Alcoholism and the Family

Approximately 25 million, or about 8.5% of American adults meet criteria for an alcohol use disorder (either alcohol abuse or dependence) in the past year.  Approximately one out of every four U.S. children under the age of 18 years is exposed to the effects of alcohol abuse or dependence in a family member. One of the most powerful social contexts across a person’s lifespan is the family system. Not only does the family influence the developmental course of alcohol use disorders, but the alcohol use disorders of individual family members influence the entire family’s functioning.

Family biology and family dynamics both contribute to an individual’s risk and vulnerability for alcohol use disorders, as well as providing protections and resilience.

Are children of alcoholic parents  at a greater risk for developing alcoholism (and other mental or behavioral health problems)? The short answer is yes.

Problems with alcohol and other substances have been associated with family factors such as:

1.      parental substance use

2.      sibling substance use

3.      family values and attitudes about substance use

4.      family dynamics

5.      relational patterns and interaction effects with biological or genetic factors

There are many different cultural definitions of “family”. American family forms include nuclear, single parent mother, single parent father, ex- and step relations, grandparent/aunt/uncle as parent, foster families, and others. There are tremendous ethnic and cultural differences in family roles, family interdependence and informal support systems, and values about how families interrelate. Regardless of all these differences however, a family can be conceptualized as a dynamic system that changes over time as membership changes, individuals change and develop, relationships change, and the family’s context changes.

There are certain rules about families:

1.      The family as a system is more than the sum of its parts:  a.k.a “circle of influence” between individual members and the system as a whole

2.      Changes in any part of the system affect the entire system

3.       Subsystems are embedded throughout the larger family system: couple subsystem, parent-child and siblings subsystems

4.      Families exist within a larger social environment context which includes: neighborhood, community, health care, school, workplace, service delivery, societal, economic, historical, and cultural systems

5.      Families are multigenerational, hence the use of genograms in dissecting family dynamics.

6.      Families are a homeostatic environment: they tend to maintain the status quo (and sometimes this is accomplished through drinking). Once systems have achieved a level of stability or homeostasis, they apply concerted efforts to maintain their hard-earned balance. In fact, warnings have been offered about intervening to change an individual’s alcohol abuse without adequately responding to the potentially destabilizing effect of an individual’s recovery on the family system – the individual’s drinking may represent a family system’s homeostatic solution to otherwise distressed relationships.

There are several family problems that are likely to co-occur with an individual’s alcohol abuse, including intimate partner violence, conflict and low relationship satisfaction and economic and legal vulnerability. Communication in family systems that involve members with substance problems may be characterized as highly critical, involving considerable amounts of nagging, judgments, blame, complaints, and guilt.

Families of individuals with alcohol use disorders are often characterized by conflict, chaos, communication problems, unpredictability, inconsistencies in messages to children, breakdown in rituals and traditional family rules, as well as emotional and physical abuse. Alcohol problems are common among couples. Alcohol abuse affects couples’ relationships in a variety of negative ways, including communication problems, increased conflict, nagging, poor sexual relations, and domestic violence. Parenting functions performed by individuals who are alcohol-impaired may be characterized as inconsistent, unpredictable, and lacking in clear rules and limits. Children of alcoholic parents frequently experience chaotic parenting and poor quality home environments during significant developmental periods. Parents with a history of substance abuse show lower constraint, control, harm avoidance, and traditionalism in relation to their families than other parents do. Also disturbances in the mother-infant attachments can occur in families where the father is a heavy drinker.

Children of alcoholic parents may have behavioral and school difficulties, including negative self-concepts, fearfulness, loneliness, difficulties in concentrating, attendance, and work completion. It is important to mention that, while it is clear that some risks exist for children growing up exposed to a parent’s alcohol abuse, it is also clear that considerable amounts of resiliency also exist.

Do you know adult children of alcoholics? Are you one of them?

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