Affected family members' experience of, and coping with, aggression and violence within the context of problematic substance use: a qualitative study

Experience of Family Members of Relatives With Substance Use Disorders: An Integrative Literature Review

Background: Substance use disorders (SUDs) present substantial challenges for family members living with or supporting relatives with SUDs. This review explores existing literature on family members' experiences with relatives with SUDs and their support needs. Method: An integrative review was conducted by searching literature in the Cumulative Index of Nursing and Allied Health, PubMed, PsycINFO, ProQuest, and Scopus databases. Results: Five themes were generated based on analysis of 26 empirical studies: (a) family members' and caregivers' experiences of SUDs; (b) impact of SUDs-related aggressive/violent behaviors on families; (c) dilemmas faced by family members; (d) culture and family stigma related to SUDs; and (e) factors contributing to SUDs, challenges, and support needs. The review highlighted barriers to seeking support due to stigma and guilt, underscoring the need for structured support programs. Conclusions: This review sheds light on the challenges faced by family members with relatives suffering from SUDs and emphasizes the crucial need for structured support programs. The findings provide insights for developing initiatives to address the social and trauma-induced needs of family members and to establish support resources for them.

SMART Family and Friends: Feasibility and outcomes of a video-conference delivered intervention for families impacted by another's methamphetamine use

INTRODUCTION

Families affected by another's substance use, including methamphetamine, experience harms to their mental and physical health. Yet, research has paid little attention to support and service needs of this population. This pilot study examines the feasibility and outcomes of SMART Family and Friends, a video-conference-delivered mutual-support group targeting families affected by another's methamphetamine use.

METHODS

Recruitment for this study occurred between March-October 2021 via the SMART Recovery Australia website. Participants were English-speaking Australian residents, ≥18 years, affected by another's methamphetamine use, interested in participating in a manualised eight-module group delivered via video-conferencing. Feasibility was evaluated by attendance rates, participant satisfaction, fidelity ratings, and semi-structured interviews. Measures of distress, quality of life, and family functioning assessed outcomes at baseline and one-month post-treatment conclusion.

RESULTS

Forty-three participants commenced SMART Family and Friends groups. 84 % (n = 36) completed ≥4 modules, 67 % (n = 29) completed ≥6, and 42 % (n = 18) completed all 8 modules. Participant satisfaction (M = 4.32, SD = 0.66, out of 5) and facilitator fidelity (>94 % for all modules) were high. A within-group analysis, without comparison condition demonstrated significant improvements in psychological distress (d = 0.38), family impact (d = 0.64), family strain symptoms (d = 0.48), and total family burden (d = 0.69) post-treatment. Qualitative findings illustrated the benefits and challenges of the video-conference-delivered group, as well as recommendations for improvement.

CONCLUSIONS

Results provide initial support for the feasibility and positive outcomes of the SMART Family and Friends program. These findings demonstrate the successful provision of a mutual-support group for affected families delivered via video-conferencing, and merit further sufficiently powered randomised-control-trials to evaluate efficacy.

Challenges in addiction-affected families: a systematic review of qualitative studies

BACKGROUND

The relative paucity of research on Addiction-Affected Families' (AAF) issues and the lack of attention given to their difficulties and treatment in interventions and clinical practices indicate that the primary focus consistently revolves around individuals with addictive disorders, even when the treatment process involves their families. However, it is believed that family members endure significant pressures that result in extensive negative consequences on the personal, familial, and social aspects of their lives. Aiming for a better understanding of the challenges and issues that AAF's experience, this systematic review explored qualitative studies with a focus on the impact of addiction on different aspects of families.

METHODS

We searched Research Gate, Scopus, Web of Science, ProQuest, Elsevier, and Google Scholar Databases. We included studies of qualitative design which have investigated the effects of addiction on families. Non-English language studies, medical views, and quantitative approaches were excluded. Participants in the selected studies included parents, children, couples, sisters/brothers, relatives, drug users and specialists. The data from the selected studies were extracted using a standard format for the systematic review of qualitative research (the National Institute of Health and Care Excellence [NICE] 2102a).

