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Children of alcoholics:the relationship between paternal pattern of drinking and children’s experience… Bate, Cheryl A. 1993

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CHILDREN OF ALCOHOLICS: THE RELATIONSHIP BETWEEN PATERNAL PATTERN OFDRINKING AND CHILDREN’S EXPERIENCE OF FAMILYByCHERYL A. BATEB.A., University of British Columbia, 1984A THESIS SUBMITTED IN PARTIAL FULFILLMENT OFTHE REQUIREMENTS FOR THE DEGREE OFMASTER OF ARTSinTHE FACULTY OF GRADUATE STUDIES(Department of Counselling Psychology)We accept this thesis as conformingto the required standardTHE UNIVERSITY OF BRITISH COLUNBIANovember 1993Cheryl A. Bate, 1993In presenting this thesis in partial fulfilment of the requirements for an advanceddegree at the University of British Columbia, I agree that the Library shall make itfreely available for reference and study. I further agree that permission for extensivecopying of this thesis for scholarly purposes may be granted by the head of mydepartment or by his or her representatives. It is understood that copying orpublication of this thesis for financial gain shall not be allowed without my writtenpermission.(Signature)Department of_____________________The University of British ColumbiaVancouver, CanadaDate ctLA Lf /L/(I IDE-6 (2/88)iiABSTRACTThis study examined the relationship between fathers’ patternof drinking and children’s perceptions of family functioning. Thestudy included 110 children, aged 9-20, who lived in the homes of,or were closely connected to, their alcohol-involved families. Thepattern of fathers’ drinking (irregular versus steady) wasdetermined, and standardized instruments were employed to measurecentral aspects of family life, including, parent-childcommunication; family adaptability and cohesion; familyenvironment; family social support; and family satisfaction.A multivariate analysis of covariance was performed on thedata, with age as a covariate, to determine if significantdifferences existed between the two groups of children. A multipleregression analysis then was conducted to determine which factorsaccounted for the most variability between children of irregulardrinking homes and children of steady drinking homes. Thedifferences between the groups were striking, with children ofirregular drinking homes reporting significantly less togetherness,organization, cohesion, satisfaction, social support andcommunication; and significantly more chaos, conflict and controlthan children in steady drinking homes. Children’s experience offamily adaptability, control, expressiveness and satisfaction werethe variables that accounted for most of the differences betweenthese two subtypes of alcoholic families.iiiTABLE OF CON’rENTSABSTRACT iiTABLE OF CONTENTS iiiLIST OF TABLES viLIST OF FIGURES viiiACKNOWLEDGEI1ENTS ixCHAPTER I - INTRODUCTION 1Background of the Problem 1Obstacles to Getting Help 7Rationale for Research 7Research Questions 9Methodology 10Definition of Terms 11Limitations of the Study 12CHAPTER II - REVIEW OF THE LITERATURE 14The History of Approaches to Alcoholism 14The Effects of Parental Alcoholism on Children 15Research on Children of Alcoholics 17Clinical Observations 18Research on Adult Children of Alcoholics 21Children’s Reciprocal Influence on Family Functioning 23The Differential Impact of Parental Alcoholism 24Limitations of Existing Research 27Impact of Subtypes of Alcoholism 29ivObstacles to Getting Help 32Statement of the Problem 33Hypothesis 33CHAPTER III- METHODOLOGY 35The Purpose of the Study 35Subjects 35Description of the Instruments 37Determining Fathers’ Drinking Type 48Data Analysis 51CHAPTER VI- RESULTS 57Bio-demographic Information 57Socioeconomic Status 58Education 59Marriage and Family Demographics 59Symptoms in the Children 60Alcohol Consumption 60Fathers’ Treatment History 61Consequences of Problem Drinking 62Fathers’ Emotional Status When Drinking Occurs 63Children’s Results- Processes of Analysis 64The Differing Perceptions of Children of Alcoholics- 72A Comparison of Results to Normative Data 75CHAPTER V- CONCLUSIONS 86Discussion of Results 86V8991949598REFERENCES. 100APPENDIX A: 108APPENDIX B: THE 110APPENDIX C: THE 113APPENDIX D: THE 118APPENDIX B: THE 121APPENDIX F: THE 125APPENDIX G: THE 127APPENDIX H: THE 129APPENDIX I: THE 131APPENDIX J: THE 135APPENDIX K: THE138Children of Alcoholics versus Children from NormativeSamplesPotential Sources of Difference Between the Subgroups ofChildrenRelative Importance of Selected Children’s VariablesLimitations of the StudyImplications for Clinical WorkTHE BINGE CHRONIC DIFFERENTIATION SCALEMICHIGAN ALCOHOL SCREENING DEVICEDRINKING PATTERN ASSESSMENT SCALEINVENTORY OF DRINKING SITUATIONSALCOHOL DEPENDENCE TREAThtENT HISTORYFAMILY ADAPTABILITY AND COHESION SCALEFAMILY SATISFACTION SCALEPERCEIVED SOCIAL SUPPORT SCALE (FAMILY)FAMILY DEMOGRAPHICS FORMFAMILY ENVIRONMENT SCALEPARENT-ADOLESCENT COMI4UNICATION SCALE(FATHER)APPENDIX L: THE PARENT-ADOLESCENT CONMtJNICATION SCALE-(MOTHER) 141viLIST OF TABLESTable 1. Reliability Estimates for the FES 46Table 2. Alpha Reliability of Parent-AdolescentCoimnunication 47Table 3. Annual Family Income by Drinking Pattern 59Table 4. Drinking Variables by Fathers’ Drinking Pattern 62Table 5. A Comparison of Irregular and Steady DrinkingFathers on the IDS-42 63Table 6. Alpha Reliabilities on Children’s Scales andSubscales 65Table 7. Pearson Product-Moment Correlation Coefficientsbetween Variables (Part 1) 67Table 8. Pearson Product-Moment Correlation Coefficientsbetween Variables (Part 2) 67Table 9. Verification of Subject Independence 71Table 10. MNCOVA Results: Multivariate and UnivariateTests 73Table 11. Children of Irregular and Steady Drinkerscompared to Normative Families on the FES 75Table 12. Children of Irregular and Steady Drinking FathersCompared to Normative Populations on the FACES III andthe Family Satisfaction Scale 77viiTable 13. Children of Irregular and Steady Drinkers comparedto Normative Populations on the Parent-AdolescentCommunication Scale 81Table 14. First Equation Results of a Multiple Regression . 83Table 15. First Equation Summary Table 83Table 16. Second Equation Results of a Multiple RegressionAnalysis 84Table 17. Third Equation Results of a Multiple RegressionAnalysis 85viiiLIST OF FIGURESFigure 1. Children of Irregular and Steady DrinkersCompared to Normative Families on the FES 76Figure 2. Children of Irregular and Steady Drinking FathersCompared to Normative Populations on the FACES III 78Figure 3. Children of Irregular and Steady Drinking FathersCompared to Normative Populations on the FamilySatisfaction Scale 79Figure 4. Children of Irregular and Steady Drinking FathersCompared to Normative Populations on Parent-AdolescentCommunication 82ixACKNOWLEDGEMENTSI would like to express my appreciation to the members of mycommittee, Dr. J. Friesen, Dr. R. Conry, and Dr. W. Borgen fortheir support, patience and guidance throughout the process ofpreparing this document. Moreover, I would like to acknowledgethe professors and instructors of the Counselling PsychologyDepartment, who have awakened in me a new way of seeing myselfand a new way of helping others.In addition, this document could not have been completed withoutthe support, knowledge and understanding of my partner, WarrenWeir, whose unfaltering trust in my ability helped me to keepgoing. My thanks go also to Darryl Grigg, whose friendship wasconstant, and whose heart seemed to know no bounds. Further, Iwould like to acknowledge Dr. Gordon Cochrane, who helped me tofind my wings.Lastly, I want to express my appreciation to my father, whosesteadfast commitment to courage and integrity helped me to find away of life that I can believe in.-In memory of my mother, Nina,because things are airight now.x1CHAPTER IINTRODUCTIONBackground of the ProblemEstimates suggest that 28 million North Americans areschool-age or adult children of alcoholics (Sher, 1991).Research to date indicates that, in turn, one in four of thesechildren will experience alcohol abuse problems as adults.Children of alcoholics are also at risk for a variety ofdifficulties that emerge in other realms of functioning such asbehaviour, social adjustment, cognitive processes andneuro-psychological development (Johnson & Rolf, 1990). However,little is known about the factors that predispose particularchildren for difficulties later in life. For the most part,research investigations on the effects of alcoholism on childrenhave tended to rely upon the recollections of adult children ofalcoholics (Black, 1986). Comparatively few studies haveincorporated the perceptions of children for whom parentalalcoholism is still a condition of everyday life. However, asmany as one third of the offspring of alcoholics are school-agedchildren still living within the alcohol abusing home (Ackerman,1987; Black, 1981; Booz-Allen and Hamilton Inc., 1974; Sher,1991). The difficulty in accessing school-age children andadolescents for the purposes of research has resulted in apaucity of literature that includes the perceptions of children2of alcoholics.Over the years, research in the field of alcohol abuse hastended to envision alcohol dependency as a problem of theindividual, and studies into alcohol abuse have tended to limittheir attention to the alcohol dependent person. In recentyears, investigations in the field of alcohol dependency haveexpanded in focus somewhat to include the dynamics ofinterpersonal relationships. However, while there is a trend tomove away from individually-oriented models and attend to moresystemic paradigms (Steinglass, Bennet, Wolin, & Reiss, 1987;Wegscheider, 1981), the scope of even these more recent studiestends to be limited to the spousal dyad (eg., Billings, Kessler,Gomberg & Weiner, 1979; Jacob, & Leonard, 1988; Roberts, Floyd,O’Farrell, & Cutter, 1985; & Wiseman, 1981). There remains ashortage of research that includes perspectives of the children,even though calls for such research are not new. For example,Moos & Billings (1982) remark:Since an individuals’ perceptions of the family are alikely intervening step in the process by which anegative family environment mediates emotionaldisturbance, future work might profitably focus on -children’s perspectives of their family environment.(p.162)Of note here is the observation that some of the studies that3have included the experiences of children have relied onparental reports of children’s behaviour and perceptions (eg.Jacob, Seilhamer, & Rushe, 1989). Children’s perspectives werenot directly assessed.In an examination of the effects of drinking on family life,Moos and Billings (1982) observe that, in and of itself, theseverity of parents’ drinking is not a strong predictor of thefunctioning level of the children. The damaging result ofparental drinking appears to involve a complex combination offactors above and beyond the single factor of the amount ofalcohol consumed. For example, some studies indicate that anumber of children raised in alcoholic homes function relativelywell (Kammeier, 1971; Werner, 1986). However, the conditionsthat serve to influence the effects of parental alcohol use onchildren’s family experience are poorly understood and in need offurther study (Black, 1986; Jacob, Favorini, Meisel, & Anderson,1978; Jesse, 1989; Moos & Billings, 1982; Wilson & Orford, 1978)Over the past decade, Theodore Jacob and his colleagues haveconducted some compelling investigations into patterns ofdrinking and effects on the family. Examined collectively, thisbody of work reveals some of the factors that might combine toproduce the differential effects of alcoholism on fami1y life.For example, in a study of levels of drinking and maritalsatisfaction, Jacob, Dunn, and Leonard (1983) found that highalcohol consumption was associated with high marital satisfactionand fewer psychiatric symptoms in both the drinker and his4spouse, except where the pattern of drinking was episodic.Unlike the scores from chronic drinkers, heightened quantity-frequency scores for episodic drinkers were not associated withimprovements in individual or marital functioning. Furtherdifferences emerged as well. Notably, episodic drinkers werelinked with greater levels of psychopathology as recorded on thePsychopathic Deviate, Schizophrenia, and Mania scales of the?MPI, more negative social consequences from drinking, and moreout of home drinking than steady drinkers. In summing theirfindings, Jacob and his colleagues comment that, “clearly, thebinge group was involved in more sociopathic behaviour and showeddisturbed relationships in domains other than the maritalrelationship” than steady drinkers (p. 384). Thus, the patternin which a husband drinks may be as damaging, if not moredamaging, to the marriage than the amount he consumes. However,as this study does not include information gathered from thechildren in these homes, we do not know if there are similarlysignificant interactions in terms of family satisfaction, asopposed to strictly marital satisfaction.In a subsequent study involving non-drinking and drinkingsessions (Jacob, 1989), the wives of episodic drinkers wereobserved in greater detail. In contrast to wives of steadydrinkers, these women were found to be significantly morenegative in their communications with their spouses.Furthermore, in drinking sessions that involved problem solving,steady drinking couples were found to be more task-focused and5more effective at determining solutions than episodic drinkingcouples. In contrast to theories that suggest that parentaldrinking plays a stabilizing role in alcoholic families(Steinglass, 1987), alcohol seems to play a disruptive role inthe families of episodic drinkers,It has been mentioned that children are not uncommonlyexcluded from research investigations. However, not only is theresearch community prone to limiting its focus to the explorationof marital functioning, but therapists working in the field ofalcohol recovery are also likely to direct their interventionsexclusively at the spousal dyad. Systemic clinicians argue thatby focussing corrective efforts on the marital dyad alone, theprofessional community overlooks the need for intervention withthe children (Morehouse, 1979; Black, 1986; & Jesse, 1989).Alternatively, the professional community often attempts toprovide treatment for behaviour disordered children while failingto address the complicating factor of parental drinking.Furthermore, researchers have noted that very little is knownabout children who mask the problems at home and go unnoticed byprofessionals (Booz-Allen & Hamilton, Inc., 1974; El-Guebaly &Offord,1979; and Black, 1979)That research investigations, for example, have intervenedonly at the level of the spousal relationship is an importantlimitation given the evidence that family dynamics play a keyrole in reports of marital satisfaction (Jacob & Krahn, 1988).Furthermore, marital conflict over the children has been found to6be a significant factor in recovering alcoholics’ reports ofrelapse (Moos & Billings, 1982). Elsewhere, marital and familyconflict has been found to account for 48% of the reasons whyalcoholics return to drinking (Conners, O’Farrell, & Pelcovits,1988)Additionally, neglecting the perspectives of the childrenincreases the reliance on the adults’ perceptions of familyfunctioning. This dependence means that there is lesspossibility of exposing disharmony even if it does exist. Forexample, clinicians not uncommonly report that parents preventthemselves from experiencing distressing marital conflict byover-focusing on one particular child’s behaviour. Thisover-focusing is often called “triangling”. If parents aretriangling a child in order to avoid contending with maritaldiscord, then it is conceivable that they may present very wellas a couple to outside observers. It is not impossible that theinclusion of children’s scores may reveal a very differentexperience of family functioning. This argument has importantimplications in relation to above-cited studies by Jacob and hiscolleagues. It is possible to conceive that children of steadydrinkers might in fact experience their family to be quitedysfunctional, despite the finding that their parents appear toboth relate to each other and solve problems in positive ways.Whether or not this is the case, the relationship betweenfathers’ pattern of drinking and children’s experience of familyis worthy of exploration.7Obstacles to getting helpDue in part to lack of awareness amongst professionals,children often encounter obstacles to receiving treatment forparental alcoholism issues. For example, the commonly heldassumption that alcoholism is a symptom of other family problemsleads to one barrier. This assumption is only partially correctin that alcoholism in and of itself generates difficulties. Forexample, the alcoholic may use alcohol to anesthetizeuncomfortable feelings. As a result, he may not feel compelledto alter current circumstances and seek help. To accept thatalcoholism is only a symptom that can be altered by addressingother “core” problems is to minimize the very real and disruptiverole that alcohol plays.Another problem commonly faced by children of alcoholics inreceiving effective treatment is that parental alcoholism israrely identified as the presenting problem. Professionalsworking with the children may not know to enquire about substanceabuse or for that matter know how to gain such information.Perhaps for fear of unpleasant confrontations, or concern forembarrassing children’s parents, child care professionals oftenavoid pursuing the issue of alcoholism in the home.Rationale for ResearchWhile the incidence of children living within alcoholdependent families is high, very little of the information thatguides our theories or determines our clinical interventions is8based on research (Sher, 1991). Because of the difficultyassociated with accessing children as subjects, research andclinical communities experience a shortage of informationgathered directly from children. The current study provided aunique opportunity to contribute to the existing body ofknowledge. First, this study proposed to gather data fromchildren who are still living in alcohol-involved homes. Thisinformation was seen to be more reliable than retrospectivestudies involving adult children of alcoholics. Second, assubjects were living in families who presented themselves foralcohol treatment, the results were generalizeable to otherfamilies seen by substance abuse professionals working withfamilies in recovery.Third, the current investigation broadened the scope of theresearch traditionally gathered in this field. Rather thanfocussing on the individual alcoholic or the alcohol-involvedmarriage, this study included a third level of the family system,the children. Fourth, the current study was intended tounderscore the needs of children still living in the alcoholabusing homes, and to draw attention to this important area ofintervention. Lastly, this study followed logically from thedecade of work by Theodore Jacob and his colleagues. Thesestudies suggest that pattern of drinking is an important factorin functioning levels of the family.If children of alcoholics are to be assisted in developinghealthy ways of coping as well as to be guided in participating9their families’ recovery from paternal alcohol abuse, a betterunderstanding is needed of their experiences. This studyintended to explore the factors that mediate the deleteriouseffects of parental alcoholism, and to discern the perceptionsand experiences that foster hardiness in children.Research questionsFollowing from the above discussion, this research willaddress the following questions:(1) Do children of episodic drinking homes experience theirfamilies differently than children of steady drinking homes?