Introduction to Special Issue

Substance use and substance use disorders (i.e., dependence on or abuse of alcohol, tobacco/nicotine, e-cigarettes, marijuana, cocaine, heroin, opioids, or other substances) pose substantial challenges to people’s mental, physical, relational, and economic well-being. Demonstrating the pervasiveness of substance use disorders (SUDs), data from a 2013 national survey revealed that approximately 1.3 million adolescents aged 12–17 (5.2% of adolescents) and 20.3 million adults aged 18 or older (8.5% of adults) had an SUD in the past year, with few of them receiving treatment (Center for Behavioral Health Statistics and Quality, 2014). Despite the prevalence of substance use and SUDs, and the popularity of television shows such as “Intervention” (Mettler & Sharenow, 2005), there is limited research conducted within the field of communication to understand the role of communication in the prevention of substance use and treatment of SUDs. This is unfortunate given the significance of this public health issue. Many lives continue to be affected by substance use and SUDs, leading the United States to dedicate a substantial amount of money to addressing this problem. For example, President Obama recently proposed a $31.1 billion budget for 2017 “to support National Drug Control Strategy efforts to reduce drug use and its consequences in the United States,” which was a $500 million increase from the previous year of funding in 2016 (National Drug Control Budget, 2016, p. 2). President Obama’s proposal emphasizes the pressing need for additional research and other efforts to address substance use and SUDs.

Different psychological, environmental, economic, and biological factors may affect the development and management of SUDs; however, family communication may play a unique role in substance use prevention, intervention, and coping. Extensive research has been conducted on substance use and SUDs outside of communication (e.g., psychology or human and family development), but family communication scholars can offer unique and important contributions to the literature. Family communication can help us understand ways to: (a) prevent SUDs, (b) intervene in an SUD, (c) treat an SUD, and (d) facilitate coping with an SUD. At the same time, SUDs affect family communication and relationships in powerful ways.

For this special issue, we invited submissions that placed family communication at the center of understanding substance use prevention, intervention, and coping. The research articles that comprise this special issue advance our understanding of family communication and substance use, specifically in prevention, by applying different theoretical and methodological approaches. Together, the articles also offer insight into future research directions, thereby emphasizing the fact that despite being an old topic, many unanswered questions still remain regarding substance use prevention, intervention, and coping.

Substance use prevention and communication research

The Behavioral Health Continuum of Care Model (Mrazek & Haggerty, 1994) recognizes multiple opportunities for addressing behavioral health problems such as substance use disorders, including health promotion, prevention, treatment, and recovery. In the context of addressing SUDs, health promotion builds capacities in individuals, families, and communities to promote and support the non-use of illicit substances and appropriate use of prescribed medications. Prevention is understood as any activity designed to avoid substance abuse and reduce its health and social consequences. Primary prevention strategies are implemented prior to the onset of substance use with the intention of preventing or reducing the risk of developing an SUD, such as preventing underage alcohol and other illicit drug use.

Early intervention strategies are employed with individuals who have experimented with illicit substances or begun to misuse prescribed substances but are not severely dependent. The actual onset of experimentation and use tends to begin during adolescence; therefore, prevention efforts often target youth in late childhood or early adolescence (Hopfer et al., 2010). Treatment strategies are employed to reduce symptoms, support coping, and improve quality of life when an individual is diagnosed with an SUD. Finally, recovery provides support to individuals to sustain productive, substance-free lives. The Behavioral Health Continuum of Care Model is useful for mapping out the various opportunities for family communication involvement in minimizing SUDs.

The overwhelming effects of SUDS on individuals, families, and societies demand effective mechanisms of deterrence. Until the past few decades, there was a tendency to regard primary prevention as the only true form of prevention (Spoth et al., 2013). It is now recognized that effective prevention approaches are required before and after symptoms become apparent, because substance abuse disorders are chronic and relapsing or recurring in nature (Medina-Mora, 2005). The vast majority of research in family-based approaches to SUDs has been situated within the area of prevention.

