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Effects on children of alcohol dependent parents

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Parents play an important role in their children's development during their adolescence. Dr. Michael Windle describes how alcohol abuse can interfere with parenting skills and marital relations, thereby affecting adolescent development and adjustment. Parents who abuse alcohol place their children at increased risk for alcohol and other drug use as well as for psychological problems.1 Both genetic and environmental factors affect a child's development and may increase risk for future alcohol use. Using a purely epidemiological approach, the observation that alcoholism tends to run in families might lead to the inference that social learning processes are the main factor in its development.2

Physical effects on the children of alcohol dependent parents all bear close examination. This may even start to manifest itself before birth. Parental alcoholism may affect the fetus even before a child is born. In pregnant women, alcohol is carried to all of the mother's organs and tissues, including the placenta, where it easily crosses through the membrane separating the maternal and fetal blood systems. When a pregnant woman drinks an alcoholic beverage, the concentration of alcohol in her unborn baby's bloodstream is the same level as her own. A pregnant woman who consumes alcohol during her pregnancy may give birth to a baby with Fetal Alcohol Syndrome (FAS). Fetal Alcohol Syndrome is one of the three top known causes of birth defects. According to the National Council on Alcoholism and Drug Dependence, about 5000 babies are born each year with severe damage caused by FAS; another 35000 babies are born with more mild forms of FAS. 3

Children of alcoholic parents, either prenatally or later in life, if they themselves develop alcoholism, may fall prey to one or more of the following physical problems inherent to alcoholism. 4

Gastrointestinal. Alcohol dependence is the most common cause of cirrhosis of the liver, the eighth leading cause of death in the United States. Alcohol is also associated with other gastrointestinal disorders such as ulcers, gastritis, and pancreatic cancer.

Cardiovascular. Alcohol causes several cardiovascular complications and is responsible for about 15% of all cases of hypertension and most of the cases of cardiomyopathy.

Neurological. Chronic alcohol dependence can produce severe damage to the peripheral and central nervous system. Peripheral neuropathy is often responsible for the ataxia seen in chronic alcoholics. Other neurological complications caused by chronic alcohol abuse include the following: Wernicke's disease (ocular disturbance, ataxia and confusion) associated with thiamine deficiency, Korsakoff's psychosis, a permanent inability to learn new information and finally, structural changes in the brain associated with severe cognitive impairment (dementia).

Immunologic. Alcohol drinking suppresses neutrophil function and cell-mediated immunity. This predisposes alcoholics to serious infections including fatal cases of pneumonia and tuberculosis. Suppression of cell-mediated immunity may be responsible for the higher incidence of several types of cancers seen in alcoholics.

Endocrine. Male alcoholics have increased estrogen and decreased testosterone. This leads to impotence, testicular atrophy and gynecomastia.

Obstetric. An often-overlooked complication of alcohol drinking is the adverse effects of alcohol during pregnancy that can cause mental retardation, facial deformity and/or other neurological problems (fetal alcohol syndrome).

Psychiatric. Chronic alcohol dependence is often associated with emotional problems. Many alcoholics have co-existing anxiety disorders (about 25%), depression (20%-40%), and occasionally hallucinations (alcohol hallucinosis). It is not clear if psychiatric disorders predispose to alcohol dependence (self- medication hypothesis) or result from chronic abuse of alcohol. Alcohol-dependent patients are often suicidal, and about one-quarter of all suicides are committed by alcoholics, generally white males over 35 years old.

Withdrawal. Just as alcohol intake depresses the nervous system, alcohol withdrawal produces overexcitation of the nervous system. Many alcoholics begin to experience tremors called "the shakes" about 24 hours after their last drink. Without a drink, they begin to experience rapid heart rates, sweating, decreased appetite, and difficulty sleeping. For some individuals, symptoms of withdrawal can become quite severe. One to three days after their last drink, alcoholics can have a generalized seizure (rum fits). About three to five days after their last drink, these patients can suffer from disorientation, high fevers, and visual hallucinations. This syndrome is call delirium tremens (DTs). During the DTs people are very susceptible to suggestion. For example, one patient became convinced that a pink elephant was dancing on an imaginary string between his therapist's fingers. Individuals in DTs can also be paranoid. The DTs are a serious medical emergency. Before aggressive modern medical treatment, fifteen percent of patients with DTs died. Now with adequate medication and nutritional support, fatalities from DT's are rare.

Following this initial withdrawal phase, many people go through protracted alcohol withdrawal. This can last anywhere from one to four weeks. People in the protracted withdrawal phase remain anxious and have difficulty eating and sleeping. In serious cases, alcohol hallucinosis occurs.

