files.eric.ed.govDOCUMENT RESUME ED 335 623 CG 023 616 AUTHOR Austin, Gregory; Prendergast, Michael TITLE Young Children of Substance Abusers. Prevention Research Update No. 8. INSTITUTION

DOCUMENT RESUME

ED 335 623 CG 023 616

AUTHOR Austin, Gregory; Prendergast, Michael

TITLE Young Children of Substance Abusers. PreventionResearch Update No. 8.

INSTITUTION Western Center for Drug-Free Schools andCommunities.

SPONS AGENCY Department of Education, Washington, DC.

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Serials (022)JOURNAL CIT Prevention Research Update; n8 Wir 1991

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DESCRIPTORS *Adolescents; Alcoholism; *At Risk Persons; Children;Drug Abuse; Elementary Secondary Education; ParentChild Relationship; School Role; *Substance Abuse

IDENTIFIERS *Children of Alcoholics; *Children of SubstanceAbusers

ABSTRACTThe stated objectives of this document are: to

increase awareness of and clarify the risks facing children ofsubstance abusers (COSAs) through a review of recent empiricalresearch literature; and to examine the prevention and interventionissues involved in providing services to these youth in the schools.The literature review deals mainly with children of alcoholicsbecause of the longer history and greater prevalence of alcoholism inthis country and the relative lack of research on children of otherdrug abusers. The similarities and differences between childrenaffected by parents who use different drugs are clarified as much aspossible, particularly as much less is known about the effects oftheir illicit drug use. The focus is specifically on adolescents.Terminology issues centering on COSAs, Children of Alcoholics (COAs),

and Children of Other Drug Abusers (CODAs) are discussed. Specifictopics discussed include: (1) prevalence; (2) characteristics andproblems of COAs and CODAs; and (3) prevention and intervention,including id3ntification and assessment, labeling, program goals andtechniques, parental involvement, and program evaluations.Twenty-seven abstracts of research studies involving COSAs areincluded. An extensive list of references is included, as well as aselected list of some of the main sources on services for children of

substance abusers. (ABL)

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Prevention Research UpdateNo. 8

Winter 1991

YOUNG CHILDREN OF SUBSTANCE ABUSERS

2ar West Laboratory for EducationalResearch and Development

730 Harrison Street

San Frandsco, California 94107.1242

Northwest Regional Educational Laboratory101 S.W. Main Street, Suite 500

Portland, Oregon 97204

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REST CoPY AVAILABLE

The Southwest Regional

Educational Laboratory

4665 Lampson Avenue

Los A tamitos, California 90720

Prevention Reset-vet Update

Gregory A. Austin, EilitorSouthwest Regional Laboratory

Western Center for Drug-Free Schools and CommunitiesJudith A. Johnson, Director

Northwest Regional Educational Laboratory101 SW Main Strett, Suite 500Portland, OR 97204(503) 275-9500

Field Office1164 Bishop Street, Suite 1409Honolulu, Hawaii 96813(808) 532-1904

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© 1991 NWREL, Portland, Oregon

Permission to reproduce in whole or in part is granted with the stipulation that the WesternRegional Center for Drug-Free Sciaools and Communities, Northwest Regional EducationalLaboratory, be acknowledged as the source on all copies.

The contents of this publication were developed under Cooperative Agreement NumberS188A00001 with the U.S. Department of Eclucation. However, the contents do not necessarily

represent the policy of the Department of Education, and endorsement of the contents by thefederal government should not be assumed.

Plow Gannon 12(1)Yth VpcIe2t;ino. 8 / Winter 1991

YOUNG CHILDREN OF SUBSTANCE ABUSERS

Gregory Austin, Ph.D.Michael Prendergast, Ph.D.

Western Center for Dmg-Free Schools and CommunitiesSouthwest Regional Laboratory

4

Prevention Research Update is a quarterly current awareness service, pre-pared by the Western Center for Drug-Free Schools and Communities,which summarizes recent research on adolescent drug abuse and its preven-tion. Each issue abstracts and reviews the prevention implications of newresearch dealing with a major topic of concern in the field, placing the newinformation in the context of past findings. The goal is tu help bridge thecommunications gap between the researcher, the practitioner, and the gen-eral population, by disseminating research fmdings in an accessible mannerand providing an introductory review of their significance. Abstracts arearranged alphabetically by first author's last name. Preceding the abstractsis an overview discussion in which references to abstracted studies areidentified by an asterisk (*). References to all documents cited are locatedfollowing the abstracts. Copies of the Updates are available from all theWestern Center sites, listed on the last page of this issue.

CONTENTS

OVERVIEW 1

Introduction 1

Terminulogy Issues 2Methodology Issues 3

Prevalence 4Alcohol 4Other Drugs 5Conclusion 5

Characteristics and Problems 6Children of Alcoholics and Alcohol Abusers 6

Risk of AOD Use and Abuse 8Health Effects 8The Alcoholic Family 9Psychosocial and Psychiatric Problems 11Resiliency Factors 14Conclusion 16

Children of Other Drug Abusers 17The Drug-Abming Family 17Risk of Drug Abuse 18Psychosocial Problems 19Health Problems 19Conclusion .21

Prevention and Intervention '?,1

Identification and Assessment 22Labeling 23Goals, Strategies, and Techniques 24

Regular Classroom Techniques . 24Generic AOD Education Programs 24COSA Programs . 24Student Assistance Programs 25

Programs for Drug-Exposed Children 26Parental Involvement 26Programs Evaluations 28

CASPAR 28SMAAP 28

Conclusion 29Issues in Research and Practice 29Conclusions 31

ABSTRACTS 33

REFERENCES 51

Author Addresses 66Organizations, Programs, and Resource Materials 68

OVERVIEW

INTRODUCTION

One of the most discussed specialpopulations at risk of alcohol and other drug(AOD) abuse and related problems is childrenof substance abusers (COSAs); that is, peoplewho are raised by parents addicted to or heavyabusers of alcohol and other drugs. Thispopulation has long been characterized as atexceptionally high risk of becoming AODabusers themselves as well as of developing awide range of social, behavioral, andemotional problems stemming from thedysfunctional family life that results fromparental AOD abuse. Much of this discussionhas focused around adult children of alcoholics(COAs). In this Update we focus on thecurrent state of knowledge about school-agechildren of both alcoholics and other drugabusers.1

Concerns over the effects of parental AODabuse on children run throughout history. Inthe West, these concerns have focused on al-cohol, the drug of choice. In particular, thespread of gin consumption among poorwomen in 18th-century London sparkedwidespread concern (Austin et al. 1985).Temperance tracts beginning in the 1830s de-scribed the many negative effects of maledrunkenness on families, emphasizing that itled to subsequent alcohol problems in childrenand even hereditary degeneration, as well as tonumerous economic and social hardships andother detrimental impacts on family life. Thechild as victim was an especially strong themewithin the Woman's Christian TemperanceUnion.

Such concerns subsided in the aftermath ofProhibition, when alcoholism was primarilyviewed as an individual problem of a smallsegment of the population. Indeed, the pri-mary image of the alcoholic was that of a sin-

1We are grateful for the comments and criticism of thisreview provided by Margret Dugan, of the NationalAssociation for Children of Alcoholics; MichaelFitzgerald, drug education consultant in the NevadaDepartment of Education; Jeannette Johnson of theUniversity of Baltimore, Maryland; and Richard Yoast,of the Wisconsin Clearinghouse. In addition, we wouldlike to acknowledge the ar3istance provided by AnnBickel, Karen Fie land, and Melinda Jones of theWestern Regional Center for Drug-Free Schools andCommunities.

gle, homeless male--the skid-row drunkard--cut off from all ties to the family. MargaretCork's 1969 book, The Forgotten Child,heralded a new awareness that the most com-mon environmental setting in which to find analcoholic is "a stnicturally intact, and by andlarge completely functioning, family"(Steinglass 1987:21). The problems faced bythe children of alcoholics (COAs) were dis-cussed in terms of a neglected, hidden tragedyinvolving numerous unseen casualties. In1974, the National Council on Alcoholismcreated a Department of Prevention and Educa-tion, which decided to focus on COAs as thepopulation most at risk of becoming al-oholicsthemselves, and in the same year the NationalInstitute on Alcohol Abuse and Alcoholismcontracted for a study on the needs and re-sources for COAs (O'Gorman 1982:37-38).

As in the 19th-century temperance tracts,concerns were not limited to the risk COAsfaced of becoming alcoholics themselves. Bythe late 1970s, clinicians began describingclients who did not have alcoholism problemsthemselves but who came from alcoholic fami-lies and seemed to be manifesting a particularset of other adverse characteristics (e.g., lowself-esteem, inability to achieve intimacy). Al-coholism came to be recognized as a "familydisease" on the premise "that the sharing of thedysfunctional behavior of the alcoholic by theother family members through the adoption ofindividual dysfunctional behaviors is likesharing the disease of alcoholism" (NIAAA1985:4).

Responding to, and in many ways fueling,these changing perceptions, a vigorous grass-roots movement with evangelical overtonesemerged encompassing clinicians and coun-selors, 12-step programs, national organiza-tions, and popular media (Williams 1990:210-211; Seilhamer and Jacob 1990:168). Thismovement has sought to address the concernsof COAs and improve public understanding oftheir problems. Formal advocacy organiza-tions have been created (notably the Childrenof Alcoholics Foundation, founded in 1982,and the National Association for Children ofAlcoholics, founded in 1983), and a cottageindustry has evolved for the counseling andtreatment of COAs.

Furthermore, as a result of the normaliza-tion of illicit drug use over the same period,awareness of the problems of children whose

Prevention Research Update 8

parents are dependent on other drugs has alsogrown. The rise of cocaine and crack addic-tion among women has produced a sense ofurgency over the need to develop programs todeal with a new generation of youth adverselyaffected by maternal drug use during preg-nancy.

Despite these efforts, considerable uncer-tainty surrounds the scope and nature of theproblem as well as the most effective means todeal with h. The public remains only vaguelyaware of the risks faced by COSAs. ThisUpdate aim:, first, to increase awareness of,and clarify, the risks facing COSAs through areview of recent empirical research literatureand, second, to examine the prevention andintervention issues involved in providingservices to these youth in the schools.2 Thisreview deals mainly with children of alcoholicsbecause of the longer history and greaterprevalence of alcoholism in this country andthe relative lack of research on children ofother drug abusers. At the same time, we havesought to clarify as much as possible thesimilarities and differences between childrenaffected by parents who use different drugs,particularly as much less is known about theaffects of their illicit drug use. Whereas muchof the literature deals with adult COAs or thepopulation as a whole, we are specificallyconcerned with adolescents.

The focus is also on research rather than onthe large and growing body of clinically basedCOA literature directed at practidoners and thegeneral public. The concepts and techniquesof this literature are essential to anyoneproviding help to COSAs. Attention shouldespecially be directed to the early books onchildren of alcoholics that have influenced allsubsequent writers (e.g., Black 1981;Wegscheider 1981; Ackerman 1983; Woititz1983). But there are numerous practitionerhandbooks and self-help guides, whereasfindings from the research literature are lessfamiliar. We are concerned, however, with theconnection between research and practice;specifically, the extent to 'which research

2Although the literaturt on this subject spans theperiod from the 1960s to the present, the discussionemphasizes studies that have appeared since 1985. Forreviews of the earlier literature, see el-Guebaly andOfford 1977, 1979; Giglio and Kaufman 1990; Jacob,Favorini, et al. 1978; Watters and Theimer 1978; Westand Prinz 1987; Woilitz 1978; Woodside 1983, 1988,1988a).

2

supports the characteristics of COSAs asdescribed in the clinical literature.

It will be shown that youthful COSAs are apopulation at high risk of substance abuse andother problems and that prevention and inter-vention efforts in both schools and communi-ties need to be expanded to address theirneeds. However, many of the assumptionsand assertions made in the clinical and popularliterature about the scope and nature of thisproblem, much of it based on observations ofadult patients, is not supported by existingresearch dealing with youth. Although muchof the popular and clinical literature describesCOSAs, and particularly COAs, as apopulation almost universally at risk of aclearly defined syndrome, the researchsuggests considerable variability.

Before pmceeding to the review of the re-search itself, two general issues need to be dis-cussed: the confusion surrounding terminol-ogy and the limitations of the research.

Terminology Issues

The substance abuse field is plagued bymany definitional problems, and this is particu-larly the case in regard to COAs (children ofalcoholics) and COSAs (children of substanceabusers). There is a pronounced lack of claityin the use of these term that needs to be ad-dressed. Although COSA is the most com-monly used term to refer to the "illicit drug"equivalent of COA, conceptually the terms arenot equivalent since an alcoholic is not thesame as a substance abuser, who may or maynot be drug dependent. Furthermore,"substance abuse" is a generic term that refersto alcohol as well as other drugs.

A more appropriate equivalent to COAwould be "children of drug addicts" or"children of drug dependent parents." Thereare several problems with the use of the latterterms, however. The defining characteristic ofa COA or a COSA is not always parental de-pendency. In common usage, COA andCOSA do not just refer to children of parentswho are clinically defined as alcoholics or ad-dicts. In fact, many of the estimates of theprevalence of COAs are based on respondentperreptions that alcohol use was a problemwithin a family. For example, to identifyCOAs DiCicco, Davis, and Orenstein (1984)argue that drinking behavior that results in achild wishing that his or her parent woulddrink less should be considered "alcoholic,"

even though this might not conform to a strictclinical defutition of alcoholism.

In addition, the concerns about these chil-dren are not simply rooted in their risk of al-coholism or addiction per se, but more broadlyon the adverse effects that the child experiencesas a result of the parent's excessive AOD abuseand on the accompanying chaotic and stressfulfamily life. From the perspective of schoolprevention and intervention efforts, whether aparent meets the clinical criteria of alcoholismor addiction may be less important than that thechild exhibits problems related to parentalalcohol abuse, or feels troubled by it, to theextent that his or her development is impaired.In this context, it is important to remember thatany parental AOD use does not in iteselfwarrant classification of a child as a COSA.

Thus, for purposes of this Update, COAshould be understood to mean "children of al-coholics and alcohol abusers," although spe-cific studies of this population are confined toclinically diagnosed alcoholics. Similarly,COSA is used to refer to any child who experi-ences a dysfunctional family and personal lifeas the result of parental abuse of any licit or il-licit drug. The acronym CODA is used to referspecifically to "children of other drugabusers."

Distinguishing between children of sub-stance abusers, alcohol abusers, and otherdrug abusers is conceptually important. On theone hand, there are many similarities in theexperiences and problems faced by all childrenof substance abusers, as well as in theprevention and intervention strategies recom-mended for them. Furthermore, with thespread of multiple drug use, the number ofCOSAs is increasing. Alcoholics are oftenabusers of other substances, although alcoholis probably the drug that is most visible in thefamily. On the other hand, children of parentswho are predcminantly other drug abusers faceproblems stemming from the illegality of theirparents' drug use that are not faced by childrenof alcoholics. Becwise of these differences, aswell as the lop-sided nature of the literature,we will discuss children of alcoholics and chil-dren of other drug abusers separately.

Methodology Issues

Assessing the scope and nature of theCOSA population is made difficult by severallimitations in the research itself, although momrecent studies have managed to use designs

3

Young Children of Substance Abusers

and analyses that avoid many of them. Thesemethodological problems will be discussedfurther in the text as relevant, but they includethe following:3

Use of unrepresentative samples. Most re-search has been conducted on childrenwhose parents are in treatment and who amtherefore likely to be from families that aremore dysfunctional than those in which theparents are not in treatment, thereby ren-dering the results unrepresentative of thegeneral population of COSAs. Also, manyadolescent samples are unrepresentative ofthe general youth population (e.g., delin-quents) or combine children of differentdevelopmental stages.Study samples that are confined to sonsand fathers or to parents and children.Relatively little research is available onmothers or daughters.Failure to control for confounding vari-ables, such as psychiatric diagnoses in par-ents other than alcoholism (e.g., antisocialpersonality disorder, schizophrenia) anddrinking or drug use by the mother duringpregnancy. Thus, problems among chil-dren attributed to parental alcoholism mayactually be rooted in other parental disor-ders.Failure to control for substance use vari-ables (e.g., duration of use, severity of de-pendence) and for demographic and familyvariables.Interviewing or other data collection that isnot blind to the status of the subjects.Use of correlational rather than longitudinaldesigns, making it difficult to determinecausal or developmental factors.Inconsistent or imprecise definitions andmeasures of alcoholism, drug dependence,and ether variables.Failure to consider the clinical significanceof differences found between groups in re-search studies, so that the practical implica-tions of the research are unexplored.Reliance on a single source or instniment,raising questions about the validity of theassessment or diagnosis.

3This summary of the limits of COSA research wasdrawn from Drake and Vaillant 1988; el-Guebaly andOfford 1977, 1979; Jacob 1987; Jacob and Leonard1986; Kumpfer and DeMarsh 1986; Roosa, Sandler, etal. 1988; Tarter, Jazob, and Bremer 1989; and West andPrinz 1987.

9


Use of control groups that are not compa-rable to the treatment group.

These limitations make it difficult to gen-eralize the results of a particular study to theentire population of COSAs, to infer causalpathways between parental AOD abuse andproblems in offspring, or to determine whetherproblems observed among COSAs are uniqueto them or whether they are typical of childrenfrom families that are generally dysfunctional(Burk and Sher 1988:287; see especially Westand Prinz 1987 for recommended methodolog-ical improvements in COA research). As fu-ture research addresses these methodologicallimitations, the validity and generalizability ofour knowledge of children of substanceabusers will improve. In the meantime, theselimitations need to be kept in mind while read-ing this review.

PREVALENCE

In terms of numbers a people affected, weknow much more about children from alco-holic homes than from homes in which otherdrugs are abused. The exact number of eitherpopulation is uncertain, however, in large partbecause of the methodological difficulties inidentifying this population, including thetendency of children from alcoholic or drug-dependent families to deny their status and lackof clarity and consistency in how thepopulation is defined.

Alcohol

Estimates of the number of COAs varygreatly, and figures are often cited withoutproviding any evidence as to their source. Forexample, on the high end, Allen (1983:165)simply states as fact that COAs comprise ap-proximately 25% of the school population.The generally accepted estimate of the numberof COAs in the United States is 12.5% of thegeneral population (28.6 million) and 10% ofthe under 18 population (6.6 million) (Russell,Henderson, and Blume 1985:1-2). This esti-mate was derived by the Children of Alco-holics Foundation in the early 1980s on thebasis of data from the 1979 National DrinkingPractices Survey (Clark and Midanik 1982), inwhich 15% of men and 6% of women wereclassified as problem drinkers on the basis ofloss-of-control and alcohol-dependency

4

scores. Strictly speaking, therefore, the 28-million figure refers to children of problemdrinkers rather than to children of alcoholics.Also, the figure may be an underestimatebecause the 1979 survey did not include peoplewho were in the military or in institutions orwho were homeless (Woodside 1988:643;Kumpfer and De Marsh 1986:50).

Only a few surveys have attempted to de-termine more precisely the number of COAs inthe youth population, and these have tended tobe based on small samples. Some have re-ported rates close to the 10% estimate givenabove. In a survey of 18-year-olds fromKauai, Werner (1986*) was able to identify7% of them as children from alcoholic fami-lies. A survey of 1,300 adolescents (ages 12-21) in New Jersey found that 10.6% had atleast one alcoholic parent and 9% had a grand-parent who was alcoholic (Pandina and John-son 1989*).

Other studies, using more liberal criteria,have found higher prevalence rates. Re-searchers at Arizona State University asked asample of high school students to complete theChildren of Alcoholics Screening Test(CAST); 18% of the students met the COAcriterion. Since the CAST measures concernabout parental thinking, not whether the parentmeets clinical criteria for alcoholism, the stu-dents are more properly labelled "self-identi-fied children of alcoholics," which may ac-count for the high percentage (Rcosa, Sandler,et al. 1988*). Similarly, in Lillis' (1987) sur-vey in New York, 17% of respondents statedthat one or both parents were alcoholic.

An even higher estimate of from 27% to30% was found by the CASPAR Alcohol Edu-cation program in Somerville, Massachusetts(DiCicco, Davis, and Orenstein 1984:5).These estimates were based on the number ofsaidents in junior and senior high schools whomponded "yes" when asked, "Have you everwishel that either one or both of your parentswould drink less?" The authors argue thatdrinking behavior that results in a child wish-ing that his or her parent would drink lessshould be considered "alcoholic." However, asuch perceptions are also influenced by whatyouths are taught in school. The highpercentage may also be related to the high rateof alcoholism in Somerville (its cirrhosis mor-tality rate is 65% above the national average).

In the absence of more reliable data, thefigure of 10% for preadolescents and adoles-cents proposed by Russell, Henderson, and

I 0

Blume (1985) is a reasonable, although possi-bly conservative, estimam of the number ofschool-age youth whose parents are alcoholicsor alcohol abusers. However, other studiesusing more liberal criteria suggest that as manyas 1 in 5 youth may be experiencing difficultiesbecause of, or have concerns about, their par-ents' drinking that may warrant attention fromschools.

Other Drugs

Even less is known about the number ofchildren with parents who are dependent on, orheavy abusers of, other drugs. Estimatescomparable to those for children of alcoholicsare even more difficult to make. As more andmore people use both alcohol and other drugs,it becomes increasingly difficult to distinguishfamilies on the basis of the type of drug theyuse. Furthermore, even more so than in thecase of alcohol, determining the prevalence ofCODAs is plagued by definitional problems.There is little doubt, however, that the normal-ization of drug use that occurred in the 1970sand early 1980s, especially the rise of cocaineuse, has greatly expanded the dimensions ofthe problem.

Rough estimates of the size of the popula-tim can be derived from the number of peoplein drug treatment, especially women who areof childbearing age. According to Weinsteinand West (1986), the largest growing popula-tion of substance abusers is women of repro-ductive age. In 1978, about 20% of drugtreatment slots funded by NIDA were forwomen, whereas by 1984 the percentage hadincreased to 30% (Kumpfer 1987:3). In asummary of earlier studies, Beschner andThompson (1981) reported that 67% to 73% ofwomen entering drug treatment had children,although not all had their children living withthem prior to treatment (cited in Deren1986:77).

Since about 1985, increased attention hasbeen focused on the growing problzm of in-fants who are exposed perinatally to drugs,particularly cocaine or crack. In Los Angeles,regional centers that perform developmentalevaluations of children have reported that 10-15 new referrals per month are of children witha history of fetal drug exposure to PCP,heroin, and/or cocairm. In the mid-1980s, theNew York City Department of Health reportedthat about 1,000 children were born to addictedwomen annually, which was acknowledged to

5


be an underestimate. In a nationwide surveyof 36 hospitals in 1988, the National Associa-tion for Perinatal Addiction Research and Edu-cation (NAPARE) found that 11% of new-borns had traces of illicit drugs in their bodies.This study is the basis for the frequently citedestimate that 375,000 babies exposed to illicitdrugs are born each year. Of these, 200,000are believed to have been exposed to cocaine,reflecting the fact that cocaine has become themost prevalent illicit drug used by pregnantwomen (Van Dyke and Fox 1990:160; Viadero1989; Deren 1986a:20). Some researchers,however, believe that the estimate of 200,000cocaine babies is too high; Besharov (1989)places the figure between 30,000 and 50,000.Rates also vary greatly between hospitals.Some hospitals with active drug screening andmaternal interview programs have reportedrates as high as 25% (Barry, White, andYoast, forthcoming). These figures, however,say little about the influence of fathers or otheradult males in the family who may be drugabusers.

Recently, the Institute on Medicine(1990:76-80) attempted to estimate the numberof Americans who are in need of treatment forthe use of drugs other than alcohol, using datafrom NIDA's 1988 National Household DrugSurvey. The report concluded that 4.6 millionAmericans over the age of 12 were clearly orprobably in need of treatment, or roughly2.3% of the total US population age 12 andover. What percentage of these have childrenis, however, uncertain, but it is likely that thefigure (2.3%) is an upper limit of the propor-tion of the population who are children ofdrug-dependent parents.

Conclusion

Taken together, the Russell and IOM esti-mates would indicate a total dependent COSApopulation (youth and adult) of about 14.8%,consisting of 12.5% COAs and 2.3% CODAs.This is considerably less than the statement thatoften appears in the literature that 20% of chil-dren (or one in five children in a classroom)live in chemically dependent families (e.g.,Woll 1990). Furthermore, there is undoubt-edly considerable overlap between COA andCODA families, suggesting that the totalCOSA population is probably less than thecombined COA and CODA figure given above.Nevertheless, depending on the definitionused, many more youth may be affected by

1 1


parental substance use to the extent of beingplaced at higher risk of developing AOD andother problems. The real challenge to the fu-ture is not so much in developing more accu-rate estimates of the prevalence of the popula-tion, which by any count is substantial, but inbeing able to identify more effectively the risksfaced by individuals from substance-abusingfamilies and developing programs that addressthose risks.

CHARACTERISTICSAND PROBLEMS

The research literature on the characteristicsand problems of COAs and CODAs can be di-vided into four general areas: (1) the risk ofdeveloping alcoholism or other drug abuse; (2)health effects, including somatic problems andfetal effects; (3) the characteristics of COSAsfamilies and the ways children try to cope withliving in such a family; and (4) psychosocialand psychiatric disturbances, including emo-tional disorders, behavioral problems, va-demic difficulties, and cognitive deficits.There is some overlap in these categories, butthey serve as a convenient way to organize theresearch findings.

