Dr. Willis Newman, Esmeralda Newman, bible-teaching-about.com

Counseling Children of Alcoholics

by Esmeralda Newman

Abstract

This paper reviews available materials on the issues faced by children of alcoholics (COA), and the counseling approaches that are most effective in helping them. COAs grow up in an unstable and unpredictable environment that interferes with their healthy functioning and development. COAs grow up feeling afraid, angry, guilty and depressed. They also often take on adult responsibilities at a young age. However, studies have identified certain factors that buffer against the adverse effects of living with alcoholics. These factors include having positive and warm relationships with a nonalcoholic parent, and/or another responsible adult. Mental health counselors need to possess the knowledge, skills and abilities needed to apply the right intervention to help these children learn how to cope with stressors in their lives, develop normally, and learn how to function in a healthy way through their adult years. The Bible speaks against alcoholism and parents who exasperate their children with the way they live and communicate. Jesus is able to help and transform people who are willing to give their lives to Him.

Keywords: alcoholic parents, children of alcoholics, alcoholism

Counseling Children of Alcoholics

Introduction

An article from an independent online newspaper, The Washington Times, published an article by Jerome Elam (2012) about his experience living and growing up with his alcoholic mother. 

My mother began drinking as a way to deal with the despair over the loss of her “fairy tale” romance. Soon my mother and I were living with my mother’s parents where she was seldom, if ever, sober. My mother would disappear for days at a time with no explanation, and in the mind of a child there is nothing more devastating than abandonment by a parent. I was living with my grandparents whose belief was that severe beatings were the best form of punishment for children. They would even go so far as to have me go and get the belt or strap they would use to beat me.

My mother stood oblivious as this all happened, concerned with her own need to “check out” from reality. When my mother drank, she became a different person whose actions were accountable to no one. This was combined with the amnesia most hard-core alcoholics experience when they sober up. Immediately after the cap was unscrewed from the bottle, nothing else in the world mattered but its contents (2012). 

According to the U.S. Department of Health and Human Services and the Substance Abuse & Mental Health Services Administration, there are 76 million adult children of alcoholics (COA) in the United States (Hall & Webster, 2007). This means that mental health professionals are bound to encounter children who are impacted by alcoholic parents. It is therefore very important for mental health counselors to be aware of COA’s unique needs, and have the education, skills and abilities necessary to treat them. 

Using available research materials on children of alcoholics, this paper discusses how growing up with alcoholic parents affects children, and the factors that mitigate the adverse effects of living with alcoholic parents. This paper also discusses some of the preferred counseling approaches, as well as helpful recommendations that will help mental health counselors work more effectively with COAs. The paper ends with a discussion of what the Bible says about alcoholic parents, their impact on children and the hope that comes from Christ.

The home environment of children of alcoholics 

Developmental psychologists emphasize the importance of a, “warm, loving and stable home environment,” for children to grow and develop in a healthy way (Henderson & Thompson, 2011, p. 8). The home is where children’s basic needs to survive and thrive are supposed to be met. Parents and siblings are the first people through whom children experience love, affection and affirmation, and from whom they learn how to have a positive relationship with others. It is also in the home that children learn values, cultural and religious beliefs, and assumptions about their environment, which form the grid by which they will interpret and make sense of their environment. 

Alcoholic parents are often unable to maintain routines and family rituals (Orenstein & Ullman, 2001, p. 18 cited by Emshoff & Valentine, 2006, p. 18).  These parents are often unpredictable and inconsistent causing children to feel afraid, anxious, confuse and angry.  Some COAs feel guilt believing that they are causing the problem at home. They may also feel depressed as their emotional needs are unmet, and embarrassed by the secret of alcoholism that they have to keep (aacap.org, 2012). 

Alcoholism impairs parent’s ability to perform positive parenting on a consistent basis.  Children experience, “parental inconsistencies, double-bind messages, hidden feelings, incomplete information, shame, uncertainty, mistrust and roles that stifle development and identity all of which contribute to maladaptive responses including psychopathology” (Black, 1981; Wegscheider, Woititz, 1981, cited by Goodman, 1987, p. 162). 

