The Invisible Children

It's COA Awareness week!

On her latest article published on Huffington Post, Clinical Psychologist Dr. Tian Dayton examines the plight of children of dysfunctional parents as they grow to adulthood. Often their past trauma remains hidden until well after they mature and because it is buried, continues to negatively affect their relationships and how they feel about themselves.

"COAs grow up to be adult children of alcoholics ACoAs. And they carry these unresolved emotional burdens with them into their adult lives and relationships. Their disowned pain emerges, months, years or most commonly decades later in a post traumatic stress reaction as the COA, now the ACoA stands stupefied in front of an inner world that feels confusing and unknowable. It’s scary to look inside when what's inside has been so long in the making.

The addictions field should be giving very special attention to this hidden population if for no other reason, because they are statistically more likely to become addicts themselves (Cutter 1987). ACoAs also evidence higher levels of specific and generalized anxiety and lower levels of differentiation of self than their counterparts who grow up without parental alcoholism. (Maynard 1999) Scratch the paint off an addict and you will more often then not find a COA who is self medicating their unresolved, childhood pain with alcohol, drugs, food, sex, work or a combination of a couple of these.”

Read the article here: http://www.huffingtonpost.com/dr-tian-dayton/the-invisible-children-it_b_8970102.html

Check out the Orange County ACA website at: Orange County Adult Children

The Codependent Is Addicted- To The Addict

Reprinted from: http://www.actsweb.org/articles/article.php?i=74&d=1&c=4&p=1

Only in recent years has codependency been recognized as the debilitating sickness it can be. At first, it was identified as a problem in alcoholic families. For example, even after alcoholic husbands dried out, twelve months later, many of their families fell apart. When the caretaking wife no longer had a needy spouse, she felt she wasn't loved anymore because she wasn't needed. What she failed to see was that she had been dependent on his dependency. Her need to be needed was enabling her husband to stay sick. In other words, she was codependent.

Codependency, it is now seen, goes far beyond taking care of an alcoholic. It applies to the caretakers of any over-dependent person–such as drug addicts, work addicts, food addicts, spend addicts, TV addicts, sex addicts, religion addicts, sports addicts, money-making addicts, and to anyone addicted to any kind of compulsive behavior. In fact, latest estimates say that up to ninety-eight percent of us are either over-dependent or codependent to one degree or another.

Second, to resolve their problems, codependents need to admit their sickness and stop blaming others for their unhappiness or the difficulties they have.

Blaming others for their problems is denying their own problem, which is at the heart of most unhappiness. Only as we face the truth, as Jesus put it, will we ever find freedom and happiness.

Third, codependents need to stop trying to change others. They have a compulsion to fix anybody but themselves. Trying to change or fix others only leads to frustration and anger for both parties. The only person we can ever fix or change is our self, and as we change, others around us are forced to change—one way or the other.

Fourth, the codependent needs to come to terms with his or her own problem. While an overdependent person is often addicted to some form of compulsive behavior, the codependent is addicted to the addict. In reality, both are overdependent on each other.

Because codependents need to feel needed in order to feel loved, they suffer from love deprivation, usually from childhood, and have confused feeling needed for feeling loved. This is why many codependents have gone into the helping professions.

In order to feel needed, some codependents will go to any length to keep a needy person dependent on them. They can be loyal to the point of being destructive both to themselves and others.

On the surface, codependency can appear to be very loving, kind and Christian. However, at its core it is a confusion of responsibility. The codependent is so busy taking too much responsibility meeting the needs of others, he neglects taking responsibility for meeting his own needs and facing his own problems.

In so doing, he short-circuits the natural consequences of his loved one's destructive behavior.

Codependents need to allow irresponsible people to face the consequences of their actions, and, if necessary, let them hit bottom. Codependents also need to accept responsibility for themselves and work on their own growth and recovery. One effective ways to do this is to join a twelve-step support or similar group. Here, you can learn to feel loved for whom your are and not for what you do for others.

Most of all, codependents need to trust their life to God—a power greater than their own—and daily ask him to face them with the reality of their problem, help them to see the root cause of it, and lead them to the help they need plus the courage to overcome.

God can make a much better job of our life than we can. Why not trust your life to him today?


