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Alcoholism in family systems

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.[1] 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 his 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.[2][3]

Alcoholism is one of the leading causes of a dysfunctional family.[4] 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.[5] Children of addicts have an increased suicide rate and on average have total health care costs 32 percent greater than children of nonalcoholic families.[5][6]

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.[7]

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.[8] 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.[9]

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).[7] FAS (fetal alcohol syndrome) 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.[10]

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.[11][12]


Based on the number of children with parents meeting the DSM-III-R 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.[13] 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.[14] 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.[15]


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.[12][16]

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.[17][18] Problem solving discussions in families with an alcoholic parent contained more negative family interactions than in families with non-alcoholics parents.[16][17] 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.[17]

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.[19]

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.[17][20] 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.[citation needed]

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.[14]

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.[14]


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.[21][22]

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.[23]


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.[16][24] 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.[25]

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.[26][27] 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.[28][29]

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).


Suggested practices to mitigate the impact of parental alcoholism on the development of their children include:[30]

  • Attending meetings of Adult Children of Alcoholics Anonymous (ACA)
  • 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.[31]


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.[32]

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.[33]

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.[33]

See also


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