Family Studies of Alcoholism

Theodore Jacob
University of Arizona
Throughout the past several decades, clinical researchers have attempted to clarify the role of family influence in the etiology and course of alcoholism. After a brief historical overview of this literature, both of these research directions are reviewed in some detail, with an emphasis on recent empirical studies and emerging conceptualizations regarding the family alcoholism matrix. A final section of the article describes a number of important research needs, many of which are deemed relevant to the broader field of family studies of psychopathology.

Throughout the past century, researchers have been increasingly drawn to explorations of the family's role in the etiology, course, treatment, and prevention of psychopathological disorders (Jacob, 1987c; Goldstein, 1988). In attempts to unravel and elucidate relationships involving family life and disordered behavior, various theoretical perspectives and research strategies have been exploited; most importantly, genetic-biological efforts concerned with the transmission of deviant behavior from an affected parent to the child; studies of personality and psychosocial characteristics of the spouses and children of affected members; and investigations of such molar variables as family structure, social class, and ethnicity on the development of social deviance and psychopathology. Although interest in relationship parameters has been strongly implied throughout much of this literature, research and theory having a primary emphasis on family processes have only gained distinction within relatively recent times. In the current article, I discuss one aspect of this family literature: namely, that concerned with family influences relevant to alcoholism, with particular emphasis on the role of family process in the etiology and course of the disorder. Although focused on this one disorder, many features of this literature are highly relevant to family studies of other disorders a status that can be understood in terms of the many common historical, theoretical, and methodological foundations that underlie current studies of a wide range of disordered behavior (Jacob, 1987b). The article is divided into four sections. First, a brief overview of the literature on family studies of alcoholThis research was supported by the National Institute on Alcohol Abuse and Alcoholism, Grant No. 2R37AA0307. Requests for reprints should be sent to Dr. Theodore Jacob, Division of Family Studies, 210 FCR Bldg., University of Arizona, Tucson, AZ 85721.
Journal of Family Psychology, Vol. 5 No. 3 & 4, March/June 1992 319-338 1992 Division of Family Psychology, APA. 319

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ism is presented a literature that began with an emphasis on the individuallevel characteristics of the alcoholic, his spouse, and his children, and gradually came to incorporate investigations of interactional patterns that characterize families containing an alcoholic member. Second, the family's role in the etiology of alcoholism is discussed, highlighting current research efforts and experimental designs that are most relevant to understanding how family variables are related to the development and onset of alcohol disorders. Third, interactional models and research relevant to the maintenance of alcoholism are described, as well as needed research for clarifying the role of family influences on the course of the disorder. In the final section, I indicate future research efforts deserving special attention and suggest that many of these issues are relevant to the larger field of family studies of psychopathology.' OVERVIEW OF THE FIELD Although the effects of alcohol abuse pervade all levels of the social order, alcoholism has been defined, investigated, and treated as an individual problem throughout most of the past century. Given this background, it is not surprising that the earliest research from a family perspective involved a focus on individuals within the alcoholic's family most notably the spouse and, secondarily, the children. As suggested in our reviews of this literature (Jacob, 1987a; Jacob, Favorini, Meisel & Anderson, 1978; Jacob & Seilhamer, 1987; Seilhamer & Jacob, 1990), much of this work was characterized by a narrowness as to guiding conceptual framework, methodological approach, and family members assessed. Most important, the vast majority of work in this area has been based on psychodynamic, individually oriented conceptual frameworks, despite the repeatedly implied interest in interpersonal relationships. Spouses of alcoholics came to researchers' attention when clinicians began to question wives' possible contribution to the emergence and perpetuation of their mates' alcoholism. In this context, wives were initially described as "disturbed personalities" who sought to satisfy their unconscious needs by dominating a male whose alcoholic drinking rendered him weak and dependent (Futterman, 1953; Kalashian, 1959; Lewis, 1937). With the advent of the environmental perspective, wives of alcoholics were recast as victims rather than villains, and their psychological disturbance was considered to be a reaction to the accumulated stress associated with living with an alcoholic spouse (Jackson, 1954; Jacob & Seilhamer, 1982). Subsequently, investigations of coping styles led to the identification of typical response patterns (James & Goldman, 1971; Orford et al., 1975; Schaffer &

