Children of Parents with Substance Use Disorder
Substance use disorder (SUD) is a widespread problem in the United States. This condition affects individuals from every walk of life, as well as from every social or cultural background. Furthermore, as I have written about in the past, the COVID-19 pandemic has been linked to increased substance use for both drug and alcohol users.
Much research has been published on the topic of SUD in adults and how it affects mental and physical health as well as communities and societies more broadly. Too often ignored, however, are the children of adults who are struggling with alcohol or drug use. In fact, young people who grow up with parents who have SUD often face a host of challenges and are at an increased risk of being subjected to violence, developing mental health conditions of their own, and struggling with their psychological development into adolescence.
This week and next, we will look at some of the research surrounding children of adults with SUD, examining how intergenerational links place these young people at risk and how we as professionals can better address this issue in terms of support and care.
Childhood is a very vulnerable time, and knowing how parental substance abuse disorder puts a young person at risk is a critical tool in being able to prevent harm and promote their healthy mental and physical development.
Prevalence of Parental Substance Use Disorder
Getting accurate data on the number of children who are living with parents who are struggling with substance use disorder can be daunting. In part, this is because a great many parents drink or take drugs recreationally and on occasion and are still able to maintain their parental duties in spite of this occasional substance use. In order to help draw a distinction as to what exactly constitutes parental substance abuse disorder in light of this uncertainty, the National Society for the Prevention of Cruelty to Children has created a definition of “parental substance misuse.” According to this definition, a child has a parent with a substance use disorder if their carer:
- Consumes harmful amounts of alcohol (if their drinking is leading to alcohol-related health problems or accidents),
- Is dependent on alcohol,
- Uses drugs regularly and excessively,
- Is dependent on drugs.
By this definition, according to research from Cambridge University, approximately 3.4 million children under the age of 16 live with at least one-binge drinking parent, and almost a million live with two binge-drinking parents. From the same report, it is estimated that 335,000 children live with a drug-dependent user and that 430,000 children live with an alcohol user who also uses drugs.
Effects of Parental SUD on Children
In the past, we have talked about examining family systems in the context of mental health and how the behavior of one family member inevitably affects the behavior patterns of the entire family, but you do not need to be versed in family therapy to understand how parental SUD might negatively affect children. Both alcohol and drug use impair judgment, which denigrates an adult’s ability to make responsible decisions or even to be present with their families.
But there are more specific effects that the children of parents with substance abuse disorder are likely to experience. For a start, there is an increased risk that SUD will be transmitted from parent to child intergenerationally: research published in the American Journal of Orthopsychiatry highlights that there are common genetic factors which link alcohol and drug disorders to high heritability. In other words, it is extremely likely that a young person will inherit their parents’ susceptibility to substance use disorders through their genes.
In addition to the genetic risk posed to children whose parents are struggling with SUD, there are social and developmental risks as well. Substance use in a parent can lead to neglect or abuse, but alcohol or drug use also causes adult behavior to be unpredictable, chaotic, inconsistent, and unstructured. A parent who may be extremely communicative and fair and who sets clear rules when sober may become withdrawn, irrational, and prone to breaking their own rules when using drugs or alcohol. For children, the uncertainty of this home environment can cause feelings of insecurity and confusion. 
This insecurity and confusion, over time, can develop into significant problems for children. Some of the common long term symptoms experienced by children of parents with SUD include:
- Compulsive need to please others
- Low self-esteem
- Social isolation. 
This list is not exhaustive; children of parents who chronically or harmfully use drugs or alcohol are among the most at-risk groups of young people simply because the range of effects this substance use has is extensive, wide-ranging, and complex. Depending on a young person’s situation, they may be affected by exhibiting obsessive or compulsive behaviors and become fixated on people pleasing, or they might withdraw from social interactions altogether and display a flat social affect and lack of empathy or care towards others.
In next week’s blog post, we will look more closely at some of the more complex social and biological effects that parental SUD has on children as they develop into adulthood and pull from the work of specialist researchers on this topic, such as Janet Woititz and Claudia Black, both of whom have been instrumental in shaping our understanding of this issue. We will also outline some of the key ways in which therapists and healthcare professionals can provide support for children of parents with SUD.
 NSPCC Learning, (2022). Parental substance misuse. National Society for the Prevention of Cruelty to Children. https://learning.nspcc.org.uk/children-and-families-at-risk/parental-substance-misuse
 Velleman, R., & Templeton, L. (2016). Impact of parents’ substance misuse on children: An update. BJPsych Advances, 22(2), 108-117. doi:10.1192/apt.bp.114.014449
 Straussner, S., & Fewell, C. H. (2018). A review of recent literature on the impact of parental substance use disorders on children and the provision of effective services. Current opinion in psychiatry, 31(4), 363–367. https://doi.org/10.1097/YCO.0000000000000421
 Bountress, K., & Chassin, L. (2015) Risk for Behavior Problems in Children of Parents with Substance Use Disorders. American Journal of Orthopsychiatry. May; 85(3): 275-286. doi: 10.1037/ort0000063
 American Academy of Experts in Traumatic Stress, (2020). Effects of Parental Substance Abuse on Children and Families. https://www.aaets.org/traumatic-stress-library/effects-of-parental-substance-abuse-on-children-and-families
 Baker, M. et. al. (2016) Identifying, Treating, and Preventing Childhood Trauma in Rural Communities. Psychology, MentalHealth, and Behavioral Studies (APMHBS).