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. 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.

Alcoholism is one of the leading causes of a dysfunctional family. 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 than age of 18. Children of addicts have an increased suicide rate and on average have total health care costs 32 percent greater than children of nonalcoholic families.

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. 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.

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. The cumulative effect of the family dysfunction may affect the children in families with untreated alcoholics' ability to grow in developmentally healthy ways.

Prevalence
Based on the number of children with parents meetings the DSM-III-R criteria for alcohol abuse or alcohol dependents, in 1996 there was an estimated 26.8 million children of alcoholics (COAs) in the United States of which 11 million were under the age of 18. As of 1988, it was estimated 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. While growing up, nearly one in five adult Americans (18%) lived with an alcoholic. In 1992, it was estimated one in eight adult American drinkers were alcoholics or experienced problems as a consequences of their alcohol use.

Familiality
Children of alcoholics (COAs) are more at risk for 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.

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

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.

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.

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.

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.

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.

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. 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.

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. 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. Some may, however, excel at academics. This may come from trying to do better in life then their achoholic parent.

Treatment
Suggested practices to mitigate the impact of parental alcoholism on the development of their children include:
 * 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.

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.

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. Six percent of offspring from alcoholic mothers have Fetal Alcohol Syndrome (FAS). The risk a offspring born to an alcoholic mothers having FAS increases from six to 70 percent if the mother's previous child had FAS.

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.