Parental

problem

drinking

parenting

and

adolescent

alcohol

use

The

present

study

examined

whether

parental

problem

drinking

affected

parenting

-LRB-

i.e.

behavioral

control

support

rule-setting

alcohol-specific

behavioral

control

-RRB-

and

whether

parental

problem

drinking

and

parenting

affected

subsequent

adolescent

alcohol

use

over

time

A

total

of

families

consisting

of

both

parents

and

two

adolescents

-LRB-

mean

age

and

years

at

Time

-RRB-

participated

in

a

three-wave

longitudinal

study

with

annual

waves

A

series

of

path

analyses

were

conducted

using

a

structural

equation

modeling

program

-LRB-

Mplus

-RRB-

Results

demonstrated

that

unexpectedly

parental

problem

drinking

was

in

general

not

associated

with

parenting

For

the

younger

adolescents

higher

levels

of

both

parenting

and

parental

problem

drinking

were

related

to

lower

engagement

in

drinking

over

time

This

implies

that

shared

environment

factors

-LRB-

parenting

and

modeling

effects

-RRB-

influence

the

development

of

alcohol

use

in

young

adolescents

When

adolescents

grow

older

and

move

out

of

the

initiation

phase

their

drinking

behavior

may

be

more

affected

by

other

factors

such

as

genetic

susceptibility

and

peer

drinking

Introduction

Time

trends

in

Dutch

epidemiological

research

show

a

significant

increase

in

frequency

and

intensity

of

alcohol

consumption

among

year

olds

-LRB-

Poelen

et

al.

-RRB-

Alarming

high

numbers

of

Dutch

adolescents

-LRB-

-RRB-

also

report

problem

drinking

behaviors

such

as

binge

drinking

-LRB-

consuming

more

than

amounts

of

alcohol

on

one

occasion

-RRB-

when

compared

to

their

American

counterparts

-LRB-

Newes-Adeyi

et

al.

Van

Dorsselaer

et

al.

-RRB-

In

addition

previous

studies

show

that

high

levels

of

alcohol-related

problems

such

as

social

consequences

of

alcohol

use

-LRB-

e.g.

family

problems

-RRB-

and

dependence

symptoms

-LRB-

e.g.

loss

of

control

-RRB-

occur

frequently

in

Western

societies

with

approximately

of

both

American

and

Dutch

populations

reporting

or

more

alcohol-related

problems

-LRB-

Cornel

et

al.

NIAAA

Van

Dijck

and

Knibbe

Wallitzer

and

Connors

-RRB-

Parental

problem

drinking

increases

risk

for

alcohol

use

in

children

-LRB-

e.g.

Chassin

et

al.

Hawkins

et

al.

Sher

et

al.

-RRB-

Children

of

alcoholics

are

not

only

at

a

higher

risk

for

early

alcohol

initiation

-LRB-

Hill

et

al.

-RRB-

they

also

show

a

greater

increase

in

alcohol

consumption

over

time

than

adolescents

without

alcoholic

parents

-LRB-

Chassin

and

Barrera

-RRB-

In

addition

children

with

a

family

history

of

alcoholism

show

more

escalation

of

alcohol

use

-LRB-

Lieb

et

al.

-RRB-

and

more

often

develop

alcohol

disorders

and

dependence

-LRB-

Hill

et

al.

-RRB-

than

children

without

a

family

history

of

alcoholic

parents

In

an

attempt

to

explain

these

associations

social

theorists

suggested

a

modeling

effect

-LRB-

Bandura

-RRB-

that

causes

youngsters

to

imitate

their

parents

Others

have

proposed

that

parental

substance

abuse

may

impair

parenting

-LRB-

Sher

Van

der

Vorst

et

al.

Van

Zundert

et

al.

-RRB-

which

subsequently

may

affect

adolescent

alcohol

consumption

As

Mayes

and

Truman

-LRB-

-RRB-

pointed

out

personality

characteristics

disabilities

or

impairments

accompanying

an

addiction

may

affect

the

ability

to

raise

a

child

In

addition

substance

use

alters

the

state

of

consciousness

memory

affect

and

impulse

control

each

of

which

may

impair

the

adult

's

parenting

capacities

Indeed

empirical

studies

have

shown

that

children

of

alcoholic

parents

receive

less

discipline

-LRB-

King

and

Chassin

-RRB-

and

less

emotional

support

from

their

parents

-LRB-

Rutherford

et

al.

-RRB-

In

addition

Chassin

et

al.

-LRB-

-RRB-

found

that

parental

alcoholism

decreased

the

amount

of

parental

monitoring

This

is

all

the

more

problematic

since

discipline

and

rule

setting

in

turn

reduce

the

likelihood

of

youngsters

drunkenness

-LRB-

Engels

and

Van

der

Vorst

-RRB-

and

more

parental

monitoring

is

related

to

less

heavy

drinking

in

adolescents

-LRB-

Kerr

and

Stattin

Van

der

Vorst

et

al.

-RRB-

In

addition

parental

support

appears

to

prevent

early

onset

of

alcohol

use

as

well

as

frequent

and

heavy

alcohol

use

among

adolescents

-LRB-

Barnes

et

al.

-RRB-

Thus

numerous

cross-sectional

studies

have

demonstrated

associations

between

parental

alcohol

use

parenting

and

adolescent

alcohol

consumption

-LRB-

e.g.

Chassin

et

al.

Kerr

and

Stattin

-RRB-

However

with

the

exception

of

two

prospective

studies

that

showed

that

monitoring

by

fathers

and

parental

discipline

mediated

between

parental

alcoholism

and

adolescents

alcohol

use

-LRB-

Chassin

et

al.

King

and

Chassin

-RRB-

longitudinal

studies

are

lacking

In

addition

to

allow

generalization

of

findings

and

to

examine

effects

in

potentially

less

severe

cases

it

is

necessary

to

investigate

community-based

samples

-LRB-

Russell

et

al.

