acquisition of adult roles. In this transition, coping styles include responses to the stressors and opportunities associated with the emergence of adulthood. The extent to which such coping styles are skillfully employed in part determines adjustment into adulthood. The current study used a high-risk, longitudinal design to examine the development of coping styles over adolescence, continuity in these coping styles from adolescence to adulthood, the impact of coping on adult stress and substance misuse, the ability of coping to buffer effects of stress on substance use, and differences in coping between at-risk youth (i.e., children of alcoholics [COAs]) and their peers. A sample of 340 adolescents completed four assessments over ages 11-23. We used latent trajectory models to examine interindividual and intraindividual change in coping over time. Evidence for both change and continuity in the development of coping from adolescence to adulthood was found, although adolescent coping had limited impact on stress and substance use in adulthood. Support was also found for complex stress-buffering and stress-exacerbating effects of coping on the relations between major life events and adult drug use and between stress associated with the new roles of adulthood and heavy alcohol use. Implications of these findings for development and adjustment in the transition to adulthood are discussed.

Hussong AM; Zucker RA; Wong MM; Fitzgerald HE; Puttler LI. Social competence in children of alcoholic parents over time. Developmental Psychology 41(5): 747-759, 2005. (59 refs.)

In the current study, the authors tested the hypothesis that children of alcoholic parents (COAs) show deficits in social competence that begin in early childhood and escalate through middle adolescence. Teachers, parents, and children reported on the social competence of COAs and matched controls in a community sample assessed from ages 6 to 15. Hierarchical linear growth models revealed different patterns of change in social competence across development as a function of the reporter of various indicators of competence. Moreover, female COAs showed deficits in social competence in early childhood that receded in adolescence and that varied across subtypes of parent alcoholism. Implications of these findings for understanding the development of social competence in children, and at-risk children in particular, are discussed.

Jacob T; Waterman B; Heath A; True W; Bucholz KK; Haber R et al. Genetic and environmental effects on offspring alcoholism: New insights using an offspring-of-twins design. Archives of General Psychiatry 60(12): 1265-1272, 2003. (58 refs.)

Context: Although there is now considerable evidence that genetic effects play a critical role in the development of alcohol dependence (AD), theoretical and methodological limitations of this literature require caution in describing the etiology and development of this disorder. Objective: To disentangle genetic and environmental effects on AD by means of the infrequently used, yet potentially powerful, offspring-of-twins design. Design: Offspring of twins. Participants: Male monozygotic and dizygotic twins concordant or discordant for AD and control pairs from the Vietnam Era Twin Registry were assessed, as were the offspring of these twins and the mothers of these offspring. Interventions: Structured psychiatric interviews. Main Outcome Measures: Participants' psychiatric, alcohol abuse (AA), and AD histories (DSM-IV). Results: Offspring of monozygotic and dizygotic twins with a history of AD were significantly more likely to exhibit AA or AD than were offspring of nonalcoholic fathers. Offspring of an alcohol-abusing monozygotic twin whose co-twin was AD were also more likely to exhibit AD than were offspring of nonalcoholic twins. In contrast, offspring of an unaffected (ie, no history of abuse or dependence) monozygotic twin whose co-twin was AD were no more likely to exhibit AA or AD than were offspring of nonalcoholic twins. Conclusions: These findings support the hypothesis that family environmental effects do make a difference in accounting for offspring outcomes, in particular, that a low-risk environment (ie, the absence of parental alcoholism) can moderate the impact of high genetic risk regarding offspring for the development of alcohol-use disorders.

Kamarajan C; Porjesz B; Jones K; Chorlian D; Padmanabhapillai A; Rangaswamy M. Event-related oscillations in offspring of alcoholics: Neurocognitive disinhibition as a risk for alcoholism. (review). Biological Psychiatry 59(7): 625-634, 2006. (107 refs.)

Background: Event-related oscillations (EROs) are increasingly being used to assess neurocognitive functioning in normal and clinical populations. The current study compares different frequency activities in offspring of alcoholics (OA) and in normal control subjects (NC) to examine whether the OA group exhibits any abnormality in oscillatory activity while performing a Go/NoGo task. Methods: The S-transform algorithm was employed to decompose the electroencephalographic (EEG) signals into different time-frequency bands, and the oscillatory responses in the P300 time window (300-700 milliseconds) were statistically analyzed in both groups. Results: The OA group manifested significantly decreased activity in delta (1-3 Hz), theta (4-7 Hz), and alpha1 (8-9 Hz) bands during the NoGo condition, as well as reduced delta and theta activity during the Go condition. This reduction was more prominent in the NoGo than in the Go condition. Conclusions: The decreased response in delta, theta, and alpha1 oscillations, especially during the NoGo condition in high-risk individuals, is perhaps suggestive of cognitive and neural disinhibition and may serve as an endophenotypic marker in the development of alcoholism and/or other disinhibitory disorders.

Kampov-Polevoy AB; Ziedonis D; Steinberg ML; Pinsky I; Krejci J; Eick C/. Association between sweet preference and paternal history of alcoholism in psychiatric and substance abuse patients. Alcoholism: Clinical and Experimental Research 27(12): 1929-1936, 2003. (68 refs.)

