Adult Children of Alcoholics (ACOA ) Traits and Treatment

Hey there everybody, and welcome to this presentation on adult children of alcoholics traits and treatment. I'm your host, Dr. Donnellice Snipes. In this video, we're going to review what an addiction is, explore the effects of an addiction on the parent and how it can create a toxic, traumatizing environment for the child. Then we'll identify symptoms of the adult child of the alcoholic or addict and how they actually make sense in the big scheme of things. And finally we'll explore recovery strategies and goals. So what is an addict? And we have moved away from the term addict and alcoholic and talk about people with addictions now. So I think it's important to note that the only reason I'm using that term is because acoa adult child of alcoholic still uses that term. So I started out with that. But henceforth we're going to be talking about a person with an addiction, or in this particular case, a parent with an addiction. A person with an addiction uses more of a substance than intended and has difficulty stopping, has evidence of trying to quit, but been unable to quit. They spend more time than intended thinking about obtaining, using or recovering from use. They give up important activities and responsibilities because of use. The craving is so strong. It's like do I go to my kids ball game or do I go get a drink or they continue to use despite knowing that use is causing harm in one or more areas of their life. Is it? It's causing mood disorders like anxiety and depression. It may be causing physical health issues like pancreatitis. It may be causing problems at work or relationship issues. Maybe they're having difficulty with their significant other, or they're just not able to be emotionally available and present for their child. Okay, so we have somebody who has an addiction, but how does that create a toxic environment? Addictions, regardless of what they are, produce a rush of dopamine, endorphins and norepinephrine. When somebody increases engages in an addictive behavior, they get this flood of feel good chemicals. And dopamine and dopamine is that chemical that says, oh, that was fun, let's do that again. When this is frequent, the brain adapts to what we'll call a pleasure overload by turning off some of the receptors. So think of it like flooding the system. When the person's using, they're flooding the system and plenty of neurotransmitters are able to get through. If the brain shuts down five of the eight doors, you know, plenty of the neurotransmitters can get through three doors. But when the person's not using, when they're not flooding the system and it's just trickling through, they need all eight doors open in order to feel, quote, normal. Well, the brain doesn't reopen those doors once they're shut. They're shut. So the person starts to feel depressed, anxious. They start craving that substance again. They start craving that addictive behavior because they need to flood the system now even to get enough neurotransmitters through to feel normal. So now we've started this cycle. The childhood environment in a household with a person with an addiction can include abuse. They may observe abuse, verbal or physical abuse between the person with the addiction and the other caregiver. They may experience direct abuse from the person with the addiction. They may directly experience neglect. The person with the addiction is so caught up in thinking about obtaining, using, and recovering from use that they are not physically and or emotionally available to that child. Children need things. Neglect is failure to provide. It's not an overt act of abuse. It is a passive act of not meeting the child's needs, not making sure they get a bath, not making sure they've got good food to eat, not making sure they get to school, that sort of thing. The child may experience abandonment, either emotional, physical, or both. And this kind of goes along with that neglect because the caregiver may go out for hours, days, or even weeks at a time. They may end up going to jail. They may just disappear for periods. Or even if they are there, they may be, as I mentioned, emotionally unavailable. In a household where there is a person with an active addiction, it is chaotic when they are using. They tend to be calm or steady state or maybe even happy a lot of the times. Now, there is one exception. There may be the, quote, angry person who abuses alcohol. But it's important to recognize that when they're not using, they're a totally different presentation. They may be anxious, angry, depressed. So there is a lot of chaos. And. And the child doesn't understand why. The child doesn't understand why one day caregiver is present, and the next day they're not. There's also chaos because if caregiver is unable to do their caregiving duties, then the child has to step up. And that's very chaotic when those boundaries switch and the child has to become the parent. And there's often a family member with a mental illness. Generally, addiction and mental illness go hand in hand. So when that person is not using, they may still be struggling with symptoms of a mental illness, whether it's depression, anxiety, bipolar, prolonged grief, ptsd, you know, the list goes on. So it's important to recognize that this household is steeped in, in emotional dysregulation. It's steeped in chaos. The more diagnoses the parent has, the worse the prognosis for the child. Adult children, addicts and alcoholics, ACOAs form a very diverse group based on their personal characteristics and largely on their external environment. There's the child, for example, who grows up in a household or where the person with the addiction is very passive and uses and sleeps a lot and is just not present. They're physically there, their body's there, but they're checked out. And then there's the child that grows up in the household where the caregiver is angry and agitated even when they're using. And then there's everything in between. So the way the child learns how to stay safe, the way the behaviors the child develops are in direct response to the toxic environment. What can I do to try to survive