ALCOHOL USE IN ADOLESCENTS FROM NORTHERN RUSSIA: THE ROLE OF THE SOCIAL CONTEXT

Roman A. Koposov1,4, Vladislav V. Ruchkin3, Martin Eisemann2,4,* and Pavel I. Sidorov1

1 Institute of Psychiatry, Northern State Medical University, Arkhangelsk, Russia,
2 Unit of Medical Psychology, Department of Health Care Sciences, Umeå University, Sweden,
3 Yale Child Study Center, Yale University Medical School, USA and
4 Department of Psychology, Tromsø University, N-9037 Tromsø, Norway

Received 14 March 2001; in revised form 5 November 2001; accepted 30 November 2001


    ABSTRACT
 TOP
 FOOTNOTES
 ABSTRACT
 INTRODUCTION
 SUBJECTS AND METHODS
 RESULTS
 DISCUSSION
 ACKNOWLEDGEMENTS
 REFERENCES
 
— Drinking alcohol is an essential and commonplace part of life in Russia. Alcohol-related problems in the general population and among adolescents in particular has become a major public health concern. The problem cannot be solely explained by the frequency and quantity of alcohol consumption. The social determinants of drinking alcohol also need to be considered. These are the focus of the present investigation. The social determinants of drinking behaviour were assessed by self-reports (Social Context of Drinking Scale, Adolescent Alcohol Involvement Scale and Rutgers Alcohol Problem Index) in 387 secondary school students in Arkhangelsk, Russia. The factor structure for the Social Context of Drinking Scale was similar to that noted in respect of the original study [Thombs and Beck (1994) Health Education and Research 9, 13–22]. Significant gender differences in problem drinking and the social contexts of drinking were found. High intensity girl drinkers were likely to drink in most social contexts, whereas high intensity drinking boys were more likely to drink in the context of Stress Control. Furthermore, boy problem drinkers were more likely to drink in the context of School Defiance and Peer Acceptance, whereas girl problem drinkers tended to drink in the contexts of School Defiance and Stress Control. In general, the Social Context of Drinking Scale demonstrated a good ability to discriminate high from low intensity drinkers, and high from low problem drinkers. These results may provide useful information for targeted prevention programmes for adolescents.


    INTRODUCTION
 TOP
 FOOTNOTES
 ABSTRACT
 INTRODUCTION
 SUBJECTS AND METHODS
 RESULTS
 DISCUSSION
 ACKNOWLEDGEMENTS
 REFERENCES
 
For several centuries, alcohol has been playing a central role in the lives of Russian people as reported both by native writers and foreign travellers who were amazed by the very high prevalence of alcohol drinking among both adults and young people. According to reports from various regions of Russia in 1900, the majority of farmers' children in rural areas, even at the age of 8 years, were drinking alcohol, e.g. among a sample (n = 182) of 8–13-year-old pupils from secondary schools, 83% reported alcohol use (Sidorov and Mityuchlaev, 1999Go). These drinking habits have persisted to the present time resulting in an extremely high level of alcohol consumption per capita compared to other countries, e.g. the estimated annual consumption in Russia in the 1980s was 13–14 l per capita, whereas in France, the country with the highest alcohol consumption in Europe, the corresponding estimate is 12.7 l per person (Treml, 1997Go), with most other countries being in the range of 5–9 l per person. By 1998, per capita alcohol consumption in Russia was noted as 7.8 l of alcohol, though this only reflects officially recorded consumption. The European country which had the highest level in that year was the Czech Republic, with 12.3 l (Brewers and Licensed Retailers, 2000Go). As noticed by McKee (1999), ‘nearly 90% of all alcohol consumed in Russia was in the form of spirits (vodka), a much higher figure than in other countries, and drinking typically was undertaken in binges rather than the manner of consumption in, for example Mediterranean countries'. The mean age of starting binge drinking has dramatically decreased from 16–18 years old in 1976 to 14 in 1986 (Sidorov and Mityuchlaev, 1999Go). That this is a considerable problem not only in Russia, but also in the whole of Europe, is evident from the statistic that more than 8000 deaths of people aged 15–29 years in Europe in 1999 were directly attributable to alcohol use (Rehm et al., 2001Go).

