ART THERAPY FOR CHILDREN OF ADDICTED PARENTS

Art Therapy and the Treatment of Children of Parents Struggling with Addiction

Erin Zavadil
Department of Psychology, Counseling & Art Therapy
Pennsylvania Western University
COUN 7550-800
Dr. Sheila Lorenzo de la Peña

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Abstract
Children of parents struggling with addiction often face significant psychological,
developmental, and emotional risks that persist into adulthood. Despite a widespread impact of
parental substance abuse, treatment models still continue to prioritize the addicted individual
instead of the family as a whole. This paper reviews current and past literature on the effects of
parental addiction on children of various ages, including various risks such as mental disorders,
stigma, parentification, academic difficulties, and the potential for intergenerational substance
abuse. This research, grounded in family systems theory and trauma-informed care, highlights
the importance of family-focused interventions. In addition, this paper will present the
development of an art therapy-based curriculum designed to compliment the already existing
Alateen framework. Art therapy is discussed and explored as an option that is nonverbal, traumainformed, and accessible, and promotes resilience, coping skills, and emotional expression.
Findings of this research supports the need for better integrated and family-centered approaches
that address addiction and its impact on children.
Keywords: addiction, shame, guilt, family-system, Alanon

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Section I: Introduction
An estimated 1 in 4 children in the U.S. live or has lived with a caregiver struggling with
addiction, suggesting that a more comprehensive and family centered treatment approach is of
increasing importance. Children of parents struggling with addiction experience a wide range of
long-term consequences that often persist into adulthood. These children can experience
hindered academic progress and increased vulnerability to mental health disorders. Research
shows that these children face significant risks, including twice the likelihood of developing
mood disorders, and increased susceptibility to developing a substance use disorder of their own
due to genetic and environmental factors. Parental addiction can have a lasting and profound
impact on their children; however, treatment still focuses on the affected individual instead of
their families. The unique experiences of these children will be discussed, while also examining
the role of various treatment options. These treatments will include art therapy as an option that
is accessible, trauma informed and allows for safe emotional expression and healing in ways that
traditional talk therapy does not.
Problem to be Investigated
Children whose parents struggle with addiction frequently face life-long consequences,
including those that are psychological, emotional, and developmental. These children can be
exposed to various levels of instability, fear, neglect, and even abuse. These can happen because
parents struggling with addiction may prioritize their substance use over caring for their children.
Research shows that being raised in that type of environment can hinder normal development for
children (Tinnfâlt et al. 2018). Children from homes with a substance use disorder (SUD)
caregiver tend to struggle academically in areas such as reading, math, and spelling (Solis et al.,
2012). These children also face emotional challenges such as depression, various behavioral

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disorders, or anxiety. Some research indicates that these children experience double the rate of
mood disorders compared to their peers by young adulthood, no matter what the parent’s
addictive substance was. Environmental and genetic factors contribute to the likelihood of these
children developing substance disorders themselves, which would be another issue that this
population faces. Families dealing with addiction can also face various issues such as
dysfunction, potential domestic violence, distorted or skewed parental values and beliefs.
Children in these families can also develop negative self-perceptions and various unhealthy
coping mechanisms that will stick with them for life. All of these issues and consequences
highlight the importance of addiction treatment to include the entire family, especially when
children are involved, no matter their age.
Purpose Statement
The purpose of this research is to discuss the ramifications of having an addicted
caregiver when there is a child in the home and potential support service options. The experience
of these children is unique and requires further attention as addiction treatment, even when
families are involved, often tends to focus on the addicted individual and pays less attention to
family members whose lives are also being affected.
Justification
As of 2023, around 1 in 4 children in the U.S. has lived with at least one primary
caregiver, parent or other guardian, who had a substance use disorder of some kind with alcohol
use being the most prevalent (U.S. Department of Health and Human Services, 2025). Having
such a high occurrence of children living with parental substance use disorder highlights the need
to help them better connect to effective treatment, reduce the risk of using substances, and
increase early intervention for these children. Currently, most SUD treatment programs focus on

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the adult with the disorder, not their children. These children do not receive support services as
much as this information would suggest is necessary. This lack of support services could be due
to lack of awareness or access. Support services should ideally be family focused, and could be
in an alternative form such as creative arts therapy. Art therapy specifically can be especially
beneficial for children by providing them a way to express themselves non-verbally. Art therapy
can allow them to process their feelings and emotions in a safe and non-verbal way, that
traditional talk therapy doesn’t allow for. This alternative form of therapy is also trauma
informed, by providing empowerment, safety, and self-determination while using creativity to
foster resilience in these children.
Terms Related to the Study
Addiction - Chronic or relapsing disorder characterized by compulsive and frequent substance
use despite negative consequences.
Shame - Painful feeling of distress or humiliation from consciously doing something wrong or
foolish
Guilt - Feeling bad about committing a specified or implied offense or crime (doing something
you know was wrong in some way)
Family System - Interconnected emotional unit where each member’s choices, emotions, and
behaviors affect the entire group
Alcoholics Anonymous (AA) - A support group for individuals struggling with alcohol abuse
where they can share their experiences, strength and hope with one another, and is open to
anyone with a desire to stop drinking.
Al-Anon - Support group for loved ones of individuals struggling with alcoholism that is based
on the 12-Steps of AA, where they can share experiences and learn how to cope with the effects

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of another person’s drinking
Conclusion
In summary, children who grow up with parents struggling with addiction face various
challenges that are persistent and multifaceted and can shape their psychological and emotional
development. The long-term consequences such as instability, disrupted caregiving, and unmet
emotional needs, emphasize an urgent need for treatment interventions that extend to the entire
family of these struggling individuals. To address the complex needs of these families and their
children, approaches that are trauma informed and accessible is required. Art therapy is an option
that can offer interventions that are developmentally appropriate and offer valuable, non-verbal
means of expression. This form of therapy can also foster emotional processing, resilience, and
empowerment through creativity. Prevalence of parental substance abuse is still high in the U.S.,
highlighting the importance of incorporating alternative therapies such as art therapy into family
centered treatment models for addiction. Supporting these families and children using innovative
and comprehensive treatment approaches will promote healing, strengthen these families, and
reduce intergenerational risk.

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Section II: Review of Literature
Addiction is very complex, and its effects extend beyond the individual struggling with
substance use into families, and even communities. Addiction is defined as engaging with an
addictive substance, regardless of the negative consequences involved, and it is recognized as a
disease that alters brain chemistry in areas of motivation, self-regulation, and reward. There has
been plenty of research on neurobiological mechanisms that contribute to addiction; however, a
frequently overlooked dimension of addiction, the impact it has on families, deserves more
attention. The experience of individuals dealing with addiction, as well as their families, is
explored in this literature review, highlighting the importance of a holistic understanding and
approach to treatment. The literature presented explores the various ways in which addiction can
impact individuals, their families and communities, through various topics such as family
systems and therapeutic interventions. This discussion will begin with an explanation of the
neurobiology behind addiction, as well as other important aspects such as shame and guilt, and
how they are involved with addiction. The following section will then take a look at potential
long-term effects of parental addiction on children in areas such as their mental health,
development of various kinds, potential substance use of their own, and the influence of stigma.
This review will also discuss the importance of trauma-informed and family-focused therapies,
how they can be combined with alternative treatments such as art therapy, and how the two can
be used in addiction treatment. This review aims to reinforce the importance of treating addiction
as not an individual, but instead a familial disorder.
Neurobiology of Addiction
Addiction affects all areas of life and contributes to large health and economic burdens
for those struggling with addiction, and their communities. It can also negatively impact their

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families, especially children. Before discussing the impact addicted individuals have on their
families, there must be an understanding of the neurobiology behind those behaviors. While
there are a variety of treatment options for people struggling with addiction, no treatment or
intervention is effective for all individuals, and results tend to be more modest (Uhl, Koob &
Cable, 2019). Addiction is more than just behavioral, we now know that changes in the brain
occur when someone switches from use of a substance to abuse. Individuals struggling with
addiction have overwhelming feelings of wanting to perform certain behaviors or partake in
certain substances, and those behaviors in turn affect the brain’s reward system leading to cycles
of intoxication, withdrawal, and intense cravings. These individuals will also continue these
behaviors regardless of negative consequences. Research has revealed characteristics that can
increase someone’s risk of addiction as well, both behavioral and neurobiological, such as
impulsivity, early exposure to the addictive substance, mental health disorders, and having a
parent struggling with addiction.
Dopamine plays a big role in addiction, because addictive substances are rewarding, that
is an inherent part of what they are and how they affect our system. These substances interact
with the brain's dopamine system in a way that increases dopamine levels, which is a “key focal
point for reward neurocircuitry in the brain” (Uhl, Koob, & Cable, 2019, p. 7). Another aspect of
addiction is the underlying learning mechanisms, which are either goal directed or habitual
behaviors. Often, someone will use substances in order to attain a high or gain a certain reward.
For some people, those behaviors become compulsive and are no longer connected to just
receiving a reward. According to the neurobiology of addiction, this is because there is an actual
“shift in circuitry within the brain” (Uhl, Koob & Cable, 2019, p. 7).
Brain structures such as the basolateral amygdala and nucleus accumbens become

