By Dr Delyse Hutchinson MAPS, Dr Elizabeth Maloney, Dr Laura Vogl MAPS and Professor Richard Mattick MAPS
National Alcohol and Drug Research Centre, University of New South Wales
Adolescent drinking, particularly harmful binge drinking, has received considerable attention in the media in recent months - for good reason. Statistics show that 86 per cent of Australian students have tried alcohol by age 14, with this figure increasing to 96 per cent by age 17 years (White & Hayman, 2006). Moreover, 22 per cent of 14 year olds who are current drinkers consume alcohol at levels exceeding the Australian Alcohol Guidelines, with this figure increasing through adolescence, and peaking at 44 per cent among 17 year olds (White & Hayman, 2006). Adolescents are typically first introduced to alcohol in the family home, and those who drink regularly (weekly drinkers) report parents as their most common source for obtaining alcohol. In addition to providing alcohol to their teenagers, parents appear to influence children via their attitudes to drinking and, more directly, through the modeling of alcohol use. This article will examine the impacts of these three main areas of influence on adolescent drinking outcomes: (1) parental supply of alcohol use; (2) parental attitudes to drinking; and (3) parental modeling of alcohol use. The implications for working with parents and families to prevent adolescent alcohol misuse will also be discussed.
Parents are a major source of alcohol supply for many young Australians, and children are often first introduced to alcohol in the family home (King et al, 2005). The wisdom of introducing a young person to alcohol is contentious as research provides conflicting advice, making this a difficult decision for parents. A large body of research suggests that the younger the age at which a child or adolescent commences drinking, the greater the risk of problem drinking in the future, in addition to other negative outcomes including violence, motor vehicle accidents, memory loss, high risk sexual behaviour and physical injury (Clark et al, 2004). However, recent research shows that this relationship disappears once other factors are taken into account such as whether the adolescent becomes intoxicated at first use, family history of alcohol abuse, and delinquency (Warner & White, 2003). There is also evidence from Mediterranean countries, where alcohol is integrated into everyday life and served at the dinner table, that young people become intoxicated less frequently than in countries where alcohol is consumed less frequently but at higher levels (e.g., Nordic countries).
The jury is still out on whether parents should supply their children with alcohol. However, what does seem clear is that if adolescents consume the alcohol in the presence of their parents they are more likely to drink at lower risk levels, whereas if consumed in the absence of their parents and at parties, they are more likely to consume alcohol at higher risk levels.
Parental attitudes toward drinking represent an indirect means of social modeling and may be communicated either overtly or tacitly through the setting of limits or communication of values regarding alcohol use by parents. Research has found that parents who drink alcohol are more likely to exhibit permissiveness toward alcohol use in their adolescent children (Hayes et al, 2004). Parents' permissiveness regarding alcohol use appears to be influential in determining adolescent alcohol initiation and the later transition to heavier drinking.
One of the key risk factors for adolescent alcohol use problems is the presence of alcohol use problems among parents. Studies have consistently found that parents' own use of alcohol increases both the likelihood that their adolescent children will engage in alcohol use and the risk for more significant alcohol-related problems (Hayes et al, 2004). It is likely that many inappropriate and harmful patterns of drinking are learned in the family. Children exposed to alcohol at home also tend to initiate alcohol use earlier and engage in problem drinking at a younger age than non-exposed children (Bonomo et al, 2001).
Research has also demonstrated that less problematic, but frequent parental drinking is associated with negative adolescent outcomes. For example, data from the Australian Mater University birth cohort study show that maternal drinking (more than one glass of alcohol a day), assessed when the adolescent offspring were age 14, was a strong predictor of alcohol use disorder in children at age 21, even after controlling for a range of biological, familial and interpersonal factors (Alati et al, 2005). While genetic and environmental components may contribute to such problems, social learning is also likely to be an important determining factor.
