Quality of Life Among Family Members of Individuals In Recovery from Substance Use Challenges: Stigma and Family Resilience As Associated Factors

Background and Purpose: Family members are significantly affected by a loved one’s substance use disorder (SUD) across physical, psychological, social, and financial domains. When a loved one enters recovery, family members also undergo their own recovery process, and their quality of life is shaped by the trajectory of that journey. Family resilience, a family’s capacity to adapt to stress and overcome adversity, enables members to remain positive and hopeful. As families also require external resources to strengthen their ability throughout this process, stigma may act as a barrier to help-seeking, particularly when family members experience stigma by association related to their loved one’s SUD. This study examines how quality of life, stigma by association, and family resilience relate within the family recovery process to better understand family members’ needs.

Methods: The sample consisted of 131 adult family members of individuals in recovery from SUD, recruited from six family recovery documentary screenings across the United States between May and September 2025. The data used for the present analysis were drawn from the pre-film survey. Quality of life (QoL) was assessed using the EUROHIS-QOL 8-item index, a 5-point Likert scale that captures four domains: psychological, physical, social, and environmental (1=Very poor to 5=Very good). Stigma by association (SAS) was measured using a nine-item, 5-point Likert scale (1 = Never to 5 = Always) adapted from Tessler & Gamach (1993). Family resilience was measured using the Family Resilience Scale (Tang et al., 2024), a six-item, 4-point Likert scale (1 = Strongly disagree to 4 = Strongly agree). We conducted a three-step hierarchical linear regression analysis to examine the unique contribution of key predictors on QoL using SPSS 31.0. Model 1 included demographic variables (age, gender, race, socioeconomic status (SES), and loved one’s mental health diagnosis). Model 2 added stigma by association (SAS), and Model 3 further included family resilience (FR).

Results: Model 1 explained 22.3% of the variance in QoL (R²= .223, F (5, 125)=7.16, p<.001), with SES as the only significant factor (B=1.19, t=5.43, p<.001). After entering SAS in Model 2, the total variance explained was significantly increased (R²= .276, F (6, 124)=7.88, p<.001), with SES (B=1.16, t=5.45, p<.001) and SAS (B=-.15, t=-3.03, p=.003) as significant factors of QoL. After adding FR to Model 3, the total explained variance further increased to 30.6% (R²= .306, F (7, 123)=7.74, p<.001). SES (B=1.08, t=5.10, p<.001), SAS (B=-.13, t=-2.69, p=.003), and FR (B=.23, t=2.29, p=.024) were all significantly associated with QoL.

Conclusion and Implications: Overall, the findings indicate that individual, familial, and systemic factors all contribute to family members’ quality of life while supporting their loved ones during the recovery journey. SES and family resilience have emerged as positive factors associated with the quality of life, while stigma by association showed a negative association. These findings specifically highlight the needs of psychoeducation about SUD to reduce stigma and family-centered interventions focused on communication skills and stress coping strategies that enhance families’ ability to successfully navigate challenges brought by the recovery journey.