Journal of Youth and Adolescence, Vol. 13, No. 4, 1984
Adolescent Alcohol Abuse and Other Problem Behaviors: Their Relationships and C o m m o n Parental Influences Grace
M. Barnes I
Received March 19, 1984;accepted July 3, 1984
Th& study was designed to explore the relationships between adolescent alcohol abuse and other problem behaviors. Parental socialization practices, particularly support/nurturance, were also examined f or common influences on both alcohol abuse and other youthful deviance. Interviews were conducted with a representative household sample o f adolescents aged 12-17 years and their parents. The findings support the theory that adolescent alcohol abuse is part o f a complex psychosocial problem behavior syndrome and that a high degree o f parental nurturance may be a significant deterrence to alcohol abuse and more general deviant behaviors.
INTRODUCTION ...Our son is stubborn and rebellious and refuses to obey us; he wastes money and is a drunkard. Deuteronomy 21:20
As early as - 1 4 5 0 B . C . , the r e l a t i o n s h i p between alcohol abuse a n d other a n t i s o c i a l / r e b e l l i o u s behaviors was recognized. T o d a y , in a n effort to deal effectively with " p r o b l e m " y o u n g people, v a r i o u s aspects o f social tGrace M. Barnes has a Ph.D. in sociology and is a Research Scientist at the Research Institute on Alcoholism, New York State Division of Alcoholism and Alcohol Abuse, 1021 Main Street, Buffalo, New York 14203. Dr. Barnes' major research interests are in the areas of adolescent socializationwithin the familyand patterns of alcohol use and other related behaviors throughout the life cycle. 329 0047-2891/84/0800.0329503.S0/0 © 1984 Plenum Publishing Corporation
330
Barnes
behaviors have been isolated for special attention. Teenage alcohol abuse in particular, has been singled out as a topic of widespread public concern. An integral part of the concern is manifested in the directives for developing targeted prevention and intervention/treatment programs for adolescent alcohol abusers. However, the development of effective means of preventing or treating adolescent alcohol abuse necessitates a comprehensive understanding of the potential factors leading to problem drinking. For example, it has been argued that evaluations of school-based alcohol education/prevention programs show little effect on drinking behaviors, since they cannot overcome the vast influences of other adolescent socialization experiences, especially within the family (Barnes, 1984). Similarly, Pattison (1980, 1982) has strongly argued that a critical hindrance to the development of effective treatment for alcoholism in general has been the conceptualization of alcoholism as a "unitary" disease. This unitary concept implies that all persons so afflicted are substantially the same and experience a similar progressive deterioration (Pattison, 1980). Pattison argues that it is more appropriate to speak of alcoholism as a multivariate syndrome whereby alcohol use is complexly intertwined with other psychosocial variables. [Cf. also the review by Room (1983) which discusses at length the sociological aspects of the disease concept of alcoholism.] Other empirical work has shown that adults may move in and out of problem drinking in association with various social factors (e.g., marital and employment status) (Cahalan, 1970). If these arguments against the unitary disease model of alcoholism are critical for adults, they are even more critical for conceptualizing problems among youth, where manifestations of various behavioral problems are often incipient and where "diagnosis" (or formal labeling) may prove to ingrain more deeply the social effects of developing problems of youth (cf. Scheff, 1966). Specifically, "teenage alcoholism" is an example of a widely used expression which has more negative emotional content than substantive meaning. Thus, if alcoholism in adolescence implies the development of physical dependence to alcohol with accompanying physiological damage (as it typically is used to describe adult alcoholics in treatment), then indeed there is a small proportion of teenagers who can be classified as alcoholics. There are relatively few reports in the literature documenting signs of physical dependence to alcohol and various late-stage signs of alcohol abuse such as alcohol-induced liver cirrhosis and delerium tremens among teenagers (see Barnes, 1982). On the other hand, the vast majority of teenagers does drink alcohol at least occasionally. More importantly, significant proportions of youth drink heavily, become intoxicated regularly, and experience various alcohol-related problems (e.g., Rachal et al., 1975, 1980; Barnes, 1978, 1979, 1981). One definition of youthful problem drinking is being drunk six or more times in the previous year and/or having negative consequences two or more times
Adolescent Alcohol Abuse
331
in that year in at least three of five problem areas (trouble with school officials, friends, a date, or the police because of drinking and driving after having too much to drink). According to this criterion, it is estimated that as many as 30o7oof tenth to twelfth grade students in the United States misuse alcohol (Rachal et al., 1980). Problem drinking among youth may be related to a variety of other problem behaviors or antisocial activities. School surveys have shown that adolescent problem drinkers are more likely than nonproblem drinkers to exhibit acceptance of and participation in deviant acts (Jessor et al., 1968; Mandell et al., 1963; Rachal et al., 1975). Similarly in studies among delinquent populations, excessive drinking is likely to be reported (McKay et al., 1967; Pearce and Garrett, 1970; Blacker et al., 1965; Widseth and Mayer, t971). Whether youthful antisocial behaviors precede or follow problem drinking is not known. It appears that problem drinking covaries within a complex network or syndrome of deviant behaviors (Jessor and Jessor, 1973, 1977; Donovan and Jessor, 1978). In other words, it has been suggested that heavy drinking, problem drinking, and antisocial activities represent alternative pathways for the expression of similar need systems (Zucker, 1976). How youthful alcohol abuse is conceptualized has important implications not only for the establishment of appropriate intervention/treatment programs, but also for studying the causal factors leading to potential problem drinking. If problem drinking is integrally linked with other problem behaviors, both