Ten to 20 years ago the field of alcoholism focused on the drinking alcoholic only, .... without a drinking problem, based only on a family history of alcoholism.
National Association for Children Of Alcoholics Quantification Study 'Is There Really A Problem?' C.M. Gilvarry Summary A survey was carried out for the National Association for Children of Alcoholics (Nacoa) employing standard market research methods on a nationally representative sample of adults, in order to obtain a measure of 1) the prevalence of adult children of alcoholics (ACOAs) in the community and 2) to estimate what percentage of those identifying themselves as ACOAs, perceive themselves as having problems in their adult lives as a consequence of having been brought up by an alcoholic parent(s). Of those interviewed 4.7% identified themselves as ACOAs and of this number 62% maintained that it caused problems for them at the time, and continues to cause them problems in their adult lives. Introduction Ten to 20 years ago the field of alcoholism focused on the drinking alcoholic only, with little attention paid to those close to the drinker. The families of problem drinkers were, and to a large extent still are the unrecognised casualties of problem drinking, and alcohol treatment agencies have made, at best, a hesitant response in this area. Writing in 1971, Goodwin stated 'Without known exception, every family study of alcoholism, irrespective of country of origin, has shown much higher rates of alcoholism among the relatives of alcoholics than apparently occurs in the general population'. Many studies followed supporting Goodwin's findings and the familial nature of alcoholism has been a robust finding, persisting across differences in ascertainment of alcoholics, in study methodologies, and even in the definition of alcoholism. However, against this, constitutional vulnerability to develop alcoholism need not be entirely genetic in nature. The effects of exposure to alcohol in utero, if any, on later drinking or alcoholism have not been studied, and genetic factors may act indirectly, for example, by influencing behaviour that might in turn increase the likelihood of developing alcohol related problems. Complicating the task of separating genetic from nongenetic factors are the findings that alcoholics appear to preferentially mate with other alcoholics, and that both the prevalence and the transmissibility of alcoholism appear to be changing over time. Furthermore, there may be distinct subtypes of alcoholism with different degrees of heritability and environmental sensitivity. Environmentally caused phenocopies of the illness may be clinically indistinguishable from other forms. Generalisations about ACOAs have to be made with considerable care, but the literature suggests that ACOAs are vulnerable on many fronts. The literature is extensive, and tabulated for convenience (Appendix 1). It is clear from this research literature that alcoholism is but one risk factor for the offspring of an alcoholic.
For children of alcoholics, the home environment very often is characterised by inconsistent parenting, with unpredictable rules and limits; chaotic or tense family environments; parental violence and spouse abuse; unpredictability; poor communication, with unclear messages and broken promises; loneliness and isolation, as family members attempt to hide the family's problems and reduce the potential for shame and embarrassment by withdrawing into itself. The parent's illness often takes centre stage and depletes the family's ability to adequately meet, or indeed recognise, the physical and emotional needs
1
of the developing child. What is objectively distorted and grossly disorganised becomes incorporated as 'normal' for the growing child. Children develop coping mechanisms which allow them to adapt to an unpredictable and often chaotic childhood, however these coping mechanisms, developed to sustain survival during childhood, may become dysfunctional once the child becomes an adult. The degree to which children are able to shelter themselves from the negative impact of parental alcoholism may vary enormously. In fact, there is increasing evidence that many ACOAs may grow up to be well adjusted (Velleman, 1993), despite the difficulties they have encountered in childhood (or perhaps, some argue, because of the coping skills that they have developed). While about equal numbers of resilient and problematic children came from families with an alcoholic father, in one study it was shown that the majority of children of alcoholic mothers failed to make a successful adjustment by the age of 18. (Werner, 1986). In recent years more and more ACOAs are finding their way into treatment, having recognised as adults, that they are currently facing emotional and interpersonal difficulties that they attribute, at least in part, to the consequences of having grown up in an alcoholic family. There has been