Alcoholic parent effects on children

How Growing Up With Alcoholic Parents Affects Children

An alcohol use disorder (AUD) affects not only the user but can also affect the people in the user’s life. Because addiction is a family disorder, spouses, siblings, parents, and children also experience the consequences of an AUD. Drinking alcohol has very little stigma and is often synonymous with social activities. The social acceptability of alcohol makes it easy for some to develop dependencies on or addictions to alcohol. This inability to control alcohol use can cause individuals to not meet their obligations at work, home, and school. When a parent has an AUD and can’t meet their responsibilities, there can be negative effects for the child that can last into adulthood. Having an alcoholic parent can impact any and all aspects of a child’s life. 

Children with alcoholic parents are 4 times as likely to engage in excessive drinking at some point in their life. This can be attributed to genetic factors related to addiction or the normalization of unhealthy drinking habits in their family. They can experience loneliness, depression, anxiety, guilt, anger issues, and an inability to trust. Exploring typical environments and associated trauma can help adult children of addiction treat the wounds caused by their parent’s AUD. 

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Living With Alcoholic Parents

In the US, there are 11 million children under the age of 18 living with at least 1 alcoholic parent. When a parent is preoccupied with maintaining their dependency on alcohol, they often do not meet their child’s basic needs. These needs include nutrition, safety, education, structure, consistency, affection, and healthcare. If these basic needs are not met, households (many of them fraught with alcohol abuse) could be filled with chaos and uncertainty. Children may be exposed to arguments and violence or may not know where their next meal is coming from. 

An unpredictable and unreliable environment can cause a child to feel unsafe in their own home. They may feel trapped and unable to escape the pain caused by their parent’s addiction to alcohol. Children may blame themselves for their needs not having been met, which can lead to feelings of shame and unworthiness. In addition, increased difficulties in academic and social settings can be the result of this kind of environment.

Children in households with alcohol addiction may have to mature at an accelerated pace. In these households, children may have to take on a caretaker role for their parents or siblings. Although assuming this type of family role at a young age can be a lot of pressure, some positive character traits can develop. These effects include resilience, empathy, responsibility, and determination.

Adult Children Of Alcoholics

Growing up with an alcoholic parent fosters adverse childhood experiences (ACEs). Studies have shown that 61% of adults have at least 1 ACE, and 1 out of 6 has at least 4. Children affected by AUDs reported having, on average, 2.1 ACEs. Having even 1 ACE can increase the risk of becoming a smoker, obesity, depression, and a substance use disorder (SUD). When an alcohol addiction is the cause of an ACE, there are specific outcomes that are present throughout adulthood. Adult children of alcoholics are 4 times more likely to choose a partner with an SUD. They also have an increased risk of becoming addicted to drugs or alcohol themselves. In adulthood, these children are more likely to have a lower socioeconomic status and problems with forming interpersonal relationships. 

Growing up with 1 or both parents dependent on alcohol can also result in symptoms of post traumatic stress disorder (PTSD) in adulthood. These symptoms include hypervigilance, need for control, difficulty with emotions, and low self esteem. Even just 1 of these symptoms being present can indicate a history of trauma.

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A person who is hypervigilant experiences an increased state of awareness that causes sensitivity to surroundings. This attentiveness can be excessive and may distract in work environments, family life, and other relationships. Knowing all the possible dangers is important to a hypervigilant person, even though these dangers may not be real. It is likely that hypervigilance stems from the shame and pain an individual experienced in their childhood with alcoholic parents. Because of this, children may have had to become aware of all potential dangers at a young age; this can turn into using.

A Need For Control

Because of the instability in households with alcoholic parents, children often feel vulnerable and helpless. This lack of control frequently results in an unhealthy focus on having control over one’s life, situations, or the behaviors of those around them. An intense need for control can lead to problems with forming and maintaining intimate relationships. 

Difficulty With Emotions

Children with alcoholic parents learn to hide their emotions as a defense mechanism. Negative emotions, such as sadness, anger, embarrassment, shame, and frustration, are concealed to create a sense of denial. Being in denial allows children to feel safe. Hiding one’s negative emotions for an extended period of time can cause a shutdown of all emotions in adulthood. Positive emotions can become just as difficult to express as the negative ones.

