Youth at Risk and Resilience - Juanita Mejia Professional ...



Youth at Risk and Resilience

Children of Alcoholic Parents

Coun 545: Youth at Risk

August 5, 2012

Children of Alcoholic Parents

Statistics and Affects

An estimated 9,700,000 children (or 15% of the 66 million children) 17 years of age or younger are living with an adult diagnosed with alcohol abuse or dependence in the past year (Lambie & Sias, 2005). Children raised in alcohol-abusing families have different life experiences than children raised in non-alcohol abusing households. Alcohol-abusing parents generally are ineffective in meeting their children’s educational, developmental, social, and emotional needs. Unfortunately, the number of children receiving services to deal with this is not great. Therefore, early prevention and intervention efforts are essential in these students lives (Lambie & Sias, 2005). There are many affects and challenges children of alcoholic parents (COAs) may face throughout their lives. Some children may suffer adverse affects that follow them throughout their lives, others may grow up to be fairly well functioning. There is no certain prediction to determine the affects alcoholic parents have on a child. Marital and family therapists recognize there is not a single kind of alcoholic family. A variety of factors converge in developmental trajectories resulting in diverse individual outcomes (Walker & Lee, 1998).

There are ten specific problem areas of children from alcoholic families. Most common are school problems, substance abuse, problems with peer relationships, depression, hyperactivity, aggression, low self-esteem, external locus of control, dependency, and legal problems (McGaha et al., 1995). COAs are also four times more likely to develop alcohol abuse or dependence than non-COAs (Lambie & Sias, 2005). According to McGaha and Leoni (1995), COAs are more likely to be expelled from school, become dropouts, or be referred to the school psychologist for psychological and emotional problems. They are three times more likely to be placed in foster homes, twice as likely to be married under the age of 16, and have a much higher incidence of juvenile delinquency and mental illness (McGaha & Leoni, 1995). Parental influence, peer influence, social context of adolescent involvement in school, and personality characteristics are some of the risk factors that may influence alcohol abuse in adolescents (Tomori, 1994).

Family-related variables consistently have been shown to be factors in the absence or presence of criminality (McGaha et al, 1995), a risk factor for COAs. Juvenile offenders with an alcoholic parent are found to have been victims of and exposed to much higher levels of family violence and abuse; they responded by running away and becoming substance abusers themselves significantly more than did those from nonalcoholic homes (McGaha & Leoni, 1995). Studies have shown the relationships between being raised in such an environment and a variety of emotional and deviant characteristics.

Families abusing alcohol are often closed systems; family members are not encouraged to build relationships outside of the immediate family, and the “family secret” of alcohol abuse is hidden from other individuals in the community (Lambie & Sias, 2005). Alcohol abuse is a multigenerational issue, in which this biopsychosocial disorder is often passed from one generation to the next. Approximately 30% of alcoholics had at least one alcoholic parent (Walker & Lee, 1998). Families are systems in which each member’s behaviors, or lack thereof, influence every other family member in some way (Lambie & Sias, 2005). The degree to which members of alcoholic families can intentionally and unintentionally alter each other and their contexts depends on who has an instrumental role in producing adaptive outcomes (Walker & Lee, 1998). According to Lambie and Sias (2005), parental alcohol abuse not only affects the abusing individual, but also the entire family. In the alcoholic family system, the parents cannot give the type of consistent love and nurturing necessary for proper bonding. The alcoholic is often absent, or when present, is very inconsistent in his or her behavior, harsh and abusive one minute and remorseful and kind the next (McGaha & Leoni, 1995). Conflict between parents is often a key factor in a child’s school performance as well. Teachers very frequently observe that, when family conflicts occur, academic performance is lower and school motivation decreases (Casas-Gil & Navarro-Guzman, 2002).

According to the studies of Hussong et al, (2008), life stress is typically defined by a count of negative life events endorsed by participants. The experience of more negative life events is posited to increase internal distress for COAs, therefore taxing available coping resources, and, in turn, increasing the risk for maladaptive responses. COAs may lack the resources and coping skills both to successfully negotiate stressors once experienced but also to preemptively maneuver to avoid such stressors (Hussong et al, 2008). COAs are at greater risk for more negative life events than their peers. They also differ in the types of stressors experienced, the severity of those stressors, and the chronicity of stress exposure (Hussong et al, 2008). According to Hussong et al, (2008), by young adulthood, children of alcoholic parents show rates of psychopathology that far exceed those of non-children of alcoholic parents for a broad range of outcomes, including alcohol use, drug use, and affective and anxiety disorders.