a growing body of clinical literature, which although largely impressionistic and anecdotal, addresses itself to the consequences in adulthood of having been reared by an alcoholic parent (Brown, 1988). Secondly empirical investigations of alcoholic families are beginning to document alcoholism's effects, not only on the chemically addicted family member, but on the entire family system (Steinglass, 1988). The National Association for Children of Alcoholics was set up to 1) Generate awareness amongst professionals of the existence of this group and the associated problems; 2) Develop a 'toolkit' to help professionals deal with the problems; 3) Enable counselling of the children (now mostly adults) to take place; 4) Undertake research in the field of alcoholism, with particular emphasis on children of alcoholics. The object of the current research was to get an estimate of the number of people in the community who identify themselves as ACOA, the number who feel that this has created ongoing problems in their lives, and who feel that they would take advantage of help/counselling if it were made available to them. Method A list of UK based names and telephone numbers of 1,006 adults (aged 18 or over) was generated using standard market research techniques. This list controlled for geographical location, sex and social class of the respondent. This sample is therefore thought to be representative of the general UK population. Using this sampling method the results were then projected onto the total UK population. Subjects were telephoned and the study was explained to them. If they agreed to take part in the study questions were then read to them from the standardised form below: =============================================================== I would like to ask you some questions on behalf of a charity called The National Association for Children of Alcoholics. This charity is concerned with the longterm consequences to a child of having one or both parents who are alcoholic. All information that we collect is of course completely confidential, and on-one's name or address will be revealed.
2
1. Did you grow up in a home in which either or both of your parents drank too much? Mother Father Neither Refused 2.
- GO TO Q5
Would you say that the excessive drinking of either or both of your parents whilst you were growing up has caused you any problems, either at that time, or as an adult? Quite a lot of problems GO TO Q3 Some problems None that I know of GO TO Q4 None at all Refused
GO TO Q4
3.
Can you describe what those problems are? Anything else?
4.
Do you think that a charity specifically set up to help the adult children of alcoholics is an organisation that might be able to help you? (1) Definitely would be of help to me (2) Might be of some help (3) Probably would not be of help (4) Definitely would not be of help (5) Do not need any help
5.
Do you think that a charity specifically set up to help the adult children of alcoholics is a good idea or not?
Yes No Don't know ============================================================== Findings Table 1: Actual numbers in the survey ============================================================== All Have Alcoholic Perceived Charity would parents a problem be of help All Men Women 521
1,006 485
48 19 29
29 9 20
3
11 3 8
ABC1* C2DE*
477 529
Non-wage Earner 421 Wage Earner
585
17 30
26
11 18
17 21
4 7
2 12
9
Separated/ Divorced 166 12 8 7 Remainder 839 35 21 4 ============================================================= (*Market Research society occupational groupings.) Only a small proportion (4.7%) of subjects claimed to have one or both parents alcoholic. The figures are: alcoholic father 3.3%, alcoholic mother 0.9%, both parents alcoholic 0.5%. By applying the estimated total adult population of the UK to these percentages it is possible to estimate that 1.45 million people had an alcoholic father, 395,000 people had an alcoholic mother, and 219,000 had parents who were both alcoholic. Table 2 ============================================================== Number of people who grew up with alcoholic parents (4.7%) 2.05 million Number who experienced problems as a direct result of this:
(2.88%)
Severe problems:* Less severe problems:*
(0.99%) (1.89%)
1.26 million 434,610 829,711
Number of ACOAs who think an Organisation for ACOAs might help: (1.09%) 478,000 ============================================================== (*Severe/less severe were subject’s own definition.) Problems that ACOAs experienced in their childhood fell into the following categories: 1. Lack of money 2. Arguments 3. Violence towards mother and children 4. Tension and stress in the home 5. Feelings of fear 6. Lack of structure in the family 7. Embarrassment 8. Loss of confidence and self esteem 9. Feelings of inability to give and receive love 10. Emotional problems 11. Worries about current alcohol consumption, and alcohol consumption of partner.
