• TABLE OF CONTENTS
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 Title Page
 Dedication
 Acknowledgement
 Table of Contents
 Abstract
 Introduction
 Review of the literature
 Methodology
 Results
 Summary, discussion, conclusions,...
 Appendices
 Reference notes
 References
 Biographical sketch
 Signature page














Title: Cognitive and experiential group counseling for university students of alcoholic parentage /
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Permanent Link: http://ufdc.ufl.edu/UF00097432/00001
 Material Information
Title: Cognitive and experiential group counseling for university students of alcoholic parentage /
Physical Description: xi, 208 leaves : ill. ; 28 cm.
Language: English
Creator: Klinefelter, Harry F., 1948-
Publication Date: 1982
Copyright Date: 1982
 Subjects
Subject: Group counseling   ( lcsh )
Children of alcoholics   ( lcsh )
College students -- Alcohol use   ( lcsh )
Counselor Education thesis Ph. D
Dissertations, Academic -- Counselor Education -- UF
Genre: bibliography   ( marcgt )
non-fiction   ( marcgt )
 Notes
Thesis: Thesis (Ph. D.)--University of Florida, 1982.
Bibliography: Bibliography: leaves 202-207.
Additional Physical Form: Also available on World Wide Web
Statement of Responsibility: by Harry F. Klinefelter, III.
General Note: Typescript.
General Note: Vita.
 Record Information
Bibliographic ID: UF00097432
Volume ID: VID00001
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: alephbibnum - 000334700
oclc - 09483112
notis - ABW4343

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Table of Contents
    Title Page
        Page i
    Dedication
        Page ii
    Acknowledgement
        Page iii
        Page iv
    Table of Contents
        Page v
        Page vi
        Page vii
        Page viii
    Abstract
        Page ix
        Page x
        Page xi
    Introduction
        Page 1
        Page 2
        Page 3
        Page 4
        Page 5
        Page 6
        Page 7
        Page 8
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        Page 11
        Page 12
        Page 13
        Page 14
        Page 15
        Page 16
        Page 17
        Page 18
    Review of the literature
        Page 19
        Page 20
        Page 21
        Page 22
        Page 23
        Page 24
        Page 25
        Page 26
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    Methodology
        Page 68
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    Results
        Page 106
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    Summary, discussion, conclusions, implications, and recommendations
        Page 143
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    Appendices
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    Reference notes
        Page 201
    References
        Page 202
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        Page 204
        Page 205
        Page 206
        Page 207
    Biographical sketch
        Page 208
    Signature page
        Page 209
        Page 210
        Page 211
Full Text











COGNITIVE AND EXPERIENTIAL GROUP COUNSELING
FOR UNIVERSITY STUDENTS OF ALCOHOLIC PARENTAGE



by



HARRY F. KLINEFELTER, III


A DISSERTATION PRESENTED TO THE GRADUATE COUNCIL OF
THE UNIVERSITY OF FLORIDA
IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY



UNIVERSITY OF FLORIDA


1982













DEDICATION


This dissertation is dedicated to all alcoholic families,
especially my own: to Dr. Harry F. Klinefelter, Jr., and the late
Elaine W. Prosser, my parents; to Stan and Susan, my brother and
sister.












ACKNOWLEDGMENTS


A number of people deserve special thanks for their con-

tributions to this tangible product of countless hours of hard

work and a seemingly endless series of emotional peaks and valleys.

Included amongst a mix of feelings that includes joy, pride,

relief, and academic exhaustion, there is a strong sense of grati-

tude. This five-person doctoral committee has been exceptionally

cooperative and supportive, and each person has been readily avail-

able for consultation. A spirit of mutual trust and respect has

been the key to optimizing this arduous learning experience.

Sincere appreciation and gratitude go to Dr. Joe Wittmer for

his consistent and cheerful supply of understanding, encouragement,

and pragmatic leadership--special thanks to Joe for his thorough,

prompt editing; Dr. Bob Ziller for his sharing of abundant enthusiasm

and creative energy in the early stages of this study; Dr. Ben Barger

for his steady support throughout and especially for consultive help

with the planning phase; Dr. Gerardo Gonzalez for his critical

comments and sharing of his substantial expertise in the field of

alcohol research; and Dr. Dorothy Nevill for providing a healthy,

refreshing perspective in addition to warm, friendly support.

Finally, thank you to all of the other people who, whether

they were even aware of it at the time or not, contributed either











directly or indirectly to this dissertation. I only wish it were

possible to personally share some of my gratitude and joy of

accomplishment with each one.













TABLE OF CONTENTS


PAGE


ACKNOWLEDGMENTS . . . . .

ABSTRACT . . . . . .


CHAPTER


I INTRODUCTION . . . .


Need for the Study . . . . . . .
Purpose of the Study . . . . . .
Rationale for the Study . . . . .
Definition of Terms . . . . . .
Alcohol Education . . . . . .
Alcoholic . . . . . . . .
Alcoholic Family or Home . ... .
Children of Alcoholics . . . .
Cognitive . . .. . . ...
Experiential . . . . . . .
Group Counseling . . . . . .
Healthy Coping Attitudes . . . .
Healthy Coping Behaviors . . . .
Negative Behavioral Consequences . .
Primary Prevention . . . . .
Responsible Attitudes Toward Drinking .
Secondary Prevention . . . . .
Structured Group . . . . . .
Subject . . . . . . . .
Organization of the Remainder of the Study .

II REVIEW OF THE LITERATURE . . . . .


Recent Literature Reviews . .
The Forgotten Children . .
Limited Coping Styles . . .
Needs of and Resources for
Children of Alcoholics. . .
Longer-Range Effects of
Parental Alcoholism . . .
Identifiable Coping Patterns.
Early Emotional Damage Related
to "Alcoholic Personality".


. . . . 20
. . . . . 24
. . . . . 26

. . . . . 28

. . . . . 32
. . . . . 34

. . . . . 36


S 1












The Lack of Scientific Progress . . . . ... 39
Inadequate Treatment Resources. . . . . . ... 41
Alateen . . . . . . . . ... .. . .. 43
Experimental Treatment Programs . . . . .... 45
Individual Counseling to Complement
Alcohol Education. .............. .45
Mother-and-Child Communication
Workshop . . . . . . . . ... . 47
CASPAR Alcohol Education Program . . . ... 47
Ideal Treatment Program. . . . . . . .. 52
Model Alcohol Education Programs
for College Students . . . . . .... 53
Family Dynamics of Alcoholism . . . . ... 58
Family Systems Theory. . . . . . . ... 59
Social Learning Theory . . . . . .... 61
Summary and Implications for the Study. . . . ... 65

III METHODOLOGY . . . . . . . .... ... .. 68

Experimental Hypotheses . . . . . . .... 68
The Research Design . . . . . . . . . 70
Subjects. . . . . . . . . ... ..... 72
Experimental Treatment Procedures . . . . .. 76
Experiential Group . . . . . . .... .77
Session #1. Alcohol, Alcoholism,
and Treatment . . . . .. 78
Session #2. Alcoholism and
the Spouse. . . . . . ... 79
Session #3. Alcoholism and the
Children; Childhood
Coping Patterns . . . ... 79
Session #4. Healthy Coping Attitudes
and Behaviors . . . . .. 79
Session #5. Responsible Behavior
Toward Alcohol;
Responsible Drinking;
Wrap-Up . . . . . . . 80
Cognitive Group. . . . . . . . .. . 81
Session #1. Alcohol, Alcoholism,
and Treatment . . . .... 81
Session #2. Alcoholism and
the Spouse. . . . . . ... 81
Session #3. Alcoholism and the
Children; Childhood
Coping Patterns . . . ... 82











Session #4. Healthy Coping Attitudes
and Behaviors . . . . . 82
Session #5. Responsible Behavior
Toward Alcohol;
Responsible Drinking;
Wrap-Up . . . . . . . 82
Instrumentation . . . . . ... . . .. . 83
Dependent Variables and Criterion
Instruments Used for Measurement
Purposes . . . . . . . . . . 84
Student Drinking Information Scale . . . .. 84
Knowledge Scale . . . . . . . . .. 85
Attitude Scale . . . . . . . 86
Negative Consequences Scale. . . . . . .. 87
Quantity-Frequency Index . . . . . . .. 87
Reliability . . . . . . . . . . 89
Validity . . ... . . . . .. . 90
Parental Alcoholism Information Survey . . .. 90
Demographic Section . . . . . . . 91
Knowledge Scale . . . . . . . .. 91
Healthy Coping Attitudes Scale. . . . .. 91
Healthy Coping Behaviors Scale. .. . . .94
Establishing Reliability and
Validity of the Research Scale. . . . .. 96
Data Collection . . . . . . . . . .. 97
Data Analysis . . . . . . . . .. . 99
Rationale for Methodology . . . . . . .. 100
The Knowledge-Attitude-Behavior Model . . ... 101
Limitations of the Study . . . . . . ... 104

IV RESULTS .. . . . . . .. ... .. . 106

V SUMMARY, DISCUSSION, CONCLUSIONS, IMPLICATIONS
AND RECOMMENDATIONS . . . . . . .... 143

Summary . . . . . . . . ... . 143
Discussion. . . . . . . . . . 146
Conclusions . . . . . . . . . . 156
Implications. . . . . . . . . . 158
Recommendations for Future Research . . . . .. 161

APPENDICES

A CRITERIA FOR PARENTAL ALCOHOLISM. . . . . . 166

B INFORMED CONSENT FORM
EXPERIENTIAL GROUP. . . . . . . . .. 168












B INFORMED CONSENT FORM
COGNITIVE GROUP .


169


C OUTLINE FOR EXPERIENTIAL GROUP. . . . . . ... 170

D ROLE PLAY VIGNETTES: HEALTHY
COPING ATTITUDES AND BEHAVIORS. . . . . ... 171

E ROLE PLAY VIGNETTES: RESPONSIBLE
BEHAVIOR TOWARD ALCOHOL . . . . . .... 173

F SCHEDULE OF FILMS . . . . . . . . ... 174

G VALUES CLARIFICATION. . . . . . . . ... 175

H OUTLINE FOR COGNITIVE GROUP . . . . . .... 177

I STUDENT DRINKING INFORMATION SCALE. . . . . ... 178

J PARENTAL ALCOHOLISM INFORMATION SURVEY. . . . ... 187

K FIRST COVER LETTER. . . . . . .... .. . 197

L FOLLOW-UP COVER LETTER. . . . . . .... .. 198

M RESPONSIBLE DRINKING PARTY. . . . . . . ... 199

REFERENCE NOTES. . . . . . . . ... ... . 201

REFERENCES . . . . . . . .. . . . . . 207

BIOGRAPHICAL SKETCH. . . . . . . . .... ... . 208

SIGNATURE PAGE . . . . . . . ... . . . 209


viii












Abstract of Dissertation Presented to the Graduate Council of the
University of Florida in Partial Fulfillment of the Requirements
for the Degree of Doctor of Philosophy


COGNITIVE AND EXPERIENTIAL GROUP COUNSELING
FOR UNIVERSITY STUDENTS OF ALCOHOLIC PARENTAGE


By


Harry F. Klinefelter, III

August, 1982


Chairman: Dr. Paul J. Wittmer

Major Department: Counselor Education


This study examined the relative effectiveness of two types

of structured group counseling specifically designed for under-

graduate and graduate students with an alcoholic parent. Thirty-

three volunteer subjects were randomly assigned to one of two

experimental counseling groups (cognitive or experiential) or

to a delayed treatment control group. Each group covered the

following sequence of identical concepts: alcoholism and treatment,

the nonalcoholic spouse, children of alcoholics, healthy coping

attitudes and behaviors, and responsible drinking behavior.

Treatment consisted of five consecutive, weekly two-hour sessions.

The didactic or cognitive group emphasized lectures, films, guest

speakers, and discussions, whereas the experiential group participated

in site visits, role plays, and expressive drawing.

ix










The cognitive and experiential groups were compared to the

control group on the basis of posttests administered immediately

following counseling, then again two months later (follow-up data

collected from 28 subjects). The dependent variables investigated

were knowledge, attitudes, and behavior related to (1) responsible

alcohol use and (2) coping with an alcoholic family. The variables

were measured by subjects' responses on the corresponding scales

of the Student Drinking Information Scale and the Parental Alcoholism

Information Survey.

Analysis of covariance revealed no significant differences

between the three groups regarding increases in responsible drinking

attitudes and responsible drinking behavior. A significant increase

(p = .05) by the cognitive group in knowledge about alcohol compared

to both the experiential and control groups (post-post only) was the

lone significant finding in the area of responsible alcohol use.

Both experimental (cognitive and experiential) groups demonstrated

a significant increase in knowledge about alcoholism and its family

effects (post only). In comparison to the control group, the

cognitive group showed a significant increase in healthy coping

attitudes (post and post-post), while the experiential group

evidenced a rise in healthy coping behaviors (post only).

The discovery of unique strengths appertaining to each of the

two experimental treatments suggests the value of employing a blended

experiential-cognitive format. Subject feedback indicates a need for

x










more support/sharing opportunities. Additional implications

of the study and recommendations for future research are discussed.












CHAPTER I
INTRODUCTION


His mother was an alcoholic, but David seemed the model
child. At 7, he was cleaning the house, making dinner, doing
the laundry, and minding his unruly younger brother. In high
school, he was class president; in college, he graduated with
the highest honors. Then, having worked hard to get into law
school, he inexplicably found the goal an empty one. Depressed,
lonely, confused, he sought help. "Finally, a therapist said
to me, 'Was either of your parents alcoholic?'"recalls David,
26. "I was flabbergasted. I had always been a good kid, a
smart kid. I couldn't make the connection." (Shah & Reese,
1979, p. 82)

Sadly, the successful linkage with appropriate treatment

depicted in the above vignette represents the exception to the rule.

Unlike many unfortunate others, this young man was twice blessed.

First, he was able to sense that something was wrong and seek help

voluntarily; secondly, he had the good fortune to encounter a

therapist with an awareness of the probable connection between his

personal problems and his alcoholic parentage.

It has long been widely acknowledged that children of

alcoholics are significantly more likely than other children

to become alcoholic themselves (Nylander, 1969); more recent

evidence strongly suggests that this group of offspring also

runs an increased risk of encountering psychosocial difficulties in

later life (Booz, Allen, & Hamilton, 1974; El-Guebaly & Offord, 1977).