Check out the Orange County ACA website at: Orange County Adult Children

Pain Is God's Megaphone

An uncomfortable feeling is not an enemy. It’s a gift that says, "Get honest; inquire." We reach out for alcohol, or television, or credit cards, so we can focus out there and not have to look at the feeling. And that's as it should be, because in our innocence we haven't known how. So now what we can do is reach out for a paper and a pencil, write thought down, and investigate.

from http://www.byronkatie.com

Check out the Orange County ACA website at: Orange County Adult Children

Are You Ready To Have A Happy Childhood?

Healing The Inner Child

The Inner Child refers to that part of each of us which is ultimately alive, it is the emotional self-where our feelings live. When we experience joy, sadness, anger, fear, or affection our Child Within is coming out. When we are being playful, spontaneous, creative, intuitive and surrendering to the spiritual self, our Genuine Authentic Self, who we know deep within us, our Real Self is being welcomed and encouraged to be present.

We all have an inner child and the wounds our inner child received can and do continue to contaminate our adult lives. Our parents helped create this Inner Child part of us, society also helped with the creation. When this child self is not allowed to be heard or even acknowledged as being real, a false or co-dependent self emerges. We begin to live our lives as victims.

Then we have situations that arise in our lives which develop into unresolved emotional traumas. The gradual accumulation of unfinished mental and emotional business can lead to and fuel chronic anxiety, fear, confusion, emptiness and unhappiness through all of our life.

Besides the Inner Child / adolescent part, we have many other selves which are trying to be heard and take control, without us really hearing the voices until we make an effort to do so. Initially, it is very important to tame the Inner Critic part of us. That voice from the past often keeps beating up our Inner Child. This voice invades whatever trauma and pain there was in our childhood.

The wise Nurturing Self part of us can learn to stand as a protector self for the Inner Child. It’s the job of the Nurturer to be loving and self-affirming. This part of us can also teach the Inner Critic a new job of support instead of beating the Child self up, and can love the Inner Critic so that the Inner Child self can relax and not have to work so hard.

This is often where the internal battle begins. The Inner Critic has been keeping the Inner Child muffled and secluded. Often, it is a case of transforming the Inner Critic to be a good internal parent, beginning to listen to the Inner Child and to allow it to have fun and be heard.

Denial of the Inner Child and the co-dependent self are particularly common among children and adults who grew up in troubled or dysfunctional families. This is where chronic physical mental illness, rigidity, frigidity or lack of nurturing is common. Yet, there is a way out. There is a way to discover and to heal our Inner Child / adolescent part and to break free of the bondage and suffering of our co-dependent or false self.

This is called self-nurturing or re-parenting which allows us to reclaim that wounded child. We can provide for ourselves all the love and support and positive regard we never had and grow up again. It’s the easiest thing in the world to turn our feelings inwards and connect directly with that part of us that can offer comfort and support.

It is not the past as such that effects us – it is our images of it. By re-parenting or reclaiming that wounded child, we uncover any conscious or unconscious mythology of ourselves and begin to re-evaluate and transform it.

Linear time does not apply when we work internally and with the unconscious. It is possible to bring our present wise and loving self, to meet and help our young Inner Child and offer comfort and support and find a new joy and energy in living. This process to discover and heal our Inner Child can be quite astounding.

Through guidance, understanding and love we can learn to know how to form healthy and loving relationships by learning to love ourselves primarily. Because we have dysfunctional relationships internally, we have dysfunctional relationships externally. Loving ourselves is about unconditional love which means no judgement and no shame.

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Examples of some of the parts of the Child you might find inside are:

The Abandoned Child

This child part that has been left in some way through divorce or adoption or just left because the parents were kept busy working. This part is always fearful that it will be abandoned again and again. This part of the self is starving for extra attention and reassurance that it is safe and wanted.
This self is very lonely.

The Neglected Child

The child self that was always left alone without much nurturing and love.
It doesn’t believe it is lovable or worthwhile. It finds it difficult to express and doesn’t know how to love.
It is depressed and wants to hide and cry.

The Playful Child

That self that is naturally playful, creative, spontaneous and fun, the loving child. This part longs to play. Many of us have forgotten how to do this and be free without guilt or anxiety because as adults we must be doing something that is `worthwhile`.

The Spoiled Child

That part of us who wants what it wants and it wants it now, and if it doesn’t get what it wants, it throws a temper tantrum.

The Fearful Child

This part has been overly criticised when young. Now it is anxious and in panic much of the time. It needs lots of encouragement and positive affirmations.

