Interventions in populations at risk: children of alcoholics
DOI:
https://doi.org/10.20882/adicciones.548Keywords:
children of alcoholics, prevention, groups, familyAbstract
This chapter reviews risk and resilience factors in children of alcoholics and the ideal methodology for preventive interventions in this high risk group for alcoholism and other related psychopathologies. An integral intervention plan is proposed including early case detection, family motivation to take part in the programme, and educational groups for parents and for children about topics related to alcoholism in the family. Also, in depth therapeutic interventions addressing very high risk cases are proposed. The ALFIL Program experience in psychoeducational groups for children of alcoholics and their parents have been conducted in several treatment centres for alcoholism and associations of recovered alcoholics in Spain. Evaluation results of 13 group interventions from 1998 to 2000 indicate that this kind of educational activities are positively evaluated by participants, both parents and children, and have positive results like a significant increase in alcohol knowledge about alcohol in children, and a subjective perception of increased dialogue and decreased conflict in the family after participating in group sessions in a significant percentage of participants. It is concluded that, in the following years, research in this field should be addressed to early detection techniques, systematic evaluation of risk and resilience factors, specific motivational strategies and the continuous evaluation of preventive interventions. It is also stated the need of designing specific preventive and self-help materials for alcoholic families, professional training, and dissemination of this kind of interventions in our country.References
(1) McNamee, J.E. y Offord, D.R. Children of alcoholics. En Canadian Task Force on the Periodic Health Examination. Canadian Guide to Clinical Preventive Health Care. Otawa: Health Canada. 1994 (pp. 470-485)
(2) Ackerman, R. J. Children of alcoholics. A guide for parents, educators and therapists. 2nd edition. A Learning Publication. New York: Firesid, Simon and Schuster. 1987.
(3) Alarcón, C., Ferrer, X., y Sierra, E. Problemática de los hijos de alcohólicos. VIII Jornadas Nacionales de Socidrogalcohol. Gandía (Valencia). 1980.
(4) Steinhausen, H.C. Children of alcoholic parents. Acta Paediatrica, 1993, 82, 208-209.
(5) Ellis, D.A. Zucker, R.A., y Fitzgerald, H.E. The role of family influences in development and risk. Alcohol, Health and Research World,
, 21 (3), 218-226.
(6) Díaz, R., Polo, M.D., Escera, C., Sánchez-Turet, M., y Grau, C. Marcadores neurogenéticos de riesgo para el alcoholismo. En M. Sánchez-
Turet (Ed.), Enfermedades y problemas relacionados con el alcohol. Barcelona: Ediciones ESPAXS. 1999 (pp. 63-111).
(7) McGue, M. A behavioral-genetic perspective on children of alcoholics. Alcohol, Health and Research World, 1997, 21(3), 210-217.
(8) Schuckit, M.A. A clinical model of genetic influences in alcohol dependence. Journal of Studies on Alcohol, 1994, 55, 5-17.
(9) Abel, E.L. Paternal exposure to alcohol. En T.B. Sonderegger (Ed), Perinatal substance abuse: Research findings and clinical implications.
Baltimore: John Hopkins University Press. 1992 (pp 132-160).
(10) Durcan, M.J., y Goldman, D. Genomic imprinting: implications for behavioral genetics. Behavioral Genetics, 1993, 23, 137-143.
(11) Díaz, R. Las repercusiones del alcoholismo paterno en la descendencia: Avances hacia la prevención en una población de riesgo. Aula Médica Psiquiátrica, 1999, 1, 51-61.
(12) Gual A., y Díaz, R. Alcoholism Prevention in children of alcoholics. Ponencia en el Symposium “Alcohol dependence: Epidemiological
and social problems”. VII Congress of the European Society for Biomedical Research on Alcoholism (ESBRA). Barcelona. Junio 1999. (Resumen publicado en Alcohol and Alcoholism, 1999, 34 (3), 440.
(13) Sher, K.J., Gershuny, B.S., Peterson, L., y Raskin, G. The role of childhood stressors in the intergenerational transmission of alcohol
use disorders. Journal of Studies on Alcohol, 1997, 58, 414-427.
(14) Adger, H. The role of primary care physicians. http:www.health.org/nacoa. 1997
(15) Weinberg, N.Z. Cognitive and behavioral deficits associated with parental alcohol use. Journal of the American Academy of Child
and Adolescent Psychiatry, 1997, 36 (9), 1177-1186.
