Alcoholism's impact on families: an interview-based study

¶ … alcoholism on the family and the benefits of a rehab. program

The impact of alcoholism on the family

General description of Interest

My interest in this subject is based on the fact that alcoholism is one of the most devastating and serious social and psychological diseases that affects thousands of people in our society. A further factor is that the impact of alcoholism is often hidden from public view as it has a social stigma that makes the treatment of this disease difficult. Therefore I felt that a research study based on interviews with people who had experienced this aspect within the family would be a valuable contribution to the subject. However the aspect that interested me and particularly motivated this research was the far -reaching and damaging affect of alcoholism on children in the family. As the research on this topic shows, the impact of alcoholism on children who grow up with a parent who is an alcoholic is often devastating and can last into adulthood. In essence my interest in this topic related to my concern for the social and psychological implications of a disease that affects many people both young and old in our society.

1. 2. Description of interview participants

Mr. A.

Mr. A was a middle-aged man who had survived an extremely traumatic childhood with two alcoholic parents. He was a very responsive interviewee and provided a wealth of information on the effects of alcoholism on children from the perspective of someone who had truly experienced the trauma of alcoholism first hand. He was also an interviewee who seemed to have the least resentment or bitterness about his experiences, even though his trauma was extreme.

Mr. And Mrs. B. Mr. And Mrs. B were two parents had an alcoholic son who had committed suicide as a result of his alcohol addiction. This interview provided insight into the trauma and tragedy of parents who had attempted every possible means of rehabilitation to no avail. They also provided insight into the psychological trauma that accompanies this type of situation.

Miss C. Miss C. told of her experiences as a teenage girl who had lived with an alcoholic father most of her life. Her story possibly echoes thousands of others and also included mention of sexual and psychological abuse.

Mr. D. Mr. D. was an elderly man who had lost a wife to alcoholism. There was a great amount of regret expressed in this interview. However, Mr. D. was not as forthcoming as the other interviewees and was difficult to interview at first.

Mrs. E. The interviewee in this case had actually turned to prostitution as a result of her alcoholism. This interview provides some interesting data with regard to the connection between sexual promiscuity and alcoholism. This was also an aspect that was noted in the literature on the subject.

Mrs. F. Mrs. F. was a woman who had two members of her family become alcoholics. The interviewee was also adamant that the root causes of alcoholism were not social but rather genetic.

1. 3. Methodology and collection of data

The central methodology in this research project was the collection of data through direct interviews of members of families who had been affected by alcoholism in a family situation. I approached a social work institution to find if there were any participants who would be willing to take part in this project.

A explained the intentions of the study and research in terms of the need to understand the full impact and significance of alcoholism on the family and to ascertain the effectiveness of rehabilitation techniques and methods. There were two interviewees who were prepared to answer the questions. I later found that due not the success of the first interviews the participants suggested a number of other people who might be willing to take part in the project. I eventually had as many as six interviewees. The method I used was fairly open - ended. While I did ask the participants to answer certain selected questions, I also made the interviews as informal and casual as possible. In other words, if the interviewees felt that one question was more important and particularly related to their situation, then I did not step them from exploring those avenues. This resulted in a free-flowing and very insightful series of interviews.

2. Results

Theme 2

Another theme which was not as evident as I had at first thought was that of the financial and more practical concerns that would have been affected by alcoholism in the family. However most of the interviewees did mention that the presence of an alcoholic did have in many cases an extremely negative effect on the family finances and the ability of the family as a whole to sustain itself. Once again this was not a clear cut issue and many of the responses to this question also showed a protective ambiguity towards the alcoholic individual. This was also complicated in many instances by the fact that the family member interviewed was often dependent for their bread and butter on the alcoholic member of the family. This meant that they had to tolerate the excesses of the alcoholic person.

