Parental Alcohol Research Articles

The Effect of Parental Attachment on Risky Alcohol Use and Disordered Eating Behaviors in College Students

Alcohol use and disordered eating behaviors (DEB) are prevalent among college students. Despite the pervasive influence of a peer culture that promotes and supports drinking and consistent dieting, parents continue to be a primary source of influence for young adults. Young adult college student attachment to their parents may have an important influence on college student alcohol use behaviors and DEBs. The present study examined the effect of parental attachment relationships, DEBs, and alcohol use behaviors for college students. Findings indicate that parent attachment had a significant and negative effect on alcohol use behavior and DEBs. Clinical implications for the treatment of college student substance use and disordered eating are presented and discussed.

From control to vulnerability: Resolution of illusory mental health within a significant change event during pluralistic psychotherapy

ABSTRACT Intensive studies of single cases represent a valuable means for developing and refining practice-relevant theory in the field of counselling and psychotherapy. A significant discrepancy between different sources of information about symptom severity was observed in a case of a client recovering from the experience of growing up with an abusive alcoholic parent. The process of change within this case, arising from an art-based pluralistic intervention, was analysed using a version of a mixed method Hermeneutic Single Case Efficacy Design (HSCED). A conceptual framework for understanding the resolution of illusory mental health is proposed, and implications for practice are discussed.

The relationship of socioeconomic status in childhood and adulthood with compassion: A study with a prospective 32-year follow-up.

The objective of this study was to investigate (i) whether childhood family SES predicts offspring’s compassion between ages 20–50 years and (ii) whether adulthood SES predicts compassion or vice versa. We used the prospective population-based Young Finns data (N = 637–2300). Childhood family SES was evaluated in 1980; participants’ adulthood SES in 2001 and 2011; and compassion for others in 1997, 2001, and 2012. Compassion for others was evaluated with the Compassion scale of the Temperament and Character Inventory. The results showed that high childhood family SES (a composite score of educational level, occupational status, unemployment status, and level of income) predicted offspring’s higher compassion between ages 30–40 years but not in early adulthood or middle age. These results were obtained independently of a variety of potential confounders (disruptive behavior in childhood; parental mental disorder; frequency of parental alcohol use and alcohol intoxication). Moreover, high compassion for others in adulthood (a composite score of educational level, occupational status, and unemployment status) predicted higher adulthood SES later in their life (after a 10-year follow-up), but not vice versa. In conclusion, favorable socioeconomic environment in childhood appears to have a positive effect on offspring’s compassion in their middle adulthood. This effect may attenuate by middle age. High compassion for others seems to promote the achievement of higher SES in adulthood.

Effectiveness of psychosocial interventions for reducing parental substance misuse.

Effectiveness of psychosocial interventions for reducing parental substance misuse.

Alcohol Consumption among Freshman College Students in Spain: Individual and Pooled Analyses of Three Cross-Sectional Surveys (2005, 2012 and 2016).

Objective: We aimed to evaluate changes in the prevalence of Heavy Episodic Drinking (HED) and Risky Consumption (RC) in freshman college students between 2005, 2012 and 2016; and to identify the explanatory variables of these patterns of consumption using individual and pooled analyses. Methods: A cross-sectional study involving 5260 students was carried out in Spain in 2005, 2012 and 2016. HED and RC were determined using the Alcohol Use Disorders Identification Test. Another questionnaire was used to measure parental education level and alcohol use, alcohol-related problems, age of onset of alcohol use and alcohol-related expectancies. Adjusted Odds Ratios (ORs) of RC and HED and their 95% Confidence Intervals were estimated using logistic regression. Results: An increase in the prevalence rates of HED and RC was observed among women during the three-study periods, nonetheless there was no statistically significant difference in the prevalence rates among men. High maternal educational level, living away from parental home, initiating drinking before the age of 15 and having positive expectancies about drinking are associated with higher prevalence of RC in both genders. High positive expectancies and early onset of alcohol use are associated with higher rates of HED among men and women. Students recruited in 2012 and 2016 are protected against RC in comparison to those recruited in 2005. Conclusions: The age of alcohol consumption onset is the most influencing factor on HED and RC for both genders in the three-study periods. Alcohol prevention campaigns targeting youth at early ages can reduce risky drinking behaviors.

