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DATE DUE DATE DUE DATE DUE MSU I: An Alfirmdlve Action/Equal Opportunity Intuition ammo-m PSYCHOSOCIAL OUTCOMES AMONG UNIVERSITY STUDENT OFFSPRING OF ALCOHOL ABUSING FATHERS By Robert Moreas A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Family and Child Ecology 1990 ABSTRACT PSYCHOSOCIAL OUTCOMES AMONG UNIVERSITY STUDENT OFFSPRING OF ALCOHOL ABUSING FATHERS By Robert Moreas The negative effects of parental alcoholism on family processes put children of alcoholics (COAs) at risk for intellectual impairment, emotional and interpersonal functioning, and a propensity to alcoholism. The main objective of this study was to examine outcomes of a population of university students operating under the assumption that processes and functioning in families with alcohol abusing fathers would be a risk factor for these offspring. This study compares university student offspring of alcohol abusing fathers with students from families without parental alcohol abuse on variables of self-esteem and quality of health and daily living. The relationship between the students' perceptions of their family environment and the psychosocial outcomes is examined. Data for this study were obtained from students ages 18-23 at a major midwestern university who were assessed by the following self-report measures: Family Environment Scale (FES: Moos, 1986); Children of Alcoholics Screen Test (CAST: Jones, 1982); Tennessee Self-Concept Scale (TSCS: Roid and Fitts, 1988); and the Health and Daily Living Youth Form (HDLY: Moos, Cronkite, Billings, and Finney, 1985). Seventeen male and 24 female COAs and 34 male and 33 female non-COAs completed the survey material. ANOVA was conducted on the variables indicated. The results indicated that the COAs group's perceptions of their families were consistent with results from previous studies using FES descriptors of alcoholic families: lower cohesion, independence, and active-recreation orientation, but higher conflict. Analysis of TSCS subscales revealed no group differences in self-esteem or self-criticism, both variables for which COAs are often cited as being at risk. However, the personality disorder subscale revealed a significant difference between the two groups, identifying the COAs at risk. Therefore, this study lends support to the view that COAs' problems may be manifested with the advent of adult stressors. Other factors found to be of interest were: 1. COAs sibships were functioning at age appropriate levels without chemical dependency problems, and 2. While 68% of the COAs sample reported episodes of family violence during parental drinking, they demonstrated generally positive psychosocial outcomes. Future research should investigate entire sibships, with multivariate models analysis. This dissertation is dedicated to my Mother, a true, great spirit, and Leo, a true friend. ACKNOWLEDGEMENTS I am indebted to several individuals without whose contributions the completion of this project would not have been possible. I thank Dr. Donald Melcer, my committee chairman, who unwaveringly championed for the completion of this dissertation, and introduced me to a different and necessary professional perspective. I am particularly pleased that Thomas Ruhala has been involved in my entire graduate education. He was responsible for my admission to Michigan State University, one of the most valued experiences of my life. Dr. Bertram Stoffelmayr has instilled in me an intellectual rigor and critical stance that, irrespective of my personal deficits, I may always hold as a standard. While Dr. Peter Gladheart was unavailable during the last phase of this research, I appreciate his ongoing support.‘ I am most grateful to Dr. Dennis Keefe who generously contributed his time at the eleventh hour. I would like to thank Dr. John Hudzik and Sharon Ruggles of the University Committee on Research Involving Human Subjects, without whose flexibility and responsiveness the data collection process would have been delayed. 11 I would also like to thank Dr. Martha Bristor, Nancy Lorris, Dr. Peter Vinten-Johansen, Dr. Gretchen Barbatsis, and Sharon Anderson, who provided the opportunity to access students for data collection. The superior typing skills of Camille McDonald and her good natured cooperation regarding pressured deadlines cannot go unmentioned. Finally, I wish to thank my daughter and wife. Sarah demonstrated cooperation and patience beyond her nine years of age, and I am thrilled that she has her Dad back again. Jan has endured many a frustration and detour on our road to my "fulfillment of the requirements for the degree of..." For her patience and support I say a heartfelt thank you. iii TABLE OF CONTENTS Page OVERVIEW OF THE PROBLEM .............................. 1 Need ............................................ A Purpose ......................................... 10 The Research Questions .......................... 11 Theory .......................................... 12 LITERATURE REVIEW .................................... 25 Introduction .................................... 25 Family Process .................................. 30 Steinglass and Associates: The Alcoholic Family ..................................... 32 Moos and Associates: Family Processes and Recovery from Alcoholism ................... HO Psychosocial Outcome Studies .................... A6 Family Process and Outcomes-The Clinical View ... 53 Children of Alcoholics Outcomes-Examining Gender of Parent and Child ................. 58 METHOD/DESIGN ........................................ 62 Sample .......................................... 62 Data Collection ................................. 66 Measures and Instruments ........................ 67 Design .......................................... 73 Research Hypotheses ............................. 73 Analyses ........................................ 77 Summary ......................................... 78 RESULTS .............................................. 79 Introduction .................................... 79 Hypothesized Results ............................ 80 Unhypothesized Results .......................... 128 CONCLUSIONS .......................................... 137 Discussion ...................................... 138 Limitations of This Study ....................... 1A7 Implications for Intervention and Treatment ..... 151 Implications for Research ....................... 15“ REFERENCES ......OOOOOOOOOOCIOOOOO0.000000000000000000 160 APPENDIX - RESEARCH INSTRUMENTS ...................... 168 iv TABLE 1. 2. 9. 10. 11 . 122. 13. 1h. 15. LIST OF TABLES Social Occupational Prestige—Father ............. Social Occupational Prestige-Mother ............. Analysis of Variance for Cohesion (N = 108) ..... Cohesion: Means for Gender, Group, and Gender by Group ......OOOOOOOOOOOOOOOO......OCOOOOOOOOO. Analysis of Variance for Expressiveness (N = 108) Family Expressiveness: Means for Gender, Group, and Gender by Group ...................... Analysis of Variance for Family Conflict (N = 108) eeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee Conflict: Means for Gender, Group, and Gender by Group ......OOOOCOCCCOCCCCC......COCCOOCCOCOOC Analysis of Variance for Independence (N = 108) . Independence: Means for Gender, Group, and Gender by Group ....IOOOOOOOOOOO0.000.000.0000... Analysis of Variance for Achievement Orientation (N = 108) eeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee Achievement Orientation: Means for Gender, Group, and Gender by Group OOOOOOOOOOOOOOOOOOOOOO Analysis of Variance for Intellectual-Cultural (N = 108) Intellectual-Cultural: Means for Gender, Group, and Gender by Group ......OOOOIOIOOOOOOOO. Analysis of Variance for Activity-Recreation (N = 108) Page 6A 65 81 82 83 8A 85 86 88 89 9O 91 92 93 16. 17. 18. 19. 20. 21. 22. 23. 2A. 25. 26. 27. 28. 29. 3C). 31 . 32.. 33. 3A. Activity-Recreation: Means for Gender, Group, and Gender by Group I0............OCOOOCOOOOOOOO. Analysis of Variance for Moral-Religious (N = 108) Moral-Religious: Means for Gender, Group, and Gender by Group O..........OOOOIOOOOO0.00.00...O. Analysis of Variance for Organization (N = 108) . Organization: Means for Gender, Group, and Gender by Group ...-.00.........IOOOOOOOIOOOOO... Analysis of Variance for Control (N : 108) ...... Control: Means for Gender, Group, and Gender by Group O0........IOOOOOIIOOOOOOOOOOOO... Analysis of Variance for Self-Criticism (N = 108) eeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee Self-Criticism: Means for Gender, Group, and Gender by Group 00..........IOOOOOOIOOOOOOOOO Analysis of Variance for Total TSCS Score (N = 108) eeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee Total Self-Concept: Means for Gender, Group, and Gender by Group 0.0.0.000.........OOOOOOOOOO. Analysis of Variance for Family-Self (N = 108) .. Family-Self: Means for Gender, Group, and Gender by Group 0.0.00.0.........OOOOOOOOOIOOOOOO Analysis of Variance for General Maladjustment (N - 108) General Maladjustment: Means for Gender, Group, and Gender by Group 0...........OOOOOOOOOOOOOOOOO Analysis of Variance for Personality Disorder (N = 108) eeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeo Personality Disorder: Means for Gender, Group, and Gender by Group ......IOOOOCOOOOOOOO000...... Analysis of Variance for Neurosis (N = 108) ..... Neurosis: Means for Gender, Group, and Gender by Group I00..................OOOOOOOOOOOOOOOO0.0 vi 9A 95 96 97 98 99 100 101 102 103 10” 105 106 107 108 109 110 111 112 35. Analysis of Variance for Personality Integration ("=108) 00.............00.........OOOOOOOOOOOO. 113 36. Personality Integration: Means for Gender, Group, and Gender by Group ...................... 11A 37. Analysis of Variance for Distressed Mood (”=108) 00................O..........C......... 115 38. Distressed Mood: Means for Gender, Group, and Gender by Group ......COIOOOCO......OOOCOOOOCOOOO 116 39° Ana1Ysis of Variance for Health Risk Behavior (N=108) ....O.............C.................... 117 A0. Health Risk Behavior: Means for Gender, Group, and Gender by Group O.....OOOOOOOOOOOOIOIOOO..... 118 A1. Analysis of Variance for Self-Confidence (N=108) 00..................IOCCOCCCCOOOO...... 119 A2. Self-Confidence: Means for Gender, Group, and Gender by Group 00.0.0.0.........OOIOOOOOOOOOIIOO 120 A3. Analysis of Variance for Activities with Friends (N=108) 0000......00.0.0.0.........OOOOOOOOOOOO 121 AA. Activities with Friends: Means for Gender, Group, and Gender by Group ...................... 122 A5. Analysis of Variance for Number of Friends (":108) ....OOOOOOOOOOOO...IOOOIOOOOOOCOOOOOOO. 123 A6. Number of Friends: Means for Gender, Group, and Gender by Group O.....OOOIOOOOOOOOIOOOOOOOOOO 12)" #7. Analysis of Variance for Grade Point Average (":108) ......OOOOOOOOOOOGOOOIOOOIOOOOOOOOOOOOO 125 453. Grade Point Average: Means for Gender, Group, and Gender by Group 0......OOOOOIOOOOOOOOOOOOOOOO 126 '49. Analysis of Variance for Social Interaction (N =108) ......C.....................C.......0.0 127 SC). Social Interaction: Means for Gender, Group, and Gender by Group 000...........OOOOOOOOOOCOOO. 128 51. Subjects' Description of Fathers' Alcohol Use ... 129 52- Subject Birth Order, Substance Abuse Treatment, Sibs' Substance Abuse Treatment-Female Index SUbjeCts (N32u) 0.0.00.0.........OOOOOOOOOOOOO 133 vii Subject Birth Order, Substance Abuse Treatment, Sibs' Substance Abuse Treatment-Male Index SUbjeCtS(N=17) .....OOIOOOOIOO0.00000000000000 13” Responses to CAST Items 7, 9, and 31A and 31C- Female Index SUbjeCtS (N = 2)") 0.0000000000000000 135 Responses to CAST Items 7, 9, and 31A and 31C- Male Index Subjects (N = 17) ............ ..... ... 136 Subjects' Alcohol Use - Frequency ............... 1A2 Subjects' Alcohol Use - Quantity ........ ..... ... 1A3 viii OVERVIEW OF THE PROBLEM Alcohol promotion, use, and misuse is ubiquitous in our society. It is estimated that 1A.? million Americans are problem drinkers with an annual increase of .A million (Fein, 198A). A 1983 National Institute of Mental Health survey indicated that 13.6% of all adults could be evaluated to be clinically dependent or alcohol abusing at some time in their lives, alcohol abuse or dependence therefore being the most prevalent of emotional disorders (Fein, 198A). The use and misuse of the only legal mood altering substance in our society, alcohol, is well suited for examination from a human ecosystem perspective. Following the model of Bubolz, Eicher, and Sontag (1979), the human ecosystem consists of environments interacting with the human environed unit (HEU), a single individual or group of individuals. The HEU interrelates with three environments: 1. the natural environment (NE) with space-time, physical, and biological components, 2. the human constructed environment (HCE), the production of humans meeting their Physical biological and social needs, and 3. the human behavioral environment (HBE), the arena of biophysical, Psychological, and social behaviors. A key concept of an ecosystem is interaction, "... a relationship of reciprocal influence among a system's components. Interaction in an ecosystem occurs when any part of an ecosystem influences or acts on any other part and is influenced or acted on in return." "Interaction also takes place within the environed unit, among the and between the environed unit and environments, In the process of alcohol environment" (Bubolz, p. 30). abuse, the alcoholic (HEU) interfaces and influences his family (HBE), the community and work place (HCE), and at a macrolevel equivalent to the ecosystem model's natural environment (NB), the Gross National Product. The financial cost to society (NE) due to alcohol misuse is estimated to be $116 billion annually (Nace, Subsumed in that figure is $65 billion in reduced 1987b Additionally, although only 5-10% of employee productivity . alcohol abusers seek treatment or support (Midanik, 1983), the cost of intervention is $1A billion (Nace, 1987). Alcoholism contributes to various medical complications. AlcOhol specific and related medical conditions generate $23 bill ion in health care costs (Fein, 198A). The social costs of alcoholism to the community (HCE) that alcoholism are also high. Mortality figures indicate and alcohol abuse may be the third leading cause of death (Pei-n, 198A). Almost one-half of automobile fatalities are alc301F101 related, half of which include intoxicated alcoholic drivers, the remainder being drivers with high blood alcohol levels at the time of the accident (Nace, 1987). Families (HBE) with alcohol abuse problems experience a AO% divorce rate, and 5.7 million episodes a year of family violence related to alcohol abuse episodes (Fein, 198A). The individual (HEU) who chronically ingests excessive amounts of alcohol suffers systemic medical complications. Nace (1987) provided an extensive overview of the damaging effects of alcohol on the organs of the body. In summary: 1. The liver processes 90% of the hepatoxic alcohol which damages hepatic cells and liver cell regeneration ability. The pathogenesis of alcoholic liver disease begins with fatty liver, proceeds to alcoholic hepatitis, and if alcohol consumption continues, results in cirrhosis, the sixth leading cause of death nationally. 2. The entire gastrointestinal system is adversely affected. Reflex esophagitis, carcinoma of the esophagus, acute hemorrhagic gastritis, and malabsorption of the small intestine result in nutritional deficiencies and accompanying weakness and weight loss. 3. Cardiovascular and hematologic insult are manifested by damaged small intramyocardial arteries resulting in cardiomyopathy, a cause of congestive heart failure. For certain individuals, even moderate alcohol use may contribute to elevated blood pressure. Depressed red blood cell formation, anemia, and impaired clotting mechanisms in turn cause other systemic problems. A. Deleterious effects on the nervous system are manifested by peripheral neuropathy with decreased reflexes, sensory loss, and pain. Autonomic system impairments may include lack of sweating, hypotension, hypothermia, impotence, urinary retention, and incontinence. Organic neurological - cognitive degeneration is irreversible in the Wernicke-Korsakoff syndromes. The deleterious effects of alcohol abuse on the human physiology demonstrates the ecosystems and general systems theory concept of interrelatedness and of subsystem modification affecting the whole system. The individual alcoholic, his or her family, and the individual members, the immediate community, and society at large suffer because of alcoholism. The human ecosystem model and family systems theory are the theoretical perspectives of this study. N331 It is estimated that there are approximately 10 million zfilcoholics in the United States, 73% of them married. Serventy-six percent of problem drinkers are males. In 20% Of' these homes, both spouses are alcoholics (Ackerman, 79636). It has been estimated that there are 6.6 million Cflinldren of alcoholics (COAs) under the age of 18, and 22 million adult children of alcoholics (ACOAs). With a number 0f almost 29 million, the result is that one of eight Americans is a child of an alcoholic (Russell, Henderson, and Blume, 1985). The literature is replete with references regarding age specific and life-long negative effects of parental alcoholism on children. Children born to women who drink during pregnancy (specific harmful levels are not as yet determined) are at risk for an identifiable birth defects cluster known as "fetal alcohol syndrome," which includes growth impairment, mental retardation, facial features anomalies, and major organ or systemic malfunctions (Warner & Rosett, 1975). Wilson and Orford (1978) cited COAs as having a higher incidence of school problems, difficulty concentrating, school truancy and conduct problems, and emotional problems such as anxiety and depression. El-Guebaly and Offord (1977) noted difficulties in personality and peer relationships, low self-esteem, manipulative and rebellious behaviors, hyperactivity and school problems. Baraga (1978) and Woititz (1976) reported Llower self-esteem for COAs. Chafetz, Blane, and Hill (1971) fkaund increased incidences of serious illness, accidents, Sczhool problems, and police and court involvement. Higher leevels of suicide attempts were found among adolescents of al.coholic fathers, while increased lethality of the suicide atitempts was related to heavy parental alcohol consumption arid family dysfunction, including physical abuse (Tishler aundHenry, 1982). Roberts and Brent (1982) reported iIncreased diagnoses of trauma and stress related diseases in alcoholic families including gastrointestinal, endocrine, neurotic and psychological disorders. Barnes (1977) concluded that the child raised by an alcoholic parent has a parent that is a "... grossly inadequate role model for the developing child." The problems of youth and adolescence for COAs continue into adulthood. Wegscheider's (1981) clinical observations indicate that familial behavioral roles that children adopt as coping mechanisms don't serve well in youth and become problematic for the ACOAs. Black (1981) concurs that even ACOAs who are competent are plagued by marital problems, interpersonal difficulties, depression, and a general sense of worthlessness, irrespective of achievement. These adults have developed rigid coping mechanisms in childhood which no longer serve them well. Woititz (1983) identified traits which portray ACOAs as insecure and confused about intimate relationships, social skills, and their abilities in general. An overly self-critical stance is coupled with an :inappropriate need for approval and affirmation. One way ACOAs cope with their feelings of wxarthlessness, anxiety, and lack of a sense of meaning in ‘tlaeir lives is to seek the relief of mood altering Slabstances. This is one mode of intergenerational tPansmission of alcoholism. This is a major legacy to COAs; 1t‘respective of issues of genetic predisposition, asssortative mating, learning models, environment, and interaction of these variables, findings repeatedly indicate that COAs are at greater risk for alcoholism (Cotton, 1979, and Goodwin, 1985). Black (1981) considers 50-60% of alcoholics as having had at least one alcoholic parent to be a low estimate. Russell (1990) indicates that COAs are "consistently found to have higher rates of alcoholism and alcohol-related problems" than non-COA's (p. 32), with the magnitude of the studied group differences reported as ranging from 9:1 to 1.5-3:1 between COAs and non-COA's (p. 33). While it is commonly agreed that COAs are at risk, some researchers feel there has been a failure "... to recognize or give adequate weight to variability in adjustment among COAs" (Clair and Genest, 1987, p. 3A5). While Black (1981) saw the forced adaptive roles and age inappropriate responsibilities of COAS as ultimately a factor in {Droblematic psychosocial outcomes, Wilson and Orford (1978) :Saw parent-child role reversals with COAs assuming household "Management tasks as possibly representing "... an advantage Pzather than a disadvantage of having an alcoholic parent" (I). 