Theme 3 third dominant theme that emerged was that of guilt. This was a theme that I did not initially expect to be so prominent in the interviews and which showed the psychological complexity of alcoholism in the family. I also began to realize that due to the fact that any family is a complex and often unique entity in itself, that there are many subtle and underlying aspects to alcoholism in the family that are often not visible at first sight. Many of the interviewees when describing their feelings as children noted a sense of guilt and a sense that in some way, through bad behavior or poor school performance, they were to blame for the actions of the alcoholic parent. This made me even more aware of the severe impact that alcoholism in the family can have on children. Many of the interviewees who described this feeling of guilt were elderly and it became obvious that in some cases this feeling of guilt had not been dealt with or eradicated and still persisted to a certain extent. The parents in the interviews who had children who had succumbed to alcoholism also showed a deep sense of remorse and a feeling that they had not been good enough as parents.

Theme 4

Another theme which was dominant in the interviews, and one which had been expected, was the way that alcoholism damaged and even destroyed relationships. This was particularity the case between man and wife but was also noted as a factor in almost all the other interviews. The sense of betrayal in the instance of the young girl how had been abused was extremely strong and this had affected not only her relationship with her father but also her relationship with other males subsequent to her father's death.

Theme 5

Another aspect that is well documented in the literature and which also formed an important part of the information provided by the interviewees was the impact of the social stigma attached to alcoholism. This stigma affected the interviewees in various ways but what was evident in many of the interviews was the fact that this stigma or social censure of alcoholism was a central issue with many implications. This was also related to another theme that emerges; namely the fact that in many cases families at first attempted to hide the fact that they had an alcoholic member in their family.

Due to the stigma attached there was in fact a form of denial of the reality of alcoholism in the family. This in turn had a number of results, some of which will be discussed in the following sections.

Theme 6

Another central theme was that all interviews expressed the fact that with an alcoholic member in the family it was impossible to live a normal and relaxed life. This response way to be expected; however this also had various implications in terms of the growth and development in the younger members of the family and with regard to problems later in life.

Theme 7

In terms of questions about the effectiveness of rehabilitation the interviewees that took part showed a very ambivalent and often negative attitude towards rehabilitation in a formal sense. This was one aspect of the interviews that tended to contract the trends in the literature on the subject. This made it very difficult to ascertain the success to otherwise of formal rehabilitation techniques. What did become evident in many of the interviews was that informal rehabilitation was seen to be have engendered a certain amount of success. This in fact related to findings in the literature and to the view that rehabilitation techniques that include the family are more successful.

Key points

The interviewees presented a number of key points that add to and extend the above central themes. This will be very briefly discussed in relation to each of each interview.

Interview

The first interviewee was a middle-ages man, Mr. A. This interviewee provided extensive insight into the issues surrounding alcoholism in the family. Mr. A had lived through a very traumatic youth with both parents who were alcoholics. He lived in continual fear of their drunken fights and had in effect to run the home by himself. Poverty was another factor that added to the gloomy scenario, with both parents spending most of the money on alcohol. This was by far the most extreme of the interviews and it painted a picture of intense privation and suffering on the part of a young child who often had to put his parents to bed.

However, it was also one of the most uplifting and compassionate interviews and the interviewee showed very little bitterness towards his alcoholic parents. Mr. A stated that he eventually became inured to their drunkenness and saw it almost as " normal." This relates to studies that show the some family members often become tolerant of the alcoholic and tend to be very accepting of his or her drunkenness.

Interview

Mr. And Mrs. B. were two elderly people who still showed the strain of having a son who had died from alcoholism at the young age of 22. This was a very traumatic and intense interview and a point that the couple repeated was that peer influences could have a very dramatic effect on the choices that a child makes. Although their son had been to numerous rehabilitation clinics, he eventual slipped into a state of depression and committed suicide.

The couple also noted the influence of the media as a cause of the tragedy. They referred to the positive way the media presented alcohol and the failure of society in general to condemn the use and abuse of alcohol. As the interview progressed, the sense of anguish at the loss of their son for no real reason was palpable and I did not question them too deeply about the actual circumstances of the son's death.

