What is Adult Children of Alcoholics (ACoA)? A Complete Guide for Recovery Professionals

The effects of growing up with an alcoholic parent don't end when childhood ends. Adult Children of Alcoholics (ACA, also called ACoA) provides a recovery pathway for adults still carrying the wounds of childhood in dysfunctional families.

For recovery professionals, understanding ACA opens treatment options for clients whose current struggles trace back to childhood family environments—even when substance abuse isn't their presenting issue.

What is Adult Children of Alcoholics?

Adult Children of Alcoholics is a Twelve Step fellowship for adults who grew up in alcoholic or otherwise dysfunctional households. Founded in 1978, ACA provides a program for recovering from the effects of growing up in a family where alcoholism, addiction, or other dysfunction created an unsafe environment.

The key insight behind ACA is that children in dysfunctional families learn survival skills that become problems in adulthood. What helped a child survive an unpredictable, chaotic, or abusive household becomes maladaptive when applied in adult relationships and situations.

Beyond Alcoholism

Despite its name, ACA welcomes anyone who identifies with the effects of family dysfunction. The organization recognizes that alcoholism is just one form of family dysfunction that produces these effects. Other sources include:

• Drug addiction in the family
• Other compulsive behaviors (gambling, eating disorders, workaholism)
• Physical, emotional, or sexual abuse
• Chronic mental illness
• Extreme religious rigidity
• Violence or rage
• Emotional neglect
• Perfectionism and harsh criticism

What matters isn't the specific dysfunction but whether the family environment was characterized by unpredictability, fear, shame, or neglect that shaped the child's development.

The Laundry List

ACA's "Laundry List" describes 14 traits commonly developed by people who grew up in dysfunctional families:

1. We became isolated and afraid of people and authority figures.
2. We became approval seekers and lost our identity in the process.
3. We are frightened by angry people and any personal criticism.
4. We either become alcoholics, marry them, or both, or find another compulsive personality such as a workaholic to fulfill our sick abandonment needs.
5. We live life from the viewpoint of victims and are attracted by that weakness in our love and friendship relationships.
6. We have an overdeveloped sense of responsibility and it is easier for us to be concerned with others rather than ourselves.
7. We get guilt feelings when we stand up for ourselves instead of giving in to others.
8. We became addicted to excitement.
9. We confuse love and pity and tend to "love" people we can "pity" and "rescue."
10. We have stuffed our feelings from our traumatic childhoods and have lost the ability to feel or express our feelings.
11. We judge ourselves harshly and have a very low sense of self-esteem.
12. We are dependent personalities who are terrified of abandonment and will do anything to hold on to a relationship.
13. Alcoholism is a family disease, and we became para-alcoholics and took on the characteristics of that disease even though we did not pick up the drink.
14. Para-alcoholics are reactors rather than actors.

Recognizing oneself in these traits often provides the first identification with ACA.

The ACA Program

ACA uses the Twelve Steps adapted for adult children:

1. We admitted we were powerless over the effects of alcoholism or other family dysfunction, that our lives had become unmanageable.
2. Came to believe that a power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood God.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked God to remove our shortcomings.
8. Made a list of all persons we had harmed and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as we understood God, praying only for knowledge of God's will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these Steps, we tried to carry this message to others who still suffer, and to practice these principles in all our affairs.

The Inner Child Concept

Central to ACA is the concept of the "Inner Child"—the wounded child part of self that remains stuck in childhood survival patterns. ACA's work involves:

• Recognizing the Inner Child's existence and needs
• Grieving the childhood that should have been
• Reparenting—learning to provide for oneself what parents couldn't provide
• Integrating the wounded child with the functional adult

This psychological framework distinguishes ACA from other Twelve Step programs and makes it particularly compatible with therapy approaches addressing developmental trauma.

The "Other Laundry List" (Flip Side)

ACA also recognizes "flip side" traits—seemingly opposite patterns that serve the same protective function:

• To avoid becoming the victim, becoming the persecutor
• Instead of fear of authority, becoming an authority figure who dominates
• Instead of people-pleasing, isolating and avoiding relationships
• Instead of feeling worthless, inflated grandiosity

These opposite manifestations stem from the same childhood wounds and require the same recovery work.

ACA Meeting Culture

ACA meetings follow standard Twelve Step formats with distinctive elements:

Reading the Laundry List – Most meetings begin with the Laundry List or other ACA readings.

Inner Child focus – Sharing often involves recognition of childhood wounds and Inner Child work.

Emotional depth – ACA meetings frequently involve tears, grief, and processing childhood experiences.

Cross-talk varies – Some ACA meetings allow gentle feedback; others follow strict no-cross-talk rules.

Loving parent meetings – Some meetings focus specifically on reparenting and Inner Child work.

Meeting Formats

• Discussion meetings – Topic-based sharing
• Step study – Working through the steps
• Literature study – ACA's "Big Red Book" and other materials
• Speaker meetings – One member shares their story
• Inner Child/loving parent meetings – Focused on reparenting work

Who Benefits from ACA?

Adults who grew up in alcoholic families – The original population ACA serves, still central to the fellowship.

Adults from other dysfunctional families – Those whose families were affected by other addictions, mental illness, abuse, neglect, or rigidity.

People recognizing Laundry List patterns – Those who identify with the traits regardless of specific family history.

People struggling with relationship patterns – Chronic relationship difficulties often trace to childhood family patterns.

People in recovery who recognize deeper issues – Many people in AA or NA recovery recognize that childhood issues underlie their addiction and add ACA to their program.

People working on developmental trauma – ACA provides peer support context for trauma work often addressed in therapy.

ACA and Professional Treatment

ACA complements trauma therapy particularly well:

For therapists – ACA provides community support, peer relationships, and daily practice between sessions. The Inner Child concept aligns with many therapeutic approaches.

For clients – ACA offers fellowship with others who understand developmental trauma, structured step work, and sponsorship focused on family-of-origin issues.

Together – Therapy addresses trauma with professional expertise while ACA provides ongoing community and peer support.

ACA and Addiction Treatment

Many people in addiction recovery recognize that childhood trauma underlies their substance use. ACA can be added to AA or NA involvement:

• AA/NA addresses addiction directly
• ACA addresses childhood wounds that may have contributed to addiction
• Working both programs addresses recovery more comprehensively

Practical Information for Professionals

Finding Meetings

ACA's meeting finder is at adultchildren.org. Availability varies:

• Urban areas typically have multiple meetings
• Smaller cities may have limited options
• Online meetings have expanded access significantly (ACA was early to adopt online meetings)

When to Suggest ACA

Consider ACA when clients present with:

• Identification with the Laundry List traits
• Chronic relationship difficulties with roots in childhood
• Developmental trauma from dysfunctional family of origin
• "Para-alcoholic" patterns (traits of addiction without substance use)
• Difficulty accessing emotions or knowing their own needs
• Persistent low self-esteem despite achievements
• Hypervigilance, people-pleasing, or control issues

Assessment Questions

• What was it like growing up in your family?
• Did you often feel unsafe, unpredictable, or anxious at home?
• Do you recognize yourself in the Laundry List traits?
• Do current relationship patterns seem connected to childhood experiences?
• Do you feel like you're still carrying wounds from childhood?

The Evidence Base

Research specifically on ACA is limited. However, the concepts underlying ACA—developmental trauma, attachment disruption, dysfunctional family systems—are well-established in psychology. ACA's approach aligns with trauma-informed care and attachment-based therapies.

Clinical observation suggests ACA benefits people with developmental trauma, particularly alongside professional therapy addressing childhood experiences.