132). Kammeier (1971) found minimal differences in ‘aCiolescents on measures of personality and intellectual iflanctioning. ’Other studies indicating minimal differences iraclude Clair and Genest (1987) who found COAs functioning at; normal and above normal levels, and Werner (1986) who in regard to cognitive deficits indicated only some of the children performed less well than controls. However, there .seems to be a consensus regarding methodological problems in (HDAs research such as a lack of suitable control or ccnnparison groups. Jacob and Leonard (1986) point to a lack of‘ sound and consistent assessment procedures, an owrerrepresentation of multiproblem families, and an absence of? psychiatric comparison groups to differentiate parental alcoholism effects from other special familial c i rcumstances . Concomitant to the valid comment by Johnson and Rolf ( 15990) that, "... the emerging findings of psychosocial studies of COAs have yet to present a consistent picture of czcxllective risk and individual vulnerabilities" (p. 162), COAS are at risk for a broad range of psychosocial- developmental outcomes. Williams (1990) states that: A surprising consistency in the description of characteristics of children from alcoholic homes has emerged, suggesting convergent validity from...diverse studies. ... The differences can be summarized as follows. ... COAs experienced more psychosocial deficits than children from nonalcoholic homes. They displayed lower levels of self-esteem, greater impulsivity and hyperactivity, greater external locus of control, more illness, accidents and psychosomatic complaints, and more conduct disorders and academic problems than did children from nonalcoholic homes. Environmental risk factors for these children were also elevated. Alcoholic families were more likely to be disrupted by divorce, separation, absence of parent or removal of child from the home, and greater financial instability. Higher prevalence of sexual and physical abuse, as well as neglect and inadequate parenting, were also reported, and children appeared to develOp fewer support systems to mitigate some of these effects (p. 195). The perspective of this study is that alcoholism and alcohol abuse negatively affect family processes, which in turn contribute to less than optimal developmental environment for children. Moos and Moos (198A) indicated that since "... recovered alcoholics and their spouses were functioning about as well as their matched community counterparts, these findings show that some recovered alcoholics and their partners can attain normal personal and family functioning" (p. 116). Walsh (1985) administered the MMPI to A3 identified patients and codependents before and after a 20-week family treatment program. There were significant differences between pre and post test scores for both patients and codependents in the desired direction, i.e., less disturbance. The changes were on the same scales, in the same direction, and with essentially the same magnitude. These two studies support the view that with the abatement of substance abuse, many, if not all, problems dissipate. Several authors (Clair and Genest, 1987; Kammeier, 1971; Moos and Billings, 1982; and Wilson and Orford, 1978) 10 have also noted that while their studies may at present indicate minimal group differences, COAs subjects may "... as they grow, ... begin to exhibit more notable differences" (Jacob and Leonard, 1986, p. 379). In addition to continued interest in alcoholic family processes, there is expressed interest in the influence of the gender of the alcoholic parent in family processes and COAs outcomes. Wilson and Orford (1978) ask about "the effects of an alcoholic father as opposed to an alcoholic mother ..." (p. 139), and Williams and Klerman (198A) state, "... studies should collect and analyze data separately by the sex of the parent and child" (p. 307). Brown (1988) cites the interest in learning about "... the impact on children if the father is an alcoholic, if the mother is, or both? What are the differences?" (p. 79). Ennnose The purpose of this study is to examine familial variables and individual outcomes in ACOAs and comparison groups to aid in understanding possible outcome differences in an overtly homogenous population. While the ACOAs group may perceive that they were raised in families with problematic parental alcohol use, there may have been sufficient "protective" factors present to result in Positive outcomes. The present study will view admission to a major state university as a positive adjustment outcome. AI 101‘ a» Kb no. 11 This examination of processes in families with an alcohol abusing parent assumes less than optimal familial functioning as a risk factor in poorer outcomes for ACOAs. This study will also question the primacy of parental alcoholism versus family processes as mediating variables. The question being, can quality family processes promote quality outcomes, or does the presence of any situation impeding optimal family processes contribute to a reduction in qualitative outcomes. WW I. Which of the following dimensions of family processes as measured by the Family Environment Scale are most affected by the presence of an alcoholic parent: 1. Relationships, measured by cohesion, expressiveness, and conflict subscales; 2. Personal growth, measured by independence, achievement orientation, intellectual-cultural orientation, active-recreational orientation, and moral-religious emphasis subscales; and 3. System maintenance, measured by organization and control subscales. How will these family processes differ between the alcoholic families and the comparison families? II. Does the presence of an alcoholic parent result in a lower sense of self-esteem, as measured by the Tennessee 12 Self-Concept Scale, compared to young adults without alcoholic parents? III. Is the qualify of life of ACOAs, as measured by the Health and Daily Living Youth Form, comparable to young adults who did not grow up in alcoholic families? Five indices are to be examined: distressed mood, health-risk behaviors, self-confidence, activities with families, and social integration in school. IV. Among the ACOAs sample group, will there be a difference in outcome measures and perceptions of family environment by sex-of—child and sex-of-parent (father)? IhfiQLl Hi | . J E I' Joan Jackson's article, The Adjustment of the Family to the Crisis of Alcoholism (195A), appeared at a time when alcoholism was still largely studied from the unidirectional perspective of the addictive personality. Contemporaneous psychological studies (Futterman, 1953, Price, 19A5, and Whalen, 1953) focused on the wives of alcoholics, and concluded that these women encouraged and contributed to the husbands' alcoholism, and that some women marry alcoholics to meet unconscious needs. As Jackson states, "The studies of the wives of alcoruflics impute psychological traits to the wife as judged from her behavior after her husband has reached an advanced 13 state of alcoholism, and posit that these psychological traits would have been found prior to the onset of drinking. None of the articles conceptualizes the behavior of the wife, or the personality traits inferred from this behavior, as reaction to a cumulative crisis in which the wife experiences progressively more stress" (p. 563). The authors Jackson cites neither possessed the conceptualizations or vocabulary to discuss either alcoholism and the effects on the codependent spouse, nor the interactional family systems view to understand that the "neurotic" traits they attributed to these women. Regarding the wives' behaviors, Jackson was able to conceptualize that "When viewed in the context of what is best for the husband, such behavior might be viewed as dysfunctional; viewed in the context of the rest of the family, it might appear to be functional" (p. 56A). When Jackson further states, "None of the studies deals with the way in which the family as a unit attempts to adjust to an alcoholic parent. None views these adjustments on a time continuum" (p. 563), she demonstrated that while she may have lacked the not yet evolved theoretical vocabulary, she understood the family processes she described from a family 3Ystems perspective. Her family adjustment stages and subsequent research questions are still being examined. Jackson's suggestions for further research included clearer delineation of the factors affecting the rate of transition 1A through the stages, and identification of familial factors that facilitate or impede sobriety, and explanation of problems due to variations in drinking patterns and drinking behaviors. The above observations, conceptualizations, and research suggestions anticipated the work that would be done in alcohol family studies, but to be couched in family systems theory constructs. Jackson described alcoholism in the family as a process wherein people react and change in response to events and behaviors of others. The family unit's interactions and functioning modifications evolve over time. She moved from an intrapsychic, deterministic explanation of human behavior, toward a systems view of the family. Much of the early research which would become the foundations of family systems theory and therapy began to appear shortly after her landmark article. When Much of the early family systems research efforts examined interactional patterns in families with schizophrenic patients (Jackson, 1965/1977; Lidz, Cornelison, et al., 1957; Weakland, 1969/1977; Wynne, Ryckoff, Day, and Hirsch, 1958). Lidz, et al., (1957) noted two recurring patterns in the family structures of schizophrenics, marital schism and marital skew. In marital schism, the parents' conflicts degenerate into an ongoing, hostile relationship in which the children are sought for 15 support and loyalty by one parent to use against the other. In the skewed relationship, the dominant partner incorporates one or more of the children in the service of unfulfilled needs and diminishes the worth of the passive spouse. In both patterns the generational boundaries are transgressed and the children, rather than realizing their own potential, are forced into constraining assigned roles. Wynne et al. (1958) described families of schizo- phrenics as participating in pseudo-mutuality, "... a predominant absorption in fitting together, at the expense of the differentiation of the identities of the persons in the relation" (p. 207). Wynne et al. perceived humans as inately object-related and continuously striving for a sense of personal identity. The mechanisms of these two functions are forms of relatedness; mutuality, nonmutuality, or pseudo-mutuality. The pseudo-mutual relation "... involves a characteristic dilemma: divergence is perceived as leading to the disruption of the relation and therefore must be avoided; but if divergence is avoided, growth of the relation is impossible" (1958, p. 207). Optimal personal growth is not possible in a family structure that preassigns roles and negates self-actualization in order to maintain a family myth or rule, e.g., "We are always a happy family." Jackson (1965/1977) stated that "... the major assertion of the theory... [of the relationship level of communication] ... is that the family is a rule-governed 16 system: that its members behave among themselves in an organized, repetitive manner and that this patterning of behaviors can be abstracted as a governing principle of family life" (p. 6). He further stated that, "these relationship agreements, ...rules ..., prescribe and limit the individuals' behaviors over a wide variety of content areas, organizing their interactions into a reasonably stable system" (p. 9). Ford (1983) viewed rules as the stuff of family systems interactions, communication, and the connection between family process, human behavior, and personality development. The rules maintain family myths, are historical, redundant through several generations, and implicit - "they have the attributes of secret, i.e., they give power over others and induce guilt" (p. 135). Ferreira (1966/1977) saw rules as "...known only by inference, and to the extent to which they are translated into family myths, i.e., the beliefs and expectations which the family members entertain about each other and the relationship" (p. 51). Family myths may be viewed as intergenerational covert supra-rules of the family relationships, which promote homeostasis and the stability of the relationships. Homeostatic mechanisms, interactional patterns, according to Jackson (1977), can be viewed as behaviors which delimit family norms and the range of other familial behaviors. 17 Speer (1970) addressed the issue of homeostasis in the thinking of family therapists. He asked whether one chooses "... to emphasize homeostatic or nonhomeostatic process principles in one's conceptual approach to families in general" (p. 263). He provided the traditional definition of negative feedback as a process wherein "input information from outside the system indicat[es] a discrepancy, incongruence, or divergence between the system's behavior and some preprogrammed environmental goal state" (p. 265). Negative feedback regulates a morphostatic, error-activated, deviations counteractivity function which results in homeostasis, maintaining change resistant geared system activity. Positive feedback, a deviation amplifying process, induces "subsequent effector operations [that] do not act to reduce the discrepancy but rather act to increase the divergence between the system's or member's status and the original goal or standard values" (Speer, 1970, p. 267). Some quality of positive feedback process is viewed as essential for social systems to maintain their viability. They must be capable of morphogenic (structure changing) process in order to grow, create, and survive. Speer (1970) pointed to the deficiency of homeostasis as an adequate concept to deal with the process of the asymptomatic, growth oriented family. Only disturbed families invest energy in constant homeostasis and can be 18 described as morphostatic. Asymptomatic families are more viable and receptive to divergence and can be described as morphogenic. Kantor and Lehr (1975) in their in-the-field observations of families found that "family systems, like all social systems, are organizationally complex, open, adaptive, and information processing systems" (p. 10). Family members are reciprocally influencing, and the family system is at least minimally open and adaptive due to the interchange with the environment. Families are also information processing systems of "distance-regulation" information with which family members monitor the relationships among themselves, and influence and are influenced by negative and positive feedback loops. In the Kantor and Lehr systems model family processes are described as follows: "Through the transmission of matter and information via energy through time and space, family members regulate each other's access to the targets of affect, power, and meaning." Family systems boundaries can either be open, closed, or random. "In the closed-family system, stable structures (fixed space, regular time, and steady energy) are relied upon as reference points for order and change" (p. 119) in the family. "Stability within and across all six dimensions of family process (space, time, energy, and affect, power and meaning) is the core purpose of the closed type family" 19 (p. 1AA). The open-style family is more receptive to examining new information and possibilities, and to some degree adapting and changing as a unit, and tolerating variety in individual members needs and behaviors. The random-type family's energy is expended toward individual free exploration. Jerry M. Lewis' (1976) systems oriented investigation of families yielded disturbed, mid-range, and optimally functioning family categories. Five family qualities viewed as important in developing "capable, adaptive, healthy individuals" were appropriate balances of: power structures; degree of family individuation (sense of each member's autonomy); acceptance of member separation and loss; perception of reality, and demonstrable affect. His disturbed or dysfunctional families had a higher incidence of schizophrenia, while mid-range families exhibited more neurotic and behavior disorder functioning. The optimally functioning families did manifest more shared power, promotion of individuation, toleration of separation due to life cycle events, perception of reality shared by outsiders, and expressive affect. Olson (1979), in developing his Family Adaptability and Cohesion Evaluation Scales (FACES), reviewed the family systems and therapy research and described conceptual clustering of dimensions of family behavior and dynamics. He reviewed Lidz's (1957) "violation of generational 20 boundaries," "marital schism and skew," Bowen's (1960), "undifferentiated ego mass," "emotional fusion," "emotional divorce," Wynne's (1958) "pseudo-hostility," "pseudo-mutuality," Minuchin's (197A) "rigid and diffuse boundaries," "disengagement and enmeshment," and Kantor and Lehr's (1975) "bounding." These terms, irrespective of their research base, all described the phenomenon of degrees of dysfunctional enmeshment or disassociation among family members, variables indicative of an inappropriate balance of emotional interaction, i.e., the level of cohesion. Olsen (1979) prOposed that appropriate levels of cohesion, along with adaptability, were most conducive to optimal marital and family development. He defined family cohesion as "the emotional bonding members have with one another and the degree of individual autonomy a person experiences in the family system" (p. 5). The extremes of cohesion are enmeshment and disengagement. Adaptability was defined as "the ability of a ...family system to change its power structure, role relationships, and relationship roles in response to situational and developmental stress." The extremes of family adaptability capacities range from chaotic to rigid. When the concepts of cohesion and adaptability are coupled with interactional-communication family theory (Jackson, 1965/1977; Watzlawick, Jackson and Beavin, 1967) and family systems studies (Kantor and Lehr, 1975), Lewis, 21 1976), families may be conceptualized as entities with communication and relationship rules, assigned family member roles, and with limits in their flexibility in responding to internal and external stimuli. When families are morphostatic in their responses to family developmental stages, crisis, or stress, they do not learn or develop from these situations as a unit or individuals. They are not morphogenic. Family power, rules, and role interactions remain static, and solutions are repetitive, predictable, and they are eventually inadequate. These are the traits of dysfunctional and mid-range families as opposed to optimal functioning families. Olson (1979, p. 12) stated that "The most viable family systems are those that maintain a balance between both morphogenesis and morphostasis." Wm Moos and Moos (1976) stated that "Although everyone agrees that the family environment is crucial in shaping the developing child, relatively few attempts have been made to systematically assess the social climate of families" (p. 357). The Family Environment Scale was developed in order to identify homogeneous types of families. There are many attributes or dimensions of family environment which characterize family processes and would be related to differential family outcomes. Relationship dimensions were assessed by the subscales: Cohesion - degree of commitment 22 and support family members provide each other; Expressiveness - the level of permission and encouragement to express feelings; Conflict - the level of family members' openly expressed anger, aggression, and conflict. Personal Growth Dimensions included the subscales: Independence - a measure of assertiveness, self-sufficiency, and autonomous decision making; Intellectual-Cultural and Active-Recreational Orientation - the degree of moral-religious emphasis; and the degree of emphasis on competition or Achievement Orientation. Family System Maintenance dimensions were assessed by the subscales: Organization - the degree to which activities and family management responsibilities are structured; and Control - the extent to which set rules and procedures run family life. Moos and Moos (1975) posited that being able to accurately assign the 100 sample families to one of six clusters reflecting the ten subscales indicated that conceptualizations about family environments and processes should not be oversimplified. Relationship and System Maintenance variables along with, and in combination with Personal Growth variables, may be more reflective of the complexities of family processes and outcomes. The work of Moos and Moos (1976) along with Olson (1979) and Lewis provides measures wherein family systems concepts are operationally defined, and applicable to research with identified problematic as well as nonclinical families. 23 The above survey of major family systems concepts and ‘assessments will facilitate the presentation of contemporary alcoholic family systems research. These systems constructs will also provide a theoretical framework for the findings of nonsystems oriented research and sundry data. Wm Peter Steinglass focused on alcoholism research from a family systems perspective. His book, Ihe_Alggnglig_Eamily (1987), addressed family growth and development from the family life cycle view, and the issue of intergenerational transmission of alcoholism. Three core systems theory concepts are applied to the "life history model" of the alcoholic family: organization, morphostasis (internal regulation), and morphogenesis (controlled growth). The term "alcoholic family" clearly suggests that the entire family has alcoholism; not that each member is an alcoholic, but rather that the entire family system's regulatory functions respond to alcoholism. This profoundly affects the family's and individual members' long term growth because the family system responds repeatedly to the needs for short-term stability. The result is "developmental distortions" as resiliency and adaptability capacities are not fully cultivated. Concomitant to these processes is the development of a "family identity," 3 shared system of beliefs. What Steinglass viewed as important here was the question, "At what point does a 2A family 'decide' to become alcoholic?", i.e., decide to expend the family's regulatory system's energies, myths and rules, and interactional processes for the parent who abuses and is dependent on alcohol. There are three phases in the family life cycle when the family identity issue can be addressed: the "early phase" with the task of establishing family generational boundaries and identity formation; the "middle phase" of commitment and stability; and the "late phase" with the process of clarification and legacy. During the family life cycle "normative" families form an identity, proceed to orderly growth with an appropriate repertoire of thematic specialization, and conclude with the ability to clarify and transmit the family identity. The alcoholic family suffers distortions via thematic overspecialization, developmental arrest, and premature developmental closure. The family process is morphostatic and the result is degeneration, as opposed to morphogenesis and familial regeneration. The individual family member's life cycle development is also distorted in alcoholic families because tasks of growth and individuation are submerged to the family process of alcoholism. From a family systems perspective, the normative family processes described above are distorted and dysfunctional in alcoholic families, and thus impede optimal development for COAs. LITERATURE REVIEW Muslim Wilson and Orford's (1978) examination of families with an alcoholic parent in the context of the literature on children of alcoholics (COA) led to conclusions about the future direction of such research. These suggestions included: the effects of the gender of the alcoholic parent; the effects of parental drinking on family members' moods and the atmosphere of family life, and in turn the impact of these mood states on family members; role and family task rearrangements and their influences on children; identification of the variables which affect an environment that may impair a child's social, psychological or intellectual functioning; and, the need to develop a theoretical direction which includes the many disciplines of child and family studies. Subsequently, much of the research enterprise has moved in these suggested directions. Previously, Joan Jackson (195A) uniquely described the stages of family adjustment to an alcoholic spouse-parent. Implicit in her analysis was a family systems perspective which attended to the influences of paternal alcoholism on family members' functioning and adaptations at one stage, and in turn how these processes affected subsequent familial responses. 