Family Structural Issues and Chemical Dependency: A Review of The Literature From 1985 To 1991

The American Journal of Family Therapy
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Family structural issues and chemical dependency:

A review of the literature from 1985 to 1991
Gail Mackensen & R. Rocco Cottone
To cite this article: Gail Mackensen & R. Rocco Cottone (1992) Family structural issues and
chemical dependency: A review of the literature from 1985 to 1991, The American Journal of
Family Therapy, 20:3, 227-241, DOI: 10.1080/01926189208250892
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FAMILY STRUCTURAL ISSUES
AND CHEMICAL DEPENDENCY:
A REVIEW OF THE LITERATURE
FROM 1985 TO 1991
Downloaded by [University of California, San Diego] at 13:19 29 June 2016
GAIL MACKENSEN and R. ROCCO COTTONE
This review of the literature summarizes publications from 1985 to

1991 that viewed the chemically dependent family from a structural
perspective, focusing on boundaries, roles, rules, and communication
patterns. The review will provide an overview of structural issues with
implications for therapy and suggestions for further research. Seven
journals were reviewed and are as follows: Family Process, Journal
of Marriage and the Family, Journal of Marital and Family Ther-
apy, American Journal of Family Therapy, Journal of Studies
on Alcohol, Journal of Chemical Dependency Treatment and
the Alcoholism Treatment Quarterly. Additionally, publications or
papers identified by a computer search of Psychological Abstracts
were included, identified using the key words “family relations” and
”alcoholism.” The intent of this review is to discuss family dynamics
from a structural and systemic perspective only. Therefore, psychody-
namic literature on family relations is not included.
Minuchin’s (1974) structural view of the family has added much to the
literature in terms of research that analyzes the boundaries, roles, rules,
and communication patterns in chemically dependent families (Erekson
& Perkins, 1989; Kaufman, 1986; Perkins, 1989; Preli et al., 1990;
Steinglass et al., 1985).
Minuchin (1974), in describing family structure, suggests that the fam-
ily develops a structure as it differentiates and carries out its functions
Gail Mackensen is a graduate student in the Department of Behavioral Studies at the

University of Missouri-St. Louis. R. Rocco Cottone, Ph.D., is Associate Professor and
Coordinator of the Marital and Family Counseling Sequence at the University of Missouri-
St. Louis. Address correspondence to Dr. Cottone, University of Missouri, Department
of Behavioral Studies, 8001 Natural Bridge Road, St. Louis, MO 63121-4499.
The American Journal of Family Therapy, Vol. 20, No. 3, 1992 0 BrunnerlMazel, Inc.
227
228 The American Journal of Family Therapy, Vol. 20, No. 3, Fall 1992
through the parental, sibling, and marital subsystems. The boundaries

between the subsystems are the basic rules defining who participates
and how. For proper family functioning, the boundaries of subsystems
must be clear and without undue interference between subsystems. Ac-
cording to Minuchin (1974), "enmeshed" family boundaries are created
when families try to develop their own inner world, which increases
concern and communication within the family (p. 54). Minuchin noted
that in this instance, the distance between subsystems decreases and
boundaries become blurred. Conversely, "disengaged' families develop
overly rigid boundaries, making communication difficult between sub-
systems and preventing the protective influences in a family to work (p.
54). All families fall somewhere in between the disengaged and en-
meshed structures. The terms enmeshment and disengagement do not

signify a functional or dysfunctional family; instead, dysfunction occurs
when the family structure is extremely skewed in one direction. Dysfunc-
tion in the enmeshed family can be seen in families that respond to
stress with immediate and overinvolved action. The same stress in a
disengaged family may not affect the members because of the extremely
rigid boundaries.
Family members adopt certain roles and adhere to particular rules
which directly relate to the experience of "boundaries." These roles and
rules become apparent when observing communication styles and pat-
terns of interaction within the family.
RELATIONAL BOUNDARIES AND CHEMICAL DEPENDENCE
Boundary Issues
Most of the research on relational boundaries in chemically dependent

