The Risk and Resistance Factors Influencing the Propensity Toward Alcoholism Among Children of Alcoholics: An Integrative Review of the Literature

Abstract Background: Currently in the United States there is an estimated 26.8 million children of alcoholics (COAs). Many healthcare professionals advise COAs to abstain from alcohol in its entirety due of the strong genetic propensity toward addiction. However, due to the complex psychological and physiological factors that are unique to each person, there are many COAs who do not become alcoholics despite their adverse environments. Objectives: The purpose of this integrative literature review was to identify the risk and resistance factors that influence the propensity toward alcoholism among children of alcoholics. This information will aid health care professionals in providing the unique and multifaceted care necessary to prevent COAs from succumbing to the negative consequences of growing up with an alcoholic parent. Method: An integrative literature review guided by Whittemore & Knalf was conducted using online databases including CINAHL Complete, PsychInfo, and PubMed. Multiple combinations of the following key words were used when searching for articles: alcoholism, alcoholics, alcoholic parents, children of alcoholics, adult children of alcoholics, resistance factors, protective factors, risk factors, vulnerability, inheritance of alcohol abuse and genetic predisposition to alcoholism. Results: Thirty studies met the inclusion and exclusion criteria. Factors that appear to increase the level of risk include family history and genetic predisposition, high family density and comorbid psychopathy, low parental monitoring behavior, addictive/impulsive personality, disrupted family rituals, sense of embarrassment or abuse, high parentification, and alcohol related cognitions. The resistance factors that were found to offset or mitigate risks associated with parental alcoholism include high self-esteem and emotional self-regulation, flexible and optimistic temperament style, social support, positive interpersonal relationships, secure attachment with non-alcoholic parent, and parent-family connectedness. Conclusion: These findings clearly illustrate that there is immense variability in the risk for negative outcomes of COAS, as many children exhibiting resilience and normal functioning. Thus, it is critical for nurses to consider the wide range of possible outcomes for these children and families to provide the best possible care. With the information gained in this research, nurses have the ability to help children discover where they can find their own particular resilience and provide them with what they need to thrive