A Systematic Review of Qualitative Studies Exploring Lived Experiences,Perceived Impact,and Coping Strategies of Children and Young People Whose Parents Use Substances

Relationship with parent

The relationship between the child and parent who uses substances was often reported as unpredictable, described as a “never ending roller coaster” (Bickelhaupt et al., 2021, p. 7), with fluctuations in the levels of love and affection shown from the parent to the child. A minority voice within some studies included children and young people who reflected that their relationship with a parent who uses substances was not affected (Alexanderson & Näsman, 2017; Bancroft et al., 2004; Bernays & Houmøller, 2011; Fraser et al., 2009; M. Hill et al., 1996; Johnson, 2013; McGuire, 2002; Moore et al., 2011; Reupert et al., 2012; Silva et al., 2013; Tinnfält et al., 2018; Wilson et al., 2012), or even that they enjoyed the affection and generosity from their parents when they had been drinking alcohol (M. Hill et al., 1996). Others deemed such affection as “meaningless” (Bancroft et al., 2004, p. 12), and often described these relationships as being hostile and manipulative, with frequent arguments, tension, and conflict or less frequently reported as a “[roommate] kind of relationship” (Moore et al., 2010, p. 23).

Cycle of use

A common experience for the young people was the uncertainty that resulted from substance use fluctuation from abstinence to heavy use. Such fluctuation was reported to impact the unpredictable and chaotic nature of their parent’s behavior and mood, leading to inconsistent parenting. During periods of abstinence, most studies reported that young people experienced this as good and happy times, where they felt loved and cared for. Periods of substance use were viewed as stressful and scary, leading to issues of unsupervised care, neglect, and creating unsafe environments for children and young people. The unpredictable nature of not knowing when or if their parents would use substances again seemed to affect children and young people’s emotional well-being. During periods of lower use, young people could become anxious or worried about when their parent would drink or use drugs (Bancroft et al., 2004; Bernays & Houmøller, 2011; Fraser et al., 2009; Hagström & Forinder, 2019; L. Hill, 2015; Houmøller et al., 2011; Moore et al., 2011; Nattala et al., 2020; Park & Schepp, 2017; Tinnfält et al., 2018; Wangensteen et al., 2019, 2020). In Moore et al. (2011), a 17-year-old male stated that, “there were the frantic times, when there were weeks when it was worse, or weeks when it seemed completely normal. I would start looking out for stuff during these good times” (p. 167). Younger children were described as having hope that their parents had stopped for good while older children recalled “losing hope” after witnessing several failed attempts by their parents to stop. However, these children began to predict the unpredictable, and were better able to find a path through the insecurity (Alexanderson & Näsman, 2017; Bancroft et al., 2004; Christensen, 1997; D’Costa & Lavalekar, 2021; Moore et al., 2010; Silva & Padilha, 2013; Yusay & Canoy, 2019).

Roles and responsibilities

A further common theme within the literature was the caring responsibilities that children and young people had taken on for other members of their family, which felt unpredictable when parents stopped use and took back the parental role from children (Ahuja et al., 2003; Backett-Milburn et al., 2008; Bancroft et al., 2004; Bernays & Houmøller, 2011; D’Costa & Lavalekar, 2021; Fraser et al., 2009; Hagström & Forinder, 2019; M. Hill et al., 1996; Holmila, Itäpuisto, & Ilva, 2011; Houmøller et al., 2011; Johnson, 2013; Lewis et al., 2021; McGuire, 2002; McLaughlin et al., 2015; Moore et al., 2010, 2011; Murray, 1998; Nattala et al., 2020; O’Connor et al., 2014; Offiong et al., 2020; Park et al., 2016; Ramírez Dávila et al., 2014; Reupert et al., 2012; Ronel & Haimoff-Ayali, 2010; Ronel & Levy-Cahana, 2011; Templeton et al., 2009; Turning Point, 2006). These relationships often resulted in the blurring of roles between being a child, sister, or brother and being a parent to siblings or parents. Such unpredictability led to confusion, tension, and arguments within the family, with young people viewing family members as lacking in care and support or finding it hard to relinquish these roles (Alexanderson & Näsman, 2017; Backett-Milburn et al., 2008; Bancroft et al., 2004; Hagström & Forinder, 2019; Holmila et al., 2011; Johnson, 2013; Moore et al., 2011; Murray, 1998; Park et al., 2016; Ramírez Dávila et al., 2014; Ronel & Haimoff-Ayali, 2010; Turning Point, 2006). In Bancroft et al. (2004), a 17-year-old female reflected on this experience, “I’m used tae daen (to doing) all the tidying and the cooking and like telling [siblings] when tae be in . . . And my mum’s started daen that and . . . it’s like a kind of conflict between us now” (p. 10).