families focuses on an examination of boundaries that are either ex-
tremely rigid or chaotic (Cermak, 1986; Coleman & Colgan, 1986; Colgan,
1987; Erekson & Perkins, 1989; Evans, 1988; Preli et al., 1990; Throwe,
1986).
In a study comparing family structure in chemically dependent, recov-
ering and control families, Preli et al. (1990) found that the alcoholic
families manifested patterns of adaptability (the ability to accommodate
new stimuli) that were overly rigid or diffuse. They found that enmeshed
families had low levels of adaptability, while disengaged families
changed radically in response to stress. Erekson and Perkins (1989), in
their discussion of family structure, note that the rigidity or diffuseness
of family boundaries often lead to supporting the alcoholism and increas-
ing the family's dysfunction. Coleman and Colgan (1986) define bound-
ary inadequacy in their study on drug dependent families as a "pattern"
of ambiguous, overly rigid or invasive boundaries that is related to physi-
cal or psychological space" (p. 21).
These studies found evidence of boundary inadequacy within the fam-
ily and outside of the family. Kaufman (1986) notes that families often
operate under several boundary types. Families may have rigid external
Family Structural Issues and Chemical Dependency 229
boundaries, which keep outsiders from coming into the family, but may
have enmeshed internal boundaries within the family. Preli et al. (1990),
in their study on alcoholic families’ interaction patterns, looked at family
cohesion as an identifier of boundary problems. They found that a high
level of cohesion (enmeshment) impeded individual autonomy, while a
low level of cohesion (disengagement) prohibited interdependence and
belonging. Friedman, Utada and Morrissey (1987), in their study of
adaptability and cohesion in chemically dependent families, found that
these families are equally as likely to be enmeshed as they are to be
disengaged.
Boundary inadequacy outside of the family may take the form of isolat-
ing members from both the outside world and potential help, because of
feelings of shame about the family problem (Berlin et al., 1988; Colgan,
1987; Throwe, 1986).Throwe (1986) found that the progression of alcohol-
ism pushes the nonalcoholic parent to protect the family in order to
maintain some sense of stability in the family. This protection prevents
help from the outside and leaves family members to resort to their inner
resources to cope with the escalating problem. This isolation from the
outside, according to Colgan (1987), shows when family members hide
their fears, angers, and frustrations. They have a distorted view of what
healthy dependence and independence are, and they are not able to ask
for help. Benson and Heller (1987) concur, finding in their study with
daughters of alcoholics that these individuals had fewer supporting rela-
tionships and friendships outside the family than did daughters from
nonalcoholic families.
Of particular importance on family boundaries is the article by Erekson
and Perkins (1989), which discusses how the parental, marital, and sib-
ling subsystems interact in the chemically dependent family. They note
that when boundaries are too diffuse in the parental subsystem, parent-
child issues are felt in the marital subsystem. They cite the example of a
child who is caught stealing and the parental response is to direct anger
at one another instead of dealing with the child.
On the other hand, Coleman and Colgan (1986) found that overly rigid
boundaries require an adherence to preset rules for behavior regardless
of the nature of the situation. Smooth efficient functioning is a priority
in this type of family structure rather than responsiveness to individuals.
When the boundaries are rigid between subsystems, communication is
restricted between subsystems and individuals may have to invoke crisis
to make contact with other subsystems in the family. Evans (1988) and
Bennet and colleagues (1987) thought that family members disengage
and reengage with their families at particular times as needed for sur-
vival. Evans (1988) notes that families with extremely rigid boundaries,
when responding to stress, come together during a crisis, freeing up the
inflexible boundaries. However, once the crisis is over, the closeness
becomes too uncomfortable, and family members look for ways to dis-
tance themselves interpersonally. Bennet et al. (1987) call this ability to
selectively engage and disengage a ”means for survival’’ for those in
chemically dependent families.
Roles
All families have roles that allow them to function effectively; however,
in a chemically dependent family, the roles that develop are often un-
healthy and destructive. There is considerable agreement in the literature
that unhealthy boundaries result in interactions that help form the dis-
torted roles that members play. The literature deals with the develop-
ment and reversal of roles as the alcoholism progresses (Erekson & Per-
