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CORK Bibliography: Adult Children of Alcoholics

90 citations. January 1996 to present

Prepared: June 2008

Agnew E; Robideaux S. My Mama's Waltz: A Book for Daughters of Alcoholic Mothers. New York: Simon & Schuster, 1998. (chapter and 41 book refs.)

This is described as "a book for daughters of alcoholic mothers." It combines the authors' personal experiences with the literature of the substance abuse field, and over 200 in-depth interviews of women whose mothers suffered from alcoholism, and who in turn found themselves coping with a myriad of emotional demands and longings, inconsistent mothering, and with secrecy and shame. The volume is organized into 4 sections. The first deals with the behaviors common among alcoholic mothers and their particular impacts upon daughters. It addresses both mother at 'her best' and mother 'at her worst.' The second section considers the legacy of maternal alcoholism in the daughter's life, in terms of body image, the role of other addictions, and eating disorders. The third section considers maternal substitutes, the impact of maternal alcoholism in their daughters relationships with men, female friends, the ability to trust, and impact as they themselves become mothers. The final chapter considers the impact of an alcoholic mother's aging, illness, death, and then turns to efforts to build happy lives despite this legacy and living with the reality of "what might have been" as well as "what should have been."

Amodeo M; Griffin M. Parental alcoholism and other family disruptions: Adult outcomes among sisters. American Journal of Orthopsychiatry 67(4): 585-593, 1997. (52 refs.)

Adult outcomes were investigated in 14 pairs of African-American and white daughters of alcoholic parents. On the basis of four outcome factors, subjects were divided into three sister-pair categories: well-adjusted, impaired, and mixed. Interviews and standardized questionnaires showed that family-of-origin variables contributing to the impaired adult outcomes included parental psychiatric problems and childhood abuse or neglect.

Baker DA. Substance abuse among college students with disabilities: The relationship between adult children of alcoholics and codependency. Dissertation Abstracts International 57(7): 2850-A, 1997

This study had several purposes: (a) to determine the prevalence of substance abuse problems among college students with disabilities; (b) to determine if there was a relationship between substance abuse problems and being an adult child of an alcoholic (ACOA) among college students with disabilities; (c) to determine if there was a relationship between substance abuse and being codependent among college students with disabilities; and (d) to determine if there was a relationship between being an ACOA and being codependent among college students with disabilities. The number of participants in this study included 312 college students with disabilities who attended school in the United States. Twenty postsecondary institutions were randomly selected by categorizing them into time zones and drawing five institutions from each time zone. Frequencies were taken to determine prevalence of substance abuse problems, with 50 percent of the participants being classified as substance abusers. Male college students with disabilities had a higher prevalence of substance abuse than did females. Males who were ACOAs had a higher prevalence of substance abuse than did males who were nonACOA. Chi square analysis indicated a significant relationship between being a male ACOA and having substance abuse problems. Similarly, a significance was found for those subjects who were ACOA and classified as substance abusers. No significant relationships were found between codependency and having substance abuse problems or being an ACOA. Recommendations are discussed.

Balsa A. Parental problem-drinking and adult children's labor market outcomes. Journal of Human Resources 43(2): 454-486, 2008. (37 refs.)

Current estimates of the societal costs of alcoholism do not consider the impact of parental drinking on children. This paper analyzes the consequences of parental problem-drinking on children's labor market outcomes in adulthood. Using the NLSY79, I show that having a problem-drinking parent is associated with longer periods out of the labor force, lengthier unemployment, and lower wages, in particular for male respondents. Increased probabilities of experiencing health problems and abusing alcohol are speculative forces behind these effects. While causality cannot be determined due to imprecise IV estimates, the paper calls for further investigation of the intergeneration costs of problem-drinking.

Bauer LO. Smooth pursuit eye movement dysfunction in abstinent cocaine abusers: Effects of a paternal history of alcoholism. Alcoholism: Clinical and Experimental Research 21(5): 910-915, 1997. (43 refs.)

The present study evaluated smooth pursuit eye movement (SPEM) function in 36 cocaine-dependent patients, with or without a paternal history of alcoholism, and 12 nondrug-dependent normal volunteers. None of the subjects in either group met DSM-III-R diagnostic criteria for schizophrenia, or delusional, major affective, or schizotypal personality disorders. None possessed a history of seizures, significant head injury, HIV-1 infection, or regular medication use. SPEMs were elicited by a pendulum, oscillated at 0.5 Hz, and recorded using electro-oculographic techniques. Tracking accuracy was estimated by the power of the horizontal electro oculograph at the stimulus oscillation frequency. Analyses revealed that the SPEM tracking accuracy of cocaine-dependent patients without a paternal history of alcoholism was superior to that of the normal control group. SPEM tracking in these patients correlated positively with years of cocaine and polysubstance abuse. In contrast, patients with a paternal history of alcoholism exhibited subnormal SPEM tracking performance. These differences could not be explained by other family history, demographic, or drug use variables.

Beaudoin CM; Murray RP; Bond J; Barnes GE. Personality characteristics of depressed or alcoholic adult children of alcoholics. Personality and Individual Differences 23(4): 559- 567, 1997. (57 refs.)

G. Winokur suggested that in an alcoholic family, alcohol abuse and depression among adult children of alcoholics (ACOAs) may be two ways of expressing the same propensity. It was hypothesised that Winokur's "Propensity" could be characterised as a construct of personality variables, specifically low self-esteem, high neuroticism, and high psychoticism. This study examined Winokur's hypothesis using 982 male and female participants (18-64 yr of age) of a general population survey in an attempt to identify the commonalities connecting alcoholic and depressed ACOAs. ACOAs were found to have significantly different personality scores than adults from non-alcoholic families (non-ACOAs), and alcoholic ACOAs shared similar scores with depressed ACOAs on all three personality variables. No differences were seen between alcoholic and depressed participants across family history groups. It would appear from these data that ACOAs can be differentiated from non-ACOAs at least by their low self-esteem, high neuroticism, and high psychoticism, and that alcoholism and depression are two ways that ACOAs can manifest these traits.

Bissonnette M; Wall AM; Wekerle C. Childhood maltreatment, parental alcoholism, and beliefs about alcohol and violence among treatment seeking adults. (meeting abstract). Alcoholism: Clinical and Experimental Research 28(5 Supplement): 144A-144A, 2004. (0 refs.)

Bookstein FL; Streissguth AP; Sampson PD; Connor PD; Barr HM. Corpus callosum shape and neuropsychological deficits in adult males with heavy fetal alcohol exposure. Neuroimage 15(1): 233-251, 2002. (88 refs.)

Persons with brain damage consequent to prenatal alcohol exposure have typically been diagnosed with either fetal alcohol syndrome (FAS) or fetal alcohol effects (FAE), depending on facial features. There is great variability of behavioral deficits within these groups. We sought to combine neuroanatomical measures with neurocognitive and neuromotor measures in criteria of greater sensitivity over the variety of consequences of alcohol exposure. To this end, midline curves of the corpus callosum were carefully digitized in three dimensions from T1-weighted MR scans of 15 adult males diagnosed with FAS, 15 with FAE, and 15 who were unexposed and clinically normal. From 5 h of neuropsychological testing we extracted 2600 scores and ratings pertaining to attention, memory, executive function, fine and gross motor performance, and intelligence. Callosal midline shape was analyzed by new morphometric methods, and the relation of shape to behavior by partial least squares. The FAS and FAE subgroups have strikingly more variability of callosal shape than our normal subjects. With the excess shape variation are associated two different profiles of behavioral deficit unrelated to full-scale IQ or to the FAS/FAE distinction within the exposed subgroup. A relatively thick callosum is associated with a pattern of deficit in executive function; one that is relatively thin, with a deficit in motor function. The two combine in a very promising bipolar discrimination of the exposed from the unexposed in this sample. Thus there is considerable information in callosal form for prognosis of neuropsychological deficits in this frequently encountered birth defect.

Boyd SJ; Plemons BW; Schwartz RP; Johnson JL; Pickens RW. The relationship between parental history and substance use severity in drug treatment patients. American Journal on Addictions 8(1): 15-23, 1999. (47 refs.)

The authors explored the relationship between the history of parental problematic alcohol and drug use and their adult children's alcohol and drug use disorders. Subjects were 347 admissions to an outpatient substance abuse program. There was a positive relationship between the number of parents affected by alcohol and/or drug problems and the percentage of probands with co-existing alcohol and drug use disorders for probands with alcohol use disorders but not for those with only drug abuse. Probands with two affected parents had significantly higher alcohol abuse scores and drug, family, and psychiatric composite test scores than those with a negative family history. This preliminary study indicates that the severity of a proband's substance use disorder may be influenced by parental substance use history.

Burd L; Marsolf JT; Jeulson T. FASD in the corrections system: Potential screening strategies. Journal of FAS International 2(February): e1, 2004. (17 refs.)

Feral alcohol syndrome (FAS) is a leading cause of intellectual deficits, behavioral disorders, impairment and neurological abnormality. co-morbid mental illness is present in over 90% of patients with FAS. Previous research has demonstrated that people with FAS have frequent contact with corrections systems. However, the disorder is largely unrecognized in corrections systems. Objectives: We present a rationale for FAS screening in corrections systems and potential screening strategies. methods Four screening strategies are presented. The four strategies A through D are incremental. Strategy A is an easy to implement, low cost effort to identify offenders considered to be of high risk for FAS by staff discussion and review. Strategy D is a resource intensive population based screening strategy to screen an entire prison or population of offenders. For eachof these strategies, the rationale, its pros and cons, costs, and requisite training, and procedures are outlined. We conclude that FAS may be common in the corrections system and that a high degree of suspicion for the disorder is warranted. We propose further research on development and epidemiological evaluation of screening tools and strategies for screening in the corrections system. Sample forms for assessment are provided.

Carroll MM. Spirituality, alcoholism, and recovery: An exploratory study. Alcoholism Treatment Quarterly 15(4): 89-100, 1997. (28 refs.)

The goals of this exploratory study were to identify mental health and social resources, as well as treatment methods, which 17 recovering alcoholic adult children of alcoholics (ACOAs) found effective for spiritual recovery. Spirituality was defined as the presence or absence of self-actualization as measured by the Personal Orientation Inventory. Ten subjects were characterized as self-actualized, and seven as not self-actualized. Comparisons were made between the two groups in terms of their use of resources and treatment methods, views of spirituality, and length of sobriety. Specific resources (workshops and retreats) and treatment methods (journaling and imagery) were identified as particularly helpful. Emerging themes were self-trust and the interrelationship of spiritual growth and human behavior and psychosocial functioning. Discussion includes implications for practice.

Chang JK; Krantz M. Personal and environmental factors in relation to adjustment of offspring of alcoholics. Substance Use & Misuse 31(10): 1401-1412, 1996. (23 refs.)

The purpose of the present study was to develop a causal model that explains how personal and family characteristics influence the well-being of adult children of alcoholics (ACOAs). The causal model was developed based on family systems theory, coping theory, social learning theory, and social support theory. Eighty-four ACOAs were tested in order to examine the fit of the model to the data by path analysis with LISREL VII. Results of the study suggested that the revised theoretical model presented good model fit to the data with .97 for goodness of fit index, .91 for adjusted goodness of fit index, .13 for root-mean-square residuals, and 11.94 for modification indices. Results of the study also showed that (1) ACOAs who are better able to perceive the availability of social supports tend to have lower emotional status; (2) ACOAs who are better able to perceive the availability of social supports have a tendency to have better adjustment; and (3) ACOAs who have higher emotional status have a tendency to be better adjusted in life.

