The Impact of a Substance Abuse Disorder on the Well-Being of Family Caregivers of Adults With Mental Illness

ABSTRACT

The impact that substance use has on an individual with mental illness has been documented; however, little is known about the impact that this may have for a family caregiver. Data was collected in a cross sectional study using mailed questionnaires to a convenience sample of family members of persons with mental illness (n = 110). Hierarchical linear regression analysis was used to determine the impact of substance use status upon four measures of well-being within a stress-coping model. The variables within the model were able to account for a significant proportion of the variance in each of the measures: perceptions of burden, depression, anxiety and physical health status (R² = .419 to .202). However, substance use status was not a significant predictor in any of these equations. Symptomatology and a measure of specific social support were the most significant predictors of burden (β = .345, p < .001 and β = .330, p < .001). Perceptions of caregiver burden were found to be the most significant predictor in each of the other three analyses (β = .515, p < .000; β = .511, p < .000; β = ? .571, p < .000). Results of this study suggest that substance use may not be as important as the other predictors included in the model in determining the well-being of family caregivers.     

The Impact of Caregiver-Care Recipient Relationship Quality on Family Caregivers of Women With Substance-Use Disorders or Co-Occurring Substance and Mental Disorders

This cross-sectional study utilized a stress-process model to examine the impact of caregivers' (N = 82) perceptions of their relationship quality with a female family member (i.e., care-recipient) with substance-use or co-occurring substance and mental disorders on caregivers' perceived burden. Regression findings indicate that relationship quality impacts both subjective and objective burden. Higher levels of emotional support given to the care recipient by the caregiver predicted lower levels of caregiver displeasure; whereas higher levels of undermining of the care recipient by the caregiver predicted higher levels of caregiver stigma. Higher levels of emotional support received by the caregiver from the care recipient were associated with lower levels of caregiver displeasure and lower objective burden; higher levels of undermining of the caregiver by the care recipient predicted higher objective burden. Implications for practice and service delivery are presented.     

Personal Social Networks of Women with Co-Occurring Substance Use and Mental Disorders

ABSTRACT

There has been relatively little examination of the social network resources of women with substance use disorder, and even fewer explorations of women with co-occurring mental disorders, such as anxiety, depression, and posttraumatic stress disorder. This study explores the nature of co-occurring mental disorders, social network characteristics and perceived social support in 136 women with substance use disorders. Respondents reported small personal networks that contained both supportive and non-supportive people. Relatives did provide social support, but those who used alcohol/drugs were viewed as tending to interact negatively. Women with dual disorders perceived less concrete, emotional, and sobriety support from some network relationships than the women with substance use disorders only. Implications for research and practice are presented.     

Dementia Caregiving in the Context of Late‐Life Remarriage: Support Networks,Relationship Quality,and Well‐being

Caregiving research has not accounted for increasingly diverse and complex marital and family histories of older Americans. The authors examined social relations and care‐specific positive and negative support networks among late‐life remarried wife dementia caregivers (N = 61) to determine associations among network structure, relationship quality with and support received from network members, and global assessments of family and stepfamily disagreement on caregiver well‐being. Own family and friends predominated in the social relations and positive networks. Although over half (54%) of respondents included a stepfamily member in their positive networks, stepchildren comprised the largest group (35%) in the negative networks. Larger negative networks and actively negative interactions were related to greater caregiver burden, and more global disagreement with stepfamily was associated with greater depression and burden. The findings illustrate the complex nature of support and the value of targeted examinations of caregiving support dynamics among late‐life remarried older adults and stepfamilies facing health demands.     

A mixed methods inquiry of caregivers of U.S. veterans with sustained “invisible” injuries from Iraq/Afghanistan

