Latinos with Schizophrenia and Their Family Members' Perceptions of Substance Use in Relation to Mental Illness

Background and Purpose:  Nearly 50% of individuals with schizophrenia have a substance use disorder. Use of substances is a major obstacle to recovery.  Social context is a relevant factor in substance use perceptions, norms, and behaviors that may influence processes that are involved in substance use.  Few studies have examined substance use and family context among individuals with schizophrenia. Among Latinos, family social context may be particularly relevant given that Latinos with serious mental illness are more likely to live with family compared to other groups.  Considering the limited number of studies addressing substance use among Latinos with schizophrenia and this group’s underutilization of services, learning about patient and family caregiver perceptions regarding use can inform potential targets for treatment.  This study explored perceptions of substance use in relation to mental illness among Latinos with schizophrenia and their primarily low-acculturated family caregivers.

Methods:  Participants were part of a NIMH-funded intervention development study for low-acculturated Latino family members of individuals with schizophrenia.  Data for the current study come from two follow-up studies with intervention group participants.  Using purposive sampling, semistructured interviews were conducted with 34 participants (14 patients; 20 family caregivers) in their preferred language. Participants were asked about challenges and facilitators of treatment. Transcripts were thoroughly analyzed for mentions of legal or illegal substance use. Several participants disclosed that substance use was or had been a major obstacle in their treatment. Using an inductive approach, a second follow-up study was conducted with 24 participants (11 patients; 13 family caregivers) wherein questions exploring substance use were posed with follow-up probes to capture views on substance use.  Data were analyzed using thematic analysis, which consisted of comparing codes across and within participant transcripts.  Memo writing was used throughout the analysis process to document decisions regarding theme development.

Results:  Findings revealed substance use challenges and strategies to address use. Patients reported socialization triggers as challenges (“I pretty much grew up around it”), whereas family caregivers experienced burden (“very difficult for me”), concerns with patient recovery (“if he does not take medication and he has alcohol, alcohol will win”), and stigma (“ill because they chose it”). To address challenges, patients limited their substance use (“I don’t want to end up too much with the habit”) and socialization (“I don’t go out as much”).  Family caregivers were vigilant of patient use (“make sure he does not drink that much”) and communicated their concerns to patients (“it is ugly to have to call it to his attention frequently”).

Conclusions and Implications:  Family social context was important to how substance use was perceived and managed.  Family involvement appeared to dissuade patient substance use. Despite this support, some patients continued to struggle with managing their substance use. In addition, for some families, providing support to their loved one with substance use problems resulted in caregiving burden. Substance use affects both patients and family members. As such, treatment approaches should include a holistic framework that incorporates family when addressing substance use problems among Latinos with schizophrenia.