Family Substance Use Research Articles

Adult Family Adversities and Bullying among Urban African American Adolescents

ABSTRACT The current study examined how adverse family events (i.e., adult family incarceration, adult family substance use, and adult family mental illness) were associated with adolescent bullying perpetration. More specifically, this study examined whether levels of future orientation mediated the link between adult family incarceration, substance use, and mental illness and bullying perpetration. A sample of 637 African American adolescents from the Southside of Chicago was used for this study. Adult family incarceration, substance use, and mental illness were all found to be positively associated with bullying perpetration. Also, adult family substance use and mental illness were positively associated with low levels of future orientation, which was significantly related to bullying perpetration. These findings demonstrate the importance of understanding how adverse family events are related to adolescent bullying. Implications for future research are discussed.

Caffeine, Alcohol and Tobacco Pattern Use and Risk Factors in Use Risk During Pregnancy in the Middle Zone of Northeastern Thailand

Background: Prenatal substance use is a public health problem deserving the highest priority of attention because it poses devastating risks of maternal and fetal consequences. Situational analysis of current substance use in pregnancy and its risk factors is essential for effective preventive strategies for maternal and child health. This study explored the prevalence of risky substance use (caffeine, alcohol, and tobacco) along with associated factors patterning among pregnant women in the middle zone of Northeastern Thailand. Method: This cross--sectional study was conducted in 58 district hospitals located in the middle zone of northeastern Thailand. The participants were 944 pregnant women attending antenatal clinics chosen based on consecutive sampling. Data collection used a questionnaire, and data analysis used multiple logistic regression. Result: More than two-thirds of the pregnant women (70.1%) reported current substance use, including caffeine (61.6%), alcohol (20.7%), and tobacco (3.3%). Risk factors such as family caffeine use (AOR=2.83, 95%CI: 2.02-3.97) and couple relationship (AOR=1.58, 95%CI: 1.07-2.33) were found to be associated with caffeine in use risk, while marital status (AOR=2.53, 95%CI: 1.11-5.77), couple relationship (AOR=2.27, 95%CI: 1.05-4.91), and family alcohol use (AOR=3.54, 95%CI: 1.49-8.42) were those associated with alcohol in use risk. It was notable that while family tobacco use (AOR=3.85, 95%CI: 1.05-14.06) was associated with tobacco in use risk, age was found to be its protective factor (AOR=0.31, 95%CI: 0.10-0.95) among those in the tobacco use risk group. Conclusion: Currently there is strong evidence about the risky substance use during pregnancy. Modification solutions for suitable consumption behavior should targeted pregnant women with family substance use, poor couple relationships, single status and more than 20 years, old.

Intergenerational transmission of maternal overprotection and child anxiety in substance-using families

The current study investigated an intergenerational transmission model between maternal overprotection and child anxiety across three generations, among a sample of substance-using women and their children. Participants included 183 mother-child pairs. Mothers reported overprotective behaviors of their own mothers, as well as their own anxiety symptoms and substance use at baseline. Mothers reported their adolescents’ internalizing behaviors, and adolescents reported their mothers’ overprotection, five times over 1.5 years. Growth curve models showed that overprotection among the first generation (G1) mothers was related to anxiety among the second generation (G2) mothers and sequentially the rate of change of overprotection among G2 mothers. Baseline overprotection among G2 mothers was related to baseline internalizing problems among the third generation (G3). More importantly, substance use among G2 mothers moderated the link between the rate of change in overprotection among G2 mothers and the rate of change in internalizing problems among G3 children. Findings uncover the intergenerational transmission model of overprotection-anxiety and shed light upon the complex relations among anxiety, substance use, and parenting in substance-using families.

