Families are the primary source of support to adults with substance use disorders or co-occurring substance and mental disorders. Yet little is known about whether the quality of family relationships has an impact on caregivers' burden in this population. This paper examines the influence of family caregivers' perceptions of the positive and negative quality of their relationship with their care-recipients on caregivers' perceived burden. The study sample consists of family caregivers to women who have substance disorders only or co-occurring substance and mental disorders (anxiety, PTSD, depression, dysthymia). Research subjects represent an understudied population.

Methods

This NIDA funded cross-sectional study interviewed women clients in one residential and one outpatient substance abuse treatment program and also a principal family caregiver designated by each woman. Almost all women who met eligibility criteria (96%, N=87) agreed to participate and provided the name of a family member, 95% of whom (N=83) were interviewed. Over four-fifths (84.1%) of the sample were African-American. A stress-coping model was utilized to identify stressors and resources hypothesized to impact objective burden (i.e., frequency of disruptions) and subjective burden (worry, stigma and displeasure). Relationship quality was defined as the caregiver's perception of emotional support and emotional undermining given to and received from the care recipient. Separate hierarchical multiple regression analyses were conducted for the four types of burden. Following the theoretical model, predictors included stressors (e.g., problem behaviors), resources (e.g., social support), relationship quality (given support/undermining or received support/undermining), and demographic variables.

Results

The burden scales had good internal consistency (α = .79 to .90), and the quality of relationship scales had acceptable internal consistency (α =.65 to .80). All regression models were statistically significant (p <.001, R² = .24 to .45). For support and undermining given by the caregiver to the care-recipient, higher levels of emotional support predicted lower levels of caregivers' displeasure, whereas higher levels of undermining predicted higher levels of caregivers' stigma. For perceived support/undermining received by the caregiver from the care-recipient, higher levels of emotional support were associated with lower levels of displeasure and lower objective burden; whereas higher levels of received undermining predicted higher objective burden. Across the models, higher levels of behavioral problems predicted higher levels of displeasure, worry and objective burden, whereas overall social support from the caregivers' social network predicted lower levels of stigma.

Implications

Findings indicate that caregiver/care recipient relationship quality does impact caregiver subjective and objective burden. The finding that different aspects of these relationships predict different types of burden suggests that interventions should address both emotional support and undermining, as well as both aspects of the support exchange – giving and receiving. Overall, other predictors were consistent with previous caregiving research. Having a dual disorder did not predict higher burden, suggesting that future analyses might be needed to distinguish the effect of specific psychiatric diagnoses on caregiver burden.