Alcohol Problems in the Community

Larry Harrison

• Publisher: Routledge
• Year: 2002
• ISBN:
  9781134836253
• Edition: 1
• Topic: Medicina
• Subtopic: Atención sanitaria

Community surveys reveal that about 6% of the adult male and 1% of the adult female population in England and Wales are drinking at high risk levels.
Alcohol Problems in the Community examines the implications of recent community care legislation for government policy on alcohol. The first part of the book begins with a report on recent US research on the role of alcohol in the perpetration of child abuse and recent research on young people's drinking problems. This is followed by a study on the prevalence of drinking problems amongst older people which has been underestimated. In the second half of the book empirical evidence is presented on the particular difficulties faced by ethnic, migrant and homeless groups and this emphasis on the centrality of social disadvantage leads on to a consideration of a specific social work role in the assessment and management of alcohol-related problems.
Alcohol Problems in the Community is aimed at social work practitioners and students on prequalifying, qualifying and postqualifying social work courses, and it addresses key social work issues in relation to poverty, homelessness, discrimination and drinking problems.

Chapter 1
Inter-generational links between childhood abuse and alcohol-related problems

William R.Downs and Brenda A.Miller

INTRODUCTION

Both childhood violence and alcohol problems are widespread in the US. In a nationally representative sample of 6,002 families, Straus and Gelles (1990) found that 11 per cent of children (approximately 6.9 million) were annual victims of parental violence (defined as being hit with an object, kicked, bitten, punched, beat up, burned, scalded, or threatened or attacked with a knife or gun). From 20 to 30 per cent of adult women and from 10 to 15 per cent of adult men report having been sexually abused during childhood (Finkelhor 1979; Finkelhor et al. 1989). Williams et al. (1989) estimated that 4.6 million women met DSM-III diagnostic criteria, for alcohol abuse or dependence, and estimates of male-female ratios of clinically diagnosable alcohol disorders have ranged from 2:1 (Williams et al. 1989) to 8:1 (Robins et al. 1988). Zucker (1986) estimated an average lifetime diagnosis of alcohol abuse/dependence of 24.3 per cent for men and 4.4 per cent for women, averaged across three Epidemiologic Catchment Area (ECA) sites.

Whether alcohol problems are associated with childhood violence is an important issue both theoretically and clinically. If children whose parents have alcohol problems have an elevated risk of childhood maltreatment, and if childhood maltreatment is then related to the development of alcohol problems for those children in adulthood, then there exists the possibility of intergenerational transmission of both childhood maltreatment and alcohol problems. This chapter examines whether experiences of childhood violence are related to alcohol problems in the parents of the child and whether experiences of childhood violence are related to the development of adulthood alcohol problems for the victims of that violence. Thus, we examine the intergenerational links between parental alcohol problems and childhood violence. In addition, we examine these associations controlling for the gender of the parent with alcohol problems as well as gender of the parent who perpetrates childhood violence. Finally, we examine the literature for these associations as well as report data from a recent study funded by the US National Institute on Alcohol Abuse and Alcoholism (NIAAA).

PARENTAL ALCOHOL PROBLEMS AND CHILDHOOD MALTREATMENT

Literature review

Early reviews of the literature indicated a lack of support for the association between parental alcohol problems and the perpetration of childhood violence by the parents, and severely criticised existing empirical literature for methodological ineptitude (e.g. Orme and Rimmer 1981). A later review also indicated that the link between parental alcoholism and perpetration of child abuse, if any, may be due to third variables such as socioeconomic status (SES) (West and Prinz 1987). Other researchers have concluded that only a modest association exists between perpetration of physical child abuse and parental alcohol problems (e.g. Black and Mayer 1980).

More recent and methodologically sophisticated studies, using indices such as the Conflict Tactics Scale and improved sampling techniques, have supported the association between parental alcohol problems and experiences of violence for their children (Kantor and Straus 1990; Radomsky 1991; Famularo et al 1992a, 1992b; Kantor 1992). In a study of alcoholism in the general population, Holmes and Robins (1988) found parental alcoholism to be related to perpetration of harsh and unfair discipline on the children of the alcoholics. Williams-Petersen et al. (1994) found that drug use is related to child-abuse potential among a prenatal group of women. Reider et al. (1989) found an association between both father’s and mother’s aggression toward their children and lifetime alcohol problems, controlling for antisocial behaviour, depression, and marital aggression.

In exploring these relationships it is important to distinguish between mother and father violence (Straus et al. 1980; Allen and Epperson 1993). Perpetration of childhood violence may be specific to the parent with the alcohol problems. If so, combining both parents in the analysis may attenuate the association between parental alcohol-related problems and childhood maltreatment, or mask gender-related associations. For example, in a sample of male parolees Miller (1990) found that father alcohol problems were related to father-to-parolee but not mother-to-parolee violence, and that mother alcohol problems were related to mother-to-parolee but not father-to-parolee violence, when the parolee was a child.

