Parental drinking, mental health and educational level, and offspring's subsequent prescription drugs treatment for sleep problems. A longitudinal HUNT survey and registry study.

BACKGROUND: Parental drinking, mental health and family socioeconomic status are all associated with offspring sleep problems, but there is a paucity of research that considers the effect of risk factors, as they co-occur within and across families. Also, sleep problems are closely linked with mental health problems. Disentangling the effects on one or the other are important. We examined whether parental risk constellations are differently associated with offspring's subsequent prescription drug use for sleep problems during nine years with or without prescription drug use for anxiety and/or depression. METHODS: The sample included 8773 adolescent offspring of 6696 two-parent families who participated in the Nord-Trøndelag Health Study in Norway. The exposures were five parental risk constellations, previously identified via Latent Profile Analysis, characterized by drinking frequencies and quantities, mental health, and years of education. The outcomes were dispensed prescription drugs in offspring during 2008-2016 for (a) only sleep problems (b) sleep problems and anxiety/depression or (c) only anxiety/depression. We used multinomial logistic regression to model the odds of the outcomes. RESULTS: Compared to the overall low-risk parental constellation, none of the risky constellations were significantly associated with increased risk of being dispensed prescription drugs only for sleep problems. Offspring from two different risk profiles were at increased risk for being dispensed both sleep and anxiety/depression prescription drugs. These were parental profiles marked by (1) low education, symptoms of mental health problems and weekly binge drinking in both parents (OR 1.90, CI = 1.06;3.42); and (2) frequent heavy drinking in both parents and symptoms of mental health problems in fathers (OR 3.32, CI = 1.49;7.39). Offspring from the risk profile with lowest parental education had increased risk of only anxiety/depression prescription drugs (OR 1.25, CI = 1.05;1.49). CONCLUSION: Our findings suggest that parental risk constellations are not associated with increased risk of offspring receiving sleep medications without also receiving anxiety/depression medications, as two risk constellations were associated with increased risk of dispensation of both sleep and anxiety/depression prescription drugs. Receiving both may be an indication of severity. The findings underscore the importance of including measures of mental health problems when investigating sleep problems to avoid misattribution of effects.

Social Class and Alcohol Use by Youth: Different Drinking Behaviors, Different Associations?

OBJECTIVE: Low socioeconomic status (SES) is related to hazardous alcohol use in adults, and the association seems to be stronger for more deviant and harmful drinking behaviors. We examined whether a similar pattern was present among adolescents. METHOD: Data stem from a Norwegian school survey of 14- to 17-year-olds (n = 12,966; response rate in participating schools: 86%). Parental education (high/ middle vs. low) was our main SES indicator. The outcomes comprised lifetime and past-year drinking and intoxication, and past-year symptoms of excessive drinking. We used Poisson regression to estimate relative risks (RR) and post-estimation Wald F tests to compare coefficient estimates. RESULTS: Parental education was related inversely to the lifetime measures of drinking and intoxication among all students but the 17-year-olds. The impact on any intoxication episodes was significantly stronger than that on any alcohol use only among the 14-year-olds (RR = 1.79, 95% CI [1.31, 2.43] vs. RR = 1.21, 95% CI [0.98, 1.49]) (p < .001). Among past-year drinkers at all ages (14-17 years; n = 7,796), the differential impact of low parental education was particularly large with respect to the frequency of intoxication (RR = 1.68, 95% CI [1.39, 2.02]) compared with the frequency of drinking (RR = 1.42, 95% CI [1.24, 1.62]) (p < .001) and frequent symptoms of excessive drinking (RR = 1.80, 95% CI [1.47, 2.20]) compared with any symptoms (RR = 1.07, 95% CI [1.01, 1.14]) (p < .001). A similar but somewhat less clear pattern emerged when using an alternative indicator for low parental SES. CONCLUSIONS: Parents' social standing was inversely related to alcohol use by youth and related more strongly so to more deviant and harmful drinking behaviors.

Social Media Use and Episodic Heavy Drinking Among Adolescents.