Children of Alcoholicsand Alcohol Abusers

For many decades, alcoholism was re-garded as a disease of the individual; few ther-apists or researchers were concerned with theimpact of alcohol on the family. More re-cently, however, it has come to be recognizedthat alcohol abuse in one or both parents af-fects all members of a family in a variety ofways, although the specific manner in which itdoes so is complex and far from being fullyunderstood.

The emphasis of most of the COA clinicalliterature has been on victimization. The bulkof it (e.g., Black 1981; Wegscheider 1981;Woititz 1983) emphasizes that COAs differfrom other children in terms of risk of AODabuse and negative psychosocial and physicalfunctioning, and that for many their parent'sdrinking is the central influence on their psy-chological development (Deutsch 1982). Forexample, Robinson (1990:68) writes: "Allchildren experience fear, anger, confusion,embarrassment, guilt, and shame, but COAsexperience these emotions in greater depth and

6

intensity and with greater frequency. Theirfeelings, personalities, and behaviors aremolded more by the fact of alcoholism than byany other force. Parental drinking becomes themajor driving force in their young lives, andeverything revolves around it."

Indeed, there is a tendency to assume thatexposure to parental alcoholism by itself re-sults in child pathology, that alcoholism is uni-versally stressful for families, and that allCOAs are impaired in some respect and in needof intervention regardless of whether they aresymptomatic or not (Williams 1990). Somewriters assert that adult COAs exhibit acohesive and distinctive clinical pattern and thatany appearance of competence is illusory(Balis 1986). Coping skills that nonsymp-tomatic children of alcoholics exhibit are evenconsidered to lead to dysfunction in adulthood(Black 1979).

A related assumption is the concept ofcodependency, "the view that the dynamics ofalcoholism, if not the actual alcoholic behavior,are inevitably shared by all members of thefamily and that the same principles of recoveryapply to family members as apply to thealcoholic" (Blane 1988). Some practitionersargue that codependency should be adiagnostic syndrome in and of itself (e.g.,Cermak 1986).

The research does support clinical findingsthat COAs are at high risk of developing AODabuse and other problems. But it also showsthat there is marked variation within the COApopulation and that COAs are not at equal riskof developing significant problems.

Risk of AOD Use and Abuse

COAs, especially males, are at higher riskfor becoming alcoholics and alcohol abusersthan is the general population. Most clients intreatment for alcoholism or drug dependencehave had alcoholic parents or relatives. Twinand adoption studies have shown that sons ofalcoholic fathers are four times more likelythan sons of nonalcoholic fathers to become al-coholics, with the risk being 9-10 times higherof developing alcoholism in early adulthood(Goodwin, Schulsinger, et al. 1973). Fedaughters of alcoholic mothers, the risk isthree times higher (Bohman, Sigvardsson, andCloninger 1981), and if they do not become al-coholic themselves, they are likely to marry al-coholic men (Nici 1979). Sons of alcoholicsare at least twice as likely to become alcoholics

1 2

as are daughters of alcoholics; alcoholic moth-ers are more likely to have alcoholic sons ordaughters than are alcoholic fathers (Kumpferand De Marsh 1986:57-58).

Whether this risk from parental alcoholismis primarily caused by genetic or byenvironmental factors has been much debated.The large body of literature on the geneticaspects of alcoholism cannot be summarizedhere in detail.4 It is evident that genetic factorsdo place COAs at higher risk. At least oneform of alcoholismcharacterized by early on-set, severe symptomatology, the need for ex-tensive and early treatment, and almost alwaysconfined to males, often with antisocial per-sonalities--has a substantial genetic basis. Butgenetics is far from adequate to explain whysome COAs become alcoholic and some donot. At best, it explains a portion of the varia-tions in severe types. The extent to which al-coholism in offspring is influenced not by ge-netics but by exposure to alcohol in utero hasyet to be determined. It is also evident thatenvironmental factors, particularly the manydysfunctional aspects of some COA families,have a ignificant effect as well (Cadoret 1990;Searles 1990; Barnes 1990). These factors willbe discussed in more detail below.

Researchers have also studied the effect ofhaving alcoholic parents on adolescentchildren's patterns of alcohol and other druguse, but with mixed results. Pandina andJohnson (1989*) conducted a prospectivelongitudinal study of a large community-basedsample (n=1,380), in which they compareddrinking and drug use by adolescents andyoung adults from four different types offamilies: (1) alcoholic parent; (2) motherand/or the father consumed alcohol at highquantity or frequency (this group could haveincluded undiagnosed alcoholics); (3) highstress levels but not alcoholism or heavydrinking; and (3) no-risk, "normal" parents.Contrary to expectations, none of the groupsdiffered on several of the main study variables:levels of use fur alcohol, marijuana, or otherdrugs; age of first intoxication; or use of al-cohol or other drugs as a means of coping with

4For reviews of the role of genetics in the etiology ofalcoholism, see Goodwin 1985; Lester 1989; Murray,Clifford, and Gur ling 1983; Pee le 1986; Searles 1990,1990a; Secretary of Health and Human Services 1990;Wardle and Searles 1990; and Zucker and LisanslyGomberg 1986.

7


problems. Although children from alcoholicfamilies were more likely than children in theno-risk group to report negative consequencesfrom alcohol and other drug use, the three riskgroups (alcoholic, heavy drinking, and stress)showed few differences in negativeconsequences. Among the oldest subjects (age21), COAs and children of heavy drinkers didreport significantly more episodes ofdrunkenness than did the other two groups.

Overall, the results of this study indicatethat adolesmit children of alcoholics arelargely indistinguishable from children ofnonalcoholics on a variety of indicators ofdrinldng and drug behavior (see also Pandinaand Johnson 1990*). A similar result wasfound in a study of Swedish male adolescentswith alcoholic fathers; the COAs in this studydid not differ significantly from non-COAs indrinking patterns or drinking history (Knop,Teasdale, et al. 1985).

Although these two studies suggest that notall adolescent COAs are at high risk of devel-oping AOD problems, the subjects in bothstudies had yet to enter the period of highestrisk for heavy drinking and serious alcoholproblems, that is, the late twenties and earlythirties. Furthermore, other studies havefound differences in AOD use between COAsand non-COAs. In a study comparing collegemales having both first- and second-degreerelatives who were alcohol-dependent withstudents having only first degree affected rela-tives and students having no affected relatives,McCaul, Turkkan, et al. (1990) found that thesubjects with first- and second-degree alco-holic relatives had higher rates of alcohol andother drug use, began using alcohol and mari-juana at an younger age, and had more AODproblems. Johnson, Leonard, and Jacob(1986) also reported that children of alcoholicswere at risk for both alcohol and drug abuse.

Unfortunately, little is known about therelationship of adolescent and adult use amongCOAs, although in the general populationadolescent abuse has not proved predictive ofadult abuse (see Donovan, Jessor, and Jessor1983; Temple and Fillmore 1986, cited inWilliams 1990). This points to the need to un-dertake more longitudinal studies that followCOAs from adolescence through young adult-hood.

In summary, contrary to the impressionoften given in the COA literature, "as manyCOAs don' t become alcoholics as those whodo" (Blanc 1988:796). Far more research is


needed to determine the reasons for thesevariations. The likelihood of COAs becominginvolved in alcohol or other drug abuse and thedegree of severity of the problem are mediatedby a variety of factors that increase or decreasethe risk of AOD use. Whereas there is a ge-netic component in the risk for some forms ofalcoholism, many components of a family'spsychosocial environment seem to increase ordecrease the likelihood for intergenerationaltransmission of AOD dependency. Thefollowing are among a variety of factorsidentified as increasing the risk that children ofalcoholics will become AOD dependent them-selves:5

Age of the child when parental substanceabuse begins;Degree of involvement in substance abuseof the primary caretaker,Nonfulfillment of parental responsibilities;Severity of emotional, physical, educa-tional, and spiritual neglect or abuse;Temperament of the child and role the childassumes in the family;Social isolation of the child and family;Degree of family stress due to inconsis-tency in rules, rituals, discipline, etc.;Degree of family conflict and lack of coop-erative, supportive behavior;Degree of open modeling by parents or sib-lings of drug or alcohol abuse;Presence of both alcoholism or substanceabuse and severe psychopathology in theparents.

For example, risk of alcoholism appears tobe increased when parental alcoholismcompounds other mental health problems andwhen both parents are alcoholics.Merikangas, Weissman, et al. (1985*) foundthat offspring of depressed parents with sec-ondary alcoholism were three times more likelyto be alcoholics than were offspring of parentswith depression alone. Offspring had a two-fold greater risk when both parents werealcoholics.

5 This list is taken from Jacob and Leonard 1986;Kumpfer and De Marsh 1986; and Lawson, Peterson,and Lawson 1983.

8

Health Problems

Parental alcoholism can have a variety ofhealth effects on their children. A number ofstudies conducted in the 1960s and 1970sfound that children of alcoholics had a higherincidence of somatic problems than did controlchildren: headache, abdominal pain,palpitations, tiredness, general debility,vomiting (in infancy), asthma, and hypersensi-tivity to noise, light, and temperature(Nylander 1960; Schneiderman 1975; Fine,Yudin, et al. 1976). Only limited confirmationof these findings have been found in the morerecent literature, however.

For example, a small study by Biek (1981)found that among adolescents seen at a clinic(mainly female), COAs had nearly twice asmany somatic complaints as did adolescentswho indicated no history of parental alco-holism (9.3 vs. 4.9). A study based on twomillion health insurance subscribers inPennsylvania found that COAs (through age19) spent more days in the hospital than didothers (an average of 7.6 days per year vs.5.9), although the specific reasons foradmission were not stated (cited in Woodside1988:644). By contfast, two studies (Moosand Billings 1982; Rimmer 1982) found nosignificant differences in health problemsbetween children with and wit%out alcoholicparents.

An additional risk for this population ischild abuse; it has been estimated that between20% and 70% of child abuse and neglect casesinvolve alcoholism, althnugh many of thestudies on which these estimates are based suf-fer from poor research designs or other limita-tions (Deren 1986:89; Famularo, Stone, et al.1986; West and Prinz 1987:212-213). Pre-sumably, a significant number of cases of childabuse also involve parental drug abuse or ad-diction.

Fetal alcohol syndrome

Of all the potential adverse health effectsthat COAs can experience, the mostdevastating and thoroughly studied are thosethat result from maternal abuse duringpregnancy (prenatal or perinatal use).Although the adverse effects of fetal andneonatal alcohol exposure have been knownfor centuries (Warner and Rosett 1975), the"fetal alcohol syndrome" (FAS) was first clini-cally recognized in the United States as a dis-

1 4

tinct set of birth defects in 1973 (Jones apdSmith 1973; Clarren and Smith 1978). Thesyndrome has four main characteristics: cen-tral nervous system dysfunction, abnormalfacial features, behavioral deficits, and growthdeficiency. A large body of literature hasdocumented the effects of alcohol on prenataland postnatal development and has exploredthe mechanisms that underlay these effects.Research on animals and humans has firmlyestablished that alcohol crosses the placentaand can affect the development of the embryo,resulting in both morphological and behavioraldeficits in the infant, with the severity ofimpairment varying with the level of drinkingduring pregnancy. FAS is the leading cause ofpreventable mental retardation in the Westernworld (Abel and Sokol 1986).

The incidence of FAS in the general popu-lation has been estimated to be 1.9 cases per1,000 live births; among heavy drinkingwomen, the incidence may reach as high as 20cases per 1,000 live births (Abel 1982; Secre-tary of Health and Human Services 1990:139-140). As children with fetal alcohol syndromemature, they typically exhibit developmentaldelays, hyperactivity, varying degrees ofmental retardation, and lower IQ scores. Inone sample of 20 children with FAS, the aver-age IQ score was 65, with the range from 15 to105. The degree of IQ impairment varied withthe severity of the FAS diagnosis (Streissguth1986:217, 220).

A major longitudinal study of children withFAS has been conducted at the University ofWashington in Seattle since the mid-1970s.Two recent reports from this study have exam-ined the long-term effects of perinatal alcoholexposure on behavior, development, andlearning among children of pre-school andelementary-school age. Streissguth, Barr, etal. (1989*) examined the relationship betweenmaternal alcohol use during pregnancy andchild IQ as measured at four years of age.Analysis of data from 421 mother/child dyadsindicated that consumption of an average ofthree drinks per day during pregnancy wassignificantly associated with an average decre-ment of nearly five IQ points, even after ad-justment for a variety of potentially confound-ing variables (e.g., education, race, smoking,medicinal drug use, child's sex and birthorder, and postnatal care). This decrement re-sulting from perinatal alcohol exposure trans-lates into a tiipling of the risk of subnormalintelligence (IQ < 85) for a child with an

9


"average background." (The authors cautionthat three drinks a day should not be regardedas a "safe" drinking level since other outcomemeasures more sensitive than IQ have shownsignificant effects at lower levels of consump-tion.)

Streissguth, Barr, et al. (1986) evaluatedthe same group of children at age seven, exam-ining the effects of perinatal alcohol exposureon attention, as measured by a computer-gen-erated vigilance task. After adjusting for po-zential confounding variables, it was found thatperinatal alcohol exposure was significantlyrelated to decrements in attention and reactiontime. Error scores on the vigilance task werealso significantly related to examiner ratings ofendurance, persistence, organization, dis-tractibility, and impulsivity. The lowered at-tention and distractibility scores and the slowerreactions times observed under laboratoryconditions are likely to translate into poor per-formance in the classroom. More research isneeded to determine how these attentionaldeficits specifically affect classroom learningand whether they persist into adolescence.

Supporting this evidence of learning im-pairment is a follow-up study of FAS childrenin Germany who were assessed at about age 4and again at age 8 (Spohr and Steinhausen1987; Steinhausen, Gobel, and Nestler 1984).The investigators found that while the childrenshowed some improvement in several behav-iors, other problems that were evident at age 4showed no improvement four years later, par-ticularly cognitive deficiencies. A large pro-portion of the children in the study requiredspecial education.

Although the link between maternalalcoholism and fetal effects is clear, researchalso indicates that the severity of the problemsdepends on other variables, such as the ade-quacy of prenatal care and the socioeconomicbackground of the mother (Bingol, Schuster,et al. 1987).

The Alcoholic Family

Beyond tne risk of adolescent alcoholabuse itself, the COA literature emphasizes thatparental alcoholism creates, or is associatedwith, a wide variety of unhealthy and stressfulsituations and behaviors in the family. Adetailed discussion of these related familyproblems is beyond the scope of this Update.Suffice it to say that families of alcoholicparents (alcoholic families) have been found to

5


exhibit a variety of problems that interfere withhealthy social, emotional, and professionalfunctioning. As summarized by Kumpfer andDe Marsh (1986:69-75), these problemsinclude:

High levels of stress;Inadequate family resources (whether oftime, finances, or emotional support);Poor life skills and family managementtechniques;Lack of family stability (frequent moves,separation, divorce, prison, death);Few family rituals;Social isolation;Decreased family cohesion;Emotional neglect of children;Less time spent with children;Family conflict;Low emphasis on prosocial values, on au-thority and tradition, on academic achieve-ment, and on religious, social, and culturalinvolvement;External locus-of-control orientation; andHigh, unrealistic expectations for theirchildren.

Woititz (1983) has listed the following asthe most common problems of adult COAs:guessing at what constitutes normal behavior;difficulty completing projects; lying whentelling the truth would be just as easy; harshself-judgments; taking oneself too seriously;difficulty having fun; difficulty establishingintimate relationships; constant need forapproval and affirmation; being excessivelyresponsible or excessively irresponsible;excessive loyalty; need for control; difficultyexpressing feelings; distrust of others; andtaking care of other people while ignoringone's own needs and desires.

Family roles

A central concept in the COA literature isthat of family roles within the alcoholic family.In the 1970s, therapists who worked withchildren of alcoholics, drawing on the familysystems theory of Virginia Satir (1972), iden-tified distinct but often overlapping role behav-iors that family members adopt in order to copewith the unpredictability, stresses, and incon-sistency of the alcoholic family. The roles en-able family members to survive by providing"a rigid set of defenses and compulsive behav-ior patterns" that protect against the excessive

stress caused by the alcoholic's drinking(Rhodes and Blackham 1987*:146). Theseroles help the child to survive and function inthe dysfunctional family situation. They maskthe pain, anger, confusion, and isolation thatthe child is experiencing. Nevertheless, it isargued that, while these roles are functional inchildhood, they have a negative impact uponchildren's academic behavior and emotionaland social adjustment. Furthermore, theseroles tend to become rigid and increasinglydysfunctional as they continue to operate intoadulthood, adversely affecting adult relation-ships and performance and making it difficultfor adult children of alcoholics to lead happy,satisfying, and fulfilling lives.

The most widely used role typologies arethose developed by Sharon Wegscheider(1981) and Claudia Black (1981). Wegschei-der's roles are the Family Hero, the Mascot,the Scapegoat, and the Lost Child. Black usesdifferent terms for similar behaviors: the Re-sponsible Child, the Adjuster, the Placater, andthe Acting Out Child. According to role the-ory, children of alcoholics may adopt morethan one of these roles, but one tends to pre-dominate.

For example, clinical literature (Black1981; Woititz 1983) describes the "responsiblechild" and the "family pet" as characterized bymaturity, achievement, or even super-achieve-ment. While this appears to be adaptive behav-ior and the child appears normal, clinicians ar-gue that it is actually a way for both the COAand the other family members to escape fromthe reality of parental alcoholism and that itcovers up symptoms of psychopathology.Regarded in this way, what is normally viewedas admirable behavior and healthy becomes asign of personal pain and denial (Burk andSher 1990:162).

The notion of roles was developed on thebasis of clinical observation and experience,and they have been widely disseminatedthrough lay literature and COAs programs.But little research has been conducted to con-firm their validity and reliability. Three studieshave been identified that do address these is-sues, and all three found only limited supportfor COA roles as they are currently defined.

Mannitl, Balson, and Xenakis (1986*)assessed children of alcoholics to determinewhether they were more likely to exhibit TypeA personality than were controls. Type A per-sonality is defined by the authors as "a rela-tively chronic struggle to achieve a series of

10

1 6

poorly defined goals in the shortest period oftime possible and is marked by competitiveachievement, striving, time urgency, impa-tience, aggression, and hostility" (p. 184).These traits appear to be an attempt to assertcontrol over uncontrollable events, whichwould describe the situation of children of al-coholics, particularly those who adopt the"Family Hero" role.

In separate ratings by nonalcoholic mothersand alcoholic fathers of two measures of TypeA personality (competitiveness and impatience-aggression), in only one case was there a sig-nificant difference between COAs and controls(mother's rating of impatience-aggression). Athird study that assessed Type A personality asrated by COAs themselves (in grades 4-12)found no significant differences with the con-trol group. Also, first-born COAs were nomore likely to exhibit Type A behavior thanwere other COAs. This is contrary to thecommon observation in the clinically basedCOA literature that the oldest child is normallythe "Family Hero" and would thus be morelikely to exhibit Type A personality character-istics (Deutsch 1982; Wegscheider 1981).Still, as the authors point out, the results oftheir study are "good news" for children of al-coholics, particularly the eldest in the family."Even holding aside the implications for coro-nary-artery disease in adulthood, the quality oflife of type A individuals is lower than forothers lot marked by their hurtful traits of im-patience, hostility, and aggression" (p. 189).

Williams and Robbins (1987) also failed tofind strong support for the four roles describedby Wegscheider and Black. Responses byadult COAs (college students) on the Interper-sonal Adjective Scale-Revised fell into fourclusters, but these clusters could not bematched with the postulated roles in alcoholicfamilies. According to the authors, "All fourclusters appear to be Placater profiles, or somecombination of Placater-Hero-Mascot profiles.Furthermore, clusters for non-ACOA data donot appear to differ to any great degree fromACOA clusters, with a virtual one-to-one cor-respondence of clusters. In addition, ACOAswere not found to diffi r significantly fromnon-ACOAs in self-reported demographic,psychological, and adjustment variables." Theauthors note various weaknesses of their studyand emphasize the problems involved in con-ducting research in this field, but their resultsdo suggest caution in using the concept ofroles to identify or work with COAs.

11)


Finally, Rhodes and Blackham (1987*)compared adolescents from alcoholic and non-alcoholic families as to whether they perceivedthemselves as exhibiting the behaviors or atti-tudes indicative of Black's four roles(responsible child, placater, adjuster, and act-ing-out child). COAs scored significantlyhigher than controls only on the acting-outrole; their mean scores on the placater and ad-juster roles were higher, but only approachedsignificance; and their mean score on the re-sponsible child role was virtually identical tothat of the control group. While femalesscored higher than males on the placater role,this is more likely explained by gender social-ization practices than by family alcoholism.Also, the four roles were not consistently as-sociated with birth order. Similarly, Manning,Balson, and Xenakis (1986*) reported thatType A behavior among COAs could not bedifferentiated on the basis of birth order.

In considering the results of these studies,it should be pointed out that children in alco-holic families, according to the clinical view ofroles, do not always follow the same role, butoften switch from one to another in differentsituations. Thus, these studies may not haveadequately captured this dynamic aspect offamily roles. Also, even though the COA rolesmay lack strong empirical validation, theynonetheless may have an important heuristicvalue in providing prevention and treatmertservices to this population. In any case, theconcept of roles in alcoholic families clearly isin need of further study and refmement beforemore credence can be placed on it. It is aninvestigation that would profit fromcollaborative studies conducted jointly byclinicians and researchers.

Psychosocial and Psychiatric Problems

On the whole, as West and Prinz(1987:214) concluded in a comprehensive lit-erature review, research supports "the con-tention that [parental] alcoholism is associatedwith heightened incidence of child symptoma-tology." However, again, there is consider-able variation in vulnerability.

Aronson, Kyllerman, et al. (1985) foundthat Swedish children of alcoholic mothersscored significantly lower than controls on avariety of developmental, perceptual, and be-havioral measures. This was one of the firststudies to document perceptual difficultiesamong children of alcoholic mothers. Study

1 7


group children raised in foster homes did notdiffer from those raised with their biologicalparents, suggesting that the observed deficitswere caused prenatally.

Bennett, Wolin, and Reiss (1988*) con-firmed findings reported in earlier studies thatchildren from alcoholic families have signifi-candy lower emotional and cognitive function-ing than do children from nonalcoholic fami-lies. Specifically, COAs scored significantlyless well on measures of IQ, reading, arith-metic, self-concept, behavior problems, emo-tional disorders, psychosomatic symptoms,learning problems, and impulsivity-hyperac-tivity.

Jacob and Leonard (1986*) found thatsons of alcoholic fathers were rated by theirparents as more poorly adjusted on measuresof social competence, behavior problems, andlearning disabilities than were sons of de-pressed fathers or of nonalcoholic fathers. Fordaughters, those with depressed fathers hadgreater deficits than did those with alcoholicfathers. The observed differences, however,were seldom large, and the mean scores werein the normal range. With the exception of asmall minority of children, the problems ex-hibited by the children of alcoholics and thechildren of depressed fathers in this study wereneither severe nor pervasive. In other words,most of the children, whether their fatherswere alcoholic, depressed, or neither, wouldnot be considered clinically impaired. Thefactor that distinguished COAs with severe im-pairment was not familial alcoholism itself, buta combination of having a father with frequentalcohol problems and severe psychopathologyand having a (nonalcoholic) mother with se-vere psychopathology.

Psychological and emotionalproblems

Research studies have found that COAs aremore likely than non-COAs to exhibit variousemotional and behavioral problems. Theseinclude social aggression, fighting, tempertantrums, truancy, impulsivity, disobedience,lying, and delinquency. COAs often have adiagnosis of conduct disorder (Russell,Henderson, and Blume 1985; Robinson1989:77-79).

Earls, Reich, et al. (1988*) studied the in-cidence of psychological and behavior dys-function in three groups of children: those ofalcoholic parents, those of antisocial parents,

and those of parents who were neither alco-holic nor antisocial. The specific childhooddisorders examined were attention deficit dis-order with hyperactivity, oppositional disor-der, conduct disorder, depression, and anxi-ety. A significantly greater number of meansymptoms and mean diagnoses were found inchildren from alcoholic and antisocial familiesthan in children from control families. Thehighest number of symptoms and diagnoseswas found in children from families in whichboth parents were alcoholic. For instance, at-tention deficit disorder was found in 12% ofthe children with neither parent alcoholic, in21% of the children with one parent alcoholic,and in 50% of the children with both parentsalcoholic. Overall, children of parents whowere both alcoholic and antisocial were two-to-three times more likely to exhibit at least one ofthe childhood disorders than were children ofparents with neither disorder.

Other studies have confirmed impairedpsychological functioning in COAs. Rolf,Johnson, et al. (1988*) reported that COAshad more problems with depressive affect thandid children from nonalcoholic families. DiCi-cco, Davis, and Orenstein (1984) examineddisturbances in the self-image of students ingrades 7 to 10 who were identified as beingfrom alcoholic and nonalcoholic families.COA students had a more external locus ofcontrol and lower scores on three of the fivesubscales of the Coopersmith Self-Esteem In-ventory (self, family, school).

