Parental Alcoholism As A Risk Factor For Dsm-Iv-Defined Alcohol Abuse And Dependence In American Women: The Protective Benefits Of Dyadic Cohesion In Marital Communication

American Journal of Drug and Alcohol Abuse, May, 2001 by Karen M. Jennison, Kenneth A. Johnson

INTRODUCTION

Important trends in research over the past decade indicate that women are affected equally or as greatly by familial alcoholism as are men (1, 2). In fact, a family history of alcoholism is one of the strongest predictors of alcoholism in women, with those having a first-degree relative with alcoholism at a twofold to fourfold increased risk of alcoholism (3). The estimated prevalence of alcoholism in female adult children of alcoholics (COAs) is 5%-10% compared with a prevalence in the general female population of 0.1% to 1% (4, 5). Familial alcoholism itself is very widespread, with 53% of adults in the population reporting an alcoholic relative or about half that when only first-degree relatives are counted (6, 7). Women are more likely than men to report that a parent was alcoholic, and they also report more alcoholic relatives (6, 8-11).

Family Influence

There is growing evidence in the research literature that early exposure to familial alcoholism places individuals at greater risk for alcoholism, substance abuse, and related problems than those who were not so exposed (1, 4, 12-16). Of the estimated 28 million American adults who are children of alcoholics, slightly more than half are female (11, 17, 18). Although women are still more likely to abstain and to consume less than are men, there has recently been a convergence between men and women in their probabilities of both alcohol use and alcohol problems (19). In the past, there has been a disproportionate research emphasis on male COAs, but women have become the focus of greater interest for all the reasons cited above (20-22).

Although there is little doubt that alcoholism is significantly present among women COAs, it is increasingly recognized that the adverse drinking outcomes predicted for them are not inevitable; only a small percentage actually become dependent on alcohol (4, 23, 24). Considerable information on the observed heterogeneity of COAs and their families suggests that the majority exhibit convincing resistance; many do not develop alcohol dependence or grow up to be alcoholic (23, 25-29).

Currently, little knowledge exists regarding moderating factors that reduce the vulnerability of women COAs to alcohol abuse and dependence in adulthood. Identifying factors that predict positive outcomes in adulthood for COAs will be helpful in areas of both treatment and policy (30). Therefore, this study focused on the association between drinking and interpersonal relationships of women COAs; specifically studied was marital communication as a factor that helps protect them from alcohol abuse and dependence in midlife.

A conclusion drawn from the literature is that the high rates of alcoholism found in COAs are attributable to both environmental and genetic vulnerability (14, 31). COAs are at the high end of vulnerability for alcoholism when compared with the general population. Eventual alcohol problems are by no means certain; however, they are more likely than for non-COAs (5, 32, 33). A number of mechanisms have been hypothesized by which parental alcoholism is environmentally transmitted to children. For instance, children model parental use of alcohol as a coping mechanism. Parents also instill expectancies about the effects of alcohol and interpret social norms and values regarding alcohol use long before actual drinking starts (2, 34, 35). This social learning model reinforces the notion that same-sex modeling (mother-daughter, father-son) has an important and possibly greater effect on alcoholism than opposite-sex modeling.

A second way parental alcoholism is transmitted is through disturbed family interaction patterns caused by drinking or other psychopathology frequently associated with alcoholism. Disruptions in family life due to the problematic use of alcohol include marital distress, health problems, legal problems, vocational/financial instability, and disrupted family rituals such as holidays, birthdays, or other special occasions. Other interaction characteristics that frequently occur in alcoholic families are disruptive attachment between the child and caregiver and poor problem-solving skills and communication. Family violence and physical abuse may also occur (5, 34, 35).

Female COAs, by and large, are affected by parents in the same ways as males are. However, women are more likely to report alcoholic parents and other alcoholic relatives; this apparent greater awareness may mean that they are affected somewhat differently, although this question has not been researched. Maternal alcoholism increases the risk of alcohol dependence in female offspring, so female COAs may be more affected by parental alcoholism if their mothers were alcoholic (11, 21). In addition to parents themselves, the family environment is an important influence on later drinking patterns:

   Common environmental sources are those that are shared by individuals
   raised in the same household. Some examples might be drinking habits and
   teachings about alcohol, shared peer groups and sociocultural and religious
   influences. (36, p. 850)