Assessing parental alcoholism: a comparison of the family history research diagnostic criteria versus a single-question method

Family history of substance problems among African Americans: Associations with drug use, drug use disorder, and prescription drug misuse

A family history of substance problems is a well-known risk factor for substance use and use disorders; however, much of this research has been conducted in studies with predominantly White subjects. The aim of this study was to examine the associations between family history density of substance problems and drug use, risk for drug use disorder, and prescription drug misuse in a sample of African American adults. Results indicate that family history density of substance problems increased the risk for all drug outcomes in the full sample. However, when subgroup analyses by gender were conducted, family history was not a risk factor among men for prescription drug misuse.

The intergenerational transmission of gambling and other addictive behaviors: Implications of the mediating effects of cross-addiction frequency and problems

INTRODUCTION

This study examined the degree to which perceptions of familial and household participation in gambling and other addictive behaviors in youth was associated with frequency and problem severity of gambling, alcohol and/or drug use in participants as adults.

METHOD

The study measured perceived frequency of gambling, alcohol use, drug use and other potentially addictive behaviors in family/household members and the frequency and problem severity of gambling, alcohol, and drugs in an epidemiological sample of adults 18 and older (N = 3,499; m = 48.26 %, f = 51.74 %).

RESULTS

About 23.45 % of participants reported their father gambled when they were a child or adolescent, followed by mother (13.56 %), grandfather (9.73 %), or grandmother (7.83 %). A pathway model demonstrated cross-addiction inter- and intra-generational influences. Gambling by a father, mother or brother; substance use by a sister; and/or engagement in other behaviors by a brother, sister, grandmother or other household member was related to higher frequency of participant gambling (ps < 0.05), and, in turn, to higher levels of gambling, alcohol, and drug use problem severity (ps < 0.05).

DISCUSSION

Findings demonstrate the complex contributions of specific family and household members in the transmission of addictive behaviors. Frequency of gambling, alcohol use, and drug use mediated the relationship of perceived family behavior with and across addictions. In addition, perceptions regarding use of alcohol and/or other drugs, or engagement in other behaviors by family or household members was related not only to participants' alcohol and drug use but also to problem gambling frequency and severity.

"It Runs in Your Blood": Reflections from Treatment Seeking Gamblers on Their Family History of Gambling

There are considerable gaps in our understanding of the familial transmission of gambling problems. This convergent mixed-methods study aimed to explore the: (1) sources of heterogeneity in the familial (paternal, maternal, and sibling) transmission of gambling problems; (2) degree to which family-of-origin characteristics are associated with family-of-origin problem gambling; and (3) beliefs of gamblers about the nature of the familial transmission of problem gambling. The sample consisted of 97 treatment-seeking gamblers in Australia. One-quarter (25.5%) of participants reported that at least one family member (16.5% father, 7.5% mother, 7.6% siblings) living with them when they were growing up had a gambling problem. Most participants reported that family members with a positive history of problem gambling were biological relatives, lived with them full-time, and experienced long-term difficulties with gambling. Participants with a family history of problem gambling were young (less than 12 years of age) at the onset of parental, but not sibling, problem gambling, were women, and reported difficulties with the same gambling activity as their family member. Participants raised in families with problem gambling were more likely to report parental separation (risk ratio [RR] = 2.32) and divorce (RR = 2.83), and extreme family financial hardship (RR = 1.80), as well as low levels of paternal authoritative parenting than participants raised in non-problem gambling families. Qualitatively, both social learning and genetics were perceived to play a central role in the familial transmission of gambling problems. These findings inform theories of the familial transmission of gambling problems and the design of targeted prevention and intervention strategies.