Alcoholic families demonstrate problems with communication and in exhibiting warmth and affection. These families also encourage, “role reversal and distorted hierarchy” (Garbarino & Strange, 1993; Rojas, 1993; Senchak, Leonard, Greene and Caroll, 1995; Chase, Deming, & Wells, 1998; Goglia, Jurkovic, Burt, & Burge-Calloway, 1992; Sheridan & Green, 1993 cited by Johnson, 2001, p. 128).  As such, COAs are forced to assume adult roles including taking care of younger siblings and/or their inebriated parents. They become “parentified” (Vought and Wittman, cited by Johnson, 2001, p. 359).  They become, “controlled, successful overachievers,” in school, while feeling depressed and isolated from others. Parentified COAs often become overly responsible adults. (aacp.org, 2012, para. 4). 

Often children of alcoholics set aside their own emotional needs and play to take care of their parents and siblings. Play is an important factor in the development of children as it has, “power to enhance normal development and alleviate normal behavior” (Henderson and Thompson, 2011, p. 559).  Play stimulates children’s creativity, encourages exploration and experimentation and increases positive self-esteem (Landreth, 2002, cited by Henderson and Thompson, 2011). Parentified children who are deprived of play time are found to grow up less socialized,  and often struggle with problems of, “anxiety, distress, dissociation, isolation, anxiety and boundary distortion between parent and child” (Byng- Hall, 2008; Hooper, cited by Vaught & Wittman, 2011, p. 363).

Adverse effects of parental alcoholism on children

Numerous studies prove that children raised in alcoholic families suffer from physical, emotional, and other psycho-social problems that persist to adulthood. Some of the problems include relationship distress, impaired familial relationships, disrupted life patterns and routines, enhanced risk for relationship distress, impaired familial relationships, disrupted life patterns and routines, enhanced risk for behavioral disorders, as well as deficits in problem-solving, professional and personal relationships, and inflexibility on handling adult roles (Kahler, McCrady,&Epstein, 2003; Crespi & Sabatelli, 1997; Bennett&Wolin, 1990; Johnson & Rolf, 1990, Crespi, 1990; Woititz, 1983; Black, 1981 cited by Johnson, 2001). 

On the unborn and young children

Drinking alcohol during pregnancy increases the likelihood of exposing the baby to fetal alcohol syndrome (FAS), a condition characterized by, “abnormal facial features, growth retardation, and central nervous system problems. Children with FAS may have physical disabilities and problems with learning, memory, attention, problem solving, and social/behavioral problems” (Bertrand et al., 2004 cited by Edwards, Eiden, Colder & Leonard, 2006, p. 3).

A recent study indicates that children with alcoholic parents exhibit aggressive behavior more than those who are born from nonalcoholic parents starting at 18 months. Boys are particularly vulnerable to developing aggressive behavior than girls.  Alcoholism combined with multiple risk factors including parental depression and psychopathology contributes to increase children’s risk for maladaptive patterns (Hussong, Zucker, Wong, Fitzgerald, & Puttler, 2005).

Studies also found a strong link between externalizing behavior and adult alcohol abuse. This association is so strong that Hussong, Zucker, Wong, Fitzgerald & Puttler (1999) used it as a, “proxy indicator,” of alcohol use in a sample of 6 to 8 year old children, those too young to yet engage in substance use, because it “captures the antisocial deviancy construct that has been so strongly and consistently linked to adolescent alcohol use, as well as adult alcoholic outcomes” (Edwards, Eiden, Colder, Leonard, 2006, p. 409). 

Young COAs are found to be more likely to experience and witness verbal and physical violence between parents and children.  Studies indicate that alcoholism in parents is a strong predictor of child abuse. COAs are also found to experience higher levels of neglect and physical abuse in their home than do children in nonalcoholic families (Hall, Bolen, Webster, 1994; Kerr and Hill, 1992, Sher, Gershuny, Peterson, Raskin, 1997, cited by Johnson, 2001).  Reports indicate that alcohol is a significant factor in approximately 81% of child abuse cases (NCOA, 1998, cited by Johnson, 2001, p.128).

On adolescents

Research has shown a link between depression and substance use in adolescence. This link is exacerbated by a lack of coping strategies, or if the adolescent COAs believe that alcohol will actually help them cope with life stresses (Zucker, 2006; Deykin, Buka, & Zeena, 1992; Rohde, Lewinson, & Seely, 1996, cited by Rice, Dandreaux, Handley, Chassin, 2006).

