Growing Up At Risk: Part Two

Children of Parents with Substance Use Disorder

This is part two of a blog series on children of parents with substance use disorder: to read part one, click here.

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.

Last week, I wrote about the prevalence of parental SUD and how it is likely to affect children in terms of physical and psychological symptoms. This week, I will use the work of two experts in this field to further delve into the ways in which childhoods are likely to be shaped by parental alcohol or drug use and to explore how we can provide support for children of adults who are struggling with SUD.

Adult Children of Substance Users

In the 1980s and 90s, researchers became aware that studies that attempted to track what happens to children who are affected by parental drug and alcohol use were not sufficient. It was established that children who grow up with parents who are struggling with substance use are affected well into their own adulthoods. 

Claudia Black is one such researcher: her work turned a focus on children of adults who problematically used substances, and she introduced the concept of “Adult Children of Addiction.” This term refers to the complex and interrelated phenomena of delayed stress, emotional trauma, and denial in children of parents with SUD and the nuanced and powerful ways they are likely to affect development into adulthood. [1]

According to Black, children who grow up with parents who struggle with SUD internalize a set of basic principles for living in order to adapt to the stress and trauma of their circumstances. She called these the dysfunctional family rules: “Don’t Talk. Don’t Trust. Don’t Feel.” [2] These rules form the foundation of adult social interaction for children who have grown up in environments where drug or alcohol use was prevalent and are often at the root of difficulties they face in relationships, friendships, or with mental health conditions such as anxiety and depression.

The work of Dr. Janet Woititz also helped to illuminate the complex and powerful ways in which parent substance use disorder affects children well into their adulthood. Her landmark 1983 book, Adult Children of Alcoholics, highlighted typical patterns that were often found in the families of adults who engaged in problematic drinking. [3]

Woititz outlined the following thirteen characteristics that adult children of parents with alcohol use disorder typically exhibit:

  1. Guessing at what normal behavior is.
  2. Having difficulty following a project through from beginning to end.
  3. Lying when it would be just as easy to tell the truth.
  4. Judging themselves without mercy.
  5. Experiencing difficulty having fun.
  6. Taking themselves very seriously.
  7. Having difficulty with intimate relationships.
  8. Overreacting to changes over which they have no control.
  9. Constantly seeking approval and affirmation.
  10. Feeling that they are different from other people.
  11. Being super responsible or super irresponsible.
  12. Being extremely loyal, even in the face of evidence that the loyalty is undeserved.
  13. Being impulsive. They tend to lock themselves into a course of action without giving serious consideration to alternative behaviors or possible consequences. This impulsivity leads to confusion, self-loathing, and loss of control over their environment. In addition, they spend an excessive amount of energy cleaning up the mess.[4]

Providing Support for Children of Parents with SUD

The ways in which parental SUD affects children through their development and well into adulthood are very alarming and present an excellent case for paying closer attention to children who may be growing up at risk in this way. However, not all children who grow up at risk or in volatile environments struggle with these types of difficulties. 

According to Cambridge researchers, whether or not a child will be negatively affected by the drug or alcohol use of a parent has a great deal to do with certain protective factors, such as an additional stable adult figure, close bonds with other adults in a caring role (teachers, grandparents, older siblings, etc.), strong community support, a well developed internal locus of control (the sense that they can make a difference to their own circumstances and change their own situation), adequate education and employment opportunities, and active agency in adopting coping strategies.[5] 

It is very promising that many of these protective factors can be strengthened or provided by others. An internal locus of control, for example, can be worked on in school or with a counselor. Strong community support can be ensured by community leaders and neighbors, and adequate education and employment opportunities can be established by local governments and authorities. 

This means that it is well within our power to provide what children of adults who are struggling with SUD need to prevent them from coming to harm. As professionals, and as members of our communities, we must make it our priority to support young people who are undergoing the stress of having a parent with SUD. If you or anyone you know is struggling with a parent who is using drugs or alcohol, reach out to us at Heather Hayes, or explore our website for more resources on how and where to get support.


[1] Black, C. (2022) About Claudia Black.

[2] Central Recovery Press (CRP), 2022. Claudia Black, PhD.

[3] Saxon, W. (1994) Janet G. Woititz, 55, Author Who Studied Alcoholics’ Children. The New York Times. June 14, 1994.

[4] Woititz, J.G. (1990) Adult Children of Alcoholics: Expanded Edition. Health Communications.

[5] 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

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