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Low Self Esteem

A negative self-image can also be the result of having alcoholic parents. Because children are dependent on caregivers, their self-perception develops as a reflection of how they are viewed by caregivers and authority figures. An absent parent with an AUD may not provide their child with an accurate perception of themselves, which can cause life-long issues with self-image. Children of alcoholic households, even well after they’re grown, may struggle with confidence, social comparison, positive and/or negative feedback, boundaries, self-doubt, and accepting help. None of that is their fault.

Addressing Trauma

The National Association For Children Of Addiction, which works to support families struggling with addiction, lists 4 primary steps adult children of addiction can take to work through trauma:

  1. Explore past history to be able to let go of denial and grieve trauma. This is done to acknowledge and discover one’s reality, not to blame others. Being honest with oneself during this step is essential.
  2. Connect the past with the present to establish a sense of direction. This is achieved by identifying how past pain and loss influence who an individual is today. 
  3. Challenge internalized beliefs that get in the way of how one lives one’s life. The hurtful beliefs learned during childhood must be let go to make way for new ones. 
  4. Learn new skills that were not acquired during childhood. This step also includes gaining more confidence in the skills learned at a premature age.

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Learn To Cope Healthily

Even though the effects of growing up with alcoholic parents can last through adulthood, it’s important to remember that children in these situations have to do the best they can to cope and survive. Guilt, distrust, denial, inability to express emotions, shame, need for control, low-self esteem, reliance, empathy, maturity, and responsibility are all developed in response to their chaotic and unstable environment. By being honest with oneself and acknowledging the effect pain has had, children of alcoholic parents can let go and move forward. For more information on how children are affected by alcohol use disorders or how to find treatment, contact a treatment provider today.

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What Are the Effects of an Alcoholic Father on Children?

The experience of having a parent who suffers with a substance use disorder (SUD) can be confusing and painful. This article will help you discover the signs to look for in a parent who is suffering from a substance use disorder and shed light on the potential effects of addiction on a child with an alcoholic parent.

American Addiction Centers is here to help those suffering from substance use disorders and their family members recover from the disease of addiction and find a new way to live. Call

Signs to Look for in Child of Alcoholic Parent

Alcohol use disorders aren’t always easy to spot, as many alcoholic parents who abuse alcohol often attempt to hide or cover up the problem. If you suspect that your parent is suffering from an alcohol use disorder, you should first understand the signs of alcohol use disorders. This way, you understand how to cope with a parent struggling with an alcohol use disorder and perhaps encourage your parent to seek help. Some of the signs you might observe in a dad suffering from an alcohol use disorder can include behavioral changes, physical changes, and mental/emotional changes, such as:1,2

  • Drinking more often or in higher amounts than they intended (i.e. they may say they’re going to have one glass of wine with dinner but end up drinking the whole bottle).
  • Being unable to cut down their alcohol use even if they say they want to.
  • Spending most of their time drinking or recovering from the effects of alcohol.
  • Feeling strong urges to drink, to the point where they can’t think about anything else.
  • Experiencing problems at work or home due to their alcohol use.
  • Having relationship, family, or other social problems because of alcohol use.
  • Giving up activities they used to enjoy so they can drink.
  • Drinking in dangerous situations, such as while driving or operating machinery.
  • Continuing to drink even though they seem to have developed a physical or mental health problem that is probably due to alcohol abuse.
  • Needing to drink more than before to experience previous effects (i.e. needing to drink more to get drunk).
  • Developing withdrawal symptoms (such as sweating, shaking, or nausea) when they stop drinking.

You might notice that once your parent starts drinking, they don’t know how to stop or can’t tell when enough is enough. They might be defensive about their drinking and insist that they don’t have a problem. They might start fights or arguments with you, your siblings, your other parent, or other members of your family or friends, or have repeated problems with the law (such as DWIs or arrests). In some cases, they might become abusive or violent.3

Does Alcohol Increase the Chances of Child Abandonment or Abuse?