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Tyler, 1979; Wiseman, 1980) but failed to clarify the relations of these patterns to spouse characteristics or situational variables. Recognizing the need to examine the alcoholic's spouse within a broader conceptual framework, Moos's work of the past decade has provided a welcome and necessary alternative to the one-sided approaches of the past (Finney, Moos, Cronkite, & Gamble, 1983). In essence, Moos has recommended integrating the "disturbed personality," "stress," and "coping" perspectives into a model that predicts spouse functioning from five sets of variables: background characteristics, level of functioning of the alcoholic partner, life-changing events, coping responses, and family environment (Moos, Finney, & Gamble, 1982). From this multifactorial perspective, it seems clear that further advances in understanding the nonalcoholic spouse's role in the alcoholic family will require the inclusion of several levels of influence and the acknowledgment and measurement of bidirectional effects that is, the alcoholic's impact on spouse functioning and the spouse's role in influencing the course of abusive drinking. Over the past several decades, an accumulating literature concerned with the psychosocial and psychiatric status of alcoholics' offspring has suggested that these children often exhibit a variety of interpersonal and cognitive difficulties as preadolescents and adolescents and that they are at high risk for alcoholism and general psychiatric disturbances as adults (Seilhamer & Jacob, 1990; Sher, 1991; West & Prinz, 1987). Although a lengthy list of maladjustments has been offered, empirical substantiation of these characterizations has been marked by a lack of consistent findings, sound research methods, and comprehensive conceptualizations. Most important, this literature points to considerable variability among children of alcoholics an observation that has led various researchers to hypothesize an interplay of multiple factors that influence child outcome. Again, the relevant literature implies that such outcomes are significantly related to disturbed patterns of marital and parent-child interaction associated with family structures that include an alcoholic parent. Close examination of this literature, however, reveals few efforts that describe patterns of interaction which may mediate adverse child outcomes, that document the temporal relationships between these processes and various child outcomes, and that distinguish patterns that are unique to alcoholic family interactions versus general stress factors associated with various types of psychopathology (Jacob, Krahn, & J^eonard, 1991; Seilhamer, Jacob, & Dunn, in press). In brief, what seems to be missing from much of the extant literature is an effort to describe actual patterns of interchange between the alcoholic and members of his or her family that are related to the etiology, course, and perpetuation of alcoholism.

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Although interaction studies of alcoholics have only recently emerged within the alcoholism literature, family interaction research has been evolving in the more general psychopathology literature during the past 30 years an approach that is best viewed as an assemblage of several models, the most influential being general systems theory, communication theory, and social learning theory (Jacob, 1987b). The earliest influence on this model can be traced back to the 1950s, when the field was introduced to family theories of schizophrenia, including the work of Bateson, Jackson, Haley, and Wcakland; Bowen; Wynne; and Lidz. (For reviews of this literature, see Mishlcr & Waxier, 1965; Olson, 1972). Based on an integration of systems and communication theories, these seminal writings had a major impact on psychiatric theory, research, and practice over much of the next two decades. Buttressing these forces were the contributions of family sociology in particular, the contributions of Parsons and Bales (1955) and their analysis of instrumental and social-emotional role functions in ad hoc as well as nuclear family groups. Equally important, the flourishing small group tradition explored communication networks and power relationships in various types of organizations, providing a rich set of concepts and innovative laboratory procedures for studying group process and outcome. Finally, the continued influence of behavioral psychology has been evident since the early 1960s, emphasizing as it has the specification of antecedent-consequent relationships, 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 patterns and processes that (a) predate and predict the development of psychiatric disorders in high-risk offspring and (b) are associated with and serve to foster current, ongoing psychiatric disturbance. Notwithstanding the importance of interaction per se, it is clear that the family interaction perspective must be integrated with developmental, genetic, and personality literatures based on the assumption of an intimate and critical interplay between these influences insofar as they guide the development of behavior (Zucker, 1989; Tarter, 1991). FAMILY INFLUENCES RELEVANT TO ALCOHOLISM ETIOLOGY Family environmental factors related to the development of alcoholism can and have been conceptualized at the level of the individual, the dyad, and the family as a system (Jacob & Leonard, 1991). Note that any of these influences can be viewed as drinking-specific effects (i.e., family influences that are specifically and directly related to the development of drinking

