The Impact Of Substance Abuse In Families

Drug and alcohol addiction affects millions of people across the United States, and behind every person with a substance use disorder is a family that is struggling alongside them. Whether it is a parent, spouse, sibling, or child, addiction rarely stays contained to just one person. Its effects tend to ripple outward, touching everyone in the household in ways that can be difficult to see until the damage has already been done.

When one family member is in the grip of addiction, the entire dynamic can shift. Trust erodes, communication breaks down, and roles within the family often change in ways that can cause long-term emotional damage. Children, partners, and parents of people with addiction frequently experience their own emotional and psychological consequences, even if they are not the ones using substances.

Substance Abuse In Families: How Big Is The Problem?

The scope of addiction’s impact on American families is significant and growing. A 2025 study published in JAMA Pediatrics estimates that 19 million children, or 1 in 4 Americans under age 18, live with a parent or other adult who meets the criteria for a substance use disorder. Of those children, an estimated 6 million live with an adult who has both a substance use disorder and a co-occurring mental illness. These numbers represent a significant increase from earlier estimates and point to a growing public health concern.

A substance use disorder is a complex condition defined by the repeated misuse of drugs or alcohol in a way that interferes with a person’s ability to function in daily life. According to the 2024 NSDUH, approximately 48.4 million people aged 12 or older, or 16.8% of the population, had a past-year substance use disorder.

Detecting The Signs Of Substance Abuse In A Family Member

Signs of drug or alcohol abuse aren’t always obvious. But because substance addiction is a progressive illness, signs of this problem will often become more visible over time.

Physical, Mental, And Behavioral Symptoms

Substance abuse in children, teens, and adults can be identified by a number of physical symptoms, as well as effects on behavior, mood, and cognition.

Physical symptoms can vary depending on the type of drug and the amount of the drug used.

Common physical symptoms of substance use include:

• bloodshot eyes
• abnormal changes in energy level
• changes in pupil size
• changes in weight (gain or loss)
• sleeping more or less than usual
• slurred speech
• impaired balance and coordination
• unusual smells on the body or breath
• shakiness of the hands, arms, or legs
• excessive runny nose or sniffling

Common behavioral signs of substance use include:

• withdrawing from friends and family members
• avoiding family gatherings
• acting angry, hostile, or defensive for no clear reason
• changes in appetite
• hanging out with new friends or social groups
• hiding drugs or alcohol
• getting into legal trouble as a result of substance use
• neglecting school, work, or family
• selling valuable items in order to buy drugs or alcohol

Common effects of substance use on the brain:

• anxiety
• depression
• irritability
• frequent mood swings
• poor concentration
• memory troubles
• seeing or hearing things that aren’t there
• delusions (i.e. false beliefs)
• paranoia
• lack of pleasure or interest

Signs Of Substance Use In Teenagers

Substance use can affect children and teenagers in ways that are different from adults, in part due to the fact that teens and young adults are still developing.

Teens are also involved in different activities. They go to school. They’re exploring their interests. But major changes in mood and behavior, however, can be a sign of a bigger problem.

Common signs of substance abuse in teens and young adults include:

• running away
• frequent mood swings
• skipping classes or school altogether
• changes in eating habits
• unusual defiance or aggression
• worsened academic performance
• loss of interest in activities previously enjoyed
• decline in personal grooming and hygiene
• troubled relationships with friends or family members

Family Roles In Addiction

Within households where addiction is present, family members will often take on some type of role, and this isn’t necessarily intentional. Nor does it always occur right away.

Common family roles in addiction include:

• Addict*: The person with the alcohol or drug addiction.
• Scapegoat: The person, or “problem child,” who acts out in the family, often diverting attention away from the “addict”.
• Enabler: Also known as the “caretaker,” this is someone who often covers up the problems of the “addict” in order to shield their loved one from consequence.
• Hero: Like the “enabler,” the hero may attempt to cover up the “addict’s” mistakes and attempt to fix their loved one’s problem themselves.
• Mascot: This is the “clown” of the group who may joke or try to lessen the stress of the “addict” and family with humor, while often masking their own anxiety or depression.
• Lost child: The child of the family who gets lost in the mix. They may begin to feel neglected, lonely, and withdraw from others.