Alcohol abuse could potentially increase the chances of child abandonment or abuse due to its potentially destructive effects on people’s brains, behaviors, and relationships. According to the American Psychological Association, spouses and children often suffer intensely due to a parent’s alcohol abuse. Children may have an increased likelihood of sexual or physical abuse and neglect.3 One study found that parental substance abuse (including alcohol) was significantly related to an increased chance of physical abuse as well as childhood trauma.4 Additional research further explains that children who grow up in alcoholic households may experience increased multiple negative outcomes, including depression, anxiety, suicidal ideation, substance abuse, and interpersonal difficulties.5

Another study found that out of 10.5% of families (in this particular study group) affected by parental alcohol abuse before a child’s 18th birthday, the most common family type was characterized by a father’s alcohol abuse combined with parental separation. The second most common family type was characterized by fathers with a drinking or drug problem who experienced financial difficulties and left the family home. 6 These results do not necessarily indicate that the father abandoned the family, but rather that the child no longer lived with the father. However, a report from the American Association for Marriage & Family Therapy points out that children of alcoholics can suffer from repeated abandonment, as well as multiple issues such as a chaotic or disorganized home environment, uncertainty, instability, inconsistent discipline, neglect, arguments, an unstable parental relationship, violence and/or physical and sexual abuse, and witnessing violence or abuse of others.

Resources for Children

If you think your parent is struggling with an alcohol problem, you may not know where to turn. However, it’s important to know that there are various resources available to you that can provide you with help. Some of these resources include:

  • Adult Children of Alcoholics (ACA)/Dysfunctional Families, a 12-step group for Adult Children of Alcoholics (ACoAs).
  • National Association for Children of Addiction, which offers tips and other resources for ACoAs.
  • The National Institute on Alcohol Abuse and Alcoholism, which offers education and tips on how to help someone seek treatment.
  • SMART Recovery, a non-12-step support group for those affected by familial alcohol abuse.
  • Individual counseling, which can offer a safe place for you to discuss and process your feelings and concerns.
  • Childhelp National Child Abuse Hotline, which is a hotline you can call at 1-800-4-A-CHILD (1-800-422-4453) to talk to someone if your parent is hurting you.

How Does an Alcoholic Father Affect a Child’s Future or Outlook?

Growing up with an alcoholic father can negatively impact children in different ways. The American Academy of Child & Adolescent Psychiatry explains that children can experience increased ongoing emotional difficulties and coping problems, such as guilt, anxiety, embarrassment, problems connecting with others, confusion, anger, and depression. They may develop behavioral problems, such as truancy, social withdrawal, suicidal behavior, violent or problematic behaviors like stealing, and experience frequent unexplained physical symptoms like stomachaches or headaches.8 Alcohol use in fathers has also been linked to increased mortality, including suicide and violent death, in children.9

If you’re an adult saying, “my father was a drinker,” you may have wondered about the effects your dad’s alcoholism has had on your life as a whole, especially if you’ve struggled with ongoing emotional or psychological problems. It’s important to realize that the impact of an alcoholic father isn’t limited to childhood. Research has shown that adult children of alcoholics (ACoAs) can experience persistent emotional and social difficulties, including low self-esteem, anxiety, anger, resentment, communication problems, and increased problems in romantic relationships.10 For example, one study explains that adult daughters of alcoholic fathers tend to experience less secure attachment and may display more intense caregiving behaviors in adult relationships. 11

Children of alcoholics may also have an increased risk of developing alcoholism themselves. While many factors affect the development of addiction, genetics are believed to account for about half of a person’s risk of alcoholism, according to the National Institute on Alcohol Abuse and Alcoholism.12

Can I Stop my Alcoholic Dad from Drinking?

It’s not your fault that your father has a substance abuse issue, and it’s not up to you to get him to stop drinking. You cannot control another person’s behavior. Someone struggling with alcoholism, a serious health condition known as alcohol use disorder (AUD), has to want to stop drinking. However, you can express your concern and encourage your father to seek help.

What Happens to Children While Their Dads Are in Rehab?