Chase ND; Deming MP; Wells MC. Parentification, parental alcoholism, and academic status among young adults. American Journal of Family Therapy 26(2): 105-114, 1998. (29 refs.)

This study examined 360 young adults in terms of their perceptions of having assumed a parentified role in their family of origin as a function of academic status and classification as children of alcoholics or nonalcoholics. Low academic status participants reported having experienced greater caretaking responsibilities and worries in their families than those admitted into a regular academic undergraduate program. Respondents who had an alcoholic parent scored higher on the parentification measure than those who were children of problem drinkers and children of nonalcoholics.

Conrod PJ; Petersen JB; Pihl RO. Disinhibited personality and sensitivity to alcohol reinforcement: Independent correlates of drinking behavior in sons of alcoholics. Alcoholism: Clinical and Experimental Research 21(7): 1320-1332, 1997. (62 refs.)

Thirty nonalcoholic young (18 to 30 years) males with extensive multigenerational family histories of male alcoholism and 29 age-matched, family history-negative controls completed a variety of trait personality questionnaires, participated in a competitive stress task (while sober and alcohol-intoxicated), and were assessed for self-report and laboratory drinking behavior. Low academic achievement, disinhibited personality (as measured by the P Scale of the Eysenck Personality Questionnaire), and sensitivity to alcohol reinforcement were significant and powerful independent predictors of self-report (approximate R-2 = 0.40, P < 0.0001) and laboratory (approximate R-2 = 0.20, P < 0.0001) drinking behavior. There seemed to be some specificity with respect to the facets of drinking behavior accounted for by each independent variable: low academic achievement and sensitivity to alcohol reinforcement were more related to quantity of alcohol consumption and frequency of excessive consumption, whereas psychoticism was more related to self-reported negative consequences with alcohol. A cluster analysis on three identified correlates of drinking behavior indicated that the two experimental groups could be more accurately subdivided into three homogeneous types. Multigenerational family history males were disproportionately represented in two of these groups: one characterized by enhanced sensitivity to alcohol reinforcement and the other characterized by high psychoticism scores and alcohol-related problems.

Conrod PJ; Peterson JB; Pihl RO; Mankowski S. Biphasic effects of alcohol on heart rate are influenced by alcoholic family history and rate of alcohol ingestion. Alcoholism: Clinical and Experimental Research 21(1): 140-149, 1997. (76 refs.)

The present study investigated cardiac response to acute alcohol challenge along the blood alcohol concentration (BAC) curve in two groups of young adult nonalcoholic men with (MFH) and without (FH-) multigenerational family histories of alcoholism, matched for drinking history. BACs and resting heart rate measurements were recorded every 10 min for 3 hr after ingestion of a 1.0 ml/kg dose of 95% USP alcohol at two different rates: one of 20 min (slow drinking) and the other of 5 min (fast drinking). Several analyses of variance were performed for each of the dependent measures [BAC and heart rate change from baseline (HRCH)]. A significant risk x BAC phase interaction emerged from the HRCH analysis, indicating that the MFH group was characterized by a significantly greater increase in resting heart rate along the ascending limb of the BAC curve. A significant risk x BAC phase x rate interaction indicated that, when alcohol was consumed at a faster rate, men with multigenerational family histories of alcoholism demonstrated a greater HRCH, which persisted throughout the BAC curve.

Coombes K; Anderson R. The impact of family of origin on social workers from alcoholic families. Clinical Social Work Journal 28(3): 281-302, 2000. (75 refs.)

This study draws on the experience of six social workers who are adult children of alcoholics, to demonstrate that childhood learned responsibility and the capacity for attachment are translated into later professional acuity. The place of resilience in developing an understanding of the linkages between the experiences of adult children of alcoholics and social workers is examined and the consequences for social work practice and the education of social workers is outlined. Undeniably, prior life experience impacts on practice. Less well understood is the positive impact of negative experience. In the case of social workers who are adult children of alcoholics we argue that being part of an alcoholic family may significantly contribute to, rather than detract from, later practice competence.

Crothers M; Warren LW. Parental antecedents of adult codependency. Journal of Clinical Psychology 52(2): 231-239, 1996. (19 refs.)

Two aspects of codependency were investigated among 442 undergraduates. First, parental antecedents were examined by subjects completing measures of codependency, perceived parental dysfunctions (compulsivity, chemical dependency, and codependency), and parental styles (coercion, control, and non-nurturance). As expected, correlations between adult codependency and parental coercion, control, non-nurturance, and maternal compulsivity were significant. However, correlations between codependency and parental chemical dependency were not significant. A multiple regression analysis identified parental codependency and maternal coercion as significant predictors of subject codependency. To examine the second aspect of codependency, which assumes that codependency was identified over 40 years ago by Karen Horney, subjects completed a loss of self measure which correlated highly with codependency.

Cuijpers P; Langendoen Y; Bijl RV. Psychiatric disorders in adult children of problem drinkers: Prevalence, first onset and comparison with other risk factors. Addiction 94(10): 1489-1498, 1999. (32 refs.)

Aims. (1) To confirm the increased risk of psychiatric disorders in Adult Children of Alcoholics (ACOAs); (2) to test if the age of onset of the disorders differs for ACOAs versus non-ACOAs; (3) to estimate the weight of being an ACOA compared to other risk factors including childhood traumas, other parental problem behaviours and current risk factors. Design, setting, and participants. A random sample of the Dutch population (N = 7147) was interviewed (response rate: 69.7%). Measurements. Psychiatric disorders were assessed using the CIDI. Parental problem drinking, other parental problem behaviours and childhood traumas were assessed using self-report measures. Findings. (1) ACOAs had a significantly higher life-time, 12-month and 1-month prevalence of mood, anxiety and abuse/dependence disorders. Sons of problem drinkers also had a higher prevalence of eating disorders and schizophrenia. The prevalence rates were particularly high for the children of fathers with drinking problems. (2) The first onset of the mood and anxiety disorders took place at a younger age in ACOAs than in non-ACOAs. (3) Relative to other parental problem behaviours and childhood traumas, parental problem drinking is a strong predictor of psychiatric disorders, in particular abuse/dependence disorders. Conclusions. Children of fathers with a drinking problem are a high-risk group for psychiatric disorder. From a public health perspective it is an important target to break through this continuing circle. The further development of prevention and early treatment interventions at schools, youth care and addiction treatment centres is an important issue.

Cuijpers P; Smit F. Nicotine dependence and regular nicotine use in adult children of alcoholics. Addiction Research & Theory 10(1): 69-81, 2002. (34 refs.)

In this study the relation between parental alcoholism and tobacco use and nicotine dependence in adult children is explored. Data were used from the National Comorbidity Survey (NCS), a nationwide survey of the US population aged 15 to 54. A sample of 2,728 subjects was selected who could answer all relevant questions about either their father or mother. Regular tobacco use and nicotine dependence are found to be strongly related to having an alcoholic parent. Among subjects who used tobacco regularly at some time, adult children of alcoholics (ACOAs) had a higher risk of developing nicotine dependence (attributable risk: 13.3%), and ACOAs had started regular nicotine use earlier (mean age 18.22 years in ACOAs versus 16.60 in non-ACOAs). The relation between parental alcoholism and nicotine dependence in ACOAs can be related to a genetic predisposition or to environmental factors.

Cuijpers P; Steunenberg B; van Straten A. When children of problem drinkers grow old: Does the increased risk of mental disorders persist? Addictive Behaviors 31(12): 2284-2291, 2006. (24 refs.)

It is well established that children of problem drinkers have an increased risk of developing mental health problems, not only during childhood but also when they grow up into adolescents and adults. However, it has not been examined whether this risk is also present during the old age of these children. In this study, we examine the question whether this increased risk is present in inhabitants of eleven residential homes (mean age 85 years). A total of 355 residents indicated whether one of their parents ever had problems with alcohol. We also used the MINI diagnostic interview to assess the presence of mental disorders. We found that parental problem drinking was significantly associated with having a major depression (current and lifetime), and with the number of drinks in the past week. No significant relationship was found with alcohol-related disorders and anxiety disorders. It was already known that parental problem drinking results in mental health problems in children. We found clear indications that these problems do not disappear when these children grow old.

Cummings SJ; Griffin JA. Identifying offspring of problem-drinking parents: Comparison of five self-report measures. Substance Use & Misuse 34(13): 1817-1836, 1999. (57 refs.)

Although there is general consensus that self-report measures are reliable in offspring identification of parental problem drinking, studies in which these measures are used differ in two important ways: 1) different self-report measures are used across investigations, and 2) when identical measures are used, idiosyncratic cutoff criteria are employed. The purpose of this study was to compare five self-report measures commonly used in college-age populations to identify problem-drinking parents. When the most conservative criterion was employed, each of the five measures identified similar percentages of offspring as having problem- drinking parents (10% for fathers and 4% for mothers). Interrelationships among the five measures were examined, and each method appeared to contribute both to the common and unique variance of the construct "parental problem drinking." Therefore no one measure can capture all aspects of a parent's drinking problem as reported by their offspring.

Davis TM. Relative contributions of family history and perceived family environment on women's reactions to alcohol. Dissertation Abstracts International 57(7): 4702-B, 1997

This study examined the contributions of family history of alcoholism and perceived family environment on alexithymia, antisocial tendencies, and reactions to alcohol in women. The Family History Research Diagnostic Criteria Interview and the Family Environment Scale were used to group 45 undergraduate females (ages 21-25) according to family history of alcoholism (FH+ or FH-) and perceived family environment (PFE+ or PFE-). FH+/PFE+ subjects were predicted to score highest on measures of alexithymia, antisocial tendencies, speed of drinking (i.e., latency to the first drink, number of sips taken, amount of time to consume one beverage, and total time to consume both beverages), and subjective experience of intoxication, followed by FH-/PFE+ subjects. FH-/PFE- subjects were expected to exhibit the lowest scores on all measures. No group differences were found on antisocial tendencies. A main effect for perceived negative family environment approaching significance indicated that women with a negatively perceived family environment tended to score higher in alexithymia than women with positively perceived family environments. No group differences were found on the measures of subjective intoxication, but significant univariate interactions were found on time to drink one drink, total time to drink, and number of sips taken. Simple effects analysis indicated (1) FH+/PFE+ subjects drank slower than FH+/PFE- subjects; (2) FH-/PFE- subjects drank slower than FH+/PFE- subjects in total time to drink; and (3) FH-/PFE- subjects took more sips than FH-/PFE+ subjects. Overall, the results offer little support for the premise that family history and perceived family environment, alone or in combination, strongly impact antisocial tendencies, alexithymia, subjective reactivity to alcoholism, or speed of drinking in the female population examined.

