الفهرس 
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Abstract
Summary
Substance use disorders (SUD) are a complex condition in which there is uncontrolled use of a substance despite harmful consequences. People with SUD have an intense focus on using a certain substance(s) such as alcohol, tobacco, or illicit drugs, to the point where the person’s ability to function in day-to-day life becomes impaired. People keep using the substance even when they know it is causing or will cause problems (Marchand, Beaumont, Westfall, MacDonald, Harrison, Marsh, & Oviedo-Joekes, 2019).
WHO estimated Substance use disorders at 14.4 per cent equivalent to 14.3 million Individuals aged 15-64 who used psychoactive substances for non-medical reasons in the past. About 4.7% of the population, accounting for about 4.6 million people, used opioids (such as tramadol, codeine or morphine) for multiple years for non-medical reasons (National institute of mental health, 2020).
Caregiver’s burden refers to the negative feelings and subsequent strain experienced as a result of presence of problems, difficulties or adverse effects which affect the lives of caregivers that leads to a mental condition that results from the combination of physical, social and emotional pressure involved in caring sick person (Abd El Menem, Abd El-Nabi & Fathalla, 2018).
The family caregivers complain of disruption in social activities and leisure time and such stresses affect the psychological well-being of relatives; they have moderately high levels of burden, and frequently have insufficient support from mental health professionals. So, social support is important for the psychological wellbeing of the family affected by mental illness (Mohammed & Ghaith, 2018).
Family Caregivers can vary considerably in their level of burden, indicating there is a subjective measure to the physical, economic, and psychosocial strain of caregiving; this is considered to be a product of dynamic interactions among caregiver resources, vulnerabilities, and care demands because of providing care for patient with SUDs (Jhang, Wang, Chang, Chang, & Wu, 2021).
Self-efficacy beliefs are cognitions that determine whether health behavior change will be initiated, how much effort expended, and how long will be sustained in the face of SUDs treatment obstacles and failures that increase caregiver burden/Self-efficacy influences how high caregiver set health goal. caregiver with high self-efficacy generally believe that are in control of SUDs patients’ care, that care actions and decisions shape lives, while caregivers with low self-efficacy may see lives as outside control and that increase burden ( Xie, Liu, Chen, Yan, & Wang, 2020).
The nurse play important role in improving the family-patient relationship. Also, a nurse can be care provider for patient with SUDs, a good instructor for the family caregivers, provides support for family caregiver’s burdens to improve adjustment and counselor of the people about substance use disorders (Bora, Das & Deka, 2017).
Aim of the study:
The aim of this study was to assess the relationship between burden and self-efficacy among family caregivers of patients with substance use disorders.
Research Question:
This study is based on answering the following questions:
1- What are the levels of burden among family caregivers of patients with substance use disorders?
2- What are the levels of self-efficacy among family caregivers of patients with substance use disorders?
3- What is the relation between burden and self-efficacy among family caregivers of Patients with substance use disorders?
Subjects and methods:
The study portrayed under four main designs as following:
Technical Design
The technical design includes research design, setting, subjects and tools used for data collection.
A- Research design:
A descriptive relational study design was used in the study to assess the relationship between burden and self-efficacy among family caregivers of Patients with substance use disorders.
B- Setting:
This study was conducted at the addiction outpatient clinic in Abassia mental health hospital affiliated to General Secretariat of Mental Health and Ministry of Health.
C- Subject of the study:
A purposive sample of 140 family caregivers of patients with SUD attending the previously mentioned setting and who were available at the time of study fulfilled the following inclusion criteria:
Inclusion criteria for the patient:
Age: adult patients
Gender: from both genders.
Diagnosed case for substance use disorder for at least one year.
Patient adhered to treatment plan for the last 6 months.
With history of relapse at least one time.
Inclusion criteria for the family caregivers:
Age: adult caregivers
All educational level and different socio-economic standards.
Family caregivers who accept to participate in the study.
Free from any psychiatric illness.
Not responsible for caregiving of other patient in the family.