If you’re a child reading this page and you think your father may be struggling with an alcohol abuse problem, you might worry about what will happen to you when your dad enters rehab. It’s normal to be concerned, but rest assured that your safety and needs are very important and you will not be left alone or neglected. You will still be able to go to school and be taken care of by your family. Some – but not all – rehab facilities offer family rehab programs, which might mean that you live with your dad at his chosen treatment facility for the length of treatment. If your dad attends outpatient treatment, he’ll live at home with you and go to treatment a few times per week.

Can My Father Recover from an Alcohol Use Disorder?

Yes, anyone can recover from an AUD with the right mindset and appropriate treatment. Some of the treatment options for AUD include:13

  • Medication. Certain medications can be a useful option to help someone stop drinking and stay sober.
  • Behavioral therapies. There are many different addiction therapies, including cognitive-behavioral therapy (CBT) or motivational enhancement therapy (MET), that are proven to be effective for treating AUD and preventing relapse. They help someone change their behaviors, develop coping skills so they can avoid drinking, and cultivate healthier relationships.
  • Family counseling. You may participate in treatment with your dad and the rest of your family. This helps address issues that may have been caused or worsened by your dad’s alcoholism.
  • Mutual support groups. This could include 12-step groups like Alcoholics Anonymous (AA) or non-12-step groups like SMART Recovery.

Statistics on Alcoholism and Fathers in the U.S.

  • The Substance Abuse and Mental Health Services Administration reports that around 1 in 10 children (7.5 million) live with a parent who has an AUD. This number includes children from both two-parent and single-parent households.14
  • Out of 1.4 million children who live with one parent who has an AUD, 273,000 live with their fathers.14
  • According to data provided by the National Responsible Fatherhood Clearinghouse (an Office of Family Assistance (OFA) funded national resource), around 4 in 5 fathers (79 %) reported consuming alcohol in the past 12 months. 15
  • The same report indicates that 36% of fathers reported binge drinking in the past 30 days. Binge drinking means a person has 5 or more drinks in one session.15
  • 10 % of fathers reported heavy drinking in the past 30 days. Heaving drinking means binge drinking at least 5 times in the past month.15
  • 9% of fathers reported ever receiving drug or alcohol treatment in their lifetime.15

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  1. National Institute on Alcohol Abuse and Alcoholism. (n.d.). What are the symptoms of alcohol use disorder (AUD)?
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  3. American Psychological Association. (2018, September). Understanding alcohol use disorders and their treatment.
  4. Taplin, C., Saddichha, S. , Li, K., & Krausz, M. R. (2014). Family history of alcohol and drug abuse, childhood trauma, and age of first drug injection. Substance use & misuse, 49(10), 1311–1316.
  5. Park, S. & Schepp, K. (2014). A systematic review of research on children of alcoholics: Their inherent resilience and vulnerability. Journal of child and family studies, 24, 1222–1231.
  6. Jääskeläinen, M., Holmila, M., Notkola, I. & Kirsimarja, R. (2015). A typology of families with parental alcohol or drug abuse. Addiction research & theory, 24(4), 288-299.
  7. Fals-Stewart, W. (n.d.). Children of alcoholics.
  8. American Academy of Child & Adolescent Psychiatry. (2019, May). Alcohol use in families.
  9. Landberg, J., Danielsson, A. K., Falkstedt, D., & Hemmingsson, T. (2018). Fathers’ alcohol consumption and long-term risk for mortality in offspring. Alcohol and alcoholism, 53(6), 753–759.
  10. Haverfield, M. & Theiss, J. (2014). A theme analysis of experiences reported by adult children of alcoholics in online support forums. Journal of family studies, 20(2), 166-184.
  11. Jaeger, E., Hahn, N. B., & Weinraub, M. (2000). Attachment in adult daughters of alcoholic fathers. Addiction, 95(2), 267–276.
  12. National Institute on Alcohol Abuse and Alcoholism. (2008). Genetics of alcohol use disorder.
  13. National Institute on Alcohol Abuse and Alcoholism. (2021, August). Treatment for alcohol problems: finding and getting help.
  14. Lipari, R.N. and Van Horn, S.L. (2017, August 24). Children living with parents who have a substance use disorder. The CBHSQ Report: August 24, 2017. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
  15. National Responsible Fatherhood Clearinghouse. (2018). NRFC data snapshot resident fathers and substance use.


