The Transgenerational Course of Addictive Behavior: Children of Alcoholics

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1 1 Poster presented at the ãseventh International Conference on Treatment of Addictive Behaviorsã May 28 - June 1, Leeuwenhorst Center, the Netherlands. The Transgenerational Course of Addictive Behavior: Children of Alcoholics Martin Zobel Fachklinik Thommener Hšhe Fachklinik Altburg Darscheid/Schalkenmehren Germany Michael Klein Katholische Fachhochschule NRW Kšln/Germany Purpose of the study Our explorative study focuses on the transgenerational effects of addictive behavior (esp. alcoholism and drug dependence). The aim of this empirical investigation was to find out whether or not there are recurring transgenerational and crossgenerational patterns of addictive behavior. Several studies in the past have shown children of alcoholics (COAs) to be the most outstanding risk group for addictive development (e.g. COTTON 1979; GOODWIN 1976). Alcoholics, in general, have more alcohol dependent relatives than non-alcoholics. The research to be presented in the following, concentrates on three questions: 1. How many adult patients (also divided according to gender and age) of an inpatient alcoholism treatment center are COAs? 2. How prevalent is alcoholism and alcohol abuse in first and second degree relatives of these adult COAs and NonCOAs? 3. What are the distinctive differences between adult COAs and NonCOAs concerning etiology of alcoholism, personality and delinquence? Sample The data were collected at the ÔFachklinik Thommener HšheÕ, Darscheid near Trier, Germany, between 1990 and The Fachklinik is an inpatient treatment facility for the long term treatment of alcoholism (averange: 4 months) of 160 alcohol dependent patients (67% men; 33% women). All patients were asked during the second week of treatment to give information about their familial and sociodemographic background. They were also requested to fill out the short version of the MMPI (221 items) as a questionaire of personality and psychopathology.

2 2 Results Of the 2248 patients treated in the clinic during the time period mentioned 358 (15,9%) had one parent suffering from alcoholism (FH+), wheras 50 (2,2%) reported both parents to be addicted to alcohol (FH++). The rest reported no familial history of alcoholism. 400 patients with a familial history of alcoholism (64% men and 36% women) were matched according to age and gender to 400 patients without a familial history of alcoholism (NonCOA- sample). The mean age of both groups was 38.5 years. The COAs had 9 years of education (NonCOAs 9.5 years) and 2.4 years of vocational training (NonCOAs 3 years). The average net income for both groups lay between DM 2000 and 2500 per month. Figure 1 shows the prevalence rates of alcohol abuse according to kinship degrees (e.g. grandparents, uncles/aunts, cousins etc.). Figure 1. Alcohol abuse in the family. 35 Percent COA's noncoa's grandf. grandm. uncle aunt cous.(m) cous.(f) ne./niece COA's 18,6 5,3 33,8 13,6 10,6 5 4,5 noncoa's 5,8 0,8 10,8 4,3 4,5 1,5 1 Note: COAs: n = 397; NonCOAs: n = 398 p <.01 At the beginning of the study patients were asked about the alcohol dependence of their siblings and about the alcohol abuse among their relatives. Results show a clear pattern: Adult COAs have twice as many alcohol dependent siblings and up to 5 times more alcohol abuse among their relatives than NonCOAs. Thus COAs come from families with more tendencies to alcohol abuse (esp. male). In our COA sample 18.6% had alcohol abusing grandfathers and 33.8% alcohol abusing uncles.

3 3 An important question is how many siblings of a family with one or two alcoholic dependent parents are also inclined to abuse psychotropic substances (esp. alcohol). According to figure 2 there are at least twice as many addicted siblings per COA than per NonCOA. In general the COAs of our sample do not have more siblings than the NonCOAs. Figure 2. Addicted siblings. 20 Percent COAs NonCOAs one two more than two COAs 19,8 6,9 2,8 NonCOAs 10,6 1,5 0,6 Note: COAs: n = 318; NonCOAs n = 331, p <.01 Futhermore we analyzed patients belonging to families with only two children in order to find out if both children were prone to addiction. The results show that in 17.4% of all cases of COAs both children became addicted to alcohol or other psychotropic substances, whereas only 5.5% of all cases of NonCOAs showed this pattern. It may also be assumed that the conditions under which COAs and NonCOAs grew up were not similar and thus led to different psychological development. This can best be seen when considering the subgroup of the COA sample where the parents were either divorced or seperated before the child was 18 years old (23.7%, n = 93). The comparative figure for the NonCOA sample is 6.1% (n = 24). When we take both groups together we get an average of 14.9% for the total sample of 800 patients. In addition, 8.1% of the COAs reported that they had been brought up mainly by their grandparents (resp. 3.8% of the Non-COAs) and 4.6% had been raised in homes (resp. 0.8% of the Non-COAs).