Read more about how family roles impact addiction

*We aim to remove all stigma associated with substance use disorder in order to best help those who need treatment. However, we include some outdated, commonly known terms to give an overview of their meaning in context as necessary.

The Reversal Of Family Roles

Addiction can cause a role reversal in families. Children, for instance, can be forced into the position of taking on a parental role. This reversal of roles, particularly for children and young adults, can have lasting effects emotionally and psychologically, and increase the risk for mental and behavioral issues.

Learn more about the reversal of family roles in addiction

Effects Of Substance Use On Families

Research shows that substance Use can affect families, and show up in the health of a household, in a number of ways.

Common traits of families affected by substance Use include:

• higher rates of abuse, neglect, and violence
• long-lasting effects on children
• higher rates of infidelity
• codependency
• dysfunctional relationship patterns

Read more about the effects of addiction on families

How Does Parental Drug Use Affect Children?

Growing up with a parent who has a drug or alcohol problem can have short- and long-term effects on children, including effects on mental health, academics, and personality.

Read more about the effects of parental substance abuse on children

Effects On Spouses Of Those With Addiction

Drugs and alcohol, unfortunately, can divide relationships, cause immense pain, and make spouses feel as if they’re unsure of who they married, and whether they can stay around to help.

Read more about how spouses are affected by their partner’s addiction

Effects On Parents With Addicted Children

Parents of children, teens, and adults with substance use disorders can experience significant distress emotionally and mentally. Having a child can elicit a sense of responsibility to be the hero, to fix, and to ensure the health and safety of your child, fully and unconditionally.

Effects On Siblings, Friends, And Extended Family Members

Substance use can affect siblings, friends, and extended family members who play an active role in a person’s life. Siblings, especially, can feel the effects of their sibling’s addiction acutely.

Read more about the effects of substance abuse on siblings, friends, and extended family

Addiction And Divorce

Some spouses may choose to divorce their addicted spouse before, during, or after they seek treatment. All of these paths are valid, if and when you feel that the time is right.

Are Domestic And Sexual Abuse Linked To Substance Use?

Some studies show that children of parents with drug or alcohol issues are more likely to experience domestic and sexual abuse, either perpetrated by the parent or someone else.

Addiction And Infidelity: Are They Linked?

Many types of drugs are known to alter a person’s inhibition, judgment, and their behavior. Particularly if their drug use becomes a problematic and compulsive habit. This can cause people, including the most loving of partners, to act in ways they normally wouldn’t, such as engaging in acts of infidelity.

Read more about the link between substance abuse and infidelity

Codependency And Substance Use In Families

Parents and children alike can develop codependent relationships with their addicted loved ones. Codependency can also become a coping strategy that parents find is necessary or helpful. Ultimately, however, this can have harmful effects to both the well-being of the parent and child.

Child Neglect And Substance Abuse In Families

According to the Child Welfare Information Gateway, children of parents with SUDs are more likely to be victims of neglect and are more likely to be placed in foster care.

Read more about the link between parental addiction and child neglect

Violence And Addiction In Families

Drugs and alcohol can radically alter a person’s behavior and state of mind when abused heavily and over a long period of time. In some cases, with certain drugs, this can lead to violence. Substance-related violence in any form can be disruptive to a family. With treatment and time, however, there can, for some, be a path towards healing.

Resilience In Substance Abuse Families: Can Families Recover?

Substance abuse can divide and inflict immeasurable pain upon families. But in many cases, there is a path towards healing. This can occur through a family-based approach to treatment, and will often require patience, commitment, and compassion.

Read more about resiliency in addiction recovery for families

Getting Help For A Loved One With Drug Or Alcohol Addiction

There are a number of avenues that family members of people with SUDs can pursue in order to find a treatment program that’s right for their family. Getting help begins, first and foremost, with calling a treatment helpline for assistance, or speaking to your family doctor about scheduling a drug or alcohol assessment.

From there, a healthcare professional or admissions specialist can recommend a treatment program or level of care that is most suitable to meet the needs of your family.

Read more about how to get help for a loved one with addiction

How Can Parents With Substance Abuse Problems Get Help?

Wanting to get help for a substance abuse problem is an enormous step in and of itself. Fortunately, there are several ways that parents can get help for a substance abuse problem.

