Families in which substance use disorders are present may experience forms of instability and emotional strain that affect the entire household, not only the individual using substances. For children and other close relatives, these disruptions can alter how they understand caregiving and their sense of self well into adulthood (Barnard and McKeganey 2004; Jesuraj 2012). When addiction is treated mainly as an individual responsibility, the needs and perspectives of surrounding family members may receive limited attention or support (Daley et al. 2018).
Current research implies that children in these environments often assume responsibilities beyond their developmental stage, navigate secrecy or social judgment related to their family's addiction, and later seek alternative communities or coping strategies to manage the emotional remnants of these experiences (Kelley et al. 2007; Van Namen et al. 2023). Although fewer studies have examined how these processes work together, less is known about how stigma influences role reversals, how early caregiving may contribute to patterns of achievement or over-functioning in adulthood, and how individuals search for community or belonging as a counterweight to isolation.
This study addresses that gap by investigating how family members of individuals with substance use disorders explain the connections between childhood responsibility, adult identity, and their orientation toward community or spirituality. Guided by family systems theory and labeling theory, the analysis focuses on the processes of taking on adult roles in childhood alongside stigma, achievement, and responsibility as coping strategies in adulthood, and spirituality or community belonging as pathways out of isolation (Rootes, Jankowski, and Sandage 2009; Raybeck 1991; McIntosh and McKeganey 2000). By focusing on the narratives of adult women with close relatives who use or used substances, this study aims to clarify how family role dynamics and broader social narratives about addiction overlap to shape identity, coping, and belonging.
Background
Families and Substance Use Disorders
Research on families affected by substance use disorders focuses on how addiction may disrupt daily life through emotional volatility, economic strain, and unpredictable patterns of caregiving. Scholars have described that children often experience chronic stress and inconsistent emotional availability, which can influence their sense of safety, attachment, and emotional regulation (Barnard and McKeganey 2004; Jesuraj 2012). These patterns may continue into adulthood, impacting how they form relationships and interpret responsibility.
A common theme across this literature is the role of stigma, which often frames substance use as an individual or moral failing rather than a relational or structural concern. From a labeling theory perspective, families associated with addiction may internalize stigmatizing narratives, leading to secrecy, limited disclosure, and caution around seeking support (Raybeck 1991). This dynamic may create an environment in which emotional strain is intensified by isolation, as family members work to protect themselves or others from social judgment. Despite the literature documenting these effects, few studies explore how stigma interacts with family role patterns and identity development across the life course.
Role Reversals and Caregiving Expectations
Children of individuals with substance use disorders are often described as taking on responsibilities that society typically associates with adults. Some scholars refer to this as parentification, a process in which children provide emotional support to caregivers, supervise siblings, or manage household tasks due to parental incapacity (Kelley et al. 2007). The concept explains how children may “grow up early” in order to maintain family stability.
However, critiques of the term bring to light the idea that what constitutes “too much” responsibility for a child depends on gendered and cultural expectations. The idea can imply dysfunction without accounting for the possibilities of limited support or the absence of community resources. Family systems theory provides an alternative perspective, suggesting that when something compromises a family member’s ability to function, others often shift roles to maintain the system's functioning. From this angle, role reversals are not exclusively signs of parental failure but can also reflect adaptive strategies in strained environments.
Importantly, caregiving expectations within families are not evenly distributed. Scholars have noted that responsibility and emotional labor are often gendered, with daughters more likely to assume adult-like roles during periods of family disruption (Burton 2007). Burton’s concept of childhood adultification brings to light how girls’ early caregiving is frequently interpreted as maturity or resilience rather than as an adaptive response to instability. When such role reversals are normalized, the emotional costs of sustained responsibility may be overlooked, even as these expectations become embedded in identity and reinforced across the life course. In families affected by substance use disorders, this dynamic may contribute to patterns of over-functioning and self-reliance that persist into adulthood.
