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Chapter 7
Growing Up in an Alcoholic Family
System
Chapter Objectives
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Describe the scope of the problem and
awareness of adult children of alcoholics.
List several behavioral characteristics of adults
who grew up in alcoholic homes.
Compare growing up in an alcoholic family
system with post-traumatic stress disorder
(PTSD) and describe the five major symptoms of
PTSD.
Identify the scope of the adult-child of an
alcoholic problem, including an estimate of how
many people are affected.
Chapter Objectives
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Describe the behaviors and communication
patterns of parents and children in an
alcoholic family system.
Describe the kinds of denial that children in
an alcoholic system maintain and some
behavioral characteristics of children of
alcoholics.
Define codependency and list the criteria of
codependency.
Describe the family disease model.
Chapter Objectives
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Describe the impact of alcoholism on marriage.
Describe the thoughts, feelings, and behaviors
of overseparated and overattached individuals.
Discuss the rationale for doing grief work with
adult children of alcoholics.
Describe second-order change and changing
interactions with family members.
Identify the 11 curative factors of group
psychotherapy and their applications to adult
children of alcoholics therapy groups.
The Adult Children of Alcoholics Movement
Bosma (1972) – ACAs as victims in a
hidden tragedy
 28 million Americans have at least one
alcoholic parent.
 Children of alcoholics are frequently
victims of incest, neglect, and other forms
of violence and exploitation.
 ACA movement was a wildfire of
information, education, and treatment.
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Characteristics of ACA’s
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Fear of losing control
 All-or-none
 Fear of feelings
 Overdeveloped sense
of responsibility
 Difficulty with
intimacy
 Flashbacks of
childhood, but many
memory gaps
 Unreasonable loyalty
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Feelings of being like a
child when under stress
Addiction to excitement
Difficulty relaxing
Feelings of guilt
Confuses love with selfpity
Backlog of shock/grief
Compulsive behavior
Living in denial
Guessing at what is normal
Physical symptoms
Post-Traumatic Stress Disorder
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The following major symptoms of PTSD are
similar to symptoms experienced by ACAs”
– Reexperiencing trauma as evidenced by:
• Nightmares
• Recurrent obsessive thoughts
• Sudden reemergence of survival behavior in the fact of events
that resemble the original trauma
• Emotional overload
– Psychic numbing, as evidenced by
• Sense of depersonalization
• Sense of not fitting into one’s surroundings
• Feeling of emotional anesthesia
Post-Traumatic Stress Disorder
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Constriction of emotions
Lack of feelings
Sudden experience of a wall between self and feelings
Confusion
Physical reactions instead of feelings
Feelings that emotions will be overwhelming
– Hypervigilance, as evidenced by
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Inability to relax
Frequent startle responses
Chronic anxiety
Panic attacks
Post-Traumatic Stress Disorder
– Survivor guilt, as evidenced by
• Chronic depression
• A sourceless sense of guilt
– Intensification of symptoms by exposure to
events that resemble the original trauma
Childhood in an Alcoholic Home
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Children in alcoholic homes learn to
distrust their own observations and
feelings, and they feel powerless to
change the family system.
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Children do not realize that alcoholism
and drug addiction is a disease that
results in unpredictable behavior.
Identification of Children in Alcoholic Families
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Behavioral characteristics
– Superachievers or perfectionists
– Need to control their environment
– Display social disengagement from or excessive
attention to peer groups
– Signs of physical neglect and/or physical abuse
– Unable to concentrate and sometimes showing
marked variations in academic performance,
especially when parents are in a binge pattern
Denial of Feelings
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Children maintain the illusion of normalcy.
 The following factors product damage in
the lives of children of alcoholics:
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Role reversal
Unpredictability
Unavailability
Social isolation
Codependency
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Diagnostic criteria for codependent personality
disorder:
– Continual investment of self-esteem in the ability to
influence or control feelings and behaviors
– Assumptions of responsibility to meet others’ needs
– Anxiety and boundary distortions
– Enmeshment in relationships with personality-disordered,
drug-dependent, and impulse-disordered individuals
Codependence
– Maintenance of a primary relationship with an
active substance abuser for at least two years
without seeking outside support and/or exhibiting
three or more of the following characteristics:
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Constriction of emotions
Depression
Hypervigilance
Compulsions
Anxiety
Excessive reliance on denial
Substance abuse
Recurrent physical or sexual abuse
Stress-related medical illnesses
Family Disease Model
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The family suffers from alcoholism,
codependency, and enabling behavior.
 The family is organized around the
alcoholic’s drinking and the consequences
of that drinking.
 The family responds to the alcoholic in a
codependent fashion.
 Family members disconnect from their own
feelings, distorting their perceptions and
invoking the “no-talk, no-feel, no-trust”
rule.
Impact on Marriage
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Feelings of betrayal
Continuous conflict
Chaos
Resentment
Sexual problems
Ambivalence
Grief Work
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Children in alcoholic families experience
loss, violation, and trauma.
 Mourning allows feelings of loss to surface.
 Grief work requires the help of a
professional therapist trained and
experienced in ACA recovery.
Choice Making
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Changes involve integration and
congruency with feelings and choosing
not to respond in dysfunctional,
codependent ways.
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Positive choices can establish the
foundation for more significant growthrelated choices later.
Second-Order Change
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Second-order change is a cognitivebehavioral technique to change the way one
traditionally responds to situations and
interpersonal interactions.
Changes in Family Interactions
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ACA’s may need to let their parents know
how they feel about continued use of
alcohol/drugs.
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Many ACA’s must let go and accept that
their parents may never choose to stop
using alcohol/drugs.
Group Psychotherapy
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Group psychotherapy is a process in which
each group member gets feedback from other
group members.
 The following 11 curative factors make group
psychotherapy an effective process:
– Instilling hope, sharing universality, imparting
information, fostering altruism, recapitulating the
primary family group, developing socializing
techniques, imitating behavior, sharing
interpersonal learning, developing group
cohesiveness, sharing catharsis, exploring
existential factors