|Year : 2014 | Volume
| Issue : 2 | Page : 124-127
Psychological impact of adult alcoholism on spouses and children
Darpan Kaur, Shaunak Ajinkya
Department of Psychiatry, Mahatma Gandhi Missions Medical College, Kamothe, Navi Mumbai, Maharashtra, India
|Date of Web Publication
8/187, M.H.B., Om-Lamba Society, Opposite Bhakti-Dham Mandir, Sion-Chunabhatti, Mumbai - 400 022, Maharashtra
Source of Support: None, Conflict of Interest: None
Chronic alcoholism can have an adverse psychological impact on the family involved in caregiving and coping with the alcoholic. This article attempts to review and discuss relevant literature pertaining to the overall psychological impact of adult alcoholism on spouses and children. A literature search on various search engines like Pubmed, Psychinfo, OmniMedicalSearch, and WebMD was done using search words such as "psychological impact", "alcoholism", "family" "spouse", "parents," and "children". The articles perceived to be relevant have been reviewed and discussed. The literature search revealed significant problems in coping among family members. It was found that there exists a huge burden on the immediate family members of the chronic alcoholic. Recent studies have found high levels of psychological stress and depressive symptoms in spouses of alcoholics. Alcohol use has also been significantly linked to aggressive behaviors and intimate partner violence. Parentification and emotional caretaking were found in the children of chronic alcoholics. This can have a major impact on the psychological development of these children. Recent studies have shown that the offsprings of alcoholics are at a high risk for Conduct Disorders, Attention Deficit Hyperactivity Disorder, Major Depressive Disorder, and Substance Dependence. Marital and Family therapy may have a role in therapeutic as well as preventive care approaches in alcoholism.
Keywords: Alcoholism, adolescents, children, family, psychological impact, spouse
|How to cite this article:
Kaur D, Ajinkya S. Psychological impact of adult alcoholism on spouses and children. Med J DY Patil Univ 2014;7:124-7
Alcoholism is characterized by an increased tolerance of and physical dependence on alcohol, affecting an individual's ability to control alcohol consumption safely. Alcoholism can have adverse effects not only on the individual's physical and mental health but also on the social wellbeing. 
Alcoholism is usually recognized as a factor of family disaggregation. Studies of alcoholics' families have revealed important data. The family has lesser cohesion and a larger number of conflicts as compared to normal families.  Alcoholism is associated with loss of employment which can lead to financial problems for the family. Alcohol abuse is associated with an increased risk of committing criminal offences against one's family members including domestic violence, marital conflicts and divorce, marital rape and assault, child neglect and abuse, with subsequent lasting damage to the emotional development of the alcoholic's children. ,
Objectives: The objective of the current review consisted in assessing the effect of adult alcoholism on spouses and children.
Method: A literature search on various search engines like Pubmed, Psychinfo, OmniMedicalSearch, and WebMD was done using search words such as "alcoholism", "family", "spouse", "parents" and "children".
We found that there were no review articles that we could find on the psychological impact of adult alcoholism on their spouses and children. There were studies which assessed independently some points like caregiver burden, coping, mental health of spouses, partner violence, and parentification of children. We have attempted to summarize and discuss certain studies which we believed to have definite relevance to our topic of review.
Caregiver Burden and Coping Mechanisms
Caregivers play an important role in the life of alcoholics. There is evidence to believe that coping with a chronic alcoholic in the family can significantly burden other family members. Sattar et al studied the relationship of alcohol use and behavioral problems in late life. They found that current or past alcohol problem use was frequent in this population of frail, older adults undergoing geriatric assessment. Regardless of current alcohol use, these patients displayed more behavioral disturbances than those without a history of problem drinking, and their caregivers experienced significantly more burden.  Rospenda et al. conducted a mail survey to assess the relationship between caregiver burden and alcohol use. They concluded that caregivers who experienced social and emotional burdens related to caregiving were at a risk for problematic alcohol use and warranted attention from health care and mental health service professionals. 
Mental Health of Spouses of Alcoholics
Moos et al. conducted a study on predictors of spouses' alcohol-related functioning and depressive symptoms. They concluded that the spouses of older adults whose late-life drinking problems remit can attain normal functioning; however, spouses of older adults with continuing late-life drinking problems experience some ongoing deficits.  Tempier et al. conducted a retrospective analysis to assess the consequences of alcoholism on the mental health of spouses of lifetime at-risk drinkers. Their results showed higher levels of psychological distress in female spouses of male lifetime at-risk drinkers in the general population. Lifetime at-risk drinking is a risk factor for the spouse's psychological distress. 
Newer Addiction Trends in Wives of Alcoholics
Literature has described that wives of alcoholics tend to show an unhealthy relationship with their husbands characterized by "addiction," which might hamper the recovery of their husbands from alcohol dependence. Ino et al. assessed the wives' character trends and their addictions. They have described trends in addiction like relation addiction and care addiction in their sample populations. They also found that the level of severity of the relation and care addiction in wives reduced favorably in parallel with the prolonged term of abstinence of their husbands. 
Romance and Alcohol
Fischer and Wiersma reviewed literature pertaining to romance and alcohol. They found that people are attracted to similarly drinking others. With greater relationship commitment there is greater desistance from drinking. Congruent drinking, even at higher levels, was associated with more positive outcomes, whereas discrepant drinking was associated with more negative outcomes. 
Marriage and Alcohol
Individuals married to heavy drinking spouses often have poorer health compared to those whose spouses are not heavy drinkers. Homish et al. conducted a study on spouse's alcohol involvement and alcohol-related problems affecting his/her spouse's depressive symptomatology over time. They found that husbands' and wives' marital alcohol problems affect wives' depressive symptoms, but only husbands' marital alcohol problems affect husbands' depressive symptoms. 