phenomena may have common causal conditions. There may be a genetic component involved in the development of alcoholism in certain people (Goodwin, 1979) or various biochemical imbalances in certain individuals characterized as antisocial personality types; however, these biological models, at best, explain a part of the frequent occurrence of alcohol-related problems and other antisocial behaviors. From socialization theory and research, the family has been shown to be crucial for childhood development. Aspects of parental socialization, for example, support and nurturance, have been positively related to a variety of childhood outcomes such as cognitive development, self-esteem, and academic achievement. [See the comprehensive review by Rollins and Thomas (1979).] Studies of adolescent alcohol behaviors using the popular school survey method provide rather sparse information on the socialization process within the family; however, the profiles of excessive alcohol users do indicate interpersonal problems within the home. Excessive drinkers are less likely to feel "very close" to their families (Wechsler and Thum, 1973); they are more likely to feel loosely controlled, particularly by their mothers, and to feel rejection and a great deal of psychological tension in relationship with their fathers (Prendergast and Schaefer, 1974). Retrospective studies of adult alcoholics also suggest that certain factors precede the onset of alcohol problems. Pittman and Gordon (1958) found
332
Barnes
that chronic inebriates' socialization experiences within the family were grossly deficient and that this undersocialization contributed to poor adolescent adjustment in these men. McCord and McCord (1962) found that the boys who later became alcoholic, in comparison to a group who showed no evidence of alcoholism in adulthood, were significantly more likely to reject their mothers and to disapprove of their fathers. These retrospective studies of alcoholics have contributed to the literature and indicate that the family socialization process may contribute to the development of alcohol problems and other problem behaviors. However, inherent in the designs of these retrospective studies is the problem of reconstructing the past, i.e., loss of memory by the alcoholics, difficulties in separating antecedent factors from the effects of the disease, and second-hand information on parental behaviors. The present study was designed to examine the relationship between drinking and various so-called deviant behaviors in a general population sample of adolescents. Representative population samples have only rarely been used to examine alcohol use and various problem behaviors of youth. The present analysis was also carried out to examine the influence of specific parental socialization factors (support/nurturance) on adolescent problem behaviors. The underlying assumption guiding this analysis was that youthful alcohol abuse is not best characterized as a unitary disease entity. Rather, it was proposed that alcohol abuse is a multifaceted social phenomenon and occurs in the context of other problem behaviors. Furthermore, alcohol abuse and other problem behaviors may have common causal factors within the context of the parental socialization process.
METHODS Sampling Design and Procedures
A random digit dial (RDD) telephone procedure was used to select a representative household sample of adolescents and their families in metropolitan Erie County. The criteria for inclusion in the sample were that the household have at least one adolescent between the ages of 12 and 17 years and at least one parent (biological or surrogate). After it was determined that a household met the eligibility requirements for inclusion in the sample, the study was explained to participants, and they were given the assurances of confidentiality. Appointments were made with the families to carry out the face-to-face interviewing. Before the scheduled interview, a letter was sent to families to give further information about the study and to confirm the appointment. Interviews were subsequently carried out by a two-person interviewing team in the respondents' home as described below.
Adolescent Alcohol Abuse
333
This methodological procedure resulted in an in-depth study of 124 families. The sample include 379 individual family members- 120 mothers, 85 fathers, 124 adolescents, and 50 adolescent siblings. Analysis of the completed interviews with available 1980 census data indicated that the sample of households obtained closely represented the population at large (Barnes and Cairns, 1982).
Interviewing Procedures A team of two interviewers was assigned on a rotating basis to the individual family respondents. Access to the home was not a problem since appointments were made previously over the phone and confirmation letters were sent prior to the date of the interview. The procedures were first explained to the family and informed consent forms were read and signed. Each family member was interviewed independently in separate areas of the house wherever possible. This was accomplished by having two parts to each instrument, i.e., a self-administered portion and a face-to-face interview. In the case of the maximum fourmember family, one interviewer gave brief instructions to the target adolescent and the adolescent sibling regarding completion of the self-administered questionnaires. That interviewer then administered the verbal interview portion to his/her assigned parent. The second interviewer completed the faceto-face interview with the other parent. (The adolescent questionnaires and the parental interviews were designed to take approximately the same amount of tirffe to complete.) When these first sections were completed, the parents were given a brief self-administered questionnaire and the two interviewers then spoke with the two adolescents. While every attempt was made to interview family members in separate areas of the living quarters, the sensitive questions (e.g., drinking questions) were placed in the self-administered portions of the respective instruments. This was done to avoid the possibility of embarrassing the respondent and to encourage truthfulness in answering questions. The average total time required to complete the family session was approximately 90 min. At the completion of the family session, respondents were thanked for their cooperation, and subsequently a $25 check was sent to them along with a letter of appreciation for their time in participating in the study.