Dooley SY. Comparison of adult children of alcoholic families with adult children from non-alcoholic families: A replication. Dissertation Abstracts International 57(7): 2875-A-2876-A, 1997

The purpose of this study was to re-examine the issue of whether adult children of alcoholics experience more depression, anxiety, and lower self-esteem than do children of non-alcoholic families. The measures used in this study were as follows: Children of Alcoholics Screening Test, the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Coopersmith Adult Self-Esteem Inventory, and a questionnaire developed by this writer designed to obtain family history regarding not only alcoholism, but other issues of family dysfunctionality as well. The subjects for this study were 231 students enrolled in the counselor education program at the University of North Texas, all aged 19 or older. Of the 230 subjects, 31 were male and 199 were female. Eleven males identified themselves as children of alcoholics, as measured by the Children of Alcoholics Screening Test, and 60 females identified themselves as children of alcoholics. Thus, a total of 71 subjects in this study were identified as children of alcoholics. T-tests were conducted to see whether any differences existed between the male and female groups. No significant differences were found. Results of this study showed that family dysfunctionality rather than parental alcoholism was the factor of variability regarding depression, anxiety, and self-esteem. There appears to be a strong relationship between parental alcoholism and family dysfunctionality, but dysfunctionality clearly has more impact upon depression, anxiety, and self-esteem in the adult children of these families than does alcoholism.

Ferraro FR; Douglas J; Marino J. Inhibiting irrelevant information in adult children of people with alcoholism. Journal of Psychology 141(2): 173-180, 2007. (23 refs.)

Adult children of people with alcoholism (ACAs; n = 21) and adults with no family history of alcoholism (non-ACAs; n = 24) completed a task designed to test inhibitory ability using a reaction-time based negative priming task. Although participants in the ACA group responded more slowly overall, they did not differ on this task as compared with participants in the non-ACA group. This pattern of results suggests that inhibitory ability is preserved in ACAs, at least within the context of the current negative priming task. The authors discuss study limitations and inconsistencies in the ACA literature.

Fischer KE; Kittleson M; Ogletree R; Welshimer K; Woehlke P; Benshoff J. The relationship of parental alcoholism and family dysfunction to stress among college students. Journal of American College Health 48(4): 151-156, 2000. (31 refs.)

The relationship between collegiate adult children of alcoholics (ACOAs) and adult children from dysfunctional families (ACDFs) was examined to determine whether ACOAs and ACDFs were at greater risk of stress than non-ACOAs and non-ACDFs. The participants were 549 students from a midwestern university. The data collection instruments were the Children of Alcoholics Screening Test, 6-Item Version (CAST-6); the Family Adaptability and Cohesion Evaluation Scales, Version LI (FACES-II); and the Perceived Stress Scale (PSS). A substantial proportion of the sample was classified as ACOA, ACDF, or both, and there was considerable overlap between the two groups. Both ACOA and ACDF status were found to be significant predictors of stress, with ACDF status being a better predictor than ACOA status. Possible explanations for the results and implications for collegiate wellness programs are discussed.

Fuller BE; Chermack ST; Cruise KA; Kirsch E; Fitzgerald HE; Zucker RA. Predictors of aggression across three generations among sons of alcoholics: Relationships involving grandparental and parental alcoholism, child aggression, marital aggression and parenting practices. Journal of Studies on Alcohol 64(4): 472-483, 2003. (84 refs.)

Objective: This longitudinal study uses a three-generation database involving measures of grandparental and parental alcohol use disorder (AUD), marital aggression and aggression to offspring to predict early and later childhood aggression of third generation offspring. Given the importance of aggressive, undercontrolled behavior in the etiology of alcoholism, the purpose of this study was to construct a statistical model of intergenerational aggression and alcoholism among family members. Method: Participants were a population-based sample of 186 young sons of alcoholics and both biological parents and 120 nonsubstance abusing families and their age-matched sons drawn from the same neighborhoods. Extensive family data were collected at baseline and at 6 years postbaseline. Structural equation modeling evaluated retrospective and prospective relationships between grandparental and parental predictors of the sons' childhood aggression when they were 3-5 and 9-11 years of age. Results: The final model showed that grandparental marital aggression predicted development of parental antisocial behavior, which predicted parental alcoholism and marital aggression and partially mediated level of child aggression among their sons as preschoolers. Significant autostabilities in level of child aggression, parental AUD and marital aggression were present in families over the 6-year interval. Marital aggression was a more important predictor of son's preschool aggression; direct parental aggression to the child was more important at 9-11. Child aggression at 3-5 also was a partial mediator of level of parent-to-child aggression at 9-11. Conclusions: Results indicate continuity of aggression across three generations and also indicate that the child's pathway into risk for later AUD is not simply mediated by parental alcoholism, but is carried by other comorbid aspects of family functioning, in particular aggression.

George WH; La Marr J; Barrett K; McKinnon T. Alcoholic parentage, self-labeling, and endorsement of ACOA-codependent traits. Psychology of Addictive Behaviors 13(1): 39-48, 1999. (50 refs.)

Traits reputed to characterize adult children of alcoholics (ACOAs) and codependent individuals were assessed among psychology undergraduates (n = 281). Students self-reporting alcoholic parentage were no different from controls on these traits or on self-reported drinking. Null effects are attributed to sample characteristics and to systematic inattention to discriminant validity concerns in the original trait formulations. Alcoholic parentage did affect willingness to self-label as ACOA and codependent. Also, regardless of parentage, participants who self-labeled as codependent scored higher on the signature traits than participants who did not self-label as codependent. This result is discussed with respect to recruitment pressures and self-fulfilling-prophecy effects engendered by the widespread dissemination of the ACOA and codependency concepts.

Gogineni A. Gender differences in parental alcoholism and alcohol use problems and depression among adult daughters. (meeting abstract). Alcoholism: Clinical and Experimental Research 28(5 Supplement): 190A-190A, 2004. (0 refs.)

Gotham HJ; Sher KJ. Children of alcoholics. Chapter 17. IN: Kinney J, ed. Clinical Manual of Substance Abuse. Second Edition. St. Louis MO: Mosby-Year Book, 1996. pp. 272-287. (158 refs.)

This chapter endeavors to set forth the limits of knowledge about children of alcoholics and to critically consider popular beliefs. It discusses the diversity of problems among children that are associated with parental alcohol problems and factors that place children at risk. It also addresses treatment approaches and targets of intervention.

Griffin M; Amodeo M. Mixed psychosocial outcomes of sisters from families with alcoholic parents. American Journal of Drug and Alcohol Abuse 24(1): 153-167, 1998. (31 refs.)

To examine intrafamilial differences in adulthood among children of alcoholic parents, 14 women with alcoholic parents and their sisters were assessed for this exploratory study. Reported here is the subset of eight "mixed" sister pairs, one with an impaired adult outcome and the other with a well-adjusted adult outcome. Subjects who scored significantly worse than community norms on depressed mood or social supports or who had a psychiatric diagnosis including substance abuse were categorized as impaired, while the remaining women were categorized as well-adjusted. Both qualitative and quantitative data were collected using a questionnaire and a structured interview. Results showed similarities between the impaired and well-adjusted sisters on individual characteristics, with few differences on characteristics of the parental alcoholism. The most marked differences showed the impaired sisters to score worse than their well-adjusted sisters on characteristics of the home environment and social supports. The impaired women were also more likely to have been physically abused in childhood and to rate the effect of having an alcoholic parent as more negative than the well-adjusted women. Unanticipated findings relating to incest, talents, denial, and racial differences, and their implications for clinicians and researchers, are discussed.

Hall AE. Coping resources and self-perceived well-being of college students who report a parental drinking problem. Journal of American College Health 45(4): 159-164, 1997. (32 refs.)

Nine hundred eighty undergraduates from a major university completed a questionnaire designed to collect data on the associations between parental drinking and the students' coping resources and well-being. Three groups were identified: those with a parental alcohol problem (DP+), those with no problem (DP-), and those who were unsure. Discriminant analysis revealed similarities between the DP+ and unsure participants on the response variables. The coping resource scores of the DP-group were significantly higher than the scores of the DP+ and unsure groups. The unsure group had the lowest mean scores on the total coping resources inventory and on the Cognitive, Emotional, and Spiritual and Philosophical subscales. The DP+ group had significantly lower scores than the DP-group on the Cognitive, Spiritual and Philosophical, and Physical scales. Although DP+ students' perception of well-being was significantly lower than that of their DP-peers, the entire sample was reasonably healthy, as measured by the General Well-Being Schedule.

Hall CW; Webster RE. Traumatic symptomatology characteristics of adult children of alcoholics. Journal of Drug Education 32(3): 195-211, 2002. (39 refs.)

Traumatic experience symptomatology, resiliency factors, and stress among young adults who had experienced alcoholism within their family of origin were assessed in comparison to adults who as children experienced traumatic life events other than alcoholism and those who indicated neither problem (parental alcoholism or traumatic life event) during their childhood. These three groups were compared on self-report measures of stress, resiliency, depressive symptomatology, and trauma symptoms. Results indicated adult children of alcoholics (ACOA) had more self-reported stress, more difficulty initiating the use of mediating factors in response to life events, and more symptoms of personal dysfunction than the control group. Results suggest ACOAs may develop less effective stress management strategies and present more clinically at-risk patterns of responses than their counterparts.

Hansson H; Rundberg J; Zetterlind U; Johnsson KO; Berglund M. An intervention program for university students who have parents with alcohol problems: A randomized controlled trial. Alcohol and Alcoholism 41(6): 655-663, 2006. (78 refs.)

Aim: To study the effects of alcohol and coping intervention among University students who have parents with alcohol problems. Methods: A total of 82 university students (56 women and 22 men, average age 25) with at least one parent with alcohol problems were included. The students were randomly assigned to one of three programs: (i) alcohol intervention program, (ii) coping intervention program, and (iii) combination program. All programs were manual based and individually implemented during two 2-h sessions, 4 weeks apart. This assessment contained both a face-to-face interview and six self-completion questionnaires; AUDIT, SIP, EBAC, coping with parents' abuse questionnaire, SCL-90 and ISSI. Follow-up interviews were conducted after 1 year. Results: All participants finished the baseline assessment, accepted and completed the intervention, while 95% of the students completed the 12-month follow-up assessment. The two groups that received alcohol intervention improved their drinking pattern significantly more than the group that did not receive alcohol intervention [change of standardized scores -0.27 (CI -0.53 to -0.03)]. The groups receiving coping intervention did not differ from the group not receiving coping intervention concerning their ability to cope with their parents' alcohol problems. Nor did they differ regarding changes in their own mental health or in their social interaction capacity. Conclusion: The intervention improved drinking patterns in adult children of alcoholics.

Hansagi H; Brandt L; Andreasson S. Parental divorce: Psychosocial well-being, mental health and mortality during youth and young adulthood: A longitudinal study of Swedish conscripts. European Journal of Public Health 10(2): 86-92, 2000. (35 refs.)

