Alcoholism results in long lasting and negative effects on the entire family. Family therapy can help the entire family whether they are the alcohol abuser or the abused family members. Including the entire family in therapy sessions can help keep the alcohol abuser out of denial when he or she hears how their alcohol abuse affects the entire family. The family members have the same chance to heal and to be heard when they might not otherwise get that chance without being included in therapy sessions. Considering that the family members are often told to keep the alcohol abuser’s behavior a secret, therapy can empower them when they talk about their experiences openly and receive much-needed support. Because the psychological effects of alcoholism can last a lifetime for the entire family, it is important to treat every person in the family, where they can learn to feel safe while revealing their feelings, fears, and disappointments. Everyone in this type of family needs help healing from the alcohol abuse and how it has affected each individual in a personal way. Because family therapy includes every member, it can mitigate some of the devastating and ongoing effects alcoholism has on each member, especially the children.
Keywords: alcoholic, family therapy, empower
Alcoholism and its Effect on the Family
The devastating effects of alcoholism on families and children have been well documented. When alcohol disrupts the normal functioning of a family in a home, a clinical diagnosis of alcohol abuse can be made (Ripley, Cunion, & Noble, 2006). There has been recent progress in the treatment of alcohol abuse with family therapy (Ripley et al., 2006). Some problems, which alcoholism can lead to in a family, might include risky behaviors such as love affairs, unplanned pregnancies, problems with the law, reduced inhibitions, and social nonconformity (Ripley et al., 2006). Family therapists usually support using family therapy as a first-line treatment for alcoholism; although in some circumstances, where there is violence or psychosis, the entire family is not always present (Ripley et al., 2006). Therapy for the entire family can make an important difference in the lives of family members, especially the children who can grow up to become adults with serious adjustment and psychological problems as a result of living with an alcoholic during their childhood.
Parental Alcoholism and Family Life
A recent ten-year study has shown a significant increase in American alcoholism (Johnson & Stone, 2009). The number of children that have been exposed to alcoholism or alcohol abuse in their homes is estimated to be 28.6% or 1 in 4 children (Johnson & Stone, 2009).
Children and families can experience many damaging effects from alcohol abuse, some being angry outbursts, physical abuse, and notable decreases in caring or warmth (Johnson & Stone, 2009). In an alcoholic home, there is increased distress for the spouse, and the spouse suffers much greater psychological upset and health problems than in a non-alcoholic environment (Ripley et al., 2006).
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In alcoholic families there is frequent fighting with angry scenes of arguing and blaming. In addition, children are frequently elevated to a parental role, becoming caretakers for parents or siblings, confusing appropriate parental/child boundaries (Johnson & Stone, 2009). When looking back on their lives, adult children of alcoholics tend to remember their families of origin as less healthy than adults who did not have an alcoholic family member. Research has also shown alcoholic families to have been less able to function as a healthy unit due to the effects of frequent drinking (Johnson & Stone, 2009). There is less cooperation, problem solving, and communication with alcoholic families than with non-alcoholic families (Ripley et al., 2006).
Other negative effects of alcoholism on children include divorce and becoming alcoholics themselves (Johnson & Stone, 2009). Children in alcoholic families experience more traumatic events and are at a higher risk of physical, emotional, and sexual abuse. Neglect is also a risk for children who grow up with an alcoholic parent (Johnson & Stone, 2009). Family functioning decreases when there is unpredictability, abuse, or lack of parent involvement in the lives of their children (Johnson & Stone, 2009).
Fathers’ Alcoholism and Infant Attachment
The decrease in family functioning can be evident in children up to 12 months of age who showed less attachment to parents than children of the same age in non-alcoholic families (Edwards, Eiden, & Leonard, 2004). Studies have suggested that there is a connection between infants who have difficult temperaments and alcoholic parents. The father’s mental health issues that usually accompany alcoholism such as avoidant behaviors and antisocial behaviors negatively affect the father-infant attachment (Edwards et al., 2004).
Infant attachment is negatively affected also when the mother has mental health issues. Depression has a strong effect on the mother-infant relationship, especially when the depression goes on long term (Edwards et al., 2004).
Another effect of alcoholism on an infant is that there is a strong association between marital animosity, alcoholism, and the parent-infant relationship. The marital relationship directly influences parent-infant attachment (Edwards et al., 2004).