RESULTS

A thematic analysis of the findings of the studies identified 5 main themes: 1) initial shock (family encounter, searching for why), 2) family in the fog (social isolation, stigma and label), 3) sequence of disorders (emotional decline, negative behavioral experiences, mental disturbance, physical degeneration, family burden), 4) internal family chaos (instability of relationships, shadow people, erosive confrontation with the drug-using member, a newly emerging member, collapsing system, financial collapse), and 5) self-protection (attracting information, support, and protective sources, coping and adjusting the effects, the emergence of spirituality).

CONCLUSION

This systematic review of qualitative research highlights the various and complex issues which addiction-affected families go through in terms of financial, social, cultural, mental and physical health problems, as a result of which experts of the field are needed to investigate and take measures. The findings can inform policy and practice and the development of interventions aimed to lighten the burdens which addiction-affected families carry.

The lived experiences of the spouses of alcohol dependent partners: a phenomenological study

Background

Alcoholism is rising in India, affecting both individuals and their families. This study explored the lived experience of women cohabiting men with alcohol use disorder (AUD) to understand the experience and coping resources they adopted from their perspective.

Methods

Interpretive phenomenology design was used. Purposive sampling was employed to select women cohabiting men with AUD attending the de-addiction clinic. After explaining the study and written informed consent, in-depth interviews were conducted. By the interview of the 11th participant, data saturation was reached.

Results

Thematic analysis was undertaken. Significant statements and meaning units were identified, and codes were assigned. Three categories, namely impact on self, effect on life and coping strategies, were developed, and two main themes (faced numerous challenges and used adaptive and maladaptive coping) were generated.

Conclusions

Women faced innumerable problems of poor health, physical misery, marital discord, emotional disturbances, strained social relations, and financial burden. Most women relied heavily on avoidance or tolerance coping like covering up, taking on extra work, withdrawing, distancing, and hiding from friends and family. Putting on a brave front and not doing anything is not productive for women and men with AUD.

Characteristics and quality of life of substance users and their caregivers

The correlation between substance use and depression has been emphasized in the literature. Substance use disorders can also adversely affect the caregivers of drug-addicted persons. A cross-sectional study was conducted at the Special Hospital for Addiction Diseases in Belgrade in 2015 to analyze the characteristics, consequences, and health-related quality of life of drug users and their caregivers. The sample comprised 136 users of various substances, and 136 caregivers. A questionnaire on socio-demographic characteristics, the Short Form Health Survey 36 (SF-36), and Beck Depression Inventory were administered to all participants. According to multivariate logistic regression analysis, compared with caregivers, substance users were significantly more frequently male (P < .001), ≤ 39 years old (P < .001), and more frequently reported the use of sedatives (P = .009) and smoking (P < .001). Some level of depression was present in all participants, but severe forms were more frequent in substance users (P = .010). Among substance users, mean scores of SF-36 domains ranged from 56.62‒87.17, and among their caregivers, from 50.37‒75.07; however, the difference was significant only for the health change domain (P = .037), the score for which was lower in caregivers. Substance users suffered from more severe forms of depression compared to their caregivers, who had lower SF-36 scores in the domain of health change.

A systematic literature review and narrative synthesis of effective interventions for family and caregivers of people who use methamphetamine

Background: Methamphetamine is a highly addictive central nervous stimulant associated with numerous adverse health, psychological, and social impacts. Family and friends of people who use methamphetamine often take on a crucial caregiving role in supporting their loved one. Consequently, they can experience a range of psychosocial challenges themselves. This review aimed to identify and assess the effectiveness of interventions designed to support caregivers of people who use methamphetamine. Methods: A systematic search of relevant literature published in the English language was conducted. Of 2257 records identified, only 2 evaluation studies examined interventions specifically designed for caregivers of people who use methamphetamine. Additionally, four qualitative accounts described experiences of caring for people who use methamphetamine. These accounts were summarized narratively to provide a more complete picture of family and caregiver experiences and coping strategies. Results: Effective treatment components included tending to caregiver concerns and providing training to enhance informational support and problem-solving skills. Qualitative accounts uncovered a range of challenges experienced by caregivers, such as emotional distress, concern for the person using methamphetamine, disrupted family structures, and financial difficulties. Coping strategies included attempts at managing and supporting the person using methamphetamine while protecting the overall cohesion and wellbeing of the family unit. Conclusions: This review highlighted a lack of evidence-based interventions for caregivers of people who use methamphetamine. More research is needed to clarify concerns that may be particularly relevant for those in a caregiving role.

