There is unequivocal evidence supporting the negative consequences of parental drug addiction with multiple risks and/or significant harm for children. However, it is clear that substance abuse is not the only determining factor in the parental behavior of individuals with drug addiction problems. This article addresses the need for comprehensive approaches to guide research and clinical intervention for parents with drug addiction problems. The authors propose a psychodynamic approach that emphasizes how the relationship between specific individual and relational factors can explain the fragile parenting qualities of such parents. First, a general literature review on the impact of parental drug addiction on children is presented, clarifying its multifactorial characteristics and identifying risk and protective factors. Then, the authors discuss the problems associated with a lack of mentalizing abilities (eg, mentalized affectivity) and its relationships with drug-addicted parents’ parenting dimensions, arguing that even when drug use is restrained/controlled, these problems impair the psychic and relational dynamics underlying the development of parenting, limiting reflective parental functioning and putting the quality of the parent–child relationship at risk. Finally, implications are discussed for clinical intervention based on the development of parenting skills by means of an integrated approach that includes, among other individual and relational factors, working on mentalizing abilities, on the reorganization of personal identity, on drug-addicted parents’ identification with their children and their own caregivers, and on maximizing the presence and effects of protective factors in the parent–child relationship and the broader context.