Parental drinking problem can directly effect on their children. For this reason, children of alcoholics (COAs) tend to show negative outcomes while they are growing up, such as depression, anxiety, suicidal ideation, substance abuse or interpersonal difficulties. However, there are several factors that effect on COAs that minimize or maximize the impact of adverse experiences related to their parental drinking problem, and it is important to understand those factors to prevent or minimize the negative outcomes in COAs. Thus, this study examined both risk and protective factors of COAs, which affect their adverse outcomes. A systematic review was conducted by following PRISMA statement. Three databases—PubMed, CINAHL, and PsycINFO—were searched, and total 39 articles were found and discussed. This study identified risk, protective, and biological factors in COAs, and categorized into four levels: individual, parental, familial and social. Each level contains specific factors that positively or negatively affect the development in COAs. In addition, biological differences between COAs and non-COAs and between resilient COAs and vulnerable COAs were discussed. Findings from this study should be applied to COAs and adult COAs through evidence-based interventions in order to help them in terms of preventing or minimizing the negative outcomes they might experience in their lives.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Papers marked with an asterisk (*) were included in the review
*Antolin, T., Berman, S. M., Conner, B. T., Ozkaragoz, T. Z., Sheen, C. L., Ritchie, T. L., et al. (2009). D2 dopamine receptor (DRD2) gene, P300, and personality in children of alcoholics. Psychiatry Research, 166, 91–101. doi:10.1016/j.psychres.2007.12.005.
*Arruda, P., & Santos, M. R. (2011). Health production in adverse contexts: A study on the life of alcoholic-fathers’ children. Online Brazilian Journal of Nursing, 10(2), 1.
*Bates, M. E., & Pandina, R. J. (1992). Familial alcoholism and premorbid cognitive deficit: A failure to replicate subtype differences. Journal of Studies on Alcohol, 53(4), 320–327.
*Bjork, J. M., Knutson, B., & Hommer, D. W. (2008). Incentive-elicited striatal activation in adolescent children of alcoholics. Addiction, 103(8), 1308–1319. doi:10.1111/j.1360-0443.2008.02250.x.
Bouchery, E. E., Harwood, H. J., Sacks, J. J., Simon, C. J., & Brewer, R. (2006). Economic costs of excessive alcohol consumption in the United States. American Journal of Preventive Medicine, 41, 516–524.
*Carle, A. C., & Chassin, L. (2004). Resilience in a community sample of children of alcoholics: Its prevalence and relation to internalizing symptomatology and positive affect. Journal of Applied Developmental Psychology, 25(5), 577–595. doi:10.1016/j.appdev.2004.08.005.
De Santis, J. (2008). Exploring the concepts of vulnerability and resilience in the context of HIV infection. Research and Theory for Nursing Practice, 22(4), 273–287. doi:10.1891/0889-7184.108.40.2063.
*Díaz, R., Gual, A., García, M., Arnau, J., Pascual, F., Cañuelo, B., & Garbayo, I. (2008). Children of alcoholics in Spain: From risk to pathology. Results from the ALFIL program. Social Psychiatry and Psychiatric Epidemiology, 43(1), 1–10. doi:10.1007/s00127-007-0264-2.
*Edwards, E. P., Eiden, R. D., Colder, C., & Leonard, K. E. (2006a). The development of aggression in 18 to 48 month old children of alcoholic parents. Journal of Abnormal Child Psychology, 34(3), 409–423. doi:10.1007/s10802-006-9021-3.
*Edwards, E. P., Eiden, R. D., & Lepnard, K. E. (2006b). Behavior problems in 18- to 36-month-old children of alcoholic fathers: Secure mother-infant attachment as a protective factor. Development and Psychopathology, 18, 395–407.
Edwards, E. P., Leonard, K. E., & Eiden, R. D. (2001). Temperament and behavioral problems among infants in alcoholic families. Jornal of Infant Mental Health, 22, 374–392.
Eiden, R. D., Chavez, F., & Leonard, K. E. (1999). Parent-infant interactions in alcoholic and control families. Development and Psychopathology, 11, 745–762.
*Eiden, R. D., Colder, C., Edwards, E. P., & Leonard, K. E. (2009). A longitudinal study of social competence among children of alcoholic and nonalcoholic parents: Role of parental psychopathology, parental warmth, and self-regulation. Psychology of Addictive Behaviors, 23(1), 36–46. doi:10.1037/a0014839.