Waldron et al. assessed the relationship between lifetime history of alcohol dependence (AD) and timing and survival of first marriages. They found that moderate delays in marriage were associated with AD for both women and men. Among ever-married respondents, AD was strongly predictive of early separation, with similar effects observed for women and men. 
Partner Violence and Alcohol
Foran and O'Leary attempted a meta-analysis of existing literature between alcohol use/abuse and partner violence; they found that there was a small to moderate effect size for the association between alcohol use/abuse and male-to-female partner violence and a small effect size for the association between alcohol use/abuse and female-to-male partner violence. Specifically, there was a larger association of alcohol and aggression in clinical versus non-clinical samples and when measured assessed more severe alcohol problems. 
Nemeth et al. assessed acute, situational factors, and chronic stressors that triggered severe intimate partner violence (IPV) in women via telephonic conversation in heterosexual couples. They found that the triggers for acute violence were accusations of infidelity, typically within the context of alcohol or drug use. They also found that ongoing anxiety about infidelity, preoccupation with heterosexual gender roles and religious expectations, drug and alcohol use, and mental health problems were chronic stressors in the relationship of the couple. 
Gilchrist et al. conducted a cross-sectional postal survey on exploring associations between alcoholic patient and depression and perceived fear in the partner. The measures included the Center for Epidemiological Studies Depression Scale, the Fast Alcohol Screening Test, and a screening question from the Composite Abuse Scale. They found that 23.9% of partners experienced depressive symptoms. There was a stronger association between depressive symptoms and ever been afraid of a partner after statistically adjusting for other variables such as age, income, employment, and education level. They emphasized the need for developing strategies for early recognition and management of intimate partner violence and depression. 
Parentification of Children of Alcoholics
Kelley et al. examined parentification and family responsibility in the families of female college students who met criteria for being Adult Children of Alcoholics (ACOAs). These students reported more parentification, instrumental caregiving, emotional caregiving, and past unfairness in their families of origin as compared to non-ACOAs. They also found that the students belonging to the ACOAs group who thought that their mothers had a problem with alcohol abuse reported more parentification and emotional caretaking. 
Substance Use, Intimate Partner Violence and Impact on Children
Alcohol dependence and relationship violence not only have serious consequences for adults but also for children. It is described that children and adolescents living with alcoholic parents are susceptible to the harmful effects of psychologically disturbed familial environments. Klostermann and Kelley have described the effects of parental alcoholism on children and intimate partner violence. They have emphasized the developmental impact of these behaviors on children and have provided recommendations for future research directions. Children of alcoholics are more likely to develop externalizing problems such as conduct disorder, oppositional defiant disorder, delinquency, and attention deficit disorder, and are at an elevated risk for internalizing behaviors such as depression and anxiety. In addition, they drink earlier, are more likely to develop alcohol use problems, progress from initial alcohol use to alcohol use disorder more quickly, and are less likely to mature out of moderate to heavy drinking. Youth who experience parental alcohol abuse and parental violence may be more likely to live in high-crime neighborhoods which may adversely impact the quality of schools and increase exposure to neighborhood violence. Witnessing paternal alcoholism and parental violence has been linked to children's fears and internalizing symptoms. The combined verbal/physical dyadic violence has also been related to greater likelihood of aggression and emotional maladjustment in children. 
Hill et al. conducted a predictive study on offspring from multiplex AD families identified through the mother or control families. Familial risk status and the presence of specific child/adolescent disorders were used as predictors of substance use disorder outcome by young adulthood. They found that offspring who were members of maternal multiplex families had elevated rates of child and young adulthood disorders. Their research highlighted that the high risk offspring of alcohol-dependent women were at increased risk for externalizing (Conduct Disorder and ADHD) and internalizing disorders (Major Depressive Disorder and Anxiety Disorders). They concluded that multiple familial risk for alcohol dependence is a significant predictor of substance use disorders by young adulthood. Familial risk and an earlier childhood disorder may set the stage for later development of Substance Use Disorders. 
Elliott et al. conduct a meta-analysis on the effects of family history on substance use and abuse in college and university students. They found that family history had a minimal effect on alcohol consumption, with stronger effects on alcohol consequences, alcohol use disorder symptoms, and other drug involvement. They concluded that relative to students without a family history of alcohol problems, students with positive family histories do not drink more, but may be at greater risk for difficulties with alcohol and drugs. 
Psychotherapy Interventions for Spouse and Family of Alcoholics
O'Farrell and Clements reviewed literature pertaining to the use of marital and family therapy in families with patients with alcohol dependence syndromes. They have discussed the role of marital and family therapy (MFT) in overall strengthening the coping mechanisms of the family and improving motivation of the unwilling alcoholic patient. Behavior couple therapy (BCT) has been described to be effective in increasing abstinence rates and improving the relationship of the couple. 
If we wish to establish a synthesis of the results obtained, it could be stated that, in the present review, the alcoholic's family distinguishes itself from other families in that there may be a negative, critical, hostile, and rejectionist environment which is eventually passed on to their own children. The alcoholic shows poor adjustment in his relationships with his wife and children, and there is possibly a show of dissatisfaction and disinterest in the dyadic relationship. Despite the small number of reviews in our study, it is clear that the alcoholic's family does show characteristics of dysfunctionality and poor adaptation. Thus, it is vital that special attention is paid to the needs of the family in the management of alcohol dependence and we suggest further systematic reviews are needed on this issue.
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