From Wikipedia, the free encyclopedia
Alcoholism in family systems refers to the conditions in families that enable alcoholism,
and the effects of alcoholic behavior by one or more family members on
the rest of the family. Mental health professionals are increasingly
considering alcoholism and addiction as diseases that flourish in and are enabled by family systems.
Family members react to the alcoholic with particular behavioral
patterns. They may enable the addiction to continue by shielding the
addict from the negative consequences of their actions. Such behaviors
are referred to as codependence. In this way, the alcoholic is said to suffer from the disease of addiction, whereas the family members suffer from the disease of codependence.
While it is recognized that addiction is a family disease, affecting
the entire family system, "the family is often ignored and neglected in
the treatment of addictive disease."
Each individual member is affected and should receive treatment for
their own benefit and healing, but in addition to benefitting the
individuals themselves, this also helps to better support the
addict/alcoholic in his/her recovery process. "The chances of recovery
are greatly reduced unless the co-dependents are willing to accept their
role in the addictive process and submit to treatment themselves." "Co-dependents are mutually dependent on the addict to fulfill some need of their own."
For example, the "Chief Enabler" (the main enabler in the family)
will often turn a blind eye to the addict's drug/alcohol use as this
allows for the enabler to continue to play the victim and/or martyr
role, while allowing the addict to continue his/her own destructive
behavior. Therefore, "the behavior of each reinforces and maintains the
other, while also raising the costs and emotional consequences for
both."
Alcoholism is one of the leading causes of a dysfunctional family.
"About one-fourth of the U.S. population is a member of family that is
affected by an addictive disorder in a first-degree relative."
As of 2001, there were an estimated 26.8 million children of alcoholics
(COAs) in the United States, with as many as 11 million of them under
the age of 18. Children of addicts have an increased suicide rate and on average have total health care costs 32 percent greater than children of nonalcoholic families.
According to the American Psychiatric Association, physicians
stated three criteria to diagnose this disease: (1) physiological
problems, such as hand tremors and blackouts, (2) psychological
problems, such as excessive desire to drink, and (3) behavioral problems
that disrupt social interaction or work performance.
Adults from alcoholic families experience higher levels of state and trait anxiety and lower levels of differentiation of self than adults raised in non-alcoholic families. Additionally, adult children of alcoholics have lower self-esteem, excessive feelings of responsibility, difficulties reaching out, higher incidence of depression, and increased likelihood of becoming alcoholics.
Parental alcoholism may affect the fetus even before a child is
born. In pregnant women, alcohol is carried to all of the mother's
organs and tissues, including the placenta, where it easily crosses
through the membrane separating the maternal and fetal blood systems.
When a pregnant woman drinks an alcoholic beverage, the concentration of
alcohol in her unborn baby's bloodstream is the same level as her own. A
pregnant woman who consumes alcohol during her pregnancy may give birth
to a baby with fetal alcohol syndrome (FAS).
FAS is known to produce children with damage to the central nervous
system, general growth and facial features. The prevalence of this class
of disorder is thought to be between 2–5 per 1000.
Alcoholism does not have uniform effects on all families. The
levels of dysfunction and resiliency of the non-alcoholic adults are
important factors in effects on children in the family. Children of
untreated alcoholics score lower on measures of family cohesion,
intellectual-cultural orientation, active-recreational orientation, and
independence. They have higher levels of conflict within the family, and
many experience other family members as distant and non-communicative.
In families with untreated alcoholics, the cumulative effect of the
family dysfunction may affect the children's ability to grow in
developmentally healthy ways.
Family roles
The
role of the "Chief Enabler" is typically the spouse, significant other,
parent, or eldest child of the alcoholic/addict. This person
demonstrates "a strong tendency to avoid any confrontation of the
addictive behavior and a subconscious effort to actively perpetuate the
addiction." The "Chief Enabler" also often doubles as the "Responsible One," or "Family Hero"
another role assumed by family members of the alcoholic/addict. Both
the "Chief Enabler" and "Responsible One" (aka "Model Child"[4]) will take "over [the alcoholic/addict's] roles and responsibilities." For example, a parent might pay for expenses and take over
responsibilities (i.e. car payments, the raising of a grandchild,
provide room and board, etc.), while a child may provide care for their
siblings, become the "peace keeper" in the home, take on all the chores
and cooking, etc. A spouse or significant other may overcompensate by
providing all the care to the children, being the sole financial
contributor to the household, covering up or hiding the addiction from
others, etc. This role often receives the most praise from non-family
members, causing the individual to struggle to see that it is an
unhealthy role which contributes to the addict/alcoholic's disease as
well as the family's dysfunction.