this? And that's all they're trying to do, is survive. They're not thinking about thriving, they're thinking, how can I make it until tomorrow? Since the adverse experiences for most adult children happen early in childhood and are ongoing, they develop what we commonly now call complex PTSD or cptsd. And I think it's really important to recognize that it is a diverse group and there are, there's a whole lot of diversity of symptoms. We can't see, say that every adult child of an alcoholic is going to have this set of symptoms. It's very diverse, but it does represent a way of responding and trying to survive trauma. However, when that child grows up in that situation, they never feel safe. So the world, the whole world starts to feel very dangerous and toxic. They don't have a secure attachment to help them feel safe and empowered and develop emotional intelligence and interpersonal skills. Remember, emotional intelligence is the ability to identify emotions, to modulate their own emotions, to identify emotions in others, and to respond appropriately to emotions in others. And children who don't have a primary caregiver often don't develop these skills. It's not something you just naturally come by. However, they do the best they can. So they become hyper vigilant. They start to try to anticipate, based on micro expressions of people, what they need and what's going on, because that helped them stay safe in their family of origin. Children growing up in a household with an addict or an alcoholic or a person with an addiction, or develops ways of Responding that allow them to stay safe with the resources they have. The resources a five year old has are very minimal. If they're growing up in this environment, especially if grandma's not two doors down, it's not like they can, you know, go somewhere else. They can't go somewhere that's safe. They're stuck there. They can't get their own apartment. You know, they can't go grocery shopping for themselves. So there are a lot of things that are very stressful and they have to figure out how to survive with by their wits basically. As a result, they often exile their inner self. Now we talk a lot about the inner child, but right now we're talking about a child. So they have all this stuff going on. This anxiety, this trauma, this anger, this depression, this feeling of hopelessness and helplessness which for an adult would be overwhelming for this child that has minimal skills to deal with it because they haven't been taught it is just overpowering. They can't deal with it. So they shut it down and they exile that part of them. They often numb up. Now at this point, again, depending on the situation, some children will numb up, some children will and be passive. Others will numb up, but may act out and may be more aggressive and have more conduct issues. Many of the traits of the adult child are similar to those commonly seen in personality disorders. So the CPTSD is often, in my opinion, misdiagnosed as a personality disorder. However, you know, little caveat here, CPTSD is not in our diagnostic and statistical manual so we can't actually give that diagnosis. However, I think there are alternate trauma related diagnoses that might be appropriate as opposed to a personality disorder in a lot of cases. But let's look at some of these behaviors that are common in adult children and see how they make sense. So the characteristics of avoidant personality disorder, and I really don't like that term, they fear criticism or rejection. Well, growing up in a family where there is someone with an addiction, they may have constantly feared abandonment. They may have wanted to be loved and they couldn't get that approval from their caregivers. They couldn't get somebody to say hey, you're worthwhile. So they have a very fragile self esteem and they, they're terrified of criticism or rejection. They may have also grown up in an environment where if they did something wrong they were going to be vulnerable to abuse, which makes them fear criticism and rejection because it's like, oh my gosh, if this happens there's going to be pain involved. They need Certainty of being liked before getting involved in relationships. Well, their primary caregiver let them down. Their primary caregiver didn't like them, didn't connect with them, was not securely attached with them. So, yeah, it's terrifying to get into another relationship where you might, you know, put your heart out there and get it all stomped on. A lack of intimacy. Now remember, intimacy is not just sexual. Intimacy means being comfortable letting people close to you physically, you know, hugs, hand holding, but also emotionally and cognitively feeling like you can confide in them your feelings and your thoughts. Well, the child that grew up in a household with an addiction didn't have anybody to share these things with, so they never learned to share these things. They never learned how to develop intimacy and feelings of inadequacy. Well, think about it from the kid's point of view. You're growing up in this household, and somewhere in the back of your mind, you're programmed to believe that your caregivers are supposed to love you and, and be there for you. Yet your caregiver's not. So you have to come up with some understanding of why that's happening. And children are very egocentric. Children take things very personally. So if caregiver is not responding appropriately to me, it's my fault, so I must be inadequate. Totally makes sense. It sucks. But these behaviors make sense. And if a person can start feeling adequate and learn how to develop intimacy and develop a sense of self esteem so they're not relying on others to tell them they're okay, then you're going to start seeing a abatement of a lot of these symptoms. Some people who grow up in addicted households may be diagnosed with borderline personality disorder. BPD is characterized by emotional dysregulation. Well, I already said that growing up in this household, there was no secure attachment, so the child never learned to identify. These are my emotions. This is how I can tolerate distress. This is how I can cope with these emotions and improve the next moment. They