Background: We investigated the association between parental divorce, adolescent well-being and later mental health and mortality in young men. Methods: A national cohort of 47,033 conscripts was followed up using registers for a period of 18 years. Baseline data were obtained from questionnaires at conscription, including data on social background, well-being, health and the use of alcohol and drugs. These data were matched with the national register of psychiatric care and with the national cause of death register. Results: Parental divorce was more common where less favourable social, behavioural and psychological characteristics were reported. For example, in families where the father frequently consumed alcohol, the odds ratio for parental divorce was 5.6 [95% confidence interval (CI): 5.0-6.2], compared with those families where the father never or rarely consumed any alcohol. In the long-term follow-up the relative risk (RR) of hospitalisation for psychiatric disorders was 1.8 (95% Cl: 1.6-2.1) for young men who had divorced parents. The RR was 2.3 (95% Cl: 2.0-2.8) for a diagnosis of alcoholism, 1.3 (95% Cl: 0.9-1.8) for a diagnosis of schizophrenia and 1.3 (95% Cl: 1.1-1.6) for mortality. Conclusions: Several indicators of low levels of well-being at conscription and mental illness, including alcoholism, later in life were found amongst young men with divorced parents. Although the results were adjusted for antecedents and covariate factors in multivariate analyses, some degree of confounding of long-term health effects from factors contributing to divorce cannot be ruled out.

Harkness D. To have and to hold: Codependency as a mediator or moderator of the relationship between substance abuse in the family of origin and adult-offspring medical problems. Journal of Psychoactive Drugs 35(2): 261-270, 2003. (66 refs.)

This pilot study explored the putative role of codependency as a mediator or moderator of the relationship between substance abuse in the family of origin (SAFO) and offspring medical problems in a counterbalanced multiple-treatment experiment with a heterogenous sample of adult males and females. Codependent attitude and behavior were moderators that attenuated the relationship between SAFO and two measures of acute offspring medical problems, but codependent behavior amplified the relationship between SAFO and chronic medical problems. Challenging replications are called for.

Hart KE; McAleer M. Anger coping style in adult children of alcoholics. Addiction Research 5(6): 473-485, 1997. (50 refs.)

This study tested the hypothesis that adult children of alcoholics (ACOAs) would cope with anger arousal by displaying a relatively more pronounced anger-in coping style than non-ACOA controls. The ACOA group consisted of 55 individuals who had sought treatment for ACOA- related issues, while the treatment control group consisted of 52 individuals who had sought treatment for non ACOA-related issues. The no treatment control group consisted of a non clinical sample of 53 employed adults. Anger-in coping style (anger suppression) was assessed using the Anger-In subscale Spielberger's (1988) State-Trait Anger Expression Inventory. Analyses that controlled for a number of potential confounds supported the hypothesis. These findings are consistent with the suggestion that childhood exposure to an alcoholic home environment many play a role in the genesis of a potentially pathogenic anger-in style of coping that endures into adulthood, and with the suggestion that ACOAs may benefit from therapeutic interventions designed to diminish the tendency to suppress anger. Future studies might explore whether anger- suppression contributes to the unusually high rates, among ACOAs, of sociobehavioural, psychological, and medical problems.

Harter SL. Psychosocial adjustment of adult children of alcoholics: A review of the recent empirical literature. (review). Clinical Psychology Review 20(3): 311-337, 2000. (120 refs.)

This review examines controlled studies of the psychosocial adjustment of adult children of alcoholics (ACOAs) published since 1988. ACOAs appear at increased risk for a variety of negative outcomes, including substance abuse, antisocial or undercontrolled behaviors, depressive symptoms, anxiety disorders, low self-esteem, difficulties in family relationships, and generalized distress and maladjustment. However, none of these outcomes are uniformly observed in ACOAs and none are specific to ACOAs. Comorbid parental pathology, childhood abuse, family dysfunction, and other childhood stressors may contribute to or produce similar outcomes. There is little empirical support for "ACOA syndromes" described in the clinical literature.

Harter SL; Taylor TL. Parental alcoholism, child abuse, and adult adjustment. Journal of Substance Abuse 11(1): 31-44, 2000. (42 refs.)

Parallel findings in the adult children of alcoholics (ACOA) and child abuse literatures are integrated and extended by assessing long-term adjustment and childhood histories of parental alcoholism and sexual, physical, and emotional abuse in college students (N = 333). Abuse histories were most strongly related to adult symptom distress and social maladjustment. Parental alcoholism had no independent effects when controlling for abuse history. Parental alcoholism interacted with abuse history in relation to social adjustment, exacerbating the effects of emotional abuse. This study adds to a growing literature calling for move complex models of ACOA development that can account for the diversity of this population.

Harter SL; Vanecek RJ. Cognitive assumptions and long-term distress in survivors of childhood abuse, parental alcoholism, and dysfunctional family environments. Cognitive Therapy and Research 24(4): 445-472, 2000. (89 refs.)

Covariance structure modeling was used to test unique contributions of childhood abuse, parental alcoholism, and dysfunctional family environment to symptom distress and to cognitive assumptions regarding a worthy self; benevolent world, meaningful world, and spiritual world in college students (N = 651). Abuse history was related to adult symptom distress, while a dysfunctional family environment was related to negative assumptions concerning the self and the benevolence of the world. When included in the model with abuse history, family environment, gender, and other characteristics of the family of origin, parental alcoholism did not appear to be causally related to symptom distress or to cognitive assumptions. Cognitive assumptions were initially presumed to be mediators of symptom distress. Sequential refinement of the model through specification procedures suggested that move negative self- assumptions may be a result, rather than a mediator, of symptom distress. Other assumptions were not related to symptom distress in the model.

Hawkins CA. Disruption of family rituals as a mediator of the relationship between parental drinking and adult adjustment in offspring. Addictive Behaviors 22(2): 219-231, 1997. (49 refs.)

This study investigated whether disruption of family-of-origin rituals and routines would mediate the relationship between family history of parental problem drinking (FH+, FH-) and two outcomes in adult offspring: adult children of alcoholics (ACOA) personality attributes and drinking problems. The self-reports of 143 students and 129 outpatients indicated that disruption of family routines and rituals mediated the relationship between family history status and both ACOA traits and problem drinking. These results suggest that the mediating effect of family-of-origin rituals and dairy routines may explain some of the heterogeneity in adult outcomes of offspring from FH+ families, in both student and clinical samples.

Hawkins CA; Hawkins RC. Alcoholism in the families of origin of MSW students: Estimating the prevalence of mental health problems using standardized measures. Journal of Social Work Education 32(1): 127-134, 1996. (16 refs.)

Previous research showing that roughly half of social work students report a history of familial alcohol abuse -- research purporting that such abuse might affect these students' current mental health and professional performance -- relied on self-reports without standardized screening measures. This 1991 study, based on a convenience sample of 136 MSW students at the University of Texas at Austin, determined students' status as Adult Children of Alcoholics (ACAs) by self-reports and scores on the Children of Alcoholics' Screening Test, and evaluated related mental health functioning with four standardized measures. The results suggest that well under half of social work students are ACAs, and that not all (nor only) ACAs were vulnerable to mental health problems.

Hill EM; Ross LT; Mudd SA; Blow FC. Adulthood functioning: The joint effects of parental alcoholism, gender and childhood socioeconomic stress. Addiction 92(5): 583-596, 1997. (74 refs.)

The popular literature has publicized the adjustment difficulties of adult children of an alcohol-dependent parent (ACOAs); however, empirical studies do not provide consistent support. This study examined the impact of parental alcoholism, degree of childhood socioeconomic stress, and gender on three broad categories of adulthood functioning (psychopathology, socioeconomic attainment, and marital stability). These effects were investigated with a heterogeneous sample of 400 men and 226 women participating in studies at the University of Michigan Alcohol Research Center. Parental alcoholism and childhood socioeconomic stress exerted significant independent effects on most adulthood functioning measures. Men and women differed substantially only on socioeconomic attainment measures, and effects of parental alcoholism and childhood economic stress on men and women were generally similar. For marital stability, parental alcoholism and childhood socioeconomic stress interacted. These results suggest that researchers who study the impact of family history for alcoholism on psychological functioning should consider other aspects of the family of origin that promote well-being. In addition, results point to the need for more research on gender differences, protective factors that promote good adjustment, and outcome measures reflecting general life adaptation.

Humphreys K. World view change in adult children of alcoholics/Al Anon self-help groups: Reconstructing the alcoholic family. International Journal of Group Psychotherapy 46(2): 255-263, 1996. (9 refs.)

Although 12-step self-help groups have become extremely popular in U.S. society, clinicians and researchers have devoted little attention to how these groups affect members. This project used naturalistic and qualitative methods to examine the processes through which committed members of self-help groups for adult children of alcoholics experience alterations in their perceptions of family of origin. Results suggest that world view transformation in the family of origin domain involves learning to define the family as pathological, assigning responsibility for this pathology to a disease, forgiving oneself, accepting that one was adversely affected by the family's problem, and ultimately learning to accept one's parents' shortcomings.

Hunt ME. A comparison of family of origin factors between children of alcoholics and children of non-alcoholics in a longitudinal panel. American Journal of Drug and Alcohol Abuse 23(4): 597-613, 1997. (43 refs.)

Secondary analysis of longitudinal panel data reveals minimal differences in family of origin factors between children of alcoholics (COAs) and children of non-alcoholics (non-COAs). From 220 subjects, 37 parents were identified as alcoholic. The COA subjects' retrospective reports about family of origin factors were compared to those of non-COAs. Contrary to the assertions of the COA clinical literature, few differences were found between the two groups. However, these differences are congruent with the findings of other panel studies which have investigated family of origin factors and adult outcome among COAs.

Jacob T; Windle M; Seilhamer RA; Bost J. Adult children of alcoholics: Drinking, psychiatric, and psychosocial status. Psychology of Addictive Behaviors 13(1): 3-21, 1999. (93 refs.)

Although family history of alcoholism represents a major risk factor in the development of drinking problems, the available empirical literature on this topic has raised significant questions regarding the strength and breadth of this relationship. In addition, few studies have evaluated factors that can ameliorate or exacerbate risk for adverse outcomes among children of alcoholics (COAs). The current study compared the drinking, psychiatric, and psychosocial status of 84 adult COAs with those of 111 offspring of normal controls and 102 offspring of psychiatric controls. Adult COAs were differentiated from control groups regarding alcohol and drug abuse and personality characteristics associated with behavioral undercontrol. Furthermore, the drinking outcomes of female versus male offspring were most clearly differentiated across groups. Future research directions are discussed.

Jaeger E; Hahn NB; Weinraub M. Attachment in adult daughters of alcoholic fathers. Addiction 95(2): 267-276, 2000. (42 refs.)

Aim. This study was designed to explore the utility of attachment theory for explaining socio-emotional outcomes in adult daughters of alcoholic fathers (ADAF). it was hypothesized that ADAF would have more insecure attachment organizations than daughters of non-alcoholic parents (non-ADAF), and that ADAF would describe themselves as more disposed towards compulsive care-giving than non-ADAF. Design. ADAF and a matched group of non-ADAF were compared on measures of attachment security and compulsive care-giving. Participants. From a larger sample of 251 female college students, 26 ADAF and a matched group of non-ADAF were identified to participate in the study. Setting. A large, urban university in the northeastern US. Measurements. Participants completed the Adult Attachment Interview and a questionnaire assessing characteristics of compulsive care-giving. Findings. As predicted, ADAF had less secure attachment organizations then did non-ADAF. Although no group differences were observed for compulsive care-giving scores, compulsive care-giving was negatively correlated with attachment security for ADAF. Conclusions. Findings indicate that the concept of attachment may be useful for understanding the developmental consequences of parenting in alcoholic families.

Jennison KM; Johnson KA. Alcohol dependence in adult children of alcoholics: Longitudinal evidence of early risk. Journal of Drug Education 28(1): 19-37, 1998. (59 refs.)

