Staff Perspective: Not Your Fault, but Still Your Responsibility: The Needs of Youth with a Parent with Alcohol Use Disorder
Note to reader: The goal of this blog is to identify a need and then urge a response. This blog is not intended to negatively portray any group of people. It is intended to speak truth to a hard topic, and doing so may cause some discomfort or dissonance. But hang in there - hope prevails.
Alcohol use disorder within families is a topic with potential impact across subpopulations and is not specific to the population of military families. In fact, although reviews of research suggest that there may be a higher incidence of problematic drinking in some segments (but not all) of the military, the highest rates of problematic drinking seem to be observed in military populations that are inconsistent with military families with children (as factors related to higher rates include those who are single and do not have children; Osborne et al., 2022). Even more explicitly, I’m not aware of any studies which have noted a heightened prevalence of problematic drinking in military families with children versus civilian families with children.
Despite who comes in for treatment, alcohol addiction impacts the entire family. Based on data from the combined 2009 to 2014 National Surveys on Drug Use and Health, at least 10% of U.S. families with youth have a parent with problematic drinking, which likely underestimates prevalence (Lipari & Van Horn, 2017). Just take a quick look on a search engine of choice, and you’ll readily see alcoholism described as a family disease.
For the children and adolescents who grow up in families with a parent (or parents) with an alcohol use disorder, home life can be chaotic, commonly disrupted by changes in parental availability and demeanor, and generally described as “dysfunctional” and difficult to overcome (Hall & Webster, 2007). These families often develop implied (and sometimes very explicitly stated) rules about engagement both within the family and with those outside. These rules typically discourage expressing feelings, deny the opportunity to talk about problems (especially the problems of the family with those outside the family), and communicate a demand for perfection from the youth (to avoid upsetting the individual with the the alcohol use disorder) while very commonly simultaneously expressing frustration with the youth for not being perfect (Ruben, 2001). Across multiple roles, I have seen firsthand how this mindset complicates youth’s comfort with seeking help and subsequently makes it harder to trust others when they do.
As you might guess, the youth of parents with problematic drinking are at greater risk of negative outcomes. These youth are more vulnerable to both immediate and long-term internalizing and externalizing behavioral health disorders, difficulties in relationships, and feelings of self-worth (Park & Schepp, 2015). For those who do struggle, it is not uncommon for youth to develop an alcohol or substance use disorder themselves (Yau et al., 2012) at rates estimated up to four times higher than youth who did not grow up with a parent who misuses alcohol (Anda et al., 2002).
There is no getting around it: children and adolescents who grow up in homes with one or more parents with alcohol use problems are at increased vulnerability to experience compromises in their developmental processes and challenges as adults.
However, they are not by any stretch doomed to a negative outcome. Remember, I told you this is a story of hope. Despite the challenges that are almost always present in families with alcohol use disorders, research continually shows us that many youth from these circumstances demonstrate tremendous resiliency. In fact, many (and in some studies, the majority!) do not exhibit difficulties at any greater level than children who did not grow up with a parent with an alcohol use disorder (Park & Schepp, 2015). Importantly, those youth who exhibit resiliency tend to have access to and use more social support, to include extra-curricular activities, peer relationships, and families who work through the impact of alcohol use.
Given that social support is protective of children and adolescents from homes with alcohol use disorders, our focus as clinicians should include paying attention to helping these youth manage the experience of living in a family impacted by alcohol use. Much of our formal mechanism for treatment for alcohol use disorders emphasize recovery of the individual who is using alcohol, but we know that treatment should also include family-centered care as the solution. Consider the benefit of ensuring treatment includes not only the individual in recovery, but also the entire family to help minimize the impact of a disease that is so enduring and can be disruptive to youth development.
When help is available, though, I would be remiss not to take a moment to describe what this help may require of children and youth. It’s hard. Really, really hard! It asks children and teens to take responsibility to address challenges and patterns of behavior that even the adults don’t want to readily look at. There will be tears; there will be discomfort as patterns get identified and shifted; and there will be heartache as truths are told. But then can come release, healthier relationships, and a chance to stop the generational cycle so often carried forward by the adult children of parents with alcohol use disorders. As I often have told my clients, it may not be their fault they need to confront these challenges, but it is their responsibility to their own health to do so.