Two screening instruments for collecting alcohol‐related information from expectant mothers and fathers: Testing the reliability of the Parent Alcohol Screening Questionnaire and the Social Support for an Alcohol‐Free Pregnancy Questionnaire

The aim is to test the reliability of two alcohol screening instruments: (1) The Parent Alcohol Screening Questionnaire (PASQ5), and (2) the Social Support for an Alcohol-free Pregnancy (SSAFP) questionnaire. This is a cohort study from the south of Sweden using repeated surveys during pregnancy. To examine if responses differed according to different data collection methods, two cohorts consisting of 289 expectant mothers and 141 fathers completed the PASQ5 both verbally (weeks 6-7) and in writing (week 12) within regular antenatal visits. One of the cohorts (n=137/64) also completed the SSAFP in week 12 and later in week 33. The third cohort, consisting of 179 and 133 expectant mothers and fathers, respectively, completed the PASQ5 and the SSAFP twice in late pregnancy (week 31+33). Eight of 10 items in the PASQ5 were stable for both expectant mothers and expectant fathers when comparing verbal versus written-delivered formats. Eight of 10 questions in the PASQ5 were stable when assessing the items in a test-retest analysis in late pregnancy for expectant mothers and nine of 10 questions were stable for fathers. The SSAFP items showed high internal consistency (0.86) for expectant mothers and excellent internal consistency (0.94) for expectant fathers. Most SSAFP items (17 of 21 for expectant mothers and 18 of 22 for expectant fathers) were also stable in a test-retest scenario in late pregnancy. Both the PASQ5 and SSAFP are reliable tools and may be helpful for clinicians who aim to have a deeper dialogue about alcohol consumption during pregnancy. These tools may also be helpful for researchers aiming to better understand a person's changes in alcohol intake and/or their social support network.

Associations of parental and peer cross-substance use with 12–17-year-old adolescents’ problematic alcohol use: A parent-child dyadic gender analysis

BackgroundAdolescent alcohol use was found to be influenced by parental and peer alcohol use. Drinking behaviors also differed by gender. However, previous studies mainly focused on adolescents’ substance use in relation to the same substance use among their salient others. Hence, this study investigated the cross-substance relationships of alcohol and tobacco use of parents and peers with adolescents’ problematic alcohol use, separately by gender. MethodsData were derived from 4445 adolescents aged 12–17 years from the 2014 National Survey of Substance Use, a nationally representative survey in Taiwan. Problematic alcohol use was assessed using the Alcohol Use Disorders Identification Test (AUDIT). Multivariate multinomial logistic regression was used, stratified by gender. ResultsFor males, maternal (adjusted odds ratio [aOR] = 1.73) and peer (aOR = 2.57) alcohol use was related to social drinking (AUDIT < 2); paternal (aOR = 3.58), maternal (aOR = 2.18), peer alcohol use (aOR = 5.37), and their own tobacco use (aOR = 4.72) were related to problem drinking (AUDIT ≥ 2). For females, maternal (aOR = 2.26) and peer (aOR = 2.84) alcohol use was related to social drinking; maternal (aOR = 2.35) and peer tobacco use (aOR = 3.48), and paternal (aOR = 4.56) and peer alcohol use (aOR = 3.36) were linked to problem drinking. ConclusionsBoth male and female adolescents’ alcohol use was associated with their peer alcohol use, and gender differences were found in relation to their parental and peer substance use. Specifically, the parental role-modeling of smoking was only significant in mother-daughter dyads. These findings could inform multifaceted adolescent alcohol prevention programs, tailoring for males and females and also targeting their parental and peer substance use.

