Thirty-one AFMs participated in the interviews, conducted between January and December 2015. Participants comprised parents (n = 14), partners (n = 13) and siblings (n = 4) from the state of Victoria, in Australia. Most participants were female (81%) and all partners were female. Their mean age was 47 years (ranging from 26 to 68 years), and almost 70% experienced family aggression and/or violence. The mean duration of time participants had been in the support-giving role was 8.05 years (ranging from 1 to 20 years). The main form of PSU in their families was alcohol (n = 14, 45%), a combination of alcohol and drugs (n = 14, 45%), and drugs alone (n = 3, 10%). Principal drugs of concern were methamphetamine (especially crystal methamphetamine) (n = 5, 16%), cannabis (n = 4, 13%), and heroin (n = 4, 13%). Polydrug use was highlighted as a concern by several participants (n = 4, 13%).
Two main themes, and related sub-themes, were abstracted from the data: aggression and violence as stressful and emotionally exhausting, and struggling to prevent and cope with aggression and violence.
Aggression and violence as stressful and emotionally exhausting
In this theme, the experience of being an AFM of an individual with PSU who was aggressive and/or violent was upsetting, stressful and emotionally exhausting. Participants felt overwhelmed, confused, anxious and frustrated as they faced the daily challenge of supporting a person whose mood, attitude and behaviour were unpredictable and frequently adversarial. The person’s apparent lack of awareness of the impact of this behaviour on the family exacerbated participants’ sense of frustration and futility. Despite this significant challenge, they affirmed their commitment to persevere supporting the individual.
It’s a war zone, because our aim is to get him through this somehow, some way. (Interviewee 30, mother)
He's a much loved member of the family and I think if we had not supported him emotionally, then he might well have been dead or been in a very bad place. (Interviewee 9, father)
The worst part for me was not knowing that person anymore and knowing he’d done things that the brother that I once knew would never have done. (Interviewee 5, brother)
AFMs felt anxious and physically and emotionally exhausted because of the person’s aggression and/or violence. For some, their anxiety had an adverse effect on their ability to cope with routine activities.
Everything I did was affected, because I was so full of anxiety, I just couldn’t cope with everyday tasks. (Interviewee 5, brother)
I try to be supportive, but it really affects my mental stability and physical exhaustion. (Interviewee 26, female partner)
The experience of aggression and/or violence was particularly challenging, as AFMs sought to maintain a reasonable relationship with the person. Two sub-themes were abstracted from the data, reflecting their experience of this challenging behaviour as stressful and emotionally exhausting: violence as variable, changeable and unpredictable, and aggression and/or violence altering social interactions and family dynamics.
Aggression and/ violence as variable, changeable and unpredictable
In this sub-theme, AFMs regarded their aggression and/or violence experience as a major concern. The behaviour was long-term, variable, changeable over time and unpredictable.
He starts swearing a lot when he talks. He’s very quick to anger, unreasonable and can be explosive. (Interviewee 20, female partner)
Very angry, can be violent, screams at you … grumpy is not a good enough word. (Interviewee 4, mother)
He was quite violent towards me, my wife, the house. (Interviewee 21, father)
Participants distinguished between aggression and violence. Verbal and emotional aggression was characterised by shouting, insults, criticism and/or harassment. The behaviour usually constituted arguments, telling lies and manipulation, whereby the person tried to force the AFM to accept their view, or force them to comply with their wishes. Participants also reported instances of being ignored or blamed unreasonably for things by the person.
We argue a lot; I guess that's around lying and manipulation and things like that. (Interviewee 10, female partner)
They lie and then they blame you … it's awful and very hard. (Interviewee 14, female partner)
Emotional aggression extended to limiting AFMs’ freedom of movement, reducing their lifestyle because of the person’s PSU-affected misperception of things. It also had adverse consequences for family structures, in particular, for future grand-parenting roles.
I’m having to change my lifestyle, because of his misconception of everything. (Interviewee 19, father)
Knowing her father’s an alcoholic; well, I know we won’t be grandparents who look after the child. (Interviewee 1, female partner)
Participants experienced physical violence over time, such as pushing, punching and biting. They reported threats of physical violence using weapons; fortunately, threats did not materialise into actual use of weapons.