Background: The relationship between preference for stronger sweet solutions and propensity to excessive alcohol drinking is supported by both animal and human studies. This study was designed to test the hypothesis that sweet preference is associated with the genetic risk of alcoholism as measured by a paternal history of alcoholism. Methods: Participants were 180 patients admitted to a residential treatment program for the treatment of alcoholism, drug dependence, or psychiatric conditions. In addition to a routine medical examination, patients completed the standard sweet preference test twice (on the 9th and 24th days after admission), and the family history of alcoholism was evaluated. Results: Sweet preference was shown to be stable over time. It was strongly associated with a paternal history of alcoholism, with family history-positive patients approximately 5 times more likely to prefer stronger sweet solutions than family history-negative subjects. Such factors as dependence on alcohol, cocaine, opiates, cannabis, other drugs (including prescription drugs), and tobacco smoking, as well as demographics (gender and age), did not significantly interfere with association between sweet preference and paternal history of alcoholism. Conclusions: These findings provide some support for the hypothesis that preference for stronger sweet solutions is associated with a genetic predisposition to alcoholism as measured by a paternal history of alcoholism.

Kelley ML; Cash TF; Grant AR; Miles DL; Santos MT. Parental alcoholism: Relationships to adult attachment in college women and men. [rapid communication]. Addictive Behaviors 29(8): 1633-1636, 2004. (11 refs.)

The present study of general and romantic adult attachment among 484 female and male college students compared those who resided with an alcohol-abusing parent prior to age 16 and those who did not. Participants completed the Relationship Style Questionnaire (RSQ; general adult attachment), Experiences in Close Relationships-Revised (ECR-R; romantic attachment), and the Children of Alcoholic Screening Test (CAST; perceived parental alcoholism). Results indicated that 23% of these young adults had lived with an alcohol-abusing parent, and relative to those who had not, they reported more anxiety and greater avoidance in romantic relationships and a more fearful style of general adult attachment. The implications of these findings in the context of the extant literature were discussed.

Kelley ML; Nair V; Rawlings T; Cash TF; Steer K; Fals-Stewart W. Retrospective reports of parenting received in their families of origin: Relationships to adult attachment in adult children of alcoholics. Addictive Behaviors 30(8): 1479-1495, 2005. (24 refs.)

The present study examined general and romantic attachment and parenting students received in their families of origin among 401 college students who resided with an alcohol-abusing parent prior to age 16 years as compared to those who did not reside with alcohol-abusing parents. Participants completed a variety of instruments: the Children's Report of Parent Behavior Instrument, Relationship Scale Questionnaire, and the Children of Alcoholics Screening Test. Young adults who met criteria for ACOAs reported more anxious and avoidant behavior in romantic relationships and a more fearful style of general adult attachment. Parenting behavior in one's family of origin predicted anxious behavior in romantic relationships and a fearful overall style of attachment, whereas being an ACOA and parenting in one's family of origin predicted avoidant behavior in romantic relationships.

Kim S; Crutchfield C. An evaluation of substance abuse aftercare program for homeless women with children using confounding variable-control design. Journal of Drug Education 34(3): 213-233, 2004. (31 refs.)

An outcome evaluation of a substance abuse aftercare program for homeless women with children was conducted using confounding variable-control evaluation design. The confounding variables are chosen from pre-treatment and other contextual variables of the clients that are known to have significant influence on the program outcome, but those that could not have been influenced a priori by the client involvement in in-treatment program activity at Transition House (TH). The latter is the independent variable of this evaluation design. The pre-treatment variables are measured by severity of alcohol and other drug (ACID) problems of the clients, their mental health status, age, and their job status before enrollment in the program. The contextual confounding variables are composed of family and social support available to the clients before and during recovery. While applying multiple regression analysis, we were able to explain 50.8% of the total variance in program outcome by four pre-treatment variables. By adding two contextual variables of family and social support, the total variance in program outcome explained is increased to 64.1%. Finally, by adding the degree of client involvement in in-treatment program activity, we were able to augment the total variance of the program outcome to 69.7%. By estimating the changed variance of program outcome by the in-treatment program activity during the final step, controlling for all other variables previously entered, we were able to establish that client involvement in in-treatment program had unique and positive impact on the program outcome distinct from those explained by the confounding variables. The additional variance uniquely added by in-treatment program activity is 5.6% (p < .001). It has been determined that the degree of client involvement in in-treatment program had positive and systematic impact on the program outcome.

King KM; Chassin L. Mediating and moderated effects of adolescent behavioral undercontrol and parenting in the prediction of drug use disorders in emerging adulthood. Psychology of Addictive Behaviors 18(3): 239 -249, 2004. (54 refs.)

This study tested whether the effects of parental alcoholism on drug use disorders in emerging adulthood were mediated by behavioral undercontrol and parenting in adolescence and whether parenting buffered the relation between undercontrol and drug use disorders. Participants were 175 children of alcoholics and 190 matched control participants from an ongoing longitudinal study (L. Chassin, F. Rogosch, & M. Barrera, 1991). Results showed that undercontrol and parental discipline mediated 58% of the effect of parental alcoholism on drug use disorders. The relation between behavioral undercontrol and drug use disorders was further moderated by parental support. This effect was "protective but reactive" (S. S. Luthar, D. Cicchetti, & B. Becker, 2000); at high levels of behavioral undercontrol the protective effect of parental support was lost. Highly undercontrolled adolescents may have such a strong diathesis for drug use disorders that buffers may not have the same effect as in those with better control.

Knopik VS; Heath AC; Jacob T; Slutske WS; Bucholz KK; Madden PAF et al. Maternal alcohol use disorder and offspring ADHD: Disentangling genetic and environmental effects using a children-of-twins design. Psychological Medicine 36(10): 1461-1471, 2006. (56 refs.)

