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The twin incidence is higher in infants with oesophageal atresia (OA) than in the general population. The purpose of this study was to review the twin OA information from five institutions and evaluate possible links between the development of OA and the twinning process. Data were compared, combined, and analysed. There was a total of 1,215 infants with OA, of whom 50 were from a twin pregnancy and 1 from a triplet pregnancy. Two sets of twins were concordant for OA. Mean birth weights and gestational ages were lower in the twin infants (P < 0.0005) and survival was lower in twins (65%, P < 0.005) than singletons. The anatomical variant of pure OA without fistula was seen in proportionally fewer twins (4%) than in singletons (7%). Multiple anomalies were present in 40% of twins compared with 33% of singletons, although this did not reach statistical significance. OA in our multicentre population was more common in twins. Several possible mechanisms are put forward to explain the apparent link between twinning and OA. Further analysis of this aspect of OA may aid in understanding the aetiology of this congenital anomaly.

Aims: To explore the structure underlying individual differences in the ways family members cope with drinking or drug problems., Design: Cross-sectional interview and questionnaire study of a series of family members in two contrasting socio-cultural groups., Setting: Mexico City and South West England., Participants: Two hundred and seven family members from separate families, three-quarters women, one-quarter men, mostly partners or parents., Data: Long semi-structured interviews; the Coping Questionnaire (CQ)., Findings: Factor and subscale analyses of the CQ data and textual analysis of the interview reports were used to test the hypothesis that the underlying structure to coping could be described in terms of eight or nine coherent and distinct ways of coping. Neither form of analysis gave strong support to this hypothesis., Conclusions: It is concluded that the structure of coping can best be described in terms of three broad coping positions: tolerating, engaging and withdrawing. These conclusions challenge some previous assumptions about functional and dysfunctional ways of coping with excessive appetitive behaviour in the family.

There is current concern about the level of excessive gambling in a number of countries, but problem gambling still occupies an uncertain place in the addictions field. The present paper presents results from a pilot study comparing 16 problem gamblers and 16 problem drinkers. Results from a new Attachment Questionnaire suggested that gamblers were just as strongly attached to gambling as drinkers to drinking, although they were significantly less likely to experience withdrawal symptoms. Interviews with the problem gamblers suggested that excessive attachment to gambling was maintained by cyclical processes involving strong, negative feelings associated with gambling losses, shortage of money and the need to keep the extent of gambling secret. It is proposed that these 'secondary' processes, along with primary incentive motivation and the tertiary effects of losses associated with excessive behaviour, are sufficient to explain addiction. It is further suggested that neuroadaptation, tolerance and withdrawal, often thought to be central to the process of addiction, may in fact be of comparatively little importance.

This paper presents a typology and transactional model of how close relatives cope with excessive drinking, drug-taking or gambling in the family. These are illustrated with four examples taken from a series of research projects in which relatives have been interviewed to understand better how they react and respond. Such information is the groundwork for a World Health Organization initiative to help primary health care workers respond to the needs of relatives. The philosophy behind this initiative, and the steps that primary health care workers might take, are outlined. It is proposed that such workers can help close relatives to find the best coping methods in their circumstances, and that this approach might constitute an important, and hitherto neglected, form of secondary prevention.

The research described in this paper resulted from a collaborative multi-centre study of the relatives of problem drug users involving six practitioners and researchers, in four centres within the south-west of England. The objective of this research was simply to interview 50 close relatives of identified problem drug users, with the identification occurring through clinics and self-help groups. Quantitative and qualitative results show that large numbers of these relatives reported many negative experiences. The partners of illicit drug users reported both more and differently patterned problematic behaviours than those of prescribed tranquillizer users. The partners of illicit users also reported different problems to those of the parents. Relatives reported many negative effects in terms of how they viewed the drug user, and how the experiences had affected their health. They also described various coping mechanisms, and the extent of the support which they had received. The results are discussed in terms of coping, and similarity with research into the families of problem drinkers.