Children and Acting out Behaviors
As the infant gets older, children of preschool age who have alcoholic fathers have more behavior problems and act out more than other children (Eiden, Edwards, & Leonard, 2006). Behavior problems starting this early have been linked to antisocial behaviors leading to substance abuse in older children (Eiden et al., 2006). Sons of alcoholic fathers showed more deviant behavior as toddlers than other children without alcoholic fathers. Daughters of alcoholic fathers showed more fear, anxiety, and uncontrolled compliance as toddlers than other children (Eiden et al., 2006).
Psychological Adjustment of Children in an Alcoholic Home
Besides children having fear, anxiety, and deviant behavior, research has shown that a father’s heavy drinking affects his children’s psychological and social adjustment over a period of time (Andreas & O’Farrell, 2007). Fathers who entered into treatment for their alcoholism, and remained in recovery, had children who showed a decrease in their adjustment issues while fathers who continued and increased their drinking had children who had an increase in their adjustment issues (Andreas & O’Farrell, 2007).
Because children in alcoholic homes have increasing adjustment issues as well as a multitude of developmental problems, being a child of an alcoholic is a high risk factor for having developmental and adjustment issues (Andreas & O’Farrell, 2007).
Children of alcoholic fathers who demonstrated having adjustment issues showed improvement when their fathers entered treatment and drank less. When these fathers returned to their heavy drinking behaviors, their children also returned to exhibiting coping and behavioral problems as before (Andreas & O’Farrell, 2007).
Children and Self Control
Children respond to their parent’s drinking behaviors and successful self control is thought to be learned and internalized by the quality of parenting. A mother’s warmth, sensitivity, and discipline have a significant role in learning self regulation (Eiden et al., 2006). Studies have shown that a mother’s responsiveness at 13 and 24 months predicted self control at 6 years old. It has also been shown that a mother’s emotional availability has a significant effect on self control. Mothers, who are warm and positive, have children who have lower levels of hostility, acting out behaviors, and higher levels of self control (Eiden et al., 2006). Alcoholic families, in which the father is the alcoholic, are less sensitive to their children’s needs for warmth, attention, and time and do not have as many positive play interactions with their children (Eiden et al., 2006).
Parental Depression and Alcoholism
Mothers who are depressed are less emotionally and verbally responsive to their children and have poor parent-child interactions. Children become more negative and irritable as a result of their parent’s depression starting as early as 3 months old (Eiden et al., 2006). With parental depression, mothers and fathers are less involved in interacting with their children, show less physical affection, and are easily aggravated and frustrated, and use more negative discipline (Eiden et al., 2006).
Family Violence and Alcoholism
Together with depression and neglect, alcoholic parents are more likely to use harsh physical punishment than non-alcoholic parents. Family violence is common within the alcoholic environment and approximately 1/3 of abused children in the alcoholic home develop PTSD (Sher et al., 2005). Research has shown that there is a significantly higher degree of verbal and physical violence in alcoholic homes when compared to non-alcoholic homes (Ripley et al., 2006).
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Effects of Alcoholism as an Adult
The abusive way of life in an alcoholic home, including verbal and physical violence, depression and neglect, can directly affect the child when he or she becomes an adult (Johnson & Stone, 2009). Some adults who have experienced a childhood alcoholic home along with emotional abuse struggle with social issues, mood problems, anxiety, and are also at risk for drug and alcohol use themselves (Johnson & Stone, 2009). Adult children of alcoholics have shown less satisfaction with their lives and relationships and tend to have negative attitudes than those who are not adult children of alcoholics. They will often marry another adult child of an alcoholic and have more divorces and less satisfaction with their own children and marriage. Adult children of alcoholics will tend to be more controlling of others and their lives (Johnson & Stone, 2009).
Sense of Self as an Adult
Other affects of living in an alcoholic home suffered by adult children of alcoholics are that they tend to react to their environment with more emotional lability, can be hyper-sensitive, and do not have a clear idea of who they are. They also tend to have difficulty with trust and intimacy and tend to be avoidant people (Johnson & Stone, 2009). Adult children of alcoholics will tend to avoid and be disconnected from their families, or overinvolved when there is more family health and cohesion (Johnson & Stone, 2009). Studies have shown that adult children of alcoholics who experienced verbal abuse were less fused to their families and more cut off from their families of origin (Johnson & Stone, 2009). Studies show that if adult children of alcoholics saw more physical violence between their parents, they ended up showing less ability to know who they were along with not being good at making their own decisions and standing by them. The longer a child lived at home with alcoholic parents, the more emotionally reactive they tended to be as adults (Johnson & Stone, 2009).