The Disconnected Child

This Inner Child part which never learns to be close to anyone. It is isolated and dissociated. Intimacy feels alien and scary. Trust is a basic issue.

The Discounted Child

This is a part of the self that was ignored and treated as though it did not exist. It feels invisible. It doesn’t believe in itself and needs lots of love to assist and support it.

These are all possibilities of the different Inner Child parts that might be inside us and they need support which will allow us to embark on a journey of profound healing, indeed Inner Child work is fundamental to healing!

NOW is the best time to do it.

"it is never to late to have a happy childhood".

excerpted from; http://elevatedtherapy.org.uk/index-page5.html

Check out the Orange County ACA website at: Orange County Adult Children

Children of Alcoholics: Important Facts

Selected excerpts from:

http://www.athealth.com/consumer/disorders/COAFacts.html

Seventy six million Americans, about 43% of the U.S. adult population, have been exposed to alcoholism in the family.

Almost one in five adult Americans (18%) lived with an alcoholic while growing up.

Roughly one in eight American adult drinkers is alcoholic or experiences problems due to the use of alcohol. The cost to society is estimated at in excess of $166 billion each year.

There are an estimated 26.8 million COAs in the United States. Preliminary research suggests that over 11 million are under the age of 18.

Children of alcoholics are four times more likely than non-COAs to develop alcoholism.

Genetic factors play a major role in the development of alcoholism. There is an expanding base of literature which strongly supports a heritable basis for alcoholism and a range of family influences that may direct the development of children of alcoholics.

Family interaction patterns also may influence the COA's risk for alcohol abuse. It has been found that families with an alcoholic parent displayed more negative family interaction during problem-solving discussions than in non-alcoholic families.

Almost one-third of any sample of alcoholics has at least one parent who also was or is an alcoholic.

Children of alcoholics are more likely than non-COAs to marry into families in which alcoholism is prevalent.

Parental alcoholism influences adolescent substance use through several different pathways including stress, negative affect and decreased parental monitoring. Negative affect and impaired parental monitoring are associated with adolescent's joining in a peer network that supports drug use behavior.


Source: SAMHSA's National Clearinghouse for Drug and Alcohol Information


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How Many COAs Are There?

http://www.coaf.org/researchlinks/numbers.htm


In the January 2000 issue of the American Journal of Public Health, an article appears with new estimates of the number of children of alcoholics. Using data from the 1992 National Longitudinal Alcohol Epidemiological Survey, the NIAAA authors found that 15% of all U.S. children were currently exposed to alcohol abuse and/or dependence in the family (which includes any adults living in the household), and 43% of all children were exposed to someone who, during their lifetime, satisfied a diagnosis of alcohol abuse or dependence.

Assuming that the best estimate lies between these two extremes, it was determined that approximately 1 in 4 children in the US is exposed to alcohol abuse and/or dependence in the family at some point before age 18.

This is just the latest in a long line of studies on this issue. The first estimates of the number of children of alcoholics were developed in 1974 by Booz-Allen and Hamilton, who suggested extrapolating national survey data on problem drinking to the U.S. population and multiplying the resulting estimate of adult problem drinkers by the ratio of adults to children in the general population.

It should also be kept in mind that the data do not include alcoholics who are in the military, institutionalized, homeless, or who may have refused to participate in the survey. Given these caveats, it was estimated that there were approximately 6,600,000 children of alcoholics under the age of 18 years in the U.S. at that time.


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CHILDREN OF ALCOHOLICS

Excerpts from RESEARCH ON CHILDREN OF ALCOHOLICS

Subject: Children of alcoholics Date: 28 Dec 1994
Copyright 1994 Health ResponseAbility Systems, Collective Work & Database

An estimated 6.6 million children under the age of 18 years live in households with at least one alcoholic parent (1). Current research findings suggest that these children are at risk for a range of cognitive, emotional, and behavioral problems.

In addition, genetic studies indicate that alcoholism tends to run in families and that a genetic vulnerability for alcoholism exists (2,3,4). Yet, some investigators also report that many children from alcoholic homes develop neither psychopathology nor alcoholism.

This Alcohol Alert focuses on three major research questions concerning children of alcoholics (COAs):

1. What contributes to resilience in some COAs?

2. Do COAs differ from children of nonalcoholics (nonCOAs)?

3. Are the differences specifically related to parental alcoholism, or are they similar to characteristics observed in children whose parents have other illnesses?