4 4 With regard to the age-of-onset-variables, adult COAs show a significantly earlier onset of all variables (cf. figure 3.): age of first drink, age of first full drunkenness, age of starting alcohol abuse and age of starting periodical drinking. COAs report an earlier age for their first alcoholic drink (14.5 years compared to 15.7 years for NonCOAs), they were on average younger the first time they were drunk (18.0 years opposed to 19.3 years), they were younger too when starting alcohol abuse (20.8 years opposed to 24.6 years), and they started periodical drinking at an earlier age (22.1 years compared to 24.8 years). All comparisons of averages show significant t-scores. The only variable which does not show a significant average age difference is that of first seeking professional help (33.5 years compared to 34.5 years.) Figure 3. Age of onset. 40 age COAs NonCOAs first drink** first drunk** abuse** frequ. intox. **first med. help COAs 14, ,8 22,1 33,5 NonCOAs 15,7 19,3 24,6 24,8 34,5 Note: COAs: n = 374; NonCOAs: n = 354, ** p <.01 COAs and NonCOAs do not differ as regards their criminal register and current criminal proceedings. They have a higher quota, however, on the question of ever having been jailed. On the other hand there is no difference between the two groups regarding the average duration of inprisonment.

5 5 Looking at the personality variables, COAs show significantly more psychopathology (on all scales of the MMPI 1 except MF) when being tested at the beginning of their treatment (cf. figure 4). Figure 4. MMPI-scores COAs/NonCOAs. 70 T - score COAs NonCOAs HS* D* HY** MF PD** PA** PT** SC** MA** SI** COAs 59,2 64,1 64,8 53,6 62,7 58,4 62,7 60,8 57,5 59,6 NonCOAs 56,6 60,9 61,5 53,4 59,3 56,2 59,5 56,8 54,8 57,8 Note: COAs: n = 346, NonCOAs: n = 341, ** p <.01 * p <.05. These pre-therapy differences were still larger when differentiating between persons with single (FH+) and double (FH++) history of familial alcoholism. While showing similiar patterns for the MMPI-T-scores of all three groups the FH++ group, where both parents had been alcohol dependent, reaches an extreme peak on almost all MMPI-T-scores, esp. D, HY, and PT (cf. figure 5). The differences between COAs and NonCOAs are balanced at the end of inpatient treatment except for the MMPI scales D, MF and PD. While COAs have higher T-scores in these areas, the remaining scales of the MMPI indicate a fairly good compensation of the negative familial pre-history. 1 Hypochondry (HS), Depression (D), Hysteria (HY), Masculine-feminine interest (MF), Psychopathy (PD), Paranoia (PA), Psychastenia (PT), Schizoidia (SC), Hypomania (MA), Social introversion/extraversion (SI).

6 6 Figure 5. MMPI-scores FH++/FH+/FH-. 70 T - score FH++ FH+ FH HS** D** HY** MF PD** PA** PT** SC** MA** SI** FH++ 62,6 67,4 68,3 55,7 64,4 60,8 67,2 64, ,2 FH+ 58,7 63,6 64,3 53,3 62,5 58, ,2 57,5 59,1 FH- 56,6 60,9 61,5 53,4 59,3 56,2 59,6 56,8 54,8 57,8 Note 1: ** p <.01 * p <.05 Note 2: FH++: 2 addicted parents (n = 44); FH+: 1 addicted parent (n = 302); FH-: n = 341. Finally figure 6 shows the MMPI-T-scores for alcohol dependent and drug dependent COAs. The drug addicts were treated at the ÔFachklinik Altburg/SchalkenmehrenÕ. Both groups have elevated scores for almost all scales, indicating a rather strained personality pattern. Drug dependent COAs even have significantly higher T-scores for PD and MA.