Primary caregivers who closely related and directly involved in the care of the patient with substance use disorder for at least one year.
Tools for data collection:
1. Interviewing questionnaire was designed by the researcher and included three parts as the following:
a. First part: socio-demographic sheet for family caregivers and patients to assess socio demographic data of both family caregivers and patients with substance use disorders and it divided into:
- Patient’s socio-demographic data: included age, gender, marital status, residence, educational level, occupation and the monthly income
- Family caregiver’s socio-demographic data: included caregiver’s age, gender, level of education, occupation, relation to patient, marital status, the monthly income and duration of caregiving.
b. The second part: Patient’s health history included data about the type of narcotic substance, start of substance abuse, route of administer the drug ,motives for use, numbers of previous treatment , and number of relapses after periods of abstinence.
The third part: Knowledge about substance use disorder to assess family caregiver knowledge about substance use disorders, it include: concept, signs and symptoms, cause, types of substance and methods of treatment.
II. Burden of family caregivers for patients with substance use disorders:
It was developed by the researcher based on (Zarit et al., 1980) and (Thara et al., 1998) to assess care burden among family caregivers of patients with substance use disorders. It includes29 items categorized in five domains as following: Physical burden consist of (6 items), Psychological burden consist of (5 items), Social burden include (12 items) financial burden consist of (5 items) and overall burden consist of (1 item).
III. Self-Efficacy Scale SES) is a 10 item that it was designed by (Ralf Schwarzer, 1981) to assess self-belief to cope with a variety of difficult demands in life.
The findings of the study can be summarized in the followings:
1- More than two fifth of the studied family caregivers their age ranged from 30-<40years. As regard to gender and marital status, more than half and less than three quarters of the studied family caregivers were female and married, respectively. Also, more than three quarters of them were residing in urban areas. In relation to educational level, more than one quarter of them had basic education. Also, less than three quarters of the studied family caregivers were working, less than half of them were employee. Furthermore, less than two thirds of the studied caregiver, their monthly income was not enough. Moreover, less than three quarters of the studied family caregivers shared the patient’s treatment expenses. Also, the minority of the family caregivers had physical illness; more than two thirds of them had hypertension.
2- Three-fifth of the studied family caregivers had unsatisfactory level of total knowledge about substance use disorder. While, two fifth of them had satisfactory level.
3- More than two thirds of the studied family caregivers had severe level of total burden for caring patients with substance use disorder. More than half, less than two thirds, more than three quarters, less than three quarters of the studied family caregivers experienced severe burden at physical, psychological, social, financial and overall burden, respectively. More than two thirds of the studied family caregivers had severe level of total burden. Also, less than one quarter of the studied family caregivers had moderate level of total burden. While the minority of them had mild level of total burden.
4- More than three quarters of the studied family caregivers had low level of self-efficacy. While, less than one quarter of them had high level of self-efficacy.
5- There are highly significant positive correlations between total family caregivers’ knowledge and their self-efficacy. While, there are highly significant negative correlations between family caregivers’ burden and their knowledge and self-efficacy .Also, there were a highly significant negative correlation between family caregivers’ physical, psychological, social, financial, overall burden and their self-efficacy.
Conclusion:
Based on the results of the present study and research questions, the following can be concluded:
Caregivers with low self-efficacy and unsatisfactory knowledge regarding SUDs experienced severe level of caregiving burden.
Recommendations:
Based upon the results of the current study, the following recommendations were suggested:
1. Designing and implementation of psycho educational program for family caregivers of patients with substance use disorders to enhance their self-efficacy, coping abilities and quality of life and to overcome their burden of caregiving.
2. Establishment of counseling clinics that tailored to provide motivational intervention, emotional regulation and life style modification for patients with SUDs.
3. Early detection of any psychosocial problems through routine screening of burden, psychosocial problems of caregivers of patients with SUDs by qualified PMH nursing.
4. Supportive intervention for caregivers of patients with SUDs.
5. Further qualitative studies to assess burden and self-efficacy among family caregivers of patients with SUDs.