Attachment Orientations and Adult Alcohol Use Among Those With Childhood Adversities

Abstract. Adverse psychological consequences have been associated with both alcohol abstinence and alcohol disorders. The current study considers those who have experienced childhood adversities and examines whether secure attachment orientation represents a protective factor against an increased likelihood of either abstinence/rare alcohol consumption or alcohol disorder diagnosis. Data were used from the National Comorbidity Survey-Revised (NCS-R) ( N = 5,692), a random sample representative of the American population. Adult personal alcohol use was considered in terms of abstinence/rare alcohol use, regular alcohol use, and alcohol disorder diagnosis. Analyses focused on those who had experienced childhood adversities ( N = 2,182) and assessed attachment orientation as a predictor of alcohol use. Within those who had experienced childhood adversities, in comparison with securely attached individuals, both anxiously attached individuals and avoidant attached individuals had a significantly increased likelihood of being in the alcohol disorder diagnosis group as opposed to the regular alcohol consumption group. Avoidant individuals also had a significantly increased likelihood of being in the abstinence/rare alcohol use group. Results are discussed in terms of subgroups (vulnerable individuals and families) that may benefit from supportive interventions, and what format these interventions might take.

The intergenerational transmission of problem gambling: The mediating role of offspring gambling expectancies and motives

INTRODUCTION

The risk for developing a gambling problem is greater among offspring who have a problem gambling parent, yet little research has directly examined the mechanisms by which this transmission of problem gambling occurs. For this reason, the present study sought to examine the degree to which children's expectancies and motives relating to gambling explain, at least in part, the intergenerational transmission of problem gambling.

METHODS

Participants (N=524; 56.5% male) were recruited from educational institutions, and retrospectively reported on parental problem gambling. Problem gambling was measured using the Problem Gambling Severity Index and a range of positive and negative expectancies and gambling motives were explored as potential mediators of the relationship between parent-and-participant problem gambling.

RESULTS

The relationship between parent-and-participant problem gambling was significant, and remained so after controlling for sociodemographic factors and administration method. Significant mediators of this relationship included self-enhancement expectancies (feeling in control), money expectancies (financial gain), over-involvement (preoccupation with gambling) and emotional impact expectancies (guilt, shame, and loss), as well as enhancement motives (gambling to increase positive feelings) and coping motives (gambling to reduce or avoid negative emotions). All mediators remained significant when entered into the same model.

CONCLUSIONS

The findings highlight that gambling expectancies and motives present unique pathways to the development of problem gambling in the offspring of problem gambling parents, and suggest that gambling cognitions may be potential candidates for targeted interventions for the offspring of problem gamblers.

The intergenerational transmission of at-risk/problem gambling: The moderating role of parenting practices

BACKGROUND AND OBJECTIVES

Although parenting practices are articulated as underlying mechanisms or protective factors in several theoretical models, their role in the intergenerational transmission of gambling problems has received limited research attention. This study therefore examined the degree to which parenting practices (positive parenting, parental involvement, and inconsistent discipline) moderated the intergenerational transmission of paternal and maternal problem gambling.

METHODS

Students aged 12-18 years (N = 612) recruited from 17 Australian secondary schools completed a survey measuring parental problem gambling, problem gambling severity, and parenting practices.

RESULTS

Participants endorsing paternal problem gambling (23.3%) were 4.3 times more likely to be classified as at-risk/problem gamblers than their peers (5.4%). Participants endorsing maternal problem gambling (6.9%) were no more likely than their peers (4.0%) to be classified as at-risk/problem gamblers. Paternal problem gambling was a significant predictor of offspring at-risk/problem gambling after controlling for maternal problem gambling and participant demographic characteristics. The relationship between maternal problem gambling and offspring at-risk/problem gambling was buffered by parental involvement.

DISCUSSION AND CONCLUSIONS

Paternal problem gambling may be important in the development of adolescent at-risk/problem gambling behaviours and higher levels of parental involvement buffers the influence of maternal problem gambling in the development of offspring gambling problems. Further research is therefore required to identify factors that attenuate the seemingly greater risk of transmission associated with paternal gambling problems.

SCIENTIFIC SIGNIFICANCE

Parental involvement is a potential candidate for prevention and intervention efforts designed to reduce the intergenerational transmission of gambling problems. (Am J Addict 2017;26:707-712).

