Kathleen Louden

November 09, 2015

CHICAGO — Teenagers who drink alcohol or use drugs in the home with the knowledge of their parents are at increased risk for addiction-related consequences, according to results from an international survey.

Although parental knowledge "may protect students from experiencing certain short-term negative consequences, it places adolescents at greater risk for addiction," said study researcher Heather Fay, MHS, from FCD Prevention Works in Newton, Massachusetts.

She presented the research here at the American Public Health Association 2015 Annual Meeting.

The results have implications for parents and for pediatricians, who are encouraged by the American Academy of Pediatrics to discuss substance abuse as part of routine healthcare (Pediatrics. 2005;115:816-821).

For their study, Fay and her colleagues analyzed responses from an anonymous survey on substance use administered to more than 50,000 students in 22 countries from 2009 to 2014. The survey was conducted by FCD Prevention Works, a nonprofit organization that is part of the Hazelden Betty Ford Foundation.

The researchers identified a sample of 15,686 respondents — after the exclusion of questionable responses — who indicated at-home use of alcohol, marijuana, or other drugs not prescribed to them within the previous year.

Of this cohort, 56% of the respondents were male and 53% were from the United States. Most students were in tenth, eleventh, or twelfth grade, and 12% attended a public school.

Fay explained that her institution primarily works with private schools, which she called a potential limitation of the study, but she added that their data usually match substance use trends in public schools.

Negative Consequences

Students were asked to report whether, in the previous 12 months, they had experienced any of 21 drinking- or drug-related consequences, including feeling sick, vomiting, having a hangover, doing something they later regretted, receiving academic disciplinary action, and behaviors that indicate alcohol addiction, such as drinking alone.

They were also asked whether a parent knew about their use of drugs or alcohol at home, aside from "a few sips of wine with the family or for religious purposes."

Substance use without a parent's knowledge was reported by 62% of respondents. The other 38% reported that a parent knew they drank or used drugs at home.

In this sample of self-reported substance users, this rate of parental knowledge is not surprising, Fay told Medscape Medical News. When respondents who indicated no at-home alcohol or drug use were included, the rate dropped to 15%.

At least one negative consequence of substance use was reported by 85% of the respondents. Those who used alcohol or other drugs without a parent's knowledge were two to five times more likely to report a negative consequence.

The risk for potentially harmful consequences — such as needing a drink or drug first thing in the morning, drinking alone, passing out after drinking, or being injured while under the influence — was higher in students whose parents knew about the at-home substance use than in students who reported no at-home use.

Table. Consequences of At-Home Substance Use With a Parent's Knowledge

Consequence Odds Ratio 95% Confidence Interval P Value
Needed a drink or drug first thing in the morning 1.5 1.3–1.8 <.001
Used alcohol or drugs when alone 1.4 1.2–1.5 <.001
Rode in a vehicle whose driver had been drinking 1.2 1.1–1.3 <.001


On logistic regression analysis, parental knowledge was protective against some negative consequences, including the student feeling guilty about drinking (odds ratio [OR], 0.7; 95% confidence interval [CI], 0.6 - 0.7), becoming drunk (OR, 0.8; 95% CI, 0.8 - 0.9), and doing something they later regretted (OR, 0.9; 95% CI, 0.8 - 0.9).

"Any substance use by an adolescent comes with risks, whether that use is with or without a parent's knowledge," Fay told Medscape Medical News.

Not being aware of what your child is doing regarding substance use is most problematic of all.

"This study raises questions that are part of a national debate about whether parents should allow their adolescent children to drink in the home," said Wesley Perkins, PhD, from Hobart and William Smith Colleges in Geneva, New York, who was not involved in the study.

"What I understood from the findings presented is that if parents allow their children to drink in the home, the children have more problems than those who did not drink in the home, but fewer problems than when kids drink at home without parental knowledge," said Dr Perkins, who did not participate in the study.

"Therefore," he told Medscape Medical News, "not being aware of what your child is doing regarding substance use is most problematic of all."

Because drinking wine with family meals is prevalent in some European countries, Dr Perkins suggested that in future analyses of this sample, the team might want to exclude drinking alcohol during a family meal at home.

Ms Fay was paid to administer the survey, but received no external funding for conducting this study. Dr Perkins has disclosed no relevant financial relationships.

American Public Health Association (APHA) 2015 Annual Meeting: Abstract 328923. Presented November 4, 2015.


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