الفهرس 
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Abstract
The effects of a substance use disorder (SUD) are felt by the whole family. The family context holds information about how SUDs develop, are maintained, and what can positively or negatively influence the treatment of the disorder. Family systems theory and attachment theory are theoretical models that provide a framework for understanding how SUDs affect the family. In addition, understanding the current developmental stage a family is in helps inform assessment of impairment and determination of appropriate interventions.
The manner in which a family copes or manages the addiction issue has a profound effect on the way others experience the problem, as well as the course and severity of the problem. In addition to the family management of the adolescent addiction. The family also has a significant role in the origin of problem behaviors such as substance abuse. Substance abuse has a devastating effect not only on the individual, but on the family system as well (Casker and Dykes, 2019).
It is important to recognize that affected family members (AFMs’) coping pattern is influenced by psychosocial factors such as emotional distress and the availability of support services. The distress that AFMs experience generally produces negative emotions of anger, resentment and disappointment which consequently compromise the nature of the AFM’s relationship with the user. The deterioration of these relationships is often not only a result of the disappointment or guilt that AFMs feel but also the conflict that arises within this relationship (Groenewald and Bhana, 2017).
Aim of this study:
The current study was conducted to assess the coping pattern among family caregivers adolescent with substances abuse.
Research Question:
What are the coping patterns among family caregiver caring adolescent with substances abuse?
l. Research Design:
A descriptive design was used to conduct this study.
Study Setting:
This study was conducted at the outpatient addiction department in Alkhanka Hospital for Mental Illness.
Subject:
Study subjects include a representative of total adolescent with substances abuse in outpatient units attendance rate (N=1825) at Alkhanka Hospital for mental Illness; were hospitalized during the period 2018-2019. Based on sample size equation 200 adolescents with substances abuse participated in this study.
- Type I error (α) = 0.05
- Type II error (B) = 0.20
- With power of test 0.80
N= Community size
z= Class standard corresponding to the level of significance equal to 0.95 and 1.96
d= The error rate is equal to 0.05
p= Ratio provides a neutral property = 0.178
Technical Design:
Tools of Data Collection:
The required data were collected through the following tools:
II. First tool : Interview Questionnaire Sheet: it was designed by the researcher and was written in simple Arabic language to gather data regarding the following three parts which includes:
1. It was concerned with characteristics of the adolescents with substances abuse.
2. , which includes; age, sex, and ranking.
3. It was concerned with clinical data about addiction of the adolescents’ with substances abuse.
4. Socio-demographic characteristics of the family caregiver of the adolescents’ with substances abuse.
5. , which includes; age, sex, educational level, residence, and marital status and monthly income.
ll. Second tool: Family Caregivers Coping: It was adopted from (Folkman & Lazarus, 1986) and modified by (Sudrabaa et al., 2015): to assess coping patterns among family caregiver caring adolescent abuser. It was consisted from 56 items that comprise six subscales: Cognitive Coping (11 items), Problems Solving (7 items), Seeking Social Support (11 items), Escape-Avoidance (12 items), Exercises / Relaxation (9 items), and Positive spiritual (6 items).
Scoring system:
The answers of each item converted to numerical data. Each item was rated on three point Likert scale ranged from (1-3) as the following (the answer never occur = 1, the answer sometimes occur =2, the answer always occur =3
The scores of the items of each part were summed-up and the total was divided by the number of the items, giving a mean score for the part. These scores converted into a percent score, and the total coping health inventory for family caregiver caring adolescent abuser was classified as the following:
Ineffective Coping ≤50% (Zero - 84)
Effective Coping >50-100% (85-168)
III. Operating Design:
The operational design for this study consisted of three phases, namely preparatory phase, pilot study, and fieldwork.
Preparatory Phase
This phase included reviewing of literature related to coping patterns among family caregiver caring adolescent abuser by using books, articles, journals, and internet. This served to develop the study tools for data collection. During this phase, the researcher also visited the selected places to get acquainted with the personnel and the study settings. Development of the tools was under supervisors’ guidance and experts’ opinions were considered.
Content and Face Validity and Reliability:
Validity: It was ascertained by a group of experts (5) in the field of psychiatric / mental health nursing to test its content validity by reviewing the tools clarity, relevance, comprehensives, simplicity, minor modification were done; reliability was tested statistically.
Reliability: The tool was tested to ensure that an assessment tool produces stable and consistent result overtimes reliability of the study tools was used Alpha Cronbach test.
N: is equal to the number of items and r- the bar is the average inter-item correlation among the items.
Pilot Study
Pilot study was carried out on 10% (20) of the adolescents’ abusers and their caregivers for follow- up in the previous mentioned sitting to test the applicability of the constructed tools and the clarity of the included questions related to coping patterns among family caregiver caring adolescent abuser. The pilot has also served to estimate the time needed for each subject to fill in the questions. According to the results of the pilot, some corrections and omissions of items were performed as needed. The pilot participants were not included in the main study sample.
