family studies alcohol abuse

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Family Studies of AlcoholismTheodore Jacob

University of ArizonaThroughout the past several decades, clinical researchers have attempted to clarify therole of family influence in the etiology and course of alcoholism. After a brief historicaloverview of this literature, both of these research directions are reviewed in some detail,with an emphasis on recent empirical studies and emerging conceptualizations regardingthe family alcoholism matrix. A final section of the article describes a number ofimportant research needs, many of which are deemed relevant to the broader field offamily studies of psychopathology.

Throug hout the past century, researchers have been increasingly draw n toexplorations of the family's role in the etiology, course, treatment, andprevention of psychopathological disorders (Jacob, 1987c; Goldstein, 1988).In attempts to unravel and elucidate relationships involving family life anddisordered behavior, various theoretical perspectives and research strategieshave been exploited; most importantly, genetic-biological efforts concernedwith the transm ission of deviant beh avior from an affected paren t to the child;studies of personality and psychosocial characteristics of the spouses andchildren of affected mem bers; and investigations of such mo lar variables asfamily structure, social class, and ethnicity on the development of socialdeviance and psychopathology. Although interest in relationship parametershas been strongly implied throughout much of this literature, research andtheory having a primary emphasis on family processes have only gaineddistinction within relatively recent times.

In the current article, I discuss one a spect of this family literature: namely,that concerned with family influences relevant to alcoholism, with particularemphasis on the role of family process in the etiology and course of thedisorder. Although focused on this one disorder, many features of thisliterature are highly relevant to family studies of other disorders a statusthat can be understood in terms of the many com mon historical, theoretical,and methodological foundations that underlie current studies of a wide rangeof disordered behavior (Jacob, 1987b). The article is divided into foursections. First, a brief overview of the literature on family studies of alcohol-This research was supported by the National Institute on Alcohol Ab use and Alcoholism, G rant No.2R37AA0307. Requests for reprints should be sent to Dr. Theodore Jacob, Division of FamilyStudies, 210 FCR Bldg., University of Arizona, Tucson, AZ 85721.Journal of Family Psycholo gy, Vol. 5 No. 3 & 4, March/June 1992 319- 338 1992 Division of Family Psychology, APA.

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320 JOU RN AL OF FAM ILY PSYCHOLOG Y / Match/June 1992

ism is presented a literature that began with an emphasis on the individual-level characteristics of the alcoholic, his spouse, and his children, andgradually came to incorporate investigations of interactional patterns thatcharacterize families containing an alcoholic member. Second, the family'srole in the etiology of alcoholism is discussed, highlighting current researchefforts and e xperimental designs that are most relevant to understanding howfamily variables are related to the development and onset of alcohol disor-ders. Third, interactional models and research relevant to the maintenance ofalcoholism are described, as well as needed research for clarifying the roleof family influences on the course of the disorder. In the final section, Iindicate future research efforts deserving special attention and suggest thatmany of these issues are relevant to the larger field of family studies ofpsychopathology. '

O V E R V I E W O F T H E F I E L DAlthough the effects of alcohol abuse pervade all levels of the social order,

alcoholism has been defined, investigated, and treated as an individualproblem throughout most of the past century. Given this background, it is notsurprising that the earliest research from a family perspective involved afocus on individua ls within the alcoholic's family most notably the spouseand, secondarily, the children. As suggested in our review s of this literature(Jacob, 1987a; Jacob, Favorini, Meisel & Anderson, 1978; Jacob & Seilhamer,1987; Seilhamer & Jacob, 1990), much of this work was characterized by anarrowness as to guiding conceptual framework, methodological approach,and family members assessed. Most important, the vast majority of work inthis area has been based on psychodynam ic, individually oriented co ncep-tual frameworks, despite the repeatedly implied interest in interpersonalrelationships.

Spouses of alcoholics came to researchers' attention when cliniciansbegan to question wives' possible contribution to the emergence and perpet-uation of their mates' alcoholism. In this context, wives were initiallydescribed as "disturbed personalities" who sought to satisfy their uncon-scious needs by dominating a male whose alcoholic drinking rendered himweak and dependen t (Futterman, 195 3; Kalashian, 1959; Lewis, 1937). Withthe advent of the environmental persp ective, wives of alcoholics were recastas victims rather than villains, and their psychological disturbance wasconsidered to be a reaction to the accumulated stress associated with livingwith an alcoholic spouse (Jackson, 1954; Jacob & Seilhamer, 1982). Subse-quently, investigations of coping styles led to the identification of typicalresponse patterns (James & Goldman, 1971; Orford et al., 1975; Schaffer &


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Jacob / FAMILY STUDIES OF ALCOH OLISM 321

