The Brief Addiction Science Information Source (BASIS)

The DRAM, Vol. 6(6) – Do as I say, not as they do: The effects of parenting style on adolescent alcohol use.

2010-07-28T12:00:00-04:00

According to data from the national Youth Risk Behavior Survey (YRBS), during the 30 days prior to survey, 42% of high school students had at least 1 drink and 24% participated in heavy drinking (Center for Disease Control and Prevention, 2009). Parenting style likely has an effect on adolescent alcohol use. However, researchers have reported conflicting results about the effects of parenting practices, specifically control (i.e., monitoring, discipline) and support (i.e., warmth, nurturance), on adolescent alcohol use (e.g., Dubow, Boxer, & Huesmann, 2008; King & Chassin, 2004). This week’s DRAM reviews a recent article that examined the effect of parenting style (i.e., authoritative, authoritarian, indulgent, and neglectful) on adolescent alcohol use in a large representative sample (Bahr & Hoffmann, 2010).

Methods

Bahr & Hoffman used a multistage probability sample to select 4,983 students in grades 6-12 to complete the survey.
The survey included the following variables:

Dependent variable: Past 30 day alcohol use: no use; light use (i.e., less than five drinks in one sitting); or heavy use (i.e., five or more drinks in one sitting)
Independent variables: Parenting style: authoritative (i.e., high support, high control), authoritarian (i.e., low support, high control), indulgent (i.e., high support, low control), or neglectful (i.e., low support, low control); Religiosity: 2 items measuring frequency and importance of religion; Peer alcohol use: among four best friends the number who drink.

The researchers used structural equation modeling (SEM) to estimate the effect of parenting style, religiosity, and peer alcohol use on past 30 day alcohol use.

Table 1. Parenting Style and Adolescent Alcohol Use (adapted from Bahr & Hoffman, 2010).
Note. Results are from SEM that included adolescent religiousness and the following covariates: age; gender; race; family structure; and parental education.
Results

As Table 1 shows, adolescents whose parents were authoritative were less likely to drink heavily than adolescents from the other three parenting styles, and they were less likely to have close friends who used alcohol.
Contrary to expectations, authoritative parenting had no significant effect on light alcohol use compared to authoritarian and indulgent parenting styles, but did have a significant effect compared to neglectful parenting.

Limitations

Barr and Hoffman employed a cross-sectional study design making it impossible to determine cause and effect.
The authors relied on student self-report, and the results are subject to the biases associated with self-report.

Conclusion
These results support the hypothesis that parental style has a significant but small¹ association with the drinking behavior of their adolescent children. These results illustrate how strong parenting styles that include monitoring adolescent behavior and/or strong social support might help deter drinking behavior and insulate adolescents from the peer pressure of heavy drinking. Future research should include longitudinal studies to measure the influence of parenting style on adolescent drinking behavior across time and further refine our understanding of the moderators and mechanisms of that influence, such as parental drinking behavior and the promotion/tolerance of underage drinking.

- John H Kleschinsky

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References

Bahr, S. J., & Hoffmann, J. P. (2010). Parenting style, religiosity, peers, and adolescent heavy drinking. J Stud Alcohol Drugs, 71(4), 539-543.

Center for Disease Control and Prevention. (2009). Trends in the Prevalence of Alcohol Use. Youth Risk Behavior Survey Retrieved July 09, 2010, from http://www.cdc.gov/healthyyouth/yrbs/pdf/us_alcohol_trend_yrbs.pdf

Dubow, E. F., Boxer, P., & Huesmann, L. R. (2008). Childhood and adolescent predictors of early and middle adulthood alcohol use and problem drinking: the Columbia County Longitudinal Study. Addiction, 103 Suppl 1, 36-47.

King, K. M., & Chassin, L. (2004). Mediating and moderated effects of adolescent behavioral undercontrol and parenting in the prediction of drug use disorders in emerging adulthood. Psychology of Addictive Behaviors, 18(3), 239-249.

¹The effect size for parenting style was smaller (0.08-0.14) compared to peer alcohol use (0.37-0.56).

