Attachment patterns in families with parental substance abuse have assumed increasing importance as a research variable and studies indicate that growing up with alcohol- and drug-abusing parents may impair the child’s ability to become securely attached (Das Eiden & Leonard, 1996; O’Connor, Sigman, & Brill, 1987). Neuroscience studies have repeatedly shown the importance of attachment relationship as an organizer of physiological and brain regulation, effecting both cognitive and emotional development (Schore, 2003). Mentalization is another concept that has gained importance in the literature as a means of explaining the pathways to acquiring emotional regulation. Mentalization is the capacity for understanding behavior in light of underlying mental states and intentions. It is acquired within the context of social interaction with a caregiver who is able to give the child the experience of being understood as an individual with a mind that experiences beliefs, desires, feelings and wishes (Fonagy & Target, 2005). This chapter explores the contributions of attachment theory and the related development of mentalizing as concepts that provide the theoretical cornerstones for clinical interventions with children of substance-abusing parents of all ages as well as for substance-abusing parents of infants. It describes attachment and mentalization-based treatment programs that have been developed to help people who have difficulty with affect regulation, resulting from insecure attachment with their substance-abusing parents.