The studies of Casas-Gil and Navarro-Guzman (2002), identified five variables on which performance in school by COAs was poorer: intelligence, repeating a grade, low academic performance, skipping school, and dropping out of school. It is important for school officials to recognize the hardships COAs may be facing and how those may affect their academic performance. COAs are more likely to have learning disabilities, be truant and delinquent, repeat more grades, and drop out of school. Many of these students also exhibit lower academic achievement and more cognitive deficits with lower intelligence scores and lower math, reading, and verbal scores (Lambie & Sias, 2005). Along with affects stated before, a hectic life environment can make it difficult for students to concentrate in classes, perform on tests, or turn in their homework. Poor school performance among COAs also appears, even if the alcoholic does not recognize his illness, does not receive or accept treatment, and has periods of sudden relapse. Conflicts arise in the family that the child is not able to assimilate. These conflicts turn into emotional problems and reduce the child’s self-esteem. If these circumstances persist through sensitive development periods such as adolescence, poor school performance will probably grow worse (Casas-Gil & Navarro-Guzman, 2002).

Research on COAs highlights an inconsistency between the advocated school counselor objectives stated by the American School Counselor Association and the services at-risk students are actually receiving. As a school counselor it is important to be aware of and able to identify students who may be coming from alcoholic homes. According to Lambie and Sias (2002), little research has been conducted relating to COAs and school counseling services; however, it is safe to presume that only a small percentage of these students do receive counseling services. Identification of COAs may be difficult due to several reasons, some already mentioned in this paper. First, students are not likely to reveal their “family secret” of alcohol abuse, and second, these students do not always present the same way. It is important to have good communication with teachers about any red flags or behavioral issues that may arise. If a counselor has reason to believe a child is exposed to an alcoholic environment they should communicate their perceptions to the student and receive clarification of their interpretations before proceeding (Lambie & Sias, 2002). Some behavioral cues may be absenteeism, tardiness, neglected physical appearance, fluctuating academic performance, problems controlling mood and behavior, parental concerns, physical symptoms, sad affect, school disciplinary problems, and peer cues (Lambie & Sias, 2002).

Being a child raised in an alcoholic home can often be treated as a diagnosis. Being a child of an alcoholic is neither a diagnosis nor a psychosocial death sentence (Walker & Lee, 1998). Due to some of the symptoms associated with growing up in an alcoholic home, research has tended to look into mainly identifying the hardships COAs may face. According to Walker and Lee (1998), therapists and clients should refrain from looking at COAs through a deficit framework and instead should look for evidence of relational resilience in alcoholic families of origin. Strength-based assessments can increase the success of treatment when working with COAs. A common risk for children of alcoholics is a development of problems with alcohol and drugs. However, on the contrary, many demonstrate low levels of alcohol use or abstain altogether. COAs do not necessarily always develop substance abuse problems, on the contrary many demonstrate low levels of alcohol use or abstain altogether. Some may abstain because they fear they will become alcoholics themselves and have seen the negative consequences of their parents drinking (Walker & Lee, 1998). According to Walker and Lee (1998), a large subpopulation of COAs demonstrates adequate functioning in a variety of domains of psychosocial development and do not have problems with substances.

Studies have shown there are well-adjusted COAs who, in contrast to symptomatic COAs, scored higher on measures of self-esteem and internal locus of control, had the ability to reframe negative experiences in a positive light, and reported less depression (Walker & Lee, 1998). Also, according to Walker and Lee (1998), well adjusted COAs sought out emotional support from informal and formal peer groups during childhood, ALATEEN during adolescence, friends during adulthood, and spouses throughout married life. When COAs come from a family with strong emotional bonds and a warm, supportive environment, they are less prone to psychiatric diagnoses such as conduct disorders and depression, and are more empathetic with and caring to family members in distress (Walker & Lee, 1998). Also according to Walker and Lee (1998), therapists should not be distracted from strengths based assessments when their clients have grown up in substance abuse homes. Therapists should aim to use models of resilience to uncover strengths that can be used in treatment.

