This qualitative evidence synthesis informs intervention development by systematically searching, evaluating and synthesizing qualitative studies on fatherhood in the context of heavy drinking and other substance use. We searched seven databases, grey literature and reference lists to identify eligible studies. Our international sample includes 156 fathers of different ages, cultural backgrounds and family living arrangements across 14 unique studies. The lead author applied thematic synthesis to develop the themes, in an ongoing dialogue with team members. Our understanding of fatherhood in the context of heavy drinking and other substance use is communicated through six themes. Fathers’ heavy drinking and other substance use can be understood as a method of emotional coping. Fathers’ substance use choices are intertwined with their social contexts from childhood to adulthood. Being a safe presence in children’s lives is a potentially overlooked aspect of fathers’ substance use interventions. In our qualitative evidence synthesis, we observed the pivotal role of supportive relationships in fathers’ substance use trajectories. We recommend co-produced intervention development that considers both fathers as individuals and as members of social networks. This is relevant across statutory, community and voluntary sector settings.