Comparison of impact of family stigma on quality of life among caregivers of male inpatients with alcohol and opioid use disorder

Alcohol use disorder research in India: An update

Background

Despite alcohol use being a risk factor for numerous health-related conditions and alcohol use disorder (AUD) recognized as a disease, there was limited research in India until 2010. This narrative review aims to evaluate AUD-related research in India from 2010 to July 2023.

Methods

A PubMed search used key terms for AUD in India after 2010. Indian and international journals with regional significance that publish alcohol-related research were searched by each author individually. These were then collated, and duplicates were removed. In addition, we also conducted a gray literature search on focused areas related to AUD.

Results

The alcohol-related research in India after 2010 focused on diverse areas associated with alcohol use. Some areas of research have received more attention than others. Two major epidemiological surveys conducted in the past decade reveal that around 5% have a problematic alcohol use pattern. Factors associated with alcohol use, like genetic, neurobiological, psychological, and sociocultural, were studied. The studies focused on the clinical profile of AUD, including their correlates, such as craving, withdrawal, alcohol-related harm, and comorbid psychiatric and medical illnesses. During this period, minimal research was conducted to understand AUD's laboratory biomarkers, course, and prognosis. While there was a focus on generating evidence for different psychological interventions for alcohol dependence in management-related research, pharmacological studies centered on anticraving agents like baclofen. Research on noninvasive brain stimulation, such as rTMS, has shown preliminary usefulness in treating alcohol dependence. Very little research has been conducted regarding alcohol policy.

Conclusion

In the past decade, Indian research on alcohol has focused on diverse areas. Epidemiological and psychological management-related research received maximum attention. Considering the magnitude of the alcohol-related burden, it is essential to prioritize research to other less studied areas like pharmacological management of alcohol dependence and alcohol policy.

Perceived Stressors and Support in Family Caregivers of Individuals With Opioid Use Disorder

ABSTRACT

Stress experienced by family caregivers of individuals with opioid use disorder (OUD) contributes to caregiver burden. To understand the stressors experienced by family caregivers of individuals with OUD and the factors that influence their personal resiliency, data were collected from a convenience sample of family caregivers who answered two open-ended questions about sources of stress and factors that affect their personal resilience as part of an online survey. Yin's thematic analysis revealed five objective and two subjective burden themes and four resilience themes. Results indicate OUD places significant burden on families and may contribute to decreased physical and mental well-being in caregivers. Caregivers who perceived adequate support were able to use their experience and innate knowledge to cope and emerge with more resilience. Results of this study support the need for translational research to increase resilience and coping in this population of caregivers.

e-Delphi Study: Expert Consensus on the Needs and Resources Available to Family Caregivers of Individuals with Substance Use Disorder

Family caregivers of individuals with substance use disorder (SUD) experience a significant burden and have few evidence-based resources available.

To obtain a consensus of expert views on the needs, and resources available, to family caregivers of individuals with SUD given the COVID-19 pandemic and other sociopolitical factors.

Quantitative design using the Classic e-Delphi method of multiple iterations of questioning to reach a consensus among expert panelists. Purposive sampling was used to recruit a multidisciplinary, nationwide panel of SUD experts from professional contacts, professional organization list servers, websites relevant to support groups for family caregivers, flyers, and word of mouth. In round 1 panelists (n = 96) responded to open-ended questions about the support provided to family caregivers, and the additional needs of family caregivers. In subsequent rounds, the panel rated collated responses in terms of agreement (n = 54) and importance (n = 48).

Thematic content analysis identified ten needs in the resources available to family caregivers. Consensus was obtained across thematic categories and the remaining items were ranked according to importance.

Participatory-based SUD research that includes the expertise of healthcare providers, support leaders, and family caregivers is necessary to develop evidence-based interventions to increase caregiver resilience and facilitate coping. Several clear conclusions that address social and structural determinants of health emerged, including the need for increased access to healthcare and community services, more self-care strategies for families, and focused public advocacy to reduce SUD-related stigma.

