The clients we miss: Adult children of alcoholics

Many therapists are working with adult children of alcoholics (ACoAs) without realising it.

These clients often come into the therapy room with insight, compassion, and a high capacity for responsibility. On the surface, they may seem self-aware, articulate, and in control, but beneath that also lies a nervous system shaped by emotional unpredictability, unmet needs, and often, a deep and unspoken grief.

An ACoA isn’t simply someone whose parent drank – it is someone whose internal world was formed in the shadow of alcohol dependency, often marked by secrecy, loyalty binds, and a profound lack of emotional (and often physical) safety.

The impact of growing up with an alcohol-dependent caregiver doesn’t vanish with age. The child adapts; survival means that the wound hides, and in adulthood, it is hidden behind high achievement, people-pleasing, emotional numbing, and hyper-independence.

It’s estimated that around one in five adults in the UK grew up with a parent who misused alcohol. That’s millions of people carrying relational templates shaped by chaos, shame, and chronic emotional dysregulation. Because alcohol misuse is common and often normalised, many live with the impact without even realising it.

Trust doesn’t come easy

Trust is not a given for these clients. Many ACoAs learned early that adults weren’t reliable, and vulnerability wasn’t safe. In therapy, this can look like resistance, avoidance, or intellectualisation, but in truth, it’s often a survival strategy. The therapeutic relationship may be the first place a client tests what a secure connection even feels like.

As therapists, it’s vital we don’t misread this. Pushing too quickly for emotional openness, or interpreting guardedness as unwillingness, can unintentionally recreate the very dynamics our clients are trying to heal from. It is essential that we honour those defences – at one time, they were needed. They were the protector.

Attachment, secrecy, and the mask of self-reliance

Attachment wounds in ACoAs can be complex. Some were emotionally parentified, taking on adult roles to survive. Others coped through invisibility. Nearly all learned that the family secret must be protected at all costs.

That secrecy doesn’t disappear when they walk into therapy. In fact, therapy may feel like a betrayal of the family system they were loyal to. Add to this a deep-rooted belief that their needs are too much or won’t be met, and you can begin to see why so many ACoAs struggle to show up fully in the therapeutic space. It is not uncommon for a therapist to believe they’ve seen the whole picture, only to find that deeper layers emerge much later. It is important not to make assumptions or believe too early that trust has been fully established.

Many took on roles to manage the family dynamic: the hero, the lost child, the scapegoat, the caretaker. These weren’t choices – they were adaptive positions, shaped by what kept them safe. In adulthood, these roles can feel like armour. And for a long time, that armour has likely helped the ACoA to navigate life. It can be extremely hard to take off, even when it no longer serves.

Hyper-independence is a common thread. These clients are often celebrated for their strength, but it’s a strength forged in silence. A strength that says, "I’ll never rely on anyone again." As therapists, if we’re not aware of where that comes from, we might mistake their distance for stability.

A client might say, "I don’t know why I can’t ask for help. It feels weak." But when we trace it back, we find a child who learned that expressing need was dangerous or simply never worked.

Why this awareness matters

Given the scale of addiction and family dysfunction in society, it’s likely that every therapist will work with ACoAs, whether or not the term is used. The legacy of being an ACoA is rarely named by clients or by therapists.

When we aren’t aware of these dynamics, we risk retraumatising our clients. We might challenge defences without understanding why they were needed. We might miss the wounded child inside the competent adult.

Without this awareness, therapist countertransference can also become confusing. We may feel rejected, overly responsible, or shut out – not realising we’re brushing up against early attachment wounds.

And more than that, without insight into this group, we miss the chance to facilitate true healing and felt safety – a space where the mask can loosen, where they don’t have to hold it all together.

A gentle call to awareness

This isn’t about adding another specialist label to our work. It’s about recognising a pattern that is both common and frequently overlooked.

Working with ACoAs isn’t niche. The numbers let us know that it is likely that, as therapists, we will work with this group. When we aim to understand their inner world – the loyalty, the secrecy, the longing for safety that never came – we are showing up for the client in a way that perhaps no one has done before.

At the heart of this work isn’t pathology – it’s protection. And when we honour that, we help our clients finally feel safe enough to stop just surviving and begin to heal and live the life they were always meant for.

We don’t need to have all the answers, but we do need the humility to notice when a client’s silence is survival, not resistance – and to meet that with patience, not pressure.

References

• Beesley, D. and Stoltenberg, C.D., 2002. Control, attachment style, and relationship satisfaction among adult children of alcoholics. Journal of Mental Health Counselling, 24(4), pp.281–298.
• Black, C., 1981. It Will Never Happen to Me: Growing Up with Addiction as Youngsters, Adolescents, Adults. Deerfield Beach, FL: Health Communications.
• Brown, S., 1988. Treating Adult Children of Alcoholics: A Developmental Perspective. New York: Wiley.
• Felitti, V.J., Anda, R.F., Nordenberg, D., Williamson, D.F., Spitz, A.M., Edwards, V., Koss, M.P. and Marks, J.S., 1998. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), pp.245–258.
• Maté, G., 2003. When the Body Says No: The Cost of Hidden Stress. Toronto: Alfred A. Knopf Canada.
• Vail, M.O., Protinsky, H.O. and Prouty, A.M., 2000. Sampling issues in research on adult children of alcoholics – adolescence and beyond. Adolescence, 35(137), pp.113–117.