Excessive alcohol consumption in young men: is there an association with their earlier family situation? A baseline-analysis of the C-SURF-study (Cohort Study on Substance Use Risk Factors).

AIMS: To determine whether parental factors earlier in life (parenting, single parent family, parental substance use problem) are associated with patterns of alcohol consumption among young men in Switzerland. METHODS: This analysis of a population based sample from the Cohort Study on Substance Use Risk Factors (C-SURF) included 5,990 young men (mean age 19.51 years), all attending a mandatory recruitment process for the army. These conscripts reported on parental monitoring and rule-setting, parental behaviour and family structure. The alcohol use pattern was assessed through abstention, risky single occasion drinking (RSOD), volume drinking and dependence. Furthermore, the impact of age, family socio-economic status, educational level of the parents, language region and civil status was analysed. RESULTS: A parental substance use problem was positively associated with volume drinking and alcohol dependence in young Swiss men. Active parenting corresponded negatively with RSOD, volume drinking and alcohol dependence. Single parent family was not associated with a different alcohol consumption pattern compared to standard family. CONCLUSION: Parental influences earlier in life such as active parenting (monitoring, rule-setting and knowing the whereabouts) and perceived parental substance use problem are associated with alcohol drinking behaviour in young male adults. Therefore, health professionals should stress the importance of active parenting and parental substance use prevention in alcohol prevention strategies.

My older sibling was drunk - younger siblings' drunkenness in relation to parental monitoring and the parent-adolescent relationship.

This study explored the links between having older siblings who get drunk, satisfaction with the parent-adolescent relationship, parental monitoring, and adolescents' risky drinking. Regression models were conducted based on a national representative sample of 3725 8th to 10th graders in Switzerland (mean age 15.0, SD = .93) who indicated having older siblings. Results showed that both parental factors and older siblings' drinking behaviour shape younger siblings' frequency of risky drinking. Parental monitoring showed a linear dose-response relationship, and siblings' influence had an additive effect. There was a non-linear interaction effect between parent-adolescent relationship and older sibling's drunkenness. The findings suggest that, apart from avoiding an increasingly unsatisfactory relationship with their children, parental monitoring appears to be important in preventing risky drinking by their younger children, even if the older sibling drinks in such a way. However, a satisfying relationship with parents does not seem to be sufficient to counterbalance older siblings' influence.

Obesity-related phenotypes are associated to parental longevity in a Swiss population-based study

PURPOSE. Longevity has been attributed to decreased cardiovascular mortality. Subjects with long-lived parents may represent a valuable group to study cardiovascular risk factors (CVRF) associated with longevity, possibly leading to new ways of preventing cardiovascular disease. Purpose: Longevity has been attributed to decreased cardiovascular mortality. Subjects with long-lived parents may represent a valuable group to study cardiovascular risk factors (CVRF) associated with longevity, possibly leading to new ways of preventing cardiovascular disease. Methods: We analyzed data from a population-based sample of 2561 participants (1163 men and 1398 women) aged 55--75 years from the city of Lausanne, Switzerland (CoLaus study). Participants were stratified by the number of parents (0, 1, 2) who survived to 85 years or more. Trend across these strata was assessed using a non-parametric kmean test. The associations of parental age (independent covariate used as a proxy for longevity) with fasting blood glucose, blood pressures, blood lipids, body mass index (BMI), weight, height or liver enzymes (continuous dependent variables) were analyzed using multiple linear regressions. Models were adjusted for age, sex, alcohol consumption, smoking and educational level, and BMI for liver enzymes. Results: For subjects with 0 (N=1298), 1 (N=991) and 2 (N=272) long-lived parents, median BMI (interquartile range) was 25.4 (6.5), 24.9 (6.1) and 23.7 (4.8) kg/m2 in women (P<0.001), and 27.3 (4.8), 27.0 (4.5) and 25.9 (4.9) kg/m2 in men (P=0.04), respectively; median weight was 66.5 (16.1), 65.0 (16.4) and 63.4 (13.7) kg in women (P=0.003), and 81.5 (17.0), 81.4 (16.4) and 80.3 (17.1) kg in men (P=0.36). Median height was 161 (8), 162 (9) and 163 (8) cm in women (P=0.005), and 173 (9), 174 (9) and 174 (11) cm in men (P=0.09). The corresponding medians for AST (Aspartate Aminotransferase) were 31 (13), 29 (11) and 28 (10) U/L (P=0.002), and 28 (17), 27 (14) and 26 (19) U/L for ALT (Alanin Aminotransferase, P=0.053) in men. In multivariable analyses, greater parental longevity was associated with lower BMI, lower weight and taller stature in women (P<0.01) and lower AST in men (P=0.011). No significant associations were observed for the other variables analyzed. Sensitivity analyses restricted to subjects whose parents were dead (N=1844) led to similar results, with even stronger associations of parental longevity with liver enzymes in men. Conclusion: In women, increased parental longevity was associated with smaller BMI, attributable to lower weight and taller stature. In men, the association of increased parental longevity with lower liver enzymes, independently of BMI, suggests that parental longevity may be associated with decreased nonalcoholic fatty liver disease.