COAs show greater risk for externalizing symptoms that emerges at least by mid-adolescence (Hussong, Wirth, Edwards, Curran, Chassin, Zucker, 2007). This may be partly caused by the fact that children of alcoholics have smaller volume in their frontal cingulate gyri, amygdala, hippocampus, thalamus and cerebellum which may explain the lack of inadequacy of inhibitory mechanisms which result in impulsiveness and lack of control. This impulsivity often leads to substance and alcohol abuse and a propensity to engage in high-risk activities. These children are also more likely to get involved with other children who have with behavioral issues, which is another predictive factor in alcoholism and substance abuse in adolescent years  (Rice, Dandreaux, Handley, Chassin, 2006, p.4).

On adults

Studies have found that difficulties stemming from being raised by alcoholic parents such as self-esteem issues, depression, anxiety, stress-related illnesses, and difficulties in school persist into adulthood (NCOA, 1998, cited by Johnson, 2001). Adult COAs have a higher prevalence of mood, anxiety, abuse/dependence disorders, lower levels of marital satisfaction, higher frequencies of divorce, lower levels of satisfaction in relationship with their own children, higher frequency of marrying alcoholics, and less overall life satisfaction (Beaudoin, Murray, Bond, Barnes, 1997; Cuijpers, Langendoen, Bijl, 1999; Kere, Hill 1992; Larson and Thayne, 1998; Hall, et. al., 1994, cited by Johnson, 2001, p. 128).

Young COAs learn to be hyper vigilant, because they grow with the feeling that they have to maintain control, because if not, chaos will ensue and/or escalate (Dumont, Hinson, & Sibcy, 2012) These COAs grow up with a bigger need to be in control of relationships, and have difficulties with the issues of intimacy and trust (Woititz, 2002; Knoblauch & Bowers, 1989, cited by Dumont, Hinson, & Sibcy, 2012). 

Adult COAs difficulties in maintaining healthy relationships may also be related to having an insecure attachment patterns with their alcoholic parents when they were young. Attachment is the positive emotional bond that develops between children and their caregiver or significant adult (Feldman, 2011).  The type of attachment that a child forms has long-term repercussions into many aspects of the child’s development and adult life (Neal & Frick-Horbury, 2001).   

Alcoholic parents are more than likely to form insecure attachment patterns with their children than nonalcoholic parents. Research has suggested that insecurely attached adults demonstrate, “guarded and conflicted relationships,” which translate to unsatisfying, and even, “threatening,” adult relationship (Lopez & Brennan, 2000 cited by Dumont, Hinson, & Sibcy, 2012, p. 51). As a result, adult COAs’ marriages and families are often characterized by unresolved conflict, fighting, arguing, and blaming. Their families are characterized by, depressed levels of togetherness, family closeness, physical and verbal expressions of positive feelings, warmth, and caring between family members than nonalcoholic families. Studies show that divorce tends to be more common in alcoholic families than in nonalcoholic families. (Johnson, 2001, p. 133).

COAs lack of play in their childhood has also been found to have a strong link to their career choices as adults. Studies reveal that adult COAs often end up choosing careers that either involved working alone, or working in a “social contribution domain,” which include being a social worker and a teacher (Vaught & Wittman, 2011, p. 362). 

Resiliency factors

There are factors that can protect the children from the adverse effects of having alcoholic parents. These factors include social class, preservation of family rituals, attention from primary caregivers,  family harmony during infancy, personality, parental support, self-awareness, cognitive-intellectual functioning and coping skills (Sher, 1991, cited by Rice, Dandreaux, Handley, Chassin, 2006).

According to Hussong, Zucker, Wong, Fitzgerald & Puttler (2005), another potential source of resilience for COAs may be the recovery of the alcoholic parent. Their study proved that children of recovered alcoholics have the same level of competence compared with children of non-alcoholics, which proved that not all COAs face the same level of risk.  

Research demonstrated the importance of a number of familial factors in buffering the risk associated with parental alcoholism including the potential for alcohol and substance abuse (King & Chassin, 2004; Marshal & Chassin, 2000; Stice, Barrera, & Chassin, 1993 cited by Chagas, Benegal, Devi, Mukundan, 2007). These include having positive and supportive parents, consistent discipline, harmony, and consistent observance of family rituals.