The role of pubertal timing in the link between family history of alcohol use disorder and late adolescent substance use

BackgroundYouth who experience puberty earlier than their peers are at heightened risk for substance use during adolescence. However, little is known about whether pubertal timing exacerbates effects of relevant early risk factors, such as family substance use history, as predicted by the “accentuation hypothesis”. Using longitudinal data from youth with and without a family history of alcohol use disorder (AUD FHx), we evaluated whether pubertal timing intensifies preexisting familial risk effects on late adolescent substance use. MethodsParticipants were 568 males and 245 females from the Michigan Longitudinal Study. Pubertal timing was indexed by fitting mixed-effects linear models to repeated measures of self-reported Tanner stage. Multilevel models then tested: (a) whether AUD FHx predicted pubertal timing, and (b) whether AUD FHx, pubertal timing, or their interaction predicted alcohol and marijuana use at ages 16–18. ResultsAUD FHx was unrelated to pubertal timing in either males or females. In males, alcohol and marijuana use in late adolescence were predicted by AUD FHx and timing, but not their interaction. In females, AUD FHx predicted alcohol-related outcomes, but there were no main or interaction effects of timing. ConclusionsPubertal timing does not moderate the link between AUD FHx and late adolescent substance use, in contrast to the accentuation hypothesis. In males, measures of pubertal maturation and familial risk provide unique information for prediction of use. Females displayed no link between pubertal timing and use, which may suggest different risk pathways, or may have been due to the female sample’s smaller size.

Exposure to Family Violence of Israeli Inmates: Does Sex Make a Difference?

The purpose of the current study was to examine differences by sex (a) in history of child abuse and neglect (CAN) and exposure to parental partner violence (PPV); and (b) in the association of CAN and PPV with violent offenses, substance use, suicidal behavior, and psychiatric problems. This cross-sectional study investigated sex differences in CAN and exposure to PPV in a sample of 290 Israeli inmates (65 women and 225 men). Participants completed a self-report measures of the Childhood Trauma Questionnaire, and the revised Conflict Tactics Scale to measure PPV. The findings indicated that the female inmates had experienced significantly more sexual abuse (p < .001), and more exposure to PPV (p = .030), compared with male inmates. Female inmates who had experienced CAN were at higher risk of committing violent offenses than male inmates and female inmates were also more likely than male inmates to have been engaged in suicidal behaviors (39.3% and 18.5%, respectively), and to have had psychiatric problems (40% and 14.2%, respectively). The findings also revealed that psychiatric problems and suicidal behavior can be predicted by CAN and family substance use. The findings highlight the effects of the adverse childhood experience of exposure to CAN and PPV on behavioral problems. Appropriate treatment requires simultaneous intervention that targets all three issues of childhood trauma, substance use disorders, and psychiatric problems for both sexes.

Help seeking behavior for problematic substance uses in north-West Ethiopia

BackgroundSubstance miss use and neuro-psychiatric conditions are a growing public health challenges, but 76 to 85% of people with those disorders in low and middle-income countries did not receive treatment. The aim of this study was to see help seeking behavior and determinant factors in residents with problematic substance uses.MethodsA total of 2400 participants had screened for problematic substance uses and 548 participants were found positive for problematic substance uses. Then, we had interviewed 548 participants for help seeking behavior by pre-tested modified General Help Seeking Questionnaire. Logistic regression with its corresponding p-value < 0.05; Adjusted odds ratios (AOR) and 95% confidence intervals (CI) have been used.ResultsAmong five hundred and forty-eight participants with problematic substance use, only one hundred and sixty-eight (30.7%) with 95% CI (27, 35%) had sought help. Age above 35 years [AOR = .47 95% CI (.25, .90)], who had common mental disorders [AOR = 4.12, 95% CI (2.7, 6.3)], who had comorbid medical condition [AOR = 3.0, 95% CI (1.7, 5.3)], and grand-families’ history of substance use [AOR = 2.18, 95% CI (1.4, 3.4)] were significantly associated with help seeking behavior.ConclusionHelp-seeking behavior was infrequent in people with problematic substance use. Advanced age was a barrier to seek help while medical illnesses, common mental disorders and history of substance use in grand families were found to enforce to seek help.

