Many children currently struggle with the overarching presence of addiction in their home. The renowned trauma, addiction, recovery psychologist, and resiliency coach, Dr. Patricia O’Gorman, says, “We are most successful in life when we can achieve a balance between self and other.” Children who deal with parental addiction in the home often have an uphill battle to achieve that balance. Part of this imbalance is due to children taking on parental roles, or role reversal, as a byproduct of parental addiction/substance use disorder in their lives. 

Understanding the Prevalence of Children Affected by Parents Struggling With Addiction

The prevalence of children living in homes affected by parental addiction is much higher than many people may think. In fact, most people never think about children impacted by addiction unless it is occurring in their homes or in some way impacting their life. According to a report produced by the Substance Abuse and Mental Health Services Administration (SAMHSA), “About 1 in 8 children (8.7 million) aged 17 or younger lived in households with at least one parent who had a past year substance use disorder (SUD).”

Due to the high numbers in these statistics, it can be easy to forget that each of these “statistics” represents a real flesh and blood child, who is being negatively affected by parental addiction. This data translates into some very real trauma and heartbreak within households, with lifelong impacts on children who don’t have access to education and healing opportunities from these early childhood events.

According to reports released by the National Center on Substance Abuse and Child Welfare (NCSACW), “[Data indicates] that the prevalence of parental alcohol or other drug (AOD) abuse as an identified condition of removal of children and placement in out-of-home care has increased from 2000 to 2020. Data from 2000 show a prevalence rate of 18.5%. This increased to 39.0% in 2020, an increase of 20.5%.” An Increase of nearly 40% is a staggering increase and one that represents a lot of trauma and turmoil for children affected by parental addiction over the last 20 years. This trauma and turmoil take on many forms for these children. 

This recent increase is most likely due to the quarantine, isolation, and job loss families frequently faced during the COVID-19 pandemic, as we now know this was a substantial contributing factor. This also correlates to an increase in help needed for children of addiction, that was unavailable to them.

Understanding the Negative Effects of Parental Addiction on the Child

Many of the negative effects felt by children of parents struggling with addiction are hard to quantify. According to the peer-reviewed article, The Impact of Substance Use Disorders on Families and Children: From Theory to Practice, “The negative consequences of having one or both parents with a SUD range from covert damage that is mild and may play out when a child or adolescent is having difficulty establishing trusting relationships with people, to being overly emotionally responsible in relationships and taking on adult roles much younger than developmentally appropriate.” This description leaves a large swath of space between the mild and the more severe symptoms. It is where many other negative effects of parental addiction on children reside.

According to the same article, “A parent with a SUD is 3 times more likely to physically or sexually abuse their child. The sequelae of this are that these children are more than 50% more likely to be arrested as juveniles, and 40% more likely to commit a violent crime. Children who have experienced abuse are more likely to have externalizing disorders such as anger, aggression, conduct, and behavioral problems whereas children who experience neglect are more likely to have internalizing disorders (depression, anxiety, social withdrawal, poor peer relations).” And yet, these are not the only negative sequelae that parental addiction can have on children.

The following are symptoms of negative consequences for children that can occur due to the impact of parental addiction in the home:

• Becoming hypervigilant and easily startled
• Have trouble with communicating, especially with adults and authority figures
• A much higher likelihood of struggling with some form of substance use disorder (SUD) themselves
• Have a higher potential of developing other mental health disorders later in life, such as post-traumatic stress disorder (PTSD), mood disorders like bipolar I and II disorder, and disorders like obsessive-compulsive disorder (OCD) and antisocial personality disorder
• Experience trouble at school, and, for older children, trouble at work
• A greater likelihood of developing an eating disorder, disordered eating, or some other form of process addiction, such as social media or exercise addiction
• More likely to have suicidal ideations
• A higher potential for committing self-harm
• More likely to attempt suicide

These aforementioned effects are far from minor and definitely emphasize the need for early intervention for children in these homes.  We must continue to research the effects of alcohol and opioid substance use disorders on these afflicted children and provide them with educational support groups to provide some element of hope for their future. 

