Subsequent Alcohol Use Research Articles

Primary anxiety disorders and the development of subsequent alcohol use disorders: a 4-year community study of adolescents and young adults.

Cross-sectional findings in community surveys of adults suggest that adolescent anxiety disorders are strong predictors of the subsequent onset of alcohol use, abuse and dependence. However, prospective data that follow a sample of adolescents into adulthood are needed to confirm these associations. Baseline and 4-year follow-up data from the EDSP-Study, a prospective community survey of 3021 (2548 at follow-up) adolescents and young adults aged 14 to 24 years at baseline carried out in Munich, were used. DSM-IV anxiety disorders, alcohol use and alcohol use disorders were assessed with the Munich-Composite-International-Diagnostic-Interview (M-CIDI). Multiple logistic regression analysis, controlling for age, gender, other mental disorders, substance use disorders and antisocial behaviour was used to study the associations of baseline anxiety disorders with the subsequent onset and course of alcohol use and alcohol disorders. Baseline social phobia significantly predicts the onsets of regular use and hazardous use and the persistence of dependence. Panic attacks significantly predict the onsets of hazardous use and abuse as well as the persistence of combined abuse/dependence. Panic disorder significantly predicts the persistence of combined abuse/dependence. Other anxiety disorders do not significantly predict any of the outcomes. Panic and social phobia are predictors of subsequent alcohol problems among adolescents and young adults. Further studies are needed to investigate the underlying mechanisms and the potential value of targeted early treatment of primary panic and social phobia to prevent secondary alcohol use disorders.

Acculturation and parental attachment in Asian-American adolescents’ alcohol use

Purpose To test whether the degree of acculturation predicts subsequent alcohol use among Asian-American adolescents, and to test the moderating effect of parental attachment. Methods This was a prospective study using a subsample of the National Longitudinal Adolescent Health data set. A nationally representative sample of 714 Asian-American boys ( n = 332) and girls ( n = 382) in grades 7–12 was analyzed. In-home self-report data were collected on two types of acculturation status, alcohol use, demographics, and parental attachment. After controlling for acculturation status and background variables at Wave I, logistic regression analysis was used to estimate the odds ratios to assess the association between acculturation and alcohol use at Wave II for adolescents. Results Asian-American adolescents with the highest level of acculturation (English use at home, born in the United States) were identified as the highest risk group. For adolescents with low parental attachment, the odds of alcohol use were 11 times greater in the highly acculturated group than in the least acculturated group. However, the odds of alcohol use for adolescents with moderate or high levels of parental attachment did not vary across acculturation groups. Conclusions Overall, a greater level of acculturation was associated with greater alcohol use. However, when parental attachment was taken into account, highly acculturated adolescents with moderate or high parental attachment had no greater risk than adolescents with same levels of parental attachment who were less acculturated. Thus, it appears that acculturation per se was not a risk factor unless it was accompanied by a low level of parental attachment.

A Longitudinal Analysis of Adolescent Substance Use and School Motivation Among African American Youth

Cross‐sectional research has shown a link between adolescent substance use and educational motivation. The purpose of the current study was to examine this link in a longitudinal sample of African American youth. The study examined the interrelationships between alcohol and both marijuana use and school motivation over the high school years and their effect on graduation in 681 African American adolescents (50.8% female). School motivation was shown to relate to subsequent alcohol use throughout high school and marijuana use early in high school. School motivation did not affect graduation status, but alcohol and marijuana use were related to a lower likelihood of graduating from high school. Some gender differences and differences among those who had tried alcohol or marijuana at the first wave as opposed to those who had not tried each substance were found. The findings support a systems model where school experiences can affect substance use, which, in turn, can affect the completion of high school.

Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature.

