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ORIGINAL ARTICLE

Family Roles in Homes With Alcohol-Dependent Parents: An Evidence-Based Review

Peter M. Vernig

Acceptance, Mindfulness, and Emotion Lab, Department of Psychology, Suffolk University, Boston, Massachusetts, USA

The behavioral health care field has seen attempts to understand the functioning of families in which a par- ent is dependent on alcohol as a set of roles into which the other family members fall. The most popular of these classifications taught in the United States in- cludes five roles (enabler, hero, lost child, mascot, and scapegoat) that are used to conceptualize families and individuals in treatment and support group settings, as well as in popular self-help literature. Attempts to operationalize and measure these roles have, however, been fraught with difficulties. The resulting research base has seen conflicting evidence for the support of such roles, as well as little work on diverse families. The evidence against such well-defined family roles, the questions surrounding their development, and the difficulties of applying such constructs in real-life sit- uations (with numerous confounding factors and un- known associated conditions) may indicate that their clinical utility does not win out over the problems in- herent with this manner of classification.

Keywords alcohol-dependent parents, family roles, adult children of alcoholics, family interaction, enabler, hero, lost child, mascot, scapegoat

INTRODUCTION

Each year, over 7% of the population will experience alcohol abuse or dependence (Office of Applied Studies, 2007), and an estimated 17 million families will cope with the effects of “heavy drinking” (National Center on Addiction and Substance Abuse at Columbia University, 2005): While the individual living with alcohol misuse is often the focus of attentions, the entire family feels the deleterious consequences. Much of the extant clinical and empirical work has focused upon families in which it is a parent who is dependent on alcohol, as this appears

The author would like to thank Drs. Susan M. Orsillo and Harvey Katz for their editorial assistance in preparing and revising this manuscript. Address correspondence to Peter M. Vernig, Acceptance, Mindfulness, and Emotion Lab, Department of Psychology, Suffolk University, 41 Temple St., Boston, MA 02114; E-mail: peter.vernig@suffolk.edu

to be the situation possessing the greatest potential for far-reaching family discord and long-term distress for the children in the home. Wegscheider-Cruse (1989) describes alcohol dependence as a “family disease” in which the other members of the family not only expe- rience the effects but also play an active role (however unknowingly) in supporting this pattern of maladaptive behavior. In an attempt to understand the dynamics of families in which alcohol dependence is a problem, the roles taken on by the other family members are sometimes conceptualized as fitting into a stable pattern that can be observed predictably across different families. Arguably the most prevalent of these classifications is that written about by Wegscheider-Cruse, in which family members fall into five well-defined and generally nonoverlapping roles: enabler, hero, lost child, mascot, and scapegoat.

So common is this model of family dynamics that it has entered into the folk wisdom of the field of substance use counseling and self-help support groups for individu- als coping with the long-term effects of growing up with an alcohol-dependent parent. Those in treatment and treat- ment providers alike are taught to conceptualize such fam- ilies as following this predetermined and rigid categoriza- tion developed from personal observation and anecdotal evidence, begging the following questions: Do these roles stand the test of empirical science? And do they have a place in modern evidence-based behavioral health care? Following a brief review of these hypothesized family roles, the state of the empirical literature will be discussed, especially the issues of measuring and categorizing these roles, as well as some salient factors influencing their de- velopment and long-term consequences.

FAMILY ROLES

As stated earlier, the system of roles proposed by Wegscheider-Cruse (1989) classifies family members into

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one of five categories: enabler, hero, lost child, mascot, and scapegoat. Each of the roles includes their own in- ternal and interpersonal features, which are proposed to not only protect the individual within the family but also maintain the family structure and allow for the parent with the alcohol use disorder to continue their pattern of be- havior unabated and with minimal aversive consequences. Black (1982) suggests that the roles taken on by children with an alcohol-dependent parent are a maladaptive ver- sion of a natural process: Within a normal family, mem- bers take on a variety of roles (provider, caregiver, dis- ciplinarian, etc.) and are able to shift between them as appropriate. When the family dynamics are strained by alcohol misuse, and responsibilities are shifted (e.g., one parent covering for another, children functioning as care- givers for younger siblings), they can become more rigid and problematic. While the roles that develop may be adaptive within the family, the point at which the fam- ily members interface with the outside world—as well as their functioning as adults—is negatively impacted by the features associated with each. Furthermore, Nardi (1981) notes that the various roles that are taken on by children growing up in such families often result in confusion of which role the child must play at any given time.