WAGER Vol. 15(6) – More or Less the Same: Variations on Brief Gambling Treatment

2010-07-21T12:00:00-04:00

Historically, effective treatment for gambling disorders has been an elusive goal, considering that only a very small proportion of gamblers ever seek treatment (Cunningham, 2005). Brief treatment, which typically involves treatment of ten sessions or less, has been effective with alcohol related problems. Therefore, an adaptation of the brief treatment model might be equally effective for disordered gamblers unwilling to seek formal treatment. This week’s WAGER reviews a report by Hodgins, Currie, Currie, and Fick (2009) in their continuing research on brief treatment variations.

Methods

Researchers used a randomized control study design and recruited 314 problem gamblers interested in reducing their gambling.
At baseline, researchers gathered data about participants’ demographics, gambling history, use of public resources for gambling treatment, and gambling severity.
Researchers assigned participants to one of four conditions:

Brief Treatment (BT) participants received a self-help workbook after one half-hour telephone session of motivational interviewing (MI). The workbook provided self-assessments for gambling problems, practical recovery strategies, and information about local resources.
In addition to the initial MI and workbook, Brief Booster Treatment (BBT) participants received six more brief telephone MIs at 2, 6, 10, 16, 24, and 36 weeks.
Workbook Only Control (WOC) participants received the workbook without MI contact.
Waiting List Control (WLC) participants waited six weeks before receiving the workbook, and had no MI contact.

For all four conditions, researchers conducted follow-up assessments at 6, 12, 24, 36, and 52 weeks after initial contact. During these assessments, researchers collected measures of gambling prior to follow-up interviews.

Results

After 6 weeks, BT and BBT participants reported significantly lower rates of gambling days per month than WOC and WLC participants. (M = 4.7, SD = 6.0; M = 4.8, SD = 5.9; M = 6.6, SD = 7.3; M = 5.7, SD = 6.4, respectively.)
As Figure 1 shows, participants across the BBT, BT, and WOC conditions reported significantly lower rates of gambling at all follow-up assessments
At the 12-month follow-up, neither BT nor BBT gambling rates differed significantly from WOC. (BT vs. WOC, χ2(1, N = 249) = 3.0, p = ns; BBT vs. WOC, χ2(1, N = 249) = 2.1, p = ns).¹

Figure 1 - Gambling Rates at Follow-Up Assessments (adapted from Hodgins et al, 2009).

Limitations

For ethical reasons, researchers could not retain participants on a waiting list for the duration of the study; therefore all participants received some form of treatment during the study year.
Participants volunteered for the clinical trial, and were interested in reducing their gambling, so the results are not generalizable to all gamblers.

Discussion

Similar to Hodgins et al.’s original study (2001), the results of this experiment highlight the efficacy of brief treatments with or without motivational therapy. Though the follow-up findings from Hodgins original study found larger differences between MI and non-MI groups (Hodgins et al., 2004) than the current study, one consistent result across these three reports is a steady decline of problem gambling, without much distinction between the types of treatment. One possible explanation is that problem gamblers naturally regress from their addiction, regardless of treatment or treatment type. An important point to consider is that all participants in these studies received follow-up interviews to collect data; therefore, another possibility is that contact, whether motivational or not, was enough to affect gambling behavior.

A noticeable similarity between the three studies is the self-selected nature of the participants. Only gamblers who expressed interest to reduce or quit their problem behavior were recruited as participants. For future studies, the inclusion of moderator and mediator variables, such as participant expectations and readiness to change, would help clarify the mechanisms through which these interventions are effecting change.

-Aaron Lim

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Footnote: Measures for WLC follow-ups after six weeks were not reported.

References

Cunningham, J.A. (2005) Little use of treatment among problem gamblers. Psychiatric Services, 56, 1024-1025.

Hodgins, D. C., Currie, S. R., & el-Guebaly, N. (2001). Motivational enhancement and self-help treatments for problem gambling. Journal of Consulting and Clinical Psychology, 69(1), 50-57.

Hodgins, D. C., Currie, S. R., el-Guebaly, N., & Peden, N. (2004). Brief motivational treatment for problem gambling: A 24-month follow-up. Psychology of Addictive Behaviors, 18(3), 293-296.

Hodgins, D.C., Currie, S.R., Currie, G., & Fick, G.H. (2009). Randomized trial of motivational treatments for pathological gamblers: More is not necessarily better. Journal of Consulting and Clinical Psychology, 77(5), 950-960.

