Social networks of substance abusers
Veerle Soyez, Ph.D.
Department of Orthopedagogics
Ghent University
1. Introduction
In the framework of clients’ assessment and treatment planning it is also highly important to consider some contextual factors, i.e. clients’ background, social relationships and social network.
In this lesson we will look what can be understood under ‘social network’ and ‘social support’; the specific issues of substance abusers’ networks will be discussed more in detail. Finally we will shortly cover the assessment of social networks / network support.
2. Social networks: a conceptual framework
Social networks
The interest in the impact of social relations on (psychological) functioning is not new (see, for instance: Bowlby, 1969). Initially, the attention of social network researchers was mainly focused on the extended network. However, in the 1970s mental health practitioners grew aware of the potential for support from the ‘personal’ or ‘core’ social networks (Gordon & Zrull, 1991), i.e. those people with whom individuals have direct personal links or those people, who through significant or important ties, provide the individual with support (Sarason, Sarason, & Pierce, 1990). Speck and Attneave (1973), for example, defined an individual’s social network as “the sum total of human relationships that have a lasting significance on his or her life” (p. 11). Plenty of other definitions have been formulated and a difference can be found between definitions focusing on the functional aspects of social networks (e.g. “a person’s social network can be defined as that group of significant others which is supposed to form a natural support system” (Sadoun, 1989, in Baars, 1996)), and those - cfr. Speck and Attneave - with a more structural character. Social networks indeed have different components, being the structure (size, homogeneity of membership, degree and strength, density or interconnectivity, and dispersion), the quality (duration, frequency of contact, intensity, directionality) and the function or ‘transactional content’ (type of help provided by each of the network members). This functional component is closely connected to the social support concept as formulated by Caplan (1974), which will be reviewed in one of the following paragraphs.
In general, networks are patterns of connections between people, that can be supportive, intrusive, binding, freeing, or neutral (Fraser & Hawkins, 1984), but in fact there is still a lack of consensus about their definition.
Social support
Over the last few decades, the interest in social network relations found evidence in theory and research on social support. This research originated in the medical field and has grown substantially in the last 25 years. There is now impressive evidence that social support plays an important role in, for example, mental and physical health, personal adaptability and coping (e.g. Beattie et al., 1993; Cohen & Wills, 1985; House, Landis, & Umberson, 1988; Reis & Collins, 2000; Sarason, Pierce, & Sarason, 1994; Sarason & Sarason, 1985b; Schwarzer & Leppin, 1991). However, as for dropout/retention and social networks, the operational definitions for social support are quite divergent (Antonucci, 1985; Shumaker & Brownell, 1984; Shumaker & Hill, 1991) and, consequently, a broad range of measures for social support have been used in research (Cohen, 1988). In line with the distinction in social network definitions, most of the distinctive measures for social support can be captured in the dichotomy ‘structure’ – ‘function’ (Cohen & Syme, 1985). The structural dimension then refers to either the existence, types and extent of supportive resources available or the quantity of social ties. The functional dimension refers to the actual or perceived availability of several support functions or types, such as emotional support (affection), instrumental support (material aid) or feelings of belonging.
One of the first definitions for social support comes from Caplan (1974), who suggests that social support systems consist of “continuing social aggregates that provide individuals with opportunities for feedback about themselves and for validations of their expectations of others” (p.4). In later definitions, other/additional forms of support are added. According to Goehl et al., for example, social support includes “all the mechanisms of interpersonal relations which protect people from the harmful effects of stress and enhance overall subjective well-being” (Goehl, Nunes, Quitkin, & Hilton, 1993 , p.252). In spite of the diversity of approaches in defining social support, some clear commonalities have emerged (Wilcox & Vernberg, 1985). It is generally believed, for example, that social support is a complex and multi-dimensional construct.
Two main hypotheses about the working mechanism of social support have been proposed. The ‘buffering hypothesis’ states that support protects a person, or operates as a buffer against harmful effects and stressful events. The ‘main effect hypothesis’ attributes a direct favourable influence to social support, irrespective of possible stress (Ames & Roizsch, 2000).
