Substance Abuse and the Impact on the Family System

The National Survey on Drug Abuse and Health shows that over 23.5 million Americans suffer from a substance use disorder. This data shows that nearly 7.3% of the American population will suffer from a drug or alcohol addiction at some point in their lives. While addiction naturally has the largest impact on the addict, it’s important to consider the widespread effects of addiction on the people surrounding the addict.  Substance abuse has a significant impact on families, both as individuals and the family system as a whole – changing dynamics, hierarchy, trust relationships, and even methods of survival.
This is especially pertinent for children, who suffer from changing relationships, increased risk of domestic violence, emotional absence, and trauma. Changes to the family homeostasis can permanently affect its members, and its future, forcing individuals into roles they are unready for.
The families of substance abusers suffer with the abuser. Substance abuse has long-term impacts on family and family systems, and to this extent, therapy for addicts with family is increasingly involving the family.

Changing Hierarchical Roles in the Family Structure

A person with substance abuse will often change their patterns, may quit work or earn less, may rack up large bills, may be unable to perform chores or tasks inside of the home, or otherwise be unable to fill their traditional role inside of the family. This can result in greatly changing hierarchical structures. For example, a primary caretaker may be forced to take a job to substitute income from a substance dependant provider, a provider may be forced to care for children or take up home care roles as a substance dependent caretaker fails their responsibilities, children may care for themselves or a parent, and so on. These shifts in hierarchy change family dynamics, forcing someone to take up the responsibilities or role of the substance dependent person. In most cases, even after the substance abuser has sought out treatment, roles never return to their pre-substance abuse status.

Effects of Substance Abuse on Children in a Family Structure

Children typically suffer the worst in any family with substance abuse problems. Most studies show that any substance abuse will negatively affect development, trust, discipline, grades, personal motivation, anger, anxiety, and even the ability to enjoy childhood. Children may be forced to come to terms with the fact that their parent(s) behavior is wrong or immoral, and possibly illegal, and may even be forced to follow through on illegal activities for their parents.
Parental substance abuse interrupts normal development in children at any age, putting them at higher risk of trauma, emotional health problems, mental problems, and physical health problems. This can result in mistrust, fear, substance abuse, shame, personal guilt (children think they are responsible for their parent’s substance use), insecurity, ambivalent emotions (love/hate relationships), and an inability to form positive relationships with others.
Even in loving relationships with a substance addicted parent, children often develop complex structures of denial and compensation, to both ignore the issue and to compensate for it as much as possible. Here, they are forced into roles outside of their age group and exposed to trauma and stress. Children may act as surrogate parents, caring for, cleaning, and even cooking for addicted parents. This is especially true in single parent households, where no other adult is available to take on responsibilities.
Children who grow up in families where substance abuse is common are more likely to abuse substances themselves, often from a young age. This can result from a lack of guidance, from anger, or from escapism, as substances are a way to avoid emotional dissatisfaction and self-blame.
Many children of substance abusers also suffer from emotional, physical, or sexual abuse. 40-80% of all child abuse cases are linked to substance abuse by a parent, and children with substance addicted parents are six times as likely to be a victim of sexual abuse. In addition, children in families with substance abuse are more likely to see a parent being abused or battered, which translates to trauma and long-term anxiety and trust issues.
Because children are interrupted at a developmental age, many of the problems caused by substance abuse go on to affect them for life, even through therapy.

Extended Family

While substance abuse has the largest impact on nuclear family extended family members are also affected by guilt, anger, fear, concern, embarrassment, and other emotions. In some cases, a substance addicted person may cut ties with extended family altogether, especially if they are prone to using manipulation to fund their habit. Because extended family rarely have the same strong ties with family members as nuclear family, the guilt reflex is not typically enough to sustain a relationship while a substance addicted person is abusing that relationship.
As a result, people who abuse substances often find themselves isolated, forcing them to spend time with others who use, which both supports and reinforces their addictive behavior.


Codependent relationships often develop inside of families where one or more person is substance dependent, which can lead to harmful behavior from multiple family members. Substance abuse typically creates economic, emotional, and physical problems, which translate into one or more family members stepping into new roles to be caretakers, to earn money, or to care for a person who has incapacitated themselves.
In some cases, this form of care may become addicting, in that the person caring for the other feels that the other person needs them, and they therefore continue to support harmful behavior and substance abuse to provide for that person or to prevent them from seeking care elsewhere.
In this case, the caretaker is as much in need of help as the substance user, because codependency invalidates the person’s own sense of self in favor of caring for the person who chronically needs high levels of care.
Codependent persons exhibit multiple symptoms including:

  • Controlling behavior of the other person, because they believe the other person is incapable of taking care of themselves.
  • Low self esteem
  • Hypersensitivity
  • Loyal
  • Compliant
  • Show a tendency to compromise their own values to avoid anger

Multiple 12-Step and non-12-step groups exist to help codependent persons including CoDependents Anonymous (CoDA), Adult Children of Alcoholics, Families Anonymous, Co-Anon, Al-Anon, and Alateen.

Emotional Relationship Changes to the Family Structure

Most family structures show a series of similar emotional and homeostasis changes, which are present depending on the family member with the substance abuse problem, and the family relationship and structure before the substance abuse. These problems may be visible at different levels depending on the social standing of the family, and the extent to which they present a healthy face to friends and extended family.
Negativism – The family communicates negatively, taking anger and displeasure out on other family members. Here, criticism, complaints, and crisis are the only form of communication and positive behavior is often ignored. This behavior often reinforces substance abuse by reinforcing stress and anxiety – but is a symptom of substance abuse.
Sidestepping Responsibility – Adults and children with substance abuse problems typically attempt to avoid feelings of inadequacy by avoiding responsibility. This can result in a family member who simply contributes nothing, or can result in a family member who tries very hard, while depreciating themselves and claiming that others cannot expect anything of them because they are a substance user.
Resentment – Children and adults who feel that their substance abusing family is not giving them emotional support will show anger, substance use, and destructive behavior such as vandalism.
Self-Medication – Parents and children often self-medicate, either to deal with stress and anxiety, to cope with feelings of inadequacy in a relationship where one family member is emotionally withdrawn and substance dependant, or to cope with intolerable thoughts and feelings.
Inconsistent Parenting – One or both parents are substance users and are therefore inconsistent as parents. This can affect rules and enforcement, eroding the family structure until children are unsure of what they can and cannot do. This often results in children pushing boundaries or behaving badly, in and outside of the home, to attempt to define what they can and cannot do. While resulting in negative behavior, children are often confused and unable to predict parental responses, leading to experimentation to get parents to ‘care’ enough to react.
Denial – Both parents and children will frequently deny substance abuse in a family member. Young children will deny that the substance abuse is a problem, often creating complex structures of denial, where parents will simply ignore warning signs.
These relationships manifest themselves in different ways depending on the substance abuse in the family, but always affect the entire family system. The family system must be restructured to correct these problems.
Substance use dramatically impacts the entire family, changing structures, damaging every member of the family, and impacting the future mental and psychological health of all family members. This can affect family members long-term, and can lead to additional family members seeking out substances as a form of escapism or denial. In all cases, seeking out family therapy alongside substance abuse treatment can be essential to beginning to rebuild trust, deconstruct negative family relationships, and helping the family to move towards a healthy new beginning.
The Oceanfront Recovery Addiction Treatment Program can help you or your loved one through the process of recovery from addiction to any substance. Our clinicians focus on bringing the underlying causes of addiction to the surface with a modern and effective recovery program in a beautiful beachfront setting. Contact Oceanfront Recovery today for a confidential assessment, and begin the journey of recovery today.