A large percentage of American children are growing up in households with at least one parent who uses alcohol or other drugs in problematic ways—raising the risk that those children will go on to do the same, a new study suggests .
Using data from 2023 to give as current a view as possible, the researchers estimate that 19 million children—1 in 4 of Americans under age 18—live with a parent or other adult who meets the definition for a substance use disorder.
Of them, an estimated 6 million children live with an adult who has a mental illness in addition to their substance use disorder.
The most common substance that parents showed disordered use of was alcohol, with survey data leading to estimates that 12 million parents meet criteria for some level of alcohol use disorder. Just over 6 million parents may meet criteria for cannabis use disorder. About 3.4 million meet criteria for disordered use of multiple substances.
The number living with a parent who had any substance use disorder in 2023 is higher than the 17 million estimated in a paper published just months ago that used data from 2020.
"The increase and fact that one in four children now live with parental substance use disorder brings more urgency to the need to help connect parents to effective treatments, expand early intervention resources for children, and reduce the risk that children will go on to develop substance use issues of their own," said Sean Esteban McCabe, lead author of the new study and senior author of the recent one.
The new findings are published in the journal JAMA Pediatrics by a team from the University of Michigan Center for the Study of Drugs, Alcohol, Smoking, and Health , which McCabe directs. He is a professor in the U-M School of Nursing and Institute for Social Research, and a member of the U-M Institute for Healthcare Policy and Innovation.
Both studies used data from the National Survey on Drug Use and Health, a federal program that has tracked U.S. drug and alcohol use since the 1970s, yielding data that researchers and policymakers have used.
That survey faces an uncertain future due to staff and budget cuts at the federal agency where it's based, the Substance Abuse and Mental Health Services Administration or SAMHSA. The survey's entire staff received layoff notices in April.
In addition to alcohol and cannabis, McCabe and his colleagues estimate that just over 2 million children live with a parent who has a substance use disorder related to prescription drugs, and just over half a million live with a parent whose use of illicit drugs such as cocaine, heroin and methamphetamine meets criteria for a substance use disorder.
The researchers include Vita McCabe, the director of University of Michigan Addiction Treatment Services in the Department of Psychiatry at Michigan Medicine, U-M's academic medical center.
"We know that children raised in homes where adults have substance use issues are more likely to have adverse childhood experiences, to use alcohol and drugs earlier and more frequently, and to be diagnosed with mental health conditions of their own," said Vita McCabe, a board-certified in addiction medicine and psychiatry. "That's why it's so important for parents to know that there is effective treatment available, including the medications naltrexone and/or acamprosate for alcohol use disorder, cognitive behavioral therapy for cannabis use disorder, and buprenorphine or methadone for opioid use disorder including both prescription and non-prescription opioids."
Both the new paper and the one published in March in the Journal of Addiction Medicine based diagnoses of substance use disorders and major mental health conditions on the criteria contained in the Diagnostic and Statistical Manual of Mental Disorders 5, or DSM-5.
In the March study, the authors showed that the change in how substance use disorder was defined in DSM-5 compared with its previous version led to a major increase in the number of children estimated to be living with a parent with a substance use issue.
Ty Schepis, an addiction psychologist at Texas State University, was the lead author of the earlier paper and is senior author of the new paper.
"Our new findings add to the understanding of how many children are living with a parent who has a severe and comorbid substance use disorder and other mental illness such as major depression," he said. "This is important to note because of the additional risk that this creates for children as they grow into adults."
The research was funded by the National Institute on Drug Abuse, part of the National Institutes of Health (R01DA031160, R01DA043691).
Study: US Children Living With a Parent With Substance Use Disorder, JAMA Pediatrics . doi:10.1001/jamapediatrics.2025.0828
Story on previous paper using 2020 data: Millions of children live with parents who have a substance use disorder