Family communication and substance use prevention

Research has consistently linked family-based factors with the initiation and escalation of substance use. For example, a number of studies have found that effective parental monitoring of adolescent activities can reduce risk for substance use (Fosco, Stormshak, Dishion, & Winter, 2012; Griffin, Botvin, Scheier, Diaz, & Miller, 2000; Van Ryzin, Fosco, & Dishion, 2012). Research also supports a link between parent-adolescent relationship quality and adolescent substance use (Hummel, Shelton, Heron, Moore, & Bree, 2013; Ledoux, Miller, Choquet, & Plant, 2002; Van Ryzin et al., 2012), as well as effective parent-youth communication and adolescent substance use (Kam, Basinger, & Abendschein, 2015; Kam, Castro, & Wang, 2015; Kam & Middleton, 2013; Miller-Day & Dodd, 2004; Miller-Day & Kam, 2010; Reimuller, Hussong, & Ennett, 2011; Zaharakis, Taylor, & Kliewer, 2015).

Within the field of family communication, an early generation of substance-use related research focused on addiction and the role of interpersonal communication in reinforcing substance use dependence (Le Poire, 1992, 1995; Thomas & Seibold, 1996). With inconsistent nurturing as control (INC) theory (Le Poire, 1992, 1995), Le Poire asserts that because of competing goals of nurturing and controlling, partners of substance-use-dependent individuals will unintentionally encourage the very behavior they are trying to extinguish through inconsistent manifestations of reinforcement (e.g., consuming alcohol with the alcohol-dependent person) and punishment (e.g., withdrawing sex from the alcohol-dependent person). This interpersonal influence approach to understanding addiction and dependence was soon logically expanded to include family interactions beyond marital relationships, with other scholars joining Le Poire to examine the reinforcement and punishment of SUDs during family interactions (Duggan, Dailey, & Le Poire, 2008; Duggan, Le Poire, & Addis, 2006; Duggan & Molineux, 2004; Le Poire, 2006; Le Poire, Erlandson, & Hallett, 1998). This body of research introduced a host of implications for prevention and early interventions for families (Duggan et al., 2006; Le Poire, 2006).

The next generation of SUD family communication research was firmly fixed in examining parent-youth communication about substances and substance use. At the turn of the century, greater attention was paid to the central role of communication within the family and substance use outcomes. Miller-Day (2002, 2005a, 2005b, 2007, 2008) conducted research on how parents talk with youth about substances and substance use and the effectiveness of those conversations. This “drug talk” research was then further developed by Miller-Day and colleagues, qualitatively exploring the contexts of drug talks (Miller-Day & Dodd, 2004), adolescents’ interpretation of their parent’s antidrug messages within the context of past and current parental use (Ebersole, Miller-Day, & Raup-Krieger, 2014), parents antidrug socialization and alcohol and tobacco media literacy (Shin, Miller-Day, & Hecht, in press), and the development of an instrument to measure targeted parent-child communication about alcohol (Miller-Day & Kam, 2010).

Identifying the construct labelled as “targeted parent–child communication about substances” refers to one-time and ongoing, direct and indirect conversations specifically against substance use. Such conversations may include warning offspring about the negative consequences of substance use, discussing others who were in trouble because of using substances, providing suggestions for avoiding substance-use offers, or clearly stating disapproval of substance use. Given the anti-substance-use messages that characterize targeted parent–youth communication, youth who discuss substances and substance use with parents are more likely to develop anti-substance-use perceptions, and in turn, less likely to use substances. The development of the Miller-Day and Kam (2010) instrument to assess parent-youth conversations about alcohol was notable because it opened the door to a new line of research empirically assessing targeted parent-youth communication about numerous illicit substances.

This led to a third generation of SUD family communication research conducted by Kam (2011) and colleagues examining parent-adolescent communication about substances as a protective factor against adolescent substance use (Kam, 2011; Kam, Basinger, et al., 2015; Lee & Kam, 2015; Miller-Day & Kam, 2010), but also exploring peer prevention communication (Kam, 2011; Kam, Figueroa-Caballero, & Basinger, 2016a; Kam, Krieger, Basinger, & Figueroa-Caballero, 2016b; Kam & Wang, 2015), and ethnic similarities and differences between non-Latino/a Whites and Latinos/as in parent-youth communication about substances (Kam & Cleveland, 2011; Kam & Middleton, 2013; Kam, Potocki, & Hecht, 2014a; Kam, Wang, & Harvey, 2014b; Kam & Yang, 2014).

