Nearly 19 Million U.S. Children Have a Parent with a Substance Use Disorder, New Study Finds

A new study published in JAMA Pediatrics reveals that nearly 19 million children in the United States—about one in four—live with at least one parent who has a substance use disorder (SUD). Alarmingly, a significant share of these parents have moderate to severe addiction rather than mild cases.

“I’m an addiction doc, and so I think about this issue all the time,” said Dr. Scott Hadland, chief of adolescent medicine at Massachusetts General Hospital, who was not involved in the study. “Even still, I was surprised at how high that percentage was… every day in our clinics we are encountering many families affected by SUD, and we need to be poised and ready to support them.”

The research draws on data from the 2023 National Survey on Drug Use and Health, updated with the latest DSM-5 diagnostic criteria. This approach led to much higher estimates than earlier studies—previously about 7 million children—underscoring the magnitude of the problem.

According to lead author Dr. Sean Esteban McCabe, director of the Center for the Study of Drugs, Alcohol, Smoking and Health at the University of Michigan:

• 7.6 million children live with a parent who has a moderate or severe SUD.

• 3.4 million live with a parent who has multiple SUDs.

• Over 6 million live with a parent who has both SUD and a mental health condition.

Alcohol use disorder was the most common diagnosis, affecting 12 million parents. While socially accepted, alcohol remains the leading cause of substance-related deaths in the U.S., killing more people annually than opioids.

Children of parents with SUD face increased risks for physical injuries, impaired caregiving, and exposure to overdoses. They are also more likely to develop mental health issues such as depression, anxiety, and ADHD, as well as their own substance use problems later in life.

Dr. Davida Schiff, a pediatrician and addiction medicine physician at Massachusetts General Hospital, emphasized that these numbers highlight the urgent need for early intervention. “Young children growing up in homes affected by parental SUD are at increased risk of harm. Screening and connecting families to treatment can make a significant difference.”

The American Academy of Pediatrics recommends that pediatricians:

• Ask about substance use in the family.

• Screen for parental SUD when parents visit clinics.

• Educate families on risks and connect them with treatment options.

Best practices for supporting families include safe storage of substances, identifying sober caregivers during active use, and providing naloxone training. For parents of infants, safe sleep practices and avoiding breastfeeding after substance use are critical to prevent harm.

One major challenge remains: over three-quarters of individuals with SUD do not receive treatment, and children in these households are less likely to get help themselves. McCabe stresses the importance of designing programs that meet these children where they are and reduce barriers to care.

“This is not a small problem—it’s a public health crisis touching millions of children,” said Hadland. “Addressing parental addiction is one of the most important steps we can take to protect the next generation.”