AN INVESTIGATION OF FAMILY CAREGIVERS BURDEN AND

MANAGEMENT OF SUBSTANCE USE DISORDERS AMONG PERSONS IN

RECOVERY, MOMBASA COUNTY, KENYA

PAMELA R. N. KAITHURU

ISSUP PRESIDENT

DR. VIRGINIA NYAGAH (PhD)

ISSUP MEMBER
 ABSTRACT

Substance Use Disorders have mild, moderate and severe effects on individual and
management can be impacted by various factors. This study investigated the psychosocial
pathways to the management of Substance Use Disorders among persons in recovery in
Mombasa County. The study was guided by five research objectives focusing on how
self-esteem, self-motivation, family care-givers burden, and referral relate to management
of Substance Use Disorders. The study was anchored on Rational Emotive Behavioral
Theory and self-concept theory. Convergent Parallel Mixed Method Research Design
was adopted. The target population was 220 individuals and a sample of 152 was selected
through stratified and simple random sampling. Data was collected using Rosenberg
Self-Esteem Scale, Self-Motivation Assessment Test, Caregivers Self-Assessment
Questionnaire and Focused Group Discussion guides. Cronbach Alpha technique was run
to test the reliability of these tools. Cronbach’s alpha for Rosenberg Self- Esteem Scale
was .987, Self- Motivation Assessment Test .975 and Caregivers Assessment
Questionnaire .879. Data was analyzed using Pearson correlation and thematic analysis
backed by narratives. The study found a weak negative and significant relationship
between self-esteem and life skills (r=-0.338; p<0.01); weak positive and significant
relationship between self-motivation and life skills (r=0.328; p<0.01),; weak negative and
significant relationship between family caregivers’ self-awareness and uptake of
counseling (r=0.91; p>0.01); clients compelled to seek treatment by police had a high
mean in life skills (Mean=5.0000) and adherence to treatment (mean=3.3333;
SD= .47140) and use of integrated model of treatment in management of Substance Use
Disorders . The study recommended a National Counseling Policy for Substance Use
Disorders management in rehabilitation. The study further recommended the County of
Mombasa to institutionalize professional counseling services, to engender early diagnosis
and treatment of Substance Use Disorders. Finally, the study recommended rehabilitation
centers to consider strengthening the counseling programs offered in the centers in
Mombasa County.

Key words: Family Caregivers Burden, Management of Substance Use Disorders,

Persons in Recovery

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 BACKGROUND OF THE STUDY

Substance Use Disorders (SUDs) refers to a mental condition which results from the use of

one or more substances that could lead to clinical impairment or distress (Chesang, 2015); it is

also called Drug Use Disorder (DUD). According to the United Nations Office of Drugs and

Crime (UNODC) there were estimated 271 million users of drugs globally in 2018 with 13

percent of the users suffering from Substance Use Disorders (United Nations Office of Drugs

and Crime, 2019). In the light of the global health body, the World Health Organization (WHO),

Substance Use Disorders caused 3 million deaths, with about 5.3 percent of all the deaths

globally being due to Substance Use Disorders (2018). Substance abuse and its effects on

physical and psychosocial health is becoming a global public health concern, mostly affecting

adolescents and youth.

Globally, 29.5 million people suffered from Drug Use Disorders, opioids being the most

harmful (WHO, 2018). Africa has not been spared the wrath of drugs and substance use, and the

related SUDS. For instance, use of drugs is prevalent in many countries in West and North

Africa (World Drug Report, 2020). Further the report stated that 1.0 percent prevalence use was

in Eastern Africa, 0.5 percent in Southern Africa (0.5percent) and Central Africa had a

prevalence of 1.8 percent.

In Kenya, substance abuse and SUDS is one of the top-ranking problems confronting the

nation today. For instance, according to Kamenderi, Muteti, Okioma, Kimani, Kanana. and

Kahiu (2019), the prevalence of multiple SUDS substance Use Disorders in Kenya stood at 5.3

percent with non-multiple Substance Use Disorders being 10%. Mostly the alcohol and tobacco

stood at 2.5 percent, tobacco and khat (0.8 percent), alcohol and khat (0.7 percent), alcohol,

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tobacco and khat (0.5 percent) and tobacco, khat and bhang (0.3 percent). Kamenderi et al (2019)

further observed that the burden of Substance Use Disorders in Kenya posed a challenge.

The extent of substance abuse in the coastal region of Kenya is alarming compared to the

other areas of the country. More particularly, in Mombasa County, one in every ten people

indulges in substance abuse and the percentage was higher among the male population (Korir,

2015). Besides, the majority of the youths in Mombasa are heavily hooked on narcotics thus

making them unproductive and easily prone to crime. Consequently, this contributes to the rise in

insecurity and acts of terrorism in the region an issue that has been associated with lack of

management strategies for the substance use disorders in the region (Muthikwa, 2016).

It is important to note that, despite the increase of SUDS, effort has been made in the

management of Substance Use Disorders and this has been on the increase throughout the world.

Specifically, family caregivers contribute to treatment engagement and adherence, reducing

substance abuse and relapse, and increasing the well-being of the person with an addiction

disorder. However, despite the great role the family of the person with SUD plays in treatment,

some of the primary caregivers may experience high levels of burden in the process of caring for

their loved ones affected by substance use disorder. These burdens may include economic,

social, psychological, emotional, and physical burdens (Dickey and Azeni 2016).

