When a parent begins treatment for a substance use disorder, adults often try to protect the children by saying little or nothing. Children usually notice anyway. They see schedule changes, tension at home, and appointments they do not understand.

This article explains what research says about children in these families, what kinds of support help, and how to talk with a child in a way that fits their age.

This is more common than many families think

Many parents feel alone in this situation. They are not. A 2025 study in JAMA Pediatrics used national survey data from 2023. It estimated that nearly 19 million U.S. children lived in a household with at least one parent who met diagnostic criteria for a substance use disorder. That is about one in four children. Alcohol use disorder was the most common type (McCabe et al.).

The same study estimated that about 6.1 million children lived with a parent who had both a substance use disorder and a mental health condition. The authors note that children in these households are more likely than their peers to have health problems later. They also state that evidence-based, family-based treatments can help prevent those problems (McCabe et al.).

The point is not to alarm anyone. A parent getting treatment is a step that can help the whole family, and children can be part of that.

Why honest information helps

It can feel kinder to keep children in the dark. Research suggests the opposite is often true.

A 2015 review looked at family programs for children whose parents had substance use problems. It found that programs that taught families about addiction and its effect on children led to better outcomes for both parents and children. One key reason was that accurate information helped children stop blaming themselves. The authors describe shame and secrecy as common in these families. When children were given information that had been held back or downplayed, they were better able to let go of feeling responsible (Usher et al.).

Children often fill gaps with their own explanations. Those explanations can be worse than the truth. A clear, calm account helps a child understand that the problem is a health condition, that adults are handling it, and that it is not their fault.

How to talk with a child

SAMHSA offers general guidance for parents and caregivers talking with children about mental health. The same approach is a reasonable starting point here. It suggests:

  • Communicate in a straightforward manner.
  • Speak at a level that fits the child's age and development. Preschool children need fewer details than teenagers.
  • Have the conversation when the child feels safe and comfortable.
  • Watch for reactions, and slow down or back up if the child seems confused or upset.
  • Listen openly and let the child share their feelings and worries.

(SAMHSA)

SAMHSA also lists simple open questions such as "Can you tell me more about what is happening? How are you feeling?" and "I'm here to listen. How can I help you feel better?" (SAMHSA).

In practice, that often means a few short messages, repeated over time:

  • The parent has a health problem and is getting help from a treatment team.
  • It is not the child's fault, and it is not the child's job to fix it.
  • It is okay to have mixed feelings, and it is okay to ask questions.
  • Adults in the family are taking care of things.

Avoid making promises you cannot keep, such as saying that everything will be fine by a certain date. Recovery takes time, and children trust adults more when what they are told matches what happens.

What kinds of support help children

Research on programs for children in these families is still limited, but some patterns are consistent.

The 2015 review found four common features in programs that worked: chances for positive time between parent and child, supportive relationships with peers who have similar experiences, education about addiction, and outreach that fits each family's practical needs. Children in peer groups often described relief at meeting others who understood. The review also notes that social isolation is common for these children (Usher et al.).

A separate 2015 review looked at four randomized controlled trials. It found that interventions focused on parenting practices and family functioning, alongside the parent's substance use treatment, showed the most promise for improving children's well-being. The authors caution that the findings are preliminary because so few trials met their criteria (Calhoun et al.).

For families, that suggests a few practical steps. Protect ordinary routines and time together. Ask the treatment team whether family sessions or parenting support are available. Look for age-appropriate groups for children. Tell a trusted adult in the child's life, such as a school counselor, if it seems helpful.

When a child may need more help

Some children cope well with steady support. Others need more. Signs worth discussing with a pediatrician or mental health professional include lasting changes in sleep, mood, eating, school performance, or friendships. If a child talks about harming themselves, get help right away. The 988 Suicide & Crisis Lifeline is available by call or text at 988.

Questions worth asking your care team

  • Does the program offer family sessions, and can children take part?
  • Is there parenting support available while I am in treatment?
  • Can you recommend groups or counselors for children in our area?
  • How should we explain treatment schedules to our children?
  • What information is shared with family members, and what stays private?

The short version

Many children live with a parent who has a substance use disorder, and they usually notice more than adults expect. Honest, age-appropriate information helps children understand that it is not their fault. Short, calm, repeated conversations work better than one big talk. Programs that combine parenting support, positive family time, education, and peer groups show the most promise, though the research is still developing.