Alcohol Use in Adolescents Whose Fathers Abuse Drugs

Alcohol Use in AdolescentsWhose Fathers Abuse Drugs

David W. Brook, MDJudith S. Brook, EdD

Elizabeth Rubenstone, BAChenshu Zhang, MAMerrill Singer, PhD

Michael R. Duke, PhD

ABSTRACT. This study examined the interrelation of several domains,including father attributes, father-child relations, peer influences, environ-mental factors, and youth personality, as they related to adolescent alcoholuse. Several aspects of the father-child relationship were also examined aspossible protective factors against adolescent drinking. Subjects consistedof 204 HIV-positive and HIV-negative drug-abusing fathers and their ado-lescent children between the ages of 12-20. Data were collected via indi-vidual structured interviews of both the fathers and the youth. Resultsindicated that several items from each domain were related to adolescentdrinking, and that an affectionate father-child bond had a protective effect.

David W. Brook, Judith S. Brook, Elizabeth Rubenstone, and Chenshu Zhang are af-filiated with the Mount Sinai School of Medicine, Department of Community and Preven-tive Medicine, New York, NY.

Merrill Singer and Michael R. Duke are affiliated with the Hispanic Health Council,Hartford, CT.

Address correspondence to: Elizabeth Rubenstone, Mount Sinai School of Medicine,1 Gustave L. Levy Place, Box 1044B, New York, NY 10029 (E-mail: [email protected]).

The authors are grateful to the anonymous reviewers for their helpful suggestions, andto Linda Capobianco for her assistance with manuscript preparation.

This work was supported by grants DA 09950 and DA 11116 from the National Insti-tute on Drug Abuse, and by Research Scientist Award DA 00244 to Dr. Judith S. Brook.

Journal of Addictive Diseases, Vol. 22(1) 2003http://www.haworthpressinc.com/store/product.asp?sku=J069

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Moreover, hierarchical regression analyses demonstrated that the youth’spersonality mediated between all other domains and adolescent alcoholuse. There was also a direct effect of peer influences on adolescent drink-ing. Findings extend the literature on the specific mechanisms which linkparental substance use with adolescent alcohol use in a high-risk popula-tion. [Article copies available for a fee from The Haworth Document Delivery Ser-vice: 1-800-HAWORTH. E-mail address: <[email protected]>Website: <http://www.HaworthPress. com> 2003 by The Haworth Press, Inc.All rights reserved.]

KEYWORDS. Adolescent alcohol use, high-risk youth, parental sub-stance use, fathers, HIV-affected children

ALCOHOL USE IN ADOLESCENTSWHOSE FATHERS ABUSE DRUGS

Evidence continues to accumulate that children in families where there is sub-stance abuse, including alcohol, have a number of difficulties.1,2 The rate ofexternalizing and internalizing problems in children of substance abusers appearsto be high.3,4 Several investigators report that children of drug and/or alco-hol-abusing parents exhibit elevated rates of delinquency,5 oppositional defiantand conduct disorders,4-6 anxiety,7 and depression.3,8 In general, prior researchhas also found both increased drug9 and/or alcohol use,10,11 as well as early onsetof these problems12 in the offspring of substance-abusing parents. In addition, in-jection drug use has become one of the primary routes of HIV transmission13,14

and an increasing number of drug-using parents have, or are at risk for contract-ing, HIV.15 Nevertheless, there is a dearth of empirical studies that examine theimpact of parental drug abuse and HIV status on their adolescent children.16 Thisstudy examines a network of paternal and adolescent factors related to the adoles-cent’s alcohol use. Moreover, to our knowledge, this is the first study designed toexamine the interrelation of the domains of father attributes (personality traits,HIV status, drug and alcohol use), father-child relations, adolescent personality,peer influences, and ecological factors as they relate to adolescent alcohol use.

Specifically, we propose that the interrelation of these domains consists of thefollowing linkages: (1) The hardships with which the father must deal as a resultof his HIV status,17 as well as his drug and/or alcohol-prone attributes, are associ-ated with disruption in the father-child relationship;18-20 (2) These father-adoles-cent processes are related to the adolescent’s association with alcohol anddrug-using friends and the adolescent’s development of alcohol-prone personal-ity attributes; (3) These factors, in turn, have a direct effect on the adolescent’suse of alcohol;21 (4) Environmental factors may also be associated with adoles-cent drinking through the mediation of the youth’s personality. Figure 1 provides

12 JOURNAL OF ADDICTIVE DISEASES

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an overview of the conceptual model guiding the research and based on the hy-pothesized linkages. Aspects of the model predicting adolescent alcohol use areconsistent with the work of other investigators, including Johnson and Pandina,18

Webb and Baer,19 and Hussong et al.22 The results of a study by Brook et al. werealso consistent with the model presented in Figure 1.23