Although there has recently been a slight upsurge of interest in their

plight, this topic has traditionally received scant recognition in

1










the scientific literature (Woititz, 1978). This lack of attention

accounts for these progeny being variously referred to by such terms

as "the forgotten children," "a neglected problem," and "the hidden

tragedy" (El-Guebaly & Offord, 1977).

Early efforts in research, prevention, and treatment have

focused almost exclusively on the socially visible casualties within

this group. This suggests that, until quite recently, caregivers have

been guided by the gratuitous and implicit belief that the vast

numbers of seemingly well-adjusted children of alcoholics had somehow

managed to survive their traumatic early environment without suffering

any noteworthy adverse effects. This naive, dangerous assumption

typifies the denial and ignorance that have characterized members of

the helping professions as well as formulators of social policy and

practice in this area (Whitfield, 1980). Experts now realize that

many children do not overtly demonstrate disturbed behavioral

responses in spite of extensive exposure to distorted familial inter-

actions (Triplett & Arneson, 1978). Data-based studies (e.g., Booz

et al. 1974; Miller & Jang, 1977) yield evidence in support of the

numerous clinical observations which suggest that these easily over-

looked and apparently unharmed survivors of parental alcoholism are

also in danger of becoming alcoholics and experiencing alcohol-

related problems as adults (Black, 1979; Chafetz, 1979; Woititz, 1978).

This study investigated the effectiveness of two educationally

based approaches to group counseling specifically designed to address











the special needs of university students with one or more alcoholic

parents. These two types of structured groups were evaluated in terms

of their impact on the following two sets of dependent variables:

(1) knowledge, attitudes, and behavior related to the responsible use

of alcohol; and (2) knowledge, attitudes, and behavior relevant to

coping with the dilemma of having an alcoholic parent.


Need for the Study

Alcoholism represents one of this country's most serious

health hazards. In addition to the roughly 10 million alcoholics,

there are an estimated 29 million children of alcoholics who represent

the secondary victims of this disease (Chafetz, 1979). This latter,

vulnerable population is officially recognized by the National

Institute on Alcohol Abuse and Alcoholism (NIAAA) as a high-risk

group and a major target of prevention efforts (Hindman, 1975).

Experts indicate that between 1/4 and 1/2 of all alcoholics have had

an alcoholic parent or close relative (Bosma, 1972; Fox, 1968;

Schuckit, 1973), and one study shows that this group is twice as

likely to become alcoholic as the children of nonalcoholic parents

(Globetti, Note 1). Research findings leave little doubt that the

offspring of alcoholics comprise the "largest high risk population

for alcoholism identified to date" (Booz et al., 1974, p. 110).

Family systems theorists and practitioners as well as the

proponents of social learning theory would undoubtedly concur with the










following unequivocal observation: "If alcoholism is present in

their family, children must experience it and suffer its impact"

(Booz et al., 1974, pp. 1-2). High in dependency needs and lacking

in awareness, their extreme vulnerability makes them susceptible to

certain common developmental problems (e.g., Whitfield, 1980);

besides the more obvious victims that are easily spotted, there are

many "symptomless" children who suffer emotional damage that only

becomes visible in later life (Black, 1979). Along with the afore-

mentioned possibility of developing alcoholism, they have an increased

likelihood of encountering the following sequelae as adults: chemical

dependency, problems relating to others, marital difficulties, and

compulsive work habits (Whitfield, 1980). Feelings of guilt, isola-

tion, depression, insecurity, and mistrust are frequently reported

(e.g., Chafetz, 1979); recent clinical findings indicate two prevalent

themes among young adult survivors of an alcoholic family. These are

an inability to trust their own feelings and a fear of not being in

control (Shah & Reese, 1979). In short, having an alcoholic parent

is an emotionally upsetting experience for youngsters; if the problems

created by parental alcoholism are not resolved (regardless of

whether or not the symptoms were evident in early years), they will

then plague these innocent victims throughout their lives (e.g.,

Black, 1979; Booz et al., 1974). The need for effective identifica-

tion, prevention, and treatment is clear.






5




In spite of recent advances in scientific research that have

contributed to a better understanding of this group's needs, available

helping resources are insufficient at best. With the notable

exceptions of Alateen (in existence since 1957) and Al-Anon (available

to adult children of alcoholics) little meaningful attention is being

paid to the treatment needs of children of alcoholics (Booz et al.,

1974; El-Guebaly & Offord, 1977). Widespread denial and ignorance

(of.the existence of a problem) among both caregivers and the would-

be help recipients (i.e., the progeny of alcoholics) are the most

formidable obstacles to successful identification, prevention, and

treatment (Whitfield, 1980).

The social stigma attached to alcoholism contributes substan-

tially to the strong denial system surrounding the disease. A

genuine lack of information concerning alcoholism and the effects of

parental drinking on the family interacts with the denial to render

these children unable to identify their problem and consequently,

unlikely to voluntarily seek out assistance. This strongly implies

that effective prevention programs would be well advised to include

a sensitive yet aggressive outreach component in order to facilitate

self-identification and subsequent referral for treatment (Hindman,

1975). The population of interest in this study poses a formidable

and unique challenge in this respect.

The overwhelming majority of the potential subject pool for

this investigation are easily overlooked by virtue of their belonging











to the "symptomless" category, They have developed highly

sophisticated denial systems and defense mechanisms that have enabled

them to cope with (and survive) the trauma of living with parental

alcoholism. The positive aspects of these roles are readily apparent

and frequently rewarded; however, regardless of the role adopted and

the strengths developed, there will inevitably be some negative

concomitants. Children of alcoholics are usually unaware of these

deficits at least until later in life, and this contributes signifi-

cantly to the difficulty they encounter in assuming the role of one

who might be in need of help. It seems that weaknesses arising from

these childhood coping patterns are rarely acknowledged (much less

dealt with), because these offspring possess minimal awareness of the

limitations inherent in whatever coping style they have adopted in

order to survive the experience of growing up in an alcoholic family

(Black, 1979). The complex and subtle dynamics of the problems facing

these superficially well-adjusted children accentuate the need for

devising imaginative approaches to preventive intervention. There

is presently an acknowledged dearth of innovation and research in

education and treatment in this field (e.g., Kern, Tippman, &

Fortgang, 1977).

Having identified the children of alcoholics as a legitimate

target of prevention efforts, it is important to assess existing

primary prevention programs in terms of their capacities for

addressing the special needs of this population. The material

covered in most alcohol education programs focuses on the effects of











drinking. While this approach is undeniably valuable to successful

primary prevention efforts, these programs are insufficient for

children of alcoholic parentage. This is partially attributable to

the fact that most general alcohol education classes present little,

if any, information concerning the effects of parental drinking on the

family (Woititz, 1979). This strongly suggests that existing primary

prevention programs in alcohol education need to be implemented by

secondary prevention efforts specially tailored to fit the unique

concerns of this high-risk group.

The few treatment programs designed exclusively for children

of alcoholics have invariably included a strong educational component.

Dr. Janet Woititz (1979), an experienced educator and private

practitioner, argues persuasively for the validity of an educationally

based approach to secondary prevention. She firmly believes that the

problems facing these secondary victims of alcoholism are primarily

informational ones; consequently, she maintains that many in this

group can be helped easily and dramatically in relatively short

periods of time with this approach (NIAAA, 1979). Understanding the

effects of parental alcoholism on the family includes both cognitive

and emotional elements. In view of the powerful denial system that

characterizes this population, it seems logical that an optimally

effective secondary prevention program needs to initially emphasize

the presentation of information and ideas as a necessary prelude to

the future understanding and expression of feelings (Deutsch, DiCicco,

& Mills, 1978).











Purpose of the Study

This study examined the effectiveness of a secondary

prevention program developed specifically for university students

having one or more alcoholic parents. The program, which was offered

at the University of Florida Counseling Center during the Spring,

1981, quarter, consists of two different styles of structured group

counseling, cognitive and experiential. Each experimental group

was compared to the other and with a delayed treatment control group

in terms of its effect on (1) the students' attitudes, knowledge,

and behavior related to alcohol use; and (2) the students' knowledge,

attitudes, and behavior associated with parental alcoholism.

The breadth of focus and goals of this secondary prevention

program for students of alcoholic parentage differs substantially

from typical alcohol education programs that are aimed at a general

population, thereby falling under the heading of primary prevention.

The target subpopulation for this study has understandably attracted

great attention as a result of its high-risk status for later

becoming alcoholic; however, this special group is also vulnerable

in terms of its increased susceptibility to a variety of other mental

health problems. This means that a secondary prevention program

designed to meet the unique needs and concerns of these neglected

casualties of parental alcoholism must necessarily adopt a broad

approach to the prevention of mental health problems; it must be one

which encompasses more than alcohol education. Consistent with this

viewpoint is the strong emphasis which this secondary prevention












program places on enabling students to better comprehend their

parent's alcoholism and its effects on the family (especially them-

selves).

Concomitant with a clearer understanding of the family

drinking problem is the learning of alternative, healthy ways of

coping (responding, reacting, etc.) with the parent's drinking and

its effects. This might also be described as the development of

optimally healthy strategies for handling situational concerns that

invariably confront members of an alcoholic family. There is a second

and equally important component to this newly acquired appreciation

of the family drinking problem. By examining the strengths and

weaknesses of assorted coping styles and strategies commonly employed

by children of alcoholics, group participants are enabled to increase

their awareness of the impact that growing up with an alcoholic parent

has had on the shaping of their personalities. Alert to deficits in

coping styles and to potential dangers of encountering certain

adjustment problems in adulthood, group members learn alternative

behaviors designed to aid their making healthy decisions concerning

how to manage these risks.

The promotion of responsible decision making about drinking

is an explicit goal of the program. Notwithstanding its critical

importance as a target of secondary prevention efforts, it needs to

be emphasized that the issue of responsible drinking constitutes but

one of many mental health concerns relevant to this subpopulation.











This means that providing participants with an accurate, objective

perspective of the dynamics of an alcoholic family and with a

versatile arsenal of healthy options for coping with the effects of

parental alcoholism are central to the purpose of this secondary

prevention program.

Topics covered in the experimental structured groups included

facts about alcohol, alcoholism, the family dynamics of alcoholism,

effects on the spouse and children, childhood coping styles, and the

responsible use of alcohol. The effects of the cognitive and

experiential approaches to structured group counseling for children

of alcoholics were examined in terms of their ability to positively

influence personal drinking attitudes, knowledge, and behavior in the

direction of greater responsibility and positively influence the

acquisition of knowledge and of healthy attitudes and behavior that

relate specifically to coping with the problems of having an alcoholic

parent.

This experiment was designed to answer the following questions:

1. Will a cognitive approach to structured (i.e., educa-

tionally based group) counseling bring about a positive change as

it concerns knowledge, attitudes, and behavior related to the use of

alcohol among university students of alcoholic parentage? Will it

change knowledge, attitudes, and behavior relevant to the issue of

coping with parental alcoholism?

2. Will an experiential approach to structured group

counseling bring about a positive change as it concerns knowledge,











attitudes, and behavior related to alcohol use among university

students with alcoholic parentage? Will it change knowledge,

attitudes, and behavior relevant to the task of coping with parental

alcoholism?

3. Will there be a difference between the two experimental

counseling groups and the delayed treatment control group within the

above areas immediately following the study? Two months later?

4. Will there be a difference between the two experimental

counseling groups within the above areas immediately following the

study? Two months later?


Rationale for the Study

An assortment of problems afflict the offspring of alcoholics

at varying stages of their lives. This means that the particular

characteristics and developmental life stage unique to the population

selected for this study need to be given careful consideration in

formulating an appropriate prevention program. Preventive interven-

tion is maximally effective when aimed at the youngest possible age

group most likely to benefit. Therefore, elementary school children

are frequently chosen as the ideal target audience. However, this

dominant model of preventive intervention (i.e., directed at little

children) is not appropriate for use with the population chosen for

this investigation.

The roles adopted by these university students, seemingly well

adjusted despite an alcoholic parent, evolved as survival mechanisms;










they served the crucial, adaptive function of providing a way of

coping with the task of growing up in an alcoholic home (Black, 1979).

Consequently, a program is likely to exert optimal impact if it is

implemented when these offspring leave the alcoholic family system

and their childhood patterns of coping first begin to show signs of

outliving some of their earlier usefulness.

The vast majority of the students in this study are living

apart from their alcoholic family for the first time. This provides

them with the opportunity to cultivate a more objective perspective

of their home situation and to consider alternative ways of dealing

with the parent's drinking problem. The time is also ripe for trying

out new ways of problem solving if old methods have lost some of their

former utility. More importantly, however, these students are

confronted with the challenging job of adapting to a new and highly

stressful environment in which such sensitive and extremely personal

matters as interpersonal relationship formation and responsible

drinking become significant issues.

The college years (i.e., the time spent by both graduate and

undergraduate students in the pursuit of a formal education) are

traditionally regarded as a transitional period in a person's life.

Most university students are sufficiently mature to begin making

important decisions for themselves, but they are still young enough

to effect changes in their behavior patterns (Kraft, 1976). Generally

acknowledged to be a difficult adjustment time for all students, the












offspring of alcoholics are especially vulnerable to these imposing

situational demands. Regardless of whether or not these progeny of

alcoholics are experiencing problems adapting to college life, the

examination of personal coping styles in terms of their strengths,

weaknesses, and present adaptive value serves the purpose of promoting

increased self-awareness. If these students are able to make some

connection between difficulties in adjusting to the college environ-

ment, and possible lingering effects of their alcoholic parentage,

then this will serve as an important first step in assisting their

undertaking a transitional process leading to improved adjustment.

More serious troubles with alcohol abuse and close personal relation-

ships may surface later in life in the form of alcoholism and divorce

(Goodwin, Schulsinger, Hermansen, Guze, & Winokur, 1973). Nonethe-

less, college age (i.e., ranging from the youngest freshman to the

oldest graduate student) represents an ideal opportunity for learning

about early warning signs to be on the alert for as adults.

An earlier study of offspring of alcoholic parents by Cork

(1969) revealed a substantial amount of mistrust of adults among

adolescents (between the ages of 10 and 16). This observation

furnished some indirect support for this study's intentional focus

on an older (i.e., presumably more trusting) population. Although

earlier studies in this area offer no bases for exact comparison,

the successes achieved by these efforts are an encouraging sign for

the present effort (Deutsch, DiCicco, & Mills, 1978; Weir, 1970;











NIAAA, 1979). Also, the continuing effectiveness of Alateen

contributes further to the rationale for this program.