25 26 Steinglass and associates (1971) explicitedly used a systems model which also included the psychodynamic and sociological-interactional approaches to shift their research to a "drinking system" perspective. Initial observational research indicated that periods of alcohol abuse had a stabilizing and predictable aspect in interactional processes. Subsequent research by Steinglass et al. focused on the alcoholic process in the family life cycle and identified stages of progression and patterns of alcohol abuse (1980), as well as types of alcoholism and the structuring of daily family routines (1981). Other researchers associated with Steinglass investigated familial transmission of alcoholism by studying the role alcohol abuse played in disrupting family rituals (Wolin et al., 1980), and the effects of association of new conjugal couples with their alcoholic families of origin (Bennett, Wolin, Reiss, and Teitelbaum, 1987). Steinglass's systems approach to studying the alcoholic family revealed discrete, functional, and predictable aspects of alcoholic process and behavior in the family. Rudolf Moos of the Social Ecology Laboratory at Stanford University, using various Social Climate Scales that he developed, examined alcoholics in the process of recovery. In a series of studies (1979, 1981, 1982, 1932: 198A) Moos and associates examined recovered alcoholics, their families, spouses, and children, and compared them to v vv Aflv a: 27 community control families, and families of relapsed alcoholics. Repeatedly, in these studies and others using the Family Environment Scales (FES), active alcoholic families had lower cohesion, organization, expressiveness, and active recreational orientation, but greater level of conflict. The recovered alcoholic families experienced more positive and fewer negative life events, manifested fewer physical and emotional symptoms, and generally matched community controls in outcomes. The importance of Moos' work is his development of operationally defined family systems constructs and objective measures. Also significant is his development of scales such as the Work Environment Scale, the Health and Daily Living Scales which, when used in conjunction with other measures such as stress, coping, life-change events, and social-environ-resources, reflect a family ecosystem perspective. Some findings from the "recovery process" studies are: 1. Spouses of alcoholics are affected by their partners' drinking patterns, with greater alcohol abuse associated to poorer outcomes; 2. Children in the relapsed alcoholic families were more depressed and anxious than recovering and control families, with a "tendency" for more physical problems; 3. While children in the recovered families were less depressed than controls, and their family functioning was 28 the same as controls, long term effects of parental alcoholism cannot be determined; A. Recovered alcoholics and spouses can attain adequate personal familial functioning; and 5. The adequacy of functioning of one member of the family in one area affects other members or the entire family system in other areas. This clearly reflects the systems perspective of family processes. Moos and Moos (198A) concluded that, "We cannot argue that the characteristics of the alcoholic or of the spouse 'cause' a certain type of family functioning any more than a supportive family environment 'causes' good treatment outcome. Future research should develop conceptual models to probe the interrelationships between the characteristics of each of the marital partners and the functioning of the family unit" (p. 117). Black (1981), Wegscheider (1981), and Brown (1988) use family systems concepts to describe COAs and ACOAs outcomes based on their clinical experiences with this population. They maintain strongly that the negative effects of parental alcoholism affect all children, is a life-long issue, and problems may manifest at any time. When alcohol abuse becomes the main organizing principle for the family, resulting family myths and rules necessitate behavioral roles and role reversals for the children which confuse authentic emotions and impede the development of personal identity formation. The alcoholic family processes can be 29 described as dysfunctional, with family energies devoted to the homeostatic mechanisms directed by the family myths and rules of denial and enabling. The rigid coping mechanisms of youth become problematic in adulthood as marital problems, difficulties with intimate relationships, depression, and a general sense of worthlessness manifest, irrespective of personal achievement. There are few COA studies which attend to sex-of—child by sex-of—parent outcomes. McKenna and Pickens (1983) found no parent—child interaction effects. Schuckit (198”) found no subject gender differences other than more drug misuse in sons of alcoholic mothers. While Ackerman (1987) found that having an alcoholic parent of the same gender had the least effects on selected personality characteristics of ACOAs, Warner (1986) observed that females of alcoholic fathers had better outcomes than males of alcoholic mothers. Jacob and Leonard (1986) noticed no gender differences of alcoholic fathers' offspring. Most studies indicate minimal, if any, gender differences. Baraga (1978) and Woititz (1976) found COAs to have poorer self-concepts than control groups. Clair and Genest (1987) found no differences in 18-23 year old ACOAs and controls on self-esteem, and Callan and Jackson (1986) found adolescents of alcoholics, recovered alcoholics, and controls to be similar in self-esteem. The major questions in COAs outcome research are, does the presence of parental alcoholism bring about negative 3O outcomes, or are negative outcomes the result of alcoholism in combination with other factors? Do the effects of alcoholism on family processes "cause" problematic outcomes for these offspring? Why are the ranges of outcomes for COAs so broad, and often within the same sibship? Increasingly, the interactionistic perspective containing biopsychosocial factors is brought to COA studies (Zucker, 1990). When, for example, genetic predispositions to alcoholism, endowed individual temperament, family processes, nonshared environments and extra-familial supports, and individual coping mechanisms are considered in a developmental model, the study of COAs could serve as a paradigm for behavioral research (Steinglass, 1987). Emily—Emcee: Joan Jackson's classic study (195A) was one of the first to examine alcohol addiction in terms of its effects on family processes and the individual family members. Over a three-year period Jackson participated in an Alcoholics Anonymous Auxiliary group for women whose husbands were "excessive drinkers", irrespective of their Alcoholics Anonymous membership status. Through her contact with 50 women who were group members at various points in their adjustment to their spouses' alcoholism, Jackson reported the following family adjustment stages: 31 1. Attempts to deny the problem - husband and wife don't attend to other problems in an effort to avoid provoking drinking. 2. Attempts to eliminate the problem - familial social isolation and an inappropriate emphasis on family processes considered to contribute to the husband's drinking or that are a response to his drinking. The wife begins to manifest codependency symptoms. 3. Disorganization - the family's energies are devoted to tension release rather than long term plans. Children's disturbances become evident, and the wife's self-confidence decreases. A. Attempts to reorganize in spite of the problem - the wife takes on more family responsibilities, her self-confidence improves, the family structure begins to change. 5. Efforts to escape the problem - if resources ,permit, the wife will leave her husband, otherwise she becomes increasingly self-reliant . 6. Reorganization of part of the family - mother and chijldren reorganize without father. Loyalty issues and confusion continue for the children. 7. Recovery and reorganization of the whole family - husband's recovery requires yet another familY‘ reorganization and facing the problem of his assuming former family responsibilities . 32 Jackson saw the family as enmeshed in a cumulative crisis with each member's actions influenced by his previous personality, role and status in the family, and the effects on the personality of each phase of the crisis, which in turn contributes to the quality of the family's response to each evolving stage. Jackson's observations captured essential systems - interactional theory tenets including reciprocal influences and behaviors (or reciprocally influencing behaviors), and family life cycle issues. They also encompassed the implicit: that the family's struggle was in large part an effort to maintain family system homeostasis in lieu of broader options of growth experiences available to the more morphogenic family. Jackson cites limitations of her study as not having reports from the husbands; having no measures to validate actual from reported behaviors; and, that her sample was limited to families that sought help for the husbands' alcoholism. Also, these findings could not be generalized to families with wife-mother alcoholics. SI . J I E . | . I! E] l J' E '] Steinglass, Weiner, and Mendelson (1971) suggested that a systems research model would avoid an unideterministic view of alcoholic behavior, shift clinical research focus from the "individual alcoholic to the individual drinking System," and would promote direct observation of the alcoholic system in its natural environment rather than 33 relying on data from an isolated member or subgroup of the system. By observing two pairs of alcoholic brothers during periods of experimentally induced intoxication, the authors concluded that the alcohol abuse served to stabilize the observed "dyadic system which might otherwise be expected to be characterized by chaos" (p. A01). The use of a systems model would contain both the psychodynamic and sociological-interactional approach to studying alcohol and the family and help to understand the many manifestations of drinking behaviors. Steinglass's continued research of alcoholic families revealed the adaptive function of alcoholism to maintain homeostasis in the marital dyad and family system. His life history model of the alcoholic family (1980) addressed the long-range developmental implications of alcoholism for the family, i.e., "The family is presumed to have a life cycle or life history that can be divided into a series of recognizable stages, each stage in turn associated with a series of developmental tasks. ...it is postulated that the family must also pass sequentially through this series of stages and that inability to manage successfully the tasks associated with an earlier stage will compromise family resources in dealing with subsequent stages" (p. 212). It is in the early marriage period that alcohol use becomes a recognizable pattern, and invades important family behaviors and rituals. As the family tries to learn to live 3A with alcoholism to establish stability, it makes the transition from a family with an alcoholic member to that of an "alcoholic family," "...alcohol use has become incorporated into the homeostatic mechanisms of the family" (p. 216). During the "mid-life plateau" phase, the alcoholic family is subjected to the same internal and external stressors and life events as normative families. In the alcoholic family the response to these events may be an increase in alcohol use, or a cessation of drinking, either of which cause an instability in a previously homeostatic system. With the event of increased drinking, the "stable-wet" family becomes "unstable-wet." Steinglass describes a mid-life pattern for most alcoholic families consisting of alternating phases of stable-wet, transitional, stable-dry, transitional, stable-wet, etc. For the "late resolution" period, Steinglass describes four family level solutions: 1. Stable-wet, the steady-state solution continues with an unchanging quality; 2. Stable- dry Alcoholic, the conversion to the dry state has been maintained, but with the alcoholic family identity still intact to some degree depending on their rigidity of adaptation in order to sustain abstinence; 3. Stable-dry Nonalcoholic, alcohol has been eliminated in physical and emotional sense. There is little concern about alcohol as a recurring problem; and A. Stable controlled drinking, 35 nonalcoholic, the successful return to controlled social drinking. This is a controversial issue, but a reality for certain individuals. Steinglass points to the important role that alcohol plays in the homeostatic mechanisms of alcoholic families, evidenced in part by the clinical failures when attempting to remove alcohol without understanding its role in the family process; "...these families may place such a high value on stability as to be willing to trade long-term growth for short-term stability" (p. 22A). In a home observational study, Steinglass (1981, 1987) examined the patterns of interaction in dry, wet, and transitional stages of alcoholism. The focus of this study was the "correlationships between types of alcoholism and the different styles families evidence in structuring daily routines" (1987, p. 181). Three drinking patterns were identified: stable-wet (SW), drinking occurs on a regular and predictable basis; alternator (ALT), unpredictable binge drinking of several weeks or months with alternating dry periods; and stable dry (80), drinking has ceased. Home behavior of 31 families (10 SW, 7 ALT, and 1A SD) was assessed using the Home Observation Assessment Method (HOAM), an instrument "specifically designed to collect accurate data on interactional behavior in the home as it unfolds in a real-time framework" (1987, p. 192). Each spouse is observed on seven aspects of behavior: physical 36 location, people in the room with them, physical distance of family members, physical and verbal interaction rates, content of verbal exchange regarding decision making, affective levels of the verbal exchange, and their outcomes. The HOAM indices were described with dimensions: intrafamily engagement, distance regulation, extrafamily engagement, structural variability, and content variability. The rationale for this study was that, "although often far less dramatic and therefore easily overlooked, the family's pattern of organizing its daily life proves an excellent measure of how the family regulates its own environment" (1987, p. 196). The results indicate that the HOAM can tap the differences of the three family types' "temperamental characteristics"; the authors claim if all they know about an alcoholic family is their HOAM measures, they can predict with 75% accuracy whether the family is SW, ALT, or SD. These are middle-phase families that have "committed" themselves to alcoholism; their daily routines and drinking behaviors fit in a mutually reinforcing pattern. This research revealed that during intoxicated interactional states families are often more energized, expressive, and have a predictable response to necessary problem solving. The assumed chaos to the observer has a regulating function in these family systems. There is a stability of family process, albeit one that does not allow for optimal change and growth. 37 Wolin, Bennett, Norman, and Teitelbaum (1980, cited in Steinglass, 1987) investigated disrupted family rituals as a factor in the intergenerational transmission of alcoholism. Maintaining family rituals is viewed as an important dimension in early-phase options, a quality of life factor for middle-phase families, and ultimately serves in the process of transmission of alcoholism. Alcoholic middle-phase families must choose whether or not alcoholic drinking and behavior will be kept out of important family rituals. The subject pool consisted of 25 middle and upper-middle class white families. Family heritage to three generations and six areas of family life were explored: dinners, holidays, evenings, weekends, vacations, and visitors in the home. Comparisons of preonset of and heavy drinking periods of the alcoholic parent, and the family's plans and responses during rituals were coded. Two patterns emerged comparing pre- and heavy drinking periods. In the first type little change in family rituals was observed, indicating families kept drinking behavior distinct from ritual life. These were identified as "distinctive" families. In the second type considerable change in family rituals was observed, suggesting the family ritual events were subsumed by the consumption of alcohol. These were identified as "subsumptive" families. "For these subsumptive families, where there was once a tradition, a 38 gap now exists" (Steinglass, 1987, p. 236). The subsumptive pattern fixes the alcoholic family identity and the family suffers the loss of the valuable resource of heritage and tradition. For the purpose of studying intergenerational transmission of alcoholism, a third group was designated as intermediate families, those in which only half the rituals had been changed by alcohol. The research premise was that distinctive families, in spite of chronic alcoholism, were able to send a different message about alcohol to the children than did the subsumptive families. Also, that a quality of family life had been preserved, providing positive memories and tradition. The results are interesting: the eight distinctive families had five offspring identified as "no alcohol problem," three with some "difficulties" with heavy drinking, and none identified as having "alcoholic drinking behavior." The seven subsumptive families had four alcoholics, two heavy drinkers, and one "no problem drinker." The ten intermediate families had two alcoholic and two heavy drinker offspring, but six with "no alcohol problems." The authors concluded that nontransmitting families were able to offer some protection from alcoholism for their offspring when they directly rejected alcohol and drink behavior from their family rituals. 39 Bennett, et al, (1987) studied couples at risk for transmission of alcoholism by investigating why "some early phase families who have one or more alcoholic families of origin seem not to develop alcoholic identities, while other families with quite comparable heritages carry the alcoholic tradition into the next generation" (Steinglass, 1987, p. 129). The subjects were siblings (with in-marrying spouses) of parents of whom at least one was alcoholic. The focus of the study was "ritual practices" in the family of procreation compared to family of origin. The question studied was, is there a deliberateness in the subject families in selecting one family of origin as a model over the other in their efforts to form a family identity? The areas of inquiry included family demography, nuclear family relations, extended family relations, alcohol history (three generations), dinner time, holidays, and family structure. The findings indicated that for early-phase couples, "deliberateness in family-ritual development, and extent of contact with the alcoholic origin family not only set the tone for family-identity formation; they also ... are linked to whether or not the couple perpetuates the alcoholism from the previous generation" (Steinglass, 1987, p. 139). Minimized contact with the alcoholic family of origin and deliberate selection of family rituals seem to protect couples from recurrence of alcoholism. The authors posit no "that early phase is an ideal time for couples to face issues of family-identity formation, as well as concerns over repeating an alcoholic family legacy" (Steinglass, 1987, p. 139). M I E . | . E .1 E I B immhclism In a series of studies examining the process of recovery from alcoholism, Rudolf Moos and associates reported on the family processes and functioning of the children, spouses, and of former alcoholic patients in recovery or relapse. The two groups were compared to community controls with no history of alcohol problems. Variables examined throughout the four studies included drinking patterns, mood and health-related functioning, social and occupational functioning, personal responses, life change events, and social environmental resources. The Family Environment Scale was used in each study. Moos, Finney and Chan (1981) in comparing married recovered and relapsed alcoholics with matched community controls concluded that recovered alcoholics were similar in functioning to nonalcoholic community subjects. Recovered alcoholics differed slightly with less social activities, and experienced higher levels of anxiety and somatic complaints. Positive and negative life events were similar to the nonalcoholic neighbors. Relapsed alcoholics functioned "considerably more poorly in all areas than either recovered alcoholics or community controls" (p. 398). A1 The authors specify that these differences were not due to sociodemographic factors. The family environment as measured by the PBS indicated that except for the controls greater emphasis on the active-recreational orientation, they were similar to recovered alcoholics. The relapsed alcoholics showed greater conflict, and less cohesion, expressiveness, organization, and active-recreational orientation than either group. Recovered alcoholics showed a high agreement with their spouses on their perceptions of the family characteristics. The authors state that, "The successfully treated alcoholics have managed to create relatively benign circumstances which may contribute to their continued recovery" (p. 399). Moos, Finney and Gamble (1982) compared spouses of recovered and relapsed alcoholics with spouses of matched community controls. Spouses of recovered alcoholics were similar to controls except for less alcohol use, fewer social contacts, and less family emphasis on active recreational orientation. The spouses of relapsed alcoholics, however, drank more alcohol (although in normal ranges), experienced more negative life events, and had fewer social activities and less family cohesion. The Spouses of alcoholics who returned to heavy drinking had greater depression, drank more, and complained of medical conditions. To restate the PBS measures, spouses of A2 relapsed alcoholics perceived less family cohesion than recovered and control groups, and both recovered and relapsed groups perceived a less family active-recreational orientation than the community controls. The authors conclude that "... spouses of alcoholics are affected by the current functioning of their partners" (p. 902). Partners with drinking problems had spouses report anxiety, depression and somatic complaints. The spouses' mood and physical symptoms were related to the alcoholic partners' anxiety, depression and physical symptoms. Regarding implications for personality, stress, and coping perspectives, Moos et al. state, "The most parsimonious conclusion is that spouses of alcoholics are basically normal people who are trying to cope with disturbed marriages and behaviorally dysfunctional partners" (p. 905). The continuing research issue here is can one make the same conclusion about developing children and their exposure to manifestations of alcoholism in parents. While "normal" adult spouses may enjoy the recovered state with their partners, do COAs have the developmental ego integrity and life experience to resume qualitative functioning when their parents recover, or when they extricate themselves from an alcoholic family at age appropriate life cycle stages. Moos and Moos (198A) compared functioning in families 0f relapsed and recovered alcoholics, and matched community A3 controls. In exploring three "domains" of family functioning (family environment, role functioning, and husband-wife congruence), the authors concluded: families of recovered alcoholics were functioning like the community control families but with more joint household tasks and with fewer arguments. This was attributed to the recovery process and the effort to avoid conflicts and tension. The lower activity-recreational orientation can be understood as an effort to avoid social settings where alcohol may be served. Family environment indicators were such that the recovered families were not higher in conflict or lower in cohesion, expressiveness, and organization than controls. The relapsed families indicated less cohesion, expressiveness, active recreational orientation, and agreement about the family environment than controls. In the families where there was a return to heavy drinking, there was more conflict and less organization. Generally the family functioning among the relapse group was poorer than the recovered and control groups. The authors conclude that, "... some recovered alcoholics and their partners can attain normal personal and family adaptation" (p. 116). Moos and Billings (1982) compared children of relapsed and recovered alcoholic patients with children of matched community controls regarding their psychological and PhYsical functioning. While the data on the parents' functioning was acquired from measures used throughout this AA series of studies, the functioning of the children was determined from the mothers' reports. The children from the relapsed families were more depressed and anxious than controls, while children of recovered families were less depressed than controls. The family environments of the relapsed alcoholics differed from controls while those of the recovered families did not; relapsed families reported less cohesion and expressiveness, and less emphasis on independence, achievement, moral- religious, intellectual - cultural, and active recreational