Alcohol and Alcoholism Advance Access originally published online on April 19, 2006
Alcohol and Alcoholism 2006 41(4):464-471; doi:10.1093/alcalc/agl018
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FAMILY BONDING AND ADOLESCENT ALCOHOL USE: MODERATING EFFECT OF LIVING WITH EXCESSIVE DRINKING PARENTS
Research Department, Swiss Institute for the Prevention of Alcohol and Drug Problems (SIPA), PO Box 870, 1001 Lausanne, Switzerland
* Author to whom correspondence should be addressed at: Tel: +41 21 321 29 48; Fax: +41 21 321 29 40; E-mail: hkuendig{at}sfa-ispa.ch
(Received 4 August 2005; first review notified 22 October 2005; in revised form 16 Feburary 2006; accepted 17 Feburary 2006)
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ABSTRACT |
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 TOP ABSTRACT INTRODUCTIONMETHODSRESULTSDISCUSSIONREFERENCES |
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Aims: Excessive parental drinking has been shown to be positively related to adolescent alcohol use and family bonding negatively related. The aim of the present study was to determine if the perception of parental drinking moderates the relationship between family bonding and adolescent alcohol use. Methods: Linear structural equation models for multiple group comparisons were estimated based on a national representative sample of 3448 eight and ninth graders in Switzerland (mean age 14.77; SD 0.89). Results: Adjusted for gender and age, the results confirm that strong family bonds were negatively related to both frequency of alcohol intake and lifetime frequency of drunkenness. Furthermore, a positive link was found with regard to the perception of parental drinking. However, the multiple group comparison revealed that the negative relationship between bonding and adolescent alcohol use was even stronger among adolescents whose parents drink excessively than among those whose parents did not. Conclusions: These results indicate that it may be particularly important for parents in the former category to establish strong family bonds (e.g. by spending free time with their children, listening to their worries) so as to limit adolescent excessive drinking.
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INTRODUCTION |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONREFERENCES |
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Of all family-based risk factors, the literature shows that excessive parental drinking and family bonding are important determinants of adolescent alcohol use (for reviews see Denton and Kampfe, 1994
; Vakalahi, 2001; Kuntsche and Kuendig, 2006). However, few studies investigated the interaction between these two factors in predicting adolescent alcohol use (Farrell et al., 1995; Jung, 1995; Zhang et al., 1999). The present article aims to determine if the adolescent perception of excessive parental drinking moderates the relationship between family bonding and adolescent alcohol use.
Family bonding, defined as a feeling of closeness and intimacy towards one's parents and reflected in perceived monitoring, communication, involvement, and joint activities in the family (Bahr et al., 1995; Zhang et al., 1999), has been repeatedly shown to be negatively related to adolescent drinking (Bahr et al., 1995; Vakalahi, 2001; Crawford and Novak, 2002; Kuntsche and Kuendig, 2006). For instance, researchers suggest that strong family bonding is reflected in the adolescent's adoption of parental and societal norms and values, which in turn protects against involvement in risk behaviours (Bell et al., 2000).
Growing up in an environment where alcohol use is common has been shown to increase risky alcohol use. For example, previous studies have shown that adolescents who grow up with parents who drink excessively may replicate this behaviour and tend to drink frequently and to excess (Weinberg et al., 1994; Jackson et al., 1999; Adalbjarnardottir and Rafnsson, 2001; Ellickson et al., 2001; Kuntsche and Meyer, 2002; Li et al., 2002). Research has also demonstrated the particular relevance of adolescents' perception of parental drinking as a predictor of their subsequent alcohol use (Weinberg et al., 1994; Smith et al., 1999). In accordance with social learning theory (Bandura, 1977), researchers suggest that adolescents may initiate drinking by observing and modelling parental drinking behaviour and associated values (Beman, 1995; Zhang et al., 1999; Li et al., 2002). A further explanation given in the literature is that excessive drinking parents create higher levels of stress and negative effects (Beman, 1995; Jung, 1995; Elkins et al., 2004), thereby leading the child to drink more (Beman, 1995; Jung, 1995). Accordingly, there is an expectation that adolescents who perceive their father or mother as excessive drinkers drink more frequently and are drunk more often than their peers who do not have such a perception (Smith et al., 1999; White et al., 2000).