kins, 1989; Evans, 1988; Kaufman, 1986; Perkins, 1989; Throwe, 1986).
Several studies refer to family roles that shift and change depending on
the current levels of stress in the family. Ziter (1988) found that in the
confusion of inconsistent boundaries between subsystems at different
times, uncertainty grows about who should perform which roles. Throwe
(1986) notes that family members continuously change roles as the alco-
holism progresses. She notes that family members learn quickly that they
cannot expect the usual performance of family roles and functions and
they redistribute tasks in an attempt to maintain structure and function
within the family unit. Throwe also discusses ”role inconsistency” (p.
83), which manifests itself in childrearing practices when parents give
conflicting messages because they are constantly shifting roles de-
pending on the alcoholic’s abusive behavior.
Role rigidity was most often discussed in the literature as a means for
members to cope with the family situation. Perkins (1989) found that
family members, in order to survive, settle into rigid roles that give them
some predictability in their lives. Coleman and Colgan (1986) describe
these rigid roles as dichotomous and clearly defined without overlap or
interdependence. Colgan (1987) notes that the adoption of rigid roles
shows a family priority of creating smooth and efficient functioning over
being responsive or adaptable. Family members adhere to this preset
code of behavior, regardless of situation. Ziter (1988) thinks that the
unhealthy roles so distort family emotions and relationships that even
when the alcoholic ceases to drink and family relations improve, the
individual roles still persist. Of special interest regarding roles, is an
article by Perkins (1989), which dealt with altering rigid family role behav-
iors. He found that in response to the lack of protection and lack of
rationality in the alcoholic home, children adopt rigid roles in order to
survive. Unfortunately, he found that the rigid roles help to maintain
the dysfunctional nature of the family interaction and actually inhibited
individual growth.
Many of the articles reviewed agreed that parentification of a child
occurs when the adult alcoholic becomes so involved with alcohol use
that parental duties are ignored. “Parentification” is the transformation
of a child into a parent-like figure (see Sauber et al., 1985; Jurkovic et al.,
1991). In families of alcoholics, Kaufman (1986) found the functions of
the male parent will quickly move to the older son. Parentification really
becomes apparent as a role reversal, according to Kaufman, when the
alcoholic is relegated to the role of invalid or child. Erekson and Perkins
(1989) note that the child may enter the marital and/or the parental
subsystem to take over for the noninvolved parent; they cite the example
of an alcoholic father who acts like a brother to his son, or a son who
acts as a parent to the rest of the siblings. Nardi (1987) cites similar
examples in discussing role inconsistencies in the chemically dependent
family. A child may take on a parental role at home, but the more depen-
dent role of a child at school. An interesting study on parentification, or
role reversal, was conducted by Preli and Protinsky (1988), whereby
respondents from chemically dependent, recovered, and nonalcoholic
families were asked to select (from a diagram) the relationship that was
closest in their families. In the chemically dependent families, 59% se-
lected the mother/child dyad, while the other groups selected that dyad
only 7% and less than 1%,respectively.
Evans (1988) found that family members adopt roles out of the shame
that comes from unhealthy boundaries. She found that children protect
themselves from feeling the shame by moving into a variety of roles,
such as pushing people away by becoming the family scapegoat, becom-
ing abusive in order to feel safe by becoming a perpetrator or becoming
invisible so that they will not be available for abuse by becoming a lost
child. And, of course, those children who adopt the role of the family
hero hope that by being a perfectionist they can somehow remain safe.
Rhodes and Blackham (1987), in a study on role development in chemi-
cally dependent families, found that individuals from these families rated
themselves consistently higher on the acting-out (scapegoat) role than
did controls. However, the same study produced no prominent correla-
tions with the well-known roles of placater, responsible child, and ad-
justor. Potter and Williams (1991), in their analysis of the chemically
dependent family roles established in previous literature, found that
these roles exist in all families and are not found only in chemically
dependent families.
Bennet et al. (1987), in their study on ritual disruption in the chemically
dependent family, conclude that family ”rituals” or traditions help to
form roles in the family, and in the absence of healthy rituals, distorted
roles develop.
Characteristic Family Interactions