Although there has been much progress in delineating underlying factors of alcohol misuse and its treatment (Safer and Harding, 1993Go; Miller et al., 2001Go), alcohol and other drug misuse in adolescents remains a major medical and public health problem. A variety of drinking patterns and practices among the adolescent population have been described, which cannot be sufficiently explained by alcohol frequency and quantity measures alone (Beck et al., 1991Go; Hughes et al., 1992Go). In spite of the large variety of reasons for drinking and drinking practices, people tend to have preferred patterns of alcohol use, some of which may become habitual and relatively stable, although others occur in response to changing life circumstances and stress (McCreary and Sadava, 2000Go; Holahan et al., 2001Go). Reasons for drinking are based on needs and mood, and those drinking together often share beliefs, expectancies and hardship. Motivational models of alcohol consumption also suggest a positive relationship between number of reasons for drinking and the amount of alcohol consumed (Bradizza et al., 1999Go).

Generally, motives for alcohol consumption have been emphasized in the aetiological and the reasons-for-drinking literature (Abbey et al., 1993Go). Firstly, people drink to cope with stress. Drinking alleviates distress and temporarily enhances self-perception and self-esteem. People may also drink because they wish to get rid of problems by ‘drowning their sorrows'. The latter represents a psychologically immature, avoidant type of coping and is related to low self-directedness of the individual (Ruchkin et al., 2001Go). Secondly, people drink alcohol because of social influences, i.e. they may drink if their companions do, often just to become accepted in that context (e.g. by peers), or to enhance social facilitation. It should also be mentioned that some authors have pointed out other reasons for drinking alcohol, e.g. the pleasure people derive from its consumption (Peele and Grant, 1999Go; Finn et al., 2000Go; Lindman et al., 2000Go).

In spite of some support for these motives, results to date have not been able to explain convincingly all the variety of drinking patterns, and most authors agree that more complex theories of alcohol consumption are needed (O'Callaghan et al., 1997Go). In particular, social influences in adolescent environments might include enhancement of social interaction, peer acceptance, control from the parents, or rebellious drinking by defying existing rules (e.g. school defiance). The role of these factors is expected to differ between sexes, e.g. concerning context of drinking. Orford and Keddie (1985) found that men were more likely than women to report drinking for positive emotional or social reasons, or because of social pressure. Beck et al. (1995) reported that high intensity drinkers of either gender were more likely to drink in a context of social facilitation, although high intensity women drinkers also tended to drink in a context of emotional pain.

In addition, there is often a discrepancy between frequency and quantity of alcohol use and the development of drinking-related problems. Some youths drink heavily and do not experience serious problems, whereas others misuse alcohol and encounter severe consequences (White and Labouvie, 1989Go). These discrepancies have been particularly attributed to the social context of drinking, which involves the combined influence of motivational and situational factors (Thombs and Beck, 1994Go). Previous research has identified five such distinct and reliable factors (Beck et al., 1991Go, 1993Go), including Social Facilitation (drinking in a party, with friends, to have a good time, to get drunk etc.), School Defiance (drinking on school grounds, with intention to defy school rules etc.), Stress Control (drinking alone, to enhance a sense of well-being, to get rid of depression etc.), Peer Acceptance (drinking as a member of a group, to act older, to get someone's approval etc.) and drinking under Parental Control (e.g. at home, at family events). These social contexts of drinking have been found to represent different roles for boys and girls (Beck et al., 1991Go). The large scale European Schools Project on Alcohol and other Drugs (ESPAD) was conducted in 1995 and 1999. The more recent of these studies included >90 000 school students aged 15 or 16 years old in 30 European countries (Hibell et al., 1997Go, 2001Go; Morgan et al., 1999Go); the importance of cultural and contextual factors for the determination of teenage alcohol use was underlined by the findings of these surveys. ESPAD 1999 indicated that teenagers in Moscow reported what by international standards were medium/high levels of heavy spirits drinking and intoxication. They were less likely to report heavy consumption of either beer or wine. Russian teenagers were also among those who were most likely to report the expectation of positive consequences from drinking, while also reporting high levels of problems due to drinking (Hibell et al., 2001Go).