(2) What is the relative importance of children’s perceptions offamily satisfaction, family adaptability and cohesion,family environment, perceived social support, and parent-adolescent communication in explaining the differences inchildren’s perceptions of episodic versus steady drinkinghomes?In order to answer the above questions, 110 children from 61families were included in the study. Specifically, this study isone in a series of investigations resulting from large-scaleresearch project entitled The Alcohol Recovery Project (TARP).Carried Out over a preiod of five years, TARP has receivedfunding from the British Columbia Alcohol and Drug Program (now10part of the Ministry of Health and formerly in the Minstry ofLabor an Consumer Services) and from the British Columbia HealthResearch Foundation (Health Services Research Programme). Otherassistance has been extended by the University of BritishColumbia and the Humanities and Social Sciences ResearchServices. These funds and other forms of assistance have enabledthe completion of this study, as well as others resulting fromTARP activities. This body of research has been conducted underthe general direction of the Principal Investigator, John D.Friesen, Ph. D., Co-investigator Robert Conry, Ph. D., andProject Co-ordinator, Darryl N. Grigg. It should be noted thatonly the families who had children of appropriate age took partin the current investigation.MethodologyData analysis was conducted in five stages, including1) a descriptive analysis of the sample,2) a test of subject independence,3) an assessment of the inter-correlations of the independentvariables,4) a multiple analysis of covariance, with age as the covariate, and,5) a multiple regression analysis.The final two steps of statistical analysis were particularlyimportant to the study, as these processes addressed Research11Questions 1 and 2. The multivariate analysis of co-variance wasemployed to determine if the perceptions of children of episodicdrinking homes were significantly different from those ofchildren of steady drinking families. Next, the multipleregression analysis was conducted in order determine which of theindependent variables explained significant amounts of variancein the dependent variable, paternal drinking pattern.Definition of TermsAlcoholism Alcoholism is the problematic consumption of alcoholsuch that one or more areas of the drinker’s life are negativelyeffected. The complexity of alcoholism is reflected in thefollowing working definition:Alcoholism is a general term frequently used to indicate anyof various types of alcohol use, misuse, abuse, ordependency problems, some of which may be progressive; maybe of varying and multiple etiologies and may follow varyingcourses of development; may involve multiple organ systemsto varying degrees; may pervade, to varying degrees, avariety of psychological, personal, interpersonal,occupational, spiritual, social, or other behavioraldomains; may recur after attempted therapy; and may lead tothe decline or death of the patient unless adequately andproperly treated. (Jacobson, 1989, p. 19).12For the purposes of this study, alcohol dependency wasestablished by use of The Michigan Alcohol Screening Test(Seltzer, 1971), and was determined on the basis of a score of 5or more on the 25 item questionnaire.Steady Drinking Steady, or chronic, drinking is a pattern ofalcohol use that is denoted by consistent amounts of alcoholconsumed on a daily or almost daily basis. For the family of thealcoholic, drinking states are predictable, and are incorporatedinto the manner in which family matters are conducted. Regulardrinking was determined by employing the binge-chronic subsectionof the Marlatt Drinking Profile (Marlatt, 1976).Episodic Drinking Episodic drinking is a pattern of alcoholconsumption characterized by bouts of heavy drinking interspersedwith periods of little or no alcohol consumption. Episodicdrinking, sometimes called binge drinking, is distinguished fromchronic drinking by its unpredictable, inconsistent nature suchthat the family of the alcohol dependent person must accommodatebinge and non-binge states in the drinking member. Episodicdrinking was determined by use of the binge-chronic subsection ofthe Marlatt Drinking Profile (Marlatt, 1976).Limitations of the StudyThis study restricted its participants to a very specificsample. First, all children came from intact or blended13families, in which there are no single parents. Second, allchildren were the offspring of male alcoholics: none of thechildren had mothers who were problem drinkers. Lastly, in allof the families, fathers were seeking treatment for alcoholism.These requirements of participation resulted in conlusions thatcan be generalized only to similar populations.14CHAPTER IIREVIEW OF THE RELATED LITERATUREWhat is missing is information about how exactly having analcoholic parent can lead to childhood problems, that is,the processes in the family. . . which mediate the impact ofproblem drinking on children. Wilson, 1982, p.151The History of Approaches to AlcoholismIn her review of the literature, Seilhamer (1991) provides asummary of attitudes towards alcoholism over the past 100 yearsand observes that in the earlier years of this century,alcoholism was considered a character weakness within theindividual alcoholic. Abusive drinking was considered aconscious choice of the individual and the self-destructivepattern was held to be the responsibility of the drinker. Theproblem was viewed strictly within the domain of the individual.By the 1930’s, the paradigm had shifted to one of seeingalcoholism as a medical condition, in which there wereobservable, physiological symptoms such as tolerance to thesubstance and withdrawal effects. Alcoholism was considered tobe a particular kind of disease. However, this shift inexplanation of the problem did not unfold with a reciprocal shiftin the domain of the problem. The focus remained upon the15individual drinker, and perhaps as means of sparing loved onesundue pain and embarrassment, the family was left out of both thediagnosis of the problem and the treatment of the symptoms.The mid-seventies saw a shift in emphasis as cliniciansbegan to share the observation that recovering alcoholics felttheir sobriety was most challenged when they returned to thefamily home and began to try to negotiate day-to-day strugglesand challenges. Partners who had come to assume many of thedrinker’s responsibilities as a means of keeping the familytogether had a hard time surrendering those tasks (Wiseman, 1980;Jackson, 1954). Similarly, children who had adopted adult-likeroles within the family were reluctant to give up their specialstatus. Other children who had coped by keeping their feelingsinside themselves began to act out, further challenging theparents’ sobriety. The focus of intervention became the familyand its interwoven network of relationships. This change in theway the problem was conceptualized brought with it a heightenedinterest in the particular impact of alcoholism on children.The Effects of Parental Alcoholism on ChildrenSeilhamer and Jacob (1990) suggest an overarchingorganization to describe the effects of alcohol abuse on-children.1. Primary effects of ethanol The first concerns the effect ofthe alcohol itself, that is, the changes in the parent when he orshe is intoxicated. Mood swings, heightened irritability and16blackouts characterize the parents’ drunken state and often meanchildren cannot develop a sense of trust and safety with regardto the drinker. The contrast between drinking and sober statesmay leave children bewildered as to how to predict or respond toparents’ behaviour. In addition to their parent’s “short fuse”and increased unpredictability, children also lose out on theexperience of social support and emotional availability when theparent is caught in a cycle of drinking. Not uncommonly,children of alcoholics become so adept at sensing the moods ofothers and responding to them in strongly patterned ways thatthey lose a sense of themselves.2. Secondary effects Ancillary problems arise when the familybegins to experience financial instability, bouts ofunemployment, marital discord and social isolation brought on bythe drinking. For children, the increased conflict within thehome and the uncertainty about the family’s economic stabilityincrease the pressures they face. The unhappiness of family lifemay compound children’s experience of isolation as they becomereluctant to bring friends home for fear of embarrassment. In areport commissioned by the National Institute on Alcohol Abuseand Alcoholism, Booz-Allen & Hamilton, Inc. (1983) found thatchildren commonly feel a sense of shame about their family’scircumstances.3. Role modelling When parents turn to alcohol as a means ofcoping with difficult circumstances, they are unwittinglyteaching their children the use of substances to solve problems.17By turning to their parents as role models, children learn thatsubstance abuse is the way to deal with personal problems. Theyfail to be taught alternative problem solving skills that may bemore effective.Research on Children of AlcoholicsOver the years, investigations have been conducted toexplore the adverse effects of parental alcoholism on children(El-Guebaly & Of ford, 1979; Jackson, 1954; Kaufman, 1984; Newall,1950; Steinglass, 1976). Children of alcoholics have been shownto demonstrate higher levels of maladaptive behaviours, socialadjustment problems and cognitive difficulties than children ofnon-abusing parents (Seilhamer & Jacob, 1990; Sher, 1987; andWest & Prinz, 1987)Children of alcoholics have been found to experience lowself-esteem, hyperactivity, and manipulative and rebelliousbehaviour (El-Guebaly & Of ford, 1977; Hughes, 1977). They havealso been found to display more depressive affect than childrenof non-alcoholic parents (Roif, Johnson, Israel, Baldwin, &Chandra, 1988; Roosa, Sandler, Beals, and Short, 1988).Similarly, it has been found that children of alcoholicsexperience high levels of negative mood, and difficulties withpeer relationships (Hughes, 1977). Academic troubles have beennoted in children of alcoholics, along with school suspensions,and antisocial and delinquent behaviour (Chafetz, Blane, & Hill,1971; El-Guebaly & Of ford, 1977; Herjanic, Herjanic, Pencik,18Tomelleri,& Armbruster, 1977; Hughes, 1977). While somecontroversy exists regarding the presence of cognitive deficits(West & Prinz, 1987), it has been observed that the cognitivefunctioning of children of alcoholics tends to be underestimatedby both the mothers and children of alcoholics themselves(Johnson & Rolf, 1988). Toward early adulthood, or later,children of alcoholics have been shown to be vulnerable todeveloping character disorders or substance abuse problems oftheir own (Winokur, Reich, Rirnmer, & Pitt,1970).Clinical ObservationsClinical reports based on interviews and clinical work withchildren of alcoholics document a host of additional concerns(Ackerman, 1979; Booz-Allen & Hamilton, Inc., 1974; Cork, 1969;and, Woititz, 1983). Emotional and physical neglect are notinfrequent experiences of children of alcoholics, as children areoften left alone or, alternatively, left in the inadequate careof older siblings (Booz-Allen & Hamilton, Inc., 1983). Risk ofphysical abuse from siblings or others arises from a lack ofadequate parental supervision. In addition, risk of physicalabuse from one or both of the parents increases as thefunctioning of the parental unit disintegrates and parents becomeunable or unwilling to intervene to protect their children fromviolence. Further, evidence suggests that there are increasedrates of alcoholism amongst adults who abuse children (Hamilton &Collins, 1985), indicating a link between alcoholism and child19abuse.Clinical reports also document heightened levels of familyconflict, regardless of whether or not violence is present (BoozAllen & Hamilton, Inc., 1983). Children report being unable todo homework because of disruption due to fighting, and spendincreased amounts of time isolated in their bedrooms as a shelterfrom the arguing (Booz-Allen & Hamilton, Inc., 1983).Research has indicated that children of alcoholics feelincreased levels of shame (Deutsch, 1982), and regard theirfamily with an acute sense of humiliation (Bucky, 1979; Wilsonand Orford, 1978). This may well contribute to the clinicalobservations that adult children of alcoholics recall havingavoided bringing friends over to the family home (Morehouse,1979) and to the observation that alcohol-involved familiesbecome isolated from neighbours and the larger community as awhole.Neglect, family conflict and violence, and extraordinarypressures placed on the offspring of alcoholics leave thesechildren feeling confused and overwhelmed. Children usually feelintense anger toward the drinking parent, coupled with feelingsof loyalty and concern for their well-being (Booz-Allen &Hamilton, Inc., 1983). Conversely, children may feel lovetowards the non-drinking parent and yet resent that parent fornot being more understanding of the alcoholic. In their report,Booz-Allen & Hamilton (1983) comment that there is “embarrassmentover the chaos and dysfunctioning of the family, confusion over20what is right and wrong, and guilt about a powerlessness to makethings right” (p.8).When interviewed, children report that the two strongestfeelings that they have about their circumstances are resentmentand embarrassment (Booz-Allen & Hamilton, Inc., 1974). Theirfeelings toward the alcoholic parent, however, may simultaneouslyinclude “love, admiration and respect” (Booz-Allen & Hamilton,Inc., 1974, p.iii) While emotional neglect and family conflictare the predominant challenges that children of the alcoholicsface, other problems include:-non-fulfilment of parental responsibilities,-instability, separation, divorce, death,-inappropriate physical behaviour(Booz-Allen & Hamilton, Inc., 1974, p.iii)Harmful effects of the presence of alcohol are exacerbatedby the tendency amongst children of alcoholics to blamethemselves for their parents’ drinking (Cork, 1979) and thetendency of the alcohol-involved parents to blame their childrenfor the problems in the family (Booz-Allen & Hamilton, Inc.,1983)Children of alcoholics also display an inability to trustother people, are overly independent, and tend to feel doubtfulabout the future (Cork, 1979). In later years, as parentsthemselves, children of alcoholics are likely to 1) interpretchildren’s behaviours to have a negative intention that is not21actually present, 2) develop a parenting approach based onderogatory stereotypes such as “all children are bad”; and, 3)maintain a self-absorbed stance in interacting with theirchildren (Creighton, 1985).Not infrequently, the boundaries between parental andchildren’s responsibilities are blurred. For example, parentsmight expect children to perform tasks that are beyond theirdevelopmental capabilities. Similarly, parents may choose todiscuss their emotional, financial and sexual problems with theirchildren, apparently oblivious to the possibility that theirchildren are not equipped to cope with the pressure of suchdifficulties (Booz-Allen & Hamilton, Inc., 1983). As a result,children of alcoholics become familiar with the experience offeeling bewildered and helpless. Children of alcoholics alsoreport being embarrassed in front of their peers when theirparents behave in inappropriate ways, or fail to tend to personalappearance and hygiene, (Booz-Allen & Hamilton, Inc., 1983).Research on Adult Children of AlcoholicsA growing movement focuses on the effects of being raised inan alcohol dependent environment through the eyes of the adultchild. In a review of retrospective studies on adult children ofalcoholics, Beletsis and Brown (1981) found that the themes ofhome life that tend to be common are 1) inconsistency in rules,2) unpredictability of events and parental response, and, 3)generalized experience of chaos. In general, reports suggest22that children in alcoholic homes fail to receive clear,consistent behavioral guidelines, physical and emotional care,and dependable and sensitive communication and interaction(Beletis and Brown, 1981). Furthermore, adult children ofalcoholics report excessive verbal arguing amongst familymembers, in particular, between parents (Black, Bucky & WilderPadilla, 1986) . Black et al. (1986) surmise that the highdivorce rate in adult children of alcoholics is directly relatedto the diminished conflict resolution skills in their families oforigin. In comparing adults raised in alcoholic homes to thoseraised in non-alcoholic homes, Black and her colleagues (1986)found that the former:1) sought out the help of others significantly less often,2) had experienced more disruptive events such as divorceand death in their families of origin3) experienced more personal problems as adults,4) suffered more physical and sexual abuse aschildren, and,5) more frequently became an alcoholic or married analcoholicthan did children raised in non-alcoholic homes.While the recollections of adult children of alcoholics areimportant, they are retrospective accounts of experiences andfeelings that took place years before. Black and Bucky (1986)warn:It is essential for treatment practitioners to understand23the perceptions of the adult children of alcoholics and atthe same time be cautious about potential perceptual andmemory distortions as treatment proceeds. (p.229)Children’s Reciprocal Influences on Family FunctioningThe past decade has seen an upsurge in interest in theeffects of family dynamics on the maintenance of alcoholism. Assuch, the behaviours of children have come to be viewed for theirinfluence in perpetuating the problem drinking.Children are actively in the process of learning values,beliefs, and a sense of self-concept each time they interact withfamily members. Their process of development involvesexperimenting with and imitating the behaviours of their lovedones, including parents, siblings and peers. If children feelthat they are taken seriously and valued, then they treatthemselves and others In a similar fashion. If childrenexperience neglect, criticism, and rejection, then they will tendto view others as being deserving of ill-treatment. Their socialskills will be severely diminished.This troubled relationship dynamic may become unfortunatelyself-perpetuating as a C0A’s approach to parents and other familymembers may contribute to a parent’s difficulty in dealingpositively with the child. For example, clinical reports havehighlighted a tendency amongst some children of alcoholics to bedeceptive, changing their agreements with others in order tosecure things that they fear may be taken away from them24(Morehouse & Richards, 1986). Elsewhere, clinicians working withfamilies in recovery document a tendency for children to act outrepressed emotional and developmental struggles as their parentsbegin to resolve their own respective conflicts (Jesse, 1989).Further, children’s challenging behaviour may account for some ofthe reports from relapsed drinkers who declare that familyconflict is the primary reason for returning to drinking.Connors, O’Flarrel, & Pelcovits (1988) concluded that marital andfamily conflict and the desire to gain control over familyfunctioning accounts for almost one half of the reasons cited byrelapsed alcoholics for their return to drinking. Further, Lang,Pelhani, Johnston, and Gelertner (1989) found that interactionswith unruly and hostile children can lead to increased rates ofdrinking in adult caretakers. Understanding the interactionbetween parents and children in the drinking family is becomingan increasingly important area of focus within the field ofalcohol research.Differential Impact of Parental AlcoholismEvidence is also growing to suggest that alcohol’s harmfuleffects may be somewhat mediated by the disposition andresponse of the child. For example, while much of the focus onchildren of alcoholics in the last 15 years has centered aroundthe negative effects of parental alcoholism on children,certainly there exists an abundance of literature that indicatesthat not all children of alcoholics fair poorly. In fact,25considerable diversity exists amongst children of alcoholicparents with respect to levels of functioning (Burk & Sher,1988; el-Guebaly & Of ford, 1979, 1980; Heller, Sher & Benson,1982; Jacob, Favorini, Meisel, & Anderson, 1978; Russel,Henderson, & Blume, 1984; West & Prinz, 1987 Woodside, 1988).A number of studies and clinical reports point to“resilient” or “invulnerable” children (Black, 1981; Clair &Genest, 1987; Jacob & Leonard, 1986; Seilhamer & Jacob, 1990;Wegscheider, 1981; Werner, 1986). These are children who seem tobe impervious to the deleterious effects of familial alcoholism.In fact, some of these children seem to become exceptionallyhardy, and unexpectedly competent (Clair & Genest, 1987).Seilhamer & Jacob (1990) discuss the inherent traits of thesechildren, such as intelligence and temperament, as possiblebuffers to the deleterious effects of alcohol. Additionally,social factors such as the presence of extended family, or theavailability of support within the community may serve to assuagethe absence of effective parents.Some studies have found that certain groups of children ofalcoholics are functioning better than children of nonalcoholics. Jacob and his colleagues (1989) analyzed parents’perceptions of 296 children using the Achenbach Child BehaviourChecklist (Achenbach, 1978). These children came from 134families, and the sample was comprised of 100 children ofalcoholics, 105 children of normal controls and 91 children ofdepressed parents. The researchers found that the number of26children of alcoholics scoring within the impaired range weresubstantially in the minority. Furthermore, when a with-in groupanalyses of impaired C0A’s versus non-impaired CQA’s wasconducted, impaired CoA’s were found to be more likely to haveparents who scored high on scales of psychiatric disturbance, orhave fathers who had experienced more adverse effects because ofdrinking.In a longitudinal study of 698 children of various troubledor normal backgrounds, Werner (1986) found that the majority ofthe children of alcoholics (n=49) were coping well at age 18.Almost 60% showed no serious impairments at work, at school or intheir social lives. In addition, they were found to have set“realistic