Variations in risk and promotive factors on substance use among urban American Indian youth

Although roughly 70% of the American Indian and Alaska Native (AI) population live in urban areas, research is scarce regarding this population. As a consequence, there is limited understanding about the salient socioenvironmental factors that aid in preventing substance use among urban AI communities. This study utilized a statewide, cross-sectional, school-based survey of urban AI adolescents (N = 2,375) to (a) examine the associations between substance use and risk and promotive factors within the family and peer group, and (b) explore how these associations vary by subgroups (gender, racial/ethnic background, and grade level). Results suggest that risk factors—familial substance use and antisocial peer affiliation—were associated with higher alcohol, cigarette, and marijuana use. However, these findings varied by subgroup. For males, involvement with antisocial peers was associated with greater marijuana use. Involvement with antisocial peers was also positively associated with alcohol and marijuana use for multiracial/multiethnic AI adolescents and those adolescents in 10th and 12th grades. The promotive factors—supportive family environment and prosocial peer affiliation—were not universally associated with lowered substance use by subgroup. This study advances understandings of the risk and promotive factors important in reducing and preventing substance use among urban AI adolescents. Experiencing familial substance use and affiliating with antisocial peers were the salient factors associated with increased substance use, particularly for urban AI adolescents who are older, male, and with multiracial/multiethnic AI backgrounds.

Implementation of a Standardized Integrated Screening Tool to Identify Behavioral Risks in Pregnancy [39G

INTRODUCTION: Pregnancy provides a unique opportunity to identify women exposed to risky behavior. Standardization has proven to decrease variability and improve quality of care across a breadth of disciplines. We aimed to increase screening and detection of behavioral health risks by introducing the standardized Integrated Screening Tool (IST). The IST uses 11 yes or no questions to screen for patient, peer and family substance use, domestic violence, and emotional health, and takes less than 3 minutes to complete. METHODS: We retrospectively reviewed 100 charts to evaluate baseline rates of screening. No standard tool was used at baseline. In January 2018, we launched universal screening using the IST at intake, 28-week, and 36-week visits within the Maternal-Fetal Medicine ambulatory clinic. Clinical staff instructed all patients to complete the IST while awaiting the provider. We reviewed 186 active patients' charts from January to July 2018. RESULTS: During the study period, 295 screening visits occurred. Chart review of these visits revealed 90% of opportunities to screen were completed compared to only 65% at baseline. Positive screens were significantly higher at intake and 28-week visits than when compared to baseline (33% vs 16% [P=.006], and 26% vs 11% [P=.017], respectively). CONCLUSION: Our data demonstrate a standardized, written tool increases screening in our patient population and significantly increases the detection of positive screens in pregnant patients. Identification of behavioral health risks in pregnancy can lead to potential interventions to mitigate the effect of these behaviors.

Using opioid therapy for pain in clinically challenging situations: questions for clinicians

Healthcare professionals and organizations increasingly face the conundrum of treating patients with active substance use disorder, a history of personal or familial substance use disorder, or those at elevated risk for substance abuse. Such patients need compassionate care when facing painful conditions; in fact, denying them pain control makes it likely that they will seek out ways to self-medicate with illicit drugs. Yet it remains unclear how to safely and effectively treat patients in these challenging situations. The authors have formulated ten questions to address in order to provide adequate analgesia for such patients. These questions demand a highly individualized approach to analgesia. These ten questions involve understanding the painful condition (presumed trajectory, duration, type of pain), using validated metrics such as risk assessment tools, guidelines, protocols, and safeguards within the system, selection of the optimal analgesic product(s) or combination therapy, and never starting opioid therapy without clear treatment objectives and a definitive exit plan. It is tempting but inaccurate to label these individuals as "inappropriate patients," rather they are high-risk individuals in very challenging clinical situations. The challenge is that both options - being in pain or being treated with opioids to control pain - expose the patient to a risk of rekindling an addiction. The question is how do we, as clinicians, adequately respond to these very perplexing clinical challenges?

