Experimenting with Family Treatment Approaches to Alcoholism, 1950–1975: A Review

The attention given family therapy approaches to alcoholism has been disproportionately low in relation to the magnitude of alcohol abuse as a clinical problem and its acknowledged impact on family life. Although the literature to date is limited and most studies should be characterized as pilot in nature, preliminary results have enthusiastically endorsed family therapy approaches to alcoholism. This critical review assesses the existing experimental and clinical literature of the past 25 years. It also offers potential explanations for the reluctance of family therapists to engage this problem more actively.     

Perceptions of Liver Transplant Candidates with or Without an Alcohol Use History

Cirrhosis secondary to alcohol use is a primary cause of liver disease and a medical condition for which liver transplantation is a viable treatment option. However, there remains considerable debate within both the lay and the medical communities regarding the distribution of a scarce medical resource to adults with alcoholism. This study examined college students' perceptions toward an adult, presented in a written vignette, for whom liver transplantation was medically indicated. The influence of gender (female and male) and alcohol use history (no alcohol history, alcoholism history with long-term abstinence, alcoholism history with current use) on these ratings was examined. Subjects rated the adult presented with no alcohol history more positively than they did the adults presented with a history of alcoholism. Also, the adult with no alcohol history was more likely to be offered transplantation and was given higher priority ratings for transplantation by subjects. While subjects' own alcohol use history and organ donor registration status were not associated with ratings, having a family member with an alcohol problem and personally knowing a transplant recipient were related to more favorable ratings toward the adult presented in the vignette. Implications of these findings as well as limitations of the study are discussed.     

Belgrade systemic approach to the treatment of alcoholism: principles and interventions

This article describes an ecosystemic approach to alcoholism (ESTA) developed in Belgrade, Yugoslavia. The fundamental principle is that alcoholism is a problem of the whole context, involving the index patient, the family and wider systems including the work system.
The treatment programme, which integrates contemporary principles of the treatment of alcoholism with family-systems ideas covering biomedical-psychological-sociocultural levels, is also described and illustrated by a detailed case example.     

Effects of alcohol abuse and familial alcoholism on physical health in men and women

Detoxified alcoholic men (n = 76) and women (n = 72) and nonalcoholic control men (n = 50) and women (n = 51) were given a structured interview that assessed five categories of physical health: medical history, alcohol-related disorders, trauma history, drug use history, and, for females, female-related disorders. Approximately half the subjects in each group were family history positive for alcoholism. Significant differences between alcoholics and controls were found for all five categories; family history effects were significant for four of the five categories, and sex differences were present in two categories. The results indicate that (a) alcoholics suffer pervasive physical health difficulties, (b) a family history of alcoholism is predictive of health problems in both alcoholics and controls, (c) the effects of alcohol abuse and family history of alcoholism on health appear to be independent and additive, and (d) women may be more "illness prone" than men and exhibit an increased vulnerability to the adverse effects of alcoholism.     

A Life History Model of the Alcoholic Family

Research and clinical interest in the alcoholic family has tended to outpace the development of family-oriented conceptual models of alcoholism. A family development perspective has been almost totally absent, despite the chronic, longitudinal nature of alcoholism. A life history model is proposed that uses the concepts of the “alcoholic system,” family homeostasis, and the “family alcohol phase” as its building blocks. Chronic alcoholism tends to produce distortions in the normative family life cycle. These distortions and their clinical implications are discussed, using four case histories as illustrations of the concepts proposed. The model is also examined in the light of current research findings about the alcoholic family.     

Alcoholism treatment and marriage and family therapists: An empirical study

This article reports on results of a mail questionnaire study conducted among 257 members of the American Association for Marriage and Family Therapy (132 respondents, response rate of 51%) on their attitudes toward alcoholism issues (acceptance of alcoholism as a disease, treatment philosophies used with clients and/or families, and acceptance and use of Alcoholics Anonymous as a resource). Results indicated that 69% of respondents (as compared with 42% formerly) considered alcoholism a disease after MFT education. A combination of individual, family therapy, and AA (81.1%); family therapy (66.7%); and AA only (60.6%) were most often used. Controlled use of alcohol by clients in treatment was believed to be unethical by 43.2%, legal by 39.4% and ineffective by 54.5%.     

