Abstract
Impacts from substance use within families demonstrate there is a reciprocal relationship between substance use and family dysfunction/conflict and low family support. Caregivers supporting loved ones engaged in substance use experience wellbeing consequences. Few studies address both the individual tangible strains of the care provided and the role of relationship quality factors between loved ones in recovery including communication, trust, and family stability. Participants (N = 160, mean age 48.14 years; 48% female, 52% male) in the current study were 72% white and 11% Black, Indigenous, and People of Color (3%) and were recruited through substance use treatment agencies and recovery support forums for family members; 90% of participants reported being a parent or in a primary family caregiver role (step-parent, grandparent/extended family member who had raised the child; 10%) of an adult child who had sought treatment for substance use disorders. Results indicate these caregivers experience exacerbated psychological distress with mental health symptom ratings above the most severe clinical thresholds anxiety, depression, stress, and caregiver burden. Concerning ratings on family relationship quality factors were also evident. Linear regression using forward-entry methods significantly predicted over 40% (R2 = .419) of variance in caregiving burden F(5, 161) = 23.24, p = .000 and indicated that increases in anxiety, financial anxiety, and stress are the most significant predictors of caregiving burden. This study suggests that stress reduction interventions for family caregivers may be critical, particularly given of their central roles in their loved ones’ treatment as facilitators of treatment activation, engagement, long-term recovery supports.
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References
Antonucci, T. C., Birditt, K. S., Sherman, C. W., & Trinh, S. (2011). Stability and change in the intergenerational family: A convoy approach. Ageing and Society, 31(7), 1084–1106. https://doi.org/10.1017/S0144686X1000098X
Biegel, D. E., Ishler, K. J., Katz, S., & Johnson, P. (2007). Predictors of burden of family caregivers of women with substance use disorders or co-occurring substance and mental disorders. Journal of Social Work Practice in Addictions, 7, 25–49. https://doi.org/10.1300/J160v07n01_03
Biegel, D. E., Katz-Saltzman, S., Meeks, D., Brown, S., & Tracy, E. M. (2010). Predictors of depressive symptomatology in family caregivers of women with substance use disorders or co-occurring substance use and mental disorders. Journal of Family Social Work, 13, 25–44. https://doi.org/10.1080/10522150903437458
Broese van Groenou, M. I., & De Boer, A. (2016). Providing informal care in a changing society. European Journal of Ageing, 13, 271–279. https://doi.org/10.1007/s10433-016-0370-7
Butler, R., & Bauld, L. (2005). The parents’ experience: Coping with drug use in the family. Drugs: Education Prevention and Policy, 12, 35–45. https://doi.org/10.1080/0968763042000275308
Chandler, J., & Shapiro, D. (2016). Conducting clinical research using Crowdsourced convenience samples. Annual Review of Clinical Psychology, 12(1), 53–81. https://doi.org/10.1146/annurev-clinpsy-021815-093623
Cohen, S., & Williamson, G. (1988). Perceived stress in a probability sample of the US. In S. Spacapam & S. Oskamp (Eds.), The social psychology of health: Claremont Symposium on Applied Social Psychology. Sage.
Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385–396.
Craig, L., & Mullan, K. (2010). Parenthood, gender and work-family time in the United States, Australia, Italy, France, and Denmark. Journal of Marriage and Family, 72, 1344–1361.
Cutrona, C. E. (1996). Sage series on close relationships, Vol. 13. Social support in couples: Marriage as a resource in times of stress. Sage Publications, Inc.
Dombestein, H., Norheim, A., & Lunde Husebø, A. M. (2019). Understanding informal caregivers’ motivation from the perspective of self-determination theory: An integrative review. Scandinavian Journal of Caring Sciences, 34, 267–279. https://doi.org/10.1111/scs.12735
Fletcher, A. C., Steinberg, L., & Williams-Wheeler, M. (2004). Parental influences on adolescent problem behavior: Revisiting Stattin and Kerr. Child Development, 75, 781–796. https://doi.org/10.1111/j.1467-8624.2004.00706.x
Gavazzi, S. M., & Sabatelli, R. M. (1990). Family systems dynamics, the individuation process, and psychosocial development. Journal of Adolescent Research, 5, 500–519.
