In the article on Children of Alcoholics (Rice 2006) the authors discuss the effects of being a child of an

alcoholic, (COA) enumerating the risks this group has for a variety of negative outcomes. Specifically noted is that

COAs have an increased risk of developing alcoholism and other substance abuse (SA) problems. (Schukit,

2000,cited in Rice 2006). Risk is best understood as a complex interaction between environmental and

hereditary factors (McGue, Elkins & Iacano 2000, cited in Rice 2006) but the article examines several models that

speak to the development of a COA. One is the “Deviance Prone Pathway” (DPP) which predicts that parental SA

increases the likelihood of anti-social behavior (including SA) later in life due to poor parenting/family conflict that

interacts with a child's difficult temperament and cognitive dysfunctions . There is also discussion of COAs who

defy predictions of all models. Garmezy & Neuchterlen, (1972, cited in Rice 2006) label these children “Resilient”.

DPP theory suggests that poor parenting puts COAs at risk for increased levels of SA in adolescence due to less

parental supervision/support with unpredictable discipline. This increases the risk of academic non performance and

for choosing peers that have high levels of conduct problems. Poor peer choice increases the likelihood of more

anti-social behavior which in turn predicts development of an adult SA disorder.(Chassin et al.,1999, Molina

Buksstein and Lynch, 2002, cited in Rice 2006). Temperament factors of a difficult child's personality traits may

include sensation seeking, aggression, impulsiveness and an inability to delay gratification. (Gerrerra et al.,2004,

Wills, Windle and Clear 1998, cited in Rice 2006) Defects in executive function result in the inability to adjust

behavior to fit individual situations and being unable to inhibit responses, as well as problems with planning and

working memory. (Nigget et al., 2004, cited in Rice 2006)

Validity of the DPP would further seem to be asserted in Ohannessian & Hesselbrok (2008). Data was collected

from 249 adolescents aged 15 to 19 and their biological fathers with SA from 1993 with five year follow ups (still

ongoing). Subjects were recruited from parental responses to advertisements or presentations at information/support

groups. Participants who could not meet basic reading requirements were excluded, the remainder were tested using

a structural equation model to determine which of three models best predicted the onset of substance abuse. Research

showed COAs (Chassin et al., 2002, Dawson 2000, cited in Ohannessian & Hesselbrock 2008)begin using

substances at an earlier age and are likely to drink more heavily and experience aspects of SA than non COAs, with

an accelerated route to excessive use.((Hussong et al.,1998, cited in Ohannesian & Hesselbrock 2008). When

discussing temperament, Scher, (1991, cited in Ohanessian and Hesselbrok 2008) opines that delinquency plays an

important role. Temperamental characteristics such as extraversion, lack of inhibition and impulsiveness
consistently predict delinquent behavior(Chassin et al., 2004, Loukas et al 2000, Martin & Sher1994, Sher et al

2000, 2005, Flory et al., 2002 Wennberg 2002, cited in Ohannessian & Hesselbrock 2008). These characteristics link

delinquency and SA in early adolescence and are indicators for early beginnings of substance use, frequency, higher

proportionality of substance use and are found to predict delinquent behavior and SA in later development. (Caspi &

Silva 1995, Caspi et al., 1996, cited in Ohannessian and Hesselbrock 2008) Despite the attempts to use other models,

in this case a negative affect model and a comprehensive model incorporating both negative affect and delinquency,

a DPP model was thought to be the best framework for further exploration. This temperament-delinquency model

significantly predicted lower levels of agreeableness, and higher levels of disinhibition and susceptibility to

boredom which in turn led to a younger age of first substance use.

The study of Shukit, Smith, Bernow, Preuss, Luczak & Radziminski (2003) gathered data from a 15 year follow

up of 453 families and controls. Original subjects were chosen from those who responded to a questionnaire sent at

random to students and non-academic staff at the University of California. Subjects who were thought to be at risk

from depressive or schizophrenic disorders were excluded. Results were obtained by using the Child Behavioral

Checklist, usually administered to the mother. Their DPP model theorizes that a family history of disinhibited

behaviors lead to cognitive difficulties in children, which in turn produce externalizing behaviors. Again, these

externalizing behaviors are suggested as leading COAs to choosing substance abusing peers.(Sher 1991, Cudorety et

al., 1995, Crowley et al., 1998. Puttler , 1998 Jacob and Windle, 2000, Zucker et al., 2000, Tartar 2002, cited in

Schukit et al., 2003). What Scher 1991, cited in Schukit et al., 2003) found most relevant was the externalizing

symptom of behavioral undercontrol. More subjects (45%) with family histories of SA developed SA problems as

opposed to those with no history of SA.(20%).(Schukit and Smith 1996, 2000, cited in Schukit et al 2003).