Concerns exist that stimulant therapy of youths with attention-deficit/hyperactivity disorder (ADHD) may result in an increased risk for subsequent substance use disorders (SUD). We investigated all long-term studies in which pharmacologically treated and untreated youths with ADHD were examined for later SUD outcomes. A search of all available prospective and retrospective studies of children, adolescents, and adults with ADHD that had information relating childhood exposure to stimulant therapy and later SUD outcome in adolescence or adulthood was conducted through PubMed supplemented with data from scientific presentations. Meta-analysis was used to evaluate the relationship between stimulant therapy and subsequent SUD in youths with ADHD in general while addressing specifically differential effects on alcohol use disorders or drug use disorders and the potential effects of covariates. Six studies--2 with follow-up in adolescence and 4 in young adulthood--were included and comprised 674 medicated subjects and 360 unmedicated subjects who were followed at least 4 years. The pooled estimate of the odds ratio indicated a 1.9-fold reduction in risk for SUD in youths who were treated with stimulants compared with youths who did not receive pharmacotherapy for ADHD (z = 2.1; 95% confidence interval for odds ratio [OR]: 1.1-3.6). We found similar reductions in risk for later drug and alcohol use disorders (z = 1.1). Studies that reported follow-up into adolescence showed a greater protective effect on the development of SUD (OR: 5.8) than studies that followed subjects into adulthood (OR: 1.4). Additional analyses showed that the results could not be accounted for by any single study or by publication bias. Our results suggest that stimulant therapy in childhood is associated with a reduction in the risk for subsequent drug and alcohol use disorders.

Comparison of Psychosocial Influences on Substance Use in Adolescents: Implications for Prevention Programming

ABSTRACT This paper compares the potential for twelve psychosocial variables to act as change agents (mediators) in substance use prevention programs. A sample (N = 4,412) of students in grades six through eleven were surveyed during two consecutive years of a longitudinal study. A five-factor model of psychosocial influences was used to predict subsequent alcohol, cigarette, and marijuana use. Structural equation modeling revealed that a factor labeled Drug Attitudes most consistently related to decreased future use of all three substances. The four variables composing this factor were beliefs about consequences, normative beliefs, lifestyle incongruence, and commitment. In several cases, current use mediated the relationship between a mediator factor and future use. Relationships between psychosocial factors and substance use varied little across age groups (middle school vs. high school students). Some effects were substance-specific. Implications for substance use prevention programming are discussed.

Positive impact of competence skills and psychological wellness in protecting inner-city adolescents from alcohol use.

Research has shown that competence enhancement prevention programs for substance use are effective in reducing alcohol use and other problem behaviors. However, less is known about the mechanisms by which high competence helps youth avoid negative outcomes. This study explored whether greater competence is associated with increased levels of psychological wellness that in turn deters subsequent alcohol use. Specifically, 1,459 students attending 22 middle and junior high schools in New York City completed surveys that included measures of competence (decision making, self-efficacy), psychological wellness, and alcohol use. Students completed surveys at baseline, 1-year follow-up, and 2-year follow-up. Data collectors administered the questionnaire following a standardized protocol during a regular 40-min class period. On the basis of a longitudinal structural equation model, adolescents who were highly competent reported greater psychological wellness, which was then associated with less drinking. These findings highlight the potential of alcohol prevention programs designed to enhance competence and psychological wellness.

Longitudinal relationship between the alcohol warning label and alcohol consumption.

The present study reports the longitudinal relationship between alcohol warning label exposure and alcohol consumption among adolescents. In-school surveys assessed adolescents at three annual time points beginning in tenth grade. There were 649 participants measured at all three time points; 51% were female. Four effects were the focus of the covariance structure, latent growth analysis of these data: (1) an exposure effect, whereby earlier alcohol use leads to more exposure to the warning label; (2) a deterrent effect, whereby earlier alcohol warning label exposure reduces subsequent alcohol consumption; (3) a harmful effect, corresponding to a positive relationship between early exposure and subsequent consumption; and (4) both exposure and deterrent effects operating at the same time. There was a statistically significant exposure effect such that earlier alcohol use was associated with later exposure to the warning. The association between earlier alcohol warning label exposure and subsequent alcohol use was generally negative but not statistically significant, suggesting that the warning did not affect alcohol consumption. These results suggest that the alcohol warning label is having the intended effect as described in the law requiring the warning. That is, it is informing and reminding persons of the risks associated with alcohol use. The warning does not appear to significantly increase or decrease alcohol consumption.

The impact of involuntary job loss on subsequent alcohol consumption by older workers: findings from the health and retirement survey.