Although having positive family relationships help, other people in the child’s life may step in and meet the COAs need for positive and affirming relationships such as extended family members including grandparents, aunts/uncles, and older siblings. Other responsible and caring adults may include friends, teachers, youth workers, pastors, and even caring neighbors (Werner, Johnson, 2004, p. 717).  Studies suggest that for older children, peer relationships may be, “as influential as family relationships on adolescents’ decision to use substances” (Mayes & Suchman, 2006, cited by Rice, et.al., 2006, p. 3).  Ohannessian and Hesselbrock (1993) found that COAs with very supportive and positive social support from peers and friends did not drink differently from those who are not COAs. (Rice, et.al. 2006). 

Other miscellaneous factors that help in the resilience of COAs include educational and religious involvement, finding a supportive mates or friend, having skilled trades, and being in the middle to upper class status (Werner & Johnson, 2004, p. 716).   Involvement in church activities and a strong faith also provided meaning for many adult COAs. Werner and Johnson (2004) states, “Participation in their communal activities provided structure for their lives and assured them of salvation, security, and a sense of mission in an alien world” (p. 716).

Recommendations to mental health counselors

Mental health counselors who work with children must possess the necessary training, skills and ability to effectively address the COAs unique needs. Although most counseling approaches can be applied to children, counselors must consider the child’s developmental stage and apply the treatment principles and methodologies accordingly. Young children are unable to articulate what they think and/or feel, requiring special communication skills from counselors. Certain approaches may not work in the same way it would with adults, such as psychodynamic approach and its emphasis on going back to their past and delving into their unconscious. 

Counselors must also understand how living with alcoholic parents affects children’s brain and psyche, as well as their social and behavioral development. Child counselors must always inquire about the child’s family of origin experiences, including possible child abuse, divorce, violence and parental substance and alcohol abuse.  Some ACOAs will have unresolved issues related to physical or sexual abuse that needs to be addressed. 

Having a comprehensive clinical assessment of COAs family experiences will assist mental health counselors with the development of appropriate treatment plans and interventions. The assessment must include an assessment for alcohol and substance abuse by both parents and children, and if there is any problem, address those through individual or group counseling or through a substance abuse program (Johnson, 2001).

If the child is still living with the alcoholic parents, counselor must help uncover and assess existing relationships, and help the children have positive relationships. Counselors must help children develop positive attachment and relationship with a nonalcoholic parent and supportive extended families. Teachers, youth workers, ministers, and Sunday school teachers may be called on to advocate and helper to these children. Counselors also need to uncover internal and external resources the COAs may have that may buffer against the adverse effects of being a COA.

Counselors must also provide information about available resources within the community that may help address the issue of alcoholism, and the family members affected by it. These resources may include outpatient and inpatient treatment, AA meetings, and ACOA support groups which may help with personal changes and growth (Johnson, 2001). 

Best therapeutic approach/es

Marriage and family therapy for families of alcoholics is growing (Rotunda & O’Farrell, 1997, cited by Crespi & Rueckert, 2006, p. 39). Mental health counselors must therefore be thoroughly prepared to help children of alcoholics. 

Proper intervention starts with an effective and appropriate assessment. Rubin (2001) recommends a type of assessment, and intervention for adult COAs, based on functional assessment model that emphasizes identifying resiliency factors, and the development of personal coping styles and methods. This assessment also includes addressing the usual concerns of adult that come as a result of living in an alcoholic home (Hall l& Webster, 2007, p. 505).

In a similar way, the assessment used for young COA must help identify problem areas including in their familial environment, and their personal and internal factors that may exacerbate or buffer against the impact of parental alcoholism such as their temperament, and desire for control and attention. 

The intervention used must be applied with great sensitivity to children’s development stage. It must also help them COAs learn coping skills to handle the stressors they encounter, and help build resiliency while they are yet developing (Rubin, 2001, cited by Hall & Webster, 2007).

