ALCOHOL ABUSE AND DEPRESSION AND ANXIETY
IN THE COLLEGE POPULATION
The glamorized version of the alcoholic as the “skid row,” or grossly dysfunctional, chronically unemployed drinker represents less than five percent of the alcoholic population (Forrest, 1986, p. 11). In fact, the college student as alcohol user and abuser and with the corresponding problems of depression and anxiety is now receiving considerable attention.
Alcohol abuse is a pervasive element in the college environment. The American College Health Association has announced concern about the problem of substance abuse, including alcohol and drug use. The Association is concerned about the “pervasive detrimental impact” on the quality of campus life (Journal of American College Health [JACH], 1986).
Alcohol use is a particular concern because, pharmacologically, it is among the most potent of the self-prescribed agents. And, alcohol usage among college students is higher than in the general population (Kinney & Peltier, 1986).
Recent studies indicate that substance abuse is the most common psychiatric disorder in the 18- to 45-year-old age group. Additionally, among the 15- to 24-year-old age group, accidents and suicide are the leading causes of death. Alcohol use is implicated in statistics regarding these deaths and disability among college students (Kinney & Peltier, 1986).
Alcohol is over twice as popular among college students as other drugs. Estimates indicate that 92 percent of college students reported using alcohol in a 12-month period (National Council on Alcoholism [NCA], 1986).
Experts indicate that alcohol is the number one campus abuse problem (Hirschorn, 1987, pp. 32-4). A recent survey of college students suggests that approximately 89 percent of the students reported drinking and that almost 50 percent of the students either began or increased their drinking after entering college. Twenty-five percent of these students were classified as “having a drinking problem” and seven percent were classified as being alcoholics (Seay & Beck, 1984).
Factors associated with the incidence of alcohol use among college students include parental drinking patterns, relationships with parents, attitudes toward drugs, and peer pressure (Sherry & Stolberg, 1987).
Purpose of This Report
The purpose of this report is to present and analyze some of the recurring themes of the relationship between parental alcohol abuse and the manifestation of anxiety and depression in the college population. More specifically, the report will review the empirical studies of college undergraduates who come from families where one or both parents are alcoholics. The corresponding depression and anxiety in this undergraduate population will be examined. The report will be divided into five sections. First, several concepts that will be used throughout the report will be defined. Second, characteristics of alcoholism and alcoholics will be discussed. This presentation is important because it provides the foundation for the backgrounds of adult children of alcoholics. This section will present a general description of the common elements of the family life. Third, causes of alcoholism will be given. This is also foundation material for later discussions of the consequences of the alcohol abusive background on the college student. Fourth, characteristics of adult children of alcoholics will be examined. The literature suggests that adult children of alcoholics have core personality traits as a result of their abusive backgrounds. These traits are also important to later discussions of the college student. Fifth, characteristics of the college student will be analyzed. This section will be a synthesis of the foundation materials. This section will also integrate previous findings into a coherent framework for understanding adult children of alcoholics as college students and their corresponding depression and anxiety.
Definitions Important to This Analysis
“Adult children” refers to the common traits of children growing up in families where there is alcoholism, such as emotional, physical, and spiritual problems (Gravity & Bowden, 1985, p. 1).
”Alcoholic” refers to someone who 1) drinks, 2) gets into trouble repeatedly because of drinking, and 3) continues to drink (Gravity & Bowden, 1985, p. 8).
”Addictive personality” or “alcoholic personality” refers to an individual who is impulsive, aggressive, overly emotional, agitated, and easily frustrated (Lawson, Peterson, & Lawson, 1983, p. 9).
Causes of Alcoholism
A definitive cause for alcoholism has not been found. Some behavioral scientists contend that alcohol dependence may be hereditary, others contend that it is due to abnormal biophysiological conditions, or psychological factors.
With respect to heredity, alcohol use does tend to run in families and experts estimate a 25 percent chance that the child of one or more alcoholic parents will become an alcoholic (NCA, 1986).
