Treating Adult Children of Alcoholics. A Behavioral Approach

281 Pages·2000·2.66 MB·English

by  Douglas H. Ruben

FOREWORD
There is an obvious reason why mental health practitioners are
fascinated with Adult Children of Alcoholics (ACOAs). Trained
clinicians are compassionate; they are naturally and emotionally
sensitive to traumatically troubled patients~patients who strug-
gle to rebuild their lives. Abused and neglected patients suffering
a plethora of psychopathololgy since childhood agonize in pain.
Their elevated anxiety for cures compel caring practitioners to act
swiftly and efficiently. They seek treatment for debilitating symp-
toms before those symptoms cause irreversible emotional damage.
Treating chronically pathologic patients also is highly reward-
ing for clinicians. Reducing symptom severity is invigorating and
typically, adds to therapist credibility. Pleasure from observing pre-
treatment to post-treatment changes derives from knowing one
has reached a higher caliber of competency in solving challenging
cases. Therapists feel reinforced by hearing laudable remarks from
the healed patient.
Illness severity in Adult Children of Alcoholics may be the rea-
son why so many clinicians are drawn to treat this unusual popu-
lation. Professional fascination sparks almost an occult attraction
to ACOAs, witnessed by the prolific market of self-help books,
audiotapes, seminars, and even magazines dedicated to recovering
ACOAs. Topics range from understanding categories of ACOAs
xii Treating Adult Children of Alcoholics: A Behavioral Approach
(scapegoat, mediator, etc.) to accelerated self-interventions for
overcoming dysfunctional behaviors. Remedies abound for chang-
ing personality defects, employing either watered-down versions
of cognitive-behavior therapy, or adaptations of Eastern philoso-
phy. The infinite litany of methodologies~some tested, others
extremely theoreticalmprovide genuine hope for cerebrally astute
readers who believe the methods they read are empirically sound.
For example, an article appeared in Changes magazine several
years ago attesting to the validity of Shamanic therapy in reducing
intrafamily discord. Healing ceremonies for "soul retrieval" sup-
posedly empowered recipients to channel their inner spiritual
resources to recover from devastating wounds. This ancient rem-
edy, using "journeying," safely transitioned a distressed person
through passages of pain to relaxed karma, gaining ethereal expe-
riences along the enlightening path until reaching renewal of soul
and, consequently more rational, functional coping skills. Altered
states of consciousness accompanied this cleansing process
through a meditative phase and back to reality. The whole process
boasted miraculous results in escaping depression and binding
loose ends of family trauma.
Empirically minded clinicians find meditation a tenable modal-
ity for anxiety reduction and relief of depression. Certainly, medi-
tation, relaxation, doubles for ACOAs as moments of emotional
"decompression." They can take refuge in de-escalating tension
and achieving sensory equilibrium. Scientific logic, in other
words, lends credibility to employing meditation in any cognitive-
altering technique.
So, why do we have to spoil the science by calling the method
"soul retrieval? .... Meditation" is perfectly acceptable without
reifying its positive effects with supernatural-like descriptions.
Calling the procedure "Shamanism" dilutes the empirical purity
and conjures a mysterious belief that magical healing powers
occur through unknown properties, a spiritual quick-fix that sur-
passes traditional therapy. Testimonials of soul-retrieval survivors
assure that the journeying is completely harmless and trans-
Foreword xiii
formed them from chronic worriers to a celebrated believer.
Shamanistic promises are persuasive and extremely enticing to the
vulnerable.
That's why they are effective~not because they are scientific.
Sadly, no personified spiritual journey, no matter how galactic the
travel, will erase childhood dysfunctions of ACOAs because the
structure of ACOA behavior is too intricately rooted in both individ-
ual history and current life. Another name for "structure" is contin-
gencies. Contingencies represent one or many functional relation-
ships between the patient's behavior and countless consequences
amassed over the patient's lifespan. In childhood, for example,
simple contingencies are formed in reflexive reactions to sensory
stimuli, such as the Babinski response, in which an infant's toes
fanning out or big toe flexing when the foot is gently stroked from
heel to toe, or, the Palmar Grasp, where babies grasp objects when
a rod or adult fingers press against the infant's palms.
