Stress and strain: a qualitative study into the impact of having relatives with addiction problems on students’ health and daily lives

Figures & data

Figure 1. Stress-Strain-Coping-Support Model (Orford, 2013).

Figure 2. Flowchart identification to inclusion

Figure 3. Saturation. Total number of stress and strain factors (y axis) mentioned during the 30 interviews (x axis).

Table I. Characteristics of participants.

	Men (N = 11)	Women (N = 19)	Total
Age in years
17–20	1	3	4
21–24	8	12	20
≥25	2	4	6
Mean (SD)	23.0 (3.0)	22.7 (2.4)	22.9 (2.7)
Study program
Economics	3	2	5
Social studies	-	7	7
Health care	1	4	5
Art	1	1	2
Media and ict	2	3	5
Teacher training	1	2	3
Engineering	3	-	3
Study delay (yes)	5	6	11
Parents divorced (yes)	7	15	22
Lives in same house as relative with addiction (yes)	4	5	9
Number of relative(s) with addiction in nuclear family *
1 relative	6	4	10
2 relatives	3	11	14
3 relatives	2	2	4
4 relatives	-	2	2
Mean (SD)	1.6 (0.8)	2.1 (0.9)	1.9 (0.9)
Number of relative(s) with addiction in extended family *
1 relative	5	3	8
2 relatives	2	3	5
3 relatives	1	2	3
4 relatives	1	2	3
≥5 relatives	1	1	2
Mean (SD)	1.9 (1.5)	1.5 (0.7)	1.6 (1.6)
Total number of relatives with addiction in family
1 relative	1	2	3
2 relatives	4	7	11
3 relatives	1	1	2
4 relatives	1	3	4
≥5 relatives	4	6	10
Mean (SD)	3.6 (2.0)	3.6 (2.1)	3.6 (2.0)
Relationship with relative with addiction in nuclear family**
Father	7	7	14
Mother	4	9	13
Stepmother	1	-	1
Stepfather	1	5	6
(Step)brother/sister	4	8	12
(Ex-)partner	1	4	5
Type of relative’s addiction in nuclear family
Alcohol only	5	6	11
Drugs only	-	1	1
Alcohol, drugs, gambling	1	1	2
Alcohol, drugs	2	6	8
Alcohol, gambling	1	1	2
Alcohol, drugs, gaming	-	1	1
Alcohol, drugs, sex	-	1	1
Alcohol, eating disorder	1	1	2
Drugs, sex, tranquilizer	1	-	1
Drugs, sex	-	1	1
Ethnic background
Dutch	9	17	26
From Suriname and Netherlands Antilles	1	1	2
From another Western country	1	1	2
Age at which the participants became aware of the relative’s addiction
As long as they can remember	3	4	7
5–10 years old	4	5	9
11–15 years old	2	5	7
16–20 years old	2	5***	7

Note: * All sorts of combinations occurred: having 1 relative with addiction in the nuclear family and 2 in the extended family, or for example 2 in the nuclear family and none in the extended family.

**Participants can have more than one relative with addiction.

***Especially partner relations.

Table II. Experienced and witnessed violence by participants.

Physical violence	Experienced:
	Beating up; punching a fist in the face; kicking when the participant was on the floor; punching; pushing; pulling; pulling out of bed; pushing out cigarette butts on arm; frolicking too hard and not stopping; sent to bed without eating; shutting out of the house; throwing household goods.
	Witnessed:
	Seeing parents attacking each other; seeing parent beating up sibling; seeing partner of sister beating up sister; seeing relative injuring himself, e.g., hands/head hitting on the wall.
Mortal danger	Experienced:
	Traffic situations (drunk/stoned driving, collisions, pulling the handbrake on the car while on the road, trying to throw participant out of a car); attempted strangulation; confrontation with relative or creditor with a knife; relative fell asleep while cooking pot on the fire; relative tried to throw participant from stairs; participant being left home alone for long periods at a very young age.
	Witnessed:
	Sibling pulled over streetcar rails while streetcar was approaching.
Emotional violence	Experienced and witnessed:
	Often angry; threatening; yelling; scolding; sneering; belittling; insulting; humiliating; blaming the participant for addiction; saying the participant is worth nothing; saying no one wants the participant—not even their own parents; relative wishing participant had not been born; relative saying participant is not good for anything; relative saying participant is never going to accomplish anything in life; relative saying participant is a whore; relative using a swear name for participant instead of real name; relative speaking ill of other parent; relative constantly criticizing participant; relative threatening with suicide; relative being extremely suspicious; relative being cynical/manipulating/throwing away make-up of participant/throwing away things with emotional value. Being bullied at secondary school.
Sexual violence	Experienced:
	Raped by friends; raped by ex-partner; attracted wrong men which resulted in sexual violence; sexually abused by much older men when looking for a father figure.

Table III. Health problems and diagnoses of participants.