Parental monitoring: a way to decrease substance use among Swiss adolescents?

The objective of this research was to determine whether the level of parental monitoring is associated with substance use among adolescents in Switzerland, and to assess whether this effect remains when these adolescents have consuming peers. For this purpose, we used a nationally representative sample from the Swiss participation in the 2007 European School Project on Alcohol and Other Drugs survey, which included 7,611 adolescents in public schools (8th-10th grades). Four levels of parental control were created and four substances (tobacco, alcohol, cannabis, and ecstasy) were analyzed. All significant variables at the bivariate level were included in the multivariate analysis. Most adolescents had a high level of parental monitoring and that was associated with younger age, females, high socioeconomic status, intact family structure, and satisfactory relationships with mother, father, and peers. Overall, substance use decreased as parental monitoring increased and high parental monitoring decreased as having consuming peers increased. Results remained essentially the same when the variable "having consuming peers" was added to the analysis. Conclusion: parental monitoring is associated to positive effects on adolescent substance use with a reduction of consumption and a lower probability of having consuming peers, which seems to protect adolescents against potentially negative peer influence. Encouraging parents to monitor their adolescents' activities and friendships by establishing rules about what is allowed or not is a way to limit the negative influence of consuming peers on adolescent substance use.

Parental monitoring: an easy way to decrease adolescent substance use?

Objective: To examine whether the level of parental monitoring is associated with substance use among Swiss adolescents, and to assess whether this effect remains when these adolescents have consuming peers. Methods: Nationally representative sample from the Swiss participation in the 2007 European School Project on Alcohol and Other Drugs (ESPAD) survey, which included 7611 adolescents issued from public schools (8th-10th grades). Four levels of parental control were created and four substances (tobacco, alcohol, cannabis and ecstasy) were analyzed. All significant variables at the bivariate level were included in the multivariate analysis. Results: Most adolescents had a high level of parental monitoring and that was associated with younger age, being female, high socioeconomic status, intact family structure and a satisfactory relationship with mother, father and peers. Globally, substance use decreased as parental monitoring increased and high parental monitoring decreased having consuming peers. Results remained essentially the same when consuming peers were added in the analysis. Conclusions: Parental monitoring has positive effects on adolescent substance use with a reduction of consumption and a lower association with consuming peers, which seems to protect adolescents against their potential negative influence. Encouraging parents to monitor their adolescents' activities and friendships by establishing rules about what is allowed or not are simple ways to limit the negative influence of consuming peers on adolescent substance use.

Obesity-related phenotypes are associated to parental longevity in a Swiss population-based study

METHODS. We analyzed data from a population-based sample of 2561 participants (1163 men and 1398 women) aged 55-75 years from the city of Lausanne, Switzerland (CoLaus study). Participants were stratified by the number of parents (0, 1, 2) who survived to 85 years or more. Trend across these strata was assessed using a non-parametric kmean test. The associations of parental age (independent covariate used as a proxy for longevity) with fasting blood glucose, blood pressures, blood lipids, body mass index (BMI), weight, height or liver enzymes (continuous dependent variables) were analyzed using multiple linear regressions. Models were adjusted for age, sex, alcohol consumption, smoking and educational level, and BMI for liver enzymes. RESULTS. For subjects with 0 (N = 1298), 1 (N = 991) and 2 (N = 272) long-lived parents, median BMI (interquartile range) was 25.4 (6.5), 24.9 (6.1) and 23.7 (4.8) kg/m2 in women (P <0.001), and 27.3 (4.8), 27.0 (4.5) and 25.9 (4.9) kg/m2 in men (P = 0.04), respectively; median weight was 66.5 (16.1), 65.0 (16.4) and 63.4 (13.7) kg in women (P = 0.003), and 81.5 (17.0), 81.4 (16.4) and 80.3 (17.1) kg in men (P = 0.36). Median height was 161 (8), 162 (9) and 163 (8) cm in women (P = 0.005) and 173 (9), 174 (9) and 174 (11) cm in men (P = 0.09). The corresponding medians for AST (Aspartate Aminotransferase) were 31 (13), 29 (11) and 28 (10) U/L (P = 0.002), and 28 (17), 27 (14) and 26 (19) U/L for ALT (Alanin Aminotransferase, P = 0.053) in men. In multivariable analyses, greater parental longevity was associated with lower BMI, lower weight and taller stature in women (P < 0.01) and lower AST in men (P = 0.011). No significant associations were observed for the other variables analyzed. Sensitivity analyses restricted to subjects whose parents were dead (N = 1844) led to similar results, with even stronger associations of parental longevity with liver enzymes in men. CONCLUSIONS. In women, increased parental longevity was associated with smaller BMI, attributable to lower weight and taller stature. In men, the association of increased parental longevity with lower liver enzymes, independently of BMI, suggests that parental longevity may be associated with decreased nonalcoholic fatty liver disease.