There is a tendency among researchers to equate social network involvement in treatment with social support. As a result, possible negative influences of social networks have been neglected for a long time (Barrera, Chassin, & Rogosch, 1993). Only some authors refer to the potential costs of social relationships (Pagel, Erdly, & Becker, 1983; Riley & Eckenrode, 1986; Rook, 1984); however, these are extremely important, as Rook (1984) concluded that negative social interactions are more influential for general well-being than positive ones. These negative interactions have in some cases been referred to as ‘negative social support’; however, this term is rather confusing. It may therefore be better to opt for the term ‘social network’ instead, as this term carries no presumption about the supportive nature of social relations (Antonucci, 1985). Furthermore, it is important to keep in mind that ‘support’ is only one function of social networks. When the focus is exclusively on ‘supportive’ social networks, the ‘support’ element becomes a constant rather than a variable. In other words, this element then becomes a new priory category, which bounds the network (Hall & Wellman, 1985).
In this context the term social network may sometimes be preferred to social support and it can then be defined as “all the people who have intimate relations with an individual, who may affect the quality of life or who may offer support or prove a deleterious influence” (definition based on Gordon & Zrull (1991, p.144)).
Apart from the definition of networks and support it is, in clinical contexts, important to consider the specific influence of persons in the social network. In this context, we will focus on different influences in relation to specific moments: (1) aetiological influences, (2) influences during substance abuse (3) influences during treatment and (4) influences following treatment will be discussed.
The following text offers a broad, though not complete overview. Additional interesting overviews are available in literature; see, for example: Mitchell, Spooner, Copeland et al. (2001)
<insert following link here>
http://www.nhmrc.gov.au/publications/pdf/ds8.pdf
3. The influence of social networks on the development of substance abuse and related problems
Numerous empirical studies and theoretical models have attempted to explain the complex factors that lead individuals to use / misuse drugs. Different multidimensional models have been developed. The majority of those factors can be allocated to either a psycho-social or a biological / genetic component.
One important multidimensional model that gives the social element and the influence of social networks a central place is the “social stress model” (Rhodes & Jason, 1990), which integrates knowledge of numerous psychological theories and models. It emphasizes individual and family system variables (Bandura, 1986; Jessor and Jessor, 1977; Kandel, 1980) and social networks, with attention to social influences of family and peers (Hansen, 1988). Furthermore, the model incorporates recent research on competence and coping.
The close link between the aetiology of substance misuse / abuse, and family and social network, had an large impact on prevention concepts, both in research <insert following link here> http://165.112.78.61/pdf/monographs/monograph177/012-041_Merikangas.pdf as in practice. <insert following link here>
http://165.112.78.61/pdf/monographs/download56.html
4. Social networks of substance abusers
The social networks of substance abusers are usually smaller (Fraser & Hawkins, 1984), and clearly different from those of the ‘normal’ population (Uchtenhagen & Zimmer-Höfler, 1987).
Their family network is typically characterised by poor relations (Kaufman, 1981; Stanton, Todd, & Associates, 1982). There is a structure in which a mother is enmeshed with her addicted son; the father is often excluded from this dyad, and he is usually quite aggressive. The relationship between mothers and substance abusing daughters tends to be hostile, competitive and chaotic (Kaufman, 1981; Madanes, Dukes, & Harbin, 1980). Despite these negative characteristics, a majority of substance abusers do maintain close ties to their family of origin (Noone & Reddig, 1976) and tend to be more involved with their families than non-drug users (Stanton et al., 1982). The more elaborate networks of substance abusers contain more substance abusers (friends as well as family members) and persons with a psychiatric dysfunction compared to normal populations. The networks are characterised by interpersonal conflict, poor communication, and poor interpersonal boundaries (Stanton et al., 1982). Only few substance abusers have a stable partner relationship (Uchtenhagen & Zimmer-Höfler, 1987) the dysfunctional characteristics of relationships experienced during childhood being often re-created in their own partnerships (Harbin & Maziar, 1975). Substance-abusing women are more likely to be divorced, or separated, or have unhappy relationships with male partners than non-using women (Schilit & Gomberg, 1987). In general, substance abusers see their partner more often as a source of emotional stability compared to the non-using population (Uchtenhagen & Zimmer-Höfler, 1987).
Within the total group of substance abusers, the networks of opioid abusers appear significantly less conventional than those of non-opioid abusers (Fraser & Hawkins, 1984). Many studies also report gender differences: substance-abusing women appear to function on a poorer level and are believed to receive less social support than their male counterparts (O'Dell, Turner, & Weaver, 1998).