Background. Children of alcoholics are significantly more likely to experience high-risk environmental exposures, including prenatal substance exposure, and are more likely to exhibit externalizing problems [e.g. attention deficit hyperactivity disorder (ADHD)]. While there is evidence that genetic influences and prenatal nicotine and/or alcohol exposure play separate roles in determining risk of ADHD, little has been done on determining the joint roles that genetic risk associated with maternal alcohol use disorder (AUD) and prenatal risk factors play in determining risk of ADHD. Method. Using a children-of-twins design, diagnostic telephone interview data from high-risk families (female monozygotic and dizygotic twins concordant or discordant for AUD as parents) and control families targeted from a large Australian twin cohort were analyzed using logistic regression models. Results. Offspring of twins with a history of AUD, as well as offspring of non-AUD monozygotic twins whose co-twin had AUD, were significantly more likely to exhibit ADHD than offspring of controls. This pattern is consistent with a genetic explanation for the association between maternal AUD and increased offspring risk of ADHD. Adjustment for prenatal smoking, which remained significantly predictive, did not remove the significant genetic association between maternal AUD and offspring ADHD. Conclusions. While maternal smoking during pregnancy probably contributes to the association between maternal AUD and offspring ADHD risk, the evidence for a significant genetic correlation suggests: (i) pleiotropic genetic effects, with some genes that influence risk of AUD also influencing vulnerability to ADHD; or (ii) ADHD is a direct risk-factor for AUD.

Kroll B. Living with an elephant: Growing up with parental substance misuse. Child & Family Social Work 9(2): 129-140, 2004. (66 refs.)

Although parental substance misuse is now a focus of concern in child welfare practice, we know little about what it is really like for children who grow up in families where adult drug and/or alcohol use is an issue. Set against a backdrop of research links between parental substance misuse and child maltreatment, this article examines a number of studies that focus on the experiences of children and young people in this context. Emerging themes are identified which provide insight into the world of children for whom a substance is, effectively, a family member--'the elephant in the living room'--and the implications for practice, particularly in relation to children's visibility, disclosure and confidentiality, are considered. It is argued that a focus on the 'elephant' often leads to children remaining 'invisible' to those whose role it is to ensure their welfare.

Kuendig H; Kuntschee E. Family bonding and adolescent alcohol use: Moderating effect of living with excessive drinking parents. Alcohol and Alcoholism 41(4): 464-471, 2006. (47 refs.)

Aims: Excessive parental drinking has been shown to be positively related to adolescent alcohol use and family bonding negatively related. The aim of the present study was to determine if the perception of parental drinking moderates the relationship between family bonding and adolescent alcohol use. Methods: Linear structural equation models for multiple group comparisons were estimated based on a national representative sample of 3448 eight and ninth graders in Switzerland (mean age 14.77; SD 0.89). Results: Adjusted for gender and age, the results confirm that strong family bonds were negatively related to both frequency of alcohol intake and lifetime frequency of drunkenness. Furthermore, a positive link was found with regard to the perception of parental drinking. However, the multiple group comparison revealed that the negative relationship between bonding and adolescent alcohol use was even stronger among adolescents whose parents drink excessively than among those whose parents did not. Conclusions: These results indicate that it may be particularly important for parents in the former category to establish strong family bonds (e.g. by spending free time with their children, listening to their worries) so as to limit adolescent excessive drinking.

Lewis P. Behind the glass wall: Barriers that incarcerated parents face regarding the care, custody and control of their children. Journal of the American Academy of Matrimonial Lawyers 19: 97-113, 2004. (146 refs.)

In 1999, approximately 1,498,800 children under the age of 18 had a parent housed in the criminal justice system. This article focuses on the rights incarcerated parents have in regard to their children while the parents are in prison, including the constitutional protections that all parents, including incarcerated parents, possess. Part II of the article evaluates the fundamental rights that parents have in the rearing of their children. It also explores the nature of those fundamental rights as they apply to prisoners, and it looks at the standard of review that courts use in prisoner's rights cases. Part IIIl focuses specifically on the rights that incarcerated parents have to visit their children and some of the barriers they have to overcome to prove that it is in the best interests of the child to have continuing contact with them while the parents are incarcerated. Part IV describes termination of parental rights as the ultimate barrier that incarcerated parents face. It reviews the procedural due process protections that are available for incarcerated parents who are at risk of having their parental rights terminated. This article concludes by discussing a few of the factors that contribute to the termination of parental rights.

Lipscomb HJ; Dement JM; Li LM. Health care utilization of families of carpenters with alcohol or substance abuse-related diagnoses. American Journal of Industrial Medicine 43(4): 361-368, 2003. (23 refs.)

Background: Patterns of health care utilization of families of carpenters with and without alcohol and/or substance abuse related diagnoses (ASRD) were compared. Methods: Utilization data for families of 13,657 carpenters for a 10 year period were analyzed. Concordance of diagnoses among family members was assessed and proportionate utilization ratios were used to compare the experiences of families of carpenters with and without ASRD. Results Twenty-eight percent of the spouses with ASRD had a carpenter spouse with a similar diagnosis. Twenty-four percent of the families with a child with ASRD had a parent with one of these diagnoses compared to 9.4% of families without any children with ASRD (P < 0.0001). Families of carpenters with alcohol or ASRD also had different patterns of health care utilization. Conclusions: Utilization patterns were influenced to a significant degree by concordant diagnoses among spouses and children. Excess mental health care was seen among families of carpenters with ASRD above their care for substance abuse treatment.