If you find yourself working with a client who is a parent with an alcohol use disorder, please consider discussing the need for services for their family and their children. If you are working with a child or teen who has lived or is living with a parent with an alcohol use disorder, please embrace the importance of working through their experiences, identifying patterns, and fostering positive social connections that can enhance their resilience and protect their development. And if you are working with an adult child of a parent with an alcohol use disorder, please remember that early relational patterns often play into an adult’s ability to connect with others, seek help, and resolve difficult emotions.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Andrea Israel, Ph.D., is a clinical psychologist serving as a Military Behavioral Health Child Psychologist at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.
References:
Anda, R. F., Whitfield, C. L., Felitti, V. J., Chapman, D., Edwards, V. J., Dube, S. R., &
Williamson, D. F. (2002). Adverse childhood experiences, alcoholic parents, and later
risk of alcoholism and depression. Psychiatric Services, 53(8), 1001-1009.
Hall, C. W., & Webster, R. E. (2007). Risk factors among adult children of alcoholics.
International Journal of Behavioral Consultation and Therapy, 3(4), 494-511.
Lipari, R.N., & Van Horn, S. L. (2017). The CBHSQ report: Children living with parents who have
a substance use disorder. Rockville, MD: Center for Behavioral Health Statistics and
Quality, Substance Abuse and Mental Health Services Administration.
Osborne, A. K., Wilson-Menzfeld, G., McGill, G., & Kiernan, M. D. (2022). Military service and
alcohol use: a systematic narrative review. Occupational Medicine, 72(5), 313-323.
https://doi.org/10.1093/occmed/kqac045
Park, S., & Schepp, K. G. (2015). A systematic review of research on children of alcoholics:
Their inherent resilience and vulnerability. Journal of Child and Family Studies, 24(5),
1222–1231. https://doi.org/10.1007/s10826-014-9930-7
Ruben, D. H. (2001). Treating adult children of alcoholics: A behavioral approach. Academic
Press.
Yau, W.-Y. W., Zubieta, J.-K., Weiland, B. J., Samudra, P. G., Zucker, R. A., & Heitzeg, M. M.
(2012). Nucleus accumbens response to incentive stimuli anticipation in children of
alcoholics: Relationships with precursive behavioral risk and lifetime alcohol use. The
Journal of Neuroscience, 32(7), 2544–2551.
https://doi.org/10.1523/JNEUROSCI.1390-11.2012.
Note to reader: The goal of this blog is to identify a need and then urge a response. This blog is not intended to negatively portray any group of people. It is intended to speak truth to a hard topic, and doing so may cause some discomfort or dissonance. But hang in there - hope prevails.
Alcohol use disorder within families is a topic with potential impact across subpopulations and is not specific to the population of military families. In fact, although reviews of research suggest that there may be a higher incidence of problematic drinking in some segments (but not all) of the military, the highest rates of problematic drinking seem to be observed in military populations that are inconsistent with military families with children (as factors related to higher rates include those who are single and do not have children; Osborne et al., 2022). Even more explicitly, I’m not aware of any studies which have noted a heightened prevalence of problematic drinking in military families with children versus civilian families with children.
Despite who comes in for treatment, alcohol addiction impacts the entire family. Based on data from the combined 2009 to 2014 National Surveys on Drug Use and Health, at least 10% of U.S. families with youth have a parent with problematic drinking, which likely underestimates prevalence (Lipari & Van Horn, 2017). Just take a quick look on a search engine of choice, and you’ll readily see alcoholism described as a family disease.
For the children and adolescents who grow up in families with a parent (or parents) with an alcohol use disorder, home life can be chaotic, commonly disrupted by changes in parental availability and demeanor, and generally described as “dysfunctional” and difficult to overcome (Hall & Webster, 2007). These families often develop implied (and sometimes very explicitly stated) rules about engagement both within the family and with those outside. These rules typically discourage expressing feelings, deny the opportunity to talk about problems (especially the problems of the family with those outside the family), and communicate a demand for perfection from the youth (to avoid upsetting the individual with the the alcohol use disorder) while very commonly simultaneously expressing frustration with the youth for not being perfect (Ruben, 2001). Across multiple roles, I have seen firsthand how this mindset complicates youth’s comfort with seeking help and subsequently makes it harder to trust others when they do.
