The substance is often needed to attain a sense of well being (Flagler, Hughes, and Kovalesky, 1997). Goodman (2007) commented that addiction refers to the situation whereby an individual’s life is overtaken by the need to obtain and consume substances to achieve a sense of well being. It is the addictive nature of substance misuse which affects family members. Children affected by parental substance misuse now account for 350,000 in the UK according to the Advisory Council on the Misuse of Drugs as mentioned by Barnard (2007).
Research undertaken so far is largely from a small team of UK researchers (Copello and Orford (2002), Orford et al. (1998), Orford et al. (2001), and Velleman and Templeton (2003)), who maintained that stress experienced by family members can lead to high levels of physical and psychological morbidity of parents (Barnard, 2007). This paper will present a number of different models on the subject of family members but will focus on the stress-strain-coping-support model which is recommended as a basis in improving professional responses to family members.
Research was focused on both quantitative and qualitative data as it was better to see them as complimentary rather than adversarial approaches as noted by Neale, Allen and Coombes (2005). The Family Pathology Model Substance misuse was first conceptualized and theorized during the early 1940’s until the 1960’s as a result from domestic problems. Family members were described in the theory in psychopathology perspectives, and as individuals who sustain their needs by living with a person having substance problem.
Price (1945) started this analysis, but Whalen and Thelma (1953) developed this theory by analyzing how the wives of alcoholics identify with four different personalities. The four different personalities are suffering, controlling, wavering, and punitive. The view that wives actively contributed to their husband’s substance problem was supported because many woman married their husbands in the knowledge that they had a substance problem (Rae & Forbes, 1966). In McDonald (1958) study, results showed that wives showed a resistance to change and were reluctant to get involved in treatment.
Seljamo et al (2006) suggest that exposure of children to substances would increase their risk of use. The Family Systems Perspective The family systems model proposed by Steinglass (1982) and later used by Vetere (1998), asserts that to understand the behaviour of an individual, it is important to consider the group or system of which the individual is a part, the relationships within the group and what the individual contributes towards maintaining the system. Therefore a number of family processes and factors which influence the nature of family behaviour are examined.
In the context of problem substance use a systems view is taken, analysis is not based on the stress caused by the behaviour of one family member but in terms of whole family patterns and processes. Steinglass (1982) concluded that family members over a long period of time accommodate the substance use of a relative and that the effects of the latter’s substance use on family interactions can be positive and adaptive in a way that is frequently, though not consciously appreciated by family members.
This suggests that the use of substances may be seen as dysfunctional for the family but can also be seen as functional in other ways. Stanton & Todd (1992) similarly maintained that the substance use by young adults had served to maintain the family system, concluding that the removal of the ’symptom’ would provoke a family crisis. However the model achieved very marginal status in the treatment of substance problems as it required intensive supervision and highly specialised training with engagement from several members of the same family which is hard to achieve.
Blechmen (1982) suggested that the development of substance problems in the young were a result of the qualities of parenting and the characteristics of the families from which the young people came from. The Co-Dependency Model The co-dependency model another school of thought which assumed that family members are ’part of the problem’ and are therefore themselves suffering from a condition-co-dependency. The origins of the model are more popular in the USA where it has a large number of co-dependency self-help groups (Orford et al. , 2005).
Attempts have been made to export services based on the model to countries such as the UK and Australia. As Futterman (1953) suggested, alcoholics are subconsciously encouraged by their wives because of their own persona needs. The pioneers of the stress-strain-coping-support model carried out a study on family members affected by substance misusing relatives in three socio-cultural groups. 107 families took part in the City of Mexico, 100 families from the South-West of England, and 48 interviews were carried out in Aboriginal Australia.
All family members were concerned about a relative’s substance problem and took part in lengthy, in-depth semi structured interviews. The stress-strain-coping-support model conceived that certain circumstances people face in their every day lives result in long-standing, stressful circumstances or conditions of long standing chronic adversity, which included chronic personal illness or living with a close relative with such illness (Orford et al. , 2005). Such problems are construed as long-standing stressful situations because they are often unabated over a period of years and during this time are intensified.
This model views family members as being at risk of strain; this is as a result of living with a relative with a substance problem. The strain can take the form of symptoms such as physical and/or mental ill health. One of the dilemmas faced involve the complex task of how to respond to the relative with the substance problem, ways of responding are referred to as coping which includes methods of responding used by the family member which he/she believe to be effective and may yield effective, or ineffective means (Orford et al., 2005).
It is also an assumption of the model that family members have the capability to influence their relatives; hence they are not totally powerless. The model assumes that some methods of coping are found to be more effective than others for family members. At this point the word ‘effective’ is used in two senses. First, some ways of responding may be more productive in reducing the effects of stress on family members and therefore reducing the strain family members themselves experience.
Second, some methods used by family members to manage the problem maybe effective whereas some maybe more counter-productive in having the desired effect on the relatives substance problem. The final assumption of the model is that social support is a powerful factor in mitigating the effects of stress on health. Support can come from many directions as exemplified in Kroll (2006) study which concluded that when parental substance misuse is an issue, grandparents in particular have been identified as a significant protective factor for children. Other sources include more professional services or self help (Orford et al. , 2005).