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1 in 4 US Children Live With Addicted Parents

Nearly 19 million US children live with at least one parent meeting Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition; DSM-5) criteria for substance use disorder (SUD), representing one quarter of all US children in 2023. Over 6.1 million of these children have parents with comorbid SUD and mental illness, making them particularly at risk for adverse childhood experiences. METHODOLOGY: Analysis included nationally representative data from the 2023 National Survey on Drug Use and Health of the civilian, noninstitutionalized US population aged ≥ 12 years. Researchers followed the STROBE reporting guideline, with institutional review boards deeming the study exempt from review due to the use of deidentified data. Data collection involved interviewing one adult per selected household, who reported relationships to other household members, including biological, step, foster, or adoptive children aged < 18 years. Statistical analysis estimated weighted counts and 95% CIs of youth exposed to parental DSM-5–defined SUD, including disorders related to alcohol, cannabis, cocaine, hallucinogens, heroin, inhalants, methamphetamine, and prescription medications. TAKEAWAY: Based on the 2023 National Survey on Drug Use and Health total weighted number of 62,637,851 parents, researchers estimated 18,968,894 (95% CI, 16,806,368-21,261,446) children lived with at least one parent meeting DSM-5 SUD criteria. Among affected children, 7,643,244 (95% CI, 6,468,786-8,911,360) lived with a parent having moderate or severe SUD, while 3,409,675 (95% CI, 2,568,782-4,358,248) had parents with multiple SUDs. Researchers found that 6,148,289 (95% CI, 5,012,046-7,389,039) children lived with a parent having comorbid SUD and mental illness, defined as major depressive disorder and/or serious psychological distress. Parental SUDs predominantly consisted of alcohol use disorder, followed by cannabis use disorder, prescription-related use disorder, and noncannabis drug use disorder. IN PRACTICE: '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 findings signal the need for more attention at the federal, state, and local levels on the children and families affected by addiction. Evidence-based, family-based treatments for SUD and mental illness can prevent adverse health consequences in this population,' the authors of the study wrote. SOURCE: This study was led by Sean Esteban McCabe, PhD, Center for the Study of Drugs, Alcohol, Smoking, and Health, University of Michigan School of Nursing in Ann Arbor, Michigan. It was published online in JAMA Pediatrics . LIMITATIONS: According to the authors, the study faced limitations common to large-scale national surveys, including potential sampling bias, selection bias, and self-report bias. Additionally, the number of offsprings in households was truncated at three or more, suggesting that the estimates represented the lower bound of youths exposed to parental SUD. DISCLOSURES: This study was supported by grants RO1DA031160 and RO1DA043691 from the National Institute on Drug Abuse of the National Institutes of Health. McCabe reported receiving grants from the National Institute on Drug Abuse during the conduct of the study. Additional disclosures are noted in the original article.