(16) Clark, D.B., Moss, H.B., Kirisci, L., Mezzich, A.C., Miles, R., y Ott, P. Psychopathology in preadolescent sons of fathers with substance
use disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 1997, 36 (4), 495-502.
(17) Hawkins, C.A. Disruption of family rituals as a mediator of the relationship between parental drinking and adult adjustment in offspring.
Addictive Behaviours, 1997, 22 (2), 219-231.
(18) Hill, E.M., Thomson Ross, L., Mudd, S.A., y Blow, F.C. Adulthood functioning: the joint effects of parental alcoholism, gender and
childhood socio-economic stress. Addiction, 1997, 92 (5), 583-596.
(19) Aragón, N., Bragado, M.C., y Carrasco, I. Alcoholismo parental y psicopatología infantojuvenil. Una revisión. Adicciones, 1997, 9 (2),
-277.
(20) Pérez-Galvez, B.S., y Vicente, M.P. Trastornos psicopatológicos en hijos de alcohólicos: Diferencias en relación al tiempo de abstinencia
paterna y sexo filial. Libro de actas de las XX Jornadas de Socidrogalcohol. Córdoba. Noviembre, 1992
(21) Jiménez, J.L., Barrios, A., Yoller, A.B., y Pérez de Heredia, J.L. Psicopatología en hijos de padres alcohólicos. Revista de Psiquiatría Infantil, 1992, 2, 95-99.
(22) Wegscheider, S. Another chance: Hope and health for the alcoholic family. Palo Alto: Science and Behavior Books. 1981.
(23) Black, C., Bucky, S.F. y Wilder-Padilla, S. The interpersonal and emotional consequences of being an adult child of an alcoholic. International Journal of the Addictions, 1986, 21, 213-231.
(24) Harter, S.L. Psychosocial adjustment of adult children of alcoholics: A review of the recent empirical literature. Clinical Psychology Review,
, 20 (3), 311-337.
(25) Christiansen, H.B., Bilenberg, N. Behavioural and emotional problems in children of alcoholic mothers and fathers. European Child and Adolescence Psychiatry, 2000, 9, 219-226.
(26) Sher, K.J. Children of alcoholics. A critical appraisal of theory and research. Chicago: University of Chicago Press. 1991.
(27) Goodwin, D.W. Alcoholism and heredity: A review and hypothesis. Archives of General psychiatry, 1979, 36, 57-61.
(28) Cloninger, C.R. Neurogenetic adaptive mechanisms in alcoholism. Science, 1987, 236, 410-416.
(29) Seilhamer, R.A. y Jacob, T. Family factors and adjustment in COAs. En M. Windle y J.S. Searles (Eds.). Children of alcoholics. Critical
perspectives. New York: Guildford Press, 1990 (pp. 168-185).
(30) Tarter, R.E., y Vanyukov, M. Alcoholism: A developmental disorder. Journal of Consulting and Clinical Psychology, 1994, 62 (6), 1096-1170.
(31) Zucker, R.A., Fitzgerald, H.E. y Moses, H.D. Emergence of alcohol problems and the several alcoholism: A developmental perspective on etiologic theory and life course trajectory. En: D. Cicchetti y D. Cohen (Eds.). Manual of Developmental Psychopathology. New York: Wiley. 1995, Vol 2. (pp. 677-711).
(32) Pogge, D.L., Strokes, J., y Harvey, Y. Psychometric vs attentional correlates of early alcohol and substance abuse. Journal of Abnormal
Psychology, 1992, 20 (2), 151-162.
(33) Berman, S.M., Whipple, S.C., Fitch, R.J. y Noble, E. P. P3 in young boys as a predictor of adolescent substance abuse. Alcohol, 1993,
, 69-76.
(34) Schuckit, M.A., y Smith, T.L. An 8-year followup of 450 sons of alcoholic and control subjects. Archives of General Psychiatry, 1996, 53, 202-210.
(35) Volavka, J., Czobor, P., Goodwin, D.W., Gabrielli, W.F., Penick, E.C., Mednick, A., Jensen, P., Knop, J., y Schulsinger, F. The electroencephalogram after alcohol administration in high-risk men and the development of alcohol use disorders 10 years later. Preliminary
findings. Archives of General Psychiatry, 1996, 53, 258-263.
