Helping Children of Adults with Alcohol Use Disorder

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. 

What Is Alcoholism?

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

Is Alcoholism Genetic?

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 to Explain Alcoholism to a Child

The National Association for Children of Alcoholics (NACOA) suggests using the “7 Cs” to talk to kids about alcoholism:²⁶

• “I didn’t cause it.
• I can’t control it.
• I can’t cure it.
• I can help take care of myself by communicating my feelings, making healthy choices, and celebrating myself.”

It’s especially important to remind children that their parent’s alcohol addiction is not their fault. Many kids will blame themselves or feel guilt or shame. Remind children that addiction is a disease that needs treatment, just like any other disease. It’s also important to let them ask questions, and to answer as honestly as possible in an age-appropriate way.  Reassure kids that they are not alone, and that there are resources to help them, which we’ll discuss more below.

How Does Alcoholism in a Parent Affect a Child?

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.
• Risk-taking.

Common 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 and may include:^7–11

• Taking on more responsibilities than other children, which can mean acting more like the parent.
• Basing their self-worth on helping others. They may put a lot of effort into being successful at anything they do, often striving for perfectionism.
• Feeling guilt, having unrealistic expectations, and being excessively self-critical.
• Being hypervigilant when interacting with others. This can look like being guarded when communicating and especially sensitive to criticism or conflict, whether actual or perceived, as well as distrusting others.
• Anxiety and depression.
• Externalizing anger. This can manifest 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
• Drinking alcohol and acting out in various ways.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 for Children of Parents with AUD

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 This may include:

• Anxiety disorders and depression, which can occur at any age.^{1, 7,13} Anxiety disorders can include agoraphobia, social phobia, and generalized anxiety disorder.¹⁴
• Personality disorders, including antisocial personality disorder and borderline personality disorder.^{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.¹⁷Learning 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
• Suicidal thoughts.¹⁸
• Developing alcohol use problems themselves.^2,4,8 Children of parents with an AUD 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 also drink earlier because of access to alcohol or lack of consistent supervision.^9,13,19Alcohol 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 It can also help family membersn address 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. Al-Anon and SMART Recovery Family and Friends are self-help groups geared toward 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 free programs 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

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