NAMA : NURRIZQY AULIA H.

KELAS : 3C

NIM : P1337420216132

Family Support and Substance Use Outcomes foR Persons With

Mental Illness and Substance Use Disorders
Surprisingly, few researchers have examined the role that instrumental support,
such as financial contributions or direct caregiving by families, plays in the well-
being of people with mental disorders. Although the significance of families as
caregivers for people with SMI is well documented, we know little about how
informal care affects mental health and substance abuse.
Associations between family support and substance use outcomes were examined
with bivariate comparisons of abstainers and nonabstainers and with regression
models using change in substance use and cumulative substance use as dependent
measures.
Family economic support was associated with substance abuse recovery in bivariate
and regression analyses. The findings suggest that direct family support may help
people with dual disorders to reduce or eliminate their substance use.

Family caregivers for people with severe mental illnesses such as schizophrenia are
an increasingly important focus of treatment and research. Several studies
demonstrate how family interventions can improve the course of illness.

At least one study suggests that people with comorbid substance use disorders are
significantly less satisfied with their family relationships than are those with SMI
alone.

Relying on family support might exacerbate problems by increasing conflict, by

supplying additional money to purchase drugs or alcohol, or by insulating people
with dual disorders from the negative consequences of their substance use.

Several factors have impeded our understanding of informal support: the difficulty
of measuring family contributions, the impracticality of developing randomized
studies of informal assistance, and a failure of researchers and funding sources to
recognize its potential importance. Participants were asked to nominate for study
participation the family member or friend who gave them the most assistance.
One primary caregiver per participant reported amounts of time and money spent
on behalf of the study participant by all family members.

27, No. 1, 2001 hold expenses if the client lived with family; mental health, medical,
and dental care; transportation; leisure activities; fines and property damage; and
other family expenses.

Family expenditures on behalf of the client were classified in the following

categories: food and clothing; client's rent and utilities if client did not live with the
family; client's share of family house- 2.13(8.49) Medical and dental care
12.42(36.61) Leisure activities 22.67 Family household expenses 32.58 Client's
contribution to family 32.46(101).

The number of family interviews completed in each time period was as follows: 66
at study entry, 111 at 6 months, 141 at 12 months, 151 at 18 months, 142 at 24
months, 140 at 30 months, and 134 at 36 months.

Comparison of families who completed all interviews with those who completed
fewer interviews showed no significant differences in average family expenditures
or in average number of caregiving hours per month.

Client-reported family contact was no different in periods of missing and

nonmissing family reports.

This scale is based on participant interviews and combines the following four
questions concerning the participant's feelings about his or her family, each
question beginning with "How do you feel about": Your family in general? How
often you have contact with your family? The way you and your family act toward
each other? The way things are in general between you and your family? Finally,
we examined client reports of cash income received from family members in each
study period.

Variables related to clients' demographic or psychiatric status were added to the

analysis to account for factors other than family support that might affect substance
use. Self-reported family income was included to differentiate the direct effects of
family support from those that might be associated with family wealth.

Adding outpatient treatment allowed us to examine the independent effects of

formal treatment and family support on substance use.

Participants who achieved abstinence did not receive more assertive community
treatment or case management services than nonabstainers, nor did their families.
Dixon, L.; McNary, S.; and Lehman, A. Substance abuse and family relationships
of persons with severe mental illness. Special thanks to study participants with dual
disorders and their family Commented [1]:
 The Social–Environmental Context of Violent Behavior

in Persons Treated for Severe Mental Illness

33 These items yielded an index of violence comparable to that used in the

MacArthur Violence Risk Assessment Study.

Subjects' degree of exposure to violence in their surrounding social environment

was measured with the Exposure to Community Violence Scale.

Variables found to be associated with violent behavior in the previous year included
homelessness, experiencing or witnessing violence in the surrounding environment,
substance abuse, mood disorder, PTSD, lower severity ratings on the Brief
Psychiatric Rating Scale, poor subjective mental health status, earlier age at onset
of psychiatric illness, and psychiatric hospital admission.

Model 2 examines the effects of clinical and institutional variables, showing that
substance abuse, self-rated mental health status of "Poor", age at onset of disorder
below the sample median of 19 years, and psychiatric admissions in the past year
all significantly increase risk of violence.

In male subjects, the association between sustained violent victimization and later
perpetration of violence remained significant after control for additional significant
risk factors, including cohabitation, homelessness, exposure to community
violence, and substance abuse.

DISCUSSION Focusing on the empirical relationship between violence and mental

disorder can reinforce the stigma that persons with psychiatric disabilities continue
to face in the community.

In relative terms, this prevalence rate is substantially higher than estimates of the
violence rate for the general population, while it still supports the conclusion of
other epidemiological studies that the large majority of persons with SMI do not
commit violent acts.5 This study examined an extensive range of epidemiological
risk factors and found that violence was independently associated with history of
violent victimization, homelessness, cohabitation, exposure to community
violence, substance abuse, poor self-rated mental health status, and history of
psychiatric hospital admission.

The analysis depicted in Figure 1 indicates that subjects with none, or only 1, of
these factors had predicted probabilities of violence of 2% or below-which is close
to the National Institute of Mental Health Epidemiologic Catchment Area Study
estimates of the 1-year prevalence of violence in the general population without
mental illness.

Adding a second risk factor doubled the probability of violence, and respondents
with all 3 risk factors combined were by far the most likely to commit violent acts-
with a predicted probability of 30%. These analyses support the view that violence
by persons with SMI is the result of multiple variables with compounded direct and
indirect effects over the life span.

Effective interventions to reduce risk of violence among persons with SMI must be
comprehensive yet specifically targeted-addressing underlying major psychiatric
disorder but also addiction, trauma sequelae, domestic violence, and need for
housing, income, and community support.

Arseneault L, Moffitt TE, Caspi A, Taylor PJ, Silva PA. Mental disorders and
violence in a total birth cohort: results from the Dunedin Study.

1998;33(suppl 1):S68-S74. his book discusses interpersonal violence, including

child and elder abuse, sexual assault, murder, suicide, stranger violence, and youth
violence.

A longitudinal analysis of the overlap between violence and victimization among

adults with mental illnesses.

Systemic perspective of violence and aggression in mental health care: Towards a

more comprehensive understanding and conceptualization: Part 1.

Characteristics of recent violence among entrants to acute mental health and

substance abuse services.

Family representative payeeship and violence risk in severe mental illness