Who Are The Adult Children Of Alcoholics?

Adult children of alcoholics (ACoAs) are individuals whose parents had alcohol use disorder. They may experience a range of emotional and social difficulties as a result of their childhood experiences, such as low self-esteem, rejection sensitivity, over-reactivity, and constant approval-seeking or people-pleasing. These traits can lead to issues with substance abuse, anxiety, and phobic disorders. ACoAs may also exhibit denial, poor coping skills, poor problem-solving, and form dysfunctional relationships. They may find themselves attracted to alcoholics or other compulsive personalities, such as workaholics, who are emotionally unavailable. Various organizations and support groups, such as the Adult Children of Alcoholics (ACA) organization, aim to help ACoAs identify and overcome the problems that have arisen due to their upbringing.

The prevalence of adult children of alcoholics in psychiatric admissions

The study by el-Guebaly and colleagues provides valuable insights into the psychiatric issues faced by ACOAs. The findings suggest that growing up in a family with alcoholism can have long-lasting impacts on mental health and well-being. However, it is important to recognize that not all children of alcoholics will develop psychiatric disorders, and individual resilience and protective factors also play a role.

Further research is needed to understand better the complex relationship between parental alcoholism and psychiatric admissions among adults. It is crucial to identify the specific risks and protective factors that may influence the mental health outcomes of this population. By understanding these factors, targeted interventions and support services can be developed to address the unique challenges faced by ACOAs.

Additionally, it is important to recognize that the impact of parental alcoholism on children can vary depending on various factors, including the severity of the alcoholism, the presence of other mental health disorders, and the family's social support systems. Some children may be more resilient and able to cope with the challenges of having an alcoholic parent, while others may struggle with long-term mental health issues.

Overall, the prevalence of adult children of alcoholics in psychiatric admissions highlights the need for targeted interventions and support services for this vulnerable population. By understanding the unique challenges and risks faced by ACOAs, mental health professionals can provide effective treatment and support to help them overcome the trauma of growing up in a family with alcoholism.

Common traits and behaviours

Adult Children of Alcoholics (ACoAs) often exhibit common traits and behaviours that can be traced back to their childhood experiences of growing up alongside addiction and within a dysfunctional family. Here are some of the key commonalities observed in ACoAs:

Emotional and Social Challenges: Children of alcoholics often have their emotional and social needs unmet, leading to low self-esteem, rejection sensitivity, over-reactivity, and a constant need for approval-seeking or people-pleasing. They may struggle with forming healthy, trusting relationships as adults due to their inability to establish secure attachments with caregivers during infancy. Hiding their feelings of sadness, fear, and anger becomes a survival mechanism, which can make it challenging to express emotions authentically later in life.

Impulsivity and Confusion: ACoAs may exhibit impulsive behaviours, locking themselves into courses of action without fully considering alternative options or potential consequences. This impulsivity can lead to confusion, self-loathing, and a sense of losing control over their environment. They may spend excessive energy trying to rectify the consequences of their impulsive decisions.

Relationship Dynamics: Adult children of alcoholics often find themselves attracted to other alcoholics or compulsive personalities, such as workaholics, who are emotionally unavailable. They may form relationships with people they feel need their help or rescue, neglecting their own needs in the process. By focusing on the overwhelming needs of others, they can avoid addressing their own difficulties and gain a sense of self-worth. This dynamic can also lead to the adoption of alcoholic traits, such as denial, poor coping skills, and dysfunctional relationships, even if they do not engage in substance use themselves.

Coping Mechanisms and Trauma: Growing up in a dysfunctional family can result in the development of harmful coping mechanisms that persist into adulthood. ACoAs may exhibit controlling behaviours, judgement of self and others, and an overdeveloped sense of responsibility. They may view themselves as victims and seek out relationships where they can play the role of the rescuer. Unaddressed childhood trauma can lead to self-hatred, fear, anxiety, and anger. Recognising and unlearning these maladaptive strategies is an important aspect of healing for ACoAs.

Sense of Self and Self-Worth: ACoAs often struggle with low self-esteem and a harsh inner critic. They may judge themselves harshly and feel guilty when standing up for themselves. Their sense of self-worth can become tied to rescuing or helping others, making it challenging to prioritise their own needs.

Personality subtypes

A two-part study identified and validated five personality subtypes in adult children of alcoholics. Four of these subtypes were highly similar to those found in adolescents of alcoholics: externalizing, inhibited, emotionally dysregulated, and high-functioning.