Circumstances of substance use by street youth in Egypt support the case for intervening to prevent adverse childhood experiences

ABSTRACTBackground: Egyptian street youth use substances including tobacco, illicit drugs, and pharmaceutical drugs. To understand the circumstances, including adverse childhood experiences, that place adolescents at risk for engaging in substance use, we conducted in-depth interviews among a sample of Egyptian street children. Methods: From youth residing at or attending Caritas, a non-profit organization, which provides shelter and education to street youth, seven girls and twelve boys, aged 12–18 years, participated in open-ended, in-depth interviews. Results: Eight out of the 19 participants reported family history (early exposure) to substance use; and seven of them were initiated by either a family member (sibling), friend or coworker. Most of the participants reported a history of conflict with or abuse (verbal or physical) by their parents or siblings, or stressful situations at home; they used substance(s) to alleviate their stress. Few attended school, and some were forced to work and help their family. Conclusions: Among Egyptian youth, adverse childhood experiences, such as poverty, child abuse, and family substance use, challenge somewhat susceptible youths and lead them to the path of substance use and addiction. Prevention intervention should be multifaceted, culturally adaptable, and primarily targeting the social environment during childhood.

Children in the Opioid Epidemic: Addressing the Next Generation's Public Health Crisis.

* Abbreviation: MAT — : medication-assisted treatment The United States is experiencing unprecedented rates of drug overdose deaths and drug-related problems. This epidemic is driven primarily by opioids. Although most responses to this opioid epidemic are focused on preventing harm to adults, there are at least 5 pathways by which opioid-related problems can spill over and affect child health and safety: 1. child or adolescent poisoning and overdose: this could happen because of intentional misuse or accidental ingestion of prescription drugs by young children; 2. opioid misuse in pregnancy: opioid misuse in pregnancy is associated with inadequate prenatal care, preterm birth, low birth weight, respiratory depression, and neonatal abstinence syndrome1; 3. impaired parenting and attachment: parents’ opioid misuse may impair their ability to adequately supervise, bond with, and care for their children; 4. material deprivation: money spent on drugs may come out of family finances needed to care for children; and 5. extended separation from parents: children may be separated from a parent with an opioid-related problem because of a parent’s incarceration, residential psychiatric or drug treatment, or death or because of a child’s placement in foster care. Indeed, quantitative and qualitative studies suggest that increases in parental opioid misuse and overdose death have resulted in concomitant increases in these adverse childhood experiences and that many children are ending up in … Address correspondence to Kenneth A. Feder, Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Hampton House Room 782, 624 N. Broadway, Baltimore, MD 21205. E-mail: kfeder1{at}jhu.edu

Relative influence of perceived peer and family substance use on adolescent alcohol, cigarette, and marijuana use across middle and high school

PurposeSubstance use by peers and family may affect adolescent substance use, yet the relative influence may shift during adolescence as youth differentiate themselves from family and more closely affiliate with peers. This study examined trends in concordance of adolescent cigarette, alcohol and marijuana use and corresponding perceived use by friends and family members during middle and high school. MethodsData are from a longitudinal cohort of 12,038 youth who completed up to five surveys during grades 6–12. At each wave, adolescents reported past month use of cigarettes, alcohol and marijuana, as well as perceived use by their best friend, older sibling and most important adult figure. For each substance, we used time-varying effect models to estimate how associations between adolescent use and perceived use varied across grade. ResultsFor all substances, concordance with best friend use was positive and stronger than concordance with older sibling or adult use at all grades. Concordance with both best friend and older sibling use of all substances was pronounced in 6th grade. Concordance peaked again during mid-high school for smoking (best friend, older sibling) and marijuana (best friend). Concordance with adult marijuana use peaked in middle school, yet associations with adult alcohol and cigarette use were relatively stable. ConclusionsSubstance use prevention efforts that seek to counter peer normative pressures should begin prior to middle school and span high school. Such efforts should address the role of peer and family environments, as both were found to be relevant during middle and high school.

