The impact of alcohol use disorders on family life

110 Pages·2014·0.86 MB·English

by  Danya Braunstein

Delyse M. Hutchinson, Richard P. Mattick,
Danya Braunstein, Elizabeth Maloney, Judy Wilson

The Impact of Alcohol Use Disorders
on Family Life: A Review of the Empirical Literature

NDARC Technical Report No. 325

THE IMPACT OF ALCOHOL USE
DISORDERS ON FAMILY LIFE:
A REVIEW OF THE EMPIRICAL
LITERATURE

Delyse M. Hutchinson, Richard P. Mattick,
Danya Braunstein, Elizabeth Maloney, Judy Wilson

NDARC Technical Report Number: 325

ISBN: 978-0-7334-3392-4

JUNE 2014

©NATIONAL DRUG AND ALCOHOL RESEARCH CENTRE,
UNIVERSITY OF NEW SOUTH WALES, SYDNEY, 2014

This work is subject to copyright protection. except as permitted under the copyright act 1968 and
this notice, no part of this work may be reproduced, stored in a retrieval system, communicated or
transmitted in any form or by any means without prior written permission from the owner. All
other rights are reserved. Requests and enquiries concerning reproduction and rights should be
addressed to the information manager, National Drug and Alcohol Research Centre, University of
New South Wales, Sydney, NSW 2052, Australia.

TABLE OF CONTENTS
LIST OF TABLES .................................................................................................... 2
LIST OF FIGURES .................................................................................................. 2
ACKNOWLEDGEMENTS ..................................................................................... 3
EXECUTIVE SUMMARY ....................................................................................... 4
CHAPTER 1. INTRODUCTION ...................................................................... 6
1.1 Overview, aims and objectives ................................................................................... 6
1.2 Description of studies included in the review ......................................................... 6
1.3 The spectrum of alcohol use: Key definitions ......................................................... 7
CHAPTER 2. THE PREVALENCE OF ALCOHOL USE AND ALCOHOL
USE PROBLEMS IN FAMILIES ........................................................................... 8
2.1 Introduction .................................................................................................................. 8
2.2 Prevalence of alcohol use and alcohol use problems in Australian families ....... 8
2.3 International research on the prevalence of alcohol use problems in families .11
CHAPTER 3. FRAMEWORK FOR REVIEWING LITERATURE ............... 13
CHAPTER 4. REVIEW OF EMPIRICAL LITERATURE ON THE IMPACT
OF ALCOHOL USE DISORDERS ON FAMILIES ............................................ 17
4.1 Five key areas in the research literature ..................................................................17
4.2 Impact on marital and intimate partner relationships ..........................................17
4.2.1 Marital/ intimate partner dissatisfaction and breakdown .............................17
4.2.2 Marital/ intimate partner violence ....................................................................20
4.3 Impact on family life and functioning ....................................................................24
4.3.1 Communication problems and family cohesion .............................................24
4.3.2 Family violence ....................................................................................................26
4.3.3 Organisation and routine ...................................................................................28
4.3.4 Financial strain .....................................................................................................29
4.3.5 Social isolation .....................................................................................................32
4.4 Comorbid mental health and substance use disorders .........................................34
4.4.1 Prevalence and research on comorbid disorders ............................................34
4.4.2 Poly-substance use ..............................................................................................35
4.4.3 Affective and Anxiety Disorders ......................................................................36
4.4.4 Psychotic Disorders ............................................................................................37
4.4.5 Personality Disorders ..........................................................................................37
4.4.6 Impacts of comorbidity on families .................................................................38
4.5 Impact on parenting ..................................................................................................40
4.5.1 Disrupted parenting ............................................................................................40
4.5.2 Parental attitudes towards drinking and modeling of alcohol use ...............47
4.6 Impact on the physical, cognitive and psychological health of children ...........54
4.6.1 Prenatal exposure to alcohol, prevalence and impacts ..................................54
4.6.2 Disturbances in childhood, adolescence and adulthood......................................59
4.7 Protective Factors ......................................................................................................65
CHAPTER 5. SYNTHESIS AND OVERVIEW OF THE FINDINGS .......... 68
CHAPTER 6. CONCLUSION AND FUTURE DIRECTIONS ..................... 75
REFERENCES ...................................................................................................... 79

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LIST OF TABLES
Table 1: Percentage of students who drank alcohol in the past seven days (current
drinker) by age and gender from ASSAD (2011) survey ...............................................50
Table 2: Most common sources of alcohol for those who drank in the past seven days
(current drinker) from the ASSAD (2011) survey ..........................................................51
Table 3: Most usual places for drinking by students who drank alcohol in the past seven
days (current drinkers) from the ASSAD (2011) survey ...............................................52
Table 4: Summary of research evidence for a significant relationship between alcohol use
disorders and problems in family life ...............................................................................69

LIST OF FIGURES
Figure 1: Influences model .................................................................................................14
Figure 2: Family influences on the development of child problem behavior and
alcohol abuse........................................................................................................................16
Figure 3: Conceptual model of the relationships between parental alcohol use
disorders and family functioning ....................................................................................71

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ACKNOWLEDGEMENTS
This review was funded by the Australian Government Department of Health and
Ageing. The National Drug and Alcohol Research Centre at the University of New
South Wales is also supported by the Australian Government. Doctor Delyse
Hutchinson is supported by a Vice-Chancellor’s Postdoctoral Research Fellowship
from the University of New South Wales. Professor Richard P Mattick is supported by a
Principal Research Fellowship Award from the National Health and Medical Research
Council.