Much of the literature includes discussion of family communication
patterns and characteristic interactions. Most authors focus their discus-
sions on analyzing chemically dependent families in terms of cohesion,
levels of conflict, and problem-solving methods (Barry & Fleming, 1990;
Jacob et al., 1990; Kaufman, 1986; Petersen-Kelly, 1985; Preli et al., 1990;
Steinglass et al., 1985). Barry and Fleming (1990), in their study compar-
ing alcoholic with nonalcoholic homes, found that members of alcoholic
families reported less cohesion, less expressiveness, and more conflicting
interactions than did the nonalcoholic families. In Clair and Genest’s
(1987) study of adult children of alcoholics, their respondents noted more
disruption in family life, less cohesion, and greater conflict. However,
their respondents noted no difference in expressiveness as compared to
the control group of children from nonalcoholic homes. Benson and

Heller (1987), in their study of daughters of alcoholic fathers, found that
the women reported higher levels of conflict in the home and inconsis-
tent, nonsupportive relationships with their parents. Baer and colleagues
(1987), in their study of seventh graders with chemically dependent par-
ents, found that children from the alcohol-abusing families reported a
significant number of major life stressors and family conflict.
In their book on shame-based family systems, Fossum and Mason
(1986) outline the basic rules underlying family communication that gov-
ern all interactions. Family members learn: to not expect reliability and
constancy in relationships; to strive for perfection in order to feel worth-
while; to blame others or self to maintain the system’s equilibrium; to
not talk about the family situation in order to protect family members;
to be in control of all behavior and interaction to maintain predictability

and security; to disqualify experiences that go against the family status
quo; and to accept incomplete transactions without fully exploring why
such transactions occur.
Treadway (1987) describes the climate in the alcoholic home as one in
which the members behave in a very inconsistent and unpredictable
fashion. He describes a situation wherein a six-year-old sees his parents
fistfighting one evening and the next morning is told that nothing was
wrong. Throwe (1986) found that children learn not to trust others be-
cause their emotional needs are not met at home. She found that these
trust issues follow children to adulthood. Evans (1988) says that children
in chemically dependent homes learn very early which feelings and be-
haviors are not acceptable in the home, so the children ignore their own
needs and follow the rule of the family. Treadway (1987) found that the
family itself learns not to trust others, hence their implicit rule of not
talking to others about the family problem. Cermak (1986) describes the
prohibition against speaking honestly about the alcoholism in the family
and how members adhere to this rule to be accepted as members of the
family. Ziter (1988) notes that family interactions are characterized by
blaming, guilt, denial, and manipulation.
There is consistency in the literature regarding characteristic family
interactions in chemically dependent families. Evans (1988) discusses the
“shame spiral” (p. 166) that governs interactions of family members. She
notes that family members, to avoid the shame, may isolate themselves
or substitute other behaviors to keep from feeling the pain. The family
members may abandon these behaviors when a family crisis occurs, but
only temporarily.
Throwe (1986) found that chemically dependent families have altered
communication patterns. She cites a breakdown in the free exchange of
information in the family in an attempt to protect the family from the
alcoholism. The marital dyad breaks down as conflict between spouses
increases, and Throwe suggests that the alcoholic is cut out of the com-
munication to allow the family unit to continue as normally as possible.
Erekson and Perkins (1989) agree with this, finding that the nonalcoholic
spouse becomes overinvolved with the children. This often presents dif-
ficulties in another way, they found, when the alcoholic parent moves
from sober to drinking states and moves back and forth from the parental
subsystem to the child subsystem. Throwe (1986) found that the marital
dyad focuses on building walls between one another to avoid being hurt
by the other. Jacob et al. (1989), in their study of family interaction, note
that interactions in the marital dyad are mainly negative, perhaps to
avoid any conflict regarding the alcoholism. Kaufman (1986) found that
the increasing “marital and family conflict may evoke, support, and
maintain alcoholism as a symptom of family dysfunction, as a coping
mechanism to deal with family dysfunction, and as a consequence of
dysfunctional family styles and rules” (p. 349). Kaufman notes further
that the male alcoholic loses his role in the marital dyad first, as his
spouse’s needs are neglected, and subsequently loses his role in the
parental dyad.
Bennet et al. (1987) describe family rituals as being the basis for all
family interaction. In the chemically dependent home, the absence of
organized and predictable rituals, such as family dinners, causes commu-
nication to break down. Kaufman (1986) agrees that family rituals are an
important sign of family functioning and notes that when ritual interac-
tions are organized around alcohol, unhealthy family interactions occur.
Colgan (1987) identifies rigid patterns of interaction whereby family
members restrict their communication to problem solving without letting
emotions interfere. He also describes an ambiguous pattern whereby
communication is characterized by rationalizations, double messages,
and lack of problem-solving skills. He cites the interactional climate in
the chemically dependent family as rife with double messages due to the
alcoholic’s inability to send clear messages. Jacob et al. (1989) found that
the alcoholic sends a metacommunication to the family by sending a
message that he has committed a deviant act, but because of the alcohol
he is not responsible for this behavior. Ziter (1988) concurs with this,
finding that the overwhelming denial, rationalization, excusing, and
blaming increase family frustration to a point where problem solving
becomes impossible.
Several authors labeled dysfunctional family interactions in chemically
dependent families as ”co-alcoholism’’ (Kaufman, 1986), ”codepen-
dency” (Cermak, 1986; Gierymski & Williams, 1986), or “enabling” (Erek-
son & Perkins, 1989). They found that these behaviors progress as the
alcoholism progresses. Berlin et al. (1988) characterize daily life with the
alcoholic as an organization around the drinking, all members waiting
apprehensively for the next episode to begin, with children being told
what to do or not to do in order to control or influence the drinking.
Kaufman (1986) notes that in the early stages, family interactions are
characterized by a sense of guilt and responsibility. As the problem pro-
gresses, members are motivated to continue these interactions by hostil-
ity, disgust, pity, and preoccupation with protectiveness and shielding
of the alcoholism.
Steinglass (1985) found that the seemingly chaotic patterns of interac-
tion were an “interactive jockeying” (p. 162) between the family’s desire
to maintain stability and the conflicting desire to change and grow. He
concludes that, unfortunately, most chemically dependent families will