Harris and MacQuiddy (1991) have argued that the role a child develops in a family with an alcohol-dependent parent forms a stable and inflexible part of their person- ality. They suggest that for individuals who grew up in families with an alcohol-dependent parent, emotional and interpersonal problems later in life are a common result of continued attempts to play the same role that they became used to in childhood and adolescence. The high preva- lence of alcohol or other drug misuse (as well as other disorders of impulse control) in individuals who origi- nate from a family containing an alcohol-dependent par- ent is often cited as evidence for this model (Black, 1982; Wegscheider-Cruse, 1989). In clinical settings, these fam- ily roles have been used for the conceptualization of fam- ilies that present for treatment. The identification of each family member’s role and its consequences (for the indi- vidual, the alcohol-dependent parent, and the family as a whole) allow for these relationships to be challenged and for the family to be reorganized with a more adap- tive interactional pattern. This model has also taken root in self-help and support groups for individuals with al- cohol dependence in their families of origin (e.g., Adult Children of Alcoholics and Al-Anon, both 12-step-based self-help groups). The roles, as originally discussed by Wegscheider-Cruse, and their associated features are pre- sented below.

The Enabler Commonly, the enabler is the spouse of the alcohol- dependent parent. Their closeness allows them to see the effects of the continued alcohol misuse firsthand. Accord- ing to the theory, the enabler’s primary role is to insu- late their spouse from the aversive consequences of his or her actions, thereby preserving the maladaptive patterns of drinking behavior. Outwardly, the enabler may appear

to be doing everything in their power to stop their spouse’s drinking, but the constant acceptance of additional re- sponsibilities (making excuses to employers, driving their spouse home from parties when he or she has had too much to drink, etc.) may actually prevent the alcohol- dependent spouse from experiencing the natural conse- quences of his or her behavior that could bring about a desire to change. In many cases, this involves the enabler dealing with and absorbing the consequences themselves, so as not to allow them to fall to their spouse. The enabler is hypothesized to insure that the family maintains an out- ward appearance devoid of any signs of dysfunction and reinforces that the rest of the family members play their own roles. Behaviors such as these are seen by the enabler as a matter of loyalty and have often been modeled and re- inforced by their own parents. Placing the alcohol misuser (and his or her harmful behavior) at the center of the en- abler’s life allows the instability and chaos of alcohol de- pendence to become the ebb and flow of the family’s daily functioning. It has been hypothesized that feelings of inad- equacy and helplessness pervade the enabler’s personality, as they must constantly react and respond to the behavior of their spouse. The enabler is thought to have very little time to devote to their own needs and interests, as they are constantly protecting and supporting someone else.

The Family Hero The role of the hero is believed to be commonly played by the oldest child, who is capable of taking on greater re- sponsibility for the well-being of the family early on. They will often be highly accomplished in arenas that are valued by the rest of the family: If their parents place high esteem on career advancement, the hero will excel in their profes- sional life. They provide a family exemplar for the parents to brag about and enable the family to receive praise and reinforcement from others. The hero is said to leave the family early on in life (for a career, school, etc.) but is always ready to come to the rescue when needed (often when the enabler is unable to completely fulfill their role). Literature regarding the hero has often stated that, inter- nally, they may be very driven to succeed but in areas de- fined for them by others; they are not motivated by their own desires. The hero’s high levels of outward success and apparent satisfaction belie their constant self-scrutiny and feelings of inadequacy. They are thought to neglect other areas of their lives (self-care, relationships, etc.) in the pursuit of the virtues set forth by their parents’ values. They may also feel overwhelmed, as if the entire family is dependent on them to fulfill their role.

The Lost Child The lost child is the one whose needs and wants are over- looked by the rest of the family in their attempts to cope with the behavior of the alcohol-dependent parent. The other family members are said to pay little attention to the lost child, and he or she develops a world completely separate from them. Within the home, he or she may be withdrawn, having learned to disappear into the back- ground of the family. This behavior is reinforced by other

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members of the family, all of whom are too busy in their own roles to deal with the needs of yet another child. The lost child may be involved in fantasy (often through read- ing or television), and the family may be ignorant of his or her interests and outside pursuits. He or she is unlikely to receive the same recognition and regard for outside ac- complishments as the other children and learns early on not to “make waves” by seeking attention or question- ing the family structure. The lost child’s feelings are often thought to be characterized by loneliness and sadness, and they may fail to develop close peer relationships, a prob- lem that can extend into adulthood. It is believed that, as adults, they tend to have little contact with the family, hav- ing developed a physical separation from their parents and siblings to match the psychological separation learned in childhood.