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decreasingly important as these problematic behaviors become established (O'Tousa & Grahame,
2014). That would be because these two structures work together to regulate reward-seeking
behavior. This connection is important in learning to associate certain cues with rewards, such as
the rewards someone looks to gain from using an addictive substance. The activation of the
pathway between these two brain structures promotes motivation in an individual to partake in
more behaviors leading to those desired rewards. The interaction between these two pathways
might link rewarding effects of the addictive substance with certain environmental factors such
as places to obtain the substance or other specific locations. The link between these two brain
structures can also lead to an enhancement of the craving associated with an addiction. When an
addicted individual is a parent, these cravings could conflict with how they parent their children,
potentially leading to long-term consequences in their children’s development. When an
individual struggling with addiction is in an addictive state, activation of the basolateral
amygdala might become more inflexible, leading to inappropriate drug or substance seeking
behavior. This connection can also promote relapse of the addiction due to potential triggers
from environmental cues, especially during periods of time where the individual has been
abstinent. As well there are various genetic predispositions, and risk factors that are both
psychological and environmental, which will be further discussed later, and can make children of
these individuals at greater risk of various negative outcomes. When the individual was exposed
to the substance, it also plays an important role. Substances that are abused and used in an
unhealthy way, as mentioned above, act on the brains’ reward system, by changing in a way that
produces activation that is more intense.
The Role of Shame and Guilt
Before discussing the impact addicted individuals have on their families, there must also

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be an understanding of the roles that shame and guilt play in addiction. People who struggle with
addiction often have lots of feelings of guilt and shame stemming from their behaviors and how
their behaviors affect those around them. Research suggests guilt might help some overcome
their addiction, but that shame does not help in that regard (Snoek et al. 2021) Snoek et al. (2021,
p. 2) suggests that therapeutic interventions for addiction should focus to “up-regulate guilt and
down-regulate shame”. Both shame and guilt can, however, be just as counterproductive or
productive. Per Snoek et al. (2021) it really depends on the individual's shame and whether it is
retributive, meaning they feel they are fixed and unchanging, or scaffolding, meaning they feel
they are capable of self-change. It has been suggested that therapy for these individuals should
ideally be tailored according to their degrees of guilt-proneness versus shame-proneness.
Individuals who are more guilt-prone tend to make amends for past misdoings, by avoiding or
overcoming dysfunctional behavior patterns. Those who are more shame-prone on the other
hand, are more likely to persist in those dysfunctional patterns and instead avoid responsibility.
Literature supports the general consensus that guilt focuses on the person’s actions, while shame
focuses on themselves.
For example, someone who is shame-driven would be more likely to consider themselves
unreliable, after missing an important work meeting due to a terrible hangover. Whereas
someone guilt driven might focus on the people inconvenienced as a result. In that type of
situation, feelings of guilt are “in connection with a perceived violation of socially endorsed
norms or principles” and shame is more associated with “a perceived violation of one’s own
values or ideals” (Snoek et al., 2021, p. 2). Those two ways of thinking can be very detrimental
for someone struggling with addiction and can inhibit their healing and treatment in various
ways. Shame in particular can also lead to various types of social interactions. Someone

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struggling with an addiction who has a shame focused mindset might want to withdraw from
others; this could be family, friends, others in the community, to hopefully avoid any type of
situation that would bring them shame. They could also become more aggressive towards others
around them, in an effort to try and put the blame on someone else in these shame-inducing
situations.
Importance of Family Focused Treatment for Addiction
Although there is not a lot of research on addiction affected families, the research that
has been done shows that the primary focus is still on the addicted individual. However, it is just
as important that the family is cared for and supported as well, because the entire family is
affected when even just one member struggles with addiction. It is well known that family
members can, and often are, greatly affected by the addiction. These family members can endure
quite a bit of pressure from the addiction and its consequences, which can affect their personal
and social lives in various ways. A systematic review conducted by Mardini et al (2023) found
five main themes in the studies they reviewed. Those themes would be initial shock from the
family, family in the fog, sequence of disorders, internal family chaos, and self-protection. A
family might feel initial shock when they find out their family member(s) are addicts. This could
lead to feelings of trying to figure out why, what happened, what went wrong, or wondering
what they did wrong, feeling it is somehow their fault and experiencing shame and guilt. The
theme of family in the fog refers to the social isolation felt by the family, as others find out about
the addiction; they might also face stigma and negative labeling as a result of one member
struggling with addiction. That stigma and labeling can unfortunately affect the entire family.
The third theme mentioned was a sequence of disorders (Mardine et al, 2023). Having a
family member with an addiction can lead to a great burden being put on the family, potential

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emotional decline, or the start of negative behaviors being used as a way to cope or from finding
out about the addiction. The last two themes mentioned in the article include internal family
chaos and self-protection. Having an addicted family member can lead to lots of internal family
chaos creating instability in relationships between all individuals, erosive confrontation of the
addicted individual, or potential financial decline, to name a few examples. Lastly, having a
family member who is an addict can lead to increased use of self-protection in an effort to reduce
negative impacts the addiction has on the family. While the use of self-protection does not
necessarily lead to negative outcomes, the family can still struggle for various reasons. The nonaddicted family members might attract more information to better help the family member who
is struggling. They might also seek support from their community and protective services. All the
mentioned themes go to show how important incorporating the entire family into addiction
treatment is, especially when children are involved.
Effects of Addiction Felt by the Whole Family
Therapists in the past 20 years have increasingly considered addiction from a family
system perspective because families are completely warped by substance abuse. There is
potential for many inconsistent behaviors in these families as well as a sense of lack of rules.
This may be observed in a situation such as the spouse of the addicted family member calling the
addict’s work and claiming they are unwell; but then also teaching their children, as plenty of
parents do, that they should never lie (Crnkovic & DelCampo, 1998). That would be one instance
of children living with an addicted parent and growing up with conflicting information being
taught to them, whether explicitly or not. Children of addicts also display hypervigilance to some
degree, where they are constantly watching cues from the adults in the family to see what types
of subjects can be talked about, and what subjects should be avoided. Such learned

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hypervigilance may lead to anxiety and generalized insecurity about the environment they live
and are growing up in. Children of addicts might even embrace the addiction, as a normal part of
the family system they belong to, as a way to survive the disease (Crnkovic & DelCampo, 1998).
Another big area that would be affected in a family system would be boundaries. Families
affected by addiction of any kind struggle with having boundaries that encompass both extremes,
with the possibility of being either too rigid and strict, or lacking entirely. Such extreme
boundaries are unhealthy for children, providing them with unpredictable and conflicting
information. Such information can create lots of isolation between family members, or even the
opposite extreme of having relationships that are too close, in an unhealthy way. As stated by
Crnkovic and DelCampo (1998), three primary rules of addicted effected families often are
“don’t feel”, “don’t talk”, and “don’t trust.”
Unfortunately, families struggling with addiction are often at an increased risk for child
maltreatment and potential involvement of child welfare services. Roughly one out of five
children live in a household with an adult who is an addict of some kind (McCarthy et al, 2022).
These children are also twice as likely to be at risk of maltreatment. According to the child
welfare system “parental substance use is increasingly implicated in substantiated allegations of
abuse and neglect” and that “about 40-80% of parents on their [child welfare caseworkers]
caseloads have problems with substance use” (Shockley McCarthy et al, 2022, p. 2).
To better understand families struggling with addiction, family context can provide
important information as to how certain disorders will develop in the family, how they are or will
be maintained, and what can influence treatment for the family. Each member in a family
struggling with addiction is affected uniquely, in areas such as unmet developmental needs,
impaired, or otherwise affected attachment, potential legal problems, and emotional distress.