Within- and between-person associations with drug use disorder among adolescents and emerging adults presenting to an urban emergency department

BackgroundThe distinction between within- and between-person associations with drug use disorder (DUD) has implications for intervention targets and content. We used longitudinal data from youth entering an urban emergency department (ED) to identify factors related to changes in DUD diagnosis, with particular emphasis on alcohol use. MethodsResearch staff recruited youth age 14–24 (n = 599) reporting any past six-month drug use from a Level-1 ED; participants were assessed at baseline and four biannual follow-ups. Participants self-reported validated measurements of peer/parental behaviors, violence/crime exposure, drug use self-efficacy, and alcohol use. Research staff performed diagnostic interviews for DUD with nine substances, post-traumatic stress disorder (PTSD), and major depressive disorder (MDD). We used repeated measures logistic regression models with person-level covariate means, and person-mean-centered covariates, as separate variables, to separate within- and between-person covariate effects. ResultsAmong 2,630 assessments, 1,128 (42.9 %) were DUD diagnoses; 21.7 % were co-diagnoses with multiple drugs. Positive (aOR = 0.81, 95 %CI:[0.70, 0.94]) and negative (aOR = 1.73, 95 %CI:[1.45, 2.07]) peer behaviors related to DUD, primarily through between-person effects. Parental support (aOR = 0.92, 95 %CI:[0.83, 0.99]), community violence/crime (aOR = 1.28, 95 %CI:[1.14, 1.44]), PTSD/MDD diagnosis (aOR = 1.36, 95 %CI:[1.04, 1.79]), and alcohol use quantity (aOR = 1.06, 95 %CI:[1.02, 1.11]) were associated with DUD, showing primarily within-person effects. Other factors, such as interpersonal violence involvement (aOR = 1.47, 95 %CI:[1.21, 1.78]), showed both within- and between-person effects. ConclusionsDUD is prevalent in this population, and within-person changes in DUD are predictable. Within-person effects suggest the importance of addressing escalating alcohol use, enhancing parental support, crime/violence exposure, and other mental health diagnoses as part of DUD intervention.

Adverse childhood experiences and problematic smartphone use among college students: Findings from a pilot study

BackgroundThere has been a tremendous increase in the use of smartphones among college students and alongside the benefits there is growing concern over problematic/addictive smartphone use (PSU). Among the most robust predictors of behavioral and substance use disorders are a subset of adverse childhood experiences conceptualized as household dysfunction (HHD). Despite the high prevalence of HHD and risk of PSU among college students, research investigating the link between HHD and PSU among college populations is sparse, especially in the United States. MethodsStudents (N = 351) from a diverse, southern California university responded to an online survey. Regression models assessed the association between HHD (e.g., parent alcohol and drug use, mental health, incarceration, suicide, intimate partner violence, separation/divorce, and homelessness; categorized into 0, 1–3, and 4 or more) and PSU using Smartphone Addiction Scale short version (SAS-SV) scale, adjusted for covariates. ResultsOver 50% of students reported at least one type of household dysfunction and about 25% were at high risk for PSU. Compared to students who report no household stressors, students with 1–3 had twice the odds (AOR: 2.11, 95% CI: 1.13–3.83) and students with 4 or more had four times the odds (AOR: 4.01, 95% CI: 2.35–6.82) of PSU, after adjusting for covariates. There were no sex differences in this association. ConclusionFindings suggest that household dysfunction can increase the likelihood of developing behavioral disorders such as PSU. Implications for prevention efforts are discussed.

Differences in Personality and Family Environment of Heroin Addicts And Non-consumers of Psychoactive Substances

