How Does Addiction Affect Families?

Summary: Addiction can affect families in a variety of negative ways. One primary impact of addiction on families is an erosion of the trust required to maintain open, honest communication in healthy, sustaining family relationships.

Key Points:

• Addiction, clinically known as substance use disorder (SUD), can increase conflict in families.
• In families with young children, the presence of an adult with addiction or SUD increases risk of physical and emotional harm to children.
• Among families with teenagers and young adults, addiction can impair academic performance, and delay productive participation in the work force.
• In families with middle-aged and older parents and family members, the presence of a family member with addiction can decrease family cohesion and increase reported feelings of isolation and depression.

Substance Use Disorder (SUD) and Addiction: What’s the Extent of the Harm?

When we write about addiction on this blog, we often remind people that the addiction and substance use disorder (SUD) affects individuals, families, and communities. Over the past decade, national attention around addiction has been on people with opioid use disorder (OUD) and people who misuse opioids as a result of the ongoing opioid addiction and overdose crisis in the U.S. They experience overdose emergencies and various issues that need attending to right away, or they’ll escalate to something worse, like overdose fatality, job loss, or other negative psychological, emotional, or social consequences.

However, opioid use disorder (OUD), opioid addiction, and opioid misuse causes harm to others. That harm is not always as acute as the harm experienced by the person with OUD, but it can be. It’s important to remember that when harm doesn’t manifest as an emergency or crisis, it’s still harm, and still causes serious problems.

Let’s make this clear: opioid addiction harms individuals, families, and communities, and while we focus on supporting people with OUD by offering them the best possible addiction treatment available, we need to be aware of the collateral damage caused by the opioid crisis.

However, opioid use is not the only type of substance use that can also harm others:

Research identifies the five primary ways alcohol use and alcohol addiction can harm others:

Five Ways Excess Alcohol Use Harms Others

1. Harassment and threats
2. Property damage and/or vandalism
3. Physical aggression
4. Driving related problems
5. Family and/or financial

The misuse or disordered use of opioids can cause a nearly identical set of harms to family members. To get a firm grasp on the indirect impact of the opioid crisis, i.e. how it harms others, we’ll share the results of two studies: one on opioid use/opioid addiction in the U.S., and one on the impact of substance use disorder (SUD), in general, on families.

The Impact of Addiction on Families

According to information published by Yale Medicine, the misuse or disordered use of opioids can lead to serious personal and interpersonal problems that extend beyond the person using opioids:

“Misuse of these drugs can disrupt relationships with friends and family, harm performance at work or school, and can result in serious health and legal consequences.”

When a person with OUD has problems at work, school, or with the law, the family feels the effect. Their lives are not only disrupted by the behavior of the family member using opioids, but their lives are disrupted as they rearrange them, make accommodations, and allocate resources to support the person misusing opioids. That creates real problems on multiple levels and across multiple life domains.

With that in mind, let’s take a look at how the presence of a substance use disorder (SUD) can impact the life of a family at various stages. The study “The Impact of Substance Use Disorders on Families and Children: From Theory to Practice” identifies issues across the following stages/phases of family life.

How SUD Affects Families

Couples with no kids:

Increased risk of:

• Poor communication
• Increased conflict
• Loss of intimacy

SUD and families with infants:

Increased risk of:

• Physically unsafe home
• Emotionally unsafe home
• Insecure attachment with child/children

SUD and families with preschoolers:

Increased risk of:

• Inconsistent parenting
• Abusive/neglectful parenting
• Removal of children by child services
• Marital conflict

SUD and families with school-age kids:

Increased risk of:

• Failure to meet educational needs of children
• Family conflict
• Domestic violence

SUD and families with teens:

Increased risk of:

• Engaging in drug use
• Problems forming healthy meaningful relationship
• Academic problems
• School discipline problems
• Family conflict
• Anxiety, depression, or other mental health disorders
• Behavioral/oppositional disorders.

SUD and families with young adults:

Increased risk of:

• Failure to launch phenomenon.