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Therefore, treating only the addicted individual and not the family as a whole willbe less
effective.
How addiction impacts the family system will differ depending on which member is the
substance user. The family will be affected differently if a parent is an addict, as opposed to an
adolescent, or a senior member of the family. As the clinician treating, understanding the role of
the addicted individual within the family system is crucial as it will influence treatment and
recovery. That should be considered, especially when thinking about how the family members
view the addiction compared to the model of addiction the therapist works from. A family is very
mobile, when one individual starts to change their behavior or thinking, it will affect the rest of
the family one way or another.
The developmental stage of a family refers to which stage of the family life cycle they are
in. There have been eight stages identified that have corresponding developmental tasks. Having
a family member struggling with addiction can interrupt and disrupt those various developmental
tasks, especially depending on which family member is the addict, and again, what stage the
family is in. The eight stages are married without children, childbearing families, family with
preschool children, families with school age children, families with teenagers, families launching
adults, middle-age parents, and aging family members (Carter & McGoldrik, 1989). In the stage
of families with preschool children, some developmental tasks would include adapting to the
needs of those young children to help them grow and develop. Families at this stage would also
be working on coping with lack of privacy and greater energy usage. The struggle of an
addiction, while at this stage, could contribute to issues such as inconsistent parenting, or even
extremes such as neglect or abuse and the removal of children from Child Protective Services. In
the stage of families with teenagers, some developmental tasks would include parents helping

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their teens balance freedom with responsibility, helping them establish healthy relationships with
their peers, as well as educational and career goals. Children could be especially affected at this
stage. They could potentially follow and model the addicted individual, especially if it is their
parent. They might also have trouble forming healthy relationships. Teens in a family dealing
with addiction could also struggle with their mental health in the form of anxiety, or depression.
Some forms of treatment that could specifically benefit families in those two stages,
would include assessing safety for the children and spouse, couples counseling, and referral to
AA, NA, Al-Anon, or Nar-Anon. Al-Anon could especially benefit teens, as children at that age
could be more likely to feel their parent’s addiction is somehow their fault. The structure of AlAnon is similar to the 12-steps of AA, with a primary focus on how loved ones of individuals
struggling with addiction did not cause the addiction, they cannot control it, and they cannot cure
it. By focusing on these statements, an adolescent can work to change their thinking in a way that
removes the blame they feel is on them, for their parent’s addiction. Another guiding statement
that some might focus on in Al-Anon would be that the loved one does not have to contribute to
the addiction. Contributing to the addiction in this way could look like doing things for the
addicted individual that they can and should be able to do for themselves, or trying to cushion
them from the negative consequences of their unhealthy choices. Using Al-Anon in combination
with an alternative form of therapy, such as art therapy, could enhance the healing of these loved
ones and ability to detach from their parent’s addiction.
Bronfenbrenner’s Theory
One framework used when considering and treating families struggling with addiction is
Bronfenbrenner’s ecological systems theory. The structure of Bronfenbrenner’s theory can allow
one to consider other factors in the child’s (child of an addict) life, beyond their immediate

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environment. This theory includes four systems; Microsystem (immediate environment),
Mesosystem (wider family, neighborhood, social networks), Exosystem (community resources),
and Macrosystem (wider political systems) (Todman & McLaughlin, 2024). Regarding a child’s
microsystem, this can include some things that have been mentioned already, such as neglect
where these children are not receiving their day-to-day care. These children might need to be
resourceful to meet their needs on their own, in ways they should not have to as children, as a
result. A child’s environment, their mesosystem, is also affected. Their environments can be very
inconsistent and unpredictable.
Participants in this study by Todman and McLaughlin (2024) mentioned concerns that
professionals might not always include other family members, such as grandparents and others
outside the family, in their assessments and care plans for the children. Those added people
outside the home could, and likely are, also affected by the addiction. But they can also be a
great help for children whose parents are struggling. When it comes to a child’s exosystem, there
is an increased risk of harm when one of their parents is an addict, such as the potential to be
exploited, for example. Lastly, a child’s macrosystem can be affected, as well as incredibly
beneficial. This level can include community support in the form of youth and children’s centers
or potential changes in the welfare system (Todman & McLaughlin, 2024).
Using Bronfenbrenner’s model, Brankenhoff and Slesnick’s (2015) study, focused
specifically on mothers struggling with addiction and their children, and the fact that they are
often understudied and underserved. According to this article, these mothers are likely to have
grown up in a similar family situation, also involving substance abuse of some kind. This could
lead to poor or lack of knowledge about proper parenting, as well as trouble understanding their
children’s needs, especially emotional and developmental needs. This article also touches on

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another important topic regarding children of addicts, that will be touched on further later. That
would be parentification, where the child must take on more adult responsibilities and
expectations, due to their parents' addiction. Once again, “the whole family suffered, so the
whole family needs to recover” (Brakenhoff & Slesnick, 2015, p. 1).
Family Systems and Other Theories
Some other theories used in the treatment of families dealing with addiction include
social control theory, behavioral economics/behavioral choice theory, social learning theory, and
stress and coping theory. Social control theory focuses on strong bonds between others in areas
such as family, work, and religion. In this theory, it is thought that these strong bonds help to
motivate people to “engage in responsible behavior and refrain from substance use and other
deviant pursuits” (Moos, 2007). It is also thought that these bonds monitor, supervise, and direct
behavior towards what is more acceptable. Behavioral economics/behavioral choice theory is
similar to social control theory as it focuses on the involvement of protective activities. The key
here would be focusing on activities other than substance use that can still provide rewards, but
in alternative ways. In turn, individuals who might be struggling with addiction could then be
protected from exposure to the substance they are addicted to and chances to use it.
Social learning theory focuses on specific attitudes and behaviors related to the
substance, from adults and peers who are the individual’s role models. Through the lense of this
theory modeling effects begin with observation and imitation of substance-specific behaviors,
continue with social reinforcement...and culminate in substance use and misuse (Moos, 2007).
Lastly, is stress and coping theory, which proposes that stressful life events relating to family,
friends, and work can “lead to distress and alienation and eventually to substance misuse”
(Moos, 2007). Various family stressors, especially when they are continual, can lead to an

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individual feeling alienated and distressed. This theory says that these stressors are more likely to
lead to substance misuse in those who are more impulsive and lack self-confidence, and that
these individuals use their substance as a form of avoidance coping.
In general, all family counseling approaches reflect principles of family systems theory,
which sees the individual as an integral part of many systems, not just the family but also their
community, culture, and society as well. That is why Bronfenbrenner’s Ecological Theory,
previously mentioned, is sometimes used. This framework is very important to keep in mind,
because “when family members change their thinking about and responses to substance misuse,
the entire family system changes” (U.S. National Library of Medicine, 1970). Some core
principles demonstrating the importance of using a family systems approach would include
incorporating a non-blaming approach that is instead collaborative, expanding the idea of
“successful treatment” to include the well-being of the family as a whole, as well as
“appreciating the importance of adapting family counseling methods” to fit values and cultures
of the family being treated as well (U.S. National Library of Medicine, 1970)
When it comes to treating families struggling with addiction, whether the therapy is
structural or strategic matters as well. That is because, a basic premise in the field of addiction is
that an individual is “more likely to continue chemical use/abuse if fundamental family
functioning does not readjust to the dynamics of recovery” (Crnkovic & DelCampo, 1998). From
a structural point of view, role reversals can happen between parents and their children. For
example, as mentioned previously, children might have to take on more adult roles by taking on
parental roles. A therapist working from a structural perspective would want to focus on taking a
more direct role in helping parents regain “their position of setting and maintaining rules
regarding treatment and enabling behaviors” (Crnkovic & DelCampo, 1998, p. 30). A therapist

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who utilizes a strategic approach would look at the situation differently. They might consider it
as something that was survival behavioral in the past. But they would also acknowledge that said
behavior is now undesirable, hence the family is getting treatment. This type of therapist would
also consider enabling behaviors and how they are ultimately detrimental. In general, a structural
approach would challenge the family organization in a way that can hamper addictive behaviors,
while a strategic approach would work to cause disequilibrium in the family system, to promote
and lead to positive change.
Some final approaches to addiction treatment for families include family disease models,
and family prevention models. The disease model of addiction, when used to treat families
struggling, is often focused on abstinence and 12-step programs. As previously mentioned,
addiction affects the entire family and is often thought of as a family disease. This theory
suggests that “parental addiction leads to secrecy, shame, codependency, and isolation” (Usher et
al 2015, p. 3). This can, as a result, lead to dysfunction of various types. Treatment interventions
that utilize this theory and this philosophy tend to focus on breaking down patterns of secrecy,
often by providing information to family members about the effects addiction can have on
children. On the other hand, family prevention models view addiction as one of many risk factors
that characterize dysfunctional families (Usher et al, 2015). This theory has the idea that having a
parent struggling with addiction can lead and contribute to poor function in the family in areas
such as family cohesion, parenting, and emotional regulation. In turn, children are likely to have
or develop psychosocial problems, and are more likely to struggle with delinquency, or eventual
substance abuse themselves.
Effects of Addicted Parents on Children
Being the child of an addict can have many long-term effects, that “do not reduce as they

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get older”, meaning they will likely be affected into adulthood and for the rest of their lives
(Todman & McLaughlin, 2024, p. 1). Many children dealing with parental substance misuse or
abuse live through things that children should not have to deal with; fear, danger, unpredictable
behavior from the adults who are supposed to be taking care of them, or even absent parenting.
These parents are generally fighting the decision to satisfy their addiction, meaning less time is
spent nurturing their children in the way parents are supposed to. The developmental needs of
these children are not consistently nurtured, with various degrees of severity. As previously
mentioned, this negative impact can be worsened by possible abuse of some kind as well.
Research done in the UK by Roy (2021), that included a profile of 299 children living with
parents struggling with abuse, looked at the complexity of their lives in relation to concerns
about their physical safety, potential significant mental health struggles, and the impact of
potential deprivation. This research indicated the importance of support for these children and
their families, alongside other research.
Numerous studies have found that having a parent struggling with addiction, specifically
alcohol addiction, is associated with lower academic functioning. An article by Solis et al (2012)
focuses on three primary areas; academic and cognitive functioning, mental health functioning,
and substance involvement. This can include lower grades, or failure to pursue secondary
education. For younger children, on average, those with parents who struggle with alcoholism
tend to “show weaker performance in reading, spelling, and math... compared to their peers”
(Solis et al, 2012, p. 3). Some potential reasoning for these connections could be that these
children could have cognitive deficits. Regarding mental health functioning, these children,
compared to their peers, are often more likely to, and have higher rates of disorders such as
depression, conduct problems, and anxiety to name a few. These children also often have lower

