Children of Addiction: Research, Health, and Public Policy Issues(Garland Reference Library of Social Science)

251 Pages·2003·1.57 MB·English

by  Hiram E. Fitzgerald

C A
HILDREN OF DDICTION

CHILDREN OF
ADDICTION
RESEARCH, HEALTH, AND
PUBLIC POLICY ISSUES
EDITED BY
HIRAM E.FITZGERALD
BARRY M.LESTER
BARRY S.ZUCKERMAN
ROUTLEDGEFALMER
NEW YORK & LONDON/2000
Published in 2000 by
RoutledgeFalmer
29 West 35th Street
New York, NY 10001
Published in Great Britain by
RoutledgeFalmer
11 New Fetter Lane
London EC4P 4EE
This edition published in the Taylor & Francis e-Library, 2003.
RoutledgeFalmer is an imprint of the Taylor & Francis Group
Copyright © 2000 by Hiram E.Fitzgerald, Barry M.Lester, and Barry S.Zuckerman
All rights reserved. No part of this book may be reprinted or reproduced
or utilized in any form or by any electronic, mechanical, or other means,
now known or hereafter invented, including photocopying and recording,
or in any information storage or retrieval system, without permission in
writing from the publisher.
Library of Congress Cataloging-in-Publication Data
Children of addiction: research, health, and public policy issues/edited by Hiram E.
Fitzgerald, Barry M.Lester, Barry S.Zuckerman.
p. cm.—(Garland reference library of social science; 1486. Source books on
education)
Includes bibliographical references and index.
ISBN 0-8153-3899-6 (alk. paper)
1. Children of alcoholics. 2. Children of narcotic addicts. 3. Alcoholics—
Family relationships. 4. Parents—Drug use. I. Fitzgerald, Hiram E. II. Lester,
Barry M. III. Zuckerman, Barry S. IV. Garland reference library of social
science; v. 1486. V. Garland reference library of social science. Source books on
education (Unnumbered)
HV5132 .C47 2000
362.29'13–dc21
00–024777
ISBN 0-203-90460-5 Master e-book ISBN
ISBN 0-203-90464-8 (Adobe eReader Format)
Contents

Preface vii
Contributors xi
List of Tables and Figures xiii
Chapter 1 Are There Dose Effects of Prenatal Cocaine Exposure
on Children’s Bodies and Brains? 1
Deborah A.Frank, Marilyn Augustyn, Mark Mirochnick,
Tripler Pell, and Barry S.Zuckerman
Chapter 2 Prenatal Cocaine Exposure and Child Outcome:
From Research to Public Policy 29
Linda L.LaGasse and Barry M.Lester
Chapter 3 Parenting and Parent-Child Relationships
in Families Affected by Substance Abuse 45
Sydney Lynn Hans
Chapter 4 Assessing Vulnerability to Moderate Levels of
Prenatal Alcohol Exposure 69
Sandra W.Jacobson and Joseph L.Jacobson
Chapter 5 The Teratologic Model of the Effects of
Prenatal Alcohol Exposure 91
Nancy L.Day and Gale A.Richardson
v
vi Contents
Chapter 6 The Clinical and Social Ecology of Childhood
for Children of Alcoholics: Description of a Study
and Implications for a Differentiated
Social Policy 109
Robert A.Zucker, Hiram E.Fitzgerald, Susan K.Refior,
Leon I.Puttler, Diane M.Pallas, and Deborah A.Ellis
Chapter 7 American Indian Children of Alcoholics 143
Paul Spicer and Candace Fleming
Chapter 8 Alcohol and Drug Use among African-American Youth 165
H.Elaine Rodney
Chapter 9 Substance Use and Abuse Outcomes in Children
of Alcoholics: From Adolescence to Young Adulthood 193
Laurie Chassin and Aaron Belz
Author Index 217
Subject Index 231
Preface