Treatment interventions to COAs can follow many different formats ranging from behavioral and cognitive behavioral interventions, family systems intervention, and multicultural interventions to using “harm reduction models,” (Larimer & Cronce, 2002; Rubin, 2001; Marlatt, Blume, & Parks, 2001; Bepko & Krestan, 1985; Cable, 2000;  Coyhas, 2000; Parks, Anderson, & Marlatt, 2001, cited by Hall & Webster, 2007, p. 505). Cognitive behavioral therapy will help change faulty thinking, such as the self-blame that goes in their minds that result in maladaptive behaviors. The systems theory helps evaluate and address the interdependent parts and dynamics within the family that affect the COAs maladaptive patterns. 

In a study made with school aged children of alcoholics, group counseling has been found to be effective in helping children improve self-esteem and develop elevated, effective social skills during group sessions. In addition, the children also learned about the disease of alcoholism, strategies to cope with parental alcoholism, and the fact that they neither caused the alcoholism nor can cure it (Riddle, Bergin, Douzenis, 1997)

The Bible and what it says about the children of alcoholics.

Parenting is both a privilege and a responsibility. The Bible says that children are a, “gift of the LORD, The fruit of the womb is a reward” (Psalm 127:3, NASB). God also  mandated parents to teach children His precepts (Deut. 6:7-9), and to, “train up a child in the way he should go,” (Proverbs 22:6, NASB). The Apostle Paul also tells parents not to, “exasperate,” their children, but rather, “to bring them up in the discipline and instruction of the Lord” (Ephesians 6:4, NIV).

However, we are fallen people living in a fallen world. Alcoholic parents fail to treat their children as a precious gift from God.  Alcohol impairs their ability to fulfill their God-given responsibilities as a parent,  hindering children from growing and going in the way, “they should go.” Alcoholic parents, often intentionally or unintentionally, “exasperate,” their children to anger and hopelessness.

However, there is hope in God. God’s love and grace is sufficient to cover parent’s sins, and transform them into the kind of people, and parents, God intended them to be. Neglected and abuse children can experience the consistent love they missed, from God, and through the body of believers the Bible calls the church (John 3:16; 2 Corinthians 5:17). 

Even mental health experts agree. Kirkpatrick (1999) has suggested that a person’s attachment to God can accomplish for the person what a failed attachment pattern with their parents failed to do. He enumerated the similarities between attachment and faith:

(1) An identified relationship with God is central to the religious belief of many people;

(2) the emotional bond encountered in this relationship is strikingly similar to the love in the infant-mother relationship; and (3) the beliefs about God parallel the qualities of secure attachment figures (cited by Dumont, Jenkins, Hinson, Sibcy, 2012, p. 53). 

Kirkpatrick (1999) also mentioned that a, “secure relationship with God affords both a shield of safety and a secure base which aids in the development of a secure attachment.” Also, church participation, “provided structure for their lives and assured them salvation, security, and a sense of mission in an alien world”  (Kirkpatrick & Shaver, 1992; El-Guebaly et al., 1993; Kelley et al., 2004; cited by Dumont, Jenkins, Hinson, Sibcy, 2012, p. 71). 

Conclusion:

COAs who live in chaotic, unpredictable, and even violent home environment cause them to experience distress, depression, anxiety, fear, and anger. They often learn to take on adult responsibilities at an early age, which often turn them into overly responsible people who have problem maintaining warm and caring relationships. Children of alcoholic parents are found to be high risk for substance and alcohol abuse once they reach adolescence. 

However, there are many factors that could buffer and mitigate the adverse effects of being a COA. These factors include having coping skills, and positive relationships with other people including extended families, peers and teachers. Alcoholic parents’ rehabilitation is also a strong indicator of positive change.  Mental health counselors need to be aware of children’s development stages to effectively apply the intervention they use to help COAs. 

Parenting is both a privilege and a responsibility. Alcoholic parents often fail to be the parents God intended them to be. Children of alcoholics, especially those who are less resilient grow up needy and unable to function in a healthy way at different levels. However, God provides hope and healing. Christ is sufficient and able to save and transform alcoholic parents and their children into the kind of people He wants them to be. Even mental health professionals agree that church involvement can do one a lot of good.  

References

American Academy of Child and Adolescent Psychiatry (2012). Children of alcoholics. Retrieved on October 8, 2012 from http://aacap.org/page.ww?name=Children+of+Alcoholics§ion=Facts+for+Families

Crespi, T. D., & Rueckert, Q. H. (2006). Family Therapy and Children of Alcoholics: Implications for Continuing Education and Certification in Substance Abuse Practice. Journal of Child & Adolescent Substance Abuse, 15(3), 33-44. doi: 10.1300/J029v15n03̱03.