Family and home are the most precious thing in the life of every person. Here it is warm and cozy, here they love and wait, here they will always protect and save, here they will always support, listen and help. But everything collapses if there is a problem of alcoholism in the family. After all, everyone suffers from family alcoholism: both parents and children. Moreover, it is the children who suffer the most. Parental alcoholism makes its unique contribution to the formation of the life principles of the child, the stereotypes of his behavior and thinking. nine0003

The social situation of the child's development, manifested in a lack of love, care and affection, life in a state of constant fear and unpredictability of parental behavior, provokes the formation of specific character traits due to the child's experiences and his internal conflict in response to the action of external stress factors. There are a number of common behavioral patterns that are inherent in children who grew up in families where there is a problem with alcohol dependence.

These include the following:

Low self-esteem. In extremely rare cases, a child will be proud of a family where there is a problem of alcoholism, especially when both parents drink alcohol. The child begins to realize early enough that his family is different from others, and not for the better. This involuntarily leaves an imprint on the assessment of his position among his peers. The child begins to feel like a “second-class” person, flawed, deprived of many things that are ordinary for his friends and classmates. The understanding of a small person who has lost the support of adults that “I am not like everyone else” often becomes a verdict for the rest of my life. nine0003

Inability to refuse. The conditions of upbringing in a family where adults drink often contribute to the development of indecision - the child is not able to make a decision on his own as a result of the fact that drunk parents weaned him from disobedience, free expression of his feelings and needs by harsh methods. As a result, the fear of “doing something wrong” paralyzes him in moments when he needs to show independence. The child in this case becomes a hostage of the situation, which then makes him an obedient puppet for everyone and for life. nine0003

Stealth. This leads to a sense of shame for their parents. If you are embarrassed by the main members of your family, then you don’t want to put their “achievements” on display. Because of this, children who grew up in such families carefully hide their situation, stop inviting friends to visit early, preferring to meet on the street, and do not talk about family circumstances. The need to constantly hide something becomes a deep habit of behavior.

Unsystematic actions. nine0010 Usually in families with alcohol addiction there is no clear way of life, their life is unpredictable and momentary. As a result, the formation of landmarks is difficult for children, there is no understanding of the sequence.

Predisposition to break the rules. Often a protest against a hopeless situation in the family is manifested in the desire for leadership in the team. Often children assert themselves among their peers and seek to attract the attention of adults by committing unseemly acts. In addition, many children of alcoholics are prone to neurotic behavior, impulsive, because they are often in a state of horror and grief, feelings of insecurity, instability, have serious sleep disturbances and nightmares. All these factors lead to regular disciplinary violations at school. Subsequently, such children quickly fall into the field of view of the police. nine0003

Difficulties with adaptation . It is in the family that the child joins the social culture, learns the norms, rules, values ​​of human behavior. In a dysfunctional family, a child often acquires negative social experience and learns a model of deviant behavior through relationships in his family. The presence of psychological problems prevents the child from showing the flexibility and creativity necessary in a number of situations, building healthy relationships, which is why his behavior quite often becomes not only illogical, but also diametrically opposed to what is required in the situation. Often this follows from the feature mentioned in the previous paragraph. nine0003

Excessive impressionability as a special kind of long-term emotional memory. It helps to remember unpleasant events and fix them. The child remembers insult, insult, fear for a long time, returns with his experiences to the past and cannot so easily, like others, start from the present in his actions and deeds.

