Self- and other- communication work among parents navigating an adult child’s substance use

In 2025, drug overdose deaths in the United States numbered 73,000 individuals. Additionally, the risk of overdoses due to the prevalence of fentanyl is a risk to young people. Under these conditions, parents are increasingly facing scenarios where they must manage a child with substance use disorder (SUD). This dissertation sought to examine how parents with an adult child experiencing SUD engage in laborious communication tasks in their efforts to manage a family crisis, turning on the integrative theory of communication work (ITCW). The ITCW asserts that people engage in five types of communication work to cope with difficult health circumstances when the demands of the situation outweigh the resources available. I set out to understand how parents enact these types of work, as well as extend scholarship regarding how people might engage in this process for themselves and their loved ones. I utilized thematic co-occurrence analysis (TCA) to examine interviews with 40 parents of adult children with SUD. My findings extend the ITCW in several ways, including: (a) understanding what communication behaviors parents deem effective and ineffective towards accomplishing goals for the self and the other, (b) introducing an internal-external tension characterizing effortful communication, (c) exploring the trade-offs of completing tasks towards self-goals versus the goals of others, and (d) characterizing the communication work process as dynamic and iterative. These findings illuminate the communicative realities of parents in these circumstances, extend the ITCW to better understand health stress, and provide practical implications to families, treatment providers, counselors, and clinicians.