One hundred and sixty-four 16-35-year-old offspring of parents with drinking problems, recruited from a variety of clinical and community sources, were compared with 80 respondents of similar ages from similar sources who did not have parents with drinking problems. Each was interviewed using a semistructured interview. Adult adjustment was similar in the two groups, but the offspring of parents with drinking problems did report considerably more disharmony in their families of origin, and many more childhood difficulties. Factor analysis of the adult adjustment data for the samples combined showed four factors which accounted for 41% of the variance; these factors differed little in their effect in the two groups. The groups' reports of the drinking problems of their siblings, however, suggests that this sample might be unrepresentative of the true risk to the children of parents with drinking problems for the development of alcohol-related (although not other) difficulties in adulthood: 16% of this group reported a sibling with a drink problem and a further 9% were unsure, but only one member of the comparison group reported a sibling with a drink problem, and one was unsure. Path analysis showed that both parental problem drinking and family disharmony are related in complex ways to adjustment difficulties in adulthood. 'Demoralisation', the largest of the four factors, was particularly related to disharmony in the family of origin: in the absence of disharmony, offspring versus comparison status was negatively correlated to demoralisation in adulthood, suggesting that having a parent with a drinking problem might sometimes be a strengthening experience.

Results are reported of a study in which 547 general hospital medical in-patients were screened, using a computer-administered questionnaire, for alcohol consumption, problems and concerns. Of males, 22.5% were classified as 'risk drinkers', of women 6.5%. Rates of risk were particularly high amongst younger male patients. It was concluded that certain screening questionnaire items were more useful than others in the general hospital context, and that standard questionnaires developed for other populations should not automatically be used in general hospitals. Comparisons with items relating to other health behaviours suggested that the medical profession, the general public and the patients themselves might be relatively insensitive to the risks associated with heavy drinking in comparison to those associated with smoking, weight and lack of exercise. Data from initial screening and from 75% of patients who were asked to repeat the questionnaire six months later, were used to test certain assumptions of a model of change based in part upon that of Prochaska & DiClemente (1986). Results suggested that processes of change were more complex than the model supposed.

Research on excessive drinking in the family context has revealed the range of ways of coping used by close relatives. Case material from ongoing research in England and Mexico is used to illustrate this point. This research is also revealing the ways in which the family, close and extended, often fail to support the coping actions of close relatives. The analogy is drawn between coping with excessive drinking in the family and coping in the work setting. In the latter context explicit alcohol policies have been developed. These often recommend combining confrontative and supportive coping. It may be difficult for relatives, in the family setting, to adopt such a policy without support. The forms of coping identified in family research and in work policies correspond to basic and universal dimensions of interpersonal behaviour: dominance-submissiveness and friendliness-hostility. These forms of responding to excessive drinking may be identified beyond the microsocial systems of family and workplace. They are evident, also, in the responses of community agents such as police and social workers, and at the level of local and national government.

Two competing hypotheses concerning the mechanism of transmission of excessive substance use from one generation to the next are tested, using data from a study of 16- to 35-year-old offspring of problem-drinking parents. The 'positive influence' hypothesis predicts that the more positive has been the offspring's relationship with the problem-drinking parent during upbringing, the greater the risk of excessive drinking or drug taking in young adulthood. This hypothesis received support only for women with fathers with drinking problems. The 'relationship deficiency' hypothesis predicts that those offspring most at risk are those who have had the more negative relationships with parents. This hypothesis received some support in the case of men with mothers with drinking problems: this subgroup of offspring were more at risk if they reported having had poor relationships with their fathers. It is concluded that the environmental intergenerational transmission of problems of excessive substance use occurs via a variety of mechanisms which are likely to be of differential importance in different subgroups.

One hundred and seventy 16- to 35-year-old offspring of parents with drinking problems were recruited from a variety of clinical and community sources and each was interviewed at length using a semi-structured interview. The present paper focuses upon carefully reconstructed recollections of childhood, and presents quantitative information from the whole sample and three briefly described individual examples. Large variances on quantitative measures and very varied qualitative accounts of childhood were evident. The large majority described parental drinking problems which spanned their childhood and adolescent years without interruption and without treatment. Amongst the most frequently recalled effects on life at home were parental moodiness, unreliability, and a tendency to upset or fail to join in with family activities. Amongst negative childhood experiences recalled most frequently were worry and uncertainty, a feeling of family instability, the experience of being caught between the interests of two parents, and the adoption of certain adult roles. Those with mothers with drinking problems scored significantly higher on a scale of negative childhood experiences and mothers with drinking problems were more likely to have drunk regularly at home. Those offspring from families of higher social status estimated their parental problems to have started slightly later in childhood. Qualitative analysis suggested that whether excessive parental drinking is perceived as alien to or integral with family life may have been a neglected variable.

