User:Scarpy/Alcoholism and family systems

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Alcoholism in family systems refers to the conditions of 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 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.[2][3]

Alcoholism is one of the leading causes of family dysfunction.[4] 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.[5] Children of addicts have an increased suicide rate and on average have total health care costs 32 percent greater than children of nonalcoholic families.[5][6]

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.[7] 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.[8]

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 distance and non-communicative. They cumlative may effect of the family dysfunction may affect the children in familes with untreated alcoholics ability to grow in developmentally healthy ways.[9][10]

Contents

[edit] 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 children of alcoholics (COAs) in the United States of with 11 million were under the age of 18.[11] 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 grow up with an alcoholic, having an alcoholic blood relative, or marrying an alcoholic.[12] 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.[13]

[edit] Familiality

There is strong, scientific evidence that alcoholism tends to run in families. Children of alcoholics are more at risk for alcoholism and other drug abuse than children of non-alcoholics.[11][14][15][10][16]

  • Children of alcoholics are four times more likely than non-COAs to develop alcoholism.
  • Genetic factors play a major role in the development of alcoholism. There is an expanding base of literature which strongly supports a heritable basis for alcoholism and a range of family influences that may direct the development of children of alcoholics.
  • Children's perceptions of parental drinking quantity and circumstances appear to influence their own drinking frequency.
  • Children's alcohol expectancies reflect recognition of alcohol-related norms and a cognizance of parental drinking patterns by a very early age.
  • Alcohol expectancies appear to be one of the mechanisms explaining the relationship between paternal alcoholism and heavy drinking among offspring during college.
  • Parental alcoholism and other drug dependencies have an impact upon children's early learning about alcohol and other drugs.
  • Family interaction patterns also may influence the COAs risk for alcohol abuse. It has been found that families with an alcoholic parent displayed more negative family interaction during problem-solving discussions than in non-alcoholic families.
  • Almost one-third of any sample of alcoholics has at least one parent who also was or is an alcoholic.
  • Children of alcoholics are more likely than non-COAs to marry into families in which alcoholism is prevalent.
  • Parental alcoholism influences adolescent substance use through several different pathways including stress, negative affect and decreased parental monitoring. Negative affect and impaired parental monitoring are associated with adolescent's joining in a peer network that supports drug use behavior.
  • 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.[17]

[edit] 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.[12]

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.[12]

[edit] Domestic violence

Alcohol is associated with a substantial proportion of human violence, and perpetrators are often under the influence of alcohol[15][18]

  • Alcohol is a key factor in 68% of manslaughters, 62% of assaults, 54% of murders and attempted murders, 48% of robberies, and 44% of burglaries.
  • Studies of family violence frequently document high rates of alcohol and other drug involvement.
  • COAs may be more likely to be the targets of physical abuse and to witness family violence.
  • Compared with non-alcoholic families, alcoholic families demonstrate poorer problem-solving abilities, both among the parents and within the family as a whole. These poor communication and problem - solving skills may be mechanisms through which lack of cohesion and increased conflict develop and escalate in alcoholic families.
  • COAs are more at risk for disruptive behavioral problems and are more likely than non-COAs to be sensation seeking, aggressive, and impulsive.

Based on clinical observations and preliminary research, a relationship between parental alcoholism and child abuse is indicated in a large proportion of child abuse cases[19][20]

  • A significant number of children in this country are being raised by addicted parents. With more than one million children confirmed each year as victims of child abuse and neglect by state child protective service agencies, state welfare records have indicated that substance abuse is one of the top two problems exhibited by families in 81% of the reported cases.
  • Studies suggest an increased prevalence of alcoholism among parents who abuse children.
  • Existing research suggests alcoholism is more strongly related to child abuse than are other disorders, such as parental depression.
  • Although several studies report very high rates of alcoholism among the parents of incest victims, much additional research is needed in this area.