Proceedings of the Third Society for Research
on Child Development Round Table:
Children of Addiction
Alcoholism is the most common form of substance abuse in the United States,
with at least 28 million children exposed prenatally or postnatally to alcohol-
abusing parents or other caregivers. Of the 7 million children under 18 who are
exposed to alcohol, approximately 679,000 are younger than 2 years of age,
and 1,555,000 are between 2 and 5 (cf. Fitzgerald, Puttier, Mun, & Zucker,
2000). Recent epidemiological analyses indicate that prevalence for an alcohol
dependence diagnosis as defined by the American Psychiatric Association’s
Diagnostic and Statistical Manual of Mental Disorders, 4th edition (1994)
decreases with age at drinking onset. The later the onset, the less likely that the
individual will ever have a diagnosis of alcohol dependence. Prevalence rates
have increased in the past decade at the same time that the age of first use has
decreased to about 12 (Grant & Dawson, 1997). When one adds prenatal and
postnatal exposure to cocaine, opioids, and other drugs into the substance abuse-
risk equation, one is forced to conclude that exposure to substance-abusing
parents and/or other adults is a setting event that places children at high risk for
the intergenerational transmission of substance abuse and related forms of
psychopathology (Fitzgerald, Davies, & Zucker, in press; Zucker, Fitzgerald,
& Moses, 1995). The third SRCD Round Table brought together individuals
from nine major research centers, each of which focuses on some aspect of the
intergenerational impact of exposure to substance-abusing parents.
The first five chapters address issues related to prenatal exposure to alcohol
and/or other drugs and its impact of postnatal growth and development. In
Chapter 1, Deborah Frank, Marilyn Augustyn, Mark Mirochnic, Tripler Pell,
and Barry Zuckerman at Boston Medical Center review evidence that links
prenatal exposure to cocaine to brain and behavioral outcomes. They point out
that tracing the route from prenatal exposure to postnatal outcome is difficult
vii
viii Preface
because a standardized method for quantifying prenatal exposure is not yet in
use, many effects may be dose dependent, and exposure is always linked to the
individual characteristics of the mother-fetus dyad (i.e., exposure takes place in
a dynamic system). One way to try to understand diversity in research outcomes
is to identify normative elements across studies that vary in sampling
characteristics, sample sizes, cultural contexts, and research methodologies. In
Chapter 2, Linda LaGasse and Barry Lester at Women’s and Infants’ Hospital
and Brown University describe a database that has been constructed to code all
published studies of cocaine exposure in an effort to isolate normative trends as
well as identify critical individual differences that may better predict the
boundaries of the route from prenatal exposure to postnatal outcome. Such
databases allow for meta-analytic scans that dampen the methodological
limitations of individual studies, while simultaneously providing sufficient
statistical power to identify the critical predictors of postnatal outcomes. Such
findings can then lead to replication studies testing specific hypotheses that
emerge from such meta-analyses. In Chapter 3, Sydney Hans discusses her
research at the University of Chicago that focuses on the quality of parenting
given to infants who are exposed prenatally to opioids. She raises crucial issues
related to parenting. For example, do infants who have been exposed prenatally
to drugs differ from nonexposed infants with regard to the quality of parenting
they receive postnatally? Stressing the biology-environment transactions now
recognized by all developmental sciences, Hans attempts to tease out the relative
contributions to infant outcomes made by prenatal exposure to drugs and
postnatal exposure to the caregiving environment. In Chapter 4, Sandra and
Joseph Jacobson at Wayne State University address issues related to what
traditionally has been referred to as fetal alcohol effects. The work they describe
homes in on a critical question: Do levels of exposure that are insufficient to
produce fetal alcohol syndrome influence the etiology of such problems as
attention deficit, learning disorder, language delay, and poor self-regulation
that often are difficult to diagnose during the birth-to-3 age period? Moreover,
if such effects can be linked to prenatal exposure to alcohol, what are the critical
variables that modulate the expression of such social, cognitive, and behavior
problems? In the final chapter to address prenatal exposure, Nancy Day and
Gale Richardson at the Univeristy of Pittsburgh School of Medicine discuss the
implications of the teratologic model for research with humans and especially
with children. The teratologic model posits direct effects from prenatal exposure.
In contrast, a developmental model accepts both direct and indirect effects due
to the dynamic system in which fetal exposure to teratogens takes place. Their
work suggests that both the teratologic and developmental models help us
understand the effects of prenatal exposure on prenatal and postnatal
development.
The final four chapters address issues related to the etiology of alcoholism.
In Chapter 6, Robert Zucker, Hiram Fitzgerald, Susan Refior, Leon Puttier,
Preface ix
Diane Pallas, and Deborah Ellis address a wide range of issues related to the
social ecology of the alcoholic environment in which children are reared and
their risk for various pathological outcomes. Drawing on data from the Michigan
State University-University of Michigan Longitudinal Study, they raise important
questions concerning etiologic models of psychopathology, at least with respect
to familial alcoholism. What are the longterm consequences of differential
patterns of exposure to parental alcoholism and co-active forms of
psychopathology? What role do such co-active forms of parental
psychopathology as antisocial personality and depression play in structuring
risk for the intergenerational transmission of substance abuse and
psychopathology? How does one factor the dynamics of developmental change
into etiologic models of psychopathology? Such questions are especially relevant
for populations for whom etiologic issues are poorly understood. In Chapter 7,
Paul Spicer and Candace Fleming, investigators at the National Center for
American Indians and Alaska Natives, draw attention to a wide range of issues
related to alcohol abuse and dependence among American Indians. They note
that established epidemiologic morbidity and mortality rates for alcohol-specific
effects among American Indians has detracted from studies of within-tribe and
between-tribe variation in such risk factors. Moreover, insufficient attention to
etiology has detracted from identifying etiologic factors that are common to all
populations, such as parental violence and spouse and/or child abuse, and those
that may be specific to American Indian cultures. From their anthropological
perspective, preventive intervention programs directed at American Indians must
be informed by the cultural context of Indian drinking, while simultaneously
taking into account the destructive effects of alcohol abuse and individual and
family life. In Chapter 8. Elaine Rodney describes her research at Prairie View
A & M University and in the Midwest on alcohol and drug use among African-
American youth. Her extensive studies of alcohol and drug use among African-
American children, youth, and young adults provide additional support for the
necessity of taking cultural variation into account in etiologic studies. Finally,
in Chapter 9. Laurie Chassin and Aaron Belz, drawing on data from the Adult
and Family Development Project at Arizona State University, illustrate the
significant role that alcoholism plays in risk for alcohol and drug use independent
of associated forms of parental psychopathology. Moreover, they stress the fact
that the dynamics of alcoholism show great variation from one individual to
another and from one family to another. This heterogeneity challenges
investigators to identify the critical mediators and moderators that affect
developmental pathways that either maintain risky environments and/or risky
behaviors (Fitzgerald et al., 2000) and lead to poor outcomes or provide a
resilience structure that substantially reduces risk for intergenerational problems
related to alcohol use.
Readers searching for definitive answers concerning the etiology of
alcoholism will find few of them in this volume. Indeed, a key purpose of the