Data from two studies are used to examine the proposition that excessive gambling, unlike excessive substance use, is not generally viewed as a form of dependence. In the first study, the attitudes of 100 members of the general population towards the causes of excess and towards appropriate treatments, indicated that excessive gambling was seen in more moral terms than were other addictive behaviours. In the second study, of 54 people receiving treatment for one of four forms of excessive behaviour, gamblers were just as likely to use terms such as 'addiction' or 'compulsion' to describe their behaviour but were also more likely than others to describe it in terms of moral weakness or vice. Concern is expressed at the way in which gambling may be marginalized as a form of dependence.

One hundred and seventy 16 to 35 year-old offspring of parents with drinking problems and 80 comparison young adults were recruited from a variety of clinical and community sources. Each was interviewed at length using a semi-structured interview and 86% were re-interviewed one year later. No between-group differences were found in current quantity of alcohol consumption nor in percentages who had ever used or were currently using illicit or prescribed drugs. However, larger numbers of offspring had commenced alcohol use in their early teens and had used other drugs in their later teens, and more offspring than comparisons were currently using alcohol in a risky way, more were using illicit drugs more than occasionally, and more were heavy smokers. These differences were not great, and gender and source of recruitment (clinical versus community) were equally important predictor variables. Analyses conducted within the offspring group offered no support for hypotheses linking adulthood risk with years of exposure, severity of childhood effects and experiences, maternal as opposed to paternal problems, or problems in the same sex parent. However, some support was found for the importance of having had two parents with drinking problems and having had a drinking parent who often drank at home.

In a study comparing abstinence and controlled drinking treatments, differences were found between men (n = 30) and women (n = 16) which confirmed some previous views on sex differences and problem drinking, and which have implications for choice of drinking treatment goal. On average women had problems of shorter duration, were less likely to have previously received out-patient specialist treatment only, reported consuming smaller quantities of alcohol, and reported a more regular recent pattern of consumption. Mean SADQ scores, and numbers 'definitely alcoholic' by Rand criteria, were similar, as were the numbers reporting a positive family history of drinking problems. Contrary to expectations, women were no more likely than men to report interpersonal functions and effects of drinking. Men were more likely than women to report drinking for positive emotional or social reasons or because of social pressure, were more likely to report positive effects of drinking, and among negative effects were more likely than women to report effects on work, finances, leisure, and fitness. Levels of self-esteem were very similar, but men described more positive effects of moderate drinking upon self-esteem than women.

Two groups of alcoholics received either one counseling session or several months of in- and outpatient treatment. One year later there were no significant differences in outcome between the two groups.

One-hundred husbands, diagnosed as suffering from alcoholism, and their wives, were followed up twelve months after initial consultation and assessment. Follow-up information was complete in 89 cases. On the basis of both husband and wife accounts of the husband's drinking behaviour during the follow-up period, and their assessment of the drinking problem at twelve-months follow-up, 28 were classified as having a 'good' outcome and 29 as having a 'bad' outcome. In the remaining 32 cases outcome was considered 'equivocal'. A composite measure of marital cohesion was predictive of twelve-month outcome classification, cohesive marriages being significantly more likely to have a good outcome. The measure of marital cohesion was based upon husband and wife reports of mutual affection and of husband involvement in family tasks, favourable spouse perceptions and meta-perceptions, and optimism about the future of the marriage. Composite measures of dominance balance within the marriage were not predictive of outcome. Husband's job status, husband's self-esteem, and wife's reported hardship were not independent of marital cohesion, and were themseleves predictive of twelve-months outcome. When these variables were partially controlled it was found that marital cohesion remained predictive for husbands with relatively low status jobs and husbands with relatively low levels of self-esteem. It is an over-simplification to state that either the marriage, the spouse, or the severity of the patient's condition is alone the cause of variation in outcome. It is possible to integrate these findings with those of other studies on the influence of family variables on the outcom of conditions other than alcoholism. Together these studies suggest a general hypothesis linking a breakdown in the cohesiveness, or mutual rewardingness, of family relationships and unfavourable outcomes following treatment or consultation for psychological disorder.