Research indicates that early responsibilities can impose emotional burdens while also developing competencies, establishing patterns of self-reliance, and creating subsequent caregiving inclinations. When caregiving responsibilities are assumed during key developmental periods, they may become internalized as stable aspects of identity rather than temporary adaptations (Elder, Johnson, and Crosnoe 2003). Over time, these internalized expectations can shape orientations toward work, relationships, and responsibility in adulthood, making it difficult to disengage from over-functioning roles. However, the current study clearly highlights how these initial roles may persist into adulthood through achievement, over-functioning, and caregiving-oriented professions, an area seldom examined by research.
Stigma, Isolation, and Social Support
Stigma associated with substance use disorders influences not only those who use substances but also their family members. Fear of judgment or blame may lead relatives to conceal the addiction or distance themselves from potential sources of support. Labeling theory suggests that these patterns reflect efforts to avoid being associated with a stigmatized identity, which can reinforce feelings of shame and restrict help-seeking (Raybeck 1991).
Scholars of social support emphasize that connection to others, through kin, peer groups, community organizations, or religious institutions, can buffer the effects of chronic stress. Research on families and recovery indicates that spirituality and religious communities may offer meaning, structure, and belonging for those navigating the long-term impacts of addiction within their families (Weinandy and Grubbs 2021). Supportive networks may facilitate coping by reducing isolation and offering alternative narratives about self-worth, responsibility, and agency.
However, most prior research has focused on individuals who struggle directly with substance use. Less attention has been given to how their family members, especially adult children, seek or avoid community as they reconstruct identity in the aftermath of earlier family instability. For some, patterns of secrecy or over-responsibility may continue to influence how they enter relationships, pursue careers, or determine what kinds of communities feel safe.
Building on classical labeling theory, modified labeling theory suggests that the consequences of stigma do not depend only on whether an individual is formally labeled, but on whether they anticipate being devalued and discriminated against (Link et al. 1989). According to this theory, individuals who are closely associated with stigmatized conditions–for example, family members of people with substance use disorders–often develop expectations of rejection or social distancing, even in the absence of direct discrimination. These expectations alter coping strategies, promoting secrecy and heightened self-monitoring, as well as efforts to present oneself as “normal” or morally distinct. Importantly, modified labeling theory suggests that these strategies may reduce immediate social harm while simultaneously increasing long-term psychological strain and social isolation. In the context of addiction-affected families, this study helps explain why participants described concealing family struggles and over-functioning to strive for achievement as protective responses to anticipated stigma, rather than reactions to overt judgment. These findings suggest that stigma operates not only through external labeling, but through internalized vigilance that structures identity and belonging across the life course.
Methods
Study Design
This study used a qualitative design to explore how family members of individuals with substance use disorders cope with their experiences and whether the effects from childhood persist into adulthood. The objective was to document participants' personal narratives, emotional experiences, and the construction of meaning within the framework of addiction-affected families. Because the study sought depth rather than breadth, semi-structured interviews were chosen to allow participants to guide the conversation and highlight what felt most important to them.
Participants
Five adult women participated in the study, ranging in age from 20 to 80. Each participant had a close family member–a parent, sibling, or child–who struggled with a substance use disorder. Participants were recruited through community posts on Nextdoor and Instagram. All participation was voluntary, and informed consent was obtained prior to each interview. To protect confidentiality, participants were assigned pseudonyms: Brooke, Carrie, Mary, Linda, and Alyssa. Identifying details, such as specific locations and family member names, were removed from transcripts.
Data Collection
Data were collected in July 2025 through a series of semi-structured interviews, each lasting approximately one hour. Some interviews were conducted in person, while others took place online to accommodate participants’ preferences and schedules. All interviews were audio-recorded with permission. The interview guide included open-ended questions about family dynamics, coping strategies, the role of religion or spirituality, career and personal development, and perceptions of stigma. Participants were also invited to share advice or reflections they would offer to others coping with a loved one’s addiction. Although guiding questions were used, participants were encouraged to lead the discussion to ensure that their individual perspectives shaped the direction of each interview.