The Mascot The child who falls into the role of the mascot (commonly thought to be the youngest) plays the part of a distracter from the problems within the family. It is his or her job to be cute, funny, and outgoing: Other family members can easily become swept up in the mascot’s personality so as not to focus on the problem at hand. He or she is thus often considered “the life of the party.” The other family members all like the mascot but seldom take him or her seriously and may have low expectations for the mascot’s abilities and intelligence. The family will often withhold information as a means of “protecting” the mas- cot; however, he or she tends to be more aware of the fa- milial strife than others think but lacks the ability to un- derstand the family dynamics supporting these problems. The mascot is, according to family roles theorists, usu- ally frightened by the conflict within the family and en- gages in this role as a means of lightening the mood and relieving tension. When they find how well this works, it becomes negatively reinforced as a pattern of behavior defining their role in the family. This avoidance of con- frontation may make close interpersonal relationships dif- ficult later in life. As an adult, the mascot is said to often have trouble coping with problems directly, having always resorted to behavioral disengagement.

The Scapegoat Like the mascot, the scapegoat is hypothesized to draw attention from the turmoil elsewhere in the family; how- ever, she or she engages in less prosocial behavior than the mascot. The scapegoat is often in trouble, having difficul- ties in school, legal problems, and other maladaptive (of- ten dangerous) outlets. They are attracted to peer groups that are involved in similar pursuits and are likely to use drugs and alcohol themselves. Early on they may try to fill the role of the hero, but their accomplishments are always overlooked and minimized in deference to those of their older sibling (the scapegoat is almost always the next child after the hero). The concerned and caring ac- tions of the hero may cause resentment in the scapegoat, who sees the hero as insincere and acting only to placate others. It is believed that as their behavior begins to de-

teriorate, the scapegoat is blamed for many of the prob- lems of the family, and they learn that they cannot suc- ceed in the eyes of their siblings or parents. The rest of the family is easily distracted by the problems created by the scapegoat and can focus on their defiant behavior as an alternative to dealing with the alcohol-dependent par- ent (or the consequences of their own actions). The scape- goat is said to usually feel out of control and believe that there is little they can do to avoid the trouble that comes so naturally to them. They may have a tendency to experi- ence anger, which they turn outward (unlike the rest of the family members, who strive to keep their emotions from showing). The effects of these patterns of behavior later in life often manifest as legal problems, poor academic and vocational performance, and drug or alcohol use.

Alternative Role Classifications Black (1982) provides an alternative system for classify- ing the roles of family members, which includes the code- pendent spouse and four roles into which children may fall. These roles have a great deal of overlap with those proposed by Wegscheider-Cruse (1989), and Black notes that some of Wegscheider-Cruse’s names are commonly used terms for her own roles. Black discusses the respon- sible child (cf. hero) as the one who must take on extra responsibility for both the alcohol-dependent parent and the other family members. He or she has a strong desire for order and is often praised by one or both parents for being mature and responsible. The role of adjuster (cf. lost child) is filled by the child who changes or adjusts them- selves to fit the situation. They are a less visible mem- ber of the family and have developed a pattern of denial in response to the chaos within the home. The placater (cf. mascot) is the more emotional of the children, at- tempting to diffuse tension. Other family members may label him or her as being more sensitive to family dis- cord and thus attempt to buffer or protect the placater. Black also proposes the acting-out child (cf. scapegoat) as a less common role in which the child exhibits nega- tive behaviors that are modeled by the parents. This child suffers from low self-esteem and often receives referral(s) for treatment services while their parent’s alcohol depen- dence continues unabated.