The research dealt with the identification of significant differences in the basic dimensions of personality according to the five-factor model between two groups of respondents: heroin addicts and the control group of respondents, non-consumers of psychoactive substances. Also, we wanted to determine whether the respondents - heroin addicts in relation to the non-clinical group differ significantly in personality traits given the completeness of the family environment in which they grew up, and the propensity of parents to alcoholism and violent behavior. The study included a sample of 297 subjects, of which 155were heroin users and 142 were non-clinical control group subjects, students of different study profiles of the University of Tuzla. The clinical and non-clinical samples were uniform in terms of characteristics important for the research. In order to test the research hypotheses, in addition to the insight into the descriptive parameters, a one-way analysis of variance was used. The results show that heroin users achieve significantly higher results in the dimensions of Agreeableness (F = 21.51; p = 0.00),Conscientiousness (F = 13.89; p = 0.00) and Neuroticism (F = 13.23; p = 0.00), while the clinical and non-clinical groups do not differ significantly in the dimensions of Openness and Extraversion. In the group of heroin consumers, respondents coming from incomplete families achieve significantly lower results on the Conscientiousness dimension (F = 4.20; p = 0.04), the tendency to consume parental alcohol proved to be a significant factor for the Neuroticism dimension (F = 4.39; p = 0, 04) and openness (F = 15.41; p = 0.00), while parental propensity to violent behavior proved to be a significant factor for the Neuroticism dimension (F = 4.49; p = 0.04) and Openness (F = 15.41; p = 0.00). ). When it comes to the non-clinical control group, family completeness and characteristics of the family environment (parents ‘tendency to consume alcohol and parents’ tendency to violent behavior) did not prove to be significant factors for differences in personality traits.

Adverse childhood experiences and impact on quality of life in adulthood: development and validation of a short difficult childhood questionnaire in a large population-based health survey

PurposeA short adverse childhood experiences (ACEs) measure is needed with non-intrusive items that include subjective evaluations of childhood. We validated a short Difficult Childhood Questionnaire (DCQ) that assesses ACEs using personal perceptions of events.MethodsThe study relied on 2019 data from a representative survey (N = 28,047) in Norway. We examined the DCQ’s factor structure, internal consistency, and discriminant validity in a multi-group confirmatory factor analysis. As a group variable, we used whether the respondent had the ACE of parental alcohol use disorder (adult children of alcoholics; ACOA). To assess the DCQ’s convergent validity, we used latent regression analysis with adulthood quality of life (QoL) as the outcome and mental distress and loneliness as potential mediators.ResultsThe DCQ’s latent mean was 0.86 (95% CI 0.82–0.90, p < 0.001) higher in the ACOA versus the non-ACOA group. The effect size suggested a large magnitude of this difference. The DCQ score was negatively associated with QoL and positively associated with mental distress and loneliness. For the score’s QoL effect [− 0.84 (95% CI − 0.87 to − 0.80, p < 0.001)], − 0.80 was indirect, and − 0.04 was direct. Thus, most of the association of DCQ with QoL occurred via mediators.ConclusionsThe results confirmed the DCQ’s discriminant and convergent validity and highlight this tool as an empirically supported approach to assess ACEs. Because of its brevity and psychometric strengths, the DCQ is useful for research and likely suited to mental health treatment settings.

Risk and Protective Pathways to Peer Victimization from Infancy to Adolescence: Role of Fathers.

This study examined the developmental pathways from fathers' psychopathology in early childhood to child peer victimization (bullying and cyber victimization) in late adolescence via family relationships and early adolescent psychosocial functioning (anxiety, emotion regulation, social problems). A conceptual model with pathways through inter-parental aggression and fathers' parenting (harshness and sensitivity) was tested. Participants were 227 families (51% female children recruited as infants) who participated in a longitudinal study examining the role of parental alcohol problems and associated risks on developmental and family processes from infancy to late adolescence. Multi-method (observational, parent report, adolescent report) assessments of family processes and child outcomes were conducted across all time points. Fathers' alcohol problems and depressive symptoms in early childhood was prospectively associated with inter-parental aggression in middle childhood and social problems in early adolescence. For boys only, early adolescent social problems were predictive of bullying victimization. Fathers' antisocial behavior in early childhood was associated with less sensitive parenting in middle childhood. Fathers' sensitivity in middle childhood was protective, being associated with lower cyber victimization in late adolescence. Fathers' sensitivity was also associated with higher emotion regulation in early adolescence; however, counter to expectations, higher emotion regulation was associated with more bullying and cyber victimization. Findings shed light on differences in the etiological pathways to bullying and cyber victimization, as well as how distinct forms of paternal psychopathology in early childhood associate with family relationships, child adjustment, and vulnerability to peer victimization in late adolescence.

