Investigations of various factors known to increase the risk of alcohol addiction in adolescents have invariably stressed the association between the personality traits of prospective alcoholics and their dysfunctional family. The unsatisfactory social context, which aggravates the adverse effects of those factors, is commonly determined by parental alcoholism, which significantly affects the dysfunctional family dynamics.
The studies addressing the issue of alcohol abuse in adolescents deal primarily with the following clusters of risk factors: parental influence, peer influence, social context of adolescent involvement in alcohol, and personality characteristics of adolescent misusers (Mayer, 1988).
Our clinical and research work has indicated that in adolescence the above-mentioned factors are most closely interrelated and highly interdependent. Since personality traits are formed within the family, family relations and family dynamics represent, in addition to a number of subjective and objective factors, important determinants of the adolescent personality profile. Similarly, social behavior characteristics, which are so intimately connected with self-image and the process of separation and individuation, reflect all strong and weak points of the family process. Several researchers have identified high levels of depression, anxiety, low self-esteem, and low educational goals as common personality characteristics of adolescent problem drinkers (Lisansky & Gomberg, 1982; Mayer, 1988). These characteristics are in many aspects determined by the parental abuse of alcohol and the deleterious effects of alcoholism on the family. Unassertive parents are unable to enhance assertiveness in their children, nor can they promote their uneventful and trauma-free experiences separation process, one of the main axes of adolescent psychodynamics.
Feelings of being rejected and constant fear of emotional loss, which accompany children of alcoholic parents throughout their childhood, tend to culminate in adolescence, a time when the feelings become even more destructive and are further intensified by the adolescent's need for independence. Feelings of inferiority additionally impede separation of children from alcoholic families. Their loneliness provides an ideal breeding ground for the accumulating anxiety, self-rejection, and mistrust of others. Hostility associated with these feelings may assume various forms of aggression. Such adolescents use alcohol to relieve anxiety, reduce dissatisfaction and mistrust, and give vent to accumulated aggression. In adolescents brought up in alcoholic family environments, alcohol, entering through several receptor sites, fills many gaps left over from the development period prior to separation. Their parents--either the alcoholic parent, or the partner living with him/her in co-dependency, or both of them--who are themselves filled with distress, depression, and anxiety, usually cling to their children while at the same time manifesting overt signs of resentment and rejection. In this state of pathological ambivalence, they both reject their children and try to tie them to themselves, thus seriously hindering their separation. As a result, many children of alcoholic parents develop defensive aggression or passive resistance, or take recourse to some other inappropriate patterns of defensive behavior. Their negative self-image, rendered even more somber by the feeling of shame caused by the alcoholism of their parents, only adds to their loneliness and low sense of well-being. They have no opportunity to learn how to cope with anxiety and depression. Encouraged by the disinhibiting effects of alcohol, they find it easier to enter the world outside their family borders in search of relief and self-assertion (Berlin, Davis, & Orenstein, 1988).
Filled with feelings of inferiority, such adolescents cannot or dare not seek accomplishment in a healthy peer group, although their need for social approval and their wish to be accepted as part of the group is much stronger than in their peers who are growing up in a supportive and affectionate family environment. Thus, they are even more vulnerable to influences of delinquent adolescent groups. The use of alcohol relieves stress, regulates moods, and enhances communication skills and relations with peers whose approval boosts their low self-esteem (Thompson, 1989). Drinking compensates for the lack of social skills which cannot be learned in an alcoholic home, and at the same time acts as an anxiolytic drug (Smith, Canter, & Robin, 1989). To such adolescents, socialization enhanced by the use of alcohol is more easily accessible than other healthier patterns of the socialization process. Adolescent children of alcoholic parents are therefore more vulnerable to early alcoholism than are their peers from nonalcoholic homes. Alcohol abuse, however, is not the only hazard that threatens these adolescents to a much greater extent than it does their peers from healthy families. Authors who have investigated personality characteristics of adolescents with alcoholic parents portray them as having difficulty with issues of self-esteem, depression, ego control, and feelings of guilt (Tweed & Ryff, 1991) Also, they are found to have higher somatization scores, poor self-concept, inability to develop emotional and intimate relationships, and a low level of resistance to illness and stress (Whipple & Noble, 1991; Wagner-Glenn & Parsons, 1989). Not only are children of alcoholics more vulnerable to use alcohol and other drugs, they are to a greater extent also exposed to other psychosocial risks (Chassin et al., 1992). These findings stress the need for the identification of protective factors which would reduce these hazards to their mental and physical health. By establishing and developing such factors, we could contribute to more effective prevention of alcohol and drug abuse and other psychosocial disturbances.
