In addition, some of the characteristics of at-risk children have become known, and that knowledge opens up a host of possibilities using other research approaches, such as electrophysiological testing to identify who is at risk as done by Henri Begleiter, Bernice Porjesz, Cindy Ehlers, and Shirley Hill. Overall, COA research today might be divided into two categories. Other laboratories have been interested in identifying differences in additional domains.
Although these findings are interesting, they are difficult to interpret. Some of these differences relate to factors that impact characteristics such as impulsivity, and some very interesting leads have emerged in this area. In addition, some very technical chemical findings have come forth, such as variations in the activity levels of the enzyme monoamine oxidase, which plays a role in the breakdown of important neurotransmitters thought to influence mood and behavior.
A second category of COA research involves longitudinal studies. These investigations follow up on the findings from cross-sectional results to see whether the risk-related characteristics identified in those studies actually predict alcoholism. To my knowledge, only three major longitudinal COA studies currently exist, of which ours Schuckit and Smith is the largest. In our work, out of men Response to alcohol does not operate alone, however, and during our year followup, we are interested in finding other characteristics that might add to or detract from the ability of the low response to alcohol to lead to alcoholism.
An additional factor that has increased the sophistication of COA research is the availability of new and sometimes expensive techniques to perform these studies, using advances in brain imaging, neurochemistry, and statistical methods.
The overall result has been a nearly exponential increase in study sophistication, making COA research an exciting field to be in. A particularly notable milestone in this literature involves the increasing emphasis on describing mediators and moderators of risk and testing models concerned with how the risk-outcome relationship is explained i.
To a significant extent, this work has been spearheaded by the theoretical and empirical studies of Sher and colleagues Sher ; Sher et al. Most of these efforts have focused on three general mediator mechanisms i. Sher and Windle and Searles assessed the state of COA literature and pointed out directions for future research, and Zucker proposed a developmental perspective on COA risk. The research agenda set out in these publications illustrates many of the features or, at least, aspirations of current COA studies.
Contemporary studies also are characterized by numerous methodological improvements. For example, researchers are paying greater attention to sampling strategies e. As another noteworthy improvement, researchers have expanded the guiding conceptual frameworks of their studies to consider biopsychosocial models. Rather than positing a competition between biological and environmental causes, investigators are now accepting the need to examine the interrelation and interaction among multiple risk factors and levels of analysis.
We are recognizing that numerous pathways underlie risk and resilience. Researchers also are conducting more longitudinal studies that use a developmental framework to assess outcome models with multiple variables. In addition, researchers are taking advantage of innovations in quantitative methods to test these complex, multivariate, longitudinal models more appropriately.
Researchers are trying to sort out how risk is fulfilled or avoided in these groups and determine how risk changes over time. Achieving scientifically accurate predictability could help direct how we apply limited prevention dollars. As already noted, some of the more recent COA studies have benefited enormously by introducing the methodological perspectives of the developmental psychology and developmental psychopathology fields, where the question of continuity and discontinuity of normal and problem behaviors has been examined.
Unfortunately, not all COA studies have incorporated such developmental perspectives, and these studies continue to muddy the field. Because children of different ages and stages vary qualitatively and quantitatively, research design and methodology must be adjusted appropriately.
Sher: From my perspective, COA research is part of the much larger issue of the effect that parental variables e. Increasingly, people recognize that alcoholism is not a single discrete entity that can be studied outside of a larger social context. In addition, people realize that environmental and genetic effects are not easy to disentangle. The persistence of alcohol problems in the face of life roles that are incompatible with abusive drinking patterns probably represents a particularly severe form of alcoholism.
Most important, we want to examine the course of alcoholism from adolescence through young adulthood, particularly to try to identify individual and relationship variables that characterize different developmental pathways. This is an important age period, because we can now begin to examine the adolescent antecedents of substance abuse and dependence outcomes. We also are beginning an investigation of the young offspring of the young adults in our study.
By extending our research to another generation, we are coming full circle developmentally to examine some of the early temperamental underpinnings of risk. Sher: In my own research, I am currently studying the factors that influence the course of alcohol use disorders in early adulthood. I am particularly interested in how various courses of alcoholism e. In addition, I am interested in examining how these variables and transitions work independently and in interaction with each other to determine the course of alcohol use disorders.
These disorders may be time limited, episodic, or chronic, yet we know very little of what factors differentiate them. Certainly many potentially important findings have emerged, but their ultimate significance is still unknown. Perhaps the most important finding is the fact that both alcoholics and their children represent extremely diverse groups and any generalizabilities about them are likely to be of limited validity.
Johnson: I think a great achievement has been the refinement of methodological techniques and increasing understanding of the complexities involved in conducting developmental research. Johnson: There are three possible directions for COA research. The first is to continue as we have, completing cross-sectional studies that eventually will give us some limited information about small COA subgroups.