There has been push and shove and he has hit the wall. (Interviewee 30, mother)
Violent, smashing things, just really awful to be around, threaten a lot of things. (Interviewee 5, sister)
While I was pregnant, my sister threatened to stab me in the stomach and kill my baby. (Interviewee 27, sister)
Several AFMs commented about experiences of the person deliberately, and often seriously, causing property damage. This form of violent behaviour ranged from punching holes in walls, breaking household items, to crashing cars.
I've got holes in my house (walls) everywhere. (Interviewee 27, sister)
He's already wrecked three cars of mine. I've got a brand new one now, so I've hidden the keys. (Interviewee 18, mother)
Sometimes, aggression and/or violent episodes were unpredictable and triggered by something seemingly innocuous. In some cases, participants reported that they could not identify a trigger for the behaviour, other than substance use.
It can be really wonderful one minute and then he can just change like that. (Interviewee 18, mother)
He hits a certain point and goes downhill and becomes irritable … it might be about something at work, it might be about something I've said or done, as small or trivial or whatever as it is. (Interviewee 26, female partner)
Aggression and/or violence altering social interactions and family dynamics
In this sub-theme, the person’s aggression and/or violence had a direct adverse effect on social interactions with AFMs’ friends and family dynamics. Because of the unpredictable and undesirable nature of the behaviour, it contributed to their social isolation from friends, reducing their access to this potential form of support.
I don't feel comfortable inviting people over to my house, because I don't know what he's going to be like. (Interviewee 10, female partner)
Aggression and/or violence also impacted unfavourably on family dynamics. At times, children assumed a caretaker or protector role consciously or sub-consciously, and frequently played different roles before, during and after an episode of this behaviour. Their roles changed from being ‘passive’ witnesses, to assuming active roles to protect themselves or other AFMs from it, to subduing the frequency and severity of outbursts, of the behaviour.
I think my husband doesn't take us on as much because [my son] will step in and protect us now physically. (Interviewee 11, female partner)
While these role changes provided new support to AFMs, they could create additional tensions between family members, and with the young person who had to adapt to the change in his/her family status. Even though mother participants appreciated the support they received from their growing children, this came at a cost to some adult children or siblings missing out on having ‘normal’ age-appropriate parent or sibling relationships. It could also lead to role reversal situations, whereby a son or daughter would become the main support person to the parent with PSU.
I feel sad, the profound effect it's had on the children these years. (Interviewee 11, female partner)
You don’t have a normal mother-daughter relationship … I’ve been the mother and she’s been the daughter. (Interviewee 15, daughter)
Struggling to prevent and cope with aggression and/or violence
In response to aggression and/or violence being stressful and emotionally exhausting, and largely through trial and error, AFMs identified several direct measures they used to try to prevent and cope in these circumstances; however, most continued to struggle to deal with the behaviour. They also highlighted additional indirect strategies, which if implemented, would enhance the existing strategies used to cope with aggression and/or violence.
Strategies used to prevent and cope with aggression and/or violence
Most participants developed several strategies to try to prevent and cope with the behaviour. Four main prevention- and coping-oriented strategies were developed.
Maintaining constant vigilance to avoid triggering aggression and/or violence
Participants identified the need to maintain constant vigilance to recognise early signs of aggression and/or violence and avoid triggering an episode. This entailed treading carefully, being cautious about words or actions that might trigger an episode of the behaviour, a fragile situation they equated to ‘walking on eggshells’. Constant vigilance left AFMs resigned to their circumstances, as they tried to cope with the person’s behaviour, but without much hope of change.
That’s the hardest … always thinking about what I have to say or how I have to say something. (Interviewee 1, female partner)
I've come to realise that the signals and the triggers that are coming and I'll avoid them. I don’t want to have to live this way, having to watch what I say in case it ends up in an argument …. I tread carefully and avoid an argument, because a word can trigger an argument. (Interviewee 19, father)
When he’s drinking, I am walking on eggshells because he gets so angry so fast. (Interviewee 20, female partner)
Curtailing social activities
Some participants commented that aggression and/or violence was associated with engagement in social activities with the person with PSU. This situation made it difficult for AFMs to plan ahead and enjoy social activities, as they could not assume the person would behave appropriately. As a consequence, intimate partners in particular sometimes resorted to curtailing social activities to reduce the risk of the behaviour being triggered. While curtailing social activities had some benefits, it also reinforced AFMs’ isolation and limited their access to informal support.
