Alcoholism and family roles

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  • SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.

    Also visit the online treatment locator.

SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

Also visit the online treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.

The service is open 24/7, 365 days a year.

English and Spanish are available if you select the option to speak with a national representative. Currently, the 435748 (HELP4U) text messaging service is only available in English.

In 2020, the Helpline received 833,598 calls. This is a 27 percent increase from 2019, when the Helpline received a total of 656,953 calls for the year.

The referral service is free of charge. If you have no insurance or are underinsured, we will refer you to your state office, which is responsible for state-funded treatment programs. In addition, we can often refer you to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. If you have health insurance, you are encouraged to contact your insurer for a list of participating health care providers and facilities.

The service is confidential. We will not ask you for any personal information. We may ask for your zip code or other pertinent geographic information in order to track calls being routed to other offices or to accurately identify the local resources appropriate to your needs.

No, we do not provide counseling. Trained information specialists answer calls, transfer callers to state services or other appropriate intake centers in their states, and connect them with local assistance and support.

  • Suggested Resources

    What Is Substance Abuse Treatment? A Booklet for Families
    Created for family members of people with alcohol abuse or drug abuse problems. Answers questions about substance abuse, its symptoms, different types of treatment, and recovery. Addresses concerns of children of parents with substance use/abuse problems.

    It's Not Your Fault (NACoA) (PDF | 12 KB)
    Assures teens with parents who abuse alcohol or drugs that, "It's not your fault!" and that they are not alone. Encourages teens to seek emotional support from other adults, school counselors, and youth support groups such as Alateen, and provides a resource list.

    After an Attempt: A Guide for Taking Care of Your Family Member After Treatment in the Emergency Department
    Aids family members in coping with the aftermath of a relative's suicide attempt. Describes the emergency department treatment process, lists questions to ask about follow-up treatment, and describes how to reduce risk and ensure safety at home.

    Family Therapy Can Help: For People in Recovery From Mental Illness or Addiction
    Explores the role of family therapy in recovery from mental illness or substance abuse. Explains how family therapy sessions are run and who conducts them, describes a typical session, and provides information on its effectiveness in recovery.

    For additional resources, please visit the SAMHSA Store.

Last Updated: 08/30/2022

Alcohol, Tobacco, and Other Drugs

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Misusing alcohol, tobacco, and other drugs can have both immediate and long-term health effects.

The misuse and abuse of alcohol, tobacco, illicit drugs, and prescription medications affect the health and well-being of millions of Americans. SAMHSA’s 2020 National Survey on Drug Use and Health reports that approximately 19.3 million people aged 18 or older had a substance use disorder in the past year.



  • In 2020, 50.0% of people aged 12 or older (or 138.5 million people) used alcohol in the past month (i.e., current alcohol users) (2020 NSDUH)
  • Among the 138.5 million people who were current alcohol users, 61. 6 million people (or 44.4%) were classified as binge drinkers and 17.7 million people (28.8% of current binge drinkers and 12.8% of current alcohol users) were classified as heavy drinkers (2020 NSDUH)
  • The percentage of people who were past month binge alcohol users was highest among young adults aged 18 to 25 (31.4%) compared with 22.9% of adults aged 26 or older and 4.1% of adolescents aged 12 to 17 (2020 NSDUH)
  • The 2019 National Survey on Drug Use and Health reports that 139.7 million Americans age 12 or older were past month alcohol users, 65.8 million people were binge drinkers in the past month, and 16 million were heavy drinkers in the past month
  • About 2.3 million adolescents aged 12 to 17 in 2019 drank alcohol in the past month, and 1.2 million of these adolescents binge drank in that period (2019 NSDUH)
  • Approximately 14.5 million people age 12 or older had an alcohol use disorder (2019 NSDUH)
  • Excessive alcohol use can increase a person’s risk of stroke, liver cirrhosis, alcoholic hepatitis, cancer, and other serious health conditions
  • Excessive alcohol use can also lead to risk-taking behavior, including driving while impaired. The Centers for Disease Control and Prevention reports that 29 people in the United States die in motor vehicle crashes that involve an alcohol-impaired driver daily