4
Discussion The evidence in this report is based on very small sample sizes, and therefore must be taken as 'indicative' rather than absolute. The survey suggests that there are substantial numbers of people who grew up with alcoholic parents, experienced problems at that time and into the present and believe that an organisation set up for the purpose of helping them deal with these problems would be of value. The survey will undoubtedly underrecord the scale of the problem as people in institutions of various types (hospitals, prisons, the armed forces) are excluded from the survey. Also people who are homeless or living in sheltered accommodation will not be interviewed. It is further possible that the study will underrecord because people will not be prepared to admit to, or discuss these issues with strangers over the telephone. It appears to have been the popular press and selfhelp movements, rather than academic research and treatment agencies that have provided an ordering schema that stressed the centrality of parental alcoholism as a governing agent in child and family development. There has been a tendency to lay an oversimplified focus on the drinking alcoholic, which denies acknowledgement of parental alcoholism as a central organising principle in the family. Attention needs to be drawn to the children of alcoholics in order to attenuate cross generational transmission of maladaptive and psychopathological behaviour patterns, as well as to relieve the more immediate stresses of living in an abusive family environment. At present the only support agency for children of alcoholics are selfhelp groups. Adult Children of Alcoholics, the movement, is barely 10 years old. This movement has developed and thrived despite any guidance or input from mental health professionals. It is therefore largely a lay movement, but the ACOA construct is well grounded in psychodynamic theory.
However, this group is available only to adult children of alcoholics, its object is to help repair damage, not prevent it. It is the hope of Nacoa that through raising awareness of the problems encountered by children of alcoholics, professionals might be better equipped to recognise and deal with the issues involved. In the United States, children of alcoholics can now find outpatient education, support and longterm psychotherapy groups, as well as the ACOA programmes. Treatment can also be offered on an inpatient basis, and treatment centres are expanding their programmes to include children of alcoholics as primary patients, separate from the alcoholic parent. There is now an identified alcoholism patient population for individuals without a drinking problem, based only on a family history of alcoholism. Perhaps in the UK it is now time to consider extending care and attention to the family and particularly to the children of the alcoholic, as well as the alcoholic him/herself and to recognise the pressing reality of the treatment needs of these children.
Karyna Gilvarry 3 August 1994 ____________
5
Appendix 1 ============================================================== The Pre-school Child: 1. Fetal alcohol syndrome (Olegard, 1979) 2. Speech and language impairments, delayed developed (Iosub et al 1981) 3. The 'battered baby syndrome' (Callaghan & Fotheringham 1970) 4. Behaviour and learning difficulties (Shaywitz, 1980) 5. Child abuse (Creighton, 1984, Hamilton, 1981) The School Child: 1. Physical problems (Nylander , Rydelius 1981) 2. Hyperactivity (Cantwell, 1971, Knope 1985, Tarter, 1984) 3. Conduct disorder (Earls, 1988, Rydelius, 1981) 4. Sensory problems (Fine, 1976) 5. Neuropsychological deficits (Morrison & Steward 1971, Tarter, 1984, Cantwell, 1972) 6. Depression/anxiety/nightmares (Moos & Billing 1982) 7. Cognitive deficits (Marcus, 1986) 8. Lower academic achievement (Tarter 1985) 9. Lower IQ (Ervin 1984) The Adolescent 1. Legal problems/criminal behaviour/delinquency (West & Prinz 1987, Miller 1988). 