Procedimientos contables

The COA literature raises a number of other methodological issues to consider in studies examining the intergenerational or sibling transmission of problem gambling. Most relevant are calls for the COA literature to consider important potential sources that may account for the heterogeneity of COA outcomes (66, 67, 96, 100, 101)_{. These sources of heterogeneity create formidable methodological challenges for} research into the intergenerational transmission of alcohol use problems (67, 97). However, an understanding of the heterogeneity relating to transmission can facilitate the development of targeted prevention and treatment strategies (101).

3.6.1 Cohabitation issues and relationship to the child

While cohabitation issues and relationship to the child are generally not considered in the COA literature, the heterogeneity in outcomes associated with COA status may be associated with the level of direct exposure to parental alcohol use problems and associated difficulties (96). Specifically, the degree of exposure is important for etiological theories that suggest that social learning is associated with the intergenerational transmission of alcohol use problems (96). Some COAs may have relatively low contact with their biological parent(s) and/or siblings (72). Study 4 of the Children at Risk Project, which comprised the largest number of problem gamblers, examined the nature of the relationship (biological or step-family members) and the degree of contact between the participant and family member (living with the family member on a full- or part-time basis) (72).

3.6.2 Density of family history

Most of the COA literature has generally ignored the density of alcohol use problems in the family (e.g., both parents have alcohol use problems, parents and siblings have alcohol use problems, or mutigenerational alcohol use problems) (66, 67, 91, 100, 101, 208)_{. It has, however, been argued that assortative mating serves to increase} the rate of alcohol use disorders in COAs due to a genetic predisposition for alcohol dependence inherited from both sides of the family and to an increase in compromised rearing environments and “alcohologenic nature” of the family environment (96, 100). There is some evidence that COAs with two alcohol dependent parents are more likely than COAs with one alcohol dependent parent or no alcohol dependent parents to report an earlier age of first alcohol intoxication, more behavioural problems preceding alcohol treatment, and a faster procession from first intoxication to treatment for alcohol use problems (227). However, the number of alcohol dependent parents has not affected measures of pre-treatment drinking, drinking severity, and treatment outcome (227). The Children at Risk Project will examine the effect on problem gambling outcomes when one or more family members are problem gamblers.

3.6.3 Lifespan developmental factors

The COA literature requires increased attention to lifespan developmental factors in considering the outcomes of parental alcohol use problems (66, 91, 96, 101, 208). These factors include: the child’s developmental stage at the time of active parental drinking; the parent’s current stage of alcoholism or recovery; the current

developmental level of children; the recency of parental alcohol use problems; and the duration of parental alcohol use problems (66, 67, 91, 99,208). An understanding of which factors are differentially important at different developmental stages will facilitate targeted preventive intervention (96). Study 4 of the Children at Risk Project will explore some of these developmental factors.

3.6.4 Gender of the problem gambling parent

It is acknowledged that effects of parental alcohol use problems may vary with the gender of the alcohol dependent parent (67, 91, 99). Given that changes in legislation and public acceptance of gambling in Australia and other western countries have led to an increase in the prevalence of gambling and problem gambling for women (e.g., 8), caution must be taken in generalising across genders. Although there is some evidence that suggests that male problem gamblers may display stronger familial transmission than their female counterparts (refer to Section 2.3.4), it has been speculated that the deleterious effects of female problem gambling on the family, particularly on dependent children, may be exacerbated given women’s historically greater involvement with the family and their traditional familial roles as caregiver and nurturer (20, 24, 29, 205, 228, 229). The Children at Risk Project administered separate screening questions for fathers, mothers, and siblings in order to further explore the differential impacts on children of paternal and maternal forms of problem gambling (29)_.

3.6.5 Other ‘third variable’ influences

In Section 2.2.5, we argued that much of the COA literature is limited in its ability to draw conclusions regarding the effects of parental alcohol use problems independent of co-occurring parental psychiatric disorders. It has also been argued that much of the COA literature also does not adequately account for other ‘third- variable’ influences associated with alcohol use problems such as unemployment, socio-economic status, relocations, financial hardship, and divorce or separations (67, 71 91, 96, 99-101, 207, 208)_{. Given that these family stressors in problem gambling families may} result in a higher degree of risk by potentiating each other (96, 99), the Children at Risk Project took these influences into account in order to identify the factors that are uniquely associated with parental gambling problems (96, 100, 101).

3.6.6 Predominant gambling form

It has been suggested that the effect of parental alcohol use problems differs depending on the subtype of alcohol use problem (66, 91, 96, 100, 101). The most influential attempt at subtyping problem gambling is the ‘pathway typology model’, which proposes that there are three major entry pathways into PG: 1) ‘normal’ or non- pathologically disturbed gamblers; 2) emotionally disturbed or vulnerable gamblers; and 3) biologically-based impulsive gamblers (230). However, research attempting to subtype problem gambling is in its infancy (230, 231). When there is some consensus on the optimal way of subtyping problem gambling, future research should explore the effect of problem gambling subtypes on the intergenerational transmission of problem gambling. It is also reasonable to assume that the predominant form of problem gambling may have a differential effect on the experience of a family history of problem gambling. Study 4 of the Children at Risk Project explored the problem

gambling activities for each family member as it had the highest number of problem gamblers.

3.6.7 Child characteristics

Most of the COA literature investigates COAs as a unitary group. However, potential differential effects of parental alcohol use may vary as a function of child socio-demographic factors, such as gender, age, ethnicity, and comorbidity (66, 91, 96, 101)_{. The}

Children at Risk Project examined these factors in the familial transmission of gambling problems.

3.6.8 Family structure

Much of the COA literature has limited its evaluation to children growing up in intact families because researchers have been interested in family dynamics. However, it is likely that findings derived from evaluation of two-parent families may not be generalisable to those from one-parent families or step-families (66). Study 1 of the Children at RiskProject therefore considered the impact of children growing up in one-parent families, step-parent families, and two-parent families.