ABSTRACT

An exploratory study of caregiver burden associated with family caregivers enrolled in the VA Caregiver Support Program who assist veterans with serious invisible injuries sustained post September 11, 2001. A mixed methods analysis was completed with a retroactive chart review of already collected data (172 participants) in addition to a phenomenological query of 16 participants. Results: T-tests resulted in a significantly higher caregiver burden score with caregivers who had children in the home (M = 6.84; SD = 3.21) versus those who did not (M = 5.57; SD = 2.75), t (160) = ?2.36, p = .02. An ANOVA across caregiver role (parent, spouse, significant other and other) and the Zarit Burden Inventory (ZBI) resulted in a significant difference (F [3, 159] = 1.59, p < .01, with spousal caregivers having a significantly higher ZBI score (M = 6.83; SD = 3.10) than parental caregivers (M = 4.46; SD = 2.70). The phenomenological research resulted in 22 major themes (family adjustment, subjective demands, coping techniques, social support, VA/DOD, self-care, intimacy, role strain, financial resources, life course, obligation, rewards, isolation/loss of self, reciprocity, stigma, community resources, spiritual support, tools, hope, uncertainty, guilt, leash syndrome) which supported quantitative findings. Conclusions: Caregivers and their families had a difficult time adjusting post injury. Caregivers relied heavily on their own coping mechanisms to adapt to their new role and did not find social support to be helpful with caregiving. Spousal caregivers and caregivers with children in the home had more difficulty adjusting when compared with parental caregivers.     

Kinship Care: Analysis of the Health and Well-Being of Grandfathers Raising Grandchildren Using the Grandparent Assessment Tool and the Medical Outcomes Trust SF-36 TM Health Survey

ABSTRACT

As more and more children are being separated from their biological parents because of AIDS, substance abuse, mental and physical illness, incarceration, and child abuse and neglect, child welfare agencies are relying more often on kinship care as a viable option for out-of-home placements. In many cases, kinship care falls on the grandparents. While keeping children within their families is generally viewed as preferable by child welfare agencies, it can be a burden on grandparent caregivers, who often exist on severely limited incomes and without much assistance or support from social service agencies. A research project was conducted which used both quantitative and qualitative data from research conducted by Jones and Gibbons (2000) on grandparent care, but this study focuses on the experiences of grandfathers who participated in the project and examines their outcomes in several different areas.     

Comorbid Substance Use and Mental Disorders Among Offending Youth

ABSTRACT

This study examines the offense, substance use, and mental illness characteristics for a subset of adolescent juvenile detainees receiving services through a federally funded system of care initiative. Findings indicate that 65% of these youth were comorbid for both mental and substance use disorders. Female detainees were at greater risk on almost every measure of mental health impairment and dual substance use and mental disorders. Study results highlight the need for effective, integrated treatment models that can serve youth involved in multiple child-serving systems, and address the challenging constellation of comorbid conditions faced by many juvenile offenders.     

Friendsourcing Peer Support for Alzheimer’s Caregivers Using Facebook Social Media

ABSTRACT

This research piloted an e-health intervention that used social media to friendsource peer support for Alzheimer’s disease (AD) caregivers. Friendsourcing is a variant of crowdsourcing. Crowdsourcing recruits online participants who share a characteristic that makes their volunteerism meaningful when they join to achieve an outcome. Friendsourcing recruits online participants who share membership in a social network that makes their volunteerism meaningful when they join to achieve an outcome. This article introduces our friendsourcing intervention research and examines the effects on the psychological well-being of AD caregivers. After a 6-week intervention, caregivers were found to have significantly decreased burden (Z?=??2.01, p?<?.05) and perceived stress (Z?=??2.95, p?<?.01). Emotional and informational support scores were significantly increased (Z?=??2.32, p?<?.05). Qualitative data analysis of the intervention identified positive effects in new caregiving knowledge acquisition and application and reduced stress in the acceptance of the caregiving role. Joining social networks in support groups through friendsourcing was feasible for AD caregivers who were familiar with social media, and can provide another means of guiding the development of their personal support networks.     

Military Caregivers

Military caregivers provide essential services for their veteran or military service members who have serious injuries or illness. Of the estimated 39.8 million Americans who provide care for an adult, 1.1 million care for a post 9/11 veteran or service member. Caregivers may experience greater physical or mental health concerns including stress, depression and/or chronic illness, and have greater financial burden than their non-caregiving counterparts. Policy shifts such as the Caregivers and Veterans Omnibus Health Services Act of 2010 (2018) have created and expanded programs to support caregivers. Practitioners working with injured or ill military service members or veterans and their families should include a comprehensive biopsychosocial assessment of the whole family, utilizing several interventions, such as support groups, peer support, psychoeducational programs, training, individual and family counseling, and/or respite care services, to improve family function and reduce caregiver burden.     