Interview

Miss C. told the story of her ordeal when as a young girl she had lived alone with her alcoholic father. This interview included rather detailed accounts of the way that the father would be fairly caring during the day but abusive at night.

This also led to sexual abuse, which was to result in serious issues for Miss C. later in life.

Interview

Mr. D. was very reticent about the loss of his wife through alcoholism. There was the suggestion that Mr. D blamed himself to a certain extent for this. There was also an implied criticism that the acceptance of social drinking was partly the cause of his wife's alcoholism.

Interview

Mrs. E. A was a mother who had overcome alcoholism but spoke mainly about her earlier decline into prostitution as a result of alcoholism. This was an extremely difficult interview as the subject of her prostitution was obviously a very sensitive issue. The prostitution was linked to an alcoholic father who had abused her as young girl. This had led to feelings of guilt and worthlessness which resulted in her becoming an alcoholic and turning to prostitution. The literature and studies on the connection between child abuse, alcoholism and sexual deviance later in life were instructive in this case.

Interview

Mrs. F. provided background to the theoretical view that alcoholism was hereditary and not entirely socially or psychologically socially caused. This participant had two family members who were alcoholics and she was convinced that this was a genetic trait that occurred regularly in the history of her family.

Background: Literature review

The available literature on this topic is extensive. The central themes that were derived from the interviews are also referred to and dealt with in much of literature; which tends to support many of the aspect and themes that became evident in the interviews.

A very useful general resource is Medications Can Aid Recovery from Alcoholism by Paula Kurtzweill. (1996) This study provides insight into the way that medications can assist the recovering alcoholic. Furthermore it is useful as an introduction to the subject as it provides a succinct overview of what alcoholism is and the various effects that alcoholism can have on the family and those who are directed affected. It is also a useful in that it provides insight into the status of thinking and research on alcoholism. For example, the study states that, "Alcoholism is a complex disease with physical, social and psychological consequences -- not only for alcoholics but also for people closest to them. "(Kurtzweill 1996) The study also emphasizes an important aspect that was prominent in the interviews.

In the past, alcoholism was often viewed as a moral weakness or character flaw; it was thought that the person could stop drinking if he or she really wanted to. It wasn't until 1970, with the establishment of NIAAA and a national public education effort that people began to understand and accept that alcoholism is a life-threatening, chronic disease involving psychological and physical dependence on alcohol. (Kurtzweill 1996)

This view relates to much of what has already been discovered about alcoholism in the interview section on this study. This refers particularly to the stigma attached to alcoholism. In terms of the interviews that were undertaken it also became evident that alcoholism has not been fully accepted as a disease and still has socially negative associations.

An important aspect that adds depth to the interviews and the results of the study is that recent findings have shown that there are different types of alcoholism. The study by Kurtzweill states that while the causes of alcoholism are still a mystery yet "...scientists now agree that a combination of genetic and environmental factors increases a person's vulnerability." (Kurtzweill 1996) This view goes a long way to explaining some of the results of the research finding in the interviews; for example, the conflict that was expressed about family history and social causative factors in alcoholism. These finding might help to assuage the guilt of parents and children who may feel that they are the cause of the problems. Kurtzweil refers to " type 1" and " type 11" alcoholism. Type 1 is referred to as the most common form of alcoholism and "... appears to be the result of "genetic predisposition and environmental provocation..." (Kurtzweill 1996) Type 11 is more genetic in origin. " Type II,...is due mainly to genetics. It occurs... usually with early onset in the teen years, and is more difficult to treat. Type II alcoholics tend to exhibit antisocial, aggressive behavior." (Kurtzweill 1996)

This study also noted that rehabilitation is the preferred course once the individual becomes sober. " According to a 1991 survey by the U.S. Department of Health and Human Services, nearly 575,000 people were treated in 8,298 facilities in the United States on Sept. 30, 1991. Of those, 12% were treated as inpatients, 88% as outpatients. "(Kurtzweill 1996) However, the selection of participants in the interview did not refer to this process in any great depth, which tends to suggest that there are many alcoholics and families alcoholics who do not yet make use of the formal rehabilitation avenues.

