Furthering understanding of the scope and variation of alcohol and drug harms to others: Using qualitative discussion groups to inform survey development.

Aims: Alcohol and drug use can have negative effects on family and friends of someone who uses these substances. To give voice to people with lived experience, we sought in-depth qualitative data from people who experienced such harms to others (HTO) to better understand the scope and variation of alcohol and drug HTO to inform future survey research in the United States (US). Design: Five discussion groups with people from varied racial and ethnic groups. Setting: Five US cities with different sociodemographic profiles and alcohol and drug use patterns. Participants: Family members of individuals with substance use disorders (SUD). Measures: Thematic analysis was used to identify themes and highlight harms that have not been well-represented in US general population surveys to date. Findings: Discussion group participants described how alcohol and drug HTO can have long-lasting effects, raising questions about strategies to query and document harms occurring over the lifecourse. The emotional stress and burden of a close relationship with someone with SUD was a recurrent theme. Participants also noted how systems and policies may inadvertently intensify HTO through negative interactions with legal or social service entities. They also identified helpful community resources (including Al-Anon) for people impacted by someone else's substance use. Conclusions: Qualitative data from people with relevant lived experience identified new areas for alcohol and other drug HTO research, including duration of harms across the lifespan, emotional and psychological impacts, and systems-level harms. Findings informed a redesign of our national survey instrument to efficiently capture the broad range of HTO.