2. Substance abuse (Cadoret 1986, Schuckit 1984) 3. Personality characteristics (Berkowitz & Perkins, 1988, Hoffman 1984, Loranger & Tulis 1985, Whipple & Noble 1991, Cloninger 1988) 4. Alcohol expectancies/tolerance (Brown 1987) 5. Academic achievement (Ervin 1984, Marcus 1986) 6. Cognitive functioning (Wilson & Nagoshi 1988, Tarter 1989, Drejer 1985) 7. Suicide/depression (Angel 1978, Goodwin 1977, Cloninger 1985) 8. Interpersonal difficulties (Deutsch 1982, Seixas & Youcha 1985)
The Adult : 1. Personality disorders (Schubert 1988, Loranger 1985) 2. Psychiatric disorders (el-Guebaly 1991, Barnes 1979) 3. Criminality (Gittelman 1985) 4. Psychosocial functioning (Frances 1980) 5. Physical problems (Rydelius 1981, Nylander 1960) 6. Cognitive functioning (Wilson and Nagoshi, 1988) ==============================================================
6
References Angel, P., Teleghani, M., Choquet, M. and Courtecuisse, N. An epidemiological approach to suicide attempts by adolescents: some answers from the environment (in French). L’Evolution Psychiatrique 43. 351-367 (1978). Barnes, G.E. The Alcoholic Personality: A reanalysis of the literature. Journal of Studies on Alcohol 40: 571-634 (1979). Berkowitz. W. and Perkins, H.W. (1988) Personality characteristics of children of alcohlics. Journal of Consulting and Clinical Psychology Vol 56.No.2. 206-209. Brown, S.A., Creamer, V.A. and Stetson, B.A. Adolescent alcohol expectancies in relation to personal and parental drinking patterns. Journal of Abnormal Psychology. 96: 117-121 (1987). Brown, S. Treating Adult Children of Alcoholics. New Haven, CT, College and Universities Press, 1960. Cadoret, R.J., Troughton, E., O'Gorman, T.W. and Heywood. E. (1986). An Adoption Study of Genetic and Environmental Factors in Drug Abuse. Archives of General Psychiatry. Vol 43. Creighton, S. (1984). Trends in Child Aubse. London; NSPCC. Callaghan, K.A. and Fotheringham, B.J. Practical Management of the battered baby syndrome. Medical Journal of Australial. I: 1282-1284 (1970). Cantwell, D.P. Psychiatric Illness in the families of hyperactive children. Archives of General Psychiatry 70: 414-417 (1971). Cloninger, C.R., Sigvardsson, S. and Bohman, M. Childhood personality predicts alcohol abuse in young adults. Alcohol: Clinical and Experimental Research 12: 494-505 (1988). Cloninger, C.R., Sigvardsson, S. and Bohman, M., and von Knorring, A.L. Psychopathy in adopted-out children of alcoholics: The Stockholm Adoption Study. In: Galanter, M. (ed) Recent Developments in Alcoholism. Vol.3 New York, Plenum Press, 37-51 (1985). Deutsch, C. Broken Bottles, Broken Dreams. New York, Teachers College Press (1982). Drejer, K. Theilgaard, A., Teasdale, T.W., Schulsinger, F. and Goodwin, D.W. A prospective Study of Young men at high risk for alcoholism: neuropsychological assessment. Alcohol: Clinical and Experimental Research 9: 498-502 (1985). Earls,F., Reich, W., Jung, K.G. and Cloninger, C.R. Psychopathy in children of alcoholic and antisocial parents: Alcohol: Clinincal and Experimental Research 12 : 481-487 (1988). El-Guebaly et al (1991). The Adult Children of Alcoholics in a Psychiatric Population. American Journal of Drug and Alcohol Abuse. 17(2), 215-226. Ervin, C., Little, R., Streissguth, A. and Beck, D. (1985). Alcoholic fathering and its relation to child’s intellectual development: A pilot investigation. Alcohol: Clinical and Experimental Research. 8: 362-365.
