Elsevier

Addictive Behaviors

Volume 89, February 2019, Pages 200-205
Addictive Behaviors

Testing the stress-strain-coping-support (SSCS) model among family members of an alcohol misusing relative: The mediating effect of burden and tolerant-inactive coping

https://doi.org/10.1016/j.addbeh.2018.10.010Get rights and content

Highlights

  • Family members experience chronic stress due to substance misusing relatives.

  • Three coping types identified in the model: engaged, tolerant and withdrawal coping.

  • The burden due to caretaking and tolerant coping may increase the feeling of hopelessness in family caretakers.

  • The relationship between perceived misuse and strain mediated by burden and tolerant coping.

Abstract

Background

Excessive alcohol use may harm not only the individual drinker, but also the lives of their family members. The stress-strain-coping-support (SSCS) model emphasizes that the stress experienced by family members could lead to the development of various physical and psychological symptoms.

Objectives

The aim of the current study is to examine the possible moderating and mediating role of coping on the relationship between stress and strain among family members seeking help due to a relative's alcohol misuse.

Methods

Data from 168 help-seeking affected family members were analyzed (mean age: 44.61 years; 87.5% were female). The cross-sectional study used a set of standard questionnaires measuring the perceived severity of the relative's alcohol-related problem, the family member's feelings of hopelessness, their coping styles, and the strain and burden of caring for the relative who is misusing alcohol. Path analyses were used to test the direct and indirect effects of the mediational model.

Results

Current findings provided support for the moderating effect of engaged coping. Moreover, tolerant-inactive coping style and burden on hopelessness have an addictive effect. The mediational model showed an adequate fit. The pathways between (1) the perceived alcohol-related problem – burden – hopelessness, (2) the perceived alcohol-related problem – tolerant coping – hopelessness, and (3) the perceived alcohol problem-related – burden –tolerant coping – hopelessness each showed significant indirect effects.

Conclusions

The findings support the suggestion of the SSCS-model on the mediating role of coping between stress and strain. Affected family members who perceive more severe alcohol-related problems could show increased rates of burden and tolerant-inactive coping style, which could separately or sequentially result in increased symptoms of hopelessness.

Introduction

Excessive alcohol consumption has a significant detrimental impact not only on the drinker but on close family members, friends and even strangers (Storvoll, Moan, & Lund, 2016). Consequently, family members exposed to harm as a result of a partner's or close relative's drinking reported lower rates of psychological well-being, higher distress, and even symptoms of depression or anxiety (Greenfield, Karriker-Jaffe, Kaplan, Kerr, & Wilsnack, 2015).

The stress-strain-coping-support (SSCS) model emphasizes that the substance misuse of a relative is a chronic stressor, thus putting strain on the family members and resulting in stress-related consequences and maladjustment (Orford, Velleman, Natera, Templeton, & Copello, 2013). The affected family members often experience burden due to caring for the relative, especially when the relative drinks high quantities of alcohol per session (Jiang, Callinan, Laslett, & Room, 2015). The SSCS model assumes that, as a result of a highly stressful family environment due to the drinking problem of a relative, the affected family members may report various negative effects on their physical and psychological health such as anxiety, hopelessness, depression, or fear. The SSCS model also proposes that family caregivers are actively able to reduce the negative impact of stress and strain by receiving social support and using coping strategies such as engaged, tolerant-inactive and withdrawal coping (Orford, Copello, Velleman, & Templeton, 2010). In the case of engaged coping, the family member tries to control and protect the family structure via assertive, supportive or emotional reactions. Tolerant-inactive coping contains elements of acceptance or support of the substance misuse and promotes self-sacrificing behavior on the part of the relative. The withdrawal coping strategy refers to techniques that encourage family members to focus on their own needs and to increase the distance between them and their alcohol-misusing relative (Orford, Velleman, Copello, Templeton, & Ibanga, 2010). Several cross-cultural studies have consistently reported that tolerant-inactive and engaged coping styles have shown the strongest association with negative family impact and harmful symptoms. Generally, withdrawal coping was not significantly related to any detrimental psychological or physical symptoms (e.g. Lee et al., 2011).