The extreme effects of alcoholism were also a central focus of the study and also feature in the literature on the topic. An article by Fernquist, (2000) entitled Problem Drinking in the Family and Youth Suicide provides some very insightful information on this aspect. As was discussed in the interview section, alcoholism in the family can lead to and severe repercussions for the non-alcoholic members of the family.

The effect of alcoholic patterns of behavior on the child is explored in the article by Fernquist. In the study it was found that, "... parents' problem drinking led to child abuse or neglect and, consequently, suicide; yet, it is also possible that parents resorted to drinking as a coping mechanism after their child's suicide." (Fernquist, 2000, p. 551) Therefore this shows that alcoholism in the family can be a double-edged sword and also refers to the central point in the research and interviews that alcoholism affects the members of the various families often just as much as the alcoholic. The article also notes that further research on this issue is needed.

Another interesting and useful area of the literature is the many studies which show that family history and genetics play a role in the cause of alcoholism. This was also a point referred to in some of the interviews. A study by Chermack et all (2000) entitled Gender Differences in the Development of Substance-Related Problems: The Impact of Family History of Alcoholism, Family History of Violence and Childhood Conduct Problems refers to some of the central views in this area, The study found that a family history of alcoholism (FHA) was "...a decided risk factor in the development of alcohol abuse problems. "(Chermack, Stoltenberg, Fuller & Blow, 2000, p. 845)

Furthermore the study established that "Risk for developing problems with alcohol increases roughly as a function of the number of affected relatives or density of FHA." (Chermack, Stoltenberg, Fuller & Blow, 2000, p. 845) This would be a view that some of the interviewees in this study would agree with. The study also found that more research was needed into the way that FHA interacted with other social and psychological aspects within the family. "What is less well understood are the ways in which FHA fits into a more complete risk structure." Chermack, Stoltenberg, Fuller & Blow, 2000, p. 845) It is suggested by the authors that there is a "... need for researchers examining FHA and family background influences to conduct more detailed assessments of violence in the family of origin in order to better understand or account for the influence of FHA on the development of adult problems with substance use and violence." (Chermack, Stoltenberg, Fuller & Blow, 2000, p. 845)

An article that further extends our insight into the way that alcoholics affect the family in a multitude of ways is Growing up with alcoholism: alcoholism is a disease that affects the entire family by Robert Taibbi (1993) This study also refers to the psychology of the alcoholic and the various personal traits that may be precursors to later alcoholism. More importantly, the article discusses one of the central findings of the present research; namely the effect of alcoholism on children in the family.

Children of alcoholics tend to have poor self-esteem, a lack of trust for others and a higher risk of becoming alcoholics." (Taibbi 1993) The study also refers to aspects that were also evident from the interviews conducted. For example; "Alcoholism is a disease that not only affects the person who drinks, but the entire family as well. All children are influenced by and dependent on their parents. But children who grow up with alcoholic parents are particularly vulnerable. " (Taibbi 1993)

According to the article this may result in various issues for the child, such as difficulty with intimacy and trust; difficulty expressing feelings and poor self-esteem (Taibbi 1993) Significantly, one of the central themes that emerged from the interviews was a misplaced feeling of guilt among many affected children and adults. This aspect is underscored in the article. " Because all children easily blame themselves for what happens in the home, these children often feel guilty or bad. They suffer from feelings of inadequately. They have a hard time believing they can ask for what they need or that they are good the way they are or that they have the ability to accomplish what they wish." (Taibbi 1993)