This line of research contributed a great deal to understanding parent-youth communication about substance use, illuminating how parents shape youths’ anti-substance-use beliefs and behaviors and associating anti-substance-use beliefs with lower substance use rates among youth, often utilizing longitudinal survey data. This research also revealed that anti-substance-use parent-youth communication has the potential to protect against the negative effects of certain cultural stressors that Latino/a early adolescents face. Kam, Castro, et al. (2015) found that across a one-year period, more frequent engagement in anti-substance-use parent-youth communication attenuated the indirect effects of perceived ethnic/racial discrimination on alcohol consumption through depressive symptoms.

Kam and colleague’s research also revealed that non-Latino/a White and Latino/a youth who participated in parent-youth conversations about substance use were more likely to report that, if their friend used substances, they would talk to their friend, seek help from others, and potentially end the friendship; additionally, these youth were also less likely to ignore the friend’s substance use (Kam et al., 2014a; Kam & Yang, 2014). Kam, Basinger, et al.’s (2015) research along with Ebersole et al.’s (2014) investigation revealed how parents’ mixed messages about substance use impedes the effectiveness of anti-substance-use messages. For example, parents may ask youth not to drink, but then be the “designated driver” providing safe rides home for their adolescent children after drinking, or tell youth that they can drink at special occasions or under their supervision (Ebersole et al., 2014). The presence of contradictory messages may attenuate the protective nature of targeted parent–child communication.

A number of other scholars have examined family communication and substance use since the turn of the century contributing useful knowledge for both prevention and treatment. Contributing to the family communication literature and providing useful information about parenting practices that might serve to protect youth from SUD, Jackson and Dickson (2011) found that youth have significantly lower rates of smoking intention and initiation when parents engage in antismoking socialization, even if parents currently smoked. Similarly, Menegatos, Lederman, and Floyd (2016) discovered that parent-youth conversations about alcohol use rules had a significant, negative association with students’ alcohol consumption; however, they also discovered that if parents focused too much on the negative aspects of alcohol use this could have a boomerang effect, leading to an increase in students’ dangerous drinking.

Other study findings reinforce the importance of discussing clear alcohol use rules and expectations with youth (Baxter, Bylund, Imes, & Routsong, 2009; Bourdeau, Miller, Vanya, Duke, & Ames, 2012), the value of an authoritative parenting in preventing youth substance use (Baxter, Bylund, Imes, & Scheive, 2005; Stephenson, Quick, Atkinson, & Tschida, 2005), and the unique challenges provided by families with an alcoholic parent (Haverfield & Theiss, 2016; Haverfield, Theiss, & Leustek, 2016).

Theories guiding family communication and substance use research

The early generation of substance use related research that focused on addiction, and the role of interpersonal communication in labelling and reinforcing substance use dependence was guided by inconsistent nurturing as control (INC) theory (Le Poire, 1992, 1995), which is a theory developed within the field of communication. By contrast, theories guiding later generations of communication research tend to be appropriated from other fields of study. For example, the primary theories guiding the research addressing parent-youth communication about substances include social learning theory (Bandura, 1986), primary socialization theory (Oetting & Donnermeyer, 1998), and the ecological systems theory (Bronfenbrenner, 1994). Scholars interested in family communication and substance use have been drawn to these theories because the theories suggest that parents’ attitudes and behaviors have a crucial impact on their offspring’s attitudes, behaviors, and view of the world.

In short, parents and family systems exert a powerful influence over youth, and communication within the family is consequential. Primary socialization theory is employed most often because Oetting and colleagues argue that youth develop certain norms, attitudes, and values regarding substance use (and other delinquent behavior) through their direct interactions with parents, peers (and friends), and school, as well as their indirect interactions with associational groups (e.g., clubs, volunteer groups, or sports teams), extended family, religious institutions, communities, and media (Oetting & Donnermeyer, 1998). Although a number of primary and secondary sources shape youth’s substance use beliefs and behaviors, primary socialization theory predicts that if parents engage in anti-substance-use conversations with their youth, the youth will likely develop anti-substance-use beliefs, and in turn, less likely to engage in substance use (Kam & Middleton, 2013).

