Are you worried about a loved one’s substance use? Do you see his or her behavior becoming more erratic and self-destructive? Maybe it is time to finally get help.

Many families start the recovery process by calling a family drug helpline. Making that call could seem difficult or uncomfortable at first. It takes courage, but the results can be life changing.

So when should you call a family drug support helpline? What signs should you look for in your loved one? One of the best indicators is listening to your instincts. What does your gut tell you? When considering making the call, some people tend to make excuses or justify a family member’s behaviors. Others think they may be overreacting. These are common reactions for people unsure how to deal with their loved one’s addiction.

If you have a strong feeling you need to call, don’t talk yourself out of it because of uncertainty or fear of the unknown. Our drug helpline is happy to receive calls from any family member seeking help.

Addiction is a Family Disease

It is a common misconception that battling a substance use disorder is a personal experience. However, alcohol or drug misuse does not have devastating effects on the user alone. There is a growing body of evidence that suggests substance misuse has severe and lasting effects on families. People who are in the grips of addiction may not take into consideration that their family members are directly affected by their drug or alcohol use. But make no mistake, addiction affects the entire family. Spouses, children, parents, and members of the extended family who witness a family member struggling with addiction often experience a range of emotional, legal, financial, and health consequences.

Drug and alcohol misuse can turn what was once a peaceful, happy family into one that is divided by conflict and strain. Over time, trust can begin to erode, secrecy can become the norm, and communication can become frustrating. Some people deal with the trauma of alcohol and drug misuse in the family by developing unhealthy coping mechanisms.

The effects on family members by a relative’s harmful use of substances can range from unmet needs to impaired relations, economic hardship to legal problems, emotional distress to violence and abuse. 1 Children can be at particularly high risk of suffering the consequences of addiction in the family. For example, studies show that children of parents with drug or alcohol use disorders are more likely to develop a substance use disorder themselves.  1

For the reasons mentioned above, addiction treatment that focuses only on the individual with the substance use disorder may have limited success. Many social workers, healthcare providers, and addiction treatment experts recognize the importance of providing care in the context of the person’s family environment. Studies have shown, for example, that family-based approaches for the treatment of substance use disorders among adolescents have superior results compared to individual or group-based therapies. 2

Role of Family Members in Addiction

Over the last few decades, family structures in the United States have become more complex. Not everyone lives in a traditional nuclear family. There are single-parent families, foster families, step families, and multigenerational families. In each family unit, the various members may play one or more roles that help the family function and maintain stability and balance. When you add the effects of alcohol or drug addiction to these complex dynamics, there may be a shift in family roles. For example, if one parent is misusing alcohol, the non-addicted parent may become a “superhero,” taking on additional responsibilities and focusing on caring for the children.

In one theory, six main roles are used to describe family dynamics. In the context of drug or alcohol abuse, these roles may take on even greater importance. 3

Enablers: These are family members that take care of everything that needs to be done, including things that should be (or previously were) the responsibility of the member suffering from addiction. This can include anything from ensuring the children are fed to taking care of finances. Enablers make excuses for the person suffering from addiction in professional or social situations, and protect them from the consequences of their own actions. Examples of enablers include a spouse without a substance use disorder, or an older sibling in a single-parent household. Enablers are often in denial about the addiction and find ways to justify the behavior of their family member suffering from addiction.

Heroes: This is a role typically assumed by an overachiever or a confident, serious member of the family. For example, an older child may take on responsibilities that exceed what’s appropriate for their age. Heroes tend to be perfectionists, but with time, the responsibilities in an addiction-affected household mount and it can become increasingly difficult to maintain this role.

Scapegoats: These are people, usually children, who respond to the trauma of alcohol or drug misuse in the family by misbehaving and defying authority. This can get them into trouble at school and home, and as they grow older, it can get them into trouble with the law. They are scapegoats because their defiant behavior is nothing but a reflection of the chaotic or unhealthy atmosphere at home.

Mascots: Some people cope with difficult situations by turning to humor or other ways of distracting themselves or the rest of the family. Mascots are aware that there is a problem with addiction. They may use comedy for temporary relief and to try and restore some semblance of normalcy in the family.