Loukas A; Zucker RA; Fitzgerald HE; Krull JL. Developmental trajectories of disruptive behavior problems among sons of alcoholics: Effects of parent psychopathology, family conflict, and child undercontrol. Journal of Abnormal Psychology 112(1): 119-131, 2003. (112 refs.)

This study examined trajectories of disruptive behavior problems from preschool to early adolescence in 302 boys from a community-recruited sample of high-risk families. Growth modeling showed that paternal alcoholism was associated with elevated levels of sons' disruptive behavior problems. Family conflict predicted more disruptive behaviors at school entry and a slower rate of decline in such problems. Parent antisocial personality disorder (ASPD) exacerbated the effects of high preschool levels of sons' undercontrol on level of disruptive behaviors at school entry; this effect became progressively stronger across time. Low levels of undercontrol protected sons of ASPD parents from experiencing heightened levels of disruptive behaviors both at school entry and increasingly as sons grew older. Implications for subsequent maladjustment are discussed.

Maaranen P; Tanskanen A; Haatainen K; Koivumaa-Honkanen H; Hintikka J; Viinamaki H. Somatoform dissociation and adverse childhood experiences in the general population. Journal of Nervous and Mental Disease 192(5): 337-342, 2004. (24 refs.)

Childhood trauma has been associated with psychological dissociation, but there is evidence that trauma may also result in somatoform dissociation. We performed a general population study with 1739 subjects, using the Somatoform Dissociation Questionnaire, measures of adverse childhood experiences, and sociodemographic background. The prevalence of high somatoform dissociation (Somatoform Dissociation Questionnaire greater than or equal to30) was 9.4% in the Finnish general population. Unemployment, a reduced working ability, and a poor financial situation were associated with high somatoform dissociation. Of the adverse childhood experiences, high somatoform dissociation was strongly linked to physical punishment but not associated with domestic violence, including sexual and physical abuse. The odds of high somatoform dissociation were also increased among men by a poor relationship between their parents, and among women by alcohol abuse in their childhood home. We found a strong, graded relationship between an increasing number of adverse childhood experiences and high somatoform dissociation.

Marshal MP; Molina BSG; Pelham WE; Cheong J. Attention-deficit hyperactivity disorder moderates the life stress pathway to alcohol problems in children of alcoholics. Alcoholism: Clinical and Experimental Research 31(4): 564-574, 2007. (69 refs.)

Background: Parent alcoholism is a well-established risk factor for the development of pathological alcohol involvement in youth, and life stress is considered to be one of the central mechanisms of the parent alcoholism effect; however, little is known about the moderators of the life stress pathway. Attention-deficit hyperactivity disorder (ADHD) has also been shown to predict pathological alcohol involvement, however, little is known about whether or not ADHD interacts with parent alcoholism to increase offspring risk. The goals of this study were to examine stressful life events as mediators of the relationship between parent alcoholism and adolescent pathological alcohol involvement, and to examine whether or not this mediated pathway was stronger for adolescents with ADHD than for adolescents without ADHD. Method: Participants were 142 adolescents with a childhood ADHD diagnosis (probands) and 100 demographically matched control adolescents without childhood ADHD. Probands, controls, and at least 1 parent were interviewed about drinking behavior; probands and controls were interviewed about negative life events. Results: A moderated mediation paradigm was used to test the hypotheses using ordinary least squares regression. Results showed that the relationships between parent alcoholism and 2 of the stress variables ("family" stress and "peer" stress) were significant for probands only, and that stress in the probands mediated the parent alcoholism effect on offspring alcohol involvement. Conclusions: These results provide preliminary support for the hypothesis that offspring characteristics might moderate the life stress pathway to alcoholism, and indicate that ADHD may serve to facilitate the transmission of pathological alcohol use from parent to child.

Munro CA; McCaul ME; Oswald LM; Wong DF; Zhou Y; Brasic J et al. Striatal dopamine release and family history of alcoholism. Alcoholism: Clinical and Experimental Research 30(7): 1143-1151, 2006. (74 refs.)

Background: The offspring of alcohol-dependent individuals are at increased risk for alcoholism. The present study was designed to determine whether mesolimbic dopamine binding potential (BP), dopamine release, stress hormones, and subjective responses to intravenous amphetamine are different in nonalcoholic offspring from families with a history of alcohol dependence [family history positive (FHP)] than in nonalcoholic offspring without a family history of alcohol dependence [family history negative (FHN)]. Methods: Participants were 41 healthy men and women (11 FHP, 30 FHN; age range 18-29). After completing baseline psychiatric symptom and personality measures, striatal D-2/D-3 dopamine BP and dopamine release in response to an amphetamine challenge were measured with positron emission tomography (PET) using the D-2/D-3 dopamine (DA) receptor radioligand [C-11]raclopride. Binding potential was defined as B-max/KD, percent change in BP from baseline defined dopamine release. During the scans, subjects rated the degree to which they were experiencing each of 10 possible drug effects. Plasma cortisol and growth hormone (GH) were also measured at scheduled intervals during the scans. Results: Neither baseline BP nor dopamine release differed by family history. Similarly, subjective responses to amphetamine did not differ by a family history of alcoholism. Although both cortisol and GH increased following administration of amphetamine, these increases did not differ between family history groups. Conclusions: Using amphetamine to provoke mesolimbic dopamine, we did not show significant differences in dopamine release, subjective responses, or stress hormone measures as a function of family history of alcoholism.