orientation. Differences on individual physical problems were not statistically significant for the three groups, but the composite measure of physical problems indicated a "tendency" for the relapsed families offspring to have more such problems than the control group (p < .10) The authors concluded that the health and functioning of children from families of relapsed alcoholics were related to the emotional, physical, and occupational functioning of their parents, and not of the quality of the recovered and control family children. Negative effects on family members due to parental alcohol abuse need not continue, but the effects on children over time has not yet been determined. Since the relapsed parents had more emotional problems, negative life change events, avoidance coDing style, and perceived their families as characterized by conflict, their children's needs and behaviors may have A5 been perceived as yet another stressor. Objective measures and children's self-reports, as the authors themselves indicate, would have been preferable. Other studies using the FES describe families with alcohol problems similarly to the recovery process studies cited above. Moos and Moos (1976), in an effort to develop a typology of family social environments, found that 100 sample families were clustered across six distinct descriptors: Expression-Oriented, Structure-Oriented, Independence-Oriented, Achievement-Oriented, Moral/ Religious-Oriented, and Conflict-Oriented. Thirty-two of the families responded that they were "frequent drinkers," and were recorded for each cluster. These families were "disproportionately" represented in the Conflict-Oriented cluster (55.2%), and also first in the Expression-Oriented cluster (33.3%), while being last in the Structure- Oriented cluster (12.5%). In examining family characteristics, Moos, Bromet, Tsu, and Moos (1979) found that alcoholic patients showed better treatment outcomes coming from families which were higher in cohesion, active-recreation orientation, and organization, while lower in conflict and control. Filstead, McElfresh, and Anderson (1981), in comparing the family environments of alcoholics and "normal" families, reported alcoholic families perceive less cohesion, expressiveness, and ‘ organization, and more conflict than the normative sample. A6 E I . J 0 | SI I. One trend in COAs outcome studies is that while COAs are seen as at risk for developmental and psychosocial variables, often when compared to controls the differences are less substantial and more varied than expected. Kammeier (1971) compared 20 boys and A5 girls from families with identifiable alcohol problems against same number and gender high school students from families without identifiable alcohol related problems. The Minnesota Counseling Inventory (MCI) and the Personal Orientation Inventory (POI) were used to measure personality factors, and the Iowa Test of Educational Development and the Lorge-Thorndike Intelligence Tests measured cognitive levels. On the POI only the self-actualization scale indicated a significant difference between the two groups, with the nonproblem group scoring higher. The MCI scores indicated differences for only the 9th and 10th grade problem family girls who showed more distress on the emotional stability, family relationships, social relationships, conformity, mood, and leadership scales. No other grade or gender subgroup demonstrated differences. Kammeier concludes that the lack of differences, "in general," seem to indicate that parental alcohol abuse was not a direct cause of problems for this group of adolescents. This sample from a Catholic high school where 92% of the problem group had intact families is clearly 1:7 different than usual 50% or greater divorce rate for alcoholic families. The intact families could serve as a protective factor. Kammeier notes that, "peer group pressure to conform during the teens temporarily masks other personality problems already well developed during the preadolescent years" (p. 370). Jacob and Leonard (1986) investigated 13A families - A3 alcoholic fathers, A6 controls, and A5 depressed fathers, which included 296 children almost equally distributed by groups and gender. The Achenbach Child Behavior Checklist was completed by the parents. Teachers responded via the Myklebust Pupil Rating Scale, and the Conners Teaching Rating Scale. Factors such as social competency, conduct, hyperactivity, communication competency and the like could be analyzed. The findings indicated that the children of alcoholic and depressed fathers were more problematic than controls, but a very small group were significantly impaired. For the more impaired children there was higher levels of parental alcoholism, and greater psychopathology for both parents. (Interaction of effects of alcoholism and pathology was not investigated.) Daughters of depressed fathers were reported by parents as having greatest degree of impairment, while the teacher reports did not differentiate among sons or daughters of the three groups. The authors recognize that these sample children, aged 12-18, may manifest serious A8 problems when older and plan to continue the project to this cohort. The authors "encourage efforts to examine bidirectional effects involving the alcoholic and his family - in particular, the impact of parental alcoholism on the psychosocial functioning of spouse and offspring together with the role that the spouse's psychiatric and coping status play in diluting the adverse effects that alcoholism can exert on marital and parent-child interactions" (p. 379). Callan and Jackson (1986) examined 21 adolescent children of recovered alcoholic fathers and 19 children of alcoholic fathers and were compared with 35 socio- demographically matched children on aspects of family and personal adjustment, the parent-child relationship, and perceptions of alcoholism. The rationale for this study was that "little is known about the functioning of children in families where the alcoholic parent becomes abstinent" (p. 180). Results indicated the following: 1. Children of alcoholic fathers viewed their families as more tense, nuoody, unreliable, strict and less nurturing. Controls and recovered group felt they had happier, more responsive f‘amilies. 2. There were no significant differences regarding relationship with parents. 3. In their personal linves children of recovered fathers were "happier" than A9 COAs. A. Controls viewed alcoholics as weak and lacking willpower, which differed from the other two groups. COAs more often rated alcoholics as dangerous. COAs of the recovered fathers rated their lives as happy along with controls, and happier than the children whose fathers still drank. But all three groups were similar regarding self-esteem and locus of control; "Having an alcoholic parent affected the quality of their lives rather than how they felt about themselves" (p. 182). This study lends support to the view that families with recovering alcoholics do quite well compared to controls, as well as again indicating that most often alcohol fosters personal pathology and familial difficulties, rather than pathological persons and systems routinely gravitating to alcohol abuse. Interestingly, the three groups did not differ in the reported relationships with their fathers or mothers. In a prospective study Werner (1986) monitored 26 males and 27 females to age 18. Thirty-eight had fathers who were alcoholics, 6 mothers with "serious drinking problems," and 5 had both problem drinking parents. Socioeconomic status, educational stimulation, emotional support, and stressful life events were rated as an assessment of the home environment. The children were assessed by the California P8Ychological Inventory, Locus of Control Scale, scholastic achievement scales, and interviews regarding family crisis 50 history, attitudes towards family and friends, personal aspirations, and self-perception. While risk was greater for the COAs to develop learning and coping difficulties, "approximately 59% of the A9 offspring of alcoholics had not developed such problems by age 18" (p. 36). The "resilient" group received more primary caretaker attention during the first year of life, and were more likely to be perceived as "cuddly and affectionate." Also, their parents demonstrated no remarkable conflict during the first two years of life, and no new sibs were born during that time. Throughout the tracking the "resilients" did better in school, had a greater sense of well being, were more socialized, and had a more internal locus of control. Analysis by gender revealed the following: "Males and the offspring of alcoholic mothers had higher rates of psychosocial problems in childhood and adolescence than females and the offspring of alcoholic fathers" (p. 3A). The characteristics of the resilient COAs, and the early care-giving environment, (along with other research) Provides "empirical evidence for a transactional model of human development that takes into account the bidirectionality of child/care-giver effects" (p. 39). ‘While Werner points to endowed temperament, its effects on the care-giver, and predisposed resilience, it would have been iJiteresting to also analyze the data by sibship. As 51 there always is the question of why doesn't the entire sibship of the same environment develop the same positive or negative behaviors, syndromes, etc., such an analysis would have given even more insight to the issues of temperament, nonshared environment, and external supports for COAs. Clair and Genest (1987) state that COAs research ignores positive adjustment and fails to address the variability in adjustment among ACOAs, while it is well recognized that some children do quite well and others can become dysfunctional. In this study parental alcoholism was "not treated as a stressor in itself, but as a risk factor" (p. 3A6) which could be moderated by family variables, social support, and variations in coping behavior. Thirty offspring of alcoholic fathers and A0 control group, 18-23 years of age, were asked to respond to the following measures regarding their 13th to 18th year: Family Environment Scale, Dimensions of Social Support Scale, The Ways of Coping, Depression - Proneness Rating Scale, and the Tennessee Self-Concept Scale. Results: 1. Family environment - offspring group had higher conflict scores, and lower cohesion and intellectual-cultural orientation scores than controls. 2. Social support - informational support was lower for ACOAs, emotional support similar for both groups. 3. Appraisals and coping - only 5°85 (If ACOAs viewed family problems as controllable and had greater tendency to use emotion-focused rather than 52 problem-focused coping responses. ACOAs also were inclined to use avoiding strategies (drinking, smoking, denial). A. Adjustment - offsprings were more inclined to depression—proneness, but did not differ on self-esteem. However, the authors indicate COAs range of scores was higher than the controls. The authors noted that depression-proneness was related to tendency to self-blame regarding familial problems, and self-esteem was higher when families maintained cohesion and subjects engaged in problem-focused coping responses. ACOAs are viewed by the authors as developing in higher risk family setting with more stress and less support. Their greater tendency to emotion-focused coping and avoidant strategies may be a basis for intrafamilial transmission of alcoholism. Notice is made of many ACOAs who function well or above nonalcoholic family children. Support and other resources may diminish the risk of living in a dysfunctional family. A small sample size and an overrepresentation of females (3A control and 28 ACOAs) make it difficult to generalize to sons of alcoholics, but the authors call for further research regarding protective moderating variables to develop interventions which enhance SYstems that counteract risk factors. Parker and Harford (1987) examined parental drinking and ‘the alcohol-related problems of adult children, as well as occupational status of adult children "that may be 53 involved in the development of alcoholism" (p. 265). Four hundred seventy-four men and 552 women were questioned about their parents' drinking and their current occupation. Drinking categories were nondrinker, light drinker, moderate drinker, heavy drinker, or very heavy drinker. (The frequency of heavy and very heavy drinking mOthers was so low the data was not analyzed.) The results indicated that adult children of heavy-drinking parents have higher percentages of dependent problem drinking than those without heavy-drinking parents, but not higher percentages of nondependent problem drinking. The authors conclude that ACOAs are at greater risk for alcoholism, but not for problem drinking. The interaction effects of parental drinking and occupational status indicate that those subjects with heavy-drinking parents and blue-collar jobs were at elevated risk for alcohol abuse and related problems. E I] E I E I _ I] C]' . J M' Several authors who work clinically with alcoholic fanfllies, COAs, and ACOAs view the effects of alcohol abuse on the family system so damaging that they conclude, "All children raised in alcoholic homes need to be addressed. All children are affected" (Black, 1981, p. 27). Wegscheider (1981) points to the family rules that develop as substance abuse becomes the major organizing Primuziple of the family system: 1. Alcohol is not the cause 5A of the family's problem. 2. The alcoholic is not responsible for the dependency. 3. The status quo must be maintained at all costs. A. No one may discuss what is really going on in the family, with one another or with outsiders. 5. No one may say what he is really feeling. 6. Everyone in the family must be an "enabler." The family rules of coping with the problem of alcohol dependency forces members into "enabling" roles. The behaviors identified with each role are often shared, or members may switch periodically, but in larger families, Wegscheider had noticed a recurring pattern. The spouse of the alcoholic becomes the Enabler, who protects the dependent from consequences, assumes more family responsibilities, eventually becomes physically and emotionally drained, and engages in self-blame and guilt regarding the spouses addiction and the dysfunctional state of the family. The role of the Hero usually belongs to the oldest child, who participates in parental responsibilities at an early age, and feels compelled to do especially well in school or sports to provide the family with a point of pride. The second child becomes the Scapegoat, who needing attention and feeling limited ways to express anger and ffiuastration in the family, participates in acting out behavior. This is the child who becomes the scapegoat for the family's problems, and may even be told that if it weren't for their behavior the parent might not have to 55 drink. The third child becomes the Lost Child, overshadowed by the hero and scapegoat, and taken for granted by the parents as he or she finds their own way to cope with the family difficulties. Wegscheider views this child as a candidate for suicide attempts. Finally, there is the Mascot, who often as the youngest is not able to understand the distorted family process, nor is it explained to him. He becomes overprotected from the family's pains and secrets, and as a mode of belonging continues the behaviors which initially provided attention for the "baby" of the family; being cute and entertaining. The family rules and subsequent roles impose demands and limitations on each person, and Wegscheider discusses the various losses of emotional, social, mental, and spiritual potential for each role. Black (1981) also found the development of identifiable roles in alcoholic families. She believes that COAs who become identifiable behavioral problems are the exception, and that most COAs quietly engage in their roles as they attempt adaptation to the family alcohol abuse. Initially, there may even be positive aspects to the behaviors each role requires. For the "Responsible One" (the Hero), learning to take on responsibilities at an early age and excelling in arenas that would please the parents, provides self-esteem and leadership qualities. The "Adjuster" escapes the responsibilities of the hero, and responds to 56 the specific family tenor at any given time. They become flexible and easily adapt in most social situations. The "Placater" smooths over familial conflicts and helps others to adjust and feel comfortable, thereby developing sensitivity and listening skills which may help with social popularity. Black states that the adaptive measures of youth remain in adulthood where continued behavioral roles are no longer effective. The "responsible" children grow up continuing to excel, but work alone and are inept in intimate relationships. The "placaters" don't recognize their own needs and without understanding become unable to express anger or assertiveness because of the fear of anger from others. They can feel chronically depressed. The "adjusters" continue to allow themselves to be manipulated and lose self-esteem and the feeling of power in their lives. The "acting out" child enters adulthood with difficulties due to academic deficits, legal problems, progressing addiction, and poor social skills. For ACOAs the gaps in emotional and psychological development manifest in early adulthood and affect intimate relationships, lead to depression, continuance in an alcoholic or other problematic relationship or marriage, and/or the progression of alcoholism (p. 6A). Woititz (1983) identified thirteen traits of ACOAs who: 1. guess at what normal behavior is, 2. have difficulty 57 following a project through conclusion, 3. lie when it would be just as easy to tell the truth, A. judge themselves without mercy, 5. have difficulty having fun, 6. take themselves very seriously, 7. have difficulty with intimate relationships, 8. overreact to changes over which they have no control, 9. constantly seek approval and affirmation, 10. usually feel they are different than other people, 11. are super responsible or irresponsible, 12. are extremely loyal even in the face of evidence that the loyalty is undeserved, and 13. are impulsive, don't consider alternative behaviors, which leads to confusion, self-loathing, and loss of control over their environment (p. A-5). Clearly, these behaviors, tensions, and self-doubts, experienced on a daily basis and readily alleviated by alcohol, can lead to problematic alcohol use or dependence, thus perpetuating the alcoholism into the next generation. M. Duncan Stanton and associates have done extensive work regarding family systems and alcoholism and other addictions. In summarizing differences between drug abusers' families and other dysfunctional families Stanton (1985) indicates the following regarding family process: 1. Higher frequency of multigenerational chemical «dependency (especially alcohol among males), and propensity for other addiction-like behaviors (gambling, TV). 2. More Priuutive and direct expression of conflict. 3. Overt 58 alliances between the addict and the overinvolved parent. A. Mothers of addicts display "symbiotic" child rearing practices further into the life of the child, and manifest greater symbiotic needs than mothers of schizophrenics and normals. 5. Greater frequency of premature and unexpected deaths, and generally a preponderance of death themes. 21']! E E] I 1' 0 I E . . E I E E I I C] 1| Some of the above cited studies attend to the variable of the gender of parent and the child. Ninety-seven percent of the Kammeier (1971) COAs came from homes where the father was identified as the alcohol abuser. Kammeier noted that only the 9th and 10th grade COAs girls subgroup showed significant negative outcomes, and that the "slight trend" of COAs having adolescent adjustment problems was more evident in the girls. Jacob and Leonard (1986) noted no gender differences among the alcoholic fathers' offspring. Werner (1986) observed that the females of alcoholic fathers had better outcomes than males of alcoholic mothers. McKenna and Pickens (1983) examined 518 female and 1A11 Inale alcoholic patients regarding "the relationship between the~number of alcoholic parents and measures of personality .functioning in alcoholics" (p. 689). They considered the possibility that "... the sex of an alcoholic parent contributes to psychopathology in children, either as a main 59 effect or by interaction with the sex of the child" (p. 689). The alcoholic patients were grouped by having had no alcoholic parents, an alcoholic father, an alcoholic mother, or both parents alcoholic. Using the MMPI and variant scales, the authors found no differences between subjects of only an alcoholic mother or only alcoholic father, or any sex-of—child by sex-of—alcoholic-parent interactions. Increased levels of aggression and psychopathology in alcoholic children were associated with the number of alcoholic parents. Schuckit (198A) explored the relationship between the sex of an alcoholic parent and the course of primary alcoholism in A53 males. The subjects were categorized into four groups: I (N=1AA) had an alcoholic father, II (Na29) had an alcoholic mother, III (N=27) had two alcoholic parents, and IV (N=255) had no alcoholic parents. Information was received through interviews with the patients and up to two resource persons concerning background, drinking patterns and problems, early antisocial life patterns, and major depressive episodes. Patients with first-degree alcoholic relatives had the most early life problems and alcohol related difficulties, while those with no alcoholic parents (Group IV) the least early life and alcohol-related difficulties. The major difference between subjects of alcoholic fathers and alcoholic mothers was the tendency toward more drug misuse in sons of the alcoholic 60 mothers. The sons with two alcoholic parents had more alcoholism in their sibship, with brothers at greater risk with alcoholic fathers, but sisters were not at increased risk with alcoholic mothers. In a major study of 50A ACOAs and similar number of offspring of nonalcoholic parents, Ackerman (1987) explored ACOAs personality characteristics and examined gender differences. Responses to "the most commonly agreed upon personality characteristics found in ACOAs" (p. 2A) were compared by sex-of-child and sex-of—parent. Score results of the different personality characteristics indicate that having two alcoholic parents had greater impact for daughters than having an alcoholic father, and least impact when having an alcoholic mother. For sons, having an alcoholic mother had the greatest impact, followed by two alcoholic parents, and then by having an alcoholic father. Thus, for these ACOAs, having an alcoholic parent of the same gender had the least impact. Sons and daughters of alcoholic fathers had the same highest three personality characteristics, though to different degrees: taking oneself very seriously, judging oneself without mercy, and constantly seeking approval and affirmation. Where the Inother was the alcoholic parent, the three major concerns differed for the offspring. The daughters scored highest on: taking oneself very seriously, being extremely loyal, and overreacting to change. The sons' three major issues 61 were: constantly seeking affirmation and approval, being either super responsible or irresponsible, and having difficulty with intimate relationships. Williams (cited in Ackerman, 1987) examined the effects of the gender of the alcoholic parent on the quality of child care, the level of family stability, and the incidence of child abuse and neglect. When both parents were alcoholics quality of child care was lowest and child abuse highest. When the father was the alcoholic, mothers were able to maintain higher levels of child care and family stability, and low levels of child abuse and neglect. When mothers were the alcoholics, family stability was low and child neglect high. This indicates that the gender of the alcoholic parent can influence the family environment and the type of support the child receives. METHOD/DESIGN Sample One hundred eight subjects, aged 18 to 23 years, were recruited at Michigan State University. Students were solicited in the following three ways. 1. One professor provided extra credit for students who stayed after class to complete the questionnaire. 