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behavior) versus nondrinking-specific effects (i.e., family influences that produce cognitions, affect, or behavior that render the child vulnerable to a range 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's behavior on another, and, in addition to family genetic effects, have been discussed and studied in terms of the impact that a drinking parent (in this case, an abusively drinking parent) can have on the developing child. Such an influence is viewed as a drinking-specific effect (Noll, Zucker & Greenberg, 1990). At the opposite end of the continuum are family systems effects involving the complex family system within which members operate and the impact of this system on individual and relationship behavior. Although recognized as the hallmark of family systems theory and therapy, this level of family influence has rarely been subjected to empirical study. In the alcoholism etiology literature, the best (and probably the only) example of this focus is found in the often-cited work of Wolin and Bennett on family rituals (Wolin, Bennett, Noonan & Teitelbaum, 1980; Wolin, Bennett & Noonan, 1979; Steinglass, 1987). Briefly, these investigators have suggested that cross-generational transmission of alcoholism increases in likelihood to the extent that alcoholism invades the family system and disrupts the enactment of family rituals; that is, patterns of behavior that give identity and meaning to the family (e.g., celebration of holidays, special events, routine daily activities such as dinnertime, etc.). Finally, several dyadic level influences have been implicated in the etiology of alcoholism, including both marital and sibling effects (Belsky, 1984; Brook & Brook, 1990; Emery, 1982; Fauber, Forehand, Thomas, & Wierson, 1990; Rowe, Woulbroun, & Gulley, in press). The vast majority of work in this domain, however, has focused on the nondrinking-specific effects of the parent-child influence structure a theoretical and research literature that has provided strong support for the role of family effects in the etiology of alcoholism. The impact of the parent-child relationship on the child's social and cognitive development has been a major foundation in the child development and family studies literature for more than 50 years (Maccoby & Martin, 1983; Martin, 1987; Rollins & Thomas, 1979). Distillation of this now voluminous body of theory and research yields three conclusions of particular relevance to present concerns: (a) All other variables that can affect child outcomes parental dispositions, marital and sibling influences, and the sociocultural context in which the family operatesare played out within the interactional sequences that come to define the parent-child relationship.

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(b) The two major parenting dimensions of nurturance and control provide the stuff out of which parent-child interactions are made. Disturbance in either or both of these parenting dimensions can have severe and wideranging effects on the child's social-emotional and cognitive development. (c) Of the various child outcomes that have been linked to inadequate parenting (characterized by a lack of affection and/or high levels of criticism and hostility, lax or inconsistent discipline and supervision, and general lack of involvement), the development of aggressive, antisocial behavior has been most strongly documented. That such family influences are of tremendous importance in understanding alcoholism etiology is strongly supported in light of the significant associations that have been repeatedly found between child conduct disorder, adolescent delinquency, and adult antisocial behavior; between adolescent antisocial behavior and initiation of alcohol abuse; and between adult antisocial behavior and adult alcoholism. (See Jessor & Jessor, 1977; Lewis, 1984; Lewis & Bucholz, 1991; Loeber & Dishion, 1983; Zucker, 1989; and Zuckcr & Gomberg, 1986, for reviews of this literature.) Although many have contributed to the development and validation of this parenting effects model, the work of Patterson and colleagues has been most influential. (For a summary of their work, see Patterson, Reid, & Dishion, in press.) Although embedded in a larger social learning framework that includes multiple influence domains, the critical nature of parenting effects has been highlighted over the course of these research efforts. Briefly, disruption in family management practices (what is referred to as inadequate parenting) sets the stage for all that follows. Most important, a failure in compliance training begins during the child's early years and becomes the key feature of those families who produce antisocial children a breakdown which is defined in terms of inadequate discipline, monitoring, modeling, involvement, and positive reinforcement strategies. The major outcome of this process is the development of a coercive interaction style, which slowly but steadily generalizes to relationships outside the home and severely interferes with the child's social and cognitive development. As described by Snyder and Huntley (1990), Over time, the child acquires a more coercive relational style, leading to parental rejection and reduced contact with the child. This reduction in positive, constructive parent-child interaction further interferes with the development of social and cognitive competence. Failure to teach adequate social and cognitive skills and continued reinforcement of coercive social behavior set the stage for problems outside the home. The child's lack of skills and coercive repertoire generalize to interactions with peers and teachers. They are unable to discourage the child's antisocial behavior and to engage the child in

