Since an individual's personality and behavior are mainly shaped in the family environment, parental substance abuse and its consequences can lead to confusion and instability in the family environment and reduce child-parent relationship. This study was conducted to investigate the relationship between different aspects of parental communication patterns and self-efficacy in adolescents with parental substance abuse. In this descriptive correlational study, a total of 100 adolescents with parental substance abuse were selected via random sampling. The data collection tools included the parental communication patterns scale and self-efficacy questionnaire. Data were analyzed in SPSS version 20, using linear regression analysis and Pearson's correlation coefficient test. The mean age of the adolescents was 14.5±2.5 years. Pearson's correlation coefficient showed that the adolescents' self-efficacy score was directly correlated with the score of conversation orientation dimension (a parental communication pattern) and inversely correlated with the dimension of conformity orientation (P<0.001). Development of educational programs to promote communication skills, positive family interactions, decision-making, and flexibility can change the unhealthy family environment into a healthy and productive one, which promotes self-efficacy beliefs in children.