A preview of this special issue

In this special issue, the studies represent qualitative and quantitative methodologies, utilizing semistructured interviews or surveys with early adolescent and young-adult samples primarily from the United States. We know that effective prevention approaches are required before and after symptoms become apparent, because substance use disorders are chronic and relapsing or recurring in nature. So, the studies represented in this special issue examine communication in both primary prevention and early intervention. The first two research articles address primary prevention of substance use, focusing particularly on how substance-specific prevention communication operates within early adolescents’ family communication environment to predict adolescents’ substance use. The latter two research articles address early intervention, focusing particularly on the ways in which parents and siblings help or hinder young adults coping with a substance use disorder. All four research articles emphasize the important role that families play in substance use developmental trajectories, from early experimentation to identifying a disorder to coping with the disorder. Such work enhances our understanding of substance use prevention, intervention, and coping, but also reveals the gaps that remain to be filled by family communication scholarship. In the following section, we offer a summary of each research article in this issue and discuss their commonalities.

In the first research article, Choi and colleagues (2017) identified different subgroups (i.e., profiles) of rural early adolescents based on the adolescents’ substance-specific prevention communication (SSPC; e.g., warning, hinting, establishing family rules against use) and their family communication environment. Past research (e.g., Kafka & London, 1991) has primarily focused on: (a) general openness or frequency of parent-child communication in relation to adolescent substance use, and more recently, (b) how SSPC relates to adolescent substance use (Kam & Middleton, 2013; Miller-Day & Kam, 2010). To extend such research, Choi and colleagues suggested that the effects of SSPC on adolescent substance use likely depend on their family communication environment, as characterized by their expressiveness, structural traditionalism, and avoidance. Families may engage in different types of SSPC strategies depending on the type of family communication environment (Miller-Day, 2008).

Consequently, Choi and colleagues inquired as to whether their sample of rural early adolescents could be divided into subgroups based on particular SSPC strategies that their parents utilized (e.g., warning, expressing disapproval, conveying family rules), as well as their family communication environment. Utilizing latent profile analysis, the authors found four profiles, which they labeled as: Active-Open (i.e., high SSPC, high expressiveness, high structural traditionalism, relatively high avoidance), Passive-Open (i.e., low SSPC, high expressiveness, medium-to-relatively-high structural traditionalism, medium-to-relatively-low avoidance), Active-Silent (i.e., high SSPC, low expressiveness, medium-to-relatively-high structural traditionalism, relatively high avoidance), and Passive-Silent (i.e., low SSPC, low expressiveness, low structural traditionalism, low avoidance). After tracking the changes in alcohol and tobacco use over a two-year period, they found that the Passive-Silent profile engaged in significantly greater alcohol and cigarette use than the other profiles; they were most at risk for alcohol and cigarette use.

By contrast, Active-Open adolescents exhibited the lowest rates of alcohol and cigarette use over the two-year period, thereby leading Choi and colleagues to conclude that substance-use prevention programs might encourage high SSPC, high expressiveness, low traditionalism, and low levels of topic avoidance in families. They also pointed out the need for family communication scholars interested in substance use prevention to consider the heterogeneity among early adolescents and their families. Given that some families may differ in their family communication environments and SSPC, substance use preventionists and family communication scholars may need to develop programs that take into account different parent prevention communication profiles.

Like Choi and colleagues, Pettigrew and colleagues (2017) emphasized the importance of considering SSPC and family communication environments in predicting early adolescents’ lifetime alcohol use. Pettigrew et al., however, extends our understanding of how the two communication processes operate together by considering their applicability to an international sample of Nicaraguan early adolescents. Among 499 early adolescents in the western region of Nicaragua, Pettigrew et al. found that family expressiveness was indirectly related to early adolescents’ lifetime alcohol use through SSPC. Stated differently, the more Nicaraguan early adolescents felt they could be expressive with their parents, the more likely they were to report engaging in SSPC, and in turn, the less likely they were to report lifetime alcohol use.

What is particularly fascinating about Pettigrew et al.’s findings is that family expressiveness was not significantly directly related to lifetime alcohol use. Instead, it was only significantly indirectly related to lifetime alcohol use through SSPC. Consistent with past research by Miller-Day and Kam (2010), SSPC might play a unique and powerful role in alcohol prevention. Maintaining a warm and open family environment may make it easier for parents to engage in SSPC, but an open and warm environment was not enough on its own to prevent alcohol use among this sample of early adolescents. Thus, Pettigrew et al.’s finding reveals the importance of considering family communication environments, particularly expressiveness, in conjunction with SSPC when developing substance use prevention programs for early adolescents in Nicaragua and possibly in other regions, as well.