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constructive social interaction and learning. In a relatively short time, the child is rejected by peers and within a few years is identified as an academic failure. This rejection and failure set further limits on opportunities for positive socialization experiences. The range of peers and activities from which the child can select are reduced. The antisocial child associates with other antisocial peers who have compatible attitudes, behaviors, and interests. Interaction with this peer group then reinforces and expands the antisocial repertoire of the child, (p. 204)

Empirical support for the hypothesized relationships between inadequate parenting and the development of aggressive, antisocial behavior in childhood and adolescence can be found in various sources the voluminous child development literature of the past 50 years (Maccoby & Martin, 1983; Rollins & Thomas, 1979), social-learning-based studies of childhood conduct disorder (Patterson, Reid, & Dishion, in press; Snyder& Huntley, 1990; Wahler & Dumas, 1987), and the longitudinal literature relevant to the development of both delinquency and antisocial behavior, which has reported strong associations between inadequate parenting in the early child h istories of those who subsequently develop adolescent and adult expressions of antisocial behavior and of alcohol abuse during adolescence and adulthood (Loeber & Dishion, 1983; Loeber & Stouthamer-Loeber, 1986; McCord, 1991; Zuckcr, 1989; Zucker & Gomberg, 1986). For many, these nondrinkingspccific family variables and their relationship to a generalized deviance syndrome are considered our most powerful conceptual tools in attempts to understand the family's role in the development of alcohol abuse and alcoholism. Although few would question the association between inadequate parenting and childhood aggression and the relationship between adolescent deviance and the emergence of adolescent and adult expressions of alcohol abuse, the applicability of this model may be limited for various reasons. First, the essence of this model concerns the development of a general deviance syndrome, characterized by an aggressive antisocial behavior pattern (Donovan & Jessor, 1985; Jessor & Jessor, 1977). As such, its relevance to subtypes of alcohol abuse other than antisocial alcoholism can be questioned. Specifically, many researchers have concluded that alcoholism is an etiologically and developmentally heterogeneous disorder which subsumes a number of relatively distinct subtypes. All observers concur that antisocial alcoholism is a major subtype of the disorder and probably the one that has received the greatest attention in clinical and research literature. Other subtypes, however, probably represent equally important variants, although much less is known about their initial conditions and developmental course. Zucker (1991), for example, has discussed four alcoholism subtypes, one referred to as negative affect alcoholism. Although it is beyond the scope of

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this article to critically analyze this I iterature, it is worth noting that psychosocial researchers arc now beginning to point out family and peer influences that may be relevant to the etiology of such a subtype: in particular, family interactional antecedents of childhood internalizing disorders and childhood depression (Snyder & Huntley, 1990; Wahler & Dumas, 1987). To the extent that such child dispositions relate to negative affect alcoholism, these developing conceptualizations may become increasingly relevant. Second, the driving force of the child socialization model has been the impact of the family environment (in particular, the parents) on the child, notwithstanding the multivariate framework within which the model has been placed during more recent times. That biologically based child behavior plays an equally important role in explaining parent-child interaction is not only possible, but is a very credible alternative to the "social mold" position (Hartup, 1978). The strong variant of this position would suggest that aggressive, antisocial behavior, and, in turn, antisocial alcoholism, is to a large extent the result of constitutional and/or hereditary influences, and that the association between parenting and child outcome is best viewed as a child-to-parent effect (Lytton, 1990). A diverse theoretical and empirical literature now provides considerable support for this perspective, including an impressive child effects literature, elegant behavioral genetics accounts of how biologically based individual differences affect a child's environment and development, and increasing support from alcoholism literature that genetic contributions are significantly related to antisocial alcoholism (Jacob & Leonard, 1991). Most important, the overwhelming number of experimental designs supporting the child socialization model has been based on procedures that can neither determine the direction of effects nor dilute the influence of parent behavior and parent genes. Clearly, we must move beyond cross-sectional and passive-longitudinal designs to more informative and illuminating approaches: namely, to research designs that provide for the measurement of genetic and/or constitutional effects, the study of different alcoholism subtypes and developmental pathways, and the assessment of family influences that are interactional in nature rather than global, static indicators of the environment. FAMILY INFLUENCES RELEVANT TO THE COURSE OF ALCOHOLISM Thus far, the family's role in the etiology of alcoholism has drawn the strongest support from two literatures, one related to family genetic effects and the other to family interaction effects involved in the development of a generalized deviance syndrome including, but not limited to, alcohol-abusing