Data Analysis
After transcribing the interviews, I read each transcript multiple times to identify recurring themes and patterns across participants. I utilized a comparative methodology to analyze both common and distinct experiences concerning coping mechanisms, emotional adaptation, and the enduring consequences of familial addiction. Reflexivity was central throughout the analysis process; I continuously reflected on my assumptions and emotional reactions to the data. I also debriefed regularly with my faculty mentor to ensure the credibility and clarity of emerging interpretations.
Ethical Considerations
The study followed ethical guidelines consistent with Institutional Review Board (IRB) standards for student research. Participants were informed of their right to withdraw or modify their responses at any time. All data were stored securely, and anonymity was maintained throughout data collection, transcription, and analysis.
The Findings
Three themes emerged from the interviews: taking on adult roles in childhood alongside stigma; achievement and over-functioning as coping strategies; and spirituality or community belonging as pathways out of isolation. Although the participants varied in their relationships to the family member who used substances, they consistently described how addiction reshaped the emotional climate of the family, expectations around care, and their sense of self.
Taking on Adult Roles and Living with Stigma
Across participants, caregiving responsibilities emerged early, often paired with secrecy about what was happening inside the home. What some scholars might describe as parentification– children taking on adult duties–appeared deeply ingrained with stigma and efforts to maintain a façade of normalcy (Kelley et al. 2007). Participants’ stories suggested that these roles were not simply imposed by family dysfunction, but were also shaped by moral judgments surrounding addiction (Barnard and McKeganey 2004; Daley et al. 2018).
Brooke, for example, vividly captured the experience of living in a family that looked stable from the outside but felt as if it were collapsing internally:
Little supportive community. That’s nice. And we’re still friends. [...] Nobody knew what was going on. [...] Well, it's so easy to hide. I used to look at this house that my dad built, and, and you know, I would be walking up the street to the house, and I would say to myself, the house, nobody can tell, but the house is going like this, and the roof is going like this. From the inside. It was like imploding. From the inside.
Her metaphor of the house “imploding from the inside” evokes a family system under pressure, structurally intact yet emotionally unstable. Family systems theory helps understand this image: when one member’s substance use destabilizes the system, others often take on new roles to preserve order (Heiden Rootes et al. 2009). Brooke's statement that "nobody knew what was going on" illustrates the impact of labeling theory; the apprehension of being perceived as a "bad family" fosters secrecy, resulting in an emotional burden that worsens isolation (McIntosh and McKeganey 2000; Raybeck 1991).
Alyssa described a similar inversion of roles, though with more explicit emotional tension:
I felt parentified—like a guinea pig for both parents. I often felt like the mature one in the relationship, like I had to care for them. I felt needed, but not enough to help them fix their issues.
Her reflection reveals both agency and helplessness. She was indispensable yet powerless to change her parents’ behavior. Although she used the word "parentified," her language complicates that label. Rather than simply replacing parental authority, Alyssa’s caregiving existed within a broader absence of support. Being “needed but not enough” captures how early responsibility was accompanied by emotional invisibility, a relational contradiction that continued into adulthood and is not fully captured by standard accounts of parentification (Kelley et al. 2007).
Linda, who spoke in short, deliberate sentences, offered a more restrained account that nevertheless revealed internalized stigma and moral reasoning:
But it’s just the cycle of alcoholism that is... I’m surprised that I broke it. Yeah. I’m very surprised, because I could have very easily gone there. My sister, who’s 90, is still drinking. So it’s just crazy to even... I don’t know. I’m baffled by it. By the addiction. But although it gets to numb pain—I know it’s to numb pain and not deal with conflict. And it’s just too hard. Yeah. It’s the maturity skills of learning to do hard things. And I’m sad that at 90 she hasn’t learned to do hard things.