The purpose of the present study was to: (1) validate the Social Context of Drinking Scale in a Russian adolescent sample; (2) examine gender differences in alcohol involvement, problems related to drinking and social context of drinking; (3) assess the ability of the Social Context of Drinking Scale to discriminate between the subgroups of boys and girls with higher versus lower levels of alcohol involvement and problems related to drinking.


    SUBJECTS AND METHODS
 TOP
 FOOTNOTES
 ABSTRACT
 INTRODUCTION
 SUBJECTS AND METHODS
 RESULTS
 DISCUSSION
 ACKNOWLEDGEMENTS
 REFERENCES
 
Subjects and procedure
The set of questionnaires was administered to pupils of senior classes from secondary schools in Arkhangelsk, Northern Russia. In all, 22 classes with pupils from the last 2 years of studying were approached in five schools randomly selected among 25 schools in Arkhangelsk. The assessments were performed by paper-and-pencil tests during class sessions, supervised by the first and the second author. The instruments were completed during one lesson. The participants were informed about the voluntary nature of participation in the study and they were assured of anonymity. None of the students openly refused to respond to the survey and <2–3% of the answer sheets had to be discarded for obviously thoughtless or largely incomplete responses, e.g. completing a form just by randomly ticking an answering alternative. Data were obtained during the winter–spring 1999 from 580 students (212 boys and 368 girls). For the purpose of the present study, only those subjects who had used alcohol were included (127 boys and 260 girls). The age in the study group varied from 14 to 17 years with a mean (± SD) age for boys of 15.5 ± 0.9 years and for girls of 15.7 ± 0.9 years.

The Social Context of Drinking Scale
This instrument was developed and subsequently refined by Beck et al. (1991, 1993). The heading ‘How often do you drink alcohol?’ is followed by a set of 32 items, which assess the social and motivational contexts of adolescent drinking, arising from the interaction of internal psychological and social–environmental factors (e.g. ‘at a party with friends', ‘for a sense of well-being’, ‘to act older or feel more grown-up’, ‘to defy school rules' etc.). A four-point scale measures the frequency of drinking in each context, ranging from ‘never’ (scored as 0) to ‘frequently’ (scored as 3). In the original study (Beck et al., 1993Go), five scales were obtained, including Social Facilitation, School Defiance, Stress Control, Peer Acceptance, and Parental Control. In the Russian translation, the wording of two items was slightly changed to fit the Russian context. In particular, the item ‘While on a school-related trip’ was followed by the example ‘on camping’ since, in the present Russian school context, joint school-related cultural trips are almost absent, though there are still occasional trips to camping sites. The item ‘In a school bus' was changed to ‘On the way to school’, since special school transportation is not provided for Russian school children.

The Adolescent Alcohol Involvement Scale (AAIS)
The AAIS (Mayer and Filstead, 1979Go) is a 14-item screening questionnaire, designed to identify adolescents with drinking problems. This instrument assesses quantitative aspects of alcohol use and psychosocial consequences in three domains: psychological functioning, social relations, and family living. Several studies have supported the reliability and validity of the instrument (Mayer and Filstead, 1979Go; Moberg, 1983Go; Putnins, 1992Go). In the present study, an acceptable level of internal consistency for the scale was obtained (Cronbach's {alpha} = 0.86).

Rutgers Alcohol Problem Index (RAPI)
The RAPI is a 23-item screening tool (White and Labouvie, 1989Go), assessing the magnitude of problems related to drinking in adolescents. The instrument asks how often certain problems associated with alcohol use have occurred and yields a total score by summing the reported frequency. The original study (White and Labouvie, 1989Go) revealed a high internal consistency of the scale in a general population sample (Cronbach's {alpha} = 0.92) and a moderate range of correlations between RAPI scores and alcohol-use intensity (0.20–0.57). In the present study, satisfactory internal consistency for the instrument was obtained (Cronbach's {alpha} = 0.88).