While research findings suggest that some children suffer negative consequences due to parental alcoholism, a larger proportion of COAs function well and do not develop serious problems.

In a longitudinal study of COAs born on the island of Kauai, Werner (5) reported that, although 41 percent of the children developed serious coping problems by 18 years of age, 59 percent did not develop problems.

These resilient children shared several characteristics that contributed to their success, including the ability to obtain positive attention from other people, adequate communication skills, average intelligence, a caring attitude, a desire to achieve, and a belief in self-help.

Studies comparing COAs and nonCOAs have suggested that, although the two groups differ in a variety of psychosocial areas, differences in cognitive performance are observed most frequently.

Cognitive function in COAs has been examined by many researchers because it is an important element needed for adaptation at all stages of development; it can be measured uniformly across developmental stages; and it often is associated with the symptoms of alcoholism.

Ervin and her colleagues (6) found that Full IQ, performance (a measure of abstract and conceptual reasoning), and verbal scores were lower among a sample of children raised by alcoholic fathers than among children raised by nonalcoholic fathers.

Gabrielli and Mednick (7) reported similar results for verbal and Full IQ tests, but not for performance tests.

In a study comparing COAs and nonCOAs whose families were educated and whose parents lived in the home, Bennett and colleagues (8) found that children from alcoholic families had lower IQ, arithmetic, reading, and verbal scores. Despite the lower scores, however, COAs performed within normal ranges for intelligence tests in each of these studies.

It is important to note that cognitive competence can vary with the instrument used to measure performance as well as with the individual who is evaluating function. Johnson and Rolf (9) compared the academic abilities and cognitive function of COAs and nonCOAs from nondisadvantaged backgrounds and found no differences between the groups.

The investigators noted, however, that the children with alcoholic parents underestimated their own competence. In addition, the mothers of COAs underrated their children's abilities. The mother's and children's perceptions of abilities may affect the children's motivation, self-esteem, and future performance.

School-aged children of alcoholic parents often have academic problems. Academic performance may be a better measure than IQ of the effect of living with an alcoholic parent. School records indicate that COAs experience such academic difficulties as repeating grades, failing to graduate from high school, and requiring referrals to school psychologists (10,11).

Although cognitive deficits in COAs may account, in part, for their poor academic performance, motivational difficulties or the stress of the home environment also may contribute to their problems in school. Studies comparing COAs with nonCOAs also have found that parental alcoholism is linked to a number of psychological disorders in children.

Divorce, parental anxiety or affective disorders, or undesirable changes in the family or in life situations can add to the negative effect of parental alcoholism on children's emotional functioning (12,13). The results of several studies have shown that children from alcoholic families report higher levels of depression and anxiety and exhibit more symptoms of generalized stress (i.e., low self-esteem) than do children from nonalcoholic families (12,13,14,15).

In addition, COAs often express a feeling of lack of control over their environment. A recent study by Rolf and colleagues (16) noted that COAs show more depressive affect than nonCOAs and that their self-reports of depression are measured more frequently on the extreme end of the scale.

Moos and Billings (13) found that the emotional stress of parental drinking on children lessens when parents stop drinking. These investigators assessed emotional problems in children from families of relapsed alcoholics, children from families with a recovering parent, and children from families with no alcohol problem. Although the children of relapsed alcoholics reported higher levels of anxiety and depression than children from the homes with no alcohol problem, emotional functioning was similar among the children of recovering and normal parents.

Finally, children from homes with alcoholic parents often demonstrate behavioral problems. Study findings suggest that these children exhibit such problems as lying, stealing, fighting, truancy, and school behavior problems, and they often are diagnosed as having conduct disorders (17).

Teachers have rated COAs as significantly more overactive and impulsive than nonCOAs (11,18). COAs also appear to be at greater risk for delinquency and school truancy (12,19,20). Several investigators have reported an association between the incidence of diagnosed conduct disorders and parental alcohol abuse (21,22,23). However, other problems associated with alcoholism (e.g., depression among the alcoholic parents and divorce) also may contribute to conduct problems and disorders among COAs.

