NRC Studies on Stigma and Family, Day 1, Track 2, 15:30-17:00

Presented as part of the Uniting the global community to face the challenge of addiction event, in-person on 12th May,2022

Presentations:

• An Exploratory Study on Individual stigma to Substance Use in a Clinical Population - Dr. Hisham Elarabi
• Substance Use and the Role of Families - Dr. Hisham Elarabi
• Comparison of the results received from Kazakhstan, Pakistan and Ukraine on the role of family in substance use disorders - Dr. Olha Myshakivska

Abstracts:

• An Exploratory Study on Individual stigma to Substance Use in a Clinical Population - Dr. Hisham Elarabi

Objectives

• To measure individual stigma levels at for patients seeking treatment from Substance Use Disorders.  
• To examine the association between individual stigma levels and treatment outcomes measure by positive toxicology screens, retention in treatment and change in Work and Social Adjustability.

Rationale

Stigma is acknowledged as a complex negative attitudes and behaviors towards an attribute (Goffman, 1963). Stigma has been associated with mental health illness including substance use disorder (SUD) (Corrigan et al., 2004). In the United Arab Emirates, Stigma is reported as a barrier to treatment seeking and recovery (Elarabi et al., 2012; Al Suwaidi et al., 2018). Despite that stigma associated with SUD being a global challenge, little effort has been made to study self-stigma (Corrigan et al, 2003; Rusch et al., 2005).

Methodology

After consenting, patients seeking treatment at the National Rehabilitation Center – the National Substance Use Response Center- in the UAE, the intake procedures include administering self-stigma scale (King et al., 2007), Work and Social Adjustment Scale (WSAS- Mundt, Marks, Shear, & Greist, 2002);  Rosenberg self-esteem scale (Rosenberg, 1965).

Urine Drug Screens collected under-supervision at admission and for 16-weeks at the outpatient care. Participants are offered follow up to 52-weeks.

Statistically Analysis- Bivariate analyses are conducted to between the self-stigma scores, self-esteem and patient characteristics, and treatment outcomes. Participant characteristics showing significant associations are included in a linear regression model to examine independent predictors of treatment outcomes. 

• Substance Use and the Role of Families - Dr. Hisham Elarabi

Objectives:

• To identify the involvement of families in the treatment/recovery process of NRC patients using substances
• To measure the family’s perception of stigma using a standard instrument
• To contribute data for a multicentre study involving other countries
• To identify examples of good practice and disseminate this information

Rationale

Cappello and Orford (2002) argue that the literature strongly suggest that family members are important stakeholders in the process of change. They make the case for capitalizing on family members to get substance abusers into treatment, maintaining their participation, improving outcomes and reducing negative impact on the family itself. However, in many countries those members are not involved in addressing ways they could support or impact the treatment/recovery process. Stigma may be a key mediator in this and has not been extensively studied in relation to addictions (Wanigaratne et al 2022).

Method

Two surveys, one direct and one online. Using a mixed methods study design where one survey would be filled out by subject who use psychoactive substances or diagnosed substance use disorder. The second survey to be completed by those identifying as family members of substance users.

Results

The findings from the study will be presented. Comparison of the findings with studies conducted in other countries by ISSUP International will be made. Implications of the findings will be discussed.

• Comparison of the results received from Kazakhstan, Pakistan and Ukraine on the role of family in substance use disorders - Dr. Olha Myshakivska

Objective, rationale:

The impact of having a family member with a substance use disorder can be a significant life circumstance for other family members. There is lack of prevention and understanding of the treatment provided for families in many countries, that do not focus on the family needs while providing interventions for a subject with substance use disorder. This research identifies a range of learnings about the role of family members and substance users across three countries: Kazakhstan, Pakistan and Ukraine.

Methodology: 

ISSUP Pakistan, ISSUP Kazakhstan and ISSUP Ukraine undertook a joint research project “Substance Use and the Role of Families”. Respondents were family members living with those who had a substance use disorder. During the online survey conducted among the family members the type of relationship in the family was identified, attitudes to substance use and to treatment and the recovery process were evaluated, and a review to identify if any interventions were being conducted with families in their country was included. The level of significance adopted was p < 0.05.       

Results:

In total 1099 responses of the survey were collected from family members of the subjects who use substances in Kazakhstan, Pakistan and Ukraine. 

Analysis of the results received from each of the countries revealed that most of the responders in these three countries identified their role as “protection of subject from the negative consequences of their substance use and taking on responsibilities and achievement-oriented role”. Relating to a role as “strong emotional involvement, warm and supportive relationship” came mostly from biological parents in different countries – 66 % or 730 replies from the three countries.

47% of the family members did not receive any therapeutic interventions. In Kazakhstan, Ukraine and Pakistan 77% of the family members agreed that substance use negatively impacted them. 55% of responders reported that functioning of the family worsens, and in total 87% believed that treatment can be an effective option to address the issue of drug use.

Family members were asked: What is the best way to treat a SUD? In each of the three countries most replied that the best way was to isolate those using substances in the health care facility -  69% responded from three countries, 66% in Kazakstan, 71% in Ukraine and 71% in Pakistan. 

77% in Kazakhstan, 84% in Pakistan and 76% in Ukraine felt “shame” - a feeling of guilt, regret, or sadness because of family member using substances. 

The biggest challenges that family members are facing with respect to family members who use substances are fears about relapse and the inability to trust.

Conclusions:

Family plays a very important role in treatment and recovery of those with substance use disorders. This study has highlighted that most of the relatives in Kazakhstan, Pakistan and Ukraine were not involved in the therapeutic interventions, and substance use of their family member has negatively impacted them and worsened the functioning of the family.