The translation of these scales into Russian followed established guidelines, including independent back-translations (Sartorius and Kuyken, 1994Go). Russian translations, made by the second author, were followed by discussion with monolingual colleagues. Finally, an official interpreter made independent back-translations, the versions obtained were compared with the originals, and inconsistencies were analysed and corrected. For example, when an item could not be translated literally, we tried to find an expression which corresponded to its meaning.

Statistical procedures
A principal component exploratory factor analysis with oblique rotation was run to describe the factorial structure of the Social Context of Drinking Scale. Furthermore, discriminant analysis (Wilks' stepwise method) was used to test the discriminative power of factors. Inter-group differences were examined by means of one-way analysis of variance (ANOVA).


    RESULTS
 TOP
 FOOTNOTES
 ABSTRACT
 INTRODUCTION
 SUBJECTS AND METHODS
 RESULTS
 DISCUSSION
 ACKNOWLEDGEMENTS
 REFERENCES
 
All items of the Social Context of Drinking Scale underwent a principal component exploratory factor analysis with oblique rotation. Results of the factor analysis are described in Table 1Go. Five main factors were obtained, with the factor structure similar to that from the original study (Thombs and Beck, 1994Go). The internal consistency of the obtained factors was tested by means of Cronbach's {alpha} (Nunnally, 1978Go). The first factor, Social Facilitation, had a value of {alpha} = 0.91 and consisted of nine items, involving use of alcohol with a group of friends, outdoors or on camping, on weekends, with the purpose of having a good time or getting drunk. The second factor, Stress Control, had a value of {alpha} = 0.85, and, as in the original study, included seven items concerning relief from tension, control of stress, and improvement of mood and self-esteem. The third factor, called Peer Acceptance ({alpha} = 0.78), was composed of six items concerning drinking to get somebody's approval, to be more sociable and a part of a group, and to act or feel older. The fourth factor, comprised of six items concerning drinking in a way that defies school rules, was called School Defiance, and had a value of {alpha} = 0.67. Finally, a four-item factor, called Parental Control, contained items describing drinking with family, on special occasions, or for the enjoyment of the taste, and had a value of {alpha} = 0.68. All the factors were moderately inter-correlated (Table 1Go).


View this table:
[in this window]
[in a new window]
 
Table 1. Factor structure of the Social Context of Drinking Scale
 
Minor differences between the original factor structure and our findings were obtained. In particular, four items yielded different loadings: ‘To be sociable’, ‘For the enjoyment of taste’, ‘As a part of a drinking game’ and ‘While on school-related trips'.

Pearson correlation coefficients were calculated to assess the relationships between AAIS and RAPI scores, which were r = 0.29 for boys and r = 0.51 for girls, which is similar to the findings from the original study (White and Labouvie, 1989Go).

Alcohol involvement and problem drinking in boys tended to increase with age, whereas in girls these reached peaks at age 15 years, then steadily decreased thereafter (Table 2Go).


View this table:
[in this window]
[in a new window]
 
Table 2. Distribution of Adolescent Alcohol Involvement Scale (AAIS) and Rutgers Alcohol Problems Index (RAPI) scores by age groups among boys and girls
 
Generally, boys had higher rates of problem drinking (7.94 ± 11.07 vs 5.55 ± 6.89; F = 6.77), as well as higher rates of drinking in the contexts of School Defiance (1.35 ± 2.23 vs 0.53 ± 1.13; F = 23.09) and Parental Control (4.98 ± 2.81 vs 4.35 ± 2.63; F = 4.41).