The first subtype scored highly on sociability, self-acceptance, well-being, responsibility, self-control, achievement, and intellectual efficiency. The second subtype scored slightly below the first subtype on all the previously mentioned scales but still maintained scores characteristic of a normal population. The third subtype produced low scores on all of these scales and was significantly associated with higher rates of parental death, sexual abuse, and physical abuse.

The fourth subtype, Emotionally Dysregulated adults, exhibited many features of Borderline Personality Disorder (BPD). They experience spiralling emotions, difficulty soothing themselves, problems with identity, and impulsivity. The fifth subtype, Reactive/Somatizing adults, tended to exhibit physical and emotional reactivity to interpersonal slights and conflicts. They develop somatic symptoms in response to stress, ruminate on relational problems, react severely to slights or insults, hold grudges, and tend to be critical, controlling, anxious, and angry.

It is important to note that these subtypes are not mutually exclusive, and individuals may exhibit traits from multiple subtypes. Additionally, while these subtypes provide a framework for understanding the personality characteristics of adult children of alcoholics, each person's experience is unique and may not fit neatly into one subtype.

Substance abuse and phobic disorders

The issues faced by adult children of alcoholics (ACOA) are widely known, but there is a lack of empirical evidence to support them. A screening of 250 psychiatric admissions revealed a high prevalence of ACOAs across diagnoses. Compared to other patients, the ACOA group was younger, with a higher prevalence of substance abuse and phobic disorders. They also had earlier psychiatric hospitalizations.

The impact of being an ACOA varies depending on the parental biological relation and gender, as well as the premorbid antecedents of parental alcoholism. Studies have found that 40% of patients in an outpatient anxiety disorder program were ACOAs, a similar proportion to those found in substance abuse programs. These ACOAs were younger, had higher co-dependency scores, and had their first psychiatric contact at a younger age. They were also more likely to be female, and their alcoholic parents were less likely to have had psychiatric antecedents to alcoholism.

These findings suggest that vulnerabilities to anxiety disorders and alcoholism may overlap. This is further reinforced by the similarities in sociodemographic variables and the impact of parental alcoholism observed in the studies. Furthermore, children of alcoholics often have their emotional and social needs unmet, leading to traits such as low self-esteem, rejection sensitivity, over-reactivity, and constant approval-seeking. They may also exhibit denial, poor coping skills, poor problem-solving, and form dysfunctional relationships.

The characteristics of ACOAs were first outlined by Janet G. Woititz, EdD, in her 1983 book, "Adult Children of Alcoholics." She identified 13 common characteristics prevalent not only in alcoholic families but also in those with other compulsive behaviors. These characteristics include impulsivity, spending excessive energy cleaning up their messes, and forming relationships with emotionally unavailable people.

Support groups and recovery

One well-known support group is Adult Children of Alcoholics (ACA) Fellowship, which has supported countless members across the globe in their recovery journeys. ACA provides in-person, online, and telephone meetings, ensuring accessibility and flexibility for its members. These meetings are typically discussion-based, allowing members to openly share their thoughts and feelings in a supportive environment.

Another resource for ACoAs is SAMHSA's National Helpline, a free and confidential service that provides treatment referral and information to individuals and families facing mental and/or substance use disorders. This helpline operates 24/7, 365 days a year, offering support in English and Spanish. In addition to referrals, they provide information on substance abuse, its symptoms, different types of treatment, and recovery. SAMHSA also offers a booklet specifically for families of people with alcohol or drug abuse problems, addressing concerns of children impacted by their parents' substance use.

There are also support groups tailored to specific needs and preferences, such as the Agnostic ACA group. This group is open to atheists, agnostics, freethinkers, and anyone uncomfortable with the religious language in traditional ACA literature. Agnostic ACA believes that personal accountability is key and that recovery can be successful regardless of one's spiritual beliefs. They offer a secular approach to the traditional 12-step program, acknowledging that a Judeo-Christian Higher Power may not resonate with everyone.

The "Loving Your Inner Child" support group is another example of a specialised offering. This group focuses on strengthening recovery by fostering self-love and inner child acceptance, which is crucial for ACoAs who may have struggled to form healthy attachments with their caregivers during their infancy.

These support groups and recovery programs empower ACoAs to face their challenges head-on, develop healthier coping strategies, and build a strong support system to aid in their healing journey.

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