Gilligan, M., Suitor, J. J., Rurka, M., Con, G., & Pillemer, K. (2017). Adult children’s serious health conditions and the flow of support between the generations. The Gerontologist, 57, 179–190. https://doi.org/10.1093/geront/gnv075
Golics, C. J., Basra, M. K., Salek, M. S., & Finlay, A. Y. (2013). The impact of patients’ chronic disease on family quality of life: An experience from 26 specialties. International Journal of General Medicine, 6, 787–798. https://doi.org/10.2147/IJGM.S45156
Groenewald, C., & Bhana, A. (2016). “It was Bad to See My [Child] Doing this”: Mothers’ experiences of living with adolescents with substance abuse problems. International Journal of Mental Health and Addiction, 14, 646–661. https://doi.org/10.1007/s11469-015-9605-7
Israel, A. C., & Roderick, H. A. (2001). A measure of the stability of family activities: An initial examination. Assessment, 8(4), 417–424. https://doi.org/10.1177/107319110100800406
Ivanova, M. Y., & Israel, A. C. (2006). Family stability as a protective factor against psychopathology for urban children receiving psychological services. Journal of Clinical Child and Adolescent Psychology, 35(4), 564–570. https://doi.org/10.1207/s15374424jccp3504_7
Johnson, L. N., Ketring, S. A., & Abshire, C. (2003). The revised inventory of parent attachment: Measuring attachment in families. Contemporary Family Therapy: An International Journal, 25(3), 333–349. https://doi.org/10.1023/A:1024563422543
Johnson, L. N., Ketring, S. A., Rohacs, J., & Brewer, A. L. (2006). Attachment and the therapeutic alliance in family therapy. The American Journal of Family Therapy, 34, 205–218. https://doi.org/10.1080/01926180500358022
Johnson, S. U., Ulvenes, P. G., Øktedalen, T., & Hoffart, A. (2019). Psychometric properties of the General Anxiety Disorder 7-item (GAD-7) scale in a heterogeneous psychiatric sample. Frontiers in Psychology, 10, 1713. https://doi.org/10.3389/fpsyg.2019.01713
Karriker-Jaffe, K. J., Room, R., Giesbrecht, N., & Greenfield, T. K. (2018). Alcohol’s harm to others: Opportunities and challenges in a public health framework. Journal of Studies on Alcohol and Drugs, 79, 239–243. https://doi.org/10.15288/jsad.2018.79.239
Kaur, A., Mahajan, S., Deepti, S. S., & Singh, T. (2018). Assessment of role of burden in caregivers of substance abusers: A study done at Swami Vivekananda Drug De-addiction Centre, Govt. Medical College, Amritsar. International Journal of Community Medicine and Public Health, 5(6), 2380–2383. https://doi.org/10.18203/2394-6040.ijcmph20182162
Lander, L., Howsare, J., & Byrne, M. (2013). The impact of substance use disorders on families and children: From theory to practice. Social Work in Public Health, 28(3–4), 194–205. https://doi.org/10.1080/19371918.2013.759005
Lazarus, R. S. (1993). Coping theory and research. Psychosomatic Medicine, 55, 234–247.
MacMaster, S. A. (2008). The impact of a substance abuse disorder on the well-being of family caregivers of adults with mental illness. Journal of Family Social Work, 11, 50–73. https://doi.org/10.1080/10522150802007311
McCann, D., Bull, R., & Winzenberg, T. (2012). The daily patterns of time use for parents of children with complex needs. Journal of Child Health Care, 16, 26–52.
McPherson, C., Boyne, H., & Willis, R. (2017). The role of family in residential treatment patient retention. International Journal of Mental Health and Addiction, 15(4), 933–941. https://doi.org/10.1007/s11469-016-9712-0
Minaie, M. G., Hui, K. K., Leung, R. K., Toumbourou, J. W., & King, R. M. (2015). Parenting style and behavior as longitudinal predictors of adolescent alcohol use. Journal of Studies on Alcohol and Drugs, 76, 671–679.
National Institute on Drug Abuse. (2020). Is drug addiction treatment worth its cost? Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/drug-addiction-treatment-worth-its-cost on 2020, December 18.
Ng, H. Y., Griva, K., Lim, H. A., Tan, J. Y. S., & Mahendran, R. (2016). The burden of filial piety: A qualitative study on caregiving motivations amongst family caregivers of patients with cancer in Singapore. Psychology and Health, 31(11), 1293–1310.
Olsen, L. R., Jensen, D. V., Noerholm, V., Martiny, K., & Bech, P. (2003). The internal and external validity of the Major Depression Inventory in measuring severity of depressive states. Psychological Medicine, 33(2), 351–356. https://doi.org/10.1017/S003-3291702006724
Orford, J., Velleman, R., Natera, G., Templeton, L., & Copello, A. (2013). Addiction in the family is a major but neglected contributor to the global burden of adult ill-health. Social Science & Medicine, 78, 70–77.
