Problematic Substance Research Articles

Young Adults with a History of Residential Youth Care: A Cohort Profile of a Hard-to-Reach Population

Adults with a history of living in residential youth care (RYC) face elevated risks across various life domains. In this cohort profile paper, we outline the design of a comprehensive follow-up study—the VINGO study—targeting young adults (22–30 years) with a history of living in RYC (T2). We describe the recruitment strategy and present sample characteristics. Data were collected in the baseline study (T1) from 2011 to 2014. At T1, the 400 adolescent participants showed a high prevalence of mental disorders, maltreatment experiences, substance use, and self-reported suicide attempts. Data collection at T2 10 years later (2021–2023) included self-reported sociodemographic information, physical health, childhood maltreatment, dissociation, quality of life, social support, and self-esteem using standardized and validated instruments. A diagnostic psychiatric assessment and subjective evaluation of service utilization were conducted by telephone interviews. Additionally, a qualitative sub-study involved in-depth interviews of fourteen participants. We reached a 52% response rate at T2. Comparing participants (n = 157, 107 females) to non-participants (n = 243, 123 females) based on T1 data revealed that T2 participants had a higher prevalence of depression, anxiety, and conduct disorder and a lower prevalence of ADHD at T1. Furthermore, T2 participants reported more suicide attempts, experiences of maltreatment, and problematic substance use at T1. Our results show that we reached a burdened population, positioning the VINGO study as a unique opportunity to examine a vulnerable population of emerging adults.

A study to explore the role of a low threshold, fitness focussed physical rehabilitation intervention with protein supplementation to target physical function and frailty in people with problematic substance use and homelessness: protocol for a single-arm pre-post intervention study.

Background People who are homeless are more likely to experience poor mental health and addiction as well as suffering from non-communicable diseases. There is evidence of frailty and accelerated physical ageing among people experiencing homelessness. Appropriate physical rehabilitation and nutritional supplementation strategies can stabilise or reverse frailty and general physical decline, but it is not known how this type of intervention would work in practice in this population. Aim To evaluate the feasibility and pre-post intervention impact of a low threshold physical rehabilitation intervention with protein supplementation to target physical functioning and frailty in people with problematic substance use who are experiencing homelessness. Methods The intervention will consist of a 12-week low threshold rehabilitation programme with protein supplementation. Participants will be service users of the Ballyfermot Advance Project, a day services centre for people with addiction issues and experiencing homelessness. Primary outcomes will be feasibility including numbers recruited, retention of participants and adherence to the exercise intervention and protein supplement. Any adverse events will be recorded. Secondary outcomes will be strength and muscular mass, physical performance and lower extremity physical function, pain, frailty and nutritional status. Discussion An immediate impact may be simply a distraction from difficult circumstances and potentially an improvement of physical health of participants, which can be a conduit for the emergence of other positive behaviours and recovery. Longer term, this study will generate preliminary data on which to inform the design of a definitive randomised controlled trial of physical rehabilitation and protein supplementation, if indicated. Ethics and dissemination Ethical approval was granted by the Faculty of Health Sciences Research Ethics Committee in TCD. Study findings will be disseminated through publication into an international peer-reviewed journal and presented at national and international conferences.

Social influence on post-drinking risky sexual behaviours: evidence in France and South Korea

Abstract Background Post-drinking risky sexual behaviours are at the conjunction of the dual risks of sexually transmitted infections and further problematic substance use, necessitating contextual analysis for determinants that promote these behaviours. This study examines the influence of social groups on post-drinking risky sexual behaviours in different cultural samples. Methods A cross-sectional survey was conducted among young adults aged 18-30 in France and in South Korea in 2023-2024 (n = 998). A construct of post-drinking risky sexual behaviours includes 3 types: having sex without condoms, having sex with occasional partners, and having transactional sex. Perceived drinking norms were measured as a proportion. Multivariate logistic regression was conducted after controlling for sociodemographic factors. Results Young adults who reported that their social group had a higher proportion of drinkers were more likely to engage in a wider range of post-drinking risky sexual behaviours (aOR=1.02 [95%CI 1.01-1.03] in France; 1.01 [1.01-1.03] in Korea). Young adults in social groups who had experienced two types of risky sexual behaviours were more likely to engage in risky sexual behaviours after drinking (5.13 [2.21-14.1] in France; 10.65 [5.86-19.8] in Korea), compared to young adults in social groups with no experience. Young adults in social groups who had experienced all three types of risky sexual behaviours had a 10 times higher likelihood of engaging in post-drinking risky sexual behaviours in the French sample (10.12 [3.69-31.4]) and a 16 times higher likelihood in the Korean sample (16.0 [7.31-35.8]). Conclusions Alcohol-related risky sexual behaviours among young adults were found to be significantly associated with their social group’s drinking and risky sexual behaviours, across different cultural settings. More attention should be paid to direct/indirect influence of social groups on health risk behaviours. Key messages • The influence of social groups on alcohol-related risky sexual behaviours is significant regardless of cultural setting. • Peer and social norms-based health promotion is recommended to prevent IST and HIV/AIDS.