As Choi et al. and Pettigrew et al. focused on substance use prevention efforts aimed at early adolescents, Middleton and colleagues (2017) were interested in how parents communicatively respond to their adult child’s problematic substance use, as well as the barriers that prevent parents from communicating their concerns to their adult child. More specifically, Middleton et al. conducted semistructured interviews with 24 parents of young adults who had a problem with substance use. Although past research on SUDs has primarily encouraged parents and other family members to confront the individual with the disorder, Middleton and colleagues argued for a more nuanced approach to understanding the communication challenges and strategies that parents face when interacting with a young adult child who has a SUD. Based on a normative approach (Goldsmith, 2004), Middleton et al. identified a number of reasons why parents might avoid intervening in their adult child’s substance use disorder, as perceived by the parent.

For example, parents were hesitant to discourage their adult child from using substances because of: (a) parents’ own past histories of using substances that threatened their credibility, (b) parents’ fear of ruining their relationship with their adult child, (c) differing views among family members as to whether parents should intervene in their adult child’s substance use, and (d) uncertainty regarding whether they could label their adult child’s substance use as problematic.

In response to such concerns, most parents engaged in topic avoidance and felt that any intervention attempts would be ineffective; however, some turned to third parties for assistance or social networking sites for more information. Other parents focused on their child’s safety instead of trying to stop their child from using substances. Parents who directly talked to their adult child about substance use were more likely to be relationally close to their child compared to parents who did not directly talk to their adult child about her/his substance use problem. In their research article, Middleton and colleagues advocate for a normative approach to understanding parents’ communication with an adult child who has a substance use disorder. Contrary to the popular belief that parents should directly confront their adult child when he/she has a substance use disorder, Middleton and colleagues argued that parents must manage multiple demands (e.g., maintaining their relationship or ensuring that their child is safe), some of which might require more indirect and avoidant strategies at times.

Similar to Middleton et al., Glowacki (2017) was interested in understanding family communication surrounding problem drinking. Through semistructured interviews with 35 young adult college students, Glowacki explored the ways in which young-adult siblings communicate about problematic or excessive drinking. Utilizing inconsistent nurturing as control theory (Le Poire, 1995), Glowacki examined how siblings reinforce and punish young adults to discourage them from drinking alcohol excessively and in problematic ways throughout the prelabel, postlabel, and postfrustration phases. Contrary to expectations that older siblings would label a younger sibling’s drinking as excessive or problematic, Glowacki instead found that 71% of younger siblings labeled an older sibling’s drinking as problematic or excessive. She identified four types of power distributions among siblings:

“equal and open with one another (friend-like relationship), one sibling in control (parent-like sense of power), contextual power (i.e., parents’ divorce, sibling substance abuse), and maintaining power through one’s personality” (p. 79).

Siblings could identify moments when they labeled the other as excessively drinking, but many engaged in reinforcing behavior by drinking with their sibling or avoiding the topic. Drinking alcohol together was a way for siblings to bond. If a sibling came to the point where he or she perceived some sort of intervention was needed, this often led to confrontation. The articulated motives behind these confrontations were to increase the sibling’s awareness of the excessive drinking, but not to punish him/her for excessive drinking. Over half of the siblings felt that they could not stop the sibling from drinking excessively, thereby indicating a lack of efficacy. Overall, siblings were able to label drinking as problematic, which coincides with INC theory, although the ways in which siblings enacted reinforcement and punishment appeared different from the reinforcement and punishment behaviors used among romantic partners and parents and children. Glowacki suggested that because sibling relationships are not as hierarchically structured as parent-child relationships, siblings may engage in confrontation rather than punishment.

All four research articles converge on many key points, the primary one being that “one size does not fit all” when it comes to family communication and its role in substance use prevention, intervention, and coping (Choi et al., 2017; Miller-Day, 2002). Choi and colleagues demonstrate this point by identifying four distinct profiles of parent-child communication that differ in their associations with early adolescent substance use. Choi et al. argue that parent prevention communication patterns might vary by families; therefore, it is important to consider the multiple strategies that parents might use to discourage substance use among adolescents, some of which were more effective than others. Similarly, Pettigrew and colleagues suggest that engaging in SSPC might depend on an adolescents’ family communication environment. Both Choi et al. and Pettigrew et al. provide evidence for the protective nature of SSPC, but also reveal that certain family communication environments (e.g., high expressiveness) create a supportive environment for SSPC to occur.

