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Substance Abuse and Children

“Children are the most vulnerable witnesses of the opioid epidemic and further research is urgently 

needed to expand prevention interventions.”National Institutes of Health (


“Every 25 minutes in America, a baby is born suffering from opioid withdrawal, which can mean 

lower birthweights, respiratory conditions, feeding difficulties, seizures

and longer hospital stays.” American Academy of Pediatrics (AAP) Fact Sheets, 2020

“Children who have parents with substance use disorders need healthy attachment bonds with their  

primary adult caregiver in order to grow, develop and thrive,” 

(Journal of Applied Research on Children: Informing Policy for Children at Risk, 2019)


  • 8.7 million children have a parent who suffers from a substance use disorder (American Academy of Pediatrics). 

  • 41% of these children are under the age of 6 ( 

  • 400,000 births a year are affected by prenatal exposure to alcohol and illicit drugs (SAMHSA: Substance Abuse and Mental Health Services Administration). 

  • 59% of adults in treatment programs are parents of children, 27% have had one or more children removed by child welfare services (Journal of Applied Research on Children: Informing Policy for Children at Risk).

  • Approximately 70% of women in treatment have children (Journal of Applied Research on Children, 2019).


According to SAMHSA (  Accessed 4.7.20)

  • Based on data from the combined 2009 to 2014 National Surveys on Drug Use and Health, about 1 in 8 children (8.7 million) aged 17 or younger lived in households with at least one parent who had a past year substance use disorder (SUD). SUDs are characterized by recurrent use of alcohol or other drugs (or both) that results in significant impairment.

  • About 1 in 10 children (7.5 million) lived in households with at least one parent who had a past year alcohol use disorder.           

  • About 1 in 35 children (2.1 million) lived in households with at least one parent who had a past year illicit drug use disorder. 


National Association for Children of Alcoholics 

Alcoholism and other drug addictions have genetic and environmental causes. Both have serious consequences for children who live in homes where parents are involved. More than 28 million Americans are children of alcoholics; nearly 11 million are under the age of 18. This figure is magnified by the countless number of others who are affected by parents who are impaired by other psychoactive drugs.

1. Alcoholism and other drug addiction tend to run  in families. Children of addicted parents are more at risk for alcoholism and other drug abuse than are other children. 

• Children of addicted parents are the highest risk group of children to become alcohol and drug abusers due to both genetic and family environment factors.1 

• Biological children of alcohol dependent parents who have been adopted continue to have an increased risk (2-9 fold) of developing alcoholism.2 

• Recent studies suggest a strong genetic component, particularly for early onset of alcoholism in males. Sons of alcoholic fathers are at fourfold risk compared with the male offspring of non-alcoholic fathers. 3 

• Use of substances by parents and their adolescent children is strongly correlated; generally, if parents take drugs, sooner or later their children will also. 4 Adolescents who use drugs are more likely to have one or more parents who also use drugs. 5 

• The influence of parental attitudes on a child’s drug taking behaviors may be as important as actual drug abuse by the parents. 6 An adolescent who perceives that a parent is permissive about the use of drugs is more likely to use drugs. 7 

2. Family interaction is defined by substance abuse or addiction in a family. 

• Families affected by alcoholism report higher levels of conflict than do families with no alcoholism. Drinking is the primary factor in family disruption. The environment of children of alcoholics has been characterized by lack of parenting, poor home 

management, and lack of family communication skills, thereby effectively robbing children of alcoholic parents of modeling or training on parenting skills or family effectiveness. 8 

• The following family problems have been frequently associated with families affected by alcoholism: increased family conflict; emotional or physical violence; decreased family cohesion; decreased family organization; increased family isolation; increased family stress including work problems, illness, marital strain and financial problems; and frequent family moves. 9 

• Addicted parents often lack the ability to provide structure or discipline in family life, but simultaneously expect their children to be competent at a wide variety of tasks earlier than do non-addicted parents. 10 

• Sons of addicted fathers are the recipients of more detrimental discipline practices from their parents. 11 

3. A relationship between parental addiction and child abuse has been documented in a large proportion of child abuse and neglect cases. 