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characteristics. Ironically, both of these influences seem most relevant to the same subtype of the disorder antisocial alcoholism and it remains for future research to clarify the independent, joint, or confounded nature of these various associations. As suggested, such clarifications will require complex, multifaccted designs capable of separating family genetic from family environmental effects and of relating these influences to different alcoholism subtypes. In considering the course of alcoholism, the family environmental literature implicates both individual member and interaction characteristics. As described earlier, the earliest literature on the alcoholic family focused primary attention on the personality features of the wife, suggesting that psychodynamic needs motivated her to encourage her husband's drinking, to undermine his efforts to abstain, and to perpetuate a destructive and dominating relationship with a weak and passive spouse. Almost all of these characterizations, however, emanated from clinical and clinical anecdotal reports. An ensuing empirical literature involving a series of studies comparing the personality characteristics of alcoholics' wives with psychiatric and normal controls and based upon objective personality assessment provided very little, if any, support for the "disturbed personality" hypothesis. At the same time, these theoretical and empirical efforts did imply that interpersonal aspects associated with alcoholism may be relevant to the perpetuation of the disorder; in particular, that alcoholic marriages may be characterized by relationship patterns that influence the course of the disorder. It was not until the late 1960s and early 1970s, however, that observational studies of family interactions involving alcoholics began to appear in the literature. As described elsewhere (Jacob & Seilhamer, 1987) this is still a relatively small literature, which, for the most part, is composed of preliminary, small, sample efforts; nevertheless, this research literature has moved the field toward a consideration of interactional effects and has introduced innovative methods and provocative conceptualizations with which to explore the role of family interaction in the course of alcoholism. Most relevant to such concerns are the studies of Stcinglass and my own studies. Steinglass's work on alcoholic families began during the late 1960s with a series of experimental studies at NIMH that included observations of inpaticnt alcoholics during an experimental drinking phase and a subsequent withdrawal period (Steinglass, 1975). Most important, these early drinking studies suggested that acute intoxication can have various effects on the role relationships and interactional behaviors of the involved members; in particular, that affective and structural characteristics of relationships can be dramatically altered during periods of drinking. For Steinglass, these obser-

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vations confirmed the significance of reciprocal effects involving alcohol and interpersonal interaction and led to a preliminary model of alcoholism based on family systems theory. Specifically, Stcinglass (Steinglass, Weiner & Mendelson, 1971) suggested that abusive drinking could serve two different functions. In one case, drinking can be a signal or sign that individuals and relationships within the system are experiencing significant stress. In contrast with the signal function, which is most likely in families where drinking has not become an ongoing process, drinking can maintain and stabilize the family as an ongoing unit. Although alcohol may effect different behaviors in different families for example, the controlled release of aggression in one case and the clarification of dominance patterns in another in each instance, alcohol was seen to stabilize an otherwise unstable and/or chaotic family system (Steinglass et al., 1971). For Steinglass, these interactional differences between sober and intoxicated periods appeared to serve important adaptive functions for the family. That is, the behavior that emerged during intoxicated periods appeared to potentiate or inhibit certain aspects of the relationship which, in effect, reduced tensions through the temporary solution to a conflictual or stressful process and, in essence, served to stabilize an unstable system. As will be seen, this "alcohol maintenance model" stimulated a number of important interaction studies aimed at testing and elaborating the key aspects of this framework. The most recent phase of Steinglass's work has involved a more macroscopic, longitudinal view of drinking patterns. This life history model of alcoholism (Steinglass, 1987) suggests that periods of sobriety and active drinking form a cycle over a long period of time in the lives of most alcoholics. In contrast with the maintenance model, which spoke of rapid changes from sober to intoxicated states with associated changes in patterns of interaction, the life history model suggests that dry, wet, and transition phases appear and reappear many times over an alcoholic's drinking career. For some families, there may be many occurrences of dry, wet, and transition phases, whereas for other families there may be only one stable wet phase that is ultimately resolved into a stable dry phase or simply continues until death or divorce changes the structure of the family system. Although the work of Steinglass has been a major influence in the study of family interaction and alcoholism, his empirical efforts were based on extremely small, highly selective samples that lacked normal comparison groups and that failed to control for various possible problems. Most important, the basic tenets of Steinglass's alcohol maintenance model that interaction differs in intoxicated versus sober states and that interactions during intoxication are sufficiently reinforcing as to maintain abusive drinking