This study investigates familial alcoholism effects and the comparative probability of risk for alcohol dependence in adult children of alcoholics (ACAs) with a control group of non-ACAs. A cohort of 12,686 young adults from the National Longitudinal Survey of Youth (NLSY) is examined over a five-year period and conventional and lineal intergenerational models of alcoholism transmission are assessed. The results of multivariate logistic regression analyses indicate that the risk is relatively greater for male ACAs; sons of alcoholics drink significantly more heavily, experience problems earlier, and develop alcohol dependence more extensively than female ACAs or non-ACAs of either gender. The extent of dependence found in subjects with a lineal history of alcoholism on the father's side of the family, as well as heavy drinking, cigarette smoking and drinking onset in adolescence should be considered as critical predisposing factors of high risk for dependence at later ages. These observations corroborate clinical studies and support a growing body of biopsychosocial research literature.

Jennison KM; Johnson KA. Resilience to drinking vulnerability in women with alcoholic parents: The moderating effects of dyadic cohesion in marital communication. Substance Use & Misuse 32(11): 1461-1489, 1997. (80 refs.)

Data from a subsample of women (N = 4,235) in two waves of the National Longitudinal Surveys of Youth (NLSY) are used to examine the relationship between parental alcoholism and alcohol use in adult life. Dyadic cohesion in marital communication (frequency of interaction and agreement on substantive issues that affect couples) is investigated as a resilience factor that could potentially mitigate adverse drinking outcomes in adult children of alcoholics (ACAs). A moderated mediation model is estimated using a Two-Stage Least Squares (2SLS) regression analysis. The results indicated that an imputed transmission of risk for drinking vulnerability in women ACAs, controlling for nonACA status, was effectively moderated by positive dyadic interaction.

Johnson P. Predictors of family functioning within alcoholic families. Contemporary Family Therapy 24(2): 371-384, 2002. (33 refs.)

This study assessed the effects of various predictor variables on dimensions of functioning within alcoholic families. Participants were 173 college student volunteers from alcoholic families who completed a measure of family functioning, demographic questions, and questions related to experiences in their families of origin. Child abuse, spousal violence, parental divorce, length of time living with an alcoholic parent, parental marital status, and parental availability and predictability significantly affected family functioning, whereas frequency of parental drinking did not. Results suggest that quality of parental interactions with children is more important for functioning in alcoholic families than frequency of parental drinking.

Kelley ML; French A; Bountress K; Keefe HA; Schroeder V; Steer K et al. Parentification and family responsibility in the family of origin of adult children of alcoholics. Addictive Behaviors 32(4): 675-685, 2007. (33 refs.)

The present study examined parentification and family responsibility in the families of origin of 103 female college students who met criteria for being Adult Children of Alcoholics (ACOAs) as compared to 233 women who did not. The gender of the parent with an alcohol problem (mother only, father only, both parents, neither) was also examined in relation to family roles. Participants completed the Parentification Questionnaire-Adult (PQ-A; Sessions, M. W, and Jurkovic, G. J. (1986). Parentification Questionnaire-Adult (PQ-A). Unpublished document. Department of Psychology, Georgia State University, Atlanta, GA), the Filial Responsibility Scale-Adult (FRS-A; Jurkovic, G. J., and Thirkield, A. (1999). Filial Responsibility Scale-Adult (FRS-A). Unpublished document. Department of Psychology, Georgia State University, Atlanta, GA), the Children of Alcoholics Screening Test (CAST; Jones, J. W. (1983). The Children of Alcoholics Screening Test: Test manual. Chicago: Camelot), and indicated whether they suspected their mother/father of a drinking problem. ACOAs reported more parentification, instrumental caregiving, emotional caregiving, and past unfairness in their families of origin as compared to non-ACOAs. However, as compared to ACOAs who indicated that their father was the alcohol-abusing parent or non-ACOAs, respondents who thought their mothers had an alcohol problem reported greater past unfairness. In addition, ACOAs who thought their mothers had a problem with alcohol abuse reported more parentification and emotional caretaking than did non-ACOAs.

Kingree JB. Predictors and by-products of participation in a mutual help group for adult children of alcoholics. Alcoholism Treatment Quarterly 18(2): 83-94, 2000. (18 refs.)

This prospective study examined correlates of participation in a mutual help group for 43 adult children of alcoholics (ACOAs). The mutual help group was based on Al-Anon guidelines and was delivered to the ACOAs during the first month that they were enrolled in a residential, substance abuse treatment program. Results indicated that age and self-esteem at baseline predicted level of participation in the mutual help group. In addition, level of participation in the group was associated with less relapse and more positive changes in status-based self-stigmatization and self-esteem at a six month follow up assessment.

Kingree JB; Thompson M. Mutual help groups, perceived status benefits, and well-being: A test with adult children of alcoholics with personal substance abuse problems. American Journal of Community Psychology 28(3): 325-342, 2000. (48 refs.)

A field experiment was conducted to examine the potential effects of mutual help group participation on perceived status benefits, depression, and substance use among adult children of alcoholics (ACOAs) with personal substance abuse problems. Participants were randomly assigned to attend either ACOA-specific mutual help group meetings or substance abuse education classes during the initial month that they were enrolled in a residential treatment program for low-income substance abusers. Analyses were based on assessments made at baseline, a 1-month posttest, and a 6-month followup. Results indicated that participation in the mutual help group promoted perceived status benefits, which in turn led to reductions in depression and substance use. These findings have clear implications for consumers of ACOA groups and can inform research on the social psychological underpinnings of different types of mutual help groups.

Larson JH; Holt HB; Wilson SM; Medora N; Newell K. Dating behaviors, attitudes, and relationships satisfaction of young adult children of alcoholics. Alcoholism Treatment Quarterly 19(1): 1-18, 2001. (68 refs.)

The dating behaviors, attitudes, and relationship satisfaction of a nonclinical sample of single young adult children of alcoholics (ACOAs) (N = 172) were compared to a sample of non-ACOAs (N = 771). Subjects completed measures of dating behaviors, anxiety, intimacy, trust, commitment and relationship satisfaction. ACOAs began dating at a significantly younger age and dated significantly fewer individuals than non-ACOAs. They also reported significantly more dating anxiety than non-ACOAs. Male ACOAs reported less commitment, intellectual intimacy, trust and relationship satisfaction than male non-ACOAs. Compared to non-ACOAs, female ACOAs reported no differences on these variables. The results provide some support for research suggesting that ACOAs may experience difficulties in their opposite-sex intimate relationships.

Larson JH; Thayne TR. Marital attitudes and personal readiness for marriage of young adult children of alcoholics. Alcoholism Treatment Quarterly 16(4): 59-73, 1998. (62 refs.)

Marital attitudes and perceived readiness for marriage of young adult children of alcoholics (ACOAs) were investigated. Never-married young adults (N = 943) completed the Children of Alcoholics Screening Test (CAST) to determine whether they were ACOAs. Other instruments were completed to measure family dysfunction, marital attitudes, and perceived readiness for marriage. ACOAs were found to be significantly more negative in their opinions and feelings about marriage than were non-ACOAs. They also perceived themselves as being less ready for marriage than non-ACOAs and wanted a significantly longer waiting period before marriage. These results were found even when controlling for family dysfunction and parental divorce. Implications for premarital counseling are discussed.

Lease SH. A model of depression in adult children of alcoholics and nonalcoholics. Journal of Counseling and Development 80(4): 441-451, 2002. (76 refs.)

This study investigated the relationships between levels of depression in a sample of adult children of alcoholics (ACOAs) and non ACOAs and patterns of parental drinking behaviors, intergenerational family interactions, attachment behaviors, and self- esteem. Drinking behaviors directly influenced family processes and indirectly influenced self-esteem but did not influence depression. An angry/violent drinking style influenced family processes and attachment styles supporting the hypothesis that certain drinking behaviors disrupt family functioning. The findings contribute to explanations of resilience in ACOAs; ACOAs termed as resilient might have been exposed to a less violent drinking style with resultant healthier familial interactions and adult attachments.

Lewchanin S; Sweeney S. Developmental approach to the group treatment of adult children of alcoholics. Alcoholism Treatment Quarterly 15(2): 51-62, 1997. (4 refs.)

The experience of growing up in an alcoholic family results in impairment of a child's development of a healthy sense of self. The failure of satisfactory bonding between the alcoholic and co-alcoholic parents and the child often leads to long term impairment in the adult child's ability to function in a genuine and self-determined way. The individual may become unable to regulate self-esteem and to form and maintain healthy intimate relationships. A therapy approach is presented which emphasizes the centrality of these early losses and the adult child's persistent attempts to get early needs met in later relationships. The power of the therapy group as a context for healthy re-parenting experiences and resolution of those early losses is also discussed.

Maynard S. Growing up in an alcoholic family system: The effect on anxiety and differentiation of self. Journal of Substance Abuse 9: 161-170, 1997. (20 refs.)

Adults from alcoholic families of origin were compared with persons from non-alcoholic families on differentiation of self and state and trait anxiety. Data were collected from community college students, clients in a private psychotherapy practice, and individuals attending several community-based Al-Anon/Adult Children of Alcoholics (ACOA) meetings. A total of 112 volunteers met the criteria for participation in the study. Offspring from alcoholic families experienced higher levels of state and trait anxiety and lower levels of differentiation of self than offspring from non-alcoholic families. Subjects from alcoholic families who had obtained professional treatment reported significantly more trait anxiety than those who had not obtained treatment. Results also showed an inverse relationship between anxiety and differentiation of self in offspring from alcoholic families

Melchert TP. Clarifying the effects of parental substance abuse, child sexual abuse, and parental caregiving on adult adjustment. Professional Psychology: Research and Practice 31(1): 64-69, 2000. (39 refs.)

Parental alcoholism, childhood sexual abuse, and other forms of child maltreatment are generally viewed as contributing to adult adjustment problems. The long-term effects of these various factors, however, are actually not well understood. The present study found that the largest amount of variance in college students' psychological distress was explained by parental emotional abuse and neglect, with child sexual abuse, parental substance abuse, and other factors explaining additional but smaller amounts of variance in distress. This suggests that comprehensive conceptualizations of family influences on development will result in a more complete understanding of long-term adjustment outcomes than merely focusing on particular childhood risk factors.

Menees MM; Segrin C. The specificity of disrupted processes in families of adult children of alcoholics. Alcohol and Alcoholism 35(4): 361-367, 2000. (46 refs.)

Children of alcoholics (COAs) have been characterized as an at-risk population in part, because of the dysfunctional family environments that disrupt psychosocial development among offspring exposed to parental alcoholism. This study examined the specificity of problematic family environments to children of alcoholics vs children exposed to other significant family stressors that included parental death, unemployment, separation, divorce, or major illness. University students completed self-report measures of family stressors, family relationship problems, family communication quality, family conflict, and relationship with parents. Based on a family stressor checklist, 20 students exposed only to parental alcoholism and no other family stressors were compared to several other groups exposed to specific family stressors, and to 50 control subjects who had reported no family stressors. Results showed that students from families where a parent is or was an alcoholic, and where there were no other family stressors, recall disturbed family relations no more commonly than students specifically exposed to other family stressors such as parental divorce, death, or major illness, and no more commonly than those who reported no family stressors. Further analyses suggest that the disruption of COAs' family environments may be explained by their increased likelihood of experiencing additional family stressors that can have a disruptive effect, such as parental separation, divorce and unemployment.