Her analytical tone– “maturity skills of learning to do hard things”–suggests both empathy and moral distance. Labeling theory helps interpret this tension. Linda recognizes addiction as coping with pain, yet still contrasts herself as the one who “learned to do hard things” (McIntosh and McKeganey 2000; Raybeck 1991). Her self-description reflects how societal narratives of self-control position recovery as moral strength and addiction as failure, even among those directly affected.
Together, these accounts demonstrate that taking on adult roles in addiction-affected families may both protect and burden individuals. They create temporary stability but also reinforce secrecy and internalized stigma, leaving family members responsible for maintaining appearances while managing their own emotional distress (Barnard and McKeganey 2004; Van Namen et al. 2023).
Achievement and Over-Functioning as Coping
For all participants, achievement emerges as a central strategy for regaining control and meaning. Many chose careers in caregiving or social service professions, suggesting that early family roles shaped not only coping but also adult identity formation (Kelley et al. 2007; Van Namen et al. 2023).
Mary’s account offers a clear example:
So my experience was being the child of someone who was addicted and taking on a parenting role in the family. I didn’t feel like I was my mother’s daughter. I felt like I was her mother, and the same for my younger siblings. I have remnants of that. I’m a social worker, have a master’s in social work. My energy went into helping people and making a difference. I never had a close relationship with my mother.
Her statement directly links her early role in the family to her career choice. Through the lens of family systems theory, Mary’s “over-functioning” helped preserve stability at home and later became a professional identity, turning survival skills into expertise (Heiden Rootes et al. 2009). Yet her remark that she “never had a close relationship” with her mother underscores the emotional cost: professional caregiving did not necessarily heal the personal rupture.
Mary later described how this pattern of productivity also served as avoidance:
But in my younger years, it was work really hard and deny that anything bad was happening. Right. You go into paralyzed, and you... You just froze. And survived. That’s basically it.
Here, achievement appears as both resistance and repression, an attempt to regulate fear through constant motion. This pattern aligns with labeling theory’s insight that individuals respond to stigma by performing normalcy and constructing a non-addict-related identity (McIntosh and McKeganey 2000). By working hard and denying pain, Mary both distanced herself from the label of “addict’s child” and reproduced the silence that stigma demands.
Alyssa’s earlier sense of being “needed but not enough” may also help explain why some participants gravitated toward service careers. Achievement offered structure, validation, and purpose, but could simultaneously reproduce feelings of conditional worth. As a group, these participants seemed to transform caregiving from a private burden into a public, professional role–what some scholars might call the “professional ex,” someone who channels lived experience into helping others (Brown 1991). Whether this transformation is adaptive or continues the pattern of over-responsibility remains a critical question.
Spirituality, Community, and Belonging
Participants also described searching for belonging in spaces that were not defined by addiction or caregiving. Some found these through faith; others found them through creative or social communities that allowed different versions of the self to emerge (Heiden Rootes et al. 2009; Weinandy and Grubbs 2021).
Brooke, for instance, found connection and identity in comedy:
I was a manager, personal manager of comedian. That's how I survived. Did I pursue religion? No. Did I pursue science? No, I went into comedy. [...] So one day I met a comic along my travels and he asked me if I wanted to go to a comedy show. And I sat in the back of the room with the comics. And within about 20 minutes, I'm like, oh my God, these are my people. They think as crazy as I do.
Her description of “these are my people” reframes belonging as acceptance without pretense. Within social support and buffering theories, such communities can reduce the psychological impact of stress and stigma by offering nonjudgmental recognition and shared meaning (Bekiros et al. 2022; Weinandy and Grubbs 2021). For Brooke, humor became both a coping mechanism and a form of community, a way to regulate emotions that replaced secrecy with shared absurdity.
Alyssa’s reflections on her mother’s death reveal a different pathway to belonging through spirituality:
Our relationship had dwindled over time, and I hadn't seen her for six years. Her death was sudden; she was only 39. It was very jarring. I feel much better now. When it happened, I didn’t really know what to feel. I was stunned. I cried, but it didn’t fully click for me. Now, spirituality has helped me process it, and I’ve worked on healing my relationship with my mom in my own way.
