Study: Evaluating Family Burden Among US Adults Experiencing Secondhand Harms from Alcohol, Cannabis or Other Drug Use

There is a growing body of research on the secondhand harms from alcohol and drug use that points to the negative health impacts of substance use extend beyond the individual engaged in the behavior. The literature on alcohol-related harms has explored the connections between secondhand alcohol and drug harms (ADH) and their impact on quality of life, well-being and mental health issues among those affected, often including family members, but there hasn’t been any specific research done on the family burden related to alcohol and other drug harms until now.

This study from PHI’s Alcohol Research Group and independent scientific research institute RTI International evaluates the familial burden of the secondhand ADHs, investigating associations between a seven-item summative burden scale and different types of harms attributed to someone else’s use of alcohol, cannabis or other drugs. The findings reveal the need for family support interventions and policy remedies to mitigate these burdens.

Background: Family burden has not been studied in relation to alcohol and other drug harms from others. We adapted a family burden scale from studies of caring for those with mental health conditions for use in the US Alcohol and Drug Harm to Others Survey (ADHTOS). We investigated associations between a seven-item summative burden scale and different types of harms attributed to someone else’s use of alcohol, cannabis, or another drug: (a) being assaulted/physically harmed; (b) having family/partner problems; (c) feeling threatened or afraid; and (d) being emotionally hurt/neglected due to others’ substance use.

Methods: A survey of adults aged 18 years and over conducted between October 2023 and July 2024 (n = 8,311), involved address-based sampling (n = 3,931 including 193 mail-backs) and web panels (n = 4,380), oversampling Black (n = 951), Latinx (n = 790) and sexual or gender minority (SGM) respondents (n = 309). Data from seven items on types of burdens experienced from other people’s alcohol or drug use were provided by those harmed by someone else’s alcohol or drug use and were used to create a burden scale. Analyses used negative binomial regression on burden sum adjusting for covariates, such as age, gender, race and ethnicity, marital status and years of education.

Results: The single factor burden scale showed good internal consistency (α = .91). Components assessing being emotionally drained/exhausted and family friction/arguments were endorsed by 38–39% of participants; finding stigma of the other’s substance use upsetting was affirmed by 33%. Fewer endorsed feeling trapped in caregiving roles (22%), problems outside the family (26%), neglect of other family members’ needs (16%), and having to change plans (14%). In adjusted regression models, seven of eight harm exposures were significantly associated with burden scores.

Discussion: People reported substantial burden from others’ use of alcohol, cannabis, and other drugs. Family support interventions and policy remedies to mitigate these burdens are needed.

About RTI International

RTI International is an independent scientific research institute dedicated to improving the human condition. Their vision is to address the world’s most critical problems with technical and science-based solutions in pursuit of a better future. Clients rely on us to answer questions that demand an objective and multidisciplinary approach—one that integrates expertise across social, statistical, data, and laboratory sciences, engineering, and other technical disciplines to solve the world’s most challenging problems.

Originally published by International Journal of Alcohol and Drug Research