McKesson Clinical Reference Systems: Pediatric Advisor 2002.1

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One in five adults Americans lived with an alcoholic while growing up. Child and adolescent psychiatrists know these children are at greater risk for having emotional problems than children whose parents were not alcoholics. Alcoholism runs in families, and children of alcoholics are four times more likely than other children to become alcoholics. Most children of alcoholics have experienced some form of neglect or abuse.

A child in such a family may have a variety of problems:

• Guilt. The child may see himself or herself as the main cause of the mother's or father's drinking.
• Anxiety. The child may worry constantly about the situation at home. He or she is afraid the alcoholic parent will become sick or injured. The child may also fear fights and violence between the parents.
• Embarrassment. Parents may give the message that there is a terrible secret at home. The ashamed child does not invite friends home and is afraid to ask anyone for help.
• Inability to have close relationships. Because the child has been disappointed by the drinking parent many times, he or she often does not trust others.
• Confusion. The alcoholic parent will change suddenly from being loving to angry, regardless of the child's behavior. A regular daily schedule, which is very important for a child, does not exist because bedtimes and mealtimes are constantly changing.
• Anger. The child feels anger at the alcoholic parent for drinking and may be angry at the nonalcoholic parent for lack of support and protection.
• Depression. The child feels lonely and helpless to change the situation.

Although a child may try to keep the alcoholism a secret, teachers, relatives, and other adults or friends may sense that something is wrong. The following behaviors may signal a drinking problem at home:

• failure in school, truancy
• lack of friends, withdrawal from classmates
• delinquent behavior, such as stealing or violence
• frequent physical complaints, such as headaches or stomachaches
• abuse of drugs or alcohol
• aggression toward other children
• depression or suicidal thoughts or behavior.

Some children of alcoholics may act like responsible "parents" within the family and among friends. They may cope with the alcoholism by becoming controlled, successful overachievers throughout school. At the same time, they may be emotionally isolated from other children and teachers. Their emotional problems may show only when they become adults.

Whether or not their parents are receiving treatment for alcoholism, these children and adolescents can benefit from educational programs and mutual-help groups such as programs for children of alcoholics, Al-Anon, and Alateen. Early professional help is also important in preventing more serious problems for the child, including alcoholism. For example, child and adolescent psychiatrists can help these children with their own problems, and also help them to understand they are not responsible for the drinking problems of their parents.

A treatment program may include group therapy with other youngsters, which reduces the isolation of being a child of an alcoholic. A child and adolescent psychiatrist or other mental health professional will often work with the entire family, particularly when the alcoholic parent has stopped drinking, to help members of the family develop healthier ways of relating to one another.