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were based on clinical impressions and were never directly and systematically assessed in his later research efforts. Since Steinglass's early publications, four studies have reported on experimental drinking procedures with families of alcoholics. In three of these studies, however, methodological and design weaknesses seriously compromised the interpretability of findings. Jacob, Ritchey, Cvitkovic, and Blane (1981), for example, reported a number of interesting findings, although findings were based on a relatively small sample and there was no psychiatric control group for examination of the specificity of alcoholism's impact. Billings, Kesslcr, Gomberg, and Weiner (1979), on the other hand, did include a distressed (nonalcoholic) control group as well as a nondistressed control group; unfortunately, half of the couples in each group did not consume any alcohol during the drinking session and those who did drink consumed only minimal amounts. Finally, a study by Frankenstein, Hay, and Nathan (1985) rigorously controlled for alcohol consumption of participants by administering fixed doses of alcohol prior to the interaction session; however, findings were based on a very small sample size, the design included alcoholic couples only, and the fixed dose administration procedure probably diminished the naturalness of the context in which couple interaction occurred. Although these initial efforts were characterized by considerable creativity, methodological and conceptual weaknesses limited the reliability and generalizability of reported findings. In an effort to address these limitations and to implement a more comprehensive study of family influences relevant to the course of alcoholism, I embarked on a large-scale interaction study of alcoholic families during the late 1970s (Jacob, Seilhamer, & Rushe, 1989). Most important, this effort involved a carefully selected group of alcoholics who exhibited no additional psychiatric disorder; the inclusion of a nondistressed as well as a psychiatric control group (clinically depressed subjects without evidence of alcohol abuse); an experimental drinking procedure in which couples consumed significant amounts of alcohol in a selfadministered manner; the application of a theoretically relevant, empirically based coding system for videotaped interaction data; and the assessment of relatively large subject samples so that statistical power could be maximized and alcoholism subgroups examined.2 Our major analysis of the marital interactions of alcoholics and depressed and nondistressed couples over drinking and nondrinking sessions revealed a number of important findings (Jacob & Krahn, 1988). Most relevant to present concerns was the finding that alcoholic-spouse interactions were more negative than those of depressed and nondistressed couples, and this was 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 alcoholism seemed particularly relevant to the maintenance functions of drinking-related interactions. Gorad (1971), for example, suggested that alcoholics exhibit a "responsibility-avoiding" communication style that becomes exaggerated in interactions with intimates and during periods of drinking and intoxication. In essence, the alcoholic is sending two messages one indicating some negative or deviant act and the other (more precisely, a qualification of the first message) implying that "1 am not responsible for what I say or do: I am under the control of the alcohol." In so doing, the alcoholic acts but avoids accepting responsibility for his actions. The core aspect of this theory that the alcoholic can attribute his deviant behavior to the alcohol and can therefore avoid responsibility for his actions has also been discussed in the social-labeling literature as "deviance disavowal" or "timeout" (MacAndrew & Edgerton, 1969). Regarding present findings, one might conjecture that, in essence, the alcoholic can attribute his nastiness to the alcohol. To the extent that this occurs and that his spouse accepts this attribution, periods of drinking might allow for the expression of negative affect toward the relationship and spouse that might be more inhibited if the alcoholic were to be held accountable for these behaviors. As such, the context of drinking enables the alcoholic to express strong, negative feelings that otherwise could be given only partial expression. Although these findings were both interesting and consistent with various clinical and theoretical expectations, other work by the investigator suggested that alcoholic-spouse interaction may have to be qualified in terms of the specific alcoholism subgroup under study. As noted earlier, alcoholics are a very heterogeneous population and the impact of alcoholism on the family is unlikely to be a constant. Various alcoholism subgroups have been discussed in the extant literature, and our own efforts have focused on episodic versus steady drinking styles. Two of our earlier reports linking episodic and steady drinking styles to different marital effects are particularly relevant to issues of maintenance. First, we reported that alcoholics who consumed large amounts of alcohol in the past month had wives who reported relatively low levels of psychiatric symptoms and relatively high levels of marital satisfaction a relationship that was very robust for steady drinking alcoholics, yet absent for episodic drinking alcoholics (Jacob, Dunn & Leonard, 1983). Based on these findings, we hypothesized that a steady (versus an episodic) pattern of drinking represents a predictable source of stress, and as a result, the steady alcohol consumption pattern may be more easily adapted to 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 characterize the former rather than the latter group of alcoholics. Despite the stimulating nature of these findings and associated hypotheses, these analyses were based on cross-sectional, retrospective data. To conclude 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 and their spouses were engaged in a 90-day assessment, during which time each partner provided daily information regarding alcohol consumption, psychiatric symptomatology, and marital satisfaction. Application of univariate and bivariate time series analyses to these data was extremely informative. Most important, for those alcoholics who exhibited heavy weekend drinking (in addition to lower levels of weekday consumption), wives' marital satisfaction not only decreased following husbands' alcohol consumption but decreased 5 days later as well. Further analyses of these relationships indicated that the wives' decline in marital satisfaction 5 days after heavy drinking reflected their anticipation of husband's drinking in 2 days that is, in anticipation of another round of heavy weekend consumption. A second subset of four alcoholics exhibited a pattern of less variable drinking; they consumed most of their alcohol in the home. Two of these couples replicated the general findings from our cross-sectional study (Jacob, Dunn & Leonard, 1983); that is, the husband's alcohol consumption was negatively associated with the wife's symptomatology and/or positively associated with the wife's satisfaction. For a third couple, no relationships were found between husband's drinking and wife satisfaction or symptomatology findings which appeared consistent with the fact that this couple had already experienced a marital separation and at the time of their participation in the study were very much estranged. For the last couple, husband's alcohol consumption was associated with an increase in wife's symptomatology. Closer examination of this couple, however, indicated that the husband's drinking pattern and marital interactions were probably more similar to the episodic, out-of-home alcoholics than to the steady, in-home drinkers. In summary, both our cross-sectional findings and the short-term longitudinal findings indicated the power and importance of defining more homogeneous subgroups within a heterogeneous sample of alcoholics. Most notably, these data suggest quite different relationship patterns in marriages containing episodic versus steady-drinking alcoholics and imply that the family's role in the maintenance of abusive drinking can differ greatly when subgroup status is taken into consideration. If true, differences in the actual

