Psychosocial Factors in Alcohol Use and Alcoholism

1 Psychosocial Factors in Alcohol Use and Alcoholism181 There is no single, simple explanation for whysome individuals develop problems with of the central findings of the large body ofresearch that has examined the psychosocialcauses, or etiology, of Alcohol use is that there are multiple pathways to behavior that involvesalcohol consumption (Cloninger et al. 1996; Sher et al. 1997; Zucker et al. 1994). Multiplebiological and Psychosocial Factors mutuallyinfluence each other in causing Alcohol abuse; it would be incorrect to view Psychosocial causesas either independent from, or competing with,biological causes. Rather, Alcohol use andalcoholism are best viewed as end products of a combination of biopsychosocial face the challenge of explainingdiverse Alcohol -related behavior ranging fromsimple Alcohol experimentation to severe alcoholdependence.

2 Clearly, different Factors may in-fluence different aspects of drinking, such asinitial experimentation, later maintenance ofregular drinking, and the decision to stop drink-ing. Not only is Alcohol use different fromalcoholism, but Alcoholism itself takes differentforms; researchers have suggested that differentsubtypes of Alcoholism may have differentetiologies (Cloninger et al. 1996; Zucker et ).This section is not intended as a comprehensiveoverview of Psychosocial research, but insteadfocuses on research that has been conducted sincethe Ninth Special Report to the Congress onAlcohol and Health(National Institute on AlcoholAbuse and Alcoholism [NIAAA] 1997) in fourareas: family history of Alcoholism , develop-mental issues, motivations, and Alcohol -relatedcognitions (beliefs about Alcohol ). Recentresearch into the causes of Alcoholism emphasizesthe links between biological and psychosocialvariables rather than studying each in hypothesize, for example, that inchildhood, biologically based vulnerabilities inemotional and behavioral regulation (tempera-ment or personality) interact with poor parentingto create emotional distress and exposure to nega-tive peer influences, both of which create risk foralcohol , environment encompasses a wide range ofinfluences, including not only family and peers,but also culture, social forces, advertising, andeconomics.

3 Other sections of this report discussthese History of AlcoholismIt has long been recognized that Alcoholism runsin families. A family history of Alcoholism is awell-established risk factor for the development ofalcoholism (Cotton 1979; McGue 1994). None-theless, the majority of children of alcoholics donot develop Alcohol use disorders. In fact, there isgreat variation among children of alcoholics withregard to their use of Alcohol , and recent researchhas been directed at explaining this Ninth Special Report to the Congress on Alcohol and Health(NIAAA 1997) identifiedseveral ways in which children of alcoholics havebeen found to differ from children without afamily history of Alcoholism . These findingsinclude a higher prevalence of psychopathology(mental and behavioral disorders), more adversefamily environments, and physiologic responses to Alcohol that are known to be associated withrisk in particular, a lack of sensitivity toalcohol s intoxicating effects or an increasedsensitivity to its anxiety-reducing effects.

4 It isimportant to note that these characteristics arenot unique to children of alcoholics, and that thesame Factors that mediate risk of developingalcohol problems in children with a family historymay also explain the risk faced by those without afamily history (Molina et al. 1994). Models thatseek to explain how these risk Factors interact Psychosocial Factors in Alcohol Use and Alcoholism182 Chapter 3: Genetic and Psychosocial Influencesto lead to Alcohol -related problems suggest thatchildren of alcoholics are exposed to higher levelsof these risk Factors than are other , research aimed at clarifying whychildren of alcoholics are more likely than othersto develop Alcohol problems can reveal muchabout how the same risk Factors are at play inchildren without a family of Parental Psychopathology Other Than AlcoholismOne source of the variation in the outcomes of children of alcoholics that is, whether theydevelop Alcohol -related problems themselves isthat familial Alcoholism occurs in different have identified subtypes of alcoholismthat are characterized by the type and degree ofpsychopathology associated with the alcoholabuse in particular, antisocial personality andaffective (mood)

5 Disorders such as studies suggest that the type of alcoholicsyndrome present in the family influences thechild s risk of having psychological characteristicsassociated with risk for , for example, a research team identifiedthree subtypes of familial Alcoholism risk: onewith familial Alcoholism but low levels of otherpsychopathology; one with high levels of bothfamilial Alcoholism and familial antisocial per-sonality and violence; and one with high levels of familial Alcoholism along with depression,mania, and anxiety disorders (Finn et al. 1997).Predictably, young adult offspring from thefamilies with Alcoholism had elevated levels ofalcohol problems compared with peers with nofamily history of Alcoholism . In addition, otherdifferences in offspring among the families werenoted; for example, offspring of the families withalcoholism and antisocial personality themselveshad the highest levels of antisociality and negativeaffect (anxiety, depression, and neuroticism)compared with offspring in the other (alcoholic) findings emerged from a communitysample of younger children (preschool throughage 8) (Zucker et al.)