Moak JT. Parent-target similarity as a stimulus for aggression in adult children of alcoholics. Dissertation Abstracts International: Section B 63(11-B): 5529, 2003

The purpose of this study was to compare adult children of men alcoholics (COAs) to other adults on a laboratory measure of aggression. Participants (total N = 90) were allowed to press a button that purportedly delivered an unpleasant noise to headphones that were worn by two unseen targets, one of whom was described similarly to each participant's biological father. The two targets, who were actually fictional, were purportedly engaged in a task that required concentration and fine motor skills, and for which they could lose accumulated monetary rewards if they were sufficiently distracted by the noise. The dependent variables were number and duration of button presses. It was hypothesized that the COA Group would be more aggressive overall, and that COAs, but not Non-COAs, would direct more aggression toward the Father-Similar Target. Contrary to the hypotheses, there was a significant Group X Target interaction, in which the Father-Similar Target elicited greater duration of button presses by the Non-COA Group than by the COA Group. There was no significant main effect for either Group or Target. The laboratory measures could not be validated, because they did not correlate with previously-validated, self-report measures of aggression. Men scored higher than did women, on both of the laboratory measures, and on the Physical Aggression and the Verbal Aggression Scales of the Aggression Questionnaire. There were no group differences on any of the self-report aggression measures. Multiple regression analyses of the self-report data revealed that respondents' own alcohol use, but not paternal alcoholism, nor years of cohabitation with their biological fathers, was a significant predictor of aggression on the Aggression Questionnaire Anger Scale and Total Aggression Scale, and on the Aggression Subscale of the Adjective Checklist. Years of cohabitation, not paternal alcoholism, was a significant predictor of participant score on the Alcohol Use Disorders Identification Test (AUDIT). Years of cohabitation and AUDIT score were positively correlated. Results appear consistent with some previous studies that found COAs to be no more aggressive than non-COAs.

Ohannessian CM; Hesselbrock VA. Do alcohol expectancies moderate the relationship between parental alcoholism and adult drinking behaviors? Addictive Behaviors 29(5): 901-909, 2004. (17 refs.)

The relations between parental alcoholism, alcohol expectancies, and adult drinking behaviors were examined among 76 offspring of alcoholics and 68 offspring of nonalcoholics. The primary goals of the present study were to examine whether maternal and/or paternal alcoholism are related to adult alcohol expectancies and to explore whether the relationship between parental alcoholism and adult drinking behaviors is moderated by alcohol expectancies. Gender differences also were assessed. Findings indicated that alcohol expectancies were not significantly influenced by parental alcoholism. Significant moderating effects for global-positive expectancies and sexual enhancement expectancies also were not obtained. In contrast, social assertiveness expectancies were found to consistently moderate the relationship between paternal alcoholism and drinking behaviors. These results indicated that offspring of alcoholic fathers with high expectations for increased social assertiveness were most "at risk" for problematic drinking, especially males.

Olmsted ME. "If you don't become one, you'll marry one": Close relationships of adult children of alcoholics. Dissertation Abstracts International 58(8): 4493-B, 1998

The increased risk for alcoholism in adult children of alcoholics' (ACOAs) is well documented. Academic literature and the experience of self-help movement suggest that ACOAs have unique emotional problems, psychological problems, or both, particularly regarding their close relationships. This study was designed to evaluate assumptions about ACOAs' close relationships. New scales that measure parental and partner alcoholism (AUS-Parent and AUS-Partner) were used in conjunction with the Short Michigan Alcoholism Screening Test (SMAST). A normative, non-clinical sample of married couples was studied through questions about codependency; marriage to alcoholics; stability of close relationships; and satisfaction, discord, adjustment, aggression, jealousy, and intimacy in close relationships. Differences between the SMAST and AUS-Partner suggested that the SMAST measures problems associated with alcohol use and the AUS-Partner measures alcohol dependency. Male and female ACOAs were more likely to report that their partner is alcohol dependent, but ACOAs and non-ACOAs did not differ on the other relationship variables. Relationships in which at least one partner is alcoholic were less stable and the way in which these marital problems manifest themselves depends on which partner has the alcohol problem. The authors conclude that the pilot-study results suggest that being an ACOA may affect some individuals negatively, but that there is a growth enhancing effect on resilient ACOAs.

Public Domain

Olmsted ME; Crowell JA; Waters E. Assortative mating among adult children of alcoholics and alcoholics. Family Relations 52(1): 64-71, 2003. (57 refs.)

Relations between parental alcoholism, self-alcoholism, and partner-alcoholism were examined in a nonclinical, non-self-identified sample of 128 married and engaged young couples. Couples were recruited to participate in a longitudinal study of close relationships. They were assessed using three alcoholism questionnaires that included reports of parent-, partner-, and self-alcohol use. Participants were predominantly White and well educated. Cross-sectional analyses indicated that alcoholics tend to marry other alcoholics and that male adult children of alcoholics (ACOA) are more likely, to be alcoholic than their female counterparts. The relation between parental alcoholism and partner's alcoholism was affected by self-alcoholism in male participants. There was a significant relation between ACOA status and marriage to alcoholics for women that was not affected by their own alcoholism.

Ozkaragoz T; Satz P; Noble EP. Neuropsychological functioning in sons of active alcoholic, recovering alcoholic, and social drinking fathers. Alcohol 14(1): 31-37, 1997. (52 refs.)

Sons of active alcoholic, recovering alcoholic, and social drinking fathers were administered neuropsychological tests to assess whether they differ in their cognitive functioning. Multivariate analyses of variance showed that sons of active alcoholic sons perform significantly worse on visuospatial, memory, and attentional tasks as well as general intellectual functioning than sons of social drinking fathers. The sons of recovering alcoholic fathers showed no significant difference from social drinking fathers in their cognitive functioning. These results suggest that the clinical type of the alcoholic father (i.e., inability to abstain, more severe alcoholic vs. ability to abstain, less severe alcoholic) may be an important factor that determines whether offspring of alcoholics have neuropsychological deficits.

Palmer N. Resilience in adult children of alcoholics: A nonpathological approach to social work practice. Health and Social Work 22(3): 201-209, 1997. (43 refs.)

Imperative for social work practice is the need to examine practice frameworks that may inadvertently label variations in cultural expression, ways of navigating stress and threat of harm or social oppression, or periods of reassembly in negative or pathological terms. This article reviews research that explored another way of viewing adult children of alcoholics (ACOAs), because of the epistemology of pathology that grounds research and practice in the area of alcoholism. Using the Differential Resiliency Model (DRM) developed by the author, the study examined qualitative data to obtain a nonpathological approach to understanding the resilience of ACOAs. The DRM can help practitioners provide more timely and appropriate support and services that complement the survival and growth needs of individuals and families. A case example illustrates the use of the model.

Petry NM; Kirby KN; Kranzler HR. Effects of gender and family history of alcohol dependence on a behavioral task of impulsivity in healthy subjects. Journal of Studies on Alcohol 63(1): 83-90, 2002. (27 refs.)

Objective: Substance misusers are often considered impulsive, but it is unclear whether impulsivity precedes substance misuse or develops as a consequence of it. Because alcohol dependence has a clear familial component, a study comparing impulsivity in nonaffected individuals who differ with respect to paternal history of alcohol dependence may provide evidence of familial vulnerability to impulsivity. Method: 122 healthy individuals participated, none of whom misused alcohol or drugs 58 were paternal history positive (PHP) and 154 were paternal history negative (PHN) for alcohol dependence. The paternal-history groups were balanced on gender, and the four paternal-history-by-gender groups were comparable with respect to demographic features. Participants were offered choices between monetary rewards (e.g., $34) available immediately and larger rewards (e.g., $50) available after delays ranging from I week to 6 months. This task measures a construct of impulsivity by assessing the rates at which individuals discount rewards delayed in time. Results: Although discount rates in PHP men did not differ reliably from those in PHN men, PHP women had higher discount rates than PHN women. Post hoc contrasts revealed that PHN women had lower discount rates than the other three groups. Similar results were obtained when age, education, socioeconomic status, and scores on a measure of sociopathy were used as covariates. Conclusions: Paternal history of alcohol dependence is associated with greater discount rates among women. The lack of an effect for men may suggest different mechanisms by which risk is transmitted from alcohol-dependent fathers to daughters compared with sons. Further research examining these relations and the implications that delay discounting has for drinking and related behaviors is warranted.

Ramsey SE; Finn PR. P300 from men with a family history of alcoholism under different incentive conditions. Journal of Studies on Alcohol 58(6): 606-616, 1997. (43 refs.)

Objective: Males with a family history of alcoholism (Family History Positive [FHP]) have frequently been reported to show an attenuated amplitude of the P300 component of the EEG event-related potential (ERP). The purpose of the present study was to explore the influence of incentives on the amplitude of the P300 to Target stimuli in FHP and FHN (Family History Negative) men. Methods: The ERPs of 20 FHP and 20 FHN men were recorded in a visual discrimination task under two conditions: a no incentive (Neutral) and a reward/loss of reward (Incentive) condition. ERPs following Target, Non-Target and Novel stimuli were examined. Results: The FHP subjects displayed the expected attenuation of P300 amplitude, regardless of the stimulus type (Target, Non-Target or Novel), compared to the FHN subjects. The FHN subjects showed the predicted effect of a significantly increased P300 amplitude following Target stimuli in the Incentive condition whereas the FHP subjects did not display significantly greater P300 amplitudes in response to the incentive. Conclusions. These results may reflect a deficit in the motivational-cognitive system of FHP subjects. Analyses suggest that changes in P300 amplitude in response to the incentive can be predicted by subjects' scores on self-report measures of sensation seeking and behavioral undercontrol. However, such measures could not explain subjects' absolute P300 amplitude to Target stimuli.

Ratsma JE; van der Stelt O; Schoffelmeer ANM; Westerveld A; Gunning WB. P3 event-related potential, dopamine D2 receptor A1 allele, and sensation-seeking in adult children of alcoholics. Alcoholism: Clinical and Experimental Research 25(7): 960-967, 2001. (48 refs.)

Background: Research has indicated a close relationship between the P3 event-related potential and the dopamine D2 receptor Al allele in individuals at high risk for alcoholism. Other research has suggested an association between the dopamine D2 receptor A1 allele and sensation-seeking. In this study, we further examined the relationships between the P3, the A1 allele, and sensation-seeking in a sample of nonalcoholic adult children of alcoholics. Methods: Participants (n = 57; range, 19-30 years; 41 women), who performed a visual novelty oddball task to elicit the P3, were asked to fill in personality questionnaires, including Zuckerman's Sensation-Seeking Scale, and were classified according to the presence of the dopamine D2 receptor A1 allele. The effects of sex, age, and socioeconomic status were assessed to determine whether these variables affected the relations between the P3, the A1 allele, and sensation-seeking. Results: A small P3 amplitude was associated with high sensation- seeking, particularly with high disinhibition. The presence of the A1 allele was also associated with high disinhibition, but only in men. By contrast, P3 amplitudes and latencies were not associated with the presence of the A1 allele. Conclusions: Although a small P3 amplitude, high sensation-seeking, and the presence of the A1 allele were all associated with alcoholism risk, these findings indicate that these three characteristics together do not reflect a common risk factor in alcoholism.