goals and expectations for the future” (p. 36). Thesefindings occured despite the complicating factor of chronicpoverty that plagued many of those homes.A summary of outcome studies shows a wide variation inadjustment amongst children of alcoholics. Some reports (BoOzAllen & Hamilton, 1974; Black, 1979), even indicate that certainchildren actually excel seemingly as a result of the adversitythey experience. While it should be noted that these “familyheroes” draw concern from a small but vocal group of therapistsand theoreticians who stress that childhood “overcoping”-leads todifficulty in adulthood (Black, 1979; Gravitz & Bowden, 1987),these findings point to the heterogeneity of this population andsuggest the importance of enriching our awareness of the needs ofeach distinct group.27Limitations of Existing ResearchAlthough the increased clinical focus on the needs ofchildren of alcoholics has produced a wealth ofdescriptive and sympathetic reports, the currentliterature lacks comprehensive theories and soundempirical research. Seilhamer & Jacob, 1990, p.168Nardi(1981) expresses concerns about conclusions that can bedrawn from existing research on children of alcoholics.Specifically, he addresses issues with regard to the research andliterature on children of alcoholics. Nardi observes, first,that this literature is often focussed on very specific subjectpools and that conclusions drawn are difficult to apply to widerpopulations. Second, in the main the research tends to lack astrong theoretical foundation and demonstrates limitedreliability. Third, topics of study and data collectiontechniques are so diverse that it is difficult to drawcomparisons between research investigations. Lastly, aconsistent weakness within the research is the lack of adequatecontrol groups (Nardi, 1981).Seilhamer and Jacob (1990) observe additional concernsregarding methodology. For example, they argue that there is alack of attention paid to confounding stress factors such asmarital distress, family violence, and chronic unemployment.Additionally, there is a lack of assessment of the mental healthof the non-drinking partner, an important factor given that he or28she may act as a buffer between the behaviours of the alcoholicand the children. Jacob and Seilhamer (1990) also note thatthere is an overall lack of attention to “drinking-relatedvariables such as duration, severity, consumption pattern andlocation of drinking, and interaction of sex of drinking parentwith the sex of the child” (p.172). These shortcomings diminishthe ability to confirm a causal relationship between the presenceof alcohol in the family home and the wide variety of symptomsthat are often seen in children of alcoholics, for example,depression, poor school performance and inhibited socialdevelopment.Principal reviewers of the literature on children ofalcoholics, however, do tend to conclude that despitemethodological deficiencies, the weight of the evidence indicatesthat children of alcoholics are at increased risk for deleterioussymptoms. Russel, Henderson, & Blume (1984) conclude that, whenall findings are taken into account, “studies convincinglydemonstrate that children of alcoholics are at a particularlyhigh risk for emotional and behavioural problems” (p.52). Inaddition, Of the above delineated concerns, the present studymakes a contribution towards two of these problems. First, thetwo groups of children, those of episodic drinkers and those ofsteady drinkers, had very similar backgrounds, includingcomparable marital stability, family income and levels ofparental unemployment. Second, the current investigationspecifically examines one of the important drinking-related29variables indicated by Seilhamer et al., (1990), that being,paternal drinking pattern.Impact of Subtypes of AlcoholismWithin the field of alcohol research, an awareness isgrowing about the various subtypes of alcoholism. Traditionallyalcoholism has been viewed as a distinct ailment with a finitenumber of symptoms and a specific pattern of onset. However,just as evidence is mounting to say that children of alcoholicsare not a homogenous group, so too research continues to drawdistinctions between varying subtypes of alcoholics. In fact,the literature suggests that considerable diversity existsamongst alcoholics with respect to characteristics such as thepattern of drinking, the type of dependence, and the temperamentof the individual problem drinker (Wanberg & Horn, 1983; Read etal., 1990; & Powell, Read, Penick, Miller, Bingham, 1987).Important research has been conducted recently that furtherexplicates differences amongst drinkers (Babor et al., 1992) Ina cluster analysis of data obtained from 321 male and femalealcoholics, Babor and his colleagues were able to construct atypology that consisted of 2 groups, based on a wide array offactors. Seventeen characteristics were examined in the clusteranalysis, including biological, psychological and social factors.This research suggests that two broad but distinctive groups canbe discerned, Type A and Type B. Type A is distinguished by alater onset of alcohol misuse, fewer childhood risk factors, less30personal and economic problems, (such as social isolation andchronic unemployment), and greater psychological stability. TypeB, on the other hand, was characterized by “childhood riskfactors, familial alcoholism, early onset of alcohol-relatedproblems, greater severity of dependence, polydrug use, a morechronic treatment history (despite their younger age) greaterpsychopathological dysfunction, and more life stress” (Babor etal., 1992, p. 599). Babor (1992) also found encouragingsimilarity to subtypes previously hypothesized but notempirically documented.Prior to the work of Babor and his colleagues, Connors,Tarox and McLaughlin (1986) examined factors associated withContinuous versus bout drinking. They looked at 6 variables bymeans of a discriminant function analysis, and concluded thatbout drinkers were significantly more likely to have experiencedsevere liver ailments and to have come from families in whichthere was parental alcoholism. In addition, they were found toreport more alcohol-related arrests and hospital stays. Connorsand his colleagues (1986) also observe that, whereas regulardrinking may occur in conjunction with other, typical dailyfunctions, episodic drinking becomes “a singular behavioralobjective for variable periods of time” (p.105).-Vaillant (1983) found that sporadic drinkers tend to have ahigher mortality rate due to alcohol-related causes than drinkerswho consume more or less the same amount on a daily basis.Cahalan and Room (1974) found sporadic drinking to be strongly31associated with other particular alcohol problems such assymptomatic drinking, employment difficulties, inability tocontrol amount of alcohol consumed at any one time, andhostility.In an American nation wide survey, Clark & Midanik (1983)found some compelling differences between continuous and boutdrinkers. First, they observed that sporadic drinking tended tobe found only amongst the most severe drinkers. Bout drinkingwas relatively uncommon amongst average or non-drinkers. Second,sporadic drinkers reported more negative consequences fromdrinking, that is, more health problems, more social disruptionand conflicts and more difficulty controlling the amount ofalcohol consumed.With regard to the issue of subgroups, Steinglass, Tislenko& Reiss (1985) also favoured an approach to alcoholism thatincorporates the notion of heterogeneity. Steinglass and hiscolleagues found this particularly useful in studying theinterpersonal dynamics of families. These researchers found thatthe family “temperament” was “strongly associated with differentdrinking patterns manifested by the alcoholic subjects. . . that is,there was a goodness-of-fit between ‘drinking type’ and ‘familytype’” (Steinglass et. al., 1985, p.366). Steinglass discernsthree types of drinking patterns, stable wet, alternator (ortransitional) and stable dry patterns. Steinglass groups dailyand weekend drinkers together to form the “stable wet” categoryand compares his alternator group to the traditional descriptive32grouping of binge drinker. Lastly, stable dry were thosealcoholics who entered this longitudinal study in sobriety, andmaintained their sobriety throughout treatment.The argument that there are varying subtypes of alcoholismhas particular relevance to children of alcoholics. Sher (1991)observes that “while there are probably a number of otherimportant, identifiable sources of heterogeneity among COAs, theissue of the form of the parental alcoholism has been largelyunexplored” (p.10).Obstacles to Getting HelpChildren often encounter obstacles to receiving treatmentfor parental alcoholism issues. For example, one barrier arisesfrom the commonly held assumption that alcoholism is a symptom ofother family problems. This assumption is only partially correctin that alcoholism in and of itself generates difficulties. Forexample, the alcoholic may use alcohol to anesthetizeuncomfortable feelings. As a result, he/she may not feelcompelled to alter current circumstances and seek help. Toaccept that alcoholism is only a symptom that can be altered byaddressing other “core” problems is to minimize the very real anddisruptive role that alcohol plays.Another problem commonly faced by children of alcoholics inreceiving effective treatment is that parental alcoholism israrely identified as the presenting problem. Professionalsworking with the children may not know to enquire about substance33abuse or for that matter know how to gain such information.Perhaps for fear of unpleasant confrontations, or concern forembarrassing children’s parents, child care professionals oftenavoid pursuing the issue of alcoholism in the home.Statement of the ProblemThe evidence presented herein supports the idea thatchildren are powerfully affected by the paternal abuse ofalcohol. However, the offspring of alcoholics also would appearto play an influential role in the recovery process of thefamily. Understanding family life through the eyes of childrenof alcoholics has the potential to make a worthy contribution tothe field of alcohol research. According to Seilhamer & Jacob(1990), the critical issue at this time is “the clarification ofthe parameters of risk, those biological and psychosocial factorsthat mediate vulnerability” ( p. 169). The present study aims toclarify one such factor, that is, paternal pattern of drinking.In the light of the work to date by Jacob and his colleagues,(Dunn, Jacob, Hunimon, & Seilhamer, 1987; Jacob, Dunn, & Leonard,1983; Jacob, Favorini, Meisel, & Anderson, 1978; Jacob & Leonard,1988) an important assumption guides the present work, namely,HypothesisChildren of episodic drinkers will report their families tobe functioning significantly less well than children of steadydrinkers, as measured by341) The Family Adaptability and Cohesion Scale (FACES III)(Olson, Portner, & Lavee, 1985);2) The Family Environment Scale (FES) (Moos, & Moos, 1981);3) The Family Satisfaction Scale (FS) (Olsen & Wilson, 1982);4) The Parent-Adolescent Communication Scale (PAC) (Barnes &Olson, 1982), and,5) The Perceived Social Support Scale - Family (PSSFa) (Procidano & Heller, 1983).35CHAPTER IIIMETHODOLOGYThe Purpose of the studyThe purpose of the present study was to examine thedifferential perceptions of family functioning of children livingin episodic drinking homes versus children living in steadydrinking homes. The goal of this endeavour was to shed furtherlight on factors that play a critical role in the adjustment ofchildren of alcoholics.Subj ectsThe subjects were 110 children, 9-20 years of age (m=13.7),identified from 61 families who presented themselves foroutpatient counselling at one of two pre-selected clinics inBritish Columbia. One centre had a rural catchment area, whereasthe second clinic was situated in an urban area. The childrenhad fathers who were alcohol dependent men between the ages of 21and 65, and each of their fathers scored 5 or greater on theMichigan Alcohol Screening Test (Seltzer, 1971) prior to beingaccepted into the study. Mothers did not have a history ofalcohol or drug dependency, and scored less than 5 on theMichigan Alcohol Screening Test (MAST). The marital relationshipwas in a state of distress as reflected by a score of 100 or lesson the Dyadic Adjustment Scale (Spanier, 1976). Despite theduress that they were experiencing, both parents were committed36to the marital relationship.Families were excluded from the study if either member ofthe couple indicated serious psychiatric disturbance based onscores from the Symptom Checklist-90-Revised (Derogatis, 1983)and a clinical interview conducted by the researchers during thescreening process. Neither parents nor children participatingin the study were in the regular care of other health careprofessionals, limiting the possibility that outside professionalinvolvement would serve as a confound to the study results.Families were intact, or blended, and in all cases parents hadregular access to their children and were responsible for theircare.Questionnaires were administered to all families in a take-home format, after the parents had satisfactorily completed asemi-structured interview and had been accepted into The AlcoholRecovery Project. Research procedures were explained to theparents by researchers, and all question booklets had complete,step-by-step instructions included with them. Questionnaireswere completed by the participant family members at their leisureand returned to the researchers in sealed envelopes that ensuredthe privacy of each person.The battery of questionnaires that the children filled outincluded the Family Environment Scale (FES), the FamilyAdaptability and Cohesion Scale (FACES III), the FamilySatisfaction Scale (FS), the Parent-Adolescent CommunicationScale (PAC), and the Perceived Social Support Scale for Family(PSS-Fa). In addition to the above questionnaires, parents37completed the Family Demographic Form (FDF), the Binge-ChronicDifferentiation Scale (BCDS), the Drinking Pattern AssessmentScale (DPAS), and the Inventory of Drinking Situations (IDS-42).Description of the InstrumentsAlcohol Measures1. The Binge-Chronic Differentiation Scale (BCDS) is asubsection of a larger questionnaire, the Marlatt DrinkingProfile (Marlatt, 1976), and was designed to assess theregularity of fathers’ alcohol consumption. The BCDS wasused to classify fathers’ drinking pattern into eitherepisodic or steady categories, and was a key questionnairein the series of studies completed by Jacob and hisassociates (Jacob, Dunn & Leonard, 1983; Jacob & Leonard,1988; Jacob & Krahn, 1988). In this series of studies, theMarlatt Drinking Profile questionnaire was utilized toassist subjects in classifying themselves by their weeklypattern of alcohol consumption as well as by a moreoverarching pattern assessed across a year’s time. Thequestionnaire was selected for the present study in order toprovide consistency with the methodogy employed by Jacob inthe course of his investigations. The questions ascertainthe amount of alcohol consumed, the number of days per weekdrinking is occurring, and/or the number of drinking boutsper year (see Appendix A).382. The Drinking Pattern Assessment Scale (DPAS) wasconstructed for the present study from subsections ofexisting alcohol measurement questionnaires. The DPAS wasutilized in the current study to gather detailed informationabout fathers’ drinking characteristics. The questionnairewas designed to assess factors such as the length of timedrinking had been a problem, the typical amount consumed ondrinking days, and the specific types of personal, familyand work difficulties that had resulted from excessivealcohol consumption (see Appendix C).3. The Inventory of Drinking Situations - ShortenedVersion (IDS-42) was created by Annis, Graham, and Davis in1982 and is used to identify the places and times that putan alcoholic at risk for drinking. That is, thequestionnaire assists alcoholics in clarifying theconditions that put them at risk for relapse. For itsconstruction, eight situation categories were identifiedfrom interviews with clinicians and clients, and from anextensive review of parallel instruments. These eightcategories fell under two general domains, 1) PersonalStates, and 2) Situations Involving Other People, asfollows:1) Personal States- Unpleasant Emotions- Physical Discomfort- Pleasant Emotions- Testing Personal Control39- Urges and Temptations2) Situations Involving Other People- Conflict with Others- Pleasant times with Others- Social Pressure to DrinkThe eight subscales of the IDS-42 demonstrated moderateto high Cronbach’s alpha coefficients for reliability,ranging from .80 to .92. The instrument designers reportthat the questionnaire shows strong content validity asconfirmed through the process of having three raters sortthe 100 items on the original scale into the eightcategories. The resulting interrater reliability wasbetween 92%-99%, suggesting that the construct of eachsubscale was being accurately reflected in the substance ofthe questions. These findings lend support for the positionthat the IDS-42 possesses acceptable levels of internalvalidity.Regarding external validity, the full length version ofthe IDS was correlated to both situation-specific drinkingpatterns and instances of heavy drinking in a sample of 247alcoholics (Annis et al., 1982). It was found that arelationship existed between the amount of alcohol consumedand scores on the IDS, that is, increased levels of- heavydrinking bouts were related to higher scores on the IDS. Inaddition, the full version of the IDS was contrasted toresponses on Alcohol Dependence Scores (Skinner and Horn,1984) and the above findings were moderately reflected.40That is, Annis et al., (1982) found that high scores forfrequency of heavy drinking on the IDS were reflected inincreased levels of alcohol dependence on the ADS (seeAppendix D).4. The Alcohol Dependence Treatment History Questionnaire(ADTH) was constructed for the purposes of The AlcoholRecovery Project and was designed to assess fathers’ priorexperiences with treatment and therapy. In addition, theADTH assesses for the presence of alcoholism amongst thedrinkers’ biological relatives. The questionnaire wasemployed by the current study to examine episodic drinkingfathers versus steady drinking fathers on extensivess ofprior treatment (see Appendix E).Family Measures1. The Family Adaptability and Cohesion Scale (Olson,Portner, & Lavee, 1985) is a 20 item scale designed tomeasure family flexibility and family togetherness. TheFamily Adaptability and Cohesion Scale (FACES III) derivesfrom the Circumplex Model, as developed by David Olson andhis associates, which conceptualizes family functioningalong the intersecting dimensions of adaptability andcohesion.Olson et. al. (1985) maintain that the health of afamily is reflected in the balance the family maintains41between a receptivity to change and an ability to retain asense of continuity and family identity. Specifically,adaptability is a construct that measures the family’sopenness to accommodating new ideas and practises.Typically these new attitudes and behaviours are presentedto the family by the children and by the larger community.Along the dimension of adaptability, the scale wasoriginally designed such that a family scored in one of fourranges: chaotic, flexible, structured, or rigid. Eachrange denoted particular qualities of family life. Forexample, in the extreme of “rigidity” at the one end, afamily has a fixed set of accepted rules and maintainsunyielding control over which behaviours are tolerated inthe family. Most importantly, there is a lack ofwillingness to accommodate new practises and ideas thatdeveloping children will introduce to the family. On theother extreme is “chaotic”, which according to the originaldesign of FACES III, indicates that the family has noconsensus on accepted family rules and is unable to controlwhich behaviours become characteristic of the family. Aswill be discussed more thoroughly, Olson seems to haveamended his position on this latter category, recommendingthat families that score high on this subscale be considered“very flexible” as opposed to chaotic (Olson, 1991).Cohesion is a construct that reflects a family’s senseof togetherness and belonging. The original range goes from42“disengaged” at the one end, reflecting a sense ofdetachment between family members, to “enmeshed” at theother end, indicating that the family members are overlyinvolved with each other’s activities and experiences. Thetwo categories that form the middle-ranges of the cohesioncontinuum are “separated” or “connected”. Like flexible andstructured on the adaptability continuum, these two rangesexpress a middle ground that is thought to be “balanced”, orhealthy.Concerns regarding the concepts of “enmeshment” and“chaos” as they pertain to the FACES III appear to haveresulted in a modification to the scale. In particular,Olson (1991) now recommends that high scores for cohesionand adaptability