Father Attributes

The conceptual model (see Figure 1) proposes that paternal drug and alcoholuse, as well as having HIV or fear of contracting HIV, are linked with the fatherbeing depressed, demoralized, pessimistic about the future, and generally lessemotionally stable.24,25 Depressed mood and emotional instability in the fatherwere expected to influence his behaviors and adversely effect the development ofhis adolescent child, ultimately affecting the latter’s alcohol use.26 There is someempirical evidence to support these hypothesized processes. Both experimentaland naturalistic studies of depressed affect have suggested that depressed mood isassociated with irritable or hostile behavior toward individuals with whom one isclose, as well as difficulty in establishing and maintaining socially skilled behav-iors such as effective parenting practices.27 Our conceptual model (Figure 1) isbased on the expected association between certain of the father’s attributes (e.g.,depression and fear of contracting HIV) and his difficulty in enacting skilledparenting practices. This line of reasoning is in accord with Patterson et al.28 whoposit that adverse family conditions have an impact on adolescent childrenthrough the disruption of the parent-child attachment relationship. Also in sup-port of aspects of the postulated model, Brook et al. found that parental drug useadversely effected several components of the parent-child relationship.29

Brook et al. 13

FatherAttributes

FatherChild Rearing

Ecology

AdolescentPersonality

PeerAlcohol

andDrug Use

AdolescentAlcohol

Use

FIGURE 1. Hypothesized model.

Father-Child Relationship

We further predicted that a close father-child relationship would be importantin linking earlier steps in the model (e.g., paternal attributes) to the youth’s per-sonality and eventual alcohol use. The parent-child attachment relationship con-sists of the following three dimensions, which prior research has found to have apositive influence on adolescent development and to be related to decreased ado-lescent alcohol use: (a) a close and affectionate mutual attachment relationshipbetween the father and child, which includes paternal warmth and the child’sidentification with the father;18,30 (b) control techniques which are appropriateand designed to provide the youth with structure regarding his or her alcoholuse;20,28,31 and (c) time spent with the child.21 As noted by Jacob and Johnson,32

the father-child relationship is expected to be related to adolescent personality at-tributes.

Adolescent Personality Attributes

The domain of adolescent personality attributes is organized around four di-mensions related to drinking: unconventional behavior, intrapersonal distress,poor emotional control, and problem behavior.33,34 Numerous investigators havereported that adolescent alcohol use is related to unconventional behavior such asrebelliousness.33,35 Maladaptive coping techniques have also been found to berelated to the adolescent’s use of alcohol,36 as have problem behaviors. For ex-ample, several studies have shown that delinquency and the use of illegal drugsare associated with increased alcohol use by adolescents.1,37 Adolescent person-ality attributes are expected to have a direct effect as well as an indirect effect(through the adolescent’s peer interactions) on adolescent drinking.

Peer Group

The peer group is of significance in adolescent alcohol use because beer, wine,and hard liquor are frequently part of social gatherings or parties.38 The peergroup has been cited in numerous studies as one of the most important predictorsof adolescent drinking behavior.33,39,40 In this study, we hypothesize that the peergroup will have both direct and indirect effects on the adolescent’s use of alcohol.We expect direct effects to arise through role modeling of peer drinking.41 As re-gards indirect effects, involvement in groups composed of peers who are deviantand drink is likely to influence the personality attributes of the adolescent (e.g.,unconventionality), which, in turn, will be associated with his or her alcohol use.


Environmental Factors

The environmental risk factors used in this study are drawn from the frame-work of family interactional theory,42 and are consistent with variables used byother researchers.43,44 The environmental factors that we analyzed include dis-crimination,45 victimization,46 and low school satisfaction.47 The environmentaldomain is expected to have an indirect effect on adolescent alcohol use throughthe mediation of the adolescent’s personality.

Interactions

As previously noted, paternal drug and/or alcohol use are risk factors for alco-hol use in the adolescent. According to family interactional theory, however, aclose father-child bond is capable of offsetting paternal risk factors for his child’sproblematic behaviors.42 There is also support in the literature for the role of thefather in buffering adversity in his offspring’s life.20 Therefore, in line with afamily interactional perspective, we examined the protective aspects of the fa-ther-child relationship that lessen the influence of the father’s drug and/or alcoholuse on the adolescent’s use of alcohol.

In contrast to contemporary emphases on the mother in this area of research,we tested the empirical adequacy of our hypothesized model with adolescentswhose fathers are HIV-positive and HIV-negative drug abusers. In addition, weused a study design that incorporates responses from both father and child. Anadvantage of this procedure is that it helps to correct for single-respondent biasesin the study of father-adolescent relations.