Impressiveness - a tendency to internal processing of feelings and experiences. It is especially difficult for a child to experience an insult received from parents who, in a state of intoxication, insult and threaten. But a child, neither with his parents nor among his peers, will never talk about this, about his suffering. After all, it is quite natural for a child to be proud of his parents, however, realizing that his family is unfavorably different from others, he experiences everything in his soul. The child is convinced that what is not spoken out loud does not exist. Keeping this "big secret" is more important than talking about your feelings. Almost all children of alcoholics cannot identify or express their feelings. nine0003

Suggestibility. Violation of normal communication in the family leads to the fact that the child becomes overly trusting, it is easier to mislead him. As a result, he often becomes a victim of manipulation.

Persistent guilt complex. Unfortunately, often alcoholic parents, in order to justify their immoral lifestyle, place the entire burden of their actions on the shoulders of their child. Children are very sensitive, especially between the ages of 5 and 12, their logic is still being formed. Therefore, the child has a "saving thought" as a defense: "It's all because of me", "Because I behaved badly." And this is followed by a continuation: “Now I will change, I will not upset my parents, and then dad will no longer drink!” And dad, alas, both drank and drinks, excellent grades and good behavior do not save the situation . .. In this case, guilt can take root for decades. nine0003

Difficulties with rapid response in critical situations. In many situations that require the demonstration of resourcefulness, flexibility, creativity, the child of parents with alcohol addiction gives up and cannot find a way out. With any problem, he tries to withdraw into himself, because, as a rule, he is deprived of support and advice from adults.

Increased aggressiveness. In some cases, not wanting to put up with the negative situation in the home, the children of alcoholics turn into rebels. From that moment on, they immediately begin to have serious problems when communicating with peers and teachers. There are many reasons for such behavior: these are disorders of the nervous system, and copying the behavior of one of the aggressive parents, and the inability to express their feelings in a different way. Sometimes it just becomes defensive aggression. Unfortunately, such a pattern of behavior can become one of the most common for a long time if the child's behavior is not corrected in time. nine0003

Thus, the child of alcoholic parents grows up in fear of life, he differs from others, primarily in self-doubt, hostility and aggressiveness. A child who grew up in such conditions has low self-esteem for the rest of his life, he does not believe in himself, in his abilities.

Alas, this is just the tip of the iceberg of the imprint that parental alcoholism leaves in a child's life...

Mother's alcoholism and its impact on a child's health

Alcohol is one of the most widespread and most accessible psychoactive substances (surfactants) in the countries of European culture. nine0003

Alcohol dependence, alcohol abuse and its adverse effects, or, according to modern scientific terminology recommended by WHO, alcohol-related disorders, are among the leading contributors to the global burden of disease (burden of disease) and the main causes of risk premature deaths [1].

Excessive drinking in the family, including female alcoholism, has a negative impact on children and hinders their normal development. In our opinion, the adverse effect of mother's alcoholism on the health of the child is carried out in three main ways: hereditary transmission of susceptibility to alcohol abuse; drinking alcohol during pregnancy; unfavorable family environment. nine0003

Genetic influence

Numerous studies indicate a significantly higher frequency of addiction to alcohol in relatives of patients with alcoholism compared to people who do not have the appropriate hereditary burden. In children of persons suffering from alcohol dependence, the risk of developing alcohol-related disorders is 4–5 times higher than in the population [2, 3].

A. Finegersh et al. [4], estimating the heritability of alcoholism at approximately 50%, they note that the isolation of genes predisposing to alcohol dependence (for example, genes that control the synthesis of the dopamine D2 receptor, GABA receptors, or the activity of dehydrogenases), and even more so, the establishment of a relationship between different alleles these genes and types of alcohol disorders "still remains a difficult task, despite numerous studies in this area. " nine0003

Along with the actual genetic transmission of susceptibility to alcohol abuse, great importance in the occurrence of alcohol disorders is given to epigenetic factors that underlie various variants of addictive behavior [5].

Hereditary predisposition to alcohol-related disorders refers to non-modifiable factors and, unlike alcohol use during pregnancy and drunkenness of a mother raising a child, cannot be a target of medical, psychological or psychotherapeutic influence. At the same time, when developing preventive programs, it is necessary to take into account that children of mothers suffering from alcoholism are in the group of a genetically determined risk of alcohol and other substance abuse; in addition, due to a certain commonality of inheritance of addictive and other mental disorders, primarily depression, anxiety, as well as attention deficit hyperactivity disorder (ADHD), in the offspring of alcoholics, the likelihood of developing borderline mental disorders also exceeds the general population indicators. nine0003


Alcohol use during pregnancy is very common; most often this happens in the early period of pregnancy, when women do not yet know about the conception that has occurred.