Riedford KB. Sibling offspring of alcoholic parents: Variations among stressors, resources, coping styles, biological vulnerability and adjustment in sibling groups. Dissertation Abstracts International 58(8): :4146-B, 1998

This study's purpose was to identify psychological adjustment factors of adult children of alcoholics (ACOAs). The study sample consisted of 88 subjects drawn from 29 sibling groups and 33 more individuals from other families who were part of a multisite study entitled Collaborative Study on the Genetics of Alcoholism (COGA). Information on adaptive resources, adjustment, coping, demographics, and family stressors was collected from ACOAs. Biological and diagnostic data were used to examine associations with coping strategies and with adjustment in ACOA siblings. Cross-sectional analyses were performed and they included correlation analyses, descriptive statistics, multiple regression analyses, and structural equation modeling. Greater family resources were associated with better global adjustment. The positive association between resources provided by family and Self-Esteem was mediated by Avoidance Coping. Higher stressor levels during childhood and increased Avoidance Coping during adulthood were related to higher levels of alcohol abuse/dependence. Increased Avoidance Coping was also related to Lifetime Major Depression. No biological variable, other than longer PZP3 EEG lead latency in a non-target condition, was related to depression or alcohol dependence in ACOAs. There were trends for better adjustment scores among females than males when their father was alcohol-dependent, and better adjustment scores for males when both parents or their mothers were alcohol-dependent. The author concluded that Avoidance Coping is related to all adjustment components.

Public Domain

Robitschek C; Kashubeck S. A structural model of parental alcoholism, family functioning, and psychological health: The mediating effects of hardiness and personal growth orientation. Journal of Counseling Psychology 46(2): 159-172, 1999. (78 refs.)

The purposes of this study were to (a) determine whether personal growth orientation and hardiness mediated the relations of parental alcoholism and family functioning to psychological well-being and distress; (b) determine whether this mediational model was invariant across women and men; and (c) examine the role of parental alcoholism in a model that included family functioning. Personal growth orientation appeared to mediate fully the relation of family functioning to distress for both genders. For women, hardiness appeared to mediate partially the relation of family functioning to well-being. For men, this relation appeared to be fully mediated by hardiness. The models were predominantly invariant across genders. Parental alcoholism had no direct effects on well-being or distress; indirect effects were found through family functioning, personal growth orientation, and hardiness. Implications for theory, research, and practice are discussed.

Rodney HE. Inconsistencies in the literature on collegiate adult children of alcoholics: Factors to consider for African-Americans. (review). Journal of American College Health 45(1): 19-25, 1996. (58 refs.)

In a review of more than 50 literature entries on Adult Children of Alcoholics, the author found a number of inconsistencies. The author emphasizes that clinicians and those who develop alcohol prevention programs should stop believing that certain characteristics are typical of all adult children of alcoholics. She makes specific recommendations for factors to be considered in programs for African American collegiate children of alcoholics.

Rodney HE; Rodney L. An exploratory study of African-American collegiate adult children of alcoholics. Journal of American College Health 44(6): 267-272, 1996. (48 refs.)

The authors examined the relationship between students at a Black university who were adult children of alcoholics (ACOAs) and students who were not children of alcoholics (non-ACOAs) regarding levels of self-esteem, health in the family of origin, and social support during adolescence. The study participants were African American undergraduate students who responded to five surveys. The only significant relationship found was with results from the Michigan Alcoholism Screening Test (MAST). Level of drinking was significantly related to the self-esteem of the ACOAs. A significant positive correlation between self-esteem and social support (mother) for the ACOAs and a negative correlation between self-esteem and health in the family were also found. The findings are consistent with earlier reports in which an association was found between mother support and health of the family.

Ross LT; Hill EM. Drinking and parental unpredictability among adult children of alcoholics: A pilot study. Substance Use & Misuse 36(5): 609-638, 2001. (75 refs.)

Within-family differences that mediate the relationship between family history for alcoholism and alcohol consumption were investigated. Twenty adult children of alcoholics (ACOAs) and 20 children of social drinking parents (non-ACOAs) were interviewed in 1991 (mean age 24.2 years). Participants described family functioning while growing up and indices of their alcohol consumption. Family history for alcoholism had a direct association with two aspects of drinking. ACOAs reported more lifetime drinks and tended to report drinking more frequently during high school, as compared to non-ACOAs. ACOAs also reported more parental unpredictability, which in turn was associated with the above drinking indices. Finally, family history for alcoholism had an indirect association with drinking, as unpredictability mediated this relationship. Research and prevention implications are discussed.

Ruben DH. Treating Adult Children of Alcoholics. A Behavioral Approach. New York: Academic Press, Inc., 2000. (Book refs.)

This book uses behavioral constructs to consider the origins and treatment of adult children of alcoholics. The author proposes both functional and behavioral characteristics that are seen as characteristic of adult children of alcoholics, and which comprise the "ACOA syndrome." It then identifies intervention that are purported to be fast and effective in treating longstanding clinical symptoms of children of alcoholics. The volume is organized into two sections. The first section deals with assessment, provides definitions of the Adult Children of an Alcoholic (ACOA) Syndrome. Both operational analysis and behavioral patterns that are indicative of this syndrome are described. In addition, there is discussion in section one of the "rules" and contingencies that are part of the family, as well as the impact of spouses and children when living with the adult child of an alcoholic. Section two is directed to treatment, the basic components of short-term treatment as well as the "side effects" of healthy recovery.

Sandoz CJ. Effects of parental alcoholism upon locus of control and intimacy of recovering alcoholics. Alcoholism Treatment Quarterly 16(4): 91-99, 1998. (24 refs.)

This study examines the effects of parental alcoholism on the differentiation of self, locus of control scores among 68 members of Alcoholics Anonymous (AA) in New Jersey 46 of whom were adult children of alcoholics (ACOA). ACOAs with alcoholic mothers had higher chance external locus of control scores than did ACOAs with an alcoholic father. ACOAs with alcoholic mothers had lower spousal intimacy scores than did the ACOA group with both alcoholic parents.

Sandoz CJ. Interaction effects of gender with recovering ACOA alcoholics and non-ACOA alcoholics. Alcoholism Treatment Quarterly 14(2): 67-77, 1996. (14 refs.)

This study examined the effects of parental alcoholism on gender and recovery maintenance variables among 71 alcoholics in Alcoholics Anonymous (AA) groups located in southern New Jersey. Results included significant interaction effects with Children of Alcoholics (COA) Screening Test (CAST) scores and gender with attendance at AA meetings, length of sobriety, and the number of AA promises received. Specific group differences included: (1) adult males who were not COAs (non-ACOA) males attended more weekly AA meetings than did non-ACOA females, (2) non-ACOA women had longer sobriety than ACOA women, (3) non-ACOA women claimed to have received more AA promises than non-ACOA males.

Sayette MA; Martin CS; Perrott MA; Wertz JM. Parental alcoholism and the effects of alcohol on mediated semantic priming. Experimental and Clinical Psychopharmacology 9(4): 409-417, 2001. (61 refs.)

In this study, researchers tested the effects of a moderate dose of alcohol on the spread of activation of associated information in memory using a mediated semantic priming task in which target words are preceded by primes that are either unrelated or indirectly related to the target. Mate and female participants with or without a parental history (PH+ and PH-, respectively) of alcoholism were administered the priming task after consuming alcohol or a placebo beverage. Among PH- individuals, alcohol constrained the spread of activation of associated information, as manifested by a reduced priming effect. In contrast, alcohol enhanced priming effects among PH+ participants, though this latter effect appears to be due to a particularly slow response among these individuals to unprimed words. Results are discussed with regard to theories of alcohol's effects on cognitive processes.

Scharff JL; Broida JP; Conway K; Yue A. The interaction of parental alcoholism, adaptation role, and familial dysfunction. Addictive Behaviors 29(3): 575-581, 2004. (20 refs.)

Many people believe that parental alcoholism has adverse consequences on children -- some research fails to support this hypothesis. Familial dysfunction is often regarded as having a more important impact on adults, perhaps because of a failure to recognize that adult children of alcoholics (ACOAs) may have adopted more than one coping strategy. The present study investigated within-group differences in psychological symptomology as measured by the Millon Clinical Multiaxial Inventory (MCMI). ACOAs, were compared by roles (Hero, Mascot, Lost Child, and Scapegoat) to non-ACOAs as measured by familial dysfunction and roles. MANOVA indicated significant main effects of dysfunction, role, ACOA, and an interaction of role and ACOA. Failures to recognize the impact of parental alcoholism may be caused by multiple adaptation strategies.

Senchak M; Greene BW; Carroll A; Leonard KE. Global, behavioral and self-ratings of interpersonal skills among adult children of alcoholic, divorced and control parents. Journal of Studies on Alcohol 57(6): 638-645, 1996. (43 refs.)

OBJECTIVE: The goal of this study is to evaluate interpersonal skills and the relationships among interpersonal skills in a non-clinical sample of adult children of alcoholic, divorced and control parents using a multimethod assessment strategy. METHOD: Subjects were pre-screened to rule out parental psychopathology and maternal alcoholism. Subjects (N = 238, 50% male, 86% white) interacted with a same- or opposite-sex confederate in a series of videotaped role plays, which were either unstructured or structured via discussion topics and acquaintance instructions. The videotapes were coded for (1) global or general impression ratings of subject and (2) four behavioral components of interpersonal skill: talk, gaze, smile and self-manipulation. Subjects also rated their own skill and anxiety during the role plays. RESULTS: Male and female children of alcoholics were judged to be more anxious when interacting with an opposite-sex partner than with a same-sex partner. Children of divorce and controls were not influenced by the gender of their interaction partner. Children of alcoholics were also judged to be less socially skilled then children of divorce. There was some suggestion that children of alcoholics and divorce may not accurately perceive their own level of skill. CONCLUSIONS: The findings provide some support for interpersonal skills deficits among adult children of alcoholics, although the deficits were not pervasive or consistent across methods. Limitations of the findings and the overall study were discussed.

Sher KJ; Wood PK; Gotham HJ. The course of psychological distress in college: A prospective high-risk study. Journal of College Student Development 37(1): 45-51, 1996. (29 refs.)

The longitudinal course of psychological distress, as measured by the Brief Symptom Inventory, was examined in a cohort of 457 first-time freshmen college students over four yearly assessments. Individuals reported a clear, steady decline in distress across the 4 years, which appeared more a function of adaptation to school or to the young adult life stage than an artifact of collegiate attrition.

Steinberg SI; Bellavance F. Characteristics and treatment of women with antenatal and postpartum depression. (review). International Journal of Psychiatry in Medicine 29(2): 209-233, 1999. (124 refs.)