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self-esteem and social competence on average.
By the time these children are young adults, “mood disorders... are nearly double those of
their peers” (Solis et al, 2012, p. 5). It has also been found that, whether the addiction is related
to drugs or alcohol does not matter, as it seems both are just as predictive of behavioral issues
and disorders in these children (Marmostein et al. 2009). There are some studies stating that
these children showed higher rates of these disorders if their parents struggled with some of these
things themselves; meaning the parents also struggled with depression or antisocial problems, to
name a couple examples (Marmostein et al. 2009). Lastly, these children are also at risk of
substance involvement. This could look like the child struggling with the addiction themselves,
to some degree. There is a genetic component as well as children of addicts are more likely to
become addicts themselves, simply because their parents have a history of substance abuse.
Children with parents struggling with addiction are also likely to start using substances
themselves earlier and increase how often they use it more quickly as well (Solis et al, 2012).
This risk is even greater when both parents are addicted.
Families struggling with addiction tend to have some degree of dysfunction. This can
look like children of struggling parents, as well as other family members, constantly feeling
anxious. Unfortunately, in many cases, “there is no possibility in the family for the autonomous
development of an individual, and their self-image is distinctively negative” (Simonič &
Osewska, 2023, p. 66). Addiction can also negatively affect the marriage of the struggling
individual. According to this article as well, 55% of families struggling with addiction also deal
with domestic violence, and in 90% of these families that are also dealing with child abuse,
alcohol is a big factor. In general, parents struggling with addiction will likely use a different
approach in how they parent their children that could conflict with how the non-addicted parent

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chooses to parent. Parenting in this way can “pass on different values and thus also give a picture
of reality that is completely distorted” to their children (Simonič & Osewska, 2023, p. 66). This
will, in turn, affect how the children learn to see and interact with the world around them, which
will likely stay with them in adulthood.
Experience of Younger Children
An article by Tinnfält et al (2018) states that there is plenty known about children of
parents struggling with alcoholism, but not as much research looking at the experience of the
younger of these children. The researchers in this article interviewed 18 children ages 7-9, and a
major finding was that a lot of these children “took a great responsibility for their alcoholic
parent, and the family” (Tinnfält et al, 2018, p. 538). Some themes that came up from these
interviews were feeling sad when their parents are fighting, trying to control the situation, and
wishing for change. This study advocates for further research in this age group of children of
parents struggling with alcoholism, as these children were still very “well aware of the
connection between the parent’s alcohol abuse and [their] feelings of sadness, leading to feelings
of disappointment towards parents” (Tinnfält et al, 2018, p. 538). That being said, it is just as
important to provide support for these children, in a way that is developmentally appropriate.
Also mentioned in this study is the idea of parentification: when children must take on
more adult roles which can look like parenting their parents. In this specific study, this was seen
through some of these children trying to hide money from their parents or hide car keys so as to
prevent them leaving the house to buy alcohol. Children who struggle in this way, and must deal
with parentification, can have a much higher risk of feeling ashamed of themselves as an adult
(Wells & Jones, 2000). Which reiterates the fact that being the child of an addict can have lasting
effects that can, and likely will, stay with them into adulthood. This study suggests that more

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23

attention should be payed to listening to children of addicts of all ages, and that children even
this young still “knew a great deal about their situation and were very aware of what this meant
for the family” (Tinnfält et al, 2018, p. 537), despite a common thought that children don’t
understand adult topics such as addiction.
Family as Codependents
Family members of addicts can become codependents, and according to Baker (1990)
they can potentially become sicker than the addict. Baker states this is because “the addict can
drug his problems away, while family members must act out their frustrations.” This is why
family members and other loved ones of someone struggling with addiction can also struggle.
They might have to take on more roles to help the addicted individual, in ways that they should
not necessarily have to, especially if they are children. They might unintentionally encourage
addictive behavior by becoming an enabler as well. This could be due to a feeling of wanting to
avoid conflict or actively trying to ignore their addiction by acting like it does not exist.
Loved ones of addicts, especially children of all ages, can sometimes feel the addiction is
somehow their fault. This pattern of thinking can be harmful for the development of these
children, no matter what age they are. It can lead to maladaptive thinking patterns about
themselves and the world around them, and might even affect their relationships going forward,
even into adulthood. This is one reason groups such as Al-Anon and Nar-Anon exist. These
types of groups are for loved ones of addicts where they are able to change the way they think
about the addiction, learning that they are not at fault, that they are absolutely not alone in their
struggle, and that there are ways for them to detach from the addiction. These groups and
programs are often modeled after common 12-step programs and tend to be nonjudgmental,
which can allow these family members and other loved ones to work through any guilt that they

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might have.
Experience of Teens
Adolescence is a time of many changes that are psychological, social, and biological.
During this time, even though adolescents tend to value their independence, parents continue to
play a big role in their development. Parental drinking during this time, same as with children of
any age, can negatively affect adjustment and development. Poor or mismatched parenting skills
interfere. Parents who are struggling with addiction might even model, perhaps without even
realizing it, ineffective coping skills. This can be especially problematic during adolescence
when teens are especially vulnerable and easily swayed by those around them, friends, and
family. This time in a child’s life might be considered a time of storm and stress (Windle, 1996)
when it comes to their relationships with their parents. They often prefer to deal with various
challenges that come with being a teenager on their own, but often still consider parents very
important confidants in their lives. Parents and teen children often disagree on a lot of things
from curfews to dating and whether it should be allowed, but parents are still just as important in
the development of their children, even as teenagers. Some big areas that could be affected by
parental addiction, for teens especially, would be parenting skills, marital and family functioning,
and role modeling.
Parents who are addicts can negatively influence parenting skills in many ways.
Primarily, their problem drinking can contribute to parenting that is more inconsistent or
unpredictable. This potential inconsistency can “undermine a child’s sense of order, control, and
stability in the family environment, reducing feelings of self-esteem and perceptions of selfcompetence" (Windle, 1996, p. 181). A parent struggling with addiction might also be likely to
monitor their adolescent child’s behavior more poorly than they should. Parents monitor their

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25

children to establish rules such as curfews and household responsibilities to name a couple, all in
an effort to establish a more orderly structure. These parents might also have lower levels of
nurturing and emotional availability for their children. This could increase the risk for their
adolescent children to start drinking themselves. Parents who struggle with alcohol can be more
likely to use harsher discipline, as well as more likely to provide implicit approval for their
children’s alcohol use if that is happening.
Another area that can be affected within the family system of an addicted individual
would be marital and family functioning. Parental addiction can contribute to marital conflict
between parents, which can lead to the use of alcohol and aggression by the children themselves.
When parents are in conflict, other family members can feel threatened, and the family as a
whole can feel destabilized. Children in these families might express worry about the family unit
breaking up, or even for their own personal safety. If this type of parental conflict continues for
an extended period of time, children might be more likely to attempt to “escape these adverse
conditions through personal alcohol use with peers...,” among other forms of unhealthy coping
(Windle, 1996, p. 182). Marital conflict can also contribute to physical abuse, as previously
mentioned in this review. Overall, parental drinking can lead to marital conflict, which can in
turn influence how an adolescent views their family and families in general. Adolescents could
be influenced by the way they perceive families are supposed to function. This view on families
creates a blueprint for how they view other relationships in their life as well.
Parents struggling with addiction can also model maladaptive and harmful behaviors to
their adolescent children, through processes such as socialization. Children exposed to alcohol
specifically might be more likely to view alcohol consumption as a positive activity (Gaines et
al. 1988). This is because many children, including adolescents who are becoming more

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26

independent, view their parents as “powerful figures to emulate” (Windle, 1996, p. 183). Parents
who struggle with an addiction are also modeling a negative coping strategy, especially when
done in response to various life stressors. Adolescents and other children may view this behavior
as an effective coping strategy for stress and would therefore be more likely to adopt the
behavior themselves. For adolescents specifically, relying on a substance such as alcohol to cope
with their various life stressors could “contribute to more frequent and serious alcohol use and
associate problems” (Windle, 1996, p. 183). Life stressors could be escalated as a result, creating
a harmful cycle centered around unhealthy and maladaptive coping.
Stigma
A big part of addiction is the stigma that can, and often does, surround it. Stigma can
negatively affect the individual struggling with the addiction, as well as their loved ones
including friends and family. Children of addicts can experience stigma, that carries into
adulthood. Children who have parents struggling with substance abuse tend to have a higher
chance of developing a substance use disorder themselves (Meulewaeter et al, 2025).The three
main themes that emerged from the interviews done by Meulewaeter et al, (2025) are the role of
social connection in substance use and recovery, loneliness and neglect in childhood, and stigma
and the self.
Most adults interviewed in this study stated that they felt completely alone as a child,
feeling like they never had a family because of the addiction, or feeling that way because they
always had to try and hide their parents’ addiction. In addition, all participants in this study felt
shame as a child due to the environment they were in. Some even felt shame from trying to reach
out for support. That is because, as research shows, these “feelings of shame and self-blame....
may hamper help-seeking in children, with implications for long-term mental and physical