The Association Between Chronic Pain, Substance use, and Primary Care Experience Among Veterans with Ongoing or Recent Homelessness.

Chronic pain and problematic substance use are prevalent among Veterans with homeless experience (VHE) and may contribute to a challenging primary care experience. To examine the association of chronic pain and problematic substance use with unfavorable primary care experiences among VHE and to explore the association of pain treatment utilization and unfavorable care experiences in VHE with chronic pain. We surveyed VHE (n = 3039) engaged in homeless-tailored primary care at 29 Veterans Affairs Medical Centers (VAMCs). We assessed unfavorable primary care experiences with four validated Primary Care Quality-Homeless (PCQ-H) scales: multivariable logistic regressions explored associations between unfavorable care experiences for VHE with chronic pain and problematic substance use, chronic pain alone, problematic substance use alone, or neither. We then examined the association between receipt of pain treatments and unfavorable experiences among VHE with chronic pain. Last, we identified PCQ-H items that had the greatest difference in unfavorable response rates between VHE with and without chronic pain. The prevalence of unfavorable primary care experience was higher on all four scales for patients reporting chronic pain (with or without problematic substance use) (all p < 0.001), but not for problematic substance use alone, compared to VHE with neither pain nor problematic substance use. In analyses limited to VHE with chronic pain, those on long-term opioids were less likely to report an unfavorable experience (OR = 0.49, 95%CI 0.34-0.69). Receipt of occupational therapy was associated with lower odds of reporting an unfavorable experience (OR = 0.83, 95%CI 0707-0.98). PCQ-H items related to trust, relationships, and provider communication had the greatest differences in dissatisfaction ratings (all p < 0.001). Chronic pain is associated with unfavorable primary care experiences among VHE, potentially contributing to poor care outcomes. Strategies are needed to enhance patient-provider trust and communication and increase VHE's access to effective pain treatments.

The relative influence of cognitive and emotional impulsivity on emotional availability in mothers with problematic substance use

Emotional availability (EA) reflects caregiving that is sensitive, non-intrusive, and non-hostile, and provides the child with structure to learn and safely explore their world. While variable, EA can be lower in mothers with problematic substance use compared to non-clinical samples. Despite strong support for a relation between impulsivity and problematic substance use (including as it relates to regulation of strong positive or negative emotion), its impact on EA has not been explored. This relationship was examined in a sample of 29 mothers who were attending substance use treatment. Video recordings of mother and child (under 4 years of age) playing were coded for EA and mothers completed a self-report questionnaire examining impulsivity. Given shared variance among types of impulsivity (cognitive, positive, and negative) and EA dimensions (sensitivity, structuring, non-intrusiveness, and non-hostility), canonical correlational analysis (CCA) was used to identify variables contributing most strongly to the relation between impulsivity and EA. A single function accounted for 56% of variance. Cognitive and negative emotional impulsivity contributed significantly to structuring and non-intrusiveness dimensions of EA. Positive emotional impulsivity made a smaller nonsignificant contribution but was noted to support EA sensitivity. Developing awareness of impulsivity and times that it may hinder or support EA may enhance the quality of parent-child relationship development, improve parenting confidence, and decrease risk for harsh or neglectful parenting.

The Association between Post-Traumatic Stress Disorder and Problematic Alcohol and Cannabis Use in a Multi-Ethnic Cohort in The Netherlands: The HELIUS Study.