Substance Abuse,Homelessness, Developmental Decision-Making and Spirituality: A Women's Health Issue

ABSTRACT

A qualitative methodology was used to examine the relationship between homeless women's spirituality, substance abuse, moral reasoning and developmental decision-making. Findings indicated that a lack of development in spirituality and the ability to make decisions in childhood is related to homeless, addicted women's inability to maintain abstinence and achieve social independence. Spirituality impacted decisions to abstain from substance abuse and increased the women's social independence. Findings suggest that treatment needs to incorporate spirituality, family of origin, and the development of skills for independent decision-making. The authors propose that childhood maltreatment, homelessness and substance abuse impede spiritual development. Therefore, substance abuse treatment needs to include a focus on spirituality and moral reasoning in the recovery process.     

A Family Perspective for Substance Abuse: Implications from the Literature

SUMMARY

This paper calls for researchers and treatment providers to increase their recognition of the role that family and family functioning has for understanding the incidence and impact of substance abuse. Substance abuse is identified as a family problem by exploring its occurrence within families as well as its impact on marital relationship, family violence, and child abuse and neglect. The impact of substance abuse on the roles of spouses and parents are examined, as is the impact of substance abuse on children at various developmental stages. The role of the family as participant in active substance abuse as well as a valuable treatment resource is also explored. Finally, the authors present recommendations for increasing the focus on family in substance abuse research.     

Stress,strain, coping and social support for affected family members attending the National Problem Gambling Clinic,London

Aims were: to compare burden experienced by affected family members (AFMs) attending a problem gambling treatment clinic in London, England with that of AFMs affected by substance problems; to examine socio-demographic correlates of AFM burden; to evaluate change following an intervention designed for AFMs; and to test the assumption of the stress-strain-coping-support (SSCS) model that change in AFM coping is important. AFMs (N = 215) completed a gambling version of the short questionnaire for family members affected by addiction (SQFM-AA) which assesses stressful impact, symptoms of ill health, ways of coping, social support and overall burden. All received a 5-Step Method workbook, based on the SSCS model. The SQFM-AA was repeated three to six months later (n = 96). T-test analyses showed that baseline burden and related variables were comparable to those of family members affected by substance problems, were greater for wives and those living in the same household as the gambling relative, and were significantly reduced at follow-up. Regression modelling indicated the importance, for AFMs’ health, of reduced levels of engaged-emotional coping. Family members affected by gambling, some subgroups especially, experience high levels of burden. They can benefit from a model-based intervention, and coping change may be an important process.     

Social Networks,Substance Use,and Mental Health in College Students

Abstract

Objectives: The relationship between social network risk (alcohol-using close friends), perceived peer closeness, substance use, and psychiatric symptoms was examined to identify risk and protective features of college students’ social context. Participants: Six hundred and seventy undergraduate students enrolled in a large southeastern university. Methods: An online survey was administered to consenting students. Results: Students with risky networks were at a 10-fold increase of hazardous drinking, 6-fold increase for weekly marijuana use, and 3-fold increase for weekly tobacco use. College students’ who feel very close to their peers were protected against psychiatric symptoms yet were at increased risk for marijuana use. Perceived closeness of peers was highly protective against psychiatric symptoms, adding a natural preventive effect for a population at great risk for mental illness. Conclusions: Results support targeting college students through network-oriented preventive interventions to address substance use as well as mental health.     

Kinship Care: A Cultural Resource of African American and Latino Families Coping with Parental Substance Abuse

SUMMARY

This paper examines kinship care as a cultural resource used by African American and Latino families coping with substance abuse by a family member. Although there is a growing body of literature on kinship care, there are no conceptual or empirical studies that have drawn or built on cultural similarities between these two groups of ethnic minority families. A framework that prioritizes cultural assessment and relevance in using familial and cultural resources is proposed to assist practitioners confronted with the demographic realities of working with social, clinical and ethnocultural complexities when serving ethnic minority families. The framework is based on practice implications raised by recent studies on kinship care and from the perspective of pertinent cross-cultural and anthropological literature.     