The effects of the caregiver burden in other areas of terminal illness health have been

studied widely but the burden of caring for persons with substance use disorder has largely been

ignored (Weisner et al. 2013). As a result of this ignorance, many people caring for persons with

Substance Use Disorder continue to suffer resulting to poor health of the care giver and care

recipient, especially when the caregiver assisting the recipient with activities like bathing,

feeding or elimination. The upward trend of SUDS has created burden among families, as
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parents who are caregivers. Hence, this study aimed at investigating family caregivers’ burden

and the management of Substance Use Disorders among persons in recovery in Mombasa

County in order to address the knowledge gap.

1.3 Statement of the Problem

Substance Use Disorders has become an emerging public health issue in Kenya over the past few

years and its presence in one family member has enormous impact on the whole family in

different ways, with the greatest burden experienced by the immediate members of the family

especially the parents and the spouses (Schulze, 2015). These caregivers in particular, have a

high likelihood of encountering high distress levels as they have to care for a person having

problems with substance abuse and can even include a touch of mental illness or rather a ‘dual

diagnosis’ (Carpentier et al. 2012).

There has been a notable increase in rehabilitation centers, majorly private with a few

government facilities, regulated by NACADA. However, despite these efforts, the rates of

substance use continue to increase to epidemic proportion, with many more caregivers being

burdened with the difficult situation of caring for people with SUDs. In addition, there is paucity

of literature on burden of family caregivers in Kenya which constitute a knowledge gap.

Therefore, this study aimed at investigating family caregivers’ burden and the management of

Substance Use Disorders among persons in recovery in Mombasa County in order to add to the

body of knowledge.

1.4 Objectives of the Study

1. To assess the burden of family caregivers for the persons in recovery of SUDS

2. To evaluate the management of SUDS amongst persons in recovery in Mombasa County

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 3. To investigate the relationship between family caregivers’ burden and the management of

SUDS among persons in recovery

CHAPTER TWO

LITERATURE REVIEW

2.1 Introduction

This chapter presents the theoretical framework and a review from findings of other

studies that are closely related to the current study. Empirical literature has been discussed under

this chapter. The studies were critically analysed identifying the gaps in knowledge that the

current research attempted to fill. It also highlighted the knowledge gap as well as conceptual

framework.

2.2 Theoretical Framework

This study was guided by rational emotive behavior theory.

2.2.1 Rational Emotive Behavioral Theory (REBT)

The theory developed by Albert Ellis in the 1950s views problems with substance use as

being a result of an interaction between genetic and familial, and is multi-determined by the

individual’s social learning history (Dryden, 2014). The theory hypothesized that the desire to

change and to maintain follow-up action on a decision is a precondition to the result at the end.

The decision to manage Substance Use Disorders consists of evolving introspective thinking

processes about drugs and the related effects. Notably, in upholding abstinence, the improvement

of higher frustration tolerance is essential (Eiden, 2018).

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 Rational Emotive Behavior therapy explains addiction as caused by the interaction of

behavior, images, and cognition (Eiden, 2018). The thoughts that an individual has on substance

use and related mal-functions presents the imaginations (images or pictures they form of the

SUDs) and therefore the consequent behavior is determined. The persons in recovery reason

irrationally and visualize dysfunctional acts in a self-defeating manner fueling the ‘inability and

or inconsistency’ to perceive management in a sustainable manner. The importance of therapy is

therefore to challenge the person in recovery to question the unrealistic assumptions, fixations

and to draw reasonable conclusions on a behavioral presentation. This would then strengthen the

persons in recovery resolve to adopt behavior change for management of the Substance Use

Disorders. The consequent positive control over substance use would be attained through

exercise, repetition, and reinforcement of realistic and rational tensions.

The REBT is a theory focused on helping persons in recovery to change their irrational

beliefs. This is premised on the assertion by this theory that "people are not disturbed by things

but rather by their view of things." The view of the presenting substance related disorders

(thing/s) therefore influences persons in recovery thinking and feelings as the critical

fundamental assertion of the REBT is how people feel by how they think. This means that when

people hold irrational beliefs about themselves or the world that they live in, problems can result.

Ellis further proposed the ABC model under his theory that sought to expound on how people

mistakenly blame external events for unhappiness. He argued that it all depends on an

individual's interpretation of events that genuinely lies at their heart psychological distress.

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2.3 Empirical Literature Review

This section deals with critical review of the studies done empirically on the family givers

burden and management of Substance Use Disorders among adults

2.3.1 Burden of Family Caregivers for the Persons in Recovery of Substance Use Disorders

Human beings, just like most other creatures thrive in relationships and situation of life

can strain the relationships making them burdensome. Environments, family, peers and

socioeconomic status alter emotions, mental processes, and general wellness. Various physical

settings may stimulate a wide range of emotions, including anger, anxiety, depression, boredom,

frustration, and happiness. Stevens and Light (2014) stated that social support in clients with

SUDs often involves the status of the physical settings, relationships within the environment and

their conditioning effect which further enhances their response to treatment. Furthermore, it is

possible to describe the impact of environmental variables for example colors, temperature,

lighting intensity, and noise on emotions systematically.

Stevens and Light also noted that social relationships have a strong bearing on how an

individual respond to a treatment program administered to them. For instance, they observed that

when an individual with a given Alcohol Use Disorder is undergoing a treatment program under

the direct influence of their family members or support, besides any other trainers, their response

to the treatment program is fast and decisive and such individuals have lower chances of

relapsing as opposed to those who do not experience any care, where the family caregivers feel

over burdened by the situation. Besides, the two researchers also discovered that family

relationships facilitated a sense of wellbeing and thus played a significant role in the recovery

process of a person with SUDs. Families that presented their patients to treatment programs and

continued to monitor their progress alongside their trainers had their patients, with low family

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caregivers’ burden, take the shortest time to recover make good recovery progress while at the

centers and the response by their patients was positive. This study agreed with the findings,

underpins the importance of family caregivers’ support and sought to explore the effect of family

caregivers’ burden in management of Substance Use Disorders among coastal family settings.