  • STOP Underage Drinking interagency portal - Interagency Coordinating Committee on the Prevention of Underage Drinking
  • Interagency Coordinating Committee on the Prevention of Underage Drinking
  • Talk. They Hear You.
  • Underage Drinking: Myths vs. Facts
  • Talking with your College-Bound Young Adult About Alcohol

Relevant links:

  • National Association of State Alcohol and Drug Abuse Directors
  • Department of Transportation Office of Drug & Alcohol Policy & Compliance
  • Alcohol Policy Information Systems Database (APIS)
  • National Institute on Alcohol Abuse and Alcoholism



  • In 2020, 20.7% of people aged 12 or older (or 57. 3 million people) used nicotine products (i.e., used tobacco products or vaped nicotine) in the past month (2020 NSDUH)
  • Among past month users of nicotine products, nearly two thirds of adolescents aged 12 to 17 (63.1%) vaped nicotine but did not use tobacco products. In contrast, 88.9% of past month nicotine product users aged 26 or older used only tobacco products (2020 NSDUH)
  • Data from the 2019 NSDUH reports that 58.1 million people were current (i.e., past month) tobacco users. Specifically, 45.9 million people aged 12 or older in 2019 were past month cigarette smokers (2019 NSDUH)
  • Tobacco use is the leading cause of preventable death, often leading to lung cancer, respiratory disorders, heart disease, stroke, and other serious illnesses. The CDC reports that cigarette smoking causes more than 480,000 deaths each year in the United States
  • The CDC’s Office on Smoking and Health reports that more than 16 million Americans are living with a disease caused by smoking cigarettes

Electronic cigarette (e-cigarette) use data:

  • Data from the Centers for Disease Control and Prevention’s 2020 National Youth Tobacco Survey.  Among both middle and high school students, current use of e-cigarettes declined from 2019 to 2020, reversing previous trends and returning current e-cigarette use to levels similar to those observed in 2018
  • E-cigarettes are not safe for youth, young adults, or pregnant women, especially because they contain nicotine and other chemicals


  • Tips for Teens: Tobacco
  • Tips for Teens: E-cigarettes
  • Implementing Tobacco Cessation Programs in Substance Use Disorder Treatment Settings
  • Synar Amendment Program


  • Truth Initiative
  • FDA Center for Tobacco Products
  • CDC Office on Smoking and Health
  • National Institute on Drug Abuse: Tobacco, Nicotine, and E-Cigarettes
  • National Institute on Drug Abuse: E-Cigarettes



  • Among people aged 12 or older in 2020, 3.4% (or 9.5 million people) misused opioids in the past year. Among the 9.5 million people who misused opioids in the past year, 9.3 million people misused prescription pain relievers and 902,000 people used heroin (2020 NSDUH)
  • An estimated 745,000 people had used heroin in the past year, based on 2019 NSDUH data
  • In 2019, there were 10.1 million people age 12 or older who misused opioids in the past year. The vast majority of people misused prescription pain relievers (2019 NSDUH)
  • An estimated 1.6 million people aged 12 or older had an opioid use disorder based on 2019 NSDUH data
  • Opioid use, specifically injection drug use, is a risk factor for contracting HIV, Hepatitis B, and Hepatitis C. The CDC reports that people who inject drugs accounted for 9 percent of HIV diagnoses in the United States in 2016
  • According to the Centers for Disease Control and Prevention’s Understanding the Epidemic, an average of 128 Americans die every day from an opioid overdose


  • Medication-Assisted Treatment
  • Opioid Overdose Prevention Toolkit
  • TIP 63: Medications for Opioid Use Disorder
  • Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings
  • Opioid Use Disorder and Pregnancy
  • Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants
  • The Facts about Buprenorphine for Treatment of Opioid Addiction
  • Pregnancy Planning for Women Being Treated for Opioid Use Disorder
  • Tips for Teens: Opioids
  • Rural Opioid Technical Assistance Grants
  • Tribal Opioid Response Grants
  • Provider’s Clinical Support System - Medication Assisted Treatment Grant Program