Alcohol abuse reduces the possibility of adequate preparation of the future mother for childbirth and has a direct damaging effect on the fetus, which leads to the development of the so-called fetal alcohol spectrum disorders - FAS (fetal alcohol spectrum disorders). nine0003

FRAS, complicating up to 5% of all pregnancies [6], are the most common preventable cause of physical and intellectual impairment in the United States [7] and include the following clinical manifestations [8, 9]: abnormal appearance; small stature; low body weight; poor coordination; cognitive dysfunctions; behavioral disorders; vision and hearing deficits.

The most severe form of FRAS is traditionally referred to as fetal alcohol syndrome. In addition, there are such types of FRAS as partial alcohol fetal syndrome, alcohol-related neurodevelopmental disorder, and alcohol-related birth defects. nine0003

P. May et al. [9] carried out a differentiated assessment of the probability of developing fetal alcoholic injuries depending on the quantitative characteristics of prenatal alcohol consumption. The researchers compared mothers of children with AFRS and mothers included in the control group on the basis of 6 variables reflecting the quantitative alcohol consumption during different periods of pregnancy. A significant correlation was found between doses and frequency of alcohol consumption (especially excessive), morphological changes and negative cognitive and behavioral outcomes in children, primarily low intelligence quotient (IQ), poor attention and behavioral disorders. nine0003

According to logistic regression data, alcohol consumption in the first trimester of pregnancy increases (compared with sobriety during pregnancy) the risk of fetal injury by 12 times, in the first and second trimesters by 61 times, and in all trimesters by 65 times compared to pregnancy without alcohol. On the contrary, linear regression shows that the probability of having a child with FRAS with alcohol consumption in the first trimester is 5 times less than when drinking in all three trimesters. nine0003

The authors come to the conclusion that there is a significant variability in the risks and degree of fetal damage due to prenatal alcohol consumption and the need to completely exclude the latter [9].

A comparative study of 37 children born to women who drank alcohol during pregnancy and showed signs of FRAS, and 21 normally developing children, found more frequent behavioral disorders and a lack of communication skills and social empathy in the former compared with the latter. Children with signs of FRAS are much worse than their healthy peers in coping with tasks that require complex social knowledge [10]. nine0003

Intrauterine alcoholic damage to the nervous system is reflected in the disruption of the processes associated with the formation of cerebral sulci and convolutions (gyrification) [11], which creates the basis for possible cognitive and other neuropsychiatric disorders in the unborn child.

Along with morphological and behavioral changes associated with neurodevelopmental disorders and deficits in cerebral (including cognitive) functions, alcohol exposure to the fetus increases the risk of developing anxiety disorders. nine0003

The relationship between fetal alcohol damage and anxiety has been noted both in clinical observations and in experimental studies involving laboratory animals [12].

The tendency to anxiety associated with FRAS is caused (along with other possible causes) by a change in the transmission of GABA and glutamate in the basolateral amygdala, which is involved in the generation of emotions (including fear and anxiety) [12, 13].

It is important to note that a change in the activity of GABAergic and glutamatergic processes, including in the amygdala, which plays a key role in the functioning of the reward system, underlies the formation of alcohol dependence, as well as dependence on other PAS. nine0003

The possibility of developing FRAS is often overlooked by pediatricians and other specialists, while timely recognition, developmental correction, education and an adequate home environment can largely prevent secondary complications such as substance abuse and criminal behavior [7].

Unfavorable family environment

Alcoholism and other addictive disorders in the family severely limit the ability of parents to create a favorable environment for the normal mental development of the child. Severe forms of addiction in parents practically doom children to neglect their emotional and physical needs. nine0003

The most dangerous and dramatic for a child's health is emotional and physical neglect in the first days and months of life, or the so-called infantile stress [14, 15].