The alcoholic family's home environment and the manner in which family members interact may contribute to the risk for the problems observed among COAs. Although alcoholic families are a heterogeneous group, some common characteristics have been identified. Families of alcoholics have lower levels of family cohesion, expressiveness, independence, and intellectual orientation and higher levels of conflict compared with nonalcoholic families (13,24,25,26).

Some characteristics, however, are not specific to alcoholic families: Impaired problem-solving ability and hostile communication are observed both in alcoholic families and in families with problems other than alcohol (27). Moreover, the characteristics of families with recovering alcoholic members and of families with no alcoholic members do not differ significantly, suggesting that a parent's continued drinking may be responsible for the disruption of family life in an alcoholic home (13).

The family environment also may affect transmission of alcoholism to COAs. Children with alcoholic parents are less likely to become alcoholics as adults when their parents consistently set and follow through on plans and maintain such rituals as holidays and regular mealtimes (28).

Interestingly, the problems of COAs may not be specific to this population. In a review of research on children whose mothers were schizophrenic, Garmezy (29) reported that, like COAs, these children had cognitive deficits. In particular, they had a limited ability to maintain attention and to perceive relevant stimuli.

Children at high risk for schizophrenia revealed a more negative self-image. The family environment also may influence the risk for schizophrenia; children of schizophrenic parents - whose home environment is turbulent - have an increased risk for developing schizophrenia.

Research on COAs is still in its infancy. Many studies suggest that a variety of differences exist between children of alcoholics and children of nonalcoholics and these differences occur at all ages. However, because of the limitations of the methodology and the inadequate number of comprehensive studies, research findings cannot be generalized to all children who grow up with alcoholic parents.

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References

(1) RUSSELL, M.; Henderson, C.; and Blume, S.B. Children of Alcoholics: A Review of the Literature. New York: Children of Alcoholics Foundation, Inc., 1984.

(2) KAIJ, L. Alcoholism in Twins. Studies on the Etiology and Sequels of Abuse of Alcohol. Stockholm: Almqvist & Wiksell Publishers, 1960.

(3) CLONINGER, C.R.; Bohman, M.; and Sigvardsson, S. Inheritance of alcohol abuse. Archives of General Psychiatry 38:861-868, 1981.

(4) GOODWIN, D.W.; Schulsinger, F.; Hermansen, L.; Guze, S.B.; and Winokur, G. Alcohol problems in adoptees raised apart from alcoholic biological parents. Archives of General Psychiatry 28:238-243, 1973.

(5) WERNER, E.E. Resilient offspring of alcoholics: A longitudinal study from birth to age 18. Journal of Studies on Alcohol 47(1):34-40, 1986.

(6) ERVIN, C.S.; Little, R.E.; Streissguth, A.P.; and Beck, D.E. Alcoholic fathering and its relation to child s intellectual development: A pilot investigation. Alcoholism: Clinical and Experimental Research 8(4):362-365, 1984.

(7) GABRIELLI, W.F., JR., & Mednick, S.A. Intellectual performance in children of alcoholics. Journal of Nervous and Mental Disease 171(7):444-447, 1983.

(8) BENNETT, L.A.; Wolin, S.J.; and Reiss, D. Cognitive, behavioral, and emotional problems among school-age children of alcoholic parents. American Journal of Psychiatry 145(2):185-190, 1988.

(9) JOHNSON, J.L., & Rolf, J.E. Cognitive functioning in children from alcoholic and non-alcoholic families. British Journal of Addiction 83:849-857, 1988.

(10) MILLER, D., & Jang, M. Children of alcoholics: A 20-year longitudinal study. Social Work Research & Abstracts 13:23-29, 1977.

(11) KNOP, J.; Teasdale, T.W.; Schulsinger, F.; and Goodwin, D.W. A prospective study of young men at high risk for alcoholism: School behavior and achievement. Journal of Studies on Alcohol 46(4):273-278, 1985.

(12) SCHUCKIT, M.A., & Chiles, J.A. Family history as a diagnostic aid in two samples of adolescents. Journal of Nervous and Mental Disease 166(3):165-176, 1978.

(13) MOOS, R.H., & Billings, A.G. Children of alcoholics during the recovery process: Alcoholic and matched control families. Addictive Behaviors 7:155-163, 1982.

(14) ANDERSON, E., & Quast, W. Young children in alcoholic families: A mental health needs-assessment and an intervention/prevention strategy. Journal of Primary Prevention 3:(3)174-187, 1983.