To estimate the effect of involuntary job loss on subsequent alcohol consumption by older workers in the United States. Using longitudinal data from the 1992 and 1994 waves of the Health and Retirement Survey, the authors estimated multivariate models to assess the impact of involuntary job loss on subsequent alcohol use. Two outcomes were investigated: reported daily alcohol consumption and onset of drinking. The analysis sample included 207 workers who experienced involuntary job loss between survey dates and a comparison group of 2,866 continuously employed workers. After baseline alcohol consumption and a variety of socioeconomic and illness-related covariates were controlled, involuntary job loss was not associated (p>.05) with number of daily drinks consumed at follow-up. However, among those who did not consume alcohol at baseline, individuals who suffered involuntary job loss were twice as likely as continuously employed individuals to start drinking by follow-up (OR = 2.01; CI = 1.06-3.80). The majority of those who began drinking at follow-up reported drinking less than 1 drink per day. The findings provide evidence of a significant relationship between job loss and subsequent alcohol use among baseline nondrinkers. However, the magnitude of the changes in drinking was quite modest.

Alcohol and Sexual Aggression

Although alcohol consumption and alcohol-related problems are positively associated with women's experiences of sexual aggression, the direction of causality is not clear. A longitudinal design was used to examine the impact of women's alcohol consumption and alcohol problems on subsequent experiences of sexual aggression and to examine the impact of sexual aggression experiences on subsequent alcohol use and alcohol problems. The sample consisted of 93 single women, ages 20 to 35, who were at elevated risk for both alcohol-related problems and sexual aggression. After controlling for initial sexual aggression, alcohol problems predicted subsequent sexual aggression. Initial sexual aggression did not result in increased alcohol consumption or alcohol-related problems. Previous sexual aggression experiences and alcohol consumption were associated with higher perceived vulnerability to subsequent sexual aggression. Furthermore, perceived vulnerability to sexual aggression was positively associated with actual Time 2 experiences of aggression, suggesting some degree of accuracy in appraisals of risk.

Peer Influence on Adolescent Alcohol Use: The Moderating Role of Parental Support and Discipline

This study tested the moderating effects of parental social support and consistency of discipline on the relation between adolescents' affiliation with drug-use promoting peers and their subsequent alcohol use. Participants were a subsample (n = 300) of 454 children of alcoholics and matched community controls (ages 101/2-151/2 years). Results indicated that mothers' and fathers' social support and consistency of discipline buffered the effects of peer group affiliation on girls' alcohol use; however, both variables exacerbated peer effects on boys' alcohol use. For girls, results are consistent with the notion that parenting behaviors can serve as protective factors by promoting qualities that serve to resist peer group pressure. For boys, increases in support and discipline behaviors may be interpreted as threats to autonomy.

A Longitudinal Analysis of Internalization of Parental Alcohol-Use Norms and Adolescent Alcohol Use

A model was tested in which predictions were advanced about children's internalization of their parents' alcohol-use norms and their own subsequent alcohol-use behavior. The sample included 132 families with a child who was 10-12 years old at the Time 1 assessment. Data were obtained in 3 waves at 1-year intervals. Parents' alcohol-use norms were assessed at Time 1, children's alcohol-use norms at Time 2, and children's drinking behavior at Time 3. The link between parents' alcohol-use norms and children's drinking behavior was mediated through the children's own norms. Father-child relationship processes moderated the links between fathers' and children's norms and between children's norms and subsequent alcohol use. The findings highlight a need for further research on internalization processes using samples large enough to detect moderational effects.

Role of general and specific competence skills in protecting inner-city adolescents from alcohol use.

The purpose of this longitudinal investigation was to test whether higher levels of general competence are linked to greater refusal assertiveness that is, in turn, related to less subsequent alcohol use among inner-city adolescents. A large sample of students attending 22 middle and junior high schools in New York City participated. Students completed surveys at baseline, at 1-year follow-up and at 2-year follow-up (N = 1,459; 54% female). The students self-reported alcohol use. decision-making skills, self-efficacy and refusal assertiveness. Teams of three to five data collectors administered the questionnaire following a standardized protocol. The data were collected in school during a regular 40-minute class period. According to the tested structural equation model, Decision Making (beta = .07, p < .05) and Self-Efficacy (beta = .24, p < .001) predicted higher Refusal Assertiveness and this greater assertiveness predicted less drinking at the 2-year follow-up (beta = -.21, p < .001). Earlier drinking predicted 2-year follow-up drinking (beta = .40, p < .001). Goodness-of-fit indices were excellent (chi2 = 1107.9, 238 df, N = 1,438, p < .001; NFI = .93, NNFI = .94, CFI = .95). The tested model had a good fit and was parsimonious and consistent with theory. This research highlights the importance of addressing decision-making skills, self-efficacy and refusal assertiveness within adolescent alcohol prevention programs.

