By John Messmer
Penn State Family and Community Medicine
Penn State Milton S. Hershey Medical Center
Penn State College of Medicine
Consider Mary, the teenage daughter of a middle-class family, who is out with friends at a party. Someone brought beer. Mary has never had a drink, although she's familiar with the effects. Her father is a heavy drinker. Many nights he has drunk heavily at home. When he does, he picks on her about her friends, her appearance and her grades. Then he gets into boisterous arguments with her mother, who defends her. She has seen her mother slapped a few times after trying to protect Mary.
Mary used to try to mediate between her parents with little success. To try to prevent problems, she has worked two jobs to help maintain the family finances, since her father misses a lot of work. She also tries to please her father by getting good grades, but some subjects are difficult for her. To make up for it, she helps her mother keep things neat and tidy around the house to avoid her father's rants about her mother's housekeeping skills.
Mary knows how alcohol affects her father, but her friends are urging her to be part of the group. She has learned to try to please people so she gives in and has a beer. Soon she feels better. Her anxieties are forgotten as she has another and another, until her friends are amazed at her ability to hold her booze while she finishes a six-pack.
She doesn't remember getting home, but the next morning she realizes things were different the night before. There's a party later in the week that she had not planned to attend, but maybe now she will.
Mary is a child of an alcoholic (COA) and has likely inherited the genetic propensity for alcoholism herself. Unless someone intervenes, she may continue to drink until her life is ruled by alcohol. Because she is young, this will happen in the next couple years rather than in the decades it took her father, who did not drink until his 20s. His father was an alcoholic also, but he died in a car accident, and his mother rigidly controlled his life until he married.
Mary's mother is not an alcoholic, but during her pregnancy she drank because her father did and demanded she drink with him. Mary does not have full-blown fetal alcohol syndrome, but her academic struggles probably reflect the problems with attention seen in children exposed in utero to alcohol.
It's estimated that 15 to 25 percent of all U.S. children are exposed to alcohol abuse and/or dependence in their family by age 18. Besides the greater risk of physical, emotional and sexual abuse, COAs face many other problems. They often blame themselves for their parent's drinking problems and are anxious about fights and violence at home. They become inappropriately compliant and try to become peacemakers, a role unsuited to a child. Alcoholic parents switch moods suddenly, causing confusion in the child and interfering with his or her ability to form close relationships. Children suffer continued embarrassment by the terrible secret in their families. All these problems lead to depression and loneliness.
Some children become co-dependents by cleaning up after their alcoholic parent and protecting them from harm. This can lead to role reversal and the development of overly controlling personalities in the children. While some may be overachievers in school, they tend to be withdrawn and isolated. By contrast, a child who was exposed to alcohol before birth may have intellectual and functional deficits. Instead of excelling in school, some children do the opposite by becoming truant, aggressive or delinquent.
Alcoholism is genetic. Children of alcoholics have a greater risk of becoming alcoholics themselves. Because the brain is not fully mature until sometime in one's 20s, children at risk for alcoholism who are exposed to alcohol will develop problems much sooner than will adults. Their parents' drinking sends them confusing messages about the use of alcohol, and American society is ambivalent about restricting alcohol to minors. This creates a dangerous situation for the at-risk child.
COAs may not receive help or even realize the problems they face until they reach adulthood or someone intervenes. It's not easy, but there is help available. Alanon and Alateen chapters ( http://www.al-anon.alateen.org/ online ) are available in most communities. Friends or relatives of the child and alcoholic parent may need to intervene.
It's a difficult issue for everyone who knows a child of an alcoholic. To learn more, visit http://www.niaaa.nih.gov/FAQs/General-English/FAQs19.htm on the Web.
John Messmer is associate professor of family and community medicine at Penn State College of Medicine and a staff physician at Penn State Milton S. Hershey Medical Center.