6 1996). In a comparison ofchildren of families without Alcoholism , familieswith Alcoholism , and families with coexistingalcoholism and antisocial personality disorder,children whose families showed both alcoholismand antisociality had the highest levels of riskfactors for developing Alcohol problems poorfamily environments and conduct problems and were also most likely to maintain this riskover the Effects of Parental Alcoholism :Mediational ModelsEarly research on risk Factors in Alcoholism tendedto examine each one in isolation. A study might,for example, focus on one risk factor and attemptto identify differences between children of alco-holics and other children, the hypothesis beingthat the presence or absence of this single riskfactor might explain why children of alcoholicsthemselves develop more recent trend has been the attempt tounderstand the mechanisms or processes thatunderlie the effects of parental Alcoholism andthe associated risk Factors on children.

7 Animportant approach involves the developmentand testing of mediational models,such as thosedescribed below, that provide an overall concep-tion of how particular risk Factors play out in thelives of the individuals affected to result in alcoholuse or abuse. A test of the validity of a media-tional model must include a demonstration thatthe risk factor is a feature of parental Alcoholism ;that individuals who show the highest level of therisk factor are most likely to develop drinkingproblems; and that this risk factor accounts forthe effects of parental Alcoholism on the develop-ment of drinking problems in their children (formore detail on mediational models, see Sher1991). Recent advances in statistical methodsallow tests of these have been three broad groups of theoreticalmodels that provide platforms for exploring thetransmission of Alcoholism from parent to child: deviance proneness, negative affectivity (oremotionality), and sensitivity to the effects ofalcohol.

8 These hypothetical models, discussedbelow, are not mutually exclusive, but areinterrelated and Factors in Alcohol Use and Alcoholism183 Deviance deviance pronenessmodel focuses on deficits in children in behavioralself-regulation and socialization and on the cas-cade of effects that result from and interact withthese deficits. According to this model, childrenof alcoholics have difficult temperaments andexperience poor parenting, both of which placethem at risk for failure in school and emotionaldistress. This, in turn, raises risk for affiliationwith a deviant peer group likely to promotealcohol use and misuse. Thus, according to thismodel, risk for Alcohol misuse is part of a largercontext of poor socialization and adolescentproblem data are consistent with this model. Forexample, one study found that offspring of alco-holic fathers were more likely to abuse substances,in part because paternal Alcoholism increased the likelihood of a child s having early conductproblems (Cadoret et al.)

9 1995). Similarly, havingan alcoholic father was found to be related topoor parental monitoring of adolescent behavior,which, in turn, was associated with membershipin a drug-using peer group and escalating sub-stance use over time. However, in both studies,the effect of paternal Alcoholism could not becompletely explained by these mediators,suggesting that other variables also must negative affectivity modelfocuses on the importance of stress and negativeaffect in explaining the transmission of alcoholismfrom generation to generation. According to thismodel, children of alcoholics are exposed to highlevels of life stress and are, as well, temperamen-tally hyperreactive to stress. These childrendevelop high levels of emotional distress anddrink to relieve these feelings. Again, recent testsof this model provide supportive data. In onestudy, researchers found that the environments of adolescent children of alcoholics were morestressful than those of other children, and thatgreater emotional reactivity was part of theirtemperaments.

10 Both Factors predicted morenegative affect self-reported crying and tension,for example among these children than amongchildren without a family history of Alcoholism (Chassin et al. 1996). In turn, children in thestudy with high levels of negative affect weremore likely than other children to join a drug-using peer group and to increase their substanceuse over study found paternal Alcoholism to bestrongly associated with childhood stressors (forexample, disrupted family rituals, embarrassment,neglect, or abuse). However, these stressors wereonly moderately and inconsistently related to thedevelopment of an Alcohol use disorder in youngadulthood (Sher et al. 1997). In both studies, thestressors only partly explained the effects ofpaternal Alcoholism on the outcomes for children,again suggesting that other mediators must to the Effects of Alcohol .