(36) Webb, J.A., Baer, P.E., y McKelvey, R.S. Development of a risk profile for intentions to use alcohol among fifth and sixth graders. Journal of the American Academy of Child and Adolescent Psychiatry, 1995, 34 (6), 772-778.
(37) Poikolainen, K. Risk factors for alcohol dependence: A questionnaire survey. Alcoholism: Clinical and Experimental Research, 1997, 21 (6), 957-961.
(38) Vitaro, F., Dobkin, P.L., Carbonneau, R., y Tremblay, R.E. Personal and familiar characteristics of resilient sons of male alcoholics. Addiction, 1996, 91 (8), 1161-1177.
(39) Dobkin, P.L., Tremblay, R.E., Desmarais-Gervais, L., y Dépelteau, L. Is having an alcoholic father hazardous for children’s physical health?.
Addiction, 1994, 89, 1619-1628.
(40) Díaz, R., y Gual, A. Adolescent living with parental alcoholism. Alcoscope, 2001, 4(2), 9-15.
(41) Dobkin, P.L. y Dongier, M. Les parents ont mangé des raisins verts et les enfants n’ont pas eu les dents agacées: peut-on identifier des facteurs de protection contre le risque génétique de devenir alcoolique?.
Psychotropes, 1990, V (2), 15-21.
(42) Hill, E.M., Nord, J.L., Blow, F.C. Young-adult children of alcoholic parents: protective effects of positive family functioning. British Journal
of Addiction, 1992, 87, 1677-1690.
(43) Wolin, S., y Wolin, S.J. The challenge model. Working with strengths in children of substance-abusing parents. Child and adolescent
psychiatric clinics of North America, 1996, 5 (1), 243-256.
(44) Hussong, A.M., y Chassin, L. Substance use initiation among adolescent children of alcoholics: Testing protective factors. Journal
of Studies on Alcohol, 1997, 58, 272-279.
(45) Díaz, R. Programa ALFIL: Intervención psicoeducativa para jóvenes con antecedentes familiares de alcoholismo. Manual para educadores
y terapeutas. Socidrogalcohol. Anagrafic, S.A. Barcelona. 2000.
(46) Gual, A., y Díaz, R. Children of alcoholics: Risk factors and preventive strategies. WHO Ministerial Conference about Young People
and Alcohol. Working group: The Family, Stockholm. Sweden. February, 2001.
(47) Nye, C.L., Fitzgerald, H.E., Zucker, R.A. Early intervention in the path to alcohol problems through conduct problems: treatment involvement
and child behavior change. Journal of Consulting and Clinical Psychology, 1995, 63 (5), 831-840.
(48) Dawson, D.A., Harford, T.C. y Grant, B.F. Family history as a predictor of alcohol dependence. Alcoholism: Clinical and Experimental
Research, 1992, 16(3), 572-575.
(49) Hohman, M.M. Motivational Interviewing: An intervention tool for child welfare case workers working with substance abusing parents. Child
Welfare, 1998, LXXVII (3), 275-289.
(50) Woodside, M., Coughey, K., y Cohen, R. Medical costs of children of alcoholics: pay now or pay later. Journal of Substance Abuse, 1993, 5 (3), 281-287.
(51) Children of Alcoholics Foundation. Children of Alcoholics in the Medical System: Hidden Problems, Hidden Costs. Children of Alcoholics
Foundation, Inc., New York, NY. 1990.
(52) Bates, M.E., y Labouvie, E.W. Adolescent risk factors and the prediction of persistent alcohol and drug use into adulthood. Alcoholism:
Clinical and Experimental Research, 1997, 21 (5), 944-950.
(53) Hall, C.W., Bolen, L.M., Webster, R.E. Adjustment issues with adult children of alcoholics. Journal of Clinical Psychology, 1994, 50 (5), 787-791.
(54) Giunta, C.T., y Compas, B.E. Adult daughters of alcoholics: Are they unique?. Journal of Studies on Alcohol, 1994, 55, 600-606.
(55) Roosa, M.W., Gensheimer, L.K., Short, J., Ayers, L.S., and Short, J.L. Development of school-based prevention program for children in alcoholic families. Journal of Primary Prevention, 1990, 11, 119-141.