Yet another issue not addressed systematically in the empirical literature is whether parental alcohol problems are related to experiences of childhood maltreatment from adults outside the nuclear family. This question may be especially poignant for victims of sexual abuse (Miller and Downs 1995). Parental preoccupation with abusing alcohol or coping with a partner who abuses alcohol may result in neglect of children, which in turn may place these children at risk of other adults who perpetrate sexual abuse on them. Parental unavailability has been found to be associated with childhood sexual abuse (Finkelhor and Baron 1986). In addition, children of alcoholic parents may not experience the nurturing parent-to-child relationship that other children experience, thereby increasing psychological vulnerability to the manipulations of perpetrators who link adult nurturance with sexual access to the child.

In sum, more recent and methodologically sophisticated studies have indicated that parental alcohol problems are related to the perpetration of abuse against their children. However, several issues remain to be addressed by future research. There is a need to control for the gender of the parent with the alcohol problems and perpetrating the violence. Further, there is a need to examine experiences of childhood violence perpetrated by other adults in addition to the parent with the alcohol problems. There is also a need to control for additional variables, such as SES, that may account for the association between parental alcohol problems and experiences of childhood violence. To address these issues, a study concerning the association between family violence and alcohol problems for women and funded by the NIAAA was conducted from 1988–1992.

NIAAA STUDY

Methodology

Samples of women ages 18–45 (N = 472) were recruited from clinical and nonclinical sources in Western New York. The clinical sources consisted of women from outpatient alcoholism clinics (N = 98), women receiving services from shelters or support groups for women experiencing partner violence (N = 97); and women in outpatient mental health clinics (N = 77) (total N = 272). Nonclinical sources included women attending drinking and driving classes following conviction for a driving while intoxicated (DWI) offence—hereafter referred to as the DWI sample (N = 100); and women from households obtained through random digit dialling (N = 100)—hereafter referred to as the community sample (Miller et al. 1993; Miller and Downs 1995). The total nonclinical sample size was thus 200.

Women who were currently receiving treatment for alcoholism from one of six clinics in Western New York were recruited at the clinics either through personal contact by one of the interviewers or through flyers which were given to eligible women by their counsellors. The majority of the battered women (77 per cent) were recruited during their stay at a shelter for battered women through personal contact with one of the interviewers during one of the house meetings. The remainder were receiving counselling services for battered women at an agency affiliated with the shelter. They were either given flyers by their counsellors or contacted by an interviewer before the start of their group counselling session.

Women in mental health treatment at six different clinics in Western New York were recruited through flyers which were given to them by their counsellors. Women who were either actively psychotic or suicidally depressed were excluded from the research. In the first instance, actively psychotic women were not expected to be able to provide reliable data for the study. In the second instance, the exclusion was based upon the concern for the women; the interview dealt with extremely sensitive issues and there was concern that the interview process might contribute to negative consequences for the women.

The DWI sample consisted of women who had been arrested for driving while intoxicated and chose to attend a series of seven drinking driver education classes in order to maintain a conditional licence. Women arrested for DWI who chose to have their licence suspended or who had been arrested more than once in the past five years for DWI did not participate in the classes. One of the interviewers described the study at the end of one of the classes and offered women the chance to participate. Although these women experienced an intervention involving their drinking, they were not seeking treatment and hence are considered a nonclinical sample.

The community sample was recruited through random digit dialling in the Buffalo area. If there was a woman in the household between the ages of 18 and 45 the study was described briefly to her and participation was solicited. Out of a total of 331 contacts with women aged 18–45, 34 per cent refused before hearing the description of the study, another 29 per cent refused after hearing about the study, 7 per cent agreed to be interviewed but failed to establish or keep appointments, and 30 per cent were interviewed.

Two in-depth interviews were conducted, with an 18-month time lag between the first and second interview. A major purpose of the first interview was to examine associations among parental alcohol problems, experiences of childhood violence, and development of adulthood alcohol problems for women. Data from this first interview is reported in the present study. A major purpose of the second interview was to examine longitudinal associations between alcohol problems and experiences of partner violence for women. This data is reported elsewhere (e.g. Downs and Miller 1994). Each participant completed a two and a half hour, face-to-face, in-depth interview that included both structured and open-ended questions. Prior to signing informed consents, participants were told that the interview would include questions about childhood family relationships, childhood sexual experiences, parental alcohol and drug use, current family, relationship with spouse/partner, and her own and her partner’s alcohol and drug use. All respondents were asked and agreed to allow audio taping of the interview.