Living arrangements

The lack of stability within their living arrangements and home environment played into the experience of insecurity for children and young people. Young people recalled having transient lifestyles, with frequent moves, often described as chaotic, leading to young people feeling unsettled (Alexanderson & Näsman, 2017; Backett-Milburn et al., 2008; Bancroft et al., 2004; Fraser et al., 2009; L. Hill, 2015; Houmøller et al., 2011; Lewis et al., 2021; McGuire, 2002; Moore et al., 2010, 2011; O’Connor et al., 2014; Offiong et al., 2020; Park et al., 2016; Reupert et al., 2012; Ronel & Haimoff-Ayali, 2010; Tamutienė & Jogaitė, 2019; Templeton et al., 2009; Turning Point, 2006; Wangensteen & Westby, 2019; Wilson et al., 2008). A 10-year-old female recalled her experience of such transience, “I use to live with my mum, but she got a bit ill, so we moved into Gran’s house. Then she got better (sighs), so we moved back down, and then she got a bit ill again, and then she got better . . . That was a big breath! Phew” (L. Hill, 2015, p. 348). Furthermore, some young people also experienced the stress and insecurity of the often-present threat that they would be forced to leave the family home by a parent (Ahuja et al., 2003; Backett-Milburn et al., 2008; Johnson, 2013; Lewis et al., 2021; Nattala et al., 2020; Wilson et al., 2008). When recalling the home environment, some children and young people described it as untidy, unstable and one in which “unsafe adults” frequently visited (Backett-Milburn et al., 2008; Bancroft et al., 2004; Hagström & Forinder, 2019; Houmøller et al., 2011; McGuire, 2002; Moore et al., 2010; Murray, 1998; Park & Schepp, 2018; Park et al., 2016; Reupert et al., 2012; Wangensteen & Westby, 2019). Regardless of their parent’s substance use and subsequent insecurity, many children perceived family as important, felt a strong loyalty to their parents, and wanted to belong to a family (Alexanderson & Näsman, 2017; Backett-Milburn et al., 2008; Bernays & Houmøller, 2011; Dundas, 2000; Houmøller et al., 2011; Moore et al., 2011; Reupert et al., 2012; Tinnfält et al., 2018; Turning Point, 2006; Wangensteen & Westby, 2019; Wilson et al., 2012). Where young people did not have close family relationships, they spoke about developing family-like relationships with others, including friends, social workers, or teachers (Backett-Milburn et al., 2008; Bancroft et al., 2004; McLaughlin et al., 2015; O’Connor et al., 2014; Offiong et al., 2020; Wilson et al., 2008, 2012).

Family adversity

Children and young people commonly experienced interrelating and compounding factors beyond parental substance use, which contributed to the complexity, insecurity, and trauma within children and young people’s lives. These cumulative factors led to one 23-year-old male recounting his experiences as, “the most hellish experience that you could ever imagine” (Backett-Milburn et al., 2008, p. 466). Across most studies, many young people were additionally exposed to parental intimate partner violence and abuse (IPVA), violence and abuse against them directly, siblings or pets, as well as parental mental health problems, intergenerational substance use, or family imprisonment. A minority of young people also recalled incidents when parents forced them to use substances (Alexanderson & Näsman, 2017; Hagström & Forinder, 2019; Nattala et al., 2020). IPVA compounded their difficult situation and was associated with feelings of abandonment and a lack of protection (Alexanderson & Näsman, 2017). However, children and young people spoke more about the harmful impact of parental alcohol use than violence in their families (Templeton et al., 2009), while others perceived parental mental health problems to have a particularly detrimental impact on them (Bancroft et al., 2004).

