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In Reply.—I accept the criticism from Dr Van Ost that I could have emphasized more strongly the family nature of chemical dependency and the importance of obtaining a careful history of family drinking and drug use.
Pediatricians need to constantly remind themselves of the dynamic interrelationship of family members. When one family member is dysfunctional, each other member makes compensatory adjustment. Children of alcoholics face life from an unhealthy perspective and have a variety of characteristic and pathologic defense mechanisms with which we should be familiar. The relationship of chemical dependency to such pediatric concerns as child abuse and incest represents only the tip of an iceberg that includes rejection, lack of communication, dishonesty, denial, and a number of serious and often lifelong problems.
Alcoholics Anonymous and Narcotics Anonymous are effective organizations, but I find Al-Anon and Alateen even more helpful for the family members (adult and child) in
MacDONALD DI. Chemical Dependency and Adolescence-Reply. Am J Dis Child. 1984;138(11):1085–1086. doi:10.1001/archpedi.1984.02140490085027
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