Tyler, 1979; Wiseman, 1980) but failed to clarify the relations of thesepatterns to spouse characteristics or situational variables. Recognizing theneed to examine the alcoholic's spouse within a broader conceptual frame-work, M oos's work of the past decade has provided a welco me and necessaryalternative to the one-sided approaches of the past (Finney, Moos, Cronkite, &Gamble, 1983). In essence, Moos has recommended integrating the "dis-turbed personality," "stress," and "coping" perspectives into a model thatpredicts spouse functioning from five sets of variables: background charac-teristics, level of functioning of the alcoholic partner, life-changing events,coping responses, and family environme nt (Mo os, Finney, & Gam ble, 1982).From this multifactorial perspective, it seems clear that further advances inunderstanding the nonalcoholic spouse's role in the alcoholic family willrequire the inclusion of several levels of influence and the acknowledgmentand measurement of bidirectional effects that is, the alcoholic's impact onspouse functioning and the spouse 's role in influencing the course of abusivedrinking.

Over the past several decades, an accumulating literature concerned withthe psychosoc ial and psych iatric status of alcoh olics' offspring has suggestedthat these children often exhibit a variety of interpersonal and cognitivedifficulties as preadolescents and adolescents and that they are at high riskfor alcoholism and general psychiatric disturbances as adults (Seilhamer &Jacob, 1990; Sher, 1991; West & Prinz, 1987). Although a lengthy list ofmaladjustments has been offered, empirical substantiation of these charac-terizations has been marked by a lack of consistent findings, sound researchmethods, and comprehensive conceptualizations. Most important, this liter-ature points to considerable variability amo ng children of alcoholics anobservation that has led various researchers to hypothesize an interplay ofmultiple factors that influence child outcome. Again, the relevant literatureimplies that such outcomes are significantly related to disturbed patterns ofmarital and parent-child interaction associated with family structures thatinclude an alcoholic parent. Close examination of this literature, however,reveals few efforts that describe patterns of interaction which may mediateadverse child outcomes, that document the temporal relationships betweenthese proce sses and va rious child outcom es, and that distinguish patterns thatare unique to alcoholic family interactions versus general stress factorsassociated with various types of psychopathology (Jaco b, Krahn, & J^eonard,1991; Seilhamer, Jaco b, & Dunn , in press). In brief, what seem s to be m issingfrom much of the extant literature is an effort to describe actual patterns ofinterchange betwee n the alcoholic and m emb ers of his or her family that arerelated to the etiology, course , and perpetuation of alcoholism.


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Although interaction studies of alcoholics have only recently emergedwithin the alcoholism literature, family interaction research has been evolv-ing in the more general psychopathology literature during the past 30 years an approach that is best viewed as an assemblage of several models, themost influential being general systems theory, communication theory, andsocial learnin g theory (Jaco b, 1987b ). Th e earliest influence on this modelcan be traced ba ck to the 1950s, whe n the field was introd uced to familytheories of schizophrenia, including the work of Bateson, Jackson, Haley,and W cakland; B owen; W ynne; and Lidz. (For reviews of this literature, seeMishlcr & Waxier, 1965; Olson, 1972). Based on an integration of systemsand communication theories, these seminal writings had a major impact onpsychiatric theory, research, and practice over m uch of the next two dec ades.Buttre ssing thes e forces we re the con tributio ns of family sociolo gy inparticular, the contributions of Parsons and Bales (1955) and their analysisof instrumental and social-emotional role functions in ad hoc as well asnuclear family groups. Equally important, the flourishing small group tradi-tion explored communication networks and power relationships in varioustypes of organizations, providing a rich set of concepts and innovativelaboratory procedures for studying group process and outcome. Finally, thecontinued influence of behavioral psychology has been evident since theearly 1960s, emp hasizing as it has the specification of antecede nt-conseque ntrelationships, the careful definition and measurement of behavioral targets,and the analysis of Behavior x Situation relationships.

Alternatively referred to as family interaction or family systems research,this perspective is currently characterized by an attempt to identify patternsand processes that (a) predate and predict the development of psychiatricdisorders in high-risk offspring and (b) are associated with and serve to fostercurrent, ongoing psychiatric disturbance. Notwithstanding the importance ofinteraction per se, it is clear that the family interaction perspective must beintegrated with developmental, genetic, and personality literatures based onthe assumption of an intimate and critical interplay between these influencesinsofar as they guide the development of behavior (Zucker, 1989; Tarter,1991).FAMILY INFLUEN CES RELEVANT TO ALCOHO LISM ETIOLOGY

Family environmental factors related to the development of alcoholismcan and have been conc eptualized at the level of the individual, the dyad, andthe family as a system (Jacob & Leonard, 1991). Note that any of theseinfluences can be viewe d as drinking-specific effects (i.e., family influencesthat are specifically and directly related to the development of drinking


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behavior) versus nondrinking-specific effects (i.e., family influences thatproduce cognitions, affect, or behavior that render the child vulnerable to arange of deviant outcomes, including but not limited to alcohol abuse;Zuckcr, 1979; Zuckcr & Noll, 1982).