Emotional impacts

The emotional impacts of living with parental substance use and other adverse childhood experiences, were reported in all studies. Children and young people often reported experiencing mental health problems and feeling “hurt in the inside” (M. Hill et al., 1996, p. 163), including feelings of sadness and depression, fear, anxiety, and worry as well as describing externalized feelings of anger that “erupt like a volcano” (McLaughlin et al., 2015, p. 46). A minority of young people experienced guilt or blame for their parent’s substance use at a young age, before they realized they were not to blame (Bickelhaupt et al., 2021; Christensen, 1997; M. Hill et al., 1996; Mudau, 2018; Murray, 1998; Park & Schepp, 2017; Turning Point, 2006). Additionally, it was often reported that caring responsibilities within the family felt burdensome, whereby young people expressed a sense of loss at not having a normative childhood, missed opportunities for family bonding, and decreased self-esteem and confidence as they abandoned their own needs for the needs of their families. Yet, a minority of young people described such roles as improving their self-esteem (Backett-Milburn et al., 2008; Bancroft et al., 2004; D’Costa & Lavalekar, 2021; O’Connor et al., 2014; Ronel & Haimoff-Ayali, 2010). Siblings also tended to experience and be impacted by parental substance use differently, depending on birth order. Younger siblings often reported being protected or shielded by their older siblings but became more vulnerable if their older siblings subsequently left home. Older siblings had advanced understandings of parental substance use but opportunity for independence and space (Alexanderson & Näsman, 2017; Backett-Milburn et al., 2008; Bancroft et al., 2004; Bernays & Houmøller, 2011; Houmøller et al., 2011; Templeton et al., 2009). Children and young people also reported experiencing low confidence, poor self-esteem, and limited hope for the future (Moore et al., 2010, 2011; Murray, 1998; Nattala et al., 2020; Park et al., 2016; Ronel & Levy-Cahana, 2011). Such emotional distress was described as affecting some children and young people’s physical health, sleep, and diet (Bickelhaupt et al., 2021; Hagström & Forinder, 2019; Holmila et al., 2011; Houmøller et al., 2011; Nattala et al., 2020; Templeton et al., 2009; Velleman et al., 2008).

Stigma and shame

Young people were often impacted by the secrecy of substance use within the family, whereby parents’ continued efforts to hide, disguise, or deny their substance use established the topic as taboo, and created the perception that substance use is embarrassing, shameful, and to be hidden (Backett-Milburn et al., 2008; Barnard & Barlow, 2003; Houmøller et al., 2011). Young people reported feeling great shame and embarrassment when they realized that their families were unlike other families, and that their parent’s behavior was not perceived as “normal” within society. Such induced shame due to the association with parental substance use led to fear of being treated unfairly (Bancroft et al., 2004; Barnard & Barlow, 2003; Bernays & Houmøller, 2011; Christensen, 1997; Dundas, 2000; Holmila et al., 2011; Houmøller et al., 2011; McGuire, 2002; Park et al., 2016) or judged and rejected by others regardless of enacted discrimination (Backett-Milburn et al., 2008; Bancroft et al., 2004; Holmila et al., 2011; Houmøller et al., 2011; McGuire, 2002; Moore et al., 2010; Mudau, 2018; Murray, 1998; Yusay & Canoy, 2019). However, if others found out about parental substance use, stigma, bullying, and discrimination often ensued (Backett-Milburn et al., 2008; Bancroft et al., 2004; Barnard & Barlow, 2003; Bernays & Houmøller, 2011; Fraser et al., 2009; Hagström & Forinder, 2019; M. Hill et al., 1996; Houmøller et al., 2011; McGuire, 2002; Moore et al., 2010; Nattala et al., 2020; O’Connor et al., 2014; Tamutienė & Jogaitė, 2019; Tinnfält et al., 2018; Wangensteen et al., 2020). Experiencing shame, stigma, and discrimination impacted on young people’s emotional development, their ability to trust and develop social relationships, and perpetuated the isolation felt by young people (Bancroft et al., 2004; Hagström & Forinder, 2019; Houmøller et al., 2011; McGuire, 2002; Moore et al., 2010; Mudau, 2018; Nattala et al., 2020; Offiong et al., 2020; Reupert et al., 2012; Tamutienė & Jogaitė, 2019; Turning Point, 2006; Yusay & Canoy, 2019).

