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{{Short description|Social and psychological factors that cause alcoholism in families}}
[[File:'Temperance Lecture' by Edward Edmondson, Jr., Dayton Art Institute.jpg|thumb|''Temperance Lecture'' an 1861 portrait by Edward Edmondson, Jr. now on display at the [[Dayton Art Institute]]]]
'''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 [[Substance dependence|addiction]] as diseases that flourish in and are enabled by family systems.<ref name="CRNKOVIC1998"/>

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 their actions. Such behaviors are referred to as [[codependence]]. In this way, the alcoholic is said to suffer from the [[disease model of addiction|disease of addiction]], whereas the family members suffer from the disease of codependence.<ref name="OFARRELL2006"/><ref name="CERMAK1989"/> While it is recognized that addiction is a family disease affecting the entire family system, "the family is often ignored and neglected in the treatment of addictive disease."<ref name=":5">{{Cite book|title=Uppers, downers, all arounders: physical and mental effects of psychoactive drugs|first=Darryl|last=Inaba|date=2011|publisher=CNS Publications|others=Cohen, William E., 1941–|isbn=9780926544307|edition=7th|location=Ashland, Or.|oclc=747281783}}</ref> Each member is affected and should receive treatment for their benefit and healing, but in addition to benefitting the individuals themselves, this also helps better to support the addict/alcoholic in their recovery process. "The chances of recovery are greatly reduced unless the co-dependents are willing to accept their role in the addictive process and submit to treatment themselves."<ref>(Gorski, 1993; Liepman, Keller, Botelho, et al., 1998)</ref> "Co-dependents are mutually dependent on the addict to fulfill some need of their own."<ref name=":5" />

For example, the "Chief Enabler" (the main enabler in the family) will often turn a blind eye to the addict's drug/[[alcohol (drug)|alcohol]] use as this allows for the enabler to continue to play the victim and/or martyr role while allowing the addict to continue his/her own destructive behavior. Therefore, "the behavior of each reinforces and maintains the other, while also raising the costs and emotional consequences for both."<ref name=":6">{{Cite book|title=Loosening the grip : a handbook of alcohol information|last=Kinney|first=Jean|date=2012|publisher=McGraw-Hill|isbn=9780073404684|edition=10th|location=New York, NY|oclc=696942382}}</ref>

Alcoholism is one of the leading causes of a [[dysfunctional family]].<ref name="BARNETT2003"/> "About one-fourth of the U.S. population is a member of a family that is affected by an addictive disorder in a first-degree relative."<ref name=":5" /><ref>(Liepman, Parran, Farkas, et al., 2009)</ref> 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.<ref name="MULLIGAN2001"/> Children of addicts have an increased suicide rate and on average have total [[health care costs]] 32 percent greater than children of nonalcoholic families.<ref name="MULLIGAN2001"/><ref name="DRAKE1990"/>

According to the [[American Psychiatric Association]], physicians stated three criteria to diagnose this disease:

* physiological problems, such as hand tremors and blackouts
* psychological problems, such as excessive desire to drink
* behavioral problems that disrupt social interaction or work performance.<ref name="allpsych.com" />

Adults from alcoholic families experience higher levels of [[Psychological resistance#State and trait resistance .28situational and characteristic.29|state and trait]] [[anxiety]] and lower levels of [[Murray Bowen#Differentiation of self|differentiation of self]] than adults raised in non-alcoholic families.<ref name="MAYNARD1999"/> Additionally, adult children of alcoholics have lower [[self-esteem]], excessive feelings of responsibility, difficulties reaching out, higher incidence of [[clinical depression|depression]], and increased likelihood of becoming alcoholics.<ref name="CUTTER1987"/>

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).<ref name="allpsych.com"/> FAS 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.<ref>{{cite journal| doi=10.1002/ddrr.67| title=Intervention for individuals with fetal alcohol spectrum disorders: Treatment approaches and case management| last1=Paley| first1=Blair| last2=O'Connor| first2=Mary J.| journal=Developmental Disabilities Research Reviews| date=3 September 2009| volume=15| issue=3| pages=258–267| pmid=19731383| doi-access=free}}</ref>

Alcoholism does not have uniform effects on all families. The levels of dysfunction and resiliency of non-alcoholic adults are important factors in effects on children in the family. Children of untreated alcoholics have lower 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.<ref name="MOOS1982">{{cite journal | last = Moos | first = R.H. |author2=Billinop, A.B. | title = Children of alcoholics during the recovery process: Alcoholic and matched control families | journal = Addictive Behaviors | volume = 7 | issue = 2 | pages = 115–164 | year=1982 | doi = 10.1016/0306-4603(82)90040-5| pmid = 7102446 }}</ref><ref name="WINDLE1997"/>