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health” (Meulewaeter et al. 2025, p. 10). A child growing up in this type of environment can
also experience a lack of positive self-esteem, as evident by those interviewed in this study. This
influenced how they navigated social life outside their home “which further influenced
perceptions of social isolation and stigma” (Meulewaeter et al. 2025, p. 5).
Unfortunately, loved ones of individuals struggling with addiction can experience stigma
even after the death of the struggling individual. Dyregrov and Selseng (2022) explain how there
is still little knowledge relating to individuals grieved by drug related deaths and that this group
still tends to be marginalized from the stigma they experience. Important themes that came from
this research include stigma once again, dehumanizing remarks and labeling, and blaming the
deceased by claiming that “death was the only and best outcome” (Dyregrov & Selseng, 2022).
Some of the comments these respondents received are related to stereotypes about individuals
struggling with addiction, highlighting thoughts by some who do not believe people struggling
with addiction can or are able to solve their own problems. These individuals might be likely to
consider death as the better and only choice. When expressing that thought to someone dealing
with the death of a loved one who struggled with addiction, their grief and validation of their
feelings can be undermined in a way that will be harmful instead of supportive. These harmful
comments and thoughts regarding the deceased individual can pose a barrier to healthy grieving
for their loved ones. Someone grieving the death of a loved one who struggled with addiction
will likely avoid or withdraw from those who share these hurtful and negative comments, even if
they are friends and family. As a result, these grieving individuals could experience prolonged
grief, complicated grief, or potential trauma reactions. Each of those outcomes can create an
entire host of psychological health issues for these grieving individuals.
Potential to Become Addicts Themselves

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Children of addicts are more likely to become addicts themselves, as previously
mentioned, because genetic factors account for about 40-60% of someone’s susceptibility to
substance use disorders (Wandler, 2025). For example, the ADH1B gene is associated with
alcohol use disorder. An individual's genetic predisposition can be combined with various
environmental factors as well, which can increase their risk of developing a substance use
disorder even further (Wandler, 2025).
The potential to become addicts themselves is just one of the many negative
developmental, social, and emotional outcomes these children can face. Family focused
interventions for children of addicts can help prevent and lessen those negative influences. Two
primary models of addiction in a family would be family disease models, and family prevention
models. Family disease models consider addiction as a disease that affects the entire family. Its
goals and focus are often on abstinence from addictive behavior and the inclusion of 12-step
programs. When a family struggling with addiction is considered from a disease perspective, it is
clearer that the parent’s addiction can lead to dysfunction in the family as a result of the
isolation, shame, and secrecy that comes from the addiction. Children in these families would
then need very specific interventions within the context of their families that help disrupt the
cycle of addiction (Usher et al. 2015). On the other hand, there are family prevention models,
which would consider addiction to be just one of many risk factors that can characterize a
dysfunctional family. A family prevention model would suggest that children in these families
experience delinquency and psychosocial problems due to poor parenting skills, family cohesion,
and emotional regulation. Family prevention models tend to emphasize skills and target parents
primarily, while someone taking a disease-oriented perspective will emphasize knowledge and
target the children.

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Each model has its own strengths when treating families struggling with addiction.
Family prevention-based programs evaluated in this study seem to be effective when they are
attuned to client engagement, encourage positive parent-child interactions, and facilitate
supportive peer relationships. Important mechanisms triggered in those situations would be trust,
hopefully enjoyment, and validation. Programs backed by the family disease model seem to be
effective because of their facilitation of supportive peer relationships as well, but also the way
they harness the power of knowledge regarding addiction and how the family is affected by it.
Some important mechanisms in this case would be trust as well, children relinquishing
responsibility for parental addiction, and validation. That to say, more research still needs to be
done on addiction affected families, as a lot of the research that has been done still focuses
primarily on the addicted individual, while not providing enough attention to the family.
More Research Needed on Addiction Affected Families
Plenty of research on addiction-affected families still seems to center more on the
addicted individual as opposed to the family as a whole. These families need special support, and
that support can be most effective when services are tailored to their unique conditions; their
voices are heard, and their needs are noticed and provided for. Mardani et al. (2023) Conducted a
systematic review of addiction affected families and found five main themes specific to the
challenges these families face: initial shock, family in the fog, sequence of disorders, internal
family chaos, and self-protection. Families face initial shock when they find out about their loved
one’s addiction, and they are stuck in a place of potential lack of knowledge and uncertainty in
the next steps. The family can put themselves in a process of mourning that is profound, long,
and reoccurring, in a way that is very specific to this population. Some family members might
even consider this the hardest experience in the entire process of treating addiction.

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When families are in the stage of being “in the fog,” their biggest challenge is likely
being willing to get help. They might be unwilling to do so as a type of defense mechanism,
feeling it is better to keep the addiction a secret. They might even prefer to figure it out on their
own, to avoid potential judgement, stigma, and labeling. These feelings can be mitigated by
policymakers and service providers working to eliminate misconceptions about these families
and provide support to help remove the effects of social stigma. The themes of sequence of
disorders and internal family chaos indicate, in a way, the extent of harm on the family from the
addiction. That is because addiction affects families on emotional, psychological, behavioral, and
physical levels. Some interventions that can help with these two stages of families dealing with
addiction include increasing social support, modulating stress and pressure, reducing symptoms
of any mental disorders, and training families in areas of social acceptance and emotional
support, to name a few. Mardani et al (2023) also notes the importance of paying attention to
those “under the shadow” of the drug-abusing people, such as children. That would be because
members in these families, especially parents, might tend to neglect others due to problems
caused by addiction, intentionally or not. Lastly, the fifth theme identified is self-protection, and
is the primary factor in starting the recovery process for these families. This process can include
moral support, seeking help in various forms such as financial and information, and trying to
reduce negative effects of addiction in various ways as well.
Art Therapy; Including How it is Trauma Informed
Art therapy is an expressive therapy that is also trauma informed. Art therapy can activate
neural networks that can also be affected by trauma, which is why it is thought to be useful in
treating something such as addiction, as addiction is often tied to trauma of some kind (Quinn,
2025). Quinn also explains how art therapy activates the reward system involved in addiction.

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This can make art therapy especially beneficial and useful for the stress and inhibition aspects of
addiction. Art therapy has been found to be beneficial in many ways, such as augmenting
learning and motivation, and in other ways that can enhance and add to traditional talk therapy.
Individuals who have struggled with addiction for quite some time have existed and functioned
in altered states of consciousness that greatly impact their perception, and how they related to
those around them, including their children and other family members. This could also be due to
potential dissociation from past trauma. Art therapy, which engages creativity, can help anchor
individuals in the present feeling or experience through the art materials chosen to work with.
Art therapy is also visual as well as tactile, which can help an individual process traumatic
memories in a way they might not be able to with words in traditional talk therapy.
Art therapy can allow an individual to become more aware of trauma and reduce denial,
which can help large-scale brain networks involved in trauma and addiction work better together.
Brain imaging conducted during art therapy provides evidence that activation of these large-scale
networks can help an individual with self-regulation, cognition, and memory when processing
trauma that could be related to their addiction. Someone dealing with addiction could also be
struggling with PTSD (post-traumatic stress disorder). One negative outcome of PTSD is a
reduced capacity for goal attainment and socialization. Art therapy can help in that area by
helping increase self-efficacy, among other things, in an experiential format. Combining trauma
informed art therapy and addiction treatment in this way can help mediate traumatic memories.
Per Quinn (2025), “a major hurdle in addiction treatment is reducing the euphoric recall of
substances during withdrawal cravings that lead to relapse” (p. 2). Art making could help in
restoring the brain’s ability to anticipate more natural rewards, as opposed to those from the
addictive substance. This can be done through novel sensory experiences, experienced during art