Poverty and financial impact

Many young people had been exposed to poverty throughout their lives, with resources further diminished by parental substance use. Exposure to poverty and the financial impact of parental substance use left little money for things such as food, clean clothes, or school fees (Houmøller et al., 2011; McGuire, 2002; Moore et al., 2010; Mudau, 2018; Nattala et al., 2020; Ramírez Dávila et al., 2014; Yusay & Canoy, 2019), and reportedly resulted in some young people feeling shame as well as being bullied (Houmøller et al., 2011; McGuire, 2002; Park & Schepp, 2018; Tamutienė & Jogaitė, 2019). While one study found that children of substance using parents experienced stigma regardless of their socioeconomic status (Hagström & Forinder, 2019), other studies reported a socioeconomic advantage from belonging to a higher social class or lack of exposure to poverty (Bancroft et al., 2004; McGuire, 2002; Ronel & Levy-Cahana, 2011). Within these families, parents could purchase lifestyles which were relatively free of discrimination and stigma relating to their alcohol or drug use, as they could more easily hide it from others. A young person recalled their reasons for not being bullied was because they, “always had the best of gear [clothes]” (McGuire, 2002, p. 26).

Agency and safety

While young people were generally negatively impacted by parental substance use, they were not passive within these experiences and often reported trying to “control the situation” at home or within their family (D’Costa & Lavalekar, 2021, p. 20). Hypervigilance allowed children and young people to notice signs and clues that better prepared them for escalating substance use, imminent conflict, violence, or abuse (Backett-Milburn et al., 2008; Barnard & Barlow, 2003; Bernays & Houmøller, 2011; Bickelhaupt et al., 2021; Christensen, 1997; Fraser et al., 2009; Hagström & Forinder, 2019; L. Hill, 2015; M. Hill et al., 1996; Houmøller et al., 2011; McGuire, 2002; Moore et al., 2011; Tinnfält et al., 2018; Velleman et al., 2008). Being able to identify potentially risky situations allowed young people to adapt, mediate, control, or avoid such escalating situations, keeping them safe and able to survive. Children and young people spoke of ways they enacted agency by taking control of their environment and creating safe spaces for themselves and siblings to escape within an otherwise unsafe home (Ahuja et al., 2003; Backett-Milburn et al., 2008; Bancroft et al., 2004; Bickelhaupt et al., 2021; Christensen, 1997; D’Costa & Lavalekar, 2021; Dundas, 2000; Hagström & Forinder, 2019; M. Hill et al., 1996; Holmila et al., 2011; Houmøller et al., 2011; Johnson, 2013; Nattala et al., 2020; Park & Schepp, 2017, 2018; Park et al., 2016; Ramírez Dávila et al., 2014; Templeton et al., 2009; Tinnfält et al., 2018; Turning Point, 2006; Velleman et al., 2008; Wangensteen et al., 2019; Yusay & Canoy, 2019). In Hagström and Forinder (2019), a 6-year-old boy would, “hide in a small space under the house with a torch” as it was “a scary dark place where no one else dares to go” (p. 16). This allowed children and young people to resist parents’ threatening and controlling behaviors by finding ways to minimize contact with the parent, for example, by taking up hobbies or spending extended periods of time at the homes of others (Ahuja et al., 2003; Alexanderson & Näsman, 2017; Backett-Milburn et al., 2008; Bancroft et al., 2004; Dundas, 2000; Hagström & Forinder, 2019; Holmila et al., 2011; Houmøller et al., 2011; Johnson, 2013; McGuire, 2002; Moore et al., 2010, 2011; Nattala et al., 2020; O’Connor et al., 2014; Park & Schepp, 2017; Reupert et al., 2012; Ronel & Haimoff-Ayali, 2010; Templeton et al., 2009; Tinnfält et al., 2018; Turning Point, 2006; Velleman et al., 2008; Wangensteen & Westby, 2019; Wilson et al., 2012). They also constantly monitored their parent’s reactions, trying to understand their parent’s emotions, and adapted their response to the perceived mood (Bernays & Houmøller, 2011; D’Costa & Lavalekar, 2021; Dundas, 2000; Hagström & Forinder, 2019; Park & Schepp, 2017; Park et al., 2016; Reupert et al., 2012; Tinnfält et al., 2018; Yusay & Canoy, 2019). In Reupert et al. (2012), an 8-year-old boy recalled, “It’s important that I am good and [do] not make dad angry” (p. 157). Additionally, gaining independence from the family allowed young people a sense of control over their relationships and to put their needs first (Backett-Milburn et al., 2008; Bancroft et al., 2004; Bernays & Houmøller, 2011; Bickelhaupt et al., 2021; Hagström & Forinder, 2019; Houmøller et al., 2011; Park & Schepp, 2017; Ramírez Dávila et al., 2014; Ronel & Haimoff-Ayali, 2010; Wangensteen et al., 2019; Wilson et al., 2012). However, it was difficult for some children and young people to fully gain independence from these relationships (Ahuja et al., 2003; Backett-Milburn et al., 2008; Bancroft et al., 2004; Houmøller et al., 2011; Wilson et al., 2012), even more so for young people living in societies where cultural norms expected children to support their aging parents (Park et al., 2016).