choose short-term solutions to maintain family homeostasis, rather than
long-term growth.
THERAPEUTIC IMPLICATIONS
Much of the literature calls for increased knowledge and focus of

healthcare professionals on treating inappropriate boundaries and dys-
functional roles in chemically dependent families. Despite several au-
thors' discussions of treating families according to the stage of alcohol-
ism, Ziter (1988) found that the complexities of interacting variables are
too great to approach therapy from a stage or phase perspective. These
variables include treatment beginning with only part of the family, the
specific developmental stage the family may be in, or the number of
years that the family has lived with alcoholism. She says that if the
therapist views the family from the perspective of boundary ambiguity,
treatment will be more clearcut. However, Liepman and colleagues (1989)
found that clinicians must be able to distinguish between the stages and
phases of alcoholism to effectively treat the different dynamics of each
stage. Szapocznik and colleagues (1991) recommend the use of the Struc-
tural Family Systems Rating Scale (SFSR) to assess the level of family
functioning in terms of stages and flexibility before treatment begins.
They found that the SFSR also assists in conducting therapy because
families are assessed and treated while they perform a series of family
tasks.
Perkins (1989), in his article on family roles, suggests that using a
sculpting technique in therapy sessions to allow family members to act
out their roles can be effective in altering rigid roles. He also suggests
the use of role trading, so family members can take on new roles, thereby
breaking the standard interactional patterns in the family and developing
more constructive interactions. Coleman and Colgan (1986) call for thera-
pists to be skilled at identifying dysfunctional boundaries and to have
the ability to help families develop healthy boundaries for the forming
of functional relationships. Colgan (1987) feels that it is imperative that
therapists have a clear understanding of their own boundaries before
treating families with boundary problems. He suggests that therapists,
rather than acting as the expert, should adopt a "curious" attitude in
dealing with clients with boundary problems in order to deter their own
boundary issues from clouding therapy. Throwe (1986) found that thera-
pists can better deal with unhealthy boundaries and roles in chemically
dependent families by addressing the guilt and anger felt by family mem-
bers. She suggests that health care professionals should encourage open
feelings of guilt and anger to help clients move toward healthy interac-
tions. Evans (1988) suggests that the most important part of the therapeu-
tic process in dealing with boundary problems is the therapist's utmost
respect for client boundaries. She agrees that therapists must have clear
boundaries to be effective in the therapeutic relationship and also to be
able to provide a trusting environment.
Ziter (1988) outlines family recovery as a four-step process, with differ-