don't learn any of that. They don't learn how to effectively respond to their emotions or even to other people's emotions. Other people's emotions may be very overwhelming to them, so it puts them in a fight or flee state. Some withdraw, some become aggressive and push people away. They have an unstable sense of self, and this is similar to avoidant personality. This unstable sense of self comes from constantly being a chameleon, trying to be whatever the child thought would that their caregiver wanted in order to love them. Okay, you want me to be Purple with blue spots. If that'll make you love me, I'll be purple with blue spots. You want me to do this? And that'll make you love me? Okay, I'll try doing that. Unfortunately, the caregiver was just randomly responding when they were sober or marginally attentive. So there wasn't any regular reinforcement of any particular set of characteristics. So the person just kept trying to shoot in the dark to figure out, is there something I can do that will get me consistent approval? And the answer was generally no. They alternate between extremes of love and hate. Remember, Borderline? The best example or image metaphor I can use for borderline is walking a tightrope. They are constantly walking this tightrope between safe and danger, between love and hate. And growing up in an addicted household, the caregiver was often either sober and, you know, depressed or angry or they were under the influence. So they were either. Either way, they were kind of not safe. But sometimes, every once in a while, that love would come out and there would be a glimmer of it, and the person would latch onto that, going, okay, I love this feeling. But then they started to become hyper vigilant, hyper aware of when the bottom was falling out. And instead of understanding where it was coming from, they would just push it away, okay, fine, we're going to go back there. Fine, I hate you. So they're love or hate. Constant fear of abandonment, which makes sense because even if they weren't being physically abandoned, the caregiver was rarely consistently there for the person. Feelings of emptiness and needing to seek approval are very common in Borderline. Because they were never given approval and loved for who they were, they were rarely consistently given approval for anything. So they spent most of their formative years just desperately scrambling, fawning, trying to figure out, what is it that I can do that will make you love me? Some people kind of go to the opposite end of the spectrum, and they may end up developing narcissistic behaviors, needing to be the center of attention. If they grew up in a household in which that was rewarded, the only time their caregiver was would actually come out of their stupor was if they were, you know, the center of attention for something, then they may still feel a need to be the center of attention to be safe. Otherwise, being the center of attention may have been a coping skill they learned because they weren't getting any sort of attention or feedback at home. So being the center of attention at school, school or somewhere else provided them that sense of connection and safety critical of Others, they were probably exposed to situations in which the person with the addiction was very critical of them. A lot of times when people are detoxing especially, they may be very irritable and very angry. So they tend to be set off more easily and tend to be more critical. So the child in this environment may have picked that up as a appropriate way to respond, that we're supposed to be critical of others. That's how I was raised. That's how everybody should be raised. They may have a sense of entitlement. Some people who grow up in addicted households feel like they deserve special treatment because of the trauma they went through. So they express to others that they are entitled to this treatment. They may exaggerate their achievements to others, which again, goes with needing to be the center of attention. If the adult child feels unworthy of love for who they are, they may need feel they need to exaggerate their achievements in order to be the center of attention, in order to feel like they deserve to exist. They may have an unwillingness to recognize the needs of others. Think about growing up in that household where the caregivers were emotionally chaotic, were physically sporadically there, and the child was just completely overwhelmed. They couldn't even deal with their own feelings, let alone the feelings of anybody else. Well, they still have that exiled child inside of them who is still completely overwhelmed. So as an adult, it may just be too overwhelming to recognize or empathize with the needs of others. Other explanation is they grew up feeling like, well, nobody ever cared about my needs. Why should I care about yours? Again, there could be multiple reasons for why this exists, which is why, as therapists, it's important for us to examine the behavior and what it means. What is it telling us? What is it communicating? And narcissists also tend to have a need going along with the center of attention to show off. They need to be haughty, they need to brag. They need to try to paint this picture that everything is fine and everything is grand and they're the best things since sliced bread. The antisocial angry subset, we will say, may have a disregard for the rights of others. Well, if their rights were never taken into consideration, they may have developed this killer be killed attitude, if you will. Not saying that anybody kills, but saying that they have to watch out for themselves. So they may not respect the rights of others because their rights were never respected. They may be impulsive because when they're exposed to all that trauma, all that stress, their HPA axis, their stress response system becomes dysregulated. And they may go from flat to, to furious. You know, they go along, they're not bothering anybody. But if somebody triggers them, it's not just a little irritation. It's going to be, you know, explosive. They tend to be irresponsible in what they do. They do what they want when they wanted to do it. Now again, think about