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marital interactions of these two subgroups should be discernible, especially during periods of alcohol consumption. To test these expectations, we reanalyzed our laboratory interaction data so that we could compare the marital interactions of steady versus episodic alcoholics during drinking and nondrinking sessions (Jacob & Leonard, 1988). Most important, steady alcoholics and their wives increased their rate of problem solving from the no drink session to the drink session, whereas episodic drinkers and their spouses exhibited a decrease in problem-focused behavior during the drink session. Furthermore, the episodic alcoholic exhibited more anger-hostility than did the steady alcoholic. At this point, our picture of the family's role in the maintenance of alcohol abuse has taken on several key features. For steady-drinking alcoholics, periods of drinking may actually encourage and/or facilitate the couple's engagement in problem-solving efforts and when associated with increased satisfaction, may be reinforced within the family context a view that is consistent with Steinglass's suggestion that "certain interactional behaviors become associated with the intoxicated interactional state, and inasmuch as these behaviors are functional or adaptive for the family, alcoholism itself takes on an 'adaptive' flavor" (Steinglass, Davis, & Berenson, 1977, p. 13). In contrast, the interaction pattern associated with the episodic alcoholic and his spouse (increased negativity on the part of the husband and decreased problem-solving on the part of the couple in the drinking session) does not appear to serve a positive function for the family, although it may be of "benefit" to the alcoholic. Specifically, alcohol consumption and the alcoholic's negativity may serve to discourage his wife from attempts at direct problem solving. That is, it seems likely that angry-hostile behavior expressed by the husband during periods of drinking might prevent active consideration of conflictual issues a process that comes to be characterized by coercive control features whereby he avoids dealing with conflictual issues by expressing high levels of negativity while drinking. To the extent that such interchanges become embedded in family life, the alcoholic's drinking can be seen as preventing him from acknowledging and dealing with a range of marital and family problems. For various reasons, present findings must be interpreted cautiously. It is of particular importance that we determine if our findings stand the test of replication when relationships are assessed with an independent sample, we must extend our initial findings through application of sequential analytic procedures so that various contingent relationships implied by our rate-perminute analyses can be explicitly examined, and we must examine more systematically our definition of drinking style and identify distinguishing features of episodic versus steady drinking patterns. In regard to this last