Association of respondent psychiatric comorbidity with family history of comorbidity: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III

OBJECTIVE

Substance use disorders and major psychiatric disorders are common, highly comorbid with each other, and familial. However, the extent to which comorbidity is itself familial remains unclear. The purpose of this study is to investigate associations between comorbidity among respondents with family history of comorbidity.

METHODS

We analyzed data from the National Epidemiologic Survey on Alcohol and Related Conditions-III to study the associations of family history (FH) of comorbidity among alcoholism, drug problems, depression, antisocial behavior, and anxiety disorders in parents and maternal and paternal grandparents with corresponding DSM-5 diagnostic comorbidity among respondents. We utilized multivariable multinomial logistic regression models controlling for age, sex, race, education, family income, marital status, and adverse childhood experiences (ACEs).

RESULTS

All comorbid associations of any two disorders with FH were statistically significant; almost all adjusted odds ratios (ORs) for respondent comorbidity in the presence of FH of the parallel comorbidity exceeded 10. ORs involving antisocial behavior in relatives and antisocial personality disorder in respondents were consistently larger than those for any other pairs of disorders. After further adjustment for ACEs, most patterns of association were similar but the ORs were reduced twofold to threefold. ACEs may be mediators in relationships between familial and respondent comorbidities.

CONCLUSION

Further investigations of relationships among familial comorbidity, ACEs, and respondents' diagnoses may improve understanding of comorbidity.

A multidimensional model of mothers' perceptions of parent alcohol socialization and adolescent alcohol misuse

We assessed a multidimensional model of parent alcohol socialization in which key socialization factors were considered simultaneously to identify combinations of factors that increase or decrease risk for development of adolescent alcohol misuse. Of interest was the interplay between putative risk and protective factors, such as whether the typically detrimental effects on youth drinking of parenting practices tolerant of some adolescent alcohol use are mitigated by an effective overall approach to parenting and parental modeling of modest alcohol use. The sample included 1,530 adolescents and their mothers; adolescents' mean age was 13.0 (SD = .99) at the initial assessment. Latent profile analysis was conducted of mothers' reports of their attitude toward teen drinking, alcohol-specific parenting practices, parental alcohol use and problem use, and overall approach to parenting. The profiles were used to predict trajectories of adolescent alcohol misuse from early to middle adolescence. Four profiles were identified: 2 profiles reflected conservative alcohol-specific parenting practices and 2 reflected alcohol-tolerant practices, all in the context of other attributes. Alcohol misuse accelerated more rapidly from Grade 6 through 10 in the 2 alcohol-tolerant compared with conservative profiles. Results suggest that maternal tolerance of some youth alcohol use, even in the presence of dimensions of an effective parenting style and low parental alcohol use and problem use, is not an effective strategy for reducing risky adolescent alcohol use. (PsycINFO Database Record

The effects of mirtazapine versus placebo on alcohol consumption in male high consumers of alcohol: a randomized, controlled trial

BACKGROUND

The number of therapeutic drugs available for the treatment of alcohol use disorders (AUDs) is limited, and a well-tolerated, self-administrable drug is much needed. Subgroups of alcohol-dependent individuals, for example, individuals with heredity for AUD, may respond differently to pharmacological treatments, particularly to drugs affecting the serotonergic system in the brain.

RATIONALE

Clinical observations and case reports indicate that mirtazapine, a widely used and well-tolerated antidepressant drug, which increases both noradrenaline and serotonin release but simultaneously blocks serotonergic (5-hydroxytryptamine)3 receptors, reduces alcohol consumption. Moreover, drugs affecting serotonergic (5-hydroxytryptamine)3 receptors have been shown to work differently in individuals with heredity for AUD.

METHODS

This double-blind, randomized, placebo-controlled, 2-armed clinical trial aimed to establish whether mirtazapine lowers alcohol consumption in male high consumers. The study population was also subgrouped in accordance with heredity for AUD. After 2 lead-in weeks of single-blind placebo, 59 males were randomly assigned to receive 8 weeks of treatment with 30-mg mirtazapine daily (n = 29) or placebo (n = 30). The main outcome was self-reported alcohol consumption (drinks per day) measured by an alcohol diary. The alcohol consumption was calculated as weekly mean during the study period compared with baseline. The data were analyzed in accordance with intention to treat and per protocol.