Prevalence, consequences and factors associated with drug use among individuals over 50 years of age in the family perspective

OBJECTIVES

The aim of this study was to investigate the prevalence, consequences and factors associated with drug use among individuals over 50 years of age, from the perspective of their families, with particularly reference to cocaine use.

METHODS

Cross-sectional study based on secondary data with 624 family members of substance users who sought family support in 14 units of the Recomeço Família Program in São Paulo, Brazil.

RESULTS

The participants were predominately men, aged 50 to 59 years (68%); cocaine users (inhaled and/ or smoked); living alone; with a low level of education and were unemployed. They were likely to use family money to pay for their substance use, with a history of theft and aggression against strangers, and were not in treatment. Unlike other participants [≥ 60 years (31.1%)]; who were better educated and retired. In this latter group, 32.8% are alcohol users, 14.8% cocaine users (inhaled and smoked), 32.6% has physically assaulted their family, 39.7% had assaulted someone else and 18.3% had stolen objects or money from home.

CONCLUSIONS

The population has peculiar characteristics of vulnerability (cocaine use and violence) that remain under investigated; not only do routes into treatment for older adults (≥ 60) but appropriate treatment packages need to be developed too.

“He is lovely and awful”: The challenges of being close to an individual with alcohol problems

Introduction: In the last 20 years, there has been growing evidence that heavy drinking causes serious harm not only to the person who drinks but also to the person's relations and concerned significant others (CSOs). A relationship with a heavy drinker is often full of conflicts, and CSOs are frequently exposed to aggression, psychological, and sometimes physical violence from the heavy drinker. Despite their struggles, CSOs often feel it is difficult to seek professional help for these problems. The aim of this study was to investigate what problems CSOs of people with alcohol problems experience prior to seeking professional help to handle these issues. Moreover, to investigate what led to seeking professional help at all. Methods: This is a qualitative study with 12 female help-seeking CSOs of persons with alcohol problems. The participants were recruited from a randomised controlled trial (RCT) on Community Reinforcement and Family Training (CRAFT). Semi-structured interviews were conducted, audio-recorded, and transcribed. The analysis was based on interpretative phenomenological analysis. Results: Three overall themes and one sub-theme emerged from the analysis: (1) The CSO’s feelings and experiences of the situation prior to help-seeking, (2) The relationship with the drinker, (3) Reasons for help-seeking and its trajectory; and the sub-theme, What the CSOs hoped to gain from help-seeking. Conclusion: The present study showed that female CSOs of people with alcohol problems had suffered for a long time before seeking professional help. They felt their daily lives were unpredictable and stressful. They were often exposed to verbal and mental abuse and their relationships with the drinking relative were often characterised by frequent rowing. The CSOs had tried to cope for a long time using a number of different strategies; seeking help seemed to be the last option considered. Despite all the struggles and pain, the CSOs also felt a lot of love for their drinking relative and hoped for the return of their once sober relative. Our findings can be viewed as a support to the stress-strain-coping-support (SSCS) model proposed by Orford and colleagues.

Stress-adaptation among Family of Adolescent with Substance Misuse: Systematic Literature Review

BACKGROUND: Families of an adolescent with substance use disorders report significant burden and stress. Adequate coping strategies can modify the impact of stressful situations and increase family function. AIM: The aim of the study was to systematically review the literature related to the coping strategies and adaptations used by family members of the adolescent with substance use disorders to manage their stress. METHODS: We conducted electronic searches using MEDLINE (PubMed), EBSCO, databases to select studies on family stress, and coping strategies that were published from January 2000 to December 2020. The search terms were family, parent, father, mother, coping, caregiver, strategy, adaptation, adolescent, and substance use disorders. RESULTS: We found 961 articles. After application of exclusion criteria and exclusion of redundant references, ten articles were thematically analyzed. The studies were organized into five categories: Engaged, tolerance, withdrawal, problem-focused, and emotion-focused coping strategies. The family members felt devastated by the incidents of violence and aggressive outbursts, and felt they failed as parents. As a result, the parents felt very isolated from other family members and friends, and ashamed of their children’s behavior. Most families used problem-focused and emotion-focused coping strategies in different combinations. CONCLUSION: The identified studies show that the use of emotional focus coping is the coping strategy most often done by families. Problem focus coping involved family efforts to find sources of information and seek treatment services as a mechanism for adaptive coping strategy. However, a mixed methods study is still needed that clearly illustrates the types of coping strategies used in various cultural perspectives and social status.