Lost Children: These are members of the family who withdraw from the family and become isolated. Lost children often have difficulty interacting with people in social situations as a result of the negative home environment. They might use fantasy as a means of distraction from the family situation.

Addicted PersonThe person who is misusing drugs or alcohol can be consumed by feelings of guilt, shame, and remorse about the hardships they are causing to their family. However, due to the nature of the disease, they may be unable to stop substance use. This can lead to resentment and anger among family members who may feel that the person suffering from addiction does not care about them.

Behavior Patterns in Families Battling Addiction

In addition to the roles various family members may assume, certain characteristic patterns of behavior are often present in families where a person is abusing alcohol or illegal drugs.  4 Various roles and behavioral patterns may develop and become established in families battling addiction, and can continue to evolve and play out over time. These include:

Negativity: In families struggling with addiction, criticisms, complaints, and other expressions of discontent are commonplace. Over time, the mood in the household can become dominated by these negative emotions, with a failure to acknowledge positive behavior. The desire to escape from these negative emotions can reinforce substance misuse. In other words, addicts may use drugs or alcohol to avoid the negative mood in the household.

Inconsistency: In households battling alcoholism or drug use disorders, rules are erratic and their enforcement is inconsistent. This lack of predictable parental response can confuse the minds of children. In such cases, children are unable to tell right from wrong. Some children may even behave badly in attempts to get their parents to set clear boundaries.

Denial: It’s common for many families to be in denial about a drug problem or heavy alcohol use in someone they love. For example, even when social services intervene, many parents will take the stance that it’s all a mistake and their teenager couldn’t possibly be doing drugs. This may occur despite obvious warning signs and symptoms of substance abuse.

Misdirected anger: In homes affected by a drug use disorder or alcoholism, family members are often emotionally deprived. Relatives may be afraid to express their anger at the addicted person’s use of drugs or alcohol. The repressed anger and outrage may instead find an outlet in social situations, where a person might misdirect their anger and frustration on others.

Self-medication: Family members of people suffering from drug or alcohol addiction may start self-medicating with drugs or alcohol themselves to cope with the feelings of anxiety, depression, isolation, and helplessness.

Expectations: Children of parents with drug or alcohol use disorders can be difficult to discipline. They might get away with a lot by pointing out the parent’s shortcomings and battles with substance use. This can lead to low expectations and lost academic and career opportunities. On the other hand, some children respond to addiction in the family by becoming overachievers and perfectionists, sometimes pushing themselves to burnout.

Impact of Addiction on Children

While every member of the family is affected by addiction, the effect can be particularly harsh on children. Children learn by example. Exposure to damaging influences, such as drug misuse, by an adult family member, can have lifelong consequences. In some cases, the effects of parental drug addiction and alcoholism can last well into adulthood.

Studies have shown that children of alcoholics and drug abusers are at risk of a variety of behavioral problems, such as anxiety, depression, low self-esteem, and cognitive deficits. 5 These adjustment issues can lead to more severe problems later in life, such as one’s own substance use and problems.

Children in addiction-afflicted families may be exposed to violence, aggression, and physical or emotional abuse. The trauma of growing up in such a family can lead to mental health issues that can last for the rest of the child’s life. Some of the effects of parental substance abuse on children include: 6

  • Lower socioeconomic status
  • Access to fewer resources
  • Poorer academic performance
  • Emotional, behavioral, and social problems
  • Parental neglect
  • Parental abuse

Children of People with Alcohol and Drug Use Disorders: Facts and Figures

There are nearly 9 million children aged 17 or younger in the United States who live in households where at least one parent has a substance use disorder (alcohol or drugs). This figure includes:

  • 1.5 million children aged 0 to 2
  • 1.4 million children aged 3 to 5
  • 2.8 million children aged 6 to 11
  • 3.0 million children aged 12 to 17

 Not only are these children at risk of negative outcomes, but they also have a higher likelihood of battling drug and alcohol problems themselves. Addiction runs in families and there is a biological risk in children of those with drug and alcohol use disorders.