Subsequently, based on mean values and one standard deviation, two subgroups, one with extremely high rates of AAIS and one with extremely high rates of RAPI, were selected. These groups were contrasted with the remaining subjects (normal and low scorers). Subsequently, the groups were subjected to discriminant analysis to check the ability of the Social Context of Drinking Scale to discriminate between the subgroups. Wilks' stepwise method was used in order to select the most predictive variables. Also, we used one-way ANOVA to test for group mean differences on all variables of interest. Boys with high levels of alcohol involvement were discriminated from the other boys by high scores on the scale Stress Control, whereas high intensity girl drinkers were discriminated from others by the number of problems related to drinking and by drinking for Social Facilitation (Tables 3–6GoGoGoGo). Boys scoring high on problems related to drinking were discriminated from the other boys by Peer Acceptance and School Defiance, whereas girls with high scores on problems related to drinking could be discriminated from others by School Defiance and Stress Control (Tables 3–6GoGoGoGo).


View this table:
[in this window]
[in a new window]
 
Table 3. Results of discriminant analyses in boys by means of the Social Context of Drinking Scale: between subgroups with high versus low levels of alcohol usea
 

View this table:
[in this window]
[in a new window]
 
Table 4. Results of discriminant analyses in boys by means of the Social Context of Drinking Scale: between subgroups with high versus low levels of alcohol-related problemsa
 

View this table:
[in this window]
[in a new window]
 
Table 5. Results of discriminant analyses in girls by means of the Social Context of Drinking Scale: between subgroups with high versus low levels of alcohol usea
 

View this table:
[in this window]
[in a new window]
 
Table 6. Results of discriminant analyses in girls by means of the Social Context of Drinking Scale: between subgroups with high versus low levels of alcohol-related problemsa
 

    DISCUSSION
 TOP
 FOOTNOTES
 ABSTRACT
 INTRODUCTION
 SUBJECTS AND METHODS
 RESULTS
 DISCUSSION
 ACKNOWLEDGEMENTS
 REFERENCES
 
As mentioned earlier in this paper, social determinants of drinking behaviour are crucial, especially considering gender differences in alcohol involvement and for drinking patterns. This paper sought to validate the Social Context of Drinking Scale in a sample of Russian adolescents and to further investigate the power of this instrument to discriminate between high and low drinkers, separately for boys and girls. An obtained factor structure for this scale was highly similar to that from the original study (Thombs and Beck, 1994Go). Summing up, we found significant gender differences in problem drinking and the social contexts of drinking. High intensity girl drinkers were likely to drink in most social contexts, whereas high intensity drinking boys were more likely to drink in the context of Stress Control. Boy drinkers with higher levels of problem drinking were also more likely to drink in the contexts of School Defiance and Peer Acceptance, whereas girl problem drinkers tended to drink in the contexts of School Defiance and Stress Control.

As shown in Table 1Go, we were able to confirm the original factor structure of the Social Context of Drinking Scale. The minor differences between the factor structure of the scale in the present findings and in the original study (Thombs and Beck, 1994Go) could be ascribed to slight differences in formulation of the items (e.g. the item ‘While on a school-related trip’ in the Russian version was followed by an example: ‘While camping’). Thus, the content of the item is changed from defying school rules to the facilitation of social interactions in outdoor settings. There were also some items loading (i.e. correlations between items) similarly on the original factor and an additional factor, for which the loadings were somewhat higher. In particular, the item ‘To be sociable’ loaded similarly on two factors [Social Facilitation (original) and Peer Acceptance] and the item ‘For the enjoyment of taste’ also had two loadings [Social Facilitation (original) and Parental Control]. Minor differences in the factor structure, however, did not compromise the psychometric properties of the scales.

As concerns drinking patterns, higher rates of drinking in boys were related mostly to Stress Control, which was the only factor that was able to discriminate between the subgroup with particularly high rates of drinking and the rest of the boys. However, the discriminative power was rather low (64.5%), and thus, these results should be considered cautiously. On the other hand, in girls, a subgroup with higher levels of alcohol consumption was discriminated from the rest of the girls by Social Facilitation and RAPI score. These findings imply that higher levels of alcohol use in girls are directly related to the specific role of alcohol as a social facilitator and as a tool to improve social communication, which, however, is also closely related to problems caused by drinking.

