Substance Abuse

Substance abuse is the result of a complex interaction of individual, family, peer, community, and societal factors (United Nations Office for Drug Control and Crime Prevention 2000). A consistent global finding is that substance abuse runs in families. A family history of drug abuse and dependence substantially increases the risk for such problems among members (Madianos et al. 1995; Wester-meyer and Neider 1994; Wu et al. 1996). The same pattern occurs with alcohol abuse and dependence (Curran et al. 1999; Jauhar and Watson 1995). Although genetics plays a substantial role in both alcohol (Bierut, Dinwiddie, and Regleiter 1998) and drug dependence (Tsuang et al. 1996), the family environment plays a role in both promoting and protecting from substance abuse and dependence. This section reviews some of these factors. Due to the limitations of the research designs, many of these findings are correlational and not causal.

Child physical and sexual abuse. Although much of the research is limited in design (e.g., retrospective designs, clinical samples), childhood abuse appears to be a risk factor for substance abuse. Women who were physically or sexually abused as children are at risk for alcohol abuse as adults (Langeland and Hartgers 1998; Rice et al. 2001) but the evidence for males is contradictory (e.g., contrast Galaif et al. 2001 and Langeland and Hartgers 1998). Childhood sexual abuse may also increase the risk for adolescent drug abuse among females ( Jarvis, Copeland, and Walton 1998). Tracey Jarvis and colleagues speculated that the use of drugs might be an effort to self-medicate the emotional pain associated with the abuse.

Family attitudes and practices about substance abuse. Although peer influences are important in explaining substance use among youth (Lane et al. 2001), family attitudes and practices are also significant. Among Hispanic/Latino youth in particular, parents have been more influential than peers (Coombs, Paulson, and Richardson 1991). Family members' attitudes about and use of substances influence youth substance use. For example, an analysis of the 1997 household survey on substance use found that youth ages twelve to seventeen who perceived that their parents would be "very upset" with marijuana, cigarettes, and binge drinking reported the lowest prevalence of use of these substances in the past year (Lane et al. 2001). Similarly, the protective influence of strong family sanctions against alcohol use reduced the use of that substance among girls in Hungary (Swaim, Nemeth, and Oetting 1995). The level of influence seems to extend to siblings. In one household study in Canada, older sibling drug use, more than parental drug use, was the dominant influence of substance use among youth (Boyle et al. 2001).

Problematic family and partner relations. Family and partner conflict tends to increase risk for substance abuse. The national household survey in the United States found that adolescents who argued with their parents at least several times a week were more likely to have used marijuana in the past year than those who argued with their parents only once a week to once a month (Lane et al. 2001). Internationally, family conflict and lower perceived family caring increases the risk for adolescent substance abuse (Al-Umran, Mahgoub, and Qurashi 1993; Nappo, Galduroz, and Noto 1996; Swaim, Nemeth, and Oetting 1995).

Marital and family conflict appear to increase risk for alcoholism among women in Zagreb (Breitenfeld et al. 1998). Over three-quarters of 100 males admitted for alcohol abuse in Scotland ascribed their marital breakdown or family neglect to their drinking ( Jauhar and Watson 1995).

Family structure. Studies of family structure around the world have found that youth who live with both biological parents are significantly less likely to use substances, or to report problems with their use, than those who do not live with both parents (Challier et al. 2000; Johnson, Hoffman, and Gerstein 1996). However, family structure alone does not appear to explain substance abuse. The characteristics of these family structures offer some clues. For example, boys who are in care of their mothers and whose fathers are drug abusers are at increased risk for drug abuse but this is due to the genetic transmission of risk and lack of resources for effective parenting for single mothers (Tarter et al. 2001). Studies in Brazil and Saudi Arabia have noted that the quality of family relationships was more important than structure in explaining substance use (Al-Umran, Mahgoub, and Qurashi 1993; Carvalho et al. 1995).

Disruptions in the family life cycle seem to characterize these single-parent households. An unstable family environment (i.e., father absence, one or both parents who had immigrated, or death of parents) was associated with substance abuse among a nationwide sample of youth in Greece (Madianos et al. 1995). White non-Hispanics/Latinos and African Americans in changed families (e.g., those that changed from two parents to single parents during the study) had the highest rates of substance initiation (Gil, Vega, and Biafora 1998). Moreover, deteriorating family environments were stronger influences of drug initiation among Hispanic/Latino immigrants than nonimmigrants to the United States. Among African Americans, family structure and environment had the weakest effect on substance use and African-American youth in the care of their mothers or other adult family members, had the lowest proportion of drug onset (Gil, Vega, and Biafora 1998).

Thus, family structure along with characteristics of these families seems to account for substance abuse. More research is needed on the quality of the relationships within these family structures and on the time-order of the onset of substance use among youth with different family structures ( Johnson, Hoffman, and Gerstein 1996).

Protective family factors that mitigate risk for substance abuse. Although they may place members at risk of substance abuse, family factors may also be protective. As noted above, two-parent households appear protective. High levels of perceived support from family members seems to protect against youth alcohol use (Foxcroft and Lowe 1991) and drug use among Hispanics/Latinos (Frauenglass et al. 1997) and African Americans (Sullivan and Farrell 1999). Researchers have found that effective family relationships (e.g., family involvement and communication, proactive family management, or attachment to family) protect against adolescent substance abuse across racial and cultural groups (Carvalho et al. 1995; Stronski et al. 2000; Williams et al. 1999). Further, the positive effects of family support during adolescence seem long lasting. Greater family support and bonding during adolescence has predicted less problem alcohol use in adulthood (Galaif et al. 2001).

In families with substance-abusing parents, there may be influences that protect from abuse. Preliminary research has suggested that a factor that provides some protection for children in homes with substance-abusing parents is the availability of a stable, nurturing relative such as grandmothers or aunts ( Jones-Harden 1998). In research in Colombia, the adverse effects of parental substance abuse were buffered by effective parent-child rearing practices (Brook et al. 2001).

Protection extends beyond parents to siblings. One study reported that older brother abstinence from drugs, as well as strong attachment to parents, explained reduced drug use among younger brothers (Brook, Brook, and Whiteman 1999).

In sum, the risk and protective factors suggest that family relationships have a significant impact on substance abuse and dependence. However, the research is not sufficiently developed to indicate which or how much of these protective factors are necessary to reduce risk. There are variations across groups and in timing in their importance for preventing or reducing risk (Gil, Vega, and Biafora 1998). Further, the risk and protective factors at other levels, such as community or societal, may mitigate or attenuate risk.