be viewed as indicating that families are“very connected” and “very flexible” as opposed to“enmeshed” and “chaotic”. Hence, the instrument is nowbeing interpreted in a linear fashion such that high scoreson the cohesion and flexibility scales reflect high levelsof those constructs measured.The reliability of FACES III as indicated in itsaccompanying manual (Olson et. al., 1985) was determined byestimates of internal consistency. The alpha coefficientfor the Cohesion subscale is reported as .77, while thealpha coefficient for the Adaptability subscale is .62.Further, Olson et al. (1985) report that FACES IIIdemonstrates very good face and content validity. Edman,43Cole, and Howard (1990) document that the instrumentdemonstrates good convergent validity. For the purposes ofthis study, FACES III demonstrates adequate psychometricproperties (see Appendix F).2. The Family Satisfaction Scale (Olson & Wilson, 1982) isbased on the principles of the Circumplex Model, andassesses the overall level of contentment within the familyhome. The Family Satisfaction Scale (FS) is important inthat it allows for a family to express satisfactionindependently of the classification within the 16 potentialcategories of the FACES III. Thus a family may score in anextreme categorical range, like rigidly enmeshed, and yetreport feeling comfortable with their way of functioning.If family members are satisfied with their status quo, thenthey may not feel the need for anything to change. The FSprovides an important complement to the FACES III in that itallows for a subjective assessment of overall contentmentwith family functioning.The FS is a 14-item scale which utilizes a S pointLikert scale, with responses ranging from dissatisfied toextremely satisfied. Reliability, as indicated by theCronbach alpha coefficient, was found to be .91 for a sampleof 2,076 subjects. Test-retest trials, conducted over afive-week period on 106 subjects, resulted in a PearsonProduct Moment correlation coefficient of .75. In terms of44test construction, a pilot instrument consisting of 28 itemswas subjected to a factor analysis. A varimax rotation wasutilized on the principal factors, and only items thatloaded more than .50 were retained (see Appendix G).3. The Perceived Social Support Scale - Family (Procidano& Heller, 1983) was developed to explore the mediating rolethat networks of relationships play in mitigating thenegative effects of stress. The Perceived Social SupportScale - Family (PSS-Fa) reflects the extent to whichindividuals believe they will receive support, nurturanceand positive feedback from family members. The concept ofperceived social support is unique in that it addresses theimportance of the sense of support that the individualexperiences as opposed to the sheer presence and structureof a social network (Procidano & Heller, 1983). The PSS-Faassesses the extent to which individuals feel that theirneeds for assistance and understanding will be met by theirfamily.The PSS-Fa scale has demonstrated high test-retestreliability (r=.83 over a 1 month interval), and a highinternal consistency estimate (Cronbach’s alpha= .90). In asubsequent validation study, Lyons, Perrotta, & Hancher-Kvam(1988) found the PSS-Fa to be reliable, valid, andgeneralizeable. Validation studies of the instrument(Procidano & Heller, 1983) have shown high internal45consistency estimates and evidence of good constructvalidity (see Appendix H).4. The Family Demographic Form (FDF) was created for theumbrella research project, The Alcohol Recovery Project, byadapting sections of the Family Assessment Device (Epstein,Baldwin, & Bishop, 1983). The FDF yields information onsocial-economic status, medical history, racial/culturalbackground, and other demographics. The FDF identifieswhich family members are currently living within thehousehold, and which are residing outside the family home,either independently or with another parent (see AppendixI)5. The Family Environment Scale (Moos, & Moos, 1981)measures aspects of social climate within the family home.Three versions of the scale are available, including theReal Form, the Ideal Form, and the Expectations Form; thisutilized the Real Form, which is designed to measure theexperience of family functioning in its current state. TheFamily Environment Scale (FES) is comprised of 10 subscales,which fall under 3 broad domains of family functioning,including Relationship, Personal Growth, and SystemMaintenance.The Relationship domain addresses the quality ofpersonal connections within the family, that is, how much46family members support one another, express themselvesopenly with each other, and deal with conflict amongstthemselves. The Personal Growth grouping of subscalesassess goal orientation along a number of different themes,the one selected for use in this study being independence.Independence in this use refers to “the extent to whichfamily members are assertive, are self-sufficient, and maketheir own decisions” (Moos & Moos, 1981, p.3). The SystemMaintenance subscales assess the level of organization andstructure within the family, as well as the existence ofrules that guide home life. To summarize, out of a total of10 subscales, 6 were selected for use in this study, asfollows: the Relationship subscales were Cohesion,Expressiveness and Conflict; the Personal Growth subscalewas Independence; and the System Maintenance subscales wereOrganization and Control.TABLE 1: RELIABILITY ESTIMATES FOR THE FES2-Month InternalTest-retest ConsistencyReliabilityRelationship Dimensions1. Cohesion .86 .782. Expressiveness .73 .693. Conflict .85 .75Personal Growth Dimensions4. Independence .68 .61System Maintenance Dimensions5. Organization .76 .766. Control .77 .67Note. From Family Environment Scale: Manual (p. 6) by R. H. Moos and B. S.Moos, 1981, Palo Alto, CA: Consulting Psychologists Press.47As Table 1 shows, test-retest and internal consistency-reliability estimates, as determined by Moos & Moos (1981>, arewithin acceptable levels (see Appendix J).6. The Parent-Adolescent Communication Scale (PAC) wasdeveloped by Barnes & Olson (1982) based on their CircumplexModel. The rationale for this instrument was thatcommunication mediates the processes of adaptability andcohesion.The final form of the instrument consists of twosubscales:1) Openness measures the ease with which dialogue takesplace between children and their parents, and,2) Problems measures the blocks to communication, andissues which are excluded from discussion.Barnes and Olson (1982) explored the reliability of thefinal factors with two samples of adolescents (see Table 2).TABLE 2: ALPHA RELIABILITY OF PARENT-ADOLESCENT COTMUNICATIONSample I Sample II Total(n=925) (n=916) (n=l,841)Open FamilyCommunication .87 .87 .87Problems in FamilyCommunication .78 .77 .78TOTAL SCALE .87 .88 .88Note. From Parent-Adolescent Communication (p. 57) by H. Barnes and D. H.Olson, 1982, St. Paul, MN: Family Social Science.48The final version of the test consists of 20 items, and asksrespondents to determine the degree to which they agree withstatements about family communication on a 5 point LikertScale. Adolescents answer each question twice, once withreference to their mother and once with reference to theirfather (see Appendices K & L).Determining Fathers’ Drinking TypeEfforts were made to gather as much information as possibleabout fathers’ drinking pattern, including how many days of theweek drinking took place, how many bouts of intensive drinkingoccurred in a year, and how much alcohol was consumed on atypical drinking day. In addition to completing the Binge-Chronic Differentiation form (BCDS) as presented in a semi-structured interview format, fathers’ were descibe their typicaldrinking routine in their own words. As detailed descriptions offathers’ drinking patterns began to emerge, it became evident tothe researcher that fathers’ patterns of drinking would not befully represented by the standard categories of “episodic” and“steady”. In order to confirm appropriate assignment to drinkingpattern groups, two steps were taken. First, the raw data wasexamined by the primary researcher to determine if a modified setof categories would better describe fathers’ drinking pattern.After comparing fathers’ responses on the BCDS to thesupplementary notes recorded by the interviewer, it wasdetermined that four patterns existed. These included:491) Steady - indicating that roughly the same amounts of alcoholwere consumed on a daily basis,2) Episodic - drinking occurred in bouts, with little or nodrinking in between. Additionally, there was no set patternto when the drinking took place,3) Regular Weekly - reflected a pattern of drinking thatoccurred on weekends or days off, and,4) Combination- a steady pattern of drinking punctuated withepisodes of heavier drinking occurring on an irregularbasis.The second step in classifying fathers’ drinking patterninvolved training two additional raters to classify fathers’drinking pattern within the above four categories. A simplechecklist was constructed and each of the three ratersindependently assigned fathers’ to one of the drinking categoriesbased on their determination of the best match. In addition,raters recorded their rationale for the assignment. The three-way rating system allowed for confirmation of appropriateassignment to drinking category. For 80% of the sample, therewas complete consensus across all four categories. In theremaining 20% of cases, most revealed that 2 of the 3 ratersagreed on an assigned category. At this point, the three ratersconferred jointly and presented their rationale for assigningfathers to particular drinking classification for all cases in.which their was discrepancy. Final classification of the50remaining cases was determined at this joint meeting. Within thepopulation of 61 families, 33 were classified as steady, 10 wereclassified as episodic, 9 were classified as regular weekly, and9 were considered combination drinkers.Once the four subcategories were clarified, it becamenecessary to create a smaller number of overarching categories ofpaternal drinking pattern. This step was essential for threereasons. First, the number of subjects in each category was notsufficient to support the type of statistical analysis that wasidentified. Second, a conceptual justification for reducing thenumber of categories existed in that the steady drinkersdemonstrated a pattern of drinking that was distinct from theothers. Their typical consumption was consistent andpredictable, and they interacted with their families in onestate, intoxicated. The remaining subcategories of drinkersdemonstrated patterns of drinking that were different from steadydrinkers in that there was no consistent rate of consumption.Further, drinkers from the remaining three classificationsinteracted with their faxniles in two conditions, sober andintoxicated. In other words, two categories seemed evident,steady and non-steady.Lastly, an empirical rationale became evident that alsosupported two overarching classifications, steady and non-steady.An analysis of the mean scores from the childrens’ datadetermined that children of steady drinkers responded uniquely inrelation to the other three groups. They consistently scored in51or next to the highest position and reflected their families inthe most positive light.Based on the above three arguments, children of episodic,regular weekly and combination drinkers were merged into oneclassification and further analysis was conducted on the basis oftwo groups, children of steady drinkers and children of non-steady, or irregular, drinkers. A steady pattern involving thesame levels of daily intoxication was held to be different frompatterns in which daily levels of intoxication fluctuated and thefamily learned to relate to father in two phases, sober andintoxicated. Steady drinkers were maintained as a distinctgroup, and irregular drinkers were seen to subsume episodic,regular weekly and combination drinkers. The originaldistinction of episodic versus steady was preserved in that twooverarching groups subsumed the 4 categories. Later stages ofanalysis incorporated this modified classification system, andfatherst drinking pattern was referred to as either irregular orsteady.Having identified two overarching categories of paternaldrinking pattern, the inter-rater reliability was recalculated todetermine levels of agreement on assignment to either steady orirregular drinking classification. The inter-rater reliabilityincreased to 90%.Data AnalysisThe complete data analysis was conducted in five stages, as52follows,1) descriptive analysis;2) test of subject independence;3) assessment of inter-correlations of independentvariables;4) multivariate analysis of co-variance, and,5) multiple regression analysis.Where appropriate, analysis was conducted on the sample ofchildren in its entirety, discussing children of episodicdrinking homes and children of steady drinking homes as a whole.For the most part, however, data analysis focused on thecharacteristics which discriminate these two subgroups ofchildren from one another. The following is an explication ofthe data analytic strategy.I. The descriptive analysis explored the characteristics ofthe collective sample of the 110 children of alcoholics involvedin this study. This analysis provided a broad brush assessmentof the attributes and features specific to this particular sampleof children. The descriptive analysis involved, first, adiscussion of the screening criteria for families entering theProject. Second, family demographics were presented, including adescription of socio-economic status, ages of the children, andrange of sizes of families. Third, the means and standarddeviations of all the subscales were compiled and comparedbetween subgroups of children. This information was used to53determine which if any variables needed to be covaried in theanalysis. Also, information arising from a comparison of meansand standard deviations was used to guide later stages of theanalysis, particularly with reference to selecting variableswhich warranted more detailed scrutiny.II. The second step, that of verifying subject independence, wasin essence a part of the above process, but warranted a specialdiscussion as it posed a potential threat to the validity of thestudy. Research principles demand that subjects should be freeof similar influences; that is, subjects’ observations should notbe affected by shared experiences or conditioning. For thesubjects in this study, the standard of independence wascompromised by the fact that a number of participants weresiblings. In order to ensure that the results derived from thisdata were valid, some precautionary measures were required.Specifically, a preliminary series of tests were conducted inorder to ensure that final results were not significantlyaffected by the inclusion of family members. The preferredmethod of analysis was:1) to separate the scores of children who have no siblingsparticipating from those of children who do have siblingsparticipating,2) to examine the variance on all factors, and,3) to explore these results for problematic differences in theamount of variance that the two groups demonstrated.54If no substantial differences in the amount of variance emergedbetween these groups, then it was reasonable to conclude thatfurther analysis would be unaffected by the participation ofsiblings in the study.III. Correlational analysis of the data entailed using a Pearsonproduct-moment correlations to determine the relationshipsbetween the independent variables. By examining the inter-correlations of the independent variables, the shared variancecould be assessed. This step was important in that itfacilitated data reduction.Correlations of independent variables is especiallyimportant where two variables have close theoretical ties. Forexample, both the FES and the FACES III have a subscale forCohesion. By squaring the correlation between these twosubscales, the overlap in the variance between the two variablescould be determined. If the overlap was high, for example, 81%,the second step would be to assess which subscale accounted formore of the variance with the dependent variable. Thisevaluation was done by correlating the two independent variableswith the dependent variables. The subscale which explained thegreater amount of variance would be retained for use in the laterstages of analysis.To summarize the above process, the first step was toconduct an inspection of the correlation matrix of the•independent variables. The second step was to determine the55shared variance of all highly correlated subscales by squaringthe correlation score. The third step was to determine which ofthe highly correlated subscales explained more of the variancewith the dependent variables by correlating the selectindependent variables with the dependent variables. The fourthstep was to isolate the more important independent variables andretain them for further analysis, and to cast of f the lesssignificant variables.IV. Following data reduction as outlined above, a multivariateanalysis of co-variance (MANCOVA) was conducted, co-varyingvariables that demonstrated overarching influences on both groupsof children. The MANCOVA determined, first, if there weresignificant overall differences between the two groups ofchildren. Second, the MANCOVA determined which, if any, of thedifferences on particular variables were significant. TheMANCOVA was performed to answer the question, “Do children ofepisodic drinking homes experience their families differentlyfrom children of steady drinking homes?”V. Lastly, a multiple regression analysis was conducted as ameans of ordering the importance of each variable, or group ofvariables, by its ability to explain the variance in paternaldrinking pattern. Because this investigation is exploratory innature, variables were entered into the equation free of anypredetermined order. Thus, the multiple regression analysis56allowed for variables to be identified based on theircontribution to the shared variance with fathers’ drinkingpattern. The variables that explained significant amounts ofdifference were selected out, and these factors were furtheranalyzed to determine the amount of shared variance that theycould account for. The multiple regression analysis was utilizedto address the question, “What is the relative importance ofchildren’s perceptions of family satisfaction, familyadaptability and cohesion, family environment, perceived socialsupport and parent-adolescent communcation in explaining thedifferences between children living in steady drinking homes andchildren living in irregular drinking homes?”Results from this process generated new informationregarding the differential experiences of children raised inepisodic drinking homes versus steady drinking homes. Further,by distinguishing the differing problem areas of these two groupsof children, the results may indicate ways in which theeffectiveness of substance abuse interventions can be maximized.57Chapter IVResultsExamination of the data provided by the children and theirfamilies in the study uncovered some important distinctionsbetween children of irregular drinking homes and children ofsteady drinking homes. The first step in analyzing the resultsinvolved developing a descriptive analysis of the population, asis presented in the following pages.Bio-demographic InformationThese paragraphs will show that blo-demographic informationfor families in which there was a steady drinking father did notvary greatly from that of families in which father was anirregular drinker.A total of 61 families and 110 children participated in thestudy. The intake sample included 13 fathers and mothers fromthe rural setting of Duncan, B.C., and 48 fathers and mothersfrom the urban site of Surrey, B.C. Fathers’ mean age was 41.4years and mothers’ mean age was 39.4 years.In terms of drinking pattern, 28 of 61 (45.9%) fathers wereirregular drinkers and 33 of 61 (54.1%) fathers were steadydrinkers. Fortr-seven children came from irregular drinkinghomes, while 63 children came from steady drinking homes.Children ranged in age from 9 - 20 years. The mean age ofchildren from irregular drinking homes was 13.7 years (SD= 3.22),58as was the mean age of children from steady drinking homes (SD=3.47) . Of the total sample of children, 48 (43.6%) were female,and 62 (56.4%) were male. In irregular drinking homes, 19(40.4%) were female and 28 (59.6%) were male. In steady drinkinghomes, females comprised 46.0% of the sample, (n= 29) and malescomprised 54.0%, (n=34)Socioeconomic StatusIn terms of employment status, 74.1% of the irregulardrinking fathers and 81.3% of steady drinking fathers wereemployed full-time. Wives reported full-time employment in 57.1%of irregular drinking homes and in 56.3% of steady drinkinghomes. In 22.2% of irregular drinking homes, fathers stated thatthey were unemployed, while fathers’ unemployment rates in steadydrinking homes were 15.6%. In irregular drinking homes, 10.7% ofmothers reported being unemployed, while in steady drinking homes12.5% of mothers reported unemployment.As Table 3 on the following page shows, annual income didnot differ greatly between the two groups of families. Theoverall range of income was very similar and, as can be seen,families in which there was a steady drinking pattern were onlyslightly better off financially than their counterparts inirregular drinking homes. A Chi-square analysis revealed nosignificant difference between these categories.59TABLE 3. ANNUAL FNILY INCONE BY DRINKING PATTERNDrinking Pattern (Number of Families)Irregular SteadyDrinking Pattern Drinking PatternAnnual Income(per $1000)$0-9 1 0$10-19 4 2$20-29 5 6$30-39 2 2$40-49 5 7$50-59 5 4$60-69 2 6$70-99 4 3$100+ 0 3EducationFathers of episodic drinking homes reported their meanyears of education as 12.2 (SD= 2.40). Their counterparts insteady drinking homes stated that they also had an average of12.2 years of education (SD= 1.66). Wives of irregular drinkersreported that they had a total of 12.5 years of education (SD=1.98), while wives of steady drinkers typically had 12.8 yearsof schooling, (SD= 1.85). No specific documentation was madewith regard to the drop-out rate of children taking part in thestudy. Visual inspection of the data indicated that the-vastmajority of children were not early school leavers.Marriage and Family DemographicsThe marital status of couples of irregular drinking homes60was reported as 82.1% married, and 17.9% common-law. In steadydrinking homes, 75.8% identified themselves as married and 24.2%stated that they were common-law. The mean number of years thatirregular drinking couples had been together was 13.0 years (SD=7.1), while steady drinking couples said that they were togetheran average of 13.7 years (SD= 6.6). The mean number of peopleliving in the household of irregular drinking homes was 4.0 (SD=1.19), while in steady drinking the mean number of people livingin the household was 4.15 (S]D= 1.20).Symptoms in the ChildrenMaternal reports of symptoms in the children suggest that10% of children experienced somatic complaints, 8.2% experiencedschool or learning difficulties and 6.2% of children experiencedemotional problems. 