Pendergrass, A., Malnis, C., Graf, U., Engel, S., & Graessel, E. (2018). Screening for caregivers at risk: Extended validation of the short version of the burden scale for family caregivers (BSFC-s) with a valid classification system for caregivers caring for an older person at home. BMC Health Services Research, 18(1). https://doi.org/10.1186/s12913-018-3047-4
Pinquart, M., & Sörensen, S. (2003). Associations of stressors and uplifts of caregiving with caregiver burden and depressive mood: A meta-analysis. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 58(2), 112–128. https://doi.org/10.1093/geronb/58.2.p112
Rowe, C. L. (2012). Family therapy for drug abuse: Review and updates 2003–2010. Journal of Marital and Family Therapy, 38, 59–81. https://doi.org/10.1111/j.1752-0606.2011.00280.x
Raina, P., O’Donnell, M., Schwellnus, H., Rosenbaum, P., King, G., Brehaut, J., Russell, D., Swinton, M., King, S., Wong, M., Walter, S. D., & Wood, E. (2004). Caregiving process and caregiver burden: Conceptual models to guide research and practice. BMC Pediatrics, 4, 1. https://doi.org/10.1186/1471-2431-4-1
Richter, L., Chatterji, P., & Pierce, J. (2000). Perspectives on family substance abuse: The voices of long-term Al-Anon members. Journal of Family Social Work, 4, 61–78. https://doi.org/10.1300/J039v04n04_06
Roth, J. D. (2010). Addiction as a family disease. Journal of Groups in Addiction & Recovery, 5, 1–3. https://doi.org/10.1080/15560350903547189
Saatcioglu, O., Erim, R., & Cakmak, D. (2006). Role of family in alcohol and substance abuse. Psychiatry and Clinical Neurosciences, 60, 125–132. https://doi.org/10.1111/j.1440-1819.2006.01476.x
Shlafer, R. J., & Poehlmann, J. (2010). Attachment and caregiving relationships in families affected by parental incarceration. Attachment & Human Development, 12, 395–415. https://doi.org/10.1080/14616730903417052
Shapiro, G. K., & Burchell, B. J. (2012). Measuring financial anxiety. Journal of Neuroscience, Psychology, and Economics, 5(2), 92–103. https://doi.org/10.1037/a0027647
Sherman, L. J., Rice, K., & Cassidy, J. (2015). Infant capacities related to building internal working models of attachment figures: A theoretical and empirical review. Developmental Review, 37, 109–141. https://doi.org/10.1016/j.dr.2015.06.001
Shumway, S. T., Bradshaw, S. D., Hayes, N., Schonian, S., & Kimball, T. G. (2019). Prefrontal cortex functioning of family members of those with substance use disorders. Alcoholism Treatment Quarterly, 37(1), 75–98. https://doi.org/10.1080/07347324.2018.1488549
Skowron, E. A., Holmes, S. E., & Sabatelli, R. M. (2003). Deconstructing differentiation: Self regulation, interdependent relating, and well-being in adulthood. Contemporary Family Therapy, 25, 111–129.
Sprague Martinez, L., Walter, A. W., Acevedo, A., López, L. M., & Lundgren, L. (2018). Context matters: Health disparities in substance use disorders and treatment. Journal of Social Work Practice in the Addictions, 18, 84–98. https://doi.org/10.1080/1533256X.2017.1412979
Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (HHS Publication No. PEP19–5068, NSDUH Series H-54). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/
Tabachnick, B. G., Fidell, L. S., & Ullman, J. B. (2007). Using multivariate statistics (Vol. 5, pp. 481–498). Boston, MA: Pearson.
Tyo, M. B., & McCurry, M. K. (2020). An integrative review of measuring caregiver burden in Substance Use Disorder. Nursing Research, 69, 391–398. https://doi.org/10.1097/NNR.0000000000000442
Uchino, B. N. (2004). Social support and physical health: Understanding the health consequences of relationships. Yale University.
Wegscheider-Cruse, S., & Cruse, J. (2012). Understanding codependency: The science behind it and how to break the cycle. Health Communications Inc.
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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Carissa D’Aniello and Rachel Tambling. The first draft of the manuscript was written by Beth Russell. Abagail Horton provided the tables and heavily edited the manuscript; all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Russell, B.S., D’Aniello, C., Tambling, R.R. et al. Distress Among Parents of Individuals with Substance Use Disorders: Factors That Shape the Context of Care. Int J Ment Health Addiction 22, 478–493 (2024). https://doi.org/10.1007/s11469-022-00884-0
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DOI: https://doi.org/10.1007/s11469-022-00884-0