  • National Institute on Drug Abuse: Opioids
  • National Institute on Drug Abuse: Heroin
  • HHS Prevent Opioid Abuse
  • Community Anti-Drug Coalitions of America
  • Addiction Technology Transfer Center (ATTC) Network
  • Prevention Technology Transfer Center (PTTC) Network



  • The percentage of people who used marijuana in the past year was highest among young adults aged 18 to 25 (34. 5%) compared with 16.3% of adults aged 26 or older and 10.1% of adolescents aged 12 to 17 (2020 NSDUH)
  • 2019 NSDUH data indicates that 48.2 million Americans aged 12 or older, 17.5 percent of the population, used marijuana in the past year
  • Approximately 4.8 million people aged 12 or older in 2019 had a marijuana use disorder in the past year (2019 NSDUH)
  • Marijuana can impair judgment and distort perception in the short term and can lead to memory impairment in the long term
  • Marijuana can have significant health effects on youth and pregnant women.


  • Know the Risks of Marijuana
  • Marijuana and Pregnancy
  • Tips for Teens: Marijuana

Relevant links:

  • National Institute on Drug Abuse: Marijuana
  • Addiction Technology Transfer Centers on Marijuana
  • CDC Marijuana and Public Health

Emerging Trends in Substance Misuse:

  • Methamphetamine—In 2019, NSDUH data show that approximately 2 million people used methamphetamine in the past year. Approximately 1 million people had a methamphetamine use disorder, which was higher than the percentage in 2016, but similar to the percentages in 2015 and 2018. The National Institute on Drug Abuse Data shows that overdose death rates involving methamphetamine have quadrupled from 2011 to 2017. Frequent meth use is associated with mood disturbances, hallucinations, and paranoia.
  • Cocaine—In 2019, NSDUH data show an estimated 5.5 million people aged 12 or older were past users of cocaine, including about 778,000 users of crack. The CDC reports that overdose deaths involving have increased by one-third from 2016 to 2017. In the short term, cocaine use can result in increased blood pressure, restlessness, and irritability. In the long term, severe medical complications of cocaine use include heart attacks, seizures, and abdominal pain.
  • Kratom—In 2019, NSDUH data show that about 825,000 people had used Kratom in the past month. Kratom is a tropical plant that grows naturally in Southeast Asia with leaves that can have psychotropic effects by affecting opioid brain receptors. It is currently unregulated and has risk of abuse and dependence. The National Institute on Drug Abuse reports that health effects of Kratom can include nausea, itching, seizures, and hallucinations.


  • Tips for Teens: Methamphetamine
  • Tips for Teens: Cocaine
  • National Institute on Drug Abuse

More SAMHSA publications on substance use prevention and treatment.

Last Updated: 04/27/2022

Alcoholic family: six destructive roles

Text: Maria Malysheva

posted June 30 ‘21 14:52

Any dependence destroys relationships. It is no coincidence that alcoholism is considered a “family” problem, since it affects everyone in one way or another.

Of course labeling is bad practice. However, this makes it possible to assess the distribution of roles in families facing the problem of addiction. Incidentally, the unhealthy dynamic persists even when the alcoholic stops drinking, dies, or leaves home. Family roles are very stable and are passed down from generation to generation through habitual patterns of behavior. nine0004

Life in a family where there is an alcoholic becomes chaotic and unpredictable, often involving physical and emotional abuse. Parents show emotional neglect, ignoring the needs of the child, as they focus on the alcoholic and his problems. As a result, children feel lonely, feel angry or ashamed. Different strategies help them cope with negative emotions: some try to become perfect, others constantly laugh and grimace, others constantly get into trouble. nine0004

An alcoholic dictates the mood of the whole family, and the rest of its members are forced to walk on tiptoe, forgetting about their own interests, just to maintain a fragile peace and save the family from disintegration.