Studies show that children of parents with substance use disorders are more than twice as likely to have alcohol or drug problems during adulthood compared to peers who grew up in non-substance abusing families. 7The risks are greater if the parents have a co-occurring psychiatric disorder (anxiety, depression, antisocial personality) and if both parents use harmful substances rather than just one parent. 8

Besides the genetic predisposition, children of parents with substance use disorders are more likely to experiment with drugs or alcohol, perhaps because they’ve witnessed these behaviors in close quarters. Children may think drug use is okay, even acceptable, and many may not realize this behavior is not the norm. Also, the presence of drugs in the household makes it easier for children to procure these harmful substances and experiment with them.

Parenting Teenagers with Addiction

Although it is illegal for anyone under 21 to purchase alcohol in the United States, underage drinking is rampant. Adolescents and young adults in the 12-20 years age group drink over 10% of the total alcohol consumed in the US. 9 Drinking alcohol is almost considered a rite of passage for teenagers.  Many underage drinkers report binge drinking, 10 defined as consuming 4 or more drinks for women, 5 or more drinks for men. Binge drinking may place people at a higher risk of alcohol addiction.The CDC reports excessive alcohol consumption is responsible for more than 3,500 deaths of American youth each year.  11

In addition to alcohol, some teenagers experiment with dangerous drugs. In particular, marijuana use is common among adolescents. Nearly 6% of 12th graders report daily marijuana use. 12

Parenting adolescents with substance use disorders can be extremely challenging. Teenagers who are misusing alcohol or drugs can have a direct and severe impact on family dynamics, including:

  • Strained relationships
  • Reckless behavior
  • Poor performance at school
  • Psychiatric problems
  • Impaired development
  • Stealing or getting into trouble with the law
  • Running away from home
  • Risk of unwanted pregnancy or sexually transmitted diseases

Drugs and alcohol are a leading cause of violent deaths in teenagers from suicide, homicide, and accidents. Also, when an adolescent in a family is using drugs or alcohol, their siblings may be neglected or ignored while the parents respond to the crisis involving the addicted youngster.

Being Married to a Person Suffering from Addiction

Addiction affects every aspect of family life, but living with someone with a substance use disorder is perhaps the most difficult for a spouse. Being married to a person who is using harmful substances often means assuming the role of a provider while dealing with difficult emotions like anger, anxiety, stress, hopelessness, and isolation.

Addiction can create a lack of trust, chaos, emotional confusion, instability, and unpredictability in intimate relationships. Even in families where the person suffering from addiction is getting help, people often do not realize that the partner also needs care.

In families where one adult is dependent on drugs or alcohol and the other is not, a phenomenon called co-dependency can occur. A co-dependent person’s behavior may be characterized by:

  • Controlling behavior based on the belief that others cannot take care of themselves.
  • Low self-esteem and denial of their feelings.
  • Excessive compliance and compromise of their integrity and values to avoid anger or rejection.
  • Oversensitive reactions.
  • Hypervigilance to avoid conflict or trouble.
  • Remaining loyal to others despite the other person not deserving it.

Studies show that co-dependency is significantly higher among women who are married to addicted vs non-addicted men. 13

Social Effects of Addiction

The effects of drug and alcohol use on a family go well beyond the four walls of the family’s home. Some of the social effects of addiction include:

Stigma: Family members may not share what they’re going through with friends or colleagues for fear of being judged or treated differently.

Isolation: Because of the stigma attached to substance use disorders and alcoholism, families can isolate themselves from friends, communities, and social networks.

Abuse: Members of a family struggling with substance use disorders are at higher risk of emotional and economic abuse by others due to a lack of familial bonding and support.

Homelessness: Substance use can lead to financial difficulties, poverty, and homelessness. Studies have found that every third person seeking treatment for substance abuse is homeless. Not only is substance abuse a risk factor for housing instability, but homelessness is associated with more serious drug and alcohol problems. 14

Criminal behaviors: There are significant links between substance misuse and criminal behavior in both men and women. 15 People with addictions are at risk of being both victims and perpetrators of crime. Substance use disorders can lead to incarceration for non-violent or violent crimes like assault and homicide. Family members, in particular children of incarcerated individuals, face a host of challenges.