There's always a fight and drama and we can't just have a weekend somewhere without a memory of him fighting. (Interviewee 26, female partner)
Disengaging from the person when PSU occurs
Once they realised the person was taking substances, some participants adopted a disengagement coping strategy to protect themselves from aggression and/or violence and the associated stress and anxiety. Disengagement ranged from distancing oneself physically from the person, not engaging the person in conversation, and in extreme circumstances, leaving the family home.
These days I do a lot of disengaging, because rather than stick around when he's very drunk, I will just go off and do something else. (Interviewee 3, female partner)
I've learnt not to talk to him and also encouraged the kids not to talk to him when he's drinking. (Interviewee 24, female partner)
I had to move him out of the house for a year when he started threatening my wife, which was really hard for all of us here. (Interviewee 9, father)
Seeking help from law enforcement and judicial agencies
When the person’s aggressive and violent behaviour exceeded AFMs’ routine coping measures, some sought help from law enforcement and legal agencies. In practice, this entailed seeking direct help from the police and/or obtaining a Family Violence Intervention Order  from a Magistrates’ Court to protect their family. Female AFMs were more likely to call the police, while fathers reported they took this initiative on some occasions, seeking to protect their partners or other children from the person’s behaviour. However, if the Family Order resulted in the person with PSU being excluded from the family home to prevent the behaviour, the exclusion process also caused distress and guilt for parents in particular.
He was really violent, really aggressive. I had to call the police a few times. (Interviewee 5, sister)
Yeah, there have been situations where we have to call police and have her restrained. (Interviewee 23, sister)
There were a couple of intervention orders put out over the time, and criminal charges through violence. (Interviewee 21, father)
Only one female intimate partner reported currently having an active Intervention Order against her male partner. This permitted him to live with her, conditional on him not being aggressive and violent towards her. The police, who had witnessed the person punching the woman, instigated the Order.
Additional indirect strategies to enhance prevention and coping with aggression and violence
Participants identified two additional indirect strategies, which, if adopted, would enhance their existing direct measures to prevent and cope with aggression and violence.
Increasing access to specialist support services
Even though most participants were recruited through an alcohol and drug helpline service in this study — primarily because of a crisis situation in their families — only a few indicated that they had sought other forms of help about supporting the person’s PSU. However, none gave specific examples of formal help seeking to enhance the existing strategies they used to prevent and cope with the behaviour. Other participants used the Internet to find out how to cope in this situation, but were concerned about, what they perceived as, inconsistent and confusing information. In essence, this highlighted the need for information to be evidence-based, relevant and easily accessible to AFMs.
My boss is a psychologist and she has a daughter who went through all of this. She gives me some books and research things and stuff. So I read a lot of that, but then I also read online. But it's such conflicting information as well, which I find quite tricky. (Interviewee 27, sister)
To be honest, I looked for some kind of online support service and I just couldn’t find one that I felt was relevant to my situation. (Interviewee 10, female partner)
Primarily because of lack of engagement with alcohol and drug services, participants had not received education on aggression and violence coping strategies from professionals. A lack of evidence-based and specialist-provided knowledge on how to cope effectively in this situation was highlighted. They were also unsure how to access evidence-based information or specialist alcohol and drug treatment services that might help them prevent and cope with the behaviour.
I've never really been aware of what support or if anyone could help us with all the things that we're going through with it. (Interviewee 11, female partner)
Learning some strategies to deal with the behaviours. Not to get involved with the arguments. To walk away when the alcoholic’s ranting and raving. (Interviewee 15, daughter)
I need somebody to sit down and spend the time needed with both of us. (Interviewee 26, female partner)
Sharing aggression and violence experiences with other families
Even though most participants were recruited through a state-wide helpline, they were often unaware of the existence of PSU support groups for families. Despite this lack of awareness, they felt they would benefit from sharing their experience of aggression and violence with other AFMs in similar circumstances, to enable them to obtain mutual support and develop appropriate and effective measures to prevent and cope with this behaviour.
Some kind of group for supporting family members would be nice … maybe people have other things that they can suggest and stuff like that. (Interviewee 3, female partner)
I was hoping there was a meeting with other people going through the same thing I’d been going through, just to hear their stories and how other people on average respond to situations like this. (Interviewee 16, female partner)