RESULTS

The results suggest that high consumers of alcohol with a heredity for AUD benefit from treatment with mirtazapine.

CONCLUSIONS

The results of this study did not support an advantage of mirtazapine over placebo on alcohol consumption in the intention-to-treat analysis. However, mirtazapine could be an alternative to available treatments for alcohol dependence in patients with heredity for AUD.

Spit for Science: launching a longitudinal study of genetic and environmental influences on substance use and emotional health at a large US university

Finding genes involved in complex behavioral outcomes, and understanding the pathways by which they confer risk, is a challenging task, necessitating large samples that are phenotypically well characterized across time. We describe an effort to create a university-wide research project aimed at understanding how genes and environments impact alcohol use and related substance use and mental health outcomes across time in college students. Nearly 70% of the incoming freshman class (N = 2715) completed on-line surveys, with 80% of the students from the fall completing spring follow-ups. 98% of eligible participants also gave DNA. The participants closely approximated the university population in terms of gender and racial/ethnic composition. Here we provide initial results on alcohol use outcomes from the first wave of the sample, as well as associated predictor variables. We discuss the potential for this kind of research to advance our understanding of genetic and environment influences on substance use and mental health outcomes.

Impulsive sensation seeking, parental history of alcohol problems, and current alcohol and tobacco use in adolescents

OBJECTIVES

This study attempted to evaluate whether impulsive sensation seeking mediated the relationship between parental alcohol problems and offspring alcohol and tobacco use.

METHODS

Participants were Connecticut high school students (n = 2733) completing a survey of high-risk behaviors. Variables of interest included past month alcohol use, past month binge alcohol use, frequency of past month alcohol use, past month tobacco use, having a biological parent with an alcohol problem, and score on the impulsive sensation seeking (ImpSS) scale from the Zuckerman-Kuhlman Personality Questionnaire - Form III.

RESULTS

ImpSS scores were elevated in past month users of alcohol, binge users of alcohol, users of both tobacco and alcohol, and they increased with increasing frequency of past month alcohol use. Also, parental history of alcohol use increased the likelihood of past month alcohol use, binge use, use of both tobacco and alcohol, and higher levels of past month alcohol use. Mediational analyses did not appear to support the hypothesis that impulsive sensation seeking mediates the relationship between parental history of alcohol problems and alcohol and tobacco use in offspring.

CONCLUSIONS

Impulsive sensation seeking and parental history of alcohol problems appear to be independent factors that contribute to the co-occurrence of alcohol and tobacco use in adolescents. These findings can inform prevention and treatment efforts.

Emerging adults' perspectives on their relationships with mothers with mental illness: implications for caregiving

Guided by a life course perspective, the current study examined whether emerging adults with and without mothers with affective disorders viewed their relationships with their mothers differently, and whether aspects of the emerging adult-mother relationship were associated with reports of caregiving for mothers. Reports from emerging adults with mothers with affective disorders (n = 46) were compared to reports from emerging adults with mothers without mental illness (n = 64). Results indicated that emerging adults with mothers with affective disorders reported significantly lower levels of affection, felt obligation, reciprocity, and future caregiving intentions, and significantly higher levels of role reversal in their relationships with their mothers. Reported current caregiving levels did not differ between emerging adults with and without mothers with affective disorders. Hierarchical multiple regression analyses generally indicated higher levels of felt obligation were associated with higher levels of caregiving, regardless of maternal mental health status. Results and future research directions are discussed from a life course perspective.