Consumo episódico excesivo de alcohol en adolescentes: su asociación con los estados de ánimo negativos y los factores familiares

Fundamentos: El consumo episódico excesivo de alcohol (CEEA) es una práctica extendida en la población adolescente con graves riesgos para la salud, incluyendo el abuso/dependencia en la edad adulta. El objetivo de este artículo es analizar su asociación con los estados de ánimo negativos y algunas variables familiares entre los adolescentes catalanes. Métodos: Estudio transversal de una muestra representativa de adolescentes (edad 14-18 años) de Cataluña (Segunda oleada del Panel de Familias e Infancia) (2006-2010). Se realizan modelos de regresión logística para mujeres (n = 1.459) y hombres (n= 1.105) para estimar si los estados de ánimo negativos auto-percibidos (tristeza, presión parental, etc.) están asociados con el CEEA, capturado como haberse emborrachado por lo menos dos veces al mes durante el último año. Se estima en qué medida esos efectos son atribuibles a algunos factores familiares. Resultados: El sentimiento crónico de tristeza está asociado con el CEEA entre los varones (OR 2,7), al igual que sentirse presionado/a por los progenitores en ambos sexos (OR 1,8 hombres y OR 2,1 mujeres). Las mujeres de rentas medio-bajas y altas son más proclives al CEEA (OR 1,6 y OR 1,7 respectivamente). La existencia de progenitores de origen inmigrante (OR 0,4) y la fijación parental de un horario de retorno a casa los fines de semana (OR 0,6) presentan una asociación negativa con el CEEA entre las mujeres. Conclusiones: Los estados de ánimo negativos (EAN) están asociados al CEEA. Los efectos de los factores socio-económicos y familiares sobre el CEEA son más relevantes en mujeres que en varones.

A Portuguese version of the Christo Inventory for Substance-Misuse Services: a simple outcome evaluation tool

The Christo Inventory for Substance-Misuse Services (CISS) is a single page outcome evaluation tool completed by drug alcohol service workers either on the basis of direct client interviews or of personal experience of their client supplemented by existing assessment notes. It was developed to assist substance misuse services to empirically demonstrate the effectiveness of their treatments to their respective funding bodies. Its 0 to 20 unidimensional scale consists of 10 items reflecting clients' problems with social functioning, general health, sexual/injecting risk behavior, psychological functioning, occupation, criminal involvement, drug/alcohol use, ongoing support, compliance, and working relationships. Good reliability and validity has already been demonstrated for the CISS [Christo et al., Drug and Alcohol Dependence 2000; 59: 189-197] but the original was written in English and a Portuguese version is presented here. The present review explores its applicability to a Brazilian setting, summarizes its characteristics and uses, and describes the process of translation to Portuguese. A pilot study conducted in a substance misuse service for adolescents indicated it is likely to be suitable for use among a Brazilian population. The simplicity, flexibility and brevity of the CISS make it a useful tool allowing comparison of clients within and between many different service settings.

Rôles sociaux et consommation d’alcool des femmes et des hommes au Canada : une analyse située du rôle parental

