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Hidden in the shadows of New Hampshire’s opioid epidemic are the children who live with their parents’ addiction every day. They fall behind in school as the trouble at home starts to dominate their lives, they make the 911 calls, they are shuttled about to live with relatives or in foster care, and they face an uncertain future when their parents can no longer care for them.

In the United States, one in eight children under age 18, or about 8.7 million, live with at least one parent who has a substance use disorder. Although many of these children will not experience abuse or neglect, they are at increased risk for maltreatment and child welfare involvement compared with other children. Parents who seek treatment can recover, yet parents using opioids are often using other substances and confronting behavioral health issues that complicate recovery.

Having one or both parents using opioids can have negative consequences on child development. Such children show increased emotional or behavioral problems and difficulty with attachment and establishing trusting relationships. The family environment when a parent uses opioids is typically characterized by secrecy, loss, conflict, violence or abuse, emotional chaos, role reversal, and fear.

Research shows that adverse childhood experiences such as a parent’s addiction and drug use increase the likelihood of the child using drugs by age 14 and of continuing use into adulthood. Stable connections and emotional bonding with a caregiver, be it a parent, grandparent, other relative, or child care provider, enable children to make social and emotional connections and build resilience that can buffer against the negative experience of living with a parent with a substance use disorder.

This brief examines parental substance use and who cares for children when their parents cannot. It uses data from the New Hampshire Department of Health and Human Services’ Division for Children, Youth, and Families (DCYF) Results Oriented Management and the Statewide Automated Child Welfare Information System (NH Bridges), and the American Community Survey (ACS).