The dynamics of stress experiences of students with relatives with addiction problems: a longitudinal qualitative study

<b>Background:</b> Family members of relatives with addiction (often referred to as Affected Family Members [AFMs]) experience potentially traumatic events, including psychological violence, physical violence, sexual violence, death, or accidents of relatives due to addiction.<b>Objective:</b> This study explores the development of stress in young adult AFMs over several years and why their stress increases or decreases.<b>Method:</b> A three-year longitudinal qualitative study. Four rounds of in-depth, semi-structured individual interviews were conducted. Twenty-four students drew a stress graph. They scored their stress levels from the first interview in 2019/2020 to the last two years later on a 10-point scale and explained why their stress increased or decreased. Interpretative Phenomenological Analysis was applied.<b>Results:</b> We distinguished four patterns of stress: stress remained stable (high or low; <i>n</i> = 3), stress increased over time (<i>n</i> = 5), stress decreased over time (<i>n</i> = 10), and stress had erratic highs and lows (<i>n</i> = 6). For most participants, stress related to their relatives' addiction problems was high and highly dynamic. We found factors associated with the direct stress of life with relatives with addiction problems, such as recovery, relapse, aggression, incidents, and accidents. We also found indirect effects, such as trust, intimacy issues, stressors related to education, work, coping strategies, and support. AFMs' stress persisted often over the long term, even after a relative died or contact was broken.<b>Conclusions:</b> Identifying reasons for stress increase or decrease might help AFMs, healthcare professionals, and educational professionals who want to support AFMs in managing their stress.