Cette thèse de doctorat a pour objectif d’examiner de quelles manières le rôle parental influence la consommation d’alcool des femmes et des hommes et plus précisément, si les relations dynamiques entre le rôle parental, les circonstances au sein desquelles il est mis en acte et les contextes immédiats de consommation permettent d’expliquer les différentes façons individuelles de consommer de l’alcool. Cette étude repose sur le constat qu’en alcoologie, il existe une tendance à considérer l’acteur et l’action comme étant détachés de leur cadre social immédiat. Conséquemment, il existe des limites importantes aux modèles permettant d’expliquer les mécanismes par lesquels les rôles sociaux influencent la consommation d’alcool. Afin d’avoir une meilleure compréhension sociologique de la consommation d’alcool, cette thèse propose un cadre théorique qui insiste fortement sur la nécessité de tenir compte de la situation. L’acteur agit en fonction de certaines circonstances (perception de conflit de rôles) au sein desquelles son rôle est mis en acte. L’action de boire est dépendante du contexte (caractéristiques spatiales, temporelles, symboliques et relationnelles) au sein duquel l’action se déroule. L’hypothèse générale de recherche stipule que pour comprendre la relation entre les rôles et la consommation d’alcool, il faut situer à la fois l’acteur et l’action. La validité empirique du cadre théorique a été testée à partir d’une analyse quantitative des données de l’enquête GENACIS Canada (GENder Alcohol and Culture: an International Study) ainsi que des données de l’Enquête sur les Toxicomanies au Canada. La présentation des résultats des analyses prend la forme de trois articles soumis pour publication. Les données analysées révèlent le bien-fondé du cadre de théorique proposé. Situer l’action a permis de constater que les contextes de consommation sont un médiateur de la relation entre le rôle parental et la consommation d’alcool et plus spécifiquement, que les parents boivent moins fréquemment de façon excessive que les non-parents parce qu’ils boivent dans des lieux différents. Situer l’action a aussi révélé que les femmes et les hommes ont tendance à adopter des comportements de boire qui s’accordent au contexte immédiat, plutôt qu’à la position qu’ils occupent. Par contre, observer les circonstances individuelles au sein desquelles le rôle parental est mis en acte n’a pas permis d’améliorer notre compréhension de la relation à l’étude. Les évidences scientifiques apportées par cette thèse de doctorat ouvrent la porte au développement de mesures préventives environnementales qui visent le contexte de l’action plutôt que l’acteur, pour limiter la consommation excessive d’alcool des femmes et des hommes.

Comportements de contrôle de poids et consommation de tabac, d'alcool et de marijuana à l'adolescence : le rôle modérateur du soutien parental

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

La comorbidité de l'épuisement professionnel et de la consommation de substances psychoactives.

L’objectif principal du présent mémoire réside dans l’exploration des liens concomitants existant entre les trois dimensions de l’épuisement professionnel telles que définies par Maslach (1981) et la consommation de substances psychoactives, plus précisément au niveau de la consommation épisodique excessive et hebdomadaire à risque d’alcool et de la consommation de médicaments psychotropes. À partir d’un échantillon composé de 1809 travailleurs provenant de 83 milieux de travail québécois, des profils-types correspondant à des formes particulières de comorbidité de santé mentale au travail sont identifiés grâce à la méthode d’analyse en classes latentes. Ainsi quatre profils-types sont dégagés: un premier regroupant les individus dits «sains», dont les scores aux différentes dimensions de l’épuisement professionnel sont faibles et dont la consommation de substances psychoactives est modérée; deux autres correspondant à des formes intermédiaires de risques; et un quatrième rassemblant des travailleurs dits «fragiles» dont les scores pour chacune des dimensions de l’épuisement professionnel se situent dans le quintile le plus élevé et dont les probabilités de consommation de substances psychoactives sont grandes. De plus, cette recherche s’est penchée sur l’identification de facteurs de risque et de protection associés à chacun des profils-types. À cet effet, les résultats des analyses corroborent la plupart des associations retrouvées au sein de la littérature quant aux facteurs du travail (composantes des modèles du stress professionnel de Karasek et Theorell (1990) ainsi que de Siegrist (1990)), hors travail (statut matrimonial, obligations parentales, revenu du ménage) et certaines caractéristiques individuelles (âge et genre). De faibles récompenses et un fort degré de surinvestissement de la part de l’individu se révèlent être des facteurs de risque particulièrement significatifs pour les formes intermédiaires et à risque de comorbidité de la santé mentale au travail. Dans une moindre mesure, une faible utilisation des compétences, des demandes psychologiques élevées, un soutien social inadéquat et le jeune âge expliquent une part de la variation observée entre les différents profils-types. Enfin, les résultats soutiennent une conceptualisation tridimensionnelle de l’épuisement professionnel.

The costs of alcohol, illegal drugs, and tobacco in Canada, 2002.

