The US substance use landscape consists of over 100 000 overdose deaths annually since 20201 and, in 2023 alone, over 46 million adults with a past-year Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition; DSM-5)–defined substance use disorder (SUD).2 Despite attempts to estimate the number of children exposed to parental substance use and DSM-IV-defined SUD,3,4 recent research indicates that past-year prevalence estimates of SUD using DSM-IV criteria are substantially higher when using DSM-5 criteria,5 resulting in a key knowledge gap. Children exposed to parental SUD are more likely to develop adverse health outcomes than their peers without parental SUD exposure, including early substance use initiation, substance-related problems, and mental health disorder.6 We aimed to estimate the number of US children living in the same household as at least 1 parent or primary caregiver with a DSM-5-defined SUD.