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making that can activate production of acetylcholine and stimulate dopamine release, for more
natural rewards not involving chemicals.
Children of parents who are addicts are at a great risk of becoming addicts themselves, as
previously mentioned, as well as a host of other mental disorders and deviant behaviors such as
externalizing behavior (Barnow et al. 2002). This is another reason why treatment for addiction
should focus on the addicted individuals as well as their families, especially when there are
children involved. It is recommended that programs focus on skills enhancement, family
functioning and coping, include self-care, and interests building, among other things (Chan et al.
2016). Art therapy can be incorporated into a more varied treatment program for these
individuals, as it can help them better narrate their life experiences, and become better able to
reveal emotions (Leung et al. 2018). Art therapy can be especially beneficial for children in these
families by allowing them to take ownership of their therapeutic process, while also giving them
motivation needed to take part in the therapy regularly. Regular participation alone can positively
affect their treatment outcome. (Leung et al. 2018). Participation in an expressive therapy, such
as art therapy, can change children’s and adolescents’ beliefs about addiction in a positive
direction. This approach to addiction treatment can, for adolescents especially, strengthen intraand interpersonal and psychosocial competencies such as identifying personal strengths, and
being better able to express their emotions. Parents discussed in this research by Leung et al
(2018) had positive outcomes and also felt helped in areas such as building positive identities
and improving problem solving skills. Another important finding was that children and
adolescents in this study were able to better realize that even though their parents were addicts,
they may still have positive self-perception, Leung et al. (2018).
An art therapy approach specific to families, Family Art Therapy, is a form of

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psychotherapy created by Hana Kwiatkowska. It can utilize many types of artistic media,
including visual and those derived from different artistic disciplines such as writing, and other
types of expressive therapies such as dance, play, or music therapy. It is also backed by many
psychotherapeutic theories and trends such as classical psychoanalysis, the ideas of Carl Rogers,
or narrative therapies. Art is used with families in this way to provide another means of
communication for the family, allowing for greater and freerer self-expression in the family
(Nieduziak, 2021). Engaging a family in this way through art making together engages all family
members in ways that cannot be done through traditional talk and psychotherapy-based therapy,
while also leveling the playing field for all involved. The art being made can present non-verbal
communication in a symbolic way that allows feelings and thoughts to be made known in
alternative ways. Family art therapy can also allow therapists and researchers the ability to
observe the family and how it functions and get a better picture of the family’s dynamics. This
type of family therapy can be used as the only treatment, as a form of evaluation, or
supplementally as part of a more comprehensive treatment plan.
Combining Art Therapy with Existing Treatment Programs
There has been a lot of research done on evidence-based practices in the treatment of
addiction, such as 12-step programs. Little attention has been given to alternative and
complementary forms of treatment, such as art therapy. According to Aletraris et al. (2014), the
use of complementary and alternative forms of treatment for addiction is growing in importance.
Art therapy can fit into existing treatment programs such as Motivational Interviewing and
Motivational Enhancement Therapy. Some goals of those two therapies would be promoting
client engagement, seeking to enhance client’s intrinsic motivation to change, and addressing any
ambivalence clients may have. Art and other expressive therapies can be used to work towards

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all of those goals. That would be because they use mind-body strategies that are more active and
fit well with the already established principles of those two therapies. Art therapy also
complements those two by utilizing cognitive processes such as allowing clients to decide what
to create, choosing the art materials they use, and valuing their work and how it’s created. Art
therapy can also be combined with traditional 12-step programs by helping better facilitate the
First Step, “we admit we are powerless...” (Alcoholics Anonymous) This is done by fostering a
creative spark that can break down any resistance to change and treatment, as well as by
facilitating acceptance of the addiction as a disease
Family Art Therapy can be used in combination with many other forms of treatment for
families and for addiction as well. It can focus on many areas in the lives of families who are
struggling with addiction such as how the family is affected by the health condition of the
struggling individual, how the family can be affected by various external factors, and
disturbances in parent-child relationships, all of which have been previously discussed. Those
would be the three main issues discussed in research done on specific art therapy interventions
for families (Nieduziak, 2021). Family Art Therapy can come in various forms and have various
types of structure.
When this form of therapy was originally created, it had a six-stage structure and
evaluation procedure that was more standardized. The client and their family would work
together for a one-to-two-hour session, while the therapist and a psychiatrist or social worker
would take on a more observational role. After the evaluation was done, treatment would
continue accordingly depending on how the family responded and the overall treatment program.
Therefore, as previously mentioned, art therapy could be very easily incorporated into a
previously started treatment program for a family struggling with addiction, that has potentially

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35

already been very successful. Art therapy could add another layer of processing for the family
that they might not be able to obtain with other forms of therapy. For example, art therapy is
considered very communicative and can allow individuals to express themselves by exploring
the relationship between their thinking and emotions, in a way that non-expressive therapies do
not allow for.
Finally, when treating addiction and how addiction affects families, the fostering of
remission for the struggling individual and their family is just as important, if not more
important. As previously mentioned by Moos (2006), there are various theories regarding
substance use disorders and helping individuals foster remission. These would be social control
theory, behavioral economics and behavioral choice theory, social learning theory, and stress and
coping theory. Social control theory focuses on strong bonds with religion, work, and family and
friends that an individual might have in their life. These strong bonds can help motivate an
individual to engage in healthier behaviors and reframe from their unhealthy substance use.
These types of bonds and relationships involve monitoring each other’s behavior towards
important pursuits and goals. Individuals might be less likely to adhere to and follow more
conventional and traditional standards, making them more likely to engage in these unhealthy
behaviors, contributing to addiction. Weak bonds could include families lacking cohesion,
friends engaging in disruptive behaviors, or even lack of supervision in work and social settings.
Behavioral economics or behavioral choice theory, closely related to the previous,
focuses on involvement in what would be considered protective activities. What is important for
this theory is the social context of rewards that can be acquired through other healthier means,
through activities other than using the addictive substance. Moos (2006) suggests that an
individual’s choice of substance use could be due to the lack of other, alternative rewards

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36

through avenues such as education or religion. An alternative option could be engaging in
physical activity, which could connect the individual with others who do not use or abuse alcohol
or other substances. Lastly, social learning theory focuses on an individual’s role models, other
adults, and peers around them. Individuals model behaviors of those around them, and certain
behaviors will be socially reinforced for various reasons. This theory would suggest that
unhealthy substance use might be a result of positive norms and expectations about substances
and family members and friends who engage in these unhealthy behaviors. This could look like
children copying unhealthy behaviors they have observed from their parents, such as abusing
alcohol or another substance.
Conclusion
The literature discussed shows that parental addiction often leads to significant long-term
consequences for children and their families, including parentification, role reversal, potential
neglect, and abuse, all of which can disrupt health development and contribute to challenges.
Some of these challenges include low self-esteem, depression, and impaired interpersonal
functioning; these outcomes are intensified by environmental instability and inconsistent
parenting. Tinnafält (2018) indicates that children exposed to these conditions are at heightened
risk of developing addictions themselves. Stigma surrounding addiction further compounds
family distress by fostering shame, self-blame, and barriers to seeking help, while addiction
related deaths can create especially complex grief. Because addiction is influenced by both
genetic and environmental factors and often perpetuates intergenerational cycles, the literature
strongly supports trauma-informed, family centered treatment approaches. Models that
conceptualize addiction as a disease, prevention-focused frameworks, and expressive modalities
like art therapy all contribute valuable strategies that enhance communication, emotional

ART THERAPY FOR CHILDREN OF ADDICTED PARENTS
regulation, and engagement when integrated with established interventions such as 12-step
programs. Together, these findings underscore the need for a multidisciplinary approach that
prioritizes the entire family system to support more comprehensive and sustainable recovery.

37

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Section III: Methodology
The following curriculum is created for master's level art therapy clinicians to use with
adolescents affected by a parent’s addiction and is intended to be used alongside the Al-Anon
framework, including its teen focused version, Alateen. This curriculum is built around the 12step structure of Alcoholics Anonymous (AA), and it includes art therapy interventions that
coincide with each step. These interventions will help participants process their experiences,
build coping skills, and gain new perspectives on their parent’s addiction. Al-Anon and Alateen
are community based, which allows clinicians using this curriculum to provide support. This
structure also allows participants to move at their own pace, engaging in creativity designed to
foster resilience and emotional growth.
Target Audience
This curriculum is designed for master's level art therapy clinicians to use in working
with children of parents struggling with addiction, alongside an Al-Anon framework. Alateen is
a specific Al-Anon program for teens and is open to those aged 11-19 who feel their lives have
been affected by someone else’s drinking. That could be a parent, another loved one, or a friend.
Participants can attend even if the addicted individual is no longer in their life or sober. Alateen
tends to follow the general structure of AA, which does have a religious backing, however no
specific belief system is required for participants to attend. The focus in meetings is on the
teenagers' experience only, not the addicted individual who has affected them. Individuals are
not allowed if they themselves are struggling with addiction of some kind, as this program is not
meant to be used as therapy or counseling. This program may take place in a community setting,
such as a community center, and is should be open to anyone interested who meets the above
criteria.