Choudhary (2016) conducted a phenomenological research design qualitative study to

assess perceived burden among family caregivers of client with substance dependence. The study

sampled out Seventeen family caregivers of the persons in recovery with substance dependence

through purposive sampling. Data was collected through semi-structured interviews and

analyzed thematically. The study found that majority (81.5 percent) of the family caregivers

were of the age group of >40 years with mean age of 46.7 years and standard deviation of 12.53.

One of the themes this study found was stress. Majority of participants expressed feeling of

stress because of continuous threats of drug persons in recovery to commit suicide, and due to

the helplessness about the future of the persons in recovery. The research adopted a mixed

method design and employed a standardized tool the ‘Family Caregivers Self-Assessment

Questionnaire’.

Kaur, Mahajan, Deepti and Singh (2018) conducted a cross sectional study to assess the

role of burden in family caregivers of substance abusers: at Swami Vivekananda Drug De-

addiction Centre, Govt. Medical College, Amritsar in India. A total of 349 family caregivers of

substance abusers were interviewed by use of pretested and semi structured questionnaire. The

findings of the study revealed that majority (44.69 percent) of family caregivers of participants

were females having mean age of 33.45 Further, the study found that majority (54.15 percent) of

family caregivers of drug addicts developed stress while caregiving another 12.60 percent

reported having had social and financial problems and 4.87 percent reported losing their social

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interactions because of lack of time and lastly 0.57 percent reported that they faced continuous

conflicts in the family. The study concluded that the quality of life of the family caregivers was

compromised and stressed. These findings agreed with Choudhary (2016) study which found

that majority of participants (family caregivers) expressed feeling of stress because of continuous

threats of persons in recovery to commit suicide, and due to the helplessness about the future of

the persons in recovery. The current study was carried out to find out the whether similar

findings could be replicated with the Kenyan population and how the family caregivers’ burden

can relate with the management of Substance Use Disorders among persons in recovery

undergoing treatment.

Marcon, Rubira, Espinosa, Belasco and Barbosa (2014) carried out a cross-sectional

study to evaluate quality of life and presence of stress in family caregivers of drug-addicted

people at four Psychosocial Care Centers for alcohol and drugs (CAPS AD, acronym in

Portuguese) in the municipalities of Mato Grosso, Brazil. Data were collected from 109 family

caregivers using the Medical Outcomes Study 36 – Item Short-form, depression symptoms (Beck

Depression Inventory) and stress of family caregivers (Caregiver Burden Scale). Descriptive

analysis was done using percentages while inferential analysis was done using Spearman

correlation techniques and multiple linear regression. The study found that majority (90.8

percent) of family caregivers were predominantly women while men were 9.1% with a mean age

of 47.6 years. Further, a strong correlation (p<0.01) was observed in all domains, with mental

health, emotional aspects and vitality more strongly correlated with the presence of depressive

symptoms. From this study findings, it is evident that 23.4 percent of the family caregivers were

either mothers or fathers to the patients. In this regard, the same number of family caregivers

corresponded to being daughters or sons to the addict, 19.1percent were either sisters or brothers

10
to the patients while 10.7 percent were colleagues. The study concluded that majority of the

family caregivers were from the nuclear family.

2.3.2 Management of Substance Use Disorders

Components of a comprehensive treatment for Substance Use Disorders include a

continuum of professional addiction services and addiction-related services. This includes

assessment, detoxification, rehabilitation, counseling or therapy, continuing care, substance use

monitoring, medications, case management, and mutual support programs (Musholt, 2015).

Many SUDs programs for individual treatment and group treatment address social recovery

issues during recovery because these issues have implications for relapse and quality of life

(Muthikwa, 2016).

These interventions may discuss topics such as how to avoid or minimize contact with

high-risk people, places, or events; resolving relationship problems; developing new friendships;

developing a recovery network of sober friends and supportive people; resisting social pressures

to use substances; improving communication or assertiveness skills; asking for help and support

from others; engaging in substance-free social activities; engaging in mutual support programs;

and/or making amends to people who have been harmed by an individual's SUD(s) (Nakajima,

2015). Management of Substance Use Disorders has proven to be a challenge due to the rising

dynamics of how these substances are acquired and consumed. Nevertheless, efforts are

underway with different stakeholders playing roles in curbing the menace among the young

adults. That brings forth the reasons why the treatment modalities should be inclusive and

considerate of the psychosocial factors and treatment dynamics to avoid relapse and failure of

objectivity in dealing with substance-related disorders.

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 According to Hampson (2014), people who are considered abuse drugs are those who feel

an overwhelming and uncontrollable need to use drugs even when they know there can be

negative consequences. Generally, people start using drugs and other substances out of curiosity

because their friends are doing it or because they want to ease another problem. As the person

uses the drug more and more, they become increasingly dependent on it and that’s when it is

time to seek the help of a drug addiction rehab center.

Foo, Tam and Lee (2014) carried out a qualitative multiple case study from a Christian-

based rehabilitation centre in Malaysia on family factors and peer influence in drug abuse. The

sample size comprised of seven participants aged 23-55 years. Data was collected through

interviews. Participants were required to recall their family situations, their peers and substance

use experience. On the models of treatment, the study found that CBT was the primary approach

in treating addiction of persons in recovery in the centre. Cognitive approach generally focused

on changing the thoughts and behavioral approach and was found to be effective as the therapist

would direct activity and reinforce goal-oriented behaviors among the persons in recovery.