75.5% of this sample population weredescribed as exhibiting no discernable difficulties by theirmothers.Alcohol ConsumptionDaily intake of alcohol did not significantly differ betweenthe two groups of fathers. Fathers who had an irregular patternof alcohol consumption reported that they consumed a mean of 21.1standard drinking units on a typical drinking day (SD= 11.22).Fathers who had a more or less stable daily pattern of drinkingreported that they drank a mean of 19.5 standard drinking unitson a typical drinking day (SD= 8.02). Additionally, more steady61drinkers than irregular drinkers were likely to report toleranceeffects, 63.6% versus 51.9% respectively.In terms of typical time of drinking, irregular drinkerswere divided almost equally between those who were more likely todrink during the day (48.1%) and those who tended to drink in theevening (51.90%). In contrast, 39.4% of steady drinkers reporteddrinking during the day, while 60.6% preferred to drink in theevening. Irregular drinkers were also evenly split between thosewho were likely to drink outside of the home and those who tendedto drink within the home (50.0% for both groups). Steadydrinkers, on the other hand, were more likely to consume alcoholwithin the home (86.2%). only 13.8% said that they do most oftheir drinking outside of the home. Lastly, fathers who had anirregular pattern of consumption were more likely to drink alonethan were steady drinkers, the respective proportion of drinkersbeing 37.0% and 18.2%, respectively. Table 4 outlines thesefindings on the following page.Treatment HistoryAll fathers were consulted regarding prior treatmenthistory. With regard to attendance at Alcoholics Anonymous(A.A.), the two groups of fathers did not differ significantly intheir attendance at this support group, a Chi-Square analysisdetermined a significance of 0.1683. Most of the fathersparticipating in the study, including 53.6% of irregular drinkingfathers and 57.6% of steady drinking fathers, either had62TABLE 4: DRINKING VARIABLES BY FATHERS’ DRINKING PATTERNIrregular SteadyDrinking Fathers Drinking Fathers(In percent) (In percent)Daytime Drinking 48.1 39.4Nighttime Drinking 51.9 60.6In-Home Drinking 50.0 86.2Out-of HomeDrinking 50.0 13.8Seldom Drink Alone 37.0 18.2Mostly Drink Alone 63.0 81.8never attended A.A. or had attended 2 or less meetings. Fatherswere asked about previous attendance at detoxification,residential and outpatient programs for alcohol abuse. Again, nosignificant differences in previous attendance for alcoholtreatment were found. Irregular drinking fathers attended a meanof 1.370 (SD=1. 334) previous treatment programs, whereas steadydrinking fathers attended a mean of 1.363 (SD= 1.141) priorprograms. It should be noted that no data were available onwhether or not fathers completed these programs.Consequences of Problem DrinkingThe negative consequences of drinking were assessed by theDrinking Pattern Assessment Scale (DPAS), which asked fathers torespond to questions in a variety of areas, including medical,work, legal and social problems. The two groups of fathers didnot differ in any significant way on these variables. Nor didthey report differences in the realm of conflict, as wasoriginally anticipated. Neither verbal nor physical fights withHIijH-0CD HCD p)ci 0l HQiCD11-I-JU) ci CDt3)CDQia U) CDH0 HiHdHiHP)CDci0) U)CDci CDCDoCDci I-J-U)oH (QU)HCtHiH0)(•) 0)CDH1‘<CD0 I-i CD‘10‘1‘ClU)HiciCl-H0H0(D3‘-3CDCD0)0)H-CDQCD<U))ci(CDCDH-P)H-0)HiCDCDCnHW<ciU)CDJH-CtCtU)0)U)HU)QH-CDHCDH-ci00)F-0)H-t100LxiciCD0IIC)0)H-ciCD300)0)0)U)U)QiH-3U)0)3U)OciciciHH0)UifrCD-H0(CdCDU)ciI---0H-0l‘-3(DL’J.flticiMi30)LiiP)0CDH-U)I--’-30H-CD1QciH-U)C)-U)0ciCVU)Lx19)H-I)CD0l-QciCDC)U)(Dcictfli‘9)ciII0U)H-‘dIlOOC)U)(-QCH-CDMiH1CD00ci0Ct0CD3H-0U)d9)H1ci-MiH-MU)U)Qi0)rJ)CDU)ci00H-H-CD9)H-H-11MiCDH-I1l’CDU)U)H0Hici9)9)0ciU)iU)3HiciU)HciH-U)H-CD0U)HU)0U)0C)ci9)C)‘1(1)CDI-QHiH-9)J)ci)U)l-CDIIciciciHU)CDciHi9)ciHHiCQ0I9)CD9)U)<cicibl-‘—.ixjQ’zjcicicil-CCl)CDL)OfWH-.)X9)HZCDH-HCDCD0ciiQCDciP)HCl)0tiCDci)HiCx)HWOi—JOitJUi9)Jl-i-3iiciU)hCDH-ci0CDUiUiDOOJCDU)U)U)HciQi3HOUiD-IltiLull-Ici0IICDciOWO,DaU)fr0H-HH-H(H-0W(-Q3Lj-[‘3MiH-HiWhCl)Hi-0H-dH-H-CDCDiI9)IIH-IIdPd(-QI-c(.QHiCDH-U)-Cl-0‘I00CD3t’3tjHH-HiCQiCDU)HH-0H-HiciU)0U)3C)H-CD‘-3CtC)I-Q0Q.CrCDfr9)LxiH-II9)Cci-t‘10Uii,1o—xlQ3CH-CCDPLO-[’3W9)1<U(QU)l-9)CDci-<CDCD(-QCDH[‘.3CDO)9)31Jci39)frCDU)HWCDMOI..OWHCDiCDI-tU9)ci30MiCTi-lHDOLOCDp—11H-H-Cci)CDH‘.DMHDH[’JU)HHciC)(QC)ZCD(QU)‘1ci0H-9)HiCDciHciCCDdciH-(QH009)0CD9)(Q--QI-U)U)9)Ct‘dH‘xjCDCl)9)‘-QCDCl)CD‘<H-Q‘<H-C-3ciU)cijciU)U)(QciH-CD0000HOC)HiH-LIICD9)C)ci,HW[”.))OH(QciCl)U)H-CD9)0CDW0’ICDUiPPOi‘zj-Cl)3HCDW64irregular drinking fathers (p= .016). Similarly, steady drinkingfathers were more likely to drink because of physical discomfortthan were irregular drinking fathers (p=.OO1). These two groupsof men also reported differences in their vulnerability to urgesand temptations, with steady drinking fathers feeling moresusceptible to drinking due to unexpected cravings than irregulardrinking fathers (p= .025).This strong trend for steady drinking fathers to report moresensitivity to external events and internal experiences thanirregular drinking fathers continues across several additionalvariables. For example, fathers who have a regular pattern ofdrinking are more vulnerable to drinking due to 1) conflict withothers (p=.038), 2) feeling social pressure to drink (p= .043),3) a desire to enhance already pleasant feelings (p=.016), and 4)a wish to enjoy pleasant times with others (p= .048).Children’s Results - Processes of AnalysisFollowing the descriptive analysis of the participants inthe study, the children’s data was analyzed. A preliminary stepin analyzing the children’s data involved examining KolmogorovSmirnov Goodness-of-Fit tests on the distributions of thevariables. This process ensures that the subject sample isresponding with satisfactory consistency to the questionnairesand that the distribution of scores approaches a normal curve.Only one independent variable had a distribution which wasdifferent from a normal one, this being the FES subscale65Expressiveness (2-tailed p= .049). Two other variablesapproached being significantly different from a normaldistribution: age in years (2-tailed p= .062) and the FESConflict (2 tailed p= .088)The second step in analyzing the children’s data includedexamining the reliabilities of the 12 scales and subscales toensure that children were responding to questions in consistentand meaningful ways. Table 6 presents these results.TABLE 6: ALPHA RELIABILITIES ON CHILDREN’SSCALES AND SUBSCALESCronbach’s Alpha Reliability EstimateYES SubscalesCohesion .8071Expressiveness .4646Conflict .7395Independence .4367Organization. 7101Control .5564FACES III SubscalesCohesion .8362Adaptability .6690Family SatisfactionTotal Score .8678Parent -AdolescentCommunicationFather .7955Mother .8634Perceived Social SupportFamily .9181Nine of the twelve measures demonstrated adequate levels ofinternal consistency reliability, confirming that children were66responding in a consistant manner to the questions being asked ofthem. For the three variables that had low reliabilityestimates, the FES subscales, Expressiveness, Independence andControl, conclusions regarding them must be made with caution dueto the high proportion of error variance.The third step in analyzing the children’s data involvedcalculating Pearson Product Moment correlations on the principalvariables, including age and years of education. Overall,correlations among variables were low enough to suggest each wastapping a unique aspect of family functioning (Table 7 and Table8). Of note was the finding that the Cohesion scores for the FESwere only moderately correlated to the Cohesion scores for theFACES III (r= .5779) This suggests that the constructs ofcohesion differ for the two scales. As explained by Olson et al.(1985), FACES III Cohesion measures the sense of separateness orcloseness amongst family members, whereas the FES Cohesionsubscale assesses the “degree of commitment, help, and support”(Moos & Moos, 1984) family members experience from one another.Given the moderate correlation between these two subscales,further analysis was conducted including both.Another important correlation emerged from the initialseries of analysis. It was found that the age in years wasmoderately but consistently correlated to responses on 7 of the10 variables. With this in mind, further analysis investigatedthe effect of age by dividing the sample into 2 age groups, 9-12year olds in one group, and 13-20 year olds in another. These67TABLE 7: PEARSON PRODUCT-MOMENT CORRELATION COEFFICIENTSBETWEEN VARIABLES (PART I)FES SUBSCALESCOH EXP CONF IND ORGZ CONTFESEXP .279bCONF-. 524c- . 188aIND .247b .298b- .217aORG .423c- .044- .466c .065CONT- .308b- .353c .246a- .485c - .024FACESCOH .578c .308b - .590c .106 .433c- .231aPDAP .201a .173- .003 .169 .101- .231aFSTOT .571c .323b- .497c .279b .486c- .256bPACF .514a .127- .638c .147 .520c- .130PACM .368c .348c- .261b .219a .129 - .328bPSSFA .618c .362c- .342c .244a .433c- .284bKEYaCohExpConfmdOrgzContp< .001Adap-FSTOT-PACF -PACM-PSSFA -TABLE R: PEARSON PRODUCT-MOMENT CORRELATION COEFFICIENTS BETWEENCOH (FACES) ADAPFACESIDAP .257b735cVARIABLES (PART II)KEYa-p< .05; b-p< .01; C-pc .00].Coh - Cohesion PACF- Parent-Adolescent CommunicationAdap - Adaptability (Father>FSTOT - Family Satisfaction Total PACM - Parent-Adolescent communicationScore (Mother)PSSFA- Perceived Social Support (Family)p< .05; b -- Cohesionp< .01; c -- Expressiveness- Conflict- Independence- Organization- controlAdaptabilityFamily Satisfaction Total ScoreParent-Adolescent Communication (Father)Parent-Adolescent communication (Mother)Perceived Social Support (Family)FSTOTPAMPACFP S SPA444c655c677cFSTOT.482c702c64lc.176.125030266bPACM.309b579cPACF487c68age divisions were consistent with the categories identified bySantrock (1988) . He distinguishes periods of childdevelopment in rough age groupings, with late childhood beginningat about 9 years of age, and adolescence beginning between theages of 11 and 13 years. Santrock (1988) suggests thatadolescence ends at approximately 21 years of age. A univariateanalysis of variance was conducted, comparing the youngerchildren with the older children on the twelve independentvariables. Since significant differences were found on 7 of thevariables, it was determined that age should be co-varied infurther analysis.In a similar vein, the researcher examined the role ofgender in the responses that children were providing. A similarunivariate analysis of variance was conducted comparing femalechildren with male children. No significant differences werefound between these two groups, confirming that males and femaleswere responding in a homogeneous manner.Other correlations were examined as well. Although somecorrelations were moderate to strong, none of the correlationsposed problems to the interpretation of further analysis. Forexample, it was found that responses on the FS were stronglycorrelated to responses on FACES III cohesion (r= .7352).Additionally, PSS Family scores were moderately correlated with,1) FES cohesion scores (r= .6179), 2) FACES III cohesion (r=.6766), and, 3) FS total score (r= .6408) . Lastly, children’sresponses on the PAC-Father showed moderate correlations to69responses on 1) the FES conflict subscale (r= - .6378), 2) FACESIII cohesion (r= .6551), and 3) FS total (r= .7019) . Thesecorrelations suggest that, while the overall sense of familyatmosphere was consistent across different variables, theinstruments employed in the study were tapping sufficientlyunique constructs.An important component of examining the correlation matriceswas confirming that multicollinearity was not affecting theanalyses. Multicollinearity refers to problematic interrelationships between variables such that two variables withperfect or near perfect correlations produce redundantinformation in multivariate analysis of variance and covariance.In their discussion of multicollinearity, Tabachnick and Fidell(1983) indicate a number of ways that high levels ofmulticollinearity can be uncovered. To begin with, they suggestthat correlation values become especially problematic when theyexceed levels of .99. In the current study, no two variablesapproached this level of inter-relationship. Because so many ofthe variables examined in this study were derived solely from therealm of family functioning, however, it was felt that furtherexploration of multicollinearity was necessary.Following from the above, data were examined for highcorrelations between variables. As previously indicated, thehighest correlation existed between FACES Cohesion and FamilySatisfaction Total Score. The correlation value was .735,appreciably below the level of .99. The subsequent amount of70shared variance accounted for by this correlation was 54%. Itshould be noted that a substantial amount of the variance, 46%,is not shared variance.Next, patterns of correlations with other variables wereexplored to determine if common trends existed. It was foundthat some similarities occurred between FACES Cohesion and FSTotal Score in terms of how they correlated with the other 10variables. Across the 10 variables (see Tables 7 & 8),differences between FACES Cohesion correlations and FS Totalcorrelations ranged from a maximum difference of .173 (FESIndependence) to a minimum difference of .007 (FES Cohesion).Specifically, the differences were as follows: 1) FES Cohesion= .007; 2) FES Expressiveness = .015; 3) FES Conflict = .093; 4)FES Independence = .173; 5) FES Organization = .053; 6) FESControl = .025; 7) PAC-Mother = .038; 8) PAC-Father = .047; 9)PSS-Family = .036; 10) FACES - Adaptability = .081.Lastly, Tabachnick and Fidell (1983) suggest thatmulticollinearity can be indicated by examining data fromMultiple Regression analyses. If standard error scores fromMultiple Regression analyses are high, then it is possible thatmulticollinearity is occurring. By exploring Table 14, it can beseen that standard error scores for both FACES Cohesion and FSTotal Score did not exceed .01, a figure which is well withinacceptable levels. Thus, although there are substantial intercorrelations, these findings cannot be interpreted as statisticalartifacts arising from multicollinearity.71A fourth step in preparing the children’s data requiredexamining the variance between two particular subgroups ofchildren, 1) those children who had no siblings participating inand 2) those children who also had siblings taking part in thestudy. Table 9 presents the results of this analysis.TABLE 9: VERIFICATION OF SUBJECT INDEPENDENCEmount of Variance1 Child 2 or More ChildrenParticipating ParticipatingFESCohesion 4.791 8.452Expressiveness 2.914 3.240Conflict 8.524 6.528Independence 2.531 3.138Organization 5.804 5.379Control 3.181 5.080FACESCohesion 50.766 72.317Adaptability 45.538 48.980FS 98.116 100.630Parent -AdolescentCommunicationFather 220.654 319.807Mother 129.441 197.753PERCEIVED SOCIALSUPPORTFamily 469.556 571.752This process was conducted in order to confirm subjectindependence. The critical issue in this examination was thatthe variance of one subgroup did not exceed twice that of the72other subgroup. It can be seen from the above table that theresponses of these two categories of children were within theacceptable range and thus the principle of subject independencewas upheld.The Differing Perceptions of Children of AlcoholicsA multivariate analysis of covariance (MANCOVA) wasconducted using raw scores. Drinking pattern (irregular versussteady) was the dependent variable, the 12 family variables werethe independent variables, and age in years was the covariate.Results of the MANCOVA demonstrate highly significant overalldifferences (p< .001) in the perceptions family functioning ofchildren of irregular drinkers versus children of steady drinkers(Table 10). As the univariate results indicate, the two groupshad significant mean scores on 9 of the 12 variables. Thesubscales of the FES revealed a number of these importantdifferences. On the FES Cohesion scale, for example, children ofirregular drinking fathers reported significantly less supportand helpfulness within their homes than did children of steadydrinking homes (m= 6.36, m= 6.34, respectively; p= .048)Conversely, children of irregular drinking fathers reportedsignificantly more Conflict within their homes (m= 5.63) than didchildren of steady drinking homes (m= 4.11; p= .004). A furtherdifference was found on the FES subscale Control, on whichchildren of irregular drinkers reported significantly higherlevels (m= 5.09) than did children of steady drinking fathers (m=734.11; p=.036). No significant differences were found for theTABLE 10: MANCOVA RESULTS: MtJLTIVARIATE AND UNIVARIATE TESTSTest Name Value Exact F Hypoth. DF Error DF Sig.of FHotellings .59783 4.13497 12.00 83.00 <.001Children of IrregularDrinking Fathers(Mean Score)Children of SteadyDrinking Fathers(Mean Score)FACESAdaptabilityCohesion29.03 (sd= 7.78)27.63 (sd= 7.96)24.70 (sd= 5.95)32.18 (sd= 8.29).003.004FAMILYSATISFACTION 37.38 (sd= 9.78) 44.84 (sd= 9.50) .000PERCEIVED SOCIALSUPPORT (Family) 81.42 (sd=24.43) 91.71 (sd=22.43) .034PARENT- ADOLESCENTCOMMuNICATIONFatherMother49.39 (sd=16.48)65.23 (sd=13.23)59.79 (sd=16.95)72.91 (sd=12.87).006.002subscales of Expressiveness, Independence, and Organization.With regard to the results of the FACES III, children ofFAMILY ENVI RON)NTSCALECohesionExpressivenessConflictIndependenceOrganizationControl5.363 . 665.635.784.085.09(sd=(sd=(sd=(sd=(sd=(sd=2.63)2.01)2.69)1.75)2.28)2.14)Sig.of F.048897.004.707.178.0366.343 . 624 . 