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Children of Alcoholics 20-234202 3 Hours Back to Course Index










Alcoholism has many victims, but perhaps the most defenseless of them are the children of alcoholics.  One in four children currently lives in a family environment where alcohol abuse or alcoholism negatively affects their life and their healthy development.  Furthermore, approximately 20 percent of adult Americans lived with an alcoholic while growing up.   There is growing evidence that living in such families during the crucial developmental years can create a lifetime of mental and physical health consequences.  Researchers have also concluded there are hereditary and environmental factors associated with alcoholism. For example, they know that alcoholism runs in families and that children of alcoholics are about four times more likely to become alcoholics than children with non-alcoholic parents.  They have also concluded that the family environment the children are exposed to during their early years is significant and influences the choices they will make during their lifetime.  Most researchers think one of the most significant issues in the alcoholic home is an attitude of permissiveness  (parents attempting to compensate for their alcoholism but are reluctant to enforce rules and limits on their behavior).  This typically results in inconsistent parenting and poor family management.  Most children of alcoholics have experienced some form of neglect or abuse and may have a variety of problems. Such as:



·        The child may see himself or herself as the main cause of alcoholism in the family.

·        The child may worry about the health of the alcoholic or may fear fights and violence between the parents.

·        The child may understand that there is a terrible secret m their family and be constantly embarrassed by the situation.  The ashamed child does not invite friends home and is afraid to ask anyone for help.

·        The child loses trust in the family because the drinking parent has disappointed them many times (absent from family functions, lack of emotional support, poor management of finances).  One must always remember the most important thing to an alcoholic is “where is my next drink coming from.”  It’s hard for a child to understand that behavior.

·        An alcoholic’s mood may change from being loving to angry without provocation; consequently, the child’s life is in constant turmoil with little or no structure.  A regular daily schedule, which is very important for a child, does not exist because bedtimes and mealtimes are constantly changing.

·        The child feels anger at the alcoholic parent for drinking and may be angry with the non-alcoholic parent for lack of support and protection.

·        The child feels helpless to change the situation and constantly struggles to cope; unfortunately it’s a difficult battle to win without considerable help from friends, other family members, and professional counselors.  Child psychiatrists advise that the following behaviors may signal a drinking or other problem at home:


o   Academic failure in school; truancy

o   Isolation and withdrawal from classmates; lack of friends

o   Delinquent behaviors

o   Frequent physical complaints, such as headaches or stomachaches

o   Abuse of alcohol or other drugs; or aggression towards other children

o   Risk-taking behaviors

o   Depression or suicidal thoughts or behavior


Some children of alcoholics may act like responsible “parents” within the family and among friends.  They may cope with the alcoholism by becoming controlled, successful “overachievers” throughout school, and at the same time be emotionally isolated from other children and teachers.  Their emotional problems may show only when they become adults.

Children of alcoholic parents may develop depression, anxiety, and other related disorders. They may even feel that they are somehow responsible for their parent’s drinking and resultant behavior, internalizing the notion so deeply that they are not even actively aware they are thinking it. The weight of the stress can be traumatic, so much so that the children grow up to be afraid and untrusting of other adults and authority figures. They may struggle to forge close friendships and intimate relationships. The anxiety that comes from not being able to understand the world around them (because of how corrupted their childhood was) could mean the development of a drinking problem of their own. This inability to separate the past from the present is why Psychology Today suggested that growing up in an alcoholic family is not dissimilar to a soldier’s horrific experiences on the battlefield. For either the child of drunk parents or a battle-scarred veteran, putting that kind of terror behind them does not come easily or naturally. It could take a lifetime of therapy and group support to bridge the emotional chasms caused by their respective situations.

Children of alcoholics face risks of mental health trauma and substance abuse in their adult years, but whether they make the choices of their parents is a complex issue.  All health care professionals who see children have a wide array of opportunities to identify and offer support.  This course will explore, first, the facts regarding the impact alcohol abuse and addiction can have on a child and then, secondly, effective treatment options for professionals to employ.





The source of Important Facts is SAMHSA’s National Clearinghouse for Drug and Alcohol Information. 

Alcoholism affects the entire family.

·         Living with a non-recovering alcoholic in the family can contribute to stress for all members of the family. Each member may be affected differently. Not all alcoholic families experience or react to this stress in the same way. The level of dysfunction or resiliency of the non-alcoholic spouse is a key factor in the effects of problems impacting children.

·         Children raised in alcoholic families have different life experiences than children raised in non-alcoholic families. Children raised in other types of dysfunctional families may have similar developmental losses and stressors, as do children raised in alcoholic families.

·         Children living with a non-recovering alcoholic score lower on measures of family cohesion, intellectual-cultural orientation, active-recreational orientation, and independence. They also usually experience higher levels of conflict within the family.

·         Many children of alcoholics (COAs) experience other family members as distant and non-communicative.

·         Children of alcoholics may be hampered by their inability to grow in developmentally healthy ways.