Antisocial Behavior and Alcoholism
Other abnormal behavior by alcoholic parents may be antisocial behavior, which can be linked to alcoholism. It can manifest as angry, aggressive behavior in the home as well as having a possible genetic link to temperament (Eiden et al., 2006). There is a correlation between alcoholics, impulsivity, and sensation-seeking behaviors (Ripley et al., 2006).
Psychopathology and Alcoholism
A family history of alcoholism is a risk factor for the development of many mental illnesses, in addition to antisocial behaviors, which include alcoholism, substance abuse, major depression, conduct disorder, and aggressive behavior (Sher et al., 2005). Studies show that people with a family history of alcoholism report a higher rate of physical and sexual abuse make more suicide attempts with more intent to die when compared to depressed subjects without a family history of alcoholism (Sher et al., 2005). Females who have a family history of alcoholism are more likely to develop major depression than males who have a family history of alcoholism. There is also a higher degree of depressed people from alcoholic homes who develop PTSD (Sher et al., 2005).
Genetic and Environmental Factors
The family members who are at greater risk for the mental illnesses associated with alcoholism and develop mental illness are more impaired by their mental illness than people who do not have a first-degree relative with alcoholism. This impairment is most likely due to genetic as well as environmental factors. Genetics may contribute to alcoholism as well as suicidal behavior in a family with alcoholism. Serotonin imbalance is implicated as a factor in alcoholism, depression, and related illnesses. Sons from alcoholic families who do not become alcoholics have been shown to be deficient in serotonin (Sher et al., 2005). Other biological differences have been found in families with a history of alcoholism (Sher et al., 2005). Because people are influenced by their environments, this has to be considered as well as biological predisposition when considering the effects of alcoholism in the home. Both biological and environmental factors work together to cause a higher rate of developing alcoholism in people with a family history (Sher et al., 2005). Other environmental issues that contribute to alcoholism include poverty or lack of opportunities (Ripley et al., 2006). The continued abuse of alcohol can cause additional health problems due to the health risks caused by the alcohol consumption (Ripley et al., 2006).
Treatment Approaches to Alcoholism
Treatment of the possible health risks associated with alcoholism is an important first step in order for the client to be healthy enough to participate in therapy. After this, the initiation of family therapy can be considered. Some evidence shows that family therapy is a superior treatment for alcoholism while other evidence shows no difference in treatment of the alcoholic as an individual versus family therapy (Ripley et al., 2006). Family therapy as the treatment approach for alcohol abuse makes sense as the primary treatment modality because everyone in the family suffers the effects of the substance abuse. If the alcohol abuser is a child, parents will suffer with worry and wait up for their child to come home at night. If the abuser is a spouse, he or she will try to hide evidence of drinking, hiding bottles, avoiding work and friends. Children of alcoholics will be affected by guilt and often be elevated to a position of adult, dealing with responsibility they are not prepared for. Adult children of alcoholics will often suffer the effects of alcoholism throughout their lives being unable to stop suffering the memories of their past and finding themselves in unhealthy relationships that mimic their past. Alcoholism can affect immediate families as well as generations of families.
The way in which families interact with each other can contribute to the continuation of alcoholism with the substance abusing member. Without realizing how alliances and enabling behavior within the family can help support unhealthy behavior, the family will not be able to change. Alcohol abuse can be missed and even unknowingly encouraged by other family members. If the family is willing to participate in therapy, and the alcohol abuser is not, change can still begin by unbalancing the family system when the other members engage in new behaviors, possibly causing the alcohol abuser to also participate in therapy and admit their problem.
When the problem of alcohol abuse is addressed as a family issue all members have responsibility for the issue. In the beginning of therapy, helping the alcoholic to stop drinking and maintain sobriety should be the highest priority. Research has shown that the alcoholic can maintain sobriety longer if the entire family is involved in problem resolution following a relapse (Ripley et al., 2006). This would be easier when the entire family is aware of the problem and willing to do whatever it takes to help the alcoholic remain sober. Any type of enabling behavior can be addressed and stopped at this time also making it more difficult for the alcoholic to rely on previous methods for getting others to help with alcohol consumption, allowing it, and tolerating addictive behavior.
