Prevention and Intervention Strategies With Children of Alcoholics

Received Jan 4, 1999; accepted Jan 5, 1999.

James G. Emshoff and Ann W. Price
From the Department of Psychology, Georgia State University, Atlanta, Georgia.

Objective. This article was designed to give pediatricians a basic knowledge of the needs of children who live in families with alcoholism. It briefly presents issues involved in the identification and screening of such individuals and provides primary attention to a variety of preventive and treatment strategies that have been used with school children of alcoholics (COAs), along with evidence of their effectiveness.

Methodology. A literature search including both published and unpublished descriptions and evaluations of interventions with COAs.

Results. The scope and nature of the problems of growing up in an alcoholic home are presented. The risk and protective factors associated with this population have been used as a foundation for preventive and treatment interventions. The most common modality of prevention and intervention programs is the short-term small group format. Programs for COAs should include the basic components of information, problem- and emotion-focused coping skills, and social and emotional support. Physicians are in a unique position to identify and provide basic services and referrals for COAs. School settings are the most common intervention sites, but family and broad-based community programs also have shown promise in alcohol and other drug prevention.

Conclusions. Several COA interventions have demonstrated positive results with respect to a variety of measures including knowledge of program content, social support, coping skills, and emotional functioning. Rigorous studies are needed to understand better the complex ways children deal with parental alcoholism. A need remains for empirically sound evaluations and for the delineation of research findings. Key words: children of alcoholics, familial alcoholism, substance abuse, prevention, treatment.

SOURCE:PEDIATRICS Vol. 103 No. 5 Supplement May 1999, pp. 1112-1121

SYDNEY, Australia — Actress Nicole Kidman is opening up about married life, saying that during the first three months of her marriage to country singer Keith Urban, the couple went to "hell and back."
In an interview with Parade magazine, Kidman, 41, spoke candidly about Urban's struggle with addiction, his stint in rehab and the birth of their daughter Sunday Rose.
"We were thrown into his alcohol problem three months into the marriage, and that was big," she told Parade. "We became the closest we would become because we had to bear our souls. We did ten years of marriage in three months."
Still, the actress and ex-wife of Tom Cruise said the marriage has granted her emotional fulfillment and blessed her with a newborn daughter, of whom she is fiercely protective.
Kidman said she experienced "whatever that primal thing is, the need and desire to keep her very protected," and vowed that she would not expose her to public scrutiny at least until she grew up.
"For now, I'm still keeping her in a bubble," she said.

Two items today involving well-known figures and the battle against addiction. From City News Service:
Sports agent Leigh Steinberg, the inspiration for the title character in "Jerry Maguire," was arrested in Newport Beach for public intoxication, police confirmed today. Steinberg, 59, was taken into custody about 7:45 p.m. Oct. 22 in the 400 block of E. Pacific Coast Highway, said Newport Beach Police Sgt. Evan Sailor. Steinberg, who has acknowledged a struggle with alcohol dependence, was released on his own recognizance after being given a Dec. 8 court date. It was not immediately clear if charges had been filed.

Pediatricians may be able to provide an additional service to the children they treat, by screening their parents for alcohol use. According to a study conducted by the Center for Adolescent Substance Abuse Research (CeASAR) at Children's Hospital Boston, parents are open to alcohol screening during their child's pediatric visit and to discussing drinking habits with a pediatrician. When a potential drinking problem arises, the pediatrician could provide educational materials about alcoholism, and refer the parents for evaluation or treatment. The findings are published in the November issue of Pediatrics.

"Pediatricians, with their commitment to child health, frequent interactions with parents, and close relationships with both children and families, have a unique opportunity to screen parents for alcohol use and refer them for further assessment and treatment," says Celeste Wilson, MD, researcher and pediatrician in the CeASAR program at Children's and lead author of the study.

In the multi-center study, 879 parents from three pediatric primary care clinic sites---rural, urban and suburban---were surveyed using anonymous questionnaires. The questionnaire included two brief alcohol screening tests and questions designed to assess parents' preferences for who should perform the alcohol screening, acceptance of the screening, and preferred interventions if the screening was positive.