Addiction and the chaos it causes is the best-kept secret in families where there is an alcoholic. Children are forbidden to talk about what is happening at home. As a result, they grow up with the feeling that something is wrong with them, and they are somehow to blame for the fact that mom or dad drinks.

These six destructive roles can be found in most families with alcohol dependence:


The severity of the disease affects the ability of an alcoholic to perform parental duties. As a rule, over time, the dose and frequency of drinking increases. Alcohol becomes the main way to cope with problems and emotional discomfort. The life of an addict is built around alcohol, and the interests of the family are forced to revolve around the alcoholic - they try to "save" or "protect" him, avoiding outbursts of bad mood. Alcoholics blame their loved ones for their problems, lash out at their spouse and children, become unpredictable, and don't care at all about how their actions affect others. nine0004


Advocate tries to reduce the harm that the alcoholic causes by their behavior by justifying their actions and trying not to notice the problems. He denies that one of the family members is sick, trying to save the family and turning a blind eye.

The defender is ready to do anything to make others consider their family happy and prosperous. Usually this role is played by the alcoholic's spouse or parents, but sometimes an older child can take on the role.


The hero is forced to become the most responsible and conscientious member of the family. Usually this is a perfectionist with an "excellent student syndrome", trying to keep everything under control. If this role is played by a child, he tries to look and act as if everything is in order in his family. He tries to earn respect by demonstrating perseverance, willpower, and academic and athletic achievement. Such children are serious beyond their years and always on their guard. As adults, they join the ranks of hyper-responsible workaholics.


This is the one who is declared guilty of all family problems. The task of the scapegoat is to divert attention from the problems associated with an alcoholic, at least for a while. Usually this is a child who is rejected by his parents and, according to some criteria (features of appearance, temperament, lifestyle), does not fit into the family.

The Clown

The Clown tries to ease tension in the family with the help of humor, jokes and tomfoolery. He constantly fools around and has a reputation for getting into trouble. He is considered infantile and immature, and the Clown supports this belief, willingly exposing himself to ridicule. Humor becomes for such a person a defense against hidden fear and repressed pain. nine0004


This role is often played by a family member who, due to temperament, is used to being invisible. He tries not to attract attention. This is usually a quiet, retiring child who spends most of his time in his room and escapes into a fantasy world, watching TV, playing a computer or reading books avidly.

No matter what role you have been assigned in family dynamics, with the guidance of an experienced psychotherapist, you can overcome its effects and learn to resist pressure. nine0004

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Children's roles in a co-dependent family

Home » Children's Center » Program for parents » Children's roles in a co-dependent family

Material 4

Price "not up to you now". Children: "hero", "scapegoat", "lost child", "clown"

I once had the good fortune to study with Jerry Moe, a child psychologist who works with families of alcoholics and drug addicts. He showed us a living sculpture of an alcoholic family, which I will simply reproduce for you with some comments. nine0004

The main character of the family is the father. He is an alcoholic. He didn't choose to be an alcoholic, he got sick, it just happened. (“Father” stands on the podium: he will become the focus of our attention. Indeed, if you ask a child from a dependent family to draw this dependent, he often turns out to be higher than the rest: he is more important!)

Jerry: “I just want everything to be with him OK. And if it's not, I just have everything falling apart inside! Most of all I worry about him and what I do with him. Should I speak? Or be silent? I just don't know what to do! Sometimes I feel like I've had my fill. Enough, I'll take matters into my own hands and handle it!" (he drags an alcoholic off the podium, but he does not even move, stares at a point on the back wall and does not respond to all efforts. Jerry collapses in exhaustion.). nine0004

- “It's hard for me! When I try to get in touch with him, nothing comes out! We've been fighting for so long. Finally, he also gets tired when I speak, or make him do something.

Father says: “I drink because of you!” This is a delusion, some kind of madness. An alcoholic is a person who goes through life with a knife in his back. And he's the last one to know about it. Sometimes family members say, “You have a knife in your back!” - "What knife?" - the alcoholic is surprised, “It's fun, it's great to drink! So what if it creates problems!” or “Oh, what troubles I have around me, and you’re all about your own again, I drink, I drink . ..” The knife brings such pain that the alcoholic begins to walk so as not to feel pain (the posture is relaxed, moves along the podium on unsteady legs), and then wonders: "Why do I feel so bad?" nine0004

So, the alcoholic needs someone, firstly, to pull the knife out of his back, and secondly, to help heal the wound.

