Background Parental substance use is a major child safeguarding and public health concern. Whilst it is important to intervene to reduce parental substance use, impacts to the young person can endure even after their parent reduces or abstains. This study aims to understand, from young peoples’ and practitioners’ perspectives, what support is needed for young people whose parent(s) use substances.

Methods Purposive sampling strategies were utilised across national statutory and voluntary organisations. Twenty-one young people aged 14–24 years whose parents use substances and forty-four health and social care practitioners who support young people took part in remote semi-structured interviews or focus groups. Three young people with experience of parental substance use supported the reflexive thematic analysis process, identifying four overlapping themes.

Results Young people reported experiencing stress in their everyday lives due to parental substance use, often resulting in feeling unsafe within their families. Due to this insecurity, young people perceived whole family support provided by services as unsafe and unhelpful, wherein the young person may be concerned about confidentiality and risks associated with disclosure. Support needed to be young person specific, focused on their needs, and facilitated by a trustworthy practitioner. Young people often felt their agency was compromised due to the unpredictability of their parental substance use, so tried to mitigate risks within their everyday lives. Support that acknowledged young people’s strengths and empowered them through providing choices or flexible access allowed for increased engagement. Moreover, young people often described feeling that they had ‘survived’ within their experiences of parental substance use, rather than thrived due to received stigma and feelings of shame which led to isolation and loneliness. Young people reported wanting to feel connected to others in similar situations. Finally, there was a need to build resilient and non-stigmatising environments for young people, in which training for practitioners could help young people to feel acknowledged and recognised.

Conclusion Future developed initiatives to support young people whose parents use substances should be co-produced and reflect young people’s needs to counter the stigma and shame experienced, promote their social and emotional wellbeing, and build upon their agency. This research reflects the experiences of those who have already received support, so future research should aim to explore the experiences of young people who have not yet accessed support for parental substance use to understand if there are differing needs.