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The phrase Adult Children of Alcoholics (ACOA) refers to those individuals who were adversely impacted by familial alcoholism. An ACOA is an individual who experiences a recognizable, diagnosable reaction to familial alcoholism. These individuals are particularly vulnerable to certain emotional, physical, and spiritual problems.

There are identifiable core issues that ACOA's experience. Control is one such issue. The fear of loss of control is a dominant theme in their lives. Control dominates the interactions of an ACOA with themselves as well as the people in their lives. Fear of loss of control, whether it be over one's emotions, thoughts, feelings, will, actions, or relationships is pervasive. ACOA's rely upon defenses mechanisms such as denial, suppression in order to control their internal world of thoughts and feelings as well as the outward manifestation of those thoughts, feelings, and behaviors.

A second core issue is trust. This is directly attributable to being raised in an environment of chaos, unpredictability, and denial. Repeatedly told to ignore the obvious, deny their own feelings, and distrust the accuracy of their own perceptions ACOA's eventually begin to distrust not only other people but their own feelings and senses as well. Father is passed out on the couch, mom's face is buried in a bowl of soup yet nothing is wrong.

A third core issue is avoidance of feelings. In the alcoholic family, the child's (COA) expression of feelings is typically met with censure, disapproval, anger, and rejection. Often the child is told explicitly, "Don't you dare say that to me; don't even think it!" or "Don't upset your mother. You have to be more understanding." In other words, COA's are taught very early that it is necessary to hide their feelings. Hiding their feelings leads to not even have any feelings as they master the art of repressing, denying, or minimizing them.

A fourth core issue is over­responsibility. ACOA's come to believe they are responsible for what is happening in their family. This is because blame is so much a part of an alcoholic family — "I drink because the kids are out of control." This just feeds a child's already existing self-centeredness. Because of these childhood experiences, COA's grow up believing they are responsible for other's emotions and actions. Because children do not know that the alcoholic drinks because the alcoholic has lost their choice to drink, they begin to believe that they are responsible for their drinking because of their "bad" behavior and therefore they are responsible for the alcoholic to stop drinking. Therefore a COA may decide that the way to end the bickering and drinking is to be a model child. Another reason that ACOA's develop a sense of overresonsibility is that children in alcoholic families often times become the family counselor or even a substitute parent for the "absent" alcoholic.

A fifth core issue of an ACOA is that they tend to ignore their own needs. This likely stems from the fact that their emotional needs continually took a back seat to alcoholism, chaos, and emotional and physical violence. All too many ACOA's equate acknowledging their emotional needs with being vulnerable or even weak. Feeling vulnerable also is equated with being out of control—a state if being which an ACOA finds intolerable. Along with feeling vulnerable and out of control, acknowledging their emotional needs may make an ACOA feel dependent, inadequate, or even worse than those states, forever in debt to the person who met their needs.

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