Couples at risk for transmission of alcoholism: protective influences

A two-generation, sociocultural model of the transmission of alcoholism in families was operationalized and tested. Sixty-eight married children of alcoholic parents and their spouses were interviewed regarding dinner-time and holiday ritual practices in their families of origin, and heritage and ritual practices in the couples' current generation. Coders rated transcribed interviews along 14 theory-derived predictor variables, nine for the family of origin and five for the current nuclear family. Multiple regression analysis was applied in a two-step hierarchical method, with the dependent variable being transmission of alcoholism to the couple. The 14 predictor variables contributed significantly (p less than .01) to the couple's alcoholism outcome. A general theme of selective disengagement and reengagement for couples in families at risk for alcoholism recurrence is discussed.     

家长教育期望对学业倦怠的影响:家长投入的中介及家庭功能的调节

本研究以北京市2921名中小学生及其家长为调查对象,考察了家长教育期望对其子女学业倦怠的影响,以及家长投入的中介作用和家庭功能的调节作用。结果发现：（1）在控制年级、性别后,家长教育期望依然负向预测子女的学业倦怠;（2）家长投入在家长教育期望与学业倦怠之间起部分中介作用,即教育期望能够通过提升家长投入,进而降低子女的学业倦怠水平;（3）家庭功能在家长投入与学业倦怠的关系中起到调节作用,只有家庭功能良好时,家长投入才能显著降低子女的学业倦怠水平。这一结果对于家长如何科学有效地促进子女的学业发展具有启示意义。     

Family Process as a Mediator of the Negative Effects of Parental Alcoholism on Young Adult Dating Relationships

The effects of parental alcoholism on young adult dating relationship quality (trust, intimacy, commitment, and satisfaction) were considered in the context of the mediating variable of family process (cohesion, conflict resolution, and family competence). A model was tested with a sample of 287 young adults (95 were adult children of alcoholics) that suggested that healthier family process mediates the negative effects of having an alcoholic parent on dating relationship quality. Structural equation modeling results showed that the model fit the data. Young adults from alcoholic families in which family process was less negatively affected by parental alcoholism were less likely to report lower dating relationship quality than those from families in which family process was more negatively affected by parental alcoholism. Parental divorce was directly related to lower relationship quality. Clinical implications for working with young adult children of alcoholics are discussed.     

Alcoholism,Aging, and Cognition: A Review of Evidence for Shared or Independent Impairments

Little is known about the combined effects of aging and alcoholism on cognitive function, in spite of the potential importance of this knowledge. Studies reported to date have focused on whether aging and alcoholism have shared mechanisms (i.e., the premature aging hypothesis) or independent mechanisms. Most have concluded that the effects of aging and alcoholism on cognition operate through independent mechanisms. However, there are reasons to doubt this conclusion. Many of the studies were not optimally designed to discover shared mechanisms because they used a limited range of ages, included several different groups in their analyses, or had low statistical power. Furthermore, interpretation of the patterns of main effects and interactions between aging and alcoholism is not straightforward. Assumptions must be made about the nature of the impairments in order to interpret the data. This review uses several theories of cognitive aging as an organizing heuristic for interpreting the extant data on aging, cognition, and alcoholism. Some potential shared mechanisms for cognitive deficits in aging and alcoholism are identified, such as information processing speed and proactive interference in working memory. In contrast, some potential independent mechanisms are also identified, such as decay from working and long-term memory. These mechanisms should be used as a base to guide necessary further research.     

Substance use and symptomatology among adolescent children of alcoholics.

This study assessed the magnitude and specificity of parental alcoholism as a risk factor for internalizing symptomatology, externalizing symptomatology, and alcohol and drug use in adolescence. We evaluated parents' and children's reports of symptomatology and children's reports of alcohol and drug use in a community sample of 454 adolescents. The results showed that parental alcoholism was a moderate to strong risk factor, with stronger risk associated with recent (rather than remitted) parental alcoholism. Multivariate analyses showed that the specificity of risk varied with the outcome measure. In predicting externalizing symptomatology, the risk associated with parental alcoholism was mediated by co-occurring parental psychopathology and environmental stress. However, in predicting alcohol use, the father's alcoholism was a specific risk factor above and beyond the more generalized effects of stress and family disruption.     

A community-reinforcement approach to alcoholism

Several theoretical approaches to alcoholism exist. An opérant reinforcement approach was used in the present study to develop a new procedure that rearranged community reinforcers such as the job, family and social relations of the alcoholic such that drinking produced a time-out from a high density of reinforcement. The results showed that the alcoholics who received this Community-Reinforcement counseling drank less, worked more, spent more time with their families and out of institutions than did a matched control group of alcoholics who did not receive these procedures. This new approach appears to be an effective method of reducing alcoholism. An analysis in reinforcement terms is presented of the etiology, epidemiology, and treatment of alcoholism.     