Her narrative illustrates a kind of redefinition: the creation of new meanings outside stigmatized scripts. Rather than accepting her family story as purely tragic or shameful, Alyssa reinterprets it through spirituality, allowing an ongoing relationship with her mother that acknowledges pain without blame (Heiden Rootes et al. 2009; Weinandy and Grubbs 2021).
Not all participants experienced belonging this way. Carrie, for instance, described relationships where affection felt conditional: “If I can just cook, they’ll let me keep them.” Her statement demonstrates how patterns of service and conditional acceptance can persist, even in adulthood. When communities recognize participants only through their caregiving roles, old dynamics reemerge under new forms (Kelley et al. 2007).
Overall, the accounts suggest that community and spirituality function as partial antidotes to isolation. When social spaces allow participants to be cared for, as well as to care for others, they provide emotional repair that neither achievement nor secrecy could offer (Bekiros et al. 2022; Weinandy and Grubbs 2021).
Discussion
This study suggests that families affected by substance use disorders produce enduring patterns of role reversal, stigma, and relational coping that shape adult identity across contexts. Using family systems theory, these findings highlight how instability prompts members, often daughters, to over-function, assuming responsibilities beyond their developmental stage (Heiden Rootes et al. 2009). Labeling theory explains how social narratives of addiction as moral failure intensify these dynamics by promoting secrecy, internalized stigma, and self-surveillance (McIntosh and McKeganey 2000; Raybeck 1991). Finally, social support and buffering theories help clarify why community and belonging serve as critical points of healing: they offer relational equilibrium that addiction-affected families could not provide (Bekiros et al. 2022; Weinandy and Grubbs 2021).
The stories reveal that taking on adult roles during childhood may appear adaptive in the short term but carries long-term emotional consequences. Participants preserved stability for others while internalizing the conviction that they must perpetually assume responsibility. Over time, this identity transformed into high achievement and caregiving professions, a pattern that simultaneously affirms competence while perpetuating emotional distance (Kelley et al. 2007; Van Namen et al. 2023). This echoes prior research but extends it by showing how such adaptations are maintained not only by family necessity but also by stigma’s continuing influence on self-concept and perceived worth (McIntosh and McKeganey 2000).
Contradictions within the data also stand out. Linda’s moralized framing of “maturity” coexists with empathy for her sister; Brooke’s humor masks exhaustion; Carrie’s caregiving secures acceptance but prevents reciprocity. These mixed patterns illustrate that coping mechanisms are rarely purely adaptive or harmful; they may offer stability while quietly reinforcing the very inequities and silences participants wish to escape (Barnard and McKeganey 2004; Daley et al. 2018).
What is unique about these participants’ circumstances is their simultaneous proximity to and distance from addiction. They are not substance users themselves but live in the emotional aftershocks of addiction’s stigma (Van Namen et al. 2023). Their narratives suggest that overcoming addiction’s legacy involves more than abstinence; it requires redefining worth outside of over-functioning and service. Spirituality and community provided spaces for this redefinition, allowing participants to construct identities grounded in mutual recognition rather than control (Heiden Rootes et al. 2009; Weinandy and Grubbs 2021).
The findings demonstrate the importance of family-centered and community-based interventions that address both structural and emotional dimensions of addiction. Programs that teach balanced caregiving, normalize help-seeking, and directly confront stigma may help prevent the intergenerational repetition of secrecy and over-responsibility (Daley et al. 2018; Van Namen et al. 2023). Future research could explore how gender, culture, and relationship type (e.g., child vs. sibling vs. parent) mediate these dynamics, and under what conditions achievement and caregiving evolve into resilience rather than avoidance. This study enhances the relational and systemic comprehension of addiction's impact by analyzing individuals’ movement from isolation to connection and by recognizing family members not merely as caregivers but as individuals worthy of care themselves.
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