In sum, the present study is designed to assess the following hypotheses:(1) Adolescent alcohol use is related to the father’s attributes (e.g., HIV status,drug and/or alcohol use, impulsivity), difficulty in the father-child relationship(e.g., less warmth and structure), and adolescent alcohol-prone personality attrib-utes (e.g., delinquency, maladaptive coping, and affiliation with alcohol-usingpeers); (2) The mediational model depicted in Figure 1 is valid; and (3) The influ-ence of father drug and/or alcohol use can be offset by a positive father-child rela-tionship.

METHODS

Participants

The sample consisted of 204 HIV-positive and HIV-negative drug-using fa-thers and their adolescent children. About one-half of the group (N = 102) was re-cruited from a variety of outpatient substance abuse and AIDS treatment

Brook et al. 15

programs in New York City, San Francisco, and Connecticut. The other half ofthe group was recruited from the general community through newspaper adver-tisements and flyers posted in these same cities. (There was no interaction be-tween the independent variables and treatment site, length of treatment, or type oftreatment, as they impacted on the adolescent’s alcohol use.) Only those malevolunteers who agreed to be interviewed along with one of their 12-20 year-oldchildren were recruited for participation. In order to qualify for the study, the meneither had to be living with the child participant (49%) or had to have had sub-stantive contact with the child at least four times in the past year (51%). Fifty-onepercent of the interviewed families had two parents living together (33% had twomarried parents, and 18% were cohabiting); 49% of the total sample were sin-gle-parent families.

All fathers had a history of either injection drug use (76%) or drug abusethrough another route of administration (24%) during the past five years. Each fa-ther participant voluntarily reported his own HIV status. Thirty-eight percent ofthe fathers identified themselves as HIV-positive, and 62% identified themselvesas HIV-negative. None of the adolescents were HIV-positive.

The ethnicity of the father-child pairs was as follows: 60% African-American,22% (non-Hispanic) Caucasian, and 18% Hispanic. The average age was 42years for the fathers (SD = 5.77), and their median educational level was the com-pletion of high school or obtaining a GED. Occupational analyses indicated that46% of the fathers had been employed in semi-skilled or unskilled work. At thetime of the interview, 21.6% of fathers were working full time, and 15.2% of thefathers were working part time. The remainder of the fathers (63.2%) were unem-ployed, looking for work, keeping house, or in treatment. Their median house-hold income was $11,000 per annum.

Prospective father participants were excluded from the study if (a) they hadAIDS dementia; (b) they were too sick to participate; or (c) they had a major psy-chiatric illness, such as bipolar disorder or schizophrenia. Less than 5% of poten-tial participants were excluded based on the latter criterion, and none wereexcluded for the other criteria. The average age was 16 years for the adolescents(SD = 2.7), 48% of whom were boys and 52% of whom were girls. The medianeducational level for the adolescents was the ninth grade.

Procedure

Each pair of fathers and adolescents was administered individual structuredinterviews by trained interviewers. The fathers and adolescents were interviewedseparately and in private, and each interview took approximately 2 hours. Sub-jects were paid for their participation in the study. Written, informed consent wasobtained in keeping with institutional and federal guidelines for the protection of


human subjects. IRB approval was obtained, as was a Certificate of Confidential-ity, prohibiting access to interview information.

Measures

The interview consisted of a number of widely-used scales assessing fatherand adolescent personality characteristics (e.g., depression, delinquency), fatherdrug and/or alcohol use and HIV status, the father-child relationship (e.g.,warmth), peer influences (such as involvement in deviant behaviors), and envi-ronmental factors (e.g., perceived discrimination). These scales were grouped intothe following domains: father attributes, father-adolescent relations, adolescentpersonality traits, peer influences, and environmental factors. The validity of themeasures that we used has been demonstrated by prior research, which foundthese measures to be predictive of alcohol use, drug use, delinquency, andpsychopathology.8,18,48 Although our study examined numerous scales, we se-lected these scales based on factors expected to relate to adolescent alcohol use,according to our previous work and that of other investigators.11,21,39,41-43,45 Thescales, sample items and Cronbach alphas for the measures appear in Table 1.The Cronbach alphas for these measures were satisfactory.