Biological reflex (respondent) contingencies may remain or
vanish but are simple to understand. As neonates grow and
encounter verbal and nonverbal experiences, reflexes comprise a
minuscule fraction of their total contingencies. Children equally
respond to speech and tonal patterns, facial and gestural reactions,
and develop visual sequence learning, whereby they act one way
or another way depending on adult behaviors. A child observing
his parent rush upstairs yelling loudly responds differently than an
infant who sees a parent gently smile and walk slowly. These event
sequences constitute the overall picture or "field" within which
infants are rapid learners. Infants learn and change behaviors dis-
criminately to minimize adversity and maximize gratification.
The logical reasoning is quite simple. Human beings avoid pain
and seek satisfaction. oT this extent, a female child terrified by
parents who explosively shout vulgarities and lash out at her for
no apparent reason learns to remain quiet, passive, and shy.
Inhibitory responses may progress from being bashful and with-
drawn in childhood to being isolative and docile in adolescence.
That same shy child in adulthood may be unassertive,
xiv Treating Adult Children of Alcoholics: A Behavioral hcaorppA
passive-dependent, anxious, and avoid any semblance of conflict,
leading to her marrying a viciously controlling and domineering
spouse who dictates her every move and obviates the need for
decision making. Insulated and protected from adversity, she
becomes an emotional hostage to her complacency and history of
interpersonal deficits. In other words, contingencies of aversive
conditioning originate in childhood and evolve unchanged
throughout life. The child passes from young to old, suffering
episodes of anxiety and depression without a clue of what went
wrong.
Now consider the obverse. A male infant affectionately nur-
tured and adored learns at the outset to speak freely, be creative,
and autonomously explore new horizons. He asks questions, dis-
agrees and even mildly debates with adult authorities. Stimulated
curiosity feeds his passion for seeking personal challenges and
information. In teenage years, his reinforced experiences build
confidence to assume leadership roles and he embarks on coura-
geous undertakings either in school or in extracurricular activi-
ties. Positive thinking and self-assurance carry into adulthood
because he knows that success is attainable. He treats failure as
normal and builds upon failure with growth opportunities. He
marries an intellectually and emotionally compatible partner with
whom communication is spontaneous and common place. As a
parent, his lessons of self-achievement trickle down to his off-
spring, who carry the message to new generations.
Is this too idealistic? Do happy-go-lucky, achievement-oriented
people really exist? They sure do. It all depends on the contin-
gencies. John .B Watson's controversial claim in 1930 that any-
body can be shaped by proper or improper conditioning is still
true today. ACOAs are not genetic mutations engineered by a cruel
conspiracy of alcoholic parents determined to ruin the lives of
their offspring. Instead, ACOAs, develop and cease maladaptive
behaviors by activities reinforced or punished along a learning
system. A young child~boy or girl, rich or poor, smart or dumb~
Foreword XV
who suffers adversity and deprivation predictably forms a defec-
tive personality symptomatic of ACOAs. Place that same child in
reinforcing environments enriched with opportunities and symp-
toms of ACOA never appear. The difference is that simple.
Life may hold surprises, but behavior is not one of them. ACOA
behavior does not operate in a vacuum. It grows with a predictable
trajectory easily traceable by examining its "field" or system of
movement. Consequently, viewing ACOA behaviors from a system
or field learning perspective accomplishes two goals. First, it pre-
serves the integrity of studying a phenomenon in scientific terms.
Analyses derive from established principles of conditioning
already tested in applied and experimental settings. Opinions that
emerge are not reified concepts or abstract, supernatural beliefs
without foundation. Instead, they are theories, carefully synthe-
sized from assessing variables found in research and logical exten-
sions of known behavioral etiology. The ACOA syndrome, in
other words, undergoes systematic operationalism.
A second purpose of a learning perspective in this book is to
erase the very powerful sentiment traditionally attached to the
ACOA syndrome. Like Shamanism, yoga, and homeopathic reme-
dies, rapid solutions that promise swift recovery from emotional
problems are delusional and damaging. They exaggerate the result
potential by pompously glorifying self-healing and pretending the
methods are fresh and unique. Sadly, personified methods are
really recycled versions of behavioral interventions published and
widely used since the early 1960s. The mentality of impulse-pur-
chase cures superimposed on gullible buyers will not advance the
research of ACOA or benefit thousands of painful and lonely vic-
tims. Misbeliefs about change may do the opposite; progress may
revert to ancient superstitions viewing mental illness as an evil
and irrevocable blemish on a personality.