Research on genetics and alcoholism indicates a high prevalence of alcoholism among the full siblings of alcoholics. For example, 46 percent of the brothers and five percent of the sisters of male alcoholics sampled were alcoholics. Siblings of female alcoholics had higher rates of alcoholism; 50 percent of the male siblings and eight percent of the female siblings were alcoholics (Lawson, Peterson, & Lawson, 1983, p. 7). It is important to point out that the research on genetics and alcoholism has raised more questions than it has answered. This will be discussed in later sections.
Other behavioral scientists believe that alcohol may be related to specific personality types or learned behavior. Transactional theories, (alcoholic “games”/”scripts” lead to addiction) psychodynamic theories (unconscious processes that originated during early stages of an individual’s development), and reinforcement theories (operant conditioning) have been proposed (Lawson, Peterson, & Lawson, 1983, pp. 5-15). Sociologists contend that the socialization process causes alcoholism and that there are regional and sociocultural variations in drinking patterns, social behavior, and the consumption of alcohol. In order to be concise, these will not be presented here.
It is important to note summarily two theories on the subject. Wilson and Herrnstein (1985, p. 357) indicate that alcoholism may be related to congenital/biological factors, differences in personality, and/or differences in social circumstances (cultural values).
Akers (Third Edition) suggests that alcoholism is learned from participation in social and cultural situations that occur within family settings or among peer groups. Positive and negative social rewards and/or reinforcement maintain drinking habits, once started.
Characteristics of Alcoholism and the Alcoholic
Alcoholism is considered a disease, a drug addiction that affects more American lives than any other drug. For this report, “alcoholic,” “alcohol dependence,” “alcohol addict,” and “chemical dependent” will be used interchangeably throughout. The terms refer to the same concept: the alcoholic.
Since 1956, the American Medical Association has defined alcohol addiction as a “chemical dependence.” The dependence is on the chemical substance ethyl alcohol. And, like all diseases, there are symptoms. The symptoms of alcohol addiction include the compulsion to use alcohol, excessive behavior and mood swings, and inappropriate, unpredictable, and constant drinking habits.
Alcohol dependence is the primary disease. It does not result from other diseases or problems. However, the dependence can lead to diseases of the liver, stomach, heart and brain. It can also lead to mental and emotional problems such as mood swings and memory loss.
An important fact about alcohol dependence is that individuals can drink once a month, once a week, or even a few times a year and still be chemically dependent. It is not how often people drink that matters, but what happens to them and to others around them when they drink. If alcohol use causes any disruption in personal, social, physical, spiritual, and/or economic life, and the individual does not stop using alcohol, he/she is chemically dependent.
Typically, there are four traits that distinguish the alcoholic. First, the alcoholic drinks compulsively and cannot control such factors as where, when, and how much he or she drinks. Second, the alcoholic has been drinking for many years. The process of becoming an alcohol addict takes place over a long period of time. Third, the alcoholic drinks to the point of intoxication. In the advanced stages of alcoholism, the amount of alcohol a person can consume without showing signs of intoxication decreases significantly. Fourth, the drinking problems of the alcoholic produce severe problems in the important interpersonal relationships in his or her life (Forrest, 1986, pp. 8-15).
People who are alcohol dependent have at least three similarities. First, once people develop the disease, they have it for the rest of their lives. Chemical dependence is a permanent disease. Second, the dependence can be treated. Alcoholics can stop using alcohol (Alcoholics Anonymous [AA], 1987). Third, if alcoholics do not get help, they die prematurely – either as a direct result of the disease, or as a result of some event that can be traced back to the disease (an automobile accident while driving under the influence).