Obot IS; Anthony JC. Mental health problems in adolescent children of alcohol dependent parents: Epidemiologic research with a nationally representative sample. Journal of Child & Adolescent Substance Abuse 13(4): 83-96, 2004. (37 refs.)

In this study, with an epidemiologic sample of national scope, we seek confirmatory evidence about specific mental health problems of adolescent children living with actively alcohol dependent parents (AD+ children) as compared to control children whose parents are not alcohol dependent (AD- children). Treatment sample research leads us to expect the most prominent AD+/AD- differences with respect to externalizing symptoms. Data for this study were from the 1995 and 1996 National Household Survey on Drug Abuse (NHSDA), with the sample and field research staff 'blinded' to the study's hypothesis. Within the NHSDA national sample, a total of 1,720 parent-child pairs living in the same household were assessed. Youths were asked to complete an adapted version of Achenbach's Youth Self-Report. Independently, the parent was asked about his or her alcohol problems using an adapted version of the Diagnostic Interview Schedule. Analysis of variance (ANOVA) showed the AD+ children (n = 79) to have higher delinquency (p < .001) and aggressive behavior scores (p < .05) as compared to AD- children (n = 1,650). Multivariate analysis of covariance (MAN COVA), with five sociodemographic characteristics as covariates, confirmed the presence of independent delinquency excesses (but not independent aggressive behavior excesses) among children living with a parent with alcohol problems (F = 9.23, df = 1, 1659, p < .01). The evidence of this study favors the hypothesis that adolescent children living with an alcohol dependent parent have more delinquency problems than other adolescents. We did not find similar patterns of association for the internalizing symptoms, nor for aggression, once delinquency was held constant.

Ohannessian CM; Hesselbrock VM; Kramer J; Bucholz KK; Schuckit MA; Kuperman S; Nurnberger JI. Parental substance use consequences and adolescent psychopathology. Journal of Studies on Alcohol 65(6): 725-730, 2004. (25 refs.)

Objective: This study examines the relationship between parental substance use consequences and adolescent psychological problems by gender of the adolescent and gender of the parent. Method: The data in this study were collected between 1989 and 1994 from 173 (116 proband and 57 control) families participating in the Collaborative Study on the Genetics of Alcoholism (COGA) project. All 173 adolescents (89 [51%] boys) completed the Structured Assessment Record of Alcoholic Homes (SARAH) to assess parental substance use consequences. In addition. the Semi-Structured Assessment for the Genetics of Alcoholism for Adolescents (C-SSAGA-A) was administered to all adolescents to obtain clinical psychiatric diagnoses. Results: Concern about mother's substance use was significantly associated with adolescent alcohol dependence and major depressive disorder. In addition, concern about father's substance use was significantly related to adolescent alcohol dependence. Avoidance of mother when she was drinking or using drugs and maternal anger when drinking or using drugs also was significantly associated with adolescent alcohol dependence, conduct disorder and major depressive disorder. In contrast, avoidance of father and paternal anger when drinking or using drugs was not related to any of the adolescent diagnoses. Conclusions: These results suggest that maternal substance use consequences may be more closely linked to adolescent psychological adjustment than are paternal substance use consequences.

Ohannessian CM; Hesselbrock VM; Kramer J; Kuperman S; Bucholz KK; Schuckit MA et al. The relationship between parental alcoholism and adolescent psychopathology: A systematic examination of parental comorbid psychopathology. Journal of Abnormal Child Psychology 32(5): 519-533, 2004. (54 refs.)

The relationship between parental alcohol dependence (with and without comorbid psychopathology) and adolescent psychopathology was examined in a sample of 665 13-17 year-old adolescents and their parents. Results indicated that adolescents who had parents diagnosed with alcohol dependence only did not significantly differ from adolescents who had parents with no psychopathology in regard to any of the measures of psychological symptomatology (substance use, conduct disorder, and depression) or clinical diagnoses (alcohol dependence, marijuana dependence, conduct disorder, or depression) assessed. In contrast, adolescents who had parents diagnosed with alcohol dependence and either comorbid drug dependence or depression were more likely to exhibit higher levels of psychological symptomatology. In addition, adolescents who had parents diagnosed with alcohol dependence, depression, and drug dependence were most likely to exhibit psychological problems. These findings underscore the importance of considering parental comorbid psychopathology when examining the relationship between parental alcoholism and offspring adjustment.

Ohannessian CM; Hesselbrook VM; Kramer J; Kuperman S; Bucholz KK; Schuckit MA et al. The relationship between parental psychopathology and adolescent psychopathology: An examination of gender patterns. Journal of Emotional and Behavioral Disorders 13(2): 67-76, 2005. (47 refs.)

The primary goal of this study was to examine the relationship between parental psychopathology (specifically, alcohol dependence and depression) and adolescent psychopathology, by the gender of the adolescent and the gender of the parent. The sample included 426 13- to 17-year-old adolescents and their parents. All participants were administered the SemiStructured Assessment for the Genetics of Alcoholism to obtain clinical psychiatric diagnoses. Paternal psychopathology (depression and alcohol dependence) significantly predicted adolescent alcohol dependence, whereas maternal psychopathology did not. Maternal alcohol dependence did not predict any of the adolescent psychiatric diagnoses. In contrast, both paternal depression and maternal depression significantly predicted adolescent conduct disorder and depression. In addition, maternal depression significantly predicted adolescent anxiety. No significant interactions between parental psychopathology and adolescent gender were observed. Nevertheless, results from this study underscore the importance of considering the gender of the parent when examining the relationship between parental psychopathology and psychopathology in the offspring.