Merikangas, Weissman, et al. (1985*)found that offspring of depressed parents withsecondary alcoholism were not only at greaterrisk of alcoholism but five times more likely tohave a diagnosis of antisocial personality-conduct disorder. There was a three-foldgreater risk of this disorder when both parentswere alcoholics than when only one was.

Moos and Billings (1982) investigated theemotional functioning of children from familiesof relapsed alcoholics, children from familiesof alcoholic parents in recovery, and childrenfrom families with no alcohol problems. Chil-dren of relapsed alcoholics reported higherlevels of depression and anxiety than did chil-dren from nonalcoholic families, but no signif-icant differences were found between childrenof parents in recovery and those of nonalco-holic parents. The results of this study indicatethat the emotional stress experienced by COAsdecreases when parents stop drinking.

Academic peiformance

Recent studies of academic performanceamong COAs have produced conflicting re-sults. Marcus (1986*) reported that childrenof alcoholic mothers (mainly white and middleclass) performed significantly more poorly onmeasures of academic achievement than didchildren of nonalcoholic mothers. Tarter,Hegedus, et al. (1984) reported similar resultsfor sons of alcoholic fathers. Ervin, Little, etal. (1984) comp.,....ed intellectual developmentand academic achievement in 50 children of al-coholic fathers and 50 children of nonalcoholicfathers, all of whose mothers were nonalco-holies. The IQ and academic achievementscores of the children of alcoholic fathers weresignificantly lower than those of the children ofnonalcoholic fathers, even when a variety ofconfounding variables were taken into account.Bennett, Wolin, and Reiss (1988*) found thatchildren from alcoholic families scored signifi-cantly less well than children from comparisonfamilies on measures of IQ, reading, and arith-metic. Results from a longitudinal study ofchildren on the island of Kauai indicated thatchildren whose alcoholic mothers drank duringpregnancy were particularly likely to exhibitlower academic performance (Werner 1986*).Knop, Teasdale, et al. (1985) reported thatsons of alcoholic fathers were more likely thansons of controls to have attended moreschools, to have repeated a grade, and to havebeen referred to a school psychologist (reasonsnot specified).

These conclusions would seem to contra-dict the observation in the clinical literature thatCOAs tend to be superachieving students. Onthe other hand, in several studies COAs didperform in the normal to high range (e.g.,Ervin, Little, et al. 1984; Bennett, Wolin, andReiss 1988*). Moreover, Johnson and Rolf(1988*) found that middle-class,nondelinquent children of alcoholics did notdiffer significantly on IQ or academicachievement from children of nonalcoholics.The two groups did differ, however, inperceptions by the children and their mothersof the child's IQ and academic achievement;both mothers and children perceived the child'scompetence as being lower than the actualacademic achievement of the child. Pre-sumably, this perception would affect thechild's motivation, self-esteem, and future per-formance in school. Johnson and Rolf suggestthat previous studies reporting differences in

13


academic performance between COAs andnon-COAs may have been measuring the ef-fects of socioeconomic status or samplingheterogeneity rather than the effects of familyalcoholism.

While further research will be needed to re-solve this discrepancy, for the present theweight of evidence indicates that parental alco-holism may result in at least moderate deficitsin academic performance. The reasons for thisare unclear.

Cognitive abilities

Low school performance may be related toa variety of factors, such as lower cognitiveability, lack of parental encouragement andsupport, difficulty in doing home work athome, attention difficulties, or other factorsrelated to living in an alcoholic family (or toseveral of these in some combination). Thefactor that has been most thoroughly investi-gated is cognitive ability.

Hegedus, Alterman, and Tarter (1984*)attempted to disentangle the effects of severalof the factors in a study of academicachievement among delinquents with andwithout alcoholic fathers. As was found inprevious studies, the academic achievement ofthe sons of alcoholics was significantly lowerthan that of the sons of nonalcoholics, eventhough both groups were equivalent in intel-lectual ability. When academic achievementscores were correlated with measures of familydisruption, psychopathology, adolescentdevim y, and neuropsychological capacity, itwas found that underachievement in sons ofalcoholics was most strongly related to neu-ropsychological capacity. Since none of thesons of alcoholics in this study had a history ofalcoholism, the authors concluded that certaincognitive impairments may precede rather thanfollow the onset of alcoholic drinking.

Tarter, Jacob, and Bremer (1989*) re-ported that sons of alcoholic fathers, whencompared with sons of fathers who were de-pressed and sons of fathers who were neitherdepressed nor alcoholic, exhibited impairmentsin planning ability, psychomotor efficiency,and inhibitory control. These impairmentswere not severe, however, nor was a general-ized cognitive deficit in sons of alcoholicsconfirmed.

In a reanalysis of the results from thissample, Tarter, Jacob, and Bremer (1989a*)found that sons of fathers with early onset al-


coholism (before age 24) had significantlylower scores on verbal IQ and atten-tion/memory processes than did sons of nonal-coholic fathers. Unlike previous studies,however, the findings did not confirm impair-ments in sons of alcoholics on spatial, abstract-ing, and praxic abilities. According to the au-thors, the sons of alcoholic fathers in thisstudy probably exhibited relatively mild cogni-tive impairment because the fathers had beenrecruited from the community rather than fromclinical populations and because none of thefathers had a diagnosis of antisocial personalitydisorder, which, when combined with alco-holism, appears to result in more severe im-pairment in offspring.

Gabrielli and Mednick (1983) administeredthe Wechsler Intelligence Scale for Children toDanish children age 11 to 13 in order to de-termine the effects of parental alcoholism onintellectual ability. A group of children ofhospitalized alcoholic fathers (high risk) wascompared with a group of children whose par-ents had been identified as having a problemcontrolling alcohol consumption (moderaterisk) and with a group of children whose par-ents were neither alcoholics nor problemdrinkers (low risk). The high risk and moder-ate risk groups scored lower on all of the sub-scales, significantly so on the scales measuringverbal IQ. Removing children ofschizophrenic parents from the analysis did notaffect the msults.

Beg leiter and his colleagues (1984) havedocumented differences in brain waves be-tween boys of alcoholic fathers and boys ofnonalcoholic fathers. As the boys in the studyresponded to a computer-generated visual task,their brain waves were recorded. The re-searchers were particularly interested in event-related potentials, which are recordings ofelectrical responses to the brain's processing ofinformation. The so-called P3 brain wave ex-amined in this study has been ar:ociated withmemory functions. It had previously been ob-served that adult alcoholics showed P3deficits. The P3 component in sons of alco-holics was significantly lower than that in con-trol subjects. According to the authors, "thesignificantly reduced P3 amplitude in high-riskboys suggests a reduced capacity to assess thesignificance or allocate the necessary neural re-sources for encoding a specific event . [T]hisspecific neurophysiological deficit in HR [highrisk] subjects suggests that sons of alcoholicsmay manifest deficits in memory." A subse-

quent study by Begleiter, Poijesz, et al. (1987)found a similar P3 deficit in response to anauditory stimulus among boys with alcoholicfathers. The finding that the P3 deficit occursin boys at risk for alcoholism who have notused alcohol suggests that the deficit precedesalcohol abuse and may be genetically deter-mined. Continued research in this field isneeded, particularly since more recent studieshave failed to find a P3 deficit in boys with afamily history of alcohol on a visual stimulustask (e.g., Polich, Haier, et al. 1988).

Resiliency Factors

It is evident that many COAs do avoiddestructive patterns of alcohol use and manageto lead lives relatively free of severe personalor social problems, contrary to the impressionin much of the clinical and popular literature.As Woodside (1988:787) has observed,"Historically, most studies of children exploreimmediate short-term negative effects ofparental alcoholism and overlook copingpatterns and mechanisms which may explainwhy some remain relatively unaffected." Indeveloping effective prevention andintervention programs for this population, it isjust as important to understand the sources ofresilience in COAs as it is to know theproblems they face. Only limited attention,however, has been given to positive adjust-ment by COAs and to moderating variables thatenable "invulnerable" children to cope with theeffects of family dysfunction. (Research onprotective factors among children of drugabusers has not been identified, but it is likelythat many of the findings from studies ofCOAs would also apply to them.)

According to Ackerman (1983:53), about10% of COAs are "invulnerables" who suc-cessfully survive their alcoholic family andgrow up into healthy, well-adjusted adults.More recent research indicates that the figuremay be even higher (Drake and Valliant 1988*;Werner 1986*), although the figure will varydepending on how adjustment and alcoholismare defined and at what point in the life spanthey are assessed.

In a 33-year-long study, Drake and Valliant(1988*) found that while COAs had moreproblems in adolescence than did children fromnonalcoholic families, by their mid-40s overhalf (58%) of them had not received a diagno-sis of either alcoholism or alcohol abuse. In asecond longitudinal study, Werner (1986*)

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found that even though children of alcoholicswere more likely than children of nonalco-holies to exhibit serious learning and behaviorproblems by age 18, the majority of COAs(59%) were doing well in school, at work, andin their social life, and had positive, realisticexpectations and goals for the future.

In large part, these resilient COAs havegone unrecognized because most COA litera-ture is based on clinical samples of help-seek-ing patients. Barnard and Spoentgen (1986)concluded from a study of college students thatsome COAs were more resilient than othersand that the more impaired ones were thetreatment seekers (Williams 1990). Similarconclusions have been reached by Jacob,Ritchey et al. (1981) and Steinglass, Bennett etal. (1987). Similarly, Blane (1988:797) warnsthat there has been relatively little consistentand systematic research on medical, psycho-logical, or social pathology in general popula-tion samples of COAs to assess rates of dys-function.

The two longitudinal studies cited aboveexamined protective factors that enabled somechildren of alcoholics to avoid both alcoholismand serious psychological or social problems.Drake and Vaillant (1988*) concluded thathealthy adult development of COAs is relatedto several factors: (1) managing to leave thealcoholic environment, (2) leaving the nonal-coholic parent (usually the mother), (3) devel-oping competency at appropriate tasks, (4) ex-periencing and internalizing healthy relation-ships, and (5) developing mature defensemechanisms. In particular, their finding thatpoor adolescent adjustment of COAs was moststrongly related to having a poor relationshipwith one's mother emphasizes the importanceof the nonalcoholic parent in buffering thechild from the effects of parental alcoholism.

Werner's (1986*) study of children inHawaii from birth to age 18 supports the viewthat the effects of alcoholism in the family aremoderated by factors other than drinking itselfand that these factors contribute to psychoso-cial adjustment. In particular, Werner identi-fied several characteristics of the family envi-ronment and the child's behavior that differen-f Lilted COAs who are resilient from those whodevelop problems:

Much attention from the primary caretakerduring infancy;No prolonged separation from the care-taker,


No additional births into the family duringthe first two years of life;The absence of parental conflict during thefirst two years of life;A temperament that elicited positive atten-tion from the primary caretakers;At least avcrage intelligence and adequatecommunication skills;Achievement orientation;A responsible, caring attitude;A positive self-concept;A more internal locus of control; andBelief in self-help.

Additional protective factors have also beenidentified. Keane (1983) reported that amongCOAs of mixed socioeconomic status, thosewho had more positive perceptions of theirfamily were able to make a more successfuladjustment to parental alcoholism than wereother COAs (cited in Woodside 1988a:788).Other researchers have cited the importance ofgood coping skills in helping to attenuate thenegative effects of parental alcoholism (Rutter1979), particularly if the coping strategies areproblem-based (directed at changing the situa-tion) rather than emotion-based (directed at re-ducing emotional distress) (Clair and Genest1987*). Chassin, Mann, and Sher (1988)found that COAs who scored high in self-awareness, self-reflection, and introspectionhad low levels of alcohol use and alcohol-re-lated problems.

Another resiliency factor may be the child'sage when parental alcoholism began. It hasbeen suggested that the later in the child's lifethat the parent(s) begins to drink abusively, thegreater is the likelihood that the child will havedeveloped a sense of trust and autonomy tobetter handle the stresses and problems ofliving in an alcoholic household (Ackerman1983:69). Peitler (1980) found that theyounger the age at the time of a father'sdevelopment of alcoholism, the greater was theimpairment in three areas of functioning: self-worth, withdrawal tendencies, and antisocialtendencies.

In a study examining the home environ-ments of children of alcoholics, Reich, Earls,and Powell (1988*) found that the incidence ofpsychiatric disorders was lower among thoseCOAs whose family life was characterized by alow level of parent-child conflict, a high levelof parent-child interaction, and infrequent ex-posure to parental drinking.


The research of Bennett and her colleaguesindicates that COAs are less likely to becomealcoholics themselves if the family is able tomaintain rituals such as holidays or regularmealtimes and to keep these times relativelystress free, and if the parents are able toconsistently make plans and follow though onthem (Bennett, Wolin, and Reiss 1988*;Wolin, Bennett, et al. 1980). According toBennett, "families which have a seriousproblem in their midst--such as parentalalcoholismand which still impose controlover those parts of family life that are central tothe family's identity--rituals, relationships, androles--communicate important messages totheir children regarding the possibility to takecontrol of present and future life events. It ispossible that in the processing of learning howto be deliberate as a family, children learn thatthey can successfully meet difficult challengesin life" (Bennett, Wolin, and Reiss19884!:828).

Viewed in another way, parental alco-holism is a form of stress that affects all mem-bers in the family. But stress itself does notproduce pathology directly since the effects ofstress are shaped, by or filtered through, avariety of moderating variables, such as familyenvironment, social supports, and coping be-haviors. These moderating variables eitherameliorate or potentiate the effects of stress as-sociated with parental alcoholism. Given a fa-vorable constellation of these variables, thechild can learn to handle the problems andstresses of living in an alcoholic family and cangrow up with relatively few severe adjustmentproblems (Clair and Genest 1987*). Futureresearch in this area should focus onattempting to determine which children ofalcoholics develop severe problems and whichdo not, and why at-risk children developdifferent problems. This knowledge can thenbe used to develop more effective preventionand intervention programs for children ofsubstance abusers.

Conclusion

The research reviewed here clearly sup-ports the view that children who grow up infamilies in which one or both parents are alco-holic face a greater risk of developing alco-holism themselves and of exhibiting otherproblems in physical, emotional, cognitive,and social functioning. However, there isconsiderable variability in risk or differences in

vulnerability. Being a COA does not neces-sarily lead to alcoholism or to psychosocialdysfunction (Letinard 1990:273). If exposureto parental alcoholism by itself resulted inpathology in the children, then all COAs wouldexhibit greater disorder, pathology, and malad-justment than the research indicates is in factthe case.6

Emphasizing the variability among COAbackgrounds, Steinglass (1987) draws a dis-tinction between "families with alcoholism,"which are not particularly affected by drinking,and "alcoholic families," which are organizedaround the central theme of drinking and arevulnerlhle to its disruption, showing greaterpsychiatric symptomatology, rigidity, highlypatterned behavior, and susceptibility to inter-generational transmission of alcoholism. Thefocus on the dramatic problems of the latter, heargues, has led to a misleading picture of theimpact of alcohol on the family, which is oftennot that of a sharp pain but of a dull ache thatsaps the familyq energy and resources overtime. The best approach, he argues, is one thatacknowledges that families with alcoholicmembers make up highly complex behavioralsystems that vary markedly and that do not fitinto simplistic formulas or uniform conceptualframeworks.

It is further doubtful that conductproblems, emotional distress, cognitivedeficits, and other problems found amongCOAs are due to parental alcoholism alone.Marital conflict, depression in parents, familydisruption, and similar factors may alsocontribute to these difficulties. Thedysfunctional characteristics of alcoholicfamilies are also found in families with otherproblems as well. One of the major weak-nesses in much of the research on COAs hasbeen the failure to control for other problems.

6 Jacob and Leonard (1986:378) observe: "...clinicalreports have consistently suggested that most childrenof alcoholics are seriously impaired, although theempirical literature addressing this issue has been muchmore equivocal. Unfortunately, it is very difficult tocompare and reconcile cross-study differences withinthis literature since most of these reports have notemployed the same measures or have not used equallyreliable and valid measures. In addition, most studieshave simply reported differences between group meansand have not considered the clinical significance of thefmdings any further. There is a clear need to considerthis issue more carefully, since it has tremendousimplications for prevention and intervention programs."

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22

There may be several complex factors inde-pendent of one's COA status that could resultin severe psychopathology (Wind le and Sear-les 1990. There is a need to differentiate theimpact of psychopathology and other problemsthat may accompany alcoholism from the morespecific impact of alcoholism itself. A relatedproblem is whether COAs are at greater risk ofbehavioral problems (other than alcoholism)than are youth from families that arenonalcoholic but still dysfunctional (Blane1988). The extent to which COAs exhibit asyndrome distinct from that of youth fromother dysfunctional families needs to beclarified (see Riddell 1988 for one of the fewefforts to study differences between multiprob-lem families and alcoholic families).

These qualifications do not detract from theheightened risks that COAs do face. The im-portance of alcohol abuse in the family is sug-gested by the fact that many problem behaviorsin alcoholic families and in affected childrenend or are greatly reduced when alcoholismstops (Kumpfer 1987:3).

Children ofOther Drug Abusers

Much less research has been conducted onthe characteristics and problems of children ofabusers of drugs other than alcohol. In fact,many statements regarding CODAs are drawnfrom the COA literature. At this time, littlecan be said definitively about the similaritiesand differences between these them.

Kumpfer (1987) suggests that there isconsiderable overlap between the two groupsin terms of the risk for AOD abuse and forother problems associated with havingsubstance abusing parents, but almost all herdata concerns alcohol. At the same time, asJohnson (1990) observes, children of otherdrug abusers differ from children of alcoholicsin several ways. First, because of the inherentrisks of illegal activity, CODAs are exposed toaspects of life that COAs are not, includingeven greater secrecy and stigma, fear of legalreprisal, drug paraphernalia. Second, wnereasthere arc several public advocacy groups forCOAs, there are none for CODAs. Third,CODAs must contend with the AIDS epidemic,especially if the parents are intravenous drugusers. They may be exposed to parental illnessand death and increased risk of AIDS them-selves if they begin intravenous usethemselves, especially since adolescents are


less likely to take steps to reduce the risk ofHIV transmission. Fourth, in many cases theycome from more disadvantaged or devianthome environments, often accompanied byloss of parents due to incarceration.

Though information on CODAs is limitedin scope, recent studies have examined charac-teristics of the drug-abusing family, the influ-ence of parental drug use on the drug use ofchildren, and the problems faced by childrenexposed to drugs perinatally.

17

The Drug-Abusing Family

Kumpfer and DeMarsh (1986) compared60 drug-dependent families and their childrenwith 60 control families on a variety of psy-chosocial, family, and child behavior vari-ables. The early childhood environment ofchildren from drug-dependent families wassignificantly more dysfunctkmal than that ofcontrols. The dependent families had higherlevels of stress, parental depression, and fam-ily conflict; fewer friends; and less involve-ment in recreational, social, religious, andcultural activities. Generally, substance-abus-ing families exhibited strain and social isola-tion, partly because of the need to maintainprotective boundaries and partly because ofcommunity rejection; thus, they received lesshelp and support from others, which furtherincreased strain on family functioning and re-sources. The study also found that substance-abusing parents spent half as much time withtheir children as nonabusing parents. Theywere also significantly less likely to spend timewith their children in family activities.

The children in the substance-abusingfamilies had fewer overt family rules to follow,were more disobedient at home, had fewer op-pciiiunities to interact with other children, hadfewer friends to whom they could tell secrets,were less likely to bring their friends home,were more likely to believe that they lacked theability to make friends, lacked age-appropriatesocial skills and behaviors, and tended to beavoided by their peers. They also attendedschool less and were more often late to school;they received limited help with homeworkfrom their parents.

This profile differs little from that of theclassic COA family. But in describing theirsample, Kumpfer and DeMarsh did not specifywhether their drug-dependent families includedalcoholics. If they did, this might account formuch of the similarity of the profiles.

23


The stress, inconsistency, unpredictability,and abuse seen in alcoholic families is likely tobe present in substance-abusing families. It is,therefore, likely that the children of parentswho abuse illicit drugs face similar challengesand adop: similar coping strategies and roles asdo children of alcoholic parents, although noresearch has been found to confirm this.Clearly, much more research is needed on thesimilarity in experiences and risks faced bychildren of alcoholics and children of otherdrug abusers. More attention also needs to bedirected toward the extent and influence ofcombined alcohol and other drug abuse andwhether children face different risks dependingon the drug of choice of their parents.

Some researchers doubt that mothers whoare heavily addicted to heroin, amphetamines,or cocaine can even adequately raise their chil-dren (Densen-Gerber 1981; Eriksson, Billing,et al. 1985; Larsson 1980; Howard, Beckwith,et al. 1989; Burns and Burns 1989). Amongheroin addicts, Densen-Gerber (1981:773)cites the inability of heroin addicts to alter theirlifestyles to accommodate a new child, to act inthe best interests of their children, or to meettheir child's needs at the expense of their own.It has been observed that the lifestyles of sub-stance-abusing mothers generally includechaos, inconsistency, and possibly violence(Howard, Bechwith, et al. 1989; Regan,Ehrlich, et al. 1987; Lief 1985; Larsson 1980).

One picture of the drug-abusing parent thatemerges from the research is that of a womanaddicted to heroin or, more recently, cocaine,who is living in a highly stressful situationcharacterized by poverty, limited education,and underemployment, if not unemployment.She likely grew up in a family that was abu-sive, neglectful, and unable to meet her devel-opmental needs. Her child is likely to be pre-mature or neurologically impaired from prena-tal drug exposure and to require increased at-tention. Without effective intervention, theseconditions intensify parental dysfunction andthe child's developmental problems (Barry,White, and Yoast, forthcoming).

This portrait, however, is biased by thecharacteristics of the subjects studied. Most ofthe subjects have been poor and Black orHispanic. The observed effects may be lessdue to addiction than to the other life problemsthey face. This limitation is especiallyimportant to keep in mind given the relativelack of research on more educated, profes-sional women who are addicted to cocaine and

other drugs (Barry, White, and Yoast,forthcoming). We know very little about thecharacteristics of families, especially middle-class families, in which heavy marijuana useoccurs, or dependency on suchpsychotherapeutics as tranquilizers, which iscommon among women.

Risk of AOD Use

Clinicians and researchers have increas-ingly come to recognize the importance of thefamily environment, particularly the substanceabuse of parents, in "the genesis, maintenance,and alleviation of drug abuse" among childrenand adolescents (De Marsh and Kumpfer1986:117). A number of studies conductedduring the 1970s found that actual or perceiveddrug use by the parent or other significant adultis positively correlated with adolescent druguse, although this research tended to focus onparental use rather than abuse (Kumpfer andDe Marsh 1986). Fawzy, Coombs, and Gerber(1983) reported that 78% of a sample of ado-lescents whose parents admitted to marijuanaor hashish use also used some type of drug.

In a recent study, Gfroerer (1987*) exam-ined drug use by teenagers and drug use byolder family members living in the samehousehold, using data drawn from NIDA'sNational Survey on Drug Abuse. He con-firmed earlier results indicating that teenageiswere more likely to use drugs--and particulalymarijuana--if the father, mother, or older sib-ling also used drugs. The results also indi-cated that even low levels of use by parents caninfluence drug experimentation by teenagers.

Clinicians have also reported high rates ofparental chemical dependency in the back-ground of adolescent and adult clients seen atsubstance abuse treatment programs (Huba,Wingard, and Bender 1980; Jessor and Jessor1977; Kandel, Kessler and Margulies 1978;for reviews of this literature, see Gfroerer1987*; Halebsky 1987; and Kumpfer and De-Marsh 1986). The cause of the correlation be-tween parental and offspring use, especiallythe role of genetics, is unclear because many ofthe studies did not control for environmentalvariables or for related diagnoses in the parentssuch as antisocial personality (for recent stud-ies on genetic and environmental influences onsubstance abuse, see Cadoret, Troughton, etal. 1986; McClearn 1983; Me Iler, Rinehart, etal. 1988). Separating environmental and ge-netic effects is also difficult because children

18

2 4

may have been affected in utero by maternaluse of heroin or cocaine during pregnancy.

In a study examining the possibility ofspecific family transmission of substanceabuse, Me ller and colleagues (1988) foundevidence of familial transmission specific todrug abuse and not alcoholism. Drug treat-ment patients (age not specified) with a DSM-III diagnosis of drug (nonalcohol) abuse had asignificantly increased likelihood of havingparents or siblings who abused drugs only orboth drugs and alcohol. Furthermore, thestrongest association was between drug abuseby the subject and drug abuse by his or herparent. In speculating on the possible causesfor the family transmission of drug abuse, theauthors note: "It seems quite possible that envi-ronmental variables influence an individual'sinitial decision to experiment with substancesof abuse and also influence the choice of sub-stance. Once the individual has begun to abusea given substance, his or her ability to toleratethai substance without developing physical de-pendence or other forms of physical and socialimpairment may be strongly influenced by hisor her genetic makeup" (p. 1038). The resultsof this study suggest a genetically transmittedbiochemical vulnerability of abuse to drugsother than alcohol, which is independent of avulnerability to alcohol dependence. In thisstudy, however, the number of drug abuserswas small (27) compared with the number ofpolydrug abusers (177) and the number of al-coholics (97).