The second character is mother. She stands below, and tries to get her father, who is on the podium, nothing happens. She's scared, she's worried all the time. She wants two simple things: for him to be healthy, and for her to be happy with him. Is it a lot?! Is it strange? But she just can't do it. And then she does what she can: protects him (“mother” stands with her arms outstretched like wings, covers him), takes care of the children (explains something to them, justifies her father), smoothes the consequences of his drinking (calls him at work to justify his absenteeism, etc.). nine0004

Jerry: “Look what's up with dad? He is studying! He has already learned that he can rely on his mother in everything ”(“ father ” lay down on his mother’s back, the position is extremely uncomfortable, but everyone endures it). Who stretches the rest of the money for a month when dad drank his salary? Who washes his dirty pants after a puddle? Mom, how do you feel?

Mom: “It's very hard for me, but I'll still carry it. I will be the one who will save the family."

Jerry: “Look. Mom starts paying for her choice. Who is in pain - both. And who has more negative consequences? - Mom. What are the chances of an alcoholic to change for the better? - none. And you yourself will go to the dentist to drill a tooth if it does not hurt, and you do not feel that something is wrong with the tooth?! How would you describe this marriage? Are these two equal adults who share hopes, dreams, fight together, support each other? No. It's more like parent and child. The parent is trying to get the child to behave.” nine0004

And now children appeared in the family. Children must be loved. This seems self-explanatory, but not in a dependent family. There is no time to love, because there is one main character: an alcoholic. It takes so much attention, it is such a "black hole" into which money, time, in general, all the resources of the family fall - and love too. Therefore, there is not enough for the rest of the family members, they are “on a starvation diet”. "Now is not up to you." Children absolutely need love, attention, they need to be noticed, and for this they also begin to play roles, pulling masks on themselves - just like adults. nine0004

The first way to get noticed is to be helpful. Such a child - often the eldest, but not necessarily - becomes an indispensable mother's assistant. He will look after the kids, and peel the potatoes, and comfort his mother in a not childishly wise way, and he studies well ... He does everything, he can do anything, his mother’s assistant - “you are my good fellow!”. Here, it worked. This child is a hero earning love, instead of getting it as a gift from his parents. He certainly has to be good to be noticed. He must. I must have time, guess, try, I must not get sick, finally. And he copes with everything, because this is the only way he gets his mother's attention, participation in his mother's life and builds his self-esteem on this. Because children build self-esteem in communication with their parents, and here the only way to notice yourself is if there are achievements. His carefree childhood is over, he is a “little man with a fingernail”, a small adult who did not grow up in childhood, but simply became an adult out of necessity. Unfortunately, this will cost him dearly in the future. He does not know how to love "just like that", as they love in childhood - he needs achievements and he will demand achievements and merits from other people. Work will become synonymous with good for him, and he will easily become a workaholic,

plugging up all their life's insufficiencies with work. It will be difficult for him to forgive and accept the shortcomings of other people, and he will sincerely believe in the limitless possibilities of himself ... if you try hard enough. This hero does not know how to only say “no”. The only person he says no to is himself. He is praised from the outside, but inside he is always dissatisfied: he is never enough. There is always a race of achievements inside, and it seems that now, now, I will finally do something - and people will love me, they will say that I am well done, that I am a special person! But that never happens, never! nine0004

Here is another child. He sees that the older brother is doing well, all the A's, and she also wants to be like the older brother, but it doesn't work. Brother is older, smarter. But the other child has something else. All children are very different. They have different gifts and talents! And she discovered that when she does something wrong, she gets attention, a lot of attention! Let it be negative, but how much attention! Now she is the scapegoat in the family. She is spanked, punished, talked about in the family - and she learned: negative attention is better than no attention! And she creates problems in the family (the second child ruins the dress, and mom and dad turn around and everyone points the finger at her!)