Ondersma SJ. Introduction to the second special section on substance abuse and child maltreatment. (commentary). Child Maltreatment 12(2): 111-113, 2007. (11 refs.)

Peiponen S; Laukkanen E; Korhonen V; Hintikka U; Lehtonen J. The association of parental alcohol abuse and depression with severe emotional and behavioural problems in adolescents: A clinical study. International Journal of Social Psychiatry 52(5): 395-407, 2006. (35 refs.)

Background: Earlier studies have indicated associations between parental psychiatric problems, such as depression, and substance abuse and adolescent problems. Aims: This study aimed to determine whether parental psychiatric problems are associated with problems and problem behaviour in adolescents in a clinical sample. Methods: The study subjects were 70 outpatient adolescents (age 13-18 years, boys 30%) and their parents. The adolescents were assessed using the structural clinical interview for DSM-III-R (SCID) and a semi-structured questionnaire, and the parents were interviewed using a semi-structured questionnaire. Results: Maternal alcohol abuse and depression were associated with serious problems, especially among girls, and paternal alcohol abuse was associated with adolescent health-compromising behaviour. Maternal depression and alcohol abuse had no association with adolescent health-compromising behaviour. Maternal depression without alcohol abuse was associated with the diagnosis of major depressive disorder in adolescents, but not with other adolescent problems, while paternal depression without alcohol abuse was not associated with any adolescent problems. Conclusions: Despite the small study sample, these findings indicate that parental psychiatric problems and alcohol abuse are correlated with adolescent psychological problems and should be considered and assessed when assessing adolescents.

Ramisetty-Mikler S; Caetano R. Ethnic differences in the estimates of children exposed to alcohol problems and alcohol dependence in the United States. Journal of Studies on Alcohol 65(5): 593-599, 2004. (43 refs.)

Objective: This study was undertaken to estimate the number of children nationwide exposed to an adult who has alcohol problems (AP) or alcohol dependence (AD) and to examine ethnic differences in the number of children exposed. Method: The study used survey data from the 1995 National Alcohol Survey, which constituted a nationally representative sample of household members 18 years of age and older in the 48 contiguous states, were randomly selected, with oversamples of blacks and Hispanics. A total of 4,925 subjects were interviewed, with a response rate of 77%. The questionnaire asked about AP and AD in the previous 12 months. Rates from the survey and data from the U.S. 2000 Census were used to calculate the estimates. Results: Overall, 11.6 million children (16%) were exposed to one or more AP and 2.1 million children (3%) were exposed to AD. A higher proportion, nearly 19%, of both black and Hispanic children as compared with 14.5% of white children were exposed to AP. Significantly higher proportions of black (5.2%) and Hispanic (4.9%) compared with white (2.0%) children were exposed to AD. Conclusions: A large number of children are being exposed to at least one adult suffering from alcohol problems or dependence. Black and Hispanic children are disproportionately affected by these problems.

Rangaswamy M; Jones KA; Porjesz B; Chorlian DB; Padmanabhapillai A; Kamarajan C et al. Delta and theta oscillations as risk markers in adolescent offspring of alcoholics. (review). International Journal of Psychophysiology 63(1): 3-15, 2007. (118 refs.)

Background: Visual P300 is consistently lower in alcohol-dependent individuals, their offspring and subjects at risk. Delta and theta event-related oscillations (ERO) are the major contributors to the P300 signal. The total and evoked power in delta and theta bands in the 300 to 700 ins post-stimulus window (corresponding to the zone of P300 maxima) was compared between adolescent offspring of alcoholics (high-risk) and age-matched normal controls (low-risk), to assess the utility of the risk markers. Methods: EEG was recorded during the performance of a visual oddball task. The S-transform algorithm decomposed the EEG signals into different frequency bands and the group differences in total and evoked power in the oscillatory responses during the P300 time window (300 to 700 ins) were analyzed using a multivariate design. Similar analysis was performed on P300 peak amplitude for the target. Results: The high-risk group showed significantly lower parietal post-stimulus evoked and total power in the delta band for targets. A decrease in total power was seen centrally and parietally in the theta band. The P300 peak amplitude in the parietal electrodes was also significantly lower in the high-risk group. Conclusions: The decreased total theta power and total and evoked delta power for visual targets in high risk individuals may serve as an endophenotypic marker in the development of alcoholism and other disinhibitory disorders. The differences seen between the offspring of alcoholics and controls may have a cholinergic basis. The ERO measures appear to be more robust than the P300 amplitude in differentiating the groups.