2. Two instructors provided class time for students to participate in a research experience with no incentive or reward. 3. Students in introductory psychology courses are required to participate in department screened and posted experiments and research projects of their choosing. Failure to attain "subject" credits results in lower course grades. Since adequate numbers of comparison subjects were available from the other classes, only men and women psychology students who felt they grew up with alcoholic fathers were asked to participate. Three students volunteered. When a $5.00 incentive was announced, 13 students presented for the next testing session. (Students from the first session were then offered $5.00.) Six men and 10 women were obtained in this manner. Class wide testing resulted in 11 men ACOAs and 1A Women ACOAs. All completed male questionnaires of the coInparison group were used. For females, 8A test packets 62 63 were completed and 33 were randomly selected for analysis. It should be noted that three of the classes were predominantly female (approximately 85%), and that male COAs and comparison subjects were at a premium. Inclusion requirements were college attendance, maximum age of 23, and for the index subjects (ACOAs) a score of 6 or more on the Children of Alcoholics Screening Test (CAST), and a positive response to CAST item number 22. The ACOAs group consisted of A1 subjects, 2A female (58.5%) and 17 males (A1.5%). Sixty-eight percent were Catholic or Protestant, with no Jewish students. Six (1A.6%) were African-Americans. The comparison group consisted of 67 students, with 33 females (A9%) and 3A males (51%). Seventy percent were Catholic and Protestant, and 10% were Jewish, with 20% responding "other". There were two (2.9%) African-Americans. The social-economic status of the students' parents was determined by the Two Factor Index of Social Position (Hollingshead, 1957). Education and occupation are each given a score value and multiplied by a factor weight to derive a social position score. The range of computed scores is divided to designate a social class with (I) being the highest, and (V) the lowest. In the comparison group, 5A% of the fathers were in the class (I) and (II), whereas in the index group, only 31% were in the upper two levels of social occupational prestige- 6A A chi-square analysis was performed to determine whether the groups differed significantly on socio- occupational prestige. The groups were found to differ significantly (p = .0009) with the comparison group having a higher overall socio-occupational prestige index. Thirty (AA.8%) of the comparison mothers had college or graduate degrees. In the Hollingshead index the 1957 housewife, as opposed to the current elevated respect for "home managers", was considered unemployed and consequently assigned the lowest level occupational status. Therefore, the social occupational prestige level for comparison mothers is somewhat higher than scored, since 5 (7.5%) of the level IV and V mothers had college or graduate degrees. For the ACOA group 11 (26.8%) 0f the mothers had college degrees, including only 1 (2.A%) level IV, and no level V mothers. Table 1 Social Occupational Prestige - Father SOCIAL CLASS INDEX COMPARISON """E """"""""" E77526 """""""" £755???" II 7 (17.0%) 18 (26.9%) III 13 (31.7%) 1A (20.9%) IV 8 (19.5%) 10 (1u.9%) V 7 (17.0%) - TOTAL. A1 (100%) 67 (100%) 65 Table 2 Social Occupational Prestige - Mother SOCIAL CLASS INDEX COMPARISON I _ A (6.0%) II 6 (1A.6%) 21 (31.3%) III 13 (31.8%) 11 (16.A%) IV 13 (31.8%) 16 (23.9%) v 9 (22.0%) 15 (22.A%) TOTAL A1 (100%) 67 (100%) The comparison students can be viewed as growing up in families with higher social-occupational prestige and the concomitant higher content of living. The mean length of marriage for index fathers and mothers was 21.3 years, and for comparison fathers and mothers 2A.5 and 25.1 years respectively. Two index and two comparison subjects indicated they were responding about their stepfathers rather than the biological fathers. While the number of divorces in the comparison group (N = A or 6%) was less than the index group (N = 12 or 29.3%), for both Broups the parental divorce rate was well below the national average for the general population and families with alcohol related problems. The fathers' alcohol use was identified in four ways: 1° Positive subject response on CAST item number 22; 2. a 66 CAST score of six or more; 3. inpatient or outpatient substance abuse treatment; and A. Alcoholics Anonymous attendance. Walled All questionnaires were completed in college classrooms. Students were given a brief explanation of the content of the study and given the opportunity to ask questions. Given the possibility that demographic or CAST items may promote personal issues for some of the ACOAs subjects, students were advised of campus and community helping resources. Once the packet was completed, the researcher was available for discussion but no students felt the need to respond to the offer. Subjects were given instructions regarding questionnaire completion, and asked to respond to the TSCS and HDL in the present. For the FES and CAST, subjects were asked to consider their family life while they still lived at home and were more intensely involved with their families, and answer accordingly. The Psychology Department requires all researchers USing its student subject pool to provide a brief instruction period regarding human subject research generally, and the specific project. This was done for PSYChology students after the questionnaires were completed. 67 William Demographics, Paternal and Subject Alcohol Use self-report questionnaires were used to collect data regarding family social-economic status, paternal and personal alcohol use history. In this study measures of the fathers' drinking patterns and history, and those designated as alcohol abusing and alcoholic, are based on the reports of the subjects. Research regarding the validity of young adults' reports of parental drinking habits indicate that students, irrespective of their misjudgments, tend to underestimate both the frequency and quantity of parental alcohol use (O'Malley, Carey, and Maisto, 1986), as well as fail to identify parental alcoholism (Thompson, Orvashel, Prusoff, and Kidd, 1982). While minimizing and underreporting parental alcohol abuse can be understood as in the service of the process of denial, other family dynamics, or ignorance of actual parental alcohol consumption, there is no recognition why subjects would overreport alcohol abuse or alcoholism. W The Children of Alcoholics Screening Test (CAST) (Jones, 1982) was used to identify the index group and to measure the students' subjective reaction to personal and familial events specifically related to parental alcohol use. This instrument is a 30 item self-report inventory 68 whose "yes" or "no" items reflect the child's interaction with parents during drinking periods, the child's psychological-emotional state, and from the child's perception identify parental alcoholism, e.g., item 22, "Did you ever think your father was an alcoholic?" The instrument was designed to identify latency age, adolescent, or adult COAS. Two to five positive responses indicate "problem drinkers - possible alcoholic," and six or more indicate an "alcoholic parent." In a sample of 215 children of clinically-diagnosed alcoholics, self-reported COAS, and controls for a validity study, 100% of the children of clinically-diagnosed alcoholics and self-reported COAS were identified with a CAST score of six or more. Following Roosa, Sandler, Gehring, Beals, and Cappo (1988), the subjects in this study designated as the index group had a score of six or more on the CAST, and answered ,positively regarding item 22, "Did you ever think your faither was an alcoholic?" The average mean CAST score for iridex males and females was 15.85, and for comparison group, .333, with only two comparison subjects responding yes to itzem 1, "Have you ever thought one of your parents had a dt‘inking problem?" For the purpose of this study, the CAST "- ..does seem to have a high content validity as a measure ‘Df‘ the child's concern or distress about his or her parent's df‘inking" (Roosa et al., 1988). 69 E .1 E . I S J (EES) The FES is one of several "social climate" scales developed by Rudolf Moos and associates, and measures the social-environmental characteristics of the family with 90 true-false items. Three dimensions of family process are measured by 10 subscales: 1. Relationship - cohesion, expressiveness, and conflict; 2. Personal growth - independence, achievement orientation, intellectual-cultural orientation, active-recreational orientation, moral-religious emphasis; 3. System maintenance - organization and control. In this study the Real Form (Form R), which measures perceptions of one's conjugal or nuclear family's actual functioning, was used. Internal consistency (Cronbach Alpha) for each of the ten FES subscales range from moderate to substantial. Test-retest reliability is reported in the acceptable range of‘ .68 to .86 for all 10 subscales. Family profile scores Stzability correlations for families tested at A and 12 flubnths apart indicate that Form R profiles are stable for The above information 1986). 131rne intervals as long as one year. "as extracted from the FES manual (Moos and Moos, R0088 and Beals (1990) have questioned the reliability and Validity of certain FES subscales (see Chapter V, p 1A8). 70 W The HDL assesses psychological and physical functioning in the social environment of adolescents of "approximate age range 12-18 years" (Moos et al., 1985). This questionnaire is based on the HDL-Adult Form, but school activity and peer interaction are examined. The Stanford University Social Ecology Laboratory was consulted regarding use of the HDL with college students up to age 23. Given the school and peer setting, and adolescent attributes of college students, the HDL was viewed as appropriate for this study. The HDL consists of six emotional and physical health related indices (self-confidence, positive mood, distressed mood, physical symptoms, medical condition, and health risk behaviors), and three indices regarding social functioning (family activities, activities with friends, and social integration in school). The youth form was developed for a research project on depressed patients. The Cronbach Alpha :for internal consistency for the health related indices I”ange from .A3 to .79 for control children, and .6A to .83 fxsr children of depressed patients. For the social fianctioning indices the alpha score ranged .59 to .62, and .E30 to .65 for controls and index scores respectively. The HDL requires subjects to respond to yes-no, or Gutman scale items. 0f the nine HDL indices, five were used 11!) this study: distressed mood, health-risk behaviors, Self-confidence, activities with friends, and social 71 integration in school. Two other items were considered, number of friends and grade point average. Therefore, the mean average HDL scores in this study are not computed on a possible total HDL score. Several studies report on HDL adult form indices (Moos, Cronkite, Billings, and Finney, 1985) but only one reports on HDL youth form indices, Billings and Moos, 1983. In an addendum to the HDL manual, Moos stated, "...the evidence gathered thus far indicates that the HDL indices generally are reasonably valid measures of the domains they purport to assess" (Moos, 1986, June, p. A). W The TSCS was designed to measure the multidimensional aspects of self-concept, a major component of the total personality and highly influential in the person's general behavior; i.e., those persons who view themselves as unworthy, undesirable, or worthless act accordingly, or <3ertainly in some arena are self-limiting. The instrument consists of 100 self-descriptive St:atements which call for five point Likert type scale responses (1 = completely false; 2 = mostly false; 3 Partly true and partly false; A = mostly true; and 5 c Ompletely true .) While there is only one response format, the clinical and research scoring and profiling form (Form C & R) used in 72 this study provides 29 scores as opposed to 1A basic scores on the counseling form. For this study the following scales were scored: 1. Self-criticism; mildly derogatory statements or "common frailities" most people would admit to when responding candidly. 2. Total score; reflects the overall level of self-esteem. 3. Family self; reflects the individual's feelings of adequacy, worth and value as a family member. A. General maladjustment; differentiates psychiatric patients from nonpatients, but not one patient group from another. 5. Personality disorder; pertains to people with basic personality defects and weakness as distinguished from psychotic states or the neurotic reactions. 6. Neurosis; identifies neurotic patients. 7. Personality integration; identifies well-adjusted, ltigh-functioning individuals from other groups of individuals. The TSCS has been used extensively in educational and s°<=ial science research. The psychometric properties regarding reliability and validity are established and rel>orted in detail in Roid and Fitts (1988). Cronbach alpha coefficients predominantly range from .70 to .87, with the 'T013a1 Scores for adolescent samples having a value of .91, 73 adults .9A, and total samples .9A (p. 65). Test-retest reliability coefficient for the Total Score was .92, and for the major scales ranged from .67 to .92 (p. 66). These instruments were selected because they tap aspects of the eco-system, family interactional perspective of this study. The FES and HDL are measures of family environment and individual functioning in several social arenas. Both instruments are a product of Rudolf H. Moos of the Social Ecology Laboratory at Stanford University. The CAST was designed to identify COAS and ACOAs. Several of the questions reflect specific familial and parent-child interactions. The TSCS provides several scales measuring psychological functioning, as well as the self-concept score and self-criticism scale, two variables frequently addressed in COA outcome literature. Design The design of this study is a 2 x 2 (Gender x Group) :factorial design with two levels of gender (male, female) and two levels of group membership (index - students with alcoholic parents; comparison - students without an 81 coholic parent). Reseanch_fixnntheses The research hypotheses that follow were developed as a r'esult of the author's interest in the main and interaction ef‘f’ects of the independent variables. While the list does 7A not exhaust all the possible hypotheses, it does represent the questions of greatest interest in this research. The hypotheses estimate the effects of sex and group membership as they influence the dependent measures. Twenty-four hypotheses were developed and are presented here: I. There will be significant differences between college students with no alcoholic parents and students with alcoholic parents, in their perceptions of the family dimensions of 1. relationships, 2. personal growth, and 3. family maintenance. H1. The comparison group will perceive their families to be significantly more cohesive than index group. H2. The comparison group will perceive their families as encouraging expressiveness to significantly greater degree than the index group. H3. The index group will perceive a significantly Eareater level of familial conflict than the comparison group. HA“ The comparison group will perceive their families 855 tolerating member independence significantly more than the index group . H The comparison group will perceive a significantly 50 greater familial achievement orientation than the index group. 75 H6. The comparison group will perceive a significantly greater familial intellectual—cultural orientation than the index group. H7. The comparison group will perceive a significantly greater familial active-recreational orientation than the index group. H8. The comparison group will perceive a significantly greater familial moral-religious emphasis than the index group. H9. The comparison group will perceive a significantly greater sense of familial organization than the index group. H10. The comparison group will perceive a significantly greater sense of familial control than the index group. II. There will be significant differences between college students with no alcoholic parents, and students with alcoholic parents on measures of self-concept. H The index group will have a significantly greater 11' nuean score on the self-criticism scale than the comparison group. H The comparison group will have a significantly 12' higher total self-concept mean score than the index group. H13. The comparison group will have Significantly hIlgher mean score on the family-self scale than the index Sl‘taup. 76 H1A' The index group will have a significantly higher general maladjustment mean score than the comparison group. H15. The index group will have a significantly higher personality disorder mean score than the comparison group. H16' The index group will have a significantly higher neurosis mean score than the comparison group. H17. The comparison group will have a significantly higher personality integration mean score than the index group. III. There will be Significant differences between college students with no alcoholic parents and students with alcoholic parents in their quality of daily life. H18’ The index group will have a Significantly higher distressed mood than the comparison group. H19. The index group will have significantly more tiealth risk behaviors than the comparison group. H20. The comparison group will have significantly liigher self-confidence than the index group. H21. The comparison group will report participating in significantly more activities with friends than the index group. H22. The comparison group will report significantly more friends than the index group. H23. The comparison group will have significantly hiSher grade point averages than the index group. H2“. The comparison group will have significantly greater mean on social interaction than the index group. 77 Analxaia Separate analyses of variance were performed across group membership and gender to determine if there were significant differences among the groups on the following variables: 1. Cohesion 2. Expressiveness 3. Conflict A. Independence 5. Achievement orientation 6. Intellectual-cultural 7. Activity-recreation 8. Moral-religious 9. Organization 0. Control 11. Self-criticism 12. Total Self-concept 13. Family-self 1A. General maladjustment 15. Personality disorder 16. Neurosis 17. Personality integration 18. Distressed mood 19. Health risk behavior 20. Self-confidence 21. Activities with friends 78 22. Number of friends 23. Grade point average 2A. Social interaction Chi-square analyses were performed on descriptive data to determine whether significant differences existed between the groups on such variables as: religion, race, socio-occupational prestige. 54mm In an effort to examine the relationship between familial variables of families with parental alcoholism and possible negative psychosocial outcomes for their children, A1 university students with parental alcoholism and 67 students without reported parental alcoholism completed self-report measures. Variables of interest directed the <3hoice of the following measures: the Family Environment .Scale, the Tennessee Self-Concept Scale, the Health and IDaily Living - Youth Form, and the Children of Alcoholics Screening Test. A 2 x 2 factorial design was used to explore the possible main and interaction effects in the variables of interest between groups of males and females and between index (ACOAs) and comparison (nonCOAs) groups. HYpotheses to be tested were concerned with group and gender differences regarding: 1. family environment; 2. self-concept and self-esteem; and 3. quality of daily 11Ving. ANOVA were conducted on the variables related to the hypotheses. RESULTS Motion The purpose of this study was to examine familial variables and individual outcomes of college students with an alcoholic parent and those students without an alcoholic parent. Specifically, the present study was concerned with the assumed negative effects of paternal alcoholism on family processes, which in turn would establish a less than Optimal developmental environment, compared with those families where parental alcoholism was not a factor. This study examined the relationships among family systems theory constructs of family processes (relationship, personal egrowth, and family maintenance), subject perceptions of effects of paternal alcoholism, subject gender, and jpsychosocial outcomes of self-concept and quality Of daily life. Hypotheses were developed to explore the possible main and interaction effects in the variables of interest between groups of males and females and between index and comparison groups. Chapter IV presents these hypotheses and reports the relevant results. All hypotheses presented in this chapter will be in the null form as well as the directional form where hypothesized. 79 80 The hypotheses were tested using the .05 level of significance. The Statistical Package for the Social Sciences X, 3.1 Edition (SPSS-X, 1980) computer programs were used to analyze the data of the study. Willis Reseanch_QnestiQn_l: There will be significant differences between college students with no alcoholic parents and students with alcoholic parents in their perceptions of the family dimensions of: 1. relationships, 2. personal growth, and 3. family maintenance. Null_fiyngthesis_l: There will be no significant difference between index and comparison groups on family cohesion. aneatignal_fllnathesis_l: The comparison group will perceive their families to be significantly more cohesive than the index group. A 2 (gender) x 2 (group) factorial analysis of variance ‘daS performed on cohesion scores. An examination of the results revealed a statistically significant main effect for waoup on cohesion: F (1,2) = A.3A7, p = .OAO (see Table 3). An tal 17878.667 107 167.090 1. P E :8? 