ent interventions in each step. This four-step process is necessary, she
states, because family interactions change as the recovery process prog-
resses. She suggests the use of paradoxical techniques to induce stress
in the family in order to promote change. However, often during this
stage, families may halt treatment under the burden of stress. In the
second stage, playfulness is introduced to help break families of the
tendency to limit themselves to behaviors that are safe and predictable.
The last two stages involve the development of healthy interactions by
defining roles and using negotiation to promote healthy and creative
problem solving.
Several authors call for multigenerational therapy, which they found
was often not used when working with chemically dependent families.
Kaufman (1986) notes that in his experience, cross-generational coalitions
spanned three generations in chemically dependent families. He found
that involving all three generations in therapy was essential in breaking
the dysfunctional patterns. Multifamily or group therapy is also sug-
gested in the literature (Bingham & Bargar, 1985; Matulis, 1985; McNabb
et al., 1989). Bingham and Bargar (1985) suggest that a group approach
assists in loosening rigid family boundaries by encouraging the identifi-
cation and expression of feelings and by promoting healthy social interac-
tions. McNabb et al. (1989) found that the group approach produced
better results with families in terms of improved family relations and
greater family involvement in the recovery process.
Erekson and Perkins (1989), while advocating a systemic therapeutic
approach in dealing with chemically dependent families, note that many
systemic therapists fail to recognize the role of the codependent and his
or her subsequent effect on the alcoholic and the rest of the family. They
argue that this role is a key part in analyzing the families’ patterned
behavior and structure and is often ignored, because therapists focus
primarily on the alcoholic and his or her ”victimizing” behavior in the
family context. They conclude that by looking at family patterns and
the interactions between subsystems, more effective therapy may occur.
Heath and Atkinson (1988) outline a graduate course for systemic chemi-
cal dependence counseling, suggesting that marital and family therapists
should be able to work effectively with the family without the participa-
tion of the alcoholic. They found that this helps to focus on the problem-
engendering behaviors of the family until the alcoholic enters treatment.
Other therapeutic issues in the literature deal with educating, identi-
fying, and assessing children of alcoholics. McElligatt (1986) thinks that
remediating family problems relating to alcoholism should focus on the
identification of children with these problems. She found that this area
of identification is crucial in being able to alleviate the sense of isolation,
guilt, and stigma that these children feel. Barry and Fleming (1990) assert
that mental health professionals should become more aware of the preva-
lence of alcoholism and should become more aggressive in screening to
identify the population affected. Berlin et al. (1988) suggest that educa-
tion for children about the effects of chemical dependency should be
dispensed through schools and the community (to better empower them
to act on their own behalf). Benson and Heller (1987) suggest that family
conflict and poor parent-child relationships are more remediable than
alcoholism and that the focus of interventions should be teaching better
communications skills. They call for the strengthening of community
resources to help remediate these problems. Pease and Hurlbert (1988)
recommend that the needs of children could be better served by teaching
parenting skills to the alcoholic to prevent further dysfunction.
FUTURE RESEARCH ISSUES
Calls for future research in the literature vary widely. Preli et al. (1990)
conclude that structural inadequacy is clearly present in chemically de-