When discussing DPP as a model for predicting future SA problems in COAs, several problems emerge. In these

discussions there are usually several cautions to the reader to remember that SA disorders arise from a variety of

factors. A first caveat is a reminder that the interaction between parents and children is a system wherein each affects

the other. DPP theorizes that lack of parental control contributes to adolescent SA but Bell and Chapman (1996,

cited in Rice 2006)note also that adolescent SA in turn decreases parental control. Also, SA is a changing illness,

where the parent may cease current substance mis-use, thus changing the family dynamic. Biological models are not

considered. More troubling is the constant intrusion of theories regarding negative affect or internalizing symptoms

that would seem to have an important effect on the likelihood of COAs developing future SA problems. The
Ohannessian study notes that negative affect may still be a predictor of later adult SA problems. Measure of negative

affect might have be better assessed if more specific domains were used in measurement, rather than just a general

measure of negative affect. Schukit et al., on the other hand, seem to try to bypass the problem altogether with their

subject exclusions. Even so, they were not able to screen for larger externalizing symptoms in the grandparents of

the subjects which might be a predictive factor for future COA substance misuse. Finding a suitable test group also

seems to be problematic. Ohannessian et al. use an admittedly high risk group who's results may not be applicable to

the general population. While downplaying the role of the negative affect model, they still are unable to explain the

admitted link between neuroticism and SA in older adults. Schulit et al., with their exclusions have tried for a a

subject group of solely functional alcoholics and tested only for domains they felt were relevant to their selected

blue and white collar group. Even then, members were excluded due to either incomplete answers or deviating

higher than the mean. The authors relied on parental evaluations of the children, point to the small sample size, the

vagaries of reporting on internalizing problems, the fact that their results come from relatively highly

educated/functional families and the likelihood that any domain in the research model is context-dependent.

Resilient COAs, despite being labeled, manage to avoid negative consequences. Carle and Chasson (2004, cited

in Rice 2006) stated that although there is a significant difference between COAs and non-COAs in terms of rule

abiding/academic behavior there was no difference found in regards to social competence. Scher (1991, cited in Rice

2006) theorized that protective factors for COAs may include social class, large amounts of support from parents or

a primary caregiver (as well as preservation of family ritual), personality type, self awareness, family harmony

during infancy, coping skills or good cognitive-intellectual functioning. Carle and Chasson (2004, cited in Rice,

2006) believe resilience to be associated with low levels of internalization and high positive affect. In older children

influential peer relationships may also provide protective factors for resilience.(Mayes & Schumann 2006, cited in

Rice, 2006) Resilience may also come from the recovery of the alcoholic parent: these children showed

proportionate levels of social competence when compared to children of non-alcoholic parents. (Husson et al, 2005,

cited in Rice 2006).

The study of Godsall, Jurkic, Emshoff, Anderson and Stanwyk, (2004) compared two groups of children from

various parts of one south-eastern state. Group one was high functioning, selected by school personnel to be trained

as peer counselors; the others were children who were hospitalized in psychiatric facilities or in the custody of the

state and living in group homes. Test results were obtained using the Piers-Harris Self-Concept Scale, Parentification
Questionnaire and the Children of Alcoholics Screening Test (CAST). They define resilience solely as referring to

the intra-personal outcome of the child's self concept, using the lens of a family systems perspective and primarily

focus on the process described as “parentification”. This generally refers to the use of children by parental figures to

satisfy parental needs. The parentified child may engage in instrumental and/or emotional caregiving. The authors

contend that a parentified child in an alcohol abusing family creates poor development of self-concept as the child

misses the opportunities for social and emotional development. Of the two control groups used in the study, the

lower functioning group reported higher parentification than the higher functioning group, with parentification being

a high predictor of self concept.(Goglia et al., 1992, cited in Godsall et al., 2004). Parentification is alleviated if this

is a temporary change and the child receives clear support from the parents. Without support, affirmation and

reciprocation, the child is considered to be “destructively parentified”. (Bszorrmenji-Nagi &Krasner 1986,

Boszormenji-Nagi & Sparks 1973, cited in Godsall et al 2004). Jurkovic and Jurkovic (2001, cited in Godsal et al.,

2004) assert the child's inability to complete developmentally appropriate tasks that build self concept undermines

children's feelings of self worth and lead them to internalize concepts that may lead them to doubt their their right to

fair treatment. Jurkovic (1997, cited in Godsal et al., 2004) therefore posits that the justice perspective of the family

is the important variable in the developing self concept.