When dealing with COAs assessment should be approached from the standpoint that alcoholic families have reservoirs of strengths that the therapists and clients must recognize and tap. The family is considered to be the source of resilience, rather than resilience being an inborn trait or a product of individual initiative (Walker & Lee, 1998). Resilient families cope with distal risks, such as poverty, while parent, adolescent, and sibling subsystems cope with more immediate familial stressors, such as substance abuse. A resilient family can adapt and possibly even have positive affects from difficult lives.

Strengths

Resilient families dealing with alcoholism adapt to stressors by utilizing resources, developing new strengths, and reorganizing family relationships (Walker & Lee, 1998). It is important for clinicians to explore challenges siblings have encountered while growing up in alcoholic families. It is quite possible the sibling is the only other person in the household who does not have a substance abuse issue. This means the siblings can understand what each other are experiencing and can relate emotionally. Some researchers speculate siblings from alcoholic families may even have more positive interactions that facilitate stronger bonds than siblings from non-substance abusing families (Walker & Lee, 1998). This relationship may help COAs seek out support from siblings throughout life, interact with each other more than with parents, and play a role in preventing substance abuse during adolescence.

Supportive parent-child relationships have been identified as the single most important protective process operating to produce resilient outcomes across several, diverse populations at risk (Walker & Lee, 1998). According to Walker and Lee, (1998), COAs with emotionally supportive relationships with their non-abusing parent had the social and academic competence needed to compensate for the negative effects of parental alcoholism. These COAs also had higher self-esteem and were less like to abuse substances than those lacking that parental relationship. It is necessary for therapists, school counselors, and other adults to recognize siblings and parents can be a great source of support to COAs who may be dealing with substance abuse themselves, coping with loss, depression, insecurity, or dealing with difficult stressors. In light of the foregoing, prudent therapists will remember to look for evidence of relational resilience in COA families of origin. Therapists should explore the extent to which these families have been able to utilize existing resources to mediate the deleterious effects of parental drinking (Walker & Lee, 1998). Therapists should also recognize that protective factors are not necessarily positive experiences and may appear to be symptoms of pathology. Behaviors that may have been seen as dysfunctional such as enmeshment and parentification, may actually be a positive ways in which family systems handle the risks associated with familial alcoholism (Walker & Lee, 1998).

Possible Interventions

According to Lambie and Sias (2005), schools are a good setting to possibly intervene and assist a child who is growing up in an alcoholic home for a couple reasons. First, children spend more time in school than anywhere else. Second, parental alcohol abuse affects children’s psychosocial development, likely retarding those students’ ability to establish interpersonal relationships and be successful at school. Also, early identification and intervention hold promise for preventing further substance abuse and reducing potentially long-lasting emotional, social, behavioral, and physical problems. The earlier students are exposed to interventions designed to provide emotional support and the development of coping skills, the greater the potential effectiveness of these services (Lambie & Sias, 2005). Other ways to assist COAs and their families include increasing knowledge about substance use and the affects on children, educating other teachers about children of alcoholics, being accessible to students and being a good listener, facilitating classroom guidance on substance abuse and COAs, offering counseling groups for COAs, and providing referral services for children and families.

There are several types of prevention programs available for COAs; “Universal Prevention” programs designed for the general population, “Selective Prevention” programs designed specifically for identified or self-identified COAs, and “Indicated Prevention” programs designed for children with addicted parents who have special emotional or behavioral problems (Ernshoff & Price, 1999). According to Ernshoff and Price (1999), there is a difference between prevention and intervention programs. Prevention programs target children due to the behavior of an adult caregiver, and intervention programs usually target children who are already exhibiting some symptomatolagy themselves.

The objective of prevention programs is to deter the development of drinking problems by targeting risk factors associated with drinking problems or other dysfunctional problems and might be general (Ernshoff & Price, 1999). There are two prevention based models; first the distribution of consumption model which tries to gain societal control over alcohol availability by raising the drinking age, increasing prices, limiting sale hours, etc. Second, is the sociocultural model aimed at education and enhancement of individuals’ competencies through information, values clarification, and skills-building techniques (Ernshoff & Price, 1999). These programs can be done through schools, in classrooms, the media, doctors’ offices, recreational facilities, etc. These types of programs are meant to target all COAs whether or not they have been identified which avoids labeling. According to Ernshoff and Price (1999), these types of interventions aimed at changing the environment have shown to be some of the most effective programs with the most consistent record of effectiveness across all types of outcomes.