This book does not offer hyperbolic promises of recovery. It is
for college students and practitioners dedicated to treating ACOA
survivors with dignity. Etiology and methodology throughout the
xvi Treating Adult Children of :scilohoclA A laroivaheB Approach
book attempt to offer concrete guidelines, describing why patients
behave the way they do. Patient motivation always is strong when
seemingly inextricable problems present clear explanations and
solutions. Part I on assessment of ACOAs conceptually lays out
fundamental tenets underlying the systems paradigm. "Personal-
ity types," defined behaviorally, simplify the integrative contin-
gencies and response patterns longitudinally developed over the
sIAOCA lifetime. Chapter 5 is particularly valuable for clinicians
since it addresses non-ACOA spouse reaction in marriages and
problems expected in conjoint therapy.
Part II on treatment methodology translates many current cog-
nitive-behavioral techniques into ACOA-reversal procedures.
Strategies literally supply skill prerequisites for ACOAs that were
absent during their childhood. Like vitamin supplements, imple-
mented skills remove the void in coping repertoires and build
stronger, more enduring behaviors. Chapter 9, reminds therapists
there are familial side-effects of patient recovery. A healthy patient
does not mean the family wants the patient healthy or is receptive
to being changed by the patient.
Readers are welcome to refine and advance ACOA interven-
tions as their own experience creatively dictates. Students, espe-
cially, will have the acumen to look at procedural flaws of the
ACOA behavioral approach, and declare what this author declared
when reading similar books during his own graduate study: That's
nice, but I can do better.
So, go for it.
1
CHAPTER
What is an Adult Child
of an Alcoholic (ACOA)?
The millennium marks a period of incredible scientific break-
throughs in the field of psychology~from Wundtian and Gestalt
labs, the dynamics of psychoanalysis, to the neurobiological basis
for memory. Innovations matured psychology from its infancy to
middle adulthood. Conceptually, every orientation in psychology
underwent metamorphic revolutions. Particularly in behaviorism,
innovative investigations in experimental research opened path-
ways to multiple branches of applied sciences. Behavioral para-
digms evolved from pre-Watsonian and Skinnerian models to inter-
disciplinary and politically correct models such as cognitive-
behavior modification, behavioral medicine and social learning
theory (Plaud & Eifert, 1998; Schlinger & Poling, 1998). Advanced
thinking sparked a torrent of remarkably creative and aspiring
4 Treating Adult Children of Alcoholics: A Behavioral Approach
analyses to describe the workings of human and infrahuman be-
havior (Fishman, 1999; Follette, 1998; Lipke, 1999; O'Donahue &
Kitchener, 1999; Uttal, 1998).
This explosion of scientific analyses contributed valuable
knowledge in a variety of ways. It debunked many reified concepts
or myths plaguing behavioral phenomena~for example, that
child misbehavior is not genetic or that origins of violence are not
racially or ethnically predetermined. Mental mysteries embodying
the human condition were unraveled as explorations covered
uncharted topics in behavioral sciences. Many examples figure
prominently in clinical areas. Guilt, for example, previously a reli-
gious topic, received a behavioral reinterpretation through exam-
ination of its unusual compound contingencies (e.g., Ruben,
1993a). Domestic violence, previously a sociologic problem,
underwent a thorough behavioral autopsy that shattered myths
about gender differences and punctuated the reciprocity of partner
abuse (Barbour, Eckhardt, Davison & Kassinove, 1998; Cherek &
Dougherty, 1997; Jacobson & Gottman, 1998; Yuksel, Kora, Ben-
zci-Ozkan, Karali, Gok & Tunali, 1999).
Similarly, reformulations of behavioral analysis inspired vision-
ary perspectives in child abuse and neglect (Peterson, Gable,
Doyle & Ewigman, 1997; Vogeltanz & Drabman, 1995), HIV-
related anxiety and coping (Heffner, Lejuez & Freeman, 1999;
Sikkema & Kelly, 1996), self-awareness (Dymond & Barnes,
1997), sexual offenses (Marshall, Fernandez, Hudson & Ward,
1998; Nezu, Nezu & Dudek, 1998), over-medication among the
elderly (Mansdorf, Calapai, Caselli & Burstein, 1999; Ruben,
1984b, 1990) and youth violence (Macciomei & Ruben, 1999;
Ollendick, 1996).
