An unknown invisible intrusion. Impact of an adult family member’s problematic substance use on family life: a meta-ethnography

Figures & data

Table 1. The inclusion/exclusion criteria.

Inclusion:  Family members’ experiences of the impact adult family member’s PSU has on family life Studies published in 2000 or later English or Scandinavian language Qualitative peer-reviewed studies No geographical restriction

Exclusion:  Focus on an individual’s experience without descriptions of family life Focus on substance use and parenting and childcare, if studies do not have clear descriptions of family life Treatment context and methods for family inclusion in different treatments Dual diagnoses or health consequences or coping strategies for individual family members Quantitative or mixed methods research Mixed perspectives such as families and health care professionals

Figure 1. The PRISMA flow diagram.

Table 2. Characteristics of Included studies.

First author	Country	Design	Aim/purpose	Sample	Substance	Results
Arcidiacono et al. (2009)	Italy	Semi-structured interviews	The impact on Italian family members of living with a relative who had an alcoholor drug problem the development of coping strategies in the context of family and socio-cultural support	n = 113 Parents 53 Partners 37 Siblings 14 Child 8 Other 1	Alcohol and drugs	Strong impact of substance use problems on the family members, like shame, guilt, discouragement, mistrust. Changes to family routines and experiences of violence and aggression. Experienced lack of support. The complexity of coping strategies in families. The importance of the family in the Italian social environment.
Church et al. (2018)	India	In-depth interviews	The aim of this article was to assess the current coping strategies used by AFMs and to examine the nature of support they already have to deal with their drinking relative.	n = 30 Mothers 3 Wives 19 Sisters 2 Brothers 1 Daughters 1 Sons 1 Sister-in-laws 2 Brother-in-laws 1	Alcohol	Experienced a considerable amount of strain in relation to their relative’s drinking. Coping strategies included accommodating to the relative’s behavior in family, financially adapting to their means, self-harm, attempting to reason with the drinking relative, covert intervening, and avoiding fights and arguments in family life. There was a general reluctance to seek support, and the type and quality of support that was available was also limited.
Fereidouni et al. (2015)	Iran	Semi-structured interviews	The aim was to examine the impact of substance misuse on spouses in Iran.	n = 24 24 spouses	Drugs	Spouses tried to hide the problem and to solve the problem alone, feeling for a long time as if they were ‘walking in the dark’ without any social support, and exposure to stigma. The substance misuse in the family can have devastating effects for spouses, on children and on all aspects of family life.
Fotopoulou and Parkes^1 (2017)	Greece	Semi-structured in-depth interviews	The aim was to explore the ways families respond to, and cope with, a relative’s drug problem by examining the perceptions of both Greek drug users and drug-affected families.	n = 48 23 men and 17 women with substance use problems 8 parents	Drugs	After discovery of the drug problem, all families reported high engagement and low withdrawal coping. This is connected with the Greek cultural milieu and the notion of familism.
Hodges and Copello (2015)	UK	Semi-structured interviews	To explore experiences of an adult with children who is providing care or support for their parent who has an alcohol problem	n = 6 Adult daughters 6	Alcohol	Identified three conflicts/dilemmas. Normative expectations or notions of the family/experience. Emotional detachment/strong emotions. Functional or practical contact/emotional or relational contact.
McCann et al. (2019)	Australia	Semi-structured interviews	To explore the experience of AFMs who support a close relative with AOD misuse	n = 31 Intimate partner 13 Parent 13 Sibling 4 Child 1	Alcohol and drugs	Affected family members experienced wide-ranging harms, which affected their emotional, social and financial well-being, safety and family dynamics, and instilled a persistent sense of fearfulness and hopelessness about the future.
Moriarty et al. (2011)^2	New Zealand	Semi-structured interviews	To explore experiences of NZ families living with addiction, identify impacts on non-addicted family members, their coping strategies and barriers to help seeking	n = 19 Adults aged 18 years or older Daughters 4 Wives 2 Ex-wives 2 Mothers 4 Sons 3 Brothers 1 Husbands 2 Extended family 1 6 persons with double or triple role as daughter–wife–sister	Alcohol and drugs	Addiction has broad effects on NZ families. The coping strategies for families described by the participants in this project lacked the positive connotations of resilience, namely positive adaptation under significant adversity.