(1) Background: Ethnic minorities exhibit a higher prevalence of post-traumatic stress disorder (PTSD), while results for problematic substance use among ethnic groups remain mixed. PTSD and problematic substance use often co-occur; however, the impact of ethnicity on this association has not yet been investigated. (2) Methods: Self-report data on problematic alcohol/cannabis use (AUDIT/CUDIT) and presence of severe PTSD symptoms (PSS-SR) of N = 22,841 participants of Dutch (n = 4610), South-Asian Surinamese (n = 3306), African Surinamese (n = 4349), Ghanaian (n = 2389), Turkish (n = 3947), and Moroccan (n = 4240) origin were available from the HELIUS study. (3) Results: We found a positive association between the presence of severe PTSD symptoms and problematic alcohol and cannabis use. Ethnicity did not moderate the association between the presence of severe PTSD symptoms and problematic alcohol/cannabis use. (4) Conclusions: We demonstrated the relationship between the presence of severe PTSD symptoms and problematic alcohol/cannabis use in a multi-ethnic sample. The relationship between the presence of severe PTSD symptoms and problematic alcohol/cannabis use was similar between ethnic groups. We recommend screening for PTSD symptoms in those exhibiting problematic substance use and vice versa, regardless of ethnic background.

Mental Health Service Referral and Treatment Following Screening and Assessment in Juvenile Detention.

Numerous recommendations have been made to address the high rates of mental health disorders among justice-involved youth. Few data are available on the use, quality, appropriateness, or availability of services to address these needs. This study examined the relationship between trauma-informed mental health screening, other referral pathways for diagnostic evaluation, subsequent DSM-5 diagnoses, and treatments for evaluated youth. Eligible participants were all youth admitted to New York City secure juvenile detention facilities from September 17, 2015 to October 30, 2016 who remained in the facility for at least five days (N = 786). Of those, 581 (73.9%) were voluntarily screened and 309 (53.2%) later received a diagnostic evaluation. Youth who screened positive for depression, posttraumatic stress disorder, and problematic substance use were more likely to be evaluated. Treatment received was related to diagnosis rather than reason for referral. For youth who were referred for behavioral or emotional concerns, 99.1 percent (114 of 115) of those diagnosed with a neurodevelopmental disorder had attention-deficit/hyperactivity disorder (ADHD). These data are among the first to describe DSM-5 diagnoses and treatment among youth detainees. They highlight the prevalence of ADHD in detained youth and argue for the coordination of universal trauma-informed mental health screening and a structured referral system for this population.

Effects on alcohol and substance use of a school-based training intervention for adolescents with ADHD

IntroductionAdolescents with attention-deficit/hyperactivity disorder (ADHD) may be at risk for early, escalating patterns of alcohol and substance use via academic, peer, and familial impairment. Existing school-based interventions for youth with ADHD effectively target these risk factors, yet their effects on alcohol and substance use have not been explored. We examined the immediate and long-term alcohol and substance use outcomes of an evidence-based school-based intervention for adolescents with ADHD. MethodA total of 186 (Mage = 15, 79% boys, 78% White, 11% Hispanic) adolescents with ADHD were randomized to either a school-based training intervention targeting academic and social skills or a treatment-as-usual control group. A subset of youth was followed into emerging adulthood (5 year follow-up; n = 73). Participants reported on their alcohol and substance use behaviors and problems at post-treatment, 6-month follow-up, and 5-year follow-up. ResultsTwo-part hurdle models controlling for prior use and demographics indicated treatment was associated with improvements in substance use outcomes among youth using any substances at 6-month follow-up (β = −0.45). However, among youth reporting any alcohol use at the 5-year follow-up, treatment was associated with worse alcohol use problems relative to the control condition (β = 0.27). Approximately 22% of intervention participants met criteria for risky drinking behavior compared to 5% of participants in the control group. ConclusionWe found mixed evidence that a school-based intervention associated with positive outcomes on academic, social, and emotional functioning for adolescents with ADHD also prevented adverse alcohol and substance use outcomes. These unexpected results serve as a call for extended follow-up periods to identify the durability of intervention benefits and potential for downstream iatrogenic effects. Additional research is needed to identify school-based intervention strategies that can effectively deter substance use risk among select populations.

Risk Factors and Moderators of Intimate Partner Violence Victimization Versus Perpetration Among Women in Spain.