Expanding behavioral analysis to interdisciplinary problems
(cf. Morris, 1997, Kunkel, 1997; Ruben 1984a) produced another
advantage. It signaled that behavioral psychology was not an
hypothesis anchored in abstract thinking, offering techniques of
"behavior modification." Rather, proponents were clever engi-
What is an Adult Child of an Alcoholic (ACOA)? 5
neers of science who formulated laboratory-tested methods and
derived universal principles and laws governing how human
behavior responds to its environment (Chorpita, 1997; Eifert,
Forsyth, Zvolensky, & Lejuez, 1999; Mechner, Hyten, Field &
Madden, 1997).
This book explores still another mysterious domain of human
behavior. For decades, addiction researchers loyal to the disease
model, and sociologists loyal to family-systems thinking, trampled
through the morass of problems in children raised by chemically
dependent parents. Polydrug-using mothers, fathers, grandpar-
ents, uncles, aunts, or whoever provided principal care for the
child, displayed polymorbidity that showed up later in the off-
spring. Intergenerational transfers of behavior provided obvious
cues that behaviors observed among parents might influence the
child's development; in turn, early exposure nearly guaranteed
drinking and drug-using patterns when the child became an adult.
Detailed longitudinal studies further hypothesized that adult off-
spring of addicted parents not only drank but also exhibited pecu-
liar and habitual patterns unmatched in nonaddiction family pop-
ulations (Chassin, Pitts, DeLucia & Todd, 1999; Hans, 1999;
Hunt, 1997; Jennison & Johnson, 1998).
Family addiction researchers amassed several reasons for the
genesis of these behavior patterns, later disseminated in both
scholarly and lay press (see Ackerman, 1983). Certainty that pre-
natal and postnatal exposure to alcohol, either biologically or
socioculturally, increased risk of pathology helped to explain
causes of childhood disorders such as Attentional Deficit and
Hyperactivity Disorders (ADHD) and related cognitive pathology
(Ruben, 1993a; McGrath, Watson, & Chassin, 1999; Molina, Pel-
ham & Lang, 1997), antisocial behavior (Kuperman, Schlosser,
Lidral & Reich, 1999; Nurco, Blatchley, Hanlon & O'Grady, 1999),
inhibition and shyness (Hill, Lowers, Locke, Snidman, & Kagan,
1999), and violence (Malpique, Barrias, Morais, Salgado, Pinto da
Costa, Rodriques, 1998).
6 Treating Adult Children of Alcoholics: A Behavioral Approach
Since second-generation offspring manifested unique patholo-
gies in childhood lasting into adulthood, researchers conceived
the generic term Adult Children of Alcoholics (ACOA) to cover
adults suffering post-family effects of alcoholism.
But, really, what is an Adult Child of an Alcoholic? And are the
behavioral phenomena displayed in adult survivors entirely due to
parents who drink or use drugs? That is a quandary. What if
parental drinking or drug abuse never occurred? Might the same
childhood and adult behavioral anomalies result? Questions like
these pose unusual complications for sociologic and traditional
psychological researchers because their investigative approaches
may lack measurable acuity to arrive at specific conclusions.
Research methods employing longitudinal or field study suffer
three shortcomings. First, research is holistic. It combines many
subtle variables into aggregate variables and projects a hypotheti-
cal path of these variables. "Alcoholism," for example, is a bun-
dled conceptual term encompassing a myriad of emotional, cog-
nitive, behavioral, and sociocultural contingencies~all predicted
to move in the same direction. In other words, progressive stages
of alcoholism include vague and abstract changes in personality
expected to worsen.
Second, the focus of research is on the effects of unilateral, not
bilateral, parental drinking or violence on offspring and assumes
a descending influence from parents' behavior to children's behav-
ior. The unilateral trajectory grossly overlooks interactions unique
to the offspring's life that defuse or aggravate acquired traits. Fos-
ter children removed from their biological addicted family and
placed in functional households, for example, may be spared from
maladaptive symptoms. Rehabilitative settings like some foster
homes or treatment centers may reverse disabling problems and
supply a corrective pathway for healthy childhood.
Third, research is exclusionary. It focuses primarily on organic
explanations such as inheritability, or on family transmission the-
ories that postulate one dysfunctional system automatically will