Objective: The aim of this study was to estimate costs attributable to substance use and misuse in Canada in 2002. Method: Based on information about prevalence of exposure and risk relations for more than 80 disease categories, deaths, years of life lost, and hospitalizations attributable to substance use and misuse were estimated. In addition, substance-attributable fractions for criminal justice expenditures were derived. Indirect costs were estimated using a modified human capital approach. Results: Costs of substance use and misuse totaled almost Can. $40 billion in 2002. The total cost per capita for substance use and misuse was about Can. $1,267: Can. $463 for alcohol, Can. $262 for illegal drugs, and Can. $541 for tobacco. Legal substances accounted for the vast majority of these costs (tobacco: almost 43% of total costs; alcohol: 37%). Indirect costs or productivity losses were the largest cost category (61%), followed by health care (22%) and law enforcement costs (14%). More than 40,000 people died in Canada in 2002 because of substance use and misuse: 37,209 deaths were attributable to tobacco, 4,258 were attributable to alcohol, and 1,695 were attributable to illegal drugs. A total of about 3.8 million hospital days were attributable to substance use and misuse, again mainly to tobacco. Conclusions: Substance use and misuse imposes a considerable economic toll on Canadian society and requires more preventive efforts.

Parental permissiveness, control, and affect and drug use among adolescents

Resumen tomado de la publicación

Integrated motivational interviewing and cognitive behavioural therapy for people with psychosis and comorbid substance misuse: randomised controlled trial

Objectives To evaluate the effectiveness of integrated motivational interviewing and cognitive behaviour therapy in addition to standard care for patients with psychosis and a co-morbid substance use problem. Design Two-centre, open, rater-blind randomised controlled trial Setting UK Secondary Care Participants 327 patients with clinical diagnoses of schizophrenia, schizophreniform or schizoaffective disorder and DSM-IV diagnoses of drug and/or alcohol dependence or abuse Interventions Participants were randomly allocated to integrated motivational interviewing and cognitive behaviour therapy or standard care. Therapy has two phases. Phase one – “motivation building” – concerns engaging the patient, then exploring and resolving ambivalence for change in substance use. Phase two –“Action” – supports and facilitates change using cognitive behavioural approaches. Up to 26 therapy sessions were delivered over one year. Main outcomes The primary outcome was death from any cause or admission to hospital in the 12 months after therapy. Secondary outcomes were frequency and amount of substance use (Timeline Followback), readiness to change, perceived negative consequences of use, psychotic symptom ratings, number and duration of relapses, global assessment of functioning and deliberate self harm, at 12 and 24 months, with additional Timeline Followback assessments at 6 and 18 months. Analysis was by intention-to-treat with robust treatment effect estimates. Results 327 participants were randomised. 326 (99.7%) were assessed on the primary outcome, 246 (75.2%) on main secondary outcomes at 24 months. Regarding the primary outcome, there was no beneficial treatment effect on hospital admissions/ death during follow-up, with 20.2% (33/163) of controls and 23.3% (38/163) of the therapy group deceased or admitted (adjusted odds-ratio 1.16; P= 0.579; 95% confidence interval 0.68 to 1.99). For secondary outcomes there was no treatment effect on frequency of substance use or perceived negative consequences, but a statistically significant effect of therapy on amount used per substance-using day (adjusted odds-ratios: (a) for main substance 1.50; P=0.016; 1.08 to 2.09, (b) all substances 1.48; P=0.017; 1.07 to 2.05). There was a statistically significant treatment effect on readiness to change use at 12 months (adjusted odds-ratio 2.05; P=0.004; 1.26 to 3.31), not maintained at 24 months. There were no treatment effects on assessed clinical outcomes. Conclusions Integrated motivational interviewing and cognitive behaviour therapy for people with psychosis and substance misuse does not improve outcome in terms of hospitalisation, symptom outcomes or functioning. It does result in a reduction in amount of substance use which is maintained over the year’s follow up. Trial registration Current Controlled Trials: ISRCTN14404480

A brief motivational intervention for substance misuse in recent-onset psychosis

Substance misuse is common in early psychosis, and impacts negatively on outcomes. Little is known about effective interventions for this population. We report a pilot study of brief intervention for substance misuse in early psychosis ( Start Over and Survive: SOS), comparing it with Standard Care(SC). Twenty-five in-patients aged 18 - 35 years with early psychosis and current misuse of non-opioid drugs were allocated randomly to conditions. Substance use and related problems were assessed at baseline, 6 weeks and 3, 6 and 12 months. Final assessments were blind to condition. All 13 SOS participants who proceeded to motivational interviewing reported less substance use at 6 months, compared with 58% (7/12) in SC alone. Effects were well maintained to 12 months. However, more SOS participants lived with a relative or partner, and this also was associated with better outcomes. Engagement remained challenging: 39% (16/41) declined participation and 38% (5/13) in SOS only received rapport building. Further research will increase sample size, and address both engagement and potential confounds.