The dependent variable, frequency of adolescent alcohol use, was a compositeindex derived from two questions. The first question dealt with the frequency ofthe adolescent’s use of beer and wine during the past year. The other question as-sessed the frequency of the adolescent’s use of hard liquor during the past year.The response range for each alcohol item was from never (1) to 3 times a monthor less (2), to one to several times per week (3), to 1 or 2 drinks every day (4), tothree or more drinks daily (5). The mean and SD for adolescent alcohol use were3.2 and 1.5, respectively. The inter-item correlation and Cronbach alpha for the

alcohol use scale were both found to be satisfactory (r = 0.67; α = .80). This scalehas been shown to have test-retest reliability, and to predict alcohol dependence,in our previous epidemiological studies on adolescents in upstate New York (N =750) and in Colombia, South America (N = 2,226), respectively. In addition, asimilar measure of alcohol use has been employed by other researchers and foundpredictive of alcohol problems.58

RESULTS

Our first step was to examine the interaction between the father and adolescentvariables with the demographic variables (gender and age of the adolescent, fa-ther’s education, father presence in the home, and paternal HIV status). Less thanfive percent of the interactions were significant and no discernible patternemerged. We then conducted a set of t-tests comparing the HIV-positive andHIV-negative fathers and each of the independent variables with respect to the

Brook et al. 17


TABLE 1. Cronbach Alphas for Father and Adolescent Scales (N = 204)

Scales(Scale Source)

Sample Item Cronbach Alpha

Dependent Variable

Adolescent alcohol use During the past year, how often did you drinkbeer or wine?

0.80(Brook & Brook, 1985)49

Father Attributes

HIV status Do you think you might have the AIDS virus? NA (single item scale)(Original)

Alcohol use (last year) In the past year, how often did you drink beer orwine?

0.82(Original)

Drug use (last year) In the past year, how often did you use cocaineor crack?

0.61(Brook et al., 1990)42

Depression Over the past few years, how much were youbothered by feeling blue?

0.78(Derogatis et al., 1974)50

Coping You often feel helpless in dealing with theproblems in life.

0.54(Pearlin, Menghan,Lieberman & Mullan, 1981)51

Impulsivity You often do things quickly without stoppingto think.

0.67(Gough, 1957; Jackson,1974)52,53

Delinquency How often have you been arrested or convictedfor destroying public or private property?

0.71(Original)

Father-Child Relations

Warmth You frequently show your love for your child. 0.71(Schaefer, 1965)54

Time spent Overall, how much time do you spend doingrecreational things with your child?

0.76(Original)42

Identification How much do you admire your father in his roleas a parent?

0.88(admiration and emulation)(Brook et al., 1990)42

Advocates alcohol to cope You tell your child it’s okay to drink beer,wine or hard liquor to deal with the threatof your getting or having AIDS?

NA (single item scale)(Wills, 1985)55

Rules about alcohol use Do you have definite rules for your childabout not drinking alcohol?

NA (single item scale)(Original)

Father drinks with his child Have you ever drunk beer, wine or hardliquor with your father?

0.75(Brook et al., 1990)42

adolescents’ alcohol use. No significant differences were found between the twogroups. Therefore, we based the analysis on the combined sample and controlledfor the adolescents’ age and sex and the fathers’ education and presence in thehome.

Brook et al. 19

Scales(Scale Source)

Sample Item Cronbach Alpha

Adolescent Personality

Marijuana use During the past year, how often did you usemarijuana or hashish?

NA (single item scale)(Brook et al., 1990)42

Depression During the past year, how much were youbothered by feeling hopeless about the future?

0.64(Derogatis et al., 1974)50

Object relations The advice of others quite often helps you tothink better.

0.66(Jackson, 1974)53

Impulsivity You often do things quickly without stoppingto think.

0.58(Gough, 1957;Jackson 1974)52,53

Delinquency How often have you taken something notbelonging to you worth more than $20.00?

0.75(Jessor & Jessor, 1977)56

School perception or How often do you feel interested in yourschoolwork?

0.37academic achievement(Brook et al., 1990)42

Peer InfluencesPeer alcohol use How many of your friends drink alcoholic

beverages (beer, wine, hard liquor) at least oncea week?


Peer marijuana use How many of your friends use marijuana at leastonce a month on average?


Peer other illicit drug use How many of your friends useamphetamines, barbiturates, cocaine, LSD,heroin, Quaaludes or tranquilizers?


Peer achievement How many of your friends get all A’s and B’sin school?

0.63(Brook et al., 1990)42

Environmental FactorsDiscrimination Have you personally experienced discrimination

when walking in a neighborhood?0.79

(Original)

Victimization How often has someone beat you up orthrew something at you?

0.79(Rodriguez, 1989)57

School satisfaction Do you feel you are getting opportunities todevelop your skills and abilities?