(15) PREWETT, M.J.; Spence, R.; and Chaknis, M. Attribution of causality by children with alcoholic parents. International Journal of the Addictions 16(2):367-370, 1981.

(16) ROLF, J.E.; Johnson, J.L.; Israel, E.; Baldwin, J.; and Chandra, A. Depressive affect in school-aged children of alcoholics. British Journal of Addiction 83:841-848, 1988.

(17) WEST, M.O., & Prinz, R.J. Parental alcoholism and childhood psychopathology. Psychological Bulletin 102(2):204-218, 1987.

(18) BELL, B., & Cohen, R. The Bristol Social Adjustment Guide: Comparison between the offspring of alcoholic and non-alcoholic mothers. British Journal of Clinical Psychology 20:93-95, 1981.

(19) FINE, E.W.; Yudin, L.W.; Holmes, J.; and Heinemann, S. Behavioral disorders in children with parental alcoholism. Annals of the New York Academy of Sciences 273:507-517, 1976.

(20) RIMMER, J. The children of alcoholics: An exploratory study. Children and Youth Services Review 4:365-373, 1982.

(21) STEINHAUSEN, H.-C.; Gobel, D.; and Nestler, V. Psychopathology in the offspring of alcoholic parents. Journal of the American Academy of Child Psychiatry 23(4):465-471, 1984.

(22) MERIKANGAS, K.R.; Weissman, M.M.; Prusoff, B.A.; Pauls, D.L.; and Leckman, J.F. Depressives with secondary alcoholism: Psychiatric disorders in offspring. Journal of Studies on Alcohol 46(3):199-204, 1985.

(23) STEWART, M.A.; deBlois, C.S.; and Singer, S. Alcoholism and hyperactivity revisited: A preliminary report. In: Galanter, M., ed. Currents in Alcoholism. Volume V. New York: Grune & Stratton, 1979. pp. 349-357.

(24) CLAIR, D., & Genest, M. Variables associated with the adjustment of offspring of alcoholic fathers. Journal of Studies on Alcohol 48(4):345-355, 1986.

(25) FILSTEAD, W.J.; McElfresh, O.; and Anderson, C. Comparing the family environments of alcoholic and "normal" families. Journal of Alcohol and Drug Education 26(2):24-31, 1981.

(26) MOOS, R.H., & Moos, B.S. The process of recovery from alcoholism: Comparing functioning in families of alcoholics and matched control families. Journal of Studies on Alcohol 45(2):111-118, 1984.

(27) BILLINGS, A.G.; Kessler, M.; Gomberg, C.A.; and Weiner, S. Marital conflict resolution of alcoholic and nonalcoholic couples during drinking and non-drinking sessions. Journal of Studies on Alcohol 40(3):183-195, 1979.

(28) WOLIN, S.J.; Bennett, L.A.; Noonan, D.L.; and Teitelbaum, M.A. Disrupted family rituals: A factor in the intergenerational transmission of alcoholism. Journal of Studies on Alcohol 41(3):199-214, 1980.

(29) GARMEZY, N. Children at risk: The search for the antecedents of schizophrenia. Part II: Ongoing research programs, issues, and intervention. Schizophrenia Bulletin 9:55-125, 1974.

ACKNOWLEDGMENTS: The National Institute on Alcohol Abuse and Alcoholism wishes to acknowlege the following individuals who have contributed their time and expertise to the development of the Alcohol Alert series over the past 2 years:

John Allen, Ph.D.; Loran D. Archer; Gerald Brown, M.D.; Fulton Caldwell, Ph.D.; Mary Dufour, M.D., M.P.H.; Michael Eckardt, Ph.D.; Terry Freeman; Richard Fuller, M.D.; Bridget Grant, Ph.D.; Thomas Harford, Ph.D.; Brenda Hewitt; Jeannette Johnson, Ph.D.; Michael J. Lewis, Ph.D.; Markku Linnoila, M.D., Ph.D.; Jane Lockmuller; Diane Miller; John Noble; H. Laurence Ross, Ph.D.; Barbara Smothers, Ph.D.; Fred Stinson, Ph.D.; Cate Timmerman; Ken Warren, Ph.D.; Dianne Welsh; Gerald Williams, D.Ed.; and Terry Zobeck, Ph.D.

Source: NIAAA, ALCOHOL ALERT, No. 9, July 1990