Abstract
Drug use disorder (DUD) is a serious health condition that imposes a heavy burden on the persons who have a drug addiction experience and their families, especially in countries, such as Myanmar, where few formal support mechanisms are in place and repressive drug laws exacerbate the situation. Yet, in Myanmar, little is known about how informal caregivers are affected. This qualitative study aims at exploring the socioeconomic and psychological burden that informal caregivers in Myanmar encounter, coping strategies they employ, as well as barriers to coping they face. Thirty primary informal caregivers were chosen purposively from a mental health hospital in Yangon for in-depth interviews. The recorded interviews were transcribed and the data were analysed using framework analysis. The results revealed that financial constraint, income loss, social limitation and negative impact on family cohesion are important dimensions of socioeconomic burden, whereas sadness, anger, helplessness, worry, fear and guilt are the main psychological distress factors encountered by caregivers of persons with DUD. Key coping strategies employed by caregivers include religious coping, financial coping, acceptance and planning. Moreover, perceived stigma towards persons with DUD and their caregivers was very high and caregivers received hardly any social support, inter alia because of the country’s drug law which reinforces stigma and discrimination. Neither the government nor any other organization in Myanmar provided financial support to the caregivers. The results of this study showed that caring for persons with DUD has devastating effects on caregivers and their families. While the 2018 National Drug Control Policy can potentially help alleviate the burden on substance users and their families, further amendments of the existing drug law are urgently needed. Moreover, strengthening prevention and harm reduction approaches, improving treatment and rehabilitation services, as well as stigma-reducing educational campaigns should be considered a priority.
Highlights
Drug use disorders (DUD) have become a major public health concern, increasing morbidity and premature mortality, and the burden of DUD has tremendous negative consequences for persons using drugs, their caregivers and families, as well as the society [1]
Almost two thirds of caregivers were the parent of a family member with substance use disorder and had their own business
This study focused on Myanmar, a country where drug use has been criminalized, and analysed qualitative data from thirty informal caregivers of persons with DUD, who were treated at the Yangon Mental Health Hospital (YMHH), one of Myanmar’s two tertiary-level mental health hospitals, to better understand the burden they are facing, coping strategies used and barriers to coping
Summary
Drug use disorders (DUD) have become a major public health concern, increasing morbidity and premature mortality, and the burden of DUD has tremendous negative consequences for persons using drugs, their caregivers and families, as well as the society [1]. DUD are mental and behavioural disorders caused by the use of psychoactive and dependence-producing drugs [2, 3]. The global burden of disease attributable to drug use and drug use disorders was estimated to be 31.8 million and 20.4 million disability-adjusted life years in 2016, respectively [5]. Not captured by these health loss estimates are related economic and social consequences, which are substantial. In the United States, the impact of opioid use disorder and fatal opioid overdose in terms of healthcare, substance abuse treatment, criminal justice, lost productivity, reduced quality of life and premature mortality costs, for example, was estimated to be about 1.02 trillion US dollars in 2017 [6]
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