Objective: Investigations of the efficacy of treatment for non-psychotic pregnancy-related mood disorders are scarce. Thus, a prospective, longitudinal study of six months duration, involving ninety-six index cases and forty-five healthy women as a reference group, was implemented to determine the response of mood, parenting stress and dyadic adjustment to an eclectic management. Method: In this naturalistic study, the index cases were offered treatment consistent with their symptoms, context, and level of compliance. All women received individual psychotherapy combining strategies from Interpersonal and Cognitive Behavioral Psychotherapy and/or Marital Interventions and Pharmacology. Rating scales (Dyadic Adjustment Scale, Hamilton Rating Scale for Depression, Edinburgh Postnatal Depression Scale, Child Stress Inventory) scored monthly, were used to measure the response to treatment over time. Results: Depressive symptoms are generally alleviated by the second to third month of treatment. Dyadic discord accentuated by traditional sex role expectations and child care stress exacerbated by low self-esteem persisted throughout the trial at levels significantly different from the untreated reference group. Conclusions: Short-term interventions are cost-effective for the relief of mood disorders. However, creative solutions, during an era of economic restraints, are required to extend treatment sufficiently to address couple conflicts and facilitate the transition to parenthood for index cases. Note: Among the characteristics assessed was being an adult child of an alcoholic.

Storhoff G. Jason's role-slippage: The dynamics of alcoholism in The Sound and the Fury. Mississippi Quarterly 49(3): 519-535, 1996. (29 refs.)

William Faulker while denying his having alcoholism or that his drinking had any negative impact on his family, was himself an adult child of an alcoholic. Thus, he knew well that an alcoholic parent's behavior has psychological repercussion in the family. Far beyond the illness, given the terrific compulsions, abuse and exploitation, alcoholic life patterns become a feature of the children as they mature. These consequences are dramatized in Faulker's first great novel, "The Sound and The Fury", that focus on the children who endure their fathers alcoholism. The discussion of the Comptom family draws upon family systems theory, and its application to alcoholism.

Stout ML; Mintz LB. Differences among nonclinical college women with alcoholic mothers, alcoholic fathers, and nonalcoholic parents. Journal of Counseling Psychology 43(4): 466-472, 1996. (29 refs.)

To further examine the uniformity myth as it pertains to adult children of alcoholics (ACAs) and to elucidate potential within-ACA difference variables, differences among nonclinical college females with alcoholic fathers (F-ACAs), alcoholic mothers (M-ACAs), and no alcoholic parents (non-ACAs) were explored. These groups were compared in terms of eating disorder symptomatology, interpersonal difficulties, and reports of abuse. F-ACAs reported significantly more distress arising from interpersonal problems than did non-ACAs. Non-ACAs reported significantly fewer threats of parent-perpetrated abuse than either ACA group, whereas F-ACAs reported significantly more father-perpetrated threats of abuse than either non-ACAs or M-ACAs. F-ACAs also reported a significantly higher prevalence of father-perpetrated physical abuse than did M-ACAs. Suggestions for future research are made, and counseling implications are discussed

Tweed SH; Ryff CD. Family climate and parent-child relationships: Recollections from a nonclinical sample of adult children of alcoholic fathers. Research in Nursing and Health 19(4): 311-321, 1996. (47 refs.)

Past family climate and past parent-child relationships of a nonclinical sample of young adult children of alcoholic fathers (n = 87) were compared to a sociodemographically similar sample of young adults with nonalcoholic parents (n = 106). Self-reports indicated that, compared to respondents from nonalcoholic families, respondents with alcoholic fathers described a more negative family climate with higher levels of conflict and lower levels of cohesion and expressiveness. Adult children of alcoholics described more negative relationships with their alcoholic fathers. However, contrary to clinical literature, adult children of alcoholics' descriptions of their relationships with their nonalcoholic mothers did not differ from the descriptions provided by young adults with nonalcoholic parents. Daughters of alcoholic fathers reported more negative relationships with their fathers in the areas of role performance, affective expression, and control than did sons. Implications for practice include reinforcing the nurturing relationship between nonalcoholic mothers and their children in families with alcoholic fathers.

Vail MO; Protinsky H; Prouty A. Sampling issues in research on adult children of alcoholics: Adolescence and beyond. Adolescence 35(137): 113-119, 2000. (19 refs.)

A critical examination of 98 studies on adult children of alcoholics, published from 1986 to 1995, was prompted by suggestions that sampling issues confound research findings. Over half of the studies that were reviewed involved college students. It is important to understand the methodology used in creating a knowledge base that relies heavily on late adolescent and young adult offspring of alcoholics. Thus, two main questions were asked when reviewing these studies: What methods were employed to classify offspring as being children of alcoholics? To what extent does our knowledge about adult children of alcoholics depend on college student samples and clinical samples?

Velleman R; Orford J. Risk and Resilience: Adults Who Were the Children of Problem Drinkers. Amsterdam: Harwood Academic Press, 1999. (Chapter refs.)

This book reports results from a study of young adults in the South-West of England who had a parent who was a problem drinker, The sample consisted of 164 offspring of problem drinkers aged 16-35 and a comparison group of 80 matched for age and sex. The subjects were volunteers recruited from variety of sources either through advertising (media, firms, colleges) or agencies (health, social services, self-help groups). The authors find that the offspring of problem drinkers are at risk of a range of emotional, conduct, educational, and friendship problems in childhood and adolescence, whilst they are living at home. Such results have been widely reported by other studies, but this study suggests that it is only those children who experience disharmonious relationships within the family who are at greater risk. The main conclusion of this study is that despite negative outcomes in childhood, many offspring of problem drinkers escaped negative consequences in early adulthood. Contrary to expectation, it was not the case that the offspring had poorer mental health as young adults or reported greater anxiety or dissatisfaction with life than the comparison group. Their lives on average were no less stable than those in the comparison group in terms of home, close relationships, friendships work or education, although they were more likely to have left home at an earlier age and to smoke or drink heavily themselves. From the qualitative information given by those interviewed, the authors studied the characteristics of those who have shown resilience in the face of a stressful childhood with a problem drinking parent. In these cases the protective factors included: external social support from schools or extended family members, a career, and above all a supportive adult relationship. One question that remains is whether the coping mechanisms that children employ have their cost in later, middle life.

Veronie L; Fruehstorfer DB. Gender, birth order and family role identification among adult children of alcoholics. Current Psychology 20(1): 53-67, 2001. (41 refs.)

Much attention has been paid to the influence of family dynamics in role identification development for the children of alcoholics. This article considers the development of stable and enduring behavior traits for the child through examination of alcoholic parent(s) gender, child birth order, and child gender correlates. An examination of the main and interaction effects of child gender, gender of the alcohol parent(s), and child birth order on strength of identification with the Hero, Scapegoat, Mascot or Lost Child family roles revealed significant gender differences for the Mascot, and Lost Child roles. The presence of two alcoholic parents was significant in producing diminished strength of identification with Mascot role behaviors.

Volavka J; Czobar P; Goodwin DW; Gabrielli WF; Penick EC; Mednick SA et al. The electroencephalogram after alcohol administration in high-risk men and the development of alcohol abuse disorders 10 years later: Preliminary findings. Archives of General Psychiatry 53(3): 258-263, 1996. (29 refs.)

Background: In 1970 through 1980, electroencephalographic (EEG) responses to an alcohol challenge in 19-year-old sons of alcoholics as well as in sons of nonalcoholic control subjects were examined. The familial risk status of the subjects and greater EEG sensitivity to alcohol were hypothesized to predict the development of alcoholism 10 years later. Methods: In 1990 through 1992, diagnostic interviews were completed to ascertain alcohol and other substance use disorders in these subjects and to update their family history. Results: Updated family history of alcoholism predicted the development of substance dependence. Density of alcoholic relatives (the number of alcoholic relatives divided by the number of known relatives) was positively related to the severity of alcohol use disorders in the probands. Contrary to expectations, a greater EEG response at age 19 years was not related to the later development of alcohol dependence. Instead, the opposite was observed: a smaller EEG alpha frequency response to alcohol at age 19 years was related to the development of alcohol dependence and high quantity and frequency of alcohol consumption 10 years later. Conclusions: Lower EEG response to a small dose of alcohol may be associated with the later development of alcohol dependence. This result is based on a small number of subjects and should be interpreted with caution. Although this result is opposite to our 1980 hypothesis, it is consistent with much of the recent literature.

Vungkhanching M; Sher KJ; Jackson KM; Parra GR. Relation of attachment style to family history of alcoholism and alcohol use disorders in early adulthood. Drug and Alcohol Dependence 75(1): 47-53, 2004. (59 refs.)

The present study examined the association between paternal alcoholism and attachment style in early adulthood and sought to determine whether attachment style might, at least partially, mediate intergenerational risk for alcoholism. The current report focuses on the cross-sectional relation between family history (FH) of alcoholism, attachment styles, and alcohol use disorders (AUD) when cohort members were, on average, 29 years old (N=369; 46% male; 51% FH+). Results indicated that FH+ participants were more likely to have insecure attachment, characterized by fearful-avoidant and dismissed-avoidant styles. Additionally, fearful-avoidant and dismissed-avoidant attachment styles were related to the presence of an AUD even after controlling for sex and FH (P<0.05). There was little evidence, however, that attachment style mediated the relation between paternal alcoholism and AUD in offspring; the FH-AUD association was only negligibly reduced when the effect of attachment style was controlled. Our findings suggest that insecure attachment style is a risk factor for AUD, independent of familial risk for alcoholism.

Wade JC. Perfectionism in adult children of alcoholics, adult children from dysfunctional but non-alcoholic families, and adults from nondysfunctional families. Dissertation Abstracts International 58(8): 3937-B, 1998

This study examined the differences between adult children of alcoholics (ACOAs), non-ACOAs, and adult children from dysfunctional but non-alcoholic families (ACDFs) on the variable of perfectionism. Three measures of perfectionism were used: the Frost et al. Multidimensional Perfectionism Scale, the Dysfunctional Attitudes Scale (DAS), and the Almost Perfect Scale - Revised (APS-R). Based on data from a background questionnaire, participants were classified as ACOAs, ACDFs, and non-ACOAs. All groups were randomly reduced to 34 participants. It was hypothesized that ACOAs would score significantly higher on the "maladaptive" factors of the APS, APS-R, Frost et al. MPS, and on both factors of the DAS. Surprisingly, no significant differences were seen between ACOAs, ACDFs, and non-ACOAs on any subscale of the three measures of perfectionism. These results suggest that contrary to assertions in the anecdotal and clinical literature, the impact of being raised in an alcoholic family does not significantly influence the development of perfectionism. In addition, ACOAs were found to be fairly similar to ACDFs on the five categories of abuse and "disruption" within the family of origin. These results suggest that parallels may exist between ACOAs and ACDFs in relationship to the experience of chronic stress within the family.

Public Domain

Watt TT. Marital and cohabiting relationships of adult children of alcoholics: Evidence from the National Survey of Families and Households. Journal of Family Issues 23(2): 246-265, 2002. (41 refs.)

The popular press has disseminated widely the idea that adult children of alcoholics (ACOAs) have relational deficiencies. This literature has been challenged due to its reliance on clinical samples: however, evidence of no difference between ACOAs and non-ACOAs has come from studies of college students. The National Survey of Families and Households is used to examine the effect of growing up in an alcoholic family on adult marital and cohabiting relationships, In support of the deficit model, results reveal that ACOAs are less likely to marry and have lower levels of marital quality and stability than non-ACOAs. Additional ACOA deficiencies that serve to mediate these relationships are also identified. However, ACOAs commonly are profiled as women exhibiting excessive dependency. Results reveal effects for men and women and evidence for relational patterns characterized by distance rather than overinvolvement. Research using more representative samples is needed to dispel misleading stereotypes.