What Exactly Is “Role Reversal” in a Parental Addiction-Affected Household?

Children of parents struggling with addiction often engage in an act known as “role reversal.” What exactly is role reversal?

According to the Journal of Child and Family Studies, “Parent-child relationships are typically characterized by a parental role focused on fulfilling the child’s needs. When these expected parent-child roles break down and the child is elevated into an adult-like role charged with meeting the parent’s needs, this is called role reversal/confusion or boundary dissolution (BD).” One of the key terms in this clinical description is that of ”confusion,” and more confusion is the last thing a child struggling with parental addiction needs.

The journal also breaks down role reversal into several different types. All of which can be damaging and detrimental to the child. 

It defines these role reversal categories as “1) role reversal parentification, a child in a parental role with parent turning to the child for nurturance or guidance; 2) role reversal adultification, a child in a peer role to the parent with parent turning to child as a friend, support or companion; 3) seductive spousification, parent involvement of a child in adult intimacies; 4) hostile spousification, a parent treating a child as a spouse in a hostile or critical manner; 5) intrusiveness or psychological control, a coercive and controlling parent; and 6) enmeshment, a lack of differentiation between parents and children.” 

While each of these types of role reversal has its very specific characteristics, they also have some universal warning signs to be aware of. Early intervention is the key to ameliorating long-term consequences in the life of a child struggling with parental addiction.

Recognizing the Warning Signs of Role Reversal

The following are suggested warning signs that there may be parental addiction and role reversal occurring in the household:

• Interaction between the school and the household primarily occurs between the child and the teachers/counselors, not the parent
• A child expresses financial concerns and makes statements that involve getting a job or needing to take care of the family
• The child may become secretive about what is going on at home, both to protect a parent and to protect any action that may remove them from the home
• A child describes their parent more as a peer or a friend 
• Appearing overly tired or run down due to taking on too much responsibility at home
• Exhibits cynical, overly “adult” behaviors
• Discusses and engages in activities and risky behaviors that are beyond age appropriateness, such as substance use and sexual activity

In North America, childhood is one of the most precious gifts that we are afforded. It is also a gift that has a very distinct timeline, and when that timeline is gone, it is gone for good. This is why it is crucial to recognize the signs of parental addiction, role reversal, and the effects they have on a child as early as possible. Some of the people who are best equipped to recognize role reversal are teachers, physicians, clergy/pastors, nurses, coaches, early childcare workers, and police officers.

An expert in co-dependency and addiction, Dr. Claudia Black is an authority on role reversal in the home. In her book, It Will Never Happen To Me, she discusses three major roles that take place when addiction is present in the home. These roles are “the responsible child,” “the adjuster,” “the placater,” and “the act-out child.” It is the responsible child role and the placater role that pertain most closely to role reversal.

The responsible child tries to take responsibility for the entire family. They will often try to keep them isolated so that there is little chance for outside intervention, as this poses a risk of exposure. This child feels that this exposure could mean disruption to the well-being of the family. The placater represents the child who tries to take care of everyone else in the family, and in doing so, they no longer take care of their own needs. 

These two roles can lead to negative psychological effects, such as false guilt, shame, feeling out of control, fearfulness, and self-doubt. Introducing the “7 Cs” to children taking on these roles can be critical. 

The 7 Cs offer a simple breakdown that can be used to help a child understand that their parent’s addiction is not their fault. They are, “I didn’t CAUSE it; I can’t CONTROL it; I can’t CURE it; I can help take CARE of myself by COMMUNICATING my feelings, making healthy CHOICES, and CELEBRATING me. 

Along with the 7 Cs, Dr. Black also offers some ways to address these two specific roles and help to reverse their role reversal. This includes praising the child when they are not acting in a leadership role, showing the child the appropriate adult/child responsibility dynamics, helping them focus on their own needs, helping them identify their needs, validating their needs, and helping them to identify their feelings when interacting with others.