Related to the point that Choi et al. and Pettigrew et al. make, Middleton and colleagues also argue against a “one size fits all” approach. The authors identify communication challenges that parents face when their young-adult child has a SUD and explore how they deal with such challenges, beyond merely confronting the young-adult child.

Based on the normative approach, Middleton and colleagues point out that although direct confrontation is a strategy that is often employed as an intervention strategy, indirect and avoidant strategies might be more effective at times. Consistent with the other authors, Glowacki argues for considering the personalized messages that young-adult siblings use to discuss problematic or excess drinking, utilizing an inconsistent nurturing as control framework. She reports that siblings often employed more subtle strategies for confronting a substance-using sibling rather than employing the more direct forms of punishment reported in prior INCT research with romantic couples.

All four research articles move away from a general view of family communication and its impact on substance use prevention, intervention, and coping. Instead, they all argue for substance-specific prevention or intervention communication. Efforts were made to understand the multiple messages that family members exchange when discussing substance use, identifying specific message content, while also identifying circumstances in which a lack of communication occurred (i.e., avoidance). The authors of all four research articles touch upon issues of openness (e.g., talking about substance use) versus closedness (e.g., avoiding the topic of substance use), adapting one’s messages to the situation (e.g., employing direct or indirect strategies), and the family environment (e.g., expressiveness, structural traditionalism, avoidance, relational closeness). Such foci highlight the complex nature of family communication about substance use.

Future research directions

In the field of family communication, there have been several generations of SUDs research. This special issue highlights the current generation of work that integrates family communication environments with SSPC and that argues for more strategic communication that can meet the multiple goals of the various parties involved (e.g., the parent and the substance user), as well as the relational context (e.g., siblings, romantic partners, parents and offspring). With over three generations of family communication research focusing on SUDs, one might assume that this area of study is past its prime. We, however, discovered in our review of the literature and in editing this special issue that many questions still remain regarding the role of family communication in SUDs prevention, intervention, and coping. Moreover, President Obama’s recently proposed $31.1 billion budget to assist the National Drug Control Strategy (National Drug Control Budget, 2016, p. 2) conveys a sense of urgency and importance for family communication scholars to identify theoretical- and evidence-based communication strategies that can support such efforts. Thus, in this section, we identify several gaps within family communication SUDs research, and we offer suggestions for future work on this topic.

Although substance use includes alcohol, tobacco/nicotine, e-cigarettes, marijuana, cocaine, heroin, and prescription drugs, among others, the four research articles in this special issue primarily focused on alcohol and tobacco consumption, which is reflective of the field of family communication and SUDs research. With the ongoing opioid overdoses, the introduction of e-cigarettes, and the legalization of marijuana in some states in the United States, it is time to broaden our attention to such substances and beyond (Johnston, O’Malley, Miech, Bachman, & Schulenberg, 2016). Each substance has certain unique characteristics, which may lead to different types of beliefs and experiences surrounding that particular substance. Such distinct beliefs and experiences may garner particular types of family communication. For example, Kam et al. (2016a) conducted interviews with high school students to identity different messages that high school students exchanged with friends about substance use. They found that students talked to their friends about the legalization of marijuana, and they used code words to refer to marijuana use (e.g., “Want to go bowling?”).

Such discussions were unique to marijuana use, particularly given the ongoing media coverage surrounding the legalization of marijuana in certain states, but this type of discussion might not be as applicable to other substances. In addition to Kam et al. (2016a), national survey data from Monitoring the Future revealed that 8^th, 10^th, and 12^th grade students varied in their disapproval and perceived risks of different substances (Johnston et al., 2016). Thus, it is possible that each substance may have distinct beliefs associated with it, which may in turn, stimulate different types of family communication. The effectiveness of a message may depend on how well family members can adapt their messages in response to the unique characteristics and experiences attached to a particular substance.