0.78(Original)

*p < 0.05; **p < 0.01; ***p < 0.001

Table 2 presents the Pearson correlation coefficients between the respectivefather and adolescent scales and the dependent variable of adolescent alcoholuse. In the adolescent personality domain, more frequent alcohol use in the ado-lescent was associated with unconventional behavior (e.g., less school achieve-ment), poor object relations, intrapersonal distress (depressive symptoms), andproblem behaviors (delinquency, marijuana use). With respect to the father at-tributes, father drug and alcohol use, but not his HIV status, were related to ado-lescent alcohol use. The four paternal personality and behavioral attributes thatwere also associated with the adolescents’ drinking included poor impulse con-trol, deviance, psychological symptoms (e.g., depression) and maladaptive cop-ing. As regards the domain of father-adolescent relations, adolescents who drankwere more likely to have fathers who (1) drank with them; (2) had fewer rulesabout drinking behavior; and (3) encouraged their children to drink as a tech-nique of coping with stress. Other aspects of the father-child relationship werealso related to adolescent drinking, such as less paternal warmth, less adolescentidentification with the father, and less time spent together. With respect to thepeer domain, more frequent adolescent alcohol use was related to having morefriends who drank and/or used marijuana and/or used other illicit drugs. As re-gards environmental factors, more frequent alcohol use in the adolescent was re-lated to less satisfaction in school, victimization, and more frequent exposure todiscrimination.

Hierarchical multiple regression analysis was then performed with the follow-ing independent domains: paternal attributes, father-child relations, adolescentpersonality, peer influences, and environmental factors. Table 3 contains the do-mains and the scales within each of the domains that were used in hierarchical re-gression analysis. (The scale ‘father drinks with his child’ was omitted from thefather-child relations domain because of the possibility of confounding the inde-pendent and dependent variables. However, the scale was included in the Pearsoncorrelations.)

Adolescent alcohol use was the dependent variable. This type of analysis al-lows for an examination of the relation of each set of variables with control oneach of the remaining sets. It also can provide an estimate of the combinedpotency of several sets of independent variables to explain the variance in a de-pendent variable. In each regression, we controlled for age, sex, father’s presencein the home, father’s educational status, and maternal warmth.

The results of the hierarchical multiple regression analysis presented in Table3 provide data to examine the hypothesized model presented in Figure 1. The fivesets of variables contributed significantly and importantly to the variation in ado-lescent alcohol use; they accounted for 58% of the variance in adolescent alcoholuse for this sample. The adjusted multiple R2 was 0.51. The association betweeneach of the sets (paternal attributes, father-child relations, adolescent personalityattributes, peer influences, and environmental factors) and the frequency of alco-


Brook et al. 21

TABLE 2. Pearson Correlations Between Father and Adolescent Scales and Al-cohol Use (N = 204)

Domain Pearson Correlation Coefficient

Father Attributes

HIV status 0.05

Alcohol use 0.16*

Drug use (last year) 0.26***

Depression 0.16*

Coping 20.15*

Impulsivity 0.18**

Delinquency 0.18**


Warmth 20.26***

Time spent 20.25***

Identification (admiration and emulation) 20.16*

Advocates alcohol to cope 0.32***

Rules about alcohol use 20.28***

Father drinks with his child 0.43***


Marijuana use 0.65***

Depression 0.24***

Object relations 20.25***

Impulsivity 0.09

Delinquency 0.49***

School perception or academic achievement 0.21**

Peer Influences

Peer alcohol use 0.49***

Peer marijuana use 0.39***

Peer other illicit drug use 0.27***

Peer achievement 20.11

Environmental Factors

Discrimination 0.31***

Victimization 0.30***

School satisfaction 20.17*

*p < 0.05; **p < 0.01; ***p < 0.001

hol use in the adolescent was examined with and without control on each of theremaining sets. The results of the regression analysis indicated the following: (1)adolescent personality was significantly related to adolescent alcohol use despitecontrol on all of the other domains; (2) the domains of environmental factors, fa-ther-child relations, and father attributes lost significance with control on the ad-olescent’s personality; (3) the peer domain was significant with control on theadolescent’s personality; and (4) the father attributes domain was no longer re-lated to adolescent alcohol use with control on the environmental, father-child re-lations, peer, and adolescent personality domains (see Figure 2).

Interactive Effects of Father Drug Use, Alcohol Use,and HIV Status and Protective Father-Child Relationship Factorsin Adolescent Alcohol Use

As already indicated, this study was designed in part to examine whether theimpact of paternal drug use, alcohol use, and HIV status could be modified by theeffect of the father-child mutual attachment relationship. Father drug use, alcoholuse and HIV status were expected to be offset (weakened) by the protective effect


TABLE 3. Hierarchical Regressions: Interrelation of Father Attributes, FatherChild Rearing, Adolescent Personality, Peer and Ecological Influences as Re-lated to Adolescent Alcohol Use

Adolescent Alcohol Use (N = 204)

WithoutControl

on the OtherDomains

With Control on the Other Domains

FatherAttributes

Father-ChildRelations


PeerInfluences

EnvironmentalFactors

R2 R2 R2 R2 R2 R2

Father Attributes 0.30*** --- 0.02 0.01 0.02 0.03

Father-ChildRelations

0.33*** 0.04* --- 0.03 0.05* 0.05*


0.50*** 0.20*** 0.19*** --- 0.17*** 0.20***

Peer Influences 0.37*** 0.09*** 0.09*** 0.04* --- 0.09**

EnvironmentalFactors

0.31*** 0.03* 0.03* 0.01 0.03* ---

*p < 0.05; **p < 0.01; ***p < 0.001

The above analyses were controlled for adolescents’ age and sex and fathers’ education and presence in the home.