7 7 Figure 6. MMPI- scores of COAs addicted to alcohol and COAs addicted to drugs. 70 T - score COAs alcohol COAs drugs HS D HY MF PD** PA PT SC MA** SI COAs alcohol 59,2 64,1 64,8 53,6 62,7 58,4 62,7 60,8 57,5 59,6 COAs drugs 57,9 66,8 65,9 53,1 67,4 61,9 62,1 65,4 64,2 57,2 Note: COAs addicted to alcohol: n = 346; COAs addicted to drugs n = 29 Discussion Our study shows, just like the mainstream of previous research (FRANCES et al. 1980; McKENNA & PICKENS 1981, 1983; SHER 1991), that there are many consistent differences between COAs and NonCOAs. COAs appear to be a distinct subgroup among alcoholics with regard to etiology, family history, personality and psychopathology. The fact that there are clearly more alcohol dependant relativs among the kinship of COAs suggests that in the childhood and adolescence of todays alcohol addicted persons there must have been several distinctive features with etiologic relevance. While the question of biological predisposition for alcohol addiction, especially for men (CLONINGER et al. 1981; GOODWIN et al. 1973; SEARLES 1988, 1990), has been discused extensivly in recent years, the possible influence of kinship networks has been rather neglected. Some worthy approches for this, however, have been introduced by the recent research on nonshared-environments (HETHERINGTON et al. 1994). To interrupt the transmission of alcoholism and other addictive deseases is the crux for effective changes in the transgenerational course of addictive behavior. Efforts to change the course of addictive behavior should be made in the fields of prevention and treatment with special regard to familial addictive disorders. Such attemps have been made at the ÔFachklinik Thommener HšheÕ by inviting the spouses and children of the patients as well as other relatives to certain parts of the inpatient treatment.

8 8 During weekends, for example, there are special offers of family therapy also seen as early intervention and primary prevention for the children of treated alcoholics. Finally, the question can be raised whether the distinctive differences between COAs and NonCOAs in general warrants an open stigmatisation of these people, even in early childhood (e.g.in school) as a way of primary prevention. It seems to be possible that public identification procedures for a risk group like the COAs would even increase feelings of loneliness, shame and guilt, and thus worsen their psychological development. It seems rather appropriate to consider COAs as an example of people growing up in dysfunctional families and networks. On the other hand, counselors and therapists should know what experiences they go through and what consequences the fact of growing up in a family with alcohol addicted members can have for children and adolescents in order to optimise treatment for them. This ist especially important regarding the early onset of behavioral and addictive problems for many COAs. Finally we would like to stress that more salutogenetic research has to be made in order to find out more about the protective factors and pathways for COAs to become normal and healthy people. Literature Cloninger, C.R., Bohman, M., & Sigvardsson, S. (1981). Inheritance of alcohol abuse: Cross-fostering alalysis of adopted men. Archives of General Psychiatry, 38, Cotton, N. (1979). The familial incidence of alcoholism: A review. Journal of Studies on Alcohol, 40, Frances, R.J., Timm, S. & Bucky, S. (1980). Studies of familial and nonfamilial alcoholism. Archives of General Psychiatry, 37, Goodwin, D., (1976). Is alcoholism hereditary?. New York: Oxford University Press. Hetherington, E.M., Reiss, D. & Plomin, R. (eds.) (1994). Seperate social worlds of siblings. The impact on nonshared environment on development. Hillsdale (N.J.) : Lawrence Erlbaum Associates. McKenna, T. & Pickens, R. (1981). Alcoholic children of alcoholics. Journal of Studies on Alcohol, 42, McKenna, T. & Pickens, R. (1983). Personality characteristics of alcoholic children of alcoholics. Journal of Studies on Alcohol, 44, Searles, J.S., (1988). The role of genetics in the pathogenesis of alcoholism. Journal of Abnormal Psychology, 97, Searles, J.S., (1990). Behavior genetic research and risk for alcoholism among children of alcoholics. In M. Windle & J.S. Searles (eds.). Children of alcoholics - critical perspectives. New York: The Guilford Press Sher, K.J. (1991). Children of alcoholics - A critical appraisal of theory and research. Chicago: University of Chicago Press. Name and address of the authors Dipl.-Psych. Martin Zobel Fachklinik Thommener Hšhe Prof. Dr. Michael Klein Katholische Fachhochschule NRW

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