Contrary to these findings, Klinge andPiggott (1986) found no relationship betweenthe drug use of a sample of adolescent psychi-atric inpatients and that of their parents.

In summarizing earlier studies of drug-ad-dicted mothers, Bauman and Dougherty (1983)noted a cycle of addiction, repeating from onegeneration to the next. Several explanationshave been advanced to explain the transmissionof addiction, including hypotheses that parentspass their addictive behavior down to theirchildren, that drug-addicted mothers are defi-cient in parenting skills, and that fetally drug-exposed children are developmentally slow andhave physiological, cognitive, and psychologi-cal difficulties that place them at risk for laterAOD abuse. Confirmation of these hypothesesare largely lacking, however, and much re-mains to be known about the long-term effectsof the mother's drug addiction on her child'srisk of drug abuse. Similarly, we know little


about the effects on the child of the father'sdrug use.

Psychosocial Problems

Johnson, Boney, and Brown (1991*)compared 35 children of substance abusers and37 children of non-substance abusers onmeasures of depression, state and trait anxiety,and three standardized measures of academicability reading, spelling, and arithmetic).Children of substance abusers scoredsignificantly lower on depression, trait anxiety,and arithmetic. This suggests potential risksfor psychological difficulties, especiallyaffective and academic problems.

Health Problems

Research on the consequence on a child'shealth of parental drug abuse has been largelylimited to fetal and neonatal effects. So far, aclinically defined "fetal drug syndrome,"similar to the fetal alcohol syndrome, has notbeen recognized, and it is unlikely that such asyndrome will be identified since so manydifferent types of drugs are involved and sincethe high prevalence of polydrug use makes itdifficult to isolate the effects of a single drug.Research has confirmed, however, that drugstaken by the mother cross the placenta and thatthe fetus is repeatedly exposed to the drug as itis eliminated from the body and thenreabsorbed from the amniotic fluid. Agrowing body of research indicates that perina-tal exposure to abused drugs can result in de-velopmental disabilities, impaired neurologicaldevelopment, and cognitive and learningdeficits, similar to those found in fetal-alcoholchildren (e.g., Sowder and Burt 1980; Hans,Marcus, et al. 1984). Studies have also foundthat the somatic, developmental, and attentionalproblems observed in drug-exposed infantscontinue into early childhood (Deren 1986:85).

Estimates of the number of drug-exposedbabies--the most commonly cited being370,000 born each year--have lead to sensa-tionalistic predictions, such as one newspa-per's headline "crack kids [are] about to plagueschools" (San Francisco Chronicle, April 24,1989). It should be noted, however, that farmore newborns have been exposed to alcoholand tobacco than to illicit drilgs and that expo-sure does not necessarily mean impairment (asis also true for alcohol). Furthermore, a par-ticular problem or deficit is not necessarily di-

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25


rectly associated with perinatal drug exposuresince the health of the infant can be affected bya variety of other factors. For instance,women who are heavy drug users seldom re-ceive adequate prenatal care, either becausethey cannot afford it or because they fear legairepercussions for the:: drug use (Van Dykeand Fox 1990:161-162). These points aremade not to minimize the seriousness of prob-lem of perinatal drug exposure, but to discour-age the stereotyping and extreme responsesthat too often occur in public policy discus-sions of drug abuse.

Studies conducted in the 1970s of drug-ad-dicted (mainly heroin) mothers and their chil-dren presented inconsistent results: someshowed deficiencies in the child's cognition,development, and interpersonal relationships;others showed a more or less normal course ofdevelopment (Bauman and Levine 1986:850).

The largest of these early studies (Sowderand Burt 1980) sought to determine whetherchildren of heroin addicts were at greater riskthan other children for health, learning, behav-ior, emotional, or adjustment problems. Thesubjects (ages 3-17) consisted of children ofdrug treatment clients (n=365) in five cities anda comparison group of children (n=369) withnon-drug abusing parents living in the sameneighborhoods as the treatment clients. In re-gard to learning and school adjustment prob-lems, the children of drug abusers were signif-icantly more likely than the comparison chil-dren to have poor IQ and perceptual-motor per-formance, more classroom behavior problems,greater need for tutoring, more school failure,more missed days of school, and more likelyto have parents contacted because of the child'smisbehavior. Children of drug abusers werealso more likely to have used mental healthservices. Differences in delinquent behaviorand health problems were not significant, orthe numbers were too small for analysis.

Bauman and Dougherty (1983) confirmedthese findings in a study that eliminatedmethodological weaknesses in earlier studies.Preschool children of women who were in amethadone maintenance program scored signif-icantly lower than preschool children of non-addicted mothers in motor development, gen-eral development, expressive language, andintelligence (though average scores for bothgroups were in the normal range). The chil-dren of methadone mothers also exhibitedmore aversive behaviors and fewer prosocialbehaviors than did children of nonaddicted

20

mothers. The lowered IQ scores of the chil-dren of methadone mothers may have been dueto their shorter attention spans or to lower taskperseverance rather to lower intellectual capac-ity. A replication of this study by Bauman andLevine (1986*), using a larger sample, foundthat children of methadone mothers were morelikely to have developmental delays, lower IQscores, and lower heights and weights.

Recently, the media has focused consider-able attention on babies exposed to crack dur-ing pregnancy. As toddlers, these childrenhave difficulty relating to the world, are easilydistracted, have poor attachment to care givers,exhibit !ess goal-directed behavior, and lagbehind in performing age-appropriate tasks.While less systematic research has been de-voted to preschool children, clinical observa-tions indicate that they exhibit temper tantrums,poor impulse control, problems in regulatingbehavior, learning problems, attention deficitdisorder, and language-development problems(Dixon 1990; Howard, Beckwith, et al. 1989;Kronstadt 1989:5-6; Weston, lvins, et al.1989).

It needs to be remembered, however, thatthe environment in which these children growup, which is usually characterized by poverty,an unstable home life, poor nutrition, andcommunity violence, also adversely affectstheir development. Indeed, it becomes difficultto determine how much of their behavior is dueto cocaine exposure and how much to themany other risk factors that they experienceboth before and after birth. According to Ju-dith Howard, a clinical professor of pediatricsat UCLA who works with children exposed todrugs prenatally, "What the school systems aregoing to have to deal with are children comingfrom very chaotic and violent homes, becausewherever there are drugs there is violence.[The children] are going to be even less orga-nized and show even more developmental de-lays" (quoted in Viadero 1989:11).

At a recent conference on "Babies and Co-caine: New Challenges for Educators" (LRPPublications 1990), the speakers outlined thedimensions of the problem and described theeffects of perinatal drug exposure on the de-velopment of children. But they also empha-sized that many, if not most, cocaine-exposedinfants develop normally and that there is greatvariability in the medical and behavioral effectsexhibited by these children. Furthermore, withadequate posmatal care, particularly in the firstweeks of life, infants exposed to cocaine can

26

overcome many of their early problems andshow significant recovery. Unfortunately,most of these infants and toddlers will not re-ceive adequate care and will reach school agewith a variety of problem that schools are notyet equipped to handle.

Children exposed to drugs prenatally arealso at particularly high risk for AOD abuse.First, it is likely that they will continue to livein an environment pervaded by drug use andby the social deprivation that encourages use.Second, and more immediately, unless thechild is placed in foster care, he or she is likelyto grow up in a family in which the parents andother older adults and siblings use alcohol andother drugs, providing a model for drug-usingbehavior. Third, these children will probablyhave difficulty throughout their school yearsand will be at high risk for school failure anddropping out, both of which increase thechance of becoming involved in drug activities.

Conclusion

The relative lack of research on children ofother drug abusers and addicts makes it diffi-cult to draw any firm conclusions. Althoughthey would appear to have many of the samerisks as COAs, they also face substantially dif-ferent, and arguably even greater, problemsassociated with the violent, deviant, and so-cioeconomically depressed environments inwhich they often grow up. Whether distinc-tions can be drawn between children with al-coholic parents and children with drug depen-dent parents is unclear, as is whether the sameprotective factors exist. In particular, far moreresearch is needed on families other than poor,ethnic minorities and on the effects of illicitdrugs other than heroin and cocaine.

PREVENTIONAND INTERVENTION

Although not all COSAs are equally at riskfor AOD abuse and other problems, they arenevertheless a population that should be givenhigh priority in our prevention and interventionefforts. The problems they face will not beovercome until we break the intergenerationalcycle that perpetuates them and this will requireconcerted efforts both to treat existing AODabusers and to prevent abuse from developingamong their offspring. It is also evident thatthese efforts must transcend the issue of AOD

21


abuse and address the problems of thedysfunctional family that both result from andfeed this behavior.

As concerns over the potential risks facedby COSAs have increased, so have the numberof prevention and intervention programs de-signed to serve them. Knowledge of effectiveprograms and strategies has grown appreciablyover the past decade. Several articles andbooks addressed to school counselors andteachers provide practical advice on helpingchildrea of alcoholics.7 In 1986, the Childrenof Alcoholics Foundation compiled the first di-rectory of programs designed specifically toserve COAs. The directory only included 235programs in 34 states, three-fourths of whichhad been in operation for three years or less.Most programs tended to be small, with abouthalf serving 50 or fewer COAs each year(Children of Alcoholics Foundation 1986;Woodside 1988a:790). Appendix A includes aselected list of organizations, programs, andcurricula that deal with children of alcoholics.

The US Office of Substance Abuse Pre-vention, in conjunction with national COA ad-vocacy organizations, is now launching a na-tional awareness campaign. But equally im-portant are efforts to expand school-basedservices to address directly the needs ofCOSAs. Because of the large amount of timethat children spend in school, the school isprobably the most promising setting for identi-fying children of substance abusers and forproviding them support, education, and coun-seling. Furthermore, since these children areat high risk of emotional, behavioral, and rela-tionship problems that interfere with success inschool and in the world at large, one can arguethat addressing their needs is essential to theschool's pedagogical mission. Considerableuncertainty exists, however, over what specifi-cally schools can and should do to preventthese problems from developing or to interveneonce they are apparent. In the remainder ofthis section, we will discuss some of these is-sues involved in service delivery and providesome guidelines for establishing effective pro-grams.

7see Ackerman 1983; Brae 1988; Campbell 1988;Deutsch 1982; Edwards and Zander 1985; Fisher 1989;Manning and Manning 1984; National Association ofChildren of Alcoholics 1989; Priest 1985; Robinson1989; Tharinger and Koranek 1988; Waite and Ludwig1985.


COSA programs are still in their infancy,however, and there are large gaps in ourknowledge about what issues need to be ad-dressed and which approaches are most effec-tive. Empirical studies on prevention andtreatment for COSAs are almost nonexistent,and the research that has been conducted pro-vides little guidance for program development.Furthermore, most programs are limited toCOAs. Indeed, as mentioned above, one ofthe problems faced by CODAs compared withCOAs is the lack of support groups and pro-grams.

The relative lack of programs for COSAsand the small number students who participatein them has been attributed to a variety of ob-stacles (Tharinger and Koranek 1988:180-182):

Public denial of the alcoholism and theneeds of COAs;Ignorance and misinformation about alco-holism and its effects on children;Ambivalence and confusion over whoshould provide help;A tendency to overlook the needs of chil-dren who appear not to require help;A variety of fears, including fear of callingattention to a problem, of doing more harmthan good, and of intruding into family af-fairs;Parental resistance to intervention; andThe denial, fear, distrust, and shame of theCOAs themselves.

In this section, we discuss some of themain topics that need to be addressed in plan-ning, developing, and implementing preven-tion and intervention programs for COSAs,including identification and assessment, label-ing, program goals and techniques, studentassistant programs (SAPs), programs fordrug-exposed children, parent involvement,and program evaluations.

Identificationand Assessment

The first stage in the process of providingeffective services to this population is develop-ing reliable identification and assessment tech-niques. It has been estimated that 95% of theschool-aged children of alcohelics are neveridentified (Robinson 1989:83-84, 102). Iden-tification of COSAs in schools can b a diffi-cult task. There is denial by parents of AOD

22

problems and reluctance of children to talkwith outsiders about their parent's use becausepeople still tend to view chemical dependencyin negative or moralistic terms (Woodside1988:646). Most children of alcoholics remainhidden; many cause no trouble, aresuperachieving students, or do not otherwisedraw attention to themselves. Others mayexhibit serious problems, but the underlyingcause of the problems may not be recognized.

If schools are to help COSAs cope withtheir situation, avoid becoming substanceabusers themselves, and develop a healthypsychosocial adjustment, COSAs must beidentified early using valid assessment instru-ments and provided with referral and interven-tion services that are appropriate to their needs.Several screening instruments have been de-veloped to help school counselors and psy-chologists identify children of alcoholics:

The Children of Alcoholics Screening Test(CAST)--the most reliable and most widelyused instrument (Jones 1982; Dinning andBerk 1989);The Children of Alcoholics Life-EventsSchedule (Roosa, Sandler, et al. 1988);The Biek screening interview (Biek 1981);andThe CAF (children from alcoholic families)item on the questionnaire completed byparticipants in the CASPAR Alcohol Edu-cation Program: "Have you wished thateither one or both of your parents woulddrink less?" (DiCicco, Davis, and Oren-stein 1984).

Since these instruments must be read, how-ever, they are not appropriate for very youngchildren. Instruments to identify children ofdrug users have not been found, although theycould probably be adapted from COA instru-ments.

Clinicians have also identified a number ofindicators or signs that the teacher or schoolcounselor can watch for which suggest that aparticular child may come from an alcoholicfamily (Ackerman 1983; Campbell 1988;Deutsch 1982; Woititz 1983). These include:

Inconsistencies in the child's appearanceand academic performance;Chronic morning lateness;Frequent requests to see the school nurseabout stomach aches;Difficulty in concentrating;

28

Expressions of anxiety about going homeor having parents come to school;Social isolation; andWithdrawal or misbehavior during alcohol-education programs.

Caution should be used in assessing youth onthese criteria. No one of these behaviorsshould be taken as conclusive. However, asthe number of these characteristics increase,the greater is the possibility of COA or CODAstatus.

Once a child from an substance-abusingfamily has been identified as being in need ofintervention, the school may need to get theparents' consent for the child to participate inwhatever program is available. Psychologistsand counselors must be aware of state laws re-garding treatment of children and the require-ments of parental consent; they must also de-velop ways to effectively work with parentswho may be reluctant to give consent(Tharinger and Koranek 1988:182).

Labeling

An issue that needs to be considered inidentifying and providing services to COSAs isthe possible negative effects of labeling.Although the Children of Alcoholics movementhas enabled many people to identify likelycauses for their distress and to take action toimprove their functioning, some researcherscaution that potential harm can result fromlabeling students COSAs, especially since notall COSAs are equally at risk. Even if schoolprc3rams are not specifically designated asbeing for COSAs, students or teachers maynonetheless learn the criteria used to selectchildren for a group or program and reactnegatively to the children who attend (Kumpferand De Marsh 1986:79).

Because of this, Burk and Sher (1988*)are especially critical of the view found inmuch of the COA self-help and treatmentcommunity that all COAs will becomedysfunctional and therefore that all COAsrequire therapeutic intervention. They note:"Although prevention and treatment efforts forCOAs are laudable, service providers havefailed to address the possibility of suchharmful effects arising from being identified asa COA and from being included in psychother-apy, especially if there is no evidence of cur-rent dysfunction" (p. 286). The focus shouldbe on the actual behavior of the individual

23


rather than on the expected behavior of agroup.

In an attempt to assess the possible dangersof labeling, Burk and Sher (19c" examinedhow high school students and mental healthprofessionals perceived children who wereidentified as children of alcoholics. On an in-strument with 11 pairs of bipolar adjectives(e.g., sad/happy, weak/strong, inac-tive/active), high school students rated COAssignificantly different overall compared withtypical teenagers and with mentally illteenagers. Typical teenagers received the mostpositive ratings, mentally ill teenagers the mostnegative. When nonsignificant differences oc-curred for specific adjective pairs, COAs weregrouped more often with mentally ill teenagersas being "deviant." The mental health profes-sionals in the study viewed a videotape of aclinical interview with at; adolescent who wasdescribed as being either from an alcoholicfamily or from a nonalcoholic family. Theytended to rate the adolescent labeled as a COAto be psychologically unhealthy solely on thebasis of family background. The adolescentfrom the alcoholic family was perceived asmore likely to develop psychopathology, lesslikely to remain psychologically healthy, andless likely to develop and maintain intimate re-lationships with family or with others.

The consequences of labeling is also evi-dent in the history of the CASPAR AlcoholEducation Program. While CASPAR wassuccessful in attracting students to the generalpopulation (BASIC) group, participation in thechildren of alcoholic families (CAF) group waslimited, and most of those who attended hadparticipated in the elementary school compo-nent of the program or in the BASIC group. Itappears that in the CASPAR program thenegative attitudes toward alcoholism and thestigma associated with familial alcoholism dis-couraged COAs from making their situationknown, preferring instead to participate in theintegrated group (DiCicco, Davis, et al.1984a).

Johnson, Boney, and Brown (1991*)recommend avoiding labeling by providingservices to families of treatment clients. Butthis would only reach a small proportion of theadolescents at risk that can be reached throughschools.

Despite the potential problems of labeling,it needs to be emphasized that the desire toavoid these problems should not become anexcuse to do nothing. For many people, the

29


label "child of an alcoholic" or "child of a drugaddict" is beneficial because it helps them tounderstand their experiences and feelings andencourages them to participate in self-helpgroups. The degree to which labeling is aproblem depends on the climate of the school.In schools that promote help seeking andwhere a variety of support programs exist, thelikelihood of stigmatization is reduced. Asmore and more student support groups becomepart of the normal school environment, thepotential harms of labeling cited by various re-searchers will become less of a problem. Inthe meantime, programs for COSAs need to bedeveloped in such a way as to minimize thestigmatizing effects of labeling by peers, teach-ers, and counselors (Blume 1985:7-8; Kauf-man 1988:177-178).

Goals, Strategies,and Techniques

In order to develop effective programs forCOSAs, it is important to establish clear goalsas to what constitutes prevention and treatmentin regard to COSAs, in large part because therisks they face are so varied. As Williams(1990:187-188) asks, "Are we treating COAsfor their exposure to parental alcoholism, pre-venting their development of future alco-holism, or accomplishing some combination ofboth?" Based on the evidence reviewed, thefocus clearly must be on both. The two majorobjectives must be to deter the development of(1) AOD and other self-destructive behaviors,and (2) risk factors associated with thesubsequent development of AOD problems orother dysfunctional patterns of behavior(Williams 1990:191). Indeed, in order toserve the needs of at-risk COSAs, it may benecessary to broaden both our conception ofprevention and our understanding of the func-tion of the school in promoting the healthy de-velopment of the child.

Once clear goals are established, schoolscan set up programs that attempt to meet theneeds of COSAs in three settings: the regularclassroom, school AOD prevention programs,or special COSA programs. Ideally, all threewould be combined into a coordinated, sys-tematic program that addresses the problemsfrom a variety of perspectives and with varyinglevels of intenF;ty, such as Student AssistancePrograms.

24

Regular Classroom Techniques

Ackerman (1983) and Campbell (1988)have summarized a number of techniquescommonly found in the COA literature thatteachers can use to create a classroom climatethat is safe and supportive to children of alco-holics. Such techniques would also appear toapply to CODAs. They include:

Establish routines that lend structure andstability to the school day;Empower the child with a sense of being incontrol of at least some of his or her wak-ing hours;Help the child see learning as a safe jour-ney;Allow time for the child to do homeworkduring the school day;Arrange for some "controlled socializing"in which the child can work with otherchildren in pairs or small nonthreateninggroups;Help the child relax and just be a kid; andSupport the school alcohol education pro-grams.

Generic AOD Education Programs

Generic primary prevent'. on programs tar-geted at all youth in a school provide a morefocused setting for addressing COSAs issues.They educate all COSAs, both identified andunidentified, thus avoiding problems associ-ated with stigmatization and harmful labeling,and they provide an opportunity to children inneed of further education and intervention.Many COSAs can also benefit from the es-teem-enhancing, copin3, decision-making, andlife skills being taught in the new generation ofcomprehensive programs. Since many COAsdo not develop alcoholism and exhibit fewsymptoms of problems, primary preventionprograms may be adequate to meet their low-risk needs (Williams 1990:192). At the sametime, such programs educate caregivers andothers in the problems faced by COAs.

COSA Programs

Although AOD education programs canplay an important role in identifying COSAsand promoting an understanding among bothstudents and teachers of the AOD-relatedproblems they face, their effect on the func-tioning of COSAs is largely unknown.

3 0

Furthermore, it is doubtful that, given themultiple risks that many COSAs face, they aresufficient for all. Thus, a more focusedstrategy is to establish programs specificallyfor COSAs, although to avoid problems oflabeling, as discussed below, such programsare usually called "concerned persons supportgroups," "affected others groups," or a similarterm that does not specify COSA status.

Various writers have identified at least fourcomponents that programs for COSAs shouldhave: (1) education about AOD use and its ef-fects; (2) identification and expression of feel-ings; (3) development of healthy self-esteemand social interactions; and (4) development ofhealthy problem-solving and coping skills(Bingham and Bargar 1985; Williams 1990;Gover 1990). Because of the variability ofindividual cases, prevention programs forCOSAs should be flexible and tailored to theneeds of children with specific problems. Alsoimportant is providing the nurturing, care-giv-ing attention that is often lacking at home. Itwould appear that many of the negative charac-teristics of the at-risk child stem from this de-ficiency, whereas the existence of such atten-tion from an adult characterizes the resilientCOSA. A caretaking teacher or other adult canhelp COSAs understand their position in theworld and empower them to develop healthyattitudes and behaviors.

Most existing programs do provide variousforms of social support, training in stress man-agement and other social skills, and educationabout alcoholism (Emshoff and Orenstein1990). Examples of several programs willsuggest the types of objectives and activitiesprovides. The CASPAR program discussedbelow includes lessons and activities designedto convey certain basic messages that are gen-erally viewed as necessary for children of al-coholics to understand and cope with their sit-uation (Davis, Johnston, et al. 1985):

You are not alone.Your parents' drinking is not your fault.Alcoholism is a disease.Alcoholics can and do recover.You are a person of worth who needs anddeserves help for yourself.

Deutsch (1984) outlines a "small, closed, time-limited, structured" support group for adoles-cents that features two adult leaders, male andfemale, and peer counselors. The objectives ofthe program, among others, include the ac-

25


quisition of constructive coping skills and in-creased self-esteem. Naiditch (1984) describesa support group for children from alcoholicfamilies, consisting of a structured, eight-weekprogram that includes activities such games,discussions, art, and poetry designed to helpchildren "find satisfying alternatives to copingwith stress." The program has been used inmany elementary schools and has been adaptedfor use in other institutions such as mentalhealth centers and youth service boards. Black(1981) developed special play therapy tech-niques for young COAs that make use ofdrawings, puppets, dolls, and other projectiveactivities to help children express their feelingsabout living in an alcoholic family.

In establishing COSA programs, threeother issues that have been identified aswarranting attention are the characteristics ofadult facilitators, the need for age-appropriatecurriculum, and counseling techniques (Gover1990; Miller 1983):

Adult facilitators. Those who wrvk withCOSA groups should have four main skills:(a) the ability to listen, paraphrase, clarify, andreflect; (b) the ability to relate to children ashuman beings: (c) the ability to share informa-tion on a level appropriate to the students in thegroup; and (d) the ability to create an atmo-sphere of trust, openness, consistency, anddependability. A team of two adult leadershelps prevent burnout, allows for feedback,and provides a model of healthy adult relation-ships.

Age-appropriate curriculum. The infor-mation and activities in the groups should takeinto account both the grade-level of the stu-dents and the concerns of each age group.

Counseling. Group counseling is prefer-able to individual counseling, since it offerschildren a setting for overcoming the isolationthat they often feel and an opportunity to inter-act with peers who have the same problem.

Student Assistance Programs

In establishing a comprehensive COSAprogram, a school student assistance program(SAP) can play a vital role. SAPs can takemany forms, but all are ideally based on ateam or individual with wide-ranging expertisein identifying and intervening with a variety ofpersonal problems that interfere with he learn-ing or social development of students. Withthe backing of appropriate policies and proce-dures, SAPs provide an "umbrella" structure

31


under which school and community serviceproviders and resources are coordinated toidentify students with problems and to providesuitable help to them and their families. De-pending upon the needs identified, typical in-terventions include curricular and classroommanagement modifications; peer or adult men-toring; placement in an appropriate supportgroup; one-to-one counseling; academic, psy-chological, or substance abuse assessment;formal intervention and referral to treatment;and counseling referrals.

Many SAP referrals will include studentswho are from alcoholic or drug-abusing fami-lies, enabling the SAP staff to play an impor-tant role in identifying COSAs. Morehouse(1979) especially advocates the use of SAPsfor students displaying problems or adjustmentdifficulties. Those identified as COSAs couldthen be referred to groups specifically address-ing the issues and consequences of familialAOD abuse. Thus, SAP directors must bewell acquainted with issues relating to COSAs.

SAPs can serve an additional function forCOSAs. If the family is not involved in theintervention process at all, parents may resentthe changes in the child's behavior, may com-plain to the school about interference in familymatters, and may attempt to restore the familyto its prior condition. SAP groups may thusprovide the support needed by COSAs to helpthem cope with these pressures.