Another role is that of the "Problem Child" or "Scapegoat." This person "may be the only [one] clearly seen as having a problem"
outside of the actual addict/alcoholic. This child (or adult child of
the alcoholic(s)) "gets blamed for everything; they have problems at
school, exhibit negative behavior, and often develop drug or alcohol
problems as a way to act out. Their behavior demands whatever attention
is available from parents and siblings."
This often "takes the focus off the parental alcohol problem," and the
child can be the "scapegoat" under the myth that his/her behavior fuels
the parent's drinking/using.
However, this child draws attention from outsiders, which may
contribute to the recognition of the family alcohol problem by
outsiders.
The "Lost Child" role is identified in this system through
children that are "withdrawn, 'spaced-out,' and disconnected from the
life and emotions around them."
They often avoid "any emotionally confronting issues, [and so are]
unable to form close friendships or intimate bonds with others."
Other children "trivialize things by minimizing all serious
issues as an avoidance strategy [and] are well liked and easy to
befriend but are usually superficial in all relationships, including
those with their own family members." These children are known as the "Mascot" or "Family Clown."
However, alcoholic family roles have not withstood the standards that psychological theories of personality are typically subjected to. The evidence for alcoholic family roles theory provides limited or no construct validity or clinical utility.
Prevalence
Based
on the number of children with parents meeting the DSM-V criteria for
alcohol abuse or alcohol dependence, in 1996 there were an estimated
26.8 million children of alcoholics (COAs) in the United States of which
11 million were under the age of 18.
As of 1988, it was estimated that 76 million Americans, about 43% of
the U.S. adult population, have been exposed to alcoholism or problem
drinking in the family, either having grown up with an alcoholic, having
an alcoholic blood relative, or marrying an alcoholic.
While growing up, nearly one in five adult Americans (18%) lived with
an alcoholic. In 1992, it was estimated that one in eight adult American
drinkers were alcoholics or experienced problems as consequences of
their alcohol use.
Familiality
Children
of alcoholics (COAs) are more susceptible to alcoholism and other drug
abuse than children of non-alcoholics. Children of alcoholics are four
times more likely than non-COAs to develop alcoholism. Both genetic and
environmental factors influence the development of alcoholism in COAs.
COAs perceptions of their parents drinking habits influence their
own future drinking patterns and are developed at an early age. Alcohol
related expectancies are correlated with parental alcoholism and
alcohol abuse among their offspring.
Problem solving discussions in families with an alcoholic parent
contained more negative family interactions than in families with
non-alcoholics parents.
Several factors related to parental alcoholism influence COA substance
abuse including stress, negative affect and decreased parental
monitoring. Impaired parental monitoring and negative affect correlate
with COAs associating with peers that support drug use.
After drinking alcohol, sons of alcoholics experience more of the
physiological changes associated with pleasurable effects compared with
sons of non-alcoholics, although only immediately after drinking.
Compared with non-alcoholic families, alcoholic families
demonstrate poorer problem-solving abilities, both among the parents and
within the family as a whole. These communication problems many
contribute to the escalation of conflicts in alcoholic families. COAs
are more likely than non-COAs to be aggressive, impulsive, and engage in
disruptive and sensation seeking behaviors.
Alcohol addiction is a complex disease that results from a variety of
genetic, social, and environmental influences. Alcoholism affected
approximately 4.65 percent of the U.S. population in 2001–2002,
producing severe economic, social, and medical ramifications (Grant
2004). Researchers estimate that between 50 and 60 percent of alcoholism
risk is determined by genetics (Goldman and Bergen 1998; McGue
1999).This strong genetic component has sparked numerous linkage and
association studies investigating the roles of chromosomal regions and
genetic variants in determining alcoholism susceptibility.
Marital relationships
Alcoholism
usually has strong negative effects on marital relationships. Separated
and divorced men and women were three times as likely as married men
and women to say they had been married to an alcoholic or problem
drinker. Almost two-thirds of separated and divorced women, and almost
half of separated or divorced men under age 46 have been exposed to
alcoholism in the family at some time.
Exposure was higher among women (46.2 percent) than among men
(38.9 percent) and declined with age. Exposure to alcoholism in the
family was strongly related to marital status, independent of age: 55.5
percent of separated or divorced adults had been exposed to alcoholism
in some family member, compared with 43.5 percent of married, 38.5
percent of never married, and 35.5 percent of widowed persons. Nearly 38
percent of separated or divorced women had been married to an
alcoholic, but only about 12 percent of currently married women were
married to an alcoholic.