Key Variables The adolescent and parental survey instruments included extensive information on sociodemographic factors, drinking behaviors, youthful de-
334
Barnes
viance, and relationships between family members, as well as information on parental socialization practices, e.g., nurturance. Alcohol Consumption Measures. The questions asking about the quantity and frequency of drinking beer, wine, and liquor were used to derive two types of alcohol consumption variables: (1) a categorical drinking variable with categories of abstainers, infrequent, light, moderate, moderate-heavy, and heavy drinkers; and (2) an interval-level drinking variable representing the average ounces of absolute alcohol per day unit [see Barnes (1978) for a complete description; also see Jessor et al. (1978) and Rachal et aL (1975)]. Within the categorical drinking scheme, abstainers, for example, are defined as never drinking or drinking less than once a year. At the other end of the spectrum, moderate/heavy drinkers drink at least once a week and drink 2-4 drinks per occasion or drink three or four times a month and consume 5-12 drink per occasion. Heavy drinkers are those adolescents who drink at least once a week and drink 5-12 drinks per typical drinking occasion. Alcohol-Related Problems Score. This measure was derived by adding the frequency of occurrence within the past year of five alcohol-related problems, i.e., trouble with teachers or principal because of drinking, difficulties with friends because of drinking, driving after having a good bit to drink, criticism by date because of drinking, and trouble with police because of drinking. Problem Drinking. Problem drinking was defined as having been drunk at least six times in the past year, or having experienced negative consequences two or more times in the past year in at least three of five areas (trouble with teachers, friends, a date, the police, or driving after drinking), or both (Rachal et al., 1980). Deviance Scale. Adolescents indicated the frequency at which they had done a series of 10 problem behaviors during the past year. The deviance scale was developed and condensed based on previous work in this area (cf. Johnston, 1973; Bachman, 1970; Gold and Mann, 1972). Thus, for analytical purposes, the five "minor deviance" items were stayed out later than parents said, argued or fought with mother, skipped a day of school without a real excuse, argued or fought with father, and used marijuana; the five "major deviance" items were ran away from home, purposely damaged or messed up something not belonging to you, tried to get something by lying to a person about what you would do for him or who you were, taken something of value which did not belong to you, and beaten up someone on purpose. The responses to the individual items (i.e., the number of occurrences during the past 12 months) were totaled together for the number of "minor," "major," and total deviant acts committed. Parental gurturance. The nurturance or support construct was developed as an independent variable and defined as parental behaviors
Adolescent Alcohol Abuse
335
toward the child which indicate to the adolescent that he/she is accepted, approved of, and loved. Operationally, the nurturance scale was derived for each parent by assigning numerical values to eight questions regarding mother and father nurturance and totaling the individual responses. These items included receiving praise or encouragement, relying on parent for advice and guidance, getting hugged or kissed by each parent, doing things together, making adolescent-parental decisions, discussing plans for the future, discussing personal problems with each parent, and in general, knowing what are the parents' expectations. For the categorical scale of low, medium, and high nurturance, the total score for mother was broken down in such a way that approximately one-third of the mothers could be classified as low, medium, or high. The same range of values was used for fathers as for mothers.
Hypotheses The substantive hypotheses set forth for testing were as follows: A heavy drinking pattern among a representative household sample of adolescents is positively associated with various alcohol-related problems; a heavy drinking pattern among adolescents is also positively related to a variety of other problem behaviors (social deviance). Parental socialization factors, specifically parental nurturance/support, are negatively associated with both alcohol abuse and other problem behaviors.
RESULTS While heavier drinking among adolescents is not necessarily synonymous with "problem drinking," the findings from this study show that the group of heavier-drinking adolescents is at a higher risk for the occurrence of various alcohol-related problems (Table I) than are adolescents who drink more moderately. Thus, the heavier drinkers compared with the others in the sample have a significantly higher average frequency of trouble with school officials, friends, dates, and the police because of drinking during the past year as well as a greater occurrence of driving a car after drinking. There is a significant positive relationship between adolescent drinking and the frequency of deviance for various individual problem behaviors and total problem behavior scores (Table II). For all items, the mean deviance scores are higher for the heavier-drinking adolescents than for abstainers or infrequent-moderate drinkers. The most highly significant differences in mean deviance scores among drinking groups are for the individual i t e m s -
0. l 1 0.01 0.18
0.00
0.08 0.00 0.00
0.00
0,15
Total problem score
0.33
0.03
0.08
Infrequent to moderate drinkers (N = 68)
Gotten into trouble with teachers or principal because of drinking Gotten into difficulties with friends because of drinking Driven a car after having a good bit to drink Criticized by someone you were dating because of drinking Gotten into trouble with police because of drinking
Abstainers (N = 33)
5.69
0.93
1.39
1.31
1.32
0.66
Moderate-heavy and heavy drinkers (N = 22)
Adolescent drinking classification
0.00
0.01
0.00
0.00
0.00
0.00
Significance
Table 1. Mean Number of Alcohol-Related Problems During the Past Year Within Drinking Classifications
w
t~
6.17 1.20 3.23 1.72
4.06 0.41 2.71 0.62 10.23
Total minor deviance
0.88
1.04 0.51 0.52
0.89
0.26 0.30 0.36 2.03 12.27