Programs forDrug-Exposed Children

In addition to the programs designed forthe current generation of student COSAs, theincreasing numbers of babies prenatally ex-posed to drugs pose new and difficult chal-lenges to schools and other service agencies.As noted earlier, a large increase in the numberof drug-exposed infants has occurred sinceabout 1985, and many of these children arenow entering preschool and kindergarten.

Much more needs to be learned about theproblems and needs of these children, but, ac-cording to Cohen (1990) and Martin (1990),two lawyers who specialize in disability andspecial education issues, many drug-exposedchildren have developmental delays in cogni-tive, physical, language, or social skills thatwould qualify them for intervention and specialeducation services under the Education of theHandicapped Act and under Section 504 of theRehabilitation Act. If the estimates of the

number of children exposed to cocaine andother drugs are at all accurate, the demands onthe schools to provide intervention and specialeducations services will be great.

Programs for these children are beginningto be developed, but only a handful are cur-rently in operation. Probably the most wellknown of these is the Prenatally Exposed toDrugs (PED) Program established by the LosAngeles Unified School District in 1987 at theSalvin Special Education Center. The programwas designed as a pilot program for drug-ex-posed children ages 3-6 who did not otherwisequalify for special education programs. As offall 1989, 23 students were enrolled in threeclassrooms at two schools. The program con-sists of part-time support from a physician, apsychiatric social worker, and a psychologist,and each classroom has three adults, of whomone or more is a teacher. All staff also makehome visits and keep in close touch with fam-ily members. In addition to teaching, the staffprovides technical assistance to other schools.Although evaluation results for the program arenot yet available, the staff has reported im-provements in many areas of development(Viadero 1989:11).

Although children in the PED program re-ceive intensive services in a highly supportiveenvironment, the administrators of the programbelieve that once drug-exposed children enterelementary school, they should be includedwithin mainstream classrooms. It is unclear,however, how these children will fare in regu-lar classrooms, where teachers seldom haveeither the time or the resources to provide themwith the attention and help they need. Many ofthem will still need to receive special services,either inside or outside the classroom. Thesuccessful integration of drug-exposed chil-dren within the classroom may depend heavilyon the degree to which teachers are willing togive up part of their traditional role as providerof information and assume more of the role ofthe case manager.

Parental Involvement

A final issue regarding services for chil-dren of substance abusers is that of parentalinvolvement. It has been argued that school-based programs or activities for children ofsubstance abusers should have as their purposeto provide help, assistance, and support to stu-dents, not to change the student's home envi-ronment or treat the substance abusing parent

263 2

(Ackerman 1983). Attempts at puental inter-vention or treatment are beyond the capabilityor authority of the schools. Furthermore, helpfor children of substance abusers is not depen-dent upon their parent's entering treatment orbeing in recovery. Even if the parent does notenter treatment, the COSA--with the help ofschool counselors, student assistance pro-grams, or other support groups--can learn tocope with the conflicts and fears of the dys-functional family environment

At the same time, no other institution is asequipped as the schools to link families withservices. Given the important role of the fam-ily environment in mediating vulnerability toAOD abuse and other problems, it would ap-pear to be critical to develop family-based pre-vention and intervention efforts in schools andcommunities. Bowen (1974:117) emphasizesthat alcoholism is a dysfunction that causesimbalance in the family system and that "whenit is possible to modify the family relationshipsystem, the alcoholic dysfunction is alleviated,even though the dysfunctional one may nothave been part of the therapy." This rationaleis often used for intervening with COAs evenwhen the parents are not in treatment.(Williams 1990:200).

Many prevention specialists are coming tobelieve that parent education and training is anecessary component of any comprehensiveprevention plan. Generally, in addition toknowledge about drug abuse itself, parentgroups provide instruction and training in childdevelopment, family dynamics, communica-tion skills, and effective parenting skills suchas attending, reinforcement, positive disci-pline, and family-bonding activities. Home-work assignments are given to enable partici-pants to practice their skills at home (Phillips1989).8

One noteworthy program is the pakentingcomponent of Kumpfer and De Marsh'sStrengthening Families Program, which isspecifically designed to be used as a preventionstrategy for children of substance abusers otherthan alcohol. This is also one of few studiesassessing the effectiveness of a parenting pro-gram. The component (called the FamilySkills Training Program) targets three areas of

8Several reviews of family-oriented strategies areavailable: DeMarsh and Kumpfer 1985; Glynn,Lukefeld, and Ludford 1983; Rose, Battjes, andLeukefeld 1984; and Sowder, Dickey et al. 1980.

Yoang Children uf Substance Abusers

risk: family function, children's behavioralproblems, and children's expressiveness.Preliminary evaluation results indicated signifi-cant improvement between pretest and posttestin all three areas of functioning. Both parentsand children reported significant declines inintentions to use tobacco and alcohol, but notother drugs. Regardless of the parents' levelof drug-involvement, the resu;ts indicated thatthey can be coached and assisted in developingmore effective parenting styles and improvingthe home environment. Children reported thattheir parents were happier, they liked schoolbetter, and they were more involved in outsideactivities. This program has been applied onlyin a treatment setting. How it would functionin a school or community setting needs furtherexamination (DeMarsh and Kumpfer1986:133, 136; Williams 1990:205).

Although some researchers believe that ad-dicts are unable to be adequate parents, otherresearchers have concluded that parentingclasses and other types of interventions canhelp them parent more effectively (Lief 1985;Fiks, Johnson, and Rosen 1985; Griffeth1989). Lief (1985:89) observes: "Our experi-ence has indicated that the stereotyped image ofthe inadequate addict parent is not necessarilythe true picture. In parenting classes, theyprove themselves capable of learning about de-velopmental issues and of responding to theneeds of the growing infant. Many developsensitivity to the physical, social, and emo-tional needs in their children and make con-certed efforts to adapt their own lifestyles tomeet these needs."

While substance abusing parents are clearlyin need of parental education, getting them toparticipate is notoriously difficult. Schoolsand communities face a major challenge in at-tempting to reach out to the entire family. Ad-dict families are considered among the mostdifficult to get involved in therapy and treat-ment, and program attrition rates are high,often as high as 40%-50%. One solution tothe problems schools encounter in engagingparents in the intervention process would be toinclude parent programs as part of substanceabuse treatment This would seem to be espe-cially fertile ground for the development ofschool-community cooperative efforts(DeMarsh and Kumpfer 1986:143-144, whoprovide several ideas to ameliorate this prob-lem; see also Bry 1983; Stanton and Todd1981).

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33


In summary, parent training programs haveonly recently been used in the AOD field, andthe effectiveness of specific family treatmentapproaches with the general population, muchless with COSAs, has not been systematicallyresearched (De Marsh and Kumpfer 1986:133;Williams 1990:200). Most of the informationwe do have on family programs has beenderived from groups of highly functional andmotivated parents, primarily Caucasian. Weface a major gap in our knowledge about pro-grams for minority parents. Finally, apartfrom the Kumpfer-DeMarsh program, weLow little about parent programs for CODAs.

Program Evaluations

Published evaluations of only two school-based prevention programs for children of sub-stance abusers have been found and th.,y focuson alcohol only: the CASPAR Alcohol Educa-tion Program in Somerville, Massachusetts(Davis, Johnston, et al. 1985), and the StressManagement and Alcohol Awareness Program(SMAAP) in Arizona (Roosa, Gensheimer, etal. 1989). Both of these are briefly describedbelow.

CASPAR

The Alcohol Education Program was de-veloped by the Cambridge and SomervilleProgram for Alcoholism Rehabilitation(CASPAR) in the mid-1970s. The curriculum,"Decisions about Drinking," was subsequentlypurchased by many schools and agenciesthroughout the country and became the first al-cohol education program included as an ex-emplary program by the National DiffusionNetwork. One component of the CASPARprogram consists of two groups for junior andsenior high school students held after school:a BASIC group that is open to anyone, and agroup designed for children from alcoholicfamilies (CAF). Groups specifically for chil-dren of alcoholics are expected to be better ableto directly and intensively address their prob-lems. They are provided lessons and activitiesdesigned to promote understanding and copingwith their situation. As described by the pro-gram staff, in the CAF group, "the norms ofsecrecy are breached; children can compare ex-periences and recognize that their parent'sdrinIcing is not their fault; and they can see thatother CAF children are valuable people,whether or not their parents stop drinking"

(Deutsch 1982; DiCicco, Biron, et al.1984:160-161; DiCicco, Davis, et al.1984:22).

The effectiveness of the CASPAR programwas evaluated using a questionnaire adminis-tered at the first and last group meetingassessing changes in laiowledge about alcohol,but without a control group. By the end of theprogram, participants had a greater awarenessof facts about alcohol and had changed theirperceptions of alcoholism in the expectexi di-rection. Anecdotal improvements and benefitswere also reported (Davis, Johnston, et al.1985; DiCicco, Biron, et al. 1984).

SMAAP

Researchers at Arizona State Universityhave developed an intervention program forCOAs in upper elementary school called theStress Management and Alcohol AwarenessProgram (SMAAP) (Roosa, Gensheimer, et al.1989*). The purpose of SMAAP is to teachchildren of alcoholics how to reduce the stressthey experience in particular situations andhow to enhance their self-esteem. In eightsessions, the program addresses five skill ar-eas believed to be relevant to at-risk child= inupper elementary grades: alcohol knowledge,self-esteem, emotion-focused coping, problemsolving, and social support seeking.

The voluntary support groups of SMAAPsucceeded in attracting a small number of stu-dents who were at risk for alcoholism becauseof their parents' alcoholism, although thegroups failed to attract many other studentswho might have benefited from them.Nonetheless, voluntary programs, in whichstudents chose to attend out of their own self-perceived need, do have the advantage ofavoiding the ethical and practical problems in-volved in referring all students at risk for alco-holism to treatment (Roosa, Sandler, et al.1988*).

A pilot test of SMAAP found that the par-ticipants showed increased use of positivecoping strategies (social support seeking,problem solving, and emotion-focused coping)and trends toward decreased depression andmore favorable teacher ratings of classroombehaviors, particularly moodiness. The resultsindicated that the SMAAP curriculum has thepotential to be an effective prevention programfor children who express concern about theirparent's drinking. A large-scale evaluation of

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34

SMAAP is currently being conducted (Roosa,Gensheimer, et al. 1989*).

Conclusion

Taken as a whole, this discussion leads tothe conclusion that to adequately address theneeds of at-risk COSAs requires a majorcommitment from schools and communities toexpand school-based AOD prevention beyondthe focus on drug use per se and to broaden theresponsibility of education beyond the te9 kingof academics to include the promotion of thehealthy development of the whole child. To doso requires developing a comprehensive, inte-grated system encompassing the regular class-room, AOD prevention programs, student as-sistance programs, and COSA programsallaimed at identifying COSAs that are most atrisk and providing them with multiple servicesthat address each child's needs. Given thefundamental role of the dysfunctional familyenvironment as a risk factor, efforts at parentinvolvement and education are also essential.It is apparent, however that there are limits tothe ability of the school to involve the parentsor to affect the family environment. This canbe addressed in part by working with thecommunity to establish treatment-based parenteducation programs. But protective factors re-search suggests that we also need to begin toconceptualize the school as an alternative fam-ily environment that provides the nurturingcare that is often lacking in alcoholic or drug-abusing homes. This will require a commit-ment that tzanscends special programs to theregular classroom itself, and as such must be-gin at the level of teacher training at institutesof higher education and school district inser-vice programs.

A comprehensive, system-wide approachto COSAs such as outlined here is inherentlylabor intensive and expensive. It may be morecost effective, however, to focus preventionand intervention efforts on COSAs than toconcentrate all prevention efforts in genericprograms that are directed at many youth whodo not need them (Miller 1983). Moreover,judged against the social costs of substanceabuse and other problems among COSAs, thecosts of prevention programs are small. Someindication of the social cost of growing up in afamily where alcohol or other drugs are abusedis seen in the fact that mcst clients in substanceabuse treatment centers a:e themselves children

29


of substance abusers. In 1984, 65% of the$1.02 billion spent on chemical dependencytreatment in the United States went to thetreatment of COSAs (Kumpfer and DeMarsh1986:50, 61).

At the same time, one is struck by the simi-larity between many of the recommendationsfor dealing with COSAs and those for dealingwith other problem children. This is notsurprising, in that alcoholic and otherdysfunctional families share similar problems.Indeed, given that not all COSAs are equally atrisk of becoming substance abusersthemselves, the question must be raisedwhether their problems are substantiallydifferent from those of children from otherdysfunctional families and to what extent theywarrant separate attention (Gordis 1990).Programs developed for COSAs may just aswell serve the needs of children from familiesthat are dysfunctional from factors other thanAOD abuse, thereby making school-basedhealth-promotion programs more cost effec-tive. The expansion of student assistanceprograms signals a move in this direction.Assessments of SAPs are essential to provideguidelines for future program development.

ISSUES IN RESEARCHAND PRACTICE

An implicit theme that has run through thisdiscussion is the tension that exists betweenresearch and practice. The rapid expansion inprograms and activities for COSAs over thepast decade or so has taken place with onlylimited guidance from empirical and theoreticalresearch. Much of the knowledge base of pre-vention and intervention activities for COSAsrests on clinical observation and experiencethat has little confirmation in research findings.To help correct this problem, the Children ofAlcoholics Foundation held two conferences inthe mid-1980s that brought researchers andpractitioners together to develop a researchagenda (Blume 1985; Children of AlcoholicsFoundation 1985; Russell, Henderson, andBlume 1985). In addition, the president of thefoundation, Migs Woodside, has attempted tobring a stronger research focus to the field(Woodside 1983, 1988, 1988a). Despite theseefforts, the gap between research and practicestill largely exists (Blanc 1988).

The clinical/practitioner literature onCOSAs (mainly dealing with children of alco-

35


holies) consists of information derived fromobservations by therapists and clinicians on thecharacteristics of children of alcoholics, thedynamics of families (rules, roles, and interac-tions) in which one or both parents are alco-holic, and the process of recovery. This clini-cal information appears in books and articlesdirected at practitioners and the general publicand is concerned with helping children of alco-holics better understand and cope with theproblems of living in a substance-abusingfamily, either on their own or by participatingin self-help or 12-Step groups, such as Alateenor Adult Children of Alcoholics.

Woodside (1988a:789) has summarized thelimitations of clinically based knowledge:"Clearly, case narrative can be important inproviding descriptions of children of alcoholicsand the dynamics at work in the family. It canalso yield a broad-brush portrayal of this popu-lation. However, as yet there have been fewformal, scientific investigations to validateclinical observations. . . . Obviously, muchmore study is needed and in the interim, cau-tion is warranted." As noted above, when ze-searchers have empirically examined one of thecentral concepts of the movement--that of thefour COA roles--the results have provided atbest marginal support. Also, without researchon the effectiveness of prevention and inter-vention programs, there is no assurance thatcxisting programs are, in fact, meeting theneeds of COSAs or that resources are beingwisely used.

At the same time, much of the empirical re-search fails to address directly the needs ofclinicians and practitioners. The empirical lit-erature consists of research-based studies ofsamples of children of substance abusers,usually compared with a control group, thatattempts to determine the specific biological,psychological, emotional, social, or cognitiverisks associated with living in an AOD-im-paired family. This literature is generally inac-cessible to most people; the studies appear inacademic journals and books. More to thepoint, they are often narrowly focused andhighly technical, and the implications of theirfindings for prevention, intervention, andtreatment are seldom obvious or direct. Re-search papers seldom cite the clinical literature,except to note its weak empirical confirmation.

According to Blanc (1988), despite agrowing number of research studies on chil-dren of alcoholics, research has been largelyisolated from the clinical observations and con-

30

ceptual models associated with the COAmovement. Researchers have tended instead tofocus on biological and genetic factors. Also,even though a research study may find a statis-tically significant difference between a sampleof children of alcoholics and a control sampleon a particular behavior, the difference may notbe of practical clinical significance; that is,even though COAs may score, on average,significantly lower than non-COAs, theirscores still fall in the normal range.

As one clinician wrote regarding the rele-vance of research to her work, "I think thatthere is also a feeling among those who seethemselves as working in the trenches that re-search really does not reflect what cliniciansexperience as the real world. Because of thelack of collaboration and lack of communica-tion (and I also suspect at some level possiblybecause of lack of mutual respect), researchersoften tend to be seen by clinical people as re-mote and interested in talking only to one an-other and interested only in esoterica" (Dwinell1986:287). People who work with children indistress on a daily basis do not have the luxuryof waiting for definitive findings from aca-demic researchers, who are continually callingfor more study (Woodside 1988a:790).

A certain degree of tension between re-search and practice is probably inevitable,given the different interests, problems, meth-ods, and outlooks of those who study peopleand those who help them. Nevertheless,closer collaboration between the two groupswould seem both necessary and possible.Studies of risk factors among children of sub-stance abusers have compared COSAs withcontrols, but little work has been done to de-termine to what extent the incidence of thesebehaviors vary among COSAs, particularly interms of the concept of roles used in clinicalwork. For instance, it might be predicted thatthe "scapegoat" in the family would be morelikely than other children to exhibit behaviorand school problems. Similar hypothesescould be developed and tested for the otherroles in order to validate and refine what hasbecome a widely used concept among practi-tioners. Even more useful would be for re-searchers and practitioners to collaborate inevaluating existing prevention and interventionprograms for COSAs in order to determinethose that are most effective, for which chil-dren, and for which desired outcomes.

36

CONCLUSIONS

Parental alcoholism and other drug abuseplaces children at risk for substance abuseproblems as adolescents or adults and for de-veloping school problems, psychopathology,and impaired social and emotional functioning,although research findings suggest that the de-gree of impairment is not as great as that re-ported in the clinical literature. The availableevidence clearly indicates that substance abuseis a multi-generational problem, although thecausal links in terms of genetic or environmen-tal influences have yet to be clearly delineated.Furthermore, because of limitations in the re-search, it is not yet clear whether the problemsidentified in children of substance abusers re-sult specifically from parental alcohol or drugdependence, or whether these problems arecommon to dysfunctional families generally(Gordis 1990).

At the same time, not all children of sub-stance abusers become substance abusersthemselves, nor do they all develop severeproblems of adjustment. A sizable number are"invulnerable" to the negative influences andstresses of the alcoholic or substance abusingfamily. While most research focuses on therisks and problems faced by COSAs, some re-searchers are beginning to examine the protec-tive factors that promote positive adjustmentand resiliency in these children. As these pro-tective factors are identified, they can be incor-porated into school-based or family-based pro-grams, which may help break the cycle of onegeneration passing on its substance abuseproblems down to the next.

Schools have begun to address the prob-lems of children of substance abusers, particu-larly those with learning disabilities associatedwith fetal drug exposure. But in the yearsahead, services to deal with the growing num-ber of children exposed to alcohol or drugs(often both) during pregnancy and during theirformative years will need to be expanded. Theschools will be faced with an increasing num-ber of children who have problems with atten-tion, memory, emotional control, social rela-tionships, and, for older children, alcohol andother drug use.

Much remains to be done to help childrenof substance abusers, including more broadlybased clinical observation, controlled researchstudies with representatives samples, more ac-curate and sensitive assessments of children,and more effective prevention and intervention

31


programs. Work in the field of COSAs iscomplex, encompassing several different dis-ciplines, Vficult questions of methodology,divergent interests between practitioners andresearchers, and a variety of competing con-ceptual models. Significant progress in thefield, both toward establishing the dimensionsof the problems and toward developing betterprevention strategies, would benefit fromgreater cooperation between researchers andpractitioners. In the meantime, those whowork with children of substance abusers inschools, whether as teachers, counselors, psy-chologists, or substance abuse specialists,must do so with imperfect knowledge andtools and with creativity, compassion, sensi-tivity, and hope.

37

ABSTRACTS

ARONSON, M.; KYLLERMAN, M.;SABEL, K.G.; SANDIN, B.; AND OLE-GARD, R. 1985. Children of alcoholicmothers: Developmental, perceptual, andbehavioural characteristics as comparedto matched controls. Acta PaediatricaScandinavica 74:27-35. 23 refs.

The present study focused on the develop-mental levels and profiles, the perception, theemotional stability, and other psychologicalfeatures in children of alcoholic mothers, withand without fetal alcohol syndrome (FAS)characteristics. From a group of 103 Swedishchildren born live of 30 alcoholic women, 23of the youngest children were selected to par-ticipate in the study. The consumption of al-cohol of the mothers during each pregnancywas unknown. The children took a series ofpsychological examinations in their home, in-cluding the Griffiths Mental DevelopmentScales, the Wechsler Intelligence Scale forChildren, and Fostig's Development Test ofVisual Perception.

Findings. The results of the developmentand intelligence tests indkated that the studygroup had significantly lower results that thecontrols. The largest differences were foundin the sub-scales "hearing and speech," "eye-hand coordination," and "practical reasoning."In terms of perception, the study group en-countered special difficulties in the areas of"figure-ground" and "spatial relations." Dif-ferences between the study and control groupswere also found in the human figure drawings.Study group children had a greater prevalenceof perceptual difficulties. Hyperactivity, dis-tractibility, and short attention span were ob-served in 13 members of the study group butin none of the controls. In the group with FAStraits, IQ was significantly lower than in thegroup without such signs.

BAUMAN, PAMELA S., AND LEVINE,S.A. 1986. The development of childrenof drug addicts. International Journal ofthe Addictions 21(8):849-863. 22 refs.

The effects of maternal drug addiction onchild behaviors has received little study. It ispossible that drug addiction results in deficientparenting, which in turn may lead to develop-mental lags, psychological impairments, andcognitive deficits in children. The presentstudy sought to correct the methodological

weaknesses of previous investigations by ex-amining a relatively large sample with adequatecontrols.

The experimental group consisted of 70methadone-maintained (MM) mothers and their70 children between ages 3 and 6; a controlgroup included the same number of nonad-dieted (NDA) mothers and their children.While the control mothers were not physicallydependent on drugs, the selection criteria didallow for low levels of nondysfunctional druguse. The NDA mothers were matched with theMM mothers on ethnicity or racc, socioeco-nomic status, and participation by a male in thechild's upbringing.

Data were collected from mothers on per-sonality, intelligence, and parenting attitudesand behavior, and from children on behavior,intelligence, and development level. Assess-ment included observation of mother-child in-teraction in the laboratory and in the mother'shome.

Findings. The MM mothers performedless well adaptively on measures of intelli-gence, personality, and parenting behavior. Inaddition, MM mothers were more likely thanNDA mothers to express authoritarian chil-drearing attitudes.

Significant differences between the chil-dren of the two groups of mothers were alsofound. Measures of intelligence and sociallyadaptive behavior were lower for children ofMM mothers than for children of NDA moth-ers. Children of MM mothers who experi-enced withdrawal from drugs as neonates werecompared with those children of MM 3therswho did not experience withdrawal. The com-parison revealed that withdrawal children hassignificantly lower general developmentalscores and a strong tendency for lower IQscores and height and weight.

Conclusions. The resalts of this studyindicate that MM mothers are impulsive, imma-ture, irresponsible, and unempathetic. Thesetraits tended to be found in the children of MMmothers. The authoritarian parenting style ofMM mothers may also contribute to impair-ments and developmental problems in theirchildren. The lower IQ scores of the childrenof MM mothers may be related to the mother'slower average IQ and to her aversive behaviorpatterns. Children of drug-addicted mothersexhibit cognitive and behavior patterns that aresimilar to that of their mothers, which may

38


place them at high risk of becoming drugabusers themselves. To the extent that treat-ment programs can teach drug-addicted effec-tive parenting skills, it may be possible tobreak the intergenerational cycle of addiction.Further research, using a longitudinal design,is needed to test this hypothesis.

BENNETT, LINDA; WOLIN, STEVENJ.; AND REISS, DAVID. 1988. Cogni-tive, behavioral, and emotional problemsamong school-aged children of alcoholicparents. American Journal of Psychiatry145(2):185-190. 38 refs.

Research conducted since the mid-1970sindicates that children of alcoholic parents ex-hibit more cognitive, behavioral, and emotionalproblems than children of nonalcoholic par-ents, with the most pronounced differenceshaving been found in the cognitive domain.This study attempted to correct methodologicalweaknesses in previous research on children ofalcoholics by (1) including a group of compar-ison families, (2) using a wide range ofassessment instniments, (3) evaluating all bio-logical children in each family, and (4) con-trolling for the potential lack of independenceof findings from children in the same familyand from families within the same sample.

The sample consisted of 37 families with atleast one alcoholic parent and 45 families withno alcoholic parent. All the biological childrenbetween ages 6 and 18 were tested. A total of144 children participated in the study: 64 inthe alcoholic-family group (mean age 12.08years) and 80 in the comparison group (meanage 11.43 years). In all but eight of the alco-holic families, only the father was the alcoholicor problem drinker. In seven families, bothparents were alcoholic, and in one family, onlythe mother was alcoholic.

Interviews with parents collected data onalcohol use history, family alcohol history, andcurrent drinking practices. A school psychol-ogist who was unaware of the alcohol status ofthe parents administered the following instru-ments to the children: (1) WISC-R or WAIS-R, (2) the Peabody Individual AchievementTest, (3) the Piers Harris Children's Self-Con-cept Scale, and (4) the Herjanic Diagnostic In-terview for Children and Adolescents. Parentsalso assessed each of their children usingAchenbach's Child Behavior Checklist and theConners Parent Rating Scale.