STASH, Vol. 6(6) – The Addictive Potential of Indoor Tanning

2010-07-14T12:00:00-04:00

The American public increasingly is becoming aware of the health risks of indoor tanning. Just this month, a 10% excise tax on indoor tanning went into effect; this tax is designed both to offset some of the costs of the nation’s health-care reform and to discourage the use of tanning beds. Given the health risks and increasing costs, why do people continue to engage in indoor tanning? For some, indoor tanning might represent an addiction, similar to the process of becoming addicted to substances. This week the STASH reviews an article that explores possible links among indoor tanning addiction, substance use, and mood disorders (Mosher & Danoff-Burg, 2010), implicating excessive indoor tanning as another manifestation of the addiction syndrome (Shaffer et al., 2004).

Methods

Participants (n = 421) were recruited from students enrolled in psychology classes at a state university in the northeastern US.
Participants completed a self-report questionnaire assessing several variables.

Participants reported history of indoor tanning (i.e., ever tanned indoors and frequency of indoor tanning in the past year).
To assess participants’ lifetime dependence on indoor tanning, researchers constructed indoor-tanning-related screens based upon the CAGE alcohol screen and the DSM-IV-TR substance-related disorder diagnostic criteria. The investigators classified participants into one of three mutually-exclusive categories: not addicted to indoor tanning, displaying addictive tendencies to indoor tanning (i.e. not addicted to indoor tanning but meeting addiction criteria for at least one of the CAGE or DSM screens), or addicted to indoor tanning (i.e. meeting criteria for both screens).
Participants described their past-month substance use by reporting the number of days they had used each of 12 different substances during the past month.
Researchers assessed past-week symptoms of anxiety and depression using standard inventories.

Results

Among the 229 participants who reported ever tanning indoors, the mean number of past year indoor tanning visits was 23 (SD=24), 70 (30.6%) met the CAGE-based criteria for tanning addiction, 90 (39.3%) met the DSM-IV-TR-based criteria for tanning addiction, and 50 (21.8%) met the criteria for both.
Table 1 shows the odds of the study measures predicting indoor tanning status.

Compared with participants who were classified as not addicted (n = 119) to indoor tanning, participants who were classified as being addicted to indoor tanning (n = 50) reported (a) more frequent past-year indoor tanning use; (b) more symptoms of anxiety; (c) more days of alcohol use during the past-month; and (d) more days of marijuana use during the past-month.
Compared with participants who were classified as not addicted to indoor tanning, participants who were classified as having addictive tendencies (n = 60) reported (a) greater past-month alcohol use, and (b) greater past-month marijuana use.
Depression rates were not significantly different across all groups.

Table 1 – Odds Ratios (95% Confidence Interval) of Indoor Tanning Addiction Status for Study Measures (adapted from Mosher & Danoff-Burg, 2010).

* p < 0.05 ** p < 0.001 CI = Confidence interval
¹Stimulants include cocaine, amphetamines, and the nicotine in tobacco

Limitations

The researchers did not measure these associations prospectively. Therefore, it is not possible, on the basis of these data, to make claims about the sequence of events (e.g., whether anxiety is a risk factor for future addiction to indoor tanning or vice versa).
The results from a survey of college students in psychology classes might not be representative of students or the general population; consequently, these findings also might not generalize to other population segments.
The CAGE and DSM based indoor-tanning-addiction screens used in this study have relatively low internal consistency (i.e., .58 for the CAGE and .56 for DSM) and some of the items evidence questionable face validity (e.g., “Do you try to cut down on the time you spend in tanning beds or booths, but find yourself still tanning?”). Future research will need to examine the validity and reliability of these criteria.

Discussion

This study investigated whether indoor tanning, a novel target behavior for addiction research, could be an object of addiction; the results suggest that it is, but how is tanning an addiction? The syndrome model of addiction offers an explanation (Shaffer et al., 2004). The syndrome model suggests that, when people with psychological risk factors repeatedly interact with a potential object of addiction and find the result desirable, they become vulnerable to addiction. Perhaps underlying anxiety and unhealthy group norms increase young people’s vulnerability to both indoor tanning addiction and the misuse of alcohol and marijuana. Engaging in these behaviors might temporarily reduce anxious feelings and or produce feelings of well-being (Feldman et al., 2004). If so, tanning can set the stage for the potential emergence of addiction. Further prospective research is needed to explore the sequelae and components of these events.