Cheney, Curran, Booth, Sullivan, Stewart and Borders (2014) exclusively studied Black

Americans and their reliance on God in the sustained recovery phase from cocaine dependency.

The study was conducted in the American South, where church and religion play a fundamental

role in people’s everyday lives. The authors showed that about 61.9 percent of Black cocaine

users who were included in the study (n=400) stated that they “sought God’s strength to cut

down on their drug use” (Cheney et al., 2014, p. 99). The individuals in this study stated that

being involved in their religious community allowed them to mingle with non-users, provided

them with positive support systems, and allowed them to discuss their cocaine usage issues with

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the clergy. These two studies agreed that being involved in a religious or spiritual community

somehow could lead to persons using drugs to rethink their use and change for better.

Parhami, Davtian, Collard, Lopez and Fong (2014) explored spirituality/religiosity and

self-reported religious preference at a Jewish residential treatment center for Substance Use

Disorders. Religiosity/spirituality was measured at a baseline, 1 month, 3 months, and 6 months.

Interestingly, religious preference did not correlate with treatment retention while

religiosity/spirituality correlated with treatment retention at 6 months. This means that the

patients who stayed in treatment at 6-months had significantly higher religiosity/spirituality

levels. Thus, this research showed a positive effect of the inclusion of spirituality and religion in

the drug treatments and interventions on the treatment outcomes for substance use.

In addition, Al-Omari, Hamed, and Tariah (2015) looked at the role of religiosity in the

recovery process among Jordanian women from substance abuse. The study used open-ended

questions to examine the concepts and roles of religiosity in recovery from substance use. The

authors found that religion “was viewed as a vital factor in the recovery process, as well as a

protector from relapse in the future. These studies also show that religiosity can play a role in

recovery process of persons using drugs. However, these studies did not go to an extent of

finding out whether type of religion can influence the recovery process of addicts. The current

study focused on finding out whether religious differences had a role in management of

Substance Use Disorders (SUDs).

Desmond, Ulmer and Bader (2013) conducted a national longitudinal study of adolescent

health to find the relationship between religion, self-control, and substance use. The study

randomly sampled 200 students from 11th grade enrollment eighty high schools. Schools were

stratified by region of the country, urbanization, percent white, size, and school type (public,
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private, and parochial). The drugs used studied were marijuana and alcohol. Data was collected

using home-based questionnaires and interviews. The study found that adolescents’ religiosity

has a significant effect on marijuana use and drinking alcohol; this was confirmed by religious

youth who were found to be less likely to use marijuana and alcohol than non-religious youth.

This study focused on a different population (adolescents). The current study focused on adults

to find out whether same results could be replicated in the population studied.

Francis, Myers, Nkosi, Petersen, Carney and Lombard (2019) conducted a cross sectional

survey to examine the prevalence of religiosity and association between religiosity and alcohol

use, other drug use, and risky sexual behaviors among grade 8-10 learners in Western Cape,

South Africa. The sample size was 20,227 learners from 240 public schools randomly selected

through a stratified multistage sampling. Data was analyzed using univariate and multivariate

logistic regression analyses. In multivariate analysis, the study found that learners with high

religiosity were significantly less likely to report using alcohol in the last 30 days (AOR = 0.86,

95%CI: 0.76–0.97).

Marsiglia, Kulis, Nieri and Parsai (2015) conducted a 2-year drug prevention study on

substance use among religious and nonreligious youth among Mexican students. The sample size

comprised of 7,304 students from middle schools spread over nine school districts in a large

Southwestern city. Respondents were requested to respond to the question, “What is your

religion?” from the five categories: Catholic, Protestant, Church of Jesus Christ of the Latter-Day

Saints, Native American church, and other religion, with the last category capturing students

identifying as Jewish, Muslim, and other religions. Multivariate analyses were done to find the

relation between religious affiliation and drug use. The study found that the greatest number of

students (51 percent) were affiliated with the Catholic church followed by (19 percent) who

14
reported to belong to the other religion category, and 14 percent who had no religious affiliation.

Members of Protestant churches (9percent), the Church of the Latter-Day Saints/Church of Jesus

Christ of the Latter-Day Saints (3 percent), or the American Indian church (3 percent) followed

respectively. To explore how religious affiliation related to drug use, Church of Jesus Christ of

the Latter-Day Saints students reported higher frequencies of recent cigarette and marijuana use,

and Catholic students reported a lower frequency of recent marijuana use. Current study was also

carried out to investigate the same to find out whether the same results could be replicated in the

population under study and find out whether religion can play a role in the treatment of

Substance Use Disorders.

Musyoka, Obwenyi, Mathai and Ndetei (2016) took a descriptive qualitative approach

seeking to establish some of the treatment models used in rehabilitation centres in and around

Nairobi for people with Substance Use Disorders. The study population comprised all

rehabilitation centres which deal with alcohol and drug abuse patients. A total of 25

rehabilitation centres in and around Nairobi area, as per NACADA website were therefore

conveniently included to participate. The sample size comprised of all counsellors employed by

the rehabilitation centers. A questionnaire guide and an interview schedule were used for data

collection. Data was thematically analyzed and presented in themes.

The study came up with three themes with regard to treatment models used in the

rehabilitation centers. First the study found that medical approach which comprised a multi-

disciplinary team of professionals is often needed to treat the chemically dependent persons. For

instance, psychiatrists were involved in medical stabilization and facilitating treatment entry.

Others included addiction counselors, social workers, psychologists, family therapists,

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psychologists and pastoral counselors. Addiction treatment involved three stages; detoxification,

stabilization and rehabilitation.

