Family Functioning and its Association with Alcohol Use Disorder among Adolescents in Southwestern Uganda: A Cross-Sectional Study

Abstract

This study investigates the association between family functioning and the severity of alcohol use disorders (AUD) among adolescents in Southwestern Uganda. Focusing on dimensions such as family cohesion, adaptability, communication, and satisfaction, the research explores how familial relationships and sociodemographic factors influence adolescent alcohol use. A cross-sectional study was conducted from September to December 2019 in Ibanda District, involving 308 adolescents aged 10 to 19 years. Participants were selected through multistage sampling, and data were collected using the Alcohol Use Disorders Identification Test (AUDIT) and the Family Adaptability and Cohesion Evaluation Scale IV (FACES IV). Ordered logistic regression was used to assess predictors of AUD severity. The findings revealed that 21.1% of participants were classified as hazardous drinkers, 9.1% as harmful drinkers, and 9.7% as dependent drinkers. Higher levels of family cohesion were associated with increased odds of more severe AUD classification (OR = 1.14, p<0.001), suggesting possible enabling or permissive dynamics in certain family contexts. In contrast, higher levels of adaptability (OR = 0.79, p<0.001) and satisfaction (OR = 0.82, p= 0.003) were protective against severe alcohol use. Additionally, lower household income, non-nuclear living arrangements, and unstable family structures were significantly associated with greater AUD severity. These findings underscore the critical role of family dynamics and socioeconomic conditions in shaping adolescent alcohol use behaviours. The study highlights the need for family-centred and context sensitive interventions that strengthen adaptability and satisfaction within the family unit, while also addressing underlying structural vulnerabilities.