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ADULT CHILDREN OF ALCOHOLICS

Running Head: ADULT CHILDREN OF ALCOHOLICS

Literature Review on Adult Children of Alcoholics

Kathryn Thompson
Wake Forest University

ADULT CHILDREN OF ALCOHOLICS

Abstract
Adult children of alcoholics are an important population in research. Although they are
not specifically recognized on the DSM, these adults offer up a wealth of information useful to
research studies and counselors. Brought into a world of chaos and unruly parenting, adult
children of alcoholics must adapt and assume roles beyond their abilities. The childhood or lack
thereof results in struggling for survival, role confusion and troubled relationships in and out of
their immediate family. Adult children of alcoholics have treatment and therapy options that
could likely lessen their sense of stress, confusion and childhood heaviness leading them towards
productive and fruitful lives.

ADULT CHILDREN OF ALCOHOLICS

Introduction
Background
Adult children of alcoholics, although not recognized on the DSM, are a relevant
population worthy of research and discussion. In hearing the term alcoholism the focus tends
to be solely on the addict(s) and not the silent sufferers. An estimated 25 percent of U.S.
children are exposed to alcohol abuse or dependence in the family. Depression among adult
children of alcoholics appears to be largely, if not solely, due to the greater likelihood of having
had adverse childhood experiences in a home with alcohol-abusing parents (Anda et al., 2002).
Adult children of alcoholics experience residual effects from their disorderly upbringing starting
at a young age. Parents who misuse alcohol and other drugs often create an environment that
promotes parentchild role reversal (Barnett & Parker, 1998; Chase, 1999; Gallant, Gorey,
Falland, Perry, & Ryan, 1998; Stein et al., 1999 as cited in Klostermann et al., 2011). Navigating
through childhood into adulthood with either one or both parents being addicted to alcohol
makes what is already a vulnerable time in life that much more unstable and stressful. More
recently, the term parentification has been defined as children or adolescents who assume adult
roles before they are emotionally or developmentally ready (Stein, Riedel, & Rothermam-

ADULT CHILDREN OF ALCOHOLICS

Borus, 1999 as cited in Klostermann et al., 2011). Adult children of alcoholics are not necessarily
due to become plagued with problems; however, growing up in such challenging and chaotic
circumstances poses real and significant risk factors for such individuals (Hall & Webster, 2007).

Methods
I began my journal article search using online resources from the Z. Smith Reynolds
Library. Initially my database selection was limited to PsycINFO where my search entry read
children of alcoholics and from there grew to include terms, in the second search box, such as
growing up, adulthood, relationships, therapy, and resilience. I placed limiters on the
publication dates starting with the year 2000 through 2013, chose the linked full text option
and changed the search entry to read adult children of alcoholics. I went on to include the
ERIC database alongside PsycINFO where I filtered through articles using their titles and
abstracts as guides. When using both ERIC and PsycINFO I would interchange the particular
word children with adults and vice versa continuing to include the same terms mentioned
above in the second search box. Throughout sifting through articles, I would skim relevant
articles that seemed particularly interesting and I would go on to include other search terms in
the second search box, coping, roles, and conflict are specific examples. PubMed was
another database I used to try and find applicable articles, but I did not find PubMed to be
particularly helpful; I found PsycINFO to be the best article-producing database for my
particular area of research.
Results
Family System

ADULT CHILDREN OF ALCOHOLICS

The U.S. Department of Health and Human Services and Substance Abuse and Mental
Health Services Administration estimate 76 million adult children of alcoholics in this country
(Hall & Webster, 2007). At the basic level of healthy families lays certain characteristics,
expectations, and rules. In a family effected by alcoholism the rules and roles of the family are
distorted and children become codependent on their alcoholic parent (Ranganathan, 2004).
Studies have identified basic rules in an alcoholic household which include: 1. Do not talk
about family problems 2. It is inappropriate to openly express feelings and emotions 3. Limit
communication outside of the home in order to keep it secret 4. Nothing is good enough, but
you are expected to reach for unobtainable perfection 5. Work for the benefit of others and dont
be selfish 6. Do what I say, not as I do 7. Play is not something you do- letting your guard
down in an attempt to enjoy could lead to bad things 8. Avoid conflict avoid and escape
confrontation (Ruben, 2001). The rules of the family affected by alcoholism teach the child
overtly and covertly, not to trust anyone, including him or herself. They are taught to not talk
and not feel, but at the same time are taught they must be responsible for their alcoholic parent
(Hall & Webster, 2007).
Adult children of alcoholics experience poorer family environments along with parentchild relationships (Klostermann et al., 2011) leading them to develop fewer and less effective
coping strategies, making them more likely to engage in avoidant coping than non-adult children
of alcoholics (Amodeo, Griffin, Fassler, Clay, and Ellis, 2007). Children in alcoholic homes
also appear to possess a diminished ability to trust or depend upon others, and develop a greater
reliance upon themselves (Veronie & Fruehstorfer, 2001). In families where alcohol is being
abused by one or both parents, children become overburdened by their parents lack of
responsibility and caretaking skills (Kelley, French, Bountress, Keefe, Schroeder, Steer &