the child that grew up in an environment that had virtually no structure, virtually no caregiving, where they got to do what they wanted to do when they wanted to do it. They carry that into adulthood because they didn't learn how to prioritize, to goal set, to delay gratification. And they may lack remorse, similar to the narcissist. They may not feel bad for what they did because they feel entitled, or they may not feel bad for what they did because other people did it to them. So, you know, what goes around comes around. There could be a lot of explanations for this, but we need to understand how the behavior in the present, what it's communicating and how it relates to the past. How did this develop as a result of trauma and or abandonment in the child's past? And then dependent personality. The person who has dependent personality fears abandonment. We've already covered that one. They're hypersensitive to criticism. We've already covered that in several of the other personality disorder characteristics. And I think it's important to recognize that hypersensitivity to criticism almost always goes along with fear of abandonment, pessimism and low self confidence. The person who is dependent often feels very hopeless and helpless and powerless. So they depend on others. And the person growing up in the addicted household may not have had anyone to depend on. So when they, as they got older, they started trying to find somebody to latch onto, somebody that would keep them safe. Other characteristics that aren't explicitly covered so much in personality disorders, being frightened by angry people and personal criticism. We've talked before about trauma and flashbacks. If the child was exposed to very angry people in their addicted household, then when people get angry now, they are flashing back to their childhood. That's triggering their inner child. That's triggering those schema to say, oh, when people get angry, crap's getting ready to hit the fan. Totally makes sense that they would be frightened by it. It's important for them to recognize it though, and be able to say, okay with this person in this context at this time, am I in danger? Recognizing that everybody gets angry. Anger is part of the fight or flight response. Anger is a normal emotion. Everybody gets angry. Not everybody acts out so it's important for them to be able to learn how to identify and cope with anger not only in themselves but in other people so they don't feel terrified so they can recognize when they're safe versus when they're not safe. They often marry people who are broken to prevent abandonment. They marry people who they pity, who are projects, who need in order to in order to be needed so they don't fear abandonment. It's like, well, you need me so you can't leave me. They may judge themselves harshly and have a very low self esteem. They were probably judged harshly as children and if they weren't, they may not have been judged at all. Their caregiver may have been so disconnected that they couldn't get approval, but they also didn't get disapproval. So they in turn interpreted that as I'm not even worthy of judgment. They don't even care enough to recognize whether I'm here or not. So that really impacts the child's self esteem and their self worth if they can't get their biological care or their caregivers to pay attention to them. Adult children often feel guilty when they stand up for themselves instead of giving in to others. Trademark of the addicted household. Don't talk, don't trust, don't feel. When people stand up for themselves in the add addicted household, it turns on the blame game. Well, I wouldn't have to do this if you didn't. I wouldn't have to do this if you didn't. How else do you expect me to cope? And so the person with the addiction often turns up that guilt meter and makes the child feel very guilty for wanting even the most basic things like groceries. There's a negative pessimistic cognitive style. Well, duh. You grow up in environments that are chaotic and not meeting your basic needs. They're neglectful. You're going to see the world as dangerous. It's hard to see the butterflies and the puppy dogs and whatever else makes kids happy. When they're trying on a day to day basis, on an hour to hour basis, just to survive. They don't know from moment to moment if they're going to walk out of their bedroom and their caregiver is going to be happy or in a rage, is going to be passed out or is going to be conscious. There's over commitment and inconsistency due to an overdeveloped sense of responsibility. In order to prevent abandonment, the child did their best to to try to keep the lid on things. And I've worked with a Lot of adult children who reflect on having to tuck their, their caregiver in when they were 8, 9 years old because their caregiver would pass out drunk or pass out stoned. And they had to take on these adult responsibilities long before they were cognitively, physically or emotionally able to do so. So they did their best, but they fell short. I mean, let's face it, an 8 year old can only do so much. And so as adults, they still try to caretake for everybody because that's what they learned. If you don't care, if you don't do the caretaking, ain't nobody going to do it. So they carried that into adulthood. But they didn't along the way have a mentor to help them develop the skills and tools necessary to effectively manage their time and be consistent. So they get over committed and then they can't actually fulfill all of their roles. Then they start feeling guilty and angry at themselves and becoming irritable. So it spirals. There's a lack of emotional intelligence. The person who grows up in the addicted household often develops an addiction, marries somebody who's addicted, or both. Number one, it's what they know. So even though it is dysfunctional, sometimes dysfunction is less scary than the unknown. Additionally, a lot of people who grow up in this household, it is so emotionally painful that they end up very quickly trying to find a way to numb that pain, to just make it stop for a few minutes. So they develop substance use issues very early on in life. They deny feelings