Alcoholism in family systems

William Hogarth's Gin Lane, 1751

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]

Prevalence

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]

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.[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.

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]

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.[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]

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.[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).

Treatment

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

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.[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

References

  1. ↑ Crnkovic, A. Elaine; DelCampo, Robert, L. (March 1998). "A Systems Approach to the Treatment of Chemical Addiction". Contemporary Family Therapy 20 (1): 25–36. doi:10.1023/A:1025084516633. ISSN 1573-3335.
  2. ↑ O'Farrell, Timothy J; Fals-Stewart, William (2006). "An Introduction to Behavioral Couples Therapy for Alcoholism". Behavioral Couples Therapy for Alcoholism And Drug Abuse. Guilford Press. pp. 1–7. ISBN 978-1-59385-324-2. OCLC 64336035.
  3. ↑ Cermak, TL (1989). "Al-Anon and recovery". Recent developments in alcoholism. Recent Developments in Alcoholism 7: 91–104. doi:10.1007/978-1-4899-1678-5_5. ISBN 978-1-4899-1680-8. ISSN 0738-422X. PMID 2648500.
  4. ↑ Barnett, Mary Ann (October 2003). "All in the Family: Resources and Referrals for Alcoholism". Journal of the American Academy of Nurse Practitioners 15 (10): 467–472. doi:10.1111/j.1745-7599.2003.tb00333.x. ISSN 1745-7599. PMID 14606136.
  5. 1 2 Mulligan, Kate (5 October 2001). "Al-Anon Celebration Spotlights Importance of Family Involvement". Psychiatric News 36 (9): 7.
  6. ↑ Drake, Robert E.; Racusin, Robert, J.; Murphy, Timothy, A. (1 August 1990). "Suicide Among Adolescents With Mentally Ill Parents". Hospital & community psychiatry 41 (8): 921–922. ISSN 0022-1597. PMID 2401483. Archived from the original on 2010-11-14.
  7. 1 2 http://allpsych.com/journal/alcoholism.html
  8. ↑ Maynard, Stuart (1999). "Growing up in an alcoholic family system: the effect on anxiety and differentiation of self". Journal of substance abuse 9: 161–170. doi:10.1016/S0899-3289(97)90014-6. ISSN 0740-5472. PMID 9494947.
  9. ↑ Cutter, CG; Cutter, HS (January 1987). "Experience and change in Al-Anon family groups: adult children of alcoholics". Journal of studies on alcohol 48 (1): 29–32. ISSN 0096-882X. PMID 3821116.
  10. ↑ Paley, B., & O'Connor, M. J. (2009). Intervention for individuals with fetal alcohol spectrum disorders: Treatment approaches and case management. (Master's thesis, University of California )Retrieved from http://journals1.scholarsportal.info.myaccess.library.utoronto.ca/tmp/12408002619781747878.pdf
  11. ↑ Moos, R.H.; Billinop, A.B. (1982). "Children of alcoholics during the recovery process: Alcoholic and matched control families". Addictive Behaviors 7 (2): 115–164. doi:10.1016/0306-4603(82)90040-5.
  12. 1 2 Windle, Michael (1997). "Concepts and Issues in COA Research" (PDF). Alcohol Health and Research World 21 (3): 185–191. PMID 15706767. Archived from the original on 2010-11-14.
  13. ↑ Eigen, L.; Rowden, D. (1996). "Section 1: Research - A Methodology and Current Estimate of the Number of Children of Alcoholics in the United States". In Abbott, Stephanie. Children of Alcoholics: Selected Readings (Volume II ed.). Rockville, MD: National Association for Children of Alcoholics (NACoA). pp. 1–22. ISBN 978-0-9645327-4-8.
  14. 1 2 3 Schoenborn, CA (September 1991). "Exposure to Alcoholism in the Family: United States, 1988". Advance Data from Vital and Health Statistics 30 (205): 1–13. ISSN 0147-3956. PMID 10114780.
  15. ↑ Hardwood, H; Fountain, D.; Livermore, (1998). "The Economic Costs of Alcohol and Drug Abuse in the United States, 1992". Rockville, MD: DHHS, NIH, NIDA, OSPC, NIAAA, OPA. NIH Publication No. 98-4327. Archived from the original on 2010-11-14. Analysis by the Lewin Group
  16. 1 2 3 Ellis, Deborah, A.; Zucker, Robert, A.; Fitzgerald, Hiram, E. (1997). "The Role of Family Influences in Development and Risk" (PDF). Alcohol Health and Research World 21 (3): 218–225. ISSN 0090-838X. PMID 15706772. Archived from the original on 2010-11-14.