Individual member effects involve the impact of one family member'sbehavior on another, and, in addition to family genetic effects, have beendiscussed and studied in terms of the impact that a drinking parent (in thiscase, an abusively drinking parent) can have on the developing child. Such aninfluence is viewed as a drinking-specific effect (Noll, Zucker & Greenberg,1990). At the opposite end of the continuum are family systems effectsinvolving the comp lex family system within which m emb ers operate and theimpact of this system on individual and relationship behavior. Althoughrecognized as the hallmark of family systems theory and therapy, this levelof family influence has rarely been subjected to empirical study. In thealcoholism etiology literature, the best (and probably the only) example ofthis focus is found in the often-cited work of Wolin and Bennett on familyrituals (Wolin, Bennett, Noonan & Teitelbaum, 1980; Wolin, Bennett &Noon an, 1979; Steinglass, 1987). Briefly, these investigators have suggestedthat cross-generational transmission of alcoholism increases in likelihood tothe extent that alcoholism invades the family system and disrupts the enact-ment of family rituals; that is, patterns of behavior that give identity andmeaning to the family (e.g., celebration of holidays, special events, routinedaily ac tivities such as dinnertime, etc.).

Finally, several dyadic level influences have been implicated in theetiology of alcoholism, including both marital and sibling effects (Belsky,1984; Brook & Brook, 1990; Emery, 1982; Fauber, Forehand, Thomas, &Wierson, 1990; Rowe, Wo ulbroun, & Gulley, in press). The vast m ajority ofwork in this domain, however, has focused on the nondrinking-specificeffects of the parent-child influence structure a theoretical and researchliterature that has provided strong support for the role of family effects in theetiology of alcoholism.

The impact of the parent-child relationship on the child's social andcognitive developmen t has been a major foundation in the child deve lopmentand family studies literature for more than 50 years (Maccoby & Martin,1983; Martin, 1987; Rollins & Thomas, 1979). Distillation of this nowvoluminous body of theory and research yields three conclusions of partic-ular relevance to present concerns: (a) All other variables that can affect childoutcomes parental d ispositions, marital and sibling influences, and thesociocultural context in which the family operatesare played out withinthe interactional sequence s that come to define the parent-child relationship.


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324 JOUR NAL OF FAMILY PSYCHO LOGY / March/June 1W2

(b) The two major parenting dimensions of nurturance and control providethe stuff out of which parent-child interactions are made. Disturbance ineither or both of these parenting dimensions can have severe and wide-ranging effects on the child's social-emotional and cognitive development.(c) Of the various child outcomes that have been linked to inadequateparenting (characterized by a lack of affection and/or high levels of criticismand hostility, lax or inconsistent discipline and supervision, and general lackof involvem ent), the development of agg ressive, antisocial behavior has beenmost strongly documented.

That such family influences are of tremendous im portance in understand-ing alcoholism etiology is strongly supported in light of the significantassociations that have been repeatedly found between child conduc t disorder,adolescent delinquency, and adult antisocial behavior; between adolescentantisocial behavior and initiation of alcohol abuse; and between adult anti-social behavior and adult alcoholism. (See Jessor & Jessor, 1977; Lewis,1984; Lewis & Bucholz, 1991; Loeber & Dishion, 1983; Zucker, 1989; andZuckcr & Gom berg, 1986, for reviews of this literature.) Although m any havecontributed to the developm ent and validation of this parenting effects mod el,the work of Patterson and colleagues has been most influential. (For asummary of their work, see Patterson, Reid, & Dishion, in press.)

Although embedded in a larger social learning framework that includesmultiple influence domains, the critical nature of parenting effects has beenhighlighted over the course of these research efforts. Briefly, disruption infamily management practices (what is referred to as inadequate parenting)sets the stage for all that follows. Most important, a failure in compliancetraining begins during the child's early years and becom es the key feature ofthose families w ho prod uce a ntisocial children a breakdown which isdefined in terms of inadequate discipline, monitoring, modeling, involve-ment, and positive reinforcement strategies. The major outcome of thisprocess is the developme nt of a coercive interaction style, which slowly butsteadily generalizes to relationships outside the home and severely interfereswith the child's social and cognitive development. As described by Snyderand Huntley (1990),

Over time, the child acquires a more coercive relational style, leading toparental rejection and reduced contact with the child. This reduction in positive,constructive parent-child interaction further interferes with the developmentof social and cognitive competence. Failure to teach adequate social andcognitive skills and continued reinforcement of coercive social behavior setthe stage for problems ou tside the home. The ch ild's lack of skills and coerciverepertoire generalize to interactions with peers and teachers. They are unableto discourage the child's antisocial behavior and to engage the child in