== Family roles ==
[[File:A maniacal man is visited in prison by his children, all rui Wellcome V0019408.jpg|thumb|"A maniacal man is visited in prison by his children, all ruined through his drinking habit". Reproduction of an etching by G. Cruikshank, 1847.]]
The role of the "Chief Enabler" is typically the spouse, significant other, parent, or eldest child of the alcoholic/addict. This person demonstrates "a strong tendency to avoid any confrontation of the addictive behavior and a subconscious effort to actively perpetuate the addiction."<ref name=":5" /> The "Chief Enabler" also often doubles as the "Responsible One",<ref name=":6" /> or "Family Hero",<ref name=":6" /> another role assumed by family members of the alcoholic/addict. Both the "Chief Enabler" and "Responsible One" (aka "Model Child"<ref name=":5" />) will take "over [the alcoholic/addict's] roles and responsibilities".<ref name=":5" /> For example, a parent might pay for expenses and take over responsibilities (i.e. car payments, the raising of a grandchild, provide room and board, etc.), while a child may provide care for their siblings, become the "peacekeeper" in the home, take on all the chores and cooking, etc. A spouse or significant other may overcompensate by providing all the care to the children, being the sole financial contributor to the household, covering up or hiding the addiction from others, etc. This role often receives the most praise from non-family members, causing the individual to struggle to see that it is an unhealthy role that contributes to the addict/alcoholic's disease as well as the family's dysfunction.

Another role is that of the "Problem Child" or "Scapegoat."<ref name=":5" /><ref name=":6" /> This person "may be the only [one] clearly seen as having a problem"<ref name=":6" /> outside of the actual addict/alcoholic. This child (or adult child of the alcoholic) "gets blamed for everything; they have problems at school, exhibit negative behavior, and often develop drug or alcohol problems as a way to act out. Their behavior demands whatever attention is available from parents and siblings."<ref name=":5" /> This often "takes the focus off the parental alcohol problem", and the child can be the "scapegoat" under the myth that his/her behavior fuels the parent's drinking/using.<ref name=":6" /> However, this child draws attention from outsiders, which may contribute to the recognition of the family alcohol problem by outsiders.<ref name=":6" />

The "Lost Child" role is identified in this system through children that are "withdrawn, 'spaced-out,' and disconnected from the life and emotions around them."<ref name=":5" /> They often avoid "any emotionally confronting issues, [and so are] unable to form close friendships or intimate bonds with others."<ref name=":5" />

Other children "trivialize things by minimizing all serious issues as an avoidance strategy [and] are well-liked and easy to befriend but are usually superficial in all relationships, including those with their own family members."<ref name=":5" /> These children are known as the "Mascot" or "Family Clown".<ref name=":5" />

However, alcoholic family roles have not withstood [[Psychometrics|the standards that psychological theories of personality are typically subjected to]]. The evidence for alcoholic family roles theory provides limited or no construct validity or clinical utility.<ref>{{cite journal|title=Family Roles in Homes With Alcohol-Dependent Parents: An Evidence-Based Review|first=Peter|last=Vernig|date=2010|journal=Substance Use & Misuse|volume=46|issue=4|pages=535–542|doi=10.3109/10826084.2010.501676|pmid=20735193|s2cid=3279171}}</ref>

== Prevalence ==
Based on the number of children with parents meeting the DSM-V criteria for alcohol abuse or alcohol dependence, in 1996 there were an estimated amount of 26.8 million children of alcoholics (COAs) in the United States, of which 11 million were under the age of 18.<ref name="EIGEN1996"/> As of 1988, it was estimated that 76 million Americans, about 43 percent 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.<ref name="SCHOENBORN1991"/> While growing up, nearly one in five adult Americans (18 percent) lived with an alcoholic. In 1992, it was estimated that one in eight adult American drinkers were alcoholics or experienced problems as a consequence of their alcohol use.<ref name="HARWOOD1998"/>

== Familiarity ==
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.<ref name="WINDLE1997"/><ref name="ELLIS1997"/>

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.<ref name="JACOB1997"/><ref name="ZUCKER1975"/> Problem-solving discussions in families with an alcoholic parent contained more negative family interactions than in families with non-alcoholic parents.<ref name="ELLIS1997"/><ref name="JACOB1997"/> Several factors related to parental alcoholism influence COA substance abuse, including stress, negative affect and decreased parental monitoring. Impaired parental monitoring and negative effect correlate with COAs associating with peers that support drug use.<ref name="JACOB1997"/>

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.<ref name="FINN1997"/>

Compared with non-alcoholic families, alcoholic families demonstrate poorer problem-solving abilities, both between the parents and within the family as a whole. These communication problems may 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.<ref name="JACOB1997"/><ref name="SHER1997"/>

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 ==
[[File:A wife asking her drunkard husband to hand over a bottle Wellcome L0067935.jpg|thumb|A French [[Temperance movement|temperance organisation]] poster depicting the effects of alcoholism in a marriage]]
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.<ref name="SCHOENBORN1991"/>

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.<ref name="SCHOENBORN1991"/>

== Children ==
[[File:Dětský alkoholismus.jpg|thumb|left|Baby drinking beer]]

=== 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 (mood)|depression]] and other disorders.<ref name="BAVOLEK1990"/><ref name="DARO1990"/>