Many people report being exposed to alcoholism in their families.


·         Almost one in five adult Americans lived with an alcoholic while growing up.

·         Roughly one in eight American adult drinkers is an alcoholic or experiences problems due to the use of alcohol. The cost to society is estimated at more than $166 billion each year.

·         There are an estimated 26.8 million COAs in the United States. Preliminary research suggests that over 11 million are under the age of 18.


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.

·         Children of alcoholics are approximately 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 drinking frequency.

·         Children’s alcohol expectancies reflect recognition of alcohol-related norms and 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 on children’s early learning about alcohol and other drugs.

·         Family interaction patterns also may influence the COA’s 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 influenced adolescent substance use through several different pathways, including stress, negative effects, and decreased parental monitoring. Negative affect and impaired parental monitoring are associated with adolescents joining 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.



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.



Alcohol is associated with a substantial proportion of human violence, and perpetrators are often under the influence of alcohol.

·         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. This poor communication and problem-solving skills may be mechanisms through which a 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.

·         Addicted parents are raising a significant number of children in this country. 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 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.



Children of alcoholics exhibit symptoms of depression and anxiety more than children of non-alcoholics.

·         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 and not relate to other children claiming they “have no one to talk to.” Teens may show depressive symptoms by being a perfectionist in their endeavors, hoarding, staying by themselves, and being excessively self-conscious. Teenage COAs may begin to develop phobias.



Children of alcoholics experience greater physical and mental health problems and higher health care costs than children from non-alcoholic families.

·         Inpatient admission rates for substance abuse are triple that of other children.

·         Inpatient admission rates for mental disorders are almost double that of other children.

·         Injuries are more than one and one-half times greater than those of other children.

·         The rate of total health care costs for children of alcoholics is 32% greater than for children from non-alcoholic families.



Children of alcoholics score lower on tests measuring verbal ability.

·         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 in job interviews.

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



Children of alcoholics often have difficulties in school.

·         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 the 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 are detectable early in the life course and, in some instances, before school entry.



Children of alcoholics have greater difficulty with abstraction and conceptual reasoning

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



Children of alcoholics may benefit from adult efforts that help them to:

·         Develop autonomy and independence.

·         Develop a strong social orientation and social skills.

·         Engage in acts of “required helpfulness.”

·         Develop a close bond with a caregiver.

·         Cope successfully with emotionally hazardous experiences.

·         Perceive their experiences constructively, even if those experiences cause pain or suffering, and gain, early in life, other people’s positive attention.

·         Develop day-to-day coping strategies.



Children can be protected from many problems associated with growing up in an alcoholic family.

·         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.



Maternal alcohol consumption during any time of pregnancy can cause alcohol-related birth defects or alcohol-related neurological deficits.

·         The rate of drinking during pregnancy appears to be increasing.

·         Non-alcoholic women have detected prenatal alcohol effects at moderate levels of alcohol consumption. 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 a 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.




There are therapeutic issues that could result in the need for counseling.  We will explore both the child or adolescent in the current situation and then also the adult dealing with the damage from living in the situation when younger.  

Treatment modalities frequently used include intensive and regular outpatient care.  The majority of individuals can be treated in an outpatient setting depending on their symptoms and the ramifications of the damage. 

Many children of alcoholics, in response to the chaotic or neglectful environment, may act like responsible “parents” within the family and among friends.  They may cope with the alcoholism by becoming controlled, successful “overachievers” throughout school, and at the same time be emotionally isolated from other children and teachers.  Their emotional problems may show only when they become adults.

The treatment program for children may include group therapy with other youngsters, which reduces the isolation of being a child of an alcoholic.  The child and adolescent psychiatrist will often work with the entire family, particularly when the alcoholic parent has stopped drinking, to help them develop healthier ways of relating to one another.  As a mental health professional, it is crucial to diagnose and treat problems in children of alcoholics as early as possible. The focus should be on helping the child to understand they are not responsible for the drinking problems of the parent, as well as looking to the future with their good decision-making skills.

Treatment should address family addiction issues to provide children with support and treatment. For younger children, play therapy (a type of talk therapy that involves the use of games and toys to express feelings) is useful for addressing issues that may be related to parental alcohol or substance use. For adolescents, more frequently talk therapy is utilized to build on strength and resilience as well as focus on any symptoms that may have arisen, including depression, self-harming behavior, eating disorders, or anxiety.


Whether or not the child’s parent/s are receiving alcoholism treatment, these children and adolescents can benefit from educational programs and mutual-help groups such as programs for children of alcoholics, Al-Anon, and Alateen.

Early professional help is also important in preventing more serious problems for the child, including alcoholism. 

A similar treatment, particularly in a group setting, is used for adult children of alcoholics.   Treatment can also include individual talk therapy.  The focus remains on building on strength and resilience.  The reinforcement of self-dependence and good decision-making is frequently helpful.  The focus again will also be on any symptoms that may have arisen, including depression, self-harming behavior, eating disorders, or anxiety, just as with the younger age client. 



