What is the likelihood of developing a substance use disorder (SUD) in adulthood for a child with two parents having addictions?

Risk of Addiction in Children with Two Addicted Parents

Children with two parents who have substance use disorders face substantially elevated risk for developing addiction in adulthood, with genetics, epigenetics, and environmental factors all contributing to this vulnerability—making early identification and intervention critical.

Understanding the Risk Factors

Genetic and Neurobiological Vulnerability

Genetics, epigenetics, and neurobiological factors are explicitly cited as influencing an individual's behaviors concerning substance use, with early onset of drinking and heavy substance use in adolescence increasing the risk of problematic use in adulthood. 1 Specific genetic variants, such as those in the cholinergic M2 receptor gene, appear to increase the risk of developing alcohol use disorder within 2 years after initiation of regular alcohol use before age 16. 1

• Children of substance-abusing parents are at biological, psychological, and environmental risk simultaneously, with parental substance-abusing behavior identified as the single most potent risk factor. 2
• The combination of multiple risk factors present in the lives of children of substance abusers makes them especially vulnerable to maladaptive behavior. 2

Environmental and Modeling Effects

Parental modeling significantly affects youth substance use, with adolescents reporting drinking more when exposed to parents who appear tolerant of underage drinking. 1

• The youth's environment, particularly parental and peer modeling, directly affects their substance use patterns. 1
• Long-lasting changes in brain networks involved in reward, executive function, stress reactivity, mood, and self-awareness underlie vulnerability to addiction, with adverse childhood experiences recognized as social determinants that contribute to developing substance use disorders. 3

Quantifying the Risk

While the provided evidence does not specify exact percentages for children with two addicted parents, the literature establishes:

• Children of alcoholics are considered high risk because there is a greater likelihood they will develop alcoholism compared with a randomly selected child from the same community. 2
• A relationship between parental substance abuse and subsequent alcohol problems in children has been documented extensively. 2
• Early adverse experiences, including drug use and abuse in parents and/or primary caretakers, represent powerful influences on the onset of drug abuse and addiction. 4

Critical Prevention and Intervention Strategies

Early Identification

Identifying and addressing adolescent substance use as soon as possible is important due to negative effects of exposure on development, with adults with substance use disorders often reporting using substances as adolescents or young adults. 1

• There is a known association between younger age of substance use initiation and greater susceptibility to developing future substance use disorders. 1
• Youth benefit from intervention at early stages of developing substance use problems, even when there is no diagnosed use disorder. 1

Protective Factors That Can Mitigate Risk

Clear parental disapproval of underage substance consumption and a teenager's close alliance to parents and family can be protective factors against adolescent substance use. 1

• Certain perceptions concerning themselves and their parents can serve as either subjective risk or protective factors for high-risk adolescents who are children of substance-dependent parents. 5
• Prevention strategies that target social risk factors can improve outcomes, and when deployed in childhood and adolescence, can decrease the risk for substance use disorders. 3

Clinical Implications

Screening for problematic substance use should occur across multiple settings including schools, primary care offices, and general mental health settings, with investment in effective early intervention services following screening and assessment. 1

• Anticipatory guidance regarding substance use is recommended as a routine part of care for youth and their families. 1
• Treatment for co-occurring disorders is associated with better substance use outcomes compared to when treatment focuses only on substance use. 1
• Family, peer, and community supports are a critical part of substance use disorder treatment and aftercare, with the family playing a central role in adolescent development. 1

Common Pitfalls to Avoid

• Failing to screen children of addicted parents systematically for early signs of substance experimentation or use. 1
• Waiting for a formal substance use disorder diagnosis before intervening—youth benefit from early-stage intervention. 1
• Overlooking the need to address underlying psychiatric conditions or psychosocial factors that often co-occur with substance use risk. 1, 6
• Neglecting to leverage protective factors such as fostering strong parent-child relationships and clear parental messaging against substance use. 1