Experiences and support needs of families affected by a loved one’s alcohol or other drug use

Background: Families affected by a loved one’s alcohol or other drug (AOD) use experience significant harm, including physical health issues, psychological distress, and relationship breakdowns. Despite this, support services have primarily focused on the Person using AOD, often overlooking or pathologising the needs of affected families. Further research is required to understand the experiences of affected families through a non-deficit perspective, including their characteristics, needs, and the support available to them as a distinct population in their own right. This thesis applied an exploratory mixed methods approach to comprehensively address this gap in knowledge through four studies exploring affected families’ characteristics, strengths, help-seeking, and treatment options.Methods: Study 1 was a cross-sectional survey of 1,756 affected family members in Australia to understand their sociodemographic characteristics, indicators of psychological wellbeing, help-seeking, and correlates of accessing specialised family-AOD support. Study 2 was a systematic review which identified nineteen studies examining the effectiveness of psychosocial interventions for affected families. Study 3 examined the feasibility and preliminary outcomes of SMART Family and Friends, a video-conference-delivered group intervention for affected families (N = 43). Study 4 was a qualitative study (N = 24) exploring families’ coping strategies in relation to a loved one’s methamphetamine use, analysed using the family-resilience framework.Results: Study 1 (Chapter 2) found high rates of psychological distress (54.0%), suicidal ideation (22.7%), and recent illicit drug use (19.7%) among study participants (affected families in Australia) across all relationships (e.g. parents, partners) to the Person using AOD. Participants took an average of 5.8 years to seek any help, and specialised family-AOD support (34.1%) was associated with being older (65+; Adjusted Odds Ratio [Adj. OR] = 1.47; 95% CI = 1.03, 2.10), less likely to reside with their Person (Adj. OR = 0.72; 95% CI = 0.55, 0.96), less likely to report risky drinking (Adj. OR = 0.53; 95% CI = 0.35, 0.80), and more likely to report that their Person had accessed AOD treatment (Adj. OR = 1.85; 95% CI = 1.33, 2.56). In Study 2 (Chapter 3), k = 3 RCTs found individually administered interventions significantly reduced families’ depression (standardised mean difference [SMD] = 0.50) and distress (SMD = 0.28). In k = 2 pre-post studies, individual interventions improved family functioning (d = 0.51) and coping (d = 0.43). In k = 3 non-RCTs and k = 2 pre-post designs group interventions significantly reduced depression (d = 0.50) and distress (d = 0.44), and improved coping (d = 0.81). The literature comprised small participant samples, low-quality methodology with little consistency in outcome measures, and no assessment of families’ own substance use. Study 3 (Chapter 4) found preliminary evidence supporting the feasibility of a video-conference group intervention for families affected by a loved one’s methamphetamine use. Post-treatment improvements were observed in psychological distress (d = 0.38), family impact (d = 0.64), family strain symptoms (d = 0.48), and total family burden (d = 0.69). The video-conference-delivery was experienced as convenient and accessible, although participants reported limited opportunities for interpersonal connection. Study 4 (Chapter 5) described families’ response to a loved one’s methamphetamine use, through a strengths-based lens. The results highlight families’ existing coping strategies and suggest that future support could be guided by facilitating acceptance, providing alternative perspectives of addiction, encouraging reconnection to self-identity, and helping to promote a sense of purpose.Conclusions: This thesis comprises four studies that advance understanding regarding the experiences of, and interventions for, families affected by a loved one’s AOD use. The results demonstrate that targeted interventions, designed specifically for families are both feasible and beneficial. However, engagement with such interventions remains limited. Further, significant and largely unmet mental health needs persist across all sub-groups of affected families. With appropriate support, families are able draw on innate strengths and resilience to cope with the challenges associated with a loved one’s AOD use. These findings highlight the need for policy action, public health campaigns, and service development that recognise families as an important population in their own right, to provide timely, accessible, and tailored support that builds on their existing strengths and capacities.