The sample investigated included 63 adolescents (32 males and 31 females), aged 12 to 19 years. In the alcohol treatment center, alcohol dependence was diagnosed in either one or both of their parents. A control group consisted of 321 same-aged adolescents (161 males and 160 females) from nonalcoholic families. Informed consent was obtained from the subjects, all of whom had volunteered for the study.
The following psychometric instruments were used in all individuals in the study: Offer's self-image questionnaire (OSIQ), which assesses impulse control (PS-1), emotional tone (PS-2), body image (PS-3), social relationships (SS-1), morals (SS-2), educational goals (SS-3), sexual attitude (SX), family relationships (FS), external locus of control (CS-1), psychopathology (CS-2), optimal adjustment (CS-3), and depression (DEPR); Aggression Questionnaire (Buss-Durkee) which asses physical aggression (assault) (A), indirect aggression (IA), verbal aggression (VA), irritability (IR), negativism (NG), resentment (R), suspicion (SU), and feelings of guilt (G); Spielberger's State-trait Anxiety Inventory (STAI), which assesses anxiety as a state (STAI X-1) and anxiety as a trait (STAI X-2).
The data obtained were analysed using the Statistical Package for the Social Sciences. The following statistical methods were employed: determination of statistical parameters; the F-test and t-test for determining the significance level; the one-way analysis of variance; the Pearson correlation coefficient; and the Kendall Tao correlation coefficient. Only relevant data are presented in the tables.
The observed differences between the control and the study group were highly significant (at the 0.01 level) in the following self-image variables: impulse control (PS-1), family relationships (FS), and optimal adjustment (CS-3).
Low impulse control scores in the study group suggested that they had great difficulty controlling internal impulses. This characteristic is manifested in uncontrolled reactivity, weak impulse control, and inability to control external and internal pressures in a rational way (characteristic of the very high inner tension in adolescence).
Differences in family relationship scores indicated that adolescents from alcoholic homes hold a very negative view of their family and experience a high degree of uncertainty about their role in the family. The resulting feelings of insecurity constitute an equally important part of their self-image.
Adolescents from alcoholic homes had significantly lower adjustment scores; since in a disrupting alcoholic environment they are frequently faced with various stressful situations, their inability to adapt to stress is a particularly severe handicap.
The groups differed significantly (at the 0.05 level) regarding their vocational and educational goals (SS-3). Adolescents with alcoholic parents scored lower on the scales for these goals as compared with their peers from nonalcoholic families. They also showed very low aspirations and invested very little energy in making plans for the future.
Group differences were statistically significant (at the 0.1 level) regarding emotional tone (PS-1), sexual attitudes (SX), psychopathology (CS-2), and depression (DEPRES).
These scores reflect emotional instability, inability to control emotions, confusion about sexual role, and viewing oneself as being different from others in terms of psychopathology and increased depression. The latter is not manifested as a disorder of mood, but as a tendency toward withdrawal and defeatism, as a derogatory attitude to oneself and other people, as well as increased uncertainty and apathy.
Aggression (Results of the Buss-Durkee Questionnaire)
The most significant differences between the groups were noted in their irritability (IR) and verbal aggression (VA) scores. Adolescents with these traits are more likely to engage in conflicts when feeling frustrated or when under subjective or objective pressure. Increased urges to quarrel and uncontrolled and loud outbursts of anger adversely affect both the adolescent and his/her environment. Adolescents from alcoholic homes score significantly higher than do controls on the scales of assault (A), suspicion (CU), and intense feeling of guilt (G) (at the 0.05 level). Also, they are quick to react by assault, show high levels of destructiveness, and are mistrustful of others. They have a very low opinion of themselves and are filled with feelings of guilt. They also differ from control peers in their level of indirect aggression (IA) (at the 0.1 level).