of the father-child mutual attachment relationship, resulting in less frequent ado-lescent alcohol use. In order to examine the risk-protective mechanism, separateregressions were run in which father drug use, alcohol use, and HIV status wereexamined in combination with the following variables: father warmth, adoles-cent identification with the father, and time spent together. The significance ofthe interaction term was determined after the main effects of the two componentsof the interaction term were partialed out. The dependent variable was adolescentalcohol use. Four of the nine interactions run were significant. The results re-vealed that father drug use was offset by several protective factors, namely, fa-ther warmth (T = 22.72; p < 0.01), father identification (T = 22.87; p < 0.01),and father time spent (T = 22.96; p < 0.01). The results also showed that fatheralcohol use was offset by father warmth (T = 22.01; p < 0.05). For the significantinteraction terms, the regression lines for the father drug use, alcohol use, andHIV status and adolescent alcohol use were plotted at three separate points foreach of the father variables (the 25th, 50th, and 75th percentile points) in order toexamine the nature of the interaction. Figure 3 presents the results in which thefather alcohol use variable was offset by father warmth, resulting in less frequentadolescent drinking. In Figure 3, the horizontal axis and the vertical axis repre-sent father warmth and adolescent alcohol use, respectively. The figure indicatesthat adolescents whose fathers were frequent alcohol users were less likely to usealcohol themselves if the relationships with their fathers were warm and affec-tionate.

In addition, the results of the interaction terms indicate that father’s currentdrug use was offset by several protective factors (warmth, identification, andtime spent), leading to less adolescent alcohol use. Adolescents whose fatherswere active drug users were less likely to drink if their relationships with their fa-thers were warm and affectionate.

Brook et al. 23

FatherAttributes

FatherChild Rearing

Ecology


PeerAlcohol

andDrug Use

AdolescentAlcohol

Use

FIGURE 2. Obtained model.

DISCUSSION

The present study extends the literature in a variety of ways: First, to ourknowledge, this is the first investigation to focus on the use of alcohol by the ado-lescent children of drug-abusing fathers who have, or are at risk for contracting,HIV. Second, we tested a mediational model that examines the mechanisms link-ing father attributes to adolescent alcohol use. This approach lends great specific-ity and understanding to studies which examine the paternal correlates ofadolescent alcohol use. Third, we include important aspects of the father-child re-lationship based on data obtained directly from the father’s self-report, in con-trast to prior research, which has relied on the adolescent’s perception of thefather-adolescent relationship. Fourth, we identify father child-rearing practices


4.75

4.50

4.25

4.00

3.75

3.50

3.25

3.00

2.75

Low High

father warmth

High Father Alcohol Use

Low Father Alcohol Use

H

H

L

L

4 12

youth

alc

oholu

se

FIGURE 3. Interaction plot for father alcohol use and father warmth on the ado-lescent’s alcohol use.

that alter the relationship between the father’s own drug and/or alcohol use andhis adolescent child’s drinking.

With respect to specific aspects of the mediational model, the results indicatethat the youth’s personality is the mediator between most of the other domains(i.e., father attributes, father-child relations, and environmental factors) and thedependent variable of adolescent alcohol use. These findings support the hypo-thetical model (Figure 1), which is based on family interactional theory, and ex-tend the literature on at-risk youth.59


Our results suggest that the adolescent’s deviance-prone personality profilewas related to the adolescent’s drinking.60 Thus, adolescent marijuana use, delin-quency, and poor school achievement were related to adolescent alcohol use. Inaddition, our results indicated that youth who used alcohol were more likely tohave poor object relations and greater depressive mood. This finding extends thetheoretical and empirical literature on predisposition to substance use, derivedfrom non-clinical community samples, to an at-risk adolescent population. Takentogether, these findings suggest that intra- and interpersonal deficits (e.g., depres-sion, poor object relations), in part as a result of paternal dysfunction, increase thelikelihood of adolescent alcohol use. In addition to its direct effect on adolescentalcohol use, the adolescent’s personality was also found to be a powerful media-tor between most of the other domains and adolescent drinking. To our knowl-edge, this is the first study to demonstrate that attributes of the adolescent’spersonality simultaneously mediate not only paternal attributes and child-rearingpractices, but aspects of the larger environmental domain as well.