Both alcohol-dependent parents and parents whom are not alcohol dependent play pivotal roles in shaping their child's drinking behavior. Parenting influences fall into two categories: alcohol specific and non-alcohol specific. Alcohol specific parenting influences include the modeling of parents' drinking behavior, "thinking" positively about alcohol and the effect it will have, the parent-child relationship and the family environment. These influences likely affect children of alcohol dependent parents more strongly than children of those who are not alcohol dependent. In contrast, non-alcohol specific influences such as parent-child interactions that favor aggressive, antisocial behavior or parents with psychological disorders similarly increase the risk for alcohol problems in both groups.5

Genetically speaking, researchers have discovered that alcohol dependence runs in families. A classic study by Goodwin (1974) compared the adopted children of alcohol-dependent parents to the adopted children of non-alcohol-dependent parents. In the children of alcohol-dependent biological parents, the risk of becoming alcohol dependent increased. In contrast, if the adoptive parents were alcohol-dependent, there was no increased risk of alcoholism. In general, if one biological parent is alcoholic, the likelihood of a child becoming dependent increases nearly three times. If both parents are alcoholic, the likelihood of alcohol dependence increases about five times. 4

Based on a child-centered definition of children of alcoholics (COA), the Children of Alcoholics Foundation defines alcohol dependence as the child's perception that a parent drinks too much and that drinking interferes with the child's life. This definition underscores the Foundation's underlying philosophy: COA's may need and deserve help, whether or not their parent or parents continue to drink and that for some, help may be needed over a lifetime. Some COA's require counseling or long-term treatment; others may do well, depending on their level of vulnerability.6

On a brighter note, not all children of alcoholics are adversely affected. Some children, for a variety of reasons, show resilience to their parents' addictions. According to Health Canada, updated May 7, 2007: 7

Resilient children are children who successfully adapt despite their exposure to risk factors. In epidemiological terms, resilient children correspond to false positive cases.

Resilience factors are frequently confused with compensatory factors. The former imply an interaction with risk factors while the latter involve additive effects.

Resilience factors, like protective factors, correspond to moderating factors. The role of moderating factors is to attenuate (or to exacerbate) the relationship between risk factors and subsequent adjustment problems. Consequently, they also include vulnerability factors.

The role of compensatory factors is to increase the well-being and adaptation of individuals, not by weakening risk factors but by developing opposite strengths. Obviously, knowledge of compensatory factors can be as useful in preventive interventions as knowledge of resilience factors.

Although the ramifications of living with an addicted, alcoholic parent are variable, nearly all children from alcoholic families are at risk for behavioral and emotional difficulties (Christensen and Bilenberg 2000), and live with scars–psychological or physical–as a result of parental alcoholism (Seixas and Youcha 1985). From prenatal influences leading to learning and memory problems (Coles and Platzman 1993) to vulnerabilities in behavioral control and aggression in adulthood ( Jacob and Windle 2000), a significant number of COAs exhibit psychological and/or interpersonal difficulties. In fact, COAs can be differentiated from nondistressed and psychiatric comparison groups in regard to such factors as personality characteristics, depressive symptomatology, and educational attainments, as well as patterns of alcohol and drug use (Jacob et al. 1999). 8

It is important to recognize that all issues of COA's are not resolved simply because a child becomes an adult. Although early intervention in childhood is key to preventing future addiction problems in adulthood, the Foundation has also included the workplace within its scope of activities. The Foundation's survey of major corporations showed that medical directors and human resource specialists failed to understand that long-term effects from family alcohol addiction could cause problem on the job. Although many adult COA's are productive employees, even those who do not have addiction or mental health problems can benefit from education about the disease and its ramifications.6

Parental alcohol misuse damages and disrupts the lives of countless children and families in all areas of society, spanning all social classes. It blights the lives of whole families and harms the development of children trapped by the effects of their parents problematic drinking. It is time to take the next step and prioritize support in order to meet the specific needs of children of alcohol misusing parents, as well as providing support directly to parents themselves.9


  1. Michael Windle, M.D., Effects of Parental Drinking on Adolescents. Alcohol Health & Research World. National Institute on Alcohol Abuse and Alcoholism. Vol. 20, No. 3, Pages 170-174. 1996.
  2. Andrew C. Heath, D.Phil., Ellito C. Nelson, M.D. Effects of the Interaction Between Genotype and Environment. Research into the Genetic Epidemiology of Alcohol Dependence. Alcohol Research & Health. National Institute on Alcohol Abuse and Alcoholism. Vol. 26, No. 3, pages 193-201. 2002.
  3. Tetyana Parsons, Alcoholism and its Effect on the Family. AllPsych Journal. December 14, 2003.
  4. Joseph R. Volpicelli, M.D., Ph.D. Alcoholics Anonymous of Dayton, Ohio. Undated.
  5. In this Issue. Alcohol Health & Research World. National Institute on Alcohol Abuse and Alcoholism. Vol. 21, No. 3, Pages 183-184. 1997.
  6. Migs Woodside. Children of Alcoholics Foundation. Alcohol Health & Research World. National Institute on Alcohol Abuse and Alcoholism. Vol. 21, No. 3, Pages 266-269. 1997.
  7. Resilient Children of Parents Affected by a Dependency. Health Canada. May 7, 2007.
  8. Children of Alcoholics – Family Dynamics And Developmental Influences, Conclusion. Copyright 2008.
  9. Bottling it up – The effects of alcohol misuse on parents, children and families. Turning Point. UK. Undated.

This page was last modified on : 10/28/2013

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