Contributions of childhood adversities to chronic pain among mid-life employees.

Aims: Chronic pain is a notable burden on public health, with past and present factors contributing to it. This study aimed to examine the associations between childhood adversities and chronic pain. Methods: Data on seven childhood adversities, chronic pain and disabling pain were derived from questionnaire surveys conducted in 2000, 2001 and 2002 among 40- to 60-year-old employees (response rate of 67%) of the City of Helsinki, Finland. The study included 8140 employees (80% women). Logistic regression was used in the analyses, and the results are presented as odds ratios (OR) and their 95% confidence intervals (CI). Age, sex, the father’s education, the participant’s education, marital status, working conditions, sleep problems and common mental disorders were included as covariates. Results: In the age-adjusted models, childhood economic difficulties (OR=1.60, 95% CI 1.41–1.81), childhood illness (OR=1.74, 95% CI 1.45–2.08), parental divorce (OR=1.26, 95% CI 1.07–1.48), parental alcohol problems (OR=1.34, 95% CI 1.18–1.52) and bullying at school or among peers (OR=1.59, 95% CI 1.37–1.89) were associated with chronic pain. Working conditions, sleep problems and common mental disorders each slightly attenuated the associations between childhood adversities and chronic pain. Childhood economic difficulties among women (OR=1.72, 95% CI 1.40–2.10), childhood illness (OR=1.40, 95% CI 1.07–1.82) and bullying at school or by peers (OR=1.91 95% CI 1.48–2.46) were also associated with disabling pain. Conclusions: Childhood adversities were associated with chronic pain in mid-life, and the associations mainly remained after adjustments. Investing in the well-being of children might prevent pain and promote well-being in mid-life.

Are emotional symptoms and depression among young people with parental alcohol problems modified by socioeconomic position?

The aim was to test the hypothesis that parental alcohol problems and low socioeconomic position would be associated with higher odds ratio of emotional symptoms and depression as compared to high socioeconomic position and parental alcohol problems. Data came from Danish National Youth Study 2014, a web-based national survey with 75,853 high school and vocational school students participating, merged with register-data on family socioeconomic position. Multi-level logistic regression models (nesting participants within schools) were used to assess the association between perceived parental alcohol problems and frequent emotional symptoms and depression and effect modification by financial strains in the family, family income, or parental educational level. All analyses were adjusted for age, sex, education, immigration status, and cohabitation with parents. Young people with parental alcohol problems had higher odds ratio of experiencing frequent emotional symptoms (OR = 1.56 [1.46-1.66]) and depression (OR = 2.07 [1.88-2.28]), compared to young people without parental alcohol problems. There was no effect modification between severity of parental alcohol problems and the measures of socioeconomic position on the odds ratio of frequent emotional symptoms and depression. This study found that young people with parental alcohol problems in all social strata had higher odds ratios of frequent emotional symptoms and depression compared to young people without parental alcohol problems; the more severely they had been affected by parent's alcohol problems, the higher the odds ratios of frequent emotional symptoms and depression.

On the Reaction Pathways and Growth Mechanisms of LiNbO3 Nanocrystals from the Non-Aqueous Solvothermal Alkoxide Route.

Phase-pure, highly crystalline sub-50 nm LiNbO3 nanocrystals were prepared from a non-aqueous solvothermal process for 72 h at 230 °C and a commercial precursor solution of mixed lithium niobium ethoxide in its parent alcohol. A systematic variation of the reaction medium composition with the addition of different amounts of co-solvent including butanol, 1,3-propanediol, 1,4-butanediol, and 1,5-pentanediol resulted in the formation of nanocrystals of adjustable mean size and shape anisotropy, as demonstrated from XRD measurements and TEM imaging. Colloidal stability of ethanol- and water-based suspensions was evaluated from dynamic light scattering (DLS)/zeta potential studies and correlated with FTIR data. Thanks to the evolution in the nanocrystal size and shape distribution we observed, as well as to the available literature on the alkoxide chemistry, the reaction pathways and growth mechanisms were finally discussed with a special attention on the monomer formation rate, leading to the nucleation step. The polar, non-perovskite crystalline structure of LiNbO3 was also evidenced to play a major role in the nanocrystal shape anisotropy.