Bidirectional intimate partner violence (IPV) appears highly prevalent, but the extant literature, which has been dominated by work in North America, has not adequately accounted for how victimization overlaps with perpetration and how potential resources may interact with risk factors. A community sample of Spanish women completed measures of IPV approval, mental health risk factors (psychological distress and problematic substance use), and interpersonal resources (partner and social satisfaction). Using Mplus accounting for victimization and perpetration overlap, findings indicate that greater psychological distress and substance use were associated with IPV perpetration, and lower IPV approval was linked to victimization. Stronger partner satisfaction did not serve a buffering role but rather interacted to increase IPV perpetration; low social support was associated with victimization and exacerbated risk of perpetration.

“Boxing Clever Cork saved my life”: a snapshot of an early addiction recovery fitness and education program

ABSTRACT Background Boxing Clever Cork is an interagency program for people who have experienced or are experiencing problematic substance use. It integrates a fitness program with education, with the aim of reducing harm and supporting addiction recovery in the lives of participants. The aim of this research was to evaluate the Cork iteration of Boxing Clever, which originated in Ballymun, Dublin. Methods A qualitative approach was taken to data collection, using the World Café 1 method along with one to one interviewing, and data was analyzed using thematic analysis. Results Research participants described feelings of vulnerability and isolation during the embryonic stages of sobriety. Boxing Clever Cork introduced structure and purpose into their lives and created a model of peer-to-peer support within a newly formed early recovery community. Challenges encountered included the diverse stages of recovery within the group, however, despite these challenges research participants felt it was important that people actively using substances continued to be included in future programs. Professionals were motivated through the principles of social inclusion. Conclusions Opportunities for development include community-based delivery, a peer mentorship model and provision of additional mental health supports.

Children's out-of-home placements: Associations with parental substance use and neighbourhood sociodemographics.

Background: Studies have shown an association between parental problematic substance use (PSU) and children's out-of-home care (OHC). But there is little researech on the kind of urban neighbourhoods in which such associations typically show up. This study aims to shed light on the associations between neighbourhood characteristics, parental PSU and children's OHC. Using register data, we explore the spatial concentration of parental PSU and children's OHC in urban areas. Methods: Register data of all children born in Finland in 2002 and their biological parents living in 14 Finnish cities were used to follow the children from birth until their 18th birthday or first OHC episode. The study looks at parental PSU andother individual-level indicators as well-as the sociodemographic neighbourhood characteristics. Cox proportional hazards modelling was used as the analysis method. Results: Parental PSU increased the probability of children's OHC regardless of neighbourhood type. The probabilty was highest if both parents had PSU (hazard ratio [HR] = 8.05, 95% confidence interval [Cl] 6.38-10.16), but this outcome did not look the same for all neighbourhoods. The risk of children's OHC placements was higher in suburbs compared to city centres (HR = 1.76, 95% Cl 1.38-2.25). Conclusion: As parental substance use is a complex problem that is often intertwined with other life challenges, such as financial difficulties and mental health problems, it is insufficient to treat caregiver conditions, such as problematic substance use in isolation. Services that increase positive, pro-social connections may be lacking in the neighbourhoods with the most challenges.

Depression, Anxiety, and Coping Strategies Among Farmworkers Exposed to Substance Use at Work

ABSTRACT Objective Migrant farmworkers are at an increased risk of experiencing high levels of stress, depression, anxiety, and problematic substance use. Farmworker behavioral health is a predominant concern for agricultural health and safety efforts. While substance use has been found to be a visible part of the work environment among farming populations, there is scarce information about how farmworkers who are exposed to substance use at work are impacted. Methods This exploratory assessment investigated the association between substance use exposure at work and migrant farmworkers’ (N = 58) symptoms of depression, anxiety, and coping strategies used. Univariate, bivariate, and regression analyses were conducted to examine data from a survey administered to migrant farmworkers in Southern California’s Riverside and Imperial Valley counties. Results Exposure to substance use at work was significantly associated with farmworkers reporting more severe symptoms of anxiety (p = .018). We also found that anxiety among farmworkers was significantly related to their experiences of sexual harassment (p = .026), being called names or insulted (p = .05), feeling unsafe (p = .005), having an increased work burden (p = .001), and caring for a colleague (p = .001). Furthermore, as exposure to substance use at work increased, farmworkers reported more severe symptoms of depression (F (1,45) = 7.90, p = .007) and anxiety (F (1,45) = 16.743, p = .001). To cope, the farmworkers in our sample reported using emotion-focused coping strategies most often. Conclusions Substance use exposure at work can affect migrant farmworker health and safety. Addressing and supporting the behavioral health of the entire farming community is warranted.