Total major deviance
Total deviance score
19.05
3.07
0.08
0.18
Major deviance variables Ran away from home Purposely damaged or messed up something not belonging to you Tried to get something by lying to a person about what you would do for him or who you were Taken something of value which didn't belong to you Beaten up someone on purpose
15.97
3.86
2.71
Infrequent, light, and moderate (N = 67)
Minor deviance variables Stayed out later than parents said Argued or fought with mother Skipped a day of school without a real excuse Argued or fought with father Used marijuana
Abstainers (N = 33)
34.66
6.41
1.50
0.82
1.95
1.52
0.61
28.25
3.69 5.43
3.68
7.18
8.43
Moderate-heavy and heavy (N = 22)
Drinking classification
0.00
0.00
0.05
0.18
0.01
0.28
0.00
0.00
0.66 0.00
0.00
0.02
0.00
Significance level (ANOVA)
Table 11. Mean Deviance Scores During the Past 12 Months Within Drinking Classifications of Adolescents
t~ t~
m"
g
I
o
338
Barnes
stayed out later than parents said, skipped a day of school without a real excuse, used marijuana, and ran away from home. There are also highly significant differences between drinking groups with regard to total minor and major deviance as well as all deviance combined. Thus, for example, among this general population sample of adolescents, abstainers averaged approximately 10 minor deviance occurrences and 2 major deviant acts, whereas the respective mean scores for the moderate-heavy- and heavydrinking group are about three times as great, i.e., 28 minor and over 6 major deviant acts. Similar analyses for males and females separately show the same relationships between drinking and deviance. Interestingly, the females have mean deviance scores of nearly the same magnitude as those of males in the same drinking group. This is again evidenced in the correlation matrix (Table III) where there is virtually no relationship between sex and the total deviance score (r -- 0.01). From the correlation matrix, the highest and most significant correlation is between total alcohol consumption (in average ounces of absolute alcohol per day) and total deviance during the past 12 months (r = 0.55; p < 0.001). When considering the relationship between total deviance and other variables separately, there are significant correlations between deviance and age of adolescents (0.33); alcohol-related problems (0.24) (i.e., problems with teachers, friends, a date, or police because of drinking and driving after having had too much to drink); and grades received in school (0.23), where the higher the deviance, the poorer the grades received. Alcohol consumption has a very similar relationship to these same variables as does deviance. Thus, alcohol consumption is significantly correlated with age (0.34), alcoholrelated problems (0.30), and grades received in school (0.24). It is noteworthy that the more psychological dimensions, i.e., self-esteem and psychological adjustment, are not significantly correlated with either deviance or alcohol consumption. However, they are correlated with each other as would be expected and this supports the validity of the measures. Using the variables displayed in the correlation matrix (Table III), a stepwise multiple regression analysis was performed, with total deviance as the dependent variable. The amount of alcohol consumed accounts for 30°7o of the variance of total deviance (Table IV). In addition to alcohol consumption, only psychosomatic illness has a large enough F to enter the equation. Even the variables which have a significant correlation with deviance, i.e., age and grades in school, do not add any predictive power for deviance once alcohol consumption has been taken into account. The psychological adjustment scale and self-esteem also do not explain any of the variance in deviant behavior after the alcohol score is taken into account. Thus, the total amount of alcohol consumed is the single best predictor of other problem behaviors and, indeed, accounts for a sizable proportion of the variance in deviance. The results are virtually the same when total quantity-frequency of alcohol
*p --< 0.05. **p -< 0.01. ***p -< 0.001.
Sex (dummy variable where 1 = male and 2 = female) Age of adolescent (12-17 years) Alcohol consumption (mean ounces of absolute alcohol consumed per day) Age first drunk or very high from alcohol Alcohol-related problem score Psychological adjustment scale Self-esteem scale Psychosomatic illness Total deviance score Grades in school (high value = poorer grades)
-0.09
0.11 -0.08 0.20* -0.24** 0.30*** 0.01
-0.01
0,05
Sex
0.15
- 0.21" 0.17 0.24** 0.13 0.02 0.33***
0.34***
Age
0.24**
-0.19" 0.30*** 0.11 0.15 --0.03 0.55*** --0.05
-0.08 - 0.09 -0.15 --0.01 --0.12 0.23**
-0.13 -0.17 --0.03 0.24**
Alcohol Age first Alcohol reconsump- drunk from lated probtion alcohol lem score
-0.22*
0.46*** -0.30*** 0.01
Psychological adjustment
Table 111. Correlation Matrix From Multiple Regression Analyses
-0.41"**
-0.48*** 0.04
Selfesteem
0.28**
0.18" 0.23**
Psychoso- Total matic deviance illness score
t~a
o_=
O
=_
Variables n o t in equation (significance level >0.05) Sex (dummy variable) Age of adolescent (12-17 years) Age first drunk or very high from alcohol Alcohol-related problem score Psychological adjustment scale Self-esteem scale Grades in school
Independent variable Total quantity/frequency of alcohol consumed (ounces of absolute alcohol per day unit) Psychosomatic illness
Standardized regression coefficient
0.55 0.20
Unstandardized regression coefficient
13.86 0.66
7.36 2.61
T value
Adolescent Alcohol Abuse and Other Problem Behaviors: Their Relationships and C o m m o n Parental Influences Grace
M. Barnes I
Received March 19, 1984;accepted July 3, 1984
Th& study was designed to explore the relationships between adolescent alcohol abuse and other problem behaviors. Parental socialization practices, particularly support/nurturance, were also examined f or common influences on both alcohol abuse and other youthful deviance. Interviews were conducted with a representative household sample o f adolescents aged 12-17 years and their parents. The findings support the theory that adolescent alcohol abuse is part o f a complex psychosocial problem behavior syndrome and that a high degree o f parental nurturance may be a significant deterrence to alcohol abuse and more general deviant behaviors.