Dumont, K.,  Jenkins, D., Hinson, V., Sibcy, G. (2012). God's shield: The relationship between God attachment, relationship satisfaction, and adult child of an alcoholic (ACOA) status in a sample of evangelical graduate counseling students.  Journal of Psychology and Christianity, 31 (1), 51-65. ProQuest document ID 1021059285.

Edwards, E.P., Eiden, R. D., Colder, C., Leonard, K.E. (2006). The development of aggression in 18 to 48 month old children of alcoholic parents. Journal of Abnormal Child Psychology, 34 (3), 409-423. doi: 10.1007/s10802-006-9021-3.

Elam, J. (2012, September 29). Children of alcoholics. The Washington Times Communities: Social Journalism from Independent Voices. Retrieved from http://communities.washingtontimes.com/staff/jerome-elam/.

Emshoff, J., & Valentine, L. (2006). Supporting adolescent children of alcoholics. Prevention Researcher, 13(4), 18-20. Retrieved from http://rx9vh3hy4r.search.serialssolutions.com.

Feldman, Robert S. (2011). Development Across the Life Span (6the ed.). Upper Saddle River (Feldman, Robert, 2003/2011) Prentice Hall. (Original work published 2003).Goodman, R. W. (1987). Adult Children of Alcoholics. Journal of Counseling & Development, 66(4), 162.

Hall, C. W., & Webster, R. E. (2007). Risk Factors Among Adult Children of Alcoholics. International Journal of Behavioral Consultation & Therapy, 3(4), 494-511. Retrieved from http://rx9vh3hy4r.search.serialssolutions.com.

Henderson, D. A. & Thompson, C. L. (2007). Counseling children (8th ed.). Belmont, CA: Brooks/Cole.

Hussong, A. M., Wirth, R. J., Edwards, M. C., Curran, P. J.,  Chassin, L. A.,  Zucker, R. A. (2007). Externalizing symptoms among children of alcoholic parents: Entry points for an antisocial pathway to alcoholism. Journal of Abnormal Psychology, 116 (3), 529-542. doi: 10.1037/0021-843X.116.3.529.

Hussong, A.M., Zucker, R.A., Wong, M.M., Fitzgerald, H.E., Puttler, L. I. (2005). Social competence in children of alcoholic parents over time. Developmental Psychology, 41 (5), 747-759. doi: 10.1037/0012-1649.41.5.747.

Johnson, P. (2001). Dimensions of functioning in alcoholic and nonalcoholic families. Journal of Mental Health Counseling, 23(2), 127-136. Retrieved from http://search.proquest.com/docview/198700178?accountid=12085.

Neal, J., & Frick-Horbury, D. (2001). The Effects of Parenting Styles and Childhood Attachment Patterns on Intimate Relationships. Journal of Instructional Psychology, 178-180. Retrieved from http://www.naobataeduque.org.br/site/documentos/ingles/43195ba5d7eaccaaa63d0c1953fdf7ac.pdf.

Rice, C., Dandreaux, D., Handley, E., & Chassin, L. (2006). Children of alcoholics: risk and resilience. Prevention Researcher, 13(4), 3-6.

Riddle, J., Bergin, J.J., Douzenis, C. (1997). Effects of group counseling on the self-concept of children of alcoholics. Elementary School Guidance and Counseling, 31 (3), 192-203. Retrieved from ProQuest.

Silva, M.C., Benegal, V., Devi, M., Mukundan, C.R. (2007). Cognitive deficits in children of alcoholics: At risk before the first sip! Indian Journal of Psychiatry, 49 (3), 182–188. doi:  10.4103/0019-5545.37319.

Werner, E., & Johnson, J. (2004). The role of caring adults in the lives of children of alcoholics. Substance Use & Misuse, 39(5), 699-720.

Vaught, E. L., & Prince Wittman, P. (2011). A Phenomenological Study of the Occupational Choices of Individuals Who Self Identify as Adult Children of Alcoholics. Journal of Occupational Science, 18(4), 356-365. doi:10.1080/14427591.2011.595893.

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