Anxiety (STAI Results)
A comparison of anxiety scores for adolescents in both groups showed that children of alcoholic parents had significantly higher scores for anxiety as a state (STAI X-1), which is manifested in acute feelings of anxiety and worry as well as anxiety as a personality trait (STAI X-2), expressed by uncertainty, pessimism, feelings of constant inner tension, and a tendency to be on the alert for threats. In addition to acute feelings of anxiety, they demonstrated high levels of anxiety which constituted a constant component of their personality profile and profoundly influenced their self-concept and attitude toward others.
Table 1 Parental alcoholism in adolescents of the study group males females both paternal alcoholism 25 22 47 maternal alcoholism 4 6 10 both 3 3 6 TOTAL 32 31 63 Table 2 Self-Image (OSIQ Results) Control group Study group N = 321 N = 63 dimension M SD M SD t s.diff. PS - 1 2.73 0.71 3.20 0.80 4.33 (***) PS - 2 2.51 0.76 2.71 0.81 1.68 (*) PS - 3 3.13 0.55 3.17 0.79 0.38 / SS - 1 2.58 0.54 2.68 0.74 1.02 / SS - 2 2.74 0.54 2.85 0.59 1.37 / SS - 3 2.50 0.54 2.22 0.78 2.61 (**) SX 3.17 0.74 3.38 0.79 1.95 (*) FS 2.40 0.67 2.76 0.75 3.54 (***) CS - 1 2.67 0.54 2.57 0.72 0.84 / CS - 2 2.55 0.62 2.73 0.75 0.79 (*) CS - 3 2.80 0.51 3.15 0.87 3.09 (***) DEPR 2.44 0.93 2.69 0.91 1.98 (*) The level of significance: No significance / Low significance * (the difference was significant at the 0.1 level) Significance ** (the difference was significant at the 0.05 level) High significance *** (the difference was significant at the 0.01 level) Different dimensions of aggression and their significance level Control group Study group N = 321 N = 63 dimension M SD M SD t s.diff. A 0.46 0.25 0.55 0.32 2.11 (**) IA 0.47 0.26 0.57 0.45 1.70 (*) IR 0.48 0.20 0.61 0.31 3.20 (***) VA 0.57 0.21 0.73 0.25 4.76 (***) NG 0.52 0.26 0.57 0.25 1.44 / R 0.45 0.23 0.49 0.38 0.81 / SU 0.53 0.17 0.59 0.22 2.05 (**) G 0.65 0.21 0.71 0.21 2.07 (**) Table 4 Significance of differences in two dimensions of anxiety. Control group Study group N = 321 N = 63 M SD M SD t s.diff. STAI X-1 38.21 7.65 44.47 12.00 3.89 (***) STAI X-2 35.89 8.46 46.01 11.43 6.68 (***)
The objective of this study was to determine the personality characteristics of adolescents with alcoholic parents which distinguish them significantly from their peers from nonalcoholic families. Since previous studies have suggested that children from families with at least one alcoholic parent are more likely to develop various forms of psychopathology, including problem drinking (Marston et al., 1988; Wagner-Glenn & Parsons, 1989; Pardeck, 1991), this study was undertaken to find out which psychodynamic pathways and social processes placed so many children of alcoholic parents at similar risks. The study focused on the adolescent self-image for two reasons: self-concept plays a key role in the development of adolescent psychosocial disturbances; and self-image is strongly influenced by the family environment. Many studies dealing with children of alcoholics have suggested that there is an increased rate of alcohol use and early problem drinking, often followed by alcohol dependence (Thompson, 1989; Englander-Golden et al., 1989; Walfish, Massey, & Krone, 1990; Page, 1990; Page & Cole, 1991; Cole, 1991; Thorlindsson & Vilhjalmsson, 1991; Martin & Pritchard (1991) in this group. Further, the identification of risk factors for drinking would throw more light on protective factors which could be included in alcohol abuse prevention programs, as well as in treatment of alcohol-dependent adolescents.