Theoretical support comes largely from assumptions derived

from family systems theory and ideas concerning social learning.

Proponents of the family systems viewpoint contend that certain

unhealthy behavior patterns are forced upon children by virtue of

their membership in an alcoholic family (Hecht, 1973). Social

learning theory regards the family as the primary matrix for the

child's education; learning occurs primarily through identification

and role playing; it is both conscious and unconscious (Hecht, 1973).

The parents, who demonstrate distorted styles of communication and

serve as defective role models, exert a powerful influence by virtue

of the child's propensity for imitative learning behavior (Burk,

1972). Evidence to support the validity of this process comes with

the results of studies which reveal that the drinking patterns of

most people closely resemble those of their parents (Chafetz, 1979).

By explaining how the early learning of these children was shaped by

their alcoholic family background, these theories furnish a solid

framework and ample justification for efforts to help these secondary

victims to more fully understand the effects of their early upbringing.

Such insight can help free them to decide what, if any, changes they

wish to make in their manner of behaving.












Definition of Terms

Certain terms and phrases are used frequently in this study,

and several are susceptible to a wide range of varying interpreta-

tions. Although most have already appeared in the text, they are

defined below to provide clarification and to avoid any further

ambiguity.

Alcohol Education

An activity or program which provides educational experiences

related to alcohol for the purpose of helping the recipients to be

able to make responsible decisions related to the use or nonuse of

alcohol.

Alcoholic

In general terms, this refers to an individual whose use of

alcohol significantly impairs personal, social, or occupational

functioning (Ray, 1978). For the specific purposes of this study,

the label is used if the student answers "yes" (for one or both

parents) to three or more of the questions (see Appendix A) con-

cerning the student's reactions to parental drinking habits.

Alcoholic Family or Home

A family or home in which at least one (step-) parent is an

alcoholic according to the specific criteria used in this study.

Children of Alcoholics

In its broadest sense, this includes all infants, children,

teenagers, adults, and the elderly who have at least one alcoholic











parent. For the purposes of this study, it refers to members of

this population who are volunteer students enrolled at the University

of Florida.

Cognitive

Primarily operating through intellectual thought and verbal

learning processes.

Experiential

Involving the gestalt composed of the cognitive-affective-

sensory-motor learning processes.

Group Counseling

A process of verbal exchange and discussion of attitudes and

feelings among individuals within the normal range of adjustment and

a counselor. The group's goal is the understanding and modification

of feelings and attitudes so that participants are better equipped

to deal with developmental concerns and problems.

Healthy Coping Attitudes

The extent to which someone is likely to endorse a group of

behaviors associated with optimally effective ways of dealing with

the situations brought on by parental alcoholism. These attitudes

correspond to predispositions to behave in the indicated manner.

Healthy Coping Behaviors

These are a specific group of activities generally acknow-

ledged to correlate directly with optimally effective reactions to

parental alcoholism.











Negative Behavioral Consequences

A specific group of events that are a direct result of

drinking alcoholic beverages, and that increase the chances of

problems or complications arising in the drinker's life.

Primary Prevention

Educational efforts aimed at a general audience and applied

for the purpose of preventing or minimizing the occurrence of new

cases of alcohol abuse in a community.

Responsible Attitudes Toward Drinking

The extent to which an individual is likely to endorse a

group of behaviors which is inversely correlated with the frequency

of negative behavioral consequences that a drinker might experience.

Secondary Prevention

The application of prevention techniques to a specific,

identifiable high-risk group within the community. In this study,

university students with one or more alcoholic parent comprise the

designated recipients of this specialized type of prevention.

Structured Group

A delimited learning experience having predetermined goals

and a plan tailored to enable each group participant to attain the

predetermined objectives with minimal frustration and maximal

capacity to transfer the newly acquired learning to actual life

situations (Drum & Knott, 1977). Educational group counseling,

educationally based group counseling, and structured group counseling

are considered synonymous and used interchangeably throughout this

study.










Subjects

Subjects for this study were students (both undergraduate

and graduate) at the University of Florida with one or more alcoholic

parents. They were voluntary participants in structured counseling

groups. Subject, participant, member, and student are terms that

are used interchangeably in referring to these persons unless

designated otherwise.


Organization of the Remainder of the Study

This study consists of five chapters. Chapter II presents

a review of the literature related to prevention for children

of alcoholics, while Chapter III discusses the methodology and

data collection. Chapter IV includes a detailed presentation

and listing of this study's findings. Chapter V discusses the

investigation and offers recommendations for further research

in addition to a summary and conclusions. Limitations of the

study are also mentioned in the final chapter.












CHAPTER II
REVIEW OF THE LITERATURE


Alcoholism is this country's third most serious health

problem; in terms of the total number of people affected, it may

represent our worst national mental health and health problem (Bosma,

1972). The alcoholic is the primary and most obvious victim, but

this insidious disease also profoundly affects the lives of others

with whom the alcoholic comes in contact. Foremost among these

secondary casualties are the alcoholic's immediate family members,

with children being the most vulnerable of all (Chafetz, 1979).

Although the status of these indirect victims appears to be

gradually receiving an increasing amount of attention in the scien-

tific literature, there remains much room for improvement in the

areas of research, prevention, and treatment (e.g., Hindman, 1975;

Whitfield, 1980; Wilson & Orford, 1978). To appreciate the genuine

shortage of material dealing with the effects of alcoholism on the

family, consider the following finding from Gail Milgram's 1975

bibliography of Alcohol Education materials: Of the 873 references

cited, only 38 relate to the effects on the family; most of these

38 are pamphlets provided by the Al-Anon Family groups. These

figures clearly reflect the minimal interest in this aspect of

alcoholism (Woititz, 1978). It appears that the family of the

alcoholic is almost totally ignored (Bosma, 1972).










This chapter is divided into the following major categories:

(1) Recent Literature Reviews, (2) The Forgotten Children, (3) Lim-

ited Coping Styles, (4) Needs of and Resources for Children of

Alcoholics, (5) Longer-Range Effects of Parental Alcoholism,

(6) Identifiable Coping Patterns, (7) Early Emotional Damage Re-

lated to "Alcoholic Personality," (8) The Lack of Scientific Prog-

ress, (9) Inadequate Treatment Resources, (10) Alateen, (11) Ex-

perimental Treatment Programs, (12) Family Dynamics of Alcoholism.


Recent Literature Reviews

Despite the appearance of a growing number of studies over

the past decade, the literature in this area remains relatively

small and methodologically weak. A broad range of dependent var-

iables have been investigated, utilizing a wide variety of methods

and samples. This research topic clearly lacks a unifying theoreti-

cal or conceptual framework to guide it; one net effect is that the

meaningful comparison of findings becomes nearly impossible (Wilson

& Orford, 1978). Before closely examining selected articles that

possess special significance for this study, a broad overview of

the general state of the literature will be provided. Two recent

and extensive literature reviews greatly simplify this seemingly

enormous undertaking.

The first of these was prompted by the confusing picture

that emerged from various contradictory findings. In a review of










studies spanning the past 25 years, El-Guebaly and Offord (1977)

found that many of the earlier investigations were concerned with

identifying specific childhood problems that are the sequelae of

having an alcoholic parent (e.g., enuresis, temper tantrums, hyper-

activity, etc.) (Whitfield, 1980); another clearly observable trend

was a preoccupation with focusing attention on the casualties among

this population. El-Guebaly and Offord (1977) argued in support

of the need for more carefully controlled studies using blind data

collection and clear operational definitions. They observed that

the variables of poverty, family disorganization, and antisocial

behavior all occurred together, but the exact nature of the causal

links connecting them presented a challenging, intricate, and un-

resolved mystery.

This same review also pointed out that the literature on

the adult psychosocial adjustment of offspring of alcoholics was

primarily concerned with trying to determine the relative impact

of genetic and environmental influences on subsequent behavior.

These efforts had failed to resolve the age-old "nature-nurture"

controversy, and most experts agreed that the ultimate answer lay

in a combination of genetic and environmental factors (Goodwin,

1973; Schuckit, 1973). El-Guebaly and Offord (1977) concluded

their massive review with the observation that "the offspring of

alcoholics appear to be at increased risk for the serious











psychosocial illnesses of adulthood" (p. 364). Finally, this

article underscored the inadequacy of treatment programs in terms

of their ability to service the needs of this group.

These same authors later participated in a comparative

behavioral study of 231 children (ages 9 to 11) of 90 psychiatric

patients and their spouses. Subjects were placed into three groups,

equally divided between men and women alcoholics, schizophrenics,

and depressives. The findings revealed that the children of alco-

holic mothers were more impaired than the offspring of schizophrenic

and depressive mothers (El-Guebaly, Offord, Sullivan, & Lynch, 1978).

The following year marked the appearance of a somewhat

similar literature review. Jacob, Favorini, Meisel, and Anderson

(1978) introduced their work by citing a consensus that children

of alcoholics are a high-risk group in terms of developing alcoholism

and a variety of behavioral disturbances in later life. This review

differed from the previous one in that it was limited to an exami-

nation of studies (over the past 17 years) that focused on the psy-

chosocial status of children of alcoholics. The absence of well-

controlled studies was again noted, and the authors concluded with

"modest-to-moderate support for the view that children of alcoholics

exhibit significant difficulties in psychological, and family

functioning" (Jacob et al., 1978, p. 1242).

Two important data-based studies using psychiatrically

disturbed controls were included in this 1978 survey of the











literature. Chafetz, Blane, and Hill (1971) compared personal and

familial characteristics of two groups of children in a child

guidance clinic, concluding that dissimilarities between the two

groups were indicative of "distinct and deleterious social conse-

quences to being the child of an alcoholic parent" (p. 232). The

second study, by Fine, Yudin, and Holmes (Note 2), showed that the

children of alcoholic parents manifested greater pathology than the

controls. These findings indicated that parental alcoholism acts

as a serious deterrent to healthy personality development in child-

ren; furthermore, Fine et al. (Note 2) concluded that the degree of

disturbance might be greater than previously suspected.

Jacob and his co-authors heavily criticized the indirect,

self-report approach employed in all of these studies. In addition

to this attack on the weaknesses of methodological foundation, the

reviewers faulted these investigations for being so difficult to

interpret. The sweeping indictment of the fundamental assumptions

underlying these methods concluded with their being characterized

as "questionable at best and untenable at worst" (Jacob et al.,

1978, p. 1243).

This brief look at these two recent and important literature

reviews provides a comprehensive overview of the state of research

in this neglected and small, but growing area of interest. Having

established this background, the next six sections closely examine

certain articles that lend support and provide the rationale for this

study.











The Forgotten Children

Margaret Cork's book, The Forgotten Children (1969), is a

landmark in the field because of its sensitive depiction of the

plight of these secondary victims of parental alcoholism. It has

attracted much needed attention to this group. Cork, a psychologist

at the Addiction Research Foundation in Toronto, located 62 sets of

former and current alcoholic parents who agreed to take part in her

study. A single interview and a questionnaire were used to query a

total of 115 children (ages 10 to 16) concerning their family life

and how alcoholism had affected them. This biased sample consisted

mostly of children from middle- or upper-class families; another

noteworthy feature of the sample was that more than 90% of the

offspring lived with intact families.

Cork performed a clinical assessment of the extent of "emo-

tional damage" among these 115 adolescent subjects (based on such

factors as hostility, trust, depression, and uneasiness with the

opposite sex), and she found varying degrees of underlying personality

disturbance in all of them. Nearly half (49%) were rated "fairly

seriously damaged," while 43% were considered "very seriously dam-

aged"; the remaining 8% were adjudged "slightly damaged" (El-Guebaly

& Offord, 1977). Additional major findings revealed that over 90%

lacked self-confidence, felt rejected by their parents, and con-

sidered their parents' behavior unpredictable (Jacob et al., 1978).

In effect, Cork identified a form of rejection synonymous with











neglect. Based on her overall assessment of these children, she

concluded that "should any one of them turn to alcohol to meet some

of their emotional needs, there is a very real possibility that

they will become alcoholic" (Cork quoted in Hindman, 1975, p. 3).

This exploratory, descriptive study explicitly revealed how these

children had experienced definite psychological and social damage

as a consequence of their alcoholic parentage; further, Cork main-

tained that this early emotional trauma was a substantial predis-

posing factor in this group's increased vulnerability for later

becoming alcoholic. The outstanding strength of this work was

the sensitive way it depicted the special needs of this unique

and oft-ignored population. By addressing the hitherto infre-

quently asked question of the consequences of an atypical family

situation for psychosocial development, Cork distinguished herself

as something of a pioneer in this field.

Unfortunately, Cork's contribution possessed serious limi-

tations as a scholarly work. The results were based on just one

interview, and no control group was used. A somewhat less obvious

flaw was the absence of any discussion of positive attitudes.

Although partially explainable in light of the tendency for negative

feelings to be first ventilated, the omission of positive feelings

was nonetheless a regrettable and avoidable oversight (Woititz,

1978). Still another detracting feature was the omission of











operational definitions for the criteria used to rate these

children (El-Guebaly & Offord, 1977).

Cork's sample population shares some important character-

istics with the population selected for investigation in this study.

There is considerable overlap among the two samples in terms of

socioeconomic background; also, even though the parents of Cork's

subjects were present or former alcoholics, their children were

not socially visible casualties. Consequently, her work sheds

valuable insight into the quality of family life experienced by

university students who grew up under similar circumstances.


Limited Coping Styles

Whereas Cork's (1969) results as described above lack

generalizability due to the selection of a biased sample, a most

important study by Rouse, Waller, and Ewing (1973) avoids that

pitfall. Using a random sample of 186 adolescents from the general

population in the South, these researchers examined the relation-

ship between the severity of a father's drinking (as perceived by

the children), the stress levels of the offspring, and the methods

used to relieve depression and anxiety by the children. The ration-

ale for this investigation of the coping styles of children of

alcoholics was derived from earlier studies (using a general popu-

lation) which had demonstrated the importance of parental model-

ing in determining the defense and coping mechanisms adopted by the

children (Swanson, 1961; Thelen, 1967; Weinstock, 1967).