115.934.724.11(sd=(sd=(sd=(sd=(sd=(sd=2.17)1.17)2.47)1.78)2.63)2.27)irregular drinking homes reported significantly higher levels of74flexibility within the home than did children of steady drinkers(29.03 vs. 24.70, respectively; p= .003). The former group ofchildren scored within the range of chaos according to Olson’soriginal formulation of this scale, while the children of steadydrinking homes scored within the normal range. On the Cohesionsubscale of the FACES III, irregular drinkers were more likely tohave children who saw their families as disengaged (m= 27.63)than were steady drinkers (m= 32.18; p= .004). With regard tofamily satisfaction, children whose fathers were irregulardrinkers reported significantly less satisfaction with theirfamily life than did children of steady drinkers (p< .001).Specifically, children of irregular drinkers scored a mean of37.38, while children of steady drinkers scored a mean of 44.84.Children of irregular drinkers experienced significantlyless availability of assistance and guidance (m= 81.42) fromtheir families than did children of regular drinkers (m= 91.71),as reported on the Perceived Social Support Scale (p= .034).Children of irregular drinkers also reported more difficulties intheir communication with their fathers (m= 49.39) than childrenof steady drinkers (m= 59.79; p= .002). Finally, children ofirregular drinkers report significantly less satisfactorycommunication with their mothers (m= 65.23) than children ofsteady drinkers (m= 72.91; p= .006)It should be noted that a small proportion of subjects didnot provide information on all of the previous categories.Hence, the findings and percentages reported herein may reflect a75slightly smaller sample size.A Comparison of Results to Normative DataAn additional layer of meaning was added to the aboveresults when normative data was explored. Comparisons were basedon raw scores. For example, the norms provided for the FES asgathered from children of 1,125 non-distressed families offeredan interesting contrast to the data collected in the currentstudy. Reports of cohesion, conflict, and independence were nottoo dissimilar between the children of steady drinkers andchildren of normative families. In general, children ofirregular drinkers, however, reported a more negative view offamily on almost all measures when compared to the normpopulation.TABLE 11: CHILDREN OF IRREGULAR AISJD STEADY DRINKERS COMPARED TONOR4ATIVE FAMILIES ON THE FESChildren of Irregular Children of Steady NormsDrinking Fathers Drinking Fathers (Raw Scores)(Mean Raw Scores) (Mean Raw Scores)FAMILYENVIRONI4ENTSCALECohesion 5.36(sd=2.63) 6.34(sd=2.17) 6.09(sd=2.ll)Expressiveness 3.66(sd=2.O1) 3.62(sd=1.17) 4.49(sd=l.76)Conflict 5.63(sd=2.69) 4.1l(sd=2.24) 4.30(sd=2.27)Independence 5.78(sd=1.75) 5.93(sd=1.78) 6.37(sd=1.49)Organization 4.08(sd=2.28) 4.72(sd=2.63) 5.43(sd=2.08)Control 5.09 (sd=2. 14) 4. l1(sd=2.27) 4. 87 (sd=2. 10)Table 11 summarizes raw scores on the FES, while Figure 1provides a bar graph of these results. It should be noted thatFT(TTRPTCHILDRENOFIRREGULTRANDSTEADYDRINEERSCOMPAREI)TO0 a) 0 C-) Cl)NORMATIVEFAMILIESONTHEFES6.5 65.5 54.5 43.5CohesionConflictOrganizationExpressivenessIndependenceControl77our results showed that adolescents tended to report morenegatively about family functioning than children under 13 yearsold. Hence, comparisons made to adolescent norms should beinterpreted with some caution.The manual of the Family Satisfaction scale also providesnorm scores from an adolescent population (n=412) (Olson et al.,1985). Additionally, the FACES III norms from a sample of 1,315families with adolescent children are reported in the instrumentmanual. Table 12 presents scores from the Family Satisfactionand the Faces III scales.TABLE 12: CHILDREN OF IRREGULAR AND STEADY DRINKING FATHERSCOMPARED TO NORMATIVE POPULATIONS ON FACES III ANDTHE FAMILY SATISFACTION SCALEChildren of Irregular Children of Steady NormsDrinking Fathers Drinking Fathers (Raw Scores)(Mean Raw Scores) (Mean Raw Scores)FACESAdaptability 29..03(sd=7.78) 24.70(sd=5.95) 24.3(sd=4.80)Cohesion 27.63(sd=7.96) 32.l8(sd=8.29) 37.l(sd=6.lO)FAMILYSATI S FACTI ONTotal Score 37.38(sd=9.78) 44.84 (sd=9.50) 45.0** No standard deviation estimate was provided for the Family SatisfactionScale.A cautious interpretation of children’s views onAdaptability suggests that children from steady drinking homesexperienced normal levels of flexibility, as indicated by meanscores that were very similar to normative families. However,the children who came from irregular drinking homes apparentlyviewed their families as lacking in consistency and continuity,78and as noted earlier, they scored within the “Chaotic range” offamily adaptability according to Olson’s original formulation.Scores on Cohesion showed more variation. Children of irregulardrinkers scored a full 10 points below normative means forfamilies with adolescent children (m= 27.6 and m= 37.1,respectively). As indicated earlier, this score suggests thatchildren of irregular drinkers experience their families asdisengaged. Children of steady drinkers, however, were lesssimilar to normative families with respect to Cohesion than inthe above-described subscales. Their mean score of 32.2 was 5points lower than that of the normative group. According toOlson’s original formulation, children of steady drinkersexperienced their families as “separated”.It should be noted that the findings of the current study donot lend support for Olson’s recent (1991) revision of the FACESIII. According to this amendment, Olson (1991) suggests that itis more accurate to see families that score high on the measureof Adaptability as “highly flexible”, an essentially positivetrait, rather than “chaos”. Given the general trend in thissample for children of irregular drinking fathers to perceivetheir families in a more negative light than children of steadydrinking fathers, Olson’s original interpretation of Adaptabilityscores has more explanatory power. In other words, the directionof the results in the present study would suggest that it ispreferable to have moderate scores on the Adaptability scale aopposed to elevated scores. Figure 2 presents these results.79Regarding scores on Family Satisfaction, comparisons to normgroups can be reported with somewhat more confidence asinformation from an adolescent population Is provided in themanual (Olson, 1982). Children of steady drinkers scores closelymatch those of adolescents from the normative sample (m= 44.838;m= 45.000, respectively), suggesting that overall, these twogroups of children experience their families in a very similarFigure 2: CHILDREN OF IRREGULAR AND STEADY DRINKING FATHERSC,)00C’)COMPARED TO NORMATIVE POPULATIONS ON THE FACES III40 -manner. Figure 3 outlines these results. This observation mustbe tempered somewhat by the fact that the population accepted/IrregularJSteadyNorm35302520 /Cohesion AdaptabilityRawScores0)0)0)01(0N-&0)01CD (-Q fr 0o M0 HU).)orr H-U)0U) H- o.)U)d CD p)H-rr ::jCr 0CrCDCD H-1CDfrtiHiCDCtC)CDCDfr U)0(1CD C-) 0ocr CDCD H-CrCt ::3CDCDi rro‘-‘CFrr CDCrU)CDtip)oH H‘dCrU)I<U)Hp)tiuu•::•:::::::•:•:::::•::ZCD:..—-‘°(DCD•••:•-:•:::-.c:::::::::::::::P)HorrHOCD U)Cr0 CDCDU)‘1•CD U) CD rr U) Cr H ti 0 H CD C) H- H CD 0 CD CD 0 rr CD CrC)H,I’CI)OH-1C)(0PiHHPit-CDCDtiCDU)H-U)0—U)-CDIOCrU)H-H-C)HbHO‘<CDCI)Cr CDH-P-)CD(-QH-U)C)‘1p.)P.)C)CDrr H-P.)H-..0H-HH p.)‘1I-ICl)bCD00HP.)CDH-H-H-1CDCD•U)0CrP.)‘-CDP.)U)C)H-HU)CDCDiictiP.)HCDCDHWCrt-‘titiCDII0U)dCD<(-tI-iU)HCDCD)jU)iCD‘<CDCf1U)P.)CtH,P.)Cr0CrI-iH-CDP.)0Ct0CDCDHOHCDHCDU)<P.)C)rrP)I-CDCDCDCrCrCrU)IH- H CD 0 0 ‘1 P.) Cr H CD P.) Cr P.) H, 0 I- Ct CD CD C) CD H CD CI) 0 C) H P.) H C,) 0 ti Ct‘-I 3 Cl) p) 0CI) I:-’ LIIC-) LII ‘-3 0 zC.) I-I I:-’ LXI 0 Ii ‘-4 LXI081TABLE 13: CHILDREN OF IRREGULAR AND STEADY DRINKERS COMPARED TONORMATIVE POPULATIONS ON PARENT-ADOLESCENT COM[VItJNICATIONChildren of Irregular Children of Steady NormsDrinking Fathers Drinking Fathers (Raw Scores)(Mean Raw Scores) (Mean Raw Scores)PARENTADOLES CENTCO!4MtJNI CATI ONFather 49.39(sd=16.48) 59.79(sd=16.95) 63.74(sd=12.02)Mother 65.23(sd=13.23) 72.91(sd=12.87) 66.56(sd=12.lO)of children in the present study. Children of irregular drinkersexperience the least satisfaction with paternal communication (m=49.39). Children of steady drinkers report better communicationwith their fathers than the previous group (m= 59.79), but stilldo not experience the quality of communication that the normpopulation reported (m= 63.74).An interesting finding emerged in the realm of maternalcommunication. Here, children of irregular drinkers andtheadolescent norm population report similar levels ofcontentment with communication (m= 65.23, m= 66.56,respectively). However, children of steady drinkers report anoticeably higher quality of maternal communication when comparedto either of the two previous groups. When consideration isgiven to the role age may play in these comparisons, it wouldseem that paternal communication is even more distressed in bothgroups of children of alcoholics in comparison to the normsample, and maternal communication may not be quite as positiveas the above scores would indicate.82FIGURE 4: CHILDREN OF IRREGULAR AND STEADY DRINKERS COMPARED TONORMATIVE POPULATIONS ON PARENT-ADOLESCENT COMMUNICATIONThe last important component of analysis on the children’sdata involved the use of multiple regression. This procedureexamines the variance of the pattern of drinking variable anddetermines which among the children’s measures accounts forsignificant proportions of the variability. The results aresummarized in Tables 14 through 15. These tables presenta series of procedures that 1) identify those children’svariables that explain significant amounts of the variance infathers’ drinking pattern, and 2) determine how much sharedvariance exists between the children’s variables and paternal/7570650C-)co 60555045E IrregularESteadyNorm______________Communicationwith Father7Communicationwith Mother83TABLE 14: FIRST EQUATION RESULTS OF A MULTIPLE REGRESSIONAdap - AdaptabilityFSTOT - Family Satisfaction Total ScorePAC - Parent-Adolescent Communication (Father)PACM- Parent-Adolescent communication (Mother)PSSFA- Perceived Social Support (Family)TABLE 15: FIRST EQUATION SUNMARY TABLEB SE B0209 0153 .1416Beta Correl. T. Sig. T. 0319- .0683- .0067- .0377- .0340- .0566.0163 1.367 .17540279.0282.0276.0311.0259• 02421836- .2529- .0363- .1347-. 1610- .2594.2851- .0117- .2820• 0417.1345- .2128- .0267.00161. 139-2.417- .245-1.212-1.313-2.340• 0066.0098.2582.0178.8071.22911929.0217- .3806 - .3031.0276 .2662.0187- .0011.0039.0000• 0084.0033.0044.0040.165 .0001-4.047 .8691.3899- .0512.1054.0221.3588.2142.2807.29402.235- .327.874• 874Multiple R .61930 R Square Change .00018R Square .38354 F Change .02381Adjusted R Square .298698 Signif F Change .8778Standard Error .41617VariableAGEFESCohExpConfmdOrg zContPACESAdapCohPSTotalPSS - PaPac-MPac-FKEYCoh- CohesionExp - ExpressivenessConf - Conflictmd- IndependenceOrgz- OrganizationCont- controlStep Rsq. F (Eqn) Sig. F. Rsq. Ch.1. Age .0003 .025 .874 .0003FES2. Coh .0886 4.567 .013 .08833. Exp .1031 3.563 .017 .01454. Conf .1219 3.194 .017 .01885. Ind .1244 2.587 .031 .00256. Org .1374 2.388 .035 .01297. Cont .1702 2.607 .017 .0328FACES8. Coh .1801 2.416 .021 .00999. Adap .3200 4.549 .000 .139910. FS .3778 5.223 .000 .057S11. PSS .3778 4.693 .000 .000012. PaCM .3834 4.352 .000 .005513. PACF .3835 3.972 .000 .0002• 02817444.3846877884TABLE 16: SECOND EQUATION RESULTS OF A MtJLTIPLE REGRESSIONB• 60800.36966• 279628.41832SE BR Square ChangeF ChangeSignif F ChangeBeta Carrel.• 369664.10518.00000T Sig. Tdrinking pattern. Specifically, Equation 1 delineates the firstphase in which all variables were force-entered into theanalysis. It was determined that age, which had been covaried inthe multivariate analysis of covariance, was not a significantcontributor (Beta= .1416; T=1.367; p= .1754). Age was notincluded in subsequent analysis.The second procedure, represented in Equation 2, tested eachRR SquareErrorMultipleR SquareAdj ustedStandardVariablePESCohExpConfmdOrgzContFACESAdapCohPSTotalPSS-FaPac-MPac-F.0302 .0281 .1744 .2851 .034 .2849- .0647 .0283- .2397 - .0117 -4.218 .0246- .0040 .0276- .0216- .2820 -2.288 .8846- .0278 .0305- .0992 .0417- .913 .3639- .0298 .0258- .1413 .1345 1.015 .2517- .0616 .0241- .2819 - .2128 -1.154 .0123- .0277 .0066- .3960- .3031 -2.558 .0001.0000 .0097 .0062 .2661- .146 .9701.0170 .0083 .3547 .3588 - .216 .0440.0000 .0033- .0338 .2141- .038 .8298.0045 .0044 .1224 .2807 1.076 .3129.0000 .0040 .0049 .2940 2.045 .9726KEYCoh - CohesionExp - ExpressivenessConf - Conflictmd - IndependenceOrgz - OrganizationCont - controlAdap - AdaptabilityFSTOT- Family Satisfaction Total ScorePAC- Parent-Adolescent Communication (Father)PAM- Parent-Adolescent communication (Mother)PSSFA- Perceived Social Support (Family)variable for its contribution to R squared by identifying the85amount of change in R squared that occurred when the variable wasremoved from the full equation. Total R squared for thisequation was .3697. Four variables were identified assignificant contributors, namely Adaptability, Expressiveness,Control and Family Satisfaction. The last phase of the multipleregression analysis involved carrying these 4 variables over intoa third equation. to determine the overall shared variance withfathers’ drinking pattern. In the end, Adaptability,Expressiveness, Control and Family Satisfaction accounted for33.22% of the shared variance with the paternal drinking patternvariable. Referring to Equation 2, it can be seen that the 8variables eliminated from the equation collectively contributedonly 3.74% to the variance accounted for.TABLE 17: THIRD EQUATION RESULTS OF A MEJLTIPLE REGRESSIONMultiple R .57640 R Square Change .33223R Square .33223 F Change 11.44325Adjusted R Square .30320 Signif F Change .00000Standard Error .41141B SE B Beta Correl. T Sig. TVariablePS Total .0202 .0044 .4204 .3588 4.593 .0000PACESAdap - .0283 .0061- .4043- .3031 -4.587 .0000FESCont- .0582 .0207- .2664- .2128 -2.804 .0062Exp- .0502 .0259- .1862- .0117 -1.942 .0552KEYCoh - Cohesion Adap - AdaptabilityExp- Expressiveness FSTOT - Family Satisfaction Total ScoreConf - Conflict PAC - Parent-Adolescent Communication (Father)md- Independence PACM - Parent-Adolescent communication (Mother)Orgz- Organization PSSFA - Perceived Social Support (Family)Cont - control86CHAPTER VCONCLUS IONSDiscussion of the ResultsThe results of this research put forth a strong argument forthe position that fathers’ pattern of drinking and children’sexperience of home life are significantly and meaningfullylinked. Children of homes in which fathers’ pattern of drinkingdoes not maintain a predictable course express a unique andimportant experience, and one that differs from children ofsteady drinking fathers. The divergent perceptions of these twogroups of children underscore the existence of different types ofalcohol-involved homes. Their differing views raise questionsabout the adequacy of global terms such as “the alcoholicfamily,” which suggest a singular experience of alcoholism withinthe family that is not reflected in the present findings.Further, the results of this study underscore the previouscomments of Moos & Billings (1982) that, in and of itself,fathers’ alcohol consumption was not a good predictor ofchildren’s functioning. In other words, factors beyond straightquantity-frequency scores were involved in children’s experienceof family life. This study confirms that fathers’ pattern ofdrinking is one such important factor.When overall contentment with the family was considered,children of irregular drinking fathers were significantly lesssatisfied with their home lives than were children of steady87drinking fathers. The former group of children expressedmarkedly more discontent with their families than children ofsteady drinkers. In the realm of family cohesion, children weremore likely to experience their family as detached from oneanother, with an increased sense of distance amongst familymembers, when fathers’ pattern of drinking was unstable than whenfathers’ drinking was steady. Similarly, in irregular drinkinghomes, children were more likely to have difficulty identifyingwho was in charge in their families and reported moreinconsistency in their homes than did children of steadydrinkers.Additionally, children whose fathers had an irregularpattern of drinking reported that their families were far lesssupportive than the families of steady drinking fathers. Theformer group of children felt less able to count on theirfamilies to stand by them in difficult times and to express careand empathy for them after personal disappointments.Communication between fathers and children is significantly morestrained within the homes of irregular drinkers than it is withinthe homes of steady drinkers. The former group of children feelless understood by their fathers and are less likely to broachdifficult topics with their fathers than are children of steadydrinking homes.Additionally, children of irregular drinkers observed moreconflict within their families than did children of steadydrinkers. This finding was one area in which the results of88Jacob and his colleagues (1983) were reflected in the currentwork. That is, these researchers found that episodic drinkerswere more likely to have demonstrated aggressive and antisocialbehaviours than steady drinkers (Jacob et al., 1983). While thecounterpart category in the present study, irregular drinkers,did not report more problems with hostility and antagonisticbehaviours than steady drinkers, their children reported morefamily conflict than did children of steady drinkers.Children reported heightened experiences of control withinirregular drinking homes, feeling more “ordered around” andconstricted by family rules than children in steady drinkinghomes. At first examination, this finding might appear tocontradict these children’s reports that their parents did notprovide a strong sense of continuity and leadership regardingfamily rules. However, this incongruity may be as much areflection of inconsistency with enforcing family rules as it isa demonstration of the children’s experience of feeling over-controlled by their parents. For example, periods of no parentaldiscipline punctuated by harsh insistence upon children’scompletion of chores may result in reports of high levels of bothchaos and feeling controlled.When considering a broader perspective of fathers’ biodemographic, socioeconomic and relationship status, unexpectedresults were uncovered in this investigation. The two subtypesof drinkers, irregular versus steady, did not differ greatly inthe above noted areas. In contrast to episodic drinkers, the89parallel classification used in previous studies, irregulardrinkers did not demonstrate less stable personal status, as wasfound, for example, in the 1983 work by Jacob and his colleagues.The men in the current investigation were not apparentlydifferent in their ability to maintain regular jobs and sustainongoing relationships. These were not men who were apparentlytroubled by the negative repercussions of anti-social tendencies.Interestingly, these findings underscore the importance ofpattern of drinking as an important factor in children’sexperience of the alcohol-involved family. In essence, thesimilarities between the two groups of fathers eliminated theconfounding factor of family distress that would have existed hadone group of children been exposed to higher parentalunemployment, lower family income and lesser levels of parentaleducation.Children of Alcoholics versus Children from Normative SamplesA caution must be maintained when referring to normativedata in that the sample of children included in the present studywas somewhat younger than children included in normative samples.Younger children may represent their families in a somewhat morepositive light than older children. With this observation inmind, a more complex series of comparisons emerged whenchildren’s scores from the present study were compared tonormative data. For instance, reports on some variablesindicated that children of steady drinking homes saw their90families similar to children of normative families. This trendwas true for Cohesion (FES), Conflict, and Adaptability, andFamily Satisfaction. In each of these cases, children ofirregular drinkers perceived their families in a noticeably morenegative light than their counterparts in steady drinking andnormative homes. In other areas, however, children of alcoholicsas a whole viewed their families more critically than children ofthe normative sample. The variables that reflect this trendinclude Expressivenss, Organization, and Cohesion (FACES III).A compelling contrast emerged in the area of communicationwith Mother. Children of irregular drinkers were very similar tochildren of normative families in their observations ofcommunications with mother. Children of steady drinkers,however, were substantially more positive in their assessment ofmaternal communication than either of the former two groups.This finding could be a reflection of a heightened dependency inchildren of alcoholics on their non-drinking parent. Forexample, even though children of irregular drinkers reported amore negative overall view of their families than children ofsteady drinkers, their need for adult interaction may bereflected in the comparatively elevated scores on Communicationwith Mother such that their experiences were similar to childrenof normative families in these area. The very positive views ofchildren of steady drinkers, which substantially exceeded theperceptions of the other two groups, may be an even greaterindication of the same need to connect with the non-drinking parent.91Comparisons with children of normative families revealed thecomplexity of experiences of children of alcoholics. In someareas, this sample of children saw their families equally aspositively as children of normative families. In other areas,their perceptions were much more negative and their struggleswere much more apparent. Further, the importance ofdistinguishing between the subtypes of parental alcoholism wasunderscored in this process, as it was clear that the twosubgroups of children of alcoholics matched or differed fromchildren of normative samples in varying places.Potential Sources of Difference Between the Subgroups of ChildrenIf the present