INTRODUCTION ...Our son is stubborn and rebellious and refuses to obey us; he wastes money and is a drunkard. Deuteronomy 21:20
As early as - 1 4 5 0 B . C . , the r e l a t i o n s h i p between alcohol abuse a n d other a n t i s o c i a l / r e b e l l i o u s behaviors was recognized. T o d a y , in a n effort to deal effectively with " p r o b l e m " y o u n g people, v a r i o u s aspects o f social tGrace M. Barnes has a Ph.D. in sociology and is a Research Scientist at the Research Institute on Alcoholism, New York State Division of Alcoholism and Alcohol Abuse, 1021 Main Street, Buffalo, New York 14203. Dr. Barnes' major research interests are in the areas of adolescent socializationwithin the familyand patterns of alcohol use and other related behaviors throughout the life cycle. 329 0047-2891/84/0800.0329503.S0/0 © 1984 Plenum Publishing Corporation
330
Barnes
behaviors have been isolated for special attention. Teenage alcohol abuse in particular, has been singled out as a topic of widespread public concern. An integral part of the concern is manifested in the directives for developing targeted prevention and intervention/treatment programs for adolescent alcohol abusers. However, the development of effective means of preventing or treating adolescent alcohol abuse necessitates a comprehensive understanding of the potential factors leading to problem drinking. For example, it has been argued that evaluations of school-based alcohol education/prevention programs show little effect on drinking behaviors, since they cannot overcome the vast influences of other adolescent socialization experiences, especially within the family (Barnes, 1984). Similarly, Pattison (1980, 1982) has strongly argued that a critical hindrance to the development of effective treatment for alcoholism in general has been the conceptualization of alcoholism as a "unitary" disease. This unitary concept implies that all persons so afflicted are substantially the same and experience a similar progressive deterioration (Pattison, 1980). Pattison argues that it is more appropriate to speak of alcoholism as a multivariate syndrome whereby alcohol use is complexly intertwined with other psychosocial variables. [Cf. also the review by Room (1983) which discusses at length the sociological aspects of the disease concept of alcoholism.] Other empirical work has shown that adults may move in and out of problem drinking in association with various social factors (e.g., marital and employment status) (Cahalan, 1970). If these arguments against the unitary disease model of alcoholism are critical for adults, they are even more critical for conceptualizing problems among youth, where manifestations of various behavioral problems are often incipient and where "diagnosis" (or formal labeling) may prove to ingrain more deeply the social effects of developing problems of youth (cf. Scheff, 1966). Specifically, "teenage alcoholism" is an example of a widely used expression which has more negative emotional content than substantive meaning. Thus, if alcoholism in adolescence implies the development of physical dependence to alcohol with accompanying physiological damage (as it typically is used to describe adult alcoholics in treatment), then indeed there is a small proportion of teenagers who can be classified as alcoholics. There are relatively few reports in the literature documenting signs of physical dependence to alcohol and various late-stage signs of alcohol abuse such as alcohol-induced liver cirrhosis and delerium tremens among teenagers (see Barnes, 1982). On the other hand, the vast majority of teenagers does drink alcohol at least occasionally. More importantly, significant proportions of youth drink heavily, become intoxicated regularly, and experience various alcohol-related problems (e.g., Rachal et al., 1975, 1980; Barnes, 1978, 1979, 1981). One definition of youthful problem drinking is being drunk six or more times in the previous year and/or having negative consequences two or more times
Adolescent Alcohol Abuse
331
in that year in at least three of five problem areas (trouble with school officials, friends, a date, or the police because of drinking and driving after having too much to drink). According to this criterion, it is estimated that as many as 30o7oof tenth to twelfth grade students in the United States misuse alcohol (Rachal et al., 1980). Problem drinking among youth may be related to a variety of other problem behaviors or antisocial activities. School surveys have shown that adolescent problem drinkers are more likely than nonproblem drinkers to exhibit acceptance of and participation in deviant acts (Jessor et al., 1968; Mandell et al., 1963; Rachal et al., 1975). Similarly in studies among delinquent populations, excessive drinking is likely to be reported (McKay et al., 1967; Pearce and Garrett, 1970; Blacker et al., 1965; Widseth and Mayer, t971). Whether youthful antisocial behaviors precede or follow problem drinking is not known. It appears that problem drinking covaries within a complex network or syndrome of deviant behaviors (Jessor and Jessor, 1973, 1977; Donovan and Jessor, 1978). In other words, it has been suggested that heavy drinking, problem drinking, and antisocial activities represent alternative pathways for the expression of similar need systems (Zucker, 1976). How youthful alcohol abuse is conceptualized has important implications not only for the establishment of appropriate intervention/treatment programs, but also for studying the causal factors leading to potential problem drinking. If problem drinking is integrally linked with other problem behaviors, both phenomena may have common causal conditions. There may be a genetic component involved in the development of alcoholism in certain people (Goodwin, 1979) or various biochemical imbalances in certain individuals characterized as antisocial personality types; however, these biological models, at best, explain a part of the frequent occurrence of alcohol-related problems and other antisocial behaviors. From socialization theory and