The literature review focuses on the typical risk factors for relapse with reference to environmental, inter-and intra-personal and physical risk factors. The focus then shifts to the unique characteristics of young African adults. Risk factors for relapse Campos (2009:773) explains high-risk situations as those situations in which there is an increased desire to use, where the drug of choice may be readily available, or where social pressure to use drugs is increased. Other high-risk situations include particular environments, cognitive patterns, mood states or social situations. As derived from Marlatt's Relapse Prevention Model (Marlatt & Witkiewitz, 2005:1), for a relapse to be prevented, high-risk situations, or risk factors, that precipitate a relapse need to be identified. Environmental risk factors Environmental risk factors that can increase the risk of relapse include increased availability and accessibility of drugs, poverty and unemployment, and encountering people, places and paraphernalia associated with earlier drug use. Bain (2004:2) suggests that the prevalence of drug use by young people escalates as the variety of drugs available increases. Environmental cues play an important role in the process of relapse (Bain, 2004:29). Simply returning to the place where the drug(s) was taken can trigger a relapse even months after abstinence commenced (Bain, 2004:29). Cami and Farrè (2003:975) add that environmental stimuli associated with drug use itself can produce withdrawal and craving in the absence of the drug. For Hyman and Malenka (2001:697) environmental cues elevate the risk of a relapse when addicts encounter people, places or paraphernalia associated with earlier drug use. Poverty and unemployment are also perceived as reasons for drug abuse (Ramlagan, Peltzer & Matseke, 2010:44). Employment opportunities are limited in South Africa and lack of education is also a contributing factor when employment is sought (National

Background Globally, the rise in the number of people living with a substance use disorder (SUD) carries a multitude of individual and social health implications for carers and their families, often impacting negatively on their quality of life. Considered from a harm reduction approach, SUD is understood as a chronic protracted, complex health and social condition. From the extant literature, there is no evidence of the harm reduction approach being applied to address the needs of carers/family members who carry the burden of SUD care. This study preliminarily evaluated the Care4Carers Programme. It is a purposively designed set of brief interventions to improve the coping self-efficacy of carers of people with SUD (PwSUD carers) by equipping them to think about ways to exert control over their motivation, behaviours and social environment. Methods A pre-experimental, one group pretest–posttest design was implemented with 15 purposively selected participants in the Gauteng Province of South Africa. The intervention was conducted by the lead researcher, a registered social worker. Eight brief intervention sessions were held, over 5–6 weeks at research sites where the participants were identified. The coping self-efficacy scale was completed before and directly after exposure to the programme. Results were analysed using paired t-tests. Results There were statistically significant (p < .05) improvements in carers’ coping self-efficacy, both overall and in respect of each of its constituent components: problem-focused coping, emotion-focused coping and social support strategies. Conclusions The Care4Carers Programme improved the coping self-efficacy of carers of people living with SUDs. The application of this programmatic harm reduction intervention to support PwSUD carers should be tested on a larger scale across South Africa.

Substance Use Disorder (SUD) is a persistent and global public health and social problem. This scoping review explores and describes the impact that Substance Use Disorders (SUDs) have on families and carers. It draws on 36 research articles published between January 2007 and August 2021. The review findings are presented according to three themes, namely (1) the impact of SUDs on families/ carers, (2) the burden on carers, and (3) coping responses to living with a person with SUD. The evidence indicates that SUDs in a family affects almost all domains of family members' and carers' lives, suggesting the need to develop targeted harm reduction interventions that could reduce vulnerability and help restore the bio-psychosocial well-being of family members and carers.

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