There was considerable attention given to the most proximate social network influences, as both constraints and triggers. Environmental variables at this level were characterized by parental influences34–36,38,43, including parental alcoholism, which, framed within the context of our model, presents both potentially controlling and triggering influences. Parental alcoholism, for example, may foster conditions where alcohol is more accessible and drinking is more acceptable or that contribute to a turbulent and stress-inducing home environment. However, this environmental influence is strongly confounded with genetic effects, unless examined using highly robust designs to isolate genetic and environmental factors, e.g., an adoption paradigm (see Irons et al.35). Also examining the role of parental influence, there was a subset of randomized studies that examined interventions targeting parenting skills26–30, including communication skills around risks and expectations for substance use and providing emotional support and instrumental assistance to children.