ADULT CHILDREN OF ALCOHOLICS

Gumienny, 2007). Children and adolescents often sacrifice their own needs in order to make up
for their parent(s) shortcomings. Children rapidly transition from adolescence into adulthood
within a family system that is uncontrollable and fractured partly due to their parent(s) inability
to provide a healthy environment in which they could properly flourish through crucial life
stages. Children of alcoholics are involuntarily entered into a family laden with secrets, disorder,
and unrealistic expectations--leaving no room for children to be children.
Loss of Childhood
The childhood of adults of alcoholics is far from the carefree childhood experienced by
those of non-alcoholics; it is unpredictable and weighed down by a parent(s) inability to be a
parent. Being raised in an alcoholic home is more likely to include such adverse childhood
experiences as abuse, witnessing domestic violence, and exposure to suicidal household
members (Anda et al., 2002). The demands of acting as an adult throughout childhood result in
children who were cheated a significant part of life.
In 1981, Sharon Wegscheider-Cruse developed the family role identification theory which is
still used by researchers and clinicians as the standard model for addressing issues within adult
children of alcoholics. The four roles, as explained by Wegscheider-Cruse, are as follows: the
hero, the scapegoat, the lost child and the mascot. The hero in the family takes on various caretaking tasks, assumes age inappropriate responsibilities, and takes on others actions and
outcomes as their own. Although appearing organized and competent, the hero of the family
seeks self-validation from others due to feelings of inadequacy. The scapegoat allows the family
to focus and place blame on someone other than the alcoholic as the scapegoat is considered the
bad seed. Negativity in the home is due to this role and the scapegoat is likely to detach from
the family and seek validity from peers. The lost child is introverted, exhibiting withdrawn

ADULT CHILDREN OF ALCOHOLICS

behavior. They develop inadequate social skills resulting in their formation of a fantasy world.
Lastly, the mascot heavily relies on humor when faced with uncomfortable situations. The family
looks to the mascot for relief from situations resulting from either the alcoholic or the scapegoat.
The mascot adheres to the notion they need to satisfy the needs and wants of others at the
expense of their wellbeing (Veronie & Fruehstorfer, 2001). Children are expected to become a
jack of all trades assuming several roles while struggling for survival; children are forced to
grow up too quickly and in adulthood feel as though they were cheated and never experienced
being a child (Pasternak & Schier, 2012). Excessive role reversal in childhood leads to
problems in developing autonomy, and hence to enmeshment and preoccupation with
relationships (Mayseless, Bartholomew, Henderson & Trinke, 2003). Being gifted the
experience of childhood vanishes in homes of alcoholic parents; instead of growing and
transitioning appropriately through stages of life, children adapt to taking care of themselves and
their addicted parent(s). "Childhood unpredictability, including within the family environment, is
associated with the development of a schema or worldview that life is unpredictable (Burnett,
Jones, Bliwise & Ross, 2006). Children must manage the circus that is their life and the affects of
all the confusion and chaos continue to trickle into adulthood; everything and everyone are
viewed as unpredictable.

Relationships
According to the attachment theory, the strength of recording of such traumatic life
experiences leaves permanent marks on people, and predisposes them to repeating the
relationship patterns developed in childhood(Pasternak & Schier, 2012). When entering into
relationships of any kind and having grown up in an alcoholic home, forming healthy
relationships is a task. Given that the rules of growing up as a child of an alcoholic include