When assessing issues in someone who has or is in this environment, the following screening tool can be utilized:



Q: Do people in authority tend to frighten you?


Q: Do you find yourself constantly seeking approval from others?


Q: Do you see yourself as a victim or look at the world from the perspective of a victim?


Q: Do you sometimes consider the needs of others to the point of neglecting your wants or needs?


Q: Have you ever had relationships with people who need taken care of or need you to rescue them?


Q: Do you tend to judge yourself harshly, especially when things do not turn out perfectly?


Q: Do you find that you have difficulty having fun?


Q: Do you feel that you are different from other ‘normal’ people?


Q: Do you tend to be either super responsible or super irresponsible?


Q: Do you have difficulty having intimate relationships?


Q: Do you tend to isolate yourself from others, especially when things are not going well?


Q: When others disapprove of you, do you feel you need to change their mind?


Q: Have you ever been in a relationship with an alcoholic, addict, or other compulsive person?


Q: Do angry people tend to frighten you?


Q: Do you enjoy being on edge or like taking risks?


Q: Is it easier to give into the demands of others than stand up for yourself?


Q: Do you have difficulty telling others about your feelings?


Q: Do you tend to hold on to relationships, even if they become one-sided or painful?


Q: Do you tend to lock yourself into a course of action even if it appears it will not turn out as you planned?


Q: Do you feel that you spend a lot of time cleaning up problems created by others?



The YES answers indicate the probability of the individual being affected by someone else’s drinking.

The majority of treatment is structured around the client challenging their belief system.  What were/are they responsible for in the situation?  What is their worth and how did they come to this conclusion, for example?  The treatment should highlight the emotionality of what they have come to see as their fundamental truths in life.  Relearning and correcting many of the misconceptions that they developed through living in this environment can be pivotal to their mental health and many more generations to come.

Will They Grow up to Become Alcoholics?

One of the concerns facing the children of alcoholics is that they will grow up to become alcoholics themselves. Is this an inevitability of biology or one of choice (or lack thereof)? The National Association for Children of Alcoholics writes that those who grow up under drunk parents are four times more likely to develop alcoholism in their own adult lives than kids who grew up in better conditions. However, the key phrase is “more likely.” Being raised in an alcoholic home is not a guarantee of future alcoholism. Other factors have to be taken into consideration, such as lifestyle, mental health makeup, demographics, environment, and genetics. To that last point, the National Human Genome Research Institute talks of how most medical conditions (such as alcoholism) have a genetic component to them, meaning that the biological child of an alcoholic parent grows up with a hereditary risk for developing that same condition. Nonetheless, this does not definitively determine if the child will become an alcoholic in their own adult life. No such definitive determination can be made, but the risk can be reasonably assessed if other conditions (e.g., lifestyle, mental health, etc.) are considered.


Is alcoholism genetic?

People aren’t born into addiction. The offspring of an alcoholic parent (or parents) will not inevitably become an alcoholic but has a significant susceptibility to being an alcoholic.  Forty percent of a predisposition to addiction is genetically determined, while other research quotes figures as high as 50 percent to 60 percent.  In some cases, the likelihood of genes influencing addiction rises even further. Male children of male alcoholics are said to be 90 percent more likely to become alcoholics than adults. Even if the babies of alcoholic parents are adopted into homes where there is no drinking at all, the babies have the same risk of becoming alcoholics in their own adult lives as if
they had remained with their original parents.


Codependent Relationships

Being the child of an alcoholic parent is not a guarantee of future alcoholism, but there are still many other dangers ahead. A pathological need for perfection and control may result in the formation of obsessive-compulsive disorder or a desire to seek the approval of others to the detriment of their well-being (as a result of never receiving approval from the parents). The adult children of alcoholics face a future where they are so accustomed to living with dysfunction that they may seek out similar traits in their friends and romantic/sexual partners. WebMD calls this a “codependent relationship,” whereby an individual’s sense of self-worth is based entirely on their partner’s whims. Adults who grew up in alcoholic households were taught (from a very young age) to bury their own needs to please their drunk parents. This creates the idea of believing that love and care can only come from similarly difficult (and/or), abusive partners, even if alcohol itself is not at the crux of the codependent relationship.



Many children internalize their parents’ drunken behavior, feeling responsible and guilty for what goes on in their households. Allowing these thoughts to fester unchecked is what leads adult children of alcoholics to act out in unhealthy ways (e.g., violence, sexual promiscuity, substance abuse, etc.). Explaining to the children that addiction is a complicated disease – one that is caused by genetics, environment, mental health, and other factors – goes a long way in releasing them from the shame and humiliation that are huge parts of growing up with alcoholic parents. Kids need to know that they are not responsible for their parent’s behavior and that they are unconditionally loved, no matter what their mother or father says or does. The presence of a grandparent, neighbor, family friend or member of the community will make a big difference in their overall well-being.


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