Adult Children of Alcoholics: Healing Lifelong Scars

Tips for Psychiatrists Treating ACOAs

Both experts suggested several approaches psychiatrists should use when treating an ACOA. Ask about parental alcoholism when taking a patient’s history. “Parental alcoholism should be ruled out in every person who walks through the door,” Dr Brown emphasized.

Because some patients do not recognize that they had alcoholic parents, “questions should be more than perfunctory. Do not ask, ‘Were your parents alcoholic?’ Instead, ask about childhood experiences. ‘Did your parents ever drink? Was it a regular feature of your childhood experience? What did they do after work?’ “

Inquire about specific scenarios. “Ask about a typical family dinner. The patient may say, ‘I remember sitting around the dinner table on Sundays with all that drinking and yelling.’ Ask about holidays, where alcohol often plays a prominent role. ‘One Thanksgiving, my father threw the turkey down the dining room table.’ “

Even if the patient does not immediately remember events or patterns, these questions can initiate a thought process that might lead to future recognition and discussion.

Address acute and chronic trauma. “Acute trauma is a punctuating event, such as when one parent threatened the other with a knife. Chronic trauma encompasses the day-to-day rituals that hold alcohol as the central organizing principle of life, so pervasive that its use and behaviors become normalized in the child’s mind.”

Make appropriate referrals. Support groups can be transformative and healing for ACOAs. Although 12-step programs are highly effective, other models can also be helpful, Dr Brown said.

Patients might find helpful resources from organizations such as Adult Children of Alcoholics World Service Organization ( and the National Association for Children of Alcoholics (

Ms Cavanaugh encouraged multidisciplinary collaboration between psychiatrists and other mental health professionals. “Individual therapy with a professional trained in ACOA issues can be very useful.”

Create a welcoming, nonjudgmental environment. Ms Cavanaugh noted that many children blame themselves for their parents’ behavior and drinking. “Children often feel it is their fault that their parents drink, or that they were unable to stop a particular parental behavior. They may feel that they provoked a parent’s wrath and caused a sibling to be punished, for example.”

Psychiatrists “should be sensitive to the patient’s fear of being judged and having their symptoms pathologized, which can be interpreted as placing blame on them.”

Working with ACOAs can be challenging but rewarding. “I have many clients who have thrived as they made connections between their current behavior and their past, received group support, and worked through trauma,” Ms Cavanaugh reported.

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  1. National Association of Children of Alcoholics (NACOA). Children of alcoholics: important facts. Available at: Accessed: May 15, 2017.
  2. Kelley ML, Pearson MR, Trinh S, Klostermann K, Krakowski K. Maternal and paternal alcoholism and depressive mood in college students: parental relationships as mediators of ACOA-depressive mood link. Addict Behav. 2011;36(7):700-706. doi: 10.1016/j.jbmt.2015.02.003
  3. Klostermann K, Chen R, Kelley ML, Schroeder VM, Braitman AL, Mignone T. Coping behavior and depressive symptoms in adult children of alcoholics. Subst Use Misuse. 2011;46(9):1162-1168. doi: 10.3109/10826080903452546
  4. Kelley ML, Linden AN, Milletich RJ, Lau-Barraco C, Kurtz ED, D’Lima GM, Bodkins JA, Sheehan BE. Self and partner alcohol-related problems among ACOAs and non-ACOAs: associations with depressive symptoms and motivations for alcohol use. Addict Behav. 2014;39(1):211-218. doi: 10.1016/j.addbeh.2013.08.037
  5. Hinrichs J, Defife J, Westen D. Personality subtypes in adolescent and adult children of alcoholics: a two-part study. J Nerv Ment Dis. 2011;199(7):487-498. doi: 10.1097/NMD.0b013e3182214268
  6. Zilberman ML, Blume SB. Domestic violence, alcohol and substance abuse. Rev Bras Psiquiatr. 2005;27(suppl II):S51-S55. doi: S1516-44462005000600004
  7. Durose MR, Harlow CW, Langan PA, et al. Family violence statistics. Washington, DC: U.S. Department of Justice, Office of Justice Programs; 2005. Available at: Accessed: May 23, 2017.
  8. Brown S. Adult children of alcoholics. The history of a social movement and its impact on clinical theory and practice. Recent Dev Alcohol. 1991;9:267-85.
  9. Christensen E. Families in distress, the development of children growing up with alcohol and violence. Arctic Med Res. 1995;54 Suppl 1:53-9.
  10. Sjoerds Z, Van Tol MJ, Van den Brink W, Van der Wee NJ, Van Buchem MA, Aleman A, Penninx BW, Veltman DJ. Family history of alcohol dependence and gray matter abnormalities in non-alcoholic adults. World J Biol Psychiatry. 2013;14(8):565-573. doi: 10.3109/15622975.2011.640942
  11. Kelley ML, Nair V, Rawlings T, Cash TF, Steer K, Fals-Stewart W. Retrospective reports of parenting received in their families of origin: relationships to adult attachment in adult children of alcoholics. Addict Behav. 2005;30(8):1479-1495. doi: 10.1016/j.addbeh.2005.03.005
  12. Haverfield MC, Theiss JA. Parent’s alcoholism severity and family topic avoidance about alcohol as predictors of perceived stigma among adult children of alcoholics: Implications for emotional and psychological resilience. Health Commun. 2016;31(5):606-616. doi: 10.1080/10410236.2014.981665