Alcohol use disorder can have far-reaching effects on the families of those who drink, especially for children.1 With about 15 million people in the United States struggling with alcohol use disorder, nearly 7.5 million children are exposed to the effects of alcoholism at home.23,24 These children are at greater risk for developing a variety of issues, including substance use, mental and behavioral health disorders, child maltreatment, child welfare involvement, and problems in relationships.1,24
Learn more about whether alcoholism is genetic, how alcoholism affects children, characteristics of children of alcoholics, risk factors among children of alcoholics and support for children of alcoholics.
Is Alcoholism Genetic?
Alcoholism, often referred to as alcohol use disorder (AUD), is a chronic and progressive pattern of drinking that results in severe distress or impairment in a person’s ability to function in one or more life areas.2,3 Symptoms of alcohol use disorder involve a lack of control over drinking; continuing to drink even after experiencing physical, psychological, or social consequences; or experiencing difficulties meeting responsibilities at home, school, or work due to drinking.2,3
Studies show that there is a genetic component to alcohol use disorder.2,3 Approximately 40-70% of the risk of developing alcohol use disorder is attributed to genetics.2,3 Having a parent with alcohol use disorder increases the risk of developing alcoholism by 3 to 4 times, and this is even seen in children adopted at birth by people who did not have AUD.2,4 The likelihood is even greater if there are more relatives with the disorder, and the more severe alcoholism is in their relatives and the closer they are to genetically to the relative.2
However, just because there is some risk of genetic predisposition to developing alcohol use disorder, it does not guarantee that it will occur.4 Alcohol use disorder is not caused by one specific gene; instead, variants across many different genes can increase the risk of developing the disorder at some point.4,5 These genes, combined with physiological, environmental, phycological and social factors, can all play a role in how a person interacts with alcohol.3,4
How Does Alcoholism Affect Children?
When a child has a parent with alcohol use disorder, they may develop unhealthy coping skills and be at greater risk for an array of issues during childhood and as adults.1,6,7 Behavioral issues, mental health disorders, relationship issues, and substance abuse disorders can occur in children of alcoholics, affecting them both as children, adolescents and adults.1,8,9
Children of alcoholics are also 3 to 4 times more likely to develop AUD than those without alcoholic parents.2,8 Exposure to drinking or substance abuse in the home encourages early experimentation in children.25 In contrast, children whose parents sought addiction treatment were shown to thrive.25
Children who grow up in a household where one or both parents has alcohol use disorder may experience a chaotic and unstable living environment, inconsistent parenting, frequent arguments between the parents, abandonment, or unpredictable behavior.1 They may also witness domestic violence and are more likely to experience neglect or physical, sexual, and/or psychological abuse than children of parents without alcoholic parents.1,6 Law enforcement or social service agencies may become involved in some cases, which can be scary or upsetting to children.7
Alcoholism frequently becomes a central issue that contributes to dysfunction within the family system but can also turn into something that family members work hard to keep as a secret within the family unit.1 Children may feel responsible for their parents or siblings and find themselves behaving more like a parent, especially if their parent is often absent or unable to function.8 Fear, shame, anger, guilt, and denial are commonly experienced emotions for family members, including children.1,8 Children of alcoholics may experience anxiety, depression, or difficulty trusting people.8
Heavy alcohol use during pregnancy can cause a child to be born with fetal alcohol spectrum disorders, which can cause facial abnormalities and problems with coordination, balance, movement, learning, memory, attention, and verbal communication.9
Children of people with alcohol use disorder may act out in various ways, including:8
- Behavioral issues, like shoplifting or fighting.
- Excessive absences or lateness at school.
- Isolating from peers.
- Struggling in school.
- Substance abuse.
- Suicidal thoughts or attempts.
- Symptoms of depression.
Characteristics of Children of Alcoholics
While each child is different and responds in their own way to alcoholism in the home, certain characteristics are frequently seen in children with alcoholic parents.7,8 These characteristics can appear during childhood or adolescence and often persist through a person’s lifetime.