Eiden, R. D., Edwards, E. P., & Leonard, K. E. (2002). Mother-infant and father infant attachment among alcoholic families. Development and Psychopathology, 14, 253–378.
*El-Sheikh, M., & Buckhalt, J. A. (2003). Parental problem drinking and children’s adjustment: Attachment and family functioning as moderators and mediators of risk. Journal of Family Psychology, 17(4), 510–520. doi:10.1037/0893-3220.127.116.110.
*El-sheikh, M., & Flanagan, E. (2001). Parental problem drinking and children’ s adjustment: Family conflict and parental depression as mediators and moderators of risk. Journal of Abnormal Child Psychology, 29(5), 417–432.
Emshoff, J., & Valentine, L. (2006). Supporting adolescent children of alcoholics. The Prevention Researcher, 13(4), 18–20.
Fabrizio, C. S., Lam, T. H., Hirschmann, M. R., & Stewart, S. M. (2013). A brief parenting intervention to enhance the parent-child relationship in Hong Kong. Journal of Child and Family Studies, 22(5), 603–613. doi:10.1007/s10826-012-9614-0.
*Godsall, R. E., Jurkovic, G. J., Emshoff, J., Anderson, L., & Stanwyck, D. (2004). Why some kids do well in bad situations: Relation of parental alcohol misuse and parentification to children’s self-concept. Substance Use and Misuse, 39(5), 789–809. doi:10.1081/JA-120034016.
*Hall, J. C. (2008). The impact of kin and fictive kin relationships on the mental health of black adult children of alcoholics. Health and Social Work, 33(4), 259–266.
Hansson, H., Rundberg, J., Zetterlind, U., Johnsson, K. O., & Berglund, M. (2006). An intervention program for university students who have parents with alcohol problems: A randomized controlled trial. Alcohol and Alcoholism, 41(6), 655–663. doi:10.1093/alcalc/agl057.
*Heitzeg, M. M., Nigg, J. T., Yau, W.-Y. W., Zubieta, J.-K., & Zucker, R. A. (2008). Affective circuitry and risk for alcoholism in late adolescence: Differences in frontostriatal responses between vulnerable and resilient children of alcoholic parents. Alcoholism, Clinical and Experimental Research, 32(3), 414–426. doi:10.1111/j.1530-0277.2007.00605.x.
*Heitzeg, M. M., Nigg, J. T., Yau, W.-Y. W., Zucker, R. A., & Zubieta, J.-K. (2010). Striatal dysfunction marks preexisting risk and medial prefrontal dysfunction is related to problem drinking in children of alcoholics. Biological Psychiatry, 68, 287–295. doi:10.1016/j.biopsych.2010.02.020.
*Herting, M. M., Schwartz, D., Mitchell, S. H., & Nagel, B. J. (2010). Delay discounting behavior and white matter microstructure abnormalities in youth with a family history of alcoholism. Alcoholism, Clinical and Experimental Research, 34(9), 1590–1602. doi:10.1111/j.1530-0277.2010.01244.x.
*Hinz, L. D. (1990). College student adult children of alcoholics: Psychological resilience or emotional distance? Journal of Substance Abuse, 2, 449–457. doi:10.1016/S0899-3289(12)80005-8.
*Hussong, A. M., Flora, D. B., Curran, P. J., Chassin, L. A., & Zucker, R. A. (2008). Defining risk heterogeneity for internalizing symptoms among children of alcoholic parents. Development and Psychopathology, 20, 165–193.
*Hussong, A. M., Wirth, R. J., Edwards, M. C., Curran, P. J., Chassin, L. A., & Zucker, R. A. (2007). Externalizing symptoms among children of alcoholic parents: Entry points for an antisocial pathway to alcoholism. Journal of Abnormal Psychology, 116(3), 529–542. doi:10.1037/0021-843X.116.3.529.
*Jennison, K. M., & Johnson, K. A. (1997). Resilience to drinking vulnerability in women with alcoholic parents: The moderating effects of dyadic cohesion in marital communication. Substance Use and Misuse, 32(11), 1461–1489.
*Jennison, K. M., & Johnson, K. A. (2001). Parental alcoholism as a risk factor for DSM-IV-defined alcohol abuse and dependence in American women: The protective benefits of dyadic cohesion in marital communication. The American Journal of Drug and Alcohol Abuse, 27(2), 349–374.
