ALCOHOL USE AND AGGRESSION IN ADOLESCENTS - A META-ANALYSIS

Jouko Miettunen, Adjunct Professor

Department of Psychiatry

University of Oulu, Finland

e-mail: jouko.miettunen@oulu.fi

Background Alcohol use and aggressive (violent)

behaviour have been found to associate with each other in adolescent samples.

The strength of this association is largely unknown

Epidemiological association or intoxication effect?

Alcohol use risk factor also for vulnerability for physical violence

Background

Adolescence important period Onset of substance use Onset of criminal behaviour Early alcohol use early alcoholism? Early behavioural problems later

criminality?

The literature search for studies was done in a systematic way. The studies were searched one database at a time, in abstract and title

Originally time limit (1995-), but now also older studies included (ongoing study!)

Databases searched included PsycINFO, Science Direct, PubMed and Google Scholar. The search was done in October and November 2008

Also manual search was done and authors were contacted to get more information

Data collection

The search was limited to studies on the relation of aggression and alcohol use in the age group of “normal” adolescents between age 13 and 18

Studies were included if they measured aggression and alcohol use in a standardized and most similar way, at the same point in time, and in an adolescent cross-sectional sample.

Results are presented with meta-analytic methods using pooled odds ratios (OR).

Data collection

Eight studies compared proportion of aggressive or violent persons between alcohol using and non-using adolescents Included to the current meta-analysis!

Many other studies compared alcohol using and non-using adolescents using various other summary statistics (correlations, means, …) These studies are not presented here!

Preliminary results

Choquet et al. Alcohol Alcohol 1991;26:381-90. Orpinas et al. J Adolesc Health 1995;16:216-25. Fergusson et al. Addiction 1996;91:483-94. Ellickson et al. Am J Public Health 1997;87:985-91. Gudlaugsdottir et al. Int J Epidemiol 2004;33:1046-51. Eklund & af Klinteberg. J Indiv Dif 2005;26:63-73. Wade & Pevalin. Can J Criminol Crim Justice 2005;47:619-49. Shepherd et al. J Adolesc 2006;29:539-53.

Included studies

Choquet et al. Interpersonal aggressive behaviour and alcohol consumption among young urban adolescents in France. Alcohol & Alcoholism 1991;26:381-90

•An epidemiological survey was carried out among 1601 adolescents (aged 13-16) from a suburban area of Paris.•A majority of the adolescents had already demonstrated violent behaviour, 41% showed repetitive delinquent behaviour, and 12% cumulated several types of such behaviour. •The aggressive teenagers differed from the non-aggressive subjects firstly in their alcohol, tobacco and illicit drug consumption, and secondly with respect to other deviant behaviour, such as stealing, running away from home or violent victimization.

Orpinas et al. The co-morbidity of violence-related behaviors with health-risk behaviors in a population of high school students. J Adolesc Health 1995;16:216-25.

•All ninth and eleventh graders (n = 2075) of a school district in Texas. •Overall, 20% of the students were involved in a physical fight but had not carried a weapon, 10% carried a weapon but had not been involved in a physical fight, and 17% had been involved in a physical fight and had carried a weapon. •Students who both fought and carried a weapon were 19 times more likely to drink alcohol six or more days than students who did not fight nor carried a weapon.

Fergusson et al. Alcohol misuse and juvenile offending in adolescence. Addiction 1996;91:483-94.

•The associations between alcohol misuse and juvenile offending during the period from 15 to 16 years of age were studied in a birth cohort of New Zealand adolescents. •This analysis showed that young people who misused alcohol had significantly (p <0.001) higher rates of both violent and property offences. •A substantial component of the association between alcohol misuse and juvenile offending arose from shared risk factors that were common to both outcomes. •However, young people who abused alcohol had odds of violent offending that were 3.2 times (p< 0.001) the odds of those offences for young people who did not misuse alcohol.

•Longitudinal data for more than 4500 high school seniors and dropouts from California and Oregon•More than half the sample had engaged in violence during the last year, and one in four had committed predatory violence. •Violent youth were more likely than their peers to have poor mental health, use drugs, drop out of school, and be delinquent.

Ellickson et al. Profiles of violent youth: substance use and other concurrent problems. Am J Public Health 1997;87:985-91.

Gudlaugsdottir et al.Violent behaviour among adolescents in Iceland: a national survey. Int J Epidemiol 2004;33:1046-51.

