The Effect of Stepfamily Closeness on Emerging Adult Prescription Drug Abuse: A Structural Equation Modeling Approach

Background and Purpose: In 2015, over 50,000 people in the United States died due to drug overdose. Nearly half of those deaths were caused by prescription drug overdose. Since that time, the Centers for Disease Control and Prevention officially declared prescription drug abuse as an epidemic in the United States. Although much research is dedicated to how prescription drug abuse negatively affects families, much less is known of how protective familial factors affect prescription drug abuse. Protective factors of drug abuse within a stepfamily context is even more rare. To address this gap in the literature, the purpose of this study was to examine how three different facets of stepfamily closeness in childhood – biological parent, stepparent, and stepsibling closeness – influenced prescription drug abuse in emerging adulthood.

 Method:Data came from the Stepfamily Experiences Project (STEP), a retrospective survey of emerging adults aged 18 to 30 who lived in a stepfamily between the ages of 8 and 18. The survey used a national quota sample based on U.S. Census race estimates (n=1,277). The key dependent variable was prescription drug abuse, which measured how many times a participant used prescription medications without a doctor’s permission. Prescription drug abuse was an ordered categorical variable consisting of 6 categories: “None,” “Once a month or less,” “2 or 3 days a month,” “1 or 2 days a week, “3-5 days a week,” and “Almost every day.” The independent variables were perceived biological parent closeness (α=0.89), perceived stepparent closeness (α=.93), and perceived stepsibling closeness (α=.87). Control variables included gender, age, and annual income.

 Results: Data were analyzed using structural equation modeling (SEM). Biological parent, stepparent, and stepsibling closeness were specified as three latent constructs, having 3, 3, and 2 indicators, respectively. Ordinal logistic regression coefficients from the final SEM model were examined. Results indicated that perceived biological parent closeness in childhood was significantly associated with a decreased odds of prescription drug abuse in emerging adulthood. Specifically, a one-unit increase in biological parent closeness was associated with a 30% decrease in the odds of advancing the amount of prescription drug abuse (i.e. moving from the “3-5 days a week” category to the “Almost every day” category) (OR= .69, p<.001). Stepparent closeness and stepsibling closeness were not significantly associated with prescription drug abuse in emerging adulthood.  

 Conclusions and Implications: Findings indicate that child-biological parent closeness within stepfamilies is significantly associated to a decrease in the odds of intensifying one’s prescription drug abuse later in life. Further, within a stepfamily context, child-biological parent closeness may serve as a protective factor against future prescription drug abuse, perhaps more so than stepparent closeness and stepsibling closeness. The clinical implication underscores the importance of a family system perspective when exploring correlates of prescription drug abuse by encouraging social workers to strengthen the child-biological parent relationship as a protective factor as children transition into a stepfamily.