US Youth Exposed to Parental Substance Use Disorder in the Home: A Comparison of DSM-IV and DSM-5 Criteria.

purposeYouth (children and adolescents under 18 yrs) exposed to parental substance use disorder (SUD) are at high risk for poor outcomes that include substance use, psychopathology, and child welfare involvement. With the changing SUD criteria from DSM-IV to DSM-5, revised estimates of youth exposed to parental SUD in the home are needed to provide more recent estimates and investigate whether the change from DSM-IV to DSM-5 may change estimated SUD exposure.

methodsNationally representative data from the 2020 National Survey on Drug Use and Health were used. Weighted counts of youth exposed to parental nonnicotine SUD in the home were estimated using both DSM-IV and DSM-5 criteria, which were assessed for every substance used by the parent in the past year; further analyses estimated counts by parental race/ethnicity, sex, household income, urbanicity, and substance leading to the SUD diagnosis.

resultsParents with DSM-IV SUD had an estimated 9,341,336 youth in their households, versus an estimated 16,937,783 using DSM-5 criteria (81.3% greater). Larger increases were observed in Asian (262.9%) or multiracial (161.9%) parents versus parents of other racial/ethnic groups and in parents with cannabis use disorder (246.4%), with smaller increases observed in parents with alcohol use disorder (71.2%). DISCUSSION: The change from DSM-IV to DSM-5 criteria resulted in a large increase in youth exposed to parental SUD. The health needs of these youth will require large-scale planning to limit poor outcomes in the roughly 17 million exposed youth; family-based interventions may help limit harms to all members of the family.