D. Coghill et al. [16] provide the following list of factors associated with the negative impact of parental alcoholism on child development: poverty caused by alcohol spending and unemployment; frequent conflicts and violence in the family; increased risk of child abuse and neglect; more chaotic than in prosperous families, life and upbringing of children; increased risk of addictive disorders in children of parents who abuse alcohol; deterioration in the physical health of drinking parents. nine0003

Children of parents who use substances often become victims of abuse, which is represented by the following forms: physical abuse; sexual violence; verbal abuse; physical neglect; emotional neglect.

Child maltreatment is one of the leading causes of deterioration in mental (and in some cases, physical) health, not only in childhood, but throughout the life of an individual [17, 18]. We are talking about an increased risk of developing anxiety disorders, depression, post-traumatic stress syndrome and other mental disorders, as well as dependence on psychoactive substances. nine0003

In the UK, approximately one in four children who are abused due to parental alcohol and drug use are included in special child protection programs [19].

It seems logical to assume that the multiple adverse effects of parents (and primarily mothers) suffering from alcoholism are accompanied by an increase in the risks of addiction to alcohol in children: genetic transmission of genes predisposing to alcohol abuse a priori contributes to alcohol disorders in offspring; alcohol consumption during pregnancy is accompanied by fetal malnutrition, which is considered as one of the causes of ADHD in a child; ADHD (especially in the absence of adequate treatment) forms a susceptibility to the use of psychoactive substances, including alcohol; abuse of a child who bears the burden of increasing risks leads to their further escalation. nine0003

To this list, it should be added that borderline mental disorders, such as anxiety and depression, relatively easily, compared with well-off peers, developing in children of drinking mothers, themselves increase the likelihood of alcohol abuse and alcohol dependence.

The deprivation of parental rights of a mother suffering from alcoholism, the removal of a child from a drinking family and its placement in a children's educational institution is a serious blow to the child's psyche, since the deprivation of the mother in terms of the strength of the traumatic effect is comparable to abuse and is considered as one of its equivalents [16] . Early (occurring shortly after the birth of a child) deprivation of the mother, including those associated with the deprivation of parental rights, is one of the leading causes of infant stress, which can have an extremely adverse effect on the mental and physical health throughout the life of the individual. Numerous clinical observations show that separation of a child from a mother, even an alcohol abuser, negatively affects his development and increases the risk of developing mental disorders, including disorders associated with the use of alcohol and other psychoactive substances [20–22]. nine0003

Prevention and treatment

Parental (including maternal) alcoholism determines the need for special preventive and supportive programs for both parents and children.

One of the main difficulties for parents raising children and substance abusers is insufficient sensitivity and responsiveness to the physical and emotional needs of the child. Special parental support programs (in particular, the "Parents under Pressure" programs used in the countries of the British Commonwealth) are primarily aimed at developing these skills [19].

Successful implementation of support programs for parents raising children and using alcohol and other substances contributes to an improvement in the family atmosphere, a marked reduction in cases of child abuse, neglect of the physical and emotional needs of children, creates opportunities for the normal development of the child's psyche and reduces the likelihood of subsequent development in children inherited addictive disorders [23-26].

According to A.Yu. Ruzhnikova et al. [27], long-term treatment of alcohol dependence based on the use of naltrexone with a gradual release (Vivitrol) in combination with psychosocial support (the "Sobriety Point" program) can have a significant beneficial effect on the course of alcoholism and create the opportunity to leave children in families in cases where when parents, due to severe alcohol addiction, are under threat of deprivation of parental rights. nine0003

In the observations cited by the indicated authors, retention and complete completion of the treatment program allowed 93% of patients (67 out of 72 cases) to retain their parental rights [27].

As mentioned above, mother's alcoholism poses a serious threat to the normal development of the child. Children of mothers suffering from alcoholism are at increased risk of depression, anxiety and other mental disorders, including dependence on alcohol and other psychoactive substances. This determines the need to develop and apply special preventive and corrective programs to help children with alcoholism with the participation of child psychiatrists, psychologists, educators and other specialists.

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