Children who take on a parenting role often accept more responsibilities than other children and base their self-worth on helping others.7,10,11 This type of person may put a lot of effort into being successful at anything they do, often striving for perfectionism.7,8 This can be a way to get attention in a way they may not be able to at home, or it can be an attempt at exerting control over an area of their life that they are able to.7,11 Often, people in this group experience feelings of guilt, have unrealistic expectations, and are excessively self-critical.7,10
Growing up with a parent with an alcohol use disorder can cause adolescents and adult children to be hypervigilant when interacting with others.7 They may be guarded when communicating and especially sensitive to criticism or conflict, whether actual or perceived.7,11 It can be difficult to put trust into other people when a parent isn’t always trustworthy.8,11
Children growing up in alcoholic homes may internalize what occurs and become anxious, especially if they worry about a parent or the situation at home.8,10 If their home life is unstable or there is a lot of fighting or domestic violence, this can also contribute to anxiety.8
Children of alcoholics may struggle with low self-esteem, passivity, fear of rejection, and depressive symptoms. They may avoid close relationships due to fear of abandonment and have poor school performance.10,11
Some children react by externalizing anger. They may demonstrate traits such as manipulating other people, lack of empathy, and not being affected by the consequences of their actions.10 People in this group may be dishonest, impulsive, and aggressive.10 People with these characteristics are more likely to have problems in school, substance use, criminal behavior, and antisocial personality disorder.10
Starting in adolescence, some children of alcoholics begin to abuse alcohol themselves and begin to act out in various ways as they continue on into adulthood.10 They tend to engage in promiscuous sexual behavior and get into unhealthy, abusive relationships. They also tend to engage in risk-taking behaviors and behave impulsively, and may self-harm.10 This may be diagnosed as borderline personality disorder.10
Risk Factors Among Children of Alcoholics
Children of people with an alcohol use disorder are at an increased risk for a variety of problems later in life.1,7 In addition to an increased hereditary risk of developing alcoholism, children of alcoholics may be more likely to experience mental health disorders, sexual and physical violence, and develop other substance use disorders that non-children of alcoholics.1,6,7,12
Anxiety disorders and depression may be present in children of parents with alcohol use disorder, and can occur at any age.1, 7,13 Agoraphobia, social phobia, and generalized anxiety disorder are also experienced at higher rates among children of alcoholics than people who grew up in homes without a parent with alcohol use disorder.14
Eating disorders and personality disorders, including antisocial personality disorder and borderline personality disorder, have also been associated with parental drinking, especially if there have been additional issues, such as childhood abuse.1,12,13,15,16 Children of women who drank 1 or more alcoholic drinks per week while pregnant are more likely to develop conduct disorder.17
Learning how to regulate emotions in a household with an alcoholic parent can be difficult. Children may not know how to express anger or frustration in a healthy way.7 Impulse control and self-esteem tend to be lower in those with a parent with alcohol use disorder.14 Children of alcoholics are also more likely to experience suicidal thoughts.18
Children of people with an alcohol use disorder are at greater risk of also developing an issue with alcohol.2,4,8 They are 3 to 4 times more likely to develop an alcohol use disorder than peers who grew up with parents without an alcohol use disorder.2,4,13 Children of alcoholics may drink earlier because of access to alcohol or lack of consistent supervision.9,13,19
Alcohol may be a way of dealing with emotions that they aren’t able or willing to express, such as guilt, shame, or anger. It can be a means of self-medicating to deal with mental health symptoms such as anxiety or depression.7,12 Children of alcoholics tend to view alcohol as a way to cope with stress.14,21
Support for Children of Alcoholics
Support is available for children of alcoholics. Adolescents can struggle with family issues even after a parent stops drinking and seeking professional help can be beneficial for a number of reasons.1 Family or individual counseling can help a person learn how to express their emotions and assist the family in communicating and functioning in a healthier way.1
Therapy can be effective for adult children of alcoholics as well. It can aid them in addressing unresolved issues and trauma, changing patterns of behavior that no longer work for them, improving relationships and treating mental health or substance use disorders that may be present, including their own alcoholism.7
Mutual help groups are another option that many people use and find to be very helpful. Al-Anon is a self-help group that is geared towards people who have been affected by the drinking of a loved one.22 Alateen is a branch of Al-Anon designed for teenagers affected by the drinking of a loved one.22
These groups are based on principles similar to those practiced in Alcoholics Anonymous and allow people to identify with peers based on similar experiences, create positive changes in their own lives, and connect with people who can understand what they’re going through.22 The programs are free to attend and have no religious component.22
. American Association for Marriage and Family Therapy. (2020). Children of alcoholics.
. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
. Tawa, E.A., Hall, S.D., & Lohoff, F.W. (2016). Overview of the genetics of alcohol use disorder. Alcohol and Alcoholism, 51(5), 507-514.
. Edenberg, H.J., & Foroud, T. (2013). Genetics and alcoholism. Nature Reviews Gastroenterology and Hepatology, 10(8), 487-494.
. Kranzler, H. R., Zhou, H., Kember, R. L., Vickers Smith, R., Justice, A. C., Damrauer, et. al. (2019). Genome-wide association study of alcohol consumption and use disorder in 274,424 individuals from multiple populations. Nature Communications, 10(1), 1499.
. Widom, C.Z., & Hiller-Sturmhöfel, S. (2001). Alcohol abuse as a risk factor for and consequence of child abuse. Alcohol Research and Health, 25(1), 52-57.
. Hall, C.W., & Webster, R.E. (2007). Risk factors among adult children of alcoholics. International Journal of Behavioral Consultation and Therapy, 3(4), 494-511.
. American Academy of Child and Adolescent Psychiatry. (2019). Alcohol use in families.
. Foltran, F., Gregori, D., Franchin, L., Verduci, E., & Giovannini, M. (2011). Effect of alcohol consumption in prenatal life, childhood, and adolescence on child development. Nutrition Reviews, 69(11), 641-659.
. Hinrichs, J., Defife, J., & Westen, D. (2011). Personality subtypes in adolescent and adult children of alcoholics: A two-part study. The Journal of Nervous and Mental Disease, 199(7), 487-498.
. University of California Santa Cruz. (2012). Adult child of an alcoholic (ACoA).
. Drapkin, M.L., Eddie, D., Buffington, A.J., & McCrady, B.S. (2015). Alcohol-specific coping styles of adult children of individuals with alcohol use disorders and associations with psychosocial functioning. Alcohol and Alcoholism, 50(4), 463-469.
. Rodgers, C. (2017). A quantitative comparison of adult children of alcoholics (ACOAs) and non-ACOAs on attachment.
. Menees, M.M., & Segrin, C. (2000). The specificity of disrupted processes in families of adult children of alcoholics. Alcohol and Alcoholism, 35(4), 361-367.
. Gasior, K. (2014). Diversifying childhood experiences of adult children of alcoholics. Alcoholism and Drug Addiction, 27(4), 289-304.
. Harman, M.J. (2004). Children at-risk for borderline personality disorder. Journal of Contemporary Psychotherapy, 34, 279-290.
. Disney, E. R., Iacono, W., McGue, M., Tully, E., & Legrand, L. (2008). Strengthening the case: prenatal alcohol exposure is associated with increased risk for conduct disorder. Pediatrics, 122(6), e1225–e1230.
. Park, S., & Schepp, K.G. (2015). A systematic review of research on children of alcoholics: Their inherent resilience and vulnerability. Journal of Child and Family Studies, 24, 1222-1231.
. Klostermann, K., & Kelley, M.L. (2009). Alcoholism and intimate partner violence: Effects on children’s psychosocial adjustment. International Journal of Environmental Research and Public Health, 6(12), 3156-3168.
. Elkins, I.J., McGue, M., Malone, S., & Iacono, W.G. (2004). The effect of parental alcohol and drug disorders on adolescent personality. American Journal of Psychiatry, 161(4), 670-676.
. Klostermann, K., Chen, R., Kelley, M.L., Schroeder, V.M., Braitman, A.L., & Mignone, T. (2011). Coping behavior and depressive symptoms in adult children of alcoholics. Substance Use and Misuse, 46(9), 1162-1168.
. Al-Anon Family Groups. What is Al-Anon and Alateen?
. National Institute on Alcohol Abuse and Alcoholism. (n.d.). Alcohol Use Disorder.
. Substance Abuse and Mental Health Services Administration. (2017). Children Living With Parents Who Have a Substance Use Disorder.
. Miller, Shannon C.; Fiellin, David A.; Rosenthal, Richard N. (2018). The ASAM Principles of Addiction Medicine, 6th Ed.