Children of Alcoholics Pay Heavy Psychological Price

STANFORD — Millions of Americans suffer medical ailments and deep psychological wounds from growing up in the abnormal atmosphere of silence and secrecy that typically surrounds an alcoholic parent, researchers say.

An estimated 28 million to 35 million Americans, about one out of every eight, have at least one alcoholic parent.

These adult children of alcoholics are showing up in vast numbers at treatment centers with such symptoms as anxieties, learning disabilities, eating disorders, stress-related medical problems, compulsive behavior and drinking problems.

“We’re suddenly noticing that very large percentages of any typical mental-health population have alcoholic parents,” said Stanford University psychologist Stephanie Brown, who has pioneered treatment for adult children of alcoholics since 1977.

“Psychiatrists who are not specializing in alcoholism tell me routinely that from 60% to 80% of their caseloads are the children of alcoholics. But they never noticed it until they began to read about it,” she said.

“There’s now a labeling and acceptance of a phenomenon that’s been denied.”

Specialists even have developed a shorthand term for children of alcoholic parents--ACA.

In contrast to a few years ago, when treatment programs for these people were virtually nonexistent, ACA patients are flocking to Stanford University Hospital’s new Alcohol and Drug Treatment Center. The program has grown from one long-term group to at least 14 groups of eight people each, said Brown, adding that there is a long waiting list.

ACA chapters, an offshoot of Alcoholics Anonymous, have sprung up across the country, and a National Organization for Children of Alcoholics has formed as a clearinghouse for information and referral.

Brown, who came from an alcoholic household, said ACA patients have for years sought help for ailments for which the real cause was not pinpointed by health professionals, a big percentage of whom have been found to be children of alcoholics themselves.

“These number in the millions and millions of people. As soon as the cultural denial was broken, the floodgates were opened,” she said. “Breaking of the denial is the first step toward recovery.

“Adult children of alcoholics now have the legitimate right and need for treatment independent of the alcoholic. There’s a phenomenal sense of rebirth, of a new beginning and an overcoming of fear--the denial and fear of having an alcoholic parent.”

Brown said studies of ACA patients show that similar patterns develop within families of alcoholics that involve strong denial of the addiction and the forming of destructive “co-dependent” relationships with the drinking parent. These co-dependent roles, she said, get carried into adult life in the form of distrust, inability to form intimate relationships, a lack of self-esteem and the need to control.

“A co-dependent is dominated by the alcoholic,” Brown said. “They adjust to the needs and behavior of the person with the problem. It’s a pattern full of disturbances and often results in the co-dependent developing the same behavior as the alcoholic.”

Another pioneer in the field, San Diego psychologist Claudia Black, has formulated a set of three rules she says govern alcoholic families: Don’t talk, don’t trust, don’t feel. Children at an early age, she said, learn that their emotional and even physical survival depends on following those rules, which follow them into their adult lives.

Brown said a large percentage of ACA patients are either practicing alcoholics, recovering alcoholics or harbor a tremendous fear of becoming alcoholic. They also have a 50% chance of marrying an alcoholic, and are about twice as likely to attempt suicide as the general population.

“If they’re not drinking, they feel the constant need for vigilance,” Brown said. “This can lead them to become tremendously rigid and withdrawn.”

Researchers say the fear of ACA patients is not unfounded because studies have indicated that the group as a whole is genetically predisposed to become alcoholic if they drink. The rate of addiction of adult children of alcoholics is four to seven times higher than the general population.

Dr. Richard Heilman of the Veterans Administration Hospital in Minneapolis said at a recent meeting of the National Council on Alcoholism in San Francisco that genetic influence is identifiable in at least 35% of alcohol abusers.

Hope for Genetic Tests

Heilman said geneticists hope to develop soon a test to determine whether a person, particularly a child, is likely to become an alcoholic. They already know, for example, that people who do not inherit genes for an alcohol-metabolizing protein called aldehyde dehydrogenase will never become alcoholics.

“Some people are really vulnerable sitting ducks for this disease and didn’t know it,” Heilman said. “Their biochemistry acted abnormally when they drank alcohol. Now, offspring of alcoholics do not have to be ignorant of this factor. Something can be done about it.”