However, this does not mean that living in a hazardous environment, such as in a household where its members drink excessively, has direct life-long consequences. Literature on resilience, defined as a phenomenon reflecting positive individual adjustment despite condition of risk (Luthar and Bidwell Zelazo, 2003), argues that the effects of hazardous growing conditions might be restrained by enhancing individual resources and adaptive competence (Masten and Powell, 2003). In this regard, family bonding, i.e. as a parenting quality indicator, appears to be a potentially powerful mechanism to develop or strengthen adaptive resources and competences (Masten and Powell, 2003).
Although family bonding is expected to be negatively associated with adolescent alcohol use, few studies have investigated whether family bonding, as a protective factor, acts differently in specific risk environments, i.e. if the adolescent who perceives his/her parents as excessive drinkers is afforded equal or greater protection than adolescents without such a perception. Zhang et al. (1999) observed that adolescent alcohol use decreased with increased family bonding where the family showed a high level of alcohol consumption; but no relationship could be found in families with low drinking levels (see also Farrell et al., 1995). Therefore, the authors concluded that a high degree of family bonding could counter-act the negative effects of heavy parental drinking (Zhang et al., 1999). Conversely, Jung (1995) showed that in the case of close bonds between family members, adolescents' drinking habits were similar to those of their parents, i.e. both adolescents and parents had a high/low drinking level. However, in families which did not have close bonds, the opposite was true, i.e. there was a negative relationship between parental and adolescent drinking. Jung (1995) concluded that a high quality parent–child relationship leads to a high similarity in drinking levels between parents and children. On the other hand, if the parent–child relationship is poor, the child might reject parental values and not only fail to copy modelled behaviours but possibly do just the opposite as a form of rebellion.
It appears that there is little evidence on the strength of the link between family bonding and adolescent alcohol use in environments with different degrees of risk, i.e. in families with different parental drinking patterns. In addition, the two main studies we identified used highly selective samples (Jung, 1995, students from introductory psychology classes in one US university; Zhang et al., 1999, adolescents at risk for delinquency in Buffalo, NY). It also remains unclear whether the results of these studies can be easily transferred to other regions, cultures, or age groups.
Based on a national representative sample of adolescents in Switzerland, the present study aims to test three hypotheses. In a first step, we test the main effects of both family bonding and perception of excessive parental drinking on adolescent alcohol use. We expect that family bonding is negatively associated with adolescent alcohol use (hypothesis 1), and that adolescents who perceive their father or mother as an excessive drinker drink more frequently and are drunk more often than adolescents without such a perception (hypothesis 2). Since resilience literature (e.g. Luthar and Bidwell Zelazo, 2003; Masten and Powell, 2003) states that adolescents who grow up in an adverse family context should noticeably benefit from the protective effects of family bonding (hypothesis 1), we then test whether the relationship between family bonding and adolescent alcohol use varies in different family contexts, i.e. families with and without excessive drinking habits. Excessive drinking in the family is expected to moderate the strength of the relationship between family bonding and adolescent alcohol use (hypothesis 3) and we expect a stronger negative relationship between family bonding and adolescent alcohol use among adolescents who perceive their parents as excessive drinkers than among adolescents without such a perception.
Besides clarifying the potentially different protective effects of family bonding against excessive alcohol use during adolescence in different family risk environments, we aim to uncover new evidence on the usefulness of targeted or general prevention programmes which focus on underlying family processes.
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METHODS |
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Study design
We used data from the Swiss contribution to the 2002 ‘Health Behaviour in School-Aged Children (HBSC)’ survey (Currie et al., 2004
) that was undertaken under the supervision of the World Health Organization (WHO). The Swiss Institute for Prevention of Alcohol and Drug Problems (SIPA) has conducted this survey (which is conducted every four years) in Switzerland since 1986. The study was undertaken in accordance with APA ethical standards (American Psychological Association, 2002) and the Helsinki Declaration (World Medical Association (WMA), 2002). For instance, the pupils could freely choose to participate and confidentiality was ensured at all stages of the study. Information about the study design can be found in Currie et al. (2001) or online at www.hbsc.org. The present data were collected by means of a paper–pencil questionnaire between April and May 2002.
Measures
The questionnaire was developed by an interdisciplinary research group from the participating countries (Currie et al., 2001) and has been translated under SIPA supervision in the four official languages of Switzerland: German, French, Italian, and Rumansch.
Independent variables: family factors
Excessive parental drinking
The perception of excessive drinking in the family was assessed by the question ‘We all have our ingrained habits; which ones best match the following people?’. The pupils were asked to indicate if their father (or step-father) or their mother (or step-mother) ‘drink too much alcohol’. A dichotomous variable was created, indicating whether or not the respondent perceived that at least one parent drank excessively.