study determines that children of irregulardrinking homes experience their family lives differently fromchildren of steady drinking homes, a question remains concerningwhat gives rise to the disparity. In other words, the cause ofthe differential experiences remains unexplained. While it isbeyond the scope of the current research to identify the root ofthe discrepant perspectives, a variety of possibilities should beraised for discussion. For example, one potential source ofdifference between views of these children involves the issue ofpredictability, that is, the certainty with which children cananticipate fathers’ actions and attitudes. As Seilhamer andJacob (1990) have commented, the changes in personality thatproblem drinkers undergo when they are intoxicated are asubstantial source of stress for children. A heightened source92of stress may be incurred if the drinking itself occurs on anirregular basis. For instance, if fathers’ pattern of drinkingis steady, with approximately the same amount of alcohol consumedon a daily basis, then children can predict their fathers’behaviour and mood somewhat reliably. Further, they can begin toplan their own activities around their fathers’ pattern, such asbringing friends over before a certain time of the afternoon. Onthe other hand, if fathers’ frequency of drinking fluctuates,then children cannot adequately predict paternal attitudes andreactions on a day to day basis. Children of steady drinkers maylearn that they can trust their expectations about home life, anddads’ behaviour, whereas children of irregular drinkers cannotreliably plan for their fathers’ state of intoxication.Predictability may provide a sense of control for the children ofsteady drinkers.A second source of the discrepancy between children ofirregular drinking fathers and children of steady drinkingfathers may be linked to differences in fathers’ personalitytraits. Although few significant differences emerged in fathers’personal status based on the data collected in this study, onearea of note was the finding that steady drinking fathersidentified emotionally based reasons for drinking significantlymore often than did irregular drinking fathers. For example,steady drinking fathers reported that they drank more often whenthey were contending with unpleasant emotions or feeling socialpressure to drink than did irregular drinking fathers. The93former group of men also reported drinking more often as a resultof succumbing to urges and temptations than did irregulardrinking men. These results may indicate either that steadydrinking men are more sensitive in general than irregulardrinking men, or that they are more able to understand andarticulate their feelings than irregular drinking men. In eithercase, these men are expressing different intrapersonal qualitiesthan irregular drinking men. Divergent paternal psychologicalcharacteristics may offer some insights into the differencesthese children experience. Further work into the links betweenpersonality traits and drinking pattern may provide beneficialinput into the findings uncovered in the current study.A third possibility regarding the differential perspectivesof children of alcoholics reflected in the current study mayarise from specific aspects of parenting, in particular, paternalproximity and accessibility. Child development theorists such asBowiby (1988) have noted the importance of the parent “beingavailable, ready to respond when called upon to encourage andperhaps to assist” (1988, p.11) . Of significance here is theissue of availability of parents when the child wishes support.As has been previously observed, a higher ratio of irregulardrinkers (50%) consumed alcohol outside of the family home thandid steady drinkers (23.8%). Thus, location of drinking mayserve to keep some irregular drinking fathers from beingavailable to their children. Above and beyond the issue offathers’ unpredictable mood swings as a result of an irregular94pattern of drinking, children within these homes cannot asreadily turn to their fathers in times of need precisely becausetheir fathers are Out of the home when they drink.A fourth potential source of the differences in familyfunctioning as expressed by the children in the current studycould arise from the personal attributes of the childrenthemselves. For example, children of irregular drinking fathersmay be predisposed towards more irritability and rebelliousbehaviour than children of irregular drinking fathers. It ispossible that the former children’s inherent traits interact withfamily dynamics such that their fathers drink on a sporadicbasis.The Relative Importance of Selected Children’s VariablesA substantial amount of the variance associated with thepaternal pattern of drinking variable was accounted for by thechildren’s variables (36.97%). Of the 12 children’s variablesselected for this study, 4 were found to be significant, in andof themselves explaining 33.22% of the total shared variance.These 4 varaibles included Family Satisfaction, Adaptability,Control and Expressiveness. Three of these 4 factors were alsosignificant in the MANCOVA, those being, Family Satisfaction,Adaptability and Control. Expressiveness was not significant inthe MANCOVA, nor did it meet standard requirements for theKolmogorov-Smirnov Goodness of Fit test for normal distributionof scores. As a result, findings for the Expressiveness variable95were more difficult to interpret. It is likely that so much ofthe variance was explained by the first three variables thatExpressiveness became significant because it captured theremaining unique variability.The finding that family satisfaction, adaptability ,controland expressiveness were significant factors in understanding thedifferent experiences of children of irregular drinkers andchildren of steady drinkers, however, offered importantinformation. If fathers’ drinking pattern is meaningfully linkedto children’s experience of the alcohol abusing home, then it islikely within these 4 areas that the differences are most greatlyfelt. For example, if a child whose father was drinking on afluctuating pattern was presented for treatment, clinicalintervention may need to attend to 1) contentment with thefamily, 2) flexibility within the home, 3) enforcement of rulesand 4) demonstration of feelings in order for the assistance tobe effective. If, on the other hand, these 4 areas were notattended to, the progress of the child might well be impeded.Limitations of the StudyPerhaps the greatest threat to the validity of this studylies within the specification of the population and the -subsequent restrictions on generalizeability. This investigationinvolved a select sample in that all subjects came from eitherintact families, or at a very minimum, families in which thechildren were in the regular care of one or both of their96biological parents. A further condition of acceptance into thestudy was that the alcoholic in the family was male. Lastly,all fathers accepted into the study were men who were seekingtreatment for their alcohol problems. Generalizeability islimited in a number of ways. First, segments of the alcoholicpopulation do not maintain family relationships and may notremain in contact with their offspring. Children of alcoholicswhose drinking parent has left, or children who are being raisedby adults other than their parents were not addressed by thisresearch. Given the instability of the alcoholic population ingeneral, this limitation may exclude a sizeable portion ofchildren of alcoholics.Second, the requirement that the alcoholic family member bethe father excluded families in which there was a mother who wasa problem drinker. An estimated 1/3 of all alcoholics arewomen, and thus conclusions from the current research likelyexclude a great number of children who are being raised by womenalcoholics.Third, the fathers who participated in the study were menwho were seeking treatment for their drinking problems. Thetherapy program that was provided involved up to 16 sessions ofcounselling over a period of 4 months. Further, for two thirdsof the men, a follow-up battery of questionnaires was required 15weeks after therapy concluded. Thus, the fathers who took partin the study agreed to an overall involvement of between 4 and 8months. Analyses on fathers’ and children’s data must be97considered with this selectivity in mind as the specificcharacteristics of the sample population may have had a bearingon some of the findings. It is conceivable that men who werewilling to undergo 4 to 8 months of treatment were different frommen who did not have to take part in a alcohol counselling. Inparticular, the families included in the current study were nottruly parallel to families involved in other similar research,for example, Jacob et al. (1978, 1983, 1988, 1989) . These latterfamilies were not required to participate in treatment. Inaddition, the irregular drinking men included in the presentstudy did not show the heightened aggressiveness scores of theircounterparts, episodic alcoholics, involved in the series ofstudies conducted by Jacob and his colleagues. It must be keptin mind, however, that even without the aggressive traits of thelatter group of men, irregular drinking fathers raised childrenwho were significantly less content with family life thanchildren of steady drinking fathers. In other words, althoughour questionnaires did not reveal many differences betweenirregular drinking fathers and steady drinking fathers asmeasured by scores for socio-economic status, employment status,education, length of marriage, amount of previous treatment,negative consequences of drinking and typical amounts of alcoholconsumed on drinking days, children were responding to perceiveddifferences in the quality of their home life.A fourth limitation of the present study is the absence of acomparison group of children from non-distressed homes. As98families taking part in the larger study were selected formarital discord, it is difficult to determine how the presentsample of children compare to those children whose parents arenot experiencing relationship problems. The use of normpopulations gives, at best, general indications of trends.Because age groups used in the normative populations do notaccurately parallel ages of children involved in the presentstudy, the data derived from these samples cannot ensure accuratecomparisons with the findings of the current research.Future studies would benefit by including comparison groups.Implications for Clinical WorkPerhaps the most important contribution the presentinvestigation makes to the overall understanding of children ofalcoholics is the confirmation that these children are not ahomogenous group. Distinct subtypes exist within this populationand they may require specific forms of treatment. Cliniciansworking with children of alcoholics might be served by knowingthat children of irregular drinking fathers may requirespecialized intervention and perhaps more intensive treatmentthan children of steady drinking homes, as the perceptions of theformer group of children suggest a more troubled experience. Apaternal drinking pattern which is steady, moreover, may be afactor that fosters resilience in children of alcoholics.A further contribution of the current work is the findingthat drinking pattern is meaningfully associated with varying99perceptions of family functioning. These results underscore theimportance of exploring drinking patterns in clinical settingswhen assessing for the presence of alcoholism. It may be easyto overlook problematic drinking because alcohol consumption isnot occurring on a daily basis. 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Journal of Studies onAlcohol, , 106-126.Woititz, J. G. (1983) Adult children of Alcoholics. PompanoBeach, FL: Health communications.Woodside, M. (1988). Research on children of alcoholics: Pastand future. British Journal Addiction, , 785-792.Zung, B. J. (1982). Evaluation of the Michigan AlcoholismScreening Test (MAST) among acutely disturbed psychiatricpatients. In J. L. Hedlund & B. W. Vieweg. (1984). TheMichigan Alcoholism Screening Test (MAST): A comprehensivereview. Journal of Operational Psychiatry, 15, p. 55-65.APPENDIX A: THE BINGE CHRONIC DIFFERENTIATION SCALE108109THE ALCOHOL RECOVERY PROJECTBINGE/CHRONIC DIFFERENTIATION FORM1. Which pattern best describes your drinking over the last year?[1) Drink heavily (6 or more drinks) every day[2] Drink moderately (3 to 5 drinks) daily[3] Drink a little (less than 3 drinks) every day[4] One day binges[5] Weekend/several day binges[6] Drink heavily (6 or more drinks) a couple of times a week[7] Drink moderately (3 to 5 drinks) a couple of times a week[8] Drink a little (less than 3 drinks) a couple of’ times aweek[9] Occasional drink but rarely get drunk[10] Never drink2. Which statement best describes your drinking habits over thelast year? (Circle A. B or C):A. A periodic, intermittent drinker (one who drinks heavily on abinge or drinking bout every so often, with periods of little orno drinking between binges) (Complete Section A only)B. A steady, regular drinker (one who continuously drinks more orless the same amount on a day-to-day basis)(Complete Section B only)C. Cannot say (Complete Sections A and B)A. SECTION FOR PERIODIC DRINKERS:1. About how many drinking bouts haveyou had in the last year? bouts2. About how long does your averagedrinking bout usually last?_____Hours_____Days3. What is the longest boutyou have ever had? Hours Days4. On average, how much time goesby between drinking bouts?____Days___Weeks MonthsB. SECTION FOR STEADY DRINKERS:1. Are there any particular days ofthe week during which you drinkmore than any other days? No Yes> If yes. circle days: M T W Th F Sa SuAPPENDIX B: THE MICHIGAN ALCOHOL SCREENING DEVICE110111QUESTIONNAIRE *INSTRUCTIONS: Please answer the following by circling Yes (“Y”)or No (“N’) on the answer sheet provided:1. Do you feel you are a normal drinker?2. Have you ever awakened in the morning after some drinkingparty the night before and found that you could not remembera part of the evening before?3. Does your spouse/partner (or parents) ever worry about yourdrinking?4. Can you stop drinking without struggle after one or twodrinks?5. Do you ever feel bad about your drinking?6. Do friends or relatives think you are a normal drinker?7. Do you ever try to limit your drinking to certain times ofthe day or to certain places?8. Are you able to stop drinking when you want to?9. Have you ever attended a meeting of Alcoholics Anonymous(AA) out of concern for your drinking?10. 1-lave you gotten into fights when you were drinking?11. Has your drinking ever created problems for you and yourspouse/partner?12. Has your spouse/partner (or other family member) ever goneto anyone for help about your drinking?MAST. 1112QUESTIONNAIRE *13. Have you ever lost friends or girlfriends/boyfriends becauseof your drinking?14. Have you ever gotten into trouble at work because of yourdrinking?15. Have you ever lost a job because of your drinking?16. Have you ever neglected your obligations, your family, oryour work for two or more days in a row because you weredrinking?17. Do you ever drink before noon?18. Have you ever been told you have liver troubles? Cirrhosis?19. Have you ever had delirium tremens (DT’s), severe shaking.or seen things that weren’t there after heavy drinking?20. Have you ever gone to anyone for help about your drinking?21. Have you ever been in a hospital because of your drinking?22. Have you ever been a patient in a psychiatric hospital or ona psychiatric ward of a general hospital when drinking waspart of your problem?23. Have you ever been seen at a psychiatric or mental healthclinic or gone to a doctor, social worker, or clergyman forhelp with an emotional problem in which your drinking playeda part?24. Have you ever been arrested, even for a few hours, becauseof your drunk behaviour?25. Have you ever been arrested for drunk driving or drivingafter drinking?MAST.2APPENDIX C: THE DRINKING PATTERN ASSESSMENT SCALE113114[1] Never[2] Once[3] Two or three times[4] Four to six times[5] Seven to ten times[6] More than ten times3. In the last year about howdrinking day?[1] None[2] 1 to 6[3] 7 to 12[4] 13 to 18[5] More than 184. In the last year about howdrinking day?Less than half a bottleHalf to a whole bottleOne to two bottlesMore than two bottles5. In the last year about how much hard liquor did you drink on atypical drinking day?NoneLess than half a bottleHalf to a whole bottleOne to two bottlesMore than two bottlesQUESTIONNAIRE *INSTRUCTIONS: Please record your answers to the following on theanswer sheet provided by circling the correct answer.1. For how long has drinking been a problem for you?[1] Less than one year[2] 1 to 2 years[31 2 to 3 years[41 3 to 5 years[5] 5 to 8 years[61 More than 8 years2. How many times have you stopped drinking and then started back?many beers did you drink on a typicalmuch wine did you drink on a typical[1) None[2][3][4][5][1)[2][3][4][5]DPAS. 1115QUESTIONNAIRE #6. I have to drink much more than I used to in order to get the sameeffects.[1] True[2] False7. Once I start drinking I continue until I’m intoxicated.[11 Never[2] Rarely[3] Occasionally[4] Frequently8. When drinking, I do most of my drinking.(1] In the morning[2] In the afternoon[3] In the evening[41 Throughout the day9. When drinking, I do most of my drinking. .[1] At home[2) At work [school][3] In bars[41 In a car[51 Other places10. When drinking, I drink alone. .[1] Never[2] Rarely[3] Occasionally[41 Frequently11. When drinking. I drink with my spouse/partner....[1) Never[2] Rarely[3] Occasionally[4] Frequently12. When drinking, I drink with friends....[11’ Never[2] Rarely[3] Occasionally[4] Frequently DPAS.2116QUESTIONNAIRE *13. Do you get into trouble at work [school] because of drinking?[1] Never[2] Rarely[3] Occasionally[4] Frequently[IF NEVER, PLEASE GO TO QUESTION 16114. Work [school] Related Problems (On answer sheet, circle all thatapply). In the past year. have you....[1] Missed work (school) due to drinking?[2] Missed doing important work (school) assignments due todrinking?[31 Lost a contract, sale, etc. (failed course, etc.) due todrinking?[41 Fired or otherwise lost job (school program terminated) dueto drinking?15. When drinking, how many days per month do you miss work [school]because of your drinking?[1] None[2] 1 to 5[3] 6 to 10[4] 11 to 15[5] 16 to 20[6] 21 to 25[7] More than 2516. Medical Problems (On answer sheet, circle all that apply). Inthe past year, have you. .[1] Gone to see a doctor due to drinking?[2] Gone to the hospital due to drinking?[3] Gone to emergency ward due to drinking?[4] Called an ambulance due to drinking?17. I have been arrested (On answer sheet circle all that apply)[1] for being drunk and disorderly-[2] for driving under the influence of alcohol (DtJI/DWI)[3] for driving under the influence of drugs[4] for buying drugs[5] for selling drugs[6] for other crimes committed while drinking or using drugs[7] for reasons other than alcohol or drugs[8] neverDPAS .311718. I have been convicted by a court (On answer sheet circle all thatapply)being drunk and disorderlydriving under the influence of alcohol (DIJI/DWI)driving under the influence of drugsbuying drugsselling drugsother crimes committed while drinking or using drugsreasons other than alcohol or drugs19. Although the legal authorities were not involved in any way, Ihad the following problems related to my drinking (Circle “Yes”or “No” on answer sheet):a) verbally fighting with: SpouseRelatives Yes NoOthersb) physically fighting with: SpouseFriend(s)RelativesYes NoYes NoYes NoYes NoOthers Yes Noc) driving while intoxicated:d) physically harming myself:Yes NoYes NoQUESTIONNAIRE *[1)[2][3][4][5][61[7][81forforforforforforforneverFriend(s)YesYesNoNoDPAS. 4APPENDIX D: THE INVENTORY OF DRINKING SITUATIONS118119QUESTIONNAIRE IINSTRUCTIONS: Listed below are a number of situations or events inwhich some people drink heavily.Read each item carefully. and answer in terms of your own drinkingover the past three months.If you “NEVER” drank heavily in that situation, circle “1”If you “RARELY” drank heavily in that situation, circle “2”If you “FREQUENTLY” drank heavily in that situation, circle “3”If’ you “ALMOST ALWAYS” drank heavily in that situation, circle “4”Never Rarely Frequently Almost AlwaysOVER THE PAST THREE MONTHS. OVER THE PAST THREE MONTHS.I DRANK HEAVILY... I DRANK HEAVILY...1. when I felt that I had let 11. when I was relaxed with a goodmyself down. friend and wanted to have a goodtime.2. when I had trouble sleeping.12. when I was afraid that things3. when I felt confident and weren’t going to work out.relaxed.13. when I felt drowsy and wanted to4. when I convinced myself that I stay alert.was a new person and could takea few drinks. 14. when everything was going well.5. when I remembered how good it 15. when I wondered about my self-tasted, control over alcohol & felt likehaving a drink to try it out.6. when I had an argument with afriend. 