Jurkovic, G. J. (1997). Lost Childhoods: The plight of the parentified child. Philadelphia: Taylor & Francis.
*Kelley, M. L., Pearson, M. R., Trinh, S., Klostermann, K., & Krakowski, K. (2011). Maternal and paternal alcoholism and depressive mood in college students: Parental relationships as mediators of ACOA-depressive mood link. Addictive Behaviors, 36(7), 700–706. doi:10.1016/j.addbeh.2011.01.028.
*Kim, H. K., & Lee, M. Y. (2011). Factors influencing resilience of adult children of alcoholics among college students. Journal of Korean Academy of Nursing, 41(5), 642–651. doi:10.4040/jkan.2011.41.5.642.
Kim, J. H. (2008). The college adjustment of adult children of alcoholics: Focused on moderating effect of protective factors. Journal of Social Work Practice, 7, 131–157.
Kim, Y. J. (2009). Effect of healing program for children of alcoholics. Mental Health & Social Work, 4, 30–62.
*King, S. M., Keyes, M., Malone, S. M., Elkins, I., Legrand, L. N., Iacono, W. G., et al. (2009). Parental alcohol dependence and the transmission of adolescent behavioral disinhibition: A study of adoptive and non-adoptive families. Addiction, 104(4), 578–586. doi:10.1111/j.1360-0443.2008.02469.x.
Kopp, C. B. (1982). Antecedents of self-regulation: A developmental perspective. Developmental Psychology, 18, 199–214.
*Lease, S. H. (2002). A model of depression in adult children of alcoholics and nonalcoholics. Journal of Counseling & Development, 80, 441–451.
*Lee, H. H., & Cranford, J. A. (2008). Does resilience moderate the associations between parental problem drinking and adolescents’ internalizing and externalizing behaviors? A study of Korean adolescents. Drug and Alcohol Dependence, 96, 213–221. doi:10.1016/j.drugalcdep.2008.03.007.
Leigh, F. F., Vergara, V. B., & Santelices, M. P. (2012). Enhancing early attachment: Design and pilot study of an intervention for primary health care dyads. Journal of Child Health Care: For Professionals Working with Children in the Hospital and Community, 17, 82. doi:10.1177/1367493512447533.
Loukas, A., Zucker, R. A., Fitzgerald, H. E., & Krull, J. L. (2003). Developmental trajectories of disruptive behavior problems among sons of alcoholics: Effects of parent psychopathology, family conflict, and child undercontrol. Journal of Abnormal Psychology, 112, 119–131.
Mathews, B., & Oaks, J. (1990). Adult children of alcoholics on college campuses: A group approach to intervention. The Journal of Health Behavior, 14(1), 9–15.
*Menees, M. M. (1997). The role of coping, social support, and family communication in explaining the self-esteem of adult children of alcoholics. Communication Reports, 10(1), 9–19. doi:10.1080/08934219709367655.
Minuchin, S. (1974). Famillies and family therapy. Cambridge, MA: Harvard University Press.
*Moe, J., Johnson, J. L., & Wade, W. (2007). Resilience in children of substance users: In their own words. Substance Use and Misuse, 42(2–3), 381–398. doi:10.1080/10826080601142147.
Moher, H., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred peporting items for systematic reviews and meta-snalysis: The PRISMA Statement. PLOS Medicine, 6(7), 264.
Mokdad, A. H., Marks, J. S., Stroup, D. F., & Gerberding, J. L. (2004). Actual causes of death in the United States, 2000. Journal of the American Medical Association, 291(10), 1238–1245.
*Molina, B. S. G., Donovan, J. E., & Belendiuk, K. A. (2010). Familial loading for alcoholism and offspring behavior: Mediating and moderating influences. Alcoholism, Clinical and Experimental Research, 34(11), 1972–1984. doi:10.1111/j.1530-0277.2010.01287.x.
*Mylant, M. (2002). Adolescent children of alcoholics: Vulnerable or Resilient? Journal of the American Psychiatric Nurses Association, 8(2), 57–64. doi:10.1067/mpn.2002.125037.