-Tasha Chandler

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References

Feldman, S. R., Liguori, A., Kucenic, M., Rapp, S. R., Fleischer, A. B., Jr., Lang, W., et al. (2004). Ultraviolet exposure is a reinforcing stimulus in frequent indoor tanners. Journal of the American Academy of Dermatology, 51(1), 45-51.

Mosher, C. E., & Danoff-Burg, S. (2010). Addiction to indoor tanning: Relation to anxiety, depression, and substance use. Archives of Dermatology, 146(4), 412-417.

Shaffer, H. J., LaPlante, D. A., LaBrie, R. A., Kidman, R. C., Donato, A. N., & Stanton, M. V. (2004). Toward a syndrome model of addiction: Multiple expressions, common etiology. Harvard Review of Psychiatry, 12, 367-374.

Addiction & the Humanities Vol 6(6) – I Wish I Said That

2010-07-07T15:33:07-04:00

The Oxford English Dictionary (OED) defines “aphorism” (second definition) as “Any principle or precept expressed in few words; a short pithy sentence containing a truth of general import; a maxim.” Arguably, much of peoples’ attitudes and knowledge are reflected in and derive from such aphorisms. However, such sayings might gain broad recognition and acceptance without containing a truth. This week, Addiction and Humanities reviews several selections from The Quotable Gambler (Paul Lyons, 1999) to determine how they map onto current knowledge and practices related to gambling.

The more it changes…

Gambling promises the poor what property performs for the rich: something for nothing.- George Bernard Shaw

Mr. Shaw would not be surprised by the number of states that earmark some casino fees and revenues for reducing property taxes.

Something for nothing

A dollar picked up in the road is more satisfaction to us than the 99 which we had to work for, and the money won at Faro or in the stock market snuggles into our hearts in the same way. ~ Mark Twain

In contrast, Aronson & Mills (1959) found that people tend to attribute a greater value to things they put effort into acquiring or achieving. They labeled the effect “effort justification.” Perhaps gamblers cognitively distort winning as a result of their efforts.

Controlling chance

You cannot beat a roulette table unless you steal money from it. ~ Albert Einstein

A gambler is nothing but a man who makes his living out of hope. ~William Bolitho

Despite Einstein’s admonition, some research demonstrates that people diagnosed with an a gambling disorder have higher than usual belief in their ability to control chance (de Stadelhofen, Aufrère, Besson, & Rossier, 2009).

Maybe it’s not about the money

There are two great pleasures in gambling: that of winning and that of losing. ~ Old French Saying

The subject of gambling is all encompassing. It combines man's natural play instinct with his desire to know about his fate and his future. ~ Franz Rosenthal

Gambling satisfies the need for stimulation and the discharge of impulses. It also distracts from stress (Clarke et al, 2007). Research has demonstrated that gambling provoked by excitement-seeking is associated with other psychological problems (Pantalon, Maciejewski, Desai, & Potenza, 2008).

But it is a slippery slope

They start gambling for fun, continue for greed, and finally the game becomes a passion. ~ Francois-Paul Brueys D'Aigalliers

The first steps on the slope

One of the worst things that can happen to you in life is to win a bet on a horse at an early age. ~ Danny Mcgoorty

Clinicians identify early wins as a risk factor for developing gambling-related addiction problems. More work needs to be done to determine whether there is much truth to Mcgoorty’s claim.

With untoward consequences

All the world loves the game, and most sensible people willingly resign themselves to it until they see violence, deception, confusion, loss of money and time paired with it; until they understand that they can spend all their life for it. ~ Montesquieu.

Words of advice

If you must play, decide upon three things at the start: the rules of the game, the stakes, and the quitting time. Chinese Proverb

It would appear that suggestions for responsible gambling have been around for many years.

Conclusion

Perhaps you have employed quotes from others or constructed your own aphorisms about the recognition and remediation of addiction. Please forward those sayings with a description of their utility to the BASIS so that we can compile them into an issue for the benefit of our readers.

