Adaptive coping strategies of affected family members of a relative with substance misuse: 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.

Family Roles in the Risk of Serious Mental Illness among Youth with Substance Misuse: A Systematic Review

Context: Psychological disorders, such as depression and anxiety, are common among young people with substance misuse. Preventive strategies can diminish the negative impact on the society, especially family function. Objectives: The objective of this study was to systematically review the family functions in the risk of serious mental illness among youth with substance misuse. Methods: The main databases Web of Science, PubMed, and SCOPUS were searched for studies published during January 2018-December 202. “Prevention”, “anxiety”, “coping”, “family”, “parents”, “patients care plan”, “adjustment”, “community”, “youth”, and “drug addiction” were the keywords searched in the databases. The present review was conducted in 2022. Results: After the screening of articles based on the exclusion criteria, we selected seven studies. The studies were classified as affianced, patience, pulling out, social support, and emotional stability actions. Society and parents, who are the core family members, feel anxious following the drug misuse of the youth. The youngsters felt that these substances were harmful for their health, especially reproductive health. The parents felt very secluded from family and friends. There are different preventive strategies to overcome this behavior. Conclusions: Results of different evaluated studies showed that using emotional strategy is the common tool to prevent substance abuse. Social status and cultural perspective are effective in preventing this issue.

Predicting Hazardous Alcohol Drinking Behaviors in Family Members of Hazardous Alcohol-Drinker Patients

Family members of hazardous or harmful alcohol drinkers suffer many consequences of their relative’s alcohol-drinking behaviors and risk developing their own hazardous alcohol drinking behaviors. Studies of alcohol-related healthcare problems have mainly focused on patients, with few studies on their family members. This cross-sectional study explored factors predicting hazardous alcohol drinking behaviors in family members of hazardous alcohol-drinker patients. Participants were recruited from four randomly chosen hospitals in Taiwan. Data were collected using self-report questionnaires on family members’ alcohol use, perceived stress, coping mechanisms, social support, health, quality of life, protective factors against hazardous alcohol drinking, facilitative factors for hazardous alcohol drinking, and demographics. The 318 family members who participated in this study were divided by their Chinese-version Alcohol Use Disorders Identification Test scores into two groups: hazardous alcohol drinkers (score ≥ 8) and non-hazardous alcohol drinkers (score < 8). Significant factors predicting hazardous alcohol drinking behaviors were found by logistic regression to be the frequency of using general coping mechanisms (OR = 1.29, p < 0.01), the frequency of using strategies to cope with patients’ drinking-related behaviors (OR = 0.89, p < 0.01), factors protecting against hazardous alcohol drinking (OR = 0.76, p < 0.01) and factors facilitating hazardous alcohol drinking (OR = 1.52, p < 0.01). Interventions should be designed for family members of hazardous alcohol drinkers to address these four significant predictors.

“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 resilience: perception of family members of psychoactive substance dependents

Objective:

to understand the perception of family members of psychoactive substance dependents on the elements of the functioning of their family in family resilience.

Method:

a qualitative approach study, based on the theoretical interpretive framework of family resilience from a systemic perspective. The participants were eleven family members of psychoactive substance dependents from a Psychosocial Care Center - Alcohol and Drugs, from a city in the state of São Paulo. For data collection, semi-structured interview, genogram and ecomap were used. Data analysis was based on the Content Analysis technique, thematic category.

Results:

from the interviews, three thematic categories were formulated: mobilization in search of support and social support; positive perspectives that would strengthen the family, and assertive communication. These categories point to references to the mobilization and unity of the family in search of social support in the intra-family, extended family and extra-family contexts and positive perspectives, such as persistence, perseverance, hope, faith and religiousness.

Conclusion:

the situation of having a psychoactive substance dependent in the family seemed to mobilize coping devices and attempts to overcome them through the resilience forces. The results may favor the daily clinical reasoning of the health professionals, helping them to recognize and value the identified resilience attributes.

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.

Moving Beyond Nursing Standardized Language for Substance Use Problems

Nursing knowledge has been accompanied by the evolution of nursing standardized language systems (SLS) that can help nurses to systematize nursing care. We analyzed referential integrity (diagnosis, results, interventions) of substance related problems in Nursing SLS through documentary analysis: ICNP^®, NANDA-I, Nursing Intervention Classification (NIC), Nursing Outcome Classification (NOC), NANDA NIC NOC (NNN). ICNP^® has a definition of "substance abuse" but there are no clinical indicators or related factors to help formulate a diagnosis. NANDA-I does not define any related diagnosis, although it appears as related to or as a risk factor in 36 diagnoses. In NIC and NOC there are interventions and outcomes related. The phenomenon is omitted in NANDA-I and treated in a stigmatized manner by ICNP. Clear clinical indicators may be needed to help nursing diagnosis and to lead clinical reasoning.