As you might guess, the youth of parents with problematic drinking are at greater risk of negative outcomes. These youth are more vulnerable to both immediate and long-term internalizing and externalizing behavioral health disorders, difficulties in relationships, and feelings of self-worth (Park & Schepp, 2015). For those who do struggle, it is not uncommon for youth to develop an alcohol or substance use disorder themselves (Yau et al., 2012) at rates estimated up to four times higher than youth who did not grow up with a parent who misuses alcohol (Anda et al., 2002).
There is no getting around it: children and adolescents who grow up in homes with one or more parents with alcohol use problems are at increased vulnerability to experience compromises in their developmental processes and challenges as adults.
However, they are not by any stretch doomed to a negative outcome. Remember, I told you this is a story of hope. Despite the challenges that are almost always present in families with alcohol use disorders, research continually shows us that many youth from these circumstances demonstrate tremendous resiliency. In fact, many (and in some studies, the majority!) do not exhibit difficulties at any greater level than children who did not grow up with a parent with an alcohol use disorder (Park & Schepp, 2015). Importantly, those youth who exhibit resiliency tend to have access to and use more social support, to include extra-curricular activities, peer relationships, and families who work through the impact of alcohol use.
Given that social support is protective of children and adolescents from homes with alcohol use disorders, our focus as clinicians should include paying attention to helping these youth manage the experience of living in a family impacted by alcohol use. Much of our formal mechanism for treatment for alcohol use disorders emphasize recovery of the individual who is using alcohol, but we know that treatment should also include family-centered care as the solution. Consider the benefit of ensuring treatment includes not only the individual in recovery, but also the entire family to help minimize the impact of a disease that is so enduring and can be disruptive to youth development.
When help is available, though, I would be remiss not to take a moment to describe what this help may require of children and youth. It’s hard. Really, really hard! It asks children and teens to take responsibility to address challenges and patterns of behavior that even the adults don’t want to readily look at. There will be tears; there will be discomfort as patterns get identified and shifted; and there will be heartache as truths are told. But then can come release, healthier relationships, and a chance to stop the generational cycle so often carried forward by the adult children of parents with alcohol use disorders. As I often have told my clients, it may not be their fault they need to confront these challenges, but it is their responsibility to their own health to do so.
If you find yourself working with a client who is a parent with an alcohol use disorder, please consider discussing the need for services for their family and their children. If you are working with a child or teen who has lived or is living with a parent with an alcohol use disorder, please embrace the importance of working through their experiences, identifying patterns, and fostering positive social connections that can enhance their resilience and protect their development. And if you are working with an adult child of a parent with an alcohol use disorder, please remember that early relational patterns often play into an adult’s ability to connect with others, seek help, and resolve difficult emotions.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Andrea Israel, Ph.D., is a clinical psychologist serving as a Military Behavioral Health Child Psychologist at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.
Williamson, D. F. (2002). Adverse childhood experiences, alcoholic parents, and later
risk of alcoholism and depression. Psychiatric Services, 53(8), 1001-1009.
Hall, C. W., & Webster, R. E. (2007). Risk factors among adult children of alcoholics.
International Journal of Behavioral Consultation and Therapy, 3(4), 494-511.
Lipari, R.N., & Van Horn, S. L. (2017). The CBHSQ report: Children living with parents who have
a substance use disorder. Rockville, MD: Center for Behavioral Health Statistics and
Quality, Substance Abuse and Mental Health Services Administration.
Osborne, A. K., Wilson-Menzfeld, G., McGill, G., & Kiernan, M. D. (2022). Military service and
alcohol use: a systematic narrative review. Occupational Medicine, 72(5), 313-323.
https://doi.org/10.1093/occmed/kqac045
Park, S., & Schepp, K. G. (2015). A systematic review of research on children of alcoholics:
Their inherent resilience and vulnerability. Journal of Child and Family Studies, 24(5),
1222–1231. https://doi.org/10.1007/s10826-014-9930-7
Ruben, D. H. (2001). Treating adult children of alcoholics: A behavioral approach. Academic
Press.
Yau, W.-Y. W., Zubieta, J.-K., Weiland, B. J., Samudra, P. G., Zucker, R. A., & Heitzeg, M. M.
(2012). Nucleus accumbens response to incentive stimuli anticipation in children of
alcoholics: Relationships with precursive behavioral risk and lifetime alcohol use. The
Journal of Neuroscience, 32(7), 2544–2551.
https://doi.org/10.1523/JNEUROSCI.1390-11.2012.