-RRB-

Accordingly

the

central

aim

of

the

present

study

was

to

longitudinally

examine

the

nature

of

the

relations

between

parental

problem

drinking

parenting

and

adolescent

alcohol

use

in

a

three-wave

community-based

sample

Alcohol-specific

parenting

Although

studies

on

parenting

and

adolescent

alcohol

use

have

been

informative

two

important

issues

have

hardly

been

addressed

First

most

studies

on

the

link

between

parenting

and

adolescent

alcohol

use

have

focused

on

general

parenting

However

alcohol-specific

socialization

which

refers

to

the

actions

parents

undertake

to

discourage

or

prevent

their

offspring

from

drinking

-LRB-

Jackson

et

al.

Van

der

Vorst

et

al.

-RRB-

has

received

less

attention

in

relation

to

parental

drinking

and

adolescent

alcohol

use

Wood

et

al.

-LRB-

-RRB-

found

that

late

adolescents

drank

less

alcohol

when

their

parents

disapproved

of

drinking

In

addition

imposing

strict

rules

prevented

youngsters

from

heavy

drinking

-LRB-

Jackson

et

al.

Van

der

Vorst

et

al.

Yu

-RRB-

However

whether

parental

problem

drinking

affects

alcohol-specific

parenting

has

not

yet

been

examined

From

studies

on

smoking

we

know

that

parents

who

smoke

are

less

frequently

engaged

in

anti-smoking

socialization

practices

than

parents

who

do

not

smoke

-LRB-

Harakeh

et

al.

-RRB-

A

similar

process

might

be

at

work

regarding

alcohol-specific

socialization

suggesting

that

parents

with

alcohol

problems

may

engage

less

frequently

in

alcohol-specific

socialization

and

as

such

provide

fewer

alcohol-specific

rules

are

more

permissive

towards

alcohol

use

and

exert

less

alcohol-specific

control

Second

it

is

crucial

to

acknowledge

that

the

association

between

parenting

and

adolescent

problem

behavior

may

be

bidirectional

Parents

do

not

only

influence

their

children

but

children

's

behavior

also

exerts

an

effect

on

parents

Indeed

recent

longitudinal

studies

showed

a

bidirectional

relation

between

parenting

and

adolescent

substance

use

Adolescent

drinking

smoking

or

deviant

behavior

decreased

the

level

of

parental

monitoring

and

rule

setting

-LRB-

Huver

et

al.

Stice

and

Barrera

Van

der

Vorst

et

al.

-RRB-

This

implies

that

when

these

child

effects

are

not

taken

into

account

this

may

lead

to

an

overestimation

of

parental

influences

-LRB-

Kerr

and

Stattin

Van

der

Vorst

et

al.

-RRB-

Current

study

and

expectancies

We

longitudinally

investigated

the

direct

effect

of

parental

problem

drinking

on

adolescent

alcohol

use

the

role

of

alcohol-specific

and

general

parenting

practices

in

this

relationship

and

the

reciprocal

effects

of

adolescent

alcohol

use

on

parenting

-LRB-

see

Fig.

-RRB-

It

was

expected

that

parental

problem

drinking

would

have

a

direct

positive

effect

on

adolescent

alcohol

use

with

more

parental

alcohol-related

problems

leading

to

more

adolescent

alcohol

use

In

addition

an

indirect

relationship

was

expected

via

parenting

more

specifically

higher

levels

of

parental

problem

drinking

were

thought

to

have

a

negative

effect

on

both

general

and

alcohol-specific

parenting

practices

which

in

turn

would

lead

to

more

adolescent

alcohol

use

Moreover

the

drinking

behaviors

of

the

adolescents

were

expected

to

influence

parenting

with

more

adolescent

drinking

resulting

in

less

parental

discipline

and

monitoring

Fig

Model

of

Parental

Problem

Drinking

Parenting

and

Adolescent

Alcohol

Use

Methods

Participants

and

recruitment

The

data

were

derived

from

an

ongoing

Dutch

longitudinal

survey

called

Family

and

Health

which

examines

different

socialization

processes

in

relation

to

various

health

behaviors

in

adolescence

-LRB-

see

Harakeh

et

al.

Van

der

Vorst

et

al.

-RRB-

A

total

of

Dutch

families

consisting

of

mother

father

and

two

adolescent

children

participated

in

our

study

in

the

first

wave

-LRB-

-RRB-

Families

were

included

when

the

parents

were

married

or

living

together

and

when

all

family

members

were

biologically

related

Families

with

twins

or

with

mentally

or

physically

disabled

offspring

were

excluded

Numbers

of

drop-outs

were

extremely

low

in

the

second

-LRB-

-RRB-

and

third

wave

-LRB-

-RRB-

with

-LRB-

-RRB-

and

-LRB-

-RRB-

participating

families

respectively

The

majority

of

the

families

were

of

Dutch

origin

-LRB-

-RRB-

The

mean

age

of

the

participants

at

Time

was

years

-LRB-

SD

-RRB-

for

the

older

adolescents

years

-LRB-

SD

-RRB-

for

the

younger

adolescents

years

-LRB-

SD

-RRB-

for

the

fathers

and

years

-LRB-

SD

-RRB-

for

the

mothers

Of

the

older

adolescents

were

girls

compared

to

in

the

younger

group

Concerning

educational

level

an

equal

distribution

was

realized

with

about

one

third

of

the

adolescents

following

low

education

one

third

following

intermediate

general

education

and

one

third

following

the

highest

level

of

secondary

school

The

different

levels

of

the

Dutch

secondary

school

system

are

comparable

with

the

different

tracks

within

a

middle

class

public

high

school

in

the

USA

although

they

may

not

be

completely

interchangeable

In

our

sample

when

compared

to

national

Dutch

figures

the

intermediate

general

education

is

slightly

underrepresented

while

the

low

and

high

levels

are

slightly

overrepresented

-LRB-

CBS

-RRB-

Procedure

The

families

were

visited

at

home

by

a

trained

interviewer

In

his

or

her

presence

all

four

family

members

individually

filled

out

an

extensive

questionnaire

which

took

about

h

to

complete

The

participants

were

not

allowed

to

consult

each

other

or

to

discuss

the

answers

When

all

family

members

had

completed

the

questionnaire

each

family

received

-LRB-

-RRB-

In

addition

after

completion

of

the

first

three

waves

of

the

project

traveler

cheques

of

-LRB-

-RRB-

each

were

raffled

among

all

participating

families

Approval

was

obtained

from

the

Central

Committee

on

Research

Involving

Human

Subjects

on

collecting

the

data

Measure

Self-reports

were

used

to

measure

parental

problem

drinking

and

adolescent

alcohol

use

The

four

parenting

practices

were

based

on

adolescents

reports

reflecting

how

they

perceived

their

parents

behaviors

The

questions

regarding

the

parenting

variables

were

asked

in

such

a

way

that

the

adolescents

were

able

to

discriminate

between

the

parenting

practices

of

their

mothers

and

fathers

Problem

drinking

To

measure

the

severity

of

fathers

and

mothers

alcohol-related

problems

both

parents

completed

the

problem

drinking

list

of

Cornel

et

al.