The most suitable treatment option for you may depend on factors such as:

• severity of substance abuse
• duration of substance abuse
• co-occurring medical or mental health problems
• financial ability (e.g. plan for using insurance, self-pay)

How To Help Children With Addicted Parents

It’s common for family friends, teachers, neighbors, and others close to children affected by a parent’s addiction to want to find help for the child.

Some important points to keep in mind include:

• Be caring, but not overbearing.
• Do not pry in ways that make the child uncomfortable (look for visual and verbal cues that signal discomfort or unease).
• Avoid conversation or language that places blame on the child or assumes that the child does not love their parent(s).
• Do not make promises to the child that you cannot keep.

Teen Substance Abuse: How To Get Help For Your Teen

Over one million teens in the United States, from all backgrounds, struggle with some form of drug or alcohol misuse. If you’re looking for help for a teen, you’re not alone.

How Can I Help a Family Member Overcome Addiction?

It’s common to feel the desire, or the responsibility, to “fix” or help loved ones overcome addiction. And there are many steps that family members can take in order to do so.

For instance:

• helping a loved one find treatment
• driving a loved one to medication-assisted treatment or support groups
• or simply reminding them that they are loved

Ways To Approach A Loved One With Addiction: Interventions And More

Staging an intervention for a loved one can in some cases be an effective approach for getting a loved one to seek treatment for substance use. Others, still, may benefit more from a one-on-one approach, or the intervention of a trusted healthcare professional, such as a family doctor.

Family Therapy for Drug Addiction

One of the most highly recommended treatments for families affected by addiction is a family-integrated treatment approach, with services such as family therapy. Family therapy is a form of therapy that incorporates and encourages family involvement in a person’s treatment process.

Substance Abuse Education To Support Your Loved One’s Recovery

Substance abuse education can be an important prevention and recovery tool for everyone, but especially for those individuals and families directly affected by addiction.

Read more about substance abuse education for family members

Support Groups And Addiction Therapy For Families

Several support groups, such as Al-Anon, across the U.S. exist specifically to help children, parents, spouses, and other loved ones affected by addiction.

Read more about support groups for families affected by addiction

Tips For Communication During Your Family Member’s Recovery

Supporting a loved one in recovery extends not only to a person’s actions, but their words and communication style as well. This doesn’t mean that you have to necessarily second-guess everything you say. There are some important tips, such as honoring your loved one’s boundaries, that can be helpful to keep in mind in the early days of your loved one’s recovery.

The Family’s Role In Addiction Recovery

Family can play a key role in helping guide loved ones toward treatment and supporting them throughout their recovery journey.

Supporting Your Loved One’s Recovery

Choosing to play an active role in your loved one’s recovery can bring a sense of healing. Through a structured treatment process, your addicted loved one and family can learn more about how you can do so in a way that meets everyone’s mental, emotional, and relational needs.

For instance:

• enabling vs. supporting a loved one in addiction recovery
• breaking the cycle of addiction in families

Resources For Families Affected By Addiction

Finding the right support can make a meaningful difference for families navigating the challenges of a loved one’s addiction. Below is a list of resources organized by topic.

Treatment And Recovery Resources

SAMHSA’s National Helpline (1-800-662-4357): A free, confidential, 24/7 helpline that connects individuals and families with local treatment facilities, support groups, and community-based organizations
FindTreatment.gov: SAMHSA’s online treatment locator for finding addiction treatment programs by location
National Alliance on Mental Illness (NAMI) Helpline (1-800-950-6264): Offers information and referrals for families dealing with mental illness and co-occurring substance use disorders

Support Groups For Families

Al-Anon: A support group specifically for family members and friends of people with alcohol use disorders, with meetings available across the country and online
Nar-Anon: Similar to Al-Anon, but focused on families and friends affected by drug addiction
Alateen: A program within Al-Anon designed specifically for teenagers who have a family member or close friend with an alcohol use disorder
Adult Children of Alcoholics (ACoA): A support group for adults who grew up in households affected by addiction
Co-Dependents Anonymous (CoDA): A support group for people who struggle with codependency in relationships, including those involving addiction