OPERATIONALIZATION AND MEASUREMENT1

The Family Role Behavior Index In an attempt to operationalize the family roles proposed by Wegscheider-Cruse (1989), Verdiano, Peterson, and Hicks (1990) conducted a factor analysis of a pool of items hypothesized to represent the characteristics of the five roles. Utilizing a high school sample, they tested these items with the intent to build an instrument capable of

1 An additional questionnaire (the Family Relations Inventory) was cre- ated by Martin, McDermott, and Tollefson (1992), who used it to test incarcerated versus nonincarcerated self-help group participants. They observed no differences between groups or sexes, and no subsequent uses of the questionnaire were found.

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identifying the degree to which people from families con- taining an alcohol-dependent parent identify with the fam- ily roles. Their analyses yielded a five-factor solution; however, some of the factors were rather weak (the factor that they deemed “enabler” only loaded three items). The resulting questionnaire, the Family Role Behavior Index (FRBI), has 46 items purported to identify family mem- ber role functioning.

Numerous studies are cited in support of the in- strument’s construct validity, but the bulk are unpub- lished manuscripts and dissertations. While these origi- nal sources (the single published dissertation abstract is cited below) are not available, the findings reported by Verdiano and colleagues (1990) are as follows. Leavell (as cited in Verdiano et al.) found all scales but the enabler to differ significantly for alcohol-dependent incarcerated adults versus a demographically matched nonincarcerated comparison group. Le Gare (as cited in Verdiano et al.) reported that differences between self-ratings and collat- eral ratings on an adjective checklist were significantly related to scores on the scapegoat and lost child scales. Verdiano and colleagues explained these results as rep- resenting a “lack of congruency in perceptions and com- munication among family members where these negative roles are pronounced” (p. 728). Cassis (as cited in Ver- diano et al.) found that the hero scale of the FRBI could discriminate between graduates of a family therapy train- ing program who eventually became supervisors and those who practiced as therapists: The supervisors averaged higher on the hero scale. This analysis, however, raises critical questions regarding the authors’ use of the deci- sion to become a supervisor (which is also probably tied to clinical skill, work performance, and many other factors) as the criterion for establishing discriminant validity. Ver- diano (1986) also found sex differences for several scales, with women scoring higher than men on the enabler and hero scales and men scoring higher than women on the scapegoat scale.

In spite of the dearth of studies reported by Verdiano and colleagues (1990) in support of the FRBI as a valid psychometric instrument, several problems pervade their methods and those of the studies they cite. First, no at- tempt was made to screen out participants with a family history of alcohol dependence. It stands to reason that not all students in the sample came from a home in which the family roles would be likely to develop in response to a parent’s alcohol misuse. A strongly skewed sample may have been utilized for the initial testing of the instrument, which would probably have produced results not represen- tative of families with an alcohol-dependent parent. Fur- thermore, the authors state that they chose the five-factor solution from a variety of possible solutions (the origi- nal, unrotated solution included 12 factors), as it was the most interpretable; there was no mention of the statisti- cal differences between the numerous solutions they men- tion. The relatively weak supporting evidence given to es- tablish the validity of the FRBI is another grave concern. None of the studies were subject to peer-review, and the little information about their designs that was presented

reveals the possibility of methodological shortcomings. While there is little doubt that statistically significant rela- tionships were observed between scales of the FRBI and other demographic and psychosocial variables, these rela- tionships fall short of demonstrating that the participants in the various studies were functioning within static roles resulting from a home environment in which a parent mis- used alcohol.

The Children’s Role Inventory Another (and arguably more successful) attempt at developing a measure to assess family role functioning came from Potter and Williams (1991). They corrected some of the problems with the FRBI by enlisting a sample of individuals whose family of origin contained alcohol dependence. The resulting Children’s Role Inventory (CRI) contains four scales; the enabler role is left out, as the instrument is designed to screen for role characteristics from childhood, and parents are primarily hypothesized to take on the role of the enabler. Potter and Williams found the CRI to have adequate internal consistency and reliability. They further tested the CRI scales’ relationships to self-esteem and support networks and found that participants classified as heroes or mascots had higher self-esteem scores than those who were classified as scapegoats or lost children. The same pattern was noted for participants’ satisfaction with their social support networks. In a study of the factor structure of the CRI, Williams and Potter (1994) found the four-factor solution to be consistent across three different samples.