Controlling parental substance use and conflict

Some children described trying to control their parent’s substance use by hiding or throwing away substances or hiding money (Ahuja et al., 2003; Backett-Milburn et al., 2008; Bancroft et al., 2004; D’Costa & Lavalekar, 2021; Fraser et al., 2009; Hagström & Forinder, 2019; M. Hill et al., 1996; Moore et al., 2011; Nattala et al., 2020; Tinnfält et al., 2018). As they aged and gained power, in terms of physical, relational, and emotional strength, young people reported mediating conflict, by putting themselves in harm’s way to protect their non-using parent or siblings and to defuse escalating arguments (Ahuja et al., 2003; Alexanderson & Näsman, 2017; Bancroft et al., 2004; Barnard & Barlow, 2003; Bernays & Houmøller, 2011; D’Costa & Lavalekar, 2021; Hagström & Forinder, 2019; M. Hill et al., 1996; Holmila et al., 2011; Houmøller et al., 2011; Johnson, 2013; McGuire, 2002; Moore et al., 2011; Nattala et al., 2020; Park & Schepp, 2018; Park et al., 2016; Ramírez Dávila et al., 2014; Ronel & Haimoff-Ayali, 2010; Silva & Padilha, 2013; Templeton et al., 2009; Tinnfält et al., 2018; Velleman et al., 2008). Some also tried to confront their parent about substance use or gave ultimatums (Backett-Milburn et al., 2008; Bancroft et al., 2004; Christensen, 1997; Hagström & Forinder, 2019; Holmila et al., 2011; Johnson, 2013; McGuire, 2002; McLaughlin et al., 2015; Nattala et al., 2020; Park & Schepp, 2017; Templeton et al., 2009; Turning Point, 2006; Yusay & Canoy, 2019).

To avoid conflict between their parents, some young people recalled withholding information about their experiences from their non-using parent (Alexanderson & Näsman, 2017; Dundas, 2000; Hagström & Forinder, 2019; Johnson, 2013; Park et al., 2016; Turning Point, 2006) or more rarely, by contacting services, for example, police or social care, to help diffuse situations (Holmila et al., 2011; Tamutienė & Jogaitė, 2019). Where they could, young people reported trying to avoid putting themselves into danger when they lived between separated parents, by calling to see if their parent was sober before returning home (Alexanderson & Näsman, 2017; Hagström & Forinder, 2019). Trying to control escalating situations between their parents with context-specific expertize, and negotiating the boundaries between risk and safety, were intended to get themselves or others out of harm’s way. However, some experienced repercussions, in terms of violence toward them or their family (Ahuja et al., 2003; Alexanderson & Näsman, 2017; Backett-Milburn et al., 2008; Bancroft et al., 2004; M. Hill et al., 1996; Moore et al., 2010; Mudau, 2018; Nattala et al., 2020; Powell et al., 2021; Ramírez Dávila et al., 2014).