Family bonding
According to previous research (Bahr et al., 1995; Zhang et al., 1999), family bonding was defined as communication, joint activities, and support with or from parents. Four items were selected. Two of them assessed aspects of the parent–child relationship: ‘I tell them about my worries’ (communication) and ‘We spend our free time together’ (joint activities). The possible answers were ‘every day’ (4), ‘1–6 times a week’ (3), ‘1–3 times a month’ (2), ‘less often’ (1) and ‘never’ (0). The two remaining items assessed how children were treated by their parents: ‘I am praised if I've done something well’ (support) and ‘If I need help, she/he is at my disposal’ (support). The possible answers for these two questions ranged from ‘Completely true’ (4) to ‘Not true at all’ (0). The internal consistency (Cronbach's 
= 0.66) of the four questions assessing family bonding is comparable with previous research (Zhang et al., 1999) and indicates, in accordance with our definition, that different aspects of family bonding were measured.
Dependent variables: adolescent alcohol use
Frequency of alcoholic beverage intake was defined as the frequency of consumption of at least one glass or can of beer, one glass of wine, one shot of spirits, or one alcoholic pre-mixed drink. The answer categories were ‘every day’, ‘every week’, ‘every month’, ‘less than once a month’, or ‘never’. To have a linear measurement, the answers were recoded in order to correspond to an annual time frame frequency that varies from zero days in the past year to every day (coded as 365) (Gmel et al., 2006).
Lifetime frequency of drunkenness was assessed using the questions ‘Have you ever had so much alcohol that you were really drunk?’ with the answer categories ‘no, never’, ‘yes, once’, ‘yes, 2–3 times’, ‘yes, 4–10 times’, and ‘yes, >10 times’. To have a linear indicator of lifetime frequency of drunkenness, the answers were recoded using the midpoints for each category. For the maximum frequency (‘yes, >10 times’), half of the range to the midpoint of the adjacent category was added (e.g. 11 + [(11 – 7)/2] = 13). Thus, the final scale varied from 0 to 13.
Sample description
The following analysis was based on an original sample of 4232 eight and ninth graders drawn from a cluster sampling including classes of theses grades in all Swiss schools.
Because gender and age were taken as control variables in the following analyses, pupils who did not indicate their gender or age were precluded (4.3%). Missing values for the questions on family bonding, frequency of alcohol intake and lifetime frequency of drunkenness varied from 0.7 to 2.0%. As it is not easy to judge or to acknowledge that a parent drinks too much, 10.0% of the adolescents were unable or refused to state if they perceived that at least one parent drank excessively. The students (14.9%) who did not answer all questions were excluded from the analysis. Since the dropout rate was rather high due to the questions on the perception of the parental drinking habits, an analysis to test for a selection bias was conducted, i.e. students who did not answer all questions were compared with the remaining and final sample. Although the remaining sample was found to be slightly younger than the drop-outs (tage = 2.55, P < 0.05), it differed neither in terms of gender nor in terms of the alcohol use variables included in the subsequent analyses. The final sample consists of 3448 pupils aged between 13 and 17 (mean age 14.77; SD 0.89); 1693 were boys and 1755 were girls.
Statistical analyses
To complete the description of the dependent and independent variables, t-tests, and corrected design-based F-values (which is equivalent to the usually reported Pearson 
2) were used to test for differences in the mean values and for the hypothesis of association in the bivariate table respectively. The software package STATA 7.0 (StataCorp, 2001) was used to this end, as it has the advantage of directly estimating robust standard errors that take into account the design effect related to the cluster sampling of school classes.
To evaluate the expected main effect of both the adolescents' perception of excessive parental drinking and family bonding on adolescent alcohol use, a first set of linear structural equation models are estimated (see upper model in Fig. 1). Adjusted for gender and age, we test the prediction of both the perception of excessive parental drinking and family bonding (as a latent variable) on adolescent alcohol use (i.e. adolescent frequency of alcohol intake and lifetime frequency of drunkenness). Owing to the sampling of clusters, the software package Mplus 3.11 (Muthén and Muthén, 2004) was used to estimate the maximum likelihood estimates parameter, with standard errors and 2 test statistics that are robust to non-normality, and non-independence of observation (Muthén, 2004); standardized regression coefficients (ß) are given. To evaluate the overall fit of the model, the comparative fit index (CFI), the root mean square error of approximation (RMSEA), and the standardized root mean square residual (SRMR) were used. The CFI is related to the total variance accounted for in the model and a value close to 1 is sought (e.g. higher than 0.90: Bentler and Bonett, 1980; Hu and Bentler, 1999; Ullman, 2001). The RMSEA and the SRMR are related to the residual variance, and values close to 0 are sought (e.g. smaller than 0.08, Browne and Cudeck, 1993; Hu and Bentler, 1999; Ullman, 2001).
