Previous research exploring the relationship between parental opioid misuse, or the use of an opioid in any way that is not directed by a doctor, and negative outcomes for children and families has produced mixed results. Established evidence suggests that the children of parents who misuse opioids are more likely to experience externalized and internalized behavioral disorders [5; 6], impaired social functioning [7; 8], academic difficulties [8], and declines in wellbeing over time [9]. However, a 2021 national study of parent-child dyads showed no association between parental prescription opioid misuse and adolescent prescription opioid use and misuse [10]. Given the host of other known risk factors for adolescent substance misuse, including adolescent trauma, neglect, abuse, and perceived social acceptance of substance use [11], parsing the influence of parental opioid misuse will be critical to understanding intergenerational patterns of substance use, as well the effects of parental opioid misuse on parenting quality and the child’s wellbeing.

Factors related to the social, economic, cultural, and structural context in which a child develops and matures, or social determinants of health (SDoH), are known predictors of both adolescent opioid misuse and overall wellbeing [12]. Recent evidence indicates a complex, non-linear, and reinforcing relationship between parental opioid misuse, parenting quality, and a child’s physical, behavioral, and emotional wellbeing [13]. A metanalysis showed that parental drug use over time had small but significant negative effects on child wellbeing; however, the authors noted a substantial unexplained variance in their model, which suggests a third factor, such as financial insecurity or marital problems, could contribute to negative outcomes [9]. Finally, parental substance misuse can shape the ways that parents interact with their children, including their communication related to substance use acceptance and prevention [14]. Parenting behavior is arguably the most feasible mechanism to change through individual- and family-level psychosocial interventions. The present research examines whether parental opioid misuse interferes with positive parenting behaviors, which are indicators of parental engagement in a child’s upbringing and associated with positive health and behavioral outcomes among adolescents [15].

Research examining the relationship between substance use and deficits in parenting behavior has shown differential effects and examined different types of substance use [16; 17; 18]. Some studies indicate that opioid misuse and OUD are associated with lower-quality parenting [19; 20], whereas other studies have found that a host of social and environmental factors (e.g., maternal resources, maternal psychopathology) may contribute to associations between opioid misuse and positive parenting [21; 22]. Risk factors for poor parenting associated with parents who have a history of opioid misuse include psychopathology, comorbidities, socioeconomic status, parenting style, parenting knowledge, emotion regulation skills, high levels of distress, and negative care-taking behaviors [23]. Peisch and colleagues [24] have noted the dearth of rigorous studies linking poor parenting behaviors to opioid misuse. They specified that studies in the substance misuse and parenting literature rarely look at the impact of opioids specifically, focusing instead on prenatal substance exposure rather than on the consequences of social exposure to substances after birth, and typically focus on mothers alone. Likewise, a review of 21 studies that measured both substance abuse and parenting outcomes described five distinct conceptual pathways linking parental substance use and child maltreatment via deficits in emotional regulation, psychosocial factors, deficits in parenting knowledge, preoccupation with drug-seeking, and decreased pleasure in the parenting role [25]. The authors recommended attention to methodological rigor, underscoring a need to isolate the effects of substance use on specific parenting behaviors and child outcomes.

Previous studies also omit comparison groups of individuals who are not misusing substances, recruit from a single (often urban) location, focus on outcomes in infants and young children, and draw from smaller samples of participants who are recruited from residential opioid treatment settings [24; 25; 26]. Thus, such studies are limited in their reflection of positive parenting and opioid misuse in the general population. Further, research on substance use and parenting behaviors has traditionally relied on self-reported measures or observations of parental behavior, which may not be reliable outside the naturalistic home environment. Parents’ self-reported parenting behavior tends to be more positive than ratings provided by their children [27], suggesting the value in exploring the adolescent child’s report of parenting behaviors. Finally, the predominant research on the effects of opioid misuse and child outcomes examines prenatal exposure in infants [28; 29], with relatively few studies generating insight on the effects of recent (past-year) parental opioid misuse on adolescent children.

The current study aims to address the limitations of previous research by using data from six consecutive years of the National Survey on Drug Use and Health (NSDUH) to examine associations between parental opioid misuse and dependence and parenting attitudes and behaviors, as well as associations between parental opioid misuse and youth perceptions of heroin risk and availability. Through the perspectives of adolescent children whose parents self-reported past opioid misuse and heroin use, we aim to clarify whether a parent’s past-year opioid misuse or past-year heroin use is associated with their parental functioning or is related to their having a preventive conversation about substance use. We will also examine the relationship between past-year opioid misuse and past-year heroin misuse and parental attitudes toward opioid misuse prevention and initiation of communication with a child about the risks of opioid misuse. These findings will inform family-centered interventions for parents who misuse opioids or have OUD.

About 4% of mothers (n = 600) and fathers (n = 400) reported past-year opioid misuse, and a small proportion (0.11% of mothers, [n < 100]; 0.13% of fathers, [n < 100]) reported past-year heroin use. Descriptive characteristics of the paired samples are in Table 1.