Näsman and Alexanderson (2017)^3	Sweden	Interviews	The aim was to get in-depth knowledge of how perspectives of children and their parents relate to one another	n = 21 9 families with substance using adult parent 5 mothers 4 fathers 12 children under 16-year-old	Drugs	Children describe more deviant behavior of their parent during intoxication and more serious consequences such as overdoses, suicide attempts, abandonment, violence and threats, which affected family life.
Ólafsdóttir et al. (2020)	Iceland	Semi-structured interviews	The aim was to explore the experiences of family members when one or more family member is afflicted with SUD and to find out how one individual’s SUD affects the psychosocial, behavioral, and physical states of other family members.	n = 16 4 spouses 4 adult children 4 parents 4 siblings	Alcohol and drugs	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 in their families. 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.
dos Reis et al. (2017)	Brazil	A case study	The aim was to understand the repercussions of drug use on the coexistence of a family, based on the daughter’s narrative of a woman who is a multiple drug user.	n = 1 Adult daughter	Drugs	The daughter’s memories emphasized repercussions in the family context: long-term living with drug abuse; absence or transience of the motherly figure, with rupture processes for homeless situation; cycle of parental disruption/forgiveness and continued presence and fatherly support in the family.
Tamutienė and Jogaitė (2019)	Lithuania	Semi-structured interviews	(1) to learn to whom children disclose experiences of harm caused by their parents’ or carers’ substance abuse, (2) to show whether professionals enable children to disclose this harm, and (3) to highlight what kind of assistance they provide after disclosure of harm.	n = 23 children under 16-year-old Female 18 Male 5	Alcohol and drugs	Children suffer not only from the maltreatment itself, but also from the associative stigma of the caregiver’s drinking to their families. They and their families prefer to disclose their troubles in informal settings because professionals often do not help children disclose harm and may even ignore it.
Tamutiene and Laslett (2017)	Lithuania	Semi-structured interviews	The aim of this study was to identify and contextualize the harms Lithuanian families experience when they include a heavy drinker.	n = 24 partners and ex-partners 20 women 4 men	Alcohol	Interviewees experienced an array of harms. These were categorized as: direct harms caused by the drinker; drinker-centred coping strategies that did not take children’s and families needs into account and affected families indirectly; abdication of or redirection of the drinker’s responsibilities to other family members; associative (reflected) stigma and isolation.
Tinnfalt et al (2018)	Sweden	Interviews	The aim of this study was to explore the consequences for a child of having an alcoholic parent, from the point of view of 7–9-year-old COA.	n = 18 18 children under 16-year-old 8 girls 10 boys	Alcohol and drugs	The children at this young age had much experience and took a great responsibility for their alcoholic parent and the family. The most significant feeling expressed by the children was a feeling of sadness. They tried to control the situation in families in different ways. They wished for a change in the future, but despite problems in the family they described things they did together with a loving parent.
Weimand et al. (2020)	Norway	Semi-structured interviews	The purpose of this study was to explore these partners’ everyday life experiences, including their parental roles.	n = 10 10 partners or ex-partners 6 women 4 men.	Alcohol and drugs	The findings demonstrated that sharing their lives, including parenthood, with a partner with substance use problems affected every aspect of the participants’ lives, and entailed being influenced by their partner’s ups and downs in families.
Werner and Malterud (2016)	Norway	Interviews	The aim of the study was to explore childhood experiences in families with problem-drinking parents.	n = 9 adult children daughters 6 sons 3	Alcohol	The social interaction in the family was disrupted during childhood because of the parent’s drinking problems. An everyday drama in families characterized by tension and threats, blame and manipulation, was the backstage for their everyday life. Dealing with the drama, the children experienced limited parental support. The children struggled to restore social order within the family and to act as normally as possible outside the family. It was a dilemma for the children to disclose the difficulties of the family.

¹ This study has included family members with PSU.

² This study has participants with double or triple role. This affects the total number of family members in this meta-ethnography.

³ This study has included participants with PSU.

Figure 2. An overarching metaphor: an unknown invisible intrusion.