Another treatment model indicated by majority of the respondents was Christian alcohol

recovery programs. This was found to encourage physical and spiritual healing and is built upon

a spirit of love and compassion. Another model established by this study used in the

rehabilitation centers was the 12 - step model which is a spiritual foundation for personal

recovery from the effects of alcoholism, not only for the alcoholics, but also for their friends and

family. The interviewees in this study indicated that they mainly use this model to train their

persons in recovery.

Finally, some of the respondents reported that therapeutic community services were

offered as treatment models. A therapeutic community exists to help people overcome an

addiction, but also recognizes that many of the people suffering from a dependency to drugs or

alcohol lack basic socialization and life skills, and that without first learning (or re-learning)

these necessary skills, they are at great risk for a relapse back to abuse.

Evidently there are many models that are applied in the management of Substance Use

Disorders, seemingly applying the same principles. These models were developed in entirely

different socio-cultural setups; drawing from experiences and realities of the developed

communities. This study sought to find out the models that are used in rehabilitation centers

found in Mombasa County and delve into the application of the same in-depth to gain knowledge

on existing gaps in the application and areas of improvement in the Kenyan context of the them

in Management of Substance Use Disorders

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2.3.3 Relationship between Family Caregivers Burden and Management of Substance Use
Disorders

Marcon, Rubira, Espinosa, Belasco and Barbosa (2014) carried out a cross-sectional

study to evaluate quality of life and presence of stress in family caregivers of drug-addicted

people at four Psychosocial Care Centers for alcohol and drugs (CAPS AD, acronym in

Portuguese) in the municipalities of Mato Grosso, Brazil. Data were collected from 109 family

caregivers using the Medical Outcomes Study 36 – Item Short-form, depression symptoms (Beck

Depression Inventory) and stress of family caregivers (Caregiver Burden Scale). Descriptive

analysis was done using percentages while inferential analysis was done using Spearman

correlation techniques and multiple linear regression. The study found that majority (90.8

percent) of family caregivers were predominantly women while men were 9.1% with a mean age

of 47.6 years. Further, a strong correlation (p<0.01) was observed in all domains, with mental

health, emotional aspects and vitality more strongly correlated with the presence of depressive

symptoms. From this study findings, it is evident that 23.4 percent of the family caregivers were

either mothers or fathers to the patients. In this regard, the same number of family caregivers

corresponded to being daughters or sons to the addict, 19.1percent were either sisters or brothers

to the patients while 10.7 percent were colleagues. The study concluded that majority of the

family caregivers were from the nuclear family.

Nyakemwa (2016) studied on the management of Alcohol Use Disorders amidst students

in specific Secondary Schools in Starehe Sub-County Nairobi county. The study centered on the

role of parents in the management of Alcohol Use Disorders. The study employed a correlation

research design on a target population of 3750 students and a sample population of 498 students.

The study found out that many students whose parents had no proper guidance and counseling in

17
terms of substance abuse would be left to make decisions on their own some of which were

derogatory. The study also established that students who were left to stay home for long without

proper parental guidance and family support easily engaged in substance abuse which later

resulted in different SUDs. The study eventually concluded that lack of family support manifest

in family caregivers’ burden, was a primary causative agent for the young people participating in

substance abuse and also contributed to the aspect of experiencing difficulties during the

treatment process. By using a different population, the adults and those already with Substance

Use Disorders this study sought to identify the relatedness of family caregivers’ role in

management of Substance Use Disorders.

Chesang (2015) associates’ misconduct such as alcohol and marijuana abuse with lax,

inconsistent or abusive parental discipline, a pointer to burdened family caregivers. On account

of diverse socialization agents, such as peer group, mass media, teachers, government and

church, youth are acquiring values that go beyond those of their immediate localized culture. In

the meantime, the family is less involved in their socialization resulting in the minimal transfer

of knowledge about the values and morals of the society. As a result, the traditional value system

has led to moral decay and resistance towards the management of SUDs.

Kahuthia (2015) gave a prevalence report on the social support of the family, peers and

the environment and other constructs towards SUDs treatment process. The research adopted a

quantitative research design on a target population of 2980 people and a sample population of

395 the study found that the quick high effect, accessibility, and affordability were the primary

reasons why the respondents abused the developing drugs and always found it hard to conform to

treatment. In return, the cost of this maladaptive behavior and its consequent management

burdens the family further straining relationships and caregiving.

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 In conclusion, the reviewed literature shows that family caregivers are burdened by the

abuse of substances of their significant others. It is notable that the literature focuses more on the

caregiver’s stress. The current study sought to understand how family caregivers burden relates

with the uptake of life-skills, counseling services and the adherence to treatment, sub-sets of

management, amongst the adults in identified rehabilitation centers in Mombasa County. Further,

this study may address the identified gap of the caregiver’s burden and its relationships with the

addict’s uptake of the services.

2.4 Research Gaps

The reviewed literature identified some knowledge gaps. First, the review revealed that

most studies done targeted the young populations and mostly those in learning institutions. In

addition, the methodologies employed in the studies were majorly quantitative and some

qualitative therefore yielding different findings. This study adopted a mixed method research

design to strengthen the quantitative and qualitative designs and add to the knowledge of

management of Substance Use Disorders.

Finally, many models were applied in the management of Substance Use Disorders,

seemingly applying the same principles. However, since these models were developed in

entirely different socio-cultural setups; drawing from experiences and realities of the developed

communities, this study sought to find out the models that are used in rehabilitation centers

found in Mombasa County and find out what can be done to improve Management of Substance

Use Disorders with respect to family care burdens.