Television and music video exposure and risk of adolescent alcohol use.

Alcohol use is frequently portrayed in television programming and advertising. Exposure to media portrayals of alcohol use may lead to increased drinking. To address this issue, we examined prospectively the associations between media exposure and alcohol use in adolescents. Prospective cohort study. Setting. Six public high schools in San Jose, California. Participants. Ninth-grade students (N = 1533; mean age = 14.6 years). Students reported hours of television, music video, and videotape viewing; computer and video game use; and lifetime and past 30 days' alcohol use at baseline and 18 months later. Associations between baseline media exposure and subsequent alcohol use were examined with multiple logistic regression. During the 18-month follow-up, 36.2% of baseline nondrinkers began drinking and 50.7% of baseline drinkers continued to drink. Onset of drinking was significantly associated with baseline hours of television viewing (odds ratio [OR] = 1.09; 95% confidence interval [95% CI] = 1.01-1.18), music video viewing (OR = 1.31; 95% CI = 1. 17-1.47), and videotape viewing (OR = 0.89; 95% CI = 0.79-0.99), controlling for age, sex, ethnicity, and other media use. Computer and video game use was not significantly associated with the subsequent onset of drinking. Among baseline drinkers, there were no significant associations between baseline media use and maintenance of drinking. Increased television and music video viewing are risk factors for the onset of alcohol use in adolescents. Attempts to prevent adolescent alcohol use should address the adverse influences of alcohol use in the media.

PTSD as a mediator between childhood rape and alcohol use in adult women

Objective: Though a relationship between childhood sexual abuse and later alcohol use among women has been documented, little is known about the pathways that link these two variables. A tension reduction hypothesis posits that emotional distress precedes substance usage. PTSD symptomatology resulting from childhood sexual abuse is examined as a possible source of emotional distress that may cause subsequent alcohol use. Method: A sample of adult women was selected and interviewed on two occasions 1 year apart and childhood rape history, lifetime PTSD symptoms, and lifetime alcohol use were assessed. Path analytic techniques were used to evaluate the mediating role of PTSD symptoms on the relationship between childhood rape and subsequent alcohol use. Results: A history of childhood rape doubled the number of alcohol abuse symptoms that women experienced in adulthood Path analysis and cross-validation results demonstrated significant pathways connecting childhood rape to PTSD symptoms and PTSD symptoms to alcohol use. Conclusions: The results of the present study suggest that PTSD symptomatology which develops after childhood rape may be one of many variables that affect alcohol abuse patterns in women who were victims of childhood sexual abuse.

Relations of Social Skills, Personal Competence, and Adolescent Alcohol Use

Findings from school-based drug prevention interventions indicate that social skills and personal competence are an effective barrier against adolescent alcohol use. Efficacious and competent youth are hypothesized to possess skills to reduce offers for alcohol and invoke alternative strategies that offset peer pressure. To understand these developmental relations, a longitudinal model that specified effects of early alcohol use on later social skills and competence and their recursive influences was tested using data obtained from a cohort of nontreatment youth participating in a drug abuse prevention trial Social skills, personal competence, and consumption were temporally stable from the 8th through 10th grade. Early competence predicted lowered alcohol use, whereas social skills were associated with greater subsequent alcohol use. Social influence risk moderated the competence-consumption relations, underscoring the close developmental interplay between social context and intrapersonal risk. Findings are discussed in terms of cognitive-behavioral strategies to effectively reduce alcohol use.

The role of childhood stressors in the intergenerational transmission of alcohol use disorders.

