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
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ABSTRACT |
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INTRODUCTION |
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Although there has been much progress in delineating underlying factors of alcohol misuse and its treatment (Safer and Harding, 1993; Miller et al., 2001
), 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., 1991
; Hughes et al., 1992
). 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, 2000
; Holahan et al., 2001
). 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., 1999
).
Generally, motives for alcohol consumption have been emphasized in the aetiological and the reasons-for-drinking literature (Abbey et al., 1993). 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., 2001
). 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, 1999
; Finn et al., 2000
; Lindman et al., 2000
).
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., 1997). 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, 1989). 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, 1994
). Previous research has identified five such distinct and reliable factors (Beck et al., 1991
, 1993
), 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., 1991
). 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., 1997
, 2001
; Morgan et al., 1999
); 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., 2001
).
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.
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SUBJECTS AND METHODS |
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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 socialenvironmental 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., 1993), 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, 1979) 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, 1979
; Moberg, 1983
; Putnins, 1992
). In the present study, an acceptable level of internal consistency for the scale was obtained (Cronbach's
= 0.86).
Rutgers Alcohol Problem Index (RAPI)
The RAPI is a 23-item screening tool (White and Labouvie, 1989), 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, 1989
) revealed a high internal consistency of the scale in a general population sample (Cronbach's
= 0.92) and a moderate range of correlations between RAPI scores and alcohol-use intensity (0.200.57). In the present study, satisfactory internal consistency for the instrument was obtained (Cronbach's
= 0.88).
The translation of these scales into Russian followed established guidelines, including independent back-translations (Sartorius and Kuyken, 1994). 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).
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RESULTS |
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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, 1989).
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 2).
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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 36). 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 36
).
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DISCUSSION |
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As shown in Table 1, 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, 1994
) 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 2). 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, 1989). Perceptions about friends' alcohol use have also been found to influence youth drinking (Fromme and Ruela, 1994
). 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., 1988
; Ruchkin et al., 1999
, 2001
). 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, 1989). In addition, some authors (Thombs and Beck, 1994
; O'Hare, 2001
) 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.
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ACKNOWLEDGEMENTS |
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FOOTNOTES |
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