Validation of the Pediatric Symptom Checklist in HIV-infected Batswana

OBJECTIVE: To determine the validity of the Pediatric Symptom Checklist (PSC), a brief measure of psychosocial health, for screening HIV+ Batswana children. METHOD: Setswana versions of the parent and child PSC were administered to 509 HIV+ Batswana children (age 8-16) and their parents/guardians. Test properties were evaluated and cut-off scores were derived using receiver operating characteristic curve analysis. Scores on the parent-completed PSC and the child-completed PSC-Y were compared to parental and clinic staff reports of concern about the child's psychosocial health and to scores on the Children's Depression Inventory and the Revised Children's Manifest Anxiety Scale. RESULTS: The Setswana PSC has high internal consistency (Cronbach's alpha 0.87 for the parent-completed version). Comparing PSC scores to parental reports of concern and child-reported depression symptoms, a cut-off score of 20 on the PSC and PSC-Y maximised the sensitivity and specificity. CONCLUSIONS: The PSC performed well in Setswana-speaking children and is a promising screening tool for paediatric psychosocial problems in busy clinical settings. Screening with the PSC may allow for early detection and treatment of psychosocial problems. This is likely to be of particular value for HIV+ children for whom HIV treatment non-adherence may result from untreated psychosocial dysfunction.

Pretreatment clinical and risk correlates of substance use disorder patients with primary depression

OBJECTIVE

The current study examined the distinction between primary and secondary depression among substance use patients to test whether the primary depressed subgroup presents to treatment with a unique profile of clinical and vulnerability characteristics.

METHOD

The heterogeneous sample comprised 286 individuals (76% male) with alcohol and/or drug abuse or dependence (according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised) across four treatment outcome studies conducted at the alcohol research center at the Rutgers University Center of Alcohol Studies. Participants were classified as having comorbid lifetime history of primary depression (21%), secondary depression (24%), or no depression (55%).

RESULTS

Participants in the primary depression and secondary depression groups were comparable in severity of substance use, and both of these groups had more severe substance use problems than the no-depression group. The primary depression group presented with more severe depression histories, higher levels of current depressive symptoms, and higher rates of additional Axis I comorbidity at treatment entry. In terms of vulnerability indices, the primary depression subgroup had a uniquely high family history risk for major depressive disorder; underlying personality vulnerability to depression was also evident in the primary depression group, with higher neuroticism and lower extraversion relative to secondary depression patients.

CONCLUSIONS

The findings suggest that careful assessment of lifetime depression symptoms vis-à-vis substance use history and severity yields important information identifying the primary depression subtype of substance use patients as a group with a unique and more severely affected clinical presentation of depression and other Axis I psychopathology relative to secondary depression patients. Effectiveness of substance use interventions may be augmented with depression treatment for primary depression patients, given their more severe clinical presentation and vulnerability characteristics.

Neighborhood socioeconomic status effects on adolescent alcohol outcomes using growth models: exploring the role of parental alcoholism

OBJECTIVE

There is conflicting evidence regarding the impact of neighborhood socioeconomic status (SES) on adolescent alcohol use. The current study tested whether the prospective effects of neighborhood SES on adolescent alcohol outcomes varied across parental alcoholism subgroups.

METHOD

Data from a group of adolescents (N=361) from an ongoing longitudinal study of children of alcoholics (COAs) and matched controls were collected at three initial annual assessments. Latent growth models were estimated with a range of related time-invariant and time-varying predictors.

RESULTS

Among non-COAs, higher neighborhood SES predicted increased rates in alcohol use and consequences, whereas among COAs, lower neighborhood SES was predictive of increased rates in alcohol use and marginally predicted rates of consequences. There were also time-specific effects of family mobility on alcohol outcomes.

CONCLUSIONS

The current study provides evidence for differential effects of neighborhood SES on adolescent alcohol use and consequences for non-COAs and COAs. The group differences found in this study may help explain the equivocal findings from previous neighborhood studies, which may use samples with an unmeasured mix of high- and low-risk adolescents. Future research should identify pathways to alcohol use and problems for high- and low-risk adolescents living in neighborhoods that span the range of the socioeconomic spectrum.

Smoking is associated with first-ever incidence of mental disorders: a prospective population-based study

AIMS

It is well established that tobacco use is associated with mental disorders. However, the association between tobacco use and mental disorders has not yet been examined sufficiently in prospective, population-based studies. The current study is aimed at examining whether smoking is associated with first-ever incidence of mental disorders.