92 Table 1A Intellectual-Cultural: Means for Gender, Group, and Gender by Group VARIABLE N Gender. Male 51 Female 57 Cineun Index A1 Comparison 67 We Male Index 17 Female Index 2A Male Comparison 3A Female Comparison 33 A9.2157 50.A912 A7.5609 51.313A A6.8235 A8.0833 50.A118 52.2A2A Null_flyngthesis_l: There will be no Significant difference between index and comparison groups on family activity-recreation orientation. Qineetienal_flxeethesis_1: The comparison group will perceive a significantly greater familial activity-recreation orientation than the index group. A 2 (gender) x 2 (group) factorial analysis of variance Fiais performed on family activity-recreation orientation Scores. An examination of the results revealed a stlatistically significant main effect for group on family aC=tivity-recreation orientation: F (1,2) = 7.9AA, p = .006 (see Table 15). An examination of cell means reveals that 93 the comparison group scores on family activity-recreatiOn orientation were significantly higher than the index group scores (see Table 16). This result indicated that students without alcoholic parents scored higher on family activity-recreation orientation than students with alcoholic parents. Therefore, the null hypothesis was rejected, and the directional hypothesis was accepted. Table 15 Analysis of Variance for Activity-Recreation (N = 108) EBBEEE'BE'mm""méEA'BE """""" AEXA”""""'EEE" VARIATION SQUARES DF SQUARE F OF F Main Effects 980.97A 2 A70.A87 A.205 .018* Group 926.619 1 926.619 7.90A .OO6** Gender 21.120 1 21.150 .181 .671 2-Way Interactions AA.603 1 AA.603 .382 .538 Group x Gender AA.603 1 AA.603 .382 .538 Explained 1025.577 3 3A1.859 2.931 .037" Residual 12130.673 10A 116.6A1 Total 13156.250 107 122.956 ‘ p < .05 ** < .01 9A Table 16 Activity-Recreation: Means for Gender, Group, and Gender by Group VARIABLE N MEANS Gender. Male 51 53.0000 Female 57 51.57AO (Imp. Index A1 A8.A39O Comparison 67 5A.5820 We Male Index 17 A9.9A12 Female Index 2A A7.3750 Male Comparison 3A 5A.529A Female Comparison 33 5A.636A Null_fllngthesis_8: There will be no significant difference between index and comparison groups on moral-religious emphasis. Qineetignal_flyngthesis_§: The comparison group will perceive a significantly greater familial moral-religious emphasis than the index group. A 2 (gender) x 2 (group) factorial analysis of variance was performed on familial moral-religious emphasis scores. An examination of the results revealed no significant main effect for group on familial moral-religious emphasis: F (1,2) = .003, p = .955 (see Table 17). An examination of 95 cell means revealed that comparison group scores on familial moral-religious emphasis were not significantly greater than index group scores (see Table 18). This result indicated that students with and without alcoholic parents do not differ significantly on familial moral—religious emphasis. Therefore, the null hypothesis is not rejected. Table 17 Analysis of Variance for Moral-Religious (N : 108) EBBEEE’BE'""""""’§6A'6E """""" AEXN """"""" 5E6" VARIATION SQUARES DF SQUARE F OF F Main Effects 87.85A 2 A3.927 .30A .739 Group .A6A 1 .A6A .002 .955 Gender 87.827 1 87.827 .607 .A38 2-Way Interactions 7A.309 1 7A.309 .51A .A75 Group x Gender 7A.309 1 7A.309 .51A .A75 Explained 162.163 3 5A.05A .37A .772 Residual 15036.837 10A 1AA.585 Total 15179.000 107 1A2.0A7 * p < .05 ** < .01 96 Table 18 Moral-Religious: Means for Gender, Group, and Gender by Group VARIABLE N MEANS Gender. Male 51 50.1178 Female 57 A8.3158 Ozone Index A1 A9.1A6A Comparison 67 A9.1791 We Male Index 17 A8.9A12 Female Index 2A A9.2917 Male Comparison 3A 50.7059 Female Comparison 33 A7.6061 Null_fl1pgtnesis_9: There will be no significant difference between index and comparison groups on family organization. Qineetienal_fiypethesis_9: The comparison group will perceive a significantly greater sense of familial organization than the index group. A 2 (gender) x 2 (group) factorial analysis of variance was performed on family organization scores. An examination of the results revealed no significant main effect for group on family organization: F (1,2) = 1.568, p = .213 (see Table 19). An examination of cell means revealed that 97 comparison group scores on family organization were not significantly greater than index group scores (see Table 20). This result indicated that students with and without alcoholic parents do not differ significantly on family organization. Therefore, the null hypothesis is not rejected. Table 19 Analysis of Variance for Organization (N : 108) ESBEEE'BE'mm""WSGA'BE """"""" {ERA """""" SE5" VARIATION SQUARES DF SQUARE F OF F Main Effects A73.533 2 236.766 1.81A .168 Group 20A.585 1 20A.585 1.568 .213 Gender 226.262 1 226.262 1.73A .191 2-Way Interactions 56.178 1 56.178 .A30 .513 Group x Gender 56.178 1 56.178 .1130~ .513 Explained 529.711 3 176.570 1.353 .261 Residual 13573.206 10A 130.512 Total 1A102.917 107 131.803 * p < .05 u p < .01 98 Table 20 Organization: Means for Gender, Group, and Gender by Group VARIABLE N MEANS Gender. Male 51 52.529A Female 57 A9.368A (Irene Index A1 A8.9268 Comparison 67 52.0AA8 We Male Index 17 49.529A Female Index 2A A8.5000 Male Comparison 3A 5A.029A Female Comparison 33 50.0000 Null_flxnethesis_lfl: There will be no significant difference between index and comparison groups on family control. Dineetienal_flxnetnesis_10: The comparison group will perceive a significantly greater sense of familial control than the index group. A 2 (gender) x 2 (group) factorial analysis of variance was performed on family control scores. An examination of the results revealed no significant main effect for group on family control: F (1,2) = 1.972, p = .163 (see Table 21). An examination of cell means revealed that comparison group scores on family control were not significantly greater than index group scores (see Table 22). 99 This result indicated that students with and without alcoholic parents do not differ significantly on family control scores. Therefore, the null hypothesis is not rejected. Table 21 Analysis of Variance for Control (N = 108) SOURCE OF SUM OF MEAN SIG VARIATION SQUARES DF SQUARE F OF F Main Effects 6A9.A92 2 32A.7A6 2.187 .117 Group 292.687 1 292.687 1.972 .163 Gender A1A.367 1 A1A.367 2.791 .098 2-Way Interactions 125.027 1 125.027 .8A2 .361 Group x Gender 125.027 1 125.027 .8A2 .361 Explained 77A.52O 3 258.173 1.739 .16A Residual 15A39.A80 10A 1A8.A57 Total 1621A.OOO 107 151.533 * p < .05 n p< .01 100 Table 22 Control: Means for Gender, Group, and Gender by Group VARIABLE N MEANS Gender. Male 51 A9.25A9 Female 57 A5.61A0 Qmun Index A1 A9.2195 Comparison 67 A6.1791 W Male Index 17 A9.882A Female Index 2A A8.7500 Male Comparison 3A A8.9A12 Female Comparison 33 A3.3333 Wm Reseanen_9nestign_2: There will be significant differences between college students with no alcoholic parents and students with alcoholic parents on measures of self-concept. Null_flyngthesis_ll: There will be no significant differences between index and comparison groups on self-criticism. Q1neetidnal_fiinethesis_113 The index group will have a significantly greater mean on self-concept than the comparison group. A 2 (gender) x 2 (group) factorial analysis of variance was performed on self-criticism scores. An examination of 101 the results revealed no significant main effect for group on self-criticism: F (1,2) : 2.20A, p : .1A1 (see Table 23). An examination of cell means revealed that index group scores on self-criticism were not significantly greater than comparison group scores (see Table 2A). This result indicated that students with and without alcoholic parents do not differ significantly on self-criticism scores. Therefore, the null hypothesis is not rejected. Table 23 Analysis of Variance for Self-Criticism (N = 108) gang’s?"“""““'ga;'a; """"""" AER; """""" sEE" VARIATION SQUARES DF SQUARE F OF F Pdain Effects 111.019 2 55.509 1.218 .300 Group 100.A22 1 100.A22 2.20A .1A1 Gender 17.192 1 17.192 .377 .5AO 2-Way Interactions 12.187 1 12.187 .267 .606 (3roup x Gender 12.187 1 12.187 .267 .606 Explained 123.205 3 A1.068 .901 .AA3 Residual A739.313 10A A5.57O Total A862.519 107 A5.AAA * p < .05 5' < .01 102 Table 2A Self-Criticism: Means for Gender, Group, and Gender by Group VARIABLE N MEANS Genden Male 51 51.6275 Female 57 50.9999 Gneun Index A1 52.A878 Comparison 67 50.5672 Wm Male Index 17 53.A706 Female Index 2A 51.7917 Male Comparison 3A 50.7059 Female Comparison 33 50.A2A2 Null_fl1ngthesis_la: There will be no significant difference between index and comparison groups on self-concept. Qineetienal_dxnethesis_la: The comparison group will have a significantly higher total self-concept score than the index group. A 2 (gender) x 2 (group) factorial analysis of variance was performed on self-concept scores. An examination of the results revealed no significant main effect for group on total self-concept: F (1,2) = 1.920, p = .169 (see Table 25). An examination of cell means revealed that comparison group scores on total self-concept were not significantly greater than index group scores (see Table 26). 103 This result indicated that students with and without ailcoholic parents do not differ significantly on total the null hypothesis is not self-concept scores . Therefore , rejected . Table 25 Analysis of Variance for Total TSCS Score (N = 108) SSBREE-65""nn'""'SGA'BE """""""" AEZN""""'"SEE" VARIATION SQUARES DF SQUARE F OF F Main Effects 219.625 2 109.812 1.101 .336 Group 191.A15 1 191.A15 1.920 .169 Gender A2.7A6 1 A2.7A6 .A29 .51A Z—Way Interactions 2.713 1 2.713 .027 .869 Gl~omp x Gender 2.713 1 2.713 .027 .869 Explained 222.338 3 7A.113 .7A3 .529 Residual 10369.292 10A 99.705 Total 10591.630 107 98.987 * < .05 it. E: :33. 10A Table 26 Total Self-Concept: Means for Gender, Group, and Gender by Group VARIABLE N MEANS Genden Male 51 A8.6079 Female 57 A9.6316 Gnome Index A1 A7.5122 Comparison 67 50.1A93 We Male Index 17 A6.529A Female Index 2A A8.2083 Male Comparison 3A A9.6A71 Female Comparison 33 50.6667 Null_flynethesis_13: There will be no significant difference between index and comparison groups on family-self. Qineetienal_flxpethesis_13: The comparison group will have a significantly greater sense of family-self than the index group. A 2 (gender) x 2 (group) factorial analysis of variance "as performed on family-self scores. An examination of the l"esults revealed no significant main effect for group on family self: r (1,2) = .125, p = .725 (see Table 27). An eXamination of cell means revealed that comparison group 105 scores on family-self were not significantly greater than :index group scores (see Table 28). This result indicated that students with and without alxcoholic parents do not differ on family-self scores. Therefore, the null hypothesis is not rejected. Table 27 Analysis of Variance for Family-Self (N = 108) SOURCE OF SUM OF MEAN SIG VARIATION SQUARES DF SQUARE F OF F Main Effects 22A.131 2 112.065 1.101 .336 Group 12.668 1 12.668 .125 .725 Gender 219.1A7 1 219.1A7 2.15A .1A5 Z-Way Interactions 29.787 1 29.787 .293 .590 Group x Gender 29.787 1 29.787 .293 .590 EXplained 253.918 3 8A.639 .832 .1479 Residual 10581.0A5 1011 101.7A1 Total 1083A.963 107 101.261 1:. :2 :8? "u! p < .001 106 Table 28 17amily-Self: Means for Gender, Group, and Gender by Group VARIABLE N MEANS Claude: Male 51 A9.0392 Female 57 51.8A21 Gmun Index A1 50.2A39 Comparison 67 50.6866 Wm Male Index 17 A7.76A7 Female Index 2A 52.0000 Male Comparison 3A A9.6765 Female Comparison 33 51.7273 Null_fiynethesis_lfl: There will be no significant difference between index and comparison groups on general maladjustment. Dineetiennl_fixnethesis_1A: The index group will have a significantly higher general maladjustment score than the comparison group. A 2 (gender) x 2 (group) factorial analysis of variance "as performed on general maladjustment scores. An ex amination of the results revealed no significant main effect for group on general maladjustment: F (1,2) = 1.553: p == .216 (see Table 29). An examination of cell means revealed that index group scores on general maladjustment “et‘e not significantly greater than comparison group scores (See Table 30). This result indicated that students with and without alcoholic parents do not differ significantly on general maladjustment. rejected. Table 29 Analysis of Variance for General Maladjustment (N = SOURCE OF VARIATION Main Effects Group Gender Z—Way Interactions Group x Gender Explained Residual TOtal g. p < .05 T. p < .01 p < .001 Therefore, SUM OF SQUARES 197.A3A 159.258 53.176 115.565 115.565 312.999 10665.630 10978.630 DF 2 1 3 10A 107 MEAN SQUARE 98.717 159.258 53.176 115.565 115.565 10A.333 102.55A 102.60A the null hypothesis is not 108) SIG F OF F .963 .385 1.553 .216 .519 .A73 1.127 .291 1.127 .291 1.017 .388 108 Table 30 (Seneral Maladjustment: Means for Gender, Group, and Gender by Group VARIABLE N MEANS Genden Male 51 53.980A Female 57 52.7895 0.2mm. Index A1 5A.8293 Comparison 67 52.AA78 We Male Index 17 57.2353 Female Index 2A 53.1250 Male Comparison 3A 52.3529 Female Comparison 33 52.5A55 Null_fllpgthesis_15: There will be no significant difference between index and comparison groups on personality disorder. Qinestienal_flxndthesis_15: The index group will have a significantly higher personality disorder score than the comparison group. A 2 (gender) x 2 (group) factorial analysis of variance "as performed on personality disorder scores. An ex amination of the results revealed a statistically $1Enificant main effect for group personality disorder: F (1 :2) = 5.38A, p = .022 (see Table 31). An examination of 109 cell means revealed that index group scores on personality disorder were significantly higher than comparison group scores (see Table 32). This result indicated that students with alcoholic parents scored higher on personality disorder than students without alcoholic parents. Therefore, the null hypothesis was rejected and the directional hypothesis was accepted. Table 31 Analysis of Variance for Personality Disorder (N = 108) SOURCE OF SUM OF MEAN SIG VARIATION SQUARES DF SQUARE F OF F Main Effects 659.AO9 2 329.705 3.208 .0AA* Group 553.A03 1 553.A03 5.38A .022* Gender 153.18A 1 153.18A 1.A9O .225 2-Way Interactions 15.763 1 15.763 .153 .696 Group x Gender 15.763 1 15.763 .153 .696 Explained 675.172 3 225.057 2.190 .O9A Residual 10689.7AA 10A 102.786 Total 1136A.917 107 106.21A * p < .05 110 Table 32 Personality Disorder: Means for Gender, Group, and Gender by Group VARIABLE N MEANS Gender. Male 51 53.3529 Female 57 51.3685 Genny. Index A1 55.0732 Comparison 67 50.6120 Qandenny—Qmun Male Index 17 57.0588 Female Index 2A 53.6667 Male Comparison 3A 51.5000 Female Comparison 33 A9.6970 Null_fl1pothesis_16; There will be no significant difference between index and comparison groups on neurosis. Qineetienal_flypgthe§1s_lfi: The index group will have a significantly higher neurosis score than the comparison group. A 2 (gender) x 2 (group) factorial analysis of variance was performed on neurosis scores. An examination of the results revealed no significant main effect for group on neurosis: F (1,2) = 3.605, p = .060 (see Table 33). An examination of cell means revealed that index group scores 111 on neurosis were not significantly greater than comparison group scores (see Table 3A). This result indicated that students with and without alcoholic parents do not differ significantly on neurosis scores. Therefore, the null hypothesis is not rejected. Table 33 Analysis of Variance for Neurosis (N : 108) SOURCE OF SUM OF MEAN SIG VARIATION SQUARES DF SQUARE F OF F Main Effects A6A.393 2 232.196 2.189 .117 Group 382.32A 1 382.32A 3.605 .060 Gender 52.675 1 52.675 .A97 .A83 2-Way Interactions A.199 1 A.199 .OAO .8A3 (3roup x Gender A.199 1 A.199 .0A0 .8A3 Explained A68.592 3 156.197 1.A73 .226 Residual 11029.A08 10A 106.052 'Total 11A98.000 107 107.A58 " < .05 112 Table 3A Neurosis: Means for Gender, Group, and Gender by Group VARIABLE N MEANS Genden Male 51 52.A118 Female 57 53.9999 Gentle Index A1 55.6098 Comparison 67 51.8059 GendeLnLCLnun Male Index 17 5A.7059 Female Index 2A 56.6250 Male Comparison 3A 51.26A7 Female Comparison 33 52.3636 Null_flypgthesis_ll: There will be no significant difference between index and comparison groups on personality integration. Qineetidnal_fl£ndthesi§_ll: The comparison group will have a significantly higher personality integration mean than the index group. A 2 (gender) x 2 (group) factorial analysis of variance was performed on personality integration scores. An examination of the results revealed no significant main effect for group on personality integration: F (1,2) = .A53, p = .502 (see Table 35). An examination of cell means revealed that the comparison group scores on personality 113 integration were not significantly greater than index group scores (see Table 36). This result indicated that students with and without alcoholic parents do not differ significantly on personality integration. Therefore, the null hypothesis is not rejected. Table 35 Analysis of Variance for Personality Integration (N = 108) £6068E'6E""m""”6676? """""" AEX§"""""'§IE" VARIATION SQUARES DF SQUARE F OF F Main Effects 117.197 2 58.598 .618 .5A1 Group A2.983 1 A2.983 .A53 .502 Gender 8A.111 1 8A.111 .887 .3A9 2-Way Interactions 35.AAO 1 35.AAO .37A .5A2 Group x Gender 35.AAO 1 35.AAO .37A .5A2 Explained 152.637 3 50.879 .536 .658 Residual 986A.576 10A 9A.852 Total 10017.213 107 93.619 * p < .05 H p < .01 11A Table 36 Personality Integration: Means for Gender, Group, and Gender by Group VARIABLE N MEANS Gender. Male 51 A9.3922 Female 57 51.0526 QLQJLD. Index . A1 A9.5610 Comparison 67 50.7015 GendeLbLGnenn Male Index 17 A7.6A71 Female Index 2A 50.9167 Male Comparison 3A 50.26A7 Female Comparison 33 51.1515 H III I D i] I' . S J N . l] Reseaneh_9nestien_3: There will be significant differences between college students with alcoholic parents and students without alcoholic parents in their quality of daily life. Null_fllngtnesis_18: There will be no significant difference between index and comparison groups on distressed mood. Qineetienal_flxnethesis_18: The index group will have a significantly higher distressed mood than the comparison group. A 2 (gender) x 2 (group) factorial analysis of variance Teas performed on distressed mood scores. An examination of 115 the results revealed no statistically significant main effect for group on distressed mood: F (1,2) = .002, p = .963 (see Table 37). An examination of cell means reveals that index group scores on distressed mood were not significantly greater than comparison group scores (see Table 38). This result indicated that students with and without alcoholic parents do not differ Significantly on distressed mood scores. Therefore, the null hypothesis is not rejected. Table 37 Analysis of Variance for Distressed Mood (N : 108) SOURCE OF SUM OF MEAN SIG VARIATION SQUARES DF SQUARE F OF F Main Effects 60.628 2 30.31A 2.75A .068 Group .02A 1 .02A .002 .963 Gender 59.896 1 59.896 5.AA2 .022* 2-Way Interactions 2.990 1 2.990 .272 .603 Group x Gender 2.990 1 2.990 .272 .603 Explained 63.617 3 21.206 1.927 .130 Residual 11AA.568 10A 11.005 Total 1208.185 107 11.291 5 < .05 ** < .01 116 Table 38 Distressed Mood: Means for Gender, Group, and Gender by Group VARIABLE N MEANS Genden Male 51 807256 Female 57 10.5790 Oman Index A1 9.9756 Comparison 67 9.8060 GendenJLGLeun Male Index 17 9.3529 Female Index 2A 10.A167 Male Comparison 3A 8.9A12 Female Comparison 33 10.6970 Null_flxpgthesis_19: There will be no significant difference between index and comparison groups on health risk behaviors. Dineetienal.flxnethesis_19: The index group will have significantly more health risk behavior than the comparison group. A 2 (gender) x 2 (group) factorial analysis of variance was performed on health risk behavior scores. An examination of the results revealed no Significant main effect for group on health risk behavior: F (1,2) = .078: p = .780 (see Table 39). An examination of cell means h d 117 revealed that index group scores on health risk behavior were not significantly greater than comparison group scores (see Table A0). This result indicated that students with and without alcoholic parents do not differ significantly on health risk behavior. Therefore, the null hypothesis is not rejected. Table 39 Analysis of Variance for Health Risk Behavior (N : 108) SOURCE OF SUM OF MEAN SIG VARIATION SQUARES DF SQUARE F OF F Main Effects .919 2 .A59 .061 .9A1 Group .590 1 .590 .078 .780 Gender .251 1 .251 .033 .856 2-Way Interactions 9.252 1 9.252 1.226 .271 Group x Gender 9.252 1 9.252 1.226 .271 Explained 10.171 3 3.390 .AA9 .718 Residual 78A.820 10A 7.5A6 Total 79A.991 107 7.A3O * < .05 *9 < .01 “E .. K.) Va the Se]; 118 Table A0 Health Risk Behavior: Means for Gender, Group, and Gender by Group VARIABLE N MEANS Genden Male 51 A.A510 Female 57 A.561A Gmun Index A1 A.6097 Comparison 67 A.AA78 W Male Index 17 5.0000 Female Index 2A A.3333 Male Comparison 3A A.1765 Female Comparison 33 A-7273 Null_flxngthesis_20: There will be no significant difference between index and comparison groups on self-confidence. Qineetienal_flynethesi§_20: The comparison group will have significantly higher self-confidence than the index group. A 2 (gender) x 2 (group) factorial analysis of variance was performed on self-confidence scores. An examination of the results revealed no significant main effect for group on self-confidence: F (1,2) = .68A, p = .A10 (see Table A1). An examination of cell means revealed that the comparison 119 group scores on self-confidence were not significantly greater than the index group scores (see Table A2). This result indicated that students with and without alcoholic parents do not differ significantly on self-confidence scores. Therefore, the null hypothesis is not rejected. Table A1 Analysis of Variance for Self-Confidence (N = 108) SOURCE OF SUM OF MEAN SIG VARIATION SQUARES DF SQUARE F OF F Main Effects 5.A05 2 2.702 .3A3 .710 Group 5.379 1 5.379 .68A .A10 Gender .002 1 .002 .000 .986 2-Way Interactions 9.998 1 9.998 1.271 .262 Group x Gender 9.998 1 9.998 1.271 .262 Explained 15.A03 3 5.13A .653 .583 Residual 818.26A 10A 7.868 Total 833.667 107 7.791 * < .05 ** < .01 120 Table A2 Self-Confidence: Means for Gender, Group, and Gender by Group VARIABLE N MEANS Gender. Male 51 13.9608 Female 57 13.9298 Gneud Index . A1 13.6585 Comparison 67 1A.119A W Male Index 17 1A.1176 Female Index 2A 13.3333 Male Comparison 3A 13.882A Female Comparison 33 1A.3636 Null_flyngthesis_al: There will be no significant difference between index and comparison groups on activities with friends. nineetienal_flxnetneeis_21: The comparison group will report participating in significantly more activities with friends than the index group. A 2 (gender) x 2 (group) factorial analysis of variance was performed on activities with friends scores. An examination of the results revealed no significant main effect for group on activities with friends: F (1,2) = .698, p = .A05 (see Table A3). An examination of cell means 121 revealed that comparison group scores on activities with friends were not significantly greater than the index group (see Table AA). This result indicated that students with and without alcoholic parents do not differ significantly on activities Therefore, with friends scores. the null hypothesis is not rejected. Table A3 Analysis of Variance for Activities with Friends (N = 108) ESEEEE'BE'm'"""WEBA'BE """""" REAR """""" 6E0" VARIATION SQUARES DF SQUARE F OF F Main Effects 5.602 2 2.801 .670 .51A Group 2.917 1 2.917 .698 .A05 Gender 3.189 1 3.189 .763 .38A 2-Way Interactions 2.75A 1 2.75A .659 .A19 Group x Gender 2.75A 1 2.75A .659 .A19 Explained 8.355 3 2.785 .666 .575 Residual A3A.6A5 10A A.179 Total AA3.000 107 A.1AO * p < .05 n p < .01 122 Table AA Activities with Friends: Means for Gender, Group, and Gender by Group VARIABLE N MEANS Gender. Male 51 6.0000 Female 57 6.3158 0.29119. Index A1 5.9756 Comparison 67 6.2836 W12. Male Index 17 5.5294 Female Index 2A 6.2917 Male Comparison 3A 6.2353 Female Comparison 33 6.3333 Null_fl1nnthesis_22: There will be no significant difference between index and comparison groups on number of friends. Qineetienal_flxndthesis_22: The comparison group will report significantly more friends than the index group. A 2 (gender) x 2 (group) factorial analysis of variance was performed on number of friends scores. An examination of the results revealed no significant main effect for group on mean number of friends: F (1,2) = .175, p = .677 (see Table A5). An examination of cell means revealed that comparison group mean scores on number of friends were not 123 significantly greater than the index group mean scores (see Table A6). This result indicated that students with and without alcoholic parents do not differ significantly on mean number of friends. Therefore, the null hypothesis is not rejected. Table A5 Analysis of Variance for Number of Friends (N = 108) SOURCE OF SUM OF MEAN SIG VARIATION SQUARES DF SQUARE F OF F Main Effects .369 2 .185 .366 .69A Group .088 1 .088 .175 .677 Gender .308 1 .308 .611 .A36 2-Way Interactions 3.A8A 1 3.A8A 6.915 .O10** Group x Gender 3.A8A 1 3.A8A 6.915 .010** Explained 3.853 10A 1.28A 2.5A9 .060 Residual 56.250 107 .526 Total * .05 12A Table A6 Number of Friends: Means for Gender, Group, and