-LRB-

-RRB-

The

original

scale

was

based

on

three

commonly

used

instruments

to

measure

problem

drinking

CAGE

-LRB-

Cut

down

Annoyed

Guilty

Eye-opener

CAGE

is

an

acronym

formed

by

taking

the

first

letter

of

key

words

from

each

of

the

following

questions

Mayfield

et

al.

-RRB-

Short

Michigan

Alcohol

Screening

Test

-LRB-

SMAST

Selzer

et

al.

-RRB-

and

a

shortened

version

of

the

Self-Administered

Alcohol

Screening

Test

-LRB-

SAAST

Davis

et

al.

-RRB-

Seriousness

of

problem

drinking

was

developed

as

a

Rasch

scale

with

items

arranged

in

order

of

increasing

severity

The

more

severe

the

items

the

less

frequently

they

are

scored

positively

Since

all

requirements

of

the

Rasch

model

were

met

the

items

form

a

reliable

and

unidimensional

scale

-LRB-

Cornel

et

al.

-RRB-

Examples

of

items

were

Do

you

ever

drink

alcohol

to

forget

your

concerns

-LRB-

item

-RRB-

and

Have

you

ever

lost

your

job

because

of

your

drinking

-LRB-

item

-RRB-

Respondents

could

respond

no

or

yes

Severity

of

problem

drinking

was

reflected

by

the

aggregated

score

with

a

maximum

score

of

Because

of

the

skewness

of

the

summed

variable

's

distribution

scores

were

categorized

into

meaningful

groups

never

had

problems

due

to

alcohol

has

had

problems

due

to

alcohol

a

couple

of

times

problem

drinkers

-LRB-

see

Cornel

et

al.

-RRB-

General

parenting

To

measure

parental

behavioral

control

we

used

a

Dutch

translation

of

the

scale

developed

by

Kerr

and

Stattin

-LRB-

-RRB-

The

scale

consisted

of

items

with

response

categories

ranging

from

no

never

to

yes

always

Examples

of

items

were

Do

you

need

to

have

your

mother

's

permission

to

stay

out

late

on

a

weekday

evening

and

Before

you

go

out

on

a

Saturday

night

does

your

father

require

you

to

tell

them

where

you

are

going

and

with

whom

Internal

consistencies

as

measured

with

Cronbach

's

alphas

ranged

from

to

for

the

reports

of

both

adolescents

about

their

mothers

and

fathers

over

the

three

waves

To

measure

parental

support

we

used

the

Relationship

Support

Inventory

-LRB-

RSI

Scholte

et

al.

-RRB-

tapping

several

aspects

of

emotional

and

instrumental

support

Examples

of

items

were

My

mother

shows

me

that

she

loves

me

and

My

father

supports

me

in

what

I

do

The

adolescents

had

to

answer

items

on

a

scale

from

absolutely

untrue

to

absolutely

true

The

amount

of

support

was

the

mean

score

on

items

Cronbach

's

alpha

coefficients

were

between

and

across

the

three

waves

Alcohol-specific

parenting

Van

der

Vorst

et

al.

-LRB-

-RRB-

developed

a

scale

to

measure

the

degree

to

which

parents

permit

their

children

to

consume

alcohol

Examples

of

items

were

I

am

allowed

to

drink

alcoholic

consumptions

when

my

mother/father

is

at

home

and

I

am

allowed

to

drink

alcohol

on

weekdays

Participants

had

to

respond

on

a

scale

that

ranged

from

completely

applicable

to

not

applicable

at

all

The

internal

consistency

was

high

with

Cronbach

's

alphas

between

and

over

the

three

waves

In

addition

the

general

behavioral

control

scale

of

Kerr

and

Stattin

-LRB-

-RRB-

was

adapted

to

measure

behavioral

control

aimed

at

affecting

adolescents

alcohol

consumption

Examples

of

the

items

were

Do

you

need

your

mother

's

permission

to

drink

alcohol

on

weekdays

and

Does

your

mother

want

to

know

whether

your

friends

drink

alcohol

As

in

the

original

scale

the

response

categories

ranged

from

never

to

always

Cronbach

's

alpha

coefficients

were

between

and

across

the

three

waves

Adolescent

alcohol

use

Intensity

of

drinking

was

assessed

by

questions

that

asked

about

the

number

of

glasses

consumed

in

the

previous

week

during

weekdays

and

weekends

both

outside

and

inside

the

house

-LRB-

Engels

et

al.

-RRB-

The

aggregated

score

on

these

four

questions

was

used

as

an

indication

of

the

adolescents

intensity

of

alcohol

use

-LRB-

Van

der

Vorst

et

al.

-RRB-

Because

of

the

skewness

in

the

distribution

of

this

variable

total

scores

were

categorized

into

groups

-LRB-

glasses

glasses

glasses

glasses

glasses

glasses

glasses

and

above

-RRB-

Strategy

of

analyses

For

the

descriptive

part

of

the

analyses

we

applied

t

tests

Pearson

correlations

and

general

linear

modeling

with

repeated

measures

-LRB-

the

latter

to

test

changes

over

time

in

alcohol-related

problems

and

alcohol

use

-RRB-

We

performed

cross-lagged

path

analyses

-LRB-

see

Fig.