SUD and families with middle-aged parents:

Increased risk of:

• Marital conflict
• Adult children may distance themselves
• Adult children may limit contact with grandchildren

SUD and families with older parents/family members:

Increased risk of:

• Isolation
• Depression

The results of this study clarify the facts: substance use disorder (SUD) can cause serious problems in families. Alienation and disrupted relationships are painful and hard to handle, while consequences like emotional and physical neglect or abuse can create physical, psychological, and emotional problems that last a lifetime.

Disclaimer: not every person who develops OUD or SUD causes all these types of harms to their family or children. What the data indicates is that the risk of these harms increases with the presence of substance use disorder.

Next, to understand the indirect impact of the opioid crisis in the U.S., we’ll look at the results of a nationwide, “50-state survey called CHIP 50: The Civic Help and Institutions Project.”

Do You Know Anyone With Opioid Use Disorder?

That’s the central question guiding the opioid component of the CHIP 50 survey, which measures how SUD, and OUD in particular, impacts families.

To answer this question, a research team from Northeastern University, Harvard University, Rutgers University, and the University of Rochester collaborated to review the results. The team was driven by the fact that in 2023, over 107,00 people died of drug overdose, with close to 75 percent of those deaths caused by opioids.

Although rates of fatal drug and opioid overdose decreased in 2024 for the first time since 2017, millions of people still feel the impact of the crisis, which is ongoing – and still needs our complete attention.

To assess the impact of addiction on families, researchers analyzed the CHIP survey results with this perspective:

“Here we look at a broader picture of who is affected by this crisis, asking our respondents if they know someone who struggles with opioid addiction.”

The research team understood three primary factors affected the survey results:

1. The overall rate of opioid use disorder (OUD) in the U.S.
2. Whether people are aware of OUD among their friends, family, and/or social network
3. How willing people are to share what the know.

The second two factors had the potential to skew the results. However, the sample set was large enough – over 25,000 respondents participated – to enable statisticians to make population-level generalizations from the data, despite the confounding influence of the factors we mention above.

Let’s take a look at what they learned. We’ll review the answers of the two top-line questions in the survey. Then we’ll dive deeper into the results, to get an idea of whether location, income, education, or race/ethnicity have any impact on knowing people with opioid use disorder (OUD).

Here are the results from the two top-line questions:

Do you personally know someone who struggles with opioid addiction?

• None: 77% / One: 10%/ Two to three: 8% / Five to Ten: 3% / Over ten: 3%

How do you know them?

• Immediate family: 9% / Extended family: 7% / Close friend: 11% / Acquaintance: 10%/ Any of the above: 23%

That last datum demonstrates the reach of the opioid crisis: more than 1 in every five people know someone with opioid addiction – and that’s only the people they know about or were willing to share what they know about.

Next, we’ll look at how various demographic factors may influence knowing someone with opioid addiction.

Do Location, Income, Education, or Race Have an Impact?

First, let’s look at location, divided into three categories: urban, suburban, or rural.

What type of area do you live in?

• Urban: One: 9% / Two to three: 7% / Five to Ten: 2% /Over ten: 3%
• Suburban: One: 9% / Two to three: 8% / Five to Ten: 3% /Over ten: 3%
• Rural: One: 11% / Two to three: 10% / Five to Ten: 4% / Over ten: 4%

These results indicate people in rural areas are more likely to know a person or people with opioid addiction, compared to people in urban or suburban areas.

Next, the results on income level.

What’s your income level (annual salary)?

• Under 25k: One: 9% / Two to three: 9% / Five to Ten: 3% / Over ten: 5%
• 25k-50k: One: 10% / Two to three: 10% / Five to Ten: 3% / Over ten: 3%
• 50k-75k: One: 10% / Two to three: 7% / Five to Ten: 2% / Over ten: 3%
• 75k-100k: One: 10% / Two to three: 7% / Five to Ten: 2% / Over ten: 1%
• 100k+: One: 9% / Two to three: 6% / Five to Ten: 2% / Over ten: 1%

These results indicate people with income over 75k are less likely to know multiple people with opioid addiction, compared to people in urban or suburban areas. However, there is no statistical income-based difference with regards to knowing at least one person with opioid addiction. That reiterates the fact we point out consistently: opioid addiction impacts everyone.