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.<ref>{{cite journal| url=https://pubs.niaaa.nih.gov/publications/ahrw20-1/18%E2%80%9323.pdf| last1=Cloninger| first1=C. Robert| last2=Sigvardsson| first2=Sören| last3=Bohman| first3=Michael| date=1996| title=Type I and Type II alcoholism: An update| journal=Alcohol Health & Research World| volume=20| issue=1| pages=18–23| pmid=31798167| pmc=6876531}}</ref>

=== 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.<ref name="ELLIS1997"/><ref name="SHER1991"/> 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.<ref name="autogenerated1"/>

Many children of alcoholics score lower on tests measuring cognitive and verbal skills than non-COAs. Lacking the requisite skills to express themselves can impact academic performance, relationships, and [[job interview]]s. The lack of these skills do not, however, imply that COAs are intellectually impaired.<ref name="DREJER1985"/><ref name="GABRIELLI1983"/> 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.<ref name="SCHAEFER1984"/><ref name="TARTER1985"/>

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).

=== Coping mechanism ===
Suggested practices to mitigate the impact of parental alcoholism on the development of their children include:<ref name="WOLIN1980"/>
* 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.
* Planning non-drinking activities to compete with alcoholic behavior and tendencies.<ref>{{cite journal | last1 = O'Farrell | first1 = T. J. | last2 = Fals-Stewart | first2 = W. | year = 2003 | title = ALCOHOL ABUSE | journal = Journal of Marital and Family Therapy | volume = 29 | issue = 1| pages = 121–146 | doi = 10.1111/j.1752-0606.2003.tb00387.x | pmid = 12616803 }}</ref>

=== Resilience ===

Professor and psychiatrist Dieter J. Meyerhoff states that the negative effects of alcohol on the body and on health are undeniable, but individuals should not forget the most important unit in society affected, family and children. The family is the main institution in which the child should feel safe and have moral values. If a good starting point is given, it is less likely that when a child becomes an adult, has a mental disorder, or is addicted to drugs or alcohol.<ref>{{cite journal|url=http://www.hdbp.org/psychiatria_danubina/pdf/dnb_vol25_sup2/dnb_vol25_sup2_74.pdf|title=The Impact of Family Environment on the Development of Alcohol Dependence|last1=Bratek|first1=Agnieszka|last2=Beil|first2=Julia|last3=Banach|first3=Monika|last4=Jarząbek|first4=Karolina|last5=Krysta|first5=Krzysztof|journal=Psychiatria Danubina|volume=25|issue=Supplement 2|date=2013|pages=74–77|pmid=23995149|access-date=26 April 2018 |archive-url= https://web.archive.org/web/20180427011636/http://www.hdbp.org/psychiatria_danubina/pdf/dnb_vol25_sup2/dnb_vol25_sup2_74.pdf |archive-date= 27 April 2018}}</ref> According to the [[American Academy of Child and Adolescent Psychiatry]] (AACAP), children are in a unique position when their parents abuse alcohol. The behavior of a parent is the essence of the problem because the children do not have and can not receive support from their own families. When they see changes from happy to angry parents, the children begin to think that they are the reason for these changes. Self-accusation, guilt, frustration, and anger arise because the child is trying to understand why this behavior occurs. Dependence on alcohol creates large amounts of harm to childhood and adolescent psychology in a family environment. Psychologists Michelle L. Kelley and Keith Klostermann describe the effects of parental alcoholism on children and describe the development and behavior of these children. Children of alcoholics often face problems such as behavioral disorders, oppression, crime, and attention deficit disorder, and there is a higher risk of internal behavior, such as depression and anxiety. Therefore, they begin drinking alcohol earlier and more often and are more likely to go from moderate to severe alcohol consumption. Young people with parental abuse and parental violence are likely to live in large crime areas, which may have a negative impact on the quality of schools and increase the impact of violence in that area. Paternal alcoholism, and general parental verbal and/or physical abuse can cause the fears of children and the internalization of symptoms, with a greater likelihood of child aggression and emotional misconduct.<ref>{{cite journal|last1=Kaur|first1=D.|last2=Ajinkya|first2=S.|title=Psychological impact of adult alcoholism on spouses and children|journal= Medical Journal of Dr. D.Y. Patil University|volume=7|issue=2|date=2014|pages=124–7|doi=10.4103/0975-2870.126309|doi-access=free}}</ref>