research, the family has been shown to be crucial for childhood development. Aspects of parental socialization, for example, support and nurturance, have been positively related to a variety of childhood outcomes such as cognitive development, self-esteem, and academic achievement. [See the comprehensive review by Rollins and Thomas (1979).] Studies of adolescent alcohol behaviors using the popular school survey method provide rather sparse information on the socialization process within the family; however, the profiles of excessive alcohol users do indicate interpersonal problems within the home. Excessive drinkers are less likely to feel "very close" to their families (Wechsler and Thum, 1973); they are more likely to feel loosely controlled, particularly by their mothers, and to feel rejection and a great deal of psychological tension in relationship with their fathers (Prendergast and Schaefer, 1974). Retrospective studies of adult alcoholics also suggest that certain factors precede the onset of alcohol problems. Pittman and Gordon (1958) found
332
Barnes
that chronic inebriates' socialization experiences within the family were grossly deficient and that this undersocialization contributed to poor adolescent adjustment in these men. McCord and McCord (1962) found that the boys who later became alcoholic, in comparison to a group who showed no evidence of alcoholism in adulthood, were significantly more likely to reject their mothers and to disapprove of their fathers. These retrospective studies of alcoholics have contributed to the literature and indicate that the family socialization process may contribute to the development of alcohol problems and other problem behaviors. However, inherent in the designs of these retrospective studies is the problem of reconstructing the past, i.e., loss of memory by the alcoholics, difficulties in separating antecedent factors from the effects of the disease, and second-hand information on parental behaviors. The present study was designed to examine the relationship between drinking and various so-called deviant behaviors in a general population sample of adolescents. Representative population samples have only rarely been used to examine alcohol use and various problem behaviors of youth. The present analysis was also carried out to examine the influence of specific parental socialization factors (support/nurturance) on adolescent problem behaviors. The underlying assumption guiding this analysis was that youthful alcohol abuse is not best characterized as a unitary disease entity. Rather, it was proposed that alcohol abuse is a multifaceted social phenomenon and occurs in the context of other problem behaviors. Furthermore, alcohol abuse and other problem behaviors may have common causal factors within the context of the parental socialization process.
METHODS Sampling Design and Procedures
A random digit dial (RDD) telephone procedure was used to select a representative household sample of adolescents and their families in metropolitan Erie County. The criteria for inclusion in the sample were that the household have at least one adolescent between the ages of 12 and 17 years and at least one parent (biological or surrogate). After it was determined that a household met the eligibility requirements for inclusion in the sample, the study was explained to participants, and they were given the assurances of confidentiality. Appointments were made with the families to carry out the face-to-face interviewing. Before the scheduled interview, a letter was sent to families to give further information about the study and to confirm the appointment. Interviews were subsequently carried out by a two-person interviewing team in the respondents' home as described below.
Adolescent Alcohol Abuse
333
This methodological procedure resulted in an in-depth study of 124 families. The sample include 379 individual family members- 120 mothers, 85 fathers, 124 adolescents, and 50 adolescent siblings. Analysis of the completed interviews with available 1980 census data indicated that the sample of households obtained closely represented the population at large (Barnes and Cairns, 1982).
Interviewing Procedures A team of two interviewers was assigned on a rotating basis to the individual family respondents. Access to the home was not a problem since appointments were made previously over the phone and confirmation letters were sent prior to the date of the interview. The procedures were first explained to the family and informed consent forms were read and signed. Each family member was interviewed independently in separate areas of the house wherever possible. This was accomplished by having two parts to each instrument, i.e., a self-administered portion and a face-to-face interview. In the case of the maximum fourmember family, one interviewer gave brief instructions to the target adolescent and the adolescent sibling regarding completion of the self-administered questionnaires. That interviewer then administered the verbal interview portion to his/her assigned parent. The second interviewer completed the faceto-face interview with the other parent. (The adolescent questionnaires and the parental interviews were designed to take approximately the same amount of tirffe to complete.) When these first sections were completed, the parents were given a brief self-administered questionnaire and the two interviewers then spoke with the two adolescents. While every attempt was made to interview family members in separate areas of the living quarters, the sensitive questions (e.g., drinking questions) were placed in the self-administered portions of the respective instruments. This was done to avoid the possibility of embarrassing the respondent and to encourage truthfulness in answering questions. The average total time required to complete the family session was approximately 90 min. At the completion of the family session, respondents were thanked for their cooperation, and subsequently a $25 check was sent to them along with a letter of appreciation for their time in participating in the study.