ADULT CHILDREN OF ALCOHOLICS

avoiding problems, not talking about issues, depending only on yourself, and denying feelings-relationships are affected from the very beginning. Children growing up in an alcoholic
environment risk becoming hyper-responsible and hold themselves accountable for anything
bad that happens in their family, which eventually includes feeling responsible for things that go
wrong in personal/social relationships. Conversely, anything positive that may occur is
considered a matter of luck (Bepko & Krestan, 1985; Krestan, 2000 as cited in Hall & Webster,
2007). Harter (2000) argued that inconsistent nurturance in childhood, combined with parents
who regard their own needs as most important, leads to difficulties trusting others, being
appropriately intimate, and having reasonable boundaries (as cited in Kelley et al., 2005).
Adult children of alcoholics are at an increased risk to experience low self-esteem,
depression and relational difficulties (Kelley et al., 2007). Healthy families allow for the positive
regard of relationships by children who transfer such relationship skills into adulthood, however,
in a family with an alcoholic parent(s) the views of relationships are negatively skewed. The
majority of adults who grew up in families with alcohol problems resign from their personal
lives. They deeply believe that their primary responsibility it to take care of their mother or
fathertheir life is more focused on being a good child rather than being a good husband or
wife (Pasternak & Schier, 2012). Relationships for adult children of alcoholics are not
necessarily easy or natural; they have internalized issues that have not been worked through
seeing as they have dedicated themselves to disregarding their best interest to focus solely on
helping their parent(s) and the only role in a relationship they know is that of a care-taker.
Treatment

ADULT CHILDREN OF ALCOHOLICS

As an adult child of an alcoholic making strides to positively move forward with life can
be trying, as so much of life learned and lessons taught are riddled with shame and silence.
However, there are ways to rebuild the parts that were insufficiently built by ill-suited, alcohol
addicted parents. The stress-strain-coping-support model, from which the 5-Step Method is
derived, guides current thinking on how families can be negatively affected by a relatives
substance misuse (Orford et al., 2010 as cited by Templeton, 2010). The 5-step method can be
administered by an array of trained professionals, ranging from general practitioners to social
workers through several forms including individual and/or group work, as well as using online or
self-help materials (Templeton, 2010). This method is considered a brief intervention aimed at
intervening with families dealing with substance misuse. When children receive help, they often
say that one of the most useful things was meeting and talking to other young people living in
similar circumstances (Templeton, 2010). With regard to adult family members, the 5-step
method has produced positive outcomes through the delivery over a number of counseling type
sessions (Templeton, 2010). Quantitative data have indicated that the intervention
significantly reduces symptoms of physical and psychological ill health, alters coping behavior
and lessens the impact of the alcohol misuse on the family (Copello, Templeton, Krishnan,
Orford & Velleman, 2000; Copello et al., 2009 as cited in Templeton, 2010).
The US Congress on Alcohol and Health reported that marital and family treatment
approaches were one of the most outstanding, current advances in the area of psychotherapy of
alcoholism (Ranganathan, 2004). In order to be successful, family therapy must include the
involvement of significant family members. Family therapy is intentional and focused on
realistic goals: providing addiction education, teaching acceptable ways of dealing with personal
defects, providing a safe environment for the family to talk about and handle their problems,

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ADULT CHILDREN OF ALCOHOLICS

improve family interaction, and equip parents with appropriate skills needed to raise their
children and improve their marriage (Ranganathan, 2004).
Treatment and interventions for adult children of alcoholics range in formats and
methods. Regardless of the intervention model chosen, a key component needs to be helping the
adult children of alcoholics understand the increased vulnerability that may come with growing
up in an alcoholic home (Hall & Webster, 2007). The one thing you can never forget, when
working with members of an alcoholic family, is their sensitivity to shame. To shame them is to
lose them, for 10 minutes, for an hour, for a week, or forever (Copans, 2006).
Discussion
Adult children of alcoholics are a relevant. There are certain special populations who
need a lot of support in the form of family therapy. Children of alcoholics form one of the
largest, most explosive and most remedial populations (Ranganathan, 2004). Parentification and
role-reversal were constant terms surfacing through this research, parentification is a continuous
phenomenon, since it affected adult children of alcoholics both, when they were children and in
their adult life (Pasternak & Schier, 2012).
There appeared to be a large amount of research on children of alcoholics with a decent
amount dedicated to adult children on alcoholics, however, treatment and therapies were harder
to uncover throughout this particular research. Although there are effective treatments, trying to
expose effective therapy styles within a lifestyle that is dedicated to remaining tightlipped was
difficult. The role of gender, socio-economic status, and comorbid factors were not considered as
the focus is children who are now adults of alcoholic parent(s).

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ADULT CHILDREN OF ALCOHOLICS

Numerous variations of family systems exist, and how they are affected by alcoholism
calls for creativity among counselors on how to uncover and treat this particular population
considering it is a complex situation for every individual involved. It would behoove this
population to understand the importance of opening up and joining forces with professionals that
can suitably reveal and expose areas that lead to the betterment of the their lives that have been
affected by alcohol addicted parents.

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