-Julia Braverman

Please use the comment link below to provide feedback on this article.

References

Aronson, E., & Mills, J. (1959) The effect of severity of initiation on liking for a group. Journal of Abnormal and Social Psychology, 59, 177-181

Clarke, D., Tse, S., Abbott, M., Townsend, S., Kingi, P., & Manaia, W. (2007). Reasons for starting and continuing gambling in a mixed ethnic community sample of pathological and non-problem gamblers. International Gambling Studies, 7(3), 299-313.

de Stadelhofen, F., Aufrère, L., Besson, J., & Rossier, J. (2009). Somewhere between illusion of control and powerlessness: Trying to situate the pathological gambler's locus of control. International Journal of Clinical and Health Psychology, 9(1), 117-126.

Lyons, P. (1999). The Quotable Gambler. New York, New York, The Lyons Press.

Pantalon, M., Maciejewski, P., Desai, R., & Potenza, M. (2008). Excitement-seeking gambling in a nationally representative sample of recreational gamblers. Journal of Gambling Studies, 24(1), 63-78.

Op-Ed/Editorials - Gambling and the Law®: Making Poker Legal as a Public Service

2010-07-02T12:00:00-04:00

I Nelson Rose

What do insurance, commodities trading and state lotteries all have in common? They were all originally outlawed as forms of gambling.

The major fight today over whether poker should be legalized usually revolves around the question of whether it is predominantly skill or chance.

But this unnecessarily gives up part of the political as well as legal battleground. Many activities that are indisputably gambling are now operated under state licenses, or by the state itself. And other activities, such as insurance and commodities, are today generally not even thought of as gambling.

Although they are.

Insurance is, after all, betting a small sum to obtain, that is, win, a much larger sum if a certain future event occurs. Of course, unlike traditional gambling, the buyer usually hopes the future event won't happen. The industry's greatest invention was changing the name of death insurance to life insurance, so that bettors would not be focusing on the fact that to win this wager they have to die.

Insurance eventually overcame its gambling roots because it was seen as creating a benefit for the general public, as an efficient way of spreading and lessening risk.

Still, some anti-gambling prohibitions remain. You cannot take out a life insurance policy on someone you have no connection with. That would be too much like making a bet that another person would die. Plus, government is afraid that you might be tempted to do something to try to increase your chances of winning.

Trading in stocks and commodities is still gambling. The Securities Exchange Act of 1934 expressly preempts state anti-gambling statutes: "No State law which prohibits or regulates the making or promoting of wagering or gaming contracts" can apply to transactions on American exchanges. Congress had to add that provision, and others similar to it, to federal laws regulating stock and futures markets, because too many states still have laws on their books that had been used against trading. Prior to these federal laws, speculators had to concoct legal fictions, such as pretending that they actually planned to accept delivery of tons of pork bellies.

Congress preempted state anti-gambling laws after becoming convinced that markets were an efficient way to raise money for businesses, and to allow farmers and food processors to shift the risk of changing prices of crops to speculators.

Federal preemption does not apply to all trades. A boiler-room operation selling penny stocks and other risky ventures on unregulated or foreign exchanges is probably still today violating state anti-gambling laws.

More conventional forms of gambling have been legalized because the public benefit was seen as outweighing the public harm. State lotteries raise money for education, casinos provide jobs and tax relief, even horseracing was seen as bettering the breed.

Poker, where legal, certainly provides as much public benefit. For example, in California most of the cities with licensed card clubs make significant percentages of their government revenue from their clubs.

We don't have enough evidence, yet, but I predict that studies will find that poker contributes in other ways. Poker players are -- probably -- smarter, happier and more sociable. They certainly have to know at least a little about math, money management and how to play by the rules.

Maybe we should start thinking up ways to prove that poker should be made legal, not because it is not gambling, but because a society is better with poker without.

END

© Copyright 2010. Professor I Nelson Rose is recognized as one of the world’s leading authorities on gambling law and is a consultant and expert witness for governments and industry. His latest books, INTERNET GAMING LAW (1st & 2nd editions), BLACKJACK AND THE LAW and GAMING LAW: CASES AND MATERIALS, are available through his website, www.GAMBLINGANDTHELAW.com.