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issue, we have suggested elsewhere that our episodic subgroup shares certain similarities with previously described alcoholism subtypes characterized by an aggressive-antisocial behavior pattern and associated with significant interpersonal disturbances in various relationship domains (Jacob & Leonard, 1988). On the other hand, our steady subgroup seems more closely associated with an internalizing coping style characterized by passivity and a lack of assertiveness that to some extent may be overcome through the use of alcohol. Although much work remains to be done in this area, it seems clear that family influences relevant to the maintenance and course of alcoholism must be qualified in terms of the specific patterns of the alcohol abuse, the individual characteristics of the alcoholic, and the nature of the family system within which relationship events transpire. SUMMARY AND FUTURE DIRECTIONS Although the literature on family interaction and alcoholism is still at a relatively early stage of development, the efforts of the past decade reflect a clear sense of excitement and potential and, from my perspective, encouragement for the continued study of the family's role in understanding the nature of alcohol abuse. In summarizing this literature, I discussed family variables that may be of etiological relevance to the disorder as well as family effects that are likely to influence the course of alcoholism over time. Throughout, I tried to emphasize recent efforts that hold particular promise for advancing this study area and suggest various research efforts aimed at important theoretical and methodological needs. Although space limitations do not allow for a full discussion of research directions deserving special attention, such efforts would certainly include the following: (a) examination of alcoholism subtypes relevant to both etiological and maintenance issues; (b) multivariate studies capable of assessing the dynamic interplay of several influence domains over time; (c) longitudinal studies aimed at transition periods (e.g., infancy to early childhood and adolescence to early adulthood); (d) identification of drinking-specific family variables at the level of the individual, dyad, and family system; (e) assessment of the independent and joint effects of family genetic and family environmental influences; (f) testing of emerging family models with female alcoholics and with minority families; (g) development of additional procedures for assessing interactional events in a valid and reasonably economical manner; and (h) the generation and systematic evaluation of theoretical models explicating the family's role in the etiology and course of alcoholism. As suggested earlier, many aspects of family literature on alcoholism are highly relevant to studies of other psychopathologies a suggestion that

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certainly seems supported when reading through the foregoing list of recommendations for future research. Most important, it now seems clear that an exclusive focus on any one influence domain can no longer be justified on scientific grounds; that the complexity of the phenomena we wish to understand requires a multivariate, longitudinal perspective within which research efforts should be grounded and interpreted; and that both family environmental and family genetic perspectives must be included in designs that are capable of clarifying the independent and interactive effects of these two influence domains as behavior unfolds over time (Jacob and Leonard, 1991; Tarter, 1991; Zucker, 1989, 1991). Finally, future research on the role of family influences in the etiology and course of disordered behavior may be best served by incorporating some of our theory-testing interests into treatment and prevention research models. The rationale for this suggestion is twofold. First, even if we take the extreme position that family genetic and/or constitutional factors are of primary importance in explaining psychopathological disorders, we will still have to determine the malleability of such biologically based dispositions and identify interventions by which adverse outcomes can be altered. In pursuit of these objectives, it is my view that psychosocial interventions will be the primary means through which correctives can be achieved. Second, our studies of human behavior especially those concerned with personal, socialinteractional, value-laden expressions of humankind often require us to compromise the rigor of our science in the interests of the higher value we place on the ethical treatment of research participants. As a result, we are rarely able to exert maximum control over our study matter through the process of random selection from a common population and random assignment to powerful and opposing experimental conditions. The one area where these more powerful manipulations can occur and can be justified is in the conduct of clinically and socially relevant interventions aimed at enhancing a person's functioning and quality of life. That such intervention efforts can lead to significant advances in our theory testing interests has been suggested by many (e.g., Kendall, Lerner & Craighead, 1984) but is perhaps best conveyed in a remark attributed to Bronfenbrenner's (1977) mentor in a conversation with his young graduate student, "If you want to understand something, try to change it." NOTES
1. 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 and discussion of themes presented in the current article.

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

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