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Jacob / FAMILY STUDIES OF ALCOHOLISM 325

construc tive social interaction and learning . In a relatively short time, the childis rejected by peers and w ithin a few years is identified as an acad emic failure.This rejection and failure set further limits on opportunities for positivesocialization experiences. The range of peers and activities from which thechild can select are reduced. The antisocial child associates with other antiso-cial peers who have compatible attitudes, behaviors, and interests. Interactionwith this peer group then reinforces and expands the antisocial repertoire ofthe child, (p. 204)Empirical support for the hypothesized relationships between inadequate

parenting and the development of aggressive, antisocial behavior in child-hood and adolesce nce can be found in various sources the volum inous childdevelopment literature of the past 50 years (Maccoby & Martin, 1983;Rollins & Thomas, 1979), social-learning-based studies of childhood con-duct disorder (Patterson, Reid, & Dishion, in press; Sn yde r& Huntley, 1990;Wahler & Dumas, 1987), and the longitudinal literature relevant to thedevelopment of both delinquency and antisocial behavior, which has re-ported strong associations between inadequate parenting in the early childh istories of those who subsequently dev elop adolescent and adult expression sof antisocial behav ior and of alcohol abuse during adolescen ce and adulthood(Loeber & Dishion, 1983; Loeber & Stouthamer-Loeber, 1986; McCord,1991; Zuckcr, 1989; Zucker & Gomberg, 1986). For many, these nondrinking-spccific family variables and their relationship to a generalized deviance syn-drome are considered our most powerful conceptual tools in attempts to un-derstand the family's role in the developm ent of alcohol abuse and alcoholism.

Although few would question the association between inadequate par-enting and childhood aggression and the relationship between adolescentdeviance and the emergence of adolescent and adult expressions of alcoholabuse, the applicability of this model may be limited for various reasons.First, the essence of this model concerns the development of a general de-viance syndro me, characterized by an aggressive antisocial behavior pattern(Donovan & Jessor, 1985; Jessor & Jessor, 1977). As such, its relevance tosubtypes of alcohol abuse other than antisocial alcoholism can be qu estioned.Specifically, many re searchers have conc luded that alcoholism is an etiolog-ically and developmentally heterogeneous disorder which subsumes a num-ber of relatively distinct subtypes. All observers concur that antisocialalcoholism is a major subtype of the disorder and probably the one that hasreceived the greatest attention in clinical and research literature. Othersubtypes, however, probably represent equally important variants, althoughmuch less is known ab out their initial conditions and deve lopmen tal co urse.Zucker (1991), for example, has discussed four alcoholism subtypes, onereferred to as negative affect alcoholism. Although it is beyond the scope of


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this article to critically an alyze this I iterature, it is worth noting that psy chos o-cial researchers arc now beginning to point out family and peer influencesthat may be relevant to the etiology of such a subtype: in particular, familyinteractional antecedents of childhood internalizing disorders and childhooddepression (Snyder & Huntley, 1990; Wahler & Du mas, 1987). To the extentthat such child dispositions relate to negative affect alcoholism, these devel-oping conceptualizations may become increasingly relevant.

Second, the driving force of the child socialization model has been theimpact of the family environment (in particular, the parents) on the child,notwithstanding the multivariate framework within which the model hasbeen placed during more recent times. That biologically based child behaviorplays an equally important role in explaining parent-child interaction is notonly p ossible, but is a very credible alternative to the "social m old" position(Hartup, 1978). The strong variant of this position would suggest thataggressive, antisocial behavior, and, in turn, antisocial alcoholism, is to alarge extent the result of constitutional and/or hereditary influences, and thatthe association between parenting and child outcome is best viewed as achild-to-parent effect (Lytton, 1990). A diverse theoretical and empiricalliterature now provides considerable support for this perspective, includingan impressive child effects literature, elegant behavioral genetics accountsof how biologically based individual differences affect a child's environ-ment and development, and increasing support from alcoholism literaturethat genetic contributions are significantly related to antisocial alcoholism(Jacob & Leonard, 1991). Most important, the overwhelming number ofexperime ntal de signs supporting the child socialization m odel has been basedon procedures that can neither determine the direction of effects nor dilutethe influence of parent behavior and parent genes. Clearly, we must movebeyond cross-sectional and passive-longitudinal designs to more informativeand illuminating a pproac hes: namely, to research designs that provide for themeasurement of genetic and/or constitutional effects, the study of differentalcoholism subtypes and developmental pathways, and the assessment offamily influences that are interactional in nature rather than global, staticindicators of the environment.

FAMILY INFLUENCES RELEVANTT O T H E C O U R S E O F A L C O H O L I S M

Thus far, the family's role in the etiology of alcoholism has drawn thestrongest support from two literatures, one related to family genetic effectsand the other to family interaction effects involved in the development of agenera lized devian ce syndrom e including, but not limited to , alcohol-abusing


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characteristics. Ironically, both of these influences seem most relevant to thesame subtyp e of the disorder a ntisocial alcoho lism and it remains forfuture research to clarify the independent, joint, or confounded nature ofthese various associations. As suggested, such clarifications will requirecomplex, multifaccted designs capable of separating family genetic fromfamily environmental effects and of relating these influences to differentalcoholism subtypes.