Schonfeld AMG. Moral judgment and reasoning in children and adolescents with prenatal alcohol exposure. Dissertation Abstracts International 63(8): 3937B, 2003

Children and adolescents with (ALC) and without (CON) prenatal alcohol exposure were evaluated on measures of moral judgment and reasoning and delinquency. Results revealed that while those in the ALC group performed at a lower level of moral maturity than the CON group, differences were not significant. Verbal IQ primarily accounted for these differences. However, this suggests that a deficit on the value judgment having to do with relationships with others is specific to prenatal alcohol exposure. Delinquency was higher for those in the ALC group; however, moral maturity did not predict delinquent behavior. In the CON group only, as the age of the subjects increased, more delinquent behaviors were endorsed. For the ALC group, socially desirable responding predicted delinquent behavior suggesting under-endorsement of such behavior. Measures of inhibition did not predict delinquency or moral maturity beyond control measures. More children and adolescents with heavy prenatal alcohol exposure, but without fetal alcohol syndrome (FAS), met criteria for Conduct Disorder (CD). Findings indicate that those with prenatal alcohol exposure are at a lower developmental level with respect to their moral reasoning about their affiliation with others. Alcohol-exposed individuals, specifically those without a diagnosis of FAS, are at higher risk for delinquency, particularly CD. These findings indicate that children and adolescents with prenatal alcohol exposure will benefit from social skills training in light of their continued deficits in interpersonal relations. Interventions aimed at their delinquent tendencies are warranted; however targeting moral judgment in an intervention may not yield additional benefit.

Schuckit MA; Smith TL; Barnow S; Preuss U; Luczak S; Radziminski S. Correlates of externalizing symptoms in children from families of alcoholics and controls. Alcohol and Alcoholism 38(6): 559-567, 2003. (82 refs.)

Aims: This paper describes a new stage in the ongoing evaluation of the original families of sons of alcoholics and controls where we now focus on the relationships among relevant domains of functioning in their young sons and daughters. Methods: The data were gathered from the 15-year follow-up of the families of the original probands (the fathers of these offspring) who had been selected from among students and non-academic staff at a university at approximately age 20. At the 15-year evaluation of these families, a structured interview and the Child Behavioral Checklist (CBCL) questionnaire were administered to a parent, usually the mother, of 145 offspring age seven through 17. The eight domains evaluated here included the extended family histories of alcohol use disorders, parental alcoholism, independent mood or anxiety disorders in the grandparents and parents, the history of potential brain insults early in life, the absence of a biological parent in the home, and scores for internalizing symptoms, with externalizing symptoms as the dependent variable. Results: Correlations among the domains were all in the predicted direction, a structural equation model revealed empirical results with an R2 of 0.26, and there were high goodness of fit characteristics for hypothesized and empirical models. The results were similar for boys and girls and older versus younger offspring. Conclusions: An understanding of the relationships among characteristics in the offspring of the original probands offers the opportunity of establishing levels of functioning in relevant domains before the onset of alcohol-related problems or related disorders. The data presented here represent a baseline upon which future follow-ups will evaluate substance-related problems and disorders as this population matures.

Scottish Executive Health Department. Getting our Priorities Right. Good Practice Guidance for Working with Children and Families Affected by Substance Misuse. Edinburgh UK: Scottish Executive, 2003. (43 refs.)

This document provides guidance for agencies in Scotland involved with families affected by parental substance misuse. The document is in six parts. Part 1 reviews current knowledge about the extent of parental substance misuse and its impact on children. Part 2 explains what agencies need to ask of families when they present with drug or alcohol problems and provides guidance to staff on identifying risks. Part 3 offers advice on what kinds of help may be needed and on how to work together more effectively. Part 4 addresses issues of confidentiality and offers advice to agencies about when and how to share information. Part 5 identifies the need to strengthen services for families and offers advice on how this might be done. Part 6 provides guidance on building a foundation of jointly-agreed policies, procedures, and practice guidance, together with sound training, for working with children and their parents. The guidebook stresses that children's welfare is the most important consideration; that it is everyone's responsibility to ensure that children are protected from harm; that children should be helped early before crises or tragedies occur; and that agencies must work together in planning and delivering services, assessment and care planning with families, and in multidisciplinary training. Appendixes review statutory duties of local authorities; information to be collated on substance misuse and its impact on parenting; substance misuse in pregnancy, including fetal alcohol syndrome; and blood-borne viruses associated with substance misuse.

Public Domain

Statham J. Effective services to support children in special circumstances. Child: Care, Health and Development 30(6): 589-598, 2004. (60 refs.)

Background Children living in special circumstances, defined as those who are at risk of achieving poorer outcomes than their peers, have a particular need of good quality, accessible services to promote their health and well-being, yet may be least likely to receive them. Aims This review considers the evidence for effective services to support children living in five kinds of special circumstances: (1) those at risk of offending; (2) teenage parents; (3) children whose parents have drug, alcohol or mental health problems; (4) children living with domestic violence; and (5) children who have been abused or neglected. In practice, there is often considerable overlap between these groups, and many children face multiple disadvantage. The review also aims to identify effective strategies for making support services more accessible to hard-to-reach groups. Methods Relevant literature was identified through searches of databases and websites, and consultation with experts. Given the broad scope of the topic, the aim was to provide an overview of best evidence rather than to undertake a systematic review. Results: Similar themes underpin the most promising approaches to supporting children in special circumstances. These include: (1) a holistic, multi-agency approach addressing the needs of the whole child rather than compartmentalising children's social, educational, health and care needs; (2) the importance of links between adults' and children's services so that children who are in need because of their parents' circumstances can be identified and supported; and (3) the value of providing children in special circumstances with intensive, targeted support within a framework of universal provision. Conclusions: Overall, there is a lack of well-designed evaluations of the effectiveness of UK services and programmes for children in special circumstances. The existing evidence base would be strengthened by the development of better outcome measures, by exploring the characteristics of effective services from the perspective of different stakeholders (including children and young people themselves) and by extending the current problem-oriented approach to consider the factors that promote resilience and coping.