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Curricular Structure
This curriculum will include art therapy interventions that coincide with the 12 steps,
adopted from AA, that Alateen also follows. Participants are able to work through the steps as
quickly or slowly as they need to and can work through all 12 multiple times if needed as well.
The primary intention of an Al-Anon program, and similar programs for other substances, is to
help participants develop or strengthen new or existing coping skills and help give them a new
perspective on dealing with addictive substance affecting their loved one. Each of the 12 steps
will have two or three art interventions that should be used alongside existing programming,
under the leadership of a master's level art therapist. Multiple interventions will be included with
each step, as some participants might take longer than others to work through some or all of the
steps. Paired with each intervention will be an explanation of the activity alongside required
materials and rationale. Participants can take as many sessions as they need to work through each
step, and sessions will be an hour long and meet at least once a week.
Curricular Outline
This curriculum is intended to be used alongside the 12-steps adopted from AA. There
will be two or three interventions per step, and the steps can be cycled through multiple times as
needed. There is no set timeline for how slowly or quickly participants should work through each
step; they can move at their own pace and use as many art interventions per step as they feel they
need. This curriculum will start with a brief introduction explaining its intended purpose, why art
therapy is being included, and brief explanation of the 12 steps that the art therapy interventions
will be accompanying. It will then move into brief sections about requirements for those
facilitating these sessions, as well as of individuals participating. This curriculum will end with a
longer section listing each of the 12 steps and their accompanying art therapy interventions. Each

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40

intervention will be described in greater detail with step-by-step instructions for those facilitating
and participating.
I. Introduction
a. Purpose of curriculum and intended audience
b. Why inclusion of art therapy
c. 12-Steps (adopted from AA)
II. Facilitator Requirements
a. Must be Master’s level art therapy clinician leading art therapy part of sessions
b. Experience in addiction treatment preferred
III. Participant Requirements
a. This curriculum will be used alongside Alateen, Al-Anon for teens, so
participants must be between the ages of 11 and 19 per Alateen guidelines.
b. NOT intended to be social hangout, open to teens who feel they have been
impacted by a loved one or friends alcohol use.
c. CANNOT be dealing substance or alcohol use of their own, as Al-Anon is not
therapy or counseling.
d. Individuals can participate even if addicted individual is no longer in their life.
IV. Accompanying Art Therapy Interventions
a. Step #1 – I admit that my life has become unmanageable as a result of another
person’s substance use, and that I cannot control o fix their behavior.
i. What I Can/Cannot Control Collage
ii.Visual Metaphor Drawing
b. Step #2 – I came to believe that healing and stability were possible through

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support, insight, and personal growth.
i. Hope Symbol
ii. Before and After Image
c. Step #3 – I have committed to focusing my energy on my own well-being, values,
and choices rather than trying to manage someone else’s addiction.
i. Energy Pie Chart
ii. Selt-Portrait with Boundaries
d. Step #4 – I took and honest and compassionate look at myself, examining how my
loves one’s addiction has affected my relationships, behaviors, and thoughts.
i. Life Timeline with Symbols
ii. Mask Making
e. Step #5 – I shared this self-reflection with a trusted person to reduce shame and
isolation.
i. Witness Art Sharing
ii. Paired Drawing
f. Step #6 – I became willing to release patterns that no longer serve me such as
people pleasing, self-blame, or avoidance.
i. Pattern Mapping
ii. Tear-and-Transform Art
g. Step #7 – I practiced self-compassion and actively worked to build healthier
coping strategies and boundaries for myself.
i. Compassionate Letter and Illustration
ii. Soothing Texture Art

ART THERAPY FOR CHILDREN OF ADDICTED PARENTS
h. Step #8 – I identified ways that my actions may have impacted others including
myself.
i. Relational Map
ii. Ripple Effect Drawing
i. Step #9 – I made amends when appropriate, except when doing so would cause
harm to myself or others.
i. Unsent Letter
ii. Symbolic Repair Art
j. Step #10 – I continued regular self-reflection, noticing when old patterns would
return and addressing them with awareness instead of judgment.
i. Visual Check-In
ii. Pattern Alert Symbol
k. Step #11 – I sought clarity, balance, and resilience through reflection,
mindfulness, creativity, or other grounding practices that support emotional
health.
i. Mandala
ii. Breath-Based Art
l. Step #12 – Having experienced personal growth and healing, I shared what I
learned with others and continued to apply these principles in my daily life.
i. Personal Recovery Notebook
ii. Legacy Piece
Conclusion
This curriculum provides a structured and flexible way to integrate art therapy into the

42

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43

Al-Anon, specifically Alateen, framework. It can offer participants an alternative means of
working through the 12-Steps in a way that is creative and supportive. Each step is paired with
developmentally appropriate and intentional art interventions that can help participants better
understand the impact that parental addiction has on their lives, while strengthening coping skills
and exploring emotions. Using an alternative therapy such as art therapy in addition, the already
supportive framework of Al-Anon is enhanced by giving participants additional tools they can
use to navigate their experiences with greater resilience.

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Section IV: Curriculum
This curriculum (see Appendix) was inspired by a desire to add to existing supporting
services for children of parents struggling with addiction, specifically teenagers. It was designed
to follow the already existing model of the 12-steps used with those struggling with addiction, as
well as accompany supporting services for their loved ones such as Alanon for teens, Alateen.
Each of the 12 steps has been slightly modified, while maintaining the same themes and purpose,
in a way that is non-religious, to help reduce any harm being caused to participants who may
have experienced religious trauma. The curriculum (see Appendix) is intended to be used in
tandem to the already existing structure of Alateen meetings. The art therapy sessions
accompanying these Alateen meetings will be separate from the meetings as they require a
licensed art therapy clinician to lead, and Alateen meetings are only peer led. These additional
activities can be completed after meetings for those who feel they could use more support. The
curriculum (see Appendix) promotes greater focus and attention on teenage children of those
struggling with addiction, emphasizing their ability to receive supportive services just as just as
important as that of their parents.
The curriculum (see Appendix) provides guidance on its intended purpose, how it is
meant to be used, as well as requirements for those participating and those leading these
sessions. The interventions outlined are intended to be used alongside each of the 12-steps
adopted by AA. Since Alateen meetings are peer led, these art therapy interventions will be used
in additional sessions, immediately following already scheduled Alateen meetings. They are
required to be lead by a licensed art therapy clinician, which is not the case with Alateen
meetings. Each of the 12 steps is accompanied by two art therapy interventions. Both can be used
or just one for each step, depending on what participants feel they need. Each intervention is

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tailored to fit with the themes and goals of each of the 12-steps, in a way that provides an
additional non-verbal form of processing.
This manual begins with an introduction explaining what it’s intended to be used for and
with, along with a brief explanation of what the 12-steps are and why art therapy is being
included. It then goes on to explain participant and facilitator requirements, as there are specific
requirements for those who participate in Alateen as well as those who are able and qualified to
lead the art therapy interventions. Following the introductory section, a table of contents is
included listing each of the 12 steps as well as each intervention. Each step includes a brief title
that summarized the main topic of the step in a few words, the step fully written out with the
adapted wording explained above, as well as a few keys terms that highlight main themes for
each step. Immediately following each step are two additional pages detailing the included
interventions. Each intervention lists recommended materials, instructions that are easy to
understand, and some suggested processing questions for participants to consider while sharing
their art, if they choose to.
Conclusion
This manual was created to support existing support services for adolescents impact by a
parent, or other caregiver’s addiction, by integrating art therapy with Alateen. It follows a
modified 12-step model, which utilizes adapted non-religious language to be more inclusive. The
program is designed to be used alongside regular Alateen meetings, offering clinician-led art
therapy sessions directly after peer-led Alateen meetings. This approach helps emphasize how
adolescents of caregivers struggling with addiction deserve developmentally appropriate support
that is dedicated to them, and how it should be just as important as support offered for the
individuals struggling with substance use. This program utilizes a structured manual that outlines

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46

its purpose, how it will be implemented, and participation requirements for both adolescents and
facilitators. Again, each of the 12-steps uses adapted non-religious language, key themes that
will be focused on, and two art therapy interventions that can be used flexibly depending on what
participants feel they need. Each intervention includes recommended or required materials,
instructions, and optional proccesisng questions created to promote reflection and sharing.
Overall, this manual offers an approach that is structured but still flexible, and nonverbal in way
that allows for enhanced emotional processing, while complementing the existing peer support of
Alateen.

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Section V: Discussion
Research presented in this paper highlights addiction as a condition that is complex and
multifaceted, and one that extends beyond the individual in ways that significantly impace
families, especially children. The literature discussed highlights neurobiological and
psychological aspects of addiction, explaining changes in brain function, reward and selfregulation, as well the important roles of shame and guilt in supporting or maintaining recovery
for struggling individuals. A prominent theme across this research is the important of
understanding and treating addiction as a family-centered issue, as it often disrupts many areas of
a family including boundaries, roles, and emotional functioning. It also puts children at increased
risks for various challenges including the potential for generational patterns of substance use
where the children develop substance use disorders as well. Literature reviewed strongly
supports the need for care that is trauma-informed and family-focused, suggesting art therapy as
a beneficial approach due to it’s expressive nature that allows for non-verbal processing
supporting resilience and emotional processing. There are some limitations however including
the evaluation of the included manual as well as issues of accessibility, highlighting the need for
more research. Some future research could include testing the manual’s effectiveness, exploring
more long-term outcomes of it’s use, increasing accessibility, and further examining the role of
family-inclusive art therapy approaches supporting these children of parents struggling with
addiction.
Brief Summary of the Research
The literature discussed in this paper demonstrates how complex and multifaceted
addiction is as well as how its effects extend beyond the struggling individual, in a way that can
and often does significantly impact their families, especially any children they may have.