7
Fine, E., Yudin, L., Holmes, J., and Heinemann, S. Behavioural disorders in children with parental alcoholism. Annals of the New York Academy of Sciences. 23: 507-517 (1976). Gittelman R., et al (1985). Hyperactive Boys almost Grown Up. Archives of General Psychiatry. Vol 42. Goodwin , D.W.(1971) Is Alcoholism Hereditary? Archives of General Psychiatry 25:545-548. Goodwin, D.W. et al. (1977) Psychopathology in Adopted and Nonadopted Daughters of Alcoholics. Archives of General Psychiatry. Vol 34. Hamilton, C. and Collins, J. (1981). The role of alcohol in wife beating and child abuse: a review of the literature. In Collins, J. (ed.). Drinking and Crime. New york; Guildford Press. Hoffmann, H., Loper, R.G., and Kammeier, M.L. Identifying Future Alcoholics with MMPI Alcoholism Scales. Quaterly Journal of Studies of Alcohol. 35: 490-498 (1974). Iosub, S., Fuchs, M., Bingol, N. and Gromisch, D.S. Fetal Alcohol Syndrome Revisited. Pediatrics. 68:475479. (1981) Knob, J., Teasdale, T.W., Schulsinger, F. and Goodwin, D.W. A prospective study of young men at high risk for alcoholism: school behaviour and achievement. Journal of Studies on Alcohol 46: 273-278 (1985). Johnson JL, Bennett, LA: Adult children of alcoholics: Theory and Research. New Brunswick, NJ, Alcohol Research Documentation, 1989. Loranger, A.W. and Tulis, G.W. (1985). Family History of Alcoholism in Borderline Personality Disorder. Vol.42. Marcus, A.M. Academic achievement in elementary school children of alcoholic mothers. Journal of Clinical Psychology 42(2):372-376 (1986). Miller, L. Neuropsychological perspectives on delinquency. Behav Sci Law 6:409-428 (1988). Moos, R.H. and Billings, A.G. Children of alcoholics during the recovery process: alcoholic and matched control families. Addictive Behaviours 7: 155-163 (1982). Morrison, J.R. and Stewart, M.A. A family study of the hyperactive child syndrome. Biological Psychiatry 3: 189-195 (1971). Nylander, I. Children of alcoholic fathers. Acta Paediatrica Scandinavia 49: Suppl. p.121 (1960). Olegard, R., Sabel, K. and Aronson, M. Effects on the child of alcohol abuse during pregnancy. Acta Pediatrica Scandinavia. Suppl. 275:112-21 (1979). Powers, R. (1986). Aggression and violence in the family. In Campbell, A. and Gibbs, J. (eds.). Violent Transactions. Oxford; Blackwell. Rydelius, P.A. (1981) Children of Alcoholic Fathers. Acta Paediatrica Scandinavica. Supplement 286.
8
Schubert, D.S.P. et al (1988). A Statistical Evaluation of the Literature Regarding the Associations among Alcoholism, Drug Abuse and Antisocial Personality Disorder. The International Journal of the Addictions 23(8) 797-808. Schuckit, M.A. Subjective responses to alcohol in sons of alcoholics and controls. Archives of General Psychiatry 41: 879-887 (1984). Seixas, J. and Youcha, G. Children of Alcoholics: A Survivors Manual. New York. Crown. (1985). Shaywitz, S.E., Cotten, D.J. and Shaywitz, B.A. Behavior and learning difficulties in children of normal intelligence born to alcoholic mothers. Journal of Pediatrics. 96:978-982 (1980). Steinglass, P., Bennett, L. Wolin, S and Reiss D. (1987). The Alcoholic Family. New York: Basic Books. Tarter, R., Hegedus, A. and Gavaler, J. (1985) Hyperactivity in sons of alcoholics. Journal of Studies on Alcohol 46:259-261. (1985). Tarter, R., Hegedus, A., Goldstein, G., Shelly, C. and Alterman. A. (1984) Adolescent sons of alcoholics: Neuropsychological and personality characteristics. Alcohol Cli Exp Res. 8:216-222. (1984). Tarter, R, Jacob, T. and Bremer, D. Cognitive status of sons of alcoholics. Alcohol: Clinical and Experimental Research 13: 232-235 (1989). The Market Research Society. Occupation Groupings. A Job Dictionary. 3rd Ed. Twentieth Century Press Ltd. London. (1991) Velleman R. Alcohol and the Family. The Institute of Alcohol Studies 1993. Werner, E.E.. Resilient offspring of alcoholics: A longitudinal study from birth to age 18. Journal of Studies on Alcohol 47(1):34-40, (1986). West, M.O. and Prinz, R.J. Parental alcoholism and childhood psychopathology. Prychological Bulletin 102:204-218 (1987). Whipple, S.C. and Noble, E.P. (1991). Personality Characteristics of Alcoholic Fathers and their Sons. Journal of Studies on Alcohol. Vol 52. No.4. Wilson, J.R. and Nagoshi, C.T. Adult Children of Alcoholics: cognitive and psychomotor characteristics. British Journal of Addiction 83: 809-820 (1988).
9