When problems related to drinking were examined (RAPI score), a subgroup of boys with higher levels of the score was discriminated from the rest of the group by School Defiance and Peer Acceptance. This implicates alcohol use as a part of a pattern of oppositional behaviour, often combined with the need to be accepted by peers. Presumably, these factors also potentiate each other, in the sense that boys may defy school rules to elicit admiration and acceptance by peers. As noted by Thombs and Beck (1994), it is particularly interesting that many substance abuse prevention programmes place attention solely on peer pressure. We assume that knowing the context where such pressure occurs (e.g. School Defiance in our study) would help to focus rehabilitation and prevention efforts more effectively.

School Defiance was also a discriminative factor between the subgroup of girls with higher RAPI score and the rest of the girls. However, among girls, most of the problems caused by drinking were also related to Stress Control, showing that the prevailing assumption of alcohol as a means of coping with stress is of doubtful value in our sample, since it is also related to problems caused by drinking.

Interestingly, alcohol involvement and problem drinking in boys tended to increase with age, whereas in girls these parameters reached a peak at the age of 15 years and then steadily decreased (Table 2Go). These findings may reflect indirectly the differences in social contexts of problem drinking: boys tend to drink together with their peers, often to get accepted by them, which may also increase the risk of school defiance. At the same time, girls, who tend to try alcohol relatively earlier than boys (probably due to earlier psychological and physical maturation), also tend subsequently to decrease their consumption (from age 15 years) and their problem drinking will then be mostly related to coping with stress. In this context, it is interesting to note that, even though alcohol involvement is more pronounced among boys who also drink more irresponsibly, they are nevertheless allowed to drink under parental supervision to a greater extent than girls. This gender-related finding might be considered as culture-specific, in the sense that boys generally are allowed to drink more and that their families and subculture accepted their drinking more readily.

It seems to be that boys and girls tend to have different drinking patterns, which has some implications for the development of preventive measures. Gender-specific drinking patterns should also be taken into account for the prognosis for alcohol use in boys and girls. In particular, drinking in boys is related to age-specific needs for acceptance by peers, which also may promote oppositional behaviour. Peer support and acceptance, however, have interactive relationships with peer alcohol use and have no effect when there are no friends who drink, but have an increasing effect for higher levels of peer drinking (Wills and Vaughan, 1989Go). Perceptions about friends' alcohol use have also been found to influence youth drinking (Fromme and Ruela, 1994Go). This pattern, however, is expected to fade out with the adolescent phase, and the most problematic persisting type of alcohol use in this age is predominantly related to specific predisposing personality factors (Cloninger et al., 1988Go; Ruchkin et al., 1999Go, 2001Go). At the same time, the use of alcohol as a way of coping with stress in girls may become a specific pattern of behaviour, providing some kind of subjective temporary relief from stress, but also leading to more drinking-related problems.

Probably the most important finding was the substantial discriminating power of the Social Context of Drinking Scale between high/low problems related to drinking in boys and girls (though somewhat weaker for the discrimination of subgroups of high/low alcohol involvement). This is particularly important, because, as previously mentioned, some youths drink heavily without experiencing serious problems, whereas others both misuse alcohol and encounter severe consequences (White and Labouvie, 1989Go). In addition, some authors (Thombs and Beck, 1994Go; O'Hare, 2001Go) reported good reliability and evidence of concurrent validity of the social context of drinking with other substance misuse indices, such as problem drinking and severity of alcohol use. Since the Social Context of Drinking Scale tends to assess alcohol-related problems in a more indirect way, it could be a useful tool for the assessment of alcohol use in adolescents. The knowledge about differences in drinking context among the above-mentioned groups may aid prevention planners in targeting and tailoring appropriate programmes for various groups. Furthermore, these findings may enhance efforts to intervene in the development of addictive behaviour patterns at a relatively early stage.


    ACKNOWLEDGEMENTS
 TOP
 FOOTNOTES
 ABSTRACT
 INTRODUCTION
 SUBJECTS AND METHODS
 RESULTS
 DISCUSSION
 ACKNOWLEDGEMENTS
 REFERENCES
 
This research was supported by scholarships to Dr Koposov from the Unit of Medical Psychology, Umeå University (Umeå, Sweden) and the Department of Psychology, Tromsoe University (Tromsø, Norway).