Generally, alcoholics display several characteristics that provide clues to the alcohol dependence. Chronic alcoholism results in serious social and psychological developmental lags (Forrest, 1986, p. 87). These characteristics include, but are not limited to: 1) drinking more than usual; 2) doing things while drinking that they deny or say that they have forgotten; 3) refusing to talk about drinking; 4) making and breaking promises to control drinking; 5) telling lies about their drinking; 6) having friends who are drinkers; 7) making excuses to justify drinking; 8) changing behaviors when drinking; 9) avoiding social functions where alcohol is not served; 10) driving under the influence of alcohol; 11) apologizing for the way they acted while drinking; and 12) hiding alcohol in the house, car or garage.
Among social, emotional, and behavioral traits, alcoholics are: anxious, angry, manipulative, tyrannical, self-deluding, dependent, depressed, irresponsible, immature, nurture inferiority/grandiosity feelings, impatient, and have sexual problems (Forrest, 1986, pp. 16-30).
Adult Children of Alcoholics
An estimated 28.6 million Americans may be children of alcoholics. It is important to note that it does not matter when parental alcoholism starts.
The literature points out that alcoholics are more likely to have an alcoholic father, mother, sibling, or distant relative, than non-alcoholics. The National Council of Alcoholism (1986) indicates that almost one-third of any sample of alcoholics had at least one alcoholic parent. Moreover, children of alcoholics have a four-times greater risk of developing alcoholism than children of non-alcoholics.
Studies of adult children of alcoholics indicate that adult children are at increased risk for developing school problems, substance abuse in adolescence and/or adulthood, social difficulties, hyperactivity, low self-esteem, an external locus of control, and legal difficulties (Poston, 1987).
The Alcoholic Family System
The family home in which one or both parents are actively alcoholic is characterized as “inconsistent, unpredictable, arbitrary, and chaotic” (Gravitz & Bowden, 1985, p. 9). For example, the alcoholic parent may have a conversation with the son or daughter one night but when the subject is raised later, the parent may have no recollection of that conversation. Or, an alcoholic parent may be loving when sober and just the opposite when drinking. Children learn specific lessons from this behavior and these lessons carry over into adult life.
Although timing is important (how long the parent had been drinking or at which point in the child’s life the alcoholism began), the negative effects are greater the younger the child is as the disease progresses.
The alcoholic family system is viewed as a unique form of systemic dysfunction. Studies indicate that the life of an alcoholic family is characterized by inconsistency, unpredictability, and arbitrary and chaotic patterns. Studies also indicate that codependency, Post Traumatic Stress Disorder, and emotional pathologies are found among family members.
For example, in studies of the alcoholic family system, children of alcoholics exhibited more emotional pathologies than did children whose parents were neither alcoholics nor psychiatrically disturbed. In fact, in the hierarchy of disturbed behavior among children, those of alcoholic parents showed the most pathology, children of parents with a psychiatric disorder were next, and children in which neither parent was alcoholic nor psychiatrically disturbed showed the least pathology (Krois, 1987).
Consequences for the Adult Child
Alcoholism is a family disease. The disease affects the well-being of the spouse, relatives, and children of the alcoholic. Adult children often find their lives influenced directly, and indirectly, because of the profound emotional, physical and spiritual involvement they continue to have with the family. Many are aware that the scars of alcoholism impact their current experiences and emotional conditions.
Children live what they learn. Adult children enter adulthood with the coping mechanisms, roles, survival techniques, and rules that they learned as children. These elements can encase the adult child into rigid, stereotyped behaviors.
Generally, adult children of alcoholics share similar, identifiable feelings of anger, guilt and denial. As a result of their backgrounds, they believed that it was easier not to trust, talk, or feel and they developed mechanisms for coping. Coping mechanisms take various forms. For example, four major roles have been identified within the family to cope with the chaos imposed by alcoholism: 1) the responsible child; 2) the adjustor; 3) the placater; and 4) the acting-out child (Krois, 1987). Each coping mechanism will be described because these strategies can have profound emotional implications for the focus of this analysis – the college student from an alcohol abusive family.
The Responsible Child: usually the first-born and often the
only child. This child assumes responsibility for him- or herself, for other family members, and for household chores. This child assumes the responsibilities for the alcoholic parent. The child does well in school and does not come to anybody’s attention as a problem.