These studies can be useful, especially if they are done well and are culturally and developmentally appropriate. The problem with this type of research, however, is that it takes a lot of time and imagination to try to piece this mosaic of studies together to create a recognizable picture of a developmental trajectory of high-risk children.
Second, COA research could analyze existing longitudinal data sets. Although the problems of identifying parental history in these data sets may not be trivial, this approach is worth a try, given that research dollars for longitudinal studies appear limited.
A third direction COA research might take is to conduct intensive studies of children at risk and extensively examine them during pubertal transitions and into adolescence using genetic, environmental, and behavioral research techniques. We know that rapid biological, physiological, and psychological changes occur simultaneously during this period.
Chassin: Telling the future is a tough assignment! I think that future directions will continue the trends of recent work. That is, because we have barely begun to scratch the surface in terms of empirically testing multivariate models of COA risk and resilience, I think that future research will continue to broaden multidisciplinary perspectives, integrating designs that have been used in the past by diverse groups working in isolation e.
This trend probably will be reinforced by changes at NIH [the National Institutes of Health] to review all research grants across the board, not simply within each Institute, which will emphasize the value of a multidisciplinary perspective. I also think that because we have a much greater understanding both conceptually and in terms of data analysis of what is required to empirically test mediational models, we will see more sophisticated work in this area.
In terms of psychosocial research, I think the level of analysis will broaden somewhat to include more community-level variables and demographic diversity as well as more rigorous attempts to evaluate preventive interventions. Jacob: For much of the past two decades, family studies of alcoholism have been conducted by two relatively nonoverlapping research groups.
One group consists of psychosocial researchers interested in family environmental variables e. The other research group consists of behavioral geneticists interested in estimating genetic contributions to alcoholism risk and in differentiating the remaining environmental influences into influences shared among siblings in the same family and influences unique to each sibling Jacob and Leonard ; McGue A rich literature of theory and findings has developed from the first research tradition, which has offered increasingly sophisticated models of alcoholism etiology; defined a number of key mediator and moderator mechanisms that may account for or qualify the impact of family history risk on offspring outcome; and produced a number of high-quality, longitudinal data sets for testing alternative models of mediation and moderation.
The major shortcoming of this research is one of indeterminacy or ambiguity of findings, however, because all efforts along this line have involved passive longitudinal designs i. In contrast, behavioral genetic studies of the past 20 years have offered an increasingly persuasive argument that genetic influences ultimately account for 50 to 60 percent of the variance in alcoholism risk and that shared family environmental effects can only partly explain the remaining variance.
At the same time, the strength of this conclusion and the extant behavioral genetic literature on alcoholism reflect several notable limitations. First, family and nonshared environmental influences have been poorly articulated and measured by behavioral geneticists. Second, we know very little about how environmental influences mediate and moderate genetic effects i. Third, researchers have not explored the impact of childhood and young adult events and behaviors e.
In particular, such efforts will need to learn more about gene-environment correlations and interactions that characterize the development and expression of alcoholism, drawing on highly informative behavioral-genetic research designs. Beyond simply estimating the strength of genetic-environmental influences, however, I hope that future research can identify and clarify genetically and environmentally based influences that account for the manner by which a family history of alcoholism predisposes people to alcoholism outcomes and that increase or decrease the likelihood of adverse outcomes among high-risk individuals.
Schuckit: In the future, COA research will continue to place more emphasis on longitudinal studies measuring multiple domains simultaneously. We also will expand our measures of environmental influences. In addition, as we make progress in understanding specific genes that influence the risk for alcoholism, we hope to develop more precise prevention strategies by molding programs to meet the specific vulnerability involved.
Because alcoholism is such a complicated disorder, however, I think it is unlikely that we will reach the point where we know that a certain characteristic definitely will lead to alcoholism. To produce this syndrome, many different biological characteristics interact with the environment, and each one explains a relatively small proportion of the risk. We are becoming increasingly sophisticated in our understanding of the biological characteristics of alcoholism, and we are also increasing the sophistication of our understanding of environmental factors.
At this point, we can identify who is at higher or lower risk, but we cannot say absolutely who will and who will not develop alcoholism. This realization is humbling, but it is also reassuring in that it is unlikely that specific findings can be used to discriminate against people e. Nevertheless, in the final analysis, the more we know about each factor that enhances the risk of alcoholism, the greater our ability to develop more effective prevention methods will be.
Codependency also has been noted as a pattern of immature adaptive mechanisms that frequently exists in alcoholics, their spouses, and their children Cermak National Center for Biotechnology Information , U. Alcohol Health Res World. Mary Beth de Ribeaux. Author information Copyright and License information Disclaimer. Copyright notice. Unless otherwise noted in the text, all material appearing in this journal is in the public domain and may be reproduced without permission.