Correlates of Substance Use Among American Indian/Alaska Native Adolescents

Substance use is a significant problem among American Indian/Alaska Native adolescents, but the risk and protective factors specific to this population are less well understood. We analyzed risk and protective factors for 30-day and lifetime use of smokeless tobacco, cigarettes, alcohol, marijuana/hashish, and inhalants in a sample of 5912 AI/AN adolescents (43.85% female; mean age = 13.95 years). Results indicated that peer and family substance use, more favorable attitudes toward substance use, greater sensation-seeking, easier access to substances, and poor school performance were associated with increased odds of substance use. Living with both biological parents was associated with lower odds of substance use. Gender, religious service attendance, peer delinquent behavior, perceived maternal warmth, school opportunities for reward and prosocial involvement, school commitment, and community support were inconsistently related to substance use. These findings highlight the importance of addressing substance use among AI/AN adolescents at the sociodemographic, cultural, and psychological levels.

Chronic School Absenteeism and the Role of Adverse Childhood Experiences

ObjectiveTo examine the association between chronic school absenteeism and adverse childhood experiences (ACEs) among school-age children. MethodsWe conducted a secondary analysis of data from the 2011–2012 National Survey of Children's Health including children 6 to 17 years old. The primary outcome variable was chronic school absenteeism (≥15 days absent in the past year). We examined the association between chronic school absenteeism and ACEs by logistic regression with weighting for individual ACEs, summed ACE score, and latent class analysis of ACEs. ResultsAmong the 58,765 school-age children in the study sample, 2416 (4.1%) experienced chronic school absenteeism. Witnessing or experiencing neighborhood violence was the only individual ACE significantly associated with chronic absenteeism (adjusted odds ratio [aOR] 1.55, 95% confidence interval [CI] 1.20–2.01). Having 1 or more ACE was significantly associated with chronic absenteeism: 1 ACE (aOR 1.35, 95% CI 1.02–1.79), 2 to 3 ACEs (aOR 1.81, 95% CI 1.39–2.36), and ≥4 ACEs (aOR 1.79, 95% CI 1.32–2.43). Three of the latent classes were also associated with chronic absenteeism, and children in these classes had a high probability of endorsing neighborhood violence, family substance use, or having multiple ACEs. ConclusionsACE exposure was associated with chronic school absenteeism in school-age children. To improve school attendance, along with future graduation rates and long-term health, these findings highlight the need for an interdisciplinary approach to address child adversity that involves pediatricians, mental health providers, schools, and public health partners.

Neighborhood, Family, and Peer Factors Associated with Early Adolescent Smoking and Alcohol Use.

There is broad agreement that neighborhood contexts are important for adolescent development, but there is less consensus about their association with adolescent smoking and alcohol use. Few studies have examined associations between neighborhood socioeconomic contexts and smoking and alcohol use while also accounting for differences in family and peer risk factors for substance use. Data drawn from the Seattle Social Development Project (N = 808), a gender-balanced (female = 49%), multiethnic, theory-driven longitudinal study originating in Seattle, WA, were used to estimate trajectories of smoking and alcohol use from 5th to 9th grade. Time-varying measures of neighborhood socioeconomic, family, and peer factors were associated with smoking and alcohol use at each wave after accounting for average growth in smoking and alcohol use over time and demographic differences. Results indicated that living in more socioeconomically disadvantaged neighborhoods, lower family income, lower family general functioning, more permissive family smoking environments, and affiliation with deviant peers were independently associated with increased smoking. Lower family functioning, more permissive family alcohol use environments, and deviant peers were independently associated with increased alcohol use. The effect of neighborhood disadvantage on smoking was mediated by family income and deviant peers while the effect of neighborhood disadvantage on alcohol use was mediated by deviant peers alone. Family functioning and family substance use did not mediate associations between neighborhood disadvantage and smoking or alcohol use. The results highlight the importance of neighborhood, family, and peer factors in early adolescent smoking and alcohol use. Future studies should examine the unique association of neighborhood disadvantage with adolescent smoking net of family socioeconomics, functioning, and substance use, as well aspeer affiliations. Better understanding of the role of contextual factors in early adolescent smoking and alcohol use can help bolster efforts to prevent both short and long harms from substance use.

