A Systematic Review of Research on Children of Alcoholics: Their Inherent Resilience and Vulnerability

Abstract

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.

Fig. 1

Reference

Papers marked with an asterisk (*) were included in the review

  1. *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.

    PubMed  Article  Google Scholar 

  2. *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.

    Google Scholar 

  3. *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.

    PubMed  Article  Google Scholar 

  4. *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.

    PubMed  Article  Google Scholar 

  5. 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.

    Article  Google Scholar 

  6. *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.

    Article  Google Scholar 

  7. 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:10.1891/0889-7182.22.4.273.

    PubMed  Article  Google Scholar 

  8. *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.

  9. *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.

    PubMed Central  PubMed  Google Scholar 

  10. *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.

    PubMed Central  PubMed  Google Scholar 

  11. 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.

    Article  Google Scholar 

  12. Eiden, R. D., Chavez, F., & Leonard, K. E. (1999). Parent-infant interactions in alcoholic and control families. Development and Psychopathology, 11, 745–762.

    PubMed Central  PubMed  Article  Google Scholar 

  13. *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.

    PubMed Central  PubMed  Article  Google Scholar 

  14. 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.

    PubMed Central  PubMed  Article  Google Scholar 

  15. *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:10.1037/0893-3200.17.4.510.

    PubMed  Article  Google Scholar 

  16. *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.

    PubMed  Article  Google Scholar 

  17. Emshoff, J., & Valentine, L. (2006). Supporting adolescent children of alcoholics. The Prevention Researcher, 13(4), 18–20.

    Google Scholar 

  18. 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.

    PubMed Central  PubMed  Article  Google Scholar 

  19. *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.

    PubMed  Article  Google Scholar 

  20. *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.

    PubMed  Article  Google Scholar 

  21. 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.

    PubMed  Article  Google Scholar 

  22. *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.

    PubMed Central  PubMed  Article  Google Scholar 

  23. *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.

    PubMed Central  PubMed  Article  Google Scholar 

  24. *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.

    PubMed Central  PubMed  Article  Google Scholar 

  25. *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.

    PubMed  Article  Google Scholar 

  26. *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.

    PubMed Central  PubMed  Google Scholar 

  27. *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.

    PubMed Central  PubMed  Article  Google Scholar 

  28. *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.

    PubMed  Article  Google Scholar 

  29. *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.

    PubMed  Article  Google Scholar 

  30. Jurkovic, G. J. (1997). Lost Childhoods: The plight of the parentified child. Philadelphia: Taylor & Francis.

    Google Scholar 

  31. *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.

    PubMed  Article  Google Scholar 

  32. *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.

    PubMed  Article  Google Scholar 

  33. 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.

    Google Scholar 

  34. Kim, Y. J. (2009). Effect of healing program for children of alcoholics. Mental Health & Social Work, 4, 30–62.

    Google Scholar 

  35. *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.

    PubMed Central  PubMed  Article  Google Scholar 

  36. Kopp, C. B. (1982). Antecedents of self-regulation: A developmental perspective. Developmental Psychology, 18, 199–214.

    Article  Google Scholar 

  37. *Lease, S. H. (2002). A model of depression in adult children of alcoholics and nonalcoholics. Journal of Counseling & Development, 80, 441–451.

    Article  Google Scholar 

  38. *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.

    PubMed  Article  Google Scholar 

  39. 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.

    Google Scholar 

  40. 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.

    PubMed  Article  Google Scholar 

  41. 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.

    Google Scholar 

  42. *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.

    Article  Google Scholar 

  43. Minuchin, S. (1974). Famillies and family therapy. Cambridge, MA: Harvard University Press.

    Google Scholar 

  44. *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.

    PubMed  Google Scholar 

  45. 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.

    Article  Google Scholar 

  46. 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.

    PubMed  Article  Google Scholar 

  47. *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.

    PubMed Central  PubMed  Article  Google Scholar 

  48. *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.

    Article  Google Scholar 

  49. *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.

    PubMed  Article  Google Scholar 

  50. 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.

    Article  Google Scholar 

  51. *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.

    PubMed  Article  Google Scholar 

  52. 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.

    Google Scholar 

  53. 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.

    PubMed  Google Scholar 

  54. *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.

    Article  Google Scholar 

  55. Rothbart, M. K. (1989). Biological processes in temperament. G. A. Kohnstamm, J. A. Bates, & M. K. Rothbart (Eds.). New York: Wiley.

  56. *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.

    PubMed  Article  Google Scholar 

  57. The American heritage dictionary. (2012). The American heritage dictionary of the English language (5th ed.). Boston, MA: Houghton Mifflin Company.

    Google Scholar 

  58. *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.

    Article  Google Scholar 

  59. *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.

    PubMed  Article  Google Scholar 

  60. 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.

    Article  Google Scholar 

  61. *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.

    PubMed  Article  Google Scholar 

  62. Webb, W. (1989). Cognitive behavior therapy with children of alcoholics. School Counselor, 40(3), 170–177.

    Google Scholar 

  63. *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.

    PubMed  Article  Google Scholar 

  64. *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.

    PubMed Central  PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Sihyun Park.

Rights and permissions

Reprints and Permissions

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

Download citation

Keywords

  • Children of alcoholics
  • Risk factors
  • Protective factors
  • Vulnerability
  • Resilience