Citation of the source is appreciated. There was no significant difference in the level of codependency between age and ethnic groups. Contrary to expectations, a higher proportion of males was classified in the two highest categories of codependency. A small correlation was found between scores on the Codependency Self-Inventory Scale and codependency measured by the characteristics of the students' significant relationships.
The implications for counseling college students are considered. One of the only attempts to investigate codependency in a college population was reported by Hewes and Janikowski Using a sample of 76 female undergraduates attending a small residential college in the eastern part of the U.
These researchers expected the children of alcoholics COAs to score higher on their measure of codependency, in that many of the very problems exhibited by children of alcoholics "have been used as operational definitions of codependency" p. Interestingly, the only significant finding reported was that the underclass women who were children of alcoholics had lower codependency scores.
Hewes and Janikowski argue that more research on codependency is needed on college age populations, including males, so that counselors may develop intervention and prevention strategies with regard to a number of problems of adjustment associated with codependency. The term codependency has been given a wide range of meanings. It has been defined as an addiction Weyscheider-Cruse, ; Schaef, ; Whitfield, ; the underlying cause of chemical addictions Bradshaw, and; the result of someone else's addiction Larsen, ; Schaef, In fact, Cermak , p.
Codependency, as a concept, evolved from the literature of the 's and 's on alcohol and drug treatment. It was theorized that the non-addicted spouse or lover indirectly encouraged continued chemical abuse in order to meet her or his own needs. Al-Anon began as part of Alcoholics Anonymous AA in the early 's as a 12 step, self-help group for those in relationships with alcoholics
I'm trying to find the word "Normal" in my alky dictionary I'm stressed In the infamous words of Naomi Judd "Normal is the cycle on a washing machine". How 'bout UN-unique, then? Me thinks that Tenderheart, hit it on the head Washing machine? Ive seen pictures Up here Redneck country? We use these 2 by 3 boards that have bumps on them Then we have clotheslines made of bindertwine In the winter? Its a bitch tryin to get clothes on eh As for un Im still trying to figure out what the hell Youre right Dean And it talks about it in the 12 and Wants and needs that we are looking to be fullfilled and arent A lot of us are incapabable of having true honest relationships And it all has to do with codependency How can we have a true relationship with someone else Theres no way in Hell its going to work Have a good night bud There is some much info in that book that you can read it times and come away with different stuff every time.
A step meeting will get through the book 4 times in a year and I think I've been thru it 50 times. All Thru the AA program there are tid bits about relationships but because of the typical group conscience, It's not really allowed to be discussed because "It doesn't directly pertain to alcohol" and generally the "Old timers" will put a stop to it. It's easy to see why if they are living alone, what's to talk about? I was very fortunate, when I was first getting sober, to have an AA club that allowed Coda to have meetings there.
I'm very certain that my relationship issues were keeping me from getting sober It's our 1 problem besides picking up a drink the two years that I was in and out. I could fill pages on end with what I learned there and by reading John Bradshaw books but this is not the place to do it. That said, I urge all recovering AA's with some time under their belt to try the Coda program and see if it can make a difference.
It sure has for me. Date: Oct 1, StPeteDean wrote: It's funny that the typical response by AA's to codependency issues is "sounds familiar but no too much", but seems to me like most AA's have a lot of relationship problems and are generally single and lonely. Or are you taking my inventory?
Seems to me the BB talks about alcoholics on ALL levels, from the binging stay at home Mom to the bum with the brown paper bag, therefore, we all may have the same afflication, but we each have different symptoms! I've been reading up on co-dependency, from a clinical point of view, NO human being is immune. Doll wrote: Am I a bit oversensitive this morning? I started attending Coda and ACOA meetings in and my comments were based on my observations over that last 17 years.
And you are correct, this is a condependent society that we live in and we are literaly brainwashed into it with music, tv, the greating card industry ect So yes, to some extent we are all a bit codependent, but alcoholics more so than "earth people".
I had two alcoholic parents so I didn't stand a chance. John Bradshaw's group workships over the past couple decades has discovered that "Adult Children" and Codependents come from families with all sorts of parental issues such as Parents that were work-a-holics, gamblers, religeous addicts, sex addicts This next generation will have dysfunctional children from the parents being video game addicts, and Internet addicts.
StPeteDean wrote: No not at all. Sorry, friend, but 17 years or 27 or in any group coda, AA, NA, GA, or whatever doesn't qualify you, or anyone else, to diagnose me As you well know, I am struggling right now and my comments and questions to Phil were sincere. Lord knows I don't need anymore than I've got on my plate right now, so your comments and yes, I believe they were directed at me, if I'm wrong, then my apologies were not necessary nor welcomed by me, first thing this morning One of the first things I learned as a small child - when you point a finger at someone else, you have 3 pointing back at yourself.