pendent families where it is not present in functional families. They note
that further research could determine the differing impact of structural
inadequacy on chemically dependent families. Coleman and Colgan
(1986) say that additional research on boundary inadequacy in chemically
dependent families might help to aid therapists in working with the
intimacy dysfunctions that occur as a result of boundary problems. Wood
(1985), in her attempt to further break down Minuchin’s boundary con-
cepts, calls for further research to determine why some families with
unhealthy boundaries remain functional while others do not.
Barry and Fleming (1990) call for research to help develop accurate
screening and diagnostic questions that will enable physicians to identify
families at risk for alcoholism. Gierymski and Williams (1986) posit that
additional research should look at issues of dependency as they relate to
dysfunctions other than chemical dependency. Cermak (1986) calls for
further research on codependency variables to reach a clarity in the defi-
nition of the concept.
Steinglass et al. (1985) call for additional research to determine why
families consistently organize their lives around alcohol and how it re-
lates to family developmental stages. They note that most studies involve
intact chemically dependent families, while families who have been af-
fected by divorce or separation are rarely included and would probably
demonstrate a different family dynamic. Jacob et al. (1989) think that
further research on identifying characteristic family interactions would
help promote early treatment of these families. They also suggest that
additional research is needed to support the assertion that interactions
in families with a female alcoholic parent differ than those in families
with a male alcoholic parent.
Googins and Casey (1987) note that the family institution has changed
considerably in terms of roles and responsibilities in the last 10 years,
and research on chemically dependent family dynamics has not reflected
this change. They call for research that includes the male spouses of
alcoholic wives as well as female spouses of alcoholic males.
OTHER ISSUES
Some reports in the literature found that the family dynamics in chemi-
cally dependent homes differed depending on which phase or stage
the alcoholic was in. Kaufman (1986) found that families can cycle from
enmeshed to disengaged activity depending on whether the alcoholic is
drinking or in an abstinent state. He found that the family interacts
differently during periods of abstinence, and when the alcohol use re-
turns, family members fall into the more familiar behavior of maintaining
rigid roles and interactions. Erekson and Perkins (1989) note obvious
differences in family dynamics from the early stages of alcoholism to
the later stages, finding that dysfunctional family patterns increased in
frequency, intensity, and duration during the later stages. Ziter (1988)
notes that family stressors increase as the alcoholism progresses, increas-
ing dysfunctional family behaviors.
Steinglass (1985), in his extensive research on phases of alcoholism,
found that family conflicts in the ”dry” state produce instabilities in
family functioning. He found that this unstable period is solved and
stabilized only when alcohol is present in the family and that families
may shift through these phases once or many times. Jacob et al. (1989),
in their study of the impact of alcoholism on family structure, found that
steady drinkers and their wives had more productive problem-solving
skills in the drinking states as opposed to the abstinent states. Liepman et
al.’s (1989) test of Steinglass’s theory supports the theory of the alcoholic
family as a biphasic entity moving between wet and dry phases. These
researchers found that during the abstinent (dry) stage, families exhibited
better problem-solving skills and communication, more functional role
status, and more affective responsiveness and involvement. However, a
study by Frankenstein, Hay, and Nathan (1985), found that the alcoholic
contributed more problem-solving suggestions during the intoxicated
state, and overall problem solving was more productive during this state.
Several articles touch on the issue of female alcoholics in the chemically
dependent family. Kaufman (1986) and Nardi (1987) found that if the
mother in the family is the alcoholic, the disruption in the family is
greater, because spouses of female alcoholics are more likely to abandon
the family. Estep (1987) found that female alcoholics are more likely to
have partners who are also alcoholics. Bepko (1987) found that wives of
alcoholics often use alcohol to relieve the pressure of the caretaker role
by momentarily flipping to an underresponsible role. In comparing fami-
lies with female alcoholic members to those with male alcoholic members,
Tislenko and Steinglass (1988) found that family interactions were rela-
tively the same regardless of the sex of the alcoholic.
Issues of power in chemically dependent families are also considered in
the literature. In his article on power and control in chemically dependent
families, Nardi (1987) found that family members have the illusion of
power regarding everyday family functioning, because they have ac-
cepted many of the parental tasks. However, this power is dependent
on the homeostatic event of the alcohol abuse. Coleman and Colgan
(1986) describe the alcoholic in the family as a “power broker” (p. 22)
who has all the rights in the family and in using this power crosses
subsystem boundaries in harmful ways. Colgan (1987) and Evans (1988)
concur with this, finding that there is an imbalance of power in the home
which creates the feeling of being overpowered and powerless in other
family members.
Prominent in much of the literature on chemical dependency is the
lasting effect on children (into adulthood). The literature reviews the
issue under the rubric of ”codependency,” and there is a debate as to
whether it should be a distinct diagnostic category (Cermak, 1986; Gier-
ymski & Williams, 1986). Cermak (1986) concludes that codependency is
a disease of relationships most commonly seen in drug-dependent fami-
lies. Gierymski and Williams (1986) conclude that codependency should
be treated as a relational dysfunction, which is not unique to chemically

dependent families, but includes all families with chronic illness. Burk
and Sher (1990) caution against hanging the ”children of alcoholics”
(COA) label on anyone. In their study polling high school students about
their opinions of children who were COAs, students rated COAs as being
psychologically unhealthy. They found additional negative stereotyping
held by mental health professionals.
The literature also touches on the probability that children of alcoholics
have a greater risk of becoming chemical abusers themselves (Barnes et
al., 1986; Bennet, et al., 1987; McCord, 1988; Rolf et al., 1988). Bennet et
al. (1987), in their study of 68 married children of alcoholics, conclude
that this group had a higher risk of becoming alcoholics than did control
groups. Barnes et al. (1986) found that determinants of alcoholism in
children were the levels of support and control provided by the parents.
They found that the highest risk group were children with parents who
exhibited low support and high control. Easley and Epstein (1991) found
that in families with consistent, predictable parenting by the nonalcoholic
spouse, the reported long-term effects of alcoholism on children could
be avoided. McCord (1988) attributes alcoholism in the children of alco-
holics in part to genetics but also to parents who taught that alcohol-
using behavior is acceptable and forgivable.
SUMMARY
Structural issues relating to chemically dependent families are re-