Previous research has suggested two leading hypotheses concerning which excessive drinkers can re-establish control: one based upon level of dependence, the other upon the client's personal persuasion. Using initial assessment data from 46 clients of a clinical psychology alcohol problems service (30 men, 16 women), an attempt was made to operationalize the concepts of dependence and personal persuasion using a variety of indicators of each. Although SADQ scores and Rand definite alcoholism were in general agreement, there were a number of borderline instances and cases of disagreement, and neither was in good agreement with estimates of problem duration, nor with reports of recent or earlier attainment of abstinence or control. Indicators of personal persuasion were more consistent. Those with dependence indicators for abstinence tended to prefer abstinence as a goal, but there were many departures from this pattern particularly for women. It is concluded that in clinical practice it will be very difficult to make a clear cut recommendation about treatment goal at initial assessment except in a few cases.

Four groups of families were investigated using an interview designed to assess expressed emotion (EE) in relatives of psychiatric patients and a family interaction questionnaire (FIQ) based upon the Leary and Benjamin schemes for coding interpersonal behaviour. The families included 25 containing a psychiatric patient aged between 18 and 46, and three groups of 12 families each, all containing a patient over 60 (patients with dementia, a functional psychiatric disorder, or a chronic physical disorder respectively). In all cases data were obtained from key relatives. The FIQ clearly separated out the group of dementia relatives who reported the most dominant and protective behaviours and the highest levels of hostile-dominance and the lowest levels of affection. EE was not found to be so sensitive to interactions occurring in families with a member with dementia, and the possible reasons for this are discussed.

There are at least six theoretical perspectives that underlie studies of alcohol misuse and the family. Adherence to one or to a limited range of viewpoints constricts the outlook of professional workers. The prevention and treatment of alcohol problems in the family setting is a neglected field, yet it offers scope for intervention with high risk groups, and at an incipient stage of alcohol misuse before help is normally sought. Despite the growing use of marital and family therapy for couples and families containing a problem drinking member, evaluative studies of such therapies generally lack methodological rigour and leave important issues unresolved. Nonspecialist professional agencies who encounter family problems often fail to identify or deal with alcohol misuse when it is present. Trained voluntary workers may be effective in the treatment of alcohol problems within the family context. There are disadvantages from viewing alcohol misuse within the family as a topic separate from other health and social problems. Finally, the issues that are reviewed have relevance for non-English speaking countries.

The frequency of the use of coping behavior by wives of alcoholics was found to be related to their husband's drinking outcome. In general, a high frequency of coping behavior was associated with a poor outcome, but some components of coping behavior were more likely than others to be linked with a poor prognosis.

Familial relationships in 11 families in which 1 parent is an alcoholic are discussed in the context of literature on the children of alcoholics.

A case is presented in which the latest methods of antenatal diagnosis of central nervous system defect were successfully employed. The advantages and drawbacks of the technique are discussed.

The effects during childhood, adolescence, and adulthood of having a parent with a drinking problem has interested researchers in several countries. The greatest number of reports related to this subject have appeared in the U.S. literature and in the literature from countries of Eastern Europe. This review encompasses the findings of researchers in these countries as well as workers in Western Europe, Latin America, and Japan. This review does not include biological, physiological, or neurological data. The epidemiologic evidence from several countries shows significant points of agreement. Problem drinking by a parent markedly increases health risks to children and adolescents. Such risks include diminished intellectual capacity and development, increased neuroticism, and a wide range of psychological and behavioral disorders. Parents who drink excessively are also likely to have children who experience long-term adverse consequences. These include heavy and problem-causing psychoactive substance use, criminality, suicide, depression, personality disorders, and psychological and behavioral disturbances. Parents who drink heavily are also especially likely to produce children who subsequently abstain from alcohol or drink only lightly.