and lost the ability to feel or express feelings because it hurts so much. Remember I said the child needs a caregiver, needs that secure attachment to learn how to identify. Oh, this is anger. This is why I have anger. This is how to tolerate the distress and de escalate and this is how to cope with the situation. That all comes from interacting with a caregiver. They didn't have somebody to show them that. So these feelings just felt like tidal waves that would come over and try to drown them. So eventually they just kind of shut down those feelings and I call it alexthymic denial. So inability to feel feelings because you're denying they even exist, emotional dysregulation. Well, we recognize that these caregivers who have addictions probably have emotion regulation problems themselves. So even when they are sober, they are probably not good teachers of emotional intelligence. So we have emotional dysregulation being modeled which contributes to the chaos. We have a child who never developed the skills and so as a result emotions feel overwhelming and when they do break through when they can't be completely locked down, the child feels overwhelmed. All, all of this feeling overwhelmed and feeling unsafe and disempowered keeps the threat response system or the HPA axis turned on. And we know that when that stays turned on for too long, it starts getting out of sync and contributes to emotional dysregulation. It contributes to flat to furious. They tend to be impulsive and reactive instead of proactive. Well, if you're not mindful, if you're not able to identify feelings, tolerate the distress, and then figure out how to cope with them, then you may. As soon as you start feeling this feeling, you don't know what it is, but you want it to go away. Daggummit. And so the person may still have some tools that they developed early on, impulsive tools that help them in some way try to deal with these feelings. Or, you know, impulsivity can also go with anger. When something happens that makes them feel threatened or reminds them of the past when they felt threatened, it may trigger an anger episode, an impulsive anger episode. And they have also found that people who are adult children have what we call high reward sensitivity, which totally makes sense. Reward sensitivity or high reward sensitivity is when people, any reward they get just is amazing to them. They crave it so much, they can take any little crumb of a reward and they are just so incredibly grateful for it. And they carry that into adulthood. And you can understand growing up in that addicted household, they didn't get rewards very often. They very rarely even got attention. So when they got any little bit of attention or any little bit of reward, they just, they treasured it and they, they feasted upon it and they crave it again after that. But it was so hard to come by. So as adults, they are very motivated by reward and they are very sensitive to, to when they are getting rewards. Adult children of alcoholics did the best they could do to survive as children. Their behaviors, coping skills and personalities were shaped by chaos and trauma. As adults, their inner child is often still exiled and terrified, leading to compensatory behaviors. They need to do what they've always done because it's a known and it's controllable. Or they may try to repeat the situation and get into a relationship with somebody who has an addiction. So they can do it right this time, they can fix them this time. Or they may completely change the script and evidence some narcissistic behaviors, for example, so nobody can hurt them anymore. Recovery requires connecting with that traumatized inner child and helping them Feel safe. That means consistently recognizing the adult, the feelings of that inner child, and behaviors that the inner child is trying to use to protect themselves. So even as adults, that inner child is coming out. And we want to recognize when as adults, we act immaturely or impulsively, so to speak, we want to look and say, is that that inner child coming out? Is that how I would have reacted back then? Is that what I learned? And then responding to the inner child by identifying the feeling, why you're feeling that way, reassuring the inner child, or reassuring yourself that you're safe and helping them, the inner child, de escalate. And I know that sounds sort of esoteric, but it's important to recognize whether you believe there's an inner child or it's just a part of yourself. There is a part of yourself that needs to learn how to de escalate, that needs to feel safe. There is a part of you that is formed by all of those memories, those traumatic memories from your childhood that is kind of locked away in Pandora's box or the inner child or whatever you want to call it. And all of that stuff needs to be dealt with. Recovery also requires identifying problematic behaviors in the present and how they developed as a result of trauma, abandonment, or a lack of emotional intelligence. Sometimes you may have developed coping strategies just because you didn't know how to identify or deal with these powerful emotions. So you developed strategies that worked to help you survive, but they may not be the healthiest strategies in the world. So learning to identify your feelings and develop emotional intelligence will help you develop alternate skills, identifying alternate ways you want to respond in situations. If you recognize that one of your problematic behaviors, for example, is running, as soon as you start to feel close to somebody, you just ghost them. Well, why do you do that? How might that have developed as a result of your past? How do you want to respond? And what fears do you have that are preventing you from responding in the way you want to respond? Now, obviously, there's a lot to do to unpack all of that, but it's important to not only identify how you want to respond and how to do that, but also why you fear it, what's blocking you from moving in that direction. I hope that gives you some tools to better understand some of the behaviors of adult children, of alcoholics. And I look forward to seeing you in the live Q and A in just a few minutes.