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2.5 Conceptual Framework

A conceptual framework refers to a diagrammatic presentation of the relationship

between the Independent variable and Dependent variable of a study (Mugenda & Mugenda,

2013). In this study, family care givers burden was the independent variable while management

of Substance Use Disorders was the dependent variable. The independent variable was

expounded under self-awareness, stress and general wellness. The dependent variable, on the

other hand, was represented by sub-variables such as life skills training, adherence to treatment

and uptake of counseling services.

Independent Variables Dependent Variables

Family Care-givers burden Management of SUDS

 Self-awareness  Life Skills

 Stress  Adherence to Treatment
 General wellness  Uptake of counseling services

Intervening Variables
 Age
 Gender
 Marital Status
 Religious Affiliation
 Education

Figure 1: Conceptual Framework

Source: Author (2020)

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 CHAPTER THREE

METHODOLOGY

The study used Mixed Method Convergent Parallel Design. This research design entails

that the researcher concurrently conducts the quantitative and qualitative elements in the same

phase of the research process, weighs the methods equally, analyzes the two components

independently, and interprets the results together (Creswell & Pablo-Clark, 2011). The target

population for this study was persons in recovery, family care givers of persons in recovery and

counselors in three rehabilitation facilities accredited by NACADA in Mombasa County

(NACADA,2015). On average the three rehabilitation centers have 110 persons in recovery, 70

family caregivers and 40 counselors. Therefore, the total target population for the study was 220.

Yamane (1967) formula was used to obtain the sample size of 152 respondents. A questionnaire

was developed to assess Substance Use Disorders management and Care Giver Self-Assessment

Questionnaire was modified to assess family givers care burden.

Data collected was systematically organized and cleaned, by the researcher and her

research assistant, by checking whether all the questions had been filled so as to carry out the

analysis. The researcher used a statistician, with education level of Masters, to conduct the data

analysis. Data was coded and entries into SPSS version 22 were done. The outcomes of the

coded data were tallied, tabulated, analyzed and summarized.

21
 RESULTS AND DISCUSSION OF FINDINGS

Response Rate

Table 1: Questionnaire Return Rate

Category Total instruments Returned Response rate

Persons in Recovery 80 69 86.3%
Family caregivers 47 33 70.2%
Counselors 25 25 100%
Total 152 127 83.55%
The response rate for persons in recovery was 86.3%, family caregivers was 70.2% while that for

the counselors interviewed was 100%.

Demographic Characteristics Persons in Recovery

Age

Table 2
Age bracket of Persons in Recovery in Mombasa County
Frequency Percent
Valid 20-25 Years 7 10.1
25- 30 Years 20 29.0
30-35 Years 18 26.1
35-40 Years 24 34.8
Total 69 100.0

Table 2 shows that majority (34.8%) of participants are between 35-40 years followed by

29.0% who are between 25-30 years and 26.1% who are between 30-35 years. The participants

aged between 20-25 years were found to be the least (10.1%).

22
Marital Status
Table 3
Marital Status of Persons in Recovery in Mombasa County
Frequency Percent
Valid Single 38 55.1
Married 21 30.4
Divorced 8 11.6
Widow (ed) 1 1.4
Others 1 1.4
Total 69 100.0

From Table 3, majority (55.1%) of participants were single followed by those married

(30.4%) and divorced (11.6%). Those who were widow(ed) and others were the least (1.4%).

The study revealed that more than half of persons with SUDs in the identified rehabilitation

centres were single which could mean that their life’s priorities had been affected by their

addiction. Notably the number of divorced individuals stood at almost 12% to show that likely

marital relationships are impacted to the extent of divorce by addiction and or that divorce may

contribute to individuals resulting to substance abuse hence related disorders.

These findings agree with Jang, Schuler, Evans-Polce and Patrick (2018) longitudinal

study on whether marital status can be a partial mediator of the associations between young adult

substance use and subsequent Substance Use Disorders. The study found that the association

between heavy alcohol use of participants aged 19-20 years and subsequent SUDs was partially

mediated by the fact of being unmarried.

Another study by Reisdorfer, Büchele, Moretti Pires and Boing (2014) on the prevalence

of Substance Use Disorders in adult population from Brazil and its association with

demographic, socioeconomic, behavioral variables and health conditions had different findings.

The study found that majority (60.6%) of respondents were married or with a partner, followed

by 29.2% who were single and 10.1% who were divorced or widowed. However, the study

23
findings agreed that respondents who were not in a stable relationship (single, divorced or

widowed) were found to have higher prevalence of Substance Use Disorders compared to those

who were married.

Education Level

Table 4
Education Level of Persons in Recovery in Mombasa County
Frequency Percent
Valid Primary 28 40.6
Secondary 28 40.6
Graduate 9 13.0
Postgraduate 4 5.8
Total 69 100.0

Table 4 shows that majority (40.6%) of participants reached primary and secondary

education level respectively while those that attained postgraduate level were the least (5.8%).

This points to school dropout at low levels of education. It therefore indicates that majority of

the persons in recovery, have attained low level of education, had low understanding of the

effects of substances hence they tend to use substances more compared to those who have high

levels of education, particularly postgraduate studies. It also points to early initiation of

substance use therefore the resultant SUDs.

Nature of Referral

Table 5
Nature of Referral for Persons in Recovery in Mombasa County
24
 Frequency Percent
Valid Self-Referral 58 84.1
Family Initiated 7 10.1
Police/Court Initiated 2 2.9
Others 2 2.9
Total 69 100.0

Table 5 shows that majority (84.1%) of participants self-referred themselves to attend the

rehabilitation center while the least (2.9%) of participants got to rehabilitation centers as a result

of police/ court-initiated cases or other reasons respectively. The findings indicate that majority

of the persons in recovery in the treatment centers were self-referred which could be due to the

fact that they were tired of the adverse effects of drugs in their lives hence needed for treatment.