Research on alcoholism within families has leaned towards exploring issues that are wrong in the community rather than potential strengths or positives.<ref>{{Cite book|title=Research as Resistance: Revisiting Critical, Indigenous, and Anti-Oppressive Approaches|last=Brown, Strega|first=Leslie, Susan|publisher=Canadian Scholars' Press Inc.|year=2015|isbn=978-1551308821|location=Toronto|pages=5}}</ref> When researchers conduct research that helps communities, it can be easier for community members to identify with the positives and work towards a path of resilience. Flawed research design in adult children of alcoholics (ACOA) research showed ACOAs were psychologically damaged.<ref name=":0">{{Cite journal|last1=Amodeo|first1=Maryann|last2=Griffin|first2=Margaret|last3=Paris|first3=Ruth|title=Women's Reports of Negative, Neutral, and Positive Effects of Growing Up With Alcoholic Parents|journal=Families in Society: The Journal of Contemporary Social Services|volume=92|issue=1|pages=69–76|doi=10.1606/1044-3894.4062|year=2011|s2cid=143817928}}</ref> Some flawed research designs include using ACOAs as part of the control group and comparing them to other ACOAs within the same study. This may have caused some limitations in the study that were not listed. When comparing ACOAs to other ACOAs, it is difficult to interpret accurate results that show certain behaviors in the group studied. Research that has been conducted more recently has used control groups with non-ACOAs to see whether the behaviors align with prior research. This research has shown that behaviors were similar between non-ACOAs and ACOAs. An 18-year study compared children of alcoholics (COA) to other COAs. In failing to use non-COAs as controls, we miss an opportunity to see if the negative aspects of a person are related to having an alcoholic parent, or are they just simply a fact of life.<ref name=":1">{{Cite journal|last=Werner|first=E E|date=2015-01-04|title=Resilient offspring of alcoholics: a longitudinal study from birth to age 18|journal=Journal of Studies on Alcohol|language=en|volume=47|issue=1|pages=34–40|doi=10.15288/jsa.1986.47.34|pmid=3959559}}</ref> For example, in Werner's study, he found that 30 percent of COAs were committing serious delinquencies.<ref name=":1" /> This data would have been more usable if they had viewed the percentage of those committing crimes when compared to non-ACOAs. In a study conducted in a [[Midwestern United States|Midwestern]] university, researchers found that there was no significant difference between ACOA and non-ACOA students. One of the main differences was the student's views on how they connect their past experiences with their current social-emotional functioning. Students who were ACOAs did not demonstrate issues with their perspective on their interpersonal issues any more than the non-ACA students. However, this study did show that there were other underlying problems in the family structure that may attribute to the perception of not being well adjusted in life.

Due to the flawed research that has been conducted in the past, many stereotypes have followed ACOAs.<ref name=":2">{{Cite journal|last1=Wright|first1=Deborah M.|last2=Heppner|first2=P. Paul|title=Examining the well-being of nonclinical college students: Is knowledge of the presence of parental alcoholism useful?|journal=Journal of Counseling Psychology|volume=40|issue=3|pages=324–334|doi=10.1037/0022-0167.40.3.324|year=1993}}</ref> ACOAs have been identified as having a variety of emotional and behavioral problems, such as sleep problems, aggression, and lowered self-esteem.<ref name=":2" /> When it comes to being a COA or ACOA, there is still hope. Results showed that a supportive and loving relationship with one of the parents can counterbalance the possible negative effects of the relationship with the alcoholic parent. When there is one alcoholic parent in the household, it helps if the child relies on other family members for support. It may be the second parent, siblings, or members of the extended family. Having other supportive family members can help the child feel like s/he is not alone.<ref name=":3">{{Cite journal|last1=Moser|first1=Richard P.|last2=Jacob|first2=Theodore|date=1997-01-01|title=Parent-child interactions and child outcomes as related to gender of alcoholic parent|journal=Journal of Substance Abuse|volume=9|pages=189–208|doi=10.1016/S0899-3289(97)90016-X|pmid=9494949}}</ref> Younger generations of ACOAs scored more positively, in terms of coping mechanisms. This may be due to the fact that alcoholism is seen more as an illness nowadays, rather than a moral defect. There has been less [[victim blaming]] of alcoholism on parents because it has now been declared a disease rather than a behavioral problem.<ref name=":0" /> Studies show that when ACOAs use positive coping mechanisms, it is related to more positive results. When an ACOA approaches their issues, rather than avoids them, it often relates to having a positive outlook.<ref name=":0" /> Studies have shown that ACOAs and COAs have more compulsive behaviors that may cause the need for higher achievement.<ref name=":4">{{Cite journal|last=Harter|first=Stephanie Lewis|date=2000-04-01|title=Psychosocial adjustment of adult children of alcoholics: A review of the recent empirical literature|journal=Clinical Psychology Review|volume=20|issue=3|pages=311–337|doi=10.1016/S0272-7358(98)00084-1|pmid=10779897}}</ref> Some ACOAs have shown that the only way to survive is to fend for themselves. This causes a sense of independence that helps them become more self-reliant. Because they perceive independence and hard work as necessary, ACOAs develop a sense of survival instinct.<ref>{{Cite journal|last=Gandara|first=Patricia|date=1994-05-16|title=Choosing Higher Education: Educationally Ambitious Chicanos and the Path to Social Mobility|journal=Education Policy Analysis Archives|language=en|volume=2|pages=8|doi=10.14507/epaa.v2n8.1994|issn=1068-2341|doi-access=free}}</ref>

