Background & Aim: As a social destructive phenomenon, substance abuse causes malfunction of the family structure and, most importantly, behavioral problems and stress for children. This study was conducted to compare the parental communication patterns and self-esteem between adolescents with addicted parents and the control group.  Methods & Materials: In this descriptive-analytical study, 200 adolescents with addicted parents and healthy parents, from the same residential region, were selected by random sampling. Data collection tool was the Parental Communication Patterns Scale, and Coopersmith Self-Esteem Inventory. Data were analyzed by SPSS 20 using chi-square test and independent t-test. Results: The mean age of the adolescents was 14.5±2.5 years in the case group, and 15.04±2.4 in the control group. Independent t-test indicated that the control group's mean score of self-esteem was significantly higher than the case group’s (P < 0.001). The control group's mean score of conversation orientation dimension was significantly higher than the case group's, and the case group's mean score of conformity orientation dimension was significantly higher than the control group's (P < 0.001). Conclusion: In light of the current study's results, it is recommended to run communication patterns and their effects on family members' mental health courses for families with parental substance abuse.