Findings. Children from alcoholic fami-lies scored significantly less well than children

34

from comparison families on measures of IQ,reading, arithmetic, self-concept, behaviorproblems, emotional disorders, psychosomaticsymptoms, learning problems, and impulsiv-ity-hyperactivity. Factor analysis found signif-icant differences between the two groups inemotional functioning and in cognitive abilitiesand performance; marginally significant differ-ences were found for behavior problems. De-spite the differences, all of the scores for bothgroups of children were in the normal range.

Conclusions. The findings confirmed re-sults found in earlier studies that growing up ina family with an alcoholic parent leads to low-ered emotional and cognitive functioning. Thereason for this may be attributed to the diffi-culty alcoholic families have in establishing awell-planned and stable life with meaningfulfamily rituals. Such a family environmentplaces children at greater risk for a variety ofproblems; self-esteem appears to be most af-fected.

BURK, JEFFREY P., AND SHER,KENNETH J. 1990. Labeling the child ofan alcoholic: Negative stereotyping bymental health professionals and peers.Journal of Studies on Alcohol 51(2):156-163. 26 refs.

Children of alcoholics (COAs) have re-ceived increasing attention recently as a groupthat is at high risk for becoming alcoholics andfor developing a variety of emotional, educa-tional, and social problems. While many peo-ple have urged the necessity of establishingprevention services for all COAs, there is evi-dence that many COAs show no signs of psy-chopathology and do not later become alco-holics. Furthermore, identifying and labelingchadren and young people as COAs may resultin negative stereotypes and other negadve out-comes. The current investigation sought todetermine the effects of labeling children of al-coholics as perceived by peers and by mentalhealth professionals. Two studies were con-ducted.

Study 1. In the first study 570 high schoolstudents at two schools in a midwestern cityprovided demographic information aboutthemselves and then indicated the degree towhich 11 pairs of bipolar adjectives (e.g.,sad/happy, seak/strong, inactive/active) de-scribed seven different roles: themselves,teenagers (male and female) with an alcoholicparent), teenagers (male and female) who were

3!,

mentally ill, and typical teenagers (male andfemale) at their high schools.

Findings. The students rated COAssignificantly different overall compared withtypical teenagers and mentally ill teenagers;they fell between the other two groups, withtypical teenagers receiving the most positiveratings. When nonsignificant differencesoccurred for specific adjective pairs, COAswere grouped more often with mentally illteenagers as being "deviant."

Study 2. To determine the views of thosewho work most closely with COAs, 80 mentalhealth professionals and paraprofessionals intwo cities, either in groups or individually,watched a videotape of a clinical interview withan adolescent who was described as havingeither a positive or a negative family history ofalcoholism and as being either a class leader ora problem teenager. After watching the video-tape, the subjects completed questionnaires thatcollected demographic information and elicitedresponses describing the adolescent in thevideotape on three scales: Current Level ofDysfunction Scale, Future Functioning Scale,and Acceptance/Rejection of the Child Scale.

Findings. COAs were seen as signifi-cantly less psychologically healthy and morepathological than the controls. They were alsoperceived as more likely to develop psy-chopathology, less likely to remain psycholog-ically healthy, and less likely to develop andmaintain intimate relationships with their fam-ily or with others. Significant effects or inter-actions for the Acceptance/Rejection of theChild Scale were not found. In short, mentalhealth professionals considered COAs(whether the class leader or the problemteenager) to be psychologically unhealthysolely on the basis of limited information onfamily background. Specifically, comparedwith non-COAs, COAs were viewed as (1) cutoff from sources of support, (2) unhappy withthe quality of their lives, (3) pessimistic abouttheir future, (4) functioning as a low psycho-logical level, (5) likely to be abusing alcohol orother drugs, (6) having numerous schoolproblems, and (7) being unpopular with theirpeers. The future for COAs was equally nega-tive, although the mental professionals gener-ally believed that COAs could become"normal" after receiving psychotherapy.

Conclusions. Although the appearance ofthe children of alcoholics movement has en-abled many people to identify a cause for theirdistress and to take action, there is potential

35


harm in labeling persons COAs, particularlythose who exhibit healthy and adaptive behav-iors. COAs may experience peer rejection,which may mull in depression, lowered self-esteem, and possibly seeking acceptalice withdeviant peers. The result is a self-fulfillingprophecy. Mental health professions, assum-ing that COAs are deviant, may subject them tounnecessary treatment. While labeling can bebeneficial, it can also have negative conse-quences, which mental health professionalsshould be aware of in making decisions aboutpsychological interventions with childrenwhose parents are alcoholics. The focusshould be on actual behavior in need of atten-tion rather than expected behavior.

CLAIR, DAVID, AND GENEST, M.1987. Variables associated with theadjustment of offspring of alcoholicfathers. Journal of Studies on Alcohol48(4):345-355. 47 refs.

Variables were examined that may accountfor the fact that some children of alcoholics ap-pear relatively invulnerable to the stressors andill effects of having an alcoholic parent,whereas others are dysfunctional. Potentialmoderating variables were examined for theirroles in buffering the stress of parental alco-holism. The study hypothesized that familyenvironment, social support, and coping be-haviors would have additive roles in account-ing for the variability in subjects' reactions tothe stresses of parental alcoholism. Copingwas of particular interest in this study becauseit can be considered a moderator over whichthe individual has some control.

The sample consisted of 30 offspring of al-coholic fathers and nonalcoholic mother and 40offspring of nonalcoholic parents aged 18-23.Subjects were asked to report retrospectivelyon their family environments, social supports,and coping behaviors used in response to spe-cific problems situations when they were be-tween the ages of 13 and 18 years of age.Women were overrepresented in this study.

Respondents were asked to complete thefollowing instruments: The Family Environ-ment Scale (FES) that assessed relationshipdimensions, personal growth dImensions, andsystem maintenance dimensions; the Dimen-sions of Social S ,pport Scale (DSSS) thatassessed the informational and emotional sup-port received by subjects; the Ways of Copingchecklist that assessed coping strategies usedto deal with problems resulting from parental

4 0


alcoholism; the Depression-Proneness RatingScale (DPRS) that assessed proneness to mod-erated depressive episodes, rather than currentdepression of clinical severity; and the Ten-nessee Self-Concept Scale (TSCS) thatasc-ssed positive and negative self-percep-tions.

Findings. Children of alcoholics hadlower scores than the comparison group on theFES sub-scales of coheaion and intellect-cul-tural orientation and higher scores on the con-flict sub-scale. Offspring of alcoholics didnot, however, score lower on the sub-scalesmeasuring expressiveness and recreational-op-eration.

Data from the DSSS indicated that both theoffspring and the comparison group scoreswere similar on the emotional support scale,but offspring reported less information supportthan the comparison group.

From the Ways of Coping checklist, theoffspring group indicated a greater tendency toappraise problem situations in their families asunchangeable or as requiring acceptance. Off-spring also had a higher mean endorsementrate on the emotion-focused coping category(directed at reducing emotional distress) thanon the problem-focused coping category(directed at changing the situation) Compari-son subjects, on the other hand, did not differon the two categories. Children of alcoholicsalso endorsed all the avoidance-escape strate-gies with the exception of medication morefrequently than did the comparison subjects.Offspring of alcoholics had higher scores ondepression-proneness, but did not differ fromthe comparison subjects in terms of theirscores on social self-esteem, general malad-justment, and total self-esteem.

Multiple regression analysis found that ap-proximately 50% of the variance in depression-proneness and 40% of the variance in self-es-teem could be accounted for by a combinationof family environment, social support, andcoping variables. This suggests the need for amultivariate approach to understanding thefunctioning of COAs.

Conclusions. Children of alcoholics re-ported considerably more disruption in theirfamily environments than did the comparisonsubjects. Alcoholic families were seen as lesscohesive, less organized, less orientated to-ward intellectual or cultural pursuits, and moreconflict-ridden. Offspring of alcoholics tendedto use more emotion-focused than pmblem-fo-cused coping in response to their problems.

ite

While the risks of maladjustment were higherfor those raised in alcoholic families, there wasa range of adjustment within these offspring.Cohesiveness, expressiveness, and encour-agement of thc child's independence were as-sociated with positive adjustment. In addition,support, both emotional and informational,was found to be related to adjustment withinalcoholic families.

DRAKE, ROBERT E., AND VAIL-LANT, GEORGE E. 1988. Predicting al-coholism and personality disorder in a 33-year longitudinal study of children of al-coholics. British Journal of Addiction83:799-807. 38 refs.

This study examined five questions relatedto the effect of COA status on adolescent ad-justment and on adult alcoholism and person-ality disorder: (1) What adjustment problemsdo nondelinquent adolescent COAs exhibitcompared with their peers? (2) In what waysare these adjustment problems related to familydisruptions? (3) What are the influences ofCOA status on adult alcoholism and personal-ity disorder? (4) What factors in adolescencepredict adult alcoholism (DSM-II1 criteria)among COAs? (5) What factors in adolescencepredict adult personality disorder (DSM-IIIcriteria) among COAs?

The subjects consisted of 174 males withbiological fathers identified as alcohol abusers.They were selected from a sample of nondelin-quent men who had participated since aboutage 14 in a 33-year longitudinal study of alco-holism. Subjects without alcoholic fathersserved as controls (n=282). Variables testedas predictors in adolescence of adult alco-holism and personality disorder were familialuse of and attitudes toward alcohol, adolescentenvironment (e.g., socioeconomic status, rela-tionship with mother, relationship with father,parental separation, parental death), and ado-lescent adjustment (e.g., hyperactivity, IQ,emotional problems, physical health, feelingsof inadequacy, and school behavior problems).

Findings. In adolescence, the COA sub-jects were significantly different from theirpeers on a variety of characteristics. TheCOAs were more likely to have alcoholic rela-tives (in addition to father), to come from anon-Mediterranean background, to have poorrelationships with their father and mother, tohave disruptions in their lives, to have emo-tional problems, to have poor competence inage-appropriate skills, and to have school

problems (although they did not demonstatepoor results on intelligence tests or hyperactiv-ity). Measures of poor adolescent adjustmentof COAs was most strongly and consistentlycorrelated with having a poor relationship withone's mother.

As adults, the primary negative conse-quences of COA status was alcoholism, notpersonality disorder. COAs were more thantwice as likely as the controls to receive a diag-nosis of alcohol dependence (28% vs. 12T ).Over half (58%) of the COAs had not receiveda diagnosis of alcoholism and another 14% hadreceived a diagnosis of alcohol abuse; compa-rable figures for controls were 73% and 16%,respectively.

COAs who became alcoholics as adultswere more likely than those with no alcoholismto have many alcoholic relatives, to have anon-Mediterranean background, to have a lowsocioeconomic status, and to have frequentschool problems.

Adult COAs were only slightly more likelythan controls to have received a diagnosis ofpersonality disorder (25% vs. 23%). Twelve(36%) of the COAs with personality disorderwere also alcoholics. Significant predictors ofadult personality disorder among nonalcoholicCOAs were environmental veAakness, poor re-lationship with mother, low IQ, and feelings ofinadequacy.

Conclusions. The finding that poor ado-lescent adjustment of COAs was most stronglyrelated with having a poor relationship withone's mother suggests the importance of thenonalcoholic parent in protecting (or not pro-tecting) the child from parental alcoholism.This point is reinforced by the finding that theadolescent variables that predicted adult alco-holism did not overlap with those variables thatpredicted adult personality disorder, except forhaving a poor relationship with one's mother.

Although COAs were more likely thancontrols to become alcoholics as adults, theiralcoholism was not related to their adjustmentproblems in adolescence. There was little con-tinuity between poor adolescent adjustment andalcoholism or personality disorder as adults.Even though COAs had more than their shareof problems in adolescence, by midlife mosthad not developed either alcoholism or per-sonality disorder. Healthy adult developmentappears to be related to several factors: (1)managing to leave the alcoholic environment,(2) leaving the nonalcoholic parent (usually themother), (3) developing competency at appro-

37


priate tasks, (4) experiencing and internalizinghealthy relationships, and (5) developing ma-ture defense mechanisms.

EARLS, FELTON; REICH, WENDY;JUNG, KENNETH G.; ANDCLONINGER, C. ROBERT. 1988. Psy-chopathology.in children of alcoholic andantisocial parents. Alcoholism: Clinicaland Experimental Research 12(4):481-487.32 refs.

Frequency and types of psychopathologywere investigated in children of parents withalcoholism and children of parents with anti-social personality disorder. The study samplewas drawn from three groups: hospitalized al-coholics, convicted felons, and hospitalizedmedical controls. The final sample consistedof 69 families and 93 children (age 6-17).Data were collected from structured diagnosticand psychosocial interviews with one of theparents (usually the mother) and with eachchild in the family in the 6-17 age range;assessment of children also included measuresof self-concept, temperament, verbal IQ, andacademic achievement.

Two sets of analysis were carried out: fre-quency of disorder between children with ei-ther one or two alcoholic parents (but neitherwith antisocial personality disorder) and chil-dren in nonalcoholic families; and frequency ofdisorder between children of antisocial parents,children of alcoholic parents, and children ofparents with neither diagnosis. Childhooddisorders examined were attention deficit dis-order with hyperactivity (ADDH), oppositionaldisorder (OPD), conduct disorder, depression,and anxiety.

Findings. Analysis of general indices ofpsychopae-Dlogy indicated that a significantlygreater number of mean symptoms and meandiagnoses in children from alcohol families andfrom antisocial families compared with chil-dren from control families. The highest num-ber of symptoms and diagnoses was found inchildren from families in which both parentswere alcoholic and in children from antisocialfamilies (many of which were also alcoholic).

For children from alcoholic homes, the fre-quency of specific behavioral disorders in-creased with the number of alcoholic parents.For instance, attention deficit disorder wasfound in 12% of children with neither parentalcoholic, 21% in children with one parent al-coholic, and 50% of children with both parents

4 2


alcoholic. Differences in emotional disorderwere not as pronounced.

When control, alcoholic only, and antiso-cial families were examined, none of the dif-ferences in the frequency of specific disordersin children were significant for reports by par-ents, but for child reports rates for several ofthe disorders were significant (attention deficitdisorder, oppositional disorder, and anxiety).Overall, the proportion of children affected bypsychiatric disorder was three times morecommon in children of antisocial and alcoholicparents than in children of parents with neitherdisorder based on child reports and twice ascommon based on parent reports.

Conclusion. The data from this study donot indicate differences in the rates of child-hood disorders between alcohol and antisocialparents. Neither did a combination of alco-holism and antisocial personality produce ele-vated rates over alcoholism alone. What wasevident was the effect on childhood disorderswhen both parents were alcoholic. Either theadverse psychological and social environmentin a two-alcoholic family or the increase in ge-netic loading or both result in a greater risk ofthe child developing a psychiatric disorder.

ERVIN, CYNTHIA S.; LITTLE, RUTHE.; STREISSGUTH, ANN P.; ANDBECK, DON E. 1984. Alcoholic fatheringand its relation to child's intellectual de-velopment: A pilot investigation. Alco-holism: Clinical and Experimental Re-search 8(4):362-365. 27 refs.

This study explored the possible effects ofbeing raised by an alcoholic father and a nonal-coholic mother on the intellectual functioningand academic achievement of the child. Theimpact of the biological father's drinking be-fore conception is considered.

The subjects consisted of 50 childrenraised for at least part of their lives by alcoholicfathers and 50 children raised entirely by non-alcoholic fathers. The children ranged in agefrom under three to 15 and older, but mostwere aged 6-14 years. The children were ad-ministered the Bayley Scales of Infant Devel-opment, the Stanford-Binet, the Wechsler In-telligence Scale for Children-Revised, theWechsler Adult Intelligence Scale, and theWide Range Achievement Test.

Findings. Intellectual and academic func-tioning was found to be significantly related tothe presence of an alcoholic father in the home.

All sub-tests IQ scores were lower for off-spring raised by alcoholic fathers. The differ-ences in intellectual functioning persisted re-gardless of child's race, sex, birth order, fam-ily socioeconomic status, maternal smoking inpregnancy, mother's age at birth, or parentaleducation. The disruptive and chaotic natureof an alcoholic home has been suggested assources of stress for children, which in turnmay affect cognitive performance.

GFROERER, JOSEPH. 1987. Correla-tion between drug use by teenagers anddrug use by older family members. Ameri-can Journal of Drug and Alcohol Abuse13(1/2):95-108. 17 refs.

This study examines the relationship be-tween drug use by teenagers and by older fam-ily members (parent or older sibling), withparticular reference to alcohol, cigarettes, mari-juana, and cocaine. The data were derivedfrom youth-adult pairs in the 1979 and 1982National Survey on Drug Abuse, which is asurvey based on a national probability sampleof households. The youth were age 14 to 17,the older siblings were age 18 to 25, and theparents were age 30 to 64. The sample foranalysis consisted of 1,177 youth-adult pairs(303 fathers, 450 mothers, and 424 older sib-lings). The relationship between teenage andadult drug use was tested for significance aftercontrolling for age of youth, geographic re-gion, and population density.

Findings. The results indicated strongpositive correlations between drug use byyouths and drug use by fathers, mothers, andolder siblings. If a parent or older siblings usedrugs, the youths were also likely use drugs.The strongest and most consistent relationshipwas that between marijuana use by youth andmarijuana use by adult. The weakest relation-ship was for cocaine; youth cocaine use wasnot significantly related to drug use by fathersor older siblings, but it was related to drug useby mothers. (Only lifetime use of marijuanafor mothers and fathers was used in the analy-sis, so it is possible that in many cases the useoccurred before the youth was born.)

Few differences were found for teenageboys and girls. Also, most of the relationshipsbetween teenage and adult drug use remainedunchanged when family circumstances wereincluded in the analyses as controls.

The likelihood of a teenager using mari-juana at least once increased with the numberof days in the past month that the fathers and

38

4 I

mothers used alcohol and with the number ofdays that the older siblings used marijuana.Cigarette use by youth was correlated with thenumber of days of marijuana use by older sib-lings, and moderate alcohol use by youth wascorrelated with the number of days of alcoholuse by older siblings.

Conclusions. The results suggest that thesocial learning process plays a major role ininfluencing youth to initiate and continue druguse. There is some evidence of a "generalizedimitation" by youth of older adult behavior,which is specific to a particular drug and whichoccurs for mothers, fathers, and older siblings.For marijuana, however, there does appear tobe a direct influence of parental use on teenageuse. The results also suggests that even infre-quent use of drugs by parents and older sib-lings may influence teenagers to experimentwith drugs. Though a variety of other possibleinfluences on teenage drug use (e.g., peer in-fluences) were not investigated in this study,the results suggest that abstention from alco-hol, cigarette, and marijuana use by parentsand older siblings would help prevent drug useby teenagers.

HEGEDUS, ANDREA M.; ALTERMAN,ARTHUR I.; AND TARTER, RALPH E.1984. Learning achievement in sons of al-coholics. Alcoholism: Clinical and Exper-imental Research 8(3):330-333. 12 refs.

This study sought to determine whether theacademic underachievement of sons of alco-holic fathers observed in a previous study(Tarter, Hegedus et al. 1984) was related tocognitive impairment or to other factors (familydisruption, psychopathology, or adolescentdeviancy). The subjects consisted of 16 ado-lescents (mean age 16 years) who had been re-ferred by juvenile court for psychiatric evalua-tion and who had alcoholic fathers; they werecompared with 25 adolescent delinquentswhose fathers had no apparent history of alco-holism. None of the adolescents in eithergroup had a history of substance abuse. Sub-jects completed a battery of tests that measuredneuropsychological capacity, educationalachievement, behavioral disorder, psy-chopathology, and family environment.

Findings. The sons of alcoholics scoredsignificantly lower than the sons of nonalco-holies on indices of academic achievement(Peabody Individual Achievement Test), eventhough both groups were equivalent on intel-lectual ability. Correlations computed between

39


the academic achievement scores and a FamilyEnvironment Scale indicated that perception ofthe family as being organized was positivelyrelated to academic performance. Psy-chopathology was measured by scores on theMMPI; results showed that subjects whoviewed themselves negatively or whose re-sponses indicted deviancy had low academicachievement scores. On the measure of behav-ioral disorder, academic achievement scoreswere significantly correlated with the Erno-tional Distance and the Bizarre Speech andCognition scales. Finally, the Pittsburgh Ini-tial Neuropsychological Test System was usedto determine cerebral dysfunction and its rela-tion to academic achievement. Significantpositive correlations were found between aca-demic achievement scores and measures oflanguage processes, memory, visuospatial ca-pacity, and perceptual-motor capacity.

Conclusions. Underachievement in sonsof alcoholics was most strongly related withneuropsychological capacity, but family orga-nization and emotional stability were also im-portant. Since none of the sons of alcoholicsin this study had a history of alcoholism, it ap-pears that certain cognitive impairments, whichhave been attributed to the effects of alcoholabuse, may precede the onset of drinking.Although the risk for alcoholism may be asso-ciated with cognitive impairment, additional re-search that controls for hereditary and envi-ronmental influences is needed to determine thecause of the cerebral deficit.

JACOB, THEODORE, AND LEONARD,KENNETH. 1986. Psychosocial function-ing in children of alcoholic fathers, de-pressed fathers and control fathers.Journal of Studies of Alcohol 47(5):373-380. 24 refs.

A considerable body of clinical literaturesuggests that many children of alcoholics havesevere psychological impairment and socialmaladjustment, but little methodologicallysound empirival research exists to confirm this.This study examined the psychosocial and aca-demic functioning of children of alcoholic fa-thers who were not in treatment. The familiesof the children had been intact for at least fiveyears, and neither parents currently exhibitedpsychiatric disorders The COA group wascompared with a group whose fathers were de-pressed and with a control group in which thefather was a social drinker who did not exhibitdepression. Data were gathered from 134

4 4


families (43 alcoholic fathers, 46 depressedfathers, and 45 control fathers), and from 296children in those families (100 children of al-coholics, 36 children of depressives, and 105children of controls). Both parents and teach-ers of the children completed instruments thatmeasured social competence, behavior prob-lems, and learning disabilities. Separate analy-ses were conducted for boys and girls.

Findings. On the basis of parents' re-ports, sons of alcoholics and depressivesscored higher than sons of controls on mea-sures of Total Behavior Problems, Number ofProblems, and Internalizing. Sons of alcoholicfathers were not significantly different fromsons of depressed fathers. Older sons of alco-holics (over 12 years old) were rated higher ondelinquency than were older sons of depressedor control fathers. On the Total Social Compe-tency score, sons of alcoholics and of depres-sives rated lower than sons of controls.

For daughters, significant group differ-ences were found for Total Behavior Prob-lems, Number of Problems, Internalizing, andExternalizing, with the daughters of alcoholicand of depressed fathers scoring higher thanthe daughters of controls. On each of thesefour scales, daughters of depressed fatherswere rated higher than daughters of alcoholics.Age comparisons also yielded significant dif-ferences between the three groups. Youngerdaughters of depressed fathers had higherscores on Social Withdrawal, Somatic Com-plaints, Hyperactivity, Sex Problems, and Ag-gressive than daughters of the other twogroups. Younger daughters of alcoholics hadhigher scores than daughters of controls onSocial Withdrawal, Schizoid-Obsessive, Hy-peractive, and Aggressive. Among olderdaughters, significant differences were foundbetween the three group on four scales: Anx-ious-Obsessive, Depressed-Withdrawal, Im-mature-Hyperactive, and Aggressive, withdaughters of depressed fathers scoring higherthan daughters of alcoholics and controls anddaughters of alcoholics scoring higher thandaughters of controls. Deficits in social com-petency were found only among the youngerdaughters of depressed fathers.

Despite differences on several of the scalesamong the three groups, most of the childrenwould not be regarded as clinically impaired.In an examination of those families in which atleast one child was rated as severely impaired(two standard deviations above the mean onthe Total Problem Behavior score), it was

40

found that 23% of the alcoholic fathers had animpaired child, as did 15% of the depressedfathers; none of the control fathers had an im-paired child. In relation to all of the childrenexamined, 13% of the children of alcoholics,8% of the children of depressives, and none ofthe children of controls were rated as severelyimpaired. The most severely impaired chil-dren, however, had fathers who experiencedboth serious problems with alcohol and highlevels of psychopathology; their mothers alsohad high levels of psychopathology.

Teacher ratings of the children did not dif-ferentiate either the sons or the daughters of al-coholics, depressives, or controls.

Conclusions. The main conclusion of thisstudy was that the degree of impairment ofchildren of alcoholics, according to parent re-ports, was substantially less than that reportedin the clinical literature,. Both children of alco-holic fathers and children of depressed fathersexperienced more problems and manifestedfewer social competencies than children of fa-thers who were not depressed and who weresocial drinkers. For specific problems,younger sons in the three group did not differ,while older sons differed only with respect todelinquency; both younger and older daughtersof alcoholics and depressives exhibited prob-lems in a variety of areas. The differences thatwere observed, even though significant, wereseldom large, and the mean scores were in thenormal range. With the exception of a smallminority of children, the problems exhibited bychildren of alcoholics and depressives wereneither severe nor pervasive. Severe impair-ment in children of alcoholics was more likelywhen the father had frequent alcohol problemsand a high level of psychopathology and whenthe (nonalcoholic) mother also had severe psy-chopathology. It is likely that a mother who iscompetent and less distressed can compensatefor the lack of an appropriate paternal rolemodel.