=== Implications for counselors ===
Counselors serving ACOAs need to be careful to not assume that the client's presenting problems are due solely to the parent's alcoholism. Exploring the ACOAs life events, such as the number of alcoholic parents, length of time the client lived with the alcoholic parent, past interventions, and the role of the extended family may help in determining what the correct method of intervention may be.<ref name=":2" />

Many factors can affect marital and/or parenting difficulties, but there has not been any evidence found that can link these issues specifically to ACOAs.<ref name=":4" /> Research has been conducted to try to identify issues that arise when someone is a COA. It has been hard to isolate these issues solely to the fact that the child's parents are alcoholics. Other behaviors need to be studied, like dysfunctional family relationships, childhood abuse, and other childhood stressors, and how they may contribute to things like depression, anxiety, and bad relationships in ACOAs.<ref name=":4" />

Counselors serving ACOAs can also help by working on building coping mechanisms such as creating meaningful relationships with other non-alcoholic family members. Having other family members who are supportive can help the ACOA feel like they are not alone.<ref name=":3" /> Counselors can also provide some psycho-education on alcoholism and its effects on family members of alcoholics. Research shows that ACOAs feel less like blaming their parents for their alcoholism after learning that alcoholism is a disease, rather than a behavior.<ref name=":0" />

== 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.<ref name="JACOBSON1997"/>

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 spectrum disorder|fetal alcohol syndrome]] (FAS). The risk an offspring born to an alcoholic mother having FAS increases from 6 percent to 70 percent if the mother's previous child had FAS.<ref name="LARKBY1997"/>

People diagnosed with FAS have [[IQ]]s ranging from 20 to 105 (with a mean of 68), and demonstrate poor concentration and attention skills. FAS causes growth deficits, morphological abnormalities, [[intellectual disability]], and behavioral difficulties. Among adolescents and adults, those with FAS are more likely to have mental health problems, drop out or be suspended from school, problems with the law, require assisted living as an adult, and problems with maintaining employment.<ref name="LARKBY1997"/>

== See also ==
{{col div|colwidth=30em}}
* [[Adult Children of Alcoholics]]
* [[Al-Anon/Alateen]]
* [[Concordance (genetics)]]
* [[Dual diagnosis]]
* [[Dysfunctional family]]
* [[Nar-Anon]]
* [[National Association for Children of Alcoholics (disambiguation)|National Association for Children of Alcoholics]]
* [[Self-medication]]
{{colend}}

== References ==
{{reflist|2|refs=

<ref name="allpsych.com">{{cite web |url=http://allpsych.com/journal/alcoholism.html |title=Alcoholism and Its Effect on the Family |last=Parsons |first=Tetyana |date=14 December 2003 |access-date=26 April 2018 |website=AllPsych}}</ref>

<ref name="BARNETT2003">{{cite journal |last=Barnett |first=Mary Ann |title=All in the Family: Resources and Referrals for Alcoholism |journal=Journal of the American Academy of Nurse Practitioners |volume=15 |issue=10 |pages=467–472 |date=October 2003 |doi=10.1111/j.1745-7599.2003.tb00333.x |issn=1745-7599 |pmid=14606136|s2cid=40389156 }}</ref>

<ref name="BAVOLEK1990">{{cite book | title = Aggression, Family Violence and Chemical Dependency | url = https://archive.org/details/aggressionfamily00pott | url-access = registration | last = Bavolek | first = Stephen J. |author2=Henderson, Hester L. |chapter = Child maltreatment and alcohol abuse: Comparisons and perspectives for treatment |editor = Potter, Ronald T. |editor2= Efron Patricia S. |pages=[https://archive.org/details/aggressionfamily00pott/page/165 165–184] |location=[[Binghamton]] |publisher=Haworth Press |year=1990 |isbn=978-0-86656-964-4}}</ref>

<ref name="CERMAK1989">{{Cite book |last=Cermak |first=TL |chapter=Al-Anon and recovery |year=1989 |volume=7 |pages=91–104 |issn=0738-422X |pmid=2648500 |doi=10.1007/978-1-4899-1678-5_5|series=Recent Developments in Alcoholism |isbn=978-1-4899-1680-8 |title=Recent Developments in Alcoholism }}</ref>

<ref name="CRNKOVIC1998">{{cite journal |last = Crnkovic |first=A. Elaine |author2=DelCampo, Robert L. |title=A Systems Approach to the Treatment of Chemical Addiction |journal = [[Contemporary Family Therapy]] |volume=20 |issue=1 |date=March 1998 |pages=25–36 |doi=10.1023/A:1025084516633 |s2cid=141085303 |issn=1573-3335}}</ref>

<ref name="CUTTER1987">{{cite journal |last =Cutter |first=CG |author2=Cutter, HS |title=Experience and change in Al-Anon family groups: adult children of alcoholics |journal=Journal of Studies on Alcohol |date=January 1987 |volume=48 |issue=1 |pages=29–32 |issn=0096-882X |pmid=3821116|doi=10.15288/jsa.1987.48.29 }}</ref>