Children
Prevalence of abuse
Over one million children yearly are confirmed as victims of child abuse and neglect
by state child protective service agencies. Substance abuse is one of
the two largest problems affecting families in the United States, being a
factor in nearly four-fifths of reported cases. Alcoholism is more
prevalent among child abusing parents. Alcoholism is more strongly
correlated to child abuse than depression and other disorders.
Adoption plays only a slight role in alcoholism in the family.
Studies were done comparing children who were born into a family with an
alcoholic parent and raised by adoptive (non-alcoholic) parents as
compared to children born to non-alcoholic parents and raised by adopted
alcoholic parents. The results (in US and Scandinavian studies) were
that those adopted children born of an alcoholic parent (and adopted by
non-alcoholic parents ) developed alcoholism at higher rates as adults.
Correlates
Children
of alcoholics exhibit symptoms of depression and anxiety more than
children of non-alcoholics. COAs have lower self-esteem than non-COAs
from childhood through young adulthood.
Children of alcoholics show more symptoms of anxiety, depression, and
externalizing behavior disorders than non-COAs. Some of these symptoms
include crying, lack of friends, fear of going to school, nightmares,
perfectionism, hoarding, and excessive self-consciousness.
Many children of alcoholics score lower on tests measuring
cognitive and verbal skills than non-COAs. Lacking requisite skills to
express themselves can impact academic performance, relationships, and job interviews. The lack of these skills do not, however, imply that COAs are intellectually impaired.
COAs are also shown to have difficulty with abstraction and conceptual
reasoning, both of which play an important role in problem-solving
academically and otherwise.
In her book Adult Children of Alcoholics, Janet G. Woititz
describes numerous traits common among adults who had an alcoholic
parent. Although not necessarily universal or comprehensive, these
traits constitute an adult children of alcoholics syndrome (cf. the work of Wayne Kritsberg).
Coping Mechanism
Suggested practices to mitigate the impact of parental alcoholism on the development of their children include:
- Maintaining healthy family traditions and practices, such as vacations, mealtimes, and holidays
- Encouraging COAs to develop consistent, stable, relationships with significant others outside of the family.
- Planning non-drinking activities to compete with alcoholic behaviour and tendencies.
Resilience
Professor
and psychiatric Dieter J. Meyerhoff state that the negative effects of
alcohol on the body and on health are undeniable, but we should not
forget the most important unit in our society that this is affects the
family and the children. The family is the main institution in which
the child should feel safe and have moral values. If a good starting
point is given, it is less likely that when a child becomes an adult,
has a mental disorder or is addicted to drugs or alcohol.
According to the American Academy of Child and Adolescent Psychiatry
(AACAP) children are in a unique position when their parents abuse
alcohol. The behavior of a parent is the essence of the problem,
because such children do not have and do not receive support from their
own family. Seeing changes from happy to angry parents, the children
begin to think that they are the reason for these changes.
Self-accusation, guilt, frustration, anger arises because the child is
trying to understand why this behavior is occurs.
Dependence on alcohol has a huge harm in childhood and adolescent
psychology in a family environment. Psychologists Michelle L. Kelley
and Keith Klostermann describe the effects of parental alcoholism on
children, and describe the development and behavior of these children.
Alcoholic children often face problems such as behavioral disorders,
oppression, crime and attention deficit disorder, and there is a higher
risk of internal behavior, such as depression and anxiety. Therefore,
they are drinking earlier, drinking alcohol more often and are more
likely to grow from moderate to severe alcohol consumption. Young
people with parental abuse and parental violence are likely to live in
large crime areas, which may have a negative impact on the quality of
schools and increase the impact of violence in the area. Paternity
alcoholism and the general parental verbal and physical spirit of
violence witnessed the fears of children and the internalization of
symptoms, greater likelihood of child aggression and emotional
misconduct.
Research on alcoholism within families has leaned towards exploring
issues that are wrong in the community rather than potential strengths
or positives.
When researchers conduct research that helps communities, it can be
easier for community members to identify with the positives and work
towards a path of resilience. Flawed research design in adult children
of alcoholics (ACOA) research showed ACOAs were psychologically damaged.
Some flawed research designs include using ACOAs as part of the control
group and comparing them to other ACOAs within the same study. This may
have caused some limitations in the study that were not listed. When
comparing ACOAs to other ACOAs, it is difficult to interpret accurate
results that show certain behaviors in the group studied. Research that
has been conducted more recently has used control groups with non-ACOAs
to see whether the behaviors align with prior research. This research
has shown that behaviors were similar between non-ACOAs and ACOAs. An
18-year-long study compared children of alcoholics (COA) to other COAs.