Resources For Children

Child Help National Child Abuse Hotline (1-800-422-4453): Provides crisis intervention, information, and referrals for children experiencing abuse or neglect related to parental addiction
National Children’s Alliance: Connects children affected by abuse and neglect with local child advocacy centers that provide trauma-informed support services
Children of Addiction (CoA): Provides resources, education, and support specifically for children growing up in households affected by addiction

Resources For Parents

Parents of Addicted Loved Ones (PAL): A support group that helps parents of individuals with addiction navigate the challenges of helping a child in the grip of substance use disorder
Partnership to End Addiction (Drugfree.org): Offers a helpline, online resources, and personalized support for parents and caregivers of people with addiction
NIDA for Parents and Educators: The National Institute on Drug Abuse provides evidence-based information for parents on how to talk to children about drugs and prevent substance use

Resources For Domestic Violence And Abuse

National Domestic Violence Hotline (1-800-799-7233): Provides support, safety planning, and referrals for individuals experiencing domestic violence, which is more prevalent in households affected by addiction
RAINN National Sexual Assault Hotline (1-800-656-4673): Offers confidential support for survivors of sexual assault, which has a documented link to substance use in families

Family Therapy And Counseling

American Association for Marriage and Family Therapy (AAMFT): Provides a therapist locator to help families find licensed marriage and family therapists who specialize in addiction-related issues
Psychology Today Therapist Finder: An online directory that allows families to search for therapists by location, specialty, and insurance acceptance, including those who specialize in addiction and family therapy

Substance Abuse In Families FAQs

Find answers to frequently asked questions about substance abuse and addiction in families.

❓ What Do You Learn During Family Therapy For Addiction?

✔️ Family therapy is a type of counseling that can help families improve their skills in communication, conflict resolution, and goal-setting for the entire family.

Common examples of what is discussed during family therapy:

• communication patterns
• emotional expression
• setting goals for individuals and family members
• how loved ones can support their family member in recovery
• needs of family members
• relapse prevention planning
• creating healthy boundaries

Furthermore, there are several modalities for family therapy (e.g. behavioral family therapy) and types of family therapy (e.g. group family therapy, private family sessions).

❓ How Do Drugs Hurt Your Family?

✔️ Drug abuse can hurt families in a number of ways: financially, emotionally, socially, and legally. This can become even more complicated when children are involved.

❓ How Does Drug Use By Family Members Impact People’s Lives?

✔️ Drug misuse, including alcohol misuse, can affect virtually every aspect of a family’s lives.

Drug misuse can affect:

• sense of safety
• trust
• family dynamics
• family roles
• school and work
• ability to provide for dependents

❓ How Does Drug Addiction Affect A Person’s Life?

✔️ Drug addiction can affect people’s lives in a myriad of ways. It can have legal consequences, social consequences, affect your health, behavior, and even your sense of self.

Drug addiction can transform you into a person you don’t recognize. It can affect your emotions, psychological state, your thoughts, and your priorities.

There is no single model for how drug addiction shows up in a person’s life, nor its effects. Drug addiction can be mild, moderate, to severe in nature.

❓ What Is It Like To Have A Drug-Addicted Parent?

✔️ Growing up with an addicted parent can be difficult. To take care of themselves, and sometimes their addicted parent, children are sometimes forced into a caretaker role.

That is, essentially a role reversal. And this can have a deep impact and how a child forms and maintains relationships with others—including their addicted parent.

❓ How Do I Get Help For Drug Addiction Without My Family Knowing?

✔️ Getting help for drug addiction can be accomplished through confidential means, although certain exceptions may apply for minors, dependents, and some others.

Many treatment helplines, for instance, offer confidentiality. In some cases, state laws on guardianship and parental notification may apply.

❓ How Do I Make Up For Lost Time With My Family After Years Of Substance Abuse?

✔️ While it may take a lot of work or even some type of family therapy, making up for lost time with family is possible.

What this looks like will depend on the makeup of your family, your relationship with your loved ones, and what they need from you.

❓ Is Having An Addictive Personality Genetic?

✔️ The existence of an “addictive personality” is controversial. A fair amount of evidence suggests that drug and alcohol addiction may have genetic factors.

Furthermore, personality traits can also be learned, or influenced by those you grow up with—including your parents, siblings, and any others in your household.

Read more about addictive personalities and genetics

Written by the Addiction Resource Editorial Staff