  17. 1 2 3 4 Jacob, Theodore; Johnson, Sheri (1997). "Parenting Influences on the Development of Alcohol Abuse and Dependence" (PDF). Alcohol Health and Research World 21 (3): 204–209. ISSN 0090-838X. PMID 15706770. Archived from the original on 2010-11-14.
  18. ↑ Zucker, Robert A.; Kincaid, Stephen B.; Fitzgerald, Hiram E.; Bingham, Raymond (August 1995). "Alcohol Schema Acquisition in Preschoolers: Differences Between Children of Alcoholics and Children of Nonalcoholics". Alcoholism: Clinical and Experimental Research 19 (4): 1011–1017. doi:10.1111/j.1530-0277.1995.tb00982.x. ISSN 1530-0277. PMID 7485810.
  19. ↑ Finn, Peter, R.; Justus, Alicia. (1997). "Physiological Responses in Sons of Alcoholics" (PDF). Alcohol Health and Research World 21 (3): 227–231. ISSN 0090-838X. PMID 15706773. Archived from the original on 2010-11-14.
  20. ↑ Sher, Kenneth, J. (1997). "Psychological Characteristics of Children of Alcoholics" (PDF). Alcohol Health and Research World 21 (3): 247–253. PMID 15706777. Archived from the original on 2010-11-14.
  21. ↑ Bavolek, Stephen J.; Henderson, Hester L. (1990). "Child maltreatment and alcohol abuse: Comparisons and perspectives for treatment". In Potter, Ronald T.; Efron Patricia S. Aggression, Family Violence and Chemical Dependency. Binghamton: Haworth Press. pp. 165–184. ISBN 978-0-86656-964-4.
  22. ↑ Daro, Deborah; McCurdy, Karen (April 1991). "Current Trents in Child Abuse Reporting and Fatalities: The Results of the 1990 Annual Fifty State Survey. Working Paper Number 808". 332 S. Michigan Ave., Suite 1600, Chicago, IL: National Committee for Prevention of Child Abuse: 34.
  23. ↑ Cloninger, C.R., Sigvardsson, S., & Bohman, M. (1996). Type I and Type II alcoholism: An update. Alcohol Health & Research World, 20(1), 18-23.
  24. ↑ Sher, Kenneth J. (1991). Children of alcoholics. United States: University of Chicago Press. ISBN 978-0-226-75271-6. OCLC 23176799.
  25. ↑ Sher, Kenneth J. (1991). "Chapter 6: Psychological Characteristics". Children of alcoholics. United States: University of Chicago Press. ISBN 978-0-226-75271-6. OCLC 23176799.
  26. ↑ Drejer, Kirsten; Theikjaard, Alice; Teasedale, Thomas W.; Schulsinger, Fini; Goodwin, Donald W. (November 1985). "A Prospective Study of Young Men at High Risk for Alcoholism: Neuropsychological Assessment". Alcoholism: Clinical and Experimental Research 9 (6): 498–502. doi:10.1111/j.1530-0277.1985.tb05590.x. ISSN 1530-0277. PMID 3911808.
  27. ↑ Gabrielli, W.F.; Mednic, S.A. (1983). "Intellectual performance in children of alcoholics". Journal of Nervous and Mental Disease 171 (7): 444–447. doi:10.1097/00005053-198307000-00009. ISSN 1539-736X. PMID 6864203.
  28. ↑ Schaefer, K.W.; Parsons, O.A.; Vohman, J.R. (July–August 1984). "Neuropsychological differences between male familial and non-familial alcoholics and non-alcoholics". Alcoholism: Clinical and Experimental Research 8 (4): 347–351. doi:10.1111/j.1530-0277.1984.tb05678.x. PMID 6385756.
  29. ↑ Tarter, Ralph E.; Hegedus, Andrea M.; Goldstein, Gerald; Shelly, Carolyn; Alterman, Arthur I. (March 1984). "Adolescent Sons of Alcoholics: Neuropsychological and Personality Characteristics". Alcoholism: Clinical and Experimental Research 8 (2): 216–222. doi:10.1111/j.1530-0277.1984.tb05842.x. ISSN 1530-0277. PMID 6375434.
  30. ↑ Wolin, S.J.; Bennett, L.A.; Noonan, D.L.; Teitelbaum M.A. (March 1980). "Disrupted family rituals: A factor in the intergenerational transmission of alcoholism". Journal of Studies on Alcohol 41 (3): 199–214. ISSN 0096-882X. PMID 7374140.
  31. ↑ O'Farrell, T. J. and Fals-Stewart, W. (2003), ALCOHOL ABUSE. Journal of Marital and Family Therapy, 29: 121–146. doi:10.1111/j.1752-0606.2003.tb00387.x
  32. ↑ Jacobson, Sandra W (1997). "Assessing the Impact of Maternal Drinking During and After Pregnancy" (PDF). Alcohol Health and Research World 21 (3): 199–203. ISSN 0090-838X. PMID 15706769. Archived from the original on 2010-11-14.
  33. 1 2 Larkby, Cynthia; Day, Nancy (1997). "The Effects of Prenatal Alcohol Exposure" (PDF). Alcohol Health and Research World 21 (3): 192–197. ISSN 0090-838X. PMID 15706768. Archived from the original on 2010-11-14.
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