Using the CRI, Alford (1998) looked at the dif- ferences between families with or without an alcohol- dependent parent that were considered either dysfunc- tional or nondysfunctional (dysfunctionality was assessed by self-report, using items indicating verbal and physi- cal fights, emotional instability, harsh discipline, divorce, and other indicators). Their findings speak to the part alcohol plays in the development of the proposed fam- ily roles: No significant differences were found between participants from families with or without alcohol de- pendence on the frequency or degree of role identifica- tion. Alford did report significant findings for dysfunc- tional families without alcohol dependence. Participants who grew up in this environment identified less with the hero role and more with the scapegoat role than those coming from either normal (nondysfunctional and non- alcohol-dependent) or alcohol-dependent (with or without other dysfunction) family environments. Participants from dysfunctional nondependent families also identified more with the lost child role than those from normal families. When divided by dysfunctional versus nondysfunctional family of origin (collapsing across alcohol dependence), the two resulting groups had significant differences in scores on the hero (nondysfunctional > dysfunctional), scapegoat (dysfunctional > nondysfunctional), and lost child (dysfunctional > nondysfunctional) scales. If one is to assume that the family roles follow the pattern laid out by Wegscheider-Cruse (1989), these results suggest that the CRI may lack construct validity, possibly tapping into

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family dysfunction more than role functioning. Discard- ing that assumption, they may indicate that alcohol depen- dence is not a necessary precondition for the development of maladaptive family roles or at least that family dys- function (a common result of alcohol dependence) may mediate this relationship. These results support the find- ings of Fisher, Jenkins, Harisson, and Jesch (1992) that the clinical characteristics of adults from families with an alcohol-dependent parent were similar to those from fam- ilies experiencing other dysfunction (e.g., divorce, abuse).

Some support for the CRI comes from Fischer, Pid- cock, Munsch, and Forthun (2005), who used the CRI to look at role differences between family members in a sam- ple of sibling pairs (college freshmen and younger siblings aged 12–17 years). For the freshmen, CRI scores were correlated neither with parental drinking nor with fam- ily dysfunction. In the group of younger siblings, scores on the hero scale bore the only significant correlations to parental drinking or family dysfunction, both in the neg- ative direction. When score differences between the sib- ling pairs were correlated with parental drinking and fam- ily dysfunction, only the hero and lost child scales were significant. The authors suggest that these results demon- strate the age effects of family roles, in that the hero score difference was correlated to parental drinking in the di- rection of higher scores for the freshmen. The score dif- ference correlations for the lost child were in the opposite direction.

The Mucowski Typology Inventory Mucowski and Hayden (1992) developed a questionnaire to evaluate Black’s (1982) family roles by compiling a set of questions derived from Black’s work. These items were sorted into the four roles by a group of human service professionals experienced in working with alcohol-dependent individuals. The resulting inventory was administered to a sample of college freshmen with family histories of alcohol dependence, as well as individuals in treatment who self-identified as having an alcohol-dependent parent. Their initial factor analysis yielded a nine-factor solution, which the authors describe as conforming to a mixed model including roles from both Wegscheider-Cruse (1989) and Black. They hypothesize the factors as representing a combined adjuster/placater, a responsible child, an acting-out child, a hero, two roles (obstinate naysayer and avoider) not discussed by either Black or Wegscheider-Cruse, and three additional roles that were too weak (loading four or fewer items each) for a detailed analysis. With regard to the two new roles, Mucowski and Hayden propose the obstinate naysayer as a confrontational family member who starts conflicts for the purpose of eliciting a reaction and the avoider as a negativistic individual who avoids problems and fails to gain insight into more effective strategies for the future.

Mucowski and Hayden’s (1992) attempt to measure family role functioning falls short of validating Black’s (1982) theory, and the resulting Mucowski Typology Inventory appears to have found little reception in the subsequent literature. With respect to the authors’ analy-

ses, only the factor structure and the internal consistency of the measure are presented. No attempts to establish the instrument’s validity were reported, and the two dissimilar participant groups (college freshmen and alcohol misusers in treatment) were grouped together for all analyses. The measure’s factor structure speaks to the difficulties of outright attempts to demonstrate a rigid theory based on personal observation. While Mucowski and Hayden originally set out to validate Black’s roles, they found that their characteristics overlapped, included one of Wegscheider-Cruse’s (1989) roles, and formed additional roles heretofore not described. Taken together, one may begin to conclude that the complex interpersonal dynamics of a family coping with alcohol dependence cannot be distilled into simple categories into which the members will predictably fall.

