How a family with misuse problems is affected varies depending on several different factors, which normally interact. Some of these factors are:

• how far the disease (the misuse) has progressed,
• the family's different strategies for handling their situation (the family's coping strategies),
• how strong their safety net is (school, family, relatives and friends),
• the family member's solidarity towards each other,
• the family's socio-economic status (the parent's income, fortune and professions).

These families often live their lives in emotional confusion with embarassment, shame, anger and frustration. The uncertainty increases when the misuse progresses, and the addict becomes increasingly unpredictable, less reliable, and the family's economy is at risk. In a misuse family, a positive, safe and emotional community often is in short supply. Instead, cooperation in the family is hampered by contradictions, insecurity, doubt and distrust. When the addict becomes increasingly isolated and self-absorbed, the family tries to protect him/her and themselves from continued embarrassment by isolating themselves from the world outside the family. The misuse has become the family's dark secret. One reason why the family wants to hide the secret is the feelings of guilt and shame that the situation is causing the family members.

The everyday existence in the family is characterized by emotional stress, which among other things, expresses itself as fear of the unpredictable. The family is also characterized by the rules and roles that have developed within the family, to try to create order and stability in the increasing chaos and the unstable situation. There are four unwritten rules that often occur within these families: inflexiblity, silence, denial and isolation. For children who are growing up with a parent's misuse, these rules become a normal way to behave and to express themselves in abnormal situations.

Research has shown that misuse families have less feelings of solidarity towards each other, care less and are less cooperative and supporting towards each other. Moreover, they have fewer options to openly express and show their feelings. The family members were also found to be less independent than members in families without misuse.

Children of addicts are an extremly vulnerable group of relatives; they are dependent on their parents for their well-being. Therefore, it is important to be aware of the signals that these children show. These warning signals can be divided into four categories:

1. Somatic: deviating height and weight curve, headache, abdominal pain, heart pain, fatigue, vomiting.
2. Psychiatric: anxiety, depression, difficulties falling asleep, food problems.
3. Psychological/educational: problems relating to other children and/or adults, school difficulties despite normal ability and not caused by reading and writing difficulties.
4. Behaviour: Impulsivity, restlessness, aggressiveness, criminal behaviour, alcohol/drug addiction.

Childhood in a family with misuse problem is characterized by unpredictableness, unsafeness, anxiety, disappointments, lies, fear, violence and sexual abuse, but also by feelings such as sorrow and anger (anger that either is turned inwards or anger that the child acts out).

Children of addicts have developed "feelers" that signal when something is wrong. They don't necessarily have to see mum or dad drink the beers, it's enough to see the glossy eyes or to listen to the tickly talk, in order to understand that the disaster is a fact. In spite of this, the addict often wrongly believes that the children do not know about the drinking.

The children in misuse environments will early take on an adult role. They do not only inherit the responsibility for different duties which the adult would normally do, they also act like deputy parent both for his/her own parents and his/her brothers and sisters. However, this role is connected to certain situations and is inconsequential; the child hovers between being the hero when mum or dad is drunk, to being the child who must obey when the same parent is sober. The pendulum can oscillate quickly, and the result is increased confusion of the child. What is an accepted behaviour and what is not is decided by the temporary psychic conditions of the addictive adult, and not what the child actually does or does not do. If the child also lacks the element of play in its development, the cognitive, linguistic, social and emotional development will be inhibited. This can be a problem later in life.

These children often grow up in environments that lack positive adult models. The home environment fails to give the children knowledge about what is a normal and acceptable adult behaviour. Often they are left without the experiences that are necessary in order to mature and be able to make their own decisions. The child can also be left without positive models concerning healthy intimate relationships. It is difficult to develop positive and healthy relationships if you have grown up in such environments.

In misuse environments feelings are repressed and distorted to a large extent. Often the family members do not talk about feelings at all. The child learns to repress his/her feelings, and this can cause the child to cease feeling anything at all. The result of this destructive adaptation strategy is that the child eventually lives with the feeling that he/she does not exist and that he/she feels that he/she has no value, since the family, despite all efforts does not seem to function.

Child abuse and incest are considerably more common in misuse environments than in environments without misuse. Especially serious child abuse - that results in permanent brain damage or death - is more common in misuse environments and is considered mainly to happen there.

Therefore, there is a clear connection between addictive parents and psychological and psychosomatic handicaps. However, there are surveys that show that some of the children cope relatively well in this situation. These resistive children seem to be equipped with protective properties that regulate, improve and change a person's ways to react and to adapt to their environment. From current research, one can draw the conclusion that these children normally have had a stable emotional relationship with at least one adult person during their upbringing. This person - a near relative or another supportive person - plays the role of deputy parent that helps the child to feel loved, respected and valuable.