Adult children of alcoholics. The history of a social movement and its impact on clinical theory and practice.

This chapter proposes that the popular social movement of adult children of alcoholics (ACOA) has had a profound impact on theory development and clinical practice in the fields of mental health and chemical dependence. The birth of the social movement is first traced, looking back to the origins of Alcoholics Anonymous in the self-help movement and the corresponding professional development of a systems perspective that included the notions of alcoholism as a "family disease" and the "alcoholic family," which included young children. Extending the idea to adults followed. This chapter examines why this movement could not originate in either professional field, accenting narrow theoretical base, oversimplification, professional denial, and bias in beliefs and values. Implications of the label ACOA are next addressed. Finally, a new integrated theory is proposed which bridges mental health, chemical dependence, and self-help disciplines. This theory includes environmental, systems, and individual development perspectives and integration of behavioral, cognitive, and dynamic psychotherapies. The chapter concludes with new challenges for diagnosis and reimbursement.