-RRB-

using

version

of

the

Mplus

statistical

package

-LRB-

Muthén

and

Muthén

-RRB-

to

test

-LRB-

a

-RRB-

to

which

degree

parental

alcohol-related

problems

parental

practices

and

alcohol

use

of

adolescents

were

stable

over

time

-LRB-

b

-RRB-

whether

parental

problem

drinking

was

related

to

parental

practices

and

alcohol

use

of

the

adolescent

over

time

and

-LRB-

c

-RRB-

whether

parental

practices

and

alcohol

use

of

the

adolescent

were

cross-related

over

time

-LRB-

Finkel

-RRB-

Cross

relations

over

time

allow

to

test

causal

predominance

Are

specific

parenting

practices

the

cause

of

adolescent

alcohol

use

or

does

adolescent

alcohol

use

provoke

specific

parenting

practices

-LRB-

Byrne

-RRB-

Structural

regression

models

are

generally

somewhat

more

sophisticated

than

the

path

models

used

in

our

study

because

they

correct

for

measurement

error

-LRB-

Kline

p.

-RRB-

This

controlling

for

error

variance

by

means

of

latent

variables

that

are

measured

by

multiple

manifest

indicators

plus

their

error

variance

however

also

increases

the

number

of

parameters

to

be

estimated

In

addition

more

complex

models

i.e.

models

with

more

parameters

require

larger

sample

sizes

than

do

more

parsimonious

models

in

order

for

the

estimates

to

be

comparably

stable

-LRB-

Kline

p.

-RRB-

Kline

-LRB-

-RRB-

recommends

a

parameter

subjects

ratio

of

As

such

we

used

path

models

in

which

one

manifest

parameter

represented

all

the

individual

items

of

one

scale

by

means

of

the

mean

or

sum

score

The

model

depicted

in

Fig.

was

tested

for

each

of

the

four

parenting

variables

separately

A

total

of

-LRB-

parenting

variables

-RRB-

-LRB-

fathers

and

mothers

-RRB-

models

were

tested

The

variables

at

and

the

disturbance

terms

of

the

variables

at

and

were

free

to

correlate

Because

adolescent

alcohol

consumption

and

parental

problem

drinking

were

relatively

skewed

and

the

measurement

level

was

ordered

more

categorical

-LRB-

ordinal

-RRB-

than

interval

maximum

likelihood

estimation

methods

-LRB-

demanding

multivariate

normal

distributed

variables

-RRB-

were

less

suited

We

used

the

weighted

least

square

method

with

adjusted

mean

and

variance

chi-square

-LRB-

WLSMV

-RRB-

estimator

an

estimation

method

specifically

developed

for

ordered

categorical

dependent

variables

-LRB-

Muthén

and

Muthén

-RRB-

To

test

model

fit

standard

chi-square

tests

as

well

as

the

number

of

degrees

of

freedom

-LRB-

df

-RRB-

were

replaced

by

robust

chi-square

tests

-LRB-

mean

and

variance-adjusted

chi-squares

-RRB-

and

estimates

of

df

-LRB-

Muthén

and

Muthén

pp.

-RRB-

The

latter

estimates

are

dependent

on

sample

information

and

this

explains

why

df

with

identical

models

can

vary

across

different

groups

Together

with

the

robust

chi-square

tests

we

used

two

fit

measures

the

Root

Mean

Square

Error

of

Approximation

-LRB-

RMSEA

Byrne

Steiger

and

Lind

-RRB-

and

the

Comparative

Fit

Index

-LRB-

CFI

-RRB-

of

Bentler

-LRB-

Bentler

-RRB-

RMSEA

is

utilized

to

assess

approximate

fit

preferably

with

values

less

than

or

equal

to

but

values

between

and

are

indicative

of

fair

fit

-LRB-

Browne

and

Cudeck

-RRB-

CFI

is

a

comparative

fit

index

values

above

are

preferred

-LRB-

Kaplan

-RRB-

but

should

not

be

lower

than

-LRB-

Kline

see

also

Hu

and

Bentler

and

for

commentary

on

existing

guidelines

Marsh

et

al.

-RRB-

Mplus

has

several

possibilities

to

handle

missing

values

depending

on

the

estimation

method

used

In

our

case

-LRB-

using

the

WLSMV-estimator

-RRB-

all

available

information

in

the

data

was

used

by

means

of

pair-wise

information

of

each

combination

of

two

variables

Results

Descriptives

on

alcohol

consumption

and

problem

drinking

Table

shows

the

means

standard

deviations

and

percentages

of

parental

problem

drinking

Fathers

reported

higher

levels

of

problem

drinking

than

mothers

at

all

three

waves

as

was

tested

with

separate

t

tests

-LRB-

t

-LRB-

-RRB-

p

t

-LRB-

-RRB-

p

t

-LRB-

-RRB-

p

-RRB-

With

general

linear

modeling

repeated

measures

we

tested

whether

maternal

and

paternal

problem

drinking

differed

over

time

-LRB-

within

factor

-RRB-

Both

paternal

and

maternal

problem

drinking

showed

significant

differences

over

time

-LRB-

for

fathers

F

-LRB-

-RRB-

p

partial

eta

squared

-LRB-

PES

-RRB-

and

for

mothers

F

-LRB-

-RRB-

p

and

PES

-RRB-

Subsequently

carried

out

repeated

contrasts

revealed

significant

differences

over

time

only

from

to

for

both

parents

-LRB-

p

-RRB-

but

not

from

to

At

the

older

adolescents

consumed

on

average

glasses

in

the

past

week

-LRB-

SD

M

SD

M

SD

-RRB-

compared

to

glasses

-LRB-

SD

-RRB-

consumed

in

the

past

week

by

the

younger

siblings

-LRB-

M

SD

M

SD

-RRB-

Older

adolescents

reported

significantly

higher

levels

of

alcohol

consumption

than

younger

adolescents

at

all

three

waves

-LRB-

t

-LRB-

-RRB-

p

t

-LRB-

-RRB-

p

t

-LRB-

-RRB-

p

-RRB-

Repeated

measures

showed

a

significant

increase

in

alcohol

consumption

over

time

for

both

adolescents

for

and

-LRB-

for

older

adolescents

F

-LRB-

-RRB-

p

PES

and

for

younger

adolescents

F

-LRB-

-RRB-

p

PES

-RRB-

Table

standard

deviations

and

percentages

of

parental

problem

drinking

-LRB-

PD

-RRB-

and

adolescent

alcohol

use

-LRB-

A

-RRB-

at

Time

-LRB-

-RRB-

Time

-LRB-

-RRB-

and

Time

-LRB-

-RRB-

SD

M

SD

M

SD

PD

PD

mother

A

younger

n.a.