Stabilizing the Family
After an alcoholic stops abusing alcohol, the changes in that person are often difficult to tolerate by other family members. Family members feel the person is different and they can feel lost and depressed. Their old enabling roles are disrupted and they do not know what to do or what to expect. These family members can feel a sense of emptiness and a feeling of being without direction. Families have been known to sabotage the alcoholic’s attempt to remain sober by providing alcohol and causing temptation. In family therapy, if a relapse does occur, the family therapist can bring up the question of who is to blame for the relapse. Because relapse can be complicated and contributed to by others in the family, it is addressed in family therapy as a family problem rather than the alcoholic’s problem alone. If a crisis of relapse occurs, this can be addressed and other family issues can be brought up to improve relationships, receive healthy support, and improve the intimacy between couples.
Behavioral Therapy for Families as a Preferred Treatment
Behavioral therapy used in family therapy is thought to be the most effective treatment for alcoholism (Ripley et al., 2006). Behavioral therapy for families focuses on determining what current situations in the family contribute to maintaining drinking, what the family thinks is the positive effects of alcohol, and consequences of drinking (Ripley et al., 2006). Behavioral therapy for families works on changing the motivation for drinking, working on the alcoholic and spouse to make needed behavior changes, teaching positive reinforcement for not drinking, and to help the alcoholic and spouse regarding new cognitive and behavioral skills for maintaining sobriety (Ripley et al., 2006). Behavioral therapy for families has been shown to cause significant reduction in alcohol use as well as improve the relationship between the alcoholic and spouse (Ripley et al., 2006).
Family Systems Therapy
Family Systems Therapy focuses on the family system in which the alcoholism is the problem rather than the individual. In the beginning stages of therapy, the alcoholic is not pressured to stop drinking. The therapist operates as a consultant until the family decides what their goal is regarding the problem drinking in the family. A goal might involve changing interactions that might contribute to maintaining drinking behavior in the family (Ripley et al., 2006). Studies have shown this approach is no better than other treatment approaches; however, other treatment modalities may use this approach as part of another approach (Ripley et al., 2006).
Structural-Strategic Family Therapy
Another family therapy modality is Structural-Strategic Family Therapy which is concerned with problems in substance abuse. It is action-oriented and this produces results because of this. This approach has been shown to be a good option for adolescent alcohol abusers.
The Johnson Intervention
Before beginning family therapy, initially the Johnson Intervention can be used to educate the family of an alcoholic regarding the preparation for a confrontation and intervention. The goal of this intervention is to help the alcoholic to overcome denial and to encourage him to enter treatment. Studies have found that this intervention technique helps the alcoholic to begin treatment, but has not made a significant difference in getting alcoholics to stay in treatment (Ripley et al., 2006).
Conclusion
Alcoholism is a problem that affects the entire family. Some of the effects last through years and even generations. Treating this as a family issue allows the family to work as a unit to bring about change for the alcoholic, and to also get help for themselves. Spouses can be affected by problematic behaviors such as physical and emotional violence, sexual affairs, and loss of jobs and income. Children of alcoholics can live through devastating scenes of physical violence and yelling. They can suffer sleep deprivation while waiting up for their alcoholic parent to come home from the bars. Adult children of alcoholics are known to continue dealing with the lasting effects of living with an alcoholic in their families of origin. Adult children of alcoholics can suffer from post traumatic stress, anxiety, fear, depression, and not knowing who they are or what their purpose is in life. These long-term psychological effects can be debilitating. Treating alcoholism as a family can bring help to every member and possibly stop the cycle of alcohol abuse. Children can express their fears, worries, and hopes for the future. Spouses can not only express their fears and worries, but can also find ways to help the alcoholic maintain a sober existence. Cooperation by every member is crucial, and if the entire family commits and agrees to therapy, the alcoholic has a greater likelihood of recovery. By having the entire family present for therapy, the alcoholic is not only offered a solution to the drinking problem, but the rest of the family has an opportunity to heal from the effects of living with the alcoholic. If this is successful, the alcoholic can stop abusing alcohol and become a contributing member of his or her family, the spouse can heal and lead a healthier and happier life, and the children can heal from their traumatic past and subsequently look forward to a more positive future.
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