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In a second set of models (second model in Fig. 1), we tested whether excessive parental drinking moderates the link between family bonding and adolescent alcohol use (Baron and Kenny, 1986
). Such moderation can be realized by means of multiple group comparisons (Cohen and Cohen, 1983; Baron and Kenny, 1986; Kuntsche et al., 2003). First, adjusted for gender and age, we estimated the association between family bonding and adolescent alcohol use for the two groups with different family drinking habits, independently from each other (unrestricted model). Then, we estimated a restricted model in which the path between family bonding and adolescent alcohol use in both groups was made equal. Subsequently, by taking into account the difference in degree of freedom, the 2-value of the restricted model was compared with that of the unrestricted model using a mean adjusted robust 2 difference test (Muthén, 2004). Use of the adjusted 2 difference test applies a scaling correction to give a better approximation of 2-values under the condition of non-independence of the observations due to the cluster sampling. If significant differences emerge from the adjusted 2 difference test, the freely estimated model (unrestricted) fits the data better than the restricted model. In this case, the relationship between family bonding and adolescent alcohol use (i.e. frequency of alcohol intake and the lifetime frequency of drunkenness) is shown to differ between adolescents whose parents drink excessively and those whose parents do not. Finally, because the significance level of 2 tests depends largely on the sample size and to support the results of the present study, the analyses were repeated with two randomly selected subsamples containing 
50% (n = 1730) and 25% (n = 863), respectively, of the final sample (n = 3448) on which the present results were based.
A desirable condition for the present procedure is the equivalence of the factor structure in the two groups. To assess the degree to which the family bonding measurement is equivalent in both groups and according to the aforementioned procedure, the factor loadings of the four items were fixed to be equal in both groups. Then, the resulting 2-value was compared with the freely estimated factor structure. A significant difference (
2 = 11.0, df = 4, P < 0.05) emerges between the restricted and the unrestricted model. However, the relative contribution of each of the four variables on the factor is proportional in each group and the items have the same rank order. Moreover, the difference was only significant at the 5% error level and might be due in part to the high sample size. As refereed by Leigh and Stacy (2004), partial invariance of the factor measurement is often a more reasonable goal than complete invariance. Therefore, the difference in measurement appears to be negligible. Consequently, in the later analyses the factor loadings of the items measuring family bonding were set as equal between the groups.
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RESULTS |
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Descriptive
As shown in Table 1, 7.8% of participants perceived that at least one of their parents drank excessively. This percentage did not differ between genders but increased the older the adolescents were (F(1.96;461.98) = 6.5, P < 0.01). Several statistical differences emerge concerning the family bonding variables. Girls talked more often to their parents about worries, whereas boys more often reported being praised when they had done something well and receiving help when needed. Concurrently, spending free time with parents increased across the age categories, while being praised for doing something well decreased.
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The alcohol use measurements follow a similar trend. Significant differences between genders and between age groups emerge for both variables. Almost 30% of the boys stated that they drank alcohol at least weekly, whereas this figure was only 18.5% for girls (F(1;236) = 44.3, P < 0.001). The proportion of weekly intake of alcohol increase from <15% among the 13–14 age group to >35% among the 16–17 age group (F(1.97;465.05) = 51.9, P < 0.001). The global proportion of respondents with two or more experiences of drunkenness is of almost 25% and the differences between genders (F(1;236) = 43.3, P < 0.001) and between age groups (F(1.99;469.24) = 71.9, P < 0.001) were also highly significant.
Main effects
As shown in Table 2, the results from the structural equation models revealed that both family bonding and the perception of excessive drinking in the family were related to the frequency of alcohol intake and to the lifetime frequency of drunkenness. Adjusted for gender and age, family bonding was negatively related, while excessive parental drinking was positively related. Additionally, a negative correlation between the two independent variables was found for both models (r = –0.20; P < 0.001). The fit indices obtained are good (CFI > 0.90; RMSEA and SRMR < 0.08) and the explained variance vary between 5.9 and 10.9%.