Next, the results on level of educational attainment.

What’s your level of education?

• College degree: One: 9% / Two to three: 6% / Five to Ten: 2% / Over ten: 2%
• Graduate degree: One: 8% / Two to three: 5% / Five to Ten: 1% / Over ten: 1%
• High school diploma: One: 10% / Two to three: 9% / Five to Ten: 3% / Over ten: 4%
• Some college: One: 10% / Two to three: 10% / Five to Ten: 3% / Over ten: 4%
• Some high school or less: One: 8% / Two to three: 9% / Five to Ten: 3% / Over ten: 4%

These results mirror those for income. People with higher levels of educational attainment are less likely to know multiple people with opioid addiction, compared to people with lower levels of educational attainment. However, there are no statistically significant differences, based on education, with regards to knowing at least one person with opioid addiction. Again, we point out this salient fact: opioid addiction impacts everyone.

Finally, we’ll look at the impact of race/ethnicity on knowing someone with opioid addiction.

What’s your race/ethnicity?

• African American: One: 9% / Two to three: 6% / Five to Ten: 1% / Over ten: 2%
• Asian American: One: 6% / Two to three: 3% / Five to Ten: 1% / Over ten: 1%
• Hispanic: One: 11% / Two to three: 6% / Five to Ten: 2% / Over ten: 2%
• White: One: 10% / Two to three: 9% / Five to Ten: 3% / Over ten: 3%

These results show Asian Americans are more likely to know fewer people with opioid addiction, compared with African American, Hispanic, or White Americans. In addition, White Americans are more likely to know two or more people with opioid addiction, compared to African Americans, Asian Americans, and Hispanic Americans.

We’ll discuss these results further, below.

Addiction, SUD and Families: Impact of Location and Race/Ethnicity

When news media began reporting on the opioid crisis in the 2010s, the highest rates of OUD and fatal overdose appeared among rural white people with income under 25k/year and educational attainment equivalent to a high school diploma or some college.

Since then, the crisis has spread and affected people from all demographic groups. While people with lower levels of educational attainment still show the highest rates of opioid use disorder (OUD) in the U.S., as indicated by the 2023 National Survey on Drug Use and Health (2023 NSDUH), differences in race/ethnicities have largely disappeared, with two exceptions: Asian American show the lowest incidence rates, while American Indian/Alaskan Native (AIAN) people – a group not accounted for in the survey we review in this article – show the highest rates of opioid use disorder.

However, the figures on people who know people with opioid addiction are similar to the figures on overdose and addiction at the beginning of the crisis: the results skew white and rural. The state-level data we share below shows this clearly.

States With Highest Indirect Impact

(Percentage of people who know someone with opioid addiction)

• West Virginia: 47%
• Vermont: 41%
• Kentucky and Alaska: 38%
• Colorado and New Hampshire: 31%

While there are urban areas in those states, and there are certainly people of all backgrounds, races, and ethnicities in those states, all six are predominantly rural and white. Here’s a summary of the findings:

• Close to one in four American adults (23%) say they know someone with opioid addiction
• Almost one in seven (14%) know more than one person with opioid addiction.
• People in rural areas have the highest likelihood of knowing someone with opioid addiction: 29% say they know someone with OUD
• People in urban areas are less likely to know someone with opioid addiction: 20% say they know someone with OUD
• West Virginia shows the highest rate of people who say they know someone with opioid addiction: 47% of survey participants reported they know someone with opioid addiction

This information is valuable to us, as addiction treatment professionals. We work every day to reach people who need our help, and we’ll use this study to reinforce our commitment to removing barriers to care for all people with OUD, and reinvigorate our efforts to serve people in need.