Assessing Grief in Family Caregivers of Individuals With Alcohol Use Disorder or Substance Use Disorder using the Marwit-Meuser Caregiver Grief Inventory Short Form (MM-CGI-SF)

This study assessed grief in caregivers of family members with alcohol use disorder (AUD) and substance use disorder (SUD) using the Marwit-Meuser Caregiver Grief Inventory Short Form (MM-CGI-SF). We used snowball sampling to recruit participants who had family members with AUD and SUD. The sample was comprised of 100 caregivers of family members with AUD and 75 caregivers of family members with SUD. The original MM-CFI-SF was modified by changing the wording to reflect those with AUD and SUD. The 18-item instrument consisted of 3 factors: personal sacrifice burden, sadness and longing, and worry and felt isolation. The professional care of caregivers with family members with AUD and SUD should be addressed by health professionals in the same manner as dementia caregivers. AUD and SUD caregivers may also downplay the distress, require social support, or have a common reaction to the stress and grief encountered. The correlations were moderate to strong and significant between each of the factors for both AUD and SUD caregiver scale.

Coping with a loved one's substance use disorder or gambling disorder: what strategies really help?

Family members of people with substance use or gambling disorders (SUD/GD) struggle to cope with ongoing impacts to family life. Effective coping is critical but it is unclear which strategies are helpful for family members, as research is lacking. Female spouses/partners of people with SUD/GD (N=211) reported helpfulness and use of engaged, tolerant, and withdrawal coping strategies. Withdrawal coping was most helpful, and commonly used. Some engaged coping strategies were unhelpful but frequently used. Coping is complex; research is needed into effective coping for differing goals and contexts Professionals should empower family members to use strategies helpful to their well-being.

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.

“That day no one spoke”: Florida Puerto Ricans’ Reaction to Hurricane María

We conducted two focus groups and four individual interviews to examine the experiences of Florida Puerto Rican adults ( N = 26) with secondary exposure to the devastation caused by Hurricane María. Results from our thematic analysis yielded four major themes and eight subthemes depicting responses to Hurricane María. Four major themes emerged across participant responses: 1) Participants’ Experience with Hurricane María, 2) Participants’ Negative Reactions to Hurricane María, 3) Participants Providing Support, and 4) Resilience and Growth. We also found that Florida Puerto Ricans’ secondary stress reactions were influenced by Puerto Rico’s political status and economic crisis. Results also indicated that participants experienced vicarious posttraumatic growth not only at the individual but also at the community level.

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.

Coping Strategies of Pregnant Women with Detected Fetal Anomalies in Iran: A Qualitative Study

Background:

Progressing technology has increased the detection of fetal abnormalities in the pregnancy. Detection of fetal abnormalities during pregnancy can cause significant social, physical, psychological, and emotional stress. The aim of this study was to explore the coping strategies of Iranian pregnant women with detected fetal anomalies.

Materials and Methods:

This qualitative content analysis study was conducted on two referral centers for fetal anomaly. The data were collected from April 2017 to January 2018 in Mashhad (Iran) through individual, semistructured, in-depth interviews with 25 pregnant women with a prenatal diagnosis of fetal anomalies. Data were analyzed using conventional content analysis based on Graneheim and Lundman's approach.

Results:

As a result of data analysis, the four categories of seeking information, religiousness and spirituality, cognitive avoidance, and seeking social support, and 12 subcategories emerged. Seeking information consisted of the four subcategories of personal search, visiting different doctors, performing various diagnostic tests and sonography, and seeking peers' experiences. Religiousness and spirituality contained the three subcategories of praying, acceptance of destiny, and reliance on faith. Cognitive avoidance consisted of the two subcategories of avoiding negative information and avoiding situations that remind them of their problem. Seeking social support contained the three subcategories of getting support from family, getting support from friends, and getting support from others.

Conclusions:

The findings showed that pregnant women with detected fetal anomalies reported a variety of coping strategies. Therefore, it is important that healthcare providers encourage mothers to use strategies that are likely to be more effective.