PARENTIFICATION

Parentification, defined as the “inappropriate and pre- mature assumption of adult roles by children or ado- lescents before they are emotionally or developmentally able to manage these roles successfully” (Stein, Riedel, & Rotheram-Borus, 1999, p. 193), is of particular in- terest in families where one or both parents are living with alcohol dependence. The aforementioned taking-on of additional household responsibilities by older children (especially the care of younger siblings) is a prime ex- ample of this parental boundary distortion. Goglia, Ju- rkovic, Burt, and Burge-Callaway (1992) looked at this phenomenon in a mixed-sex sample of adults. Female participants identified as coming from a family contain- ing a parent with an alcohol use disorder reported that they had taken on significantly more caregiving respon- sibilities as children than did comparison participants; this result was not observed for male participants in the same study. Kelley and colleagues (2007) examined par- entification and caregiving in a large sample of college women and found significant differences between those with and without alcohol dependence in their family of origin. Their results indicated that women from fami- lies with alcohol dependence scored significantly higher on measures of parentification, instrumental and expres- sive caregiving, and unfairness in their family of origin. Kelley and colleagues suggest that diffusion of parental boundaries in families where one or both parents are alcohol dependent is a common problem that underlies these results. The authors’ operationalization of paren- tification with the Parentification Questionnaire–Adult (Sessions & Jurkovic, as cited in Kelley et al.) may, how- ever, have led to some degree of overlap in their mea- surement, as this measure specifically looks at caregiving responsibilities.

BIRTH ORDER VERSUS SEX DIFFERENCES

Goglia and colleagues’ (1992) findings do not mesh with Wegscheider-Cruse’s (1989) and Black’s (1982) theo- ries of family roles, with their emphasis on birth order.

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Parentification would naturally be more the burden of the hero, but Goglia and colleagues’ results would appear to suggest that it is in fact sex, more so than birth order, that contributes to the characteristics related to the hero role (consistent with Veridiano, 1986). It stands to reason that the surrogate caregiver must be an older child, but the im- portance of the firstborn is not supported.

In a review of multiple case studies, Brisbane (1989) discusses apparent differences in the hero role among African American children with alcohol-dependent par- ents. Little work has been done to examine Wegscheider- Cruse’s (1989) family roles cross-culturally (Fischer et al., 2005, oversampled Hispanic participants to include them in equal numbers with Caucasians but did not report any analyses comparing the two groups). Brisbane suggests that the oldest female child will be more likely to take on the role of hero in African American families, a result of the caretaker role often filled by older female children in African American culture.

To investigate possible connections between family roles (as measured by the FRBI), sex, and birth order, Veronie and Fruehstorfer (2001) surveyed adults with a self-reported history of alcohol dependence in their fam- ilies of origin, who were recruited from a substance mis- use treatment provider and a variety of 12-step groups (Alcoholics Anonymous, Al-Anon, and Adult Children of Alcoholics). Inconsistent with Verdiano (1986), they found that women scored higher on the lost child scale and men higher on the mascot scale. Of particular interest are Veronie and Fruehstorfer’s findings for birth order: No significant differences were noted for any scales. These re- sults do not seem to support the theoretical foundations of the family roles, as many of the roles are hypothe- sized to develop out of the relationships arising because of birth order. The mascot, for instance, is hypothesized to commonly be the youngest child because the other family members act to protect the newest member of the family. The scapegoat’s common position as the second child is purported to result from their prosocial accomplishments being overlooked in favor of the firstborn hero. If birth order is unrelated to the scales of the FRBI, either the in- strument lacks construct validity, or the roles themselves are not materializing the way they are hypothesized to de- velop. Veronie and Fruehstorfer also note that the mascot and lost child scales contain items that may pertain to tra- ditional gender roles, possibly setting up a response bias in the direction of the results they observed for both scales.

