Familial Influences on Adolescent Substance Abuse
Substance abuse disorders (SUDs) significantly impact individuals and their families. However, as substance use commonly arises during the periods of adolescence and young adulthood,  SUDs are quickly becoming the leading health problem of adolescents. In fact, Merikangas and colleagues report that 11.4 percent of adolescents have an SUD. More unfortunately, only 15.4 percent of them receive treatment. Therefore, according to Partners Healthcare Addiction Psychiatry Fellow Amy Yule, M.D. and Clinical Director of the Center for Addiction Medicine Timothy Wilens, M.D., prevention is crucial to avoiding adolescent SUDs.1 Yule and Wilens review family influences and prevention techniques in their article “Familial Influences on Adolescent Substance Use: Modifying Behavior to Reduce Risk.”
Researchers state that SUDs affect many members of a family over a period of generations.1 In fact, 50 percent of an adolescent’s risk of substance abuse or dependence is genetically influenced. Young and colleagues report that there is a common genetic influence for the substances tobacco, alcohol, and cannabis.
Behaviorally, an adolescent’s exposure to a parent’s substance abuse also affects the adolescent’s risk factor of forming an SUD.1 Researchers connect the association between exposure to parental SUDs and an adolescent’s development of an SUD with the social learning theory and the social control theory.1 Petraitis and colleagues state the social learning theory as “the hypothesis that children model their behavior on people who are important to them and those they frequently interact with, such as their parents.” They also state the social control theory as “the hypothesis that children who are closely attached to their parents are less likely to break rules because they want to connect with their parents.”7
According to Yule and Wilens, there is evidence that supports both theories in an adolescent’s behavioral connection to SUDs. Researchers have examined all components of both theories: the relationship between adolescent substance use and parental attitudes toward substances, parental substance use, the relationship quality between parent and child, and parental monitoring.1 Bahr and colleagues reported that family factors were associated more closely with the increased risk of alcohol, cigarette, and illicit drug use when parental attitudes towards them were lax and sibling substance use was present.
Yule and Wilens state that in order to understand the familial patterns of SUDs, researchers have focused on differentiating between the risk posed by genetics and the risk posed by behavioral modeling.1 Biederman and colleagues conducted a large study of predominantly male subjects, both with and without ADHD, finding that there was an association between exposure to parental SUD and SUD in the adolescent. Yule and Wilens conducted a similar study, using a female population, and found an association between maternal drug use and SUD in the female adolescent.
Researchers also stated how important it was to take into consideration whether or not the developmental timing of behavior modeling had a significant effect on adolescent SUD development.1 Biederman and colleagues examined the offspring’s risk of developing an SUD when exposed to parental SUD during different stages of development.9 They found that boys were more likely to develop an SUD when exposed to parental SUD during adolescence than they were during the preschool or latency years.9 Yule and Wilens replicated the study with females and came to the same conclusion: adolescent years were the most vulnerable.1
While the genetic risk for developing an SUD is something that cannot be changed, Yule and Wilens state that behavior modeling is something that can. Psychiatrists are able to aid families in decreasing the risk of their child’s development of an SUD through education.1 Yule and Wilens urge clinicians to assess parents for substance use in a manner that is nonjudgmental. Stating that the screening and modification is for the health and future of their child may aid in receiving truthful information.1 To aid with screening, the Substance Abuse and Mental Health Services Administration has a brief intervention and referral to treatment, the SBIRT, which has proven effective in decreasing alcohol and drug use. Clinicians can then educate parents about the social learning theory and social control theory, further decreasing their adolescent’s chances for developing an SUD.1
Yule and Wilens restate that an SUD can interfere with many aspects of a developing adolescent’s life and can easily destroy their future. While there is a genetic risk for developing an SUD, behavior modeling makes a strong impact as well. If parental exposure to SUDs, especially during adolescence, is avoided, the adolescent has a better chance as a healthy life. Therefore, clinicians should screen regularly for parental and adolescent SUDs and offer educational information regarding how to live a substance-free life.
 Yule, A. and Wilens, T. (2011, Oct. 7). Familial Influences on Adolescent Substance Use: Modifying Behavior to Reduce Risk. Psychiatric Times 28(10). Retrieved from: http://www.psychiatrictimes.com/child-adolescent-psych/content/article/10168/1966345
 The National Center on Addiction and Substance Abuse at Columbia University. Adolescent Substance Use: Americas #1 Public Health Problem. June 2011. http://www.casacolumbia.org/templates/NewsRoom.aspx?articleid=631&zoneid=51. Accessed April 17, 2012.
 Merikangas KR, He JP, Burstein M, et al. Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010;49:980-989.
 Merikangas KR, He JP, Burstein M, et al. Service utilization for lifetime mental disorders in US adolescents: results of the National Comorbidity SurveyAdolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2011;50:32-45.
 Lynskey MT, Agrawal A, Heath AC. Genetically informative research on adolescent substance use: methods, findings, and challenges. J Am Acad Child Adolesc Psychiatry. 2010;49:1202-1214.
 Young SE, Rhee SH, Stallings MC, et al. Genetic and environmental vulnerabilities underlying adolescent substance use and problem use: general or specific? Behav Genet. 2006;36:603-615.
 Petraitis J, Flay BR, Miller TQ. Reviewing theories of adolescent substance use: organizing pieces in the puzzle. Psychol Bull. 1995;117:67-86.
 Bahr SJ, Hoffmann JP, Yang X. Parental and peer influences on the risk of adolescent drug use. J Prim Prev. 2005;26:529-551.
 Biederman J, Faraone SV, Monuteaux MC, Feighner JA. Patterns of alcohol and drug use in adolescents can be predicted by parental substance use disorders. Pediatrics. 2000;106:792-797.
 Yule AM, Wilens TE, Martelon MK, et al. Impact of exposure to parental substance use disorders (SUD) on SUD risk in girls and their siblings. Poster presented at: 57th Annual American Academy of Child and Adolescent Psychiatry Meeting; October 27, 2010; New York.
 Simmons LA, Havens JR, Whiting JB, et al. Illicit drug use among women with children in the United States: 2002-2003. Ann Epidemiol. 2009;19:187-193.
 Madras BK, Compton WM, Avula D, et al. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: comparison at intake and 6 months later. Drug Alcohol Depend. 2009;99:280-295.