The stress-strain-coping-support model shares a view very different from earlier models such as the co-dependency model and the family pathology model where family members are not viewed as victims of the substance use as are the substance users but as individuals fulfilling their own needs by choosing to live with substance users. Family members were also viewed as showing a resistance to change and were reluctant to get involved with treatment (McDonald, 1958).
However many such observations were difficult to prove and thus a matter of interpretation, very little convincing research had been carried out addressing questions such as how much a prospective wife might have known about her husbands substance use at the time of marriage, to what extent it fitted social conventions and how at that time she may have viewed her partners future substance use (Orford et al, 2005). Such literature may now be of historical interest however its importance lays in the idea that family members contribute to the problem, an idea which has not gone away.
Attention has turned to substance use amongst adolescents and young adults in the last few decades have shown focus on parents and family deficiency and pathology. Reviews of literature have taken the form of a catalogue of failures on the part of the parents having contributed to a young persons substance misuse (Jurich et al, 1985; Kooyman, 1993), suggesting that the stress-strain-coping-support model was much needed in providing literature which takes a positive family perspective.
However the concept of co-dependency has been criticised by many mainly for the idea being all embracing and difficult to pin down (Orford et al, 2005; Harper and Capdevila, 1990). The concept of co-dependency has been described as being easily applied to anyone as so many characteristics have been listed as relevant and that it lacks empirical support and fails to recognise the stress-related nature of family members as does the stress-strain-coping-support model (Orford et al, 2005; Miller, 1994).
Krestan and Bepko (1991) maintained that co-dependency makes a disorder out of behaviour which is normal for women, arguing that since substance problems are more common among men, calling the women who live with such men helps to restore the balance. Feminist critiques of the co-dependency model and the pathologizing of women have argued that calling a woman ‘sick’ who is in fact coping with and surviving in an abusive relationship with a substance user is another reason for blaming the victim, an argument which shares the perspective of the stress-strain-coping support model which view the family as victims.
They maintain that at worst the concept encourages a posture where the woman is viewed as being ill, in contrast to a perspective which emphasises how families cope in sick situations (Collins, 1993), as does the stress-strain-coping-support model. Collins (1993) maintains that the concept has provided women with a label for the pain and confusion they suffer.
The movement of co-dependency and self help literature pathologies behaviours associated with female qualities (Anderson, 1994) and as a result women flock to 12 step groups and label themselves diseased instead of oppressed, thus the concept is also recognised as a personality disorder under the Diagnostic and Statistical Manual of mental disorders, reinforcing the idea that more positive models such as the stress-strain-coping-support model are needed to provide interventions to help family members and not label them as having mental disorders.
It is apparent that the stress-strain-coping-support model has adopted a positive stance towards family members in contrast to earlier models; however it remains questionable as to how effective the model has been in helping family members and recognising their needs and belief of family members truly universal considering the pitfalls of cross-cultural research. As a result of the initiative of the research first taken by English researchers, much of the analysis had been carried out in England, including all data gained from Australia.
Carrying out research across cultures it is important for researchers to recognise that they are in receipt of privileged information and that it may be interpreted in an over theoretical framework therefore having the power of misinterpreting information and to draw conclusions based on assumptions and not on factual data. This is also a view shared by Kim et al (2000) who suggested that psychological theories and concepts assumed to be universal are in reality more often embedded in Euro-American values There remain other issues which need to be taken into consideration when conducting research across cultures.
Mexican culture puts more emphasis on religion; therefore praying is seen as a coping method and receiving support from a priest are far more reported in Mexico than in England and Australia. The aborigine culture is far more focused around family obligations than are the other two countries, whereas the Mexican culture is far more collective than individualistic therefore getting support is more common than in England and aboriginal Australia where cultures are more private and thus only receive support from close relatives and not the wider community.
The Mexican sample also suggested that the population being studied was more crowded therefore it is harder to hide the substance problem of family members, this also can be seen to have an impact on how family members cope and the support they receive (Velleman and Templeton, 2003). Other limitations of the model can be directed towards the method of data collection used. Martin & Stenner (2004) point out that more opportunistic sampling techniques and the small numbers of individuals participating in qualitative work mean that findings cannot be generalised or portrayed as representative of substance users in general.
Breadth and scale are seen to be sacrificed in order to obtain the deeper understanding of people’s lives. One of the biggest weaknesses in relation to the stress-strain-coping-support model is the potential for bias and misrepresentation, the integrity and honesty of family members can be doubted along with their ability to recall events and emotions considering the level of stress they are placed under according to the stress- strain-coping-support model (Neale, Allen, and Coombes, 2005).
There is also the danger that the respondent may report those beliefs that he/she feel the interviewer wants to hear. Finally there are practical implications involving data collection, processing and coding which all tend to be labour intensive. However in relation to the stress-strain-coping-support model qualitative methods can be the best way to explore the lived experiences of family members and appreciate why substance use occurs and how it is understood in different contexts among different social groups as done with the stress-strain-coping-support model (Rhodes, 1995).
In support of the stress-strain-coping-support model the study is unique in several respects. It gives family members their own voice; it is unique in its socio-cultural approach and broad extent. The model has adopted a position which is different from others in major ways, for example rejecting the idea that family members are co-dependent. The models biggest strengths lie in its ability to view family members as ordinary people caught up in unpleasant circumstances.
It focuses on the present circumstances and rather than being dysfunctional it sees family member’s ways of responding as being a positive action. It focuses on the family members needs and not that of the substance user as it accepts that better support and intervention for family members can have a knock on effect on the substance user also. Most importantly it provides a model for intervention to help family members overcome their problems instead of placing the blame on them (Velleman and Templeton, 2003).
The 5 step intervention is a positive development towards helping family members. The vast majority of people in the UK are registered with a primary healthcare doctor and the majority visit their doctor at least once a year suggesting that services are more readily available when family members require. It is also apparent that families of substance users visit their doctor more often (Vellemnan & Templeton, 2003) therefore increasing their accessibility to interventions delivered in primary care. The models strengths also lie within its primary care intervention.
The strengths of the intervention are that it has been found by Orford et al, (2007) to benefit family members in many ways. Family members found an increase in independence or distance from the relatives substance use. Family members have shown to be more assertive towards relatives in comparison to previous interactions. Family members have also become less emotional in their interactions with relatives as well as seeing links between the substance problem and their own mental or physical health.
Most importantly the strength of the intervention had been found in the value of talking to a primary health care professional or studying a self-help manual. The weaknesses of the intervention were that their was little or nothing that family members did not already know and that it was not directive enough, for example the self-help manual did not tell them sufficiently enough what to do. Family members also reported that it was not powerful enough to produce change in the way they coped and in some cases primary healthcare professionals lacked the expertise or were unsympathetic towards family members.
However the intervention and the stress-strain-coping-support model have helped to put focus on family members who had previously been ignored by services strongly orientated to help the substance user and not the relative despite overwhelming evidence of family members being neglected.
References
Anderson, C. S. (1994). A Critical Analysis of the Concept of Codependency. Social work, 39 (6), pp. 677-685.