As noted above, the effect of the father’s child-rearing practices on his adoles-cent’s alcohol use was mediated by the youth’s personality.61 Three dimensionsof the father’s child-rearing practices were related to the adolescent’s personal-ity, which in turn was associated with less frequent adolescent alcohol use. Thesedimensions were (1) a warm father-child mutual attachment relationship, includ-ing the child’s identification with his/her father; (2) the father and youth spendingtime together; and (3) the father’s appropriate control techniques, including rulesabout alcohol use and disapproval of use. The correlations between fatherchild-rearing practices and adolescent alcohol use indicate that a positive par-ent-child bond may decrease adolescent drinking even in an at-risk population.This finding is commensurate with prior investigations of community samples,which have identified the importance of a close and supportive parent-child rela-tionship, including time spent together, in the reduction of adolescent alcoholuse.21,42,62 In a study of the stages of substance use, for example, an inverse asso-

Brook et al. 25

ciation was found between parent-child closeness and adolescent initiation of al-cohol and drug use behaviors.63 The present study further adds to the literature bydelineating the personality mechanisms through which the father’s child-rearingpractices impact on his child’s alcohol use.

In addition, our results indicated that the father’s actual drinking with his childwas more highly related to the adolescent’s alcohol use than the father’s own useof alcohol. This may suggest that the father’s drinking with his child incorporatesmultiple factors that prior research has found to relate to adolescent drinking;namely, role modeling, inappropriate drinking norms, and the accessibility of al-cohol (in the home).64

Peer Influences

The peer group had a direct effect on adolescent alcohol use. Adolescentswhose friends used alcohol, marijuana and/or other drugs were themselves morelikely to engage in these behaviors. These findings are in accordance with theliterature33,65-67 but, as discussed below, the relationship of the peer group to thefather’s attributes is noteworthy. Also consistent with prior research, adolescentsin our sample who used marijuana were more likely to drink alcohol.67-69

Perceived Environmental Factors

The perceived environmental influences on adolescent drinking were medi-ated by the adolescent personality. It may be that the stresses caused by environ-mental characteristics, such as the adolescent’s exposure to victimization anddiscrimination, along with limited school satisfaction, contribute to deviance andintrapersonal distress, which in turn are related to the adolescent’s alcohol use.However, we did not expect the finding of our obtained model which indicatedthat perceived environmental factors also served to mediate the father’s attrib-utes. This association may suggest that the father’s cognitive, behavioral and pos-sible physical impairments increase both his and his child’s actual and/orperceived exposure to hazardous situations.70 Thus, adolescents may be morelikely to experience discrimination if their fathers are active drug users and/or areHIV-positive.71 The neighborhoods and illicit activities associated with the fa-ther’s drug use70 may also place his children at risk for violent victimization,72 ahigh rate of which has been found among adolescents who are alcohol depend-ent.45

The child’s school may also be inadequate and he or she may be further dis-tracted from academic involvement due to the family’s struggle to survive.17 In-deed, prior research has identified time spent on homework, college aspirations,commitment to studies and school satisfaction as influential factors in protectingagainst adolescent substance use.43,73


Father Attributes

Our findings indicate that the effects of the father’s attributes on adolescentdrinking were mediated by all other domains, i.e., youth personality, father-childrelations, peer influences and environmental factors. Paternal characteristics,such as depression, deviance, and drug and alcohol use, impacted the father’s re-lationship with his child and the youth’s personality, as well as the adolescent’speer group and environment (e.g., neighborhood, school). A body of research hasdemonstrated that children of substance abusers are at an increased risk for bothdrug and alcohol use.74,75 Our mediational model furthers the understanding ofthe linkage between paternal attributes and the adolescent’s alcohol use. Thesepaternal attributes include intrapersonal distress, poor emotional control, devi-ance, polydrug use and alcohol use, each of which were significantly related tothe adolescent’s more frequent use of alcohol in our study. The factors in theother domains were powerful enough to mediate the direct effect of those pater-nal attributes studied on adolescent drinking. In contrast, in our hypothesizedmodel, we had predicted both direct and indirect effects.

Although relatively few investigations have examined both paternal attributesand adolescent personality characteristics with respect to adolescent drinking,one such study was conducted by Chassin et al.59 Consistent with our results,these researchers found that paternal alcoholism and parental antisocial personal-ity were both related to adolescent externalizing symptoms, which in turn wereassociated with alcohol abuse and dependence.59 The association of parental at-tributes and adolescent personality characteristics may be explained byBandura’s social learning theory. According to this premise, the father serves as arole model for his child, who thus behaves imitatively.18,39 For example, the fa-ther’s depression, impulsivity, and drug and/or alcohol use may demonstratemaladaptive cognitive and behavioral coping styles, which foster the adoles-cent’s use of alcohol to deal with the stresses of life.32 Indeed, our results alsodemonstrated the converse, an association between the father’s effective copingand decreased adolescent alcohol use.