Stress Adaptation Among Family of Adolescent with Substance Use Disorders: Systematic Literature Review

BACKGROUND: Families of an adolescent with substance use disorders report significant burden and stress. Adequate coping strategies can modify the impact of stressful situations and increase family function. AIM: The objective of the study was to systematically review literature related to the coping strategies and adaptations used by family members of the adolescent with substance use disorders to manage their stress. METHODS: We conducted electronic searches using MEDLINE (PubMed), EBSCO, databases to select studies on family stress, and coping strategies that were published from January 2000 to December 2020. The search terms were family, parent, father, mother, coping, caregiver, strategy, adaptation, adolescent, and substance use disorders. RESULTS: We found 961 articles. After application of exclusion criteria and exclusion of redundant references, 10 articles were thematically analyzed. The studies were organized into five categories: Engaged, tolerance, withdrawal, problem-focused, and emotion-focused coping strategies. The family members felt devastated by the incidents of violence and aggressive outbursts, and felt that they failed as parents. As a result, the parents felt very isolated from other family members and friends, and ashamed of their children’s behavior. Most families used problem-focused and emotion-focused coping strategies in different combinations. CONCLUSION: The identified studies show that the use of emotional focus coping is the coping strategy most often done by families. Problem focus coping involved family efforts to find sources of information and seek treatment services as a mechanism for adaptive coping strategy. However, a mixed methods study is still needed that clearly illustrates the types of coping strategies used in various cultural perspectives and social status.

Family Stress, Well-Being and Hope for the Future When Supporting a Relative with AOD Misuse: A Cross-Sectional Survey

While families have a central role supporting relatives with alcohol and other drug (AOD) misuse, this can undermine their own well-being and hopefulness. The aims of this study were to assess the effect of supporting a relative with AOD misuse on affected family members' (AFMs) psychological and physical well-being and hope for the future about their relative, and to identify factors associated with AFMs' well-being and hope. A cross-sectional survey design with 90 AFMs. Over three-quarters of AFMs had not received any assistance from AOD services recently, nearly 80% experienced adverse effects on their physical health and ability to socialise with relatives and friends, and just over 50% reported detrimental effects on their paid employment. AFMs living with their relative with AOD misuse experienced more harmful stress than those who were not residing with their relative. Intimate partner AFMs experienced more mild-to-moderate physical and psychological ill health than non-partner AFMs. No socio-demographic factors were significantly associated with AFMs' levels of hopefulness-hopelessness. Measures are needed to increase AFMs' access to mental health nurses and other AOD clinicians for their own needs. Services and AOD clinicians should target, but not be restricted to, reducing stress and strengthening their physical and mental well-being and hopefulness.

Mixing qualitative methods versus methodologies: A critical reflection on communication and power in inpatient care

This paper offers an illustrative example to demonstrate one way of combining qualitative methods. The context for the study was a UK inpatient psychiatric hospital. Data set one was collected from weekly ward rounds where inpatient staff met with autistic patients to review medication, listen to patient concerns and make plans or adjustments in light of this. Data set two was reflective discursive interviews with patients and staff. The research objective was to critically consider the potential reasons for discrepancies in dissatisfaction reports from patients in the interviews, compared to relative compliance exhibited by patients in the ward rounds. Utilising a video-reflexive design and critical discursive psychology approach, both data sets were analysed together. It is possible to simultaneously analyse two different data sets, one naturally occurring and one researcher generated because of the epistemological congruence in the overall design. We have presented an argument for the benefits of mixing two qualitative methods, thereby extending the mixed-methods evidence base beyond the traditional discussions of quantitative and qualitative paradigms.

