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Alcohol misuse among adolescents with BPD symptoms: exploring the moderating role of reasons for drinking and perceived coping skills in a clinical adolescent sample
Author(s) -
Folk Johanna B.,
Williams Caitlin A.,
EspositoSmythers Christianne
Publication year - 2020
Publication title -
child and adolescent mental health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.912
H-Index - 46
eISSN - 1475-3588
pISSN - 1475-357X
DOI - 10.1111/camh.12378
Subject(s) - moderation , coping (psychology) , psychology , clinical psychology , alcohol , psychiatry , competence (human resources) , young adult , injury prevention , poison control , medicine , developmental psychology , social psychology , medical emergency , biochemistry , chemistry
Background Adolescents who experience symptoms of borderline personality disorder (BPD) are at high risk for alcohol misuse, yet little is known about why these adolescents drink and what factors heighten or mitigate this risk. The current study explores factors that may impact risk for alcohol misuse among youth with BPD symptoms: using alcohol to self‐medicate or to rebel and perceived coping skills. Method A sample of 181 psychiatrically hospitalized adolescents ( M age = 15.04 years, SD = 1.31 years; 71.8% female, 83.4% White) was recruited as part of a larger study from the northeastern United States. Assessments and diagnostic interviews were administered to adolescents. Results Use of alcohol for self‐medication and perceived coping skills, but not using alcohol for rebellion, moderated the relationship between BPD symptoms and alcohol misuse. A significant positive relationship between BPD symptoms and alcohol frequency and/or problems was only found among adolescents who reported lower use of alcohol for self‐medication purposes or higher perceived coping skills. Conclusions Youth with more BPD symptoms are at high risk for alcohol misuse. Moderation effects for self‐medication motives and perceived coping skills were counter to hypotheses; lower levels of self‐medication motives contributed to greater alcohol problems, as did higher levels of perceived coping skills. Results suggest the importance of assessing how much youth are drinking or experiencing consequences, as well as why they are using alcohol. It is possible adolescents with more BPD symptoms may be reporting more coping skills, but actually exhibiting the phenomenon of apparent competence (i.e., present as ‘in control’, but actually experiencing extreme distress and lacking sufficient coping skills); collateral reports of adolescents’ coping skills may provide a more objective measure of actual skill level. Key Practitioner Message What is known? Adolescents who experience symptoms of borderline personality disorder (BPD) are at high risk for alcohol misuse, yet little is known about why these adolescents drink and what factors heighten or mitigate this risk.What is new? Adolescents who use alcohol to self‐medicate or rebel are at high risk for alcohol problems, regardless of presence of BPD symptoms. Contrary to expectations, higher perceived coping skills strengthened the relation between BPD and alcohol misuse. Apparent competence (i.e., present as ‘in control’ but lack sufficient skills) may be at play.What is significant for clinical practice? Clinicians are encouraged to assess why adolescents are using alcohol and teach alternative coping strategies when self‐medication and/or rebellion is an identified use. Clinicians are encouraged to collect collateral reports of adolescent’s coping abilities rather than relying solely on self‐report.