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Various factors play a role in addiction and how it affects someone and those around them.
Neurobiological research emphasizes how addiction changes how the brain functions in areas
such as motivation, reward, and self-regulation, by reinforcing the addictive behavior or
substance use, despite negative consequences. There are also various psychological factors as
play such as shame and guilt in the struggling individual’s life, as well as the lives of their
families and children. These two factors play important roles in how the addiction is maintained,
as well as influencing how recovery happens for the struggling individual. Shame in particular
can often perpetuate maladaptive behaviors, while as guilt on the other hand can sometimes
supported necessary reparative change in the struggling individual’s life.
A primary theme in the above review of the literature, is an emphasis on the importance
of conceptualizing addiction as a family-centered issue, and not solely individual. Family system
theory and other frameworks discussed place an emphasis on addiction disrupting roles,
boundaries, and communication patterns in families. These disruptions often lead to various
degrees of secrecy, instability, and dysfunction. Families can often experience stigma, emotional
pain, and chaos to some degree as well. Children in families of an individual struggling with
addiction might adopt maladaptive roles such as parentification, or maladaptive ways of thinking
and interacting with the world around them due to the unpredictable environments they’ve
experience because of their parent or other loved one’s addiction. Research strongly suggests that
children of parents struggling with addiction of various kinds face significant risks in
developmental, behavioral, and emotional areas. These risks can include higher rates of anxiety
and depression, academic difficulties, and lower self-esteem. These children have a greater risk
of developing addictions themselves due to a mix of environmental and genetic factors. This risk
contributes to the potential for intergenerational cycles of addiction. These factors worsen with

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49

the presence of stigma, discussed earlier, and it’s ability to contribute to isolation and shame
being felt by these families.
The literature emphasizes various developmental differences in how children experience
having a parent struggling with addiction. Younger children experience it differently than older
children by internalizing responsibility or trying to control family dynamics. Adolescents on the
other hand are more vulnerable to substance use themselves, and developing maladaptive coping
behaviors modeled after their parents. The literature emphasizes the importance of family
focused interventions that are trauma informed, in response to these various challenges.
Traditional treatment programs often still focus on the struggling individual, and they are viewed
as not sufficient in treating these individuals and their loved ones. Integrated approaches can be
of a greater benefit by including the entire family, which is why these programs would be
recommended instead. Some valuable perspectives in treating addiction can come from family
disease models and prevention-based models. These models offer interventions that can help
promote coping skills, supportive relationships in the family, and emotional regulation for
everyone.
Art therapy can be a promising alternative treatment for addiction. It's nonverbal and
trauma informed which allows individuals, especially children of all ages, an outlet to express
and process complex emotions, and engage in self-expression in ways that traditional therapies
simply would not allow for. This form of expressive therapy has been shown to support many
areas of treatment including enhancing self-efficacy and activating pathways associated with
reward and healing. This type of therapy can be integrated with other already existing treatment
modalities and programs, such as 12-step programs, by offering strengthened engagement and
therapeutic outcomes. The discussed literature underlines the importance of approaches that are

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50

not only multidisciplinary but also holistic, in order to address the various dimensions of
addiction in neurobiological and psychosocial areas. This literature strongly supports integrating
family centered care with expressive therapies, such as art therapy, to better and more effectively
meet the needs of families affected by addiction in way that best promotes long-term resilience
and recovery.
Discussion
This paper aimed to underscore an important change in how addiction should be understood and
treated, as something that is not isolated and only an individual problem, but instead a systemic
issue that greatly affects entire families, especially children. The literature that has been
reviewed makes it quite clear that treatment often focuses only on the individual struggling with
substance use, which overlooks the harm experienced by their children, which can persist into
adulthood. This would ultimately indicate that current treatment models for addiction are
incomplete. An approach that is more effective is one that recognizes that these children aren’t
only passive bystanders, but that they have their own complex needs and need their own support
that is developmentally appropriate. It also emphasizes the importance of addressing both
dimensions of addiction, psychological and neurobiological, as well as the roles of guilt, shame,
and various disrupted family dynamics.
The integration of alternative therapies such as art therapy would be a meaningful and important
evolution in treatment approaches for this population. It's trauma-informed and primarily nonverbal, which can offer a way for children and adolescents to process experiences that are
difficult to articulate with words, in ways that are developmentally appropriate. This suggests
that healing and treatment for this population should focus on education and coping strategies, as
well as creating spaces for safe expression, emotional regulation, and identify formation. More

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51

broadly, this paper points toward the need for interventions that are more accessibly, holistic, and
family-centered once again. These interventions can bridge the current gap in existing support
services and treatments. The curriculum proposed in this paper offers an approach that is still
theoretical, but implies that integrative approaches, especially those that focus on children, are
incredibly important for promoting and supporting long term resilience while also breaking
cycles of addiction often within families.
Limitations
There are some limitations that should be acknowledged regarding the proposed manual.
There is a limited ability to draw conclusions about the effectiveness of the manual, as no
empirical research was done. Literature discussed strongly supports using both art therapy and
family centered approaches as interventions that can be quite beneficial. However, there still
seems to be more limited research on the use of art therapy with children of parents struggling
with addiction. This proposed manual also has not yet been implemented or evaluated in a realworld setting, so its practical effectiveness and impact on outcomes such as emotional regulation
and coping skills is unknown at this time. Another potential limitation would be regarding
accessibility and generalizability. Experiences of the children mentioned in this paper vary in
many areas such as cultural and environmental factors, which might not be fully accounted for in
the literature review. The manual also needs to be used and facilitated by a master’s level art
therapy clinician, which may limit accessibility, especially in areas that have less access to
resources.
Suggestions for Future Research
Future research should focus on evaluating the effectiveness of the manual through
various methods. Implementing the use of this manual in a real-world setting, while assessing

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52

outcomes such as coping skills development, and emotional expression would provide very
valuable data supporting its use. Longitudinal studies might also be recommended to examine
more long-term impacts of using art therapy with children of parents struggling with addiction,
especially in areas such as improving mental health outcomes for those children into their
adulthood. Studies could also be done that explore and compare differences between the use of
art therapy interventions with standard more traditional approaches such as typical Alateen
participation. Comparing these two treatment types could further emphasize the unique benefits
of nontraditional therapies, such as those that are art-based.
It is also suggested that future research explore ways to expand and adapt these
interventions to better meet needs of diverse populations. This could include increasing
accessibility through programs that are more community or school based, or exploring more
options for implementing this manual and its use with limited resources. Some valuable research
could also be done further examining family inclusive art therapy models, since involving the
entire family as explained previously can benefit communication in the family and overall
functioning. Lastly, as previously explained, there is often a strong connection between addiction
and trauma. Future studies could also focus on the impact of art therapy on trauma-related
symptoms, in the children discussed in this paper. These directions for future research, as well as
others not mentioned, can help strengthen support for the development of interventions for this
population that are more effective, comprehensive, and accessible. Conclusion
This paper explores addiction as a condition that is quite complex and multifaceted, and
one that impacts family systems, extending beyond just the struggling individual. The literature
discussed highlights both psychological and neurobiological aspects of addiction, including how
it disrupts important brain functions such as those related to motivation, and self-regulation. It

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53

also highlights the important roles of shame and guilt. A primary theme in this research is the
importance of understanding and treating addiction as a family-centered issue as it can lead to
disrupted roles in the family, varying degrees of instability, and poor boundaries. Children of
parents and other caregivers struggling with addiction are especially vulnerable facing various
risks of their own including increased risks of academic difficulties, depression, and future
substance use. These risks are often shaped by genetic and environmental factors, and the
experiences related to them can vary developmentally. Younger children might be more likely to
internalize responsibility for the addiction, while adolescents might be more likely to utilize
maladaptive coping behaviors.
In response to these various challenges and risks, this paper has proposed an art therapy
curriculum designed to support Alateen and it’s peer support for adolescents affected by parental
addiction. It's grounded in a modified version of the 12-step model that is non-religious, and
utilizes art interventions that are trauma-informed and structured in a way to promote identity
development, emotional expression, and coping skills for this population. The literature
discussed promotes the importance of both art therapy and family centered treatments, this paper
still acknowledges some limitations. These would be a lack of direct assessment of the
effectiveness of the proposed curriculum, and potential barries to accessibility. Future research
should therefore assess this curriculum’s effectiveness, explore long-term outcomes of it’s use,
and expand accessibility to be better used in diverse populations. This paper overall highlights
the importance and need for addiction treatment approaches that integrate family focused care
and expressive, or other alternative, therapies to better support children and families affected by
addiction.
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