Influence of an Alcoholic on the Family

Drinking and family functioning are linked and although the relationship may be causal, reciprocal, iterative, or incidental to other causes. 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, economic and legal vulnerability, and child risks. 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, emotional and physical abuse.

Children of Alcoholics
Of an estimated 28 million Americans who are children of alcoholics, nearly 11 million are under the age of 18. The risk estimates of children of alcoholics (COAs) developing an alcohol use disorder vary from 4:1 to 9:1. The variability in estimates is attributable to differences in study sampling, definitions and criteria, and assessment strategies. For example, some COAs have a parent who is currently alcoholic, some have been exposed to a parent's alcoholism at some point in their lives, and still others have a parent (or parents) whose alcoholism predated their birth, but it may still have an impact on their development. Another way of looking at these individuals is to identify (1) children of current alcoholics, (2) children of parental period alcoholics, and (3) children of lifetime alcoholics-a parent who was ever an alcoholic. The distinction has important implications for epidemiological and assessment purposes.

Families and Recovery
Family members and family process may play a direct role in relapse during recovery, as family conflict and/or strong negative affect (e.g., anger aroused during conflict) may precipitate renewed drinking by abstinent. On the other hand, the family may play an important role in facilitating alcohol treatment and recovery processes. The integration of relapse prevention with couples counseling has been shown to be effective. Furthermore, family-based therapeutic interventions with adolescent substance abusers are proving more effective than individual or group therapy treatment approaches.

The Family Disease Model
The family disease model suggests that alcohol use disorders are not only diseases affecting an individual, they affect other family members, as well. The model indicates that the disease is manifested in other family members in terms of phenomena such as anxiety, enmeshment and other dysfunctional relationships, low self-esteem, and "co-dependence". Co-dependence, according to this model, is a complementary or parallel disease to alcoholism, exhibited by the alcoholic's significant others. The codependent person presumably exhibits a number of symptoms associated with the disease (e.g., issues about control, perfectionism, "frozen" feelings/emotional blunting, and external referencing), and engages in "enabling" behaviors. Enabling is described as behaviors that perpetuate another person's substance use-for example, protecting the person from experiencing the natural consequences of substance use that might have led to deterrence in the future; making access easier; covering up for the other person's drinking. Treatment approaches formulated around this model do not address the individual's substance use directly, but encourage the significant others to heal themselves from their own disease and recover from the impact that the drinking has had on their lives. The family members are encouraged to detach themselves from the other's drinking, reduce their own emotional distress, and improve their own coping and functioning. There exists little in the way of empirical support for this model that underlies the Al-Anon program.

THE NATURE AND EXTENT OF UNDERAGE ALCOHOL USE
Underage drinking is a significant but often overlooked problem in the United States. Young people between the ages of 12 and 20 are more likely to use alcohol than use tobacco or illicit drugs, including marijuana (2–4) (see figure 1). Although adolescents tend to drink less frequently than adults, they drink considerably more per occasion—5 drinks on average. Underage alcohol use, and especially binge drinking1—a particularly harmful pattern of drinking—puts individuals at risk for a range of problems (4).

Despite the high prevalence of and the problems associated with underage drinking, many adults do not realize the extent of the problem, or do not view underage drinking as harmful. Many see alcohol use by teens as a “rite of passage” and may even facilitate it (1). Challenging this culture of acceptance is key to preventing and reducing underage drinking.

More Adolescents Use Alcohol Than Use
Cigarettes or Marijuana

Alcohol Use Increases
Dramatically During Adolescence

Figure 3: Number of Days in the Past 30 in Which Drinkers Consumed 5 or More Drinks, by Age and Gender.
Source: SAMHSA data from 2005 NSDUH