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Moderation effect
Table 3 shows the results of the multiple group comparisons. For the frequency of alcohol intake as well as for the lifetime frequency of drunkenness, the estimated path coefficients between parental bonding and adolescent alcohol use are negative and significant in both groups (adolescents with and without the perception of excessive parental drinking). The adjusted
2 difference tests for the two models' comparisons revealed significant differences. Owing to these interaction effects, stronger associations between family bonding and adolescent alcohol use were observed among adolescents who perceived their parents as excessive drinkers. Analogue analyses were conducted in two randomly selected subsamples to make sure that the significant findings were not only due to the high sample size. These analyses confirm the present results and the differences between groups were also significant (50 and 25% of the sample: 2frequency intake 50% = 11.7, df = 2, P < 0.01; 2drunkenness 50% = 35.2, df = 2, P < 0.001; 2frequency intake 25% = 7.3, df = 2, P < 0.05; 2drunkenness 25% = 17.7, df = 2, P < 0.001).
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The difference between these path coefficients was greater for the lifetime frequency of drunkenness than for alcohol intake frequency; the adjusted
2 difference test for the models concerning drunkenness was similarly more significant. For both final models (freely estimated) the CFI was higher than 0.90 and the RMSEA and SRMR were lower than 0.08. The explained variances are between 4.2 and 21.7%. To illustrate the interaction effect of family bonding and the perception of excessive parental drinking in predicting adolescent alcohol use, the values from the multiple group models were plotted in graphs (Fig. 2). Independently of family bonding, both the frequency of alcohol intake and the lifetime frequency of drunkenness are higher among adolescents who perceive excessive parental drinking than among those who do not. In both groups, alcohol use decreases with higher levels of family bonding, but the drop was steeper among adolescents who reported having parents who drink excessively. This drop was also steeper for the lifetime frequency of drunkenness than for the frequency of alcohol intake.
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DISCUSSION |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONREFERENCES |
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The first aim of the present study was to investigate the effects of the perception of excessive drinking in the family and of family bonding on adolescent alcohol use. The results from the first set of linear structural models confirm that both the perception of excessive parental drinking (Weinberg et al., 1994
; Adalbjarnardottir and Rafnsson, 2001) and family bonding (Bahr et al., 1995; Vakalahi, 2001) were related to the frequencies of alcohol intake and drunkenness. Growing up with parents who drink excessively was related to a higher frequency of both alcohol intake and experiences of being drunk. In contrast, family bonding was negatively associated, i.e. lower levels of bonding were related to higher levels of adolescent alcohol use. It appears that strong family bonding, i.e. communication, joint activities, and support within the family, might offer a certain degree of protection against involvement in frequent and excessive drinking during adolescence. Authors argue that family bonding is an important social control mechanism (Bahr et al., 1995), in which adolescents adopt conventional parental and societal norms and values (Bell et al., 2000).
The second aim was to determine if excessive alcohol use in the family moderates the link between family bonding and alcohol use. According to resilience literature (e.g. Luthar and Bidwell Zelazo, 2003; Masten and Powell, 2003) adolescents who grow up in an adverse family context should benefit noticeably from the protective effects of family bonding. Also, excessive drinking in the family was expected to moderate the strength of the relationship between family bonding and adolescent alcohol use. Our analyses showed that family bonding was negatively related to adolescent alcohol use in both groups (adolescents with and without perception of excessive parental drinking) and that the effect was significantly greater among adolescents who reported excessive parental drinking than among others (moderation effect).
With CFI values above 0.90, RMSEA values below 0.07, and SRMR values below 0.04, all estimated structural equation models fit the data reasonably well (cf. Bentler and Bonett, 1980; Browne and Cudeck, 1993; Hu and Bentler, 1999; Ullman, 2001). The explained variances (between 4.2 and 21.7%) appear to be particularly high, given that many other factors are associated with adolescent alcohol use, such as drinking peers.
In contrast to the findings of Jung (1995)—a high quality parent–child relationship being related to a high similarity of drinking levels between parents and children, and a poor quality parent–child relationship being related to reversed drinking levels—our results show that strong family bonds were related to lower alcohol use levels among families both with and without excessive drinking habits. Our results appear thus to concur with the findings of Zhang et al. (1999) and Farrell et al. (1995). In these studies, adolescent alcohol use decreased as bonding increased in a family with a high level of alcohol consumption. However, our results revealed that this family bonding effect was not only observed among adolescents who reported excessive parental drinking, but also among those who did not have such perception (even if this effect was more marked among the former than among the latter).