Arcidiacono, C., Velleman, R., Procentese, F., Albanesi, C., & Sommantico, M. (2009). Impact and coping in Italian families of drug and alcohol users. Qualitative Research in Psychology, 6(4), 260–280. https://doi.org/10.1080/14780880802182263

 Google Scholar

Church, S., Bhatia, U., Velleman, R., Velleman, G., Orford, J., Rane, A., & Nadkarni, A. (2018). Coping strategies and support structures of addiction affected families: A qualitative study from Goa, India. Families, Systems & Health: The Journal of Collaborative Family Healthcare, 36(2), 216–224. https://doi.org/10.1037/fsh0000339

 PubMed Web of Science ®Google Scholar

Fereidouni, Z., Joolaee, S., Fatemi, N. S., Mirlashari, J., Meshkibaf, M. H., & Orford, J. (2015). What is it like to be the wife of an addicted man in Iran? A qualitative study. Addiction Research & Theory, 23(2), 99–107. https://doi.org/10.3109/16066359.2014.943199

 Web of Science ®Google Scholar

Hodges, M., & Copello, A. (2015). How do I tell my children about what my mum's like?' Conflict and dilemma in experiences of adult family members caring for a problem-drinking parent. Families, Relationships and Societies, 4(1), 87–101. https://doi.org/10.1332/204674314X13951456077308

 Web of Science ®Google Scholar

McCann, T. V., Polacsek, M., & Lubman, D. I. (2019). Experiences of family members supporting a relative with substance use problems: A qualitative study. Scandinavian Journal of Caring Sciences, 33(4), 902–911. https://doi.org/10.1111/scs.12688

 PubMed Web of Science ®Google Scholar

Moriarty, H., Stubbe, M., Bradford, S., Tapper, S., & Lim, B. T. (2011). Exploring resilience in families living with addiction. Journal of Primary Health Care, 3(3), 210–217. https://doi.org/10.1071/hc11210

 PubMedGoogle Scholar

Näsman, E., & Alexanderson, K. (2017). Parents with substance abuse problems – Meetings between children and the parents’ perspective. [Föräldrar med missbruksproblem: möten mellan barns och föräldrars perspektiv. ]. Socialmedicinsk Tidskrift, 94(4), 447–456.

 Google Scholar

Ólafsdóttir, J., Orjasniemi, T., & Hrafnsdóttir, S. (2020). Psychosocial distress, physical illness, and social behaviour of close relatives to people with substance use disorders. Journal of Social Work Practice in the Addictions, 20(2), 136–154. https://doi.org/10.1080/1533256X.2020.1749363

 Web of Science ®Google Scholar

dos Reis, L. M., Aparecida Sales, C., & de Oliveira, M. L. F. (2017). Narrative of a drug user's daughter: Impact on family daily routine. Anna Nery School Journal of Nursing/Escola Anna Nery Revista de Enfermagem, 21(3), 1–7. https://doi.org/10.1590/2177-9465-ean-2017-0080

 Google Scholar

Tamutienė, I., & Jogaitė, B. (2019). Disclosure of alcohol-related harm: Children's experiences. Nordic Studies on Alcohol and Drugs, 36(3), 209–222. https://doi.org/10.1177/1455072518807789

 Web of Science ®Google Scholar

Tamutiene, I., & Laslett, A. M. (2017). Associative stigma and other harms in a sample of families of heavy drinkers in Lithuania. Journal of Substance Use, 22(4), 425–433. https://doi.org/10.1080/14659891.2016.1232760

 Web of Science ®Google Scholar

Tinnfalt, A., Froding, K., Larsson, M., & Dalal, K. (2018). ‘I feel it in my heart when my parents fight': Experiences of 7-9-year-old children of alcoholics. Child and Adolescent Social Work Journal, 35(5), 531–540. https://doi.org/10.1007/s10560-018-0544-6

 PubMed Web of Science ®Google Scholar

Weimand, B. M., Birkeland, B., Ruud, T., & Høie, M. M. (2020). ‘It’s like being stuck on an unsafe and unpredictable rollercoaster’: Experiencing substance use problems in a partner. Nordic Studies on Alcohol and Drugs, 37(3), 227–242. https://doi.org/10.1177/1455072520904652

 Web of Science ®Google Scholar

Werner, A., & Malterud, K. (2016). Children of parents with alcohol problems performing normality: A qualitative interview study about unmet needs for professional support. International Journal of Qualitative Studies on Health and Well-Being, 11(1), 30673. https://doi.org/10.3402/qhw.v11.30673

 PubMed Web of Science ®Google Scholar