Contrary to expectation, however, the father’s HIV status was not related tothe adolescent’s alcohol use either as a main or an interactive effect. This findingwas somewhat surprising and its basis is at present unclear. There is scant empiri-cal research on the impact of HIV-positive parents on their adolescent children,and that which exists overwhelmingly focuses on HIV-positive mothers. Our re-sults point to the importance of the separate contribution of the father since his in-fluence on his child was maintained with control on the affectional bond betweenthe mother and child. However, recent advances in the treatment of HIV, such ascombination antiretroviral therapies with the addition of protease inhibitors, havesignificantly decreased AIDS-related morbidity and mortality,76 thereby possi-

Brook et al. 27

bly affecting the impact of the adverse effects of paternal HIV on his family andchildren.

In partial sum, the father’s attributes have pervasive effects in that they are re-lated to a number of important dimensions in the adolescent’s world. More spe-cifically, the father’s attributes are associated with the perceived environmentand peer influences, the father-child relationship, the adolescent’s personality,and ultimately, the adolescent’s alcohol use.

Interactions

In addition to the mediational role of several psychosocial domains on theyouth’s personality, the latter of which has an impact on the adolescent’s drink-ing, we also examined the interactions of specific aspects of the father’s attributesand child-rearing behaviors on the adolescent’s use of alcohol. Our results dem-onstrated that the adverse effects of both paternal drug use and paternal alcoholuse were mitigated by a number of child-rearing variables, resulting in less fre-quent alcohol use in the adolescent. Our findings indicate that a strong and affec-tionate father-child bond was associated with decreased adolescent alcohol useeven when the father was a chronic abuser of drugs. Specifically, the father’swarmth toward and time spent with his child, as well as the child’s identificationwith his/her father, each served as a protective factor against the adverse effectsof paternal drug use on adolescent drinking. A warm and affectionate father-childrelationship also buffered against the adverse effects of the father’s own alcoholuse on his adolescent’s use of alcohol. In a related vein, Vitaro et al.20 found thatthe risk of substance abuse in the adolescent children of alcoholic fathers was off-set by the protective influence of parental supervision.

Prior investigations have demonstrated the protective effect of a positive andnurturing parent-child relationship with respect to adolescent alcohol use andother problem behaviors.62 In a study by Wills, for example, parental supportbuffered against risk factors, such as tolerance of deviance and affiliation withdeviant peers, with respect to adolescent substance use.61 Brook and Brook77

also found that protective family factors (e.g., paternal warmth) could decreasethe influence of peer risk factors on the likelihood of adolescent drinking. Sincethere was a synergistic interaction between high father alcohol use and low fatherwarmth, an alternative approach to the reduction of adolescent drinking might beto decrease the father’s own use of alcohol. Thus, low father alcohol use wouldoffset limited warmth in the father-child relationship. Our results extend theseprevious findings to an at-risk population in that a warm and affectionate fa-ther-child relationship buffered against adolescent drinking even among youthspecifically vulnerable to substance abuse because their fathers were actively us-ing drugs and/or alcohol.


Limitations

There are several limitations to the findings of this study. First, our data arecross-sectional and therefore do not explicate whether the independent variablesprecede or are a consequence of adolescent alcohol use. Secondly, our data on thefathers’ and adolescents’ alcohol use were obtained via the fathers’ and theyouths’ self-reports, and were not independently verified.

Conclusions and Clinical Implications

The results of this study suggest that clinicians and other service professionalsshould be sensitive to the likelihood of alcohol use among high-risk adolescentswho may not be seeking treatment. Evaluation of high-risk youth should includeassessment of alcohol use as well as the relation of alcohol use to psychosocialfunctioning and environmental influences. Treatment planning should directlyaddress alcohol use and the remediation of related problems in functioning.

Our findings expand the knowledge base and provide critical evidence of theextent to which high-risk adolescents’ alcohol use is impacted by multiple riskfactors. Also, to our knowledge, this is the first study to specifically document therole of substance-abusing fathers, some of whom are HIV-positive, in their chil-dren’s alcohol use. Particularly important are the results which indicate that ifchildren drink with their fathers, they are more likely to become heavier drinkersin adolescence. Such data can allow for better planning and forecasting of theneed for youth services. Given the prevalence of alcohol use among youth whosefathers are substance abusers, prevention and treatment should be implementedwith fathers and their children to reduce the negative effects of paternal risk fac-tors and to increase the effectiveness of paternal protective factors. A better un-derstanding of the complex factors affecting the development of alcohol use inadolescence has the potential to inform prevention and treatment plans and goalsand to address the unique needs of each father-child pair. As evidenced by thepresent findings, the father’s impact on his offspring should be a prominent con-sideration with regard to both policy and practice.

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Alcohol Use in Adolescents Whose Fathers Abuse Drugs