Coping with the emotional impacts

Children and young people reported seeking to resist the emotional impacts of parental substance use by writing in journals, practicing mindfulness, or taking part in fun activities (D’Costa & Lavalekar, 2021; Dundas, 2000; Hagström & Forinder, 2019; Holmila et al., 2011; Tinnfält et al., 2018; Velleman et al., 2008). More passive strategies used to cope, for example, avoiding thinking about their circumstances, reportedly had negative consequences on their mental health (Backett-Milburn et al., 2008; Bickelhaupt et al., 2021). Other young people externalized their emotions through anti-social behaviors including violence and bullying, offending, or substance use (Ahuja et al., 2003; Alexanderson & Näsman, 2017; Backett-Milburn et al., 2008; Bancroft et al., 2004; Barnard & Barlow, 2003; Bickelhaupt et al., 2021; Fraser et al., 2009; Hagström & Forinder, 2019; L. Hill, 2015; Holmila et al., 2011; Lewis et al., 2021; Moore et al., 2010; Murray, 1998; O’Connor et al., 2014; Offiong et al., 2020; Park et al., 2016; Ronel & Haimoff-Ayali, 2010; Ronel & Levy-Cahana, 2011; Tamutienė & Jogaitė, 2019; Templeton et al., 2009; Tinnfält, Eriksson, & Brunnberg, 2011; Tinnfält et al., 2018; Turning Point, 2006; Wilson et al., 2008). Some young people also reported self-harming behaviors to cope with the emotional impact (Bickelhaupt et al., 2021; Holmila et al., 2011; Nattala et al., 2020; Tamutienė & Jogaitė, 2019; Velleman et al., 2008). In Tamutienė and Jogaitė (2019), a 17-year-old female reflected on her experiences of how her externalized behaviors showed emotional impact as well as a call for help that she did not receive, when she, “stopped attending classes, started talking to teachers harshly and later started self-harming.” “I was showing how bad it was for me, and later, I started consuming alcohol and drugs at school” (p. 215).

Resisting the social impacts

The majority of children and young people made efforts to hide their parents’ substance use in order to reportedly resist the social impacts of parental substance use, including stigma, embarrassment, and fear of endangering social relationships (Backett-Milburn et al., 2008; Bancroft et al., 2004; Barnard & Barlow, 2003; Bernays & Houmøller, 2011; Christensen, 1997; D’Costa & Lavalekar, 2021; Hagström & Forinder, 2019; M. Hill et al., 1996; Holmila et al., 2011; Houmøller et al., 2011; McGuire, 2002; Moore et al., 2010; Murray, 1998; Nattala et al., 2020; Park & Schepp, 2018; Park et al., 2016; Reupert et al., 2012; Tamutienė & Jogaitė, 2019; Templeton et al., 2009; Tinnfält et al., 2011; Tinnfält et al., 2018; Turning Point, 2006; Velleman et al., 2008; Wangensteen et al., 2020; Wilson et al., 2008; Yusay & Canoy, 2019). An 18-year-old female recounted her reasons for non-disclosure, “I didn’t really like to talk to my friends about it . . . it was embarrassing, who wants to admit their families are alkies?” (Turning Point, 2006, p. 12). For some young people, the experience of parental drug use was seen as more stigmatizing and embarrassing to disclose than parental alcohol use (Barnard & Barlow, 2003). Other less-cited reasons for choosing not to disclose included fear of removal from the family, fear of repercussions for the parent or being disloyal, and fear of violent repercussions. Conversely, some young people also enacted agency by choosing to tell someone about their parent’s substance use, sometimes but not always, with favorable supportive outcomes (Alexanderson & Näsman, 2017; Backett-Milburn et al., 2008; Bancroft et al., 2004; Bernays & Houmøller, 2011; Christensen, 1997; D’Costa & Lavalekar, 2021; Hagström & Forinder, 2019; L. Hill, 2015; Holmila et al., 2011; Houmøller et al., 2011; Johnson, 2013; McGuire, 2002; McLaughlin et al., 2015; Moore et al., 2010; Mudau, 2018; Nattala et al., 2020; Park & Schepp, 2018; Powell et al., 2021; Tamutienė & Jogaitė, 2019; Templeton et al., 2009; Tinnfält et al., 2011; Tinnfält et al., 2018; Turning Point, 2006; Velleman et al., 2008; Wangensteen et al., 2019; Wilson et al., 2012). Moreover, younger children did not always choose to speak to people but enacted small gestures of defiance to their parents’ hidden use by talking to pets or toys (Hagström & Forinder, 2019; Holmila et al., 2011; McLaughlin et al., 2015), for example, a 6-year-old-boy stated, “I talk to the bird. She’s a friend. I tell my secret to the bird. I only whisper it to her” (Hagström & Forinder, 2019, p. 17). While young people were finding ways to show resistance, it also highlighted their isolated and lonely position.