Nancie Palmer (1997) used the CAST to select a sample of ten 24-35 year old from four geographic locations in

Kansas. Subjects were interviewed, and interrators placed the subjects into various categories of resilience. Palmer

proposes her own Differential Resiliency Model demonstrating resiliency to be a process through categories.

She expresses concern that intervention practices are based on stereotyped negative aspects of families that lead to

negative labeling; and that environmental factors are rarely considered when assessing how well the COAs are

coping. Her definition of resiliency is defined as competencies in life management where the substantive character

of the COA develops through periods of disruption. These abilities include behavioral and cognitive competencies,

problem solving skills that contribute to self-enhancement and the will to improve one's life. (Palmer, 1991) In other

words, when taken in the context of environment, some “problematic” behaviors are actually resilient skills that

promote survival in specific environments. Her categories are: firstly, Anomic Survival, where a subject is coping

with a life of constant change and and upheaval. Secondly, Regenerative Resilience which shows coping strategies

and new, though incomplete, ways of dealing with life challenges. Adaptive Resiliency is a more developed stage

with more sustained use of constructive coping skills; and finally, Flourishing Resiliency, where the subject uses
effective and constructive coping strategies, feeling not only a strong sense of self but finding life meaningful and

manageable. Rather than trying to find a catch-all label for resilience, she reflects on homeostatic resiliency, using

case examples to illustrate individuals who are coping using different strategies that function in the environment in

which they find themselves.

Finding a definition for, or predicting, resiliency appears to be problematic at best. Throughout all studies there

remains one constant thread: further investigation is needed. Comparison of test groups are questionable as well with

some groups ( Palmer) using a very small group of older subjects which also did not consider such factors in the

family such as a parent who has stopped drinking. The precision of Palmer's ratings must also be taken into

consideration, given her “qualitative” methods in delineating the experiences of the group. It it hardly comparable to

the Godshall group, given that that study used younger subjects. The comparison of that study's subjects are also

suspect given the disparity in backgrounds of the high functioning group vs. the lower functioning group. The

Godsall study is also modified by caveats, such as the lack of sub-scale scores for emotional vs instrumental

caregiving and the lack of clinical assessment of parental drinking in the control group. Both studies are hampered

by problems of racial bias. The overall perception is that no one has been able to specifically assign the

characteristics that quantify resiliency. Most of the discussion has centered around appropriate means of intervention

for families. What is still lacking is any defining set of characteristics that make up resilience that might be

developed or encouraged, whether it be something to do with the temperament of the child, the peculiar role they or

another play in the family, with any other combination of a variety of external environmental factors.

The conclusions one can draw from the analysis of the preceding data are ambiguous at best. Clearly no single

model has been found that can predict either future deviance or resiliency. Primarily indicated is a need for further

studies, particularly more longitudinal groups that are equally comparable and non-Eurocentric. Studies need to

include not only those COAs that are obviously at risk, but also those that are doing well despite the appearance of

risk factors. All one seems able to tell from our present level of knowledge is that there is no “one fits all” category

for developmentally appropriate practice when attempting interventions in the lives of COAs. Indeed, we must be

very cautious about the possible destructive effects of labeling itself. The heterogeneous nature of this group, as well

as the environment in which they exist and interact must be acknowledged. The totality of the individuals which

include (but is not limited to) temperament, genetic and family history as well as their relationship to a changeable

environment must be taken into account, as well as the totality of all those who inhabit their world.
Reference Section

Rice, Cara et al. (2006 )Children of Alcoholics, Risk and Resilience. In E. E. Junn and Chris Boyatzis (eds)

Child Growth and Development Annual Editions (09/10) pp. 124-126. Boston: McGraw-Hill

Schuckit, M. A., Smith, T.A., Barnow, S., Preuss, U., Luczak, S. & Radziminski, S.(2003), Correlates of

Externalizing Symptoms in Children from Families of Alcoholics and Controls. In Alcohol and Alcoholism,

Vol. 38 No.6 pp. 559-567. Medical Council on Alcohol

Ohannessian, C. M. & Hesselbrock, V. (2007). A Comparison of Three Vulnerability Models for the Onset of

Substance Use in a High Risk Sample. Journal of Studies on Alcohol and Drugs, January 2008 pp. 75-83.

Godsall, R. E., Jurkovic, G. J. , Emshoff, J. , Anderson, L., & Stanwyck, D. 2004. Why some kids do well in bad

situations: Relation of Parental Misuse and Parentification to Children's Self-Concept. Substance use and

Misuse Vol. 39 No.5 pp. 789-809

Palmer Nancie (1997) Resilience in Adult Children of Alcoholics: A non-pathological approach to social work

practice. Health and Social Work, Vol. 22(3) August 1997 pp. 201-209