Gravitz and Bowden (1985, p. 23) describe one responsible child who had seven sheets of paper along the wall of her room outlining her duties each hour of the day, including an hour to relax and play. The responsible child is the one who helps teachers grade papers and assists other children with their projects. This child represents the family positively to the community and acquires a sense of stability and control in one area of life.
The Adjustor seems impervious to the effects of the environment. Adjustors deal with the chaotic family situation by following directions and adjusting to the circumstances. This child does not attempt to prevent or alleviate any situation. They seem most detached from the family and the parents take little notice. However, they lose their sense of power and self through a belief that they cannot affect their environment or their own lives.
Placaters learn to be so sensitive and perceptive to the feelings, worries and troubles of those around them that they are able to resolve conflicts and negotiate the tensions around them. They are typically “their parents’ marriage counselors at age five” (Gravitz & Bowdenm 1985, p. 25). At school they are Mr./Ms. Congeniality, have no enemies, and are among the most popular at school.
The Acting Out Child draws attention to him- or herself by negative behavior. These children cause disruption in their own lives and within the family, thereby providing distractions from the alcoholism. They become the family scapegoats causing new focuses of blame on the family.
Depression and Anxiety Among Adult Children
The research indicates that adult children of alcoholics suffer from depression and anxiety more often than adult children of non-alcoholics. In fact, depression is one of the most commonly cited emotional traits in children of alcoholics (Poston, 1987). The literature includes studies of children’s and adolescents’ depression as a result of the alcohol abusive background; however, little is available about adult children’s depression as a result of parental alcohol abuse.
From the studies consulted, it appears safe to posit that children carry into adulthood those personality and emotional traits developed during early years to cope with the environment. Following this argument, empirical studies of childhood and adolescent depression are relevant.
Poston (1987) presents findings from a study of elementary-aged sons of alcoholics in a public school. The father was classified as “alcoholic” if his drinking resulted in injury to his health or to his social/economic functioning according to health and welfare agencies.
Teachers who had no idea that the study was related to alcoholism, were asked to rank order four of their male students on 36 items. Thirty-two of the items indicated that sons of alcoholics were different from the control group. The sons of alcoholics tended to be depressed and moody and less happy and content. These findings were significant at the p < .01 levels.
In another instance, 25 adolescents with one or both parents as alcoholics were compared by age, sex, grade, and father’s occupational level with adolescents with no alcoholic parents. The findings indicated that children of alcoholics had significantly more “negative mood states as measured by the Profile of Mood States Inventory.” These findings were also significant at the p < .01 levels (Poston, 1987).
An elaborate study utilizing interviews compared daughters of alcoholics (mean age 32) with age-matched controls taken from census records found that the daughters of alcoholics had significantly more history of depression (p < .02). The daughters of alcoholics had sisters who had been placed in foster care due to the disruption in the family environment (Poston, 1987).
A random sampling of adolescents aged 12 to 15 indicated that those whose fathers were heavy drinkers reported being “often blue” significantly more often than those whose fathers were abstainers (Poston, 1987). Again, the results were significant at the p < .01 level.
In a related 20-year longitudinal study that utilized many sources of records on lower-class, multi-problem families with and without alcoholic parents, researchers determined that suicide was more likely to be attempted by the offspring of alcoholics. This finding held, even when other common environmental factors were held constant. Poston (1987) suggests that it may be that these children could endure many other disadvantages as long as they had parents available for emotional support. And, since alcoholic parents fail at being available for emotional support, these children may have felt abandoned, overwhelmed and depressed. These feelings were manifest in their suicidal behavior.