The authors would like to thank Dr Heather Proudfoot, Dr Louise Mewton and Dr
Laura Vogl for their significant contributions to this review.

Additionally, the authors would like to acknowledge the Australian National Council on
Drugs, the Commonwealth of Australia, and the National Institute on Alcohol Abuse
and Alcoholism, for allowing us to reproduce the figures and tables cited.

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EXECUTIVE SUMMARY
This report aimed to review the empirical literature on the impact of parental alcohol use
disorders on family life. The report focused specifically on harms inflicted by the
problematic consumption of alcohol on members of the family, particularly spouses and
children, and on the functioning of the family unit as a whole. The key objectives of this
report were to (a) improve understanding of the nature and extent of the impacts, (b)
provide specific directions for future research, and (c) identify salient factors to be
incorporated in national health policies, and prevention and treatment initiatives that aim
to reduce the burden of alcohol use disorders in Australia.

It is important to note that the review is not all-inclusive. The impacts that were
considered most important and the ones for which there was considerable empirical
support were selected for review. The review relied on cross-sectional studies when more
rigorous longitudinal studies were not available. Much of the research has been
conducted internationally; however, where available, findings from large-scale cohort
studies in Australia and New Zealand have been included to improve understanding of
the links between parental alcohol use problems and family functioning within the local
context. The report also overviewed the available research on the impact of alcohol
within Indigenous communities in Australia.

The review demonstrated that there is a large body of research showing significant
associations between parental alcohol use disorders and a range of problems in family life
and functioning. These problems include, but are not limited to, parent and family
conflict and violence, parental separation and divorce, parent mental health and other
substance use problems, economic problems, disrupted parenting, parent-child
relationship problems and a range of mental health and cognitive disturbances in
offspring. This review has shown that these problems often co-occur in families affected
by parental drinking problems, particularly in families where both parents abuse or
depend on alcohol. As most studies in the literature reviewed have been cross-sectional,
problems in family life cannot be attributed solely to alcohol use. Rather, it is likely that
these factors interact in complex and dynamic ways, as well as with other macro- and
local environmental factors, to determine the specific impacts for each family.

The literature used in this review highlighted a number of conclusions:
1. The extent of harmful drinking patterns and alcohol use disorders among
Australian parents is significant.
2. Alcohol abuse is common among Aboriginal and Torres Strait Islanders and has
frequently been linked to family violence.
3. Parental alcohol use disorders are associated with a range of problems in family
life.
4. Consideration of a developmental perspective is important in planning future
policy and practice.
5. Treatment and intervention efforts should address the multiple risks experienced
by families affected by parental drinking problems.
6. Prenatal exposure to alcohol increases the risk for a range of physical, cognitive
and mental health problems in children, including Fetal Alcohol Syndrome
Disorders. The question of whether there is a safe level of drinking during
pregnancy remains to be established.
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7. The early introduction of alcohol to children and young people by parents may
increase the risk for future drinking problems.
8. The protective factors within families that minimise the negative impact of
parental alcohol use problems should be promoted.
9. More Australian research, especially longitudinal research, is needed to promote
understanding of the processes and developmental pathways via which parental
alcohol use impacts on family life.
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CHAPTER 1. INTRODUCTION
1.1 Overview, aims and objectives
This report aims to review the empirical literature on the impact of parental alcohol use
disorders on family life. The report will focus specifically on harms inflicted by the
problematic consumption of alcohol on members of the family, particularly spouses and
children, and on the functioning of the family unit as a whole. The key objectives of this
report are to (a) improve understanding of the nature and extent of the impacts, (b)
provide specific directions for future research, and (c) identify salient factors to be
incorporated in national health policies, and prevention and treatment initiatives that aim
to reduce the burden of alcohol use disorders in Australia.

Although research evidence is consistent with regard to the adverse impact of parental
alcohol use disorders on family life, the relationship between alcohol and family
outcomes is complex. There are various issues that need to be considered if an
understanding of this relationship is to be gained. First, it is clear that difficulties in
family life are not the result of alcohol alone. Rather, alcohol use disorders are one of
numerous social, familial and individual risk factors that have been linked to problems in
family life. Research indicates that such factors often co-occur and interact in complex
ways, increasing the overall risk of problems in family life (The National Center on
Addiction and Substance Abuse at Colombia University [CASA], 2005; Eurocare and
The Confederation of Family Organisations in the European Union [COFACE], 1998).
For example, it is not uncommon for families in which one or more parents have a
drinking problem to reside in communities with low average socio-economic status (SES)
and poor resources, or to suffer from comorbid psychological and physical health
problems, which compound the risk for problems in family life. This review therefore
aims to clarify understanding of the impact of alcohol use disorders on family life, whilst
acknowledging the context of a broader spectrum of factors that have been shown to
influence the risk of problematic family-related outcomes.

1.2 Description of studies included in the review
A large body of research has examined the impact of alcohol on family life. However,
given the space limitations for this paper, the review is not all-inclusive. The impacts that
were considered most important and for which there was considerable empirical support
were selected for review. Emphasis has been placed on the inclusion of longitudinal
studies that examine change in a given sample over an extended time, permitting the
identification of predictors of outcomes. We have relied on cross-sectional studies when
more rigorous longitudinal studies were not available. Cross-sectional studies are
important in identifying connections between predictors and outcomes that are both
assessed at the same point in time. Much of the research has been conducted
internationally; however, where available, findings from large-scale cohort studies in
Australia and New Zealand have been included to improve understanding of the links
between parental alcohol use problems and family functioning within the local context.
The report also overviews the available research on the impact of alcohol within
Indigenous communities in Australia.

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