Mental and physical health in family members of substance users: A scoping review

BACKGROUND

Due to the high pressure they sustain, family members of substance users are thought to experience negative consequences in mental and physical health. This scoping review provided a comprehensive overview on the mental and physical health of adult Affected Family Members (AFMs).

METHOD

We searched in-journal English articles in PubMed, with no date limit, guided by the concepts of stress, strain, and burden, and including several terms related to substance use. Eligibility criteria included focus on adult AFMs, mental and physical health, and clinical forms of substance use.

RESULTS

PubMed search identified 3549 articles, with 46 additional papers from other sources. Fifty-six articles were included, quantitative (N = 39), qualitative (N = 15) and both (N = 2). Quantitative findings show that AFMs are subject to increased stress and burden, and impaired mental health. Variable rates of physical problems emerge, with some medical conditions being more common among AFMs of substance users versus controls. Finally, evidence shows increased risk for aggression and reduced quality of life and social adjustment. AFMs report higher stress and strain if they are women, in low socio-economic families, and co-habiting with more severe substance users. Qualitative studies additionally suggest that stigma, self-blame, and social isolation are common.

CONCLUSIONS

AFMs of substance users represent a population at higher risk for negative health-related outcomes and should be systematically regarded as targets for treatment.

Family members' lived experiences of non-compliance to psychiatric medication given to female adults living with depression

BACKGROUND

Family members face the burden of adult females living with depression who do not comply with psychiatric medication. Discomfort, tension, anxiety, frustration, and related feelings of hopelessness and dysfunction were identified by family members. There have also been records of financial problems, physical ill-health, limitations on social and recreational opportunities and a general deterioration in their quality of life. There is a shortage of published literature and information on the reasons for non-compliance to psychiatric medications. The existing body of information needs to be strengthened and future approaches encouraged. The study aimed to improve compliance of adult females dealing with depression to psychiatric medical treatment and the effect it has on family members caring for adult females living with depression.

OBJECTIVES

To describe family members' lived experiences of non-compliance to psychiatric medication by adult females living with depression.

METHOD

A qualitative, exploratory, descriptive and contextual study design was used. A purposive sample of family members aged between 20 and 45 years was made. Data were collected by conducting eight in-depth, phenomenological interviews, and field notes were taken. The interviews focused on the central question: 'Tell me your experiences of living with your wife, mother, sister and daughter living with depression and not taking their medication as ordered by the doctor?' Tesch's method for data analysis was used, and an independent coder analysed the data and met with the researcher for a consensus discussion of the results. Measures to ensure trustworthiness were applied and ethical principles were adhered to.

RESULTS

The three themes identified were: experienced psycho-social effects, experienced treatment refusal and experienced challenges in caring for adult females living with depression who are non-compliant to psychiatric medication. As a result, the absence of social help, disturbance of family working, shame, separation and troublesome conduct of the adult females who are non-compliant to psychiatric medication developed as principal subjects.

CONCLUSIONS

The results demonstrated that family members experienced debilitation because they needed information about their relatives living with depression who are non-compliant to psychiatric medication. More information about the management of non-compliance of psychiatric medication was needed; a comprehensive awareness of the ramifications of the findings, treatment and care are required from mental health care professionals and service providers.

The Association Between Family Violence, Depression and Anxiety Among Women Whose Partners Have Been Treated for Alcohol Dependence

The negative effects of men's excessive alcohol consumption on family members are well known. However, less is known about how men's alcohol dependence is associated with the mental health of their female spouses residing with them. Therefore, the aim of this study was to investigate the prevalence and factors associated with depression, anxiety, and intimate partner violence against women (IPVAW) whose male spouses are undergoing treatment for alcohol dependence. We hypothesize that men with alcohol dependency, who are also violent, present a serious threat to women's mental health. We conducted a cross-sectional study among 104 women whose male partners had been admitted for inpatient treatment for alcohol dependence. Women's depression was measured by the Beck Depression Inventory (BDI-II); anxiety was measured by the Beck Anxiety Inventory (BAI), and exposure to physical and sexual IPVAW was measured by the Conflict Tactics Scale (CTS-2). Multinomial logistic regression analyses were conducted in order to analyze factors associated with depression and anxiety. The prevalence of moderate/severe depression and anxiety among the women was 34.6% and 25.2%, respectively, while almost half (48.1%) experienced IPV during the past 12 months. After adjustments for age, exposure to IPV increased the chances of experiencing moderate/severe depression by 37.5 times (95% CI 7.91-177.76), and 8.15 times for moderate/severe anxiety (95% CI 2.45-27.14). The mental health of women whose partners have alcohol dependence is significantly threatened and should be considered, especially when it is associated with exposure to spousal violence.