Livingston, Nugent, Rader, and Smith (1985) suggest that childhood depressive and anxiety disorders may be family-related. In a study of 127 relatives of 12 anxious and 11 depressed children, 72 percent received Family History RDC diagnoses, most commonly depression and alcoholism. The researchers used Diagnostic Interview for Children and Adolescents (DICA) records for patients entering the psychiatric inpatient unit since 1983. The children in the study displayed major depression, separation anxiety, or over-anxious disorder and were hospitalized because outpatient methods had failed or because their school performance/attendance was poor. Livingston, et al. (1985, 1498-9) concluded that affective illness and alcoholism were common in the families of depressed and anxious children. Regarding anxiety, there is also the impact of parental alcoholism on the anxiety level of the offspring. Krois (1987) cites studies employing the Devereux Child Behavior Rating Scale that indicated that alcoholism is another form of family dysfunction. Other researchers (Krois, 1987) have found that children in alcoholic homes have more unreasonable fears and stuttering. Researchers have also found that children of relapsed alcoholics had significantly more anxiety (p < .05) and higher incidence of nightmares (Poston, 1987). Poston (1987, p. 14) concludes that there is “adequate evidence for concluding that anxiety is likely a common emotional state” of children of alcoholic parents. The conclusion is that alcoholic parents generate anxiety among offspring as well as not being emotionally available to help alleviate the normal daily tensions that all
With respect to general adjustment, Clair and Myles (1984) found that not all offspring of alcoholic parents have adjustment problems. Their analysis indicated that children of alcoholics reported more distressing situations than did children of non-alcoholics. Also, children of alcoholics used “emotion-focused” rather than “problem-focused” coping strategies.
No Significant Differences
It is important to note that several researchers have found no evidence of more depression among the offspring of alcoholics. For example, college women were classified regarding their fathers’ alcoholism as determined by the Michigan Alcoholism Screening Test. The control group matched, although there were some differences in socioeconomic levels. The results showed no significant differences on the Depression Adjective Check List. Poston (1987) suggests that the subjects, who had been successful enough to enter college, were likely to represent a select sample of daughters of alcoholics. Others have indicated no significant differences between adopted and non-adopted daughters of biological alcoholic parents regarding depression. However, daughters of alcoholism raised by their alcoholic parents had a history of depression more than did non-adopted census controls (27 percent vs. seven percent). The findings were significant at the p < .02 level (Krois, 1987).
Depression and Anxiety Among College Students
Depressive disorders range from normal depression which is a transient period of sadness and fatigue from clearly identifiable stressors to disorder depression including psychotic depression where a person might lose contact with reality and develop delusions, hallucinations, and severe motor and psychological retardation (Marsella, 1985, p. 355).
Anxiety is associated with past traumatic situations, especially those that occurred during infancy or during early childhood. For example, Freud suggested that anxiety was most likely to occur following early sources including: 1) absence of mother; 2) punishments which lead to fear of loss of parental love; and 3) disapproval for actions taken which are not right, just, or moral (Kutash, 1985, p. 79).
Kashani and Priesmeyer (1983) found that freshmen used the college counseling center more frequently and had significantly more depressive symptoms than other students. The students had been referred to counseling for a variety of reasons including general advice, potential job opportunities, and psychiatric problems.
Of the sample of 100 students, 70 percent were women, 30 percent were men. The mean age was 20.2 years. The class year representation was as follows: 29 percent freshmen, 24 percent sophomores, 26 percent juniors, and 21 percent seniors. The college setting was a small, midwestern college.
The findings indicated that 69 percent of the students came to the center seeking help in “coping with and adjusting to college life and other situational stresses” (Kashani & Priesmeyer, 1983, p. 1081).
Thirty-five percent of the sample was depressed; 35.7 percent of the women and 33.3 percent of the men. There were no significant differences in the depressive symptoms. More freshmen than sophomores had feelings of worthlessness and appetite disturbances. No significant differences emerged among juniors and seniors. And, 27.6 percent of the freshmen and none of the seniors reported suicidal indications. Generally, freshmen indicated higher suicidal tendencies, more difficulty concentrating, greater feelings of uselessness and worthlessness, and appetite disturbances.