Overall, our results counter the hypothesis and common narrative that parents who have misused opioids in the past are less capable of positive parenting behaviors than parents who have no history of misuse. Of the 10 positive parenting behaviors explored, adolescent-reported deficits were evident for one behavior in maternal pairs (helping with homework) and one behavior in paternal pairs (talking about a serious problem). In pragmatic terms, mothers and fathers with past-year opioid misuse or heroin use were equally as likely as other parents to give praise, require chores, check on homework, limit time out on school nights, and otherwise have meaningful engagement in their adolescent’s upbringing. These data counteract previous evidence suggesting that parents who misuse substances are incapable of monitoring their children and providing a nurturing home environment [9; 26] and build on the hypothesis that parental deficits in people who misuse opioids are nuanced and shaped by multiple complex factors and conditions [4; 10; 13]. These findings are limited in that our models did not account for multiple complex social and structural determinants that intersect to predict child wellbeing and family outcomes.

To date, few studies have explored interventions that attempt to mitigate the potential effects of opioid misuse on positive parenting behaviors and healthy parental engagement with adolescent children [4, 10]. Such research is critical to understanding how parental opioid misuse intersects with positive parenting behaviors and developing effective interventions for families affected by parental opioid misuse to prevent intergenerational cycles of addiction [33]. Although adolescents raised by a parent who struggles with opioid misuse may experience an increased risk for adverse behavioral, psychosocial, and opioid initiation outcomes [5; 6; 7; 8; 9], these risk factors could be ameliorated by their ability to speak openly and candidly with a parent about substance use. Research has supported a combination of quality communication and parent-child connectedness as protective factors against future substance misuse [34, 35]. In addition, our data suggests that parents with past opioid and heroin misuse may be more intentional about talking with their children about substance use, which is noteworthy given that most parents find it more difficult to talk to their adolescent children about drugs as compared with tobacco and alcohol use [35], and therefore may be reticent to have conversations with their children that specifically address opioid misuse. Some research, however, cautions that parental self-disclosure of past substance use normalizes the behavior and communicates permissiveness or behavioral acceptance rather than nontolerance, thereby increasing the adolescent’s receptiveness to substance use [36]. Further research is needed to understand the nature of parent-child conversations about opioid misuse and isolate the conversational attributes that could lead to beneficial perceptions of opioid risks and protective action in youth.

Communication with a parent about substance use is a well-established protective factor against adolescent substance use [38]. Our findings suggest that mothers who misused opioids and mothers and fathers who used heroin in the past year had significantly longer conversations with their adolescent children about substance use. A study by Pettigrew and colleagues [34] showed that parents who communicate the consequences of adolescent substance use and misuse through personal narratives and avoid trite anti-drug messages (e.g., “don’t do drugs”) were more effective at building their adolescent’s resiliency skills against drug use. Storytelling and parental self-disclosure may be two powerful ingredients to building youth resilience against substance use that are unique to a parent who has misused opioids or heroin in the past.

Our findings also identified opportunities to support parents who have past opioid misuse in performing positive parenting behaviors and positively participating in their child’s upbringing. Mothers who misused opioids helped less often with homework, a positive parenting activity that requires focused attention, problem-solving skills, and the receptiveness of the adolescent. Based on this finding, family-centered interventions should incorporate strategies to encourage a mother’s motivation and self-efficacy to assist a child with schoolwork, as well as attend to the parent-child relationship. Interventions that integrate substance misuse with a family component have shown to improve parenting behaviors by teaching emotional regulation skills and increasing parenting knowledge [25]. However, our data indicates a need for integrated interventions that teach proactive parenting styles, attend to the relational dynamics between parent and child, and address underlying mental health problems that may interfere with paternal engagement. Modeling such a holistic approach, the online Family Check-Up (FCU) intervention incorporates modules on proactive and positive parenting while simultaneously addressing the parent’s mental health and teaching harm-reduction skills to keep children safe [33].

Fathers who misused opioids were less likely to engage in serious conversations with their children, which indicates detachment that could be detrimental to the adolescent’s development and wellbeing. Our findings are consistent with research predicated on attachment theory suggesting that numerous factors related to a father’s substance misuse may threaten the stability of the father-child relationship [38]. In addition, fathering self-efficacy mediates parental involvement, thereby predicting quality parenting behaviors and positive child outcomes. Recent evidence suggests that interventions that teach fathers in recovery effective family management strategies and parenting practices can bolster their parenting efficacy [39]. Thus, interventions should be designed to support fathers in initiating conversations and strengthening their bonds with children, providing coaching to initiate the “drug talk” and offer holistic support in the child’s life.

Past research has emphasized the deficits in parenting and detriments to child wellbeing related to opioid misuse without considering the positive capabilities of parents, which could be emphasized in family-centered interventions and prevention programming. Our research is the first to show that parents with past opioid misuse have the capacity to perform positive parenting behaviors as frequently as other parents and are more likely to have conversations with their children about drug use—and longer conversations about drug use—than the average parent. Further research is needed to understand the attributes of parent-child conversations about opioid misuse, including self-disclosures of past misuse, that predict a proactive stance against adolescent opioid misuse. We also identified specific deficits that should be explored in future research. Mothers with a history of opioid misuse may benefit from interventions that integrate supports for mental health disorders and promote proactive engagement with their children. Fathers with histories of opioid misuse need interventions that boost self-efficacy and impart family management skills that will allow them to form strong relational bonds with their children.