<ref name="DARO1990">{{cite report | title = Current Trends in Child Abuse Reporting and Fatalities: The Results of the 1990 Annual Fifty State Survey. Working Paper Number 808 |first=Deborah |last=Daro |author2=McCurdy, Karen | publisher=National Committee for Prevention of Child Abuse | location=[[Chicago, Illinois]] |date=April 1991 |page=34 |url=http://eric.ed.gov/ERICWebPortal/contentdelivery/servlet/ERICServlet?accno=ED337937}}</ref>

<ref name="DRAKE1990">{{cite journal|last=Drake |first=Robert E. |author2=Racusin, Robert J. |author3=Murphy, Timothy A. |date=1 August 1990 |title=Suicide Among Adolescents With Mentally Ill Parents |journal=Hospital & Community Psychiatry |volume=41 |pages=921–922 |issn=0022-1597 |pmid=2401483 |issue=8 |doi=10.1176/ps.41.8.921 }}</ref>

<ref name="DREJER1985">{{cite journal |last=Drejer |first=Kirsten |author2=Theikjaard, Alice|author3= Teasedale, Thomas W.|author4= Schulsinger, Fini|author5= Goodwin, Donald W. |volume=9 |issue=6 |pages=498–502 |date=November 1985 |title=A Prospective Study of Young Men at High Risk for Alcoholism: Neuropsychological Assessment |journal=Alcoholism: Clinical and Experimental Research |doi=10.1111/j.1530-0277.1985.tb05590.x | issn=1530-0277 |pmid=3911808}}</ref>

<ref name="EIGEN1996">{{cite book | title = Children of Alcoholics: Selected Readings | chapter = Section 1: Research - A Methodology and Current Estimate of the Number of Children of Alcoholics in the United States | last = Eigen | first = L. | author2 = Rowden, D. | location = [[Rockville, MD]] | publisher = National Association for Children of Alcoholics (NACoA) | year = 1996 | isbn = 978-0-9645327-4-8 | editor = Abbott, Stephanie | edition = Volume II | pages = [https://archive.org/details/childrenofalcoholic00acke/page/1 1–22] | chapter-url-access = registration | chapter-url = https://archive.org/details/childrenofalcoholic00acke | url = https://archive.org/details/childrenofalcoholic00acke/page/1 }}</ref>

<ref name="ELLIS1997">{{cite journal|last=Ellis |first=Deborah, A. |author2=Zucker, Robert A. |author3=Fitzgerald, Hiram E. |title=The Role of Family Influences in Development and Risk |journal=Alcohol Health and Research World |volume=21 |issue=3 |pages=218–225 |year=1997 |url=http://pubs.niaaa.nih.gov/publications/arh21-3/218.pdf |pmid=15706772 |pmc=6826803 |issn=0090-838X |archive-url=https://web.archive.org/web/20100528001357/http://pubs.niaaa.nih.gov/publications/arh21-3/218.pdf |archive-date=28 May 2010 |url-status=live }}</ref>

<ref name="FINN1997">{{cite journal |last=Finn |first=Peter, R. |author2=Justus, Alicia |title=Physiological Responses in Sons of Alcoholics |journal=Alcohol Health and Research World |volume=21 |issue=3 |pages=227–231 |year=1997 |url=http://www.hawaii.edu/hivandaids/Physiological%20Responses%20in%20Sons%20of%20Alcoholics.pdf |pmid=15706773 |pmc=6826811 |issn=0090-838X |archive-url=https://web.archive.org/web/20101226005940/http://www.hawaii.edu/hivandaids/Physiological%20Responses%20in%20Sons%20of%20Alcoholics.pdf |archive-date=26 December 2010 |url-status=dead |df=dmy-all |access-date=19 July 2008 }}</ref>

<ref name="GABRIELLI1983">{{cite journal |last=Gabrielli |first=W.F. |author2=Mednic, S.A. |title=Intellectual performance in children of alcoholics |journal=Journal of Nervous and Mental Disease |volume=171 |issue=7 |pages=444–447 |year=1983 |pmid=6864203 |issn=1539-736X |doi=10.1097/00005053-198307000-00009}}</ref>

<ref name="HARWOOD1998">{{cite report |last=Hardwood |first=H |author2=Fountain, D. |author3=Livermore |title=The Economic Costs of Alcohol and Drug Abuse in the United States, 1992 |year=1998 |quote=Analysis by the Lewin Group |location=[[Rockville, MD]] |publisher=DHHS, NIH, NIDA, OSPC, NIAAA, OPA. NIH Publication No. 98-4327 |url=http://www.nida.nih.gov/economiccosts/index.html |archive-url=https://web.archive.org/web/20100106042536/http://www.nida.nih.gov/economiccosts/index.html |archive-date=6 January 2010 |url-status=dead |access-date=19 July 2008 }}</ref>

