One of our major public health issues is the extraordinary number of children in this country who are exposed to alcohol abuse and dependence. The January 2000 issue of The American Journal of Public Health states that approximately one in four U.S. children under the age of 18 is exposed at some time to familial alcohol dependence (alcoholism), alcohol abuse, or both. Research has shown that families with an alcoholic member live in environments that are disorganized and unstable. According to the National Institute on Alcoholism and Alcohol Abuse, children of alcoholics (COAs) may be neglected or abused and frequently face economic hardship and social isolation. They are also at high risk for psychopathology and medical problems.

Reports have shown children from alcoholic families report higher levels of depression and anxiety and exhibit more symptoms of generalized stress. The COAs inpatient admission rate for mental disorders is almost double that of other children. They may show symptoms of depression and anxiety such as crying, bed wetting, not having friends, being afraid to go to school, or having nightmares. Adolescents may show depressive symptoms by being perfectionistic in their endeavors, hoarding, staying by themselves, and being excessively self-conscious.

In an alcoholic family, each family member adapts to the behavior of the chemically dependent person by developing behavior that causes the least amount of personal stress. They need to protect the painful accumulation of repressed feelings. The oldest child often takes on the role of the high achiever by excelling in school or sports (to bring a sense of esteem to the family) or they may take on the role of caretaking the younger children. The second oldest child may take on the role of the family scapegoat, acting out by drinking or drugging him/herself, or just being a problem kid. This behavior serves as a distraction to the family that diverts attention away from the problem drinker. The third child is called the lost child. This child tends to be quietly busy and spends much time alone. This role brings relief to the family. The youngest child frequently takes on the role of the family mascot or clown, providing fun and humor to the family. This child uses charm and humor to survive in the very painful family system. Although these roles sometimes evolve in healthy families, with an alcoholic family they tend to be more entrenched and get carried into adulthood.

Children of alcoholics grow up learning the family rule; "Don't talk, don't trust, don't feel." This makes it difficult for them to let someone know the pain the problem causes. These children need to know that alcoholism is a disease and their parent/parents are not able to stop drinking without help. They need to know they cannot control their parent's drinking. Most importantly, they need to be told, "It's not your fault. You did not cause the disease. You are not the reason your parent is drinking." These children need to realize that they are not alone, that there are many others in the same situation but, because of the "don't talk" rule, no one talks about it. Alcoholism has been compared to living with an elephant in the living room. People will walk round it, pick up after it, even feed it, but no one will talk about it. It is important for COAs to find a safe person to talk with -- a teacher, a friend's parent, an older sibling, an aunt or uncle, a neighbor, a coach or just someone who will listen to them.

Some COAs function well in spite of the parental alcoholism. Studies show these resilient children share several characteristics that contributed to their success, including the ability to obtain positive attention from other people, adequate communication skills, average intelligence, a caring attitude, a desire to achieve, and a belief in self-help.

A teacher can sometimes be helpful by having a discussion with a COA student. The teacher must be careful to limit talk to the student's feelings while bringing a supportive understanding of what alcoholism is and staying focused on school and social performance. It is helpful to explain to the child that the best way to aid their parent is to take good care of themselves.

The non-drinking parent can be helpful by educating him/herself about alcoholism and community resources. If the home situation is excessively disruptive or verbally abusive and your children go off to be alone, seek them out. Comfort them and assure them it's not their fault. Encourage and support your children to become involved in school and community activities. Everyone in the family needs to talk about the problem with someone that is knowledgeable and can help the family to explore options to function in healthy ways in spite of the problem.

A therapist can teach a child to survive with an alcoholic parent. This might include helping the COA to talk about their feelings, their situation and themselves. It also includes helping the child to have more rewarding and healthy relationships, and helping them develop a positive self-concept.

Anyone can help the COA understand three basic facts. First, the child is not alone; there are more than 11 million children of alcoholics under the age of 20 in the United States. Second, the child is not responsible for the problem and cannot control the parent's drinking behavior. Third, the child is a valuable worthwhile individual.

Here are seven "Cs" that may be helpful for any COA to remember:

• I didn't CAUSE it.
  
  
• I can't CURE it.
  
  
• I can't CONTROL it.
  
  
• I can take CARE of myself.
  
  
• I can COMMUNICATE my feelings.
  
  
• I can make healthy CHOICES.
  
  
• I can CELEBRATE being me. Sheila Leskinen is a marriage and family therapist with a specialty in addictions. She has a private practice in Anchorage.