The salience of intimate partner violence to coping and social support for intimate partners of people with addictions

Intimate partners of people with addictions experience significant strain, which coping and social support may reduce. They are also at increased risk for intimate partner violence (IPV: violence/abuse and coercive control), but IPV's effects on coping and social support are unclear. This study tested the salience of IPV to the Stress-Strain-Coping-Support model, using moderated mediation models with 222 intimate partners of people with addictions. Social support and coping worked differently for each type of strain. Coercive control moderated informal social support's buffering effect for anxiety and depression. Professionals assisting intimate partners should screen for IPV and offer flexible support programs.

An exploratory study on violence among the college students in Urban Bengaluru, Karnataka, India

Violence often blights people's lives for decades, leading to drug addiction, depression, suicide, school dropout, unemployment, and recurrent relationship difficulties. This exploratory study was conducted among professional degree colleges in urban Bengaluru from January to March 2017; the objectives were to find the magnitude, forms, and substance use in violence. A total of 450 students were studied. One hundred and twenty-three (27.3%) students experienced some kind of violence in the past 1 year and 77 (62.6%) were males. Verbal abuse (65.0%), pushing around (23.6%), and slapping (18.7%) were common forms of violence observed. Substance use was significantly associated with violence.

Drivers of ‘clinically unnecessary’ use of emergency and urgent care: the DEUCE mixed-methods study

Background

There is widespread concern about the pressure on emergency and urgent services in the UK, particularly emergency ambulances, emergency departments and same-day general practitioner appointments. A mismatch between supply and demand has led to interest in what can be termed ‘clinically unnecessary’ use of services. This is defined by the research team in this study as ‘patients attending services with problems that are classified as suitable for treatment by a lower urgency service or self-care’. This is a challenging issue to consider because patients may face difficulties when deciding the best action to take, and different staff may make different judgements about what constitutes a legitimate reason for service use.

Objectives

To identify the drivers of ‘clinically unnecessary’ use of emergency ambulances, emergency departments and same-day general practitioner appointments from patient and population perspectives.

Design

This was a sequential mixed-methods study with three components: a realist review; qualitative interviews (n = 48) and focus groups (n = 3) with patients considered ‘clinically unnecessary’ users of these services, focusing on parents of young children, young adults and people in areas of social deprivation; and a population survey (n = 2906) to explore attitudes towards seeking care for unexpected, non-life-threatening health problems and to identify the characteristics of someone with a tendency for ‘clinically unnecessary’ help-seeking.

Results

From the results of the three study components, we found that multiple, interacting drivers influenced individuals’ decision-making. Drivers could be grouped into symptom related, patient related and health service related. Symptom-related drivers were anxiety or need for reassurance, which were caused by uncertainty about the meaning or seriousness of symptoms; concern about the impact of symptoms on daily activities/functioning; and a need for immediate relief of intolerable symptoms, particularly pain. Patient-related drivers were reduced coping capacity as a result of illness, stress or limited resources; fear of consequences when responsible for another person’s health, particularly a child; and the influence of social networks. Health service-related drivers were perceptions or previous experiences of services, particularly the attractions of emergency departments; a lack of timely access to an appropriate general practitioner appointment; and compliance with health service staff’s advice.

Limitations

Difficulty recruiting patients who had used the ambulance service to the interviews and focus groups meant that we were not able to add as much as we had anticipated to the limited evidence base regarding this service.