Sources of support

Emotional and social support were mainly cited as being provided by older siblings, a non-using parent, an extended family member, friend, or neighbor (Alexanderson & Näsman, 2017; Backett-Milburn et al., 2008; Bancroft et al., 2004; Bernays & Houmøller, 2011; D’Costa & Lavalekar, 2021; Dundas, 2000; Hagström & Forinder, 2019; L. Hill, 2015; M. Hill et al., 1996; Holmila et al., 2011; Houmøller et al., 2011; Johnson, 2013; Lewis et al., 2021; McGuire, 2002; McLaughlin et al., 2015; Mudau, 2018; Nattala et al., 2020; O’Connor et al., 2014; Offiong et al., 2020). However, these forms of informal support were not always accessible, long-lasting, or safe, as some of these relationships were seen as inducing further risk to the young person, especially friends who encouraged substance use and offending behaviors (Backett-Milburn et al., 2008; Bancroft et al., 2004; McGuire, 2002; Ronel & Haimoff-Ayali, 2010; Ronel & Levy-Cahana, 2011; Tamutienė & Jogaitė, 2019; Wilson et al., 2008). Less often, young people reflected on the formal support they had received from within the healthcare, social care, and education systems that reportedly provided both help and hindrance (Backett-Milburn et al., 2008; Bancroft et al., 2004; Bernays & Houmøller, 2011; Fraser et al., 2009; Houmøller et al., 2011; Johnson, 2013; McGuire, 2002; McLaughlin et al., 2015; Moore et al., 2010; O’Connor et al., 2014; Offiong et al., 2020; Powell et al., 2021; Tamutienė & Jogaitė, 2019; Tinnfält et al., 2011; Turning Point, 2006; Wangensteen & Westby, 2019; Wilson et al., 2008, 2012).

Within both formal and informal forms of support, children and young people viewed interactions that were genuine, caring, compassionate, and non-stigmatizing, as helping them to feel safe and trust the other person. To build these relationships, young people spoke of needing time, consistency, flexibility, and “the need for someone stable” (Offiong et al., 2020, p. 4). Within formal forms of support provision, it was the informal approach that was often seen as most useful, for instance, a head teacher who allowed a young person who was having a difficult day to “sit in a corner on a beanbag and work in her office” and to “have a cup of tea and a biscuit” (Houmøller et al., 2011, p. 59). However, children and young people also reflected that the quality of the relationship could be detrimental to support provision when the opposite occurred, including lack of trust, lack of consistency due to high turnover of staff, rigidity in the support provided, and feeling like they are being pressured for information. Further, some young people had experienced stigma and prejudice from professionals within education (Backett-Milburn et al., 2008; Bancroft et al., 2004; McGuire, 2002; Nattala et al., 2020; Tamutienė & Jogaitė, 2019; Wilson et al., 2008), social care (McGuire, 2002), healthcare (Hagström & Forinder, 2019) or from a range of practitioners in the health, care, and education system (Wangensteen et al., 2020), impacting the support they received. Moreover, young people stated that the lack of action or adequate action when disclosure occurred left them feeling abandoned and less likely to seek further support (Bancroft et al., 2004; Hagström & Forinder, 2019; Houmøller et al., 2011; Tamutienė & Jogaitė, 2019; Templeton et al., 2009; Tinnfält et al., 2011; Turning Point, 2006; Velleman et al., 2008; Wangensteen et al., 2019). Some young people also recalled times when they did not meet the eligibility criteria or age restrictions for support, leaving them further isolated (Moore et al., 2010; Offiong et al., 2020; Wilson et al., 2008).