In considering the course of alcoholism, the family environm ental litera-ture implicates both individual member and interaction characteristics. Asdescribed earlier, the earliest literature on the alcoholic family focusedprimary attention on the personality features of the wife, suggesting thatpsychodynamic needs motivated her to encourage her husband's drinking, toundermine his efforts to abstain, and to perpetuate a destructive and domi-nating relationship with a weak and passive spouse. Almost all of thesecharacterizations, however, emanated from clinical and clinical anecdotalreports. An e nsuing em pirical literature involving a series of studies com par-ing the personality characteristics of alcoholics' wives with psychiatric andnormal controls and based upon objective personality assessment providedvery little, if any, support for the "disturbed personality" hypothesis. At thesame time, these theoretical and empirical efforts did imply that interpersonalaspects associated with alcoholism may be relevant to the perpetuation of thedisorder; in particular, that alcoholic marriages may be characterized byrelationship patterns that influence the course of the disorder. It was not untilthe late 1960s and early 1970s, however, that observational studies of familyinteractions involving alcoholics began to appear in the literature. As de-scribed elsewhere (Jacob & Seilhamer, 1987) this is still a relatively smallliterature, which, for the m ost part, is composed of preliminary, small, sam pleefforts; nevertheless, this research literature has moved the field toward aconsideration of interactional effects and has introduced innovative method sand provocative con ceptualiza tions with which to explore the role of familyinteraction in the course of alcoholism. Most relevant to such concerns arethe studies of Stcinglass and my own studies.

Steinglass's work on alcoholic families began during the late 1960s witha series of experimental studies at NIMH that included observations ofinpaticnt alcoholics during an experimen tal drinking phase and a subsequen twithdrawal period (Steinglass, 1975). Most important, these early drinkingstudies suggested that acute intoxication can have variou s effects on the rolerelationships and interactional beha viors of the involved mem bers; in partic-ular, that affective and structural characteristics of relationships can bedramatically altered during periods of drinking. For Steinglass, these obser-


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328 JOURN AL OF FAM ILY PSYCHOLOGY/March/June 1992

vations confirmed the significance of reciprocal effects involving alcohol andinterpersonal interaction and led to a preliminary model of alcoholism basedon family systems theory. Specifically, Stcinglass (Steinglass, Weiner &Me ndelson , 1971) suggested that abusive drinking could serve two differentfunctions. In one case, drinking can be a signal or sign that individuals andrelationships w ithin the system are experiencing significant stress. In contrastwith the signal function, which is most likely in families where drinking hasnot become an ongoing process, drinking can maintain and stabilize thefamily as an ongoing unit. Although alcohol may effect different behaviorsin different families for exa mp le, the controlled re lease of aggression inone case and the clarification of dominance patterns in another in eachinstance, alcohol was seen to stabilize an otherwise unstable and/or chaoticfamily system (Steinglass et al., 1971).

For Steinglass, these interactional differences between sober and intoxi-cated periods appeared to serve important adaptive functions for the family.That is, the behavior that emerged during intoxicated periods appeared topotentiate or inhibit certain aspects of the relationship which, in effect,reduced tensions through the temporary solution to a conflictual or stressfulprocess and, in essence, served to stabilize an unstable system. As will beseen, this "alcohol maintenance model" stimulated a number of importantinteraction studies aimed at testing and elaborating the key aspects of thisframework.

The most recent phase of Steinglass's work has involved a more macro-scopic, longitudinal view of drinking patterns. This life history model ofalcoholism (Steinglass, 1987) suggests that periods of sobriety and activedrinking form a cycle over a long period of time in the lives of mostalcoholics. In contrast with the maintenance model, which spoke of rapidchanges from sober to intoxicated states with associated changes in patternsof interaction, the life history model suggests that dry, wet, and transitionphases appear and reappear many times over an alcoholic's drinking career.For som e families, there may be m any occ urrences of dry, wet, and transitionphases, whereas for other families there may be only one stable wet phasethat is ultimately resolved into a stable dry phase or simply continues untildeath or divorce ch ange s the structure of the family system.

Although the work of Steinglass has been a major influence in the studyof family interaction and alcoholism, his empirical efforts were based onextremely small, highly selective samples that lacked normal comparisongroup s and that failed to control for various possible problem s. Most impor-tant, the basic tenets of Steinglass 's alcohol ma intenance mode l that inter-action differs in intoxicated versus sober states and that interactions duringintoxication are sufficiently reinforcing as to maintain abusive drinking


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were based on clinical impressions and were never directly and systemati-cally assessed in his later research efforts.

