Alcoholism in family systems refers to the conditions in families that enable alcoholism and the effects of alcoholic behavior by one or more family members on the rest of the family. Mental health professionals are increasingly considering alcoholism, substance abuse, and addiction as diseases that flourish in and are enabled by family systems.

Family members react to the alcoholic with particular behavioral patterns. They may enable the addiction to continue by shielding the addicted family member from the negative consequences of their actions. Such behaviors are referred to as codependence. In this way, the alcoholic is said to suffer from the disease of addiction, whereas the family members suffer from the disease of codependence. While it is recognized that addiction is a family disease affecting the entire family system, "the family is often ignored and neglected in the treatment of addictive disease." Each member is affected and should receive treatment for their benefit and healing, but in addition to benefitting the individuals themselves, this also helps to support the addicts in their recovery process. "The chances of recovery are greatly reduced unless the co-dependents are willing to accept their role in the addictive process and submit to treatment themselves."(Gorski, 1993; Liepman, Keller, Botelho, et al., 1998) "Co-dependents are mutually dependent on the addict to fulfill some need of their own."

For example, the "Chief Enabler" (the main enabler in the family) will often turn a blind eye to the addict's drug/alcohol use as this allows for the enabler to continue to play the victim and/or martyr role while allowing the addict to continue his/her own destructive behavior. Therefore, "the behavior of each reinforces and maintains the other, while also raising the costs and emotional consequences for both."

Alcoholism is one of the leading causes of a dysfunctional family. "About one-fourth of the U.S. population is a member of a family that is affected by an addictive disorder in a first-degree relative."(Liepman, Parran, Farkas, et al., 2009) As of 2001, there were an estimated 26.8 million children of alcoholics (COAs) in the United States, with as many as 11 million of them under the age of 18. Children of addicts have an increased suicide rate and on average have total health care costs 32 percent greater than children of nonalcoholic families.

According to the American Psychiatric Association, physicians stated three criteria to diagnose this disease:

physiological problems, such as hand tremors and blackouts psychological problems, such as excessive desire to drink behavioral problems that disrupt social interaction or work performance.

Adults from alcoholic families experience higher levels of state and trait anxiety and lower levels of differentiation of self than adults raised in non-alcoholic families. Additionally, adult children of alcoholics have lower self-esteem, excessive feelings of responsibility, difficulties reaching out, higher incidence of depression, and increased likelihood of becoming alcoholics.

Parental alcoholism may affect the fetus even before a child is born. In pregnant women, alcohol is carried to all of the mother's organs and tissues, including the placenta, where it easily crosses through the membrane separating the maternal and fetal blood systems. When a pregnant woman drinks an alcoholic beverage, the blood alcohol content of her unborn baby is the same level as her own. A pregnant woman who consumes alcohol during her pregnancy may give birth to a baby with fetal alcohol syndrome (FAS). FAS is known to produce children with damage to the central nervous system resulting in general growth deficits and craniofacial abnormality. As of 2009, the prevalence of the syndrome was thought to be between 2–5 per 1000.

Alcoholism does not have uniform effects on all families. The levels of dysfunction and resiliency of non-alcoholic adults are important factors in effects on children in the family. Children of untreated alcoholics have lower measures of family cohesion, intellectual-cultural orientation, active-recreational orientation, and independence. They have higher levels of conflict within the family, and many experience other family members as distant and non-communicative. In families with untreated alcoholics, the cumulative effect of the family dysfunction may affect the children's ability to grow in developmentally healthy ways.

Family roles

The role of the "Chief Enabler" is typically the spouse, significant other, parent, or eldest child of an addict or alcoholic. This person demonstrates "a strong tendency to avoid any confrontation of the addictive behavior and a subconscious effort to actively perpetuate the addiction." The "Chief Enabler" also often doubles as the "Responsible One", or "Family Hero", another role assumed by family members of the addict. Both the "Chief Enabler" and "Responsible One" (aka "Model Child") will take "over [the addict's] roles and responsibilities". For example, a parent might pay for expenses and take over responsibilities (i.e. car payments, the raising of a grandchild, provide room and board, etc.), while a child may provide care for their siblings, become the "peacekeeper" in the home, take on all the chores and cooking, etc. A spouse or significant other may overcompensate by providing all the care to the children, being the sole financial contributor to the household, covering up or hiding the addiction from others, etc. This role often receives the most praise from non-family members, causing the individual to struggle to see that it is an unhealthy role that contributes to the addict/alcoholic's disease as well as the family's dysfunction.