Gender by Group VARIABLE N MEANS Genden Male 51 3.1961 Female 57 3.2982 (‘21:an Index A1 3.2915 Comparison 67 3.2686 GendeLnLdmun Male Index 17 2.882A Female Index 2A 3.A583 Male Comparison 3A 3.3529 Female Comparison 33 3.1818 Null_fllngthesis_23: There will be no significant difference between index and comparison groups on grade point average. Qizeetienal_flxnethesis_23: The comparison group will have a significantly higher mean grade point average than the index group. A 2 (gender) x 2 (group) factorial analysis of variance was performed on grade point average. An examination of the results revealed a statistically significant main effect for group on grade point average: F (1,2) = A.O97, p = .0A6 (see Table A7). An examination of cell means revealed that 125 index group's grade point averages were significantly higher than the comparison group (see Table A8). This result indicated that students with alcoholic parents reported higher grade point averages than students without alcoholic parents. Therefore, the null hypothesis was rejected. Table A7 Analysis of Variance for Grade Point Average (N = 108) SOURCE OF SUM OF MEAN SIG VARIATION SQUARES DF SQUARE F OF F Main Effects 2.283 2 1.1A1 2.258 .110 Group 2.071 1 2.071‘ A.O97 .0A6* Gender .3A6 1 .3A6 .685 .A10 2-Way Interactions .001 1 .001 .002 .961 Group x Gender .001 1 .001 .002 .961 Explained 2.28A 3 .761 1.506 .217 Residual 52.568 10A .505 Total 5A.852 107 .513 9 < .05 ** < .01 126 Table A8 Grade Point Average: Means for Gender, Group, and Gender by Group VARIABLE N MEANS Gender. Male 51 2.2A56 Female 57 2.A210 QLQHD. Index A1 2.63A1 Comparison 67 2.3582 GendeLeLGmun Male Index 17 2.7059 Female Index 2A 2.5833 Male Comparison 3A 2.A118 Female Comparison 33 2.3030 Null_flypgthesis_2&: There will be no significant difference between index and comparison groups on social interaction. Dineetienal_dxnetnesie_23; The comparison group will have a significantly greater mean on social interaction than the index group. A 2 (gender) x 2 (group) factorial analysis of variance was performed on social interaction scores. An examination of the results revealed no significant main effect for group on social interaction: F (1,2) = .003, p = .960 (see Table A9). An examination of cell means revealed that 127 comparison group scores on social interaction were not significantly greater than index group scores (see Table 50). This result indicated that students with and without alcoholic parents do not differ significantly on social Therefore, the null hypothesis was not interaction. rejected. Table A9 Analysis of Variance for Social Interaction (N : 108) SSBEEE'BE'W'""nu-sin??? """""" ALEXA """""" SEE" VARIATION SQUARES DF SQUARE F OF F Main Effects 2.961 2 1.A8O .535 .587 Group .007 1 .007 .003 .960 Gender 2.956 1 2.956 1.069 .30A 2-Way Interactions 2.327 1 2.327 .8A1 .361 Group x Gender 2.327 1 2.327 .8A1 .361 Explained 5.287 3 1.762 .637 .593 Residual 287.629 10A 2.766 Total 292.917 107 2.738 * p < .05 *' < .01 128 Table 50 Social Interaction: Means for Gender, Group and Gender by Group VARIABLE N MEANS Gender. Male 51 1.7255 Female 57 2.7897 Grelm Index A1 2.5365 Comparison 67 2.6122 We Male Index 17 2.1176 Female Index 2A 2.8333 Male Comparison 3A 2.A706 Female Comparison 33 2.5758 unhanLbesized_Re§nlts I. Regarding the Fathers' Alcohol Use a. In response to the question, "How would you describe your father's alcohol use?", 23.8% of the comparison group responded abstaining, and 76.1% responded social drinker. In the index group two fathers were reported to be abstaining, four as recovering, and two as social drinkers. Index subjects reported 26.8% of the fathers were heavy drinkers, 12% were problem drinkers, and 39% were alcoholic. One subject described his father as a drunkard. 129 Table 51 Subjects' Description of Fathers' Alcohol Use INDEX COMPARISON Abstaining 2 (A.9%) 16 (23.9%) Social Drinker 2 (A.9%) 51 (76.1%) Heavy Drinker 11 (26.9%) - Problem Drinker 5 (12.2%) - Alcoholic 16 (39.0%) - Drunkard 1 (2.A%) - Recovering A (9.8%) - TOTAL A1 (100%) 67 (100%) b. Has your father ever attended Alcoholics Anonymous meetings? For the comparison group, three students responded in the affirmative, with one of the fathers attending currently. For the index group, eight have attended Alcoholics Anonymous meetings, three currently. However, 33 (80%) to the best of the respondents' knowledge, had never attended Alcoholics Anonymous meetings. c. Has your father ever been treated for alcoholism? The comparison group reported no treatment for their fathers, while the index group reported five inpatient and one outpatient treatment episode. the '1 P.h a» AAu Whe cor. the Ero 810 to g not 130 d. How old were you when your father's drinking caused the most family problems? In the comparison group, one subject indicated family problems due to father's drinking at his age 6-10 years old. In the index group, five reported family problems at their age of less than 5 years old, ten at 6-10 years old, 11 at 11-15 years old, 11 at 16 to current age, and four reported not applicable. II. Subjects' Substance Use History a. On the average, how often do you drink any kind of alcoholic beverage during a typical month? (See Table 56.) The groups reported rather similar drinking patterns, with 15% of the comparison group rarely, to one time per month, and 57% 1-2 times a week to nearly every day. For the index group 30% drank rarely or one time per month, and 58% drank 2-3 times per month to nearly every day. For the 2-3 times per month, 12% of the index responded and 28% of the comparison group. b. When you do drink any kind of alcoholic beverage, what was the average quantity you consumed; that is you consumed this amount nearly every time, or more than half the time you drank? (See Table 57.) The quantity of alcohol consumed patterns by the two groups was almost identical, except that 1A.6% of the index group consumed 7 to 10 or more drinks per session as opposed to 5.9% of the comparison group who drank 7-8 drinks per session, and none above that. () (f) 131 0. Have you ever been treated for substance abuse? One of the comparison group reported currently being in outpatient treatment, as did one of the index group. One other index subject reported having had inpatient treatment. d. Have you ever attended Alanon or Al-Ateen? Four female and one male index subject indicated participating in these support groups. None of the comparison group subjects used either self-help group. III. Index Subjects' Substance Abuse Treatment, and Sibs Substance Abuse and Treatment Six female index subjects reported seven sibs as having substance abuse problems, while three male subjects reported five such Sibs. Nine index subjects or 21.9% indicated familial substance abuse problems other than their father. However, only one (2.A%) actually received any kind of treatment. Only two index males, or A.8% of the index group, reported receiving substance abuse treatment. IV. Index Subjects' Responses to CAST Items 7, 9, and 31A, 310 (indicative of alcoholic parental abusive behavior) In response to CAST item 7, "Has a parent ever yelled at or hit you or other family members when drinking?", 17 females and ten males (65.8% of total index subjects) responded in the affirmative. In reSponse‘to CAST item 9, "Did you ever protect another family member from a parent who was drinking?", 12 females and 8 males (A8.7% of the index sample) responded in the affirmative. Four females 132 and ten males (3A.1% of the index group) indicated that the fathers became "mean, yelling and nasty" when drinking. Seventeen index subjects (15 females and 2 males) or A1.5% indicated their fathers were physically abuse when drinking, i.e., "slaps or hits and would not when not drinking," or for reasons not understood by the subject. 133 Table 52 Subject Birth Order, Substance Abuse Treatment, Sibs' Substance Abuse Treatment Female Index Subjects (N : 2A) 66 67 68 69 7O 71 72 73 7A \1 \O UlUJWN—IN—bN-AUUUTUJN-S-elr—l—t—e—AWNN—I mwwmawmmmwmwwmmzmmmmmmmm IIIIIIIIIIIIIIIIIIIIIIII O\ A 5.1. O‘ U} V —l A .C’ ‘6‘ V 0 TOTALS AK}Nllllllll-‘l—‘llllllllI—‘AA Table 53 Subject Birth Order, Substance Abuse Treatment, Sibs' Substance Abuse Treatment Male Index Subjects (N = 17) l—ellll I I llll KO \0 mmm-‘mN-J—hw-JN—A—JNAAJ NWN-‘kflNNNW—‘NNKWNNW TOTALS 3 (5 Sibs) 0 2 (17.6%) (11.7%) INDEX TOTALS 9 (21.9%) 1 2 (2.A%) (A.8%) 135 Table 5A Responses to CAST Items 7, 9, and 31A and 310 Female Index Subjects (N = 2A) ll‘.70) in three of the four family types, and for alcoholic families the coefficient was .72. The comparison 151 group in this study indicated higher levels of family cohesion than the index group. The cohesion subscale reliability coefficients ranged from .53 to .63 with a reliability coefficient of .58 for alcoholic and .63 for control families. Thus, for all intents and purposes, this study has validated previous research results on alcoholic families using the FES with regard to findings of higher levels of conflict for these families. At this time, the cohesion subscale is of more questionable validity. I 1' I. E I I I. I I | I The implications for intervention and treatment for COAS is fairly clear. Repeated reports of positive outcomes in the presence of parental alcoholism indicates that for low risk individuals educative intervention in the early years, with perhaps the availability of support groups such as Al-Anon or Alateen, could offset the negative aspects of growing up in an alcoholic family. Because of the current inability to identify low or high risk individuals, and reports that problems for COAS may not manifest until young adulthood or later, the evidence of positive outcome should not lead to the conclusion that interventions and treatments are not necessary. Williams (1990) presents a range of interventions based on the current knowledge of COAS and ACOAS through their life cycle. Primary prevention programs that are community based and in school settings should be geared to inform and 152 educate, as well as identify low and high risk youngsters. As all students learn about alcohol and other substances, specific information tracks and interventions should be available for COAS. Intervention programs consist of Al-Anon, Alateen, and ACOAS groups, and are designed to help counter co—dependency and enabling behaviors, and offset guilt and self-blame. Cutter and Cutter (1987) found that members of an observed ACOAS group reported less depression and more assertiveness, greater acceptance of self and of feelings, and decreased feelings of responsibility. The authors state that, "A common experience of parental alcoholism, and cognitive, affective, and behavioral antidotes to prior socialization in an alcoholic family contributed to the program's perceived helpfulness" (p. 29). Continuing with Williams (1990), her recommendations for treatment include incorporating the stages of alcoholic family development as described by Steinglass (1987). When families present for treatment, consideration should be given to whether or not the parents are ACOAS, and the status and risk for the current COAS in the context of the following stages: 1. Early phase, familial identity- formation regarding alcohol; 2. Middle phase, consolidation of alcoholic family identity, and 3. Late phase, family heritage transmission. 153 Several authors have reported that overt problematic behaviors are not typical for COAS (Black, 1981), and that problems may not manifest until adult life (Black, 1981, Jacobs and Leonard, 1986, and Moos and Billings, 1982). Gravitz and Bowden (198A) indicate that clinicians most often are unable to diagnose and deal with ACOAS issues, which are often masked by depression and/or anxiety. Wolkind's (1987) report that 55% of people presenting for Employee Assistance Program (EAP) services are ACOAS speaks to a nonclinical arena wherein ACOAS present with life-long difficulties. While EAP'S do deal with acute psychiatric and substance abuse problems, much of the presenting problems for the general employee population and ACOAS have to do with marital and relationship issues, work Site problems, and career issues. However, the ACOAS are differentiated by their self-critical stance, tendency to workaholism, problems with intimacy with spouses and children, self-confidence in regard to peers and managers, and either an inability to enjoy their level of achievement, or an obsessive drive to achieve senior management positions in an unrealistic time frame. If the adult child of an alcoholic is unique in the sibship and is working at a higher occupational prestige level than the parents or sibs, there is often guilt and confusion about their relationship with their family of origin. (These are personal observations from five years of EAP work, and see Kelly and 15A Friel, 1987, Woititz, 1987.) Ackerman's (1987) report that 78.2% of surveyed ACOAS (N = 50A) felt their lives were "highly affected" by parental alcoholism, coupled with above cited factors, speaks to the need for specific treatment interventions for ACOAS. I 1' I. E B I Specific to this study, this ACOAS college student sample must be recognized for their exceptional qualities. The average age for the females was 20 years and for the males, 21 years, indicative of their upper class status. Not only did these students manage to avoid failing, or otherwise dropping out in the freshman or sophmore years, they are achieving higher grades than the comparison students. There were no significant differences between the two sample groups regarding activities with friends, number of friends, and social interaction. The ACOAS were not exceptional on measures of distressed mood, neurosis, or general maladjustment. Finally, contrary to the clinical literature on ACOAS, this cohort was not significantly different regarding self-confidence and self-esteem, or a self-critical stance. Clearly, there were protective factors for these ACOAS during their earlier developmental years. Understanding factors which mediate positive outcomes necessitates further research. Beyond the scope of this study, there appears to be two major implications for future research. First, the study of 155 psychosocial outcomes for COAS could serve as a research paradigm for the human sciences. Windle and Searles (1990) highlight the themes and variables involved in COAS research. They call for a biopsychosocial model to aid in understanding which individuals are at low or high risk for alcoholism, examining the genetic and environmental interactions, and recognizing the endowed temperament which influences how the individual will mediate their environment. Which psychological variables, familial and nonshared environments that act as risk factors and contribute to alcoholism and other problematic psychosocial outcomes can be identified? From a health promotion perspective, what are the positive characteristics in these variables, and how may they serve as "protective" factors. Continued typological research would identify discrete subtypes regarding etiology and pathways to alcohol abuse and alcoholism, and in turn generate specific preventative interventions and treatments. A biopsychosocial focus which contained Steinglass's (1987) Family Life History model, coupled with a multidisciplinary life-span developmental perspective (Baltes and Schaie, 1973) could incorporate discrete research findings and contribute to a more unified theoretical position, one that is currently lacking. Windle and Searles (1990) indicate this type of research activity requires the use of multivariate statistical models, which would "facilitate the study of time-ordered structural 156 relations between multiple causes and multiple effects" (p. 229). Zucker and Gomberg (1986) specify a biopsychosocial perspective for understanding etiological aspects of alcoholism, i.e., "a longitudinal-develOpmental framework that includes physiological, behavioral and sociocultural variables" (p. 783). Such an approach allows for a broader approach than simply asking, "Is alcoholism inherited?" (p. 790). The authors advocate examining causal pathways rather than simple time-lagged associations; precipitating influences at different developmental stages in the life cycle; differing levels of heritability and modes of transmission; Specific types of alcoholism; and also exploring how alcoholism does net develop. These types of questions are particularly important in consideration of propensity to alcoholism for COAS because of the variable outcomes for these offspring, concomitant to their reported greater risk than the general population. Zucker (1987, cited in Windle, 1990) has identified four alcoholic types based on current research: 1. antisocial alcoholism, where alcohol abuse is part of a personality and behavioral profile; 2. developmentally cumulative alcoholism, representing continuous abusive drinking since adolescence; 3. developmentally limited alcoholism, wherein early adulthood heavy drinking is reduced as adulthood responsibilities are assumed; and 157 A. negative affect alcoholism, associated with family history of unipolar affect disorder. The explicit recognition of multiple etiological pathways to alcoholism allows for the examination of "...commonalities and differences in alternative developmental pathways to alcoholism. [and the possibility of more specifically identifying] the ways in which risk factors, for example being the child of an alcoholic, are expressed and modified by personality attributes and a range of life conditions" (Windle, p. 156). Second, and more specifically, given the biopsychosocial perspective, it follows that whenever ' possible entire sibships should be investigated. With this approach Specific and cumulative trends and anomalies would be better understood as more of the biological and environmental variables would be more consistent for each sibship being investigated. This study raises curious sibship findings. For example, one index subject from a sibship of five, with a high CAST score, and with affirmative responses to the CAST items regarding family violence, reported no substance abuse or treatment among the sibs or for herself. However, another index subject with three sibs and a lower CAST score reported the entire sibship as chemically abusing, and the subject as having had chemical dependency treatment. It is these differences in pathways to and away from alcoholism, 158 and other psychosocial outcomes that could be better understood if the entire sibship would be studied. Zucker and Gromberg (1986) identify explicit and implicit factors which pertain to familial aspects of intergenerational transmission of alcoholism. First, they relate that ethnicity indicates more than norms about parent and child alcohol use. Ethnic differences "...also mark a wide range of individual and interpersonal differences in educational and occupational aspiration, cohesiveness of kinship networks, and cultural values about sexuality, marriage, and other elements of socialized behaviors" (p. 789). This approach to ethnicity reflects an ecosystemic perspective. Second, Zucker and Gromberg (1986) state that "current peer influences on etiology has been insufficiently examined", and "its influence in triggering and maintaining abusive drinking patterns needs to be more thoroughly investigated" (p. 790). This line of research can be extended to the family. While the work of Steinglass and others have resulted in insight regarding the "alcoholic family", there needs to be investigation of the "drinking family", wherein the entire family participates in family rituals by consuming and abusing alcohol. How does such a familial environment transcend individual differences and render the entire kinship as "alcoholic"? In "drinking families", irrespective of the variation in genetic 159 endowment, the entire sibship abuses and/or is dependent on alcohol. Currently, most research uses individual subjects from families. The use of entire sibships, as for example in COA studies, would more readily meet the goals of a biopsycho- social paradigm, as well as being consistent with the family ecosystem model. 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B. (1957). W position. New Haven, CT. Jackson, D. D. (1977). The study of the family. In P. Watzlawick and J. H. Weakland (Eds. ), Ihe_1njenagtional 11:1,(pp. 2- 20L New York: W. W. Norton. (Reprinted from Eamily Process, 1965, A, 1-20. Jackson, J. (1954L The adjustment of the family to the crisis of alcoholism. AlQQthiim. 15 (A): 552-586- Jacob, T. and Leonard, K. (1986L Psychosocial functioning in children of alcoholic fathers, depressed fathers and control fathers. WW1. £11 (5), 373- 380. Johnson, J. L. and Rolf, J. E. (1990). When children change: Research perspectives on children of alcoholics. In R. L. Collins, K. E.Leonard and J. S. Searles (Eds.), AlQQhQL_an1_Lhfi_£amill (PP. 162‘193)- New York: Guilford Press. Jones, J. w. (1982). W lean. Chicago: Family Recovery Press. Kammeier, M. L. (1971). Adolescents from families with and without alcoholism. ‘ Alum. 32. 3611-372. Kantor, D. and Lehr, W. (1975). Inside_the_£amil1- San Francisco: Jossey-Bass. Kellog, T. and Friel, J. (1987). Adult children of alcoholics meet employee assistance programs. Eggua, 1.0. (3). pp- 22. 23. 29. 35- Kritsberg, W. (198“). Chronic schock and emotional dumbness in adult children of alcoholics. Eggns, 1 (6), pp. 2", 25, no. 163 Lewis, J. M., Beavers, R. W., Gossett, J. T. and Phillips, v. A. (1976). Ng_§inglg_thngafl. New York: Brunner/Mazel. Lidz, 1., Cornelison, A., et al. (1957). The intrafamilial environment of the schizophrenic patient: II. Marital schism and marital skew. Amenigan_ignnnal_gfi Esxchiatnl. 11.. 281- 288 McKenna, T. and Pickens, R. (1983L Personality characteristics of alcoholic children of alcoholics. W ”A. 688- 700. Midanik, L. (1983L Familial alcoholism and problem drinking in a national drinking practices survey. Won: 8 133-181- Millon, T. (1981). Disorders of personality. New York: Wiley-Interscience. Minuchin. s. (1974)- Eam1111:.and_£am111_1henan1- Boston: Harvard University Press, in D. H. Olson, 1979, op cit. Moos, R. H. (1986, June). Health and gaj1y Jjgjng form WWW Palo Alto, CA: Stanford University. Moos, R. H. and Billings, A. (1982). Children of alcoholics during the recovery process: Alcoholic and matched control families. AQQ19L11g_Bgnaligns, 1, 155-163. Moos, R. H., Bromet, E., Tsu, V. and Moos, B. (1979). Family characteristics and the outcome of treatment for alcoholism. WWW $1.0. 78- 88 Moos, R. H., Cronkite, R. C., Billings, A. G. and Finney, J. w. (1985). HealLh_and_da111_1111n2_£nzm_manual- Palo Alto, CA: Stanford, University. Moos, R. H., Finney, J. W. and Chan, D. A. (1981). The process of recovery from alcoholism. I. Comparing alcoholic patients and matched community controls. lanLnal_o£_Stndiss_cn_Alconnl. AZ. 383- “02. Moos, R. H., Finney, J. W. and Gamble, W. (1982). The process of recovery from alcoholism. II. Comparing spouses of alcoholic patients and matched community controls. lcnLnal_o£_fitudies_on_Alcahol 53. 888-909 Moos, R. H. and Moos, B. S. (1976). A typology of family social environment. Eam111_flngggas, 15, 357-372- 16A Moos, R. H. and Moos, B. S. (1984). The process of recovery from alcoholism. III. Comparing functioning in families of alcoholics and matched control families. Journal Qf Studies 9n Angth, _5, 111-118. Moos, R. H. and Moos, B. S. (1986). Eamill_enlingnm£nl. scals_manual (2nd ed.). Palo Alto, CA: Consulting Psychologists Press. Nace. E. P. (1987). Wm. New York: Brunner/Mazel. O'Brien, R. and Chafetz, M. (1982). Ihg_gngyglgpedia_gfl algghglism. New York: Facts on File Publications. Olson, D. H., Sprenkle, D. H. and Russell, C. S. (1979). Circumplex model of marital and family systems: I. Cohesion and adaptability dimensions, family types, and clinical applications. Eamily Process, 18, 3-28. O'Mailly, S. 8., Carey, K. B. and Maisto, S. A. (1986L Validity of young adults' reports of parental drinking practices. www.1m. 133-135. Parker, D. A. and Harford, T. C. (1988). Alcohol-related problems, marital disruption and disruptive symptoms among adult children of alcohol abusers in the United States. W121. _9.