DISCUSSION

It would seem that the attempt to fit members of a fam- ily affected by alcohol dependence into narrowly defined roles based upon a few salient characteristics does not posses the clinical utility that some have claimed. The changing family dynamics of the modern era, the recogni- tion of families of differing structures, and the increased awareness of families from different cultural and ethnic backgrounds all speak to the need to update the man- ner in which member functioning is conceptualized in

families with alcohol (and other drug) use disorders. It is clear that alcohol misuse does not occur in a vacuum and that family members are involved in the develop- ment and maintenance of these disorders. It is also no- table that the interpersonal, emotional, and social conse- quences for the whole family are often painful and may persist into adulthood, long after the resolution of the par- ent’s alcohol misuse. The effects of treatment on families were studied by Teichman and Basha (1996), who found that perception of family relationships and levels of code- pendency approached normative levels as treatment pro- gressed. Finzi-Dottan, Cohen, Iwaniec, Sapir, and Weiz- man (2006) found similar results in families in which the father was currently receiving treatment for substance misuse. The roles that family members play are likely to shift over time as well: New members enter the picture and others depart; commitments outside the home (i.e., work, school, etc.) change; people grow and mature; and the individual suffering from alcohol dependence ages. With respect to marital relationship stability, O’Farrell and Birchler (1987) fount that married couples with an alcohol-dependant husband did not differ from otherwise- distressed couples, and both were significantly different from nondistressed married couples.

The later-life effects of growing up in a home where a parent misuses alcohol have also been called into ques- tion: While it is evident that children with an alcohol- or drug-dependant parent may be at a higher risk for certain difficulties as adults, including substance depen- dence, mental illness, and interpersonal problems (see Peleg-Oren & Teichman, 2006, for a review), the idea of a homogeneous personality type is not supported by the literature. The assumption that individuals with alcohol- dependent parents develop codependency in adulthood was challenged by Fisher and colleagues (1992), who found that they did not differ in level of codependency from other adults. Logue, Sher, and Frensch (1992) sug- gest that the personality characteristics long attributed to individuals who were reared in a household with an alcohol-dependent parent may be less accurate than com- monly believed. They found that college students with and without a family history of alcohol misuse had no differ- ences in their agreement with self-descriptive statements suggested by the clinical literature and experts to be in- dicative of adults with alcohol-dependent parents. Fur- thermore, these levels of agreement were no different from Barnum statements (overly general statements geared to a high degree of endorsement). These results are important not only because they cast doubt on the commonly held personality profile of people with alcohol-dependent par- ents but also given the source of the information: Logue and colleagues provided these statements as the “results” of a personality inventory that participants had just com- pleted. The high degree of agreement with these person- ality traits may be due to the provision of the statements in a diagnostic manner, from an “expert source.” This mir- rors the information given by treatment providers and self- help books that provide descriptive statements that many in the general population can endorse. Indeed, much of the

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support for these roles comes from anecdotal sources (as in Harris & MacQuiddy, 1991).

From a review of the literature with an eye to the presence or absence of an empirical foundation for Wegscheider-Cruse’s (1989) model of family dynamics, it would appear that few studies have adequately investi- gated these roles. Measurement of these constructs, nec- essary to establish further research, has been plagued by poorly designed questionnaires and weak supporting evidence. Buscema (2002) discuses some of the difficul- ties inherent in modeling complex, multidimensional phe- nomena such as substance misuse using traditional lin- ear statistical techniques and suggests that understanding such nonlinear phenomena might be a task more suited to artificial neural network. Such procedures allow for the modeling of complex systems in which precursors and re- sults are known, but violations of the basic assumptions of cause and effect are also present. Furthermore, little cross- cultural work has been done to look at the differences and similarities in roles within diverse families. At first glance, the image of a family in crisis painted by these roles has a degree of face validity: The individual family mem- bers and their relationships to each other fit with common stereotypes in the media and popular culture. However, in reality, not only is alcohol dependence a family illness, but it is a diverse one as well. Thinking of the family structure within these rigid boundaries may lead clinicians and re- searchers to miss out on important facets of the home envi- ronment. Even the common idea of the father as normally being the alcohol-dependent family member has been suc- cessfully challenged. Wegscheider-Cruse admitted that occasionally the mother was dependent (with the father serving as the enabler), but usually the mother’s alcohol use is more secretive, and this role reversal is certainly rare. While alcohol use disorders are more common in men than women (10% and 5% yearly prevalence, respec- tively; Office of Applied Studies, 2007), a large number of women do meet the criteria for these disorders, and Fisher and colleagues (1992) found no differences in the prob- lems experienced by adults with an alcohol-dependent mother versus those with an alcohol-dependent father.