(56) Short, J.L., Roosa, M.W., Sandler, I.N., Ayers, T.S., Gensheimer, L.K., Braver, S.L., y Yein, J. Evaluation of a preventive intervention for a
self-selected subpopulation of children. American Journal of Community Psychology, 1995, 33 (2), 223-247.
(57) Emshoff, J.G. A preventive intervention with children of alcoholics. Prevention in Human services, 1990, 7 (1), 225-253.
(58) Price, A.W., y Emshoff, J.G. Breaking the cycle of addiction. Alcohol, Health and Research World, 1997, 21(3), 241-246.
(59) Kumpfer, K.L., Molraard, V., y Spoth, R. The “Strengthening Families Program” for the prevention of delinquency and drug use. En R. Peters, y R. McMahon (Eds.) Preventing childhood disorder: substance abuse and
delinquency. Newburg, CA: Sage Publications. 1996 (pp.241-267).
(60) Davis, R.B., Wolfe, H., Orenstein, A., Bergamo, P., Buetens, K., Fraster, B., Hogan, J., MacLean, A., y Ryan, M. Intervening with high
risk youth: A program model. Adolescence, 1994, 29 (116), 763-774. (CASPAR Cambridge and Somerville Program for Alcoholism Rehabilitation.
Massachusetts. Alcohol Education program)
(61) Nastasi, B.K., y DeZolt, D. M. School interventions for children of alcoholics. New York: The Guildford Press. 1994.
(62) Nastasi, B. K. Groups for prevention and intervention with children of alcoholics. En K. Callan, y T.R. Kratochwill (Eds.) Handbook of group intervention for children and families. Needam Heights, MA: Allyn & Bacon. 1998 (pp.193-219).
(63) Eurocare y Coface. Alcohol problems in the family. A report to the European Union. European Commission Directorate General V.
England. 1998.
(64) Emshoff, J.G. y Price, A.W. Prevention and intervention strategies with children of alcoholics. Pediatrics, 1999, 103 (5), 1112-1121.
(65) Kern, J.C. Management of children of alcoholics. En S. Zinberg, J. Wallace y S. Blume (Eds.). Practical approaches to alcoholism psychotherapy. New York: Plenum Press. 1985.
(66) Seleckman, M. Abrir caminos para el cambio. Soluciones de terapia breve para adolescentes con problemas. Colección Terapia Familiar. Barcelona: Ed. Gedisa. 1996.
(67) Rollnick, S., y Miller, W. What is motivational interviewing?. Behavioural and Cognitive Psychotherapy, 1995, 23 (4), 325-334.
(68) Díaz, R., Gual, A., y Grau, C. Intervención preventiva: Diseño de un programa de reducción del riesgo familiar en hijos de alcohólicos.
Libro de ponencias de las XXIV Jornadas Nacionales de Socidrogalcohol.
Alicante. Marzo, 1997.
(69) Díaz, R. y Gual, A. Evaluation of psychoeducational sessions for children of alcoholics from the ALFIL Program in Spain. 1st European Workshop on Families of People with Alcohol or Mental Health Problems.
Bjärsjölagard’s Castle. Sweden. August, 2001.
(70) Díaz, R. Hijos de alcohólicos: ¿debemos intervenir?. La experiencia del Programa ALFIL. XXVI Jornadas Nacionales de Socidrogalcohol.
Sta. Cruz de Tenerife. Marzo, 1999. (Resumen en la revista Adicciones, 1999, 11, Supl.1, pp. 14).
(71) Díaz, R., y Gual, A. ALFIL program: a multicomunity study of children of alcoholics in Spain: Effects of familial density of alcoholism on cognitive measures. Póster en el VII Congress of the European Society for Biomedical Research on Alcoholism (ESBRA). Barcelona. Junio, 1999. (Resumen publicado en Alcohol and Alcoholism, 1999, 34(3), 445).
(72) Kumpfer, K.L. Outcome measures of interventions in the study of children of substance abusing parents. Pediatrics, 1999, 103 (5), 1128-1144.
(73) Socidrogalcohol. ¿Alcohol en la familia?. Folleto de autoayuda para familias con problemas de alcohol. Anagrafic, S.A., 2001
(74) Wiers, R.W., Gunning, W.B., Sergeant, J.A. Do young children of alcoholics hold more positive or negative alcohol-related expectancies than
controls?. Alcoholism: Clinical and Experimental Research, 1998, 22 (8), 1855-1864.