Suchman NE; Rounsaville B; DeCoste C; Luthar S. Parental control, parental warmth, and psychosocial adjustment in a sample of substance-abusing mothers and their school-aged and adolescent children. Journal of Substance Abuse Treatment 32(1): 1-10, 2007. (37 refs.)

Parenting interventions for substance-abusing adults have been broadly based on two approaches, one emphasizing parental control as a means to managing children's behavior and the second emphasizing parental warmth and sensitivity as means to fostering children's psychological development. In this investigation, we examined associations of parental control and parental warmth, respectively, with children's behavioral and psychological adjustment in a sample of 98 women enrolled in methadone maintenance and their school-aged and adolescent children. Using collateral data collected during the baseline phase of a randomized clinical trial (Luthar, S. S., Suchman, N. E., & Altomare, M. [in press). Relational Psychotherapy Mothers Group: A randomized clinical trial for substance abusing mothers [in preparation]), we tested predictions that (a) parental control would be more strongly associated with children's behavioral adjustment and (b) parental warmth would be more strongly associated with children's psychological adjustment. Both predictions were generally confirmed, although some crossover among parenting and child dimensions was also evident. Results support the theoretical stance that parental limit setting and autonomy support, as well as nurturance and involvement, are important factors, respectively, in children's behavioral and psychological adjustment.

Tracy EM; Martin TC. Children's roles in the social networks of women in substance abuse treatment. Journal of Substance Abuse Treatment 32(1): 81-88, 2007. (48 refs.)

This study examined the status of children and the types of support available from children as reported by women in substance abuse treatment. Findings indicate that children are viewed as sources of social support to women on treatment. Children were viewed as providing as much sobriety support to respondents as that provided by adult network members. In addition, both children living with the respondent and children in the care of others were viewed as providers of specific types of social support. Implications are drawn for practice and research.

Trim RS; Chassin L. Drinking restraint, alcohol consumption and alcohol dependence among children of alcoholics. Journal of Studies on Alcohol 65(1): 122-125, 2004. (18 refs.)

Objective: Previous research has found drinking restraint to be a risk factor for alcohol use and alcohol-related problems in normative populations, but has not tested these relations in high-risk populations. The current study tested whether drinking restraint predicted alcohol-related outcomes in the same way for high-risk and low-risk individuals and tested whether there was a quadratic effect of drinking restraint on alcohol-related outcomes. Method: Data from an ongoing longitudinal study of children of alcoholics (COAs; n = 189) and controls (n = 192) were collected at two time points 5 years apart. Results: The prospective findings extended previous cross-sectional literature by replicating the main effects of drinking restraint as a risk factor for sub-sequent drinking for controls. For COAs, however, higher levels of drinking restraint were associated with lower levels of later drinking. There was also a quadratic effect of drinking restraint in the prediction of alcohol dependence diagnoses, suggesting that those at the extreme levels of drinking restraint were least likely to develop alcohol dependence. Conclusions: The relation of drinking restraint to alcohol-related outcomes may be more complex than previously hypothesized because it may work in different directions for high- and low-risk individuals and may have a nonlinear relationship to diagnostic outcomes.

Tyler KA. A qualitative study of early family histories and transitions of homeless youth. Journal of Interpersonal Violence 21(10): 1385-1393, 2006. (17 refs.)

Using intensive qualitative interviews with 40 homeless youth, this study examined their early family histories for abuse, neglect, and other family problems and the number and types of transitions that youth experienced. Multiple forms of child maltreatment, family alcoholism, drug use, and criminal activity characterized early family histories of many youth. Leaving home because of either running away or being removed by child protective services often resulted in multiple transitions, which regularly included moving from foster care homes to a group home, back to their parents, and then again returning to the streets. Although having experienced family disorganization set youth on trajectories for early independence, there were many unique paths that youth traveled prior to ending up on the streets.

Vanderploeg JJ; Connell CM; Caron C; Saunders L; Katz KH; Tebes JK. The impact of parental alcohol or drug removals on foster care placement experiences: A matched comparison group study. Child Maltreatment 12(2): 125-136, 2007. (46 refs.)

Research has established the coincidence of parental alcohol and other drug (AOD) use and child maltreatment, but few studies have examined the placement experiences and outcomes of children removed because of parental AOD use. The present study examines demographic characteristics and placement experiences of children removed from their homes because of parental AOD use (n = 1,333), first in comparison to the remaining sample of children in foster care (n = 4,554), then in comparison to a matched comparison group of children in foster care who were removed for other reasons (n = 1,333). Relative to the comparison sample, children removed for parental AOD use are less likely to experience co-occurring removal because of neglect and physical or sexual abuse and are more likely to be placed in relative foster care. In addition, these children remain in care longer, experience similar rates of reunification, and have significantly higher rates of adoption.

Westermeyer J; Yoon G; Thuras P. Psychiatric morbidity and parental substance use disorder. American Journal of Drug and Alcohol Abuse 32(4): 607-616, 2006. (26 refs.)

Objective: To assess psychiatric morbidity associated with having no, one, or two parents with Substance Use Disorder (SUD), among patients receiving SUD care. Design: Two measures of psychiatric morbidity included (a) current psychopathology and (b) lifetime use of psychiatric treatment. Settings: Alcohol-drug treatment programs were located in two university medical centers. Subjects: Four hundred ninety-five voluntary patients aged 18 and older and non-adopted. Results: Parental SUD was directly related to (a) more current psychiatric symptoms, both self-rated and psychiatrist-rated and (b) greater likelihood of ever having ever