To better understand the dynamic and multifaceted roles that family members play in a home where a par- ent is dependent on alcohol, it is necessary to move away from a strict role theory and focus on not only the com- monalities but the differences that come into play when family members cope with the myriad social, emotional, financial, and interpersonal consequences of alcohol de- pendence.

Declaration of Interest

The author reports no conflict of interest. The author alone is responsible for the content and writing of this paper.

RÉSUMÉ

Le domaine de la santé comportementale a vu des tenta- tives de comprendre le fonctionnement des familles dont

un parent est dépendant de l’alcool comme un ensem- ble de rôles dans lequel la famille d’autres membres de l’automne. Le plus populaire de ces classifications en- seignées dans les États-Unis comprend cinq rôles (cataly- seur, le héros, enfant perdu, la mascotte, et bouc émissaire) qui sont utilisés pour conceptualiser les familles et les individus dans le traitement et les paramètres de groupe de soutien, ainsi que dans les populaires auto-assistance littérature. Les tentatives visant à opérationnaliser et de mesurer ces rôles ont cependant été semé d’embûches. La base de recherche qui en résulte a vu des preuves con- tradictoires pour le soutien de ces rôles, ainsi que peu de travail sur les diverses familles. Les preuves contre ces rôles familiaux bien définis, les questions entourant leur développement, et les difficultés d’application de telles constructions dans des situations réelles (avec confond nombreux et inconnus conditions associées) peuvent in- diquer que leur utilité clinique n’a pas l’emporter sur les problèmes inhérents à ce mode de classification.

RESUMEN

El campo de la salud de comportamiento ha sido testigo de intentos de comprender el funcionamiento de las fa- milias en las que un padre es dependiente del alcohol como un conjunto de roles en los que la familia que no entran los miembros. El más popular de estas clasifica- ciones se enseña en los Estados Unidos incluye cinco fun- ciones (facilitador, héroe, niño perdido, la mascota, y el chivo expiatorio) que se utilizan para conceptualizar las familias y los individuos en el tratamiento y la config- uración de grupos de apoyo, ası́ como en la popular de auto-ayuda- la literatura. Los intentos de hacer efectivos y medir estas funciones tienen, sin embargo, ha sido pla- gada de dificultades. La base de la investigación resultante ha visto la evidencia sobre el apoyo de esos papeles, ası́ como poco trabajo en las familias diversas. La evidencia en contra de tales roles familiares bien definidos, en as- pectos relativos a su desarrollo, y las dificultades de la aplicación de tales construcciones en las situaciones de la vida real (con confunde numerosos y desconocidos condi- ciones asociadas) podrı́a indicar que su utilidad clı́nica no gana a lo largo de los problemas inherentes a este tipo de clasificación.

THE AUTHOR Peter M. Vernig, M.A., is a doctoral candidate and adjunct instructor at Suffolk University in Boston, Massachusetts. His research involves acceptance- based behavioral interventions for etiological models of substance use disorders, as well as the implementation of evidence-based practices in behavioral health care and the roles of anxiety and social skills in relationship formation.

542 P. M. VERNIG

GLOSSARY

Codependency: A proposed pattern of behavior in which a person pays extreme and often inappropriate attention to the needs of another person (in the context of alcohol misuse, often an alcohol-dependent spouse or romantic partner).

Enabler: A hypothesized role in which a family member (usually the spouse) engages in behaviors that allow an alcohol-dependent parent to continue their alcohol use.

Family hero: A role in which a child is believed to excel in parentally defined areas and take care of other family members when necessary.

Family roles: Sets of culturally bound behavior patterns and personality traits thought to encompass the func- tioning of family members within the home; such roles include flexible and naturally occurring components of a family (caregiver, disciplinarian, etc.), as well as rigid, maladaptive roles that are hypothesized to de- velop in families with an alcohol-dependent parent.

Lost child: A family role in which the child is hypothe- sized to be overlooked by other family members, re- sulting in their withdrawal from the family.

Mascot: Believed to be a role concerned with providing distraction from problems (especially the parent’s al- cohol dependence) for other family members.

Parentification: Often occurring in families with high levels of discord (from alcohol dependence or other causes). A child takes on additional developmen- tally inappropriate responsibility, including caring for younger siblings.

Scapegoat: A family role in which the child is believed to act out in a self-destructive and antisocial manner be- cause of their perceived inability to receive recognition for positive pursuits.

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