Noone is pointing fingers We just share what we have gone through and pass our experience on to others with love As we do with you I know youre hurting And Honestly? Its no damned fun Im going through it too Ide like nothing better then to strike out.. But I cant And yes Because weve been there Itll be ok Love yu. Date: Oct 2, Experience is well accepted and very much appreciated, however, I'm just asking that "we honor the house we're in".
Ok, let me expand on what I meant by "No not at all". My comments were not directed at anyone. Not there is anything wrong with that, they seem to do very well at it. But It's phenominal that when a number of these AA's with 5,10,15 years get's into a serious relationship, it causes them to drink and unfortunately some of those wind up taking their own life over it. With that said, simple logic would indicate to me that the AA program doesn't do a very good job at teaching us how to have sucessful relationships.
The views expressed above are only my opinion and certainly not intended to catagorize anyone in particular, especially since I don't know anyone on this board personally. I'm also happily married 14 years now and the father of a 3rd year college student that I raised as a single parent, and own a successful business that I started when I got sober in ' Sorry for tooting my own horn, my point is that I don't beleive that I could have even stayed sober if I hadn't stumbled into a Coda meeting by accident because my relationship skills were soooo bad that I was having trouble with AA, work, parents I can't even imagine being able to have relationships with customers and employees without the skills that I learned in Coda, and getting the chip off both my shoulders in Acoa.
I hope my comments only reason for them will encourage some others to take a look at Coda after getting a good AA program to see if it can help you. Date: Oct 4, I'd love to be able to learn how to express myself in a 'To thine own self be True' kinda way but my fear of people gets in the way. I'm sure there's a way to learn compromise as I'd like to hold with the 'an AA crawls before no-one' adage too tho I can't quite grasp that yet. It would be nice to accept that others can adapt to me as much as likewise.
I speak purely for myself. When behaviors are emphasized more then core identity and worth, with a lack of emphasizing the preciousness of a child, a child will learn to outwardly perform, while inwardly feeling lost and empty. This will last and develop through adulthood. This same person will enter into relationships in order to allow his or her identity to become enmeshed in another person. This entanglement will be so extreme in some cases that he or she will be unable to think or feel outside of that other person.
He or she will also feel responsible for that person and become obsessed with helping that individual and meeting his or her needs. In doing so, he or she will indirectly attempt to have their personal needs met. Lack of Boundaries In defining codependent behavior, a lack of boundaries is usually one of the main ingredients. A lack of boundaries is similar to a lack of identity.
Lack of boundaries produces disrespect in relationships and the willingness to allow other people into areas they should not be. Learning boundaries takes time and work. First, a codependent person must understand who he or she is and what he or she stands for. Then, that person must learn to make a stand for those things her or she represents.
We must choose wisely those people in our life. When dealing with unhealthy family members, we can learn to establish healthy and safe boundaries, while still displaying genuine love. The root of this behavior is normally formed from years if a child did not properly bond with a parent or caregiver. It also could be caused by a parent who overly bonded and did not know how and when to let go. The purpose is to properly address those issues, not to blame. Ultimately, healing will come through forgiveness.
Remember, forgiveness and acceptance of behaviors are two entirely different things. We forgive people, not behaviors. Need to Control A codependent person was normally programmed in an environment that was out of control Because of this, he or she developed survival skills in order to maintain a sense of control. As a result, a codependent will often manipulate people and circumstances to get a desired result, often in a subtle and indirect way.
The only cure for such behaviors is learning to trust that God is in control and has complete sovereignty over everything and everyone. Sometimes, a person needs to learn the belief systems that interferes with the ability to trust God and people. One of these is that chemically addictive people are often irresponsible. Often in doing this, the codependent person is neglecting his or her own responsibilities.
By not allowing a person to suffer the consequences of their irresponsible behavior, the cycle of an addiction will oftentimes not end. Setting boundaries against this behavior is essential. A codependent person must also learn that each individual is alone responsible for his behavior. While we respect and submit to each other, we should not tolerate and encourage wrongful behaviors. Perfectionism Perfectionism is the inability to see anything except in extremes.
It is important to understand that meeting a standard of perfection in the things we do is often impossible. Simply put, we are imperfect people. Trying to adhere to rigid rules perfectly and holding other people to high standards is devastating on relationships. The reason a person is a perfectionist is often rooted in a family where much criticism took place. Perhaps performance was emphasized more then anything else, with little or no affirmation for the attempts to do anything right.
Perfectionism breeds self-righteousness and pride, very difficult behaviors to overcome as they blind the ability for person to see himself or herself clearly. When we feel accepted as we are, we will accept others for who they are. Overly Giving A codependent person often finds he or she is always in the position of giving rather then receiving.