This may point also to substantially high levels of awareness on availability of treatment in the

County. A substantial percentage, 10.1%, treatment was also initiated by their family a likely

indicator of health concern occasioned by addiction to the family unit. Notably the legal referral

by corrective institutions like the police, being 2.9%, also is notable meaning that persons using

drugs found themselves in the wrong side of the law and were referred for treatment. Arguably

treatment does not need to be voluntary to be effective being that the factors to seek treatment

differ and the results vary for individual person in recovery.

This was corroborated by the focused group discussion questions that sought to find

method of referral the persons in recovery would have preferred. Respondents were asked which

their preferred mode of referral and majority was proposed self-referral. For instance, one

respondent said, ‘I came out of my own will because I was afraid my use of heroin was going to

kill me like my five friends’ (Persons in Recovery coded 005, Personal Communication, July

2019). The same was echoed almost verbatim by most of the Persons in Recovery coded 010,

022, 037, 049,053 amongst others. The study found that 10% of the Persons in Recovery that

were forced by the family members to the center decried this mode of referral. It was evident that
25
they blamed the significant others for not preparing them for what awaited them. For instance,

Persons in Recovery coded 015 said, ‘my mother hurt me to bring me in the rehab as if my life

affected her’ (Personal Communication, July 2019). It was almost the same perception for

everyone interviewed. One interviewee said, ‘I dislike my sister for taking me for a fool like I

have no control of my life. My family thinks am very bad, they take me like a child’ (Person in

recovery coded 47, Personal Communication, July 2019). This study proposes for prior

awareness to the persons using drugs before coming for treatment. This may trigger them to

appreciate the purpose of rehabilitation, break the resistance and enhance uptake of the strategies

employed to restore normalcy in their lives. Majority of the persons in recovery who preferred

self-referral may range high on intrinsic motivation such that they require to be empowered to

enhance their internal locus of control for better results in the journey of seeking sobriety.

A few persons in recovery accepted the compelled referral sighting that it helped them to

get treatment. Person in recovery coded 007 stated that ‘I was brought in by the police. At least

they have helped me to get help so that my life is better’ (Personal Communication, July 2019).

This resonates with the common knowledge amongst professionals that addiction at times is a

cry for help, which often is un-heard and those aging in abuse of drugs are vulnerable to the

effects thereof. This could be a client who is high on extrinsic motivation and would require lots

of support to make decisions to sustain recovery even after discharge from the center.

Years of Drug Use

Table 6
Years of Drug Use of Persons in Recovery in Mombasa County
Years of drug use of Persons in Recovery
Frequency Percent
Valid 1 -5 Years 12 17.4

6- 10 Years 20 29.0

26
 11-15 Years 12 17.4

Above 16 Years 25 36.2

Total 69 100.0

Table 6 shows that majority (36.2%) of participants had used drugs between above 16

years while those who have used drugs for 1-5 years and 11-15 years were the least (17.4%)

respectively. The study reveals that over 50% of the participants have used drugs for over 10

years, precisely 17.4% for 11-15 years and 36.3% for over 16 years. The other bulk, 29% have

used drugs for 6-10 years, which is a substantial period of life. This could be due to the early

initiation to drug use during early years of life which has resulted in adverse effects of addiction

making them to seek help in rehabilitation centres to help them recover.

These findings are agreed with Chan, Wing Lo, Tam, and Lee (2019) study which

adopted the perspective of the Self-Determination Theory to look at the psychological experience

of drug users and their decisions to take drugs or not. The study found that majority (N = 49,

49%) of participants had taken drugs for more than 10 years.

Family Caregivers Demographic Characteristics

Demographic characteristics of the family caregivers were analyzed in terms of

participant’s gender, age and religious affiliation.

Family Caregivers’ Gender

Table 7

Gender of family caregivers

Frequency Percent

Valid Male 7 21.2

27
 Female 26 78.8

Total 33 100.0

Table 7 shows majority (78.8%) of the caregivers were females while males were 21.2%.

This could be due to the very nature of the community which assume that the care of the people

with any kind of illness including those with SUDs is a role to be done by the female gender and

more so the mothers of the person in recovery. It points to a high family caregivers’ burden on

the female in the County.

These findings agree with Marcon, Rubira, Espinosa, Belasco and Barbosa (2014) and

Kaur, Mahajan, Deepti and Singh (2018). The studies, respectively found that majority (90.8%

and 81%) of family caregivers were predominantly women while men were 9.1% and 19%. and

quality of life and presence of stress in family caregivers of drug-addicted people.

Family Caregivers’ Age

Table 8

Age of Family Caregivers in Mombasa County

Frequency Percent

Valid 20-25 Years 7 21.2

25- 30 Years 3 9.1

30-35 Years 6 18.2

35-40 Years 12 36.4

Above 40 years 5 15.2

Total 33 100.0

Table 8 shows that majority (36.4%) of the family caregivers were aged between 35-40

years. The least age bracket of a family caregiver was 25-30 years that represent 9.1%. These
28
findings can be explained that majority of the family caregivers were of mature age as they may

have had more effects of the drug use in their family making them seek to help a member of the

family to recover from use.

Family Caregivers Burden in Mombasa County

Table 9

Family Caregivers Self-Assessment in Mombasa County

N Minimum Maximum Mean Std. Deviation

Family caregivers Stress 33 2.88 5.00 4.1326 .56763

Family caregivers Self

33 2.67 5.00 3.9192 .79944
Awareness

Family caregivers General

33 2.00 5.00 4.0061 .70620
Awareness

Table 9 shows that family caregivers stress was high (mean=4.1326, Sd= 0.56763). This

could imply that rehabilitation centers need to invest on addressing stressors among family

caregivers in order to improve on the quality of management of disorders among persons in

recovery. These findings agree with Kaur, Mahajan, Deepti and Singh (2018) study on the role of

burden in family caregivers of substance abusers at Swami Vivekananda Drug De-addiction

Centre, Govt. Medical College, Amritsar in India. The study found that the quality of life of the

family caregivers was compromised and stressed.