Transgenerational impact of maternal adverse childhood experiences on children's mental health among families experiencing homelessness

BackgroundAdverse childhood experiences (ACEs) threaten the livelihood of individuals and their families. This may be particularly detrimental for mothers facing homelessness and their children's behavioral adjustment. ObjectiveThis study compared two models to examine the impact of maternal ACEs on children's internalizing and externalizing symptoms. Rather than using the cumulative approach to conceptualize ACEs, we analyzed a model that assessed the effect of each maternal ACE individually (i.e., specificity model) and another model that categorized them into two subtypes of maltreatment and household dysfunction (i.e., dimensional model). Participants and settingWe evaluated a sample of 164 children and their mothers in a residential vocational training program in Northern California. MethodsACEs for both mother and children and children's behavioral outcomes were collected via questionnaires completed by the mothers with the assistance of trained researchers. Additional demographic data was collected via trained case managers at the residential facility. Two models (i.e., specificity model; dimensional model) were utilized to better understand how to best assess adversity in settings with limited resources. ResultsResults of the specificity ACE model identified maternal childhood physical abuse and parental incarceration as predictors of internalizing problems and parental substance problems as a predictor of externalizing behaviors. The dimensional ACE model indicated that only the broad category of maltreatment predicted internalizing behavioral difficulties. The individual ACE model demonstrated a better fit for the data and highlighted specific events relevant to children's outcomes. ConclusionsThese results suggest that programs focusing on ending generational trauma may benefit from screening participants for individual ACE and tailoring services for mothers and children accordingly.

The Immigration–Crime Nexus: Inner and Outer Containment Buffer or A Push Toward Delinquency

The ongoing debate over the immigration–crime nexus has continued to attract a wide range of research efforts in the criminal justice field. To build on these initiatives, this study not only examines the relationship between immigrants and adolescent crime but also explores attributes derived from containment effects that may contribute to or shield individuals from deviant behavior in America. Results showed that both immigrant and native-born adolescents share similar external attributes rather than internal traits that affect delinquency. For instance, inherent immigration status and identity is relatively more influential on self-reported substance problems among immigrant youth compared to their native-born counterparts. Interestingly, among external attributes, immigrant and native-born adolescents are responsive to legitimate opportunity and neighborhood order in different ways which thrust them into different deviant pathways.

Sex workers' professional agency, quality of life, and problematic substance use in Finland.

Sex workers suffer considerable marginalization that limits their choices and exposes them to various types of harm. Hence, it is important to examine sex workers' professional agency and its association with quality of life. In the current study, we investigated professional agency, quality of life, and problematic substance use among sex workers in Finland. Using an online survey, we collected data from 136 sex workers contacted through Finnish sex work organizations and social media platforms. We conducted correlational analyses between the study variables and linear regression analyses with professional agency as the independent variable and quality of life and problematic alcohol and drug use as dependent variables. As expected, in the regression analyses, professional agency was strongly positively associated with quality of life (β = 0.86, p < 0.001) and negatively associated with problematic alcohol (β = -0.38, p = 0.002) and drug (β = -0.69, p < 0.001) use. Professional agency explained as much as 73% of the variance in quality of life. Most sex workers rated their quality of life as either good or very good. Our results underscore the importance of professional agency to sex workers' well-being, explaining a substantial proportion of the variance in quality of life. Promoting agency should therefore be at the heart of sex work policymaking. However, as most of the respondents were Finnish-born cis women, our results might not generalize to foreign-born, male, and gender diverse sex workers. Future studies should prioritize reaching these populations to ensure broader representativeness.

Co-occurring Depression and Substance Use Disorders in Young People

Depression and substance use disorders frequently co-occur in young people, which leads to poor mood- and substance-related outcomes. This cooccurrence may be caused by depressive symptoms leading to problematic substance use, substance use leading to depressive symptoms, and/or common vulnerability factors that put individuals at risk for development of psychopathology. While treatments exist to address co-occurring depression and substance use disorders in young people, multiple barriers exist that inhibit treatment accessibility and effectiveness, such as differential diagnosis difficulties, siloing of treatment modalities, and shame and stigma surrounding substance use. Despite these barriers, some young people receive treatment for one or both of their co-occurring disorders. This review describes four different treatment avenues: substance use disorder focused, depression focused, integrated, and transdiagnostic treatments. We conclude with clinical recommendations for providers who work with young people with co-occurring depression and substance use disorders. [ Psychiatr Ann . 2024;54(9):e253–e257.]