<ref name="JACOB1997">{{cite journal|last=Jacob |first=Theodore |author2=Johnson, Sheri |title=Parenting Influences on the Development of Alcohol Abuse and Dependence |journal=Alcohol Health and Research World |volume=21 |issue=3 |pages=204–209 |year=1997 |url=http://pubs.niaaa.nih.gov/publications/arh21-3/204.pdf |pmid=15706770 |pmc=6826805 |issn=0090-838X |archive-url=https://web.archive.org/web/20101026135651/http://pubs.niaaa.nih.gov/publications/arh21-3/204.pdf |archive-date=26 October 2010 |url-status=live }}</ref>

<ref name="JACOBSON1997">{{cite journal |last=Jacobson |first=Sandra W |title=Assessing the Impact of Maternal Drinking During and After Pregnancy |journal=Alcohol Health and Research World |volume=21 |issue=3 |pages=199–203 |year=1997 |pmid=15706769 |pmc=6826808 |issn=0090-838X |url=http://www.hawaii.edu/hivandaids/Assessing%20the%20Impact%20of%20Maternal%20Drinking%20During%20and%20After%20Pregnancy.pdf |archive-url=https://web.archive.org/web/20110605015849/http://www.hawaii.edu/hivandaids/Assessing%20the%20Impact%20of%20Maternal%20Drinking%20During%20and%20After%20Pregnancy.pdf |archive-date=5 June 2011 |url-status=dead |df=dmy-all |access-date=19 July 2008 }}</ref>

<ref name="LARKBY1997">{{cite journal |last=Larkby |first=Cynthia |author2=Day, Nancy |title=The Effects of Prenatal Alcohol Exposure |journal=Alcohol Health and Research World |volume=21 |issue=3 |pages=192–197 |year=1997 |pmid=15706768 |pmc=6826810 |issn=0090-838X |url=http://www.hawaii.edu/hivandaids/Effects%20of%20Prenatal%20Alcohol%20Exposure.pdf |archive-url=https://web.archive.org/web/20101225005552/http://www.hawaii.edu/hivandaids/Effects%20of%20Prenatal%20Alcohol%20Exposure.pdf |archive-date=25 December 2010 |url-status=dead |df=dmy-all |access-date=19 July 2008 }}</ref>

<ref name="MAYNARD1999">{{cite journal |last=Maynard |first=Stuart |title=Growing up in an alcoholic family system: the effect on anxiety and differentiation of self |journal = Journal of Substance Abuse |year=1999 |volume=9 |pages=161–170 |doi=10.1016/S0899-3289(97)90014-6 |issn=0740-5472 |pmid=9494947}}</ref>

<ref name="MULLIGAN2001">{{cite journal |last=Mulligan |first=Kate |title=Al-Anon Celebration Spotlights Importance of Family Involvement |journal=Psychiatric News |date=5 October 2001|volume=36 |issue=9 |page=7 |doi=10.1176/pn.36.19.0007}}</ref>

<ref name="OFARRELL2006">{{cite book |last=O'Farrell |first=Timothy J |author2=Fals-Stewart, William |title=Behavioral Couples Therapy for Alcoholism And Drug Abuse |isbn=978-1-59385-324-2 |oclc=64336035 |year=2006 |publisher=Guilford Press |pages=[https://archive.org/details/behavioralcouple0000ofar/page/1 1–7] |chapter=An Introduction to Behavioral Couples Therapy for Alcoholism |url=https://archive.org/details/behavioralcouple0000ofar/page/1 }}</ref>

<ref name="SCHAEFER1984">{{cite journal |last=Schaefer |first=K.W. |author2=Parsons, O.A.|author3= Vohman, J.R. |title=Neuropsychological differences between male familial and non-familial alcoholics and non-alcoholics |journal=Alcoholism: Clinical and Experimental Research |date=July–August 1984 |volume=8 |issue=4 |pages=347–351 |pmid=6385756 |doi=10.1111/j.1530-0277.1984.tb05678.x}}</ref>

<ref name="SCHOENBORN1991">{{cite journal | last = Schoenborn | first = CA | title = Exposure to Alcoholism in the Family: United States, 1988 |date=September 1991 | volume = 30 | issue = 205 | pages = 1–13 | pmid = 10114780 | journal = Advance Data from Vital and Health Statistics | issn = 0147-3956}}</ref>

<ref name="SHER1991">{{cite book |first=Kenneth J. |last=Sher |year=1991 |publisher=University of Chicago Press |title=Children of alcoholics |location=United States |isbn=978-0-226-75271-6 |oclc=23176799 |url-access=registration |url=https://archive.org/details/childrenofalcoho0000sher }}</ref>

<ref name="SHER1997">{{cite journal|last=Sher |first=Kenneth, J. |title=Psychological Characteristics of Children of Alcoholics |journal=Alcohol Health and Research World |volume=21 |issue=3 |pages=247–253 |year=1997 |url=http://pubs.niaaa.nih.gov/publications/arh21-3/247.pdf |pmid=15706777 |pmc=6826809 |archive-url=https://web.archive.org/web/20100528001236/http://pubs.niaaa.nih.gov/publications/arh21-3/247.pdf |archive-date=28 May 2010 |url-status=live }}</ref>