Objectives Little is known about the consequences of adolescent social media use. The current study estimated the association between the amount of time adolescents spend on social media and the risk of episodic heavy drinking. Methods A school-based self-report cross-sectional study including 851 Norwegian middle and high school students (46.1% boys). MEASURES: frequency and quantity of social media use. Frequency of drinking four or six (girls and boys, respectively) alcoholic drinks during a single day (episodic heavy drinking). The MacArthur Scale of Subjective Social Status, the Barratt Impulsiveness Scale - Brief, the Brief Sensation Seeking Scale, the Patient Health Questionnaire-9 items for Adolescents, the Strengths and Difficulties Questionnaire Peer Relationship problems scale, gender, and school grade. Results Greater amount of time spent on social media was associated with greater likelihood of episodic heavy drinking among adolescents ( OR = 1.12, 95% CI (1.05, 1.19), p = 0.001), even after adjusting for school grade, impulsivity, sensation seeking, symptoms of depression, and peer relationship problems. Conclusion The results from the current study indicate that more time spent on social media is related to greater likelihood of episodic heavy drinking among adolescents.

Illicit use of opioid substitution drugs: prevalence, user characteristics, and the association with non-fatal overdoses.

BACKGROUND AND AIMS: Diversion of opioid substitution drugs (OSD) is of public concern. This study examined the prevalence, frequency, and predictors of illicit OSD use in a group of injecting drug users (IDUs) and assessed if such use was associated with non-fatal overdoses. METHODS: Semi-annual cross-sectional interviews conducted in Oslo, Norway (2006-2013), from 1355 street-recruited IDUs. Hurdle, logistic, and multinomial regression models were employed. RESULTS: Overall, 27% reported illicit OSD use in the past four weeks; 16.8% methadone, 12.5% buprenorphine, and 2.9% both drugs. Almost 1/10 reported at least one non-fatal overdose in the past four weeks, and roughly 1/3 reported such experience in the past year. Use of additional drugs tended to be equally, or more prevalent among illicit OSD users than other IDUs. In terms of illicit OSD use being a risk factor for non-lethal overdoses, our results showed significant associations only for infrequent buprenorphine use (using once or less than once per week). Other factors associated with non-fatal overdoses included age, education, homelessness, as well as the benzodiazepines, stimulants, and heroin use. CONCLUSIONS: Users of diverted OSD may represent a high-risk population, as they used more additional drugs and used them more frequently than other IDUs. However, illicit OSD use may be less harmful than previously assumed. After accounting for an extensive set of covariates, only infrequent illicit buprenorphine use, but not methadone use, was associated with non-fatal overdoses.

Children's exposure to parental conflict after father's treatment for alcoholism.

OBJECTIVE: This study investigated children of alcoholics' (COAs) exposure to inter-parental conflict before and after their fathers received alcohol treatment and compared exposure levels to a community comparison sample. METHOD: This study included 67 couples with a treatment-seeking male alcoholic partner and children aged 4-16. The alcoholic fathers and their relationship partners provided data at baseline and at six and twelve month follow-ups. A community comparison sample of 78 couples with children in the target age range completed similar longitudinal assessments. It was hypothesized that treatment of paternal alcoholism would be associated with a decrease in COAs' exposure to conflict, and that among remitted patients exposure to conflict would decrease to the level found in the community sample. RESULTS: Prior to the father's alcohol treatment, the children of the treatment sample were exposed to significantly more conflict between their parents than in the community comparison sample. After the fathers received alcohol treatment, COAs' exposure to conflict significantly decreased at both the six and twelve month follow-ups compared to baseline. Children of remitted alcoholics did not differ significantly in levels of exposure to conflict at six months follow-up compared to the community sample as predicted. However, at twelve months remitted alcoholics reported significantly more exposure to conflict compared to the community sample. CONCLUSIONS: Decreased child exposure to parental conflict is a benefit associated with the father's treatment for alcoholism, and it may lead to improvements in COAs' functioning after parental treatment.

Behavioral Couples Therapy When Both Partners Have a Current Alcohol Use Disorder.

Although behavioral couples therapy (BCT) has considerable support in treating alcohol use disorder (AUD), studies have not examined BCT for dual problem couples in which both partners have current AUD. This study compared outcomes after BCT for dual problem couples (n = 20) with outcomes for single problem couples in which only one partner had AUD (n = 386). Results showed that dual problem and single problem couples did not differ significantly on degree of improvement in abstinence following BCT. A case example illustrates the application of BCT when both partners have a current AUD.