Assessing Social Work's Contribution to Controlled Studies of Adolescent Substance Abuse Treatment

ABSTRACT

Findings from a review of social work's contribution to the adolescent substance abuse treatment outcome literature between 1990 and 2001 are presented. Social work involvement in adolescent substance abuse treatment was evaluated through a computerized bibliographic search of medical and social science databases and by a manual search of 13 core social work journals. Results indicate that social work has contributed little to knowledge development in adolescent chemical dependency treatment. Investigators affiliated with a department or school of social work accounted for three of 15 controlled treatment outcome studies. Only one report was published in a core social work journal. Efforts to develop clinical guidelines in this important practice domain will founder until a sufficiently directive body of practice-relevant research accumulates to guide evidence-based substance abuse treatment for adolescents.     

Psychosocial distress,physical illness,and social behaviour of close relatives to people with substance use disorders

ABSTRACT

This study explores how a family member with substance use disorder (SUD) affects the psychosocial, behavioral, and physical states of other family members. Sixteen in-depth interviews with relatives of Icelandic individuals afflicted with SUD were performed. The interviewees were selected from a pool of Icelandic families whose members included one or more chronic SUD users. They represented different relations to the user (spouses, parents, children, and siblings) and both genders. All participants except for siblings expressed that SUD had negatively affected their mental health by inducing depression, anxiety, and stress-related physical illness. All had experienced physical violence, mental abuse and financial loss. Parents indicated that the SUD of the family member had isolating psychosocial impacts on their children and caused a loss of connection among their family members. All participants, except the siblings, regarded their workplace as a shelter. The study’s findings can help social professionals to better understand the effects of SUD on families, family systems, and public health in general.     

Clinical Treatment of Substance Abusers: Past, Present and Future

With an estimated 9?% of the population in the United States having a substance use disorder, it is a rare social worker that has not encountered a substance abuser or a family member of one in his or her clinical practice. This article provides a brief history of social workers?? role in the treatment of substance abusing clients, an overview of the current, evidence-based treatment approaches and some of the issues that will be impacting this field in the future. A case study is used to illustrate some of the dynamics of substance abusing individuals, the impact on the family and effective treatment approaches.     

Spiritual Mechanisms Underlying Substance Abuse Behavior Change in Faith-Based Substance Abuse Treatment

ABSTRACT

Despite increasing interest in “faith-based” substance abuse treatment and HIV risk reduction interventions, there is little systematic evidence of the efficacy of explicitly spiritual interventions. However, fundamental to effective interventions is an explicit conceptualization of mechanisms underlying behavior change. This paper discusses the definition of faith-based organizations, specifically as they relate to substance abuse treatment programs, briefly reviews relevant behavior change theories to identify key variables underlying change, presents an integrative conceptual framework articulating linkages between spiritual intervention components, behavior change processes and substance abuse outcomes, and discusses how the mechanisms identified in our model can be seen in commonly used substance abuse interventions. Overall, the paper suggests that what happens in “faith-based” programs may not be so different from processes taking place in good social work practice in the addictions field.     

Co-Occurring Substance Use and Personality Disorders: Current Thinking on Etiology,Diagnosis, and Treatment

ABSTRACT

Despite the high prevalence of personality disorders among substance abusing individuals, the literature on these co-occurring disorders is limited. This paper reviews the literature and provides the most current data on the demographics, the criteria for diagnosing both personality disorders and substance use disorders, and the effects of substance abuse and co-occurring personality disorders, particularly antisocial and borderline, on prognoses and treatment approaches. Recommendations for further research on these co-occurring disorders are provided.     

Young Children of Parents with Substance Use Disorders (SUD): A Review of the Literature and Implications for Social Work Practice

SUMMARY

This article reviews the scientific literature that focuses on school-age children of parents with substance use disorder (SUD). The review examined the subjects, instruments, and results of 10 scientific studies published from 1985 to the present (2006). Generally, school-age children of parents with SUD demonstrated a variety of emotional, cognitive, behavioral, and social problems. Specifically, (a) children of drug users (CODs) were at higher risk than children of alcoholics (COAs) for psychopathology and functional impairments, and (b) Children of parents diagnosed as having SUDs (particularly alcohol), along with anti-social personality disorder (ASPD) showed more negative psychosocial outcomes than children whose parents did not have ASPD. Recommendations for future research and implications for social work practice are discussed.