•In 1997, a cross-sectional survey was conducted among a random half of all Icelandic schoolchildren aged 15-16 years (N = 3872). •The majority of the respondents reported having committed violence within the last year. •Smokers were more likely than non-smokers to use violence (OR = 1.7; 95% CI: 1.2, 2.2)•Adolescents who had used alcohol >20x in their lifetime were more than twice as likely to commit violence compared with those who had never used alcohol (OR = 2.5; 95% CI: 1.8, 3.4).

Eklund & af Klinteberg. Personality Characteristics as Risk Indications of Alcohol Use and Violent Behavior in Male and Female Adolescents. J Indiv Dif 2005;26:63–73.

•The present study focused on personality characteristics in adolescent boys (n = 414) and girls (n = 552) in 8th grade with self-reported violent behavior and risky alcohol use. •Adolescents with indications of violent behavior and/or risky alcohol use, compared to others, were generally more impulsive, had a stronger need for change and action, were less adjusted and socially conforming, as well as more aggressive. •The findings pointed toward a clustering of problem behaviors.• Similar personality profiles between alcohol using and violent adolescents.

Wade & Pevalin. Adolescent delinquency and health. Can J Criminol Crim Justice 2005;47:619-49.

•Data from the first two waves of the publicly available US National Longitudinal Study of Adolescent Health (n=4,834). •Results indicate that delinquent behaviours such as violence, aggression and property damage are similarly predicted by the same risk factors as are depression and perceived health, and tobacco, alcohol, marijuana and hard drug use. •Most outcomes were associated with one another, suggesting they may be comorbid manifestations of risk exposure.

•Cross-sectional study of 4187 adolescents aged 11-16 in a stratified sample of 13 English schools. •Relationships between fighting, hitting others and vulnerability to being hit and frequency of drinking and drunkenness were all highly significant (p<0.0001), and were evident at all ages. •The outcome most strongly related to frequency of drunkenness was hitting others (odds ratio (OR) 6.62), followed by being hit (OR 4.01) and fighting (OR 2.10).

Shepherd et al. Relations between alcohol, violence and victimization in adolescence. J Adolesc 2006;29:539-53.

Shepherd et al. Relations between alcohol, violence and victimization in adolescence. J Adolesc 2006;29:539-53.

Odds ratio

1 1.5 2 3 4 5 6 7 8

Study Odds ratio (95% CI)

USA Ellickson et al. 1997

USA Wade and Pevalin 2005

Iceland Gudlaugsdottir et al. 2004

USA Orpinas et al. 1995

France Choquet et al. 1991

UK Shepherd et al. 2006

Sweden Eklund and af Klinteberg 2005

2.1 (1.7 - 2.6)

2.3 (2.0 - 2.6)

2.8 (2.5 - 3.3)

4.2 (3.3 - 5.3)

5.9 (3.4 - 10.2)

7.1 (5.2 - 9.7)

7.4 (4.9 - 11.3)

4.07 (2.97 - 5.58) Overall (95% CI)

New Zealand Fergusson et al. 1996 6.5 (3.7 - 11.7)

Forest plot with odds ratios

Summary of results

Alcohol using adolescents had four times more commonly aggressive behaviour

Results were consistent Odds ratios between 2 and 7

Methodological issues Self-reported data

Differences in assessment methods

Alcohol and behaviour/violence

Attrition in original studies

Differences by age and sex

Similar risk factors (covariates?)

Other substances?

Dose response? Causality?

Conclusions This study was the first one to pool

studies on association between alcohol use and aggression in adolescence.

The results indicate a strong association between alcohol use and aggressive behaviour.

Odds ratios (cross-sectional associations) were quite similar between studies

Conclusions Although these results are not a proof for

causal relationship between alcohol use and aggression, the association is strong and should be paid attention to both in research and clinical settings (health and violence-prevention programs)

Temporal associations between alcohol (and other substance) use and aggressive behaviour needs to be further studied

Bettina von der Pahlen, Professor

Research Group

National Institute for Health and Welfare, Helsinki, Finland

Marina Lindholm, Student

Department of Psychology, Abo Akademi University, Turku, Finland

Mauri Marttunen, Professor

National Institute for Health and Welfare, Helsinki, Finland

Jouko Miettunen, Academy Research Fellow

Department of Psychiatry, University of Oulu, Oulu, Finland