1. Growing Up in an Alcoholic Family System
Chapter 7
Growing Up in an Alcoholic Family System

2. Chapter Objectives
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.

3. Chapter Objectives
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.

4. Chapter Objectives 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.

5. 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.

6. Characteristics of ACA’s
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
Feelings of being like a child when under stress
Addiction to excitement
Difficulty relaxing
Feelings of guilt
Confuses love with self-pity
Backlog of shock/grief
Compulsive behavior
Living in denial
Guessing at what is normal
Physical symptoms

7. Post-Traumatic Stress Disorder
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

8. Post-Traumatic Stress Disorder
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
Inability to relax
Frequent startle responses
Chronic anxiety
Panic attacks

9. 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

10. Childhood in an Alcoholic Home
Children in alcoholic homes learn to distrust their own observations and feelings, and they feel powerless to change the family system.
Children do not realize that alcoholism and drug addiction is a disease that results in unpredictable behavior.

11. Identification of Children in Alcoholic Families
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

12. Denial of Feelings Children maintain the illusion of normalcy.
The following factors product damage in the lives of children of alcoholics:
Role reversal
Unpredictability
Unavailability
Social isolation

13. Codependency 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

14. 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:
Constriction of emotions
Depression
Hypervigilance
Compulsions
Anxiety
Excessive reliance on denial
Substance abuse
Recurrent physical or sexual abuse
Stress-related medical illnesses

15. Family Disease Model
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.

16. Impact on Marriage Feelings of betrayal Continuous conflict Chaos
Resentment
Sexual problems
Ambivalence

17. Grief Work
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.

18. Choice Making
Changes involve integration and congruency with feelings and choosing not to respond in dysfunctional, codependent ways.
Positive choices can establish the foundation for more significant growth-related choices later.

19. Second-Order Change
Second-order change is a cognitive-behavioral technique to change the way one traditionally responds to situations and interpersonal interactions.

20. Changes in Family Interactions
ACA’s may need to let their parents know how they feel about continued use of alcohol/drugs.
Many ACA’s must let go and accept that their parents may never choose to stop using alcohol/drugs.

21. Group Psychotherapy
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