A National Study on Child Abuse and Neglect in Rural China: Does Gender Matter?

Does gender affect the risk of child abuse and neglect (CAN) in rural China? This study aims to answer this question through a national gender-balanced survey. An empirical investigation of 4943 children (Mage = 12.08, 48.7% male) in eight provinces was finished in December 2019. The descriptive statistics, a mean analysis, and a linear regression are used to discuss the data. Two important findings can be summarized as follows. First, the risk of CAN in rural China differs across genders. The prevalence and severity of the physical and emotional abuse are higher among boys than among girls, while girls are more likely to suffer emotional neglect. Second, the risk factors for CAN also differ across genders. Girls are more likely than boys to be affected deeply by factors such as the experience of maternal intimate partner violence (IPV), parental educational attainment, children’s age and academic performance, while boys are more associated with parental alcohol dependence than girls. The findings indicate that the prevalence of, severity of and risk factors for CAN differ significantly across genders, primarily because of gender inequality and the residual child welfare system.

Influence of Depression and Use of Alcohol and / or Tobacco by Parents in the Oral Health of Children with Disabilities

Objective: To investigate the influence of parental depression and substance use in the oral health care of children with disabilities. Material and Methods: A cross-sectional study was conducted involving 151 children with disabilities and their parents/caregivers. To detect the presence of depression and alcohol or tobacco use, the parents/caregivers answered three questionnaires: two versions of the Patient Health Questionnaire (PHQ), AUDIT (Alcohol Use Disorders Identification Test), and the Fagerstrom Test for Nicotine Dependence (FTND). Then, the children with disabilities underwent oral examination to evaluate biofilm control, gingival condition and the dental carie index (decayed, missing, and filled teeth - dmft ̸ DMFT). Results: There was a statistically significant association between tobacco use and dental caries in deciduous teeth (p=0.046). The children of smokers had six times greater need for dental treatment than that of non-smokers (OR= 6.36; CI= 1.3-30.5). There was no statistically significant association between the oral health of the children with disabilities and parental alcohol consumption and depression (p>0.05). Children with medical condition had a higher need for dental treatment than children with intellectual disability (p=0.003). Conclusion: Parental smoking habits increase dental caries in the deciduous teeth of children with disabilities, but parental depression and alcohol use do not influence the oral health of children with disabilities. Children with medical condition have more treatment needs than children with intellectual disability.

Factors Associated with Congenital Heart Diseases among Children in Uganda: A Case-Control Study at Mulago National Referral Hospital (Uganda Heart Institute)

Congenital Heart Diseases (CHD) are among the leading causes of morbidity and mortality associated with congenital malformations among children. Not knowing the risk profile of CHD among children in Uganda impedes development of effective prevention interventions. In this hospital based unmatched case-control study we examined risk factors for all types of CHD among 179 pair of case and control children aged 0-10 years old at Mulago National Referral Hospital. Odds ratios and their corresponding 95% confidence intervals were calculated using multivariate logistic regression. Low birth weight (adjusted OR: 3.15, 95% CI 1.48 - 6.69), high birth order ≥5^th birth order (adjusted OR: 3.69 (1.10 – 12.54), maternal febrile illness during pregnancy, maternal and paternal alcohol consumption, and paternal socio-economic status were associated with CHD. Family history of CHD, maternal education level, maternal chronic illness, and paternal education level were not associated with CHD. The results suggest: low birth weight, high birth order, and maternal febrile illness during pregnancy, parental alcohol use and paternal socio-economic status as dominant risk factors for CHD among children. Rigorous implementation of public health policies and strategies targeting prevention of febrile illness during pregnancy, maternal malnutrition, parental alcohol consumption, delivery of high number of children per woman, might be important in reducing the burden of CHD among children in Uganda.

