Risks for Alcohol Dependence in Older Adolescence Abbie K. Frost, Ph.D. Simmons College School of So

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Risks for Alcohol Dependence in Older
Adolescence Abbie K. Frost, Ph.D.Simmons
College School of Social Workfrost_at_simmons.edu

• Society for Social Work Research
  January
  16, 2004
• New Orleans, Louisiana
• Supported by National Institute of Mental Health
  R01 MH41560

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Alcohol Usein Older Adolescence

• Alcohol is the highest used substance in
  adolescence. By 12th grade
• 80 report using alcohol
• 31 have recently engaged in heavy episodic
  drinking
• 4 drink daily
• Johnston et al., 1998

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Alcohol Disordersin Older Adolescence

• Alcohol disorders place adolescents at higher
  risk in several areas
• anti-social behavior Chassin Delucia, 1996
• poor current functioning Chassin Delucia,
  1996
• poor academic performance Costa et al., 1997
• difficulties in early adulthood Kandel et al.,
  1986

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Development of Alcohol Disorders in Older
Adolescence

• While many youth use alcohol, fewer develop
  alcohol disorders. Colder Chassin, 1999
  Lewinsohn et al., 1993
• What factors are linked to the
• development of alcohol disorders
• in adolescence?

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Limitations of Prior Research

• There is an extensive literature on describing
  factors linked with use less describes factors
  linked with alcohol disorders. Dobkin et al.,
  1995
• The etiology of alcohol disorders may be
  different.

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Limitations of Prior Research

• Few multiple assessments of risk factors over
  time
• Small subsets of risk factors are examined
• Very few longitudinal studies exist.

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Factors linked to alcohol problems in adolescence

• Illegal use of substance
• Earlier use of alcohol Hawkins et al., 1997
• Prior use of cigarettes Hawkins et al., 1997
• Family Environment
• Family history of psychopathology or substance
  abuse Hawkins et al., 1997
• Family disruptions Colder Chassin, 1996

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Factors linked to alcohol problems in adolescence

• Problem Behavior
• Engaged in problem behavior
• Barnes et al., 1993
• Associations with peers who engage in problem
  behavior Hawkins et al., 1997
• Poor social competence Colder Chassin, 1999
• Poor academic performance Colder Chassin, 1999

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Study Objective

• To fill gaps in current knowledge
• To describe alcohol dependence in older
  adolescence by age 18
• To examine early risk factors ages 5 9
• that are present prior to the onset of alcohol
  dependence
• Prior illegal use of substances
• Family characteristics
• Behavioral/emotional characteristics
• Problems in academic settings

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Research Question

• What are early childhood risk factors for alcohol
  dependence in older adolescence?

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Study MeasuresAlcohol Dependence

• DSM-III-R diagnosis, lifetime alcohol dependence
  by age 18
• Alcohol dependence includes a cluster of symptoms
  that
• Identify physical dependence on alcohol
• Increased importance of alcohol consumption
• Impaired control over drinking behavior

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Study MeasuresEarly Risk Factors

• (1) Illegal substance use
• (2) Family Characteristics
• (3) Emotional/Behavior Characteristics
• (4) School/Academic Performance

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Risk Factors(1) Prior Illegal Use of Substances

• Early use of alcohol or other drugs
• Prior use of cigarettes

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Risk Factors(2) Family Characteristics

• Family History by age 15
• Psychopathology of family members
• Substance abuse disorders of family members
• Family Composition ages 5 9
• Low family SES
• Single parent household

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Risk Factors(2) Family Characteristics

• Disruption in Family Environment by age 9
• Parental divorce/separation
• Remarriage of parent
• Perception of Role in Family age 9
• Family Violence by age 14

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Risk Factors(3) Emotional Behavioral
Characteristics

• Mother reports ages 5 9
• Anxious/Depressed behavior
• Hostile/Aggressive behaviors
• Poor peer relations

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Risk Factors(3) Emotional Behavioral
Characteristics

• Self report age 9
• Lower anxiety/depressed behavior
• Popularity with Peers
• DIS-III-R Diagnosis by age 14
• Psychiatric diagnosis prior to onset of alcohol
  dependence

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Risk Factors(4) Academic/School Problems

• Child Assessment age 5
• Cognitive Readiness
• Information processing
• Mother report age 9
• Problem behavior

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Risk Factors(4) Academic/School Problems

• Teacher report age 9
• Low productivity
• Hostile behaviors
• Behavior problems
• Poor peer relations

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Sample Description
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Sample Description

• Alcohol Dependence
• 259 (70.2) did not meet criteria
• 110 (29.8) met lifetime criteria for alcohol
  dependence by age 18

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Current Functioning

• Odds Ratios
• Arrested
• 11.86 (4.7-30)
• Suicidal Ideation
• 2.35 (1.4-3.6)
• Expelled/suspended
• 2.25 (1.4-3.6)

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Research Question

• What are early childhood risk factors for alcohol
  dependence in older adolescence?

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Family Factors By Age 9
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Family Factors Age 9
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Emotional/Behavioral Factors Age 5
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Emotional/Behavioral Factors Age 9
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Emotional/Behavioral Factors Age 9
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Emotional/Behavioral Factors By Age 14
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Academic/School Factors Age 5
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Academic/School Factors Age 9
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Family Risk Factors

• By Age 9
• Parents Remarriage (boys only)
• Age 9
• Violence in the Family (girls only)
• Perception that She is Not
• Important in the Family (girls only)

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Emotional/Behavioral Risk Factors

• Age 5
• Less anxious/depressed
• (both boys girls)
• parent report
• Less fearsome of
• new things (both boys girls)
• parent report

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Emotional/Behavioral Risk Factors

• Age 9
• More hostile behavior (boys only)
• parent report
• Less anxious/depressed (both boys girls)
• child report
• Less hostile behavior (girls only)
• parent report
• Poor peer relations (boys only)
• parent report

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Emotional/Behavioral Risk Factors

• By Age 14
• Onset of psychiatric diagnosis BEFORE onset of
  alcohol dependence
• (boys only)
• self report

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Academic/School Risk Factors

• Age 5
• Higher proficiency in verbal reasoning
• (girls only)
• By Age 9
• Received school-based services (boys only)
• Age 9
• Problem behavior at school (boys only)
• parent report

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Implications for Services

• Prevention early intervention efforts are
  needed to identify children at risk for
  developing a dependence on alcohol by their
  adolescent years.
• These efforts need to consider the unique as well
  as shared needs of boys and girls.

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Implications for Services

• Broad-based efforts are needed, targeting family
  factors, a childs emotional/behavioral problems,
  and childs performance (academically and
  socially) in school settings.
• Parent involvement is critical.
• (Family matters!)

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Implications for Research

• More longitudinal research is needed that can
  examine risk factors along multiple domains,
  across multiple time periods, with multiple
  informants.