As far as intervention is concerned, content should be guided by scientific knowledge, information on intensive treatment if necessary, consideration of developmental issues, as well as cultural and ethnic background information (Ernshoff and Price, 1999). Whatever the age or background of a child, peer influence and mutual support makes group intervention the logical means of intervention for COAs. According to Ernshoff and Price (1999), group treatment is highly recommended because it reduces feelings of isolation, shame and guilt, while allowing individuals to give and receive support. Role-playing, modeling, practice of resistance skills, and feedback are all useful tools in groups. There are several strategies that tend to hold in common for intervention groups; information, training in skill development, focus on social support and socioemotional needs of children, and emphasis on alternatives to substance use (Ernshoff & Price, 1999).

According to Ernshoff and Price (1999), there are several good settings for prevention and intervention to take place. Physicians provide a proper setting for education and early intervention. School provide a good location due to the amount of time students are available and also identifying factors tend to expose themselves in this setting. Schools can also provide a wide network of resources for families. Student Assistance Programs are prevention programs that attempt to provide prevention and early intervention for high-risk youth. This is usually provided by master’s level counselors who provide individual and group interventions for students with family, school, peer, alcohol, drug, or other personal problems (Ernshoff & Price, 1999). Stress Management and Alcohol Awareness Programs is an 8-week, person-centered program designed specifically for COAs, and aims to enhance self-esteem, emotion and problem-focused coping strategies.

Students Together and Resourceful is an intervention program with a goal to provide students with information on alcohol, alcoholism, and family reactions to alcoholism, and reduce self-blame. CASPAR (the Cambridge and Somerville Program for Alcoholism Rehabilitation) is a program where teachers and staff conduct classes on alcohol and other drugs in schools. Children of Drug Abusers and Alcoholics is a programs for high-risk children ages 4-10 who live with at least one parent/guardian addicted to alcohol or other drugs (Ernshoff & Price, 1999). It has components for children and families over 12 weeks involving play therapy. Strengthening Families Program is an intervention shown to reduce risk factors, increase resilience, and decrease substance use through parent training programs, social skills training for children, and relationship enhancement programs (Ernshoff & Price, 1999).

Another great resource for children of alcoholic parents and their families is Al-Anon and Alateen. Al-Anon is a mutual support group of peers who share their experiences in applying Al-Anon principles to problems related to the effects of a problem drinker in their lives. Alateen is a peer support group for teens who are struggling with the effects of someone else’s problem drinking (“Al-Anon family groups, 2012). Many professionals refer family members to Al-Anon family groups as a complement to treatment. Al-Anon is not about getting advice from other members, it is about being able to share individual experiences, relate to, and learn from each other (“Al-Anon family groups, 2012).

Although it can be difficult to both identify and work with children of alcoholics it is greatly important that professionals make the effort to do so. This is an underrepresented group due to lack of reporting. It is important for community members to get involved in education, prevention, and intervention. As school counselors it is important to make the educational information available throughout the schools. It is also important for school counselors to let it be known they are openly available to assist student and their families if they are suffering from alcohol abuse. Hopefully, through further education and recognition, more children will be able to seek and get treatment.

References

Al-anon family groups. (2012). Retrieved from

Casas-Gil, M. J., & Navarro-Guzman, J. I. (2002). School characteristics among children of

alcoholic parents. Psychological Reports, 90(1), 341-348.

Ernshoff, J.G., & Price, A.W. (1999). Prevention and intervention strategies with children of

alcoholics. Pediatrics, 103(5), 1112-1121.

Hussong, A. M., Bauer, D. J., Huang, W., Chassin, L., Sher, K. J., & Zucker, R. A. (2008).

Characterizing the life stressors of children of alcoholic parents.Journal of Family

Psychology, 22(6), 819-832.

Lambie, G. W., & Sias, S. M. (2005). Children of alcoholics: Implications for professional

school counseling. Professional School Counseling, 8(3), 226-273.

McGaha, J. E., & Leoni, E. L. (1995). Family violence, abuse, and related family issues of

incarcerated delinquents with alcoholic parents compared to those with nonalcoholic

parents with alcoholic parents. Adolescence, 30(118), 473-382.

Tomori, M. (1994). Personality characteristics of adolescents with alcoholic parents.

Adolescence, 29(116), 949-959.

Walker, J. P., & Lee, R. E. (1998). Uncovering strengths of children of alcoholic parents.

Contemporary Family Therapy, 20(4), 521-538.

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