Impact of Poverty and Family Adversity on Adolescent Health: A Multi-Trajectory Analysis Using the UK Millennium Cohort Study

Background: Children exposed to poverty and family adversities including domestic violence, parental mental ill health and parental alcohol misuse may experience poor outcomes across the life course. However, the complex interrelationships between these exposures in childhood are unclear. We therefore assessed the clustering of trajectories of household poverty and family adversities and their impacts on adolescent health outcomes. Methods: We used longitudinal data from the UK Millennium Cohort study on 11564 children followed to age 14 years. Family adversities included parent reported domestic violence and abuse, mental ill health and frequent alcohol use. We used a group-based multi-trajectory cluster model to identify trajectories of poverty and family adversity for children. We assessed associations of these trajectories with child physical, mental and behavioural outcomes at age 14 years using multivariable logistic regression, adjusting for confounders. Findings: Six trajectories were identified: low poverty and family adversity (43·2%), persistent parental alcohol use (7·7%), persistent domestic violence and abuse (3·4%), persistent parental mental ill health (11·9%), persistent poverty (22·6%) and persistent poverty and parental mental ill health (11·1%). Compared with children exposed to low poverty and adversity, children in the persistent adversity trajectory groups experienced worse outcomes; those exposed to persistent parental mental ill health and poverty were particularly at increased risk of socioemotional behavioural problems (adjusted odds ratio 6·4; 95% CI 5·0 – 8·3), cognitive disability (aOR 2·1; CI 1·5 – 2·8), drug experimentation (aOR 2·8; CI 1·8 – 4·2) and obesity (aOR 1·8; CI 1·3 – 2·5). Interpretation: In a contemporary UK cohort, persistent poverty and/or persistent parental mental ill health affects over four in ten children. The combination of both affects one in ten children and is strongly associated with adverse child outcomes, particularly poor child mental health. Funding Information: This work was funded by the National Institute for Health Research (NIHR) Policy Research Programme (ORACLE: OveRcoming Adverse ChiLdhood Experiences, Grant reference number NIHR200717); and the National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust. DTR is supported by the NIHR School for Public Health Research, the NIHR Public Health Policy Research and by the Medical Research Council (MRC) on a Clinician Scientist Fellowship (MR/P008577/1). VSS is supported by the Swedish Research Council for Health, Working Life and Welfare (FORTE) [2016-07148; 2020-00274]. Professors Kaner and Howard are supported by NIHR Senior Investigator awards and Prof Kaner is Director of the NIHR Applied Research Collaboration for the North East and North Cumbria. The views expressed in this publication are those of the authors and not necessarily those of the NIHR, MRC or FORTE. Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: Ethical approval for each wave of the MCS was granted by NHS Multicenter Research Ethics Committees. No further ethical approval was required for this secondary analysis of MCS data.

“Daddy’s Head Is Broken”: The Treatment of Children of Severe Alcoholics

ABSTRACT The author explicates the complex family relationships of children of severe alcoholics, and internalizations of these relationships, which can be addressed in the treatment of children and in corollary parent work. Children of serious alcoholics (or other substance use disorders) share features with other children whose parents are troubled. However, the author suggests that it is useful to consider what children of severe alcoholics have in common. Children of serious alcoholics can experience the substance of abuse as a mysterious potion, which their alcoholic parent prefers to them. Additionally, alcoholics (along with other substance abusers) expose their children to the specific results of inebriation or withdrawal from alcohol. The author discusses the following common experiences of the children of severe alcoholics: extreme difficulty in understanding parental addiction, particularly for very young children; an unconscious struggle to repair the damaged parent and to try to protect that parent from strain; and guilt at the often-necessary exclusion of the addicted parent from the household unit. Another confusing issue is mourning for a parent who is still alive and in some contact, yet severely impaired. The author describes parent work in these situations (collateral to a child psychoanalysis or psychotherapy), both with the “co dependent” parent and the alcoholic parent.