Alcoholism Health Article

Alcoholism

Term encompassing alcohol use, alcohol consumption, alcohol problems, problem drinking, and alcohol dependence.

The concept of alcoholism, in its most general sense, refers to a disease, or disorder, typically characterized by: (a) a prolonged period of frequent, heavy alcohol use; (b) a variety of social and/or legal problems associated with alcohol use (e.g., driving while intoxicated, impaired school/work performance); and (c) the expression of dependency symptoms (e.g., unpleasant withdrawal effects when unable to consume alcohol). Although some adolescents do indeed experience difficulties associated with their use of alcohol at levels of severity so as to be aptly characterized as alcoholic, this subgroup is small relative to the number of children and adolescents who use alcohol at significant, but less severe, levels. Furthermore, there are major differences in the rates of alcohol use across the wide age range constituting childhood and adolescence. Hence, a comprehensive consideration of the role of alcohol in childhood and adolescence necessitates distinctions of what specific features of alcohol-related behaviors are being referred to. Several different features of alcohol-related behaviors (e.g., alcohol use, alcohol problems, beliefs about alcohol) of relevance to children and adolescents are presented here.

Infancy

There is considerable evidence that maternal alcohol consumption during pregnancy may contribute adversely to a baby's development. Abnormalities in offspring associated with maternal alcohol consumption may include prenatal and postnatal growth retardation, neurological deficits (e.g., impaired attentional control), intellectual deficiencies, behavioral problems (e.g., impulsivity), skull or brain malformations, and facial aberrations (e.g., a thin upperlip and elongated flattened midface). These abnormalities, influenced by maternal alcohol consumption during pregnancy, are referred to as fetal alcohol effects (FAEs), or fetal alcohol syndrome (FAS) if a sufficient number of effects are manifested by the offspring. Rates of FAS are substantially higher among African Americans relative to Caucasians, and some Native American populations have high rates of FAS. Research studies that have followed infants with FAS and FAEs across time have indicated that many of these children continue to have cognitive difficulties (e.g., lower IQ scores, more learning problems, poorer short-term memory functioning) and behavioral problems (e.g., high impulsivity, high activity level) into childhood and adolescence.

Preschool

While scientifically a relatively new area of study, evidence is accumulating that indicates that most preschool children (ages 3-5 years) can identify alcoholic beverages and have already developed certain cognitive concepts and schemas (i.e., integrated beliefs) about drinking behaviors. In an olfactory (smell) identification task, preschool children were requested to identify substances (e.g., apple juice, coffee, perfume, beer) subsequent to closing their eyes and inhaling odors from jars that contained the various substances. Prior to closing their eyes, the children did not know which substance was going to be presented in the jar. Seventy-nine percent of the preschool children successfully identified at least one alcoholic beverage. In addition, there was a higher rate of alcohol beverage identification among preschool children who had parents who were heavier drinkers. Other findings with preschool children who were and were not children of alcoholics (COAs) indicated significant group differences in beliefs about alcohol consumption. The COA preschoolers, relative to the non-COA preschoolers, were more likely to identify at least one alcohol beverage, to correctly identify a larger number of alcohol beverages (e.g., beer, wine), and to attribute heavier alcohol use to adult men, rather than women. Hence, it appears that the early formation of knowledge structures about and concepts of alcohol use are emerging during the preschool years and, furthermore, that parental drinking practices are associated with these early formative beliefs.

School-age

The acquisition and elaboration of knowledge structures about alcohol use by children continues through the elementary school years. For example, a study indicated that third graders did not know where people typically drink (e.g., at a bar, in their home), but that sixth- and eighth-graders did possess this knowledge. However, a recognition that different concentrations of alcohol were contained in different alcoholic beverages (i.e., beer, wine, and hard liquor) was known by eighth graders, but not by third- or sixth-graders. These knowledge structures by children about alcohol use manifested a cumulative pattern that was also indicated with regard to children's intentions to drink alcohol—a higher percentage of the older children indicated that they intended to use alcohol in the future. Children's intention to drink was also significantly related to parental drinking practices (i.e., the more the parents drank, the more likely that children expressed an intention to drink).

Age differences in the development of alcohol expectancies have also been indicated among children. Alcohol expectancies refer to beliefs about anticipated positive and negative consequences associated with drinking alcohol (e.g., "alcohol use increases my social skills and friendliness in group situations"). Alcohol expectancies have been related to higher levels of alcohol consumption and treatment outcome variables (e.g., length of hospital stay, relapse probability) among adolescents and adults, and thus their early origins and development in children are of importance. Findings for alcohol expectancies among school-age children indicated increasingly positive alcohol expectancies across grade levels, with a major increase between the third- and fourth grade. That is, by the fourth grade, children tended to believe that the use of alcohol results in positive outcomes such as higher levels of acceptance and liking by peers and being in a good mood with positive feelings about oneself. These positive alcohol expectancies among fourth graders correspond with findings that at least 25% of fourth graders reported feeling at least some peer pressure to consume alcoholic beverages; some level of peer pressure to consume alcoholic beverages increased to approximately 60% among seventh graders.

It is evident that a range of social events (e.g., perceived peer pressure) and developmental processes (e.g., cognitive labeling and knowledge structure elaboration and differentation) about alcohol use are ongoing during the preschool and elementary school years prior to the actual consumption of alcohol. Actual use of alcohol is also initiated by some children during the elementary school years. It has been estimated that 20 to 25% of fourth

graders report having consumed an alcoholic beverage in their lifetime, and this rate increases to slightly more than 50% by eighth grade. Thus, while drinking behavior increases substantially in the next portion of the lifespan to be discussed—adolescence—some of the cognitive foundations (e.g., beliefs and attitudes) for alcohol use and abuse such as intentions to drink, alcohol expectancies, and even initiation have been cultivated or expressed during the preschool and elementary school years.