Precarity Factors of Street-Based Sex Work Within Criminalised Contexts: A Study in Athens, Greece

This community research study aims to investigate the intersecting self-identified precarity factors and identities associated with street-based sex work in a criminalised context, specifically in Athens, Greece, to improve the effectiveness of individualised care interventions. Interviews of 264 cis and trans female sex workers were conducted from June 2021 to December 2022, at a community day centre for sex workers in Athens. The community-based precarity index for sex workers was used, which was developed at the community centre, using factors identified by sex workers themselves. Street-based sex workers more commonly reported interrelated precarious factors, such as perceived problematic substance use, homelessness, client violence, medical issues, and trouble with the police. Trans and refugee identities were both associated with street-based sex work as well. Harm reduction, gender-affirmative and multilingual and multicultural interventions are essential in street-based sex work intervention programs. Decriminalisation of sex work is recommended to reduce the harms and risks associated with sex work.

Family-centred interventions for people with substance use disorders in low-income and middle-income country settings: a scoping review protocol

IntroductionSubstance use disorder (SUD) and problematic substance use are global public health concerns with significant multifaceted implications for physical health and psychosocial well-being. The impact of SUD extends beyond the...

Child welfare workers’ understanding of young people’s sexual health when conducting assessments due to substance use problems

Young people with substance use problems often have an early sexual debut, an increased risk of sexually transmitted infections and unplanned pregnancies, and a high risk of experiencing sexual violence. At the same time, according to the national action plan on sexual and reproductive health and rights (SRHR), the social services in Sweden have an important role in addressing sexual health in various contexts, such as in child welfare investigations. Therefore, this study has investigated how Swedish child welfare workers understand and relate to sexual health issues in child welfare investigations regarding young people with substance use problems. Following a strategic sampling, 15 child welfare workers were interviewed. The interviews were examined with a thematic content analysis with results showing that sexual health issues represented an area where knowledge was lacking. This was largely connected to that the child welfare workers had not been taught about SRHR in their bachelor’s degree nor in their continued education within the child welfare system. As a result of this, they often developed their own individual, professional approach for assessing sexual health matters, guided by the principle of “not investigating more than necessary”. When addressing sexual health in their assessment work, the child welfare workers primarily focused on risk, vulnerability and exposure. Not assessing young peoples’ sexual health was seen as protecting the right to confidentiality and privacy. In summary, this meant that young people with a problematic substance use were seldom given opportunities to talk about their sexual health, and especially not about positive sexual experiences related to their substance use.

Burden and satisfaction with social support in families with a history of problematic substance use or dementia – a comparison

BackgroundLiving in a family with a history of problematic substance use or dementia is a major stressful experience for family members and results often in an impaired health condition. Seeking and receiving social support has been emphasized as a major resource while coping with this stress. However, especially family members of people with problematic substance use often refrain from help-seeking. This paper examines whether (1) family members of problematic substance users are more physically and psychologically distressed than caregivers of people with dementia, and (2) whether and to what extent differences are mediated by satisfaction with perceived professional and private social support.MethodsTwo samples of family members of people with a chronic disease (problematic substance use (n = 221), dementia (n = 322)) completed self-administered questionnaires on burden, quality of life and social support. Physical distress was assessed using the Giessen Subjective Complaints List, psychological distress using the Center for Epidemiological Studies Depression Scale and anxiety symptoms using the Hospital Anxiety and Depression Scale. Quality of life was measured using the WHOQOL-BREF, and satisfaction with professional and private social support was assessed using a visual analog scale. Multivariate analyses of variance were performed to compare the two groups on the means of (1) burden ratings and (2) QoL dimensions and followed up by discriminant analyses to explore meaningful variables according to group differences. Parallel mediation analyses were performed to test the mediators private and professional support.ResultsFamily members of problematic substance users score higher on the burden indicators, while they score lower with regard to the quality of life dimensions than caregivers of people with dementia. The difference in burden is mainly explained by the higher scores for exhaustion, stomach discomfort and depression of family members of problematic substance users. Caregivers of people with dementia reported greater satisfaction with perceived social support, either private or professional. Satisfaction with private support was shown to be more important in mediating the impact of stress.ConclusionsFamily members of people with problematic substance use are in great need of tailored support programs and should be explicitly targeted.