16. when I passed by a liquor store.7. when I was out with friends and 17. when I felt uneasy in thethey stopped by a bar for a presence of someone.drink.18. when I was at a party and other8. when I wanted to heighten my people were drinking.sexual enjoyment.19. when I wanted to feel closer to9. when other people didn’t seem to someone I liked.like me,20. when other people interfered with10. when there were fights at home. my plans.IDS .42.1120QUESTIONNAIRE IOVER THE PAST THREE MONTHS. OVER THE PAST THREE MONTHS.I DRANK HEAVILY. I DRANK HEAVILY.21. when there were problems with 32. when other people treated mepeople at work,unfairly.22. when I was enjoying myself at a 33. when I felt confused about what Iparty and wanted to feel evenshould do.better.34 when my stomach felt like it was23. when I was angry at the way tied in knots.things had turned out.35. when something good happened and24. when I felt nauseous. I felt like celebrating.25. when I felt satisfied with 36. when I wanted to prove to myselfsomething I had done. that I could take a few drinkswithout becoming drunk.26. when I started to think thatjust one drink could cause no 37. when I suddenly had an urge toharm, drink.27. when I unexpectedly found a 38. when other people around me madebottle of my favourite booze,me tense.28. when someone criticized me. 39. when I met a friend and helshesuggested that we have a drink29. when I was in a restaurant and together.the people with me ordereddrinks. 40. when I wanted to celebrate with afriend.30. when I was out with friends “onthe town” and wanted to increase 41. when I felt under a lot ofmy enjoyment. pressure from family members athome.31. when pressure built up at workbecause of the demands of my 42. when I was not getting along wellsupervisor,with others at work.IDS.42.2APPENDIX E: THE ALCOHOL DEPENDENCE TREATMENT HISTORY121122THE ALCOHOL RECOVERY PROJECTALCOHOL DEPENDENCE AND TREATMENT HISTORY1. Do you think you are dependent on alcohol?Yes No2. Do you think you could drink moderately without losing control of yourdrinking or without becoming intoxicated?Yes_____No_____3. Do you think you could stop drinking completely?[ii Yes - on my own[2) Yes — with help[3) No[4] Not sure14 Have you ever stopped drinking? Yes NoIf yes, what was the main reason for stopping drinking at that time?Why did you start drinking again?5. Since you started drinking regularly what is the longest time youvebeen without a drink?[1] Less than one week[2) One to four weeks[3] One to three months[4] Three to six months[5] Six to twelve months[6] More than a year[7] Ive never stopped6. When was your last drink?[1) Less than one week ago[2) One to four weeks ago[3) One to three months ago[] Three to six months ago[5] Six to twelve months ago[6] More than a year ago1237. 1 have been in treatment before for: (multiple options may be selected)[ii drinking problems[2] drug use problems[3) emotional or personal problems[4) I have never been in treatment before8. I have been through... (multiple options may be selected)[1) detox[2) outpatient treatment (counselling)[3] inpatient or residential treatment[4] no treatment9. If you have been in treatment, do you feel that it was helpful?[1] Yes - a lot[2] Yes — somewhat[3) No[4] No - made things worse10. I have attended Alcoholics Anonymous [AA] Meetings[1] Never[2) Once or twice[3] Several times for a brief period[4) Several times over a year or two[5] On a regular basis11. If so, do you feel that Alcoholics Anonymous [AA] helped you?[i) Yes — a lot[2] Yes - somewhat[3) Not really12. 1 have attended Narcotics Anonymous [NA] meetings or similar meetingsfor drug users[i) Never[2] Once or twice[3] Several times for a brief period[) Several times over a year or two[5] On a regular basis13. If so, do you feel that Narcotics Anonymous [NA] helped you?[ii Yes - a lot[2] Yes — somewhat[3) Not reallyADTH.2124YesYesNoNosix months17. Have any of the following of your blood relativesproblem. (Circle the appropriate word for each).ever had a drinkingYes Don’t Know N/A14. What best describes your goal for the treatment of your alcohol problem:[1) I don’t want to change anything about my drinking[2] I would like to be a daily drinker without ever getting drunk[3) I would like to become a moderate social drinker[4] I would like to become an occasional social drinker[5] 1 would like to stop drinking completely for at least[6] I would like to stop drinking completely[7] Other:15. Would you (the alcoholic) be willing to undertake individual therapy?16. Would you both be willing to undertake marital therapy?Maternal Grandmother Yes No Don’t KnowMaternal Grandfather Yes No Don’t Knowpaternal Grandmother Yes No Don’t KnowPaternal Grandfather Yes No Don’t KnowMother Yes No Don’t KnowFather Yes No Don’t KnowMother’s Sister Yes No Don’t Know N/AMother’s Brother Yes No Don’t Know N/AFather’s Sister Yes No Don’t Know N/AFather’s Brother Yes No Don’t Know N/ASister Yes No Don’t Know N/ABrother Yes No Don’t Know N/ADaughter Yes No Don’t Know N/ASon Yes No Don’t Know N/AADTH.3APPENDIX F: THE FAMILY ADAPTABILITY AND COHESION SCALE125126QUESTIONNAIRE *INSTRUCTIONS: Below are some statements that describe families.Please use the scale below to rate how much each statementdescribes your family right now.Almost Once in Sometimes Frequently AlmostNever a While Always1 2 3 4 5DESCRIBE YOUR FAMILY NOW:1. Family members ask each other for help.2. In solving problems. the children’s suggestions arefollowed.3. We approve of each other’s friends.4. Children have a say in their discipline.5. We like to do things with just our own family.6. Different persons act as leaders in our family.7. Family members feel closer to other family members than topeople outside the family.8. Our family changes its way o handling tasks.9. Family members like to spend free time with each other.10. Parent(s) and children discuss punishment together.11. Family members feel very close to each other.12. The children make the decisions in our family.13. When our family gets together for activities, everybody ispresent.14. Rules change in our family.15. We can easily think of things to do together as a family.16. We shift household responsibilities from person to person.17. Family members talk to other family members before makingtheir decisions.18. It is hard to identify the leader(s) in our family.19. Family togetherness is very important.20. It is hard to tell who does which household chores.Faces. 3APPENDIX G: THE FAMILY SATISFACTION SCALE127128QUESTIONNAIRE *INSTRUCTIONS:Please use the following scale to describe your feelings aboutyour family at present.Somewhat Generally Very ExtremelyDissatisfied Dissatisfied Satisfied Satisfied Satisfied1 2 3 4 5HOW SATISFIED ARE YOU.1. with how close you feel to the rest of your family?2. with your ability to say what you want in your family?3. with your family’s ability to try new things?4. with how often parents make decisions in your family?5. with how much father and mother argue with each other?6. with how fair the criticism is in your family?7. with the amount of time you spend with your family?8. with the way you talk together to solve family problems?9. with your freedom to be alone when you want to?10. with how strictly your family stays with who does whatchores?11. with your family’s acceptance of your friends?12. with how clear it is what your family expects of you?13. with how often you make decisions as a family rather thanindividually?14. with the number of fun things your family does together?FSAPPENDIX IT: PERCEIVED SOCIAL SUPPORT (FAMILY)129130QUESTIONNAIRE IINSTRUCTIONS: The statements which follow refer to feelings and experiences whichoccur to most people at one time or another in their relationships with families.Please think about the last 4 weeks and circle the answer you choose for each itemon the answer sheet, using the following scale:Strongly Somewhat Somewhat StronglyAgree Agree Disagree Disagree1 2 3 4 5 6 71. My family gives me the moral support I need.2. I get good ideas about how to do things or make things from my family.3. Most other people are closer to their family than I am.4. When I talk about private things to the members of my family, I get the ideathat it makes them uncomfortable.5. My family enjoys hearing about how I think.6. Members of my family share many of my interests.7. Certain members of my family come to me when they have problems or needadvice.8. 1 rely on my family for emotional support.9. There is a member of my family I could go to if I were just feeling down,without feeling funny about it later.10. My family and I are very open about what we think about things.11. My family is sensitive to my personal needs.12. Members of my family come to me for emotional support.13. Members of my family are good at helping me solve problems.14. I have a deep sharing relationship with a number of members of my family.15. Members of my family get good ideas about how to do things or make thingsfrom me.16. When I tell members of my family about private things. it makes meuncomfortable.17. Members of my family seek me out for company.18. 1 think that my family feels that I’m good at helping them solve problems.19. I don’t have a relationship with a member of my family that is as close asother people’s relationships with family members. (If you do, then youdisagree).20. I wish my family was much different.PSS. FaAPPENDIX I: THE FAMILY DEMOGRAPHICS FORM131132THE ALCOHOL RECOVERY PROJECTFAMILY DEMOGRAPHICS FORMOnly one family member should complete this form.Family Name:____Your Address:(Permanent)Home Phone Number: Work Phone Number:Day/Month/YearPlease give us the names and phone numbers of two people who couldhelp us locate you in the event that you moved.NameNamePhone Number:Phone Number:For each person living in your household, please list the following information,indicating the nature of’ each person’s role in the house (e.g., husband, wife,son, daughter, sister, friend, grandmother, etc.).Religion AgeEducation: Problems:Total Years Medical/School/Sex in School PsychiatricFor each family member orfol lowing:FullName Relationship Religion AgeEducation: Problems:Total Years Medical/School!Sex in School PsychiatricDate:FirstNameFamilyRole1.2.3.4.5.6.significant other not living in the home, list the1.2.3.133Never been marriedHarried only onceR ema r r i e dPresent marital status (Circle one): Married Common—LawHow many years have you and your spouse/partner lived together?________years$ 0- 9.999$10,000 - 19,999$20,000 - 29,999$30,000 - 39,999$40.000 - 49.999Do you identify with any specific ethnic group? If yes, check belowthe primary ethnic group.Heads of HouseholdFather MotherMediterranean (Italian, Middle Eastern,North African. Greek. Cyprian, etc.) (North American (U.S. American, Canadian.First Nations) (Marital record of each head of the household: (Check all that apply)Father MotherDivorcedWidowedNumber of previous marriages: (Father)(Mother)Total family income (all sources) during past year (Check one):$50,000 - 59,999$60,000 - 69,999$70,000 - 99,999$100,000+Western European (British, French, German etc.)Eastern European (Russian, Polish, etc.)C ) C( ) (South American (Central and South American)African (South African)( ) (( ) (Asian or Pacific IslanderAustralian/New Zealander( ) (( ) (134What is your primary racial background? Father MotherNative Indian (Oriental (Black (Hispanic (White (How many times in the last year have you attended a religiousservice?Father:___________times Mother: timesWhat is your employment status (i.e. part-time, full—time,unemployed, in school):Father:_______________Mother:________________________What is your first language:Father: Mother:The remaining questions are to be answered for the heads of thehousehold.As briefly as possible. please describe:a) What kind of work you are (or were) engaged in:(e.g. electronics engineer. nursing. stock—clerk, farming,homemaker. etc.Father:Mother:b) Your major or most important activities/duties at work:(e.g. keeping the accounts, selling cars, operating printingpress. caring for patients. etc.Father:Mother:-c) The kind of industry or organization this work is (or was) in:(e.g.. Radio-TV. manufacturing firm, retail shoe store, generalhospital. etc.)Father:Mother:APPENDIX J: THE FAMILY ENVIRONMENT SCALE135136QUESTIONNAIRE *INSTRUCTIONS: Here are 54 statements about families. Please decidewhich of these statements are true of your family and which are false.Make all your marks on the separate answer sheets. If you think thestatement is true or mostly true of your family, circle “T” for“True”. If you think the statement is false or mostly false, circle“F” for “False”.You may feel that some of the statements are true for some familymembers and false for others. On the answer sheet provided circle “T”if the statement is true for most members. Circle “F” if thestatement is false for most members. If the members are evenlydivided, decide what is the stronger overall impression and answeraccordingly.Remember, we would like to know what your family seems like to you.So do not try to figure out how others members see your family, but dogive us your general impression of your family for each statement overthe last 4 weeks.1. Family members really help 12. There are very few rules toand support one another. follow in our family.2. Family members often keep 13. We put a lot of energy intotheir feelings to what we do at home.themselves.14. It’s hard to “blow off3. We fight a lot in our steam” at home withoutfamily. upsetting somebody.4. We don’t do things on our 15. Family members sometimes getown very often in our so angry they throw things.family.16. We think things out for5. Activities in our family are ourselves in our family.pretty carefully planned.17. It’s often hard to find6. Family members are rarely things when you need them inordered around, our household.7. We often seem to be killing 18. There is one family membertime at home, who makes most of thedecisions.8. We say anything we want toaround home. 19. There is a feeling oftogetherness in our family.9. Family members rarely becomeopenly angry. 20. We tell each other about ourpersonal problems.10. In our family, we arestrongly encouraged to be 21. Family members hardly everindependent, lose their tempers.11. We are generally very neat 22. We come and go as we want toand orderly. in our family.FES. 1137QUESTIONNAIRE *23. Being on time is very 39. If there’s a disagreement inimportant in our family. our family, we try hard tosmooth things over and keep24. There are set ways of doing the peace.things at home.40. Family members strongly25. We rarely volunteer when encourage each other tosomething has to be done at stand up for their rights.home.41. Each person’s duties are26. If we feel like doing clearly defined in oursomething on the spur of the family.moment we often just pick upand go. 42. We can do whatever we wantto in our family.27. Family members oftencriticize each other. 43. We really get along wellwith each other.28. There is very little privacyin our family. 44. We are usually careful aboutwhat we say to each other.29. People change their mindsoften in our family. 45. Family members often try toone—up or out—do each other.30. There is a strong emphasison following rules in our 46. It’s hard to be by yourselffamily, without hurting someone’sfeelings in our household.31. Family members really backeach other up. 47. Money is not handled verycarefully in our family.32. Someone usually gets upsetif you complain in our 48. Rules are pretty inflexiblefamily. in our household.33. Family members sometimes hit 49. There is plenty of time andeach other, attention for everyone inour family.34. Family members almost alwaysrely on themselves when a 50. There are a lot ofproblem comes up. spontaneous discussions inour family.35. Family members make suretheir rooms are neat. 51. In our family. we believeyou don’t ever get anywhere36. Everyone has an equal say in by raising your voice.family decisions.52. We are not really encouraged37; There is very little group to speak up for ourselves inspirit in our family. our family.38. Money and paying bills is 53. Dishes are usually doneopenly talked about in our immediately after eating.family.54. You can’t get away with muchin our family.FES.2138APPENDIX K: THE PARENT-ADOLESCENT COMMUNICATION SCALE (FATHER)139INSTRUCTIONSQUESTIONNAIRE IThe following questions ask about how well you get along withyour father. Please read each statement and use the scale belowto indicate how much you agree or disagree with the statement.For example, look at statement 13. “My father is a goodlistener.” If your father is always a very good listener andreally understands what you say, you might score ‘5’ on theanswer sheet to show you strongly agree with the statement. Onthe other hand, if you don’t think your father listens well mostof the time and doesn’t seem to understand what you are sayingyou might score a ‘1’ or ‘2’. indicating that you disagree withthe statement to some extent.Please use the answer sheet provided and answer all thestatements as best you can. Remember there are no right or wronganswers. It’s just important that you answer truthfully. Pleasethink about the last 4 weeks when you answer these statements.Strongly Moderately Neither Agree Moderately StronglyDisagree Disagree Nor Disagree Agree Agree1 2 3 4 51. I can discuss my beliefs with my father without feelingrestrained or embarrassed.2. Sometimes I have trouble believing everything my fathertells me.3. My father is always a good listener.4. I am sometimes afraid to ask my father for what I want.5. My father has a tendency to say things to me which would bebetter left unsaid.6. My father can tell how I’m feeling without asking.7. I am very satisfied with how my father and I talk together.PAC.F. 1140QUESTIONNA IRE 4Strongly Moderately Neither Agree Moderately StronglyDisagree Disagree Nor Disagree Agree Agree1 2 3 4 58. If I were in trouble. I could tell my father.9. I openly show affection to my father.10. When we are having a problem. I often give my father thesilent treatment.11. I am careful about what I say to my father.12. When talking to my father. I have a tendency to say thingsthat would be better left unsaid.13. When I ask questions. I get honest answers from my father.14. My father tries to understand my point of view.15. There are topics I avoid discussing with my father.16. I find it easy to discuss problems with my father.17. It is very easy for me to express all my true feelings to myfather.18. My father nags/bothers me.19. My father insults me when he is angry with me.20. I dont think I can tell my father how I really feel aboutsome things.PAC.F.2141APPENDIX L: THE PARENT-ADOLESCENT COMMUNICATION SCALE (MOTHER)142INSTRUCTIONS:QUESTIONNAIRE *The following questions ask about how well you get along withyour mother. Please read each statement and use the scale belowto indicate how much you agree or disagree with the statement.For example. look at statement *3. “My mother is a goodlistener.” If your mother is always a very good listener andreally understands what you say. you might score ‘5’ on theanswer sheet to show you strongly agree with the statement. Onthe other hand, if you don’t think your mother listens well mostof the time and doesn’t seem to understand what you are sayingyou might score a ‘1’ or ‘2’. indicating that you disagree withthe statement to some extent.Please use the answer sheet provided and answer all thestatements as best you can. Remember there are no right or wronganswers. It’s just important that you answer truthfully. Pleasethink about the last 4 weeks when you answer these statements.Strongly Moderately Neither Agree Moderately StronglyDisagree Disagree Nor Disagree Agree Agree1 2 3 4 51. I can discuss my beliefs with my mother without feelingrestrained or embarrassed.2. Sometimes I have trouble believing everything my mothertells me.3. My mother is always a good listener.4. I am sometimes afraid to ask my mother for what I want.5. My mother has a tendency to say things to me which would bebetter left unsaid.6. My mother can tell how I’m feeling without asking.7. I am very satisfied with how my mother and I talk together.PAC.M. 1143QUESTIONNAIRE *Strongly Moderately Neither Agree Moderately StronglyDisagree Disagree Nor Disagree Agree Agree1 2 3 4 58. If I were in trouble, I could tell my mother.9. 1 openly show affection to my mother.10. When we are having a problem, I often give my mother thesilent treatment.11. I am careful about what I say to my mother.12. When talking to my mother. I have a tendency to say thingsthat would be better left unsaid.13. When I ask questions, I get honest answers from my mother.14. My mother tries to understand my point of view.15. There are topics I avoid discussing with my mother.16. I find it easy to discuss problems with my mother.17. It is very easy for me to express all my true feelings to mymother.18. My mother nags/bothers me.19. My mother insults me when he is angry with me.20. I don’t think I can tell my mother how I really feel aboutsome things.PAC.M.2

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