Since Stein glass's early p ublications, four studies have reported on exper-imental drinking procedures with families of alcoholics. In three of thesestudies, however, methodological and design weaknesses seriously compro-mised the interpretability of findings. Jacob, Ritchey, Cvitkovic, and Blane(1981), for example, reported a number of interesting findings, althoughfindings were based on a relatively small sample and there was no psychiatriccontrol group for examination of the specificity of alcoholism's impact.Billings, Kesslcr, Gomberg, and Weiner (1979), on the other hand, didinclude a distressed (nonalcoholic) control group as well as a nondistressedcontrol group; unfortunately, half of the couples in each group did notconsume any alcohol during the drinking session and those who did drinkconsum ed only minimal amo unts. Finally, a study by Frankenstein, Hay, andNathan (1985) rigorously controlled for alcohol consumption of participantsby administering fixed doses of alcohol prior to the interaction session;however, findings were based on a very small sample size, the designincluded alcoholic cou ples only, and the fixed dose adm inistration procedu reprobably diminished the naturalness of the context in which couple interac-tion occurred.

Although these initial efforts were characterized by considerable cre-at ivi ty, methodological and conceptual weaknesses l imited the rel iabi l i tyand generalizability of reported findings. In an effort to address these limi-tations and to implem ent a more comp rehensive study of family influencesrelevant to the course of alcoholism , I embarked on a large-scale interactionstudy of alcoho lic families du ring the late 1970s (Jacob , Seilhamer, & Rushe,1989). Most important, this effort involved a carefully selected group ofalcoholics who exhibited n o additional psychiatric disorder; the inclusion ofa nondistressed as well as a psychiatric control group (clinically depressedsubjects without evidence of alcohol abuse); an experimental drinking pro-cedure in which couples consumed significant amounts of alcohol in a self-administered m anner; the application of a theoretically relevant, empiricallybased coding system for videotaped interaction data; and the assessment ofrelatively large subject samp les so that statistical po wer could be maximizedand alcoholism subgroups examined.2

Our major analysis of the marital interactions of alcoholics and depressedand nondistressed couples over drinking and nondrinking sessions revealeda number of important findings (Jacob & Krahn, 1988). Most relevant topresent concerns was the finding that alcoholic-spouse interactions weremore negative than those of depressed and nondistressed couples, and thiswas particularly true when analyses were based on data obtained during the


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drinking session. Several explanations for these outcomes were offered,although those which emphasized the interpersonal aspects of alcoholismseemed particularly relevant to the maintenance functions of drinking-relatedinteractions. Gorad (1971), for example, suggested that alcoholics exhibit a"responsibility-avoiding" communication style that becomes exaggerated ininteractions with intimates and during periods of drinking and intoxication.In essence , the alcoholic is sending two messa ges one indicating som enegative or deviant act and the other (more precisely, a qualification of thefirst message) implying that "1 am not responsible for what I say or do: I amunder the control of the alcohol." In so doing, the alcoholic acts but avoidsaccepting responsibility for his actions. The core aspect of this theory thatthe alcoholic can attribute his deviant behavior to the alcohol and cantherefore avoid responsibility for his actions has also been discussed in thesocial-labeling literature as "deviance disavowa l" or "timeout" (MacAndrew &Edgerton, 1969). Regarding present findings, one might conjecture that, inessenc e, the alcoholic can attribute his nastiness to the alcohol. To the e xtentthat this occ urs and that his spouse a cce pts this attribution , periods of drinkingmight allow for the expression of negative affect toward the relationship andspouse that might be more inhibited if the alcoholic were to be held account-able for these behaviors. As such, the context of drinking enables thealcoholic to express strong, negative feelings that otherwise could be givenonly partial expression.

Although these findings w ere both interesting and consistent with variou sclinical and theoretical expectations, other work by the investigator sug-gested that alcoholic-spou se interaction may have to be qualified in terms ofthe specific alcoholism subgroup under study. As noted earlier, alcoholics area very hetero geneou s population and the impact of alcoholism on the familyis unlikely to be a constant. Various alcoholism subgroups have been dis-cussed in the extant literature, and our own efforts have focused on e pisodicversus steady drink ing styles. Two of our earlier reports linking episodic andsteady drinking styles to different marital effects are particularly relevantto issues of maintenance. First, we reported that alcoholics who consumedlarge amou nts of alcohol in the past month had wive s who reported relativelylow levels of psychiatric symptoms and relatively high levels of maritalsatisfaction a relationship that was very robust for steady drinking alcohol-ics, yet absent for episodic drinking alcoholics (Jacob, Dunn & Leonard,1983). Based on these findings, we hypothesized that a steady (versus anepisodic ) pattern of drinking represents a predictable source of stress, and asa result, the steady alcohol consum ption pattern may be more easily adaptedto and incorporated into family life than episodic drinking patterns. If true,


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the adaptive consequences of drinking would be more likely to characterizethe former rather than the latter group of alcoholics.