School environment

School was frequently cited within studies, often viewed by young people as a place of safety and support, but not without risk. Primary school was reported as a place for young people to see friends, explore hobbies, and have time for them away from concerns at home (D’Costa & Lavalekar, 2021; McLaughlin et al., 2015). However, problems tended to arise at secondary school where it became a place to worry about home, often leading to young people skipping school (Backett-Milburn et al., 2008; Barnard & Barlow, 2003; Dundas, 2000; Hagström & Forinder, 2019; L. Hill, 2015; Lewis et al., 2021; Moore et al., 2010; Nattala et al., 2020; O’Connor et al., 2014; Turning Point, 2006) or struggling to keep up with their schoolwork (Holmila et al., 2011; Moore et al., 2010; Mudau, 2018; Nattala et al., 2020; Park & Schepp, 2017; Templeton et al., 2009; Turning Point, 2006). Achieving and doing well at school was viewed as a useful strategy to lead a successful life (Ahuja et al., 2003; Bancroft et al., 2004; Bickelhaupt et al., 2021; D’Costa & Lavalekar, 2021; Hagström & Forinder, 2019; M. Hill et al., 1996; Houmøller et al., 2011; Nattala et al., 2020; Park & Schepp, 2017, 2018; Ramírez Dávila et al., 2014; Ronel & Haimoff-Ayali, 2010; Ronel & Levy-Cahana, 2011; Turning Point, 2006; Wangensteen & Westby, 2019; Wilson et al., 2008). However, this was not always easy, due to some young people being excluded or suspended for their unacceptable behavior, further isolating them from social and professional support (Bancroft et al., 2004; Tamutienė & Jogaitė, 2019; Turning Point, 2006; Wilson et al., 2008). Young people reported wanting school staff to recognize the impacts of parental substance use on children, to improve referral and early access to support (Hagström & Forinder, 2019; Holmila et al., 2011; Moore et al., 2011; Tamutienė & Jogaitė, 2019; Tinnfält et al., 2011; Turning Point, 2006). While externalized behaviors were reported as being easier to identify, this was not always the case for internalized feelings such as anxiety or fear, due to some pretending that everything was okay, to not incur social stigma (Bernays & Houmøller, 2011; D’Costa & Lavalekar, 2021; Houmøller et al., 2011; Tinnfält et al., 2011). A young person reflected, “even though I was having them problems at home I didn’t let it show in school. I’d still come in and do my work and act like a normal kid” (Houmøller et al., 2011, p. 28).

(Un)helpful helping

The focus of services on supporting the parent and ignoring the needs of the child was reportedly experienced negatively by young people as they wanted support for themselves (Alexanderson & Näsman, 2017; Moore et al., 2010; Tamutienė & Jogaitė, 2019; Wangensteen et al., 2019). A 21-year-old male expressed that “people keep talking about my mother: Your mum is on drugs, your mum is off drugs, your mum is in treatment . . . I do understand it, but we never talked much about me” (Wangensteen et al., 2019, p. 205). Support that included the whole family was viewed as useful when it alleviated family stress and conflict or improved family connectedness (Moore et al., 2010, 2011; Reupert et al., 2012; Tinnfält et al., 2018) but it was hard to talk openly in front of parents (Bancroft et al., 2004). Other young people wanted to have family support that focused on members of the family separately but concurrently (Moore et al., 2010). Kinship care was usually viewed positively (Bancroft et al., 2004; Fraser et al., 2009; L. Hill, 2015; Lewis et al., 2021), but did not always solve the emotional impact (Christensen, 1997). Young people wanted practical and financial aid to support the family (Moore et al., 2010, 2011; Park & Schepp, 2018; Powell et al., 2021; Reupert et al., 2012; Tamutienė & Jogaitė, 2019; Templeton et al., 2009; Velleman et al., 2008) or substance support for their parents alongside their own emotional support (Christensen, 1997; Holmila et al., 2011; McGuire, 2002; Moore et al., 2010; Reupert et al., 2012). Understanding more about substance use was viewed as useful and was sometimes searched for online (Bernays & Houmøller, 2011; Bickelhaupt et al., 2021; D’Costa & Lavalekar, 2021; Houmøller et al., 2011; Johnson, 2013; Murray, 1998; O’Connor et al., 2014; Park & Schepp, 2017, 2018; Turning Point, 2006; Velleman et al., 2008; Wangensteen et al., 2019; Wangensteen et al., 2020). Being involved in religious communities (D’Costa & Lavalekar, 2021; M. Hill et al., 1996; McLaughlin et al., 2015; Nattala et al., 2020) or meeting with those in similar situations were also sources of useful support (Bancroft et al., 2004; L. Hill, 2015; M. Hill et al., 1996; Holmila et al., 2011; McLaughlin et al., 2015; Moore et al., 2011; Moore et al., 2010; Mudau, 2018; Powell et al., 2021; Reupert et al., 2012; Tinnfält et al., 2011; Turning Point, 2006; Velleman et al., 2008).