The authors suggested that these results might reflect the pressure and stress experienced by first-year students. The authors also point out that the prevalence of depression might partially explain why suicide is second only to accidents as a cause of death among college students (Kashani & Priesmeyer, 1982, p. 1081).
Stangler and Printz (1980) analyzed psychiatric diagnosis among graduate, undergraduate and professional school students in a university with an enrollment of 37,000 students eligible for the clinic’s services. Records were maintained about the age, sex, ethnic status, and multi-axial DSM-III diagnosis. The DSM-III includes: Axis I, clinical syndromes, Axis II, personality and specific developmental disorders, Axis III, physical disorders, Axis IV, severity of psychosocial stressors, and Axis V, highest level of adaptive functioning. Of the 500 students examined, 63.6 percent were women, 36.4 percent were men. The mean age was 25.4; the mode was 21 years.
Among the major Axis I diagnostic classes, anxiety disorders was ranked number four among nine classes. When age and sex were controlled, “dysthymic disorder” was ranked first, “adjustment disorder with depressed mood” was ranked second, “major depression” was ranked fifth. Dysthymic disorder requires a minimum of two years of depressive symptoms. The high frequency among this university population suggests that the onset occurred in late adolescent-early adult years.
The authors concluded that “depressive symptoms” accounted for the majority of the university population’s diagnostic variance (Stangler & Printz, 1980, p. 939). The findings held when severity, presence of precipitates, recurrence, or chronicity was examined. Stangler and Printz also indicated that their “global statement is essentially consistent with the findings of earlier university mental health studies” (p. 939). They point out reasons including: relationship conflicts and loss, academic demands and failure, and separation from home and family.
Synthesis of The Literature
The literature has been clear that children of alcoholic families (in which one or both parents are alcoholic) grow up differently from those with non-alcoholic parents.
Perhaps the major difference in the family environments is that in the “normal family,” children do not live in fear, their feelings are expressed, listened to, and accepted, and children trust that they will be cared for and will be allowed to be children, not adults (Gravitz & Bowden, 1985). However, it is important to note that there is no such thing as an ideal or normal family.
It is just as important to note that not all children of alcoholics have identical emotional and/or physical consequences. Many factors influence consequences including: offspring age at the onset of parental alcoholism, whether one or both parents are alcoholics, whether the mother or father is alcoholic, number of children in the family, birth order, whether the parent is working or in recovery, whether there is sexual/physical abuse, and/or whether there are significant others available such as friends, teachers, counselors.
Within the family, as discussed above, different children may assume different roles and coping mechanisms for dealing with the alcoholism. However, certain issues remain central to the emotional states of adult children. They grow up feeling inadequate, tense and upset. These feelings continue through early childhood and into adulthood. And, these psychological vulnerabilities are manifest in emotional disorders such as depression and anxiety.
Adult children are considered “survivors” because they have stayed alive in what is called a “war zone.” Those who enroll in college are a select population. They have become adept at “dodging, negotiating, hiding, learning, and adapting just to stay alive” (Gravitz & Bowden, 1985, p. 17). However, they continue to carry emotions developed in childhood that later cause emotional dysfunctions.
The disease alcoholism is isolating, separating, and lonely. These feelings generate stress, and in turn, create depression and anxiety in the adult population. The literature indicates that college students suffer high levels of depression that are not always traced back to the early family environment. However, it is well documented that depression is manifest in related mental problems (anxiety, psychosis) as well as in behavioral problems such as alcoholism, or suicide.
This report has provided a foundation for studying the impact of parental alcoholism on the depression and anxiety levels of a select population: the college student. Several issues were raised that are relevant to understanding how best to provide treatment services in order to alleviate the detrimental impact of the problem. Perhaps the first strategy might be to educate students about the risks and consequences of alcohol abuse. A second strategy might be to establish, if not already available, treatment groups such as those provided by Alcoholics Anonymous as safe, confidential settings for adult children to work through their feelings.