(14). 306- 313. Price, G. M. (1985L A study of the wives of 20 alcoholics. WW. 5.. 620- 627 Roberts, K. S. and Brent, E. E. (1982). Physician utilization and illness patterns in families of alcoholics. WW. 93(1). 119-128. Roid. 0- H. and Fitts. w. H. (1988). W W. Los Anselesz Western Psychological Services. Roosa, M. W. and Beales, J. (1990). Measurement issues in family assessment: The case of the family environment scale. W. 2.9.. 191-198. Roosa, M. W., Sandler, I. N., Gehring, M., Beals, J. and Cappo, L. (1988). The children of alcoholics life-events schedule: A stress scale for children of alcohol-abusing parents. lgnnnal_g£_&tndies_on Alcohol. i9 (5), 822-829. 165 Russell, M. (1990). Prevalence of alcoholism among children of alcoholics. In M. Windle and J. S. Searles (Eds.), (pp. 9-38). New York: Guilford Press. Russell, M. 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Hollywood, FL: Health Communications. Woititz, J. G. (1987). Unfinished family business and professional self-sabotage. EQQMEJ lfl.(2), pp. 24, 25, 26’ 30, 310 Wolin, S. J., Bennett, L. A., Noonan, D. L. and Teitelbaum, M. A. (1980). Disrupted family rituals. A factor in the intergenerational transmission of alcoholism. 1Qnnnal.21_§11diss_on_AlcohoL .l. 199- 21M. Wolkind, B. L. (1987L [Interview with Robert Ackerman.) A new perspective on adult children of alcoholics. EAR 111215.11. 1(2), 25- 29- Wynne, L. C., Ryckoff, I. M., Day, J., and Hirsch, S. R. (1958L Pseudo-mutuality in the family relationships of schizophrenics. Es1ch1ann1. 21, 205- 220. Zucker, R. A. (1987). The four alcoholisms: A developmental account of the etiologic process. In P. c. Rivers (Ed. ). NsbLaska_s1mnns1um.on_m2111a111n1 19§§ Y 1 SH 1] I J I 11' II I l . (pp. 27-88). Lincoln: University of Nebraska Press. Zucker, R. A. (199OL New wave interactionism: A forward. In M. Windle and J. S. Searles (Eds. ). Childnsn_c£ . New York: Guilford. Zucker, R. A., and Gomberg, E. S. L. (1986L Etiology of alcoholism reconsidered: The case for a bio- psychosocial process. Amenican_£s1nhnlnzist. El (7). 783-793. APPENDIX RESEARCH INSTRUMENTS 168 CONSENT FORM I freely consent to participate in this study, which has been explained to me as investigating parental alcohol use and possible effects on the family. The questionnaire will take approximately one hour to complete. My responses are anonymous, and therefore confidential. This is the only phase of the research in which I will be asked to participate. I understand I may withdraw at any time with no consequences. Should these questionnaires raise questions or concerns for me, I have been informed of appropriate services and agencies to contact for information or counseling. Signature Date The data from this study will be used by Robert Horeas, M.S.W., toward the completion of a research dissertation as partial fulfillment of the requirements for the degree of Doctor of Philosophy, College of Human Ecology, Michigan State University. C) ['1 O 169 GENDER: 1. Male 2. Female AGE: __ RELIGIOUS PREFERENCE: 1. Catholic 3. Hebrew 2. Protestant D. Other RACE: 1. Afro-American 3. Hispanic 2. Caucasian U. Other following items pertain to your Father Stepfather What is your father's education level? 1. Less than High School A. College 2. High School 5. Post College ___ 3. Some College 6. Graduate Degree ___ What is your father's job? Marital History: 1. How long has your father been married to your mother? 2. How many times has your father been married? ____ following items pertain to your Mother .Stepmother What is your mother's education level? 1. Less than High School A. College 2. High School 5. Post College ___ 3. Some College 6. Graduate Degree ... What is your mother's job? Marital History: 1. How long has your mother been married to your father? 2. How many times has your mother been married? ____ 170 - .. «a hoot cot-o tam natao 1: -— - ___—___. - __pr TEST REPORT Tennessee Self-Concept Scale - . . . -. . . .. . . .. - _ "' statements. - 3 . - moo acalo vocluooa too atotootonta that mooauvo ‘3-thy '0”. ‘J‘MN Truo alto Pauly Ioloo. ' - - how you tool aoout younotl. M an no not“ or @Cfioflly Two. and 'EOColltolotoly Truo , s - _ mono matron. to do.“ men“ younotl ao Try to ”'0! all tho atatotttottta. out do not fill at 3 . hot-oatty as you can moto than olto cuclo to: tho aottto atatolttottt. Molt you - float Ml mtno .oootllymo MottoooyMonmo eloooao an mot-vol. mono om. hoouy ma that mo: 1 I - "to WI. encloa. Fot shoot Wt. ago. on "to noon enclo . C - , oouoatuoo. mo tno ounooro no too ooaoo aoovo too (was 1 (3Q). 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"'"" - Ion-onto" to onto: an who you start tho small-om ooa aoovo. - fltlmoooeuololotoaca atotonootuoutotllolollowutoacolo: - : o o o o o _ Complotoly Mostly Pauly Truo and Mostly Comolotoly _ Faloo Falao Pattly Faloo Truo Truo - 1 naugooamwfio-og. 9 100.00% QQL‘EC - 2 an on emu-mo oonon to 1 nova a tame not I.“ alt-ova «no «to m - J contaoov “vi." a snoopy arson any "n °' MN." - a 1 out a motor! to" at Danton ' ' I all 0 Romeo! at a no!” 9mm - s .amaonooouoonon '2 WN-ma-avonoconhooaoommo - : b°a‘...'....: ‘ - '-_'-'-oovton -' 7 ..macnoofiulw '0 .ongolulu-ttnm # - e «atom-nous . oo'tr '5 an *3 “0'0“” at who! who! ooooto so £0”.ng tmoywooto-o'oooaotoo-aatlonvooo “numnflommmmdwww Mnootovoooaoo 113000700 “can L 171 IIIIII(|III F." at one allele tor oacn statement name the lollowmg scale: Completely Mostly Partly True and Mostly Completely False False Partly False True True '5 so a:- . .... . ll.‘ me -~.:‘ 3 0 @Q 0 cl -rvoa: m. parents as wel- a' eru-o Iuso east ' ‘ ool aru‘. mam-me. 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"‘ 3' “N 'am... noose t lluSl me a" ooowa' a 'r- «other i 31 a"- mas at we anon. gong I 32 I on have to De Mono... mm 33 Once -'- a mum . tnma ol tnmqs too use 10 mt acts: 34 Sometnnes when . am not loonng mu , am can 'a‘ «or {P ‘ ’0'“ "O "9‘ '0: 5 "'0 “'1. “00's IUSI "‘0 '0' "‘0' I'D l “0000 III. to €71.59. m. 90'" 0' My body ' .0“ S' fill" M! «'1' My CO 3C. 0. “HI! | l'“ OS I! I ”'59" Slhfl-Qo no"! my I.” 0" trust my lamuo moo. 5 UNOO'SIOHO My 'Jl‘flttv Q IS ' *0"! IO 0. ll III "on I not I tn 0 whtll I GO" 1 as l want Do. shOUIOR Y I.“ I .‘l l Imanlooonlowououooutyotloo 74 75 76 87 91 at wow I do 900'" m 590"! .00 90M 1 tango my «not! a lot "ottoman-nay I once on no. . am a! mung; l M "u. to My whom)" all My "C'VOIV MO I lry to clung. anon I anon . - agnq lnmqs that at. wrong ‘ WW?!” do VON. oao "1mg; 3 CI" atmoys (it. save 09 "WM" '0 ll'lv mutton I late the blame vol mmos a-t'ool gottmg Mac 1 go 10.095 wolhOul [WM-009 6004.! them h"! I lav umn My ' 9W. m IO My 90'0"“ 0U“ DOS! IOfl“ l0 08'0“" are not Mung l ' try to onoe'stano mo otnev ve'Iow s noun 1 9.! .0009 a." wolf! 0M0! ooooce I do not lo'owe omen essay l .0000 telnet mu than lose at a I lean qooo most ol the hm. I am I 900! ”my I do mat .s ngnt most at me who Mot!!!” US. 00'." “00'“ '0 col anoao "IV. "0000. 00mg In. lhmgg "it! If. I ‘0". HIV 9'0”! 00". “in. I "V to run away "on My orooooms I 00 "W W'. 09 “'l I! HOMO ' 000"“ Will! My 9.0!". | no not act lute My lolmty tnnnao 1 shouts l see I do not not at ease oath othel neocla- I lung .1 noon to tau. um strangers .naoleeloutoll untllmmetl DOOHIS on .II I". 0.090. I M”! lutltoeoaontllootltovotoooltlllosltoot. mm: Homontooc to out... me tlmo yen umsn ...l the statements 172 II mun: "111.3912 mum - mm This is your copy of the special foeily questionnaire. Please answer each euestlon by placing an "X" in the has neat to the answer that you choose or by writing In the space provided. if for any reason you do not wish to answer a question. please circle the question so that we know you have decided not to answer it. Please ignore the snail lit-hers Idlich appear by the boxes or in the margins. They are to help no record your answers. Thank you for your help with this ioportant survey. E.L‘EEL—W' 2". l. the old are you! rt 1. Are you: tDahoy aUagirl_ , yous mm gm ust tun i. In cheat-THAI (lI-nths), haveanyo' those happened to you? Yes lo Yes Io allergies s ’ oath-o 1 D Dent-weight 00 pounds or are) s D Dstayed overnight in the hospital .a D U Mar-eight (lo pounds or P", s 2. in the LAST me. has often have you had or done the following things? m £03 Scleti-es 2:3: a) upset stuach. indigestion.... D [j if] [j s h) headaches..................... D D D D to c) night-ares or bed ores-...... D U D D it 0 also your noils............... U .D D U u o) aere}threots.................. U D U D 0 fl colds er eeoalm.............. D D D D " a) trouble palsy to aleep........ D D D D It h) acne er pi.ies............... D D D D as tl oisaod school a. so 111...... U D D U n j) visited the doctor............ D D . D D ' toayrlpht. lab" I. has. Social tooleoy Lahoratary. Stanford University. i902 173 I2 YOUR HEALTH ill THE LAST RON“! i. We love asked about your health in the last year. now we want to ltnow how you have been feeling LIL-Lil; LAST Mimi. Choc). ho- oftan you have felt each of the following: Intro? Sold. 3:; '.::'Y a) ahrt ..................... a é a b h} cheerful .................. D D D D c) reiaaad ................... D D D D .1 .... .1... ................. D D U D e) tut-tight. t-tso.......-.... D D D D r) afraid or on... ....... D D D D g) full of energy ............ D D U U h) I..." ..................... C] U D U I) call. ..................... D D D D J) mtless...’ ............... D D D D I.) very tired ................ D U D D i) worried..........., ....... D D D U 2. sawmnmmiaé Sold, it: 23:2,? a) amortise (like swio, , Jog or bibs) .......... . lever s) ' calla yit-ins ............. D c) drlfl wine ................ D d) drid bear ................ D a) drink bard lie-r ......... U n a-h cigarettes .......... D D a) weoraseotbeitio thoear ............... 1:1 DDDDDDI c1 DDUDDD-I [:1 13131313131} 174 mm 11mm iii tut ust mm (cont.) . '3 . People feel different ways about themselves. For each uord, checlt the box which shots ho- well the cord describes you: 3. Iot'? 3:“- Faifly ten .) intellfg-lt .......... a ti [3] .D b) mantra... .............. D U E] D c) dud-dabie ............ D D D D a) utfldent ............. E] U D U o) friendly .............. D D D D f) successful ............ D D U D g) athletic.............; D . D D D tout mum Lug rattling . walla: m Last mum. luv. you done. or attended, any of these activities? Honor 17:573.» each activity. ' Together with anther Together with one or fully author are friends 3...: 1'2. :13“. 2. 1 ~“.:~...l::::.t:r:::: ...... a E: .. a E: " '“"':.'::'..‘.:.lif'::‘:if':: ..... D El .. 1:1 I: c) bibaeriengt-lk. ............ D D 0 D D " "".:t‘1:’.fli':'..:ffz.-.. D D . El D e) cardg-eoerboardg-ao ..... D D o D D f) hado longs-lit...“ .......... D D as D D a) handmade-project" .. D D at D D h) enact-saucy ............... D D II D D _" “'.:'..:!::f:.::.::': ...... E] [:1 . 1:1 1:1 ” ""3 2:233:31- c1 :1 .. D :1 2. 3. Int is today's date! This is the last ouestiee on this fore. Thank you for your his. 175 how many very good friends do you have! C no" lorz 63w} DSor-are m ggtfl'lons gym-gm Are you going to aciuan ID tea lelo (if no. go so icon I!) in general. law well do you get along with your teachers? . :1. 1:15:11" .13.... .1327: that are your school gradesT CI ['1 '11] If] Excellent . Um Good Good Aver!!! (luaciy A's) (lastly A's (hotly (lbstiy ' and I's) b's and t's) t's and it's) llavo you done any of the following 1121 LAST MT 56 micro! school sports te- s DDthlnescheolpieyorehr s DDw-ttoascheoidaote s DDholpedetaechcaftorsdaool T UBweettoo-etiogefoschooieiuborgroup D Doorbedoneschooi project I C] D elected to .— schoi or ms office to '5 W ' (lbstly 0's and F's) be you have a Job outside your h- fer saith you get paid? (Check all that apply) .01.. safes. sUTes. . dates. part tin foil u. as- Job if yes. uhat is this JebT 176 A SOCIAL CLIMATE SCALE l-‘flfl'llW EI‘IVIBOMI'IEI‘IT SCHIE roam It RUDOLF H. MOOS INSTRUCTIONS There are 90 statements in this booklet. They are statements about families. You are to decide which of these statements are true of your family and which are false. Make all your marks on the separate answer sheets. If you think the statement is True or mostly True of your family, make an X in the box labeled T (true). If you think the statement is False or mostly False of your family, make an X in the box labeled F (false). You may feel that some of the statements are true for some family members and false for others. Mark T if the statement is true for most members. Mark F if the statement is false for most members. If the members are evenly divided, decide what is the stronger overall impression and answer accordingly. Remember, we would like to know what your family seems like ' to you. So do not try to figure out how other members see your family, but do give us your general impression of your family for each statement. CONSULTING PSYCHOLOGISTS PRESS, lNC. 577 College Ave, Palo Alto, Califomla 94306 OCopyright 1974 by Consulting Psychologists Press, Palo Alto, CA 94306. All rights reserved. This test, or parts thereof, may not be reproduced In any form without pennisslon of the publisher. 10. ll. 12. 13. 14. 15. l6. 17. 18. 19. . Family members really help and support one another. Family members often keep their feelings to themselves. We fight a lot in our family. We don't do things on our own very often in our family. We feel it is important to be the best at whatever you do. We often talk about political and social problems. . We spend most weekends and evenings at home. Family members attend church, synagogue, or Sunday School fairly often. Activities in our family are pretty carefully planned. Family members are rarely ordered around. We often seem to be killing time at home. We say anything we want to around home. Family members rarely be- come openly angry. In our family, we are strongly encouraged to be independent. Getting ahead in life is very important in our family. We rarely go to lectures, plays or concerts. Friends often come over for dinner or to visit. We don’t say prayers in our family. We are generally very neat and orderly. 177 20. 21. 22. 23. 24. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. There are very few rules to fol- low in our family. We put a lot of energy into what we do at home. It's hard to “blow off steam" at home without upsetting somebody. Family members sometimes get so angry they throw things. We think things out for ourselves in our family. . How much money a person makes is not very important to us. Learning about new and different things is very important in our family. Noboby in our family is active in sports, Little League, bowling, etc. We often talk about the religious meaning of Christmas, Passover, or other holidays. It’s often hard to find things when you need them in our household. There is one family member who makes most of the decisions. There is a feeling of together- ness in our family. We tell each other about our personal problems. Family members hardly ever lose their tempers. We come and go as we want to in our family. We believe in competition and “may the best man win." 36. 37. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 178 We are not that interested in cultural activities. We often go to movies, sports events, camping, etc. We don’t believe in heaven or hell. Being on time is very important in our family. There are set ways of doing things at home. We rarely volunteer when something has to be done at home. If we feel like doing something on the spur of the moment we often just pick up and go. Family members often criticize each other. There is very little privacy in our family. We always strive to do things just a little better the next time. We rarely have intellectual discussions. Everyone in our family has a hobby or two. Family members have strict ideas about what is right and wrong. People change their minds often in our family. There is a strong emphasis on following rules in our family. Family members really back each other up. Someone usually gets upset if you complain in our family. Family members sometimes hit each other. 54. 60. 61. 62. 63. 64. 65. 66. 67. Family members almost always rely on themselves when a problem comes up. . Family members rarely worry about job promotions, school grades. etc. Someone in our family plays a musical instrument. Family members are not very involved in recreational activities outside work or schooL We believe there are some things you just have to take on faith. . Family members make sure their rooms are neat. Everyone has an equal say in family decisions. There is very little group spirit in our family. Money and paying bills is openly talked about in our family. If there's a disagreement in our family, we try hard to smooth things over and keep- the peace. Family members strongly encourage each other to stand up for their rights. In our family, we don't try that hard to succeed. Family members often go to the library. Family members sometimes attend courses or take lessons for some hobby or interest (outside of school). 68. 69. 70. 71. 72. 73. 74. 75. 76. 77. 78. 79. In our family each person has different ideas about what is right and wrong. Each person ’s duties are clearly defined in our family. We can do whatever we want to in our family. We really get along well with each other. We are usually careful about what we say to each other. Family members often try to one-up or out-do each other. It’s hard to be by yourself without hurting someone's feelings in our household. “Work before play” is the rule in our family. Watching T.V. is more important than reading in our family. Family members go out a lot. The Bible is a very important book in our home. Money is not handled very carefully in our family. 179 80. 81. 82. 83. 84. 85. 86. 87. 88. 89. 90. Rules are pretty inflexible in our household. There is plenty of time and at- tention for everyone in our family. There are a lot of spontaneous discussions in our family. In our family, we believe you don’t ever get anywhere by raising your voice. We are not really encouraged to speak up for ourselves in our family. Family members are often compared with others as to how well they are doing at work or school. Family members really like music, art and literature. Our main form of entertain- ment is watching T.V. or listening to the radio. Family members believe that if you sin you will be punished. Dishes are usually done immediately after eating. You can’t get away with much in our family. PLEASE NOTE Copyrighted naterials in this document have not been filled at the request of the author. They are available for consultation, however, in the author’s university library. C.A.S.T. 180-183 University Hicrofilns International 180 C JLSJ'. Please cheek (a) the answer below that best describes your teelinqs. behavior. and exoenehoes related to a parer alcOhol uae. Take your time and be as accurate as possible. Answer all so Questions by Checking either “Yes' o." x: H _ Femele_ Ape;— Yee No Dueedm 1. Have you ever thought that one or your parents had a drrhluhg problem? 2. Have you ever lost sleep because or a parent‘s drlrlluhg? 3. Did you ever encourage one or your parents to quit drinking? 4. Did you ever reel alone. scared. nervous. angry. or lrustraled because a parent was not able to stop drlhluhg? 5. Did you ever aigue or tight with a parent when he or she was drinking? 6. Did you ever threaten to run away lrom home because or a parent's drinking? 7. Has a parent ever yelled at or hit you or other lamily members when making? I. Have you ever heard your parents light when one ot them was drurllt? 9 0 Ti 5 . Did you ever protect another ramily memoer lrom a parent who was flanking? . Did you ever reel lilie hidihp or emptying a parent's bottle of liquor? 11. Do many or ysur thoughts revolve around a problem drlhlu'hg parent or difficulties that arise because of his or her ohhliirlg? ‘ 12. Did you ever wish that a parent would stop drinking? 1:. Did you ever reel responsible tor and guilty about a parent's drinking? 14. Did you ever leer that your parents would get divorced due to alcohol misuse? 15. Have you ever withdrawn lrom and avoided outside activities and them because ol embarrass- rherlt and me over a parent's dhhluhg problem? Did you ever teel. caudht in the mlodle of an Wt or fight between a problem drlhlu'hg paren and your other parent? 17. Dldyoueverleelthatyoumadeebarehtdrirwalcohol? 1a Heveyoueverleltthateproblemohhltihgparentdldhotreallyloveyou? 19. Did you ever reserlt a parent's drinking? :0. Haveyoueverworhedaboutspareht'shealthbeeauseolhisorheralooholuse? 21. Haveyoueverbeehblemedtorapareht'sdhhluhg? 22. Didyoueverthlhltyourlatherwasahelooholic? 23. Didyoueverwishywhanecouldbemorelieetrehahesolyowmehdswhodldnmhaves parent with a drlrlluhp problem? 24. Didapuemmmaseprommteyouthuheorshedidhotheeobecauseoldhhulhp? a. Didyoueverththllyourmbtherwasahalcoholic? 28. Didyoueverwishthalyoucouldulatoaomeohewhocouldmdenuhdwhelbthealcohol. related brbblerhs in your lamlly? 27. Did you ever light with your brothers and sisters about a parent's driretulg? as 2! £3 Dldyoueverstayeweyrromrlomeloevoidtheorlrwlhpparehtoryourorherpareht'sreactiohlo the Who? . Haveyoueverrellsickerled.orhada”lthol”irlyourstomachaherworlyihpaboutspareht's drinking? Did you ever ran over shy chores and duties at home that were usually done by a parent before he or she developed a mug problem? _ TOTAL NUIIEI OF "YES” ANSWERS. 31. T 181 T "I'Q T 1' When your mother/father drinks does he or she get A. Mean - for example i J yelling [ J nasty, teasing, ridicules a. Nice - for example [ J Jokes with you I 1 is relaxed and talks with you [ 3 gives you privileges you wouldn't usually ask for or get C. Physically abusive - for example I J slaps or hits you and would not ever when not drinking [ ] slaps or hits you for punishment for things you have done wrong [ 1 slaps or hits you for no reason you understand 182 ALCOHOL USE HISTORY - FATHER Again, are you answering about your K. Father ______ Stepfather _____ How would you describe your father's alcohol use? 1. Abstaining . __ 2. Social Drinker 3. Heavy Drinker ____ . Problem Drinker . Alcoholic . Drunkard ____ . Eecovering ___" Has your father ever attended Alcoholics Anonymous meetings? 1. Never ____ 2. Yes 3. Currently How old were you when you first knew about your father's problematic drinking? 1. Your age was 2. Not applicable How old were you when your father's drinking caused the most family problems? Here you 1. Less than 5 years old ____ 2. 6-10 years old 3. 11-15 years old ___. h. tb-Current 5. Not applicable Has your father ever been treated for alcoholism? t. No 2. Don't know 3. Inpatient facility ___. u. Outpatient program 183 YOUR SUBSTANCE USE HISTORY On the average. how often do you drink any kind of alcoholic beverage during a typical month? Rarely . About once a month .___ . 2 to 3 times a month ____ . t or 2 times a week . 3 or n times a week A O Nearly every day 2 times a day 3 or more times a day when you drank any kind of alcoholic beverage. what was the average quantity you consumed; that is. you consumed this amount nearly every time or more than half the time you drank? t. Rarely drank 2. 1 to 2 drinks 3. 3 to u drinks u. S to 6 drinks 5. 7 to 8 drinks 6. 9 to 10 drinks ___- 7. More than to drinks Have you ever been treated for substance abuse? 1. Inpatient 2. Outpatient 3. Never Currently ___. Have you ever attended Alanon or Al-Ateen? 1. Never 2. How old were you? ____ 3. Do you attend meetings currently? List your brothers and sisters. by age, oldest first: Current Job. Unemployed. or Alcohol/ Substance Abuse E ii lllllllll E lllllllllF U'I e HICHIGAN STATE UNIV. LIBRARIES l I llllllll W llll lllllllllllllllllll llllllllll ill ill lllllll i ll 31293007854221