• Three of four (71.6%) child welfare professionals cite substance abuse as the top cause for the dramatic rise in child maltreatment since 1986.12 

• Most welfare professionals (79.6%) report that substance abuse causes or contributes to at least half of all cases of child maltreatment; 39.7% say it is a factor in over 75% of the cases. 13 

• In a sample of parents who significantly maltreat their children, alcohol abuse is specifically associated with physical maltreatment, while cocaine exhibits a specific relationship to sexual maltreatment. 14

• Children exposed prenatally to illicit drugs are 2 to 3 times more likely to be abused or neglected. 15 

4. Children of drug addicted parents are at higher risk for placement outside the home. 

• Three of four child welfare professionals (75.7%) say that children of addicted parents are more likely to enter foster care, and 73% say that children of alcoholics stay longer in foster care than do other children. 16 

• In one study, 79% of adolescent runaways and homeless youth reported alcohol use in the home, 53% reported problem drinking in the home, and 54% reported drug use in the home. 17 

• Each year, approximately 11,900 infants are abandoned at birth or are kept at hospitals, 78% of whom are drug-exposed. The average daily cost for each of these babies is $460.18 

5. Children of addicted parents exhibit symptoms of depression and anxiety more than do children from non-addicted families. 

• Children of addicted parents exhibit depression and depressive symptoms more frequently than do children from non-addicted families. 19 

• Children of addicted parents are more likely to have anxiety disorders or to show anxiety symptoms. 20

• Children of addicted parents are at high risk for elevated rates of psychiatric and psychosocial dysfunction, as well as for alcoholism 21 

6. Children of addicted parents experience greater physical and mental health problems and higher health and welfare costs than do children from non-addicted families. 

• Inpatient admission rates and average length of stay for children of alcoholics were 24% and 29% greater than for children of non-alcoholic parents. Substance abuse and other mental disorders were the most notable conditions among children of addicted parents. 22 

• It is estimated that parental substance abuse and addiction are the chief cause in at least 70-90% of all child welfare spending. Using the more conservative 70 percent assessment, in 1998 substance abuse and addiction accounted for approximately $10 billion in federal, state and local government spending simply to maintain child welfare systems. 23 

• The economic costs associated with Fetal Alcohol Syndrome were estimated at $1.9 billion for 1992.24 

• A sample of children hospitalized for psychiatric disorders demonstrated that more than 50% were children of addicted parents. 25 

7. Children of addicted parents have a high rate of behavior problems

• One study comparing children of alcoholics (aged 6-17 years) with children of psychiatrically healthy medical patients found that children of alcoholics had elevated rates of ADHD (Attention Deficit Hyperactivity Disorder) and ODD(Oppositional Defiant Disorder) measured against the control group of children. 26 

• Research on behavioral problems demonstrated by children of alcoholics has revealed some of the following traits: lack of empathy for other persons; decreased social adequacy and interpersonal adaptability; low self-esteem; and lack of control over the environment. 27 

• Research has shown that children of addicted parents demonstrate behavioral characteristics and a temperament style that predispose them to future maladjustment. 28 

8. Children of addicted parents score lower on tests measuring school achievement and they exhibit other difficulties in school. 

• Sons of addicted parents performed worse on all domains measuring school achievement, using the Peabody Individual Achievement Test-Revised (PIAT- R), including general information, reading recognition, reading comprehension, total reading, mathematics and spelling.  29 

• In general, children of alcoholic parents do less well on academic measures. They also have higher rates of school absenteeism and are more likely to leave school, be retained, or be referred to the school psychologist than are children of non- alcoholic parents. 30 National Association for Children of Addiction In one study, 41% of addicted parents reported that at least one of their children repeated a grade in school, 19% were involved in truancy, and 30% had been suspended from school. 31 

• Children of addicted parents compared to children of non-addicted parents were found at significant disadvantage on standard scores of arithmetic.32 

9. Maternal consumption of alcohol and other drugs during any time of pregnancy can cause birth defects or neurological deficits. 