JOHNSON, JEANNETTE L., ANDROLF, JON E. 1988. Cognitive function-ing in children from alcoholic and non-al-coholic families. Pritish Journal of Addic-tion 83(7):849-857. 36 refs.

Results from studies of cognitive function-ing in children of alcoholics have presented in-consistent results, with some studies showinglowered levels of intellectual functioning com-pared with children from nonalcoholic homesand others finding no significant differences

4 5

between the two groups. This study examinedboth academic abilities and intellectual func-tioning in children from alcoholic and nonalco-holic families from middle-class backgrounds.Participants ranged in age from 6 to 18 years;50 were children of alcoholics (mean age 13.0years) and 48 were children of nonalcoholics(mean age 13.4 years). The groups did notdiffer in their use of alcohol and other drugs.

Parents of the children provided data ondemographic information, alcohol and druguse history, and home environment. All of thealcoholic parents had been in recovery for atleast six months. Cognitive functioning of thechildren was assessed through instrumentscompleted by both the children and their moth-ers. The children completed four instniments:the Wide Range Achievement Test (WRAT),the WISC-R or the WAIS, the PerceivedCompetence Scale for Children--Child Ver-sion, and the Project Competence Child Inter-view. Mothers completed three instruments:the Child Behavior Checklist, the Parent Ques-tionnaire, and the Perceived Competence Scalefor ChildrenParents Version. Only measuresrelated to learning, cognitive performance, orlearning problems from the various instru-ments were analyzed.

Findings. No significant differences be-tween the children of alcoholics and children ofnonalcoholics with respect to IQ or basic aca-demic skills (reading, spelling, and arithmetic).All scores fell within normal range.

Compared with children of nonalcoholics,children of alcoholics liked school less, wereless likely to say they were doing as well asthey could in school, and indicated lower self-estimates of their cognitive competence.

Mothers' reports of their children's aca-demic and cognitive abilities indicted signifi-cantly lower scores on school competence andcognitive competence.

For both groups, mothers' perceptions oftheir children's cognitive competence was sig-nificantly and positively correlated with thechildren's actual performance. The correlationbetween children's perceived competence andactual performance differed for the twogroups. For children of nonalcoholics, the re-lationship was significant and positive, but forchildren of alcoholics, the relationship for mostof the scores on the WISC-R or WAIS and theWRAT was not significant.

Conclusions. Unlike previous reports,this study did not find significant differencesbetween children of alcoholics and children of

41


nonalcoholics on measures of IQ and academicperformance. All of the children for this studycame from middle-class homes, were notdelinquents o- substance abusers, and did nothave a histoiy of maternal drinking duringpregnancy. It may be that previous studies re-porting cognitive differences -were measuringthe effects of socioeconomic status or samplingheterogeneity rather than the effects of familyalcoholism. The fact that the sample consistedof children of recovering alcoholics may alsohave affected the results. The results obtainedin this study may also be explained by the factthat the type of parental alcoholism in thesample can be characterized as "milieu-lim-ited," which describes those alcoholism withmild alcohol abuse and minimal criminality.

Significant differences between the twogroups were found for perceptions of theseabilities by mothers and their children, withlower scores being recorded by children of al-coholics and their mothers. Presumably, thisbelief in lack of cognitive competence affectsmotivation, self-esteem, and future perfor-mance in the child. The results of this study,as well as the inconsistent findings of previousstudies, suggest that the focus on cognitivefunctioning as a single risk for alcoholismshould be questioned. It may be that cognitiveperformance operates in different people or atdifferent times as a risk factor for alcoholism.

JOHNSON, JEANNETTE; BONEY, T.;AND BROWN, B. 1991. Evidence ofdepressive symptoms in children ofsubstance abusers. International Journalof the Addictions 25(4A):465-479. SO refs.

The affective and academic functioning ofchildren of substance abusers wereinvestigated as possible precursors to altersubstance-abusing behavior. Thirty-fivechildren of substance abusers and 37 childrenof non-substance abusers were compared onmeasures of depression, state and trait anxiety,and three standardized measures of academicability reading, spelling, and arithmetic).Children of substance abusers scoredsignificantly lower on depression, trait anxiety,and arithmetic. This suggests potential risksfor psychological difficulties, especiallyaffective and academic problems. Immediateefforts to intervene on behalf of these childrenappear warranted. Intervention strategies needto be developed for use with children thatavoid the risk of negative labeling. This can bedone in the context of providing family

4 6


services to parents already in drug abusetreatment programs to improve parentingpractices and moctify children's inappropriatebehaviors.

MANNING, D. THOMPSON; BALSON,PAUL M.; AND XENAKIS, STEPHEN.1986. The prevalence of Type A per-sonality in the children of alcoholics. Al-coholism: Clinical and Experimental Re-search 10(2):184-189. 32 refs.

Type A personality is a behavior patternthat involves "a relatively chronic struggle toachieve a serious of poorly defined goals in theshortest period of time possible and is markedby competitive achievement, striving, time ur-gency, impatience, aggression, and hostility."This personality type has been found in chil-dren as young a five years old. Clinical obser-vation has found a high incidence of Type Abehavior in children of alcoholics, notably inthose who assume the role of "Family Hero."It is assumed that both Type A personalitiesand COAs have a strong need to control theirenvironments.

This article reports on three studies con-ducted in order to determine whether the highprevalence of Type A personality in children ofalcoholics could be established empirically.Two of the studies assessed traits associatedwith type A behavior (competition and impa-tience-aggression) using the Matthews YouthTest for Health (MYTH), which is given tononalcoholic parents to rate their children's be-havior. The third study used the Hunter WolfA-B Rating Scale, which is completed by thechildren themselves, to obtain measures of en-ergy, impatience-aggression, leadership, andalienation.

Findings. Study 1. Mothers enrolled in atreatment for spouses of alcoholics completed aseparate MYTH for each of their children aged5-17. There were 21 COA families and 46children. The comparison group consisted of65 children of 41 mothers who were attendingan evening public school meeting. Bothgroups consisted of white, blue-collar families.

Analysis of the data revealed no significantdifferences between the COA children and thecontrols by age, sex, or birth order. Themothers of COAs rated their children signifi-cantly higher on impatience-aggression thandid mothers of controls; the difference oncompetition was not significant.

42

Study 2. The first study was replicated us-ing recovering alcoholic fathers. The treatmentgroups consisted of children of alcoholic fa-thers enrolled in a military alcohol treatmentprogram. Controls were drawn from soldierswho were not identified alcoholics but in-volved in a different study on adult alcoholism.In all, 58 alcoholic and 8! control soldierscompleted the MYTH for 95 COA and 143control children.

No significant differences wzre found be-tween the COA and the control children on ei-ther of the MYTH subscales or on the totalscore. On the competition subscale, fffst-bornCOAs scored significantly higher than later-born controls.

Study 3. In the third study, 35 children(ages 4-12) from white, middle- and upper-middle class alcoholic parents involved in a re-covery program completed the Hunter-Wolf A-B Rating Scale. A similar number of controlscompleted the same instrument.

No significant differences between the twogroups were found by alcohol condition, sex,or birth order.

Conclusions. The three studies offeredlimited support for the observation in clinicalliterature that COAs exhibit high prevalence ofType A behavior. With one exception, nosignificant differences between COAs andcontrols were found for Type A traits, whetherrated by nonalcoholic mothers, recovering fa-thers, or children. The exception was moth-ers' rating of impatience-aggression. Also, itwas found that first-born COAs were no morelikely to exhibit Type A personality than wereother COAs, which is contrary to statementsfound in the clinical literature. Further work toclarify the effect of parental alcoholism onchildren's personality would benefit from in-vestigating subgroups of COAs, the type of al-coholism in the parent, and the reaction of thespouse to the parent's alcoholism.

MARCUS, ADRIENNE M. 1986. Aca-demic achievement in elementary schoolchildren of alcoholic mothers. Journal ofClinical Psychology 42(2):372-376. 10 refs.

Most research on the academic achievementof children of alcoholics has focus on the off-spring of alcoholic fathers, with little attentionbeing given to children of alcoholic mothers.To correct this lack, the present study com-pared the academic achievement of elementarychildren with alcoholic mothers with childrenwith nonalcoholic mothers. The alcoholic

mothers were not necessarily currently drink-ing, but reported having had a problem with al-cohol at some time the child's lifetime. Theexperimental group (n=40) and control group(n=40) were assessed for academic achieve-ment using the Peabody Individual Achieve-ment Test (PIAT). The mothers provided de-mographic information, pregnancy history,child's school history, maternal drinking his-tory, and present drinking practices. Themothers were mainly white, well-educated,and middle to upper class.

Findings. Children of alcoholic mothersscored significantly lower on the Mathematics,Reading Recognition, and Reading Compre-hensive subtests and on the Total Test on thePIAT than did the control group. Scores onSpelling and General Information were notsignificantly different between the two groups.

Conclusions. While this study indicatedlower academic achievement among elemen-tary-aged children of alcoholic mothers com-pared with children with no history of maternalalcoholism, the possible covariates and causesof this poorer performance remain to be stud-ied, such as family structure, cognitive im-pairment, and fetal alcohol syndrome.

MERIKANGAS, KATHLEEN R.;WEISSMAN, MYRNA M.; PRUSOFF,BRIGITTE A.; PAULS, DAVID L.;AND LECKMAN, JAMES F. 1985. De-pressives with secondary alcoholism:Psychiatric disorders in offspring. Jour-nal of Studies of Alcohol 46(3):199-204. 36refs.

Because of the familial nature of both alco-holism and depression, offspring of parentswith either disorder have been identified asbeing at high risk for developing these ill-nesses. This study compared the rates of psy-chiatric illness among the offspring of parentswith major depression in order to focus on therisk of depression and alcoholism in the off-spring of depressed parents with secondary al-coholism.

Patients at the Yale University DepressionResearch Unit were divided into two groups:mildly depressed (n=89) and severely de-pressed (n=44). The depressed subjects werealso classified according to the presence or ab-sence of alcoholism. In addition, 82 controlswith no history of psychiatric illness werematched with depressed subjects on the basisof sex and age. There were a total of 1,331

43


adult first-degree relatives of the study partici-pants. Each was interviewed using a modifiedSchedule for Affective Disorders andSchizophrenia. A different methodology fordiagnosis was used to elicit information fromchildren aged 6-17 of the subjects.

Findings. The subjects with depressiononly were no more likely to transmit alco-holism to their offspring than were the con-trols. In addition, subjects with depressionplus secondary alcoholism did not convey agreater risk of major depression or anxiety dis-orders to their offspring over the age of 18than did subjects with depression alone.However, offspring of the secondary alco-holics had a three times greater risk of alco-holism than did offspring of subjects with de-pression alone: they also had a five timesgreater risk of antisocial personality. Off-spring had a two-fold greater risk of alco-holism and a three-fold greater risk of antiso-cial personality-conduct disorder when bothparents were alcoholics than when only oneparent was affected.

Conclusions. This study indicates that al-coholism in both parents is a potent risk factorfor the development of alcoholism and antiso-cial personality-conduct disorder in offspring.Whether me increased incidence of disordersresults from increased genetic loadings ordetrimental environmental factors could not bedetermined from this study.

PANDINA, ROBERT J., AND JOHN-SON, VALERIE. 1989. Familial drinkinghistory as a predictor of alcohol and drugconsumption among adolescent children.Journal of Studies on Alcohol 50(3):245-253. 43 refs.

Male and female adolescents from familieswith histories of alcohol-related problems(Fli+) were compared with three other adoles-cent groups from families with no such drink-ing histories (FH-) on a broad array of drink-ing behaviors. It was hypothesized that FH+subjects would exhibit earlier onset of drink-ing, more intensive drinking, and a more ex-treme pattern of adverse consequences fromdrinking. It was also hypothesized that thesedifferences would be more apparent amongmale than female subjects.

The sample consisted of adolescents(n=1,308) in New Jersey involved in a longi-tudinal study of alcohol and drug use. Theywere first interviewed when they ages 12, 15,

4 8


or 18, and reinterviewed three years later. Onboth occasions, subjects completed question-naires eliciting information about the adoles-cent's self-reported drug and alcohol use,parental drinking and drug-taking behaviors,and family disease, disorders, illness, andtreatment history.

Participants were classified into one of fourgroups based on parental drinking patterns andhistory: (01) history of alcoholism in thefamily and/or past treatment for alcoholismand/or alcoholism as a factor of divorce; (02)father/mother reports high quandtiesarequencyof alcohol use and/or parental fre-quency/patterns are perceived as high or heavy;(03) no above criteria are met but history ofulcers in the family and/or history of "nervousbreakdown" or "treatment for depression" inthe family; and (04) no risk criteria met.

Findings. No risk group or gender differ-ences were found in the age at which subjectsfirst experienced intoxication for the youngestor middle age cohorts. Only gender differ-ences were found for the oldest age cohort atboth Times 1 and 2. Gender effects werefound for both number and frequency of intox-ication episodes among the oldest cohort atTimes 1 and 2. Use of alcohol and other drugsas a means of coping with problems and lifestresses did not appear to discriminate betweensubjects with varying parental histories of al-cohol use. Significant differences in the num-ber of consequences of alcohol use were foundas a function of gender for the oldest and mid-dle cohorts and as a function of risk groupmembership on several consequences sub-scales. From the longitudinal analyses, thereappears to be a shift in risk group membershipfrom Time 1 to Time 2. Most of this shiftingwas evident as an exodus of 02 youth into04.

Conclusions. Contrary to thc hypothesis,the emergence of intensive or problematicdrinking among FH+ adolescents was found tobe relatively weak. It also appears that thetransition from late adolescents to early adult-hood (18 to 21 years) ray be a critical periodduring which FH+ individuals may begin toexhibit reliable differences in a least some im-portant markers of problematic drinking.

44

PANDINA, ROBERT J., AND JOHN-SON, VALERIE. 1990. Serious alcoholand drug problems among adolescentswith a family history el alcoholism. Jour-nal of Studies on Alcohol 51(3):278-282. 27refs.

Most studies that have found that childrenof alcoholics are at high risk for alcoholismand alcohol-related problems are based onclinical samples of adults and (less often) ado-lescents. This study sought to determine, us-ing a general population sample of adolescentsand young adults, the extent of serious alco-hol- and drug-related problems in individualswith a family history of alcohol compared withthose without such a history.

Data were collected as part of a prospectivelongitudinal study (the Rutgers Health andHuman Development Project), with the sub-jects (n=1,380) being initially tested between1979 and 1981 (Time 1) at ages 12, 15, and18. The subjects were retestal in 1982-84(Time 2) and again in 1985-87 (Time 3).Nearly all (92%) of the subjects were tested atall three times. Subjects completed self-reportquestionnaires that asked about family alco-holism (parents also provided such informa-tion), current alcohol and marijuana use, andproblems associated with drinking or drug use(including treatment).

Findings. Out of the total sample, 7.5%reported that they had an alcohol or drugproblem or had been in treatment. Twice asmany subjects with a family history of alco-holism reported alcohol or drug problems asdid those without such a history (12% vs.6%). Subjects in both groups were as likely tohave a serious drug or combined alcohol-drugproblem as to have a problem with alcoholonly, Among COAs, females were more likelythan males to report alcohol-only problems,whereas among non-COAs, males were at leastthree times as likely to report any type of sub-stance use problem as females.

When siblings who experienced alcohol ordrug problems (as reported by the subject)were included, a substance use problem wasreported for over 20% of subjects and/or sib-lings in the family alcoholism group, but inonly 10% of families without a history of alco-holism.

No significant differences were found be-tween the two groups in frequency of alcoholor marijuana use, in frequency of problems as-sociated with either substance, or in the degree

49

to which alcohol or marijuana were used tocope with problems.

Conclusions. Adolescents and youngadults with alcoholic parents were twice aslikely to report serious alcohol or drug prob-lems as those without alcoholic parents, but thetwo groups did not differ on rates of use or inthe frequency of consequences of use.Although the number of prrt)lems increasedwith age, the age of onset of problems was thesame in both groups. Female COAswere as likely to report serious abuse problemsas male COAs, whereas such problems amongfemale non-COAs were much lower thanamong the other groups. While COAs werefound to be more likely to have problems as-sociated with alcohol or marijuana, a largemajority (88%) of COAs did not qualify underthe study criteria as experiencing serious sub-stance problems. At the same time, 6% of thenon-COAs reported problems with alcohol ormarijuana that were as severe as those reportedby affected COAs.

REICH, WENDY; EARLS, FELTON;AND POWELL, JACK. 1988. A compari-son of the home and social environmentsof children of alcoholic and non-alcoholicparents. British Journal of Addiction83(7):831-839. 55 refs.

This study examined the home and socialenvironments of children of alcoholic parentsto identify factors that place them at greater riskfor childhood psychopathology, alcoholism, orboth; protective factors in the home environ-ment were also examined. The sample con-sisted of 32 children with one or both parentsalcoholic and 22 children with neither parentalcoholic; the age range was 6 to 17. Datacame from children's responses on the HomeEnvironment Interview for Children and fromthe Diagnostic Interview for Children andAdolescents.

Findings. Children of alcoholic parentsdiffered significantly from those with neitherparent alcoholic on five measures reflective ofa poorer home environment: greater exposureto parental drinking, parents viewed as poorerrole models, more physical and emotionalabuse, more child-parent conflict, and moremarital conflict

Children in both groups were divided into"well" and "disturbed," based on whether ornot they had at least one major DSM-III diag-nosis. Alcoholic families with disturbed chil-

45


dren were significantly more likely than alco-holic families with well children to have greaterexposure to parental drinking, poorer parent-child relations, and greater parent-child con-flict. No significant differences were found inhome environment between the well and thedisturbed children of nonalcoholic families.

Protective factors against the developmentof childhood psychiatric disorders among chil-dren of alcoholics included absence of parent-child conflict, not being exposed to parentaldrinldng, and having positive parent-child in-teraction. Contrstry to expectations, well anddisturbed children from alcoholic families didnot differ on peer relations, school perfor-mance, or participation in extracurricular ac-tivities; nor did children of alcoholic parentsdiffer from children of nonalcoholics with re-spect to coping skills.

Conclusions. Although children of alco-holics are at high risk for developing alco-holism, childhood behavior disturbances addsan additional risk burden. In general, homeswith an alcoholic parent were found to functionmore poorly than homes without an alcoholicparent. Further, three factors seem to placechildren of alcoholics at greater risk for psy-chopathology: exposure to parental drinking, alow level of parent-child interaction, and a highlevel of parent-child conflict.

RHODES, JENNIFER, AND BLACK-HAM, GARTH J. 1987. Differences incharacter roles between adolescentsfrom alcoholic and nonalcoholic homes.American Journal of Drug and AlcoholAbuse 13(112):145-155. 26 refs.

On the basis of clinical theory and familysystems theory, Black (1981) identified fourroles that children of alcoholic parents developin order to cope with stress, unpredictability,and inconsistency of their families. The rolesare responsible child, placater, adjuster, andacting-out child. To examine the validity ofthese roles empirically, this study sought todetermine whether adolescent children of alco-holics (COAs) were more likely than controlsto perceive themselves as exhibiting one ormore of the four roles.

The subjects consisted of two groups ofhigh school students, both of whom completedthe Children of Alcoholics Screening Test(CAST). The COA group included 32 stu-dents who scored 6 or more on the CAST,while the control group consisted of 32 stu-dents who scorezi 0 on the CAST. All students

5 ()


completed the Children of Alcoholics FamilyRole Instrument (CAFRI), which was devel-oped for this study in order to measure behav-iors and attributed that are characteristics of thefour COA roles.

Findings. Only for the acting-out role didthe COA subjects score significantly higherthan the controls. For the placater and the ad-juster roles, the differences approached signifi-cance, with the COA subjects again scoringhigher. There was virtually no difference be-tween the two groups for the responsible childrole. Neither birth order nor age was signifi-cantly associated with role behaviors. Femaleshad significantly higher mean ratings thanmales for the placater role.

Conclusions. With the exception of theresponsible child role, the results were in theexpected direction, although only for the act-ing-out role did COAs rate themselves signifi-cantly higher than adolescents from nonalco-holic families. The literature provides supportfor a high prevalence of acting-out behaviorsamong COAs, such as school problems, ag-gression, and antisocial behavior, and for theimportance of the role (sometime called thescapegoat) in dysfunctional families generally.Black also postulates that while the COA maytake on a combination of the other three roles,the acting-out role tends to be adopted singly.The fact that females were more likely thanmales to perceive themselves in the placaterrole probably reflects the effects of socializa-tion rather than of family alcoholism. Finally,failure to find birth order effects conflicts withthe theory of Black and others that the rolesadopted by children in alcoholic families are af-fected birth order.

ROLF, JON E.; JOHNSON, JEAN-NETTE L.; ISRAEL, ELIZABETH;BALDWIN, JULIE; AND CHANDRA,ANJANI. 1988. Depressive affect inschool-aged children of alcoholics. BritishJournal of Addiction 83:841-848. 25 refs.

Depressive affect in young children of al-coholics (COAs) was studied in 50 COAs and48 children of nonalcoholic families. The av-erage age of the children was 13.2 years, witha range of 6 to 18 years. The alcoholic parentswere in recovery at the time of the study andwere not drinldng. None of the parents in thecontrol group were heavy drinkers, problemdrinkers, or alcoholics. Depressive affect inthe children was measured by two rating

46

inventories completed by the mothers and bytwo self-report inventories completed by thechildren.

Findings. All of the ratings indicated thatthe children of alcoholics had more problemswith depressive affect than the children fromnonalcoholic families. For both boys andgirls, mothers of COAs reported a significantlygreater number of depressive symptoms fortheir offspring than did mothers of nonalco-holic children. Similarly, COAs reported sig-nificantly more self-perceived depressionsymptoms than did control children.

ROOSA, MARK W.; GENSHEIMER,LEAH K.; SHORT, JEROME L.; AY-ERS, TIM S.; AND SHELL, RITA. 1989.A preventive intervention for children inalcoholic families: Results of a pilotstudy. Family Relations 38(3):295-300. 60refs.

Using a stress process model to understandthe risk status of children of alcoholics formental health problems, the authors developeda school-based prevention curriculum for chil-dren of alcoholics. The program, called theStress Management and Alcohol AwarenessProgram (SMAAP), is conducted over eightsessions and addresses five areas believed tobe relevant to at risk children in upir..r elemen-tary grades: alcohol knowledge, self-esteem,emotion-focused coping, problem solving, andsocial support seeking. The general purposeof the program is to teach children from alco-holic families how to reduce the stress they ex-perience in particular situations and to enhancetheir self-esteem.

Three elementary schools participated inthe pilot study of SMAAP. Students in allfourth, fifth, and sixth classrooms at theschools viewed a film about alcoholic families(Lots of Kids Like Us) and afterwards wereinvited to attend a discussion of the film and arelated program (SMAAP) that would be of-fered in the school. Parental permission wasreceived for those children who wished to par-ticipated in the program. Children were ran-domly assigned to intervention (n=26) or con-trol (n=55) groups. In addition, at one school,the program included a "Personal Trainer"component in which children (n=10) werematched with an adult who visited the schoolweekly and helped the child learn a skill of thechild's choosing (this component, however,was not separately evaluated). Before and

after the intervention, the children completedevaluation instruments that measures COAstatus, self concept, coping behaviors, andemotional adjustment; also, th( teacher's of.each child completed a questionnaire on thechild's classroom behavior at the beginningand at the end of the intervention.

Findings. Over one-half of the studentswho viewed the film attended the follow-upmeeting and one-third of these children ob-tained parental permission to participate in theprogram. Eighty percent of the self-selectedsubjects answered positively to at least one ofthe screening items indicating that they wereconcerned about their parent's drinldng. Stu-dents who participated in the SMAAP groupsexhibited an increase in the use of positivecoping strategies (social support seeking,problem solving, and emotion-focused cop-ing), whereas the control children showed nochange. SMAAP participants experienced agreater (but nonsignificant) drop on depressionscores that those in the control group. Therewas a trend for teacher rating of moodiness tobe more positive for children in the SMAAP.Self-concept measures showed no improve-ment. The results should be regarded as tenta-tive because of the small sample size and thepossibility of between school differences andother confounding factors.

Conclusion. The results indicated that theSMAAP curriculum has the potential for beingan effective prevention program for childrenwho express concern about their parent'sdrinking. A more rigorous, large-scale eval-uation of the short-term and long-term effectsof the program and the program plus the per-sonal trainer component is being conducted.The procedure of showing students a film andinviting them to a follow-up session proved aneffective means of attracting at risk children toa prevention program. It is not clear to whatextent the screening test was able to accuratelyidentify children whose parents were alco-holics.

ROOSA, MARK W.; SANDLER, IRWINN.; BEALS, JANETTE; AND SHORT,JEROME L. 1988. Risk status of adoles-cent children of problem-drinking parents.American Journal of Community Psychia-try 16(2):225-239. 38 refs.