Another article from the Times Leader (2005) also presents a similar view about alcoholism and the family. The article entitled Effects of alcoholism on families in spotlight states that "Often the people hurt most by alcohol abuse don't even drink. They are the children, spouses and relatives of the problem drinker."(Times Leader, 2005) This article also presents some valuable data on the number of children who are affected by alcoholism in their families. According to the National Association of Children of Alcoholics, "...over 11 million children under the age of 20 are living in alcoholic homes. Alcoholism affects more than 10 million people and it is the number one drug problem in this country today."(Times Leader, 2005) The article also adds that, "Because children of alcoholics are exposed to a chaotic family environment, many are at risk for developing serious emotional, behavioral and substance abuse problems." (Times Leader, 2005)

There are also a range of comprehensive studies on the rehabilitation of alcoholics. One online source states that the process of rehabilitation is intended to help the alcoholic to recognize the extent and nature of his problem. "The goal of alcohol intervention is for them to accept the reality of their alcoholism and to seek help." (Alcoholism F.A.Q.) This view is reiterated in numerous other studies. A study by Davis fro the Washington entitled, Daly Says He's Going to Win This Time: New Diet, Equipment and Outlook Help Star in War with Alcoholism paints a picture of a recovering alcoholic and the benefits and pitfalls of the rehabilitation process.

Daly's battle with alcoholism has been well documented since his arrival on Tour in 1990. Despite a wide-open, huge-hitting style that endeared him to golf galleries everywhere and earned him a victory in the 1991 PGA Championship, Daly wasn't "happy inside" during his first two years on Tour. Alcoholism had derailed one marriage and clouded both his days and his future when Daly made his first trip to a rehabilitation clinic at the end of 1992. He emerged from the first program clean and sober, but he still lacked self-control, and over the next four years (Davis, 1997, p. 1)

The literature also provided studies that explored the possibility of rehabilitation methods which included the family in a more holistic approach to the problem of alcoholism.

Therapists on their own are limited in the degree to which they can make demands on the patient's life, and the patient is free to walk away from the therapeutic situation if it is uncomfortable for him - that is to say, if it challenges a serious relapse to addiction. All these factors make the engagement and orchestration of family and friends into the therapy with a substance-abusing patient an invaluable resource, one which offers remarkable opportunity for the modification of traditional psychotherapeutic techniques to treat the substance abuser. (Galanter, 1992, p. 64) useful study that provides seem useful insights into the way that alcoholism affects and impacts on the family is Alcoholism and Society by Chafetz, and Demone (1962). This work showed that alcoholism does have a profound impact on the family and particularly on personal relationships within the family. "Spouses, parents, children, and relatives are affected by the pathological drinker; naturally, the more intimate the relationship the more severe the effect." (Chafetz & Demone, 1962, p. 166) This study also provides a more compassionate view of the world and experience of the alcoholic and suggests a more understanding and interpersonal way of dealing with alcoholism in the family. "In understanding the alcoholic, it is considered essential to understand that alcoholism is an illness and the alcoholic a sick person, that alcoholics can be helped and that pleas to will power, threats, and accusations are useless. The alcoholic's lack of drinking control is considered an obsession. "(Chafetz & Demone, 1962, p. 169) The study also reiterates the view expressed in some of the interviews that alcoholism can have a traumatic effect on the members of the family and can in fact also make them ill. (Chafetz & Demone, 1962, p. 170) very significant part of the literature which also relates to the above interviews is the way that the media and society fosters the image of alcohol and drinking as being socially acceptable. An article by Haskins (1976) explores this area of concern. This is a particularly worrying area of the research - especially when the media advertising is directed at the youth, as the following extract indicates.

