Hopefulness Among Family Members of Individuals Who Use Opioids

Background: Opioid use disorder (OUD) can have a profound effect on family members who often feel hopeless, sad, ashamed, suffer in silence and have nowhere to go (Ries, Fiellin, Miller, & Saitz, 2014; Wallace, 2019). Learned hopelessness results from the perceived inability to have control over life (Zimmerman, 1990) and, in turn, may lead to depression and suicide (Beck, Brown, Berchick, Stewart, & Steer, 2006). Thus, professional help to a family member struggling with addiction may benefit the entire family system. Families that receive support might regain a sense of control and hopefulness (Daley, Smith, Balogh, & Toscaloni, 2018). We hypothesized that self-stigma would be negatively associated with perceived hopefulness among family members of people with OUD. Furthermore, treatment involvement and social support would be positively associated with perceived hopefulness and would mediate the relationship between self-stigma and hopefulness.

Method: Adult participants (n=215) who responded to advertisements in community-based programs for families affected by addition, such as Families Against Narcotics, answered an on-line survey containing sociodemographic questions (gender, age, and race), questions from the Caregiver Self-Stigma (Girma et al., 2014) and Significant Other Support (Power, Champion, & Aris, 1988) scales, items about participation in psychological and medical treatment modalities, as well as questions from the Hopefulness-Hopelessness Questionnaire (Micallef, 1995). We tested hypotheses using structural equation modeling (SEM; StataCorp, 2015). The adequacy of the SEM model was evaluated using the chi-square statistic, the comparative fit index (CFI), Tucker-Lewis index (TLI), and the root mean squared error of approximation (RMSEA). The recommended cutoff value for CFI and TLI is .95 while for RMSEA, the cutoff of .05 represents a good fit (Acock, 2013).

Results: Lower stigma (β=-.27, z =-3.48, p<.01), higher treatment involvement (β=.24, z =2.22, p< 0.05) and social support (β=.22, z = 2.70, p< 0.01), and self-identifying with White race (β=.14, z =2.04, p< 0.05) had positive direct effects on perceived hopefulness. Additionally, lower stigma had a direct positive effect on perceived social support (β= -.23, z = -3.08, p< 0.01). The direct relationships between stigma and treatment was not statistically significant. Stigma had a significant standardized indirect effect, mediated by social support on hopefulness (β=-.032, z =-2.21, p< 0.05). The model provided a good fit for the data: χ2(57, N=215) =86.80, p< 0.01, CFI = 0.976, TLI = 0.969, RMSEA =0.049 and explained 87% of the total variance (Bentler & Raykov, 2000).

Discussion: These results suggest the need to further explore the racial disparities in emotional processes among family members of individuals with OUD. Future studies should examine whether increasing treatment involvement, reducing self-stigma, enhancing support for family members and elevating a sense of hopefulness improves overall functioning of the families and contributes to the recovery of individuals with OUD.