Delyse M. Hutchinson, Richard P. Mattick, Danya Braunstein, Elizabeth Maloney, Judy Wilson The Impact of Alcohol Use Disorders on Family Life: A Review of the Empirical Literature NDARC Technical Report No. 325 THE IMPACT OF ALCOHOL USE DISORDERS ON FAMILY LIFE: A REVIEW OF THE EMPIRICAL LITERATURE Delyse M. Hutchinson, Richard P. Mattick, Danya Braunstein, Elizabeth Maloney, Judy Wilson NDARC Technical Report Number: 325 ISBN: 978-0-7334-3392-4 JUNE 2014 ©NATIONAL DRUG AND ALCOHOL RESEARCH CENTRE, UNIVERSITY OF NEW SOUTH WALES, SYDNEY, 2014 This work is subject to copyright protection. except as permitted under the copyright act 1968 and this notice, no part of this work may be reproduced, stored in a retrieval system, communicated or transmitted in any form or by any means without prior written permission from the owner. All other rights are reserved. Requests and enquiries concerning reproduction and rights should be addressed to the information manager, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia. TABLE OF CONTENTS LIST OF TABLES .................................................................................................... 2 LIST OF FIGURES .................................................................................................. 2 ACKNOWLEDGEMENTS ..................................................................................... 3 EXECUTIVE SUMMARY ....................................................................................... 4 CHAPTER 1. INTRODUCTION ...................................................................... 6 1.1 Overview, aims and objectives ................................................................................... 6 1.2 Description of studies included in the review ......................................................... 6 1.3 The spectrum of alcohol use: Key definitions ......................................................... 7 CHAPTER 2. THE PREVALENCE OF ALCOHOL USE AND ALCOHOL USE PROBLEMS IN FAMILIES ........................................................................... 8 2.1 Introduction .................................................................................................................. 8 2.2 Prevalence of alcohol use and alcohol use problems in Australian families ....... 8 2.3 International research on the prevalence of alcohol use problems in families .11 CHAPTER 3. FRAMEWORK FOR REVIEWING LITERATURE ............... 13 CHAPTER 4. REVIEW OF EMPIRICAL LITERATURE ON THE IMPACT OF ALCOHOL USE DISORDERS ON FAMILIES ............................................ 17 4.1 Five key areas in the research literature ..................................................................17 4.2 Impact on marital and intimate partner relationships ..........................................17 4.2.1 Marital/ intimate partner dissatisfaction and breakdown .............................17 4.2.2 Marital/ intimate partner violence ....................................................................20 4.3 Impact on family life and functioning ....................................................................24 4.3.1 Communication problems and family cohesion .............................................24 4.3.2 Family violence ....................................................................................................26 4.3.3 Organisation and routine ...................................................................................28 4.3.4 Financial strain .....................................................................................................29 4.3.5 Social isolation .....................................................................................................32 4.4 Comorbid mental health and substance use disorders .........................................34 4.4.1 Prevalence and research on comorbid disorders ............................................34 4.4.2 Poly-substance use ..............................................................................................35 4.4.3 Affective and Anxiety Disorders ......................................................................36 4.4.4 Psychotic Disorders ............................................................................................37 4.4.5 Personality Disorders ..........................................................................................37 4.4.6 Impacts of comorbidity on families .................................................................38 4.5 Impact on parenting ..................................................................................................40 4.5.1 Disrupted parenting ............................................................................................40 4.5.2 Parental attitudes towards drinking and modeling of alcohol use ...............47 4.6 Impact on the physical, cognitive and psychological health of children ...........54 4.6.1 Prenatal exposure to alcohol, prevalence and impacts ..................................54 4.6.2 Disturbances in childhood, adolescence and adulthood......................................59 4.7 Protective Factors ......................................................................................................65 CHAPTER 5. SYNTHESIS AND OVERVIEW OF THE FINDINGS .......... 68 CHAPTER 6. CONCLUSION AND FUTURE DIRECTIONS ..................... 75 REFERENCES ...................................................................................................... 79 1 LIST OF TABLES Table 1: Percentage of students who drank alcohol in the past seven days (current drinker) by age and gender from ASSAD (2011) survey ...............................................50 Table 2: Most common sources of alcohol for those who drank in the past seven days (current drinker) from the ASSAD (2011) survey ..........................................................51 Table 3: Most usual places for drinking by students who drank alcohol in the past seven days (current drinkers) from the ASSAD (2011) survey ...............................................52 Table 4: Summary of research evidence for a significant relationship between alcohol use disorders and problems in family life ...............................................................................69 LIST OF FIGURES Figure 1: Influences model .................................................................................................14 Figure 2: Family influences on the development of child problem behavior and alcohol abuse........................................................................................................................16 Figure 3: Conceptual model of the relationships between parental alcohol use disorders and family functioning ....................................................................................71 2 ACKNOWLEDGEMENTS This review was funded by the Australian Government Department of Health and Ageing. The National Drug and Alcohol Research Centre at the University of New South Wales is also supported by the Australian Government. Doctor Delyse Hutchinson is supported by a Vice-Chancellor’s Postdoctoral Research Fellowship from the University of New South Wales. Professor Richard P Mattick is supported by a Principal Research Fellowship Award from the National Health and Medical Research Council. The authors would like to thank Dr Heather Proudfoot, Dr Louise Mewton and Dr Laura Vogl for their significant contributions to this review. Additionally, the authors would like to acknowledge the Australian National Council on Drugs, the Commonwealth of Australia, and the National Institute on Alcohol Abuse and Alcoholism, for allowing us to reproduce the figures and tables cited. 3 EXECUTIVE SUMMARY This report aimed to review the empirical literature on the impact of parental alcohol use disorders on family life. The report focused specifically on harms inflicted by the problematic consumption of alcohol on members of the family, particularly spouses and children, and on the functioning of the family unit as a whole. The key objectives of this report were to (a) improve understanding of the nature and extent of the impacts, (b) provide specific directions for future research, and (c) identify salient factors to be incorporated in national health policies, and prevention and treatment initiatives that aim to reduce the burden of alcohol use disorders in Australia. It is important to note that the review is not all-inclusive. The impacts that were considered most important and the ones for which there was considerable empirical support were selected for review. The review relied on cross-sectional studies when more rigorous longitudinal studies were not available. Much of the research has been conducted internationally; however, where available, findings from large-scale cohort studies in Australia and New Zealand have been included to improve understanding of the links between parental alcohol use problems and family functioning within the local context. The report also overviewed the available research on the impact of alcohol within Indigenous communities in Australia. The review demonstrated that there is a large body of research showing significant associations between parental alcohol use disorders and a range of problems in family life and functioning. These problems include, but are not limited to, parent and family conflict and violence, parental separation and divorce, parent mental health and other substance use problems, economic problems, disrupted