The Dangers of Untreated Role Reversal

As with other negative effects of parental addiction, if role reversal goes unnoticed and untreated, it can have serious consequences. Emotional effects of role reversal include the potential for thoughts of worthlessness and hopelessness and feelings like there is no reason to go on or move forward in life; Struggles with self-esteem, self-worth, and self-confidence. Additionally, these types of unwarranted stressors can lead to other types of physical tumult.

The stress from untreated role reversal can lead to the following physical issues:

• Experiencing trouble with sleep patterns, including sleeping too little and/or sleeping too much
• Having gastroenterological problems
• Elevated levels of stress can cause high blood pressure
• Muscle aches and pains that cannot be explained by any other factors
• Headaches and migraines
• Excessive weight loss and/or excessive weight gain

These are just a few more reasons why it is so crucial to find a way to intervene if we feel that a household is struggling with parental addiction. We also don’t have to be a professional in the field of parental addiction (or even a professional at all) to do so.

How to Help a Household Struggling With Parental Addiction

Another way to help a household struggling with addiction also comes from the work of Dr. Black. These are the three major rules that happen in a household affected by addiction. The rules are “don’t talk, don’t trust, and don’t feel,” and they can shut a family down emotionally. Being able to combat these issues in the home can greatly help a family heal and reduce the role reversals that children are taking on.

One way to help a household struggling with parental addiction is to assess the family dynamics. Not every child takes on role reversal. It is quite often the oldest child. They will not only take on the responsibilities for their parents, but they will often take on responsibilities for younger siblings, such as cooking and doing the rest of the household chores when the parents are unavailable due to their addiction. 

A great way to help a household struggling with parental addiction is to utilize all of the support resources currently available. The resources a child may need may come in the form of connecting them with an addiction or family addiction specialist. It may come from connecting them with online resources, such as the ones that we offer at the National Association for Children of Addiction (NACoA), like our Tools for Kids, found on our website. There are also local recovery communities that focus just on the family and children who are struggling with parental addiction. 

These include institutions such as Al-Anon and Alateen. Recovery support groups like these can be particularly effective because they offer what is known as a “shared experience” between people who have been through or are currently going through parental addiction. There are also treatment centers that can help entire families recover, such as the children’s program at the Caron Treatment Centers and the Hazelden Betty Ford Clinics.

NACoA and the Goal of Long-Term Recovery for Children in Need

Here at NACoA, we believe in being the voice of those in our society who are most vulnerable: children of parents struggling with addiction. Our primary purpose has always been long-term recovery over short-term gains when it comes to helping children suffering from parental addiction heal. It is our goal to help and support not just children and families but those who wish to work with these children and families.

There is a beloved song by the 1970s British rock group, “The Faces,” entitled Ooh La La. While many may not be familiar with the name of the song, they are probably familiar with its most iconic lyrics. They go, “I wish that I knew what I know now / When I was younger. I wish that I knew what I know now / When I was stronger.” For many of us, this brings us back to the nostalgia and joys of childhood. 

Unfortunately, children of parents struggling with addiction are in danger of missing out on this nostalgic experience, and missing out on childhood is a tragic thing.This lost opportunity is something we can change. We must, and we will.

In a healthy parent-child relationship, the parent takes on the role of the caregiver. They provide physical shelter, emotional support, and financial security for a young person who is still developing. In parent-child relationships that involve substance abuse, however, these roles are often reversed, and the child often assumes the role of the caregiver. Unfortunately, many children are not even aware that they have taken on this responsibility. This is why it remains critical to know the signs to look for when a role reversal takes place within the family unit. If role reversal goes undetected and untreated, it can cause emotional damage and unhealthy relationships with parents and others outside the home. For more information, contact NACoA at (301) 468-0985.