Despite the stimulating nature of these findings and associated hypothe-ses, these analyses were based on cross-sectional, retrospective data. Toconclude that the variables in question are related to one another over time,however, one would have to assess these associations within a longitudinal,prospective design. A subsequent effort attempted just such an analyses(Dunn, Jacob, Hummon, & Seilhamer, 1987). Briefly, eight alcoholics andtheir spouses were engaged in a 90-day assessment, during which time eachpartner provided daily information regarding alcohol consumption, psychi-atric symp tomatology, and marital satisfaction. Application of univariate andbivariate time series analyses to these data was extremely informative. M ostimportant, for those alcoholics who exhibited heavy weekend drinking (inaddition to lower levels of weekday consumption), wives' marital satisfac-tion not only decreased following husbands' alcohol consumption but de-creased 5 d ays later as well. Further analyses of these relationships indicatedthat the wives' decline in marital satisfaction 5 days after heavy drinkingreflected their anticipa tion of hus ban d's drin king in 2 day s that is, inanticipation of another round of heavy weekend consumption. A secondsubset of four alcoholics exhibited a pattern of less variable drinking; theyconsume d most of their alcohol in the home. Two of these couples replicatedthe general findings from our cross-sectional study (Jacob, Dunn & Leonard,1983); that is, the husba nd's alcohol consu mption was negatively associatedwith the wife's symptomatology and/or positively associated with the wife'ssatisfaction. For a third couple, no relationships were found between hus-band's drinking and wife satisfaction or symptomatology findings whichappeared consistent with the fact that this couple had already experienced amarital separation and at the time of their participation in the study were verymuch estranged. For the last couple, husband's alcohol consumption wasassociated with an increase in wife's symptomatology. Closer examinationof this couple, however, indicated that the husband's drinking pattern andmarital interactions we re probably m ore similar to the episodic, out-of-homealcoholics than to the steady, in-hom e drinkers.

In summ ary, both our cross-sectional findings and the short-term longitu-dinal findings indicated the power and importance of defining more homo-geneous subgroups within a heterogeneous sample of alcoholics. Mostnotably, these data suggest quite different relationship patterns in marriage scontaining episodic versus steady-drinking alcoholics and imply that thefamily's role in the maintenanc e of abusive drinking can differ greatly w hensubgroup status is taken into consideration. If true, differences in the actual


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marital interactions of these two subgro ups should be discernible, especiallyduring p eriods of alcohol consum ption. To test these expectations, we reana-lyzed our laboratory interaction data so that we could compare the maritalinteractions of steady versus episodic alcoholics during drinking and non-drinking sessions (Jacob & Leonard, 1988). Most important, steady alcohol-ics and their wives increased their rate of problem solving from the no drinksession to the drink session, whereas episodic drinkers and their spousesexhibited a decrease in problem-focused behavior during the drink session.Furthermore, the episodic alcoholic exhibited more anger-hostility than didthe steady alcoholic.

At this point, our picture of the family's role in the maintenance of alcoholabuse has taken on several key features. For steady-drinking alcoholics,periods of drinking may actually encourage and/or facilitate the couple'sengagement in problem-solving efforts and when associated with increasedsatisfaction, may be reinforced within the family context a view that isconsistent with Steinglass's suggestion that "certain interactional behaviorsbecome associated with the intoxicated interactional state, and inasmuch asthese behaviors are functional or adaptive for the family, alcoholism itselftakes on an 'adaptive' flavor" (Steinglass, Davis, & Berenson, 1977, p. 13).In contrast, the interaction pattern associated with the episodic alcoholic andhis spouse (increased negativity on the part of the husband and decreasedproblem-solving on the part of the couple in the drinking session) does notappear to serve a positive function for the family, although it may be of"benefit" to the alcoholic. Specifically, alcohol consumption and the alco-holic's negativity may serve to discourage his wife from attempts at directproblem solving. That is, it seems likely that angry-hostile behavior ex-pressed by the husband during periods of drinking might prevent activeconsideration of conflictual issues a process that com es to be characterizedby coercive control features whereby he avoids dealing with conflictualissues by expressing high levels of negativity while drinking. To the extentthat such interchanges become embedded in family life, the alcoholic'sdrinking can be seen as preventing him from a cknow ledging and de aling witha range of marital and family problems.

For various reasons, present findings must be interpreted cau tiously. It isof particular importance that we determine if our findings stand the test ofreplication when relationships are assessed with an independent sample, wemust extend our initial findings through application of sequential analyticprocedures so that various contingent relationships implied by our rate-per-minute analyses can be explicitly examined, and we must examine moresystematically our definition of drinking style and identify distinguishingfeatures of episodic versus steady drinking patterns. In regard to this last


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Jacob / FAMILY STUD IES OF ALC OHO LISM 3.13

issue, we have sugge sted elsew here that our episodic subgroup shares certainsimilarities with previously described alcoholism subtypes characterized byan aggressive-a ntisocial behavior pattern and associated with significant in-terpersonal disturbances in various relationship domains (Jacob & Leonard,1988). On the other hand, our steady subgrou p seem s more closely associatedwith an internalizing coping style characterized by passivity and a lack ofassertiveness that to some extent may be overcome through the use ofalcohol. Although much w ork rem ains to be done in this area, it seems clearthat family influences relevant to the maintenance and course of alcoholismmust be qualified in terms of the specific patterns of the alcohol abuse, theindividual characteristics of the alcoholic, and the nature of the family systemwithin which relationship events transpire.

