A Quarter of US Children Have a Parent With Substance Use Disorder, Study Finds

Nearly 19 million children in the United States have at least one parent with a substance use disorder (SUD), according to a new study published in JAMA Pediatrics on May 12. A significant number of those children have a parent whose SUD is moderate or severe as opposed to mild, the study finds.

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Witnessing a parent misusing drugs and alcohol as a child is considered an "adverse childhood experience" (ACE) that can have long-term negative impacts on health and well-being. ACEs are common. About 64 percent of adults in the United States reported they had experienced at least one type of ACE before age 18. Nearly one in six adults reported they had experienced four or more types of ACEs.

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"Children exposed to parental SUD are more likely to develop adverse health outcomes than their peers without parental SUD exposure, including early substance use initiation, substance-related problems, and mental health disorders," wrote study authors Sean Esteban McCabe, Vita McCabe, and Ty Schepis. "We aimed to estimate the number of US children living in the same household as at least one parent or primary caregiver with a DSM-5-defined SUD."

As Rhitu Chatterjee reported on NPR, "the new study used data from the 2023 National Survey on Drug Use and Health, a federal survey that estimated the prevalence of substance use and mental health disorders based on the most updated criteria in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5). The national survey is managed by the Substance Abuse and Mental Health Services Administration, but the team in charge of the survey was let go as part of the recent reduction in force. It is unclear how the cuts will affect the future of the survey."

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"If one-quarter of kids in the US have a parent with a substance use disorder, that tells us that every day in our clinics we are encountering many, if not dozens of families that are affected by substance use disorders," Dr. Scott Hadland, chief of adolescent medicine at Massachusetts General Hospital told NPR. "We need to be poised and ready to help support those families."

"The study's main finding is significantly higher than previous estimates (7 million in a study originally published in 2022), which had relied on diagnostic criteria from the DSM-IV," reported Chatterjee. "The new study also estimated how many children have a parent with a moderate or severe addiction as opposed to mild."

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McCabe and his team found that 7.6 million US children have a parent with a moderate or severe SUD, and 3.4 million live with a parent dealing with multiple substance use disorders. The authors also found that more than 6 million children have a parent dealing with both a substance use disorder and a co-occurring mental health condition.

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"These estimates are incredibly important to understand the scope of parental substance use disorder in the United States," Davida Schiff, a pediatrician and addiction physician at Massachusetts General Hospital, told NPR. Dr. Schiff pointed out that a majority of the parents (12 million) had alcohol use disorder. "While alcohol is more socially acceptable in our society, the study points to a need to pay greater attention to a rising number of children exposed to parental alcohol use disorder."

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Adverse childhood experiences and other lifetime traumas are regularly encountered by addiction professionals. The strong correlation between addiction and trauma, especially childhood trauma, is well known.

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Addiction is truly a family problem.

NRT Behavioral Health Chief Clinical Advisor Dr. Michael Barnes is a foremost expert in family system disorders and trauma. The Trauma-Integrated Care Model, developed by Dr. Barnes and used at NRT Behavioral Health treatment programs, emphasizes the importance of identifying trauma and substance use in family systems. Because parental substance use disorder exposes children to physical and psychological danger and increases their risk of developing SUD in later life, addressing the effects of these problems on all family members is key to stopping generational cycles of behavioral health disorders. Family programming is a central part of treatment at NRT Behavioral Health programs. It focuses on educating clients and family members and helps families create recovery-supportive lifestyles and home environments.

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Recognizing how families experience, normalize, and perpetuate substance use is vital to reducing high rates of SUD in America's rural communities. Close-knit families that spend more time together and are more isolated from other community members can inadvertently create an internal culture that makes using substances to self-medicate mental health disorders more acceptable. Ensuring that rural community members can access high-quality treatment is one way to address this problem. Helping individuals address anxiety, depression, loneliness, and other psychological problems through therapy and psychiatric medications can reduce their perceived reliance on alcohol and substances to reduce their symptoms. Sometimes, when one family member gets help, other members become more willing to accept help and to change their relationship with substances. 

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If you or a loved one is experiencing problematic drinking or drug use, we may be able to help. Please call us for a free and confidential conversation at (720) 807-7867.