Health-related quality of life and stigma in opioid dependence: Comparison between buprenorphine users and non-users

Objectives

Opioid dependence leads to reduced quality of life (QOL) and stigma. There is scarcity of literature on impact of buprenorphine on QOL of patients with opioid dependence from India. This study reports QOL and stigma in patients taking buprenorphine and compare it with those who were not on any treatment.

Materials and Methods

A cross-sectional, descriptive, comparative study was conducted among three groups (n = 100 each). Group 3 comprised patients who were already taking buprenorphine for at least 3 months from a government outpatient opioid-assisted treatment center. Group 2 comprised patients who were not on any treatment but had come to enrol in buprenorphine treatment and Group 1 comprised patients who had come to get some other treatment and were not willing for buprenorphine. After fulfilling inclusion and exclusion criteria, sociodemographic pro forma, Hindi self-stigma scale, and World Health Organization QOL-BREF Hindi were applied. Appropriate statistical analyses were done.

Results

Patients already taking buprenorphine had significantly better QOL and it improved as the duration of treatment increased. Patients on buprenorphine treatment had significantly lesser stigma than patients not already on treatment. Stigma negatively impacted QOL in the three groups.

Conclusion

QOL and factors affecting it should be an integral part of management of opioid dependence. Efforts should be made to enrol maximum number of patients in treatment to enhance their quality of life and reduce stigma.

Model of Family Caregiver Resilience and Burden in Opioid Use Disorder

This theory synthesis provides a theoretical model for nursing researchers to examine factors that influence resilience and burden in family caregivers of individuals with opioid use disorder. Two frameworks, the Resiliency Model and the Conceptual Framework for Family Involvement with Adults with Co-occurring Substance and Mental Disorders, were synthesized and modified by incorporating concepts and conceptual relationships from recent research studies and experiential knowledge from clinical practice to develop a new model. The model predicts the impact of caregiver characteristics, caregiver support, stressors, and caregiver-care recipient dyad characteristics on caregiver well-being.

Comparison of Recovery Capital in Patients with Alcohol and Opioid Dependence - An Exploratory Study

Background

Recovery capital helps in the assessment of the personal strengths and challenges that exist in an individual with substance use which may have an impact on recovery process. This study aims at finding out the factors which help such individuals to sustain their recovery and how these factors differ across the two groups of people suffering from Alcohol Dependence Syndrome and Opioid Dependence Syndrome.

Methods

A cross-sectional observational was designed where sociodemographic and clinical variables, the recovery capital ARC (Assessment of Recovery Capital) Scale and Severity of substance use SDS (Severity of Dependence) Scale of patients diagnosed with Alcohol Dependence Syndrome (ADS group) and those with Opioid Dependence Syndrome (ODS group) were assessed among patients not reporting withdrawal symptoms.

Findings

A total of 49 subjects in the ODS group and 30 subjects in the ADS group were enrolled. The majority of the subjects in both groups were married, belonged to urban areas, practiced Hinduism, and were living in nuclear families. There was a significant difference between the educational status (p<0.001), religion practiced (p<0.001), age of onset of dependence (p<0.001), severity of dependence (p=0.11), and duration of abstinence (p<0.001) between the ADS and ODS groups. The mean scores on ARC Scale were 45.9 (S.D. =3.5) in the ODS group and 47.4 (S.D. =4.3) in the ADS group. ADS group had higher scores in Social Support Domain (p=0.034) and Housing and Safety domain (p=0.025). Other domains like global health, citizenship, meaningful activities, risk-taking, coping, and recovery experience did not significantly differ between the groups.

Conclusion

This study aims at comparing the recovery capital of ADS patients with ODS patients. It also suggests that tailored treatment plans for people with ADS and ODS especially in housing and social support and common treatment approach in other domains of recovery will help them sustain the state for a longer term.