Mental health problems	Devalued: Low self-esteem/no self-worth; focus on others; believe insults and accusations to be true; neglected; neglect of self. Feeling low: Gloomy; depressed; sad; difficult/unable to experience emotions; burned-out; not feeling very well; hardened; crying a lot. Anxious: Panic attacks; worrying easily; high tension; unspecified anxiety; separation anxiety; fear of failure; fear of pity; chronically insecure; obsessive behaviour; strong tendency to control; very nervous. Frightened: about coming home, going to sleep, and violence. Distrustful in general; does not trust relative; does not trust friendly fathers; does not trust intentions of others; paranoia. Helpless: Powerless; uncertain; vulnerable; dependent; unable to leave parents and live independently. Disappointment and frustration: Loss of childhood; disappointment in others (esp. relative); frustration about seeking help instead of relative. Aversion: of relative with addiction problems; people drinking; going out; dirty house and therefore extremely tidy and clean. Shame: for behaviour relative; for the state of house; for public drunkenness; for self (did not do enough to help); towards friends; because relative knows tramps. Guilt: “should have done better”; feels guilty about death relative (not helping/cleaning/delivering food); about provoking violent incident; feelings of guilt towards healthy parent (not being able to stay strong); feelings of guilt towards siblings (because of leaving home and leaving sibling behind); wishing relative was dead. Angry, resentful: Rage; unable to forgive; aggression; resentful; irritated; revengeful; cynical; taking it out on others; quickly offended. Alone: Closed off; lonely; attachment problems; does not care about others; feels excluded. Inequal: Feeling better than relative; an extreme sense of responsibility; always wanting to be right.
Mental health diagnosis	PTSD; ADHD; ADD; depression; unspecified depressive mood disorder; dysthymic disorder; borderline; anxiety disorder; obsessive-compulsive personality disorder; addiction; psychosis; general personality disorder; attachment disorder; developmental disorder.
Self-harm	Suicidal thoughts; self-harm; suicide attempts.
Physical health	Eating problems; weight gain/reduction; diarrhoea; constipation; (chronic) fatigue; back pain; muscle pain; (chronic) head and abdomen pain; neck pain; unable to turn head; aggravated migraine; periods ceased; severe menstruation; anaemia; always sick at vacations; fibromyalgia; jaws locked at night; tremor in arm; poor skin; palpitations; sweating.
Sleeping problems	Can hardly fall asleep; wakes up often; tired; sleeps a lot; nightmares; can’t get up; can’t sleep because of relative yelling/throwing stuff; repeating dreams; alert sleeping; pulled out of bed/woken up by relative.

Table

Introduction Introducing myself, explaining purpose of research, naming experiential expertise, asking how participant feels, offering a drink. If necessary coffee/tea-break to reduce stress.

About the student What study, year of study, study delay, age, ethnic background, relationship to relative, type of addiction, other family members with addiction?, living situation Why do you want to participate in this study?

About the family You have indicated that you have one or more family members with addiction. Because of which relative are you participating in this study? How many people in your family with addiction? Family composition (parents together/separated, brothers/sisters)

About the relatives’ addiction What addictions are you confronted with in your nuclear family? When did you begin to realize that something was going on with your family member’s/relatives’ use/behavior? What do you think is the reason for the addiction? Does your relative with addiction work? Does he/she attend school? Otherwise active?

Stress Can you tell me something about life with your relative(s)/relatives’ addiction? What does your relative’s addiction behaviour look like? Can you outline a few events you link to the addiction? What is the worst thing about your relative’s addiction? Have you experienced violence due to the addiction? Have you ever been in mortal danger? What about others in your family? Do you experience other effects of your family member’s addiction? (e.g., financial problems/debts) How does/did everyday life in your household look like? (housework, admin, caring for younger brothers/sisters/) Do you see any positive aspects of living with someone else’s addiction?

Strain Can you describe the effects your relative’s addiction has on you? (health issues that you relate to your family member’s addictive behavior? (physical, mental))? Are you sleeping well? (if not, what sleeping problems do you have? Nightmares?) Do you use alcohol/drugs yourself? To what extent? Do you gamble/game? To what extent? How do you feel about your relative(s)?

Social life What is/was your family life like? Did you do things together? Eating together, for example? Holidays? How is your relationship with the other family members? Are you in a relationship? m/f? Do you have a side job? Where? How many hours? What do you do when you are free from school/work? (Do you have friends? Do you go out? Often? Do you do any sports? Other leisure activities? (e.g., creative))

About the study What study course do you follow? How do you like it? What does your study mean to you? Do you have study delay? Is this your first study? How are you doing in school? Does the situation in your family influence your studies? How? Has addiction in your family ever come up at school? With whom? How did it go? Have you ever been bullied? For example in high school?

Coping People cope very differently with a relative with addiction. How do you deal with it? (Tolerating, withdrawing, controlling, angry, taking over responsibilities?) When do you find it relatively easy to deal with? When do you find it more difficult to cope?

Disclosure Do you ever talk to others about the addiction of your relative(s)? To whom? How do you feel when you talk about it?

Support What do you do when you feel desperate/alone/in doubt? Have you ever looked for help? Where? Have you ever received help or support regarding the situation in your family? From family/friends/partner? From neighbors? From school/internship? Professional support? Peers? Other?

If yes, was that support helpful? If not, what kind of support did you need? Did other family members receive help or support? If so, from whom? Have you ever heard of KOPP-support groups (i.e., a support group for children 0–23 yo, with parents with mental health or addiction problems)? If so, how? Through school/doctor? Otherwise? If not (after explanation): could this be something for you?

Future What expectations do you have about the future? What do you want to have accomplished before we see each other again next year?

Closing Are there any topics we didn’t discuss that are important to you when it comes to life with someone else’s addiction? What did you think of this interview? How do you feel about it? How do you feel now? (relieved, tired, sad)

Orford, J., Velleman, R., Natera, G., Templeton, L., & Copello, A. (2013). Addiction in the family is a major but neglected contributor to the global burden of adult ill-health. Social Science & Medicine, 78, 70–77. https://doi.org/10.1016/j.socscimed.2012.11.036

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Data availability statement

The data that support the findings of this study (interview transcripts) are not publicly available because they contain information that could compromise the privacy of research participants but are available from the corresponding author [DvN] upon reasonable request.