Rouse, Waller, and Ewing (1973) reported more stress and

emotional upset together with fewer and less adaptive means of

dealing with their anxiety and depression among children with

heavy drinking fathers as compared with abstainers. The more iso-

lated nature of the coping activities engaged in by the offspring

of heavy drinkers (trying to forget, smoking, and solitary activ-

ities) contrasted sharply with the more social approach to coping

(talking with others, eating, and church activities) favored by

the children of abstainers.

This investigation by Rouse et al. (1973) directed atten-

tion to the fact that the offspring of heavy drinkers resorted to

qualitatively different (and presumably less desirable) coping

styles than those employed by children of abstaining parents.

Such isolated ways of coping seriously diminished the likelihood

that this group would seek help voluntarily. In light of these

findings, the authors hypothesized that these adolescents would

need assistance in coping with anxiety generated by the heavy

parental drinking.

Rouse et al. (1973) followed the basic line of investi-

gation begun by Cork in that they examined the emotional effects

of living with an alcoholic parent. Although similar to Cork's

work in that it was data based and relied on interviews, the study

by Rouse et al. (1973) was far superior methodologically. Besides

implying that these adolescent offspring of alcoholics needed to











learn alternative and more constructive ways of dealing with the

heavy parental drinking, the findings strongly suggested that the

very nature of their approach to coping might be maladaptive. Rouse

et al. (1973) demonstrated a need for further research aimed at

exploring the coping styles and needs of this group.


Needs of and Resources for Children of Alcoholics

On the basis of in-depth interviews, Booz, Allen, and

Hamilton (1974) carried out an extensive assessment of the needs of

and resources for the children of parents adjudged to be alcoholics

by social service agencies. This uncontrolled study was prepared

for the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

It reported on the consequences of parental and community neglect.

The findings were similar in many ways to those of Cork (1969), with

the most original feature being their review of the resources avail-

able to meet these children's needs. Except for Alateen, there was

an obvious lack of national and local response to these needs.

While it was possible to argue that resources were perhaps adequate

to meet the demand, they were deemed incapable of meeting the exist-

ing need. This led to an identification of the formidable educa-

tional challenge involved in somehow getting the demonstrated need

translated into demand. The Booz, Allen, and Hamilton (1974) report

discussed the number, characteristics, life experiences, feelings,

coping mechanisms, and problems of children of alcoholics. Also,










their concerns and the factors which variably condition the impact

of parental alcoholism were identified.

Prior to presenting some of the more relevant major findings,

some unique aspects of this sample warrant mentioning. Fifty children

of alcoholic parentage were recruited from four Pennsylvania communi-

ties considered, in the aggregate, representative of national

socioeconomic and cultural patterns. For the most part, the subjects

were white and middle class. The majority (60%) of those who

volunteered to be interviewed were between 19 and 30 years old; only

26% were under 18. This age factor is noteworthy, because most

previous samples had been limited to children under 18. The sample

population in this investigation was still nonrandom and biased,

but it reflected somewhat different biases (which closely parallel

biases operative in this investigation). Whereas previous

researchers had drawn their subjects largely from the stereotypic

"lower-class" alcoholic population, this one had a distinct "middle-

class" flavor to it. Also, this sample is of special interest here,

because it was not composed primarily of agency referrals and

identified social deviants. Many features of this particular sample

made this study an especially valuable source of information

regarding what happened to seemingly well-adjusted children of

alcoholic parents as they grew up. Cork had shown the way by

identifying many of the concerns of those in the 10 to 16 age

group; however, until Booz, Allen, and Hamilton's study (1974)











was published, very little was known of the longer-range sequelae

of parental alcoholism.

Booz et al. (1974) arrived at an estimate of the number of

children affected by a parent's alcoholism by using the Marden and

Cahalan methodologies. Based on a national estimate of 14,099,459

alcoholics, they derived a figure of 28,339,914 as an approximation

of the total number of children of alcoholics in this country.

The problems most often reported by the subjects were emo-

tional neglect by the parents (64%) and parental conflict (58%).

These findings agreed with those of Cork; the same can be said of

the discovery that the emotions most commonly expressed by these

children about their family situations were resentment and embarrass-

ment. These researchers probed considerably deeper than Cork into

the dynamics of how the offspring were affected. Also, due to the

higher age level of their sample, Booz et al. (1974) were able to

identify certain common problems typically encountered by this

population as they grew older.

Rouse et al. (1973) had reported a fundamental difference

in the coping behaviors of children of heavy drinkers versus chil-

dren of abstainers, but their work left many unanswered questions

with regard to the exact nature of these coping devices. The Booz,

Allen, and Hamilton (1974) report revealed that most offspring of

alcoholics develop identifiable coping mechanisms to facilitate

their survival; four predominant patterns were identified: "flight,"










"fight," the "perfect child syndrome," and the "super coper syndrome."

These methods of adjusting served as indispensable tools in meeting

the survival needs of many children, but there were some who were

unable to cope with the anxiety and stress that are concomitants of

growing up in an alcoholic home.

Those who relied mainly on fight typically exhibited beha-

vioral problems requiring society's attention. Some examples of this

are childhood symptoms such as school problems, temper tantrums, and

fighting. For the most part, these childhood problems were either

outgrown or else they evolved into adult-related difficulties. This

study pointed out that those children who did not rely primarily on

the fight coping style and who evidenced no signs of childhood dis-

orders, frequently experienced personal problems as young adults. In

other words, the effects of alcoholism on the offspring were much

more extensive and long lasting than short-term childhood behavioral

disturbances.

These interviews supplied a lot of information on the longer-

range adverse effects of parental alcoholism. The emotional ill

effects frequently manifested themselves in interpersonal relationship

difficulties. The majority of the respondent group (64%) reported

having problems with the opposite sex, while nearly one-third (32%)

had trouble relating to the same sex. If those in the sample under

the age of 18 are excluded, then the percentage of all those with

inadequate interpersonal relationships rose to the alarmingly high











figure of 87%! Other less commonly reported but more severe effects

included alcohol and drug abuse (16%),depression (18%) and suicidal

tendencies (12%), repressed emotions (8%), and lack of self-

confidence (34%). Also, nearly one-half of those who were married

had a spouse with a drinking problem.

Some of those interviewed believed that growing up in an

alcoholic home could contribute to high achievement and help build

character. However, the interviews disclosed that nearly all of the

high achievers had poor personal relationships; some repressed all

emotions, while others suffered nervous breakdowns. This prompted

the conclusion that, all things considered, there were no unqualified

success stories among children of alcoholics! In one way or another,

they all lost as a result of the experience. This evidence clearly

supported the truth of the following assertion: "Having an alcoholic

parent is an emotionally disturbing experience for children. If

children do not resolve the problems created by parental alcoholism,

they will carry them the rest of their lives" (Booz et al., 1974,

p. 73).


Longer-Range Effects of Parental Alcoholism

Miller and Jang (1977) adopted a different approach to

investigating the impact of alcoholic parents on the development of

their offspring. Their 20-year study combined both longitudinal and

retrospective methodology; the sample consisted of 259 children from

lower-class multiproblem families in an urban area of San Francisco.










A control group of 112 children whose parents had no official record

of alcoholism were compared with 147 children of alcoholic parents.

The subjects were extensively interviewed to determine their social

adjustment as adults; the dependent variable of adult adjustment was

measured by level of self-esteem and degree of adult adaptation.

The age of the subjects ranged from 22 to 41 at the time of

testing. The following statistic corroborated previous similar

findings: Among the adult offspring of alcoholics, 36% were

classified as heavy drinkers vs. 16% of the adult children of non-

alcoholic parents (compared with the national average rate of 7-8%).

The study was designed to test the validity of a two-part hypothesis.

The first assumption was that alcoholism leads to poor

parenting which in turn predisposes the child to a bad socialization

experience (mediated by the sex and age of the child). This was

confirmed by findings which showed that offspring of alcoholics had

greater socialization difficulties than children of nonalcoholics.

The second half of this hypothesis stated that the severity and impact

of poor parenting affects the child's later adult behavior and self-

concept (often manifesting itself in the form of individually

destructive coping behavior). Support for this assumption came from

the results which indicated that the extent of the negative impact

experienced by the child was in direct proportion to the severity of

the parental drinking problem. By way of summary, Miller and Jang

(1977) declared that although parental alcoholism significantly











increased the chances of the child encountering problems in adulthood,

it was not possible to trace a truly predictive course of inter-

generational transmission of alcoholism. This longitudinal study is

relevant to this writer's investigation, because Miller and Jang

(1977) provided further evidence to support the position that children

of alcoholics are likely to have inordinate difficulty with adult

adjustment in comparison with their cohorts from nonalcoholic

families.


Identifiable Coping Patterns

Sharon Wegsheider (1978) is a major contributor to a more

sophisticated understanding of the effects of parental alcoholism on

the offspring. After studying more than 400 families in which

alcoholism and other chemical dependency was involved, she identified

four common patterns adopted by children with this background; they

are: (1) the "family hero," (2) the "scapegoat," (3) the "lost

child," and (4) the "family pet." These childhood patterns were

described in detail, and the hazards of carrying these early coping

styles into adult life were clearly spelled out. There is a definite

similarity between these roles and those described previously by

Booz, Allen, and Hamilton (1974). For example, the super coper

closely resembles Wegsheider's "family hero"; similarly, the scape-

goat role is the logical consequence of heavy reliance on the "fight"

coping mechanism discussed by Booz et al, (1974); the withdrawal

practiced by the lost child represents a "flight" type of response











to the family situation. Finally, Wegsheider's (1978) family pet

(immature and fragile) approximates Booz, Allen, and Hamilton's (1974)

description of the child who is unable to cope. Although her coping

patterns are somewhat analogous to those identified earlier by Booz

et al. (1974), Wegsheider's descriptive study has considerably

deepened our understanding of the topic. In addition to further

delineating the various features of these coping styles, Wegsheider

described some serious negative consequences that might occur if

these childhood patterns are continued unchanged into adulthood

(Whitfield, 1980).

For example, the high-achieving family hero achieves visible

success and does what is right. This makes the family proud, but the

child is nonetheless left with feelings of inadequacy. Wegsheider

contended that, in the absence of help, this individual is apt to

become a workaholic, feel responsible for everything, have difficulty

handling failure, and marry a dependent person. All of these unde-

sirable outcomes are the logical sequelae of carrying this early

(and previously adaptive) coping style on into adult life.

Fortunately,outside help can enable the family hero (alias super

coper) to relax, be responsible for self, accept failure, and avoid

marrying an overly dependent person. Wegsheider's basic, underlying

assumption was that these adaptive childhood coping mechanisms are apt

to backfire and lead to psychosocial problems in adulthood unless

help is secured (Whitfield, 1980).











Early Emotional Damage Related
to "Alcoholic Personality"

In a somewhat similar vein, clinical social worker Claudia

Black (1979) contended that those children in an alcoholic family

who superficially appear to have adjusted satisfactorily are also

adversely affected; they are just as much in need of assistance as

their counterparts who exhibit highly visible behavioral problems.

She maintained that parental alcoholism inflicts emotional damage

on the offspring that is often not noticeable from without until

several years later. Consequently, she stressed prevention as well

as intervention, and she focused attention on the socially less

visible majority of children of alcoholics that have traditionally

escaped the attention of researchers and caregivers in this field.

Black (1979) employed the dynamics of role patterns as a

means of explaining the plight of these offspring of alcoholics.

Drawing from Adler's ideas on birth order and from family system

approaches, she outlined in detail three role patterns typically

adopted by these children either separately or in any combination

of the three. They are: (1) the "responsible one," (2) the

"adjuster," and (3) the "placater." Assumption of any one of these

roles or a combination of them enables the child to maintain a

balance or homeostasis (however fragile) within the family system.

The various roles create strengths that in turn hide the emotional

scars. To outsiders, these vulnerable children may at times appear

responsible, adapting, sociable, and bright. This illusory outward










appearance of normalcy further underscores the need to educate

people about the negative aspects of these roles; establishing this

kind of awareness is a necessary prelude to building belief in and

support of the need to direct concern and aid to all children from

alcoholic families (Black, 1979).

The workings of family dynamics give rise to these roles,

and it is almost inevitable that negative sequelae will appear after

these early roles have been transformed into adult patterns. It seems

that the maladaptive features of these formerly adaptive roles often

go unrecognized until the person has adopted a settled lifestyle.

Typical effects that then surface include feelings of depression,

meaninglessness, and loneliness; great difficulty in maintaining

intimate relationships is also common. Many offspring of alcoholic

parentage either become alcoholic and/or marry someone with a serious

drinking problem. The complex dynamics of growing up in an alcoholic

family are conducive to the development of a highly sophisticated

denial system that enables short-term emotional survival at the

expense of long-term emotional growth. First, children learn not to

express their feelings; then, they learn not to feel at all. This

pattern begins at an early age, with denial systems starting to form

in children as young as five (Black, 1979).

Black's (1979) objective was to help prevent the emotional

and psychological "alcoholic" personality that might feed the physio-

logical predisposition. Her efforts were directed at young children,










and art therapy proved to be a successful vehicle for facilitating

the expression of feelings. These children were deemed in need of

an ongoing recovery program just as much as the parent. A group

approach was advocated, because it provided a place in which the

participants did not have to adjust, be responsible, or placate

others in order to survive; a group setting furnished these young

offspring with the opportunity to experience a corrective emotional

experience.

As a further aid to understanding the complicated dynamic

which operates, here is a rough profile of "well-adjusted" children

of alcoholics. In response to parental drinking, they learn to

hold in their feelings at all costs in order-to avoid upsetting

their parents. They also learn to trust only themselves due to

uncertainty as to how their parents will react. Both of these

responses are attempts to preserve balance and order within a

basically chaotic and inconsistent family system. The "overachiever

syndrome" is most common, and it may be best explained in terms of

social learning theory coupled with knowledge of family systems.

The overachievers desperately want to gain approval; by excelling,

they become the family's representative to the outside world. The

achievement brings with it a sense of control; unlike interpersonal

relationships, an honor has the dual advantage of being easily

managed and a visible sign of success. The tremendous need to be

in control is viewed as a reaction to the chaos at home (Shah &

Reese, 1979).











Having taken an in-depth look at some of the studies on

children of alcoholics considered most relevant to this investigation,

it is now time to examine some of the existing treatment resources

for these indirect victims. However, prior to doing that, considera-

tion of some of the factors that seem to be blocking efforts to

achieve significant progress in this area will contribute to a more

complete and realistic perspective for evaluating all research,

prevention, and treatment attempts.