*Namkoong, K., Cheon, K.-A., Kim, J.-W., Jun, J.-Y., & Lee, J.-Y. (2008). Association study of dopamine D2, D4 receptor gene, GABAA receptor beta subunit gene, serotonin transporter gene polymorphism with children of alcoholics in Korea: A preliminary study. Alcohol, 42(2), 77–81. doi:10.1016/j.alcohol.2008.01.004.
Osterndorf, C. L., Enright, R. D., Holter, A. C., & Klatt, J. S. (2011). Treating adult children of alcoholics through forgiveness therapy. Alcoholism Treatment Quarterly, 29(3), 274–292. doi:10.1080/07347324.2011.586285.
*Pearson, M. R., D’Lima, G. M., & Kelley, M. L. (2011). Self-regulation as a buffer of the relationship between parental alcohol misuse and alcohol-related outcomes in first-year college students. Addictive Behaviors, 36(12), 1309–1312. doi:10.1016/j.addbeh.2011.07.009.
Price, A. W., & Emshoff, J. G. (1997). Breaking the cycle of addition: Prevention and intervention with children of alcoholics. Alcohol Health & Research World, 21(3), 241–246.
Puttler, L. I., Zucker, R. A., Fitzgerald, H. E., & Bingham, C. R. (1998). Behavioral outcomes among children of alcoholics during the early and middle childhood years: Familial subtype variations. Alcoholism, Clinical and Experimental Research, 22, 1962–1972.
*Rafferty, P., & Hartley, P. (2006). Shame about the children: A legacy of distress for adults who have grown up with parental problem drinking and family disharmony? Journal of Substance Use, 11(2), 115–127. doi:10.1080/14659890500237440.
Rothbart, M. K. (1989). Biological processes in temperament. G. A. Kohnstamm, J. A. Bates, & M. K. Rothbart (Eds.). New York: Wiley.
*Sher, K. J., Walitzer, K. S., Wood, P. K., & Brent, E. E. (1991). Characteristics of children of alcoholics: Putative risk factors, substance use and abuse, and psychopathology. Journal of Abnormal Psychology, 100(4), 427–448.
The American heritage dictionary. (2012). The American heritage dictionary of the English language (5th ed.). Boston, MA: Houghton Mifflin Company.
*Tweed, S. H., & Ryff, C. D. (1996). Family climate and parent-child relationships: Recollections from a nonclinical sample of adult children of alcoholic fathers. Research in Nursing & Health, 19(4), 311–321. doi:10.1002/(SICI)1098-240X(199608)19:4<311:AID-NUR5>3.0.CO;2-L.
*Twitchell, G. R., Hanna, G. L., Cook, E. H., Fitzgerald, H. E., Little, K. Y., & Zucker, R. A. (1998). Overt behavior problems and serotonergic function in middle childhood among male and female offspring of alcoholic fathers. Alcoholism, Clinical and Experimental Research, 22(6), 1340–1348.
Velleman, R., & Templeton, L. (2007). Understanding and modifying the impact of parents’ substance misuse on children. Advances in Psychiatric Treatment, 13(2), 79–89. doi:10.1192/apt.bp.106.002386.
*Wall, T. L., Garcia-Andrade, C., Wong, V., Lau, P., & Ehlers, C. L. (2000). Parental history of alcoholism and problem behaviors in Native-American children and adolescents. Alcoholism, Clinical and Experimental Research, 24(1), 30–34.
Webb, W. (1989). Cognitive behavior therapy with children of alcoholics. School Counselor, 40(3), 170–177.
*Werner, E. E., & Johnson, J. L. (2004). The role of caring adults in the lives of children of alcoholics. Substance Use and Misuse, 39(5), 699–720. doi:10.1081/JA-120034012.
*Yau, W.-Y. W., Zubieta, J.-K., Weiland, B. J., Samudra, P. G., Zucker, R. A., & Heitzeg, M. M. (2012). Nucleus accumbens response to incentive stimuli anticipation in children of alcoholics: Relationships with precursive behavioral risk and lifetime alcohol use. The Journal of Neuroscience, 32(7), 2544–2551. doi:10.1523/JNEUROSCI.1390-11.2012.
About this article
Cite this article
Park, S., Schepp, K.G. A Systematic Review of Research on Children of Alcoholics: Their Inherent Resilience and Vulnerability. J Child Fam Stud 24, 1222–1231 (2015). https://doi.org/10.1007/s10826-014-9930-7
- Children of alcoholics
- Risk factors
- Protective factors