Effects of sleep on substance use in adolescents: a longitudinal perspective.

Substance use (SU) and sleep problems appear interrelated, but few studies have examined the influence of adolescent sleep patterns on development of SU disorders. This study prospectively examined the influence of sleep habits on subsequent SU in youth who later transitioned into heavy drinking. At time 1 (T1), participants (n=95) were substance-naive 12- to 14-year-olds. Path-analytic models examined whether the effects of T1 risk factors (familial SU disorder, inhibition control, and externalizing and internalizing traits) on time 3 (M=19.8years old) tobacco, alcohol, and cannabis were mediated by time 2 (M=15.1years old) sleep chronotype, daytime sleepiness, and erratic sleep/wake behaviors. Significant direct path effects of T1 risk factors and time 2 sleep behaviors on time 3 SU were found, Ps<0.05. In models that examined the effect of each individual sleep behavior separately on SU, more erratic sleep/wake and greater daytime sleepiness predicted higher lifetime use events for all substances (Ps<0.01). Higher evening chronotype tendencies predicted lower tobacco and higher alcohol and cannabis lifetime use events (Ps<0.01). Erratic sleep/wake behaviors mediated the effect of inhibitory control on subsequent SU; less erratic sleep/wake behaviors predicted better inhibition control ( β̂=-0.20, P<0.05). Early-mid adolescent psychiatric health and sleep behaviors prior to drinking onset predicted greater SU 5years later. Participants were substance-naïve at baseline, allowing for the examination of temporal order in the relationship between sleep problems and alcohol use. Early adolescent sleep problems may be an important risk factor for SU in later life.

Age of Onset, Current Use of Alcohol, Tobacco or Marijuana and Current Polysubstance Use Among Male and Female Mexican Students.

This study aimed to examine alcohol, tobacco or marijuana use onset and associations between age of onset and current use, and between age of onset and current polysubstance use among a sample of Mexican young people aged 17-20 years. Alcohol, tobacco, marijuana and other substance use were identified in a 2012 cross-sectional survey of male and female students entering first year university in Mexico City. Chi-square tests and logistic regression models examined associations between gender, age of onset, order of onset, family substance use and current polysubstance use among 22,224 students. The largest proportions of males and females initiated alcohol at age 15, tobacco at ages 15-16 and marijuana at ages 16-17. Earlier alcohol and tobacco initiation was associated with past 30-day use of the same substance. Gender differences in alcohol and tobacco use were small but males were significantly more likely than females to use marijuana and be polysubstance users. Family substance use was associated with earlier onset. There was a significant association between the earliest age of any of the three substances and current polysubstance use. A number of contextual and cultural factors in Mexico may be contributing to early onset, continued use and polysubstance use and deserve attention in research and by prevention programs.

