Prevention for Children of Alcoholics

By Stephanie Abbott Reviews of the research conducted during the last several decades on studies of the prevalence of alcoholism in the United States substantiate the belief that the children of alcoholics are at high risk for alcoholism. (Jeannette L. Johnson, Ph.D., Developmental Assessment of Children of Alcoholics.) We don’t look for donuts at the hardware store; yet, when prevention efforts are organized in a community, we rarely focus our efforts on the at-risk population, children of addicted parents. “Oh right!” say the genuinely surprised participants at the planning table, as well as the writers of prevention articles and books, when the simple statistics are brought to their attention. Addiction professionals should not find this reaction surprising since “we don’t know what we don’t know” and it is human nature to fit things into compartments. We may find prevention of teen-aged drinking in our own communities a safer crusade if we don’t have to look at the problem drinking of their parents. Fortunately clinicians know quite a bit today about these children, as well as about adult children of alcoholics. The alcoholism research community seeks to understand the causes of alcoholism by identifying traits that may distinguish children of alcoholics (COAs) from non-COAs. Because alcoholism is understood to have genetic components, these differences may be important in the etiology of alcoholism. As a result of this research, clinicians have access to some well-supported information about this population. Children of alcoholics are at increased risk for a wide range of behavioral and emotional problems, including addiction to alcohol and other drugs (alcohol researchers have established that COAs are somewhere between 2 and 10 times more likely to develop alcoholism), delinquency, and school failure. Anxiety and depression may be expressed by crying, bed wetting, social withdrawal, being afraid to go to school, or having nightmares. Older youths may stay in their rooms for long periods of time and not relate to other children. Teens may show depressive symptoms by being perfectionistic, hoarding, withdrawing, being excessively self-conscious and by exhibiting phobias. The traumatic stress of living with unrecovered alcoholic parents is well documented both by anecdotal evidence and research. This stress affects the brain and immune functioning of the child. However, research has also established that this is not a homogeneous population, because alcoholic parents are not all alike. Studies indicate that the alcoholic’s comorbid psychopathology, if any, is critical in predicting problems for relatives. Many alcoholics do not have personality disorders and, when recovered, have no more problems than the nonaddicted. Yet, others have coexisting psychological disorders, such as other forms of substance abuse, anxiety disorders, mood, or antisocial disorders. These disorders can have a genetic as well as an environmental impact on offspring. Protective Factors Many COAs have protective factors in their lives that serve as prevention. If the nonalcoholic parent functions well in spite of the stressful environment, the children can stay healthy. For example, it is normal to think we can protect children from the effects of addiction by ignoring reality, but studies show that admitting the truth is better. Research also indicates that COAs educated about their risk factors drink significantly less than COAs unaware of their risk status. The parent can support the child emotionally through education: alcoholism is a disease, it is not your fault, no one can force someone to stop drinking. The higher functioning parent can be involved in a support group, such as Al-Anon, which models proactive behavior rather than helplessness, and will investigate alternatives to repeating “solutions” that don’t work. This parent will also learn to allow the addicted person to face consequences. If violence enters the picture, and studies of family violence document high rates of alcohol and other drug involvement, this parent will move to separation. Maintaining consistency around important family activities, such as vacation, mealtimes, or holidays are protective for some alcoholic families. Consistent and nurturing significant others in the lives of the children is also important. Adult COAs often report that some adult made all the difference to them. It may have been a coach, teacher, neighbor, parent of a friend, or a grandparent, and while the problems at home may have never been discussed, the concern and encouragement mattered. Religious observance has also been a protective factor for many of these children. Prevention Programs For COAs Group programs seem most effective. Groups reduce the feelings of isolation, shame and guilt so common in families with addiction. It also capitalizes on the importance to adolescents of peer influence and mutual support. Some programs may be directed at COAs in a broad based community prevention program. Other programs target specific groups that always have a large component of COAs, such as abused or neglected children or youth with academic difficulties or gang affiliations. Prevention and intervention services should be automatic as part of a comprehensive social service program. Though there is little data existing on the effectiveness of Alateen as prevention, the advantages to adolescents of peer support and education about the nature of alcoholism, seem obvious. Schools are logical places to reach COAs. School curricula should always include information about alcohol and drugs and their impact on the family. Alert teachers can easily pick up on children’s discomfort about alcohol or changes in interest or attendance during alcohol education. These children can be educated about addiction without feeling singled out. Addiction Counselors Counselors have their hands full these days and often do not have the time or opportunity to work with families of their patients. This does not mean they can’t influence the course of events. In minimal circumstances when there is no family program, much less a children’s program, there are still creative ways to help. Referral. Make yourself totally familiar with the programs in your community and automatically include them in family aftercare. Impress on your patient the importance of follow-through for their children. Bibliotherapy. There are many good books now written for COAs, both young and adolescent. Automatically recommend reading for the parents. There is some nonshaming good advice out there! The National Association for Children of Alcoholics NACoA has been advocating for COAs for 15 years and is a good resource for useful publications and videos. The book Children of Alcoholics: Selected Readings and the four “Kits,” for Kids, Parents, Therapists and Educators, are helpful for counselors to read and to suggest to patients and their families. Information videos are also available, both for children and adults. NACoA is a good resource for keeping up with research and is constantly updating a “Fact Sheet.” Also of interest is “Core Competencies,” a guide to essential knowledge about the needs of COAs for health care professionals. We know what needs to be done. No child of an addicted parent should have to grow up in isolation and without support. Addiction counselors are in a unique position to make a difference. Dies, R.R.; Burghardt, K. Group interventions for children of alcoholics; Prevention and Treatment in the schools. Journal of Adolescent Group Therapy Vol 1(3):219-234 1991. Eigen, L.; Rowden, D. A Methodology and Current Estimate of the Number of Children of Alcoholics in the United States. Children of Alcoholics: Selected Readings, National Association for Children of Alcoholics, 77-98 1996. Ellis, Deborah A.; Zucker, Robert A.; and Fitzgerald, Hiram E. The Role of Family Influences in Development and Risk. Alcohol Health and Research World. Vol 21, No. 3, 218-225. 1997. Johnson, Jeannette L. Developmental Assessment of Children of Alcoholics. Children of Alcoholics: Selected Readings. 99-136 1996. Kumpfer, K.L. Promising prevention strategies for high-risk children of substance abusers. OSAP High Risk Youth Update Vol. 2(1): 1-3, 1989. Werner, E.E. Resilient Children. Young Children Vol. 40. 68-72. 1984. Windle, Michael. Concepts and Issues in COA Research. Alcohol Health and Research World Vol. 21, No 3: 185-191. 1997. Wolin, S.; Bennett, J.; Noonan, D.; Disrupted family rituals: A factor in the inter-generational transmission of alcoholism. Journal of Studies on Alcohol, Vol. 41. 199-214. 1980. Stephanie Abbott, MA, CAC, specializes in family aspects of addiction.