Nearly 19 million children in the United States have at least one parent with a substance use disorder, according to a new study published Monday in JAMA Pediatrics. And a significant number of those children have a parent whose addiction is moderate or severe as opposed to mild, the study finds.
The number amounts to 1 in 4 children with a parent who has addiction.
"I'm an addiction doc, and so I think about this issue all the time," says Dr. Scott Hadland, chief of adolescent medicine at Massachusetts General Hospital, who wasn't involved in the new study. "Even still, I was surprised at how high that percentage was. It's just an enormous number of kids that are affected."
"If one-quarter of kids in the U.S. have a parent with a substance use disorder, that tells us that every day in our clinics we are encountering many, if not dozens of families that are affected by substance use disorders," he adds. "And we need to be poised and ready to help support those families."
The new study used data from the 2023 National Survey on Drug Use and Health, a federal survey that estimated the prevalence of substance use and mental health disorders based on the most updated criteria in the Diagnostic and Statistical Manual of Mental Disorders-V (DSM-5). The national survey is managed by the Substance Abuse and Mental Health Services Administration, but the team in charge of the survey was let go as part of the recent reduction in force. It is unclear how the cuts will affect the future of the survey.
The study's main finding is significantly higher than previous estimates (7 million in a 2022 study), which had relied on diagnostic criteria from the DSM-4.
The new study also estimated how many children have a parent with a moderate or severe addiction as opposed to mild.
"We also found that 7.6 million children live in a household with a parent that has either a moderate or severe substance use disorder," says study author Sean Esteban McCabe, director of the Center for the Study of Drugs, Alcohol, Smoking and Health at the University of Michigan. "And 3.4 million live with a parent with multiple substance use disorders."
McCabe and his team also found that more than 6 million children have a parent with a mental health condition in addition to a substance use disorder.
"These estimates are incredibly important to understand the scope of parental substance use disorder in the United States," wrote Dr. Davida Schiff in an email. Schiff is a pediatrician and addiction medicine physician at Massachusetts General Hospital and wasn't involved in the new study.
Another notable finding in the study, according to Schiff, is that a majority of the parents — 12 million — had alcohol use disorder. "While alcohol is more socially acceptable in our society, the study points to a need to pay greater attention to a rising number of children exposed to parental alcohol use disorder."
"It's also important to remember that alcohol is actually the leading cause of substance-related deaths in the United States," notes Hadland. "It actually kills more people in the U.S. than do opioids every year, but it's a slower death rate. It's a chronic disease process that affects, you know, somebody's liver, somebody's risk of developing cancer."
And children of parents with addiction are themselves at a higher risk of various physical and mental health problems.
"Young children growing up in homes affected by parental SUD (substance use disorder) are at increased risk of experiencing impaired caregiving, disruption of parental abilities, unintentional ingestions, and witnessing parental overdose," wrote Schiff.
They are also at a higher risk of developing certain mental health conditions and substance use problems in the long run.
"One thing that I'm doing as a pediatrician is when I'm caring for a young person who has a parent with a substance use disorder, is making sure that I'm doing a good job asking about and screening for mental health concerns like depression, anxiety, ADHD, all of which we know can be more common in kids of parents with addiction," says Hadland.
The American Academy of Pediatrics recommends that pediatricians ask patients and/or parents about substance use in the family in order to educate them about the risks of substance use and connect families to treatment when needed.
"We as pediatricians and family medicine doctors might think about screening parents for substance use and substance use disorders when they come into our clinics to help make sure that we can identify problems and get parents connected to treatment, because that's probably in the best interest of their child," says Hadland.
Pediatric clinics affiliated with Mass General Brigham in the Boston area use a developmental screening that includes questions about parental substance use, wrote Schiff.
Parents with addiction love their children and want the best for them, she says, but may not access treatment because of stigma about seeking help for addiction and barriers to accessing care.
For parents with substance use disorder, Schiff says, she and her colleagues "discuss safe storage of substances, identification of a safe and sober caregiver for children during periods of active use, and provide training in naloxone administration should an unintentional ingestion occur."
As for parents with addiction who have infants, she recommends avoiding breastfeeding after using substances and discusses safe sleep practices "to prevent unsafe sleep injuries and infant suffocation."
"We know that over three-fourths of people with substance use disorders do not get treatment," says McCabe. "And kids who are in households with parents that don't get help are much less likely to get help themselves. So I just think it's important for us who serve and provide care to children to understand what these numbers mean and also how we can design programs to meet these kids where they're at."
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