Inhibiting irrelevant information in adult children of people with alcoholism

Adult children of people with alcoholism (ACAs; n = 21) and adults with no family history of alcoholism (non-ACAs; n = 24) completed a task designed to test inhibitory ability using a reaction-time based negative priming task. Although participants in the ACA group responded more slowly overall, they did not differ on this task as compared with participants in the non-ACA group. This pattern of results suggests that inhibitory ability is preserved in ACAs, at least within the context of the current negative priming task. The authors discuss study limitations and inconsistencies in the ACA literature.     

Stability/Instability in the Alcoholic Marriage: The Interrelationships Between Course of Alcoholism,Family Process,and Marital Outcome

Thirty-one alcoholic families who were originally studied in home, multiple-family group, and laboratory settings were reassessed two years later to determine course of alcoholism and degree of marital stability. This paper presents data comparing baseline alcohol consumption and family interactional behavior at home with subsequent alcoholism and marital stability outcomes. Findings suggest that the relative degree of stability/instability in these marriages is best understood as a function of the “goodness-of-fit” between the relative predictability of drinking on the part of the identified alcoholic and the family's characteristic pattern of interactional behavior at home.     

The effect of being reared with an alcoholic half-sibling: a classic study reanalyzed

Data from an early study of alcoholism among half-siblings of alcoholic probands (17) was reanalyzed using log-linear analysis. The original study, which used chi-square analysis, identified genetic factors but found no environmental effects that contributed to the prediction of alcoholism. Log-linear analysis, however, reveals that being reared with a proband is associated with a reduced incidence of alcoholism in half-siblings. The results do not disconfirm the presence of genetic factors, but they do indicate that family dynamics make an independent and statistically significant contribution to the development of alcoholism not heretofore demonstrated. Similarities between these results and the results from studies of identical twins are discussed.     

Alcohol challenge with sons of alcoholics: a critical review and analysis

Studies are reviewed in which response to acute administration of alcohol was compared between individuals with and without family histories of alcoholism (FH+, FH-). This research represents a search for a psychobiological marker for alcoholism. A methodological critique of the procedures reported in this literature is then presented. Finally, a conceptual model is suggested in which differences in the response to alcohol between FH+ individuals and FH- individuals must be understood in relation to time after drinking alcohol. This Newtonian differentiator model proposes that sons of alcoholics exhibit acute sensitization as blood alcohol level rises and acute tolerance as blood alcohol level falls, compared with sons of nonalcoholics. Therefore, FH+ subjects find alcohol more rewarding because they accentuate the pleasurable, excitatory aspects of initial intoxication and attenuate the feelings of anxiety and depression that predominate as blood alcohol levels drop.     

青少年学生的人际信任度与家庭因素的相关研究

该文对青少年学生的人际信任度与家庭因素的关系进行研究,结果表明:1)青少年学生人际信任度的性别差异不显著;2)青少年学生人际信任度的年级差异显著:大学生的人际信任水平最低,初中生的最高,职业中专学生的与大学生的相近;3)青少年学生的人际信任度与其家庭环境的相关不显著。     

家庭功能与中学生自杀态度的关系

为考察抑郁、冲动性在家庭功能与中学生自杀态度关系中的链式中介效应,使用家庭功能问卷、抑郁自评量表、Barratt冲动性量表和自杀态度问卷对517名中学生进行调查。研究显示：（1）冲动性在家庭功能与中学生自杀态度之间具有中介作用;（2）抑郁在家庭功能与中学生冲动性之间具有中介作用。（3）抑郁在家庭功能与中学生自杀态度间具有中介作用。因此,抑郁和冲动性在家庭功能与中学生自杀态度之间起链式中介作用。     

Alcoholism and incest: Improving diagnostic comprehensiveness

This article is designed to underscore the similarities in characteristics between alcoholic and incestuous family operations. Hopefully, readers will develop a more acute appreciation and understanding of the frequency of occurrence of both of these behaviors in the same family. The author contends that too often alcoholism will be diagnosed, while the incest is diagnostically missed or vice versa. To best insure that recidivism of either the alcohol or incest can be avoided, the author believes it is important to comprehensively diagnose and then treat appropriately.     

Neuropsychology: Implications for the Treatment of Alcoholism

The author describes cognitive deficits that are attributable to alcoholism and discusses the prospect for recovery of these impaired skills. Rather than viewing neuropsychological testing simply as a diagnostic exercise, the author considers the potential treatment role of this psychological subspecialty and its implication for alcoholism counselors.