Fieldwork
The actual field work of this study was carried out over 3 months period started from the beginning of January 2020 till the end of March 2020 from 9 a.m. to 12 p.m., explaining the aim of the study in order to obtain their permission and cooperation. The researcher first met with the family caregiver caring adolescent abuser at the outpatient addiction department in Alkhanka Hospital for Mental Illness, explained the purpose of the study after introducing herself. The adolescents and their family caregivers were assured that information collected would be treated confidentially, and it would be used only for the purpose of the research. Then, individual interviewing was done after obtaining family caregivers consent to participate. The researcher was visiting the study setting 2days/weekly over a 3 months period using the previously mentioned study tools.
III. Administrative Design
Approval obtained through on issued letter from the Dean of Faculty of Nursing, Ain Shams University to directors of the outpatient addiction department in Alkhanka Hospital for Mental Illness. The researcher then met the hospital director and explained the purpose and the methods of the data collection.
Ethical Considerations:
The research approval obtained from the faculty ethical committee before starting the study. Verbal approval obtained from the adolescents and their family caregivers before inclusion in the study; a clear and simple explanation given according to their level of understanding, physical and mental readiness. They secured that all the gathered data was confidential and used for research purpose only. The adolescents and their family caregivers informed that they are allowed to choose to participate or not in the study and they have the right to withdraw from the study at any time.
IV. Statistical Design
Recorded data were analyzed using the statistical package for social sciences, version 20.0 (SPSS Inc., Chicago, Illinois, USA). Quantitative data were expressed as mean± standard deviation (SD). Qualitative data were expressed as frequency and percentage.
The following tests were done:
Chi-square (x2) test of significance was used in order to compare proportions between qualitative parameters.
Pearson’s correlation coefficient (r) test was used to assess the degree of association between two sets of variables
The confidence interval was set to 95% and the margin of error accepted was set to 5%. So, the p-value was considered significant as the following:
Probability (P-value)
– P-value <0.05 was considered significant.
– P-value <0.001 was considered as highly significant.
– P-value >0.05 was considered insignificant.
The main results obtained from the present study were as follows:
• The highest percent of family caregivers of adolescent with substance abuse were interested in following up daughter/son at school and discussing his/her educational problems with teachers as well as share in training programs on how to deal with the drug abuse adolescents and discuss with specialists about how to deal with the drug abuse adolescents. They represent equal percent 39%.
• Concern to problem solving coping pattern highest preparation of family caregivers are practice hobbies to mitigate the pressures they ’are exposed to because of the problems of my son/daughter; and they think of different solutions to encounter the problems of their son/daughter.
• As regard to see rings social support coping pattern 64% of family caregivers were resort to one of my close friends to help them in deal with their son/daughter who is on drug abuse, meanwhile 20.5% never seek help of the friends of their son/daughter in solving the problem.
• About escaping avoidance coping pattern 61% of family are search about other interests to keep themselves away from direct confront against the problem of drug abuse suffered by their son/daughter and avoid meeting the relatives in order not to know the problem of their son/daughter.
• Concerning exercise/relaxation coping pattern 45.5% always they take a rest to go along with their life and go to the public parks and gardens when I feel stressed because of the problem of drug abuse of my son/daughter, meanwhile they don’t practices exercise of deep breathing and not search for joy and sources of entertainment to mitigate the negative effects caused by the problem of drug abuse of their son/daughter. They represent 49.5% and 42%.
• The highest preparation of family caregivers have in effective coping pattern.
• 62% of the studied family caregivers of adolescents with substance abuse were ineffective coping regarding cognitive coping.
• 58.5% of the studied family caregivers of adolescents with substance abuse were ineffective coping regarding problems solving.
• 60.5% of the studied family caregivers of adolescents with substance abuse were ineffective coping regarding seeking social support.
• 61% of the studied family caregivers of adolescents with substance abuse were ineffective coping regarding the escape avoidance.
• 59% of the studied family caregivers of adolescents with substance abuse were ineffective coping regarding exercises/relaxation.
• 56.5% of the studied family caregivers of adolescents with substance abuse were ineffective coping regarding positive spiritual.
• 61.5% of the studied family caregivers of adolescents with substance abuse were ineffective coping regarding coping pattern generally.
Conclusion:
Studied family caregivers of adolescent with substance abuse have used different types of coping pattern and they have ineffective coping patterns as: Inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, and/or inability to use available resources.
According to study findings, it recommended that:
• Establishment of counseling clinic for family caregivers of adolescent with substance abuse to enhance their coping methods.
• Applying psycho-educational nursing intervention program for enhancing family caregivers coping methods and psychological well being.
• Further research to assess factors the affect family caregivers coping methods.
• Conduct regular workshop for family caregivers about methods of carrying adolescent and enhance parent adolescent relationship.