Examining the relationship between child maltreatment and school performance in public schools in Saudi Arabia: A pilot study

The aim of this study was to examine the relationship between child maltreatment (CM) and school performance among adolescents in Saudi Arabia. A cross-sectional study was conducted in Riyadh, Saudi Arabia, in 2014. The enrolment criteria included both male and female Saudi students ( n=674; 52.7% male) aged 12-19 years ( Mage=15.6±1.6 years), attending intermediate and secondary schools belonging to the Ministry of National Guard. A self-administered questionnaire was used to gather information on different forms of abuse that had occurred in the past or were currently occurring. Poor school performance was more likely in students who lived among substance-use family members or guardians compared with those who did not (33.3% vs. 11.4%; p<0.01), those with an imprisoned family member compared with those without (26.5% vs. 11.2%; p<0.01), those who were psychologically abused compared with those who were not abused (21.0% vs. 10.1%; p<0.01), those who were physically abused compared with those who were not abused (18.9% vs. 9.3%; p<0.01), and those suffering multiple forms of abuse compared with those not abused (23.4% vs. 9.7%; p<0.01). Logistic regression analysis showed that household dysfunction was the most predisposing factor to poor performance in school, and included living among substance-use family members or guardians (odds ratio=4.0; 95% confidence interval=1.7-9.5) and living with imprisoned family member (odds ratio=3.1, 95% confidence interval=1.5-6.3). CM, along with family structure and dynamics, has an adverse relationship with students' school performance. These findings highlight the importance of increasing awareness of the impact of CM on school performance among families, schools and the community.

Tobacco, Alcohol, and Drug Use of People With Mood and Anxiety Disorders: Differential Impact of Family and Friends

ABSTRACTObjective: Substance use among people with mood and anxiety disorders is highly prevalent. The literature suggests that substance use among people with mood and anxiety disorders is linked to social relational factors, yet it has rarely been the case that studies explicitly examine the differential impact of family and friends. This study investigated the association among family relationships, friendships, and substance use among people with mood and anxiety disorders. Methods: Using the National Survey of American Life, structural equation modeling tested the unique effects of family relationships and friendships on tobacco, alcohol, and drug use (n = 1,076). The quality of family relationships was assessed using 12 items on the frequency of contact with family, received help from family, closeness in feeling toward family, and emotional support from family. The quality of friendships was assessed using four items on the frequency of contact with friends, received and given help, and closeness in feeling toward friends. Substance use was measured using self-reported use of tobacco, alcohol, and drugs. Results: Findings indicated that family relationships (β = –.101, p = .031) and friendships (β = .142, p = .004) were associated with drug use among people with mood and anxiety disorders, controlling for gender, age, race, education level, employment status, income, and family substance use history. Yet, family relationships and friendships were not significantly associated with tobacco and alcohol use. Conclusions: People with mood and anxiety disorders who had better family relationships were less likely to use drugs, while those who had better friendships were more likely to use drugs. Practitioners should be attentive to the differential impact of family and friends when working with people with mood and anxiety disorders to reduce the risk of drug use. Family interventions promoting and maintaining quality relationships with family will be helpful. However, friendships may facilitate drug use of people with mood and anxiety disorders. Practitioners should be cognizant of the potential risks of friendship networks for people with mood and anxiety disorders.

ÁLCOOL E VIOLÊNCIA NAS RELAÇÕES CONJUGAIS: UM ESTUDO QUALITATIVO COM CASAIS

Este estudo qualitativo descritivo objetivou compreender a relação entre o consumo de álcool e a expressão da violência no relacionamento de casais compostos por pelo menos um cônjuge dependente do álcool. Foram realizadas entrevistas com uso de roteiro semiestruturado com dez casais, posteriormente transcritas e submetidas à análise de conteúdo. Todos os casais relataram violência conjugal, atrelada ao uso de álcool. A violência, principalmente verbal e física, foi protagonizada por ambos os cônjuges e agravada com o tempo e com o aumento da quantidade de ingestão de álcool. Foram relatadas outras dificuldades relacionais e de trabalho, associadas ao uso contínuo do álcool, além de histórico de uso de substâncias e de violência nas famílias de origem dos participantes. Este estudo evidenciou a complexidade e a dinâmica da violência conjugal, associada à dependência de álcool, que deve ser considerada em programas de prevenção, redução de danos ou outras intervenções e encaminhamentos do casal enquanto um sistema que demanda atenção integral.