Any type of genetic testing, though, would be years in the future according to Stanford research pharmacologist Dora Goldstein. Pinpointing the troublesome genes in the lab, she said, could occur fairly soon, but developing a test would be a lengthy and difficult process.

Finding a cure for the disease by neutralizing the genes would be even harder.

“It’s not going to be easy, but there’s hope,” Goldstein said, adding that the federal government supports research in a field considered taboo a decade ago. “We’ve been able to move forward. It’s OK to work on (alcoholism) now.”

No Alcoholic Animals

Laboratory animals, she said, can be bred for alcoholic traits, “but we’ve never had an alcoholic animal.” This makes humans unique and the research complicated.

“It just isn’t simple. We’re learning a lot about metabolism and what happens in the liver, but a lot of the trouble occurs in the brain, and there’s just not enough known about that area.”

Brown said even if researchers developed a genetic test that could show whether children were at risk in becoming alcoholic, it is unlikely that it would have much of an effect on society in general.

“Most people deny their alcoholism and wouldn’t take their kids for the tests anyway,” she said. “With alcoholics, there’s a tremendous distortion of reality that has to be maintained.”

What is needed, she said, is solid research emphasizing prevention, education and treatment.

“We don’t need to rush in with a Band-Aid response to a problem that is deeply rooted.”

Despite the growing public awareness of the detrimental physical and mental effects of heavy drinking, Brown said she does not see any slowing down of liquor consumption, which in 1985 averaged 2.77 gallons of absolute alcohol for every American over 14.

The National Council on Alcoholism said that one-tenth of the drinking population consumes half of all beverages sold and that a third of Americans do not drink alcohol at all.

“This is a drinking culture and will continue to be a drinking culture,” Brown said. “What is needed is a much greater legitimacy for being able not to drink. There’s got to be room for people with problems to abstain from drinking without being stigmatized.”

Dr. William Hazle, the physician in charge of the new Stanford clinic, said many ACAs and alcoholics seek health care for problems that would be easier to cure if the subject of alcohol was treated openly. More than 30% of all patients in hospitals, he said, are there because of alcohol abuse or addiction.

“Society hasn’t wanted to deal with drug and alcohol issues,” said Hazle. “Physicians are part of the general culture, and there’s a hesitancy to question a person’s alcohol drinking. It’s an area that isn’t talked about, like a person’s sex life.”

Doctors, he said, have not been trained to treat alcoholism, although there is a growing awareness of the disease and its impact on health. A good sign is that a lot of patient referrals by doctors are starting to occur at drug and alcohol centers, Hazle said.

sh Physicians Deny Problem

“There are many ways and tests to find evidence of alcoholism in a patient,” he said. “Yet, there are physicians out there that have so much denial about the problem that they don’t see it. This is not a whole lot different from the denial an addict has.”

In defense of practitioners, Hazle said, is the fact that drug users, alcoholics and ACAs usually deny the addiction by lying about questions asked in that area. He suggests that doctors who suspect alcoholism check liver enzymes and other evidence of the disease, and then use those facts to confront the patient about drinking habits.

Alcoholism, Hazle said, differs from other substance abuse primarily because drinking is legal and accepted in society. Most problem drinkers, he added, are over 40. Under that age, he said, there is often a mixture of alcohol abuse with drugs, both illegal and prescription.

A spokeswoman for the National Council of Alcoholism said statistics show a sharp rise in the mixing of drugs and alcohol among women and the younger population. An example, she said, is the prescribing of Valium for women who drink heavily.

One 33-year-old woman who is a recovering alcoholic said she was regularly prescribed Valium for depression by a San Francisco doctor who did not bother to question her about her heavy drinking. “My whole system was messed up all the time,” she said.

The woman said her life finally began to make sense once she became aware of ACA issues and met other people with similar family backgrounds.

“ACA has been invaluable to me,” she said. “Just the understanding of why I am the way I am has helped me deal with and overcome many of my problems.”

Brown said younger children are also in need of help in alcoholic families. One couple brought their 8-year-old daughter to a child psychiatrist for treatment of school phobia and mood disturbance. Both parents were discovered to be alcoholic and referred to Stanford for treatment.

She said the parents eventually quit drinking and the child improved dramatically and no longer had to be treated for the phobia.

“She had been afraid to go to school because she was afraid she’d come home to find her mother drunk and passed out,” Brown said.