n.a.

n.a.A

older

n.a.

n.a.

n.a.Note

M

represents

the

mean

score

calculated

from

the

aggregated

scores

of

all

items

-LRB-

maximum

score

-RRB-

of

which

the

problem

drinking

scale

consists

-LRB-

Cornel

and

Knibbe

-RRB-

Percentages

of

problem

drinkers

are

computed

with

a

cut-off

score

n.a.

not

applicable

Values

for

adolescent

alcohol

use

-LRB-

A

-RRB-

represent

the

intensity

of

alcohol

use

i.e.

the

number

of

glasses

of

alcohol

consumed

in

the

past

week

Fathers

had

significantly

more

alcohol-related

problems

than

mothers

at

all

three

time

points

with

p

Older

adolescents

reported

significantly

more

alcohol

than

younger

adolescents

at

all

three

time

points

Means

in

the

same

row

that

do

not

share

superscripts

-LRB-

a

b

c

-RRB-

are

significantly

different

-LRB-

p

-RRB-

Correlations

between

cross-sectional

and

longitudinal

variables

Maternal

and

paternal

problem

drinking

correlated

positively

but

marginally

with

adolescents

alcohol

consumption

-LRB-

r

-RRB-

Parental

problem

drinking

correlated

negatively

with

support

-LRB-

r

-RRB-

and

alcohol-specific

behavioral

control

-LRB-

r

-RRB-

and

positively

with

permissiveness

-LRB-

r

-RRB-

while

both

positive

and

negative

correlations

were

found

between

parental

problem

drinking

and

general

behavioral

control

-LRB-

r

-RRB-

Adolescent

alcohol

use

correlated

low

to

moderately

with

general

behavioral

control

-LRB-

r

-RRB-

support

-LRB-

r

-RRB-

and

alcohol-specific

behavioral

control

-LRB-

r

-RRB-

and

positively

with

permissiveness

-LRB-

r

-RRB-

General

behavioral

control

correlated

positively

with

support

-LRB-

r

-RRB-

and

negatively

with

permissiveness

-LRB-

r

-RRB-

Moderate

correlations

existed

between

the

general

behavioral

control

scale

and

the

alcohol-specific

behavioral

control

scale

-LRB-

r

-RRB-

indicating

that

they

share

the

same

basis

but

can

be

seen

as

separate

constructs

Correlation

tables

are

available

upon

request

Structural

equation

models

All

models

showed

an

acceptable

fit

-LRB-

Table

-RRB-

with

all

Comparative

Fit

Indices

-LRB-

CFI

-RRB-

at

least

above

and

all

Root

Mean

Square

Errors

of

Approximation

-LRB-

RMSEAs

-RRB-

below

Table

indices

for

all

modelsFatherMotherPMASBCSUPMASBCSUdf2630302627302928χ

²

36.1358.7376.0541.7847.9256.8078.4942.95

Note

PM

Permissiveness

AS

Alcohol-specific

behavioral

control

BC

Behavioral

control

SU

Support

Each

column

represents

one

model

with

a

specific

parenting

variable

separately

for

mothers

and

fathers

Alcohol-specific

parenting

permissiveness

and

alcohol-specific

behavioral

control

Standardized

regression

weights

-LRB-

β

-RRB-

of

parental

problem

drinking

permissiveness

alcohol-specific

behavioral

control

and

adolescent

alcohol

consumption

showed

a

strong

stability

over

time

with

values

between

and

-LRB-

see

Table

-RRB-

Table

parameters

estimates

of

the

alcohol-specific

parenting

practices

parental

problem

drinking

-LRB-

PD

-RRB-

and

adolescent

alcohol

use

-LRB-

standardized

beta

weight

-RRB-

PermissivenessAlcohol-specific

behavioral

controlFathersMothersFathersMothersStability

PD

PD

PD

PD

Parenting

OA

Parenting

OA

Parenting

OA

Parenting

OA

Alcohol

use

OA

Alcohol

use

OA

Alcohol

use

OA

Alcohol

OA

Parenting

YA

Parenting

YA

Parenting

YA

Parenting

YA

Alcohol

use

YA

Alcohol

use

YA

Alcohol

use

YA

Alcohol

use

YA

Paths

from

PD

Parenting

OA

PD

Parenting

OA

PD

Alcohol

use

OA

PD

Alcohol

use

OA

PD

Parenting

YA

PD

Parenting

YA

PD

Alcohol

use

YA

PD

Alcohol

use

YA

Cross-lagged

Parenting

OA

Alcohol

use

OA

Parenting

OA

Alcohol

use

OA

Alcohol

use

OA

Parenting

OA

Alcohol

use

OA

Parenting

OA

Parenting

YA

Alcohol

use

YA

Parenting

YA

Alcohol

use

YA

Alcohol

use

YA

Parenting

YA

Alcohol

use

YA

Parenting

YA

Alcohol

use

OA

Alcohol

use

YA

Alcohol

use

OA

Alcohol

use

YA

Note

PD

Parental

Problem

Drinking

OA

Older

Adolescent

YA

Younger

Adolescent

All

stability

paths

are

significant

at

p

The

numbered

paths

in

the

table

correspond

to

the

arrowed

paths

depicted

in

Fig.