The Lack of Scientific Progress

The science of understanding and helping the children of

alcoholics is still in its infancy. In spite of some significant

discoveries concerning the ways in which these offspring have been

influenced by parental alcoholism, comparatively little progress

has been made in providing appropriate treatment. A study performed

at the Massachusetts General Hospital in Boston indicated that chil-

dren of alcoholic parents, while highly represented at the child

psychiatric service, were least likely to obtain treatment owing to

the nature of their problem (Chafetz, Blane, & Hill, 1971). More

recently, a survey of six health professionals with expertise in this

field revealed that less than 5% of these offspring were receiving

appropriate treatment (Whitfield, 1980). These disturbing findings

have prompted experts to search for some logical explanations.

Identification of these secondary casualties is a necessary

prelude to research, prevention, and treatment efforts. The











obstacles to successful identification are many. The social stigma,

which continues to surround alcoholism, is the major stumbling block,

because it fosters a nearly universal denial and ignorance of the

problem. The resultant unhealthy climate exerts a powerful influence

on the shaping of social policy and practice in the health care

system (Whitfield, 1980). The net result is a vicious, self-

perpetuating cycle of nonrecognition of the problem and inappropriate

treatment by the majority of caregivers (Whitfield, 1980).

Denial and ignorance pose enormous barriers to the task of

identifying this population, because these two factors join forces

to effectively minimize the likelihood of these secondary victims

ever receiving the benefits of treatment. The fact that alcoholism

is known as a "family disease" (e.g., Globetti, Note 1; Keane &

Roche, Note 3), bears testimony to this complex, enmeshed process in

which denial and ignorance are heavily implicated. Nonalcoholic

members of such a family typically behave in ways that "enable" the

disease of alcoholism to progress. Prompted by feelings of care,

love, and concern, they unwittingly cover up, deny and perpetuate

the drinking problem (Sessions, Note 6); in effect, they suffer from

"co-alcoholism" and become "co-alcoholics" (Whitfield, 1980).

Denial and ignorance also operate on the treatment level to

sabotage effective efforts by caregivers. Here, the ignorance

manifests itself in the form of lack of appropriate training and

awareness (Whitfield, 1980). The problem is serious enough for










Sharon Wegsheider to have coined the term, "the professional enabler"

(quoted in Whitfield, 1980, p. 90). The matter is complicated and

worsened by some recent evidence which suggests that alcoholism and

chemical dependency may be common in the families of health

professionals. Surveys of four medical school classes in two

universities showed that a minimum of 37% had a parent or other close

family member with alcohol or other drug dependency. An even higher

percentage of medical students taking substance abuse electives had

the problem in their family of origin (Whitfield, 1980). The

implication is that health care providers are likely to encounter

difficulty performing the tasks of identification, research, preven-

tion, and treatment as a consequence of their having effectively

overcome or denied the problem in their own families (NIAAA, 1979).

Having presented this basic overview of a few of the major handicaps

to the progress of treatment efforts, it is now time to take inventory

of the resources available for treatment.


Inadequate Treatment Resources

Despite the periodic occurrence of articles stressing the need

for concerted therapeutic efforts in this area, the fact remains that

the resources available to meet the need for services are woefully

inadequate. The issue is a tremendously complex one. Caregivers

maintain that their programs come close to supplying the existing

demand for assistance, but some experts contend that treatment











providers are lax in fulfilling their responsibility for helping

translate need into demand (Booz et al., 1974).

There is widespread inertia among agencies in terms of

devising new approaches aimed at identifying and meeting the special

concerns of this neglected population. Most organizations concerned

with alcoholism focus on the primary victim (i.e., the alcoholic);

consequently, the children are usually ignored, and their needs remain

invisible to the professional treating the alcoholic (Hindman, 1975).

Until recently, the impact of alcoholism has been measured

largely in terms of loss of work productivity and of highway deaths.

Recognition of children of alcoholics as legitimate casualties of

the disease represents a recent, progressive phenomenon. The family

approach to the treatment of alcoholism is a new trend that holds

much promise for helping the victimized children. (Chafetz, 1979).

The reality is that most helping efforts occur only after the

parent is in treatment or the child has demonstrated some sort of

acting-out behavior; this means that the vast majority of these

secondary casualties totally miss out on treatment opportunities.

This fact makes it necessary to consider other ways of reaching these

easily overlooked individuals and to offer them help in developing

healthier personalities. Not only do existing services need to be

expanded, but new ones will have to be created. Imaginative, innova-

tive approaches are called for in order to translate well-intentioned

treatment goals into workable programs. Due to the aforementioned










obstacles of social stigma, denial, and ignorance, such attempts

must include an aggressive outreach component (NIAAA, 1979).


Alateen

Even though the overall picture is somewhat discouraging

(Whitfield, 1980), there have been some notably effective programs

which may prove helpful in guiding future attempts. Alateen heads

the list. In existence since 1957, this self-help organization

represents the primary resource available specifically for children

of alcoholics (ages 9 to 22). Most who have attended Alateen meetings

for a long time attest to its effectiveness and enormous personal

value. This worldwide organization has basically adopted the

Alcoholics Anonymous approach and applied it to the offspring.

Alcoholism is viewed as a family disease, and the children in

Alateen are there to learn how to help themselves, not their

alcoholic parents. Emphasis is definitely placed on the child's

own behavior and feelings and his/her responsibility for them.

Alateen is a peer group with adult sponsorship, usually meeting once

a week for an hour. This peer group aims to provide a caring,

nonjudgmental atmosphere, to help the child understand alcoholism,

and to promote personal growth and stability. Understanding and

support from the group, together with a belief in AA's Higher Power

concept, are the principle vehicles by which help is rendered. The

theory is that, with time, the child's emotional dependency needs

will shift from his family to the group, and then eventually disperse










to the Higher Power and the self (Booz et al., 1974). Additionally,

Alateen provides extensive educational material, and it operates as

a forum for exchanging information.

A recent study examined the relationship of Alateen to the

adolescent children of alcoholic parents by looking at three groups

of subjects. Group 1 consisted of 25 subjects (aged 12 to 19) who

had one or two alcoholic parents and who were not members of Alateen;

the second or control group contained a like number of adolescents

who did not have an alcoholic parent, while the third group consisted

of children who had one or two alcoholic parents and who were members

of Alateen. All groups were matched by age, sex, grade level, and

father's occupational level. This investigation reported that

adolescent children of alcoholic parents often suffered from negative

emotional moods, low self-esteem, and poor social adjustment (either

with the law or at school); the study also showed that the children

belonging to Alateen were better off emotionally than those children

who were not members (Hughes, 1977).

Despite its obvious value in helping to meet the needs of

those children who decide to join, Alateen's effectiveness is severely

limited by several factors. Many potential members are aware of its

existence, but they do not regard it as a viable option for them.

In addition to being stigmatized by its association with AA, it has

been criticized by some as being unsophisticated, juvenile, and overly

religious; some children reject Alateen because of a lack of











confidence in their peers' ability to help them with their problem,

while others are unprepared or unwilling to accept Alateen's

independent, laissez-faire attitude toward the alcoholic (Booz et

al., 1974).

One psychiatrist has claimed that it is far easier for him

to get alcoholics and their spouses to AA and Al-Anon than it is to

get a child to Alateen without strong parental support (most unlikely

in light of the strong denial practiced in most alcoholic families)

(Whitfield, 1980). In spite of its admittedly limited range of

appeal, Alateen remains the single most effective and widely known

resource available to children of alcoholics; for all intents and

purposes, it is the "only game in town" (Booz et al., 1974, p. 96).

Many children, however, require more specialized treatment alterna-

tives to supplement Alateen (Whitfield, 1980).


Experimental Treatment Programs


Individual Counseling to Complement
Alcohol Education

Weir (1970) introduced a voluntary counseling program as a

complement to an earlier alcohol and alcoholism educational program

presented to an entire North Dakota high school consisting of 421

students. When 20% of this original population were found to have

a family alcohol problem (father and/or mother), Weir (1970)

correctly hypothesized that additional needs of some young people

would surface as a result of the educational segment of the program.











Analysis of data for students with a family alcohol problem revealed

no change in attitudes toward alcohol and the alcoholic as a result

of exposure to the general alcohol education program. This provided

further rationale for counseling specifically designed to address

the special concerns of offspring of alcoholics.

The counseling program consisted of individual counseling

"in relation to the use of alcohol and to an alcohol problem" (Weir,

1970, p. 15). It included 13 students from the family alcohol group

and 15 from the remainder of the student population. Each student

received an average of 5.5 sessions.

The individual counseling sessions were designed to provide

students with support and positive options for coping with the

family drinking problem. Along with helping the students learn how

to deal with alcoholism as an illness rather than as a moral or

criminal matter, the counselor was concerned with developing the

self-awareness and understanding of clients. Positive results were

observed in the majority of those receiving counseling; noticeable

differences included better communication, improved family involve-

ment, feelings of greater self-worth, and the chance to experience

personal growth (Weir, 1970).

Weir's exploratory study demonstrated a need for alcohol

educators to devise programs specially designed to reach out to assist

children of alcoholic parentage.











Mother-and-Child Communication Workshop

Kern et al. (1977) developed an experimental treatment program

in the form of a short-term mother-and-child communication workshop.

Numerous characteristics that are common among all nonalcoholic

family members provided the rationale for this education/prevention

effort.

Kern's group consisted of three families (three mothers and

eight children); the children ranged in age from 13 to 18 years old.

For each of eight weeks, there was a structured two-hour meeting.

Relying heavily on action-oriented techniques (e.g., psychodrama)

and group processes, the two group leaders primarily sought to

clarify and focus conversation in addition to promoting adaptive

communication. Modest changes in family interactions were observed,

but there were no dramatic results.

In retrospect, Kern et al. (1977) decided that an 8- to 10-

week group without parents was needed prior to introducing a workshop

format for both together. He viewed this adolescent group as

differing from Alateen in that it was conducted by a trained leader and

more oriented toward short-term growth; Kern's future plans for the

children's group included the eventual integration of Alateen as an

adjunct and later as the appropriate long-term treatment.


CASPAR Alcohol Education Program

The Cambridge-Somerville Program for Alcoholism Rehabilitation

(CASPAR) Alcohol Education Program for children of alcoholics began











in 1976. It was far more comprehensive and sophisticated than the

two earlier exploratory studies discussed above,

This model was developed in Somerville, Massachusetts, a

blue-collar city of 85,000 adjoining Boston, where one out of every

seven adults was considered alcoholic. Although the program staff

never anticipated such a large number of children of alcoholics, the

secondary prevention program for them was a natural and inevitable

outgrowth of the primary prevention effort. Given this high rate of

alcoholism, CASPAR officials responded to the need for developing

ways of aiding children from families with alcoholism; further, they

saw the necessity of assisting these youngsters early in life, help

that would not be contingent upon the alcoholic's first receiving

treatment (Deutsch, DiCicco, & Mills, 1978).

The entire CASPAR Alcohol Education Program is based on the

belief that a school-based approach to primary prevention represents

the key to successful efforts aimed at reaching out to children of

alcoholics at an early stage, before difficulties arise and become

more difficult to reverse (NIAAA Info. & Feature Service, 1979),

Trained teachers are the heart of this prevention network. The goal

of CASPAR's primary prevention program is to enable youngsters to

make responsible decisions about drinking or abstaining.

CASPAR's secondary prevention program provided prolonged and

intensive contact to approximately 140 children over a 2-year period

(NIAAA Info. & Feature Service, 1979). The vast majority of them

came from homes where neither parent was in treatment, and where the










nonalcoholic parent was denying the problem and not functioning as a

source of support and understanding to the child. The program's

central objective was the modest but attainable one of helping these

children understand what had been the dominant fact of their lives--

a parent's alcoholism and its effects on the family. This under-

standing has both cognitive and emotional elements. Ideally,

success requires the attainment of both. However, many of these

children may be too guilty or unwilling to either express or examine

their feelings; CASPAR's program operated on the assumption that

they could still absorb and think about ideas related to family

alcoholism regardless of degree of readiness to deal with the

emotional aspect. If presented in a coherent manner by someone

respected and trusted, this would enable these children to eventually

explore, understand, and express these feelings (Deutsch et al.,

1978).

CASPAR's primary prevention involved alcohol education

throughout grades 3 to 12; most grade levels included ten sessions

with the following order of teaching objectives: facts about alcohol,

attitudes about alcohol and drinking, decision making in drinking

situations, and alcoholism. By limiting the topic of alcoholism to

the last three sessions, this made it possible to present images of

responsible behavior and to avoid a scare approach. The sequence of

topic presentation enabled many of these youngsters to establish a

societal norm with which to compare the drinking of their parents

(Deutsch et al., 1978).










The teacher was able to create an atmosphere in which talking

about the illness of alcoholism became acceptable. Unlike the

counselor, who responded to alcoholism as a problem, the teacher

could initiate help by presenting alcohol education as a subject.

This was especially important, because many of those who might bene-

fit from help were not yet in visible trouble. This educational

approach helped overcome some basic obstacles to seeking help such

as embarrassment and feelings of betraying the alcoholic parent

(Deutsch et al., 1978).

The classroom teachers were taught how to recognize pleas

for help from these children. Included in teacher training and

related to this identification process were the following five

objectives for the subunit on family alcoholism: (1) You are not

alone. (2) Your parent's alcoholism is not your fault. (3) Alco-

holism is a disease. (4) Alcoholics can and do recover. (5) You

need and should get help for yourself. While teachers were the most

important identifiers, and the primary sources of referral, CASPAR

reached children with family alcoholism in other ways. Foremost

among these were structured alcohol education workshops conducted

by peer leaders during study halls and after school. All workshop

participants were paid to attend, and nearly one-third of them

eventually identified themselves as having an alcoholic parent. Of

all the secondary school children who were identified as children

of alcoholics, roughly two-thirds became involved in intervention











which took place in structured groups composed entirely of children

of alcoholics (Deutsch et al., 1978).

These after-school workshops, compacted in age as much as

possible, were led by a pair of carefully trained and supervised

peer leaders who were themselves from alcoholic families, Groups

had 6 to 10 members, and activities included discussions, role plays,

expressive drawings, films, and field trips. Among the unique

features was the requirement that all members attend an Alateen

meeting with another person in the group; also, participants were

required to make weekly journal entries (Deutsch et al., 1978).