Advertising equates drinking with "the good life," with romance, with virile men. Since the so-called pop fruit wines have been introduced, the marketers of those wines have aimed their advertising campaigns at young adults. According to the ads, these wines are the "in" beverage for young people, and the ads have been very successful in selling their product to the target audience. Sales of strawberry, apple, and other fruit wines have increased ten times in the past four years, and it is young people who are drinking them. (Haskins, 1976, p. 44)

This also relates to the results of the interviews. The article emphasizes that, "...societal attitudes and customs and the type of advertising society accepts are important influences on young people and on their drinking habits." (Haskins, 1976, p. 44)

The literature researched also to various aspects of the central themes discovered in the interviews. For instance, the issue of the effects of the stigma attached to alcoholism is dealt with in an article entitled Impact of alcohol misuse on family life. "The shame that surrounds problem drinking contributes to delay or failure of remedy; the family tries to hide the drinking of its member from neighbors and even from the doctors. All parties to the illness choose to ignore the alcoholism and its implication for the patient. "(Arentzen)

Conclusions and recommendation

Epiphanies

Possibly the greatest revelation that emerged from this research was the extent of the ambivalence and mixed feelings in the families who suffered with alcoholic members. Generally it was found that there way a strong attachment to the alcoholic person, even when that person was abusive and destructive towards others. Another insight that the research provides was the realization of the extent to which members of the family are traumatized and in some cases themselves made ill by the presence of alcoholism in the family.

A third aspect that was a minor revelation and that was worse than initially expected was the often terrible consequences to the lives of children in families. Furthermore the interviews and literature also point out that that these effects have consequences in terms of education and psychological development later in life.

Another aspect that stood out in the interviews was the fact formal rehabilitation did not seem to be seen in as positive a light as the literature seemed to indicate. Many interviewees also expressed the view that family based intervention was more successful. However it must also be borne in mind that the participants were randomly selected and there were few who had been involved in formal rehabilitation methods.

3.2. Connections

It must be admitted that the literature research that as undertaken was influenced unconsciously to a certain extent by the interviews that had been undertaken: however almost all of the themes and central factors in the interviews could be related to the research articles and data. Many of these connections have already been referred to in the literature reviews above.

One of the connections between the literature and the interviews that have not been mentioned at any great length but which is important is the effect that alcoholism has on relationships. In almost every interview the strain on relationships in one for or anther was mentioned. However, in some instances, and this is a factor that is noted in the literature, relationships are sometimes strengthened by the trial and tribulations of alcoholism. This usually occurs when the one partner or the family members rally around the alcoholic and lend total support in an effort to help that person. On the other hand the literature is also replete with cases studies that show the way the alcoholism erodes relationships.

A connection that must also be mentioned was the significance attached to the stigma of alcoholism. This a potentially complicating aspect in terms of the recovery and rehabilitation of the alcoholic in that the family tends to deny that fact of alcoholism to themselves and to the outside world. In many cases the interviewees did not even attempt to take the alcoholic to a rehabilitation clinic or address the problem in a formal way.

3. 3. Recommendations

One of the central recommendations in terms of the research would be further exploration of the areas of interaction between family history, genetics and social and environmental influences.

This would go along way to developing appropriate strategies to help the alcoholic and their families. It is also an appropriate area of research in the light of the ongoing discoveries in genetic science.

While there are many aspects that could be mentioned in terms of research possibilities, one that that is central to this particular study is the importance of a more holistic approach to rehabilitees. In other words, the issue of the stigma attached to alcoholism should in the first instance be addressed and pressure of societal censure lifted for the families of alcoholics. This should be followed by an integrative approach to therapy which would include family members and not just the alcoholic.

A central reason for this approach is that the research and study of the problem and the responses of the interviews are strongly indicative of the fact that the family suffers as a whole and not just the alcoholic. Therefore intervention strategies need to include all members of the family. The second reason for this suggested approach goes to the very heart of the results of this study. In understanding alcoholism in the family one cannot separate the alcoholic from the family milieu. This refers to the insights gleaned from the interviews and literature that the only truly effective therapy and rehabilitation would be one that includes the entire family. Alcoholism in the family is often a complex result of many factors that involves and relates to all family members. This complexity of the interactions and connections between the family members should be taken into account towards a more integrated and comprehensive way of dealing with this serious problem.