The aim of this study was to analyse alexithymia and deficits in emotional awareness, in heroin addicts, and their relationship with perceptions of early parental interactions. The sample included 99 opiate dependent outpatients and 43 healthy controls. Assessment was performed using the Toronto Alexithymia Scale, the Levels of Emotional Awareness Scale, the Inventory for Assessing Memories of Parental Rearing Behavior, the Mini-Mental State Examination and the Hospital Anxiety and Depression Scale. Findings suggest parental representations, which were mostly characterized by emotional unavailability and a rejection interaction pattern, significantly related to alexithymia. Emotional awareness was associated with the number of years of drug use and methadone level. Negative affect was associated with alexithymia but not to emotional awareness. Regression analyses emphasized the influence of perceived dysfunctional parenting behaviors in alexithymia and difficulties in identifying feelings, particularly an interaction with paternal rejection, moderated by self-reported anxiety. These results are discussed addressing comprehensive issues of emotion regulation and treatment strategies in heroin dependence.Keywords Alexithymia . Emotional awareness . Parental rearing behaviors . Heroin dependence . Negative affect Alexithymia has been studied over the past decades in healthy subjects and in a large number of psychiatric disorders, and it seems to be well established as a personality trait that influences Int J Ment Health Addiction