Key Variables The adolescent and parental survey instruments included extensive information on sociodemographic factors, drinking behaviors, youthful de-
334
Barnes
viance, and relationships between family members, as well as information on parental socialization practices, e.g., nurturance. Alcohol Consumption Measures. The questions asking about the quantity and frequency of drinking beer, wine, and liquor were used to derive two types of alcohol consumption variables: (1) a categorical drinking variable with categories of abstainers, infrequent, light, moderate, moderate-heavy, and heavy drinkers; and (2) an interval-level drinking variable representing the average ounces of absolute alcohol per day unit [see Barnes (1978) for a complete description; also see Jessor et al. (1978) and Rachal et aL (1975)]. Within the categorical drinking scheme, abstainers, for example, are defined as never drinking or drinking less than once a year. At the other end of the spectrum, moderate/heavy drinkers drink at least once a week and drink 2-4 drinks per occasion or drink three or four times a month and consume 5-12 drink per occasion. Heavy drinkers are those adolescents who drink at least once a week and drink 5-12 drinks per typical drinking occasion. Alcohol-Related Problems Score. This measure was derived by adding the frequency of occurrence within the past year of five alcohol-related problems, i.e., trouble with teachers or principal because of drinking, difficulties with friends because of drinking, driving after having a good bit to drink, criticism by date because of drinking, and trouble with police because of drinking. Problem Drinking. Problem drinking was defined as having been drunk at least six times in the past year, or having experienced negative consequences two or more times in the past year in at least three of five areas (trouble with teachers, friends, a date, the police, or driving after drinking), or both (Rachal et al., 1980). Deviance Scale. Adolescents indicated the frequency at which they had done a series of 10 problem behaviors during the past year. The deviance scale was developed and condensed based on previous work in this area (cf. Johnston, 1973; Bachman, 1970; Gold and Mann, 1972). Thus, for analytical purposes, the five "minor deviance" items were stayed out later than parents said, argued or fought with mother, skipped a day of school without a real excuse, argued or fought with father, and used marijuana; the five "major deviance" items were ran away from home, purposely damaged or messed up something not belonging to you, tried to get something by lying to a person about what you would do for him or who you were, taken something of value which did not belong to you, and beaten up someone on purpose. The responses to the individual items (i.e., the number of occurrences during the past 12 months) were totaled together for the number of "minor," "major," and total deviant acts committed. Parental gurturance. The nurturance or support construct was developed as an independent variable and defined as parental behaviors
Adolescent Alcohol Abuse
335
toward the child which indicate to the adolescent that he/she is accepted, approved of, and loved. Operationally, the nurturance scale was derived for each parent by assigning numerical values to eight questions regarding mother and father nurturance and totaling the individual responses. These items included receiving praise or encouragement, relying on parent for advice and guidance, getting hugged or kissed by each parent, doing things together, making adolescent-parental decisions, discussing plans for the future, discussing personal problems with each parent, and in general, knowing what are the parents' expectations. For the categorical scale of low, medium, and high nurturance, the total score for mother was broken down in such a way that approximately one-third of the mothers could be classified as low, medium, or high. The same range of values was used for fathers as for mothers.
Hypotheses The substantive hypotheses set forth for testing were as follows: A heavy drinking pattern among a representative household sample of adolescents is positively associated with various alcohol-related problems; a heavy drinking pattern among adolescents is also positively related to a variety of other problem behaviors (social deviance). Parental socialization factors, specifically parental nurturance/support, are negatively associated with both alcohol abuse and other problem behaviors.
RESULTS While heavier drinking among adolescents is not necessarily synonymous with "problem drinking," the findings from this study show that the group of heavier-drinking adolescents is at a higher risk for the occurrence of various alcohol-related problems (Table I) than are adolescents who drink more moderately. Thus, the heavier drinkers compared with the others in the sample have a significantly higher average frequency of trouble with school officials, friends, dates, and the police because of drinking during the past year as well as a greater occurrence of driving a car after drinking. There is a significant positive relationship between adolescent drinking and the frequency of deviance for various individual problem behaviors and total problem behavior scores (Table II). For all items, the mean deviance scores are higher for the heavier-drinking adolescents than for abstainers or infrequent-moderate drinkers. The most highly significant differences in mean deviance scores among drinking groups are for the individual i t e m s -
0. l 1 0.01 0.18
0.00
0.08 0.00 0.00
0.00
0,15
Total problem score
0.33
0.03
0.08
Infrequent to moderate drinkers (N = 68)
Gotten into trouble with teachers or principal because of drinking Gotten into difficulties with friends because of drinking Driven a car after having a good bit to drink Criticized by someone you were dating because of drinking Gotten into trouble with police because of drinking