Conclusions

Patients use emergency ambulances, emergency departments and same-day general practitioner appointments when they may not need the level of clinical care provided by these services for a multitude of inter-related reasons that sometimes differ by population subgroup. Some of these reasons relate to health services, in terms of difficulty accessing general practice leading to use of emergency departments, and to population-learnt behaviour concerning the positive attributes of emergency departments, rather than to patient characteristics. Social circumstances, such as complex and stressful lives, influence help-seeking for all three services. Demand may be ‘clinically unnecessary’ but completely understandable when service accessibility and patients’ social circumstances are considered.

Future work

There is a need to evaluate interventions, including changing service configuration, strengthening general practice and addressing the stressors that have an impact on people’s coping capacity. Different subgroups may require different interventions.

Study registration

This study is registered as PROSPERO CRD42017056273.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 15. See the NIHR Journals Library website for further project information.

Going Online: The Affordances of Online Counseling for Families Affected by Alcohol and Other Drug Issues

Online counseling can overcome barriers families face when accessing support services for issues such as a relative's alcohol or other drug use. However, little research has explored how online counseling platforms assist family members to improve their well-being and support their relative. We thematically analyzed 90 transcripts of online counseling sessions with family and friends of people who use alcohol, opioids, and amphetamines in Australia between 2015 and 2016. In our analysis, we drew on the concept of affordances to articulate how online platforms afford or constrain potentially therapeutic encounters with families. We found online counseling enabled families to make first contact, relieve distress, plan appropriate action, improve communication, regain direction, and connect with local services. Sessions were constrained by Internet access, web-chat communication, counselors' focus on referral, and limitations in addressing the wider concerns of families. The findings present opportunities for improving online services for families.

Affected family member coping with a relative with alcohol and/or other drug misuse: A cross-sectional survey questionnaire

Families have a crucial role supporting a relative with alcohol and/or other drug misuse, but the role has adverse implications for family members' coping, which in turn, affects their ability and willingness to support the relative. The aim of this study was to assess the coping behaviours of affected family members of relatives with alcohol and/or other drug misuse and to assess if there was a relationship between the level of coping and family member type and support-giving experience. A cross-sectional survey design was used, and 90 respondents completed the questionnaire. Results suggest the following associations: that 'Other' family members made more frequent use of maladaptive coping strategies than intimate partners (P = 0.012); family members whose role had a negative effect on their physical health made more frequent use of maladaptive coping strategies than those whose role did not have this effect (P = 0.014); and family members whose role had a negative effect on their ability to socialise used maladaptive coping strategies more often than those whose role did not have this effect (P = 0.003). Engaged and tolerant-inactive maladaptive coping strategies had a significantly greater adverse influence on family members' physical health and/or socialising than withdrawal coping strategies. Affected family members should be supported to use adaptive coping strategies to mitigate the detrimental effects of their support-giving role and to sustain them in this crucial support-giving role. Family and friends, mental health nurses, and other clinicians in the alcohol and other drug field have an important role in supporting family members in this context.

The Effect of Cognitive Behavioral Therapy on the Burden in Drug Dependent Persons' Caregivers: A Randomized Controlled Clinical Trial

Background:

Drug dependence is one of the current problems that leads to the drug dependents persons' suffer and imposes a huge mental burden to their family members. This study aimed investigating to determine the effect of cognitive- behavioral therapy (CBT) on the burden of the caregivers of drug dependent people. In CBT, caregivers discover thought and behavioral mistakes and recover them.

Materials and Methods:

This randomized controlled clinical trial was conducted on 64 caregivers of drug dependent individuals referring to one of the clinical and educational centers in Isfahan, Iran, which were randomly assigned to two equal groups (intervention and control) in 2016. Intervention group under went eight 90-min CBT sessions, whereas control group attended 3 group sessions to express their experiences. Data were collected by Zarit Burden scale and the demographic questionnaire and analyzed by independent t-test, Chi-square, and ANCOVA repeated measure through SPSS 18.

Results:

Before the intervention, no statistical difference was observed among two groups in the mean scores of burden (t = 0.75, p = 0.46). There was a significant difference between three time points in the intervention group (F = 3.24, p < 0.001). However, care burden mean score did not show a significant reduction in the control group (F = 0.17, p = 0.96).

Conclusions:

The CBT can lead to reduction of burden in drug dependent caregivers'. We suggest encouraging nurses to establish educational programs such as CBT to maintain and improve caregiver's mental health.