What is very important here is that now the focus of attention has shifted from her alcoholic father to her, and this is very beneficial for dad! And she learned: all you need is just to misbehave! If the first child is compulsively set to achieve the goal, then she is compulsively not-achieving the goal! He doesn't want to, he won't - that's all! And proud of it! And as the father's dependence develops, this daughter needs to behave worse and worse! - this is truly a scapegoat. All the anger, anger in the family merges on her, she is disproportionate to the fault of this child! But it is beneficial for the family that someone becomes bad - then the rest will look better. nine0004

("Scapegoat" steps aside) - Jerry: "Look, she's gone! She left home! Indeed, no one is able to endure anger for so long! She is also accused of what she did not do! She is being yelled at in the next room without even knowing what she is doing there! She will join a gang, use drugs, get into a sect… What else can I do to behave badly?

Outside, this child is very angry. We don't like him! But inside - a small, frightened, downtrodden child. He is very hurt and scared. Sometimes he believes that if he behaves really badly, everything will be fine ... "

Here's another girl. It's hard for her, the house is getting worse. Mom is always in trouble, older brother studies well, but it's still a madhouse! And she also leaves, but not as a "scapegoat" - she is at home, but she seems to be gone. She isolates herself, is often silent ... this is a lost child. She's lonely.

When she isolates herself like this, she gets less pain. But she also loses good moments, which sometimes do happen! She is always bullied by the other guys. Do not touch your older brother, he is next to his parents, with the teacher; just hook the other daughter, she has a knife - and then do what you want. (the girl covers herself with a jacket with her head, and they bully her, she does not respond). nine0004

Jerry: “She is the potential victim of physical and sexual abuse. HER is chosen because she is isolated and alone, and therefore more vulnerable. She won't resist and won't tell anyone later. Her closest friends are a pet dog, or a toy, or imaginary friends...they are safe and won't hurt her."

“In this family, each person receives attention, taking it away from dad: they get sick, catch a cold, get into trouble, i.e. There is a good way to attract attention to yourself - get sick! But my stomach hurts, and they say: everything is fine! Maybe I'm crazy? Maybe nothing hurts me? nine0004

The last child in this family has found another way to earn his mother's love - to become his mother's joy. A cute, funny, clumsy baby, if he creates any difficulties in life, more than covering them with his cute funny character. Here's someone who never whines and gets angry! Mom's life with her alcoholic husband is full of fears and disappointments, and here is such a warm little man, and loves mom so much (not like dad) - how can you not love him ?! Growing up, a sense of humor will appear, smoothing, simplifying life, and so pleasing to everyone around! This clown, cute good-natured, will always please and defuse the situation! But if you look closely at him, he has attentive, completely sad eyes, and he carefully watches how you react to him. He never laughs alone. nine0004

Jerry: “Funny songs, funny, awkward clothes… For a couple of minutes attention to him – and everyone laughs! And the worse he is inside, the more problems, the more he is a clown. He pesters the elders, hilariously makes hands and feet, mimics animals, tells adult jokes in a childish voice, so that all adults laugh. At school, he adds gray hair to teachers, but the rest of the guys support him: come on, come on! ... But inside he is scared to death. He's not funny at all. He just earns attention, and is afraid to be alone. nine0004

Both the "hero", and the "clown", and the "scapegoat", and the "lost child" are needed by the family, they have their own role that supports father's drunkenness. For example, one can be proud of a “hero” son and think that everything is not so bad if such a good son has grown up, and he will pick it up if necessary. "Clown" relieves tension in the family and turns everything into a joke. Against the backdrop of the "scapegoat" dad's drunkenness does not look so bad at all, and dad feels very good blaming and teaching such a son. "The Lost Child" is convenient in its invisibility. Children's roles so cleverly fit into alcoholism that they contribute to their continuation. Moreover, when these children grow up, they will reproduce in their families the same roles, the same habitual way of life.

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