DESIGN, SETTING AND PARTICIPANTS

We conducted a prospective, population-based epidemiological study (the Netherlands Mental Health Survey and Incidence Study: NEMESIS) in which a representative sample of adults aged 18-64 years (n = 7076) were interviewed to establish the presence of a broad range of mental disorders. We re-interviewed them at 1 year (n = 5618; response 79.4%) and 3 years (n = 4796; 67.8%) after baseline.

MEASUREMENTS

The presence of mental disorders was assessed according to DSM-III-R criteria with the Composite International Diagnostic Interview (CIDI), which was administered by trained lay interviewers. Tobacco use was assessed by asking respondents whether they had smoked in the past year, and how many cigarettes they smoked.

FINDINGS

Subjects who smoked but never had a mental disorder in their life, had an increased risk of developing a mental disorder (P < 0.01), and this remained significant after correcting for major risk indicators of mental disorders.

CONCLUSIONS

Smoking is associated not only with the prevalence, but also with first-ever incidence of mental disorders. More research is needed to study the causal pathways.

Correspondence in collateral and self-reports on alcohol consumption: a within family analysis

The present study tests the degree to which parents and children correspond in their reports on each others quantity and frequency of alcohol consumption. Furthermore, the degree of inaccurate estimation by parents might be related to inappropriate parenting. Particularly, parents who have little control over and knowledge of their offspring's activities and whereabouts might underestimate adolescent alcohol consumption. A full family design was employed in which both parents and two adolescents were included. A total of 428 Dutch families participated and filled in questionnaires at home in the presence of a trained interviewer on frequency and quantity of drinking. Findings showed that parents as well as children underestimate alcohol consumption of each other, in particular concerning the quantity of drinking. It appears that parents are better able to accurately estimate when their child is not drinking than when their child is drinking. Children on the other hand are better able to predict frequency and quantity of parental drinking, but not parental heavy drinking. Finally, parental underestimations of adolescent drinking are indeed related to lack of parental knowledge and control. However, this was primarily found among mothers. In conclusion, survey studies using collateral reports on parental and adolescent drinking should acknowledge the fact that in most cases family members underestimate alcohol consumption.

When children of problem drinkers grow old: does the increased risk of mental disorders persist?

It is well established that children of problem drinkers have an increased risk of developing mental health problems, not only during childhood but also when they grow up into adolescents and adults. However, it has not been examined whether this risk is also present during the old age of these children. In this study, we examine the question whether this increased risk is present in inhabitants of eleven residential homes (mean age 85 years). A total of 355 residents indicated whether one of their parents ever had problems with alcohol. We also used the MINI diagnostic interview to assess the presence of mental disorders. We found that parental problem drinking was significantly associated with having a major depression (current and lifetime), and with the number of drinks in the past week. No significant relationship was found with alcohol-related disorders and anxiety disorders. It was already known that parental problem drinking results in mental health problems in children. We found clear indications that these problems do not disappear when these children grow old.

Marker or mediator? The effects of adolescent substance use on young adult educational attainment

AIMS

We tested the effects of adolescent substance use on college attendance and completion by young adulthood in the context of the behavioral and familial risk factors that influence substance use.

DESIGN, SETTING AND PARTICIPANTS

Longitudinal data were collected from a community sample of children of alcoholics (248) and matched controls (206) at three adolescent assessments (micro(age) = 13-15) and a long-term follow-up in young adulthood (micro(age) = 25).

MEASUREMENTS

College attendance and degree completion by age 25 were self-reported in young adulthood. During adolescence, self-reports of alcohol and drug use were assessed with log-transformed quantity/frequency measures; substance use risk factors [e.g. parental monitoring, externalizing and internalizing symptoms and Diagnostic and Statistical Manual version III (DSM-III) diagnosis of parental alcoholism] were assessed by both self- and parent-report, and adolescent reading achievement was assessed using a standardized assessment of reading achievement (Wide Range Achievement Test).

