Psychological factors such as low adaptability continue to influence alcohol use later in the life span. The probability of continued drinking and the eventual onset of alcohol abuse is higher if an individual is unable to develop alternative and more adaptive ways of coping with immediate situational demands, such as leaving home, changes in employment or marital status, retirement, or death of a spouse (IOM, 1989). In essence, the major determinants of problematic drinking may occur when the levels of external demand or strain are high and the individual is unable to cope with the stresses. The individual has high expectations that alcohol will produce the desired results, and he or she minimizes or denies the long-term negative consequences.
Factors external to the individual and arising in the broad social environment also affect the level of use and abuse of alcohol. The contextual factors that are strong predictors of use include community use patterns (Robins, 1984) and particularly peer group behavior (Barnes and Welte, 1986). Low socioeconomic status (Murray, Richards, Luepker, and Johnson, 1987) and neighborhood disorganization (Sampson, 1985) also contribute to increased risk for alcohol problems. Contextual factors also include the availability of alcohol, such as legality, enforcement, cost, and taxes (Hawkins, Catalano, and Miller, 1992). “Contrary to the prevalent view that prohibition failed, there is substantial evidence that it reduced alcohol consumption substantially ” (Goldstein and Kalant, 1990, p. 1515). Beginning with Cook and Tauchen (1982), a series of studies have suggested that increasing taxes decreases consumption. Levy and Sheflin (1985) showed that a 1 percent tax increase decreased consumption by 0.5 percent. Of the contextual factors, laws controlling availability and taxes controlling price are the simplest to change.
Parental alcoholism is associated with a constellation of other risk factors, and it is these factors plus the alcoholism itself that lead to poor outcomes in children—of which alcohol abuse is only one (see Box 6.2).
Although much investigation has focused on identifying and assessing the magnitude of various risk factors involved in alcohol use, less is known about factors that may protect individuals from abusing alcohol.