This study examined relations between childhood stressors (e.g., disrupted family rituals, embarrassment, neglect, abuse), family history of paternal alcoholism, and alcohol use disorders in late adolescence and early adulthood. Of particular interest was the extent to which stressor exposure mediated the association between paternal and offspring alcohol use disorders. A mixed-gender sample of 457 (238 female) participants, approximately half (N = 234) with a family history of paternal alcoholism, were assessed for alcohol use disorders and childhood stressors via clinical interviews. Family history of paternal alcoholism was associated with every childhood stressor examined, often strongly. In addition, a number of childhood stressors (e.g., verbal, emotional, physical and sexual abuse) were related to an alcohol use disorder in late adolescence/early adulthood. However, only a portion of the effect of family history on a subsequent alcohol use disorder was accounted for by the childhood stressors we examined. Findings indicate that self-reported childhood stressors are strongly related to a family history of alcoholism, but are only moderately and inconsistently related to the development of an alcohol use disorder. Moreover, they appear to, at best, only partially mediate the relation between family history of alcoholism and an alcohol use disorder.

Effects of early drinking and an antisocial orientation on the alcohol use of young Russians.

Drawing upon data from the Survey of Deviant Behavior Among Youth in the Moscow Region of Russia, this paper examines the effects of early drinking behavior and an antisocial orientation on the use of alcohol by young Russians. Using available data from the U.S. National Household Survey of Drug Abuse, the use of alcohol and the effects of early drinking among youth in the Moscow Region and the United States are compared. The analysis of the data from the two surveys indicates that a greater proportion of Russian youth began drinking by the age of 12 but that early drinking is associated with subsequent alcohol use among both Russian and American youth. Although there are no data on an antisocial orientation from the U.S. survey, there are such data from the Russian survey and an analysis of this data indicates that the greatest alcohol use is found among young Russians who began drinking by the age of 12 and who have an antisocial orientation.

The impact of behavior and addiction on psychological models of cigarette and alcohol use during pregnancy

This prospective study of 241 women investigated the impact of past behavior and psychological factors on cigarette and alcohol use during pregnancy. Smokers' cigarette use was compared with their alcohol consumption during pregnancy, and drinking among smokers was compared with that of nonsmokers. Only prior smoking directly predicted smokers' cigarette use later in pregnancy, whereas smokers' alcohol use was related to both their previous drinking and their drinking self-efficacy. Among nonsmokers, neither drinking before nor early in pregnancy was related to alcohol use later in pregnancy; only subjects' selfefficacy and their beliefs about the consequences of drinking during pregnancy predicted their subsequent alcohol use. These results are consistent with the notion that greater addictive potential lessens the direct impact of psychological factors on substance use during pregnancy. Further implications of these findings for interventions and other health-related behaviors are also discussed.

Does psychomotor sensitivity to alcohol predict subsequent alcohol use?

Data from 42 male and 58 female subjects who participated in the Colorado Alcohol Research on Twins and Adoptees (CARTA) project were subjected to model-fitting analyses. The aim of the present study was to use linear structural equation models to determine whether differences in previously measured psychomotor sensitivity to alcohol predict differences in self-reported alcohol consumption over a 4-year period. LISREL model-fitting results indicate that, for male subjects, only rail walking insensitivity is predictive of alcohol use reported 2 years after their initial CARTA testing. For females, only hand steadiness sensitivity is predictive of alcohol use reported 2 years after their initial CARTA testing. The results for males support a hypothesis that would consider alcohol insensitive individuals at greater risk for alcohol abuse. The female results, however, would argue against such a hypothesis. With only one measure of sensitivity predicting alcohol use at only one out of four time points, in both men and women, the overall results suggest that our three measures of psychomotor sensitivity to alcohol are, in general, poor predictors of alcohol consumption in this sample.

The relationship between alcohol and marijuana use and competence in adolescence.

Using longitudinal data, this study was designed to (1) examine the predictive power of baseline and changing intensities of alcohol and marijuana use on personal and social competence among adolescents and (2) examine the predictive power of baseline and changing levels of competence on subsequent alcohol and marijuana use among these same subjects. Data were obtained from a quota sample of 1308 youth at two points in time. Initially tested at ages 12, 15 or 18, subjects ere retested three years later. Findings suggest that heightened levels of alcohol or marijuana use are likely to perpetuate dysfunction across time, especially among those between the ages of 12-15 years of age. In turn, the perpetuation of deficits in competence is likely to maintain drug use. These findings suggest the importance of emphasizing the adequate development of basic competencies early in adolescence as part of a comprehensive drug prevention program.