The sequence of subjects for this group contrasted markedly

with the other CASPAR curricula. Instead of ending with alcoholism,

the group for children with family alcoholism began with several weeks

on alcoholism and ended with a subunit on responsible decision making

about drinking. The creators of this program felt that most children

of alcoholics, despite their claims to the contrary, would eventually

drink at some point in their lives; they would do so with a volatile

mixture of feelings including fear, guilt, and fascination. CASPAR

officials believed that this potentially dangerous process could be

averted only if these children were able to acquire either anew

perspective on drinking or strategies that would make abstention a

more feasible alternative (Deutsch et al., 1978).










Ideal Treatment Program

A group of twelve health professionals met recently at a

NIAAA-sponsored symposium on children of alcoholics held in

Washington, D. C. They agreed that treatment did not necessarily

need to include a formal therapy program. Instead, they believed

it should offer the child a "corrective emotional experience" (NIAAA,

1979, p. 3), provide a supportive environment conducive to change,

assist in developing coping skills and furnish education about alco-

holism (appropriate to the child's age). These same experts con-

cluded that in order to prevent or minimize the development of alco-

holism or other emotional problems, services for children of alco-

holics needed to be developed which would (1) make them aware of

their potential risk level, (2) help them make informed decisions

about how to deal with these risks, (3) alleviate the feelings of

guilt and isolation that characterizes this group, and (4) provide

ongoing treatment for specific problems they are facing (NIAAA, 1979).

The symposium clearly identified education as an indispensable

aspect of treatment. The ignorance component of denial was responsi-

ble for the fact that many children of alcoholics were unable ". .

to ask for help, because they don't know what to ask help for"

(Woititz quoted in NIAAA, 1979, p. 3). The views expressed by these

top authorities in the field make it evident that CASPAR's secondary

prevention program fulfills most of their criteria for an "ideal"

treatment program.











At first glance, it might appear that the next section (on

model alcohol education programs for college students) is erroneously

included under the heading for experimental treatment programs.

While these alcohol education programs were interested in primary

prevention rather than secondary prevention for children of alcoholics,

the rationale, methodology, and results are highly relevant to this

study.


Model Alcohol Education Programs
for College Students

Available evidence strongly suggests that the need exists

for alcohol education among college students. There is no other

population in the U. S. with a larger proportion of drinkers than

this age group (Gallup, 1977). Added to this fact is the statistic

that 18 to 20 year olds have the highest proportion of people who

have encountered some problem in connection with drinking (Harris

& Associates, 1974). A national study of 13 universities revealed

that 81% of the students were drinkers, and similar findings were

reported by a student survey at the University of Florida (Panken,

Gonzalez, & Barger, Note 4). A more recent investigation by

Gonzalez (Note 5) looked at alcohol use among students enrolled at

four major state universities in Florida; 81% of those surveyed

were drinkers, and 13% of these students were classified as

"problem drinkers"; the definition of problem drinking was a rather

conservative one based on the number of negative consequences

experienced as a result of alcohol use.











Even though few students have developed patterns of chronic

alcohol abuse, the attitudes and behaviors established during the

college years have serious implications for later patterns of abuse

(Kraft, 1976). The abusive drinking engaged in by many adolescents

does not necessarily imply that adult alcoholism will follow; it is

primarily the children of alcoholic parents who are in serious

jeopardy as a result of abusive adolescent drinking (Chafetz, 1979).

Contrary to the impression created by the media's sensationalistic

style of reporting, alcoholism is relatively rare among teenagers;

however, established alcohol addicts between 20 and 30 years of age

are becoming increasingly common (Ritson, 1975).

Alcohol education is the recent approach to the prevention

of alcohol problems (Chafetz, 1979). When the student drinking

problem first emerged and attracted attention as a crisis situation,

a variety of agencies responded by hurriedly developing educational

programs. The value of these early efforts was severely limited by

their short-sighted manner of approaching the dilemma. In their

haste to come up with solutions, program creators overlooked the

necessity of designing individual programs tailored to fit the

special needs of specific groups (Engs, 1977). The moral is that

effective alcohol prevention programs need to be created specifically

for certain audiences rather than based upon some generalized approach

(Globetti, 1973).











The 3rd Interim Report of the Education Commission of the

States on Responsible Decisions About Alcohol (1975) cited the need

for alcohol abuse programs to encourage responsible decision making

by students concerning alcohol use or nonuse. Faced with a vast

pool of ignorance and a lack of agreement in this country regarding

what constitutes healthy or responsible drinking, Gonzalez developed

standards of responsibility for college students in their attitudes

toward alcohol use. These norms were used to create a scale which

was then included in an instrument for assessing the effectiveness

of an alcohol education program presented to college students at

the University of Florida (Gonzalez, 1978).

A 4-hour alcohol education module was designed to encourage

discussion of responsible, alcohol-related standards among college

students; this module provided factual information about alcohol,

and small groups were used for the discussions. The program's impact

was measured in terms of the following dependent variables: (1) level

of knowledge about alcohol, (2) responsible attitudes toward drinking,

and (3) negative behavioral consequences. The module favorably

affected the knowledge and attitude variables, with the changes

lasting for at least three months. However, no significant difference

was found between the experimental and control groups on the incidence

of negative behavioral consequences experienced by each group within

three months following treatment.

Gonzalez offered two conceivable explanations for this finding.

Perhaps attitudes toward alcohol could be changed in a more











responsible direction without a corresponding modification in behavior,

A more optimistic interpretation was that a change in attitudes might

just be the first step toward actual changes in behavior that would

occur later as the result of follow-up activities allowing the

students to practice the desired behaviors.

An additional interesting finding of this study was that, over

a three-month period, the level of responsible attitudes began to

revert back to the pretreatment level. This observation, coupled

with the aforementioned absence of significant differences between

the experimental and control groups on the negative consequences

variable, influenced Gonzalez's decision to suggest the need for

experimental, educational activities to follow up his module.

This left the following unanswered questions: What activities

were most likely to enhance responsible decisions about alcohol? In

what form should these activities be presented? Another alcohol

educator at the University of Florida (Rozelle, 1978) conducted an

investigation aimed at answering these very questions. Before

presenting the details and results of this study, consider briefly

the rationale for this approach.

The stated purpose of the Rozelle (1978) study was to deter-

mine the relative effectiveness of an innovative experiential approach

and a more traditional cognitive approach to alcohol education. The

same indicators of effectiveness put together by Gonzalez (desirable

changes in students' knowledge, attitudes, and behavior related to

drinking) were used.











Rozelle (1978) believed that the best means of implementing

this responsible drinking approach would be within the framework of

a small discussion group moderated by a nondirective adult leader

(Williams, DiCicco, & Unterberger, 1968), or, better yet, by properly

trained peer facilitators (Lawler, 1971; Sorenson & Joffee, 1975).

Group discussion, which limited itself strictly to the cognitive

domain, was considered likely to prove far less effective than if the

knowledge or attitudes acquired vicariously in the classroom setting

were actually tested out in a personal or social context. Personal

experience was clearly advocated as a powerful and persuasive

educational force (Russell, 1969).

A leading figure in the field of alcohol abuse prevention

(Chafetz, 1970) had generated great controversy by advocating the

serving of alcoholic beverages in a supervised group setting in

the classroom. The purpose of this experiential learning is to

furnish opportunities for students to practice responsible drinking

behavior as contrasted with merely talking about it. For example,

enabling students to monitor their own Blood Alcohol Concentration

level gives them the chance to familiarize themselves with their

subjective and objective reactions; this makes it possible for them

to actually learn their limit rather than merely understanding that

it is a good idea to do so (Rozelle, 1978).

Rozelle's experiential approach consisted of more than just

learning how to drink. It also included learning to be a responsible











host or hostess, learning to deal with a problem drinker or a friend

who has drunk too much, and obtaining a deeper understanding of the

repercussions of alcohol abuse and alcoholism.

Both the experiential and cognitive small group approaches

to alcohol education for college students resulted in significantly

higher levels of responsible attitudes and knowledge about alcohol

than a control group. No significant differences were discovered

among the groups in incidences of negative behavioral consequences

immediately following treatment. However, three months later,

significantly fewer negative consequences were reported by both the

experiential group (p < .01) and the cognitive group (p < .05). A

comparison of group means showed that the experiential group

consistently scored higher in responsible attitudes and lower in

negative behavioral consequences than the cognitive group (Rozelle,

1978). A somewhat surprising finding was the delayed effect of

treatment on drinking behavior. This was explained by the simple

fact that it takes time for newly acquired attitudes and knowledge

to become internalized and subsequently translated in terms of actions

(Rozelle, 1978).


Family Dynamics of Alcoholism

Alcoholism is increasingly recognized as a serious disease

that adversely affects all family members and not just the alcoholic

(Globetti, Note 1; Keane & Roche, Note 3). One expert has even










referred to this family illness as a "collective neurosis" (Sauer,

1976). Without delving into the evidence supporting a genetic

pattern of inheriting alcoholism, it is important to consider the

family dynamics of alcoholism that contribute heavily to the environ-

mental influences affecting a child's development. The present state

of knowledge makes it possible to explain precisely the etiological

factors associated with alcoholism and the other adult psychosocial

problems related to living in an alcoholic family as a child.

Regardless of the extent to which genetic contributions predispose

these offspring to develop difficulties in adulthood, educational

counseling aimed at improving awareness of the family dynamics of

alcoholism can still serve a valuable preventive function.

To the extent that one acknowledges the validity of environ-

mental forces exerting an influence on a child's future development,

then a clear understanding of the family dynamics of alcoholism is a

necessary prerequisite of successful prevention (based on educational

counseling). Family systems theory and social learning theory are

useful tools for understanding the sequelae of growing up in an

alcoholic family.


Family Systems Theory

Family systems theorists regard the family as an operational,

interdependent system; they believe that "change in the functioning

of one family member is automatically followed by a compensatory

change in another family member" (Bowen quoted in Black, 1979, p. 24).











The child of an alcoholic family grows up in a system in which the

usual relationships between the elements forming the system have

broken down. The weakness and disorganization in the family struc-

ture caused by the alcoholism trigger compensatory changes or

reactions from the children. For example, suppose that the father

is an alcoholic and the mother expends most of her energy dealing

with her husband's drinking; she does so to the necessary neglect of

some of her maternal obligations. The oldest child may be forced

into assuming certain aspects of the alcoholic father's role that

the father is unable to perform. Also, if the mother cannot secure

gratification from her spouse, then one of the children may fill

that void by serving as the mother's confidante (Hecht, 1973).

The parental alcoholism affects the family system to such an

extent that the child is compelled to assume unusual roles and engage

in interactions and relationships within the family as each member

seeks to obtain gratification from others (Hecht, 1973). The

compensatory reactions elicited by the alcoholism represent necessary

accommodations to an inherently unstable system. These roles make

it possible for the children to preserve a sense of homeostasis that

is vital to survival (Black, 1979).

Children are the most vulnerable family members because of

their limited awareness and high dependency needs. Their efforts

to meet the needs of their siblings or parents impose heavy demands

and stresses that are inappropriate for anyone of their age (Jacob

et al., 1978). Equally disastrous in terms of their future emotional











adjustment is that these peculiar role patterns, having evolved as

natural and necessary survival responses to the alcoholic family

system, are often carried unwittingly into adulthood and into rela-

tionships outside the family (Hecht, 1973).

Family systems theory offers an extremely useful framework

for understanding alcoholism and its effects on the family; this

theory has tremendous potential for helping the alcoholic as well as

nonalcoholic family members. Potential benefits resulting from the

application of these ideas have yet to remotely approach full

realization for two reasons. First, this is still a relatively new

area that is not yet widely understood. Secondly, families need to

protect themselves by denying the existence of a problem (Whitfield,

1980).

Some progress has already been made in applying the basic

principles of family systems theory to educational efforts aimed at

assisting family members in their efforts to cope with alcoholism.

Drawing heavily on knowledge gleaned from the application of these

principles to the alcoholic family, experts have published several

books (Hornik, 1974; McCabe, 1978; Seixas, 1979; Woititz, 1979) and

articles (Black, 1979; Hecht, 1973; Mueller, 1972; Shah & Reese,

1979; Sessions, Note 6) that serve as excellent treatment resources.


Social Learning Theory

Social learning theory's contributions to an understanding

of the effects of parental alcoholism on youngsters can perhaps be










best appreciated by examining what its proponents have to say

concerning its role in the etiology of alcoholism. Some experts

maintain that the concepts of imitation and identification are

necessary though not sufficient causative factors in the development

of alcoholism (Chafetz & Demone, 1962).

The family represents the primary means by which learning

about social behavior and norms is passed on; to a large extent,

the family acts as the matrix of the child's education. As a result

of interactions occurring within this unit, children learn by

absorbing and observing the family's feelings, attitudes, and ways

of relating to others. The child learns chiefly through the process

of identification; this learning takes place both consciously and

unconsciously, and it encompasses both communication and role

playing (Hecht, 1973).

Most studies confirm that youngsters tend to adopt the

drinking habits of their parents. Heavy-drinking parents will tend

to produce heavy-drinking offspring; moderate drinkers, moderate-

drinking children, etc. (Bacon & Jones in Chafetz, 1979). Common

sense might suggest that having a parent with a serious drinking

problem would act as an excellent deterrent to alcohol abuse by

the children. A 1942 study of college students revealed that being

aware of a parent's drinking problem had not acted as a deterrent

to student drinking; the results showed that "even the actual

emotionally significant and ever present 'awful example' had no

effect on decreasing drinking. In fact, there was actually a










greater incidence of drinking ." (Strauss & Bacon quoted in

Platt & Moss, 1977, p. 35).

A fairly safe assumption is that much of the learning among

young people takes place through such vicarious means as observa-

tional learning. Subsequent performances of acts learned in this

manner are called imitation or modeling behavior. According to

Bandura (1965), no-trial learning by the observer is a frequent and

biologically adaptive behavior in humans. Several studies with

children support this view according to which much behavior can be

learned and/or later performed solely on the basis of observation

(Burk, 1972).