• Studies have shown that exposure to cocaine during fetal development may lead to subtle but significant deficits later on, especially with behaviors that are crucial to success in the classroom, such as blocking out distractions and concentrating for long periods. 33 

• Cognitive performance is less affected by alcohol exposure in infants and children whose mothers stopped drinking in early pregnancy, despite the mothers’ resumption of alcohol use after giving birth. 34 

• Prenatal alcohol effects have been detected at moderate levels of alcohol consumption in non- alcoholic women. Even though a mother may not regularly abuse alcohol, her child may not be spared the effects of prenatal alcohol exposure. 35 

10. Children of addicted parents may benefit from supportive adult efforts to help them. 

• Children who coped effectively with the trauma of growing up in families affected by alcoholism often relied on the support of a non-alcoholic parent, stepparent, grandparent, teachers and others. 36 

• Children of addicted parents who rely on other supportive adults have increased autonomy and independence, stronger social skills, better ability to cope with difficult emotional experiences, and better day-to-day coping strategies 37 

• Group programs reduce feelings of isolation, shame and guilt among children of alcoholics while capitalizing on the importance to adolescents of 

peer influence and mutual support. 38 

• Competencies such as the ability to establish and maintain intimate relationships, express feelings, and solve problems can be improved by building the self-esteem and self-efficacy of children of alcoholics. 39



1 Kumpfer, K.L. (1999). Outcome measures of interventions in the study of children of substance-abusing parents. Pediatrics. Supplement. 103 (5): 


2 Schuckit, M.A., Goodwin, D.A., & Winokur, G. (1972). A study of alcoholism in half siblings. American Journal of Psychiatry, 128: 1132- 


3 Goodwin, D.W. (1985). Alcoholism and genetics. Archives of General 

Psychiatry, 42, 171-174. 

4 Fawzy, F.I., Coombs, R.H., & Gerber, B. (1983). Generational continuity in the use of substances: the impact of parental substance use on 

adolescent substance use. Addictive Behaviors, 8, 109-114. 

5 Skiffington, E.W. & Brown, P.M. (1981). Personal, home, and school factors related to eleventh graders’ drug attitudes. International Journal of the Addictions, 16(5), 879-892.

6 Barnes, G.M., & Windle, M. (1987). Family factors in adolescent alcohol  and drug abuse. Pediatrician, 14, 13-18. 

7 McDermott, D. (1984).The relationship of parental drug use and parents’ attitude concerning adolescent drug use to adolescent drug use. Adolescence, XIX(73), 89-97. 

8 Moos, R.H. & Billings, A.G. (1982). Children of alcoholics during the recovery process: alcoholic and matched control families. Addictive Behaviors, 7:155-163. 

9 el Guebaly, N. & Offord, D.R. (1997). The offspring of alcoholics: a critical review. American Journal of Psychiatry.134:4, 357-365. 

10 Kumpfer, K.L. & DeMarsh, J. (1986). Family environmental and genetic  influences on children’s future chemical dependency. In Ezekoye, S., Kumpfer, K., & Bukoski, W., eds. Childhood and Chemical Abuse, Prevention and Intervention. New York, NY: Haworth Press. 

11 Tarter, R.E., Blackson, T.C., Martin, C.S., Loeber, R., & Moss, H.B. (1993). Characteristics and correlates of child discipline practices in substance abuse and normal families. The American Journal on 

Addictions, 2(1), 18-25. 

12 Reid, J., Macchetto, P., & Foster, S. (1999). No Safe Haven: Children of Substance-Abusing Parents. Center on Addiction and Substance Abuse at Columbia University. 

13 Ibid. page 2. 

14 Famularo, R., Kinscherff, R., & Fenton, T. (1992). Parental substance abuse and the nature of child maltreatment. Child Abuse and Neglect, vol. 

15 Leventhal, J.M., Garber, R.B., & Brady, C.A. (1989). Identification during the postpartum period of infants who are at high risk of child maltreatment. The Journal of Pediatrics, 114(3), 481-487. 

16 Reid, J., Macchetto, P., & Foster, S. (1999). No Safe Haven: Children of Substance-Abusing Parents. Center on Addiction and Substance Abuse at Columbia University. 

17 Booth, R.E., & Zhang, Y. (1996). Severe aggression and related conduct problems among runaway and homeless adolescents. Psychiatric Services, 47 (1) 75-80. 

18 U.S. Department of Health and Human Services. National estimates on the number of boarder babies, the cost of their care, and the number of abandoned infants. Found online at 

waisgate: U.S. Department of Health and Human Services. 

19 Fitzgerald, H.E., Sullivan, L.A., Ham, H.P., Zucker, R.A., Bruckel, S., Schneider, A.M., & Noll, R.B. (1993). Predictors of behavior problems in three-year-old sons of alcoholics: early evidence for the onset of risk. 

Child Development, 64, 110-123.

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