Thursday, August 26, 2010

Adult Children of Alcoholics - looking back at a perspective and a movement

When, as a doctoral psychology student, it was time for me to research and write a dissertation, my first proposal was turned down because my advisors did not like the idea of a retrospective study. I wanted to study the impact of parental alcoholism on adults who had grown up in alcoholic homes. Just a few years later, others who were not burdened by the need for scientific empiricism wrote about the same topic based on their clinical experience, and the huge Adult Children of Alcoholics (ACOA) movement was born. This movement peaked during the 1980’s, supplanted years later by clinical interest in the broader topic of survivors of abuse/trauma.

But the ACOA movement had significant and lasting influence in at least two ways:

• It contributed greatly to changing the role of the therapist to a more active and educative one, abandoning the assumption that people in therapy could be expected to find the answers within themselves given a long enough period of time responding to insight-eliciting questions and comments.
• It gave rise to a new kind of 12-step group – geared not to alcoholics/addicts or to their spouses, but to adults with problematic self-esteem/relationship problems that date to childhoods in unpredictable, often frightening and burdensome family environments. At least three of these groups still exist: (1) a subtype of Al-Anon meetings (Al-Anon being the 12-step group begun not long after AA to address the needs of family members of alcoholics, http://www.al-anon.alateen.org/); (2) Adult Children of Alcoholics (ACA), a fellowship specifically for this population (http://www.adultchildren.org/) ; and (3) CODA (Codependents Anonymous, http://www.coda.org/) , for people including ACOAs who, generally as an outgrowth of being raised in a dysfunctional family, tend to develop relationships that are not healthy for them.

Before the ACOA movement waned (at least in professional circles), a few key books became classics, and they still come readily to mind when the subject arises.

Janet Woititz’ book, simply titled Adult Children of Alcoholics, enumerated 13 characteristics that she felt were especially noteworthy in ACOAs. [Let me note here that one problem with all of these perspectives is that almost everyone relates to at least some of these. In addition, they can apply just as well to individuals raised in other kinds of inconsistent environments with behaviorally unpredictable parents – it is not the parental alcoholism per se, though that is the most common source, but the parents’ behavior.]

1. Adult children of alcoholics guess at what normal behavior is.

2. Adult children of alcoholics have difficulty following a project through from beginning to end.

3. Adult children of alcoholics lie when it would be just as easy to tell the truth.

4. Adult children of alcoholics judge themselves without mercy.

5. Adult children of alcoholics have difficulty having fun.

6. Adult children of alcoholics take themselves very seriously.

7. Adult children of alcoholics have difficulty with intimate relationships.

8. Adult children of alcoholics overreact to changes over which they have no control.

9. Adult children of alcoholics constantly seek approval and affirmation.

10. Adult children of alcoholics usually feel that they are different from other people.

11. Adult children of alcoholics are super responsible or super irresponsible.

12. Adult children of alcoholics are extremely loyal, even in the face of evidence that the loyalty is undeserved.

13. Adult children of alcoholics are impulsive. They tend to lock themselves into a course of action without giving serious consideration to alternative behaviors or possible consequences. This impulsivity leads to confusion, self-loathing and loss of control over their environment. In addition, they spend an excessive amount of energy cleaning up the mess.

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Again, in reviewing Woititz’s list, it is important to realize that these items were not derived in a rigorous, scientific manner, and that there is probably no one who has all of these features and no one who has none of them. Nevertheless, they clearly captured something that rang a bell with many ACOAs and clinicians. (And the many clinicians who were, themselves, ACOAs, since this experience lends itself to becoming one or another kind of caretaker.)

Another classic book was Claudia Black’s It Will Never Happen to Me, in which she vividly and movingly captured the pain of alcoholic family life and its impact on the children. (In the 1980’s, we also used a film called Soft is the Heart of a Child, which similarly brought the viewer into the world of these children during active parental alcoholism; few could watch without tears.) Black identified the common unspoken rules in alcoholics families: “Don’t talk; don’t trust; don’t feel.” Indeed, many ACOAs find it very difficult to identify what they are feeling or to convey their feelings in words, and it is harder for them to go about their lives assuming, as most of us do most of the time, that things will be OK.

While Black also labeled family roles, the labels that became most familiar in the field were those coined by Sharon Wegscheider-Cruse, in her book, Another Chance: Hope and Health for the Alcoholic Family. Hers was a variant of family systems theory, in which changes in one member’s behavior necessarily bring about changes in all family members, as the system attempst to maintain balance, reduce anxiety, look OK to outsiders, and otherwise survive. In this case, the alcoholic (or addicted) parent’s behavior deteriorates as their condition progresses, and the children tend to take on certain family roles (which are combined when the family size is smaller). The roles that Wegscheider-Cruse identified were:

Family Hero: Usually the oldest, seeking perfection, achievement, outward success, social approval, both to make the family look good to others and out of the unconscious fantasy that, if only they are good enough, the alcoholic parent will be OK. The Family Hero can look like a little adult, but inside has a strong sense of faking it.

Scapegoat: The child who rebels and acts out (e.g., cuts school, abuses substances), providing the family with someone at whom they can conveniently point the finger as “the problem,” rather than have to deal with the alcoholism. But in a way, there is something healthy in the Scapegoat for being able to express anger on behalf of the rest of the family.

Lost Child: The child who adapts by becoming invisible, and thus no burden to the family, quiet, isolated, ignored, and often depressed.

Mascot: The child who uses humor, cuteness, entertainment to lighten things up for the family and provide another kind of distraction from the family’s pain, but who has difficulty getting real or genuine.


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In a general sense, we are all in some way affected, in our adult interpersonal functioning, by the family dynamics and roles that took shape during our childhoods, and in that sense, for all of us, a key purpose of therapy is to become aware of those coping maneuvers that helped us survive in our younger years, but which may now be working against us. In more highly dysfunctional or stressed families, however, these roles tend to be more limiting and to leave adults with a more restricted repertoire of behaviors and access to feelings. ACOAs, on the whole, are also highly reliable, dedicated workers, and have much to offer. The good news is that, through the support and insight offered by the above groups or by a therapist, it’s never too late to grow beyond these limitations and in the direction of greater flexibility and sense of inner security.

[The books mentioned above are available as inexpensive paperbacks from Amazon.com and other sources. The film/DVD is available at various outlets including Hazelden.com, source of myriad addiction-related publications.]