viewed in the literature. Findings suggest that these families have un-
healthy relational boundaries. The boundary dysfunctions most often
discussed are relational boundaries that are overly rigid or diffuse, en-
meshed or disengaged, and inadequate or ambiguous. It is suggested
that unhealthy boundaries affect family cohesion and adaptability and
may also affect the level of conflict in families.
Interactions in chemically dependent families are also discussed. It is
noted that these families may have less expressiveness among members
and fewer supportive relationships in the home and from outside sys-
tems. Interactions may be based on a set of rules that inhibit the expres-
sion of feelings and the development of trust.
Therapeutic implications include suggestions that professionals work

at creating new boundaries, identifying unhealthy roles, and assisting
in changing dysfunctional family interactions. Other types of therapy
modalities suggested for chemically dependent families include multi-
family therapy, group therapy, and multigenerational therapy. It is also
suggested that the therapist should be able to assess and treat the family
based on which stage or phase the family may be in.
Calls for future research include additional studies on boundary inade-
quacy in chemically dependent families and additional tools to help iden-
tify families at risk. Other issues discussed include the effects on families
with female alcoholics, the issue of power in chemically dependent fami-
lies, and the long-term effects of parental alcoholism on adult children.
DISCUSSION
Despite the wealth of information provided in the literature on this

topic, few clear-cut conclusions can be reached on structural issues relat-
ing to chemically dependent families. Findings vary greatly, beginning
with the wide variety of terms used to describe dysfunctional boundaries.
Additionally, it cannot be concluded that these characteristics are inher-
ent in chemically dependent families only. Even on the issues of family
adaptability and cohesion, reports are varied and sometimes conflicting.
There is some agreement in the literature that the roles members de-
velop in chemically dependent families are often dysfunctional. How-
ever, the literature is conflicted on whether members rigidly attach them-
selves to specific roles or whether they constantly move in and out of
various roles. The assertion has also been made that these roles exist in
any family, regardless of level of functioning.
There is general agreement in the literature that interactions in chemi-
cally dependent families are more conflictual and disruptive. However,
there is little agreement on how chemically dependent families resolve
problems.
Although the structural view, which looks at dysfunctions as opposite
poles on a continuum of relational functioning, provides a useful basis
for studying chemically dependent families, other variables involved in
these families and their functioning cannot be ignored. The literature is
clear that a number of factors additional to the family structure enter into
the equation for understanding chemically dependent family func-
tioning.
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The American Journal of Family Therapy

ISSN: 0192-6187 (Print) 1521-0383 (Online) Journal homepage: http://www.tandfonline.com/loi/uaft20

Family structural issues and chemical dependency:

Gail Mackensen & R. Rocco Cottone

To link to this article: http://dx.doi.org/10.1080/01926189208250892

Published online: 13 Jun 2007.

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GAIL MACKENSEN and R. ROCCO COTTONE

This review of the literature summarizes publications from 1985 to

Gail Mackensen is a graduate student in the Department of Behavioral Studies at the

through the parental, sibling, and marital subsystems. The boundaries

meshed structures. The terms enmeshment and disengagement do not

RELATIONAL BOUNDARIES AND CHEMICAL DEPENDENCE

Most of the research on relational boundaries in chemically dependent

Characteristic Family Interactions

the control group of children from nonalcoholic homes. Benson and

to be in control of all behavior and interaction to maintain predictability

concludes that, unfortunately, most chemically dependent families will

Much of the literature calls for increased knowledge and focus of

Ziter (1988) outlines family recovery as a four-step process, with differ-

FUTURE RESEARCH ISSUES

conclude that structural inadequacy is clearly present in chemically de-

be treated as a relational dysfunction, which is not unique to chemically

Structural issues relating to chemically dependent families are re-

Therapeutic implications include suggestions that professionals work

Despite the wealth of information provided in the literature on this

Potter, A. E., & Williams, D. E. (1991). Development of a measure examining children's

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