FINDINGS

Using growth curve modeling, we found that mean levels and growth in adolescent substance use mark, or identify, those adolescents who are at risk for reduced odds of attending and completing college. Moreover, adolescent substance use was not merely a marker of risk, in that growth in drug use (but not alcohol use) significantly mediated the effects of parental alcoholism and early externalizing behavior on later college completion, partially explaining the effects of these risk factors on college completion.

CONCLUSIONS

The current study provides evidence for both the marker and the mediator hypotheses, and identifies multiple pathways to higher educational attainment. The findings point to the importance of studying the effects of adolescent substance use in a broader developmental context of its correlated risk factors to specify more effectively the key pathways to later developmental outcomes.

Pathways to alcohol use among Dutch students in regular education and education for adolescents with behavioral problems: the role of parental alcohol use, general parenting practices, and alcohol-specific parenting practices

The present study explored the role of parents' alcohol use, general parenting practices (support and behavioral control), and alcohol-specific parenting practices (alcohol-specific rule enforcement and alcohol availability at home) on adolescent alcohol use. Structural equation analyses were performed on cross-sectional data from adolescents who received special education because of behavioral problems (n=411) and from adolescents who received regular education (n=428). The main findings show that alcohol-specific parenting practices appear to be highly important in regulating adolescent alcohol use. Parental alcohol use was related to alcohol-specific rule enforcement and alcohol availability at home. Behavioral control was also related to alcohol-specific rule enforcement. Furthermore, the relationships between parental alcohol use, parenting practices, and adolescent alcohol use did not appear to differ substantially for students in special and regular education.

The University of California, San Francisco Family Alcoholism Study. I. Design, Methods, and Demographics

BACKGROUND

The University of California, San Francisco (UCSF) Family Alcoholism Study is a project designed to identify genetic loci that influence susceptibility to alcohol dependence and related phenotypes. Evidence supports a substantial genetic contribution to alcoholism susceptibility. However, the genetic epidemiology of alcoholism is complex, and its clinical manifestation is heterogeneous, making phenotype definition and demonstration of linkage difficult. Despite these challenges, some progress has been made toward identifying genes.

METHODS

The UCSF Family Alcoholism Study used a small family design, focusing primarily on sibling pairs and parent-child trios for linkage and association studies. Alcoholism-related phenotypes were assessed through interview and self-report questionnaires, with a focus on unidimensional and subphenotypical traits. Data-driven approaches to determining the most promising phenotypes for genetic analysis are being used. Both genome-wide scan and candidate gene approaches were used.

RESULTS

The study enrolled 2154 individuals from 970 families from December 1995 through January 2003. Test-retest and interrater reliability for clinical data are very good, and power estimates suggest that this study will have adequate power by linkage analysis to detect loci with moderate effects. Design, methods, and sample demographics of the UCSF Family Study are presented, along with intrafamilial correlations for primary diagnostic phenotypes.

CONCLUSIONS

Plans for genetic analysis, novel approaches to phenotype refinement, and the implications of ascertainment bias for heritability estimates are discussed.

Selecting key variables for depression prevention: results from a population-based prospective epidemiological study

BACKGROUND

Given the existing economic constraints, prevention of depression has to be carefully targeted, and applied where it is likely to yield the highest possible health benefits at the lowest possible cost.

AIM

To identify those risk factors of depression that have the greatest use potential from the perspective of prevention.

METHOD

Data were derived from a population-based prospective cohort of 4664 adults who had never experienced a depression. Their health status was re-examined after 1 year. Incidence rate ratios (IRR), population attributable risks (PAR) and numbers needed to be treated (NNT) were calculated to create a hierarchy of risk factors.

RESULTS

Selecting high-risk groups with migraine, abdominal and respiratory complaints and markers of vulnerability or childhood trauma appears to be an indicated strategy.

CONCLUSIONS

This study illustrates how epidemiology can contribute towards setting a Research and Development agenda for primary prevention of depression.