Nearly 90% of all parents responding to this anonymous survey reported being open to being asked about their alcohol use at their child's pediatric appointment. Surprisingly, over 75% of parents with a positive alcohol screen also indicated acceptance of being screened for alcohol problems during the pediatric office visit. The top three preferred screening methods for parents, including those found to have alcohol problems, were direct conversation with the pediatrician, computer-based questionnaire, and paper-pencil questionnaire. The researchers believe that the endorsement of the pediatrician over screening conducted by other medical staff (e.g., nurse, medical assistant) results from an intangible, yet distinct, quality of the parent-pediatrician relationship.

While the parents' openness to alcohol screening at pediatric appointments was encouraging, the researchers are quick to point out some of the findings are cause for concern. Of the 879 parent participants, one out of every nine (11.5%) were found to have a positive alcohol screen; an alarmingly high number when considering recruitment for study participation was on a volunteer-only basis.

"It is possible that those parents who declined participation in the study were the ones with the most severe alcohol problems," says Wilson who is also an Instructor in Pediatrics at Harvard Medical School. "However, if this is true, our results represent an underestimate of the actual problem."

According to research, children of alcoholics are at increased risk for behavioral, cognitive and mental health problems. They are more likely to witness domestic violence, and have a greater chance of becoming victims of all forms of child maltreatment including neglect, physical abuse, and sexual abuse. Furthermore, children of alcoholics are 3 to 4 times more likely to have their own alcohol problems later in life.

"Given the negative consequences of growing up with an alcoholic parent, it is critical, for the future health and well being of the child, to identify and provide a pathway to assessment and treatment for the parent with an unhealthy pattern of alcohol consumption," adds Wilson.

Dr. Wilson and her colleagues suggest that to optimally treat patients, pediatricians must acknowledge the potential adverse effects of parental alcohol use on the child and embrace the concept that alcohol use should be addressed with parents during the clinic visit. When considering possible implementation strategies, they believe that an alcohol screening tool could be incorporated into a preexisting health survey and completed by the parent prior to their child's clinic appointment.

The study was supported by a grant from the Robert Wood Johnson Foundation's Substance Abuse Policy Research Program. Dr. Wilson was supported by a faculty fellowship grant from The Center of Excellence in Minority Health and Health Disparities at Harvard Medical School.

Since the UK's move to 24-hour drinking, a large city centre hospital in Birmingham has seen an increase in drink-related attendances between the hours of 3am and 6am. A new study, published in the open access journal BMC Public Health, shows no significant decrease in alcohol-related attendances after 24-hour drinking was introduced but a significant shift in the time of attendances.

Andrew Durnford and Tommy Perkins co-led a team of researchers from the University of Birmingham who investigated the effects of the Licensing Act 2003 on Emergency Department admissions to an inner city hospital. Durnford said, "Interestingly, since 24-hour drinking, significantly more alcohol-related attendances were observed in the early hours of the morning and a significantly smaller proportion in the earlier evening. This trend was seen for weekdays and weekends".

He added, "Our findings suggest that although the Act has not affected the number of alcohol-related attendances at the Emergency Department or the day of presentation; it is associated with a shift in the time of attendances into the early hours of the morning. This may reflect a change in drinking patterns".

The research suggests that 24-hour drinking has not reduced the burden of alcohol attendances to emergency departments and has simply shifted the problem later into the night. According to the authors, "For the NHS, this suggests 24-hour drinking has not lessened the workload. Furthermore, this shift to increased attendances in the early hours will have implications for night-time service provision in the NHS and the Police".

The Licensing Act 2003 allowed longer and more flexible opening hours for pubs, clubs and other licensed premises. Durnford and his colleagues investigated the alcohol-related attendances to the Emergency Department over a week in January 2005 (before the Act was implemented) and during the same week in January 2006 (after licensing hours were changed). In the period between the Act's implementation and the start of the study, 37% of licensed premises in Birmingham had successfully applied to extend their opening hours. However, the authors do point out that "Some venues may not have changed their opening hours immediately and attitudes towards alcohol may take more time to adapt to the new environment".

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Article adapted by Medical News Today from original press release.