p

p

p

Regarding

both

the

older

and

younger

adolescents

no

significant

associations

were

found

between

parental

problem

drinking

and

parental

permissiveness

with

the

exception

of

problem

drinking

of

both

fathers

and

mothers

at

which

was

significantly

and

positively

related

to

permissiveness

towards

the

older

adolescent

at

-LRB-

for

fathers

β

p

for

mothers

β

p

-RRB-

More

problem

drinking

of

the

mother

at

and

was

significantly

associated

with

more

alcohol

use

of

the

older

adolescent

at

and

drinking

of

the

younger

adolescent

at

respectively

-LRB-

β

p

β

p

-RRB-

Problem

drinking

of

the

father

at

was

significantly

and

positively

associated

to

alcohol

use

of

the

youngest

adolescent

at

-LRB-

β

p

-RRB-

More

parental

permissiveness

at

led

to

more

alcohol

use

at

in

both

younger

and

older

adolescents

-LRB-

β

p

-RRB-

This

significant

relation

was

not

found

between

and

We

did

not

find

that

parents

adapt

their

levels

of

permissiveness

in

response

to

adolescent

alcohol

use

Paths

from

parental

problem

drinking

at

on

alcohol-specific

behavioral

control

at

were

significant

for

the

father

regarding

both

the

older

and

younger

adolescents

-LRB-

respectively

β

and

β

p

-RRB-

and

for

the

mother

regarding

the

younger

adolescent

-LRB-

β

p

-RRB-

Problem

drinking

of

the

father

at

related

substantially

to

alcohol

use

of

the

younger

adolescent

at

-LRB-

β

p

-RRB-

Problem

drinking

of

the

mothers

affected

both

the

older

-LRB-

β

p

-RRB-

and

the

younger

adolescents

alcohol

consumption

-LRB-

β

p

-RRB-

For

the

younger

but

not

for

the

older

adolescents

more

alcohol-specific

behavioral

control

at

was

related

to

lower

levels

of

adolescent

alcohol

use

at

-LRB-

β

p

for

fathers

β

p

for

mothers

-RRB-

Adolescent

alcohol

use

negatively

affected

alcohol-specific

behavioral

control

of

both

parents

-LRB-

β

p

-RRB-

General

parenting

behavioral

control

and

support

The

standardized

regression

weights

of

parental

problem

drinking

support

behavioral

control

and

adolescent

alcohol

consumption

showed

a

strong

stability

over

time

with

values

between

and

-LRB-

see

Table

-RRB-

Table

parameters

estimates

of

general

parenting

practices

parental

problem

drinking

-LRB-

PD

-RRB-

and

adolescent

alcohol

use

-LRB-

standardized

beta

weight

-RRB-

Behavioral

controlSupportFathersMothersFathersMothersStability

PD

PD

PD

PD

Parenting

OA

Parenting

OA

Parenting

OA

Parenting

OA

Alcohol

use

OA

Alcohol

use

OA

Alcohol

use

OA

Alcohol

OA

Parenting

YA

Parenting

YA

Parenting

YA

Parenting

YA

Alcohol

use

YA

Alcohol

use

YA

Alcohol

use

YA

Alcohol

use

YA

Paths

from

PD

Parenting

OA

PD

Parenting

OA

PD

Alcohol

use

OA

PD

Alcohol

use

OA

PD

Parenting

YA

PD

Parenting

YA

PD

Alcohol

use

YA

PD

Alcohol

use

YA

Cross-lagged

Parenting

OA

Alcohol

use

OA

Parenting

OA

Alcohol

use

OA

Alcohol

use

OA

Parenting

OA

Alcohol

use

OA

Parenting

OA

Parenting

YA

Alcohol

use

YA

Parenting

YA

Alcohol

use

YA

Alcohol

use

YA

Parenting

YA

Alcohol

use

YA

Parenting

YA

Alcohol

use

OA

Alcohol

use

YA

Alcohol

use

OA

Alcohol

use

YA

Note

PD

Parental

Problem

Drinking

OA

Older

Adolescent

YA

Younger

Adolescent

All

stability

paths

are

significant

at

p

The

numbered

paths

in

the

table

correspond

to

the

arrowed

paths

depicted

in

Fig.

p

p

p

Regarding

both

the

older

and

younger

adolescents

paths

of

both

maternal

and

paternal

problem

drinking

with

behavioral

control

were

generally

not

significant

Only

maternal

problem

drinking

at

showed

a

significant

association

with

behavioral

control

towards

the

youngest

adolescent

at

-LRB-

β

p

-RRB-

Problem

drinking

of

the

mother

at

and

was

significantly

associated

with

alcohol

use

of

the

older

adolescent

at

and

drinking

of

the

younger

adolescent

at

respectively

-LRB-

β

p

β

p

-RRB-

Problem

drinking

of

the

father

at

related

substantially

to

alcohol

use

of

the

younger

adolescent

at

-LRB-

β

p

-RRB-

Considering

the

cross-lagged

paths

more

parental

behavioral

control

at

was

associated

with

less

alcohol

consumption

of

the

older

adolescents

at

-LRB-

β

p

for

fathers

β

p

for

mothers

-RRB-

but

not

from

to

Younger

adolescents

also

consumed

less

alcohol

at

when

their

parents

exerted

more

behavioral

control

at

-LRB-

β

p

for

fathers

β

p

for

mothers

-RRB-

In

addition

older

adolescents

drinking

at

negatively

affected

parental

behavioral

control

at

-LRB-

β

p

for

fathers

β

p

for

mothers

-RRB-

indicating

that

when

older

adolescents

drank

more

parents

exerted

less

general

behavioral

control

This

result

was

not

found

for

the

younger

adolescent

No

significant

associations

were

found

between

parental

problem

drinking

and

the

support

parents

provide

to

both

the

younger

and

older

adolescent

Paternal

problem

drinking

at

directly

affected

alcohol

use

of

the

younger

adolescent

at

-LRB-

β

p

-RRB-

Mothers

problem

drinking

at

and

affected

alcohol

use

of

the

older

adolescent

at

and

drinking

of

the

younger

adolescent

at

respectively

-LRB-

β

p

β

p

-RRB-

More

parental

support

at

was

related

to

less

alcohol

use

of

the

younger

adolescents

at

-LRB-

β

p

for

fathers

β

p

for

mothers

-RRB-

These

associations

were

not

found

between

and

nor

for

the

older

adolescents

In

addition

more

alcohol

use

of

the

older

adolescents

at

was

associated

with

less

parental

support

at

-LRB-

β

p

for

father

β

p

for

mothers

-RRB-

Additional

analyses

We

also

tested

whether

older

adolescents

influenced

their

younger

siblings

in

drinking

behavior

Results

showed

that

alcohol

consumption

of

the

older

adolescents

tended

to

directly

affect

alcohol

use

of

the

younger

adolescent

-LRB-

β

p

-RRB-

Discussion

The

aim

of

the

present

study

was

to

gain

insight

into

the

associations

between

parental

problem

drinking

parenting

and

adolescent

alcohol

use

in

a

sample

of

Dutch

families

The

first

main

finding

shows

that

except

for

alcohol-specific

behavioral

control

parental

problem

drinking

does

not

structurally

affect

parenting

over

time

More

alcohol-related

problems

did

not

result

in

less

behavioral

control

less

general

support

or

higher

permissiveness

Our

results

differ

from

those

of

other

studies

in

which

significant

relations

between

parental

problem

drinking

and

parenting

were

found

-LRB-

Chassin

et

al.