    FOOTNOTES
 TOP
 FOOTNOTES
 ABSTRACT
 INTRODUCTION
 SUBJECTS AND METHODS
 RESULTS
 DISCUSSION
 ACKNOWLEDGEMENTS
 REFERENCES
 
* Author to whom correspondence should be addressed. Back


    REFERENCES
 TOP
 FOOTNOTES
 ABSTRACT
 INTRODUCTION
 SUBJECTS AND METHODS
 RESULTS
 DISCUSSION
 ACKNOWLEDGEMENTS
 REFERENCES
 
Abbey, A., Smith, M. J. and Scott, R. O. (1993) The relationship between reasons for drinking alcohol and alcohol consumption: an interactional approach. Addictive Behavior 18, 659–670.[ISI][Medline]

Beck, K. H., Summons, T. G. and Thombs, D. L. (1991) A factor-analytic study of social context of drinking in a high school population. Psychology of Addictive Behavior 5, 66–77.

Beck, K. H., Thombs, D. L. and Summons, T. G. (1993) The social context of drinking scales: construct validation and relationship to indicants of abuse in an adolescent population. Addictive Behavior 18, 159–169.[ISI][Medline]

Beck, K. H., Thombs, D. L. Mahoney, C. A. and Fingar, K. M. (1995) Social context and sensation seeking: gender differences in college student drinking motivations. International Journal of Addiction 30, 1101–1115.[ISI][Medline]

Bradizza, C. M., Reifman, A. and Barnes, G. M. (1999) Social and coping reasons for drinking: predicting alcohol misuse in adolescents. Journal of Studies on Alcohol 60, 491–499.[ISI][Medline]

Brewers and Licensed Retailers (2000) Statistical Handbook. Brewers and Licensed Retailers, London.

Cloninger, C. R., Sigvardsson, S. and Bohman, M. (1988) Childhood personality predicts alcohol abuse in young adults. Alcoholism: Clinical and Experimental Research 12, 495–505.

Finn, P. R., Sharkansky, E. J., Brandt, K. M. and Turcotte, N. (2000) The effects of familial risk, personality, and expectancies on alcohol use and abuse. Journal of Abnormal Psychology 109, 122–133.[ISI][Medline]

Fromme, K. and Ruela, A. (1994) Mediators and moderators of young adults' drinking. Addiction 89, 63–71.[ISI][Medline]

Hibell, B., Anderssson, B., Bjarnason, T., Kokkevi, A., Morgan, M. and Narusk, A. (1997) The 1995 ESPAD Report: Alcohol and other Drug Use among Students in 26 European Countries. Swedish Council for Information on Alcohol and other Drugs, Stockholm.

Hibell, B., Andersson, B., Alhström, S., Balakireva, O., Bjarnsasson, T., Kokkevei, A. and Morgan, M. (2001) The 1999 ESPAD Report: Alcohol and other Drug Use among Students in 30 European Countries. Swedish Council for Information on Alcohol and other Drugs. Stockholm.

Holahan, C. J., Moos, R. H., Holahan, C. K., Cronkite, R. C. and Randall, P. K. (2001) Drinking to cope, emotional distress and alcohol use and abuse: a ten-year model. Journal of Studies on Alcohol 62, 190–198.[ISI][Medline]

Hughes, S. O., Power, T. G. and Francis, D. J. (1992) Defining patterns of drinking in adolescence: a cluster analytic approach. Journal of Studies on Alcohol 53, 40–47.[ISI][Medline]

Lindman, R. E., Sjoholm, B. A. and Lang, A. R. (2000) Expectations of alcohol-induced positive affect: a cross-cultural comparison. Journal of Studies on Alcohol 61, 681–687.[ISI][Medline]

Mayer, J. and Filstead, W. J. (1979) The Adolescent Alcohol Involvement Scale: an instrument for measuring adolescents' use and misuse of alcohol. Journal of Studies on Alcohol 40, 291–300.[ISI][Medline]