In addition to studying family communication in relation to a variety of substances, this area of research would benefit from taking a life-span approach. By life-span approach, we refer to two areas: (a) human development (early childhood to older adulthood), as well as (b) substance-use development (early experimentation to later misuse). From a human development standpoint, much of family communication research on SUDs focuses on early adolescents (e.g., Ebersole et al., 2014; Miller-Day & Kam, 2010; Reimuller et al., 2011) or young adults (e.g., Menegatos et al., 2016; Miller-Day & Dodd, 2004). Concentrating on these particular developmental periods is crucial, given the evidence that suggests anti-substance-use socialization at an early age might be more successful in preventing future SUDs than starting at a later age (Hopfer et al., 2010) and the prevalence of substance use in young adulthood (Glowacki, 2017; Middleton et al., 2017).

Despite the benefits of studying family communication among early adolescents prior to substance use experimentation or to developing an SUD, more family communication research is needed among participants in midlife or older adulthood. For example, both the National Institute on Drug Abuse (2011) and the National Council on Alcoholism and Drug Dependence (2015) describe older adults (age 65+) as a vulnerable population to developing SUDs because of the loss in quality relationships as friends and family members pass away and the experience of physical decline, which might lead older adults to turn to substance use as a coping mechanism. Furthermore, diagnosis of an SUD among older adults may be difficult because the symptoms might appear similar to other types of health problems common in older adulthood, and older adults might keep such information private from family members. Thus, this area of research would benefit from family communication scholars studying issues of privacy management and self-disclosures among older adults engaging in substance use, family members’ communication surrounding an aging parent or sibling’s SUD, and supportive family communication as a protective factor against SUDs among older adults.

Although Kam and colleagues have focused extensively on parent-youth communication about substance use among Latino/a early adolescents, additional research is needed to better prevent the onset of SUDs among various cultural groups. For example, national survey data from Monitoring the Future (Johnston et al., 2016) revealed that Latino/a 8^th grade students reported the highest rates of nearly all types of substances compared to non-Latino/a White or Black 8^th grade students. With respect to 12^th grade students, Latinos/as reported the highest rates of use in marijuana, inhalants, cocaine, crack, and methamphetamine compared to non-Latino/a White or Black 12^th grade students. Much of the work, however, on parent-youth communication about substance use initially focused on non-Latino/a White samples, with Kam and colleagues focusing more recently and more extensively on Latino/a early adolescents (Kam & Middleton, 2013; Kam et al., 2015b; Kam & Yang, 2014).

In Kam and colleagues’ work, they employed a survey measure of targeted parent-child communication about substance use that was based on a non-Latino/a White, young adult sample from Miller-Day and Dodd (2004). Although that survey measure has been validated among Latino/a early adolescent samples, Reid-Quiñones (2011) is one of the first to conduct qualitative focus group discussions to identify parent-youth communication about substance use among a Latino/a sample. Some messages overlapped with past research on non-Latino/a White samples, but she also identified new messages about respect for family and adhering to religious beliefs that may more closely align with Latino/a samples. Proponents of culturally adapted and culturally grounded substance-use prevention and intervention programs have emphasized the importance of identifying effective strategies that are rooted in the cultural group of focus (Barrera, Castro, Strucker, & Toobert, 2013). Culturally adapted and culturally grounded work may garner more “buy-in” from members of a particular cultural group because the messages are likely to be more relevant to them; therefore, additional work that takes into account the cultural backgrounds of the participants would be fruitful.

In addition to taking multiple substances into account, the life-span perspective, and culture, family communication research could potentially be at the forefront of investigating how family communication within treatment contexts could facilitate recovery and identify processes that might impede treatment. Individuals with SUDs whose families are involved in care are more compliant with treatments and experience more positive outcomes than those who do not have the involvement and support of family members (Rotunda, O’Farrell, Murphy, & Babey, 2008). Yet, lack of information, exclusion from treatment, and inability to contact providers are common complaints of family members who want to provide help (England-Kennedy & Horton, 2011).

Additional research is necessary to understand more about the role of family communication in developing, implementing, and adhering to treatment plans, the challenges with drug testing an individual with an SUD, and, most significantly, the role of family support in seeking and completing treatment, attaining recovery, and in maintaining healthy behaviors moving forward. Beyond family therapy, perhaps scholars in family communication could partner with clinical personnel to conduct this much-needed research and develop efficacious interventions for families with a member who has an SUD.