In failing to use non-COAs as controls, we miss an opportunity to see if
the negative aspects of a person are related to having an alcoholic
parent, or are they just simply a fact of life. For example, in Werner's study, he found that 30% of COAs were committing serious delinquencies.
This data would have been more usable if they had viewed the percentage
of those committing crimes when compared to non-ACOAs. In a study
conducted in a midwestern university, researchers found that there was
no significant difference between ACOA and non-ACOA students. One of the
main differences was the student's views on how they connect their past
experiences with their current social-emotional functioning. Students
who were ACOAs did not demonstrate issues with their perspective on
their interpersonal issues any more than the non-ACA students. However,
this study did show that there were other underlying problems in the
family structure that may attribute to the perception of not being well
adjusted in life.
Due to the flawed research that has been conducted in the past, many stereotypes have followed ACOAs.
ACOAs have been identified as having a variety of emotional and
behavioral problems, such as sleep problems, aggression and lowered
self-esteem.
When it comes to being a COA or ACOA, there is still hope. Results
showed that a supportive and loving relationship with one of the parents
can counterbalance the possible negative effects of the relationship
with the alcoholic parent. When there is one alcoholic parent in the
household, it helps if the child relies on other family members for
support. It may be the second parent, siblings or members of the
extended family. Having other supportive family members can help the
child feel like s/he is not alone.
Younger generations of ACOAs scored more positively, in terms of coping
mechanisms. This may be due to fact that alcoholism is seen more as an
illness nowadays, rather than a moral defect. There has been less victim
blaming of alcoholism on parent's, because it has now been declared a
disease rather than a behavioral problem.
Studies show that when ACOAs use positive coping mechanisms, it is
related to more positive results. When an ACOA approaches their issues,
rather than avoids them, it often relates to having a positive outlook. Studies have shown that ACOAs and COAs have more compulsive behaviors that may cause the need for higher achievement.
Some ACOAs have shown that the only way to survive is to fend for
themselves. This causes a sense of independence that helps them become
more self-reliant. Because they perceive that independence and hard work
as necessary, ACOAs develop a sense of survival instinct.
Implications for Counselors
Counselors
serving ACOAs need to be careful to not assume that the client's
presenting problems are due solely to the parent's alcoholism. Exploring
the ACOAs life events, such as the number of alcoholic parents, length
of time the client lived with the alcoholic parent, past interventions,
and the role of extended family may help in determining what the correct
method of intervention may be.
Many factors can affect marital and/or parenting difficulties,
but there has not been any evidence found that can link these issues
specifically to ACOAs.
Research has been conducted to try to identify issues that arise when
someone is a COA. It has been hard to isolate these issues solely to the
fact that the child's parents are alcoholics. Other behaviors need to
be studied, like dysfunctional family relationships, childhood abuse and
other childhood stressors and how they may contribute to things like
depression, anxiety and bad relationships in ACOAs.
Counselors serving ACOAs can also help by working on building
coping mechanisms such as creating meaningful relationships with other
non-alcoholic family members. Having other family members who are
supportive can help the ACOA feel like they are not alone.
Counselors can also provide some psycho-education on alcoholism and its
effects on family members of alcoholics. Research shows that ACOAs feel
less like blaming their parents for their alcoholism after learning
that alcoholism is a disease, rather than a behavior.
Pregnancy
Prenatal
alcohol-related effects can occur with moderate levels of alcohol
consumption by non-alcoholic and alcoholic women. Cognitive performance
in infants and children is not as impacted by mothers who stopped
alcohol consumption early in pregnancy, even if it was resumed after
giving birth.
An analysis of six-year-olds with alcohol exposure during the
second-trimester of pregnancy showed lower academic performance and
problems with reading, spelling, and mathematical skills. 6% of
offspring from alcoholic mothers have Fetal Alcohol Syndrome
(FAS). The risk an offspring born to an alcoholic mothers having FAS
increases from 6% to 70% if the mother's previous child had FAS.
People diagnosed with FAS have IQs
ranging from 20–105 (with a mean of 68), and demonstrate poor
concentration and attention skills. FAS causes growth deficits,
morphological abnormalities, mental retardation,
and behavioral difficulties. Among adolescents and adults, those with
FAS are more likely to have mental health problems, dropping out or be
suspended from schools, problems with the law, require assisted living
as an adult, and problems with maintaining employment.