S U M M A R Y AN D F U T U R E D I R E C T I O N SAlthough the literature on family interaction and alcoholism is still at a

relatively early stage of development, the efforts of the past decade reflect aclear sense of excitement and potential and, from my perspective, encour-agement for the continued study of the family's role in understanding thenature of alcohol abu se. In summ arizin g this literature, I discusse d familyvaria bles that may be of etiologica l rele vanc e to the disorder as well as familyeffects that are likely to influence the course of alcoholism over time.Throughout, I tried to emphasize recent efforts that hold particular promisefor advancing this study area and suggest various research efforts aimed atimportant theoretical and methodological needs. Although space limitationsdo not allow for a full discussion of research directions deserving specialattention, such efforts would certainly include the following: (a) examinationof alcoholism subtypes relevant to both etiological and maintenance issues;(b) multivariate studies capable of assessing the dynam ic interplay of severalinfluence domains over time; (c) longitudinal studies aimed at transitionperiods (e.g., infancy to early childhood and a dolescence to early ad ulthood);(d) identification of drinking-specific family variables at the level of theindividual, dyad, and family system; (e) assessment of the independent andjoint effects of family genetic and family environmental influences; (f)testing of eme rging family m odels with female alcoholics and with minorityfamilies; (g) development of additional procedures for assessing interac-tional events in a valid and reasonably economical manner; and (h) thegeneration and systematic evaluation of theoretical models explicating thefamily's role in the etiology and course of alcoholism.

As suggested e arlier, many aspects of family literature on alcoholism arehighly relevant to studies of other psychopathologies a suggestion that


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certainly seems supported when reading through the foregoing list of recom-mendations for future research. Most important, it now seems clear that anexclu sive focu s on any one influence do main can no longer be justified onscientific grounds; that the complexity of the phenomena we wish to under-stand requires a multivariate, longitudinal perspec tive within which researchefforts should be grounded and interpreted; and that both family environmen-tal and family genetic perspectives must be included in designs that arecapable of clarifying the independent and interactive effects of these twoinfluence domains as behavior unfolds over time (Jacob and Leonard, 1991;Tarter, 1 991; Zucke r, 1989, 1991).

Finally, future research on the role of family influen ces in the etiology andcourse of disordered behavior may be best served by incorporating some ofour theory-testing interests into treatment and prevention research models.The rationale for this suggestion is twofold. First, even if we take the extremeposition that family genetic and/or constitutional factors are of primaryimportance in explaining p sychopathological disorders, we will still have todetermine the malleability of such biologically based dispositions and iden-tify interventions by which adverse outcomes can be altered. In pursuit ofthese objectives, it is my view that psychosocial interventions will be theprimary means through w hich correctives can be achieved. Second , our stud-ies of hum an behavior especially those co ncerned with personal, social-interactional, value-laden expressions of hum ankind often require us tocompromise the rigor of our science in the interests of the higher value weplace on the ethical treatment of research participants. As a result, we arerarely able to exert maximum control over our study matter through theprocess of random selection from a common population and random assign-ment to powerful and opp osing experimental c onditions. The one area wherethese more powerful manipulations can occur and can be justified is in theconduct of clinically and socially relevant interventions aimed at enhancinga person's functioning and quality of life. That such intervention efforts canlead to significant advances in our theory testing interests has been sug-gested by m any (e.g., Kendall, Lerner & Craighead , 1984) but is perhap s bestconveyed in a remark attributed to Bronfenbrenner's (1977) mentor in aconversation with his young graduate student, "If you want to understandsomething, try to change it."

N O T E S1. Much of the material included in this paper is based upon several recent reviews by the

authorin particular, Jacob, 1987b, 1987a; Jacob and Leonard, 1991; and Jacob and Seilhamer,1987. The interested reader is encouraged to consult these sources for further background anddiscussion of them es presented in the current article.


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Jacob / FAMILY STUDIF.S OF ALC OHO LISM .135

2. As described elsewhere (Jacob et al., 1989), this investigation involves laboratory as wellas home observations, the inclusion of female alcoholics and female depressives, and thesystematic follow-up (5 and 10 years after initial assessment) of index cases, their spouses, andoffspring. An alyses of these various data sets are ongoing, and a considerable number of reportshave been published during the pasl decade. The present article, however, is limited to laboratoryinteraction data relevant to issues of course.

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