A direct implication is that children of alcoholics are

vulnerable to becoming alcoholic in later life as a consequence of

their having observed the problem solving and coping behaviors of

their parents. These children are susceptible to the effects of

having alcoholic parents serve as poor or inadequate models. A

noted authority in this field contends that these offspring learn

complicated behavior patterns from their parents; these early

observational learning constitute a predetermined sequence of

response that may be easily triggered in the child's own adult life

when confronted by stress. Having personally witnessed complex

patterns of behavior in which adults use alcohol to deal with stress,

these youngsters are also subjected to the mass media's portrayal

of alcohol as an almost indispensable concomitant of adult social











life. Consequently, the young child is conditioned to conclude that

excessive alcohol use serves as both a reducer of anxiety and a social

stiumlant. This early observational learning sets the stage for the

future practice of analagous behavior by the grown child (Burk, 1972).

When stating the case for the social learning theory view

regarding the etiology of alcoholism, Burk (1972) contended that these

important social factors were highly likely to reinforce and pattern

the child in the direction of excessive alcohol intake. The fact that

many children of alcoholics somehow manage to develop healthy adult

attitudes toward alcohol suggests that other (as yet unidentified)

factors intervene and short-circuit this unhealthy process. With this

in mind, Burk (1972) suggested that an optimal strategy for reducing

the problem of alcoholism in the next generation would be to provide

children of alcoholics with the chance to observe mature, well-

respected models demonstrating healthy attitudes and behavior toward

alcohol.

It would be a naive and serious mistake to leave the impression

that a child's attitudes toward alcohol are influenced solely by his

own family experience of alcohol use. These attitudes develop out of

a complex interplay involving such factors as the parents' attitudes

and behaviors, the "establishment," the position of school authorities,

and the increasing influence of peers and social factors (e.g.,

advertising). It is probable, however, that children from alcoholic

families tend to attach excessive emotional meaning to alcohol as a











result of their seeing it used as a vehicle for coping with stress

and as a means of expressing defiance or anger within the home.

Alcohol possesses a special and potentially dangerous importance to

children from alcoholic homes, because it belongs to the emotional

currency of their family life (Ritson, 1975).


Summary and Implications for the Study

This chapter has shown that children of alcoholics are a high-

risk group in terms of having an increased incidence of alcoholism

and psychosocial problems in adult life. Living with an alcoholic

parent is a traumatic experience, and it is a dangerous mistake to

assume that seemingly well-adjusted children from an alcoholic home

are somehow less likely to become alcoholic or encounter other

problems stemming from their alcoholic parentage than their more

socially visible counterparts who exhibit acting out behavior as

children.

Whereas recent research efforts have contributed greatly to

an improved understanding of the needs of this vulnerable group,

available treatment resources leave much to be desired. Very few

programs have been specifically developed for the purpose of meeting

the needs of this population; Alateen is the best known and most

successful. The social stigma attached to alcoholism fosters wide-

spread denial and ignorance throughout society as well as among

members of an alcoholic family; these factors pose major hurdles to

prevention efforts directed at these offspring. Energetic, sensitive,











and imaginative outreach efforts are desperately needed to alert this

group of children to potential risks stemming from their family

alcohol problem; this must be done in order to ensure that the need

for secondary prevention programs becomes translated into a demand

for such specialized services.

Alcohol education efforts focusing on primary prevention are

indispensable, but it is clear that the unique needs of children from

alcoholic families require an additional, specially tailored form of

secondary prevention. The complicated and powerful family dynamics

of alcoholism are a significant factor predisposing these children

to develop difficulties as adults. Understanding parental alcoholism

and its effects on the family members needs to be a central focus of

any secondary prevention program for these innocent victims. With

sufficient awareness of the family problem (including possible

ramifications and sequelae), children will be in a position to learn

how to personally cope with the alcoholism on a day-to-day basis;

also, they will be equipped to make responsible decisions about how

to deal with the myriad risk factors confronting them.

Alcohol programs for college students are valuable resources

in terms of the methodological approaches and assumptions that have

accompanied these prevention efforts. Using the process of extrapo-

lation, successful ideas, approaches, and methodologies can be

borrowed, modified, and then applied to the challenge of devising an

effective secondary prevention program for university students with

one or more alcoholic parents.




67





This investigation provides an objective evaluation of a

comprehensive, innovative secondary prevention program for students

at the University of Florida who come from an alcoholic family. The

study compares the effectiveness of two approaches to structured

counseling. One relies heavily on cognitive small group discussions,

while the other is experientially based.












CHAPTER III
METHODOLOGY


The basic question investigated in this study was whether a

secondary prevention program developed specifically for university

students with an alcoholic parent would have an effect on: (1) the

students' attitudes, knowledge and behavior related to drinking; and

(2) the students' knowledge, attitudes, and behavior associated with

the parental alcoholism. The program consisted of two types of

structured group counseling: experiential and cognitive. Each

experimental group was compared to the other and with a delayed

treatment control group.


Experimental Hypotheses

The research hypotheses were tested immediately following the

program and then retested two months later to determine whether

certain effects were immediate, delayed or of longer duration. The

research hypotheses are stated below in null form:

1A. There will be no differences between students in the

experimental and control groups on the Quantity-Frequency Index of

alcohol consumption following their participation in educational

counseling.

lB. There will be no differences between students in the

experiential and cognitive groups on the Quantity-Frequency Index of

alcohol consumption following their participation in structured

counseling.










2A. There will be no differences between students in the

experimental and control groups on knowledge regarding alcohol after

participation in structured counseling by members of the experimental

groups.

2B.. There will be no differences between students in the

experiential and cognitive groups on knowledge about alcohol after

taking part in educational counseling.

3A. There will be no differences between students in the

experimental and control groups on responsible attitudes toward

drinking following participation in educational counseling by subjects

in the experimental groups.

3B. There will be no differences between students in the

experiential and cognitive groups on responsible attitudes toward

drinking following participation in structured counseling.

4A. There will be no differences between students in the

experimental and control groups on the incidence of negative behav-

ioral consequences experienced by each group after taking part in

educational counseling.

4B. There will be no differences between students in the

experiential and cognitive groups on the incidence of negative

behavioral consequences experienced by each group following structured

counseling.

5A. There will be no differences between students in the

experimental and control groups on knowledge about alcoholism and











its effects on the family after participation in structured

counseling.

5B. There will be no differences between students in the

experiential and cognitive groups on knowledge about alcoholism and

its effects on the family after participation in educational

counseling.

6A. There will be no differences between students in the

experimental and control groups on healthy coping attitudes toward

parental alcoholism following educational counseling.

6B. There will be no differences between students in the

experiential and cognitive groups on healthy coping attitudes toward

parental alcoholism following their participation in counseling.

7A. There will be no differences between students in the

experimental and control groups on healthy coping behaviors related

to parental alcoholism following their participation in structured

counseling.

7B. There will be no differences between students in the

experiential and cognitive groups on healthy coping behaviors related

to parental alcoholism following their participation in counseling.


The Research Design

This study used a longitudinal pretest-posttest control group

design to test the 14 stated hypotheses. This design was necessary

since each hypothesis was tested at two different times. These










hypotheses were tested immediately after exposure to the structured

group counseling program using pretest and posttest data, and again

two months later using pretest and post-posttest data.

The pretest-posttest control group design utilized in this

study provided the advantage of controlling for all threats to

internal validity (Campbell & Stanley, 1963). Factors that might have

jeopardized external validity included reactive arrangements and the

interaction effects of selection biases and the experimental treat-

ment (Isaac & Michael, 1971). However, it is unlikely that this

latter element represented a serious threat to the external validity

of this investigation, since random sampling techniques were used in

assigning subjects to experimental and control groups. The reactive

effect of possible interaction between testing and treatment was

controlled in this design by conducting a test of homogeneity of

regression prior to consideration of the performance of an analysis

of covariance. This means that the reactive effect of experimental

procedures was the only conceivable threat to external validity not

explicitly controlled by this research design.

The longitudinal pretest-posttest control group research

design to be used in this study can be graphically depicted as shown

on the following page.












Table 1

Longitudinal Pretest-Posttest Control Group Research Design


Two months
Groups Pretest Treatment Posttest post-posttest


Experiential 01 X1 02 03
Cognitive 04 X2 05 06
Control 07 08 09



Subjects

The experimental subjects in this investigation consisted of

male and female undergraduate and graduate students at the University

of Florida who volunteered to participate in structured group

counseling for students with one or more alcoholic parents (see

Appendix A for criteria for alcoholic parent). Groups were offered

during Spring quarter, 1981, at the University of Florida Counseling

Center. Due to the social stigma attached to alcoholism and the

denial that characterizes most members of an alcoholic family, an

extensive, carefully planned educational and advertising campaign

was initiated during the Fall quarter of 1980, and it was continued

during Winter quarter of 1981. Every effort was made to increase

student understanding in this area and to promote awareness of a

secondary prevention program (the educational counseling groups)

available to students with an alcoholic parent. Steps taken to

educate students and to publicize the availability of groups at the










Counseling Center included presentation of 15 to 20 lectures by the

writer on the topic of children of alcoholics to a variety of under-

graduate classes that included ones in introductory psychology,

personal growth, and alcohol use and abuse. Moreover, advertisements

were placed in the student newspaper to provide information about the

groups and what they had to offer; an article explaining the program

(i.e., the counseling groups) appeared in the Winter edition of the

Student Services publication; advertising also included a few lines

in the "Personal" section of the student newspaper. Finally, local

media provided other unexpected sources of publicity in the form of

a feature story in the city newspaper and mention of the groups by

the campus radio station.

Trial groups were led by the author at the Counseling Center

during Winter 1981 quarter. Feedback from group participants was

actively solicited and given strong consideration in formulating

final plans for conducting the groups during the Spring 1981 quarter.

Volunteer students were randomly assigned to either one of

the two experimental groups or to the delayed treatment control group.

Maximum group membership was set at 15 for each group. For purposes

of this study, a minimum of six members was set as an acceptable

sample size; this allowed for expected experimental mortality. Random

assignment was utilized to insure pre-experimental equality of the

three groups. The actual randomization procedure used to assign

volunteers to the various treatment groups was carried out within the










limitations imposed by such unavoidable practical considerations as

schedule conflicts and subject availability for participation in the

delayed treatment control group. The forthcoming report on the demo-

graphic data on group members demonstrates that these potentially

limiting factors imposed on the assignment process did not appear to

sabotage the primary goal of the randomization procedure (i.e., pre-

experimental equality of the three groups).

Those students assigned to the delayed treatment control group

were provided with the option of receiving one of the experimental

treatments on a delayed basis. Finally, since part of the investiga-

tion focused on level of alcohol consumption and other variables

directly related to alcohol use, only those students who indicated

that they drank alcoholic beverages were included in the analysis of

that portion of the data.

An initial pool of 38 student volunteers yielded 33 experi-

mental subjects from whom posttest data were available (28 of the 33

study participants responded to the post-posttest questionnaires

mailed out two months following completion of the counseling groups).

These students were randomly divided into two experimental groups

and a delayed treatment control group with the previously mentioned

practical considerations operating as the critical factors in the

assignment process.

The experiential group contained 11 subjects: five males

(45%) and six females (55%). Ages ranged from 18 to 32 with a mean










age of 23.54. Ten of the participants were white (90.9%), and the

remaining subject was black. The breakdown according to class

revealed nine undergraduate (81.8%) and two graduate students (18.2%).

Five of the undergraduates (55.5%) were seniors. The alcoholic

parent was the father for ten (91%) of the 11 group members. Six

(54.5%) of the alcoholic parents had acknowledged their drinking

problem, and five (45.5%) had either belonged to Alcoholics Anonymous

(AA) or received treatment at one time or another. Subjects reported

living with their alcoholic parent (i.e., after the parent's drinking

first became a problem) for anywhere from 4 to 24.5 years, with 12.11

representing the mean.

The cognitive group was comprised of eight students: three

males (37.5%) and five females (62.5%). The subjects' ages ranged

from 18 to 27, with 23.5 representing the mean age. All participants

were white, and the numbers were evenly divided between undergraduate

(50%) and graduate students (50%) with four in each. Three of the

undergraduates (75%) were seniors. Half of the group members indi-

cated that their father was the alcoholic parent, while two (25%)

subjects' alcoholic parent was the mother; another two participants

(25%) reported that both parents were alcoholic. One half of the

alcoholic parents had acknowledged their drinking problem, and the

same fraction had either been a member of AA or received some other

form of treatment. The number of years that subjects reported living

with their alcoholic parents) ranged from 2 to 18 with a mean of

13.5 years.










There were 14 subjects in the delayed treatment control

group: 12 females (86%) and two males (14%). Ages ranged from 19

to 37 with the mean age being 24.1. All subjects were white, and

six (43%) were graduate students. Three (37.5%) of the eight under-

graduates were seniors. Seven (50%) of the subjects indicated that

their father was the alcoholic, whereas the mother had the drinking

problem in four (29%) cases; the remaining three participants (21%)

had both parents who were alcoholic. Over half (56%) of the parents

had acknowledged their drinking problem, and 50% had either belonged

to AA or received some other form of help. The number of years that

the subjects had lived with their alcoholic parents) ranged from

three to 21 with 11.0 being the mean number of years having lived

with the problem.


Experimental Treatment Procedure

Subjects volunteering to participate in structured group

counseling for students with a parental drinking problem were ran-

domly assigned to either the cognitive or experiential group or the

delayed treatment control group. The experimental groups were

designed to provide participants with a better understanding of

their parent's alcoholism and its effects on the family. Major

subgoals included the promotion of healthy coping attitudes and

behaviors toward parental alcoholism and the development of respon-

sible attitudes and behavior toward the use of alcohol.










Each of the two experimental treatment procedures was offered

through the University Counseling Center at 311 Little Hall. They

were run simultaneously and consisted of five weekly sessions lasting

two hours each. All cognitive group meetings were held at Little

Hall, while the experiential nature of the other group necessitated

periodic short trips into the community. Both experimental treatment

groups were led by the writer and based on the facilitative model of

teaching (Wittmer & Myrick, 1980). As group leader, the author was

supervised by Dr. Milan Kolarik, a licensed counseling psychologist

and member of the Counseling Center staff.


Experiential Group

The experiential group consisted of 11 students. They

engaged in a variety of activities addressing five major concepts

considered essential to helping participants understand and cope

more effectively with their parent's alcoholism and its effects on

the family. The activities were predominantly experiential, but

there was some discussion for planning and feedback purposes.

Activities included role-playing exercises and visiting an Al-Anon

meeting (there is no Alateen group in Gainesville). Group members

were also given the option of choosing one of the following sites to

visit and report on: (1) a local detoxification center; (2) the

alcohol treatment program at the local Veterans' Administration (VA)

hospital; (3) an open (to non-alcoholics) Alcoholics Anonymous (AA)

meeting. Expressive drawing was incorporated into the schedule of










group activities. Still another activity involved participation in

an alcohol awareness party where alcoholic beverages were consumed

(see Appendix M). Due to moral, religious or legal factors, individ-

ual drinking and/or participation was entirely optional.

