Growing Up in Chaos: 1 in 4 Children Lives with Alcohol or Drug Addicted Parents

The study highlights a worrying reality: millions of children live in unsafe and emotionally unstable environments due to their parents’ mental health and drug addiction problems. To break this cycle, it is essential to expand access to care, support parents in treatment, and protect children with public policies focused on well-being, prevention, and education.

Many children grow up in environments that profoundly shape their physical, emotional, and social development. When these homes are marked by problems with alcohol, drugs, and mental illness, the risks for these children increase significantly.

A recent study, published in the journal JAMA Pediatrics, revealed worrying data about the reality of millions of American children who live in homes where at least one parent suffers from substance use disorders.

The researchers highlight how this situation requires urgent public health responses and interventions aimed at preventing new cycles of addiction and psychological distress.

Using data from the 2023 National Survey on Drug Use and Health, the study estimated that approximately 19 million children in the United States, approximately one in four under the age of 18, live with a parent or caregiver who struggles with a substance use disorder. This represents an increase from the 17 million estimated based on 2020 data.

This growth raises an alarm about the urgency of more effective policies to support families, prevent and access treatment for caregivers. Even more alarming is the fact that approximately 6 million of these children live in homes where, in addition to drug addiction, the adult also has a diagnosis of mental illness, such as depression or severe anxiety.

This combination of factors worsens the family environment and increases the risk that these children will develop their own problems with substance use or mental health in the future.

Among the substances most frequently involved in these cases is alcohol, responsible for approximately 12 million cases of disorders in parents. Next comes cannabis, associated with more than 6 million cases. There are also approximately 3.4 million parents who are addicted to multiple drugs simultaneously, which further complicates the family environment.

The researchers also analyzed other drugs and their impacts: about 2 million children live with parents who abuse prescription drugs, while half a million grow up in homes where parents use illicit substances such as cocaine, heroin or methamphetamine.

Growing up in a family environment marked by substance use disorders and mental illness can profoundly affect a child's neurodevelopment, causing structural and functional changes in the brain.

Chronic exposure to toxic stress, common in unstable homes with neglect, violence or unpredictability, activates the hypothalamic-pituitary-adrenal (HPA) axis for a prolonged period, increasing levels of the stress hormone cortisol, which harms critical areas such as the hippocampus, responsible for memory and learning, the prefrontal cortex responsible for executive functions and emotional control, and the amygdala, which regulates fear and the stress response.

These changes can result in cognitive deficits, learning difficulties, problems with emotional regulation and an increased risk of developing psychiatric disorders in adolescence and adulthood, such as depression, anxiety and drug addiction, thus perpetuating a vicious cycle of vulnerability.

The study was conducted by scientists at the University of Michigan, including addiction and mental health experts Sean Esteban McCabe and Vita McCabe. In addition to mapping the situation, the authors highlight the importance of access to effective treatments.

Today, there are proven options for different types of addiction, such as medications (naltrexone, acamprosate, buprenorphine, methadone) and therapeutic approaches (such as cognitive behavioral therapy).

However, these treatments are still underutilized, especially among parents who often do not receive a formal diagnosis or do not have adequate access to health services.

One of the factors that makes these new estimates more impactful is the change in the diagnostic criteria adopted. The study used the DSM-5, the most current version of the manual that guides psychiatric diagnoses.

This version expanded the recognition of symptoms and patterns of substance use, which contributed to the identification of a greater number of cases, especially those that were previously underestimated under the older DSM-IV criteria.

The substance use crisis in the United States is deep and multifaceted. Since 2020, the country has recorded more than 100,000 overdose deaths per year, while more than 46 million adults live with some kind of drug use disorder.

This scenario demands not only clinical responses, but also social and political ones. The interruption in funding and staffing at SAMHSA, the federal agency responsible for monitoring these data, jeopardizes the continuity of vital research such as this.

In short, the study highlights a troubling reality: millions of children live in unsafe and emotionally unstable environments due to their parents’ mental health and addiction problems. Breaking this cycle requires expanding access to care, supporting parents in treatment, and protecting children with public policies focused on well-being, prevention, and education.

READ MORE:

US Children Living With a Parent With Substance Use Disorder” by Sean Esteban McCabe, Vita V. McCabe, and Ty S. Schepis

JAMA Pediatrics. 12 May 2025

DOI: 10.1001/jamapediatrics.2025.0828

Abstract:

The US substance use landscape consists of over 100 000 overdose deaths annually since 20201 and, in 2023 alone, over 46 million adults with a past-year Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition; DSM-5)–defined substance use disorder (SUD).2 Despite attempts to estimate the number of children exposed to parental substance use and DSM-IV-defined SUD,3,4 recent research indicates that past-year prevalence estimates of SUD using DSM-IV criteria are substantially higher when using DSM-5 criteria,5 resulting in a key knowledge gap. 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 disorder.6 We aimed to estimate the number of US children living in the same household as at least 1 parent or primary caregiver with a DSM-5-defined SUD.