<ref name="TARTER1985">{{cite journal |last=Tarter |first=Ralph E. |author2=Hegedus, Andrea M.|author3= Goldstein, Gerald|author4= Shelly, Carolyn|author5= Alterman, Arthur I. |title=Adolescent Sons of Alcoholics: Neuropsychological and Personality Characteristics |journal=Alcoholism: Clinical and Experimental Research |volume=8 |issue=2 |pages=216–222 |doi=10.1111/j.1530-0277.1984.tb05842.x |date=March 1984 |issn=1530-0277 |pmid=6375434}}</ref>

<ref name="WINDLE1997">{{cite journal|last=Windle |first=Michael |title=Concepts and Issues in COA Research |journal=Alcohol Health and Research World |volume=21 |issue=3 |pages=185–191 |year=1997 |url=http://pubs.niaaa.nih.gov/publications/arh21-3/185.pdf |pmid=15706767 |pmc=6826804 |archive-url=https://web.archive.org/web/20101026135640/http://pubs.niaaa.nih.gov/publications/arh21-3/185.pdf |archive-date=26 October 2010 |url-status=live }}</ref>

<ref name="WOLIN1980">{{cite journal | last=Wolin |first=S.J. |author2=Bennett, L.A.|author3= Noonan, D.L.|author4= Teitelbaum M.A. |title=Disrupted family rituals: A factor in the intergenerational transmission of alcoholism |journal=Journal of Studies on Alcohol |volume=41 |issue=3 |pages=199–214 |date=March 1980 |pmid=7374140 |issn=0096-882X|doi=10.15288/jsa.1980.41.199 }}</ref>

<ref name="ZUCKER1975">{{cite journal | first =Robert A. |last =Zucker |author2= Kincaid, Stephen B.|author3= Fitzgerald, Hiram E.|author4= Bingham, Raymond |date=August 1995 |title=Alcohol Schema Acquisition in Preschoolers: Differences Between Children of Alcoholics and Children of Nonalcoholics | journal = Alcoholism: Clinical and Experimental Research |volume=19 |issue=4 |pages=1011–1017 | doi=10.1111/j.1530-0277.1995.tb00982.x |issn=1530-0277 | pmid=7485810|hdl =2027.42/65209 |url=https://deepblue.lib.umich.edu/bitstream/2027.42/65209/1/j.1530-0277.1995.tb00982.x.pdf |hdl-access=free }}</ref>

<ref name="autogenerated1">{{cite book |first=Kenneth J. |last=Sher |year=1991 |publisher=University of Chicago Press |title=Children of alcoholics |chapter=Chapter 6: Psychological Characteristics |location=United States |isbn=978-0-226-75271-6 |oclc=23176799 |url-access=registration |url=https://archive.org/details/childrenofalcoho0000sher }}</ref>
}}

{{DEFAULTSORT:Alcoholism In Family Systems}}
[[Category:Alcohol abuse]]
[[Category:Drinking culture]]
[[Category:Family disruption]]
[[Category:Parenting]]
[[Category:Relationship counseling]]

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Greek: Ά ά Έ έ Ή ή Ί ί Ό ό Ύ ύ Ώ ώ Α α Β β Γ γ Δ δ Ε ε Ζ ζ Η η Θ θ Ι ι Κ κ Λ λ Μ μ Ν ν Ξ ξ Ο ο Π π Ρ ρ Σ σ ς Τ τ Υ υ Φ φ Χ χ Ψ ψ Ω ω {{Polytonic|}}
Cyrillic: А а Б б В в Г г Ґ ґ Ѓ ѓ Д д Ђ ђ Е е Ё ё Є є Ж ж З з Ѕ ѕ И и І і Ї ї Й й Ј ј К к Ќ ќ Л л Љ љ М м Н н Њ њ О о П п Р р С с Т т Ћ ћ У у Ў ў Ф ф Х х Ц ц Ч ч Џ џ Ш ш Щ щ Ъ ъ Ы ы Ь ь Э э Ю ю Я я ́
IPA: t̪ d̪ ʈ ɖ ɟ ɡ ɢ ʡ ʔ ɸ β θ ð ʃ ʒ ɕ ʑ ʂ ʐ ç ʝ ɣ χ ʁ ħ ʕ ʜ ʢ ɦ ɱ ɳ ɲ ŋ ɴ ʋ ɹ ɻ ɰ ʙ ⱱ ʀ ɾ ɽ ɫ ɬ ɮ ɺ ɭ ʎ ʟ ɥ ʍ ɧ ʼ ɓ ɗ ʄ ɠ ʛ ʘ ǀ ǃ ǂ ǁ ɨ ʉ ɯ ɪ ʏ ʊ ø ɘ ɵ ɤ ə ɚ ɛ œ ɜ ɝ ɞ ʌ ɔ æ ɐ ɶ ɑ ɒ ʰ ʱ ʷ ʲ ˠ ˤ ⁿ ˡ ˈ ˌ ː ˑ ̪ {{IPA|}}

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