Two studies examined the psychologicalsymptoms and drinking behaviors of twogroups of high school students. The first

47


group consisted of students (n=208) whocompleted the Children of Alcoholics Screen-ing Test (CAST). The second group consistedof students (n=75) at five high schools (notincluding the one used in the first study) whowere voluntarily attending support groups forstudents concerned about chemical abuseproblems, mainly alcohol, by parents, sib-lings, or friends.

Findings. In the first study, on the basisof responses on the CAST, 18% of the stu-dents met the criterion for being a child of analcoholic, which is higher than the traditionalnational estimate of about 12% (Russell, Hen-derson, and Blume 1985). The CAST mea-sures the child's concern about his or her par-ents' drinking, not whether the parents meetthe DSM-III criteria for alcoholism, thus thestudents are more properly labelled "self-iden-tified children of alcoholics." All subjectscompleted instruments that measured depres-sion, anxiety, self-esteem, and frequency andquantity of alcohol consumption. Comparedwith their peers, children of alcoholics scoredsignificantly lower on self-esteem and signifi-cantly higher on depression; there was a trendfor children of alcoholics to drink more thantheir peers.

In the second study, the students in thesupport groups completed the same question-naires as in the first study. Given the self-se-lected nature of the sample, it is not surprisingthe 45% were self-identified children of alco-holics on the basis of the CAST scores. In thisgroup, parental drinking status did not signifi-cantly differentiate children of alcoholics fromtheir peers in the support groups, although, asin the first study, children of alcoholics tendedto drink more than their peers. Children whoattended the support groups out of concernover a parent's substance abuse did not experi-ence more psychological problems than thosewho attended out of concern over the sub-stance abuse of a sibling or a friend, possiblybecause the children of nonalcoholic parentswho attended the group experienced more psy-chological symptoms than did those who didnot attend.

Conclusions. In a general school popula-tion, self-identified children of alcoholics ex-perience more depression and have lower self-esteem than their students with nonalcoholicparents, confirming the findings of studiesbased on children of alcoholic parents involvedin treatment. While children of alcoholics inthis study were not more likely than their peers

52


to experience anxiety, they did have a slightlyhigher level of drinking. The voluntary sup-port groups generally succeeded in attractinghigh risk students, although there were manywho chose not to participate. Self-selectiondoes have the advantage of avoiding the ethicaland practical problems involved in referring allstudents at risk for alcoholism to treatment.

STREISSGUTH, ANN P.; BARR, HE-LEN M.; SAMPSON, PAUL D.; DARBY,BETTY L.; AND MARTIN, DONALD C.1989. IQ at age 4 in relation to maternalalcohol use and smoking during preg-nancy. Developmental Psychology, 25(1):3-11. 52 refs.

IQ was assessed in children who had beenwho had been exposed to alcohol and tobaccoprenatally. The children were subjects in alongitudinal study examining the developmentof children whose mothers who consumed al-cohol during pregnancy. The average amountof alcohol consumed per day, determined byself-report, ranged from 0 to 25.8 ounces(mean of 0.63 ounces, median of 0.17 ounces)before the recognition of pregnancy and from 0to 8.55 ounces (mean of 0.27 ounces, medianof 0.06 ounces) during the initial assessment atthe fifth month of pregnancy. In other terms,the average amount drunk was just over onedrink per day before recognition of pregnancyand about half a drink per day at the fifthmonth of pregnancy. Data was also collectedon the use of nicotine, caffeine, medicinaldrugs, and "street drugs" during pregnancy.The mothers were mainly middle class andwell educated.

Two psychometrists, who were blind tothe background of the children, administeredthe Wechsler Preschool and Primary Scales ofIntelligence (WPPSI). While the children werebeing tested, parents filled out a questionnaireproviding information on family environmentand the child's health history. The final sam-ple analyzed consisted of IQ scores from 421children.

Findings. IQ scores for this sampleranged from 69 to 151 (mean of 110.5, stan-dard deviation of 14.4). Analysis of the IQscores in relation to maternal alcohol use andother potentially confounding variables foundthat alcohol use during pregnancy was signifi-candy correlated with IQ at age 4. Consump-tion of 1.5 ounces of absolute alcohol per daybefore the recognition of pregnancy was asso-

48

dated with a mean decrement of 4.80 IQ pointsand with three-fold risk of subnormal IQ (lessthan 85). Prenatal alcohol exposure was morestrongly associated with performance IQ thanwith Verbal IQ. Prenatal smoking was notfound to be related to IQ.

Conclusions. Although maternal con-sumption of an average of three drinks per dayduring pregnancy was significantly associatedwith IQ scores in children at age 4, this figureshould not be taken as indicating a "save" levelof alcohol use, since behavioral outcomes thatare more sensitive than IQ show effects atlower levels of consumption.

TARTER, RALPH E.; JACOB,THEODORE; AND BREMER, DEBO-RAH L. 1989. Cognitive status of sons ofalcoholic men. Alcoholism: Clinical andExperimental Research 13(2):232-235. 16refs.

This study investigated the cognitive statusof male children (8-17 years) of alcoholic menwho were not in treatment. The sample con-sisted of the sons of alcoholic (n=33), de-pressed (n=30), and normal (n=29) men re-cruited through newspaper advertisements.Men with antisocial personality disorder wereexcluded from the study. None of the boyshad a history of neurological injury or disease,mental retardation, chronic illness, or psychi-atric disorder. Although use of alcohol orother drugs did not preclude the boys fromparticipating in the study, none of them re-ported problems with alcohol or other druguse. The boys completed a battery of neu-ropsychological tests to assess intelligence,perceptual efficiency, language, memory, psy-chomotor skill, attention, and abstracting abil-ity.

Findings. The sons of alcoholic fathersscored significantly lower than the other twogroups on seven out of 37 neuropsychologicalmeasures; specifically, impairments werefound on tests requiring planning ability, psy-chomotor efficiency, and inhibitory control.Greater back and forth ataxia (upper bodysway while standing as still as possible) wasalso observed in the sons of alcoholic fatherscompared with the two other groups.

Conclusions. Although the sons of alco-holics scored lower than sons of normal anddepressed fathers, the impairments were notsevere, nor was a generalized cognitive im-pairment in sons of alcoholic fathers con-

5 3

firmed. The relatively mild degree of impair-ment found in this study may be related to thefact that none of the fathers had a diagnosis ofantisocial personality disorder, which appearsto result in more severe impairment whencombined with alcoholism. The types ofdeficits observed indicates impairment in theability to plan and self-monitor goal directedbehavior and suggest that they may originate inan anterior cerebral dysfunction. The findingof greater static ataxia in sons of alcoholic fa-thers confirms previous studies and suggeststhat static ataxia may be a neurological markerfor alcoholism.

TARTER, RALPH E.; JACOB,THEODORE; AND BREMER, DEBO-RAH L. 1989a. Specific cognitive impair-ment in sons of early onset alcoholics.Alcoholism: Clinical and ExperimentalResearch 13(6):786-789. 40 refs.

A variety of neuropsychological instru-ments were used to compare cognitive and be-havioral functioning in school-aged sons offathers in four groups: early onset alcoholics,late onset alcoholics, normal social drinkers,and depressed fathers. Early onset alcoholicswere those who developed alcoholism beforethe age of 24. The number of biological sons(ages 8-17 years) in each group was as fol-lows: early onset, 16; late onset, 17; normal,30; and depressed, 29.

The sons completed a battery of intellectualand neuropsychological tests to assess suchcognitive abilities and performance as vocabu-lary, attention, comprehension, motor controland coordination, perceptual decision time,abstracting ability, arithmetic, and concentra-tion.

Findings Subjects in all four groupsscored in the normal range of intelligence.Sons of early onset alcoholics had significantlylower verbal IQ scores than sons in the otherthree groups; they also had significantly lowerperformance IQ scores than sons of depressedfathers.

The scores from the different neuropsycho-logical measures were subject to factor analy-sis, which yielded four factors: Factor 1: at-tention/memory processes; Factor 2: psy-chomotor skills; Factor 3: perceptual-praxicskill; and Factor 4: nonverbal intellectual abil-ity. Significant differences between the fourgroups were found only for Factor 1. Sons ofearly onset alcoholics scored lower than sonsof normal fathers on this factor.


Conclusions. Compared with sons ofnormal fathers, sons of early onset alcoholicsexhibited deficits in measures of verbalintellectual ability and attention/memory. Theimpairment in these areas could lead toproblems in school, work, and social life,which in turn could promote alcohol use andabuse. Unlike previous studies, the findingsdid not support impairments in sons ofalcoholics on spatial, abstracting, and praxicabilities, possibly because the fathers wererecruited from the community rather than fromclinical populations or because none of thefathers were diagnosed with antisocial per-sonality disorder. Also significant is that thesons of late onset alcoholics did not differ fromthe sons of normal social drinking fathers orfrom the sons of depressed fathers. Ingeneral, the findings support the hypothesisthat hyperactivity and impairment in goal-directed behavior are important factors in vul-nerability to alcoholism.

WERNER, EMMY E. 1986. Resilient off-spring of alcoholics: A longitudinal studyfrom birth to age 18. Journal of Studies onAlcohol 47(1):34-40. 19 refs.

Most studies of children of alcoholics(COAs) focus on the problems these childrenface or on the causal factors that place them athigher risk for alcohol problems or alcoholism.Also, there have been few longitudinal studiesof children of alcoholics. The present studyexamined a group of offspring of alcoholicparents from birth to age 18 to determine thechild characteristics and the qualities of thefamily environment that differentiated thoseCOAs who did and those who did not makesuccessful adjustment during childhood andadolescence.

The sample consisted of 49 youth with al-coholic parents selected from a cohort of 698Asian and Polynesian children born on the is-land of Kauai, Hawaii, in 1955. Of these 49youth, 38 had fathers with serious drinkingproblems, 6 had mothers with serious drinkingproblems, and 5 had parents who were bothproblem drinkers. Three-quarters of thesechildren of alcoholics were raised in chronicpoverty. Children and their parents wereassessed just after birth and again at ages 1, 2,10, and 18. Data were gathered throu,h in-terviews and observations by psychologists,through various psychological and ...tilligencetests, and through records from schools, social

49

54


service and mental health agencies, hospitals,courts, and police.

Findings. Compared with children in thesame birth cohort whose parents were not alco-holics, children of alcoholic parents were morelikely to develop serious learning and behoviorproblems. By age 10, nearly a third were inneed of long-term remedial education and 8%were in deed of long-term mental health care(compared with 3% of children with nonalco-holic parents). By age 18, nearly three timesas many COAs as non-COAs had seriousmental problems requiring inpatient or outpa-tient care (25% vs. 9%). Overall, by age 18,41% of the COAs had serious coping problemsthat caused problems at home, at school, atwork, or in the community. Yet, 59% of thechildren from alcoholic families were doingwell in school, at work, and in their social life,and had positive, realistic expectations andgoals for the future.

Nearly three-fourths of these "resilient"youth were females, while 70% of the problemgroup were males. While children of alcoholicfathers were as likely to fall in the resilientgroup as the problem group, all but one of thechildren of alcoholic mothers developed seri-ous psychosocial problems by age 18. Thosewhose mothers drank alcohol during preg-nancy were particularly likely to experienceproblems and to exhibit lower academicachievement performance. Thus, boys andchildren of alcoholic mothers were at higherrisk of developing problems of girls and chil-dren of alcoholic fathers

Several characteristics of the family envi-ronment differentiated COAs who developedproblems by age 18 from those who exhibitedresilience: (1) much attention from the primarycaretaker during infancy and no prolongedseparation from the caretaker, (2) no additionalbirths into the family during the first two yearsof life; and (3) the absence of parental conflictduring the first two years of life. A number ofbehavioral characteristics of the child were alsofound to distinguish the two groups: (1) a tem-perament that elicited positive attention fromthe primary caretakers; (2) at least average in-telligence and adequate communication skills;(3) achievement orientation; (4) a responsible,caring attitude; (5) a positive self-i,oncept; (6) amore internal locus of control; and (7) belief inself-help.

Conclusions. Those children who wereable to elicit mainly positive responses fromthose in their family or from other caregivers

50

developed successful coping behaviors that en-abled them to handle the stresses of childhoodand adolescence, despite living with alco-holism and chronic poverty. By contrast, chil-d= who elicited mainly negative responsesfrom their caregivers, particularly when themother or both parents wer -1 alcoholics andthere were no adequate sOstitute parents, werelikely to grow up lacking resources to copewith life stresses and consequently developed avariety of psychological, academic, and socialproblems. Familial alcoholism alone does notdetermine the psychosocial adjustment of chil-dren and adolescents. The lack of knowledgeabout how these children of alcoholics faredafter age 18 when they enter a new stage of lifewith its own stresses and challenges empha-sizes the importance of prospective longitudi-nal studies (a follow up of this sample at age30 was being planned).

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Streissguth, Ann P.; Barr, Helen M.; Sampson, Paul D.; Darby, Betty L.; and Martin, Donald C.1989. IQ at age 4 in relation to maternal alcohol use and smoking during pregnancy. Devel-opmental Psychology 25(1):3-11.

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7G


Author Affiliations

The following is a list of the institutional affiliations of the first author of the abstracteddocuments.

Aronson, M.Department of Pediatrics and PsychologyUniversity of GotenborgGotenborg, Sweden

Bauman, Pamela S.160 Sir Francis Drake Blvd.San Anse lmo, California 94960

Bennett, Linda A.Department of AnthropologyMemphis State UniversityMemphis, Tennessee 38152

Burk, Jeffrey P.Psychology Service (116B)Veterans Administration Medical Center4500 S. Lancaster RoadDallas, Texas 75216

Clair, DavidDepartment of PsychologyUniversity of SaskatchewanSaskatoon, SaskatchewanCanada S7N OWO

Drake, Robert E.West Central Community Mental Services2 Resevoir RoadHanover, NH 03755

Earls, FeltonDepartment of PsychiatryWashington University School of Medicine4940 Audubon AvenueSt. Louis, Missouri 63110

Ervin, Cynthia S.Alcoholism and Drug Abuse Institute3937 15th Avenue NE, NL-15University of WashingtonSeattle, Washington 98105

Gfroerer, JosephDivision of Epidemiology and StatisticalAnalysisNational Institute on Drug AbuseRockville, Maryland 20857

66

Hegedus, Andrea M.Western Psychiatric Institute and Clinic3811 O'Hara StreetPittsburgh, Pennsylvania 15213

Jacob, TheodoreDivision of Child Development and FamilyRelations210 Family and Consumer Resources Building(No. 33)University of ArizonaTuscon, Arizona 85721

Johnson, Jeanette L.NIDA/ARCP.O. Box 5180Baltimore, Maryland 21224

Manning, D. ThompsonAssociate Professor of Public HealthAlcee Fortier Hall, Room 211Tulane University6823 St. Charles Ave.New Orleans, LA 70118

Marcus, Adrienne M.The Week-End Center, Inc.359 Main Street, Suite 2EMt. Kisco, New York 10549

Merikangas, Kathleen R.Depression Research UnitDepartment of PsychiatryYale University School of Medicine350 Congress Avenue, A-103New Haven, Connecticut 06519

Pandina, Robert J.Center of Alcohol StudiesRutgers UniversityPiscataway, New Jersey 08855

Reich, WendyDepartment of PsychiatryWashington University School of Medicine4940 Audubon AvenueSt. Louis, Missouri 63110

Rhodes, JenniferBiodyne CentexPhoenix, Arizona 85026

71

Rolf, Jon E.Department of Maternal and Child HealthSchool of Hygiene and Public HealthJohn Hopkins University615 N. Wolfe St.Baltimore, Maryland 21215

Roosa, Mark W.Program for Prevention ResearchDepartment of Family Relations and HumanDevelopmentArizona State UniversityTempe, Arizona 85287

Streissguth, Ann P.Department of Psychiatry and BehavioralSciences2707 N.E. Blake ley, GG-20University of WashingtonSeattle, Washington 98195

Tarter, Ralph E.Department of PsychiatryUniversity of Pittsburgh Medical School3811 O'Hara StreetPittsburgh, Pennsylvania 15213

Werner, Emmy E.Department of Applied Behavioral SciencesUniversity of CaliforniaDavis, California 95616

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72



Organizations, Programs, and Resource Materials

This is a selected list of some of the main sources on services for children of substance abusers.For more information, contact the Children of Alcoholics Foundation, the National Association forChildren of Alcoholics, and the National Clearinghouse for Alcohol and Drug Information.

PROGRAMS

CASPAR Alcohol Education Program(Cambridge and Somerville Program forAlcoholism Rehabilitation)226 Highland AvenueSomerville, Massachusetts 02143617/623-2080

National Elementary School Project forChildren of Alcoholics ("It's Elementary")National Association for Children ofAlcoholics31582 Coast Highway, Suite BSouth Laguna, California 92677

Sawn Special Education SchoolLos Angeles Unified School District439 West 97th StreetLos Angeles, California 900032131754-2854

Stress Management and Alcohol AwarenessProgramProgram for Prevention ResearchArizona State UniversityTempe, Arizona

ORGANIZATIONS

Al-Anon Family GroupsP.O. Box 182Madison Square GardenNew York, New York 10159212/683-1771

Children of Alcoholics Foundation, Inc.1200 Park Avenue31st FloorNew York, New York 101662121351-2680

National Association for Children ofAlcoholics31582 Coast Highway, Suite BSouth Laguna, California 92677714/499-3889

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National Association for Perinatal AdditionResearch and Education (NAPARE)11 East Hubbard Street, Suite 200Chicago, Illinois 60611312/329-2512

National Clearinghouse for Alcohol and DrugInformation (NCADI)P.O. Box 2345Rockville, MD 20852301/443-6500

PERIODICALS AND BOOKS

Alcoholism: The National Magazine

COA Review: The Newsletter aboutChildren of Alcoholics

Focus on Family and Chemical Dependency

Student Assessment Journal

Ackerman, Robert J. 1987. Children ofAlcoholics: A Bibliography and ResourceGuide. Pompano Beach, FL: HealthCommunications.

Black, Claudia. 1982. My Daddy Loves Me,My Daddy Has a Disease. Denver:Medical Administration Company.

Campidilli, Patti. 1985. Children fromAlcoholic Families: A Resource andCurriculum Guide. Ames, Iowa: Youthand Shelter Services, Inc.

Children of Alcoholics Foundation. 1986.Directory of National Resources forChildren of Alcoholic. New York:Children of Alcoholics Foundation.

Children of Alcoholics Foundation. 1986.Resources for Children of Alcoholics.New York: Children of AlcoholicsFoundation.

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Dinklage, S.C., and Plummer, K. 1985. NewSkills: Preventing Alcohol Trouble withChildren. (Leader Manual, Children'sWorkbook.). Pawtucket: Rhode IslandYouth Guidance Center, Inc., 82 PondStreet, Pawtucket, RI 02860.

Fassler, D.G. 1986. Children's books aboutalcoholism. Childhood Education66:188-194.

Fleming, Martin. 1990. Conducting SupportGroups for Students Affected byChemical Dependence. Troy, MI:Performance Resources Press.

Hawthorne, T. 1985. Children Are People,Too. St. Paul, MN: Chemical AbusePrevention Program Publishers.

Lerner, R., and Naiditch, B. 1985. ChildrenAre People Support Group: TrainingManual. St. Paul, MN: Children ArePeople, Inc.

Moe, Jerry, and Pohlman, Don. 1988. Kid' sPower: Healing Games for Children ofAlcoholics. (Sequoia Hospital District,Whipple & Alameda, Redwood City, CA94062).

Office for Substance Abuse Prevention. 1988.Children of Alcoholics: Kit for Kids,Parents, Therapists, and Helpers.Rockville, MD: National Clearinghouse forAlcohol and Drug Information.

Pilat, Joanne M., and Jones, John W. 1987.How to Develop a Three-PhaseTreatment Program for Children ofAlcoholics. Chicago: Camelot Unlimited.

Seixas, Judith S., and Youcha, G. 1985.Children of Alcoholism: A Survivor' sManual. New York: Crown Publishers.

Veenstra, Susan. Children of AlcoholicPareats: A Handbook for Counselors andleachers. (Alcoholism Services ofCleveland, 2490 Lee Blvd. #300,Cleveland Heights, OH, 44118).

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Prevention Research Updates

Gregory Austin, EditorWestern Regional Center for Drug-Free School and Communities

Southwest Regional Laboratory

1. Prevention Goals, Methods, and Outcomes. Gregory Austin. Fall 1988.

2. Substance Abuse Among Minority Youth: Native Americans. Gregory Austin. Winter1988.

3. Substance Abuse Among Latino Youth. Gregory Austin and M. Jean Gilbert. Spring 1989.

4. Substance Abuse Among Black Youth. Michael Prendergast, Gregory Austin, Ken Maton,and Ralph Baker. Fall 1989.

5. Substance Abuse Among Asian Youth. Gregory Austin, Michael Prendergast, and HarveyLee. Winter 1989.

6. Substance Abuse Among Juvenile Delinquents and Gang Members. John A. Pollard andGregory Austin. Spring 1990.

7. Substance Abuse Among Youth with Disabilities. Michael Prendergast, Gregory Austin,and John de Miranda. Summer 1990.

8. Young Children of Substance Abusers. Gregory Austin and Michael Prendergast. Winter1991.

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Robert R. Rath,Executive Director

NORTHWEST REGIONAL EDUCATIONAL LABORATORY

The Northwest Regional Educational Laboratory (NWREL) is an independent, nonprofit research

and development institution established in 1966 to help others improve outcomes for children,youth, and adults by providing R&D assistance to schools and communities in providing equitable,high quality educational programs. NWREL provides assistance toeducation, government,

community agencies business, and labor by:

Developing and disseminating effective educational products and procedures

Conducting research on educational needs and problems

Noviding tecHical assistance In educational problem solving

Evaluating effectiveness of educational programs and projects

Pmviding training In educational planning, management, evaluation, and instruction

SeMng as an information resource on effective educational programs and processes,

including networking among educational agencies, institutions, and individuals in the region

Ethel Simon-McWilliams,Associate Director

Education Profession Program

Tom Olson, Director

Education and Work Program

Larry McClure, Director

Evaluation and Assessment

Dean Arrasmith, Director

Center gor Classroom

Assessment

Richard Stiggins, Director

Rural TechnicalAssistance Center

Kim Yap and Carole Hunt,Directors

Literacy, Language and

Communication ProgramStephen Reder, Director

Planning and ServiceCoordination

Rex Hagan!, Director

Child, Family, andCommunity Program

Nancy Faires Conidin, Director

R&D for IndianEducation ProgramJoe Coburn, Di recto r

Rural Education Program

Steve Nelson, Director

School Improvement ProgramBob Blum, Director

Technology Program

Don Holznagel, Director

Western Center for Drug-FreeSchool and CommunitiesJudith A. Johnson, Director

Institutional Developmentand Communications

Jerry Kirkpatrick, Director

Finance and AdministrativeServices

Joe Jones, Director

11190

Board of Directors

Barbara BellAttorneyGreat Falls, Montana

George Bensonciperintendent_entennial School District (Oregon)

Judith BillingsWashington Superintendent

of Public Instruction

facob Block (Vice Chairman)SuperintendentMissoula Elementary District (Montana)

Raina I. BohanekTeacherCoeur d'Alene School District (Idaho)

CatalinoCanteroAssistant to the Secretary for EducationFederated States of Micronesia

Marcia ChristianTeacherBattle Ground School District(Washington)

ferry L EvansIdaho Superintendent


Allen GlennDean, College of EducationUniversity of Washington

fames E. HarrisFirst Interstate BankPortland, Oregon

Marlys HendersonTeacherFairbanks School District (Alaska)

William HensleyNorthwest Alaska

Native Associaton

Steve HoleAlaska Acting Commissioner

of Education

Shirley HollowayAssociate ProfessorUniversity of Alaska, Anchorage

ferry JacobsonSuperintendentIdaho Falls School District (Idaho)

Spike JorgensenSuperintendentAlaska Gateway School District

Homer KearnsSuperintendentSalem-Keizer School District (Oregon)

Nancy KeenanMontana Suped ntendent of

Public Instruction

Win KohlCollege of EducationMontana State University

Laurie A. LamsonDeputy DirectorMontana Job Training

Partnership, Inc.

Rolland LundTeacherHillsboro Union High School District(Oregon)

foe McCrackenSuperintendentLockwood Elementary District(Montana)

Zola McMurrayBusiness WomanLewiston, Idaho

G. Anpla NagenpstTeacherGreat Falls High School (Montana)

Nancy W. OltmanDirector, EEO/Affirmative ActionWeyerhaeuser Company (Washington)

Sarney C. Parker (Chairman)Stsperintendentinoapendent District of Boise (Idaho)

Norma PaulusOregon Superintendent


Dennis Ray (Secretary-Treasurer)SuperintendentNorthshore School District(Washington)

Patricia RylanderPrincipalManchester Community SchoolPort Orchard, Washington

James ScottHeadmasterCatlin Gabel SchoolPortland (Oregon)

Brit a TalbottSuperintendentEducational Service District 101Spokane (Washington)

76

Northwest Regional Educational Laboratory101 S.W. Main Street, Suite 500

Portland, Oregon 97204(503)275-9500

GTE: NWREL.LAB FAX: (503) 275-9489

BEST COPY MIMI r