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Alcoholism in family systems

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 addiction as diseases that flourish in and are enabled by family systems.[1]

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 of addiction, whereas the family members suffer from the disease of codependence.[2][3] 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."[4] 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."[5] "Co-dependents are mutually dependent on the addict to fulfill some need of their own."[4]

For example, the "Chief Enabler" (the main enabler in the family) will often turn a blind eye to the addict's 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."[6]

Alcoholism is one of the leading causes of a dysfunctional family.[7] "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."[4][8] 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.[9] Children of addicts have an increased suicide rate and on average have total health care costs 32 percent greater than children of nonalcoholic families.[9][10]

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.[11]

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.[12] 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.[13]

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).[11] 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.[14]

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.[15][16]

  1. ^ Cite error: The named reference CRNKOVIC1998 was invoked but never defined (see the help page).
  2. ^ Cite error: The named reference OFARRELL2006 was invoked but never defined (see the help page).
  3. ^ Cite error: The named reference CERMAK1989 was invoked but never defined (see the help page).
  4. ^ a b c Inaba, Darryl (2011). Uppers, downers, all arounders: physical and mental effects of psychoactive drugs. Cohen, William E., 1941– (7th ed.). Ashland, Or.: CNS Publications. ISBN 9780926544307. OCLC 747281783.
  5. ^ (Gorski, 1993; Liepman, Keller, Botelho, et al., 1998)
  6. ^ Kinney, Jean (2012). Loosening the grip : a handbook of alcohol information (10th ed.). New York, NY: McGraw-Hill. ISBN 9780073404684. OCLC 696942382.
  7. ^ Cite error: The named reference BARNETT2003 was invoked but never defined (see the help page).
  8. ^ (Liepman, Parran, Farkas, et al., 2009)
  9. ^ a b Cite error: The named reference MULLIGAN2001 was invoked but never defined (see the help page).
  10. ^ Cite error: The named reference DRAKE1990 was invoked but never defined (see the help page).
  11. ^ a b Cite error: The named reference allpsych.com was invoked but never defined (see the help page).
  12. ^ Cite error: The named reference MAYNARD1999 was invoked but never defined (see the help page).
  13. ^ Cite error: The named reference CUTTER1987 was invoked but never defined (see the help page).
  14. ^ Paley, Blair; O'Connor, Mary J. (3 September 2009). "Intervention for individuals with fetal alcohol spectrum disorders: Treatment approaches and case management". Developmental Disabilities Research Reviews. 15 (3): 258–267. doi:10.1002/ddrr.67. PMID 19731383.
  15. ^ Moos, R.H.; Billinop, A.B. (1982). "Children of alcoholics during the recovery process: Alcoholic and matched control families". Addictive Behaviors. 7 (2): 115–164. doi:10.1016/0306-4603(82)90040-5. PMID 7102446.
  16. ^ Cite error: The named reference WINDLE1997 was invoked but never defined (see the help page).

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