McCreary, D. R. and Sadava, S. W. (2000) Stress, alcohol use and alcohol-related problems: the influence of negative and positive affect in two cohorts of young adults. Journal of Studies on Alcohol 61, 466–474.[ISI][Medline]

McKee, M. (1999) Alcohol in Russia. Alcohol and Alcoholism 34, 824–829.[Abstract/Free Full Text]

Miller, W. R., Walters, S. T. and Bennett, M. E. (2001) How effective is alcoholism treatment in the United States? Journal of Studies on Alcohol 62, 211–220.[ISI][Medline]

Moberg, D. P. (1983) Identifying adolescents with alcohol problems: a field test of the Adolescent Alcohol Involvement Scale. Journal of Studies on Alcohol 44, 701–721.[ISI][Medline]

Morgan, M., Hibell, B., Andersson, B., Bjarnason, T., Kokkevi, A. and Narusk, A. (1999) The ESPAD study: implications for prevention. Drugs: Education, Prevention and Policy 6, 243–256.[ISI]

Nunnally, J. C. (1978) Psychometric Theory. McGraw-Hill, New York.

O'Callaghan, F. V., Chang, D. C., Callan, V. J. and Baglioni, A. (1997) Models of alcohol use by young adults: an examination of various attitude-behavior theories. Journal of Studies on Alcohol 58, 502–507.[ISI][Medline]

O'Hare, T. (2001) The Drinking Context Scale. A confirmatory factor analysis. Journal of Substance Abuse Treatment 20,129–136.[ISI][Medline]

Orford, J. and Keddie, A. (1985) Gender differences in the functions and effects of moderate and excessive drinking. British Journal of Clinical Psychology 24, 265–279.[ISI][Medline]

Peele, S. and Grant, M. (1999) Alcohol and Pleasure: A Health Perspective. International Center for Alcohol Policies. Brunner/ Muzel, Philadelphia.

Putnins, A. L. (1992) The Adolescent Alcohol Involvement Scale: some findings with young offenders. Drug and Alcohol Review 11, 253–258.

Rehm, J., Gmel, G., Room, R. and Frick, U. (2001) Average volume of alcohol consumption, drinking patterns and related burden of mortality in young people in established market economies of Europe. European Addiction Research 7, 148–151.[ISI][Medline]

Ruchkin, V., Eisemann, M. and Hägglöf, B. (1999) Coping styles in delinquents and controls: the role of personality and parental rearing. Journal of Youth and Adolescence 28, 705–717.[ISI]

Ruchkin, V. V., Koposov, R. A., Eisemann, M. and Hägglöf, B. (2001) Alcohol use in delinquent adolescents from Northern Russia: The role of personality, parental rearing and family history of alcohol abuse. Personality and Individual Differences, in press.

Safer, L. A. and Harding, C. G. (1993) Under pressure program: using live theatre to investigate adolescents' attitudes and behavior related to drug and alcohol abuse education and prevention. Adolescence 28, 135–148.[ISI][Medline]

Sartorius, N. and Kuyken, W. (1994) Translation of health status instruments. In Quality of Life Assessment: International Perspectives, Orley, J. and Kuyken, W. eds, pp. 3–18. Springer-Verlag, Berlin.

Sidorov, P. I. and Mityuchlaev, A. V. (1999) Rannii alkogolism (in Russian). Izdatelstvo AGMA, Arkhangelsk.

Thombs, D. L. and Beck, K. H. (1994) The social context of four adolescent drinking patterns. Health Education and Research 9, 13–22.

Treml, V. G. (1997) Soviet and Russian statistics on alcohol consumption and abuse. In Premature Death in the Newly Independent States, Bodadila, J. L. Costello, C. A. and Mitchel, F. eds, pp. 220–238. National Academy Press, Washington, DC.

White, H. R. and Labouvie, E. W. (1989) Towards the assessment of adolescent problem drinking. Journal of Studies on Alcohol 45, 326–333.

Wills, T. A. and Vaughan, R. (1989) Social support and substance use in early adolescence. Journal of Behavioral Medicine 12, 321–339.[ISI][Medline]