Prospective group members were asked to sign an informed

consent form in accordance with the guidelines of the University

Committee for the Protection of Human Subjects. A copy of this form

appears in Appendix B. Had any group member elected not to partici-

pate in any activity, then that student would have been given an

optional activity covering the same concept. No students opted out

of participating in any scheduled group activity.

A sample outline for the experiential group is shown in

Appendix C. The five group sessions (which began the week after

protesting and individual screening interviews) are described below:

Session #1. Alcohol, alcoholism, and treatment. A brief

introduction to the format and purpose of the group was followed by

warm-up exercises to help participants begin the process of getting

acquainted. Students were presented with the option of selecting

one of the following sites to visit during the upcoming week: (1)

an "open" Alcoholic Anonymous meeting, (2) the alcohol treatment

program (in-patient) at the local VA hospital, or (3) a local

detoxification center. Literature was distributed to group members

to assist them in the acquisition of a deeper understanding of

alcohol, alcoholism, and the recovery process.










Session #2. Alcoholism and the spouse. Group participants

shared their experiences from last week's site visits, and the leader

elicited students' reactions to and feelings about their visits. The

leader emphasized the value of group members understanding the

special problems and pressures faced by the nonalcoholic spouse;

students were requested to visit an Al-Anon meeting during the week

in order to expand their awareness of the family dynamics of alcoho-

lism (leader helped arrange transportation and volunteered to

accompany anyone to any of the Al-Anon meetings scheduled for that

week). Literature relevant to this session's topic was handed out

to students.

Session #3. Alcoholism and the children; Childhood coping

patterns. Leader processed reactions of group members to last week's

visit to Al-Anon meeting. Students role played an Alateen meeting

according to official Alateen guidelines. Literature was distributed

that dealt with the effects of parental alcoholism on the children;

reading materials illustrated how the child's basic needs are

neglected in an alcoholic home. A brief presentation by the leader

(of some of the roles typically adopted by children in order to

survive living with an alcoholic parent) was followed by an expressive

drawing experience. Students were given crayons and a sheet of paper

and then asked to portray their childhood patterns) of coping by

means of a drawing.

Session #4. Healthy coping attitudes and behaviors. Group

members acted out role-play vignettes designed to elicit discussion











of healthy coping attitudes and behaviors (see Appendix D). Leader

supported the process of participant sharing of personal reactions

to role plays. Information relating to this topic was passed out at

end of session.

Section #5. Responsible behavior toward alcohol; Responsible

drinking behavior; Wrap-up. Group members planned and attended a

responsible drinking party (see Appendix M). The University Police

Department provided a breath analyzer that enabled students to monitor

the level of their Blood Alcohol Content (BAC). Students supplied

food, drinks (both alcoholic and nonalcoholic), ice, and mixers.

Following the party, reactions to the experience were processed by

the leader; participants then engaged in role-play vignettes dealing

with the topic of responsible drinking behavior (see Appendix E).

Attention focused on the drinker's role in enjoying alcoholic bever-

ages at a party without experiencing negative consequences.

After a final processing of members' reactions to and

feelings about the entire structured group counseling experience,

the Student Drinking and Information Scale and the Parental Alcoholism

Information Survey were distributed to students to be filled out and

returned within a few days.

The total time allowed for the various field activities was

limited to two hours (including any group time spent at Little Hall)

in order to coincide with the amount of time allotted for the

cognitive group.











Cognitive Group

The cognitive group was comprised of eight students. This

experimental group relied heavily on small group discussion of the

five major concepts discussed above. Lectures delivered by the

writer and guest speakers were used along with films (see Appendix

F) as the principal means of introducing discussion topics. Values

Clarification (see Appendix G), which asked students to rank a series

of drinking situations according to the criterion of responsible

behavior, was also used to facilitate discussion. The complete out-

line for the cognitive group is shown in Appendix H. The five group

sessions are described below:

Session #1. Alcohol, alcoholism, and treatment. Facts about

alcohol, alcoholism, and recovery were covered in the film, Chalk

Talk (see Appendix E and Note 7). These topics were also addressed

by a guest speaker from the North Central Florida Community Alcohol

Program. A question-and-answer period and group discussion followed

the film and lecture. Literature relating to the content of the

session was distributed at the end.

Session #2. Alcoholism and the spouse. The film (which

portrays life in an alcoholic home with special focus on the spouse),

If You Loved Me (see Appendix F and Note 8), was shown. This was

followed by a discussion of the special problems and pressures faced

by nonalcoholic family members. Al-Anon literature was made available

to all participants.










Session #3. Alcoholism and the children; Childhood coping

patterns. The film (which depicted the plight of children of an

alcoholic father), Soft Is the Heart of a Child (see Appendix F and

Note 9) was presented and followed a guest speaker from Al-Anon.

The group leader (author) then delivered a mini-lecture on various

roles adopted by children in order to survive growing up in an

alcoholic family. There was further discussion, and the group ended

with the circulation of Alateen literature and handouts on childhood

coping patterns and their sequelae.

Session #4. Healthy coping attitudes and behaviors. There

was a mini-lecture by the leader on ways of students coping with the

present and future stresses arising from their parent's alcoholism.

Also, a guest speaker from the University of Florida Counseling Center

staff discussed the option of receiving individual counseling (for

the purpose of demystifying the process). There was then a time for

group discussion and literature on how to cope effectively with an

alcoholic parent was distributed.

Session #5. Responsible behavior toward alcohol; Responsible

drinking; Wrap-up. The session began with a brief film dealing with

alcohol and the issue of responsible drinking, entitled Booze and

Yous (see Appendix E and Note 10).. A guest speaker from the University

of Florida Alcohol Abuse Prevention Program then discussed the

following issues: (1) Deciding whether or not to drink in social

settings in order to minimize problems created by drinking, (2) The










drinker's role in enjoying alcoholic beverages at a party without

experiencing negative consequences. Discussion and values clarifi-

cation were used by the guest speaker. Literature on alcohol use

and responsible drinking was circulated and then the two measurement

instruments (SDIS and PAIS) were distributed to all group members to

fill out and return within a few days. This last session ended with

the sharing of feedback concerning members' reactions to the entire

structured group counseling experience.

It is important to mention here that both experimental groups

received identical literature at the end of each session. However,

the formats and processes used by the two groups to address the same

content issues were clearly quite different.


Instrumentation

Two criterion instruments were used to test the research

hypotheses. The first is divided into eight sections; it contains

scales designed to measure a student's knowledge, attitudes, and

behavior in relation to the use of alcohol. Preceding these three

scales are sections which collect demographic data and other infor-

mation contributing to a fuller understanding of the respondent's

drinking behavior (including a quantity-frequency index for

operationally defining a student's drinking level). This initial

instrument concludes with a brief section of questions for non-

drinkers. The second instrument was developed solely for use with

individuals of alcoholic parentage. It contains three scales

measuring knowledge, attitudes, and behavior in connection with











parental alcoholism and its effects on the family. These scales are

preceded by a fourth section which collects demographic data. The

following chart lists the seven dependent variables and the corres-

ponding instruments used to measure them. Each of these instruments

is described in detail below.


Dependent Variables

1. Knowledge of alcohol use


2. Responsible attitudes
about drinking

3. Negative behavioral
consequences experienced
as a result of drinking

4. Reported alcohol
consumption


5. Knowledge of alcoholism
and its effects on the
family

6. Healthy attitudes for
coping with parental
alcoholism

7. Healthy behavior for
coping with parental
alcoholism


Measurement Device

1. Student Drinking Information
Scale (SDIS). Section V

2. SDIS (Section VI)


3. SDIS (Section VII)



4. Quantity-Frequency Index
(included in questions 16-20
of Section I of SDIS)

5. Parental Alcoholism Informa-
tion Survey (PAIS) Section II


6. PAIS (Section III)



7. PAIS (Section IV)


Student Drinking Information Scale

The Student Drinking Information Scale (SDIS) (see Appendix I)

was developed by G. M. Gonzalez, Coordinator of the Alcohol Abuse

Prevention Program at the University of Florida. It represents a











revised version of Gonzalez's Student Drinking Questionnaire

(Gonzalez, 1978). The SDIS was designed to measure college students'

knowledge about alcohol (Section V), attitudes about drinking (Section

VI), and negative behavioral consequences experienced as a result of

drinking (Section VII). In addition to eliciting more information

from the respondent concerning such areas as personal drinking history,

situational factors that affect the amount of alcohol consumed, and

reasons for drinking, this self-report measure is an improvement over

the SDQ by virtue of its inclusion of a quantity-frequency (Q-F)

index. The Q-F Index is valuable because it makes it possible to

operationally define and categorize the respondent's drinking behavior.

The final section of the SDIS queries nondrinkers concerning the

factors that have influenced their decision to abstain; additional

questions are aimed at acquiring a clearer comprehension of the

perceptual vantage point of nondrinking college students. In this

study, only data gathered from Sections V, VI, and VII and questions

relating to the Q-F Index (questions 16-20) were subjected to statis-

tical analysis.

Knowledge Scale. Section V consists of 12 factual statements

designed to tap the respondent's knowledge of alcohol use. Students

may answer true, false, or don't know (this last category is intended

to discourage guessing). The range of scores is 12-0, and it is

computed by simply adding up the total number of correct (true)

responses. Examples of the true-false statements are: "A person can











become an alcoholic by just drinking beer," "Drinking coffee or

taking a cold shower can be an effective way of sobering up."

Attitude Scale. The scale contained in Section VI, which may

also be referred to as the responsibility-irresponsibility scale, was

used in Hypotheses 3 and3Aof this study. It consists of 20 state-

ments concerning responsible behavior in relation to alcohol use.

Fifteen of these statements are positively expressed and depict

responsible behavior.

This Likert-type attitude measurement scale assesses the

degree of the respondent's responsible attitudes. In response to

each behavior listed, students answer in terms of how likely they

are to act in the indicated manner by selecting any of five responses

for each item: very likely, likely, somewhat likely, unlikely, or

very unlikely. A "very likely" response to one of the 15 statements

of responsible behavior receives a score of 5, whereas a "very

unlikely" answer would yield a score of 1. Examples of positive

statements are: "Set limits on how many drinks you are going to have

on a night out or at a party," "respect a person who chooses to

abstain from drinking alcohol." Examples of negative statements are:

"gulp drinks for the stronger effect that rapid drinking produces,"

"drink alone from a desire to escape boredom or loneliness," The

items representing irresponsible behavior are inversely weighted.

The range of scores for this 20-item scale is 100-20, with the higher

score indicating greater responsibility.










Negative Consequences Scale. The negative consequences

resulting from the use of alcohol were measured by the Negative

Consequences scale for use in Hypotheses 4 and 4A of this investiga-

tion. This third major scale appears in Section VII. It lists 20

behaviors which are descriptive of specific negative consequences

that sometimes occur as a result of the misuse of alcohol. Respon-

dents are requested to indicate how many times they have experienced

each consequence as a result of drinking. Examples of these

consequences are: "I have had a hangover," "I have drunk while

driving."

The response choices are: never, once, twice, three times,

four times, or five times or more. The value assigned each response

ranges from 0 for "never" to 5 for "five times or more," thereby

yielding a theoretical scoring range of 0-100 for this 20-item scale;

the higher score indicates greater negative behavioral consequences.

The items on this scale as well as those on the knowledge scale

originally came from the Student Alcohol Questionnaire (Engs, 1977).

Quantity-Frequency Index. Reported alcohol consumption by

the respondents was measured by the Quantity-Frequency (Q-F) Index

in Hypotheses 1 and 1A of this study. The Quantity-Frequency Index,

which was developed by Strauss and Bacon (1953), estimates the amount

of alcohol an individual typically consumes by multiplying the

reported amount usually drunk by the reported frequency of drinking

over a stated period. The Q-F Index was adapted for use in later

research by Persky (1979).











Items 15, 16, 17, 18, 19, and 20 on the SDIS were used to

determine a respondent's Q-F Index in this study. The response on

item 15 determined whether the response to item 16, 17, 18, or 19

was multiplied times the response to item 20 to compute the Q-F Index.

Responses "a" (beer), "b" (wine), "c" (mixed drinks) on item 15 were

matched with items 16, 17, and 18, respectively. A response of "d"

(straight liquor) was paired with item 19 to calculate the indivi-

dual's Q-F Index.

Items 16, 17, 18, and 19 indicated the alcoholic beverage

preferred by the respondent and the quantity of that beverage

consumed by the respondent. The responses for each item were

weighted (with increasing values from "a" to "e") in the following

manner:

a. Do not drink = 0

b. 1 or less = 1

c. 2 or 3 = 3

d. 4 or 5 = 5

e. 6 or more = 7

This quantity was then multiplied by the respondent's score

on item 20 (which determined the frequency of drinking). The fre-

quency score on item 20 was calculated on a per-month basis:

a. once a month or less = 1

b. 2 or 3 times a month = 3

c. once a week = 4











d. 2 times a week = 8

e. 3 times a week = 12

f. 4 or more times a week = 16

The product represented the respondent's Q-F Index.

Reliability. Reliability of the knowledge, attitude, and

behavior scales of the SDIS comes from data collected when these

scales comprised the SDQ. The attitude and behavior sections of the

SDIS are identical to those in the SDQ; however, the attitude scale

of the SDIS contains only 12 of the 30 factual statements that

originally appeared in the SDQ. The reliability of the three scores

reported by the SDQ was obtained from the evaluation of a random

sample of 499 college students from six Southern colleges and univer-

sities. The Spearman-Brown analysis was used to establish split-half

reliability, and it yielded coefficients of .79 for the responsibility

scale, .73 for the knowledge scale, and .91 for the consequences

scale (Gonzalez, 1978).

Test-retest reliability was established by using a sample of

83 to 87 University of Florida students. The SDIS was administered

on two different occasions separated by an interval of 4 to 5 weeks.

The Pearson Correlation coefficients achieved by this process were:

r = .79 for the quantity-frequency scale; r = .94 for the responsi-

bility scale; r = .97 for the knowledge scale; and r = .81 for the

consequences scale. All of the coefficients are satisfactorily high.




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