Another role is that of the "Problem Child" or "Scapegoat." This person "may be the only [one] clearly seen as having a problem" outside of the actual addict or alcoholic. This child (or adult child of the alcoholic) "gets blamed for everything; they have problems at school, exhibit negative behavior, and often develop drug or alcohol problems as a way to act out. Their behavior demands whatever attention is available from parents and siblings." This often "takes the focus off the parental alcohol problem", and the child can be the "scapegoat" under the misconception that the child's behavior fuels the parent's substance abuse. However, this child draws attention from outsiders, which may contribute to the recognition of the family alcohol problem by outsiders.

The "Lost Child" role is identified in this system through children that are "withdrawn, 'spaced-out,' and disconnected from the life and emotions around them." They often avoid "any emotionally confronting issues, [and so are] unable to form close friendships or intimate bonds with others."

Other children "trivialize things by minimizing all serious issues as an avoidance strategy [and] are well-liked and easy to befriend but are usually superficial in all relationships, including those with their own family members." These children are known as the "Mascot" or "Family Clown".

However, alcoholic family roles have not withstood the standards or testing that psychological theories of personality are typically subjected to. The evidence for alcoholic family roles theory provides limited or no construct validity or clinical utility.

Prevalence

Based on the number of children with parents meeting the DSM-V criteria for alcohol abuse or alcohol dependence, there were an estimated amount of 26.8 million children of alcoholics (COAs) in the United States as of 1996, of which 11 million were under the age of 18. In 1988, it was estimated that 76 million Americans, about 43 percent of the U.S. adult population, have been exposed to alcoholism or problem drinking in the family, either having grown up with an alcoholic, having an alcoholic blood relative, or marrying an alcoholic. While growing up, nearly one in five adult Americans (18 percent) lived with an alcoholic. In 1992, it was estimated that one in eight adult American drinkers were alcoholics or experienced problems as a consequence of their alcohol use.

Familiarity Children of alcoholics (COAs) are more susceptible to alcoholism and other drug abuse than children of non-alcoholics. Children of alcoholics are four times more likely than non-COAs to develop alcoholism. Both genetic and environmental factors influence the development of alcoholism in COAs.

COAs' perceptions of their parents' drinking habits influence their own future drinking patterns and are developed at an early age. Alcohol-related expectancies are correlated with parental alcoholism and alcohol abuse among their offspring. Problem-solving discussions in families with an alcoholic parent contained more negative family interactions than in families with non-alcoholic parents. Several factors related to parental alcoholism influence COA substance abuse, including stress, negative affect and decreased parental monitoring. Impaired parental monitoring and negative affect correlate with COAs associating with peers that support drug use.

After drinking alcohol, sons of alcoholics experience more of the physiological changes associated with pleasurable effects compared with sons of non-alcoholics, although only immediately after drinking.

Compared with non-alcoholic families, alcoholic families demonstrate poorer problem-solving abilities, both between the parents and within the family as a whole. These communication problems may contribute to the escalation of conflicts in alcoholic families. COAs are more likely than non-COAs to be aggressive, impulsive, and engage in disruptive and sensation-seeking behaviors.

Alcohol addiction is a complex disease that results from a variety of genetic, social, and environmental influences. Alcoholism affected approximately 4.65 percent of the U.S. population from 2001 to 2002, producing severe economic, social, and medical ramifications. Researchers estimate that between 50 and 60 percent of alcoholism risk is determined by genetics. This strong genetic component has sparked numerous linkage and association studies investigating the roles of chromosomal regions and genetic variants in determining alcoholism susceptibility.

Marital relationships

Alcoholism usually has strong negative effects on marital relationships. Separated and divorced men and women were three times as likely as married men and women to say they had been married to an alcoholic or problem drinker. Almost two-thirds of separated and divorced women and almost half of separated or divorced men under age 46 have been exposed to alcoholism in the family at some time.

Exposure was higher among women (46.2 percent) than among men (38.9 percent) and declined with age. Exposure to alcoholism in the family was strongly related to marital status, independent of age: 55.5 percent of separated or divorced adults had been exposed to alcoholism in some family member, compared with 43.5 percent of married, 38.5 percent of never married, and 35.5 percent of widowed persons. Nearly 38 percent of separated or divorced women had been married to an alcoholic, but only about 12 percent of currently married women were married to an alcoholic.

Children

Prevalence of abuse Over one million children yearly are confirmed as victims of child abuse and neglect by state child protective service agencies. Substance abuse is one of the two largest problems affecting families in the United States, being a factor in nearly four-fifths of reported cases. Alcoholism is more prevalent among child-abusing parents. Alcoholism is more strongly correlated to child abuse than depression and other disorders.