Social support among substance abusers is often conceptualised as being based on models formulated in non-drug using populations (Cosden & Cortez-Ison, 1999; Coughey, Feighan, Chener, & Klein, 1998; Oyabu & Garland, 1987). Research aimed at understanding the impact and importance of social support in substance abusing populations started in the 1980’s (De Civita, Dobkin, & Robertson, 2000; Gordon & Zrull, 1991), but – as was reported for research on social support in general - has been plagued by a general lack of consistent definition and assessment of social support (Oyabu & Garland, 1987; Schilling, 1987; Strauss & Falkin, 2001b). Often, one single dimension of social support is measured: some researchers (Strug & Hyman, 1981) have viewed social support in terms of its ‘structural’ aspects, while others (Beattie et al., 1993; Dobkin, De Civita, Paraherakis, & Gill, 2002; Goehl et al., 1993; Huselid et al., 1991) have focused on the ‘functional’ dimension. Still other researchers (Brown, Vik, Patterson, Grant, & Schuckit, 1995; Darke, Swift, Hall, & Ross, 1994; Gordon & Zrull, 1991; Humphreys, Moos, & Cohen, 1997; Pivnick, Jacobson, Eric, Doll, & Drucker, 1994; Silverman et al., 1996; Westermeyer & Neider, 1988) have devoted attention to the ‘quality’ component of support (e.g. support from non-substance abusers or the prevalence of non-substance abusers relative to substance abusers in the social network). This latter focus can also be defined differently as ‘abstinence-specific structural support’, when subdividing structural and functional social support into ‘general’ and ‘abstinence-specific’ subtypes. In the structural support domain, general support indicates that there is a social ‘connectedness’ or ‘embeddedness’ in a social network. In the functional support domain, general functional support refers to assistance from others (actual or perceived) that does not specifically address substance use (e.g. giving advice). Abstinence-specific functional support consists of behaviours that focus on abstinence or drug use more directly, such as encouraging someone to remain in treatment or (as a negative example) offering drugs (Wasserman, Stewart, & Delucchi, 2001). Consequently, the negative side of social networks is probably even more important in substance-abusing populations compared to non-clinical groups. Substance-using network members may act as catalysts that elicit craving and withdrawal, thereby triggering relapse (Goehl et al., 1993).
The focus on different social support dimensions in substance abusing populations has produced divergent results (De Civita et al., 2000; Havassy, Hall, & Wasserman, 1991) as each dimension of social support is relatively independent of one another in relation to its impact on treatment outcomes (Beattie & Longabaugh, 1997). However, functional social support has been reported as being a better predictor than structural social support (Beattie & Longabaugh, 1997), while abstinence-specific support was found to be more effective than general support (Wasserman et al., 2001). Actual support has seldom been measured (Antonucci, 1985) in substance abusing populations, as well as in other research on social support.
5. Social networks and social support during substance abuse treatment
Given the importance of social support for mental health, researchers have examined two general strategies to foster it: augmenting or mobilizing support from existing social ties and "grafting" new ties onto a person's social network. In substance abuse treatment the first strategy is often used to get the addict in treatment.
Already in 1966, Finlay found the "enduring role network" of an alcoholic to be important to the alcoholic's getting treatment. Later research has also stressed the importance of social network support in engaging substance abusers into treatment (Garrett et al., 1998; Landau et al., 2000; Liepman, Nirenberg, & Begin, 1989; Sisson & Azrin, 1986). Eldred & Washington (1976) found that specifically the encouragement of the spouse or opposite-sex partner is important.
However, social network factors can also negatively influence treatment entrance. A study by Laurence Linn (1967), for example, on the motivation of mental patients to seek help, revealed transitory role relationships as influential, while enduring networks (represented primarily by family) were less so. More recently, several authors have illustrated that many substance-abusing mothers in need of treatment do not have the resources to secure adequate childcare options for their children or do not want to be separated from them (e.g. Finkelstein, 1993; Swift & Copeland, 1996; Volpicelli, Markman, Monterosso, Filling, & O'Brien, 2000). The possibility of losing custody holds them back from entering treatment. Addicted male partners of substance abusing women mostly think treatment is helpful for their partners, but the actual support they offer to get their partners into treatment and keep them there is usually passive and inconsistent. Furthermore, they do not see the necessity of entering treatment themselves; their continued use of drugs can thus reinforce maladaptive behaviour in their partners (Laudet, Magura, Furst, & Kumar, 1999).