Measures

This research utilised in-depth face-to-face interviews to assess multiple types of childhood victimisation. Multiple questions were used to assess childhood sexual abuse, and mother and father verbal, moderate and severe violence. Measures of childhood sexual abuse included experiences that occurred prior to 18 years of age for the woman. A list of childhood sexual abuse incidents defined by Finkelhor (1979), and supplemented by items from Sgroi (1982), was used to generate a list of sexual abuse experiences for girls. These experiences included:

• invitation or suggestion to do something sexual;
• other person showing his/her genitals to you, you showing your genitals to another person;
• kissing or hugging in a sexual way;
• other person fondling you in a sexual way;
• you fondling other person in a sexual way;
• other person touching your genitals either with his/her hands or mouth;
• you touching other person’s genitals either with your hands or mouth;
• person rubbing his/her genitals on your body without penetration;
• intercourse;
• other person putting finger into your vagina or anus.
  (Miller et al. 1993)

Sexual abuse was then defined as follows:

victimisation experiences prior to the age of 18 and that occurred against the victim’s will or under conditions that would not allow the victim to consent with full knowledge.

This definition follows guidelines established by Finkelhor (1979). Perpetrators included any relative, someone at least five years older than the victim, or anyone who forced sexual activity against the victim’s will. To limit the measure to the most potentially harmful sexual experiences, we excluded any boyfriend experience that was defined as consensual by the woman, even if the boyfriend was more than five years older.

Parental violence was assessed by indices based on the Conflict Tactics Scale or CTS (Straus 1979; Straus et al. 1980). Measures of both mother-to-daughter violence and father-to-daughter violence were included. If more than one mother and/or father figure were present during the woman’s childhood, the parental figure that was predominant (longest duration) was used in these analyses. The CTS measures negative verbal interaction, moderate physical violence, and severe physical violence. The CTS was modified slightly for the present study. Two items were added to the negative verbal interaction index: ‘insulted or swore at you in a sexual manner’ and ‘threatened to abandon you.’

For the present analysis, verbal aggression was conceptualised as the independent variable, instead of negative verbal interaction. Thus, three items (‘sulk and/or refuse to talk about it’; ‘stomp out of the room or house’; ‘cry’) were excluded from the present analysis. Second, because virtually all respondents stated that their mothers and fathers had slapped or spanked them, this item was excluded from the analysis for the moderate violence scale.

The modified CTS used in the study consisted of four verbal aggression items, four moderate violence items, and seven severe violence items. Each item on the CTS sub-scales was dichotomised into 0 = never happened and 1 = happened at least once. One point was scored for each item that happened at least once and points were summed across items for each sub-scale. Thus the range for the verbal aggression and moderate violence sub-scales was 0–4, and for severe violence was 0–7. This measure provided an index of the number or range of different items each respondent experienced for each sub-scale. Respondents reported separate CTS sub-scale scores for mother-to- daughter and father-to-daughter interactions during childhood. For brevity, these scores are referred to as ‘mother’ and ‘father’ scores, respectively.

In addition, the number of items experienced from either parent was calculated and referred to as the ‘parent’ score. There were also assessments of parental alcohol problems for both father and mother; number of changes in the family structure (e.g., divorces, death); socioeconomic status of the family in childhood; and race of respondent. Women were given self-administered forms assessing parental alcohol and drug problems based on criteria derived from the Research Diagnostic Criteria (RD...

Table of contents

• COVER PAGE
• TITLE PAGE
• COPYRIGHT PAGE
• ILLUSTRATIONS
• CONTRIBUTORS
• ACKNOWLEDGEMENTS
• INTRODUCTION
• CHAPTER 1: INTER-GENERATIONAL LINKS BETWEEN CHILDHOOD ABUSE AND ALCOHOL-RELATED PROBLEMS
• CHAPTER 2: ALCOHOL AND YOUTH
• CHAPTER 3: ALCOHOL AND THE CARE OF OLDER PEOPLE
• CHAPTER 4: PEOPLE WITH LEARNING DISABILITIES: ALCOHOL AND ORDINARY LIVES
• CHAPTER 5: DRINKING AND HOMELESSNESS IN THE UK
• CHAPTER 6: SOCIAL INFLUENCES ON TREATMENT OUTCOMES
• CHAPTER 7: GENDER DIVISIONS AND DRINKING PROBLEMS
• CHAPTER 8: SERVICES FOR WOMEN: THE WAY FORWARD
• CHAPTER 9: DRINKING PROBLEMS AMONG BLACK COMMUNITIES
• CHAPTER 10: COMMUNITY CARE POLICY AND THE FUTURE OF ALCOHOL SERVICES