King

and

Chassin

Rutherford

et

al.

-RRB-

These

differences

could

be

due

to

methodological

issues

as

problem

drinking

or

alcoholism

in

the

latter

studies

were

often

diagnosed

in

conformity

with

the

DSM-IV

criteria

whereas

we

concentrated

on

a

broader

range

of

alcohol-related

problems

in

a

community

sample

Thus

because

of

our

assessment

of

problem

drinking

instead

of

alcohol

dependence

or

abuse

and

because

of

our

focus

on

a

community

sample

instead

of

a

clinical

sample

the

present

study

reflects

the

situation

in

the

general

population

and

as

such

enhances

the

generalizability

of

the

findings

Another

explanation

for

the

non-significant

relation

between

parental

problem

drinking

and

general

parenting

comes

from

the

buffering

hypothesis

which

states

that

support

protects

persons

from

the

potentially

pathogenic

influence

of

stressful

events

-LRB-

Cohen

and

Wills

p.

-RRB-

Accordingly

children

of

one

problem-drinking

parent

may

be

protected

from

the

parent

's

inadequate

parenting

by

the

support

and

adequate

parenting

of

the

other

-LRB-

non-problem

drinking

-RRB-

parent

A

buffering

mechanism

has

been

reported

in

the

literature

For

example

Van

Aken

and

Asendorpf

-LRB-

-RRB-

found

that

low

support

from

one

parent

could

be

compensated

by

support

from

the

other

parent

in

affecting

adolescent

self-esteem

In

addition

peer

friendships

positive

peer

relations

and

family

cohesion

have

each

shown

to

be

a

protective

factor

against

children

's

externalizing

problems

in

family

conflict

situations

-LRB-

Criss

et

al.

Farrell

et

al.

-RRB-

With

respect

to

problem

drinking

the

possibility

of

enhancing

resiliency

in

children

and

adolescents

by

protecting

against

possible

harmful

influences

from

one

parent

by

a

strong

relationship

with

the

other

parent

siblings

or

peers

should

be

a

topic

of

examination

in

future

research

In

addition

with

regard

to

the

persons

in

our

sample

being

part

of

a

stable

nuclear

family

that

consists

of

two

biological

parents

with

two

or

more

children

living

together

may

be

protective

in

itself

Our

findings

do

not

imply

that

problem

drinking

has

no

effect

on

personal

cognition

or

functioning

but

suggest

that

parents

are

able

to

regulate

their

problem

behavior

with

regard

to

their

children

and

parenting

practices

However

parental

problem

drinking

may

affect

the

way

in

which

parents

handle

alcohol

use

within

the

family

Parents

with

more

alcohol-related

problems

are

not

more

permissive

than

parents

who

do

not

have

these

problems

Maintaining

the

set

rules

by

means

of

alcohol-specific

behavioral

control

however

does

appear

to

be

a

problem

Our

second

main

finding

is

that

higher

levels

of

behavioral

control

support

rules

and

alcohol-specific

behavioral

control

account

for

less

alcohol

consumption

in

mainly

the

younger

adolescents

which

corresponds

with

the

literature

on

this

topic

-LRB-

e.g.

Kerr

and

Stattin

Van

der

Vorst

et

al.

-RRB-

Alcohol-specific

rule

setting

played

an

important

role

in

drinking

of

both

the

younger

and

older

adolescents

When

parents

were

more

permissive

toward

alcohol

use

adolescents

reported

higher

levels

of

drinking

which

is

in

accordance

with

other

studies

on

rule

enforcement

and

adolescent

alcohol

use

-LRB-

Jackson

et

al.

Van

der

Vorst

et

al.

Van

Zundert

et

al.

Yu

-RRB-

However

support

and

both

general

and

alcohol-specific

behavioral

control

were

only

associated

with

less

alcohol

use

of

the

younger

adolescent

up

to

the

age

of

about

years

For

older

adolescents

the

effect

of

parenting

disappeared

and

parental

problem

drinking

was

found

to

directly

affect

adolescent

alcohol

use

In

explaining

this

pattern

it

might

be

that

parenting

exerts

influence

before

and

during

the

initiation

phase

of

alcohol

use

which

in

Dutch

adolescents

takes

place

around

the

age

of

years

-LRB-

Poelen

et

al.

-RRB-

but

that

parenting

is

no

longer

important

once

the

habitual

drinking

pattern

has

been

established

-LRB-

DeCourville

-RRB-

Further

it

has

been

suggested

that

genetic

effects

increase

in

importance

over

time

during

late

adolescence

whereas

environmental

factors

decrease

in

importance

Twin

studies

have

indeed

shown

that

shared

environmental

factors

such

as

parenting

play

a

profound

role

in

the

initiation

of

alcohol

use

but

that

genetic

factors

are

more

important

in

frequency

of

alcohol

use

and

problem

drinking

in

young

adulthood

-LRB-

see

Hopfer

et

al.

Pagan

et

al.

-RRB-

Moreover

during

adolescence

parental

factors

decrease

in

importance

whereas

the

influence

of

peers

increases

making

the

latter

a

strong

predictor

for

adolescent

drinking

-LRB-

Fergusson

et

al.

-RRB-

As

such

shared

environmental

factors

such

as

parenting

and

parental

modeling

affect

alcohol

consumption

in

young

adolescence

Drinking

in

later

adolescence

may

be

related

to

other

non-shared

factors

such

as

genes

and

peer

drinking

Accordingly

future

research

should

apply

a

longitudinal

behavioral

genetic

design

preferably

examining

the

different

stages

of

adolescent

drinking

-LRB-

initiation

frequency

of

consumption

drinking

to

intoxication

-RRB-

in

order

to

partial

out

the

different

effects

of

genetic

and

environmental

factors

Our

third

main

finding

considers

the

reciprocal

associations

between

adolescent

alcohol

use

and

parental

behaviors

More

adolescent

alcohol

use

made

parents

decrease

their

levels

of

general

and

alcohol-specific

behavioral

control

over

time

Levels

of

support

were

also

negatively

adjusted

in

response

to

adolescent

alcohol

use

but

only

in

the

younger

adolescents

Our

findings

concur

with

recent

studies

that

also

reported

bidirectional

findings

between

parenting

practices

and

adolescent

substance

use

-LRB-

Huver

et

al.

