By Diana Mahoney, New England Bureau. Share your thoughts and suggestions at cpnews@elsevier.com
The legacy of parental alcoholism cuts deep. Nearly 6.2 million children in the United States younger than 18 years old live with at least one parent who is currently dependent on alcohol, according to estimates from the 1996 National Household Survey on Drug Abuse (NHSDA, now known as the National Survey on Drug Use and Health). The number increases exponentially when it is broadened to include those children living with adults who have abused or been dependent on alcohol some time in their lives.
Research has long established that having an alcoholic parent increases a child's risk for multiple negative behavioral and developmental outcomes. That increased risk is conveyed through social, emotional, environmental, and biologic pathways. In particular, many studies have focused on the rates of alcohol and drug use and abuse among children of alcoholics, and most have similarly concluded that this population is significantly more vulnerable to substance abuse problems than their peers from nonalcoholic families.
Data from a national epidemiologic survey out of Johns Hopkins University, Baltimore, for example, show that children of a parent with active alcohol dependence initiated use of alcohol, cigarettes, and marijuana earlier and at higher age-specific rates than children who did not have an alcohol-dependent parent.
Using NHSDA information collected from 1995 to 1997, the investigators identified a sample of 2,888 parent-child pairs, which included 114 children of alcohol-dependent parents and 2,774 children whose interviewed parent was not dependent on alcohol. The odds ratios for past-year tobacco, alcohol, and marijuana use for the children with alcoholic parents were 3.2, 1.6, and 2.9, respectively.
The differences in substance use between the two groups started to emerge as early as age 9 years, and the additional risk was sustained at least through age 17 years, the authors wrote. By 17 years, 73% the children of alcoholic parents had smoked cigarettes, 70% had begun drinking alcohol, and 41% had smoked marijuana, compared with 44%, 57%, and 26%, respectively, of the children from nonalcoholic homes (Drug Alcohol. Depend. 2001;65:1–8).
In addition to an increased risk for substance use in this population, there also appears to be a greater likelihood of an accelerated trajectory from onset of drinking and drug use to problem substance use, a recent study by Andrea Hussong, Ph.D., of the University of North Carolina, Chapel Hill, and her colleagues shows. Using longitudinal data from a community-based sample, the investigators conducted survival analyses and determined that children of alcoholics progressed more quickly from initial adolescent alcohol use to the onset of disorder than matched controls, even after controlling for externalizing symptoms and heavier drinking patterns at initiation. A similar “telescoping” risk was observed for drug disorders (J. Abnorm. Psychol. 2008;117:63–78).
With respect to illicit drug use, adolescent children of alcoholics who use drugs are more likely to continue doing so during their transition to young adulthood than their peers from nonalcoholic families. In a study that tracked and monitored the drug use habits of 545 adolescent children of alcoholics and demographically matched children of nonalcoholic parents for 15 years, David B. Flora, Ph.D., of the University of North Carolina at Chapel Hill, and his colleagues determined that the control group significantly decreased their drug use during this time, consistent with national data, while the children of alcoholics did not.
The findings show that “[children of alcoholics] do not typically follow the normative trend by which individuals are expected to mature out of drug use before age 30,” the authors wrote (Psychol. Addict. Behav. 2005;19:352–62).
The investigators also looked at the impact of marriage on drug use trajectories in young adult children of alcoholics and determined that “marriage mediated but did not moderate the relations between parental alcoholism and the rate of change in drug use during the transition into young adulthood and the level of drug use at ages 25 to 30.”
Although marriage predicted the amount of drug use in men 25–30 years old–about 94% of married men either remained abstinent from drugs or decreased their drug use–the children of alcoholics in this study were less likely to be married and thus not only had smaller decreases in drug use between 25 and 30, they had higher levels of drug use overall, according to the authors.
In addition to a proclivity for alcohol and drug use and abuse, children of alcoholics are at increased risk for other negative outcomes, including conduct problems, aggression, depression, and anxiety, according to the Substance Abuse and Mental Health Services Administration (SAMSHA).