Compared to their peers from nonalcoholic families, adolescent children of alcoholic parents are more likely to be described as impulsive, nonconforming, and depressed. Their role in the family is often conflicting, they are confused about their sexual identity, and have very low educational aspirations. Each of these traits is basic to the adolescent personality structure, and taken as a whole, they predict a higher rate of problems, conflicts, and traumatic experiences in the course of their personality development.
Poor self-concept predisposes adolescents to development of inappropriate, even destructive, defense mechanisms, and in many ways determines the development of pathological responses and somatic problems. Such emotionally unstable adolescents show poor self-control and view themselves as incompetent and unaccepted. Uncertainty about the sexual role, which is characteristic of adolescence, increases vulnerability in several ways. Such adolescents are especially prone to adopt maladaptive ways of self-assertion and tend to resort to deviant and harmful behaviors in order to relieve their emotional distress.
A comparison of adolescents from alcoholic families and their peers from nonalcoholic families showed that the former scored higher on aggression leading to conflicts. These conflicting situations increase their low opinion of themselves and mistrust of other people, and increase their dissatisfaction. The intensity of their feelings of guilt further raises the destructive effects of these conflicts on their self-concept.
Feelings of intense anxiety are an integral part of the personality structure of adolescents with a family history of alcoholism, and discriminate them significantly from their peers from nonalcoholic families. Since severe and uncontrollable anxiety is basic to most neurotic disorders and other forms of psychopathology, these adolescents appear to be at a particularly high risk.
Each of these characteristics originating in the alcoholic family, is likely to predispose the adolescent to the development of various disorders, including alcohol and drug abuse. Thus, professionals involved in clinical evaluation and therapy of children with a family history of alcoholism should pay attention to their specific personality constellation.
There is no doubt that certain weaknesses, personality traits, or disturbed mental functions may be the key factors which predispose these adolescents to problem drinking and alcohol dependence. The correlation between personality characteristics and involvement in alcohol is confirmed daily in our clinical practice. The dynamics of psychoactive substance abuse is closely connected with other issues, including negative self-concept, depression, anxiety, dissatisfaction with the role in the family, and uncertainty about the sexual self.
Involvement in alcohol and other drugs is not only a major element of the individual's pathology, but forms part of a larger social context of adolescents. It is closely linked with their social habits and their feeling of being part of the group; it increases their assertiveness and enhances their social skills and peer relations, thus contributing to the development of their social self--an essential part of one's self-image.
Self-confidence and readiness to accept different, sometimes negative views and responses of others, coupled with the ability to cope with occasional refusals or failures, are the key characteristics that help adolescents adopt healthy patterns of social behavior. Adolescents must show at least some predictability, self-control, and inner strength in order to be able to view their relationships with peers as a supplement to what they had been given by their family, rather than as compensation for what was missed as a child. Adolescents who come empty-handed from their dysfunctional families badly need to be accepted by peers, yet new social experiences, instead of helping them develop their social role in a constructive way, further increase their emotional distress. Such adolescents resort to drinking in order to relieve depression and feelings of insecurity. The disinhibiting influence of alcohol enhances their sociability and makes them feel in control, yet the cumulative effects of alcohol and high levels of aggression--which they somehow manage to restrain when sober--are most often detrimental both to the drinker and to the environment. Because of their unhappy and deprived childhood, adolescents from dysfunctional families show increased inclination toward alcohol misuse, greater susceptibility and vulnerability to the adverse effects of drinking, and therefore are at higher risk for developing alcohol dependence than are their peers from nonalcoholic families.
The results of the study can be applied directly to our clinical work with adolescents and their families. Our comprehensive therapeutic approach includes training courses in assertiveness and social skills, provides adolescents with the tools for more effective control of inner tension, and teaches them how to give vent to their aggression in less destructive ways. Psychotherapy focuses attention on the development of a realistic self-image, self-confidence, trust in others, and healthful sexual attitudes.
All of these elements used in psychotherapy need to be included in alcohol and drug abuse prevention programs designed for adolescents at risk for developing alcoholism and other psychosocial disorders.
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