[edit] Children

Children of alcoholics exhibit symptoms of depression and anxiety more than children of non-alcoholics[14][21]

  • In general, COAs appear to have lower self esteem than non-COAs in childhood, adolescence and young adulthood.
  • Children of alcoholics exhibit elevated rates of psychopathology. Anxiety, depression, and externalizing behavior disorders are more common among COAs than among children of non-alcoholics.
  • Young COAs often show symptoms of depression and anxiety such as crying, bed wetting, not having friends, being afraid to go to school, or having nightmares. Older youth may stay in their rooms for long periods of time and not relate to other children claiming they "have no one to talk to." Teens may show depressive symptoms by being perfectionistic in their endeavors, hoarding, staying by themselves, and being excessively self-conscious. Teenage COAs may begin to develop phobias.

Children of alcoholics score lower on tests measuring verbal ability[22][23]

  • COAs tend to score lower on tests that measure cognitive and verbal skills. Their

ability to express themselves may be impaired, which can impede their school performance, peer relationships, ability to develop and sustain intimate relationships, and hamper performance on job interviews.

  • Low verbal scores, however, should not imply that COAs are intellectually impaired.

Children of alcoholics often have difficulties in school[24]

  • COAs often believe that they will be failures even if they do well academically. They often do not view themselves as successful.
  • Children of alcoholics are more likely to be raised by parents with poorer cognitive abilities and in an environment lacking stimulation. A lack of stimulation in the rearing environment may account in part for the pattern of failure found in COAs compared with non-COAs.
  • Pre-school aged COAs exhibited poorer language and reasoning skills than did non- COAs, and poorer performance among the COAs was predicted by the lower quality of stimulation present in the home.
  • COAs are more likely to be truant, drop out of school, repeat grades, or be referred to a school counselor, or psychologist. This may have little to do with academic ability; rather, COAs may have difficulty bonding with teachers, other students and school; they may experience anxiety related to performance; or they may be afraid of failure. The actual reasons have yet to be determined.
  • There is an increasing body of scientific evidence indicating that risk for later problems, and even alcoholic outcomes is detectable early in the life course and, in some instances, before school entry.

Children of alcoholics have greater difficulty with abstraction and conceptual reasoning[25][26]

  • Abstraction and conceptual reasoning play an important role in problem solving, whether the problems are academic or are situation related to the problems of life. Therefore, children of alcoholics might require very concrete explanations and instructions.

Children can be protected from many problems associated with growing up in an alcoholic family[27]

  • If healthy family rituals or traditions, such as vacations, mealtimes or holidays, are highly valued and maintained, if the active alcoholic is confronted with his or her problem, if there are consistent significant others in the life of the child or children, and if there is moderate to high religious observance, children can be protected from many of the consequences of parental alcoholism.

[edit] Pregnancy

Maternal alcohol consumption during any time of pregnancy can cause alcohol related birth defects or alcohol related neurological deficits[23][28][29]

  • The rate of drinking during pregnancy appears to be increasing.
  • Prenatal alcohol effects have been detected at moderate levels of alcohol consumption by non-alcoholic women. Even though a mother is not an alcoholic, her child may not be spared the effects of prenatal alcohol exposure.
  • Cognitive performance is less affected by alcohol exposure in infants and children whose mothers stopped drinking in early pregnancy, despite the mothers' resumption of alcohol use after giving birth.
  • One analysis of 6 year-olds, with demonstrated effects of second-trimester alcohol exposure, had lower academic achievement and problems with reading, spelling, and mathematical skills.
  • Approximately 6 percent of the offspring of alcoholic women have Fetal Alcohol Syndrome (FAS); the FAS risk for offspring born after an FAS sibling, is as high as 70 percent.
  • Those diagnosed as having Fetal Alcohol Syndrome had IQ scores ranging from 20-105 with a mean of 68. Subjects also demonstrated poor concentration and attention.
  • People with FAS demonstrate growth deficits, morphologic abnormalities, mental retardation, and behavioral difficulties. Secondary effects of FAS among adolescents and adults include mental health problems, disrupted schooling (dropping out or being suspended or expelled), trouble with the law, dependent living as an adult, and problems with employment.

[edit] References

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  20. ^ Daro, Deborah; McCurdy, Karen (April 1991). "Current Trents in Child Abuse Reporting and Fatalities: The Results of the 1990 Annual Fifty State Survey. Working Paper Number 808": 34. 332 S. Michigan Ave., Suite 1600, Chicago, IL: National Committee for Prevention of Child Abuse. 
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