Unemployment: Problematic use of drugs and alcohol increases the risk of unemployment and decreases the chances of holding down a job. 16 The loss of employment can be difficult for the family, especially if the person suffering from addiction is the only earning member of the family.

Sexually transmitted diseases: People with substance use disorders are at higher risk of acquiring sexually transmitted diseases like HIV/AIDS and hepatitis due to intravenous (IV) drug use or risky sexual behaviors under the influence of drugs or alcohol. Incurable illnesses like HIV/AIDS have a severe impact on families and can lead to isolation, anger, guilt, and changing family roles.

Domestic, Sexual, and Child Abuse

Unfortunately, addiction is often associated with domestic violence, sexual abuse, and child neglect and abuse.

Abuse and addiction share several behavioral characteristics, such as loss of control, preoccupation or obsession, tolerance, and continuation of the behavior despite negative consequences. 17

Studies have shown that substance use is involved in more than 70% of cases of child abuse and neglect. Children whose parents have problems with harmful substances are more likely to be abused and more likely to be neglected compared to children who do not fall into this category 18

Besides children, adults in the family of a person with an addiction are also at risk. 19 Alcoholism and drug addiction can incite or worsen violence in the home. In a survey of people implicated in police calls for domestic assault, 92% of assailants reportedly used alcohol or other substances on the day of the incident. 20

There is a great deal of evidence linking substance use and substance use disorders to physical abuse and sexual assault. The vast majority of data has been collected in women. Women are up to 8 times more likely to be victimized than men by an intimate partner. 21 Additionally, women in abusive relationships are sometimes coerced into using drugs or alcohol by their partner. 22

Financial and Legal Difficulties

Drugs and alcohol don’t come cheap. An addiction can be a financial drain on the family. As alcohol or drug use becomes more compulsive and frequent, individuals suffering from addiction may run out of financial resources to feed the habit. A drug habit can also lead to loss of employment, redirecting money meant for other things (such as children’s education), and stealing money to fuel the habit. There may be defaults on payments and mortgages. Families may lose heating in the winter or lose a roof over their heads, leading to all kinds of hardships.

Besides, drug users often associate with people who engage in illegal activities like selling or distributing drugs. This can lead to legal problems, including arrests, jail time, fines, and a permanent criminal record. All of these financial and legal problems place an incredible amount of stress on the family.

Overcoming Addiction and Re-Establishing Family Connections

Drug and/or alcohol use disorders can take a heavy toll on families, but all is not lost if a member of the family is battling addiction. Comprehensive treatment of a substance use disorder can support families in their efforts to get back on track. In addition to individual and group therapies, family interventions play a key role in helping those impacted by substance use disorders. Family therapy helps various members support the person suffering from addiction as well as address their own reactions to the drug use. Some of the strategies that are effective for families in recovery include:

  • Engaging and involving the family in the addiction treatment process.
  • Providing education about the symptoms, causes, risks, and treatments of drug or alcohol use disorders.
  • Including couples or family counseling sessions to address the emotional burden of addiction.
  • Teaching skills to cope with the fallout of substance use disorders.
  • Educating family members about the signs of relapse.
  • Meeting the needs of family members and helping them make positive changes.
  • Focusing on children and addressing their feelings, concerns, and questions.

Last updated: September 25, 2020

About the author

Dr. Jennifer Merrill
Dr. Jennifer Merrill

Dr. Jennifer Merrill is an Associate Professor in the Department of Behavioral and Social Sciences at Brown University. She received her PhD in 2012 from the University at Buffalo, and is a licensed clinical psychologist in Rhode Island (Credential ID: PS01479).

Dr. Merrill has published over 70 peer-reviewed articles in journals such as Psychology of Addictive Behaviors, Addictive Behaviors and Journal of Studies on Alcohol and Drugs. Her published work includes 'Drinking over the lifespan: Focus on college ages' and 'Event-level correlates of drinking events characterized by alcohol-induced blackouts'.


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