Abstainers (N = 33)
5.69
0.93
1.39
1.31
1.32
0.66
Moderate-heavy and heavy drinkers (N = 22)
Adolescent drinking classification
0.00
0.01
0.00
0.00
0.00
0.00
Significance
Table 1. Mean Number of Alcohol-Related Problems During the Past Year Within Drinking Classifications
w
t~
6.17 1.20 3.23 1.72
4.06 0.41 2.71 0.62 10.23
Total minor deviance
0.88
1.04 0.51 0.52
0.89
0.26 0.30 0.36 2.03 12.27
Total major deviance
Total deviance score
19.05
3.07
0.08
0.18
Major deviance variables Ran away from home Purposely damaged or messed up something not belonging to you Tried to get something by lying to a person about what you would do for him or who you were Taken something of value which didn't belong to you Beaten up someone on purpose
15.97
3.86
2.71
Infrequent, light, and moderate (N = 67)
Minor deviance variables Stayed out later than parents said Argued or fought with mother Skipped a day of school without a real excuse Argued or fought with father Used marijuana
Abstainers (N = 33)
34.66
6.41
1.50
0.82
1.95
1.52
0.61
28.25
3.69 5.43
3.68
7.18
8.43
Moderate-heavy and heavy (N = 22)
Drinking classification
0.00
0.00
0.05
0.18
0.01
0.28
0.00
0.00
0.66 0.00
0.00
0.02
0.00
Significance level (ANOVA)
Table 11. Mean Deviance Scores During the Past 12 Months Within Drinking Classifications of Adolescents
t~ t~
m"
g
I
o
338
Barnes
stayed out later than parents said, skipped a day of school without a real excuse, used marijuana, and ran away from home. There are also highly significant differences between drinking groups with regard to total minor and major deviance as well as all deviance combined. Thus, for example, among this general population sample of adolescents, abstainers averaged approximately 10 minor deviance occurrences and 2 major deviant acts, whereas the respective mean scores for the moderate-heavy- and heavydrinking group are about three times as great, i.e., 28 minor and over 6 major deviant acts. Similar analyses for males and females separately show the same relationships between drinking and deviance. Interestingly, the females have mean deviance scores of nearly the same magnitude as those of males in the same drinking group. This is again evidenced in the correlation matrix (Table III) where there is virtually no relationship between sex and the total deviance score (r -- 0.01). From the correlation matrix, the highest and most significant correlation is between total alcohol consumption (in average ounces of absolute alcohol per day) and total deviance during the past 12 months (r = 0.55; p < 0.001). When considering the relationship between total deviance and other variables separately, there are significant correlations between deviance and age of adolescents (0.33); alcohol-related problems (0.24) (i.e., problems with teachers, friends, a date, or police because of drinking and driving after having had too much to drink); and grades received in school (0.23), where the higher the deviance, the poorer the grades received. Alcohol consumption has a very similar relationship to these same variables as does deviance. Thus, alcohol consumption is significantly correlated with age (0.34), alcoholrelated problems (0.30), and grades received in school (0.24). It is noteworthy that the more psychological dimensions, i.e., self-esteem and psychological adjustment, are not significantly correlated with either deviance or alcohol consumption. However, they are correlated with each other as would be expected and this supports the validity of the measures. Using the variables displayed in the correlation matrix (Table III), a stepwise multiple regression analysis was performed, with total deviance as the dependent variable. The amount of alcohol consumed accounts for 30°7o of the variance of total deviance (Table IV). In addition to alcohol consumption, only psychosomatic illness has a large enough F to enter the equation. Even the variables which have a significant correlation with deviance, i.e., age and grades in school, do not add any predictive power for deviance once alcohol consumption has been taken into account. The psychological adjustment scale and self-esteem also do not explain any of the variance in deviant behavior after the alcohol score is taken into account. Thus, the total amount of alcohol consumed is the single best predictor of other problem behaviors and, indeed, accounts for a sizable proportion of the variance in deviance. The results are virtually the same when total quantity-frequency of alcohol
*p --< 0.05. **p -< 0.01. ***p -< 0.001.
Sex (dummy variable where 1 = male and 2 = female) Age of adolescent (12-17 years) Alcohol consumption (mean ounces of absolute alcohol consumed per day) Age first drunk or very high from alcohol Alcohol-related problem score Psychological adjustment scale Self-esteem scale Psychosomatic illness Total deviance score Grades in school (high value = poorer grades)
-0.09
0.11 -0.08 0.20* -0.24** 0.30*** 0.01
-0.01
0,05
Sex
0.15
- 0.21" 0.17 0.24** 0.13 0.02 0.33***
0.34***
Age
0.24**
-0.19" 0.30*** 0.11 0.15 --0.03 0.55*** --0.05
-0.08 - 0.09 -0.15 --0.01 --0.12 0.23**
-0.13 -0.17 --0.03 0.24**
Alcohol Age first Alcohol reconsump- drunk from lated probtion alcohol lem score
-0.22*
0.46*** -0.30*** 0.01
Psychological adjustment
Table 111. Correlation Matrix From Multiple Regression Analyses
-0.41"**
-0.48*** 0.04
Selfesteem
0.28**
0.18" 0.23**
Psychoso- Total matic deviance illness score
t~a
o_=
O
=_
Variables n o t in equation (significance level >0.05) Sex (dummy variable) Age of adolescent (12-17 years) Age first drunk or very high from alcohol Alcohol-related problem score Psychological adjustment scale Self-esteem scale Grades in school
Independent variable Total quantity/frequency of alcohol consumed (ounces of absolute alcohol per day unit) Psychosomatic illness
Standardized regression coefficient
0.55 0.20
Unstandardized regression coefficient
13.86 0.66
7.36 2.61
T value