Given the significance of family communication and other family processes in preventing SUDs, families are logical contexts for substance use prevention intervention efforts. Consequently, numerous family based prevention programs have been developed to address substance use. Most of these projects, to our knowledge, have been developed and are implemented by scholars outside of the field of family communication, although the focus of the majority of these interventions is to enhance family communication. Most SUD family-based programs emphasize the manners in which parenting and family communication, in particular, can impact adolescent substance use and related problem behaviors. These programs work with family members in an attempt to modify and manage beliefs, communication processes, and behaviors within the family and create positive change in both individual behavior and family interaction patterns (Kuntsche & Kuntsche, 2016).

For example, the “Familias: Preparing the Next Generation” program (Marsiglia, Williams, Ayers, & Booth, 2014) provides training to Latino/a parents in setting rules and expectations with youth around substance use, as well as training in how to have effective conversations with youth on this topic. In addition, “Familias Unidas” (Prado et al., 2012) is a parent-centered group intervention for Latinos/as in the United States, which includes regular parent group meetings and includes individual family visits. The “Strengthening Families Program” (Kumpfer, 1998) is a set of lessons directed at parents, youth, and the family system with the general goal of building strong family ties, and it includes one lesson on substance use prevention. Some programs are more informational in nature, but presented in group settings or workshops.

For example, the Örebro prevention program (Koutakis, Stattin, & Kerr, 2008) includes a standardized 20-minute presentation on the importance of keeping strict rules on alcohol use for 11- to 13-year-old Latino/a children during a parent-teacher meeting in 7^th grade. The “Family Check-Up” program (Stormshak et al., 2011) is a three-session individual prevention program providing feedback focused on parental strengths. It employs motivational interviewing techniques to engage parents in a process of changing inappropriate parenting behaviors. All of these programs provide information and opportunities to practice parenting skills.

Many of the programs provide information and suggested best practices in the form on brochures, CD-ROMs, or web-based materials. The “Strengthening Families” program (Kumpfer, 1998) has a CD-ROM version of their program and “Smoke Free Kids” (Hiemstra et al., 2014) is based on five printed brochures each including detailed information for parents on how to prevent adolescent tobacco use by increasing communication with their children about smoking. There has also been some success in addressing college-aged substance use by involving parents through providing this kind of information. For example, “My Student Body program,” an online intervention for parents of college students (Donovan, Wood, Frayjo, Black, & Surette, 2012) and the “Parent-Based Intervention” program, where parents were sent a handbook by mail with information on alcohol abuse among college students and its effects, techniques for improving parent-teen communication, and advice on how to help teens become more assertive and resist peer pressure (Turrisi et al., 2013).

If the field of family communication is to have a larger impact on promoting a nation of healthy families, then family communication scholars must begin to translate their work into programs, practices, or even products that might be useful in health promotion, prevention, treatment, or recovery of behavioral health issues such as SUD. There has been a strong push for translational research from world health agencies for more than a decade encouraging scholars to participate in translational research to improve public health (World Health Organization, 2003). Translational research describes a process of transforming basic research discoveries into innovations. Type 1 translational research applies basic science discoveries to the development and preliminary or pilot testing of innovations, which for example, might include information campaigns, a product, or interventions for the prevention or treatment of a health issue (Khoury et al., 2007).

During Type I translation, researchers develop the innovation, determine whether it works as intended (efficacy), and discuss the implications for future development and refinement of the innovation. Type II translational involves a rigorous evaluation of those innovations within targeted settings (e.g., in family households) (Khoury et al.). During Type II translational research, researchers examine if the innovation works in practice in the field (effectiveness), examine how people use it, and examine the costs related to use (Khoury et al.). Type III translational research builds on the earlier efficacy and effectiveness studies to widely disseminate and implement the innovation, examine how people use it in real life, see if it is being implemented in the same way as intended, and assess the sustainability of its use (Khoury et al.). Translational research is an endeavor with many opportunities for developing partnerships across disciplines and outside of the academy.

Collaborations with others are both exciting and a bit frightening because many of us are not trained to do this sort of work. Nevertheless, if we are truly to make a difference in health promotion and the prevention, treatment, coping, and recovery of SUDs in families, a new generation of collaborative research must occur that examines, explicates, and addresses the role of family communication in substance use and SUDs. A new generation of scholarship that, perhaps like the studies represented in this special issue, could lead to the development of new theories and meaningful innovations for the families of tomorrow.