1 in 4 American Children Live with Parental Addiction

A new study published in JAMA Pediatrics paints a concerning picture of childhood in America today: approximately 19 million children—one quarter of all kids under 18—are growing up in households where at least one parent struggles with alcohol or drug addiction.

Using the most recent 2023 data, researchers from the University of Michigan have documented a troubling uptick in these numbers, highlighting the urgent need for expanded treatment options for parents and early intervention resources for vulnerable children.

Rising Numbers Point to Growing Crisis

The estimate represents an increase of 2 million children compared to similar research using 2020 data, which was published just months ago. This rapid rise signals deepening concerns about the intergenerational impacts of addiction in American families.

“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,” explained Sean Esteban McCabe, Ph.D., lead author of the new study.

McCabe directs the University of Michigan Center for the Study of Drugs, Alcohol, Smoking, and Health and is a professor in the U-M School of Nursing and Institute for Social Research.

Alcohol Leads, But Multiple Substances Cause Concern

The researchers identified the specific substances causing problems in these households. Alcohol remains the most prevalent issue, with an estimated 12 million parents meeting the clinical criteria for alcohol use disorder. The study also found:

• 6 million parents meet criteria for cannabis use disorder
• 2 million children live with a parent misusing prescription drugs
• 500,000 children live with a parent struggling with illicit drugs like cocaine, heroin, or methamphetamine
• 3.4 million parents show disordered use of multiple substances

Perhaps most concerning is the finding that approximately 6 million children live in homes where parental substance problems co-occur with mental health conditions like major depression—a combination that can further intensify negative outcomes for children.

The Cycle of Addiction

Growing up with parental addiction creates significant risks for children. According to Vita McCabe, M.D., MHSA, co-author and director of University of Michigan Addiction Treatment Services, these children face multiple vulnerabilities.

“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, who is board-certified in addiction medicine and psychiatry.

The ripple effects of parental substance problems can extend far into a child’s future, potentially creating generational cycles of addiction and mental health challenges without proper intervention.

Timing and Methods Matter

The study relied on data from the National Survey on Drug Use and Health, a federal program tracking American substance use since the 1970s. Researchers used diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) to identify substance use disorders.

This timing raises additional concerns, as the very survey providing this crucial data faces an uncertain future. The entire staff of the federal survey received layoff notices in April due to budget cuts at the Substance Abuse and Mental Health Services Administration (SAMHSA).

Will we lose our ability to track this critical health information just as the crisis appears to be worsening? This potential data gap comes at a moment when understanding the scope of the problem seems more essential than ever.

Treatment Options Exist

Despite the alarming statistics, the researchers emphasize that effective treatments are available. “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,” noted Vita McCabe.

Ty Schepis, Ph.D., an addiction psychologist at Texas State University and senior author of the study, pointed to the heightened risks faced by children living with parents who have both substance use and mental health conditions. “This is important to note because of the additional risk that this creates for children as they grow into adults,” he explained.

As rates of parental substance use disorder continue to climb, the study authors call for increased attention at federal, state, and local levels to support affected families. Evidence-based, family-focused treatments that address both addiction and mental health could help break the cycle and protect the next generation from similar struggles.