Stice

and

Barrera

Van

der

Vorst

et

al.

-RRB-

However

parents

did

not

adjust

their

levels

of

permissiveness

in

response

to

adolescent

alcohol

use

Perhaps

rule-setting

is

more

stable

over

time

and

is

not

affected

by

fluctuations

in

adolescent

alcohol

use

The

application

of

those

rules

however

by

means

of

exerting

control

was

influenced

by

the

levels

of

alcohol

that

adolescents

consumed

Since

our

study

is

one

of

the

first

to

examine

reciprocal

effects

between

adolescent

drinking

and

parental

factors

more

research

on

this

topic

is

warranted

Regarding

differences

between

fathers

and

mothers

we

found

that

maternal

but

not

paternal

problem

drinking

was

directly

associated

with

alcohol

use

of

the

oldest

adolescent

This

is

a

remarkable

finding

considering

the

fact

that

in

most

parenting

studies

with

a

focus

on

alcoholism

or

problem

drinking

women

are

underrepresented

-LRB-

e.g.

Chassin

et

al.

-RRB-

Future

research

should

specifically

include

mothers

in

studies

regarding

alcoholic

or

problem-drinking

parents

Limitations

Despite

the

advantages

of

our

study

such

as

multi-informant

data

longitudinal

design

and

the

testing

of

reciprocal

associations

in

path

analyses

some

limitations

should

be

addressed

First

we

did

not

further

examine

relationships

in

subgroups

-LRB-

for

example

sex

differences

-RRB-

because

of

a

lack

of

statistical

power

and

subsequently

the

risk

of

making

Type

II

errors

Nonetheless

it

should

be

stressed

that

in

this

type

of

longitudinal

study

with

a

full-family

design

the

sample

size

was

substantial

and

the

low

attrition

rates

over

the

three

waves

were

remarkable

Second

parental

factors

explained

only

a

small

part

of

the

variance

in

adolescent

drinking

However

finding

small

effects

does

not

imply

that

parental

factors

are

unimportant

The

finding

that

parenting

influences

adolescent

alcohol

consumption

can

have

large

practical

implications

-LRB-

see

Abelson

-RRB-

Third

parents

may

have

under-reported

their

alcohol-related

problems

because

of

social

desirability

and

adolescents

may

have

under-reported

their

alcohol

use

because

of

the

presence

of

their

parents

at

home

while

filling

in

the

questionnaires

In

an

attempt

to

anticipate

these

biases

and

to

ensure

confidentiality

the

questionnaires

had

to

be

completed

individually

and

separately

without

the

possibility

for

family

members

to

discuss

the

answers

In

addition

studies

have

shown

that

self-reports

concerning

alcohol

use

are

a

reliable

source

of

information

-LRB-

Engels

et

al.

-RRB-

Fourth

although

the

sample

was

carefully

selected

the

results

can

not

be

generalized

to

the

whole

Dutch

population

because

of

the

lack

of

for

example

single-parent

families

and

step-families

Fifth

in

the

Netherlands

the

legal

age

to

drink

beer

and

wine

is

and

the

legal

age

to

drink

liquor

is

This

may

make

it

difficult

to

compare

previous

research

from

the

USA

where

the

legal

age

to

drink

is

with

our

results

Sixth

it

might

be

that

the

initial

measurements

triggered

follow-up

discussions

about

alcohol

use

within

families

which

might

have

acted

as

an

intervention

However

since

our

study

is

longitudinal

and

ongoing

we

did

not

want

to

encourage

any

speculations

or

thoughts

on

the

content

of

the

questionnaires

which

might

affect

the

following

measurements

and

as

such

we

did

not

consult

the

families

on

these

matters

Seventh

in

our

questionnaires

the

definition

of

glasses

of

alcohol

was

left

up

to

the

respondents

to

interpret

This

may

have

lead

to

a

reporter

bias

in

the

exact

amount

of

alcohol

consumed

because

of

different

-LRB-

non-standard

-RRB-

glass

sizes

However

measurement

of

the

precise

amount

of

alcohol

consumed

is

rather

difficult

to

realize

in

our

current

study

design

Experimental

designs

or

diary

studies

will

be

able

to

more

accurately

measure

and

control

the

precise

quantity

of

consumed

alcohol

See

Kerr

et

al.

-LRB-

-RRB-

for

an

elaborated

discussion

on

this

topic

Taking

these

limitations

into

account

this

study

is

the

first

to

disentangle

the

prospective

relations

between

parental

alcohol-related

problems

parenting

and

adolescent

alcohol

use

in

a

community

sample

using

multi-informant

data

The

results

show

that

parental

problem

drinking

does

not

substantially

and

systematically

affect

parenting

and

that

parenting

influences

adolescent

alcohol

use

but

only

up

to

the

age

of

about

years

This

implies

that

shared

environment

factors

-LRB-

e.g.

parenting

and

modeling

effects

-RRB-

influence

the

development

of

alcohol

use

in

young

adolescents

When

adolescents

grow

older

and

move

out

of

the

initiation

phase

their

drinking

behavior

may

be

more

affected

by

other

factors

such

as

genetic

susceptibility

and

peer

drinking

O B I O B O O B B O O O O O O O B I O B O O O O O O O O O O O O O O O O O O B I O B O O B B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O B O O O O O O O O O O B O O B I O O O O O O O O O O O O O O O O O B O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O B B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O B O O O O O O O O O O O O O O O O O O O O B O O B O O B B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O B O O B B O O O O O O O O B O O O B O B B O O O O O O O O O O O O O O O O O O O O O B O B B O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B B O O O O O O O O O O O O O O B O O O O O O O O O O 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problem drinking
parenting
adolescent
alcohol