Similarly, Choudhary (2016) study to assess perceived burden among family caregivers

of client with substance dependence found that majority of participants expressed having feelings

29
of stress because of continuous threats of persons in recovery to commit suicide, and due to the

helplessness about their future.

Family caregiver’s self-awareness was above average at (mean= 3.9192, SD= 0.79944).

General awareness was also found to be high at (mean= 4.0061, SD= 0.70620). This implies that

the family caregivers were healthy in terms of awareness which could be harnessed by

rehabilitation centers to improve management of SUDs.

Management of Substance Use Disorders amongst Persons in Recovery

Table 10

Substance Use Disorders management for Persons in Recovery in Mombasa County

N Minimum Maximum Mean Std. Deviation

Life Skills Score 69 1.00 5.00 3.9363 .78175

Adherence to Treatment 69 1.00 5.00 3.2415 .81426

Uptake of Counseling 69 1.25 5.00 3.6232 .71823

Valid N (listwise) 68

Table 10 shows the life skills scored highly (mean of 3.9363) while adherence to

treatment regime scored lowest (mean of 3.2415). This means more emphasis at the

rehabilitation centers in Mombasa County is on building life skills of the addicts. Counseling is

also given weight in order to help the persons in recovery address the underlying relational

issues.

Relationship between Family caregivers’ Burden and Management of Substance Use

Disorders amongst Persons in Recovery in Mombasa County

30
Table 11

Relationship between Family caregivers’ Burden and Management of Substance Use Disorders
amongst Persons in Recovery in Mombasa County

Life Skills Adherence to Uptake of

Score Treatment Counseling
Family caregivers Stress Pearson Correlation -.299* .044 .061
Sig. (2-tailed) .037 .763 .676
N 49 49 49
Family caregivers Self Pearson Correlation -.166 -.083 -.091
Awareness Sig. (2-tailed) .254 .572 .535
N 49 49 49
Family caregivers Pearson Correlation .038 -.069 .046
General Awareness Sig. (2-tailed) .795 .640 .753
N 49 49 49

Table 33 shows the relationship between caregiver’s stress and management of SUDs

using Pearson correlation analysis. The results found a weak negative and insignificant

relationship between family caregivers stress and life skills (r=-0.299; p>0.01). The study found

a weak positive and insignificant relationship between care givers stress and adherence to

treatment (r=0.044; p> 0.01). A weak negative and significant relationship was found between

family caregivers’ stress and uptake of counseling (r=-0.061; p>0.01). These findings indicate

that family caregivers stress levels would not influence the management of SUDs.

31
 The results indicate a weak negative and insignificant relationship between Family

caregiver’s self-awareness and life skills (r=-0.166; p>0.01). The study found a weak negative

and insignificant relationship between family caregivers’ self-awareness and adherence to

treatment (r=0.083; p> 0.01). A weak negative and significant relationship was found between

family caregivers’ self-awareness and uptake of counseling (r=--0.91; p>0.01). These findings

indicate that caregiver’s self-awareness would not influence the management of SUDs.

The results found a weak negative and insignificant relationship between family

caregivers’ general awareness and life skills (r=-0.38; p>0.01). The study found a weak negative

and insignificant relationship between family caregivers’ general awareness and adherence to

treatment (r=-0.69; p> 0.01). A weak negative and significant relationship was found between

family caregivers’ general awareness and uptake of counseling (r=0.46; p>0.01). These findings

indicate that family caregivers’ general awareness would not influence the management of

SUDs. The findings here are surprising because it would be generally believed that the

caregiver’s burden would have significant influence on the management of SUDs but this is not

the case.

Conclusion of the Study

Notably the study found out that the family caregivers’ burden did not influence the

management of Substance Use Disorders amongst persons in recovery in Mombasa County.

Study Recommendations

The study makes the following recommendations based on its findings.

The study recommended the Government of Mombasa to enact a law to institutionalize

professional counseling services, in the sectors of education, corrective services and all
32
workplaces, to engender early diagnosis and treatment of Substance Use Disorders in the

County. This may enhance the uptake of life-skills and counseling by individuals and families.

The County may consider developing, increasing and or strengthening rehabilitation centres and

support systems in the community such as Alcoholic and Narcotic Anonymous (AA/NA), to

build capacity to manage Substance use in the County and sustain sobriety. In addition, the

County Government may allocate annual budgetary resources to fund Substance Use Disorders

management as a health component in Mombasa county. This can be used to run peer education

programs, train the sufficient professionals along the continuum of care (psychologists,

counselors, psychiatrist, social workers, spiritual leaders), run innovative technological publicity

campaigns and fund the cost of rehabilitation for the persons in recovery with Substance Use

Disorders in the County.

The study recommends that rehabilitation centers to help in management of Substance,

by strengthening the counseling programs offered in the centers. This may include ensuring

increased numbers of professional counselors, continued professional development to deal with

the dynamics of Substance Use Disorders among persons in recovery to engender management

of the same to alleviate the effects thereof.

Suggestions for Further Research

This study found a weak negative and insignificant relationship between Family caregivers’

burden and management of Substance Use Disorders, yet the significant other is involved in the

life of the persons in recovery. Future research may explore the reasons behind this and probably

use another population and or study method for this

33
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