The research described above suggests that interventions which delay adolescent initiation or experimentation with alcohol and limit the progression to regular use, misuse and disorder, may be particularly salient in the prevention of alcohol problems. In 2003, the Cochrane consortium conducted a review of primary prevention programs for alcohol misuse among adolescents (Foxcraft et al, 2003). This review found that only three out of 56 studies examined demonstrated effective long-term benefits in alcohol reduction. One of the programs that showed the strongest effects was the Strengthening Families Program (SFP). The SFP is a well-researched family program developed in the United States that aims to prevent the initiation of alcohol use in adolescents. It is a universal program for widespread application with parents and children in the general community. The program comprises seven once-a-week sessions for 10 to 14 year olds, which aims to enhance parental skills in nurturing, communication, and limit-setting, in addition to youth pro-social and peer resistance skills. The effectiveness of the SFP was tested among 446 families who were randomly allocated to treatment and control groups (Spoth et al, 1999). At the time of the intervention the children were in sixth grade. At the 1-year follow-up, significantly fewer children in the intervention group had initiated alcohol use compared with children in the control group. This treatment effect remained evident at the 2-year follow-up.
Parents often express anxiety and confusion about how to address and manage drug and alcohol issues with their adolescent children. There are a number of important recommendations that can be made based on the research literature to help guide parents and families. Children are usually first introduced to alcohol in the family home, so it is important that parents are aware of the opportunity for prevention and management. Educating parents on the harms associated with early initiation to alcohol use is important considering there is no minimal legal age of consumption in Australia which prohibits the supply of alcohol to minors by parents in their own home. In working with parents and families concerned about how to introduce their children to alcohol, the research suggests that delaying initiation is advisable. Of course, there will always be children that are likely to consume alcohol irrespective of their parent's wishes. If this is the case, it is important for parents to realise that their child is far more likely to drink at low-risk levels if under their supervision than elsewhere. Likewise, parents should be advised of the important influence that both their own attitudes toward alcohol and their drinking patterns can have on children's drinking via modelling, socialisation and limit-setting. Providing clear direction to parents about how they can modify their own behaviour to prevent the development of alcohol problems in children is therefore important. Such interventions could include encouraging parents not to drink large amounts of alcohol in front of their children, confining alcohol use to times when children are not present to reduce exposure, and, if drinking in front of children, to drink moderately with food and water to model more responsible drinking patterns. In addition to these influences, guiding parents toward setting appropriate boundaries and limits on adolescent drinking is advised (e.g., supervising adolescent social activities, particularly events such as parties where alcohol is often introduced by peers).
Research clearly tells us that intervening early with families is better than waiting until problems have developed. This may mean raising concerns with families presenting for assistance with other issues, particularly those that may be indicative of the developmental trajectory often associated with later alcohol misuse. Successful intervention programs such as the SFP also highlight the need to assess and address not only parenting influences, but other factors that tend to co-occur, especially in families with adolescents at higher risk for alcohol problems. Such issues might include parent-child relational problems, child and adolescent externalising behaviour, and involvement in deviant peer friendship cliques. Connecting parents who are themselves experiencing significant alcohol or drug problems with treatment services is also a critical step to reduce the risk of children later developing drug and alcohol or other psychological problems.
The principal author can be contacted at email@example.com.
|Recommendations for parents|
Alati, R., Najman, J. M., et al. (2005). Early predictors of adult drinking: A birth cohort study. American Journal of Epidemiology, 162(11), 1098-1107.
Bonomo, Y., Coffey, C., et al. (2001). Adverse outcomes of alcohol use in adolescents. Addiction, 96(10), 1485-1496.
Clark, T., Denny, S., et al. (2004). Alcohol and New Zealand youth: A snapshot of young people's experiences with alcohol: Findings of Youth 2000 (a national secondary school youth health survey). Auckland: Adolescent Health Research Group, University of Auckland.
Foxcraft, D., Ireland, D., et al. (2003). Primary prevention for alcohol misuse in young people. The Cochrane DataBase of Systematic Reviews, Issue 3. Article No.: CD003024. DOI: 10.1002/14651858.CD003024.
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