Moderating effects of family environment on the association between children's aggressive beliefs and their aggression trajectories from childhood to adolescence.

This study explored how children's aggressive beliefs and their family environments combine to influence the development of child aggression from middle childhood into adolescence. We utilized a "variable-centered" empirical approach, specifically examining whether children's aggressive beliefs represent a risk factor for their aggressive behaviors and whether this risk can be moderated by children's family environment. These questions were tested with individual growth modeling, using the data from a community-representative sample of 440 mother-child dyads, interviewed four times over a 6-year study period. The accelerated longitudinal design of the study enabled examination of children's aggression trajectories from age 7 to age 19. The results supported the hypothesis that elevated aggressive beliefs in children represent a risk factor for aggression, as higher aggressive beliefs were associated with greater aggression at the youngest age, as well as with increased aggression over time. However, as hypothesized, family environment moderated this association, such that changes in children's aggression over time were contingent upon the interaction of their aggressive beliefs with family environment. Specifically, aggression was reduced in children with high aggressive beliefs if they experienced better than average family environment, which included less family conflict and more family cohesion.

Alcoholics Anonymous attendance following 12-step treatment participation as a link between alcohol-dependent fathers' treatment involvement and their children's externalizing problems.

We investigated longitudinal associations between alcohol-dependent fathers' 12-step treatment involvement and their children's internalizing and externalizing problems (N = 125, M(age) = 9.8 +/- 3.1), testing the hypotheses that fathers' greater treatment involvement would benefit later child behavior and that this effect would be mediated by fathers' posttreatment behaviors. The initial association was established between fathers' treatment involvement and children's externalizing problems only, whereas Structural Equation Modeling (SEM) results supported mediating hypotheses. Fathers' greater treatment involvement predicted children's lower externalizing problems 12 months later, and fathers' posttreatment behaviors mediated this association: Greater treatment involvement predicted greater posttreatment Alcoholics Anonymous attendance, which in turn predicted greater abstinence. Finally, fathers' abstinence was associated with lower externalizing problems in children. Theoretical and practical implications of these findings are discussed.

Longitudinal associations between fathers' heavy drinking patterns and children's psychosocial adjustment.

Psychosocial adjustment in children of alcoholics (N = 114) was examined in the year before and at three follow-ups in the 15 months after their alcoholic fathers entered alcoholism treatment, testing the hypothesis that children's adjustment problems will vary over time as a function of their fathers' heavy drinking patterns. Three unique patterns of heavy drinking in alcoholic fathers were identified through cluster analysis. The results demonstrated significant and meaningful associations between these drinking patterns in fathers and adjustment problems in children over time. Overall, children whose fathers remained mostly abstinent following their treatment showed lowest and decreasing adjustment problems, while children whose fathers continued and increased heavy drinking following their treatment showed greatest and increasing adjustment problems over time.

Does individual treatment for alcoholic fathers benefit their children? A longitudinal assessment.

Psychosocial adjustment in children of alcoholics (COAs; N=125) was examined before and at 3 follow-ups in the 15 months after their fathers entered alcoholism treatment. Before their fathers' treatment, COAs exhibited greater overall and clinical-level symptomatology than children from the demographically matched comparison sample, but they improved significantly following their fathers' treatment. Children of stably remitted fathers were similar to their demographic counterparts from the comparison sample and had fewer adjustment problems than children of relapsed fathers, even after accounting for children's baseline adjustment. Thus, COAs' adjustment improved when their fathers received treatment for alcoholism, and fathers' recovery from alcoholism was associated with clinically significant reductions in child problems.

Outcomes of specialized foster care in a managed child welfare services network.

This study (N = 384) presents results from outcome measurement in a services network providing specialized foster care (SFC) to children in child protective service custody. A majority of participants improved on most outcomes. Global improvement was associated with increased length of stay up to two years, five months, and with younger age, fewer problems, and, paradoxically, the presence of a trauma history. Results suggest the value of SFC within managed services and of research using outcome measurement systems.