The main limitation of the present study is its cross-sectional design, since no causal conclusions can be drawn. Longitudinal studies are thus needed to clarify the succession and interplay of these three variables over time. Some limitations concerning the independent variables used in the analyses need to be stated as well. Although research has demonstrated the singular interest of adolescents' perception of parental drinking on predicting their subsequent alcohol use (Weinberg et al., 1994) and showed that adolescents' perception of what is modelled (i.e. parental drinking) is likely to be a better predictor of adolescents' behaviours than self-reports of alcohol consumption by family members (Smith et al., 1999), we were unable to validate our results using data from parents. The reason for this is the HBSC protocol and ethical standards such as the Helsinki Declaration (World Medical Association (WMA), 2002), which guarantee the anonymity and confidentiality of the students. Additionally, asking children to assess excessive parental drinking appears to be a very sensitive issue in Switzerland, resulting in a rather high number of missing values. Since it is apparently problematic for an adolescent to evaluate or judge whether or not a parental behaviour is excessive (they often have insufficient references for this kind of evaluation and/or might feel ashamed of parental drinking), future research should include measurements that are better suited to assess adolescents' perception of parental alcohol use as well as their perception of parental values and norms with regard to alcohol consumption. Additionally, since the relationship between parental bonding and adolescent alcohol use might vary at different levels of excessive parental drinking, it would be interesting to conduct further analyses that include graduated levels of perception of excessive parental drinking. Better adapted measurements should also aim to take account of this dimension.
In conclusion, our findings indicate that family bonding, defined as a feeling of closeness and intimacy towards one's parents, might affect frequent and excessive drinking in adolescence. Also, the effect of strong family bonds seems to be particularly important for adolescents growing up with excessive drinking parents, as they have a higher level of alcohol use compared with other adolescents. Many parents who drink excessively fail to establish strong family bonds, as they tend to create high levels of stress and emotional harm among other family members (Beman, 1995; Jung, 1995; Elkins et al., 2004). In our analyses, this was reflected by the negative correlation between family bonding and the perception of excessive parental drinking found in the first set of structural equation models. It appears then that strong family bonds are not easily developed, established, and maintained in families where excessive drinking habits are common (Eurocare and COFACE, 1998).
The results of the present study demonstrate the importance of establishing strong family bonds to limit adolescent excessive drinking. Additionally, our results suggest that both families with and without excessive parental drinking could benefit from targeted action. Accordingly, specific prevention efforts that promote or help parents to establish strong bonds with their children should be encouraged (for reviews on family-based intervention for substance use among young people see Kumpfer et al., 2003; Velleman et al., 2005; for a review on the strength and limitation of programs designed to promote family support strategies see Sanders, 2000). As referred to in the literature, preventive attempts related to adolescent alcohol use do not necessarily need to focus on alcohol to be effective, since improving the quality of family relationships and parenting aptitude has been shown to be beneficial in delaying the initiation of alcohol use (Spoth et al., 1999) so as to limit the increase in drinking levels among adolescents (Loveland-Cherry et al., 1999). Nonetheless, because of the higher general level of drinking among adolescents living with excessive drinking parents, preventive attempts primarily focused on these adolescents and their parents should be promoted. Within these attempts, specific emphasis on developing, establishing, and maintaining strong family bonds appears to be of particular importance. Furthermore, since recovery after individual treatment has been shown to be associated with improved family functioning in a variety of domains (O'Farrell and Feehan, 1999), assistance should be given to these parents with regard to coping with their own problematic alcohol use to reduce associated individual and family dysfunctions (for a review on the consequences of excessive drinking on relatives see Maffli, 2001). This should be done as part of targeted intervention.
Finally, our findings and conclusions concur with resilience literature that underlines the need to consider protective or resilient factors in addition to research on and prevention of risk factors (Velleman and Orford, 1999; Werner and Johnson, 1999; Velleman et al., 2005). It would seem that working on underlying family processes and structures that are related to both risk and resilience factors appear to offer a promising solution.
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ACKNOWLEDGEMENTS |
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The study was mainly funded by the Swiss Federal Office of Public Health, Contract 00.000300. Principal Investigator for Switzerland, H. Schmid, SIPA. International coordination, C. Currie, University of Edinburgh. Data bank manager, O. Sambdal, University of Bergen.
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