The aim of the present research is to test the moderating and mediating role of coping on the relationship between stress and strain. The SSCS model assumes that affected family members' coping attempts could enhance or attenuate the effect of stress on strain. A Mexican study documented the moderating effect of tolerant-inactive coping on the relationship between stress and strain among family members; those family members who reported higher levels of family conflict and tolerant-inactive coping experienced the highest levels of symptoms (Orford et al., 2001). However, data from later studies did not provide support for the moderating effect of coping, rather implied an additive model: higher levels of tolerant-inactive and engaged coping and stress predicted elevated rates of symptoms independently of each other (Orford et al., 2017). The purpose of the current study is to test the moderating effect of the three coping styles. Furthermore, we also hypothesized that burden and engaged or tolerant-inactive coping will additively increase the level of hopelessness.

As an alternative approach, it has been suggested that coping behaviors mediate the relationship between stress and strain. Thus, due to the characteristics of the stress experienced, family members might apply different coping strategies, which subsequently lead to physical and psychological symptoms (Arcidiacono et al., 2010). The current study set out to explore the possible mediating effect of coping in a model containing multiple elements of the SSCS model. The model consists of a combination of at least two sequential and two simultaneous mediator variables between the predictor and outcome variable. Within this framework, it is possible to explore the significant pathways between the components of the model (MacKinnon, Lockhart, Baraldi, & Gelfand, 2013). Based on previous findings (Arcidiacono et al., 2010), we hypothesize that tolerant-inactive coping will mediate the relationship between the severity of alcohol-related problems, burden and hopelessness. However it is important to note, that the present study did not assess the support component of the SSCS-model, therefore the analyses did not contain information related to the moderating or mediating effect of social support on the relationship between burden and hopelessness.

Section snippets

Participants and procedure

This cross-sectional study used a convenience sample of affected family members seeking help in relation to their relative's drinking problem. Two inclusion criteria were applied here: the affected family members must have been at least 18 years old, and they had to know a relative closely who drinks excessively. The present sample largely consisted of family members seeking some form of psychological help for themselves because of their relatives' alcohol misuse. The study had two main

Descriptive statistics

The zero-order correlations between the variables, means, confidence intervals (95%) of the means, standard deviation of the continuous variables and Cronbach's alpha estimates of the scales for internal consistencies are presented in Supplementary Table II.

Engaged coping was positively associated with age, severity of the alcohol-related problem, hopelessness, burden and tolerant-inactive coping. Withdrawal coping positively correlated with gender, length of the alcohol-related problem,

Discussion

The current study tested the moderating and mediating role of coping behavior on the association between burden and hopelessness among family members seeking help as a result of their relatives' alcohol misuse. Our results indicate that the alcohol misuse of a close relative could result in an overall negative impact on the lives of their family members, as a high level of burden is linked to more severe hopelessness. Therefore, the findings support the SSCS model, which assumes a relationship

Conflict of interest

Authors declare that they have no conflicts of interest.

References (23)

  • J. Orford et al.

    Addiction in the family is a major but neglected contributor to the global burden of adult ill-health

    Social Science & Medicine

    (2013)
  • C. Arcidiacono et al.

    Italian families living with relatives with alcohol or drugs problems

    Drugs: Education, Prevention and Policy

    (2010)
  • A.T. Beck et al.

    The measurement of pessimism: The Hopelessness Scale

    Journal of Consulting and Clinical Psychology

    (1974)
  • M. Bédard et al.

    The Zarit Burden interview: A new short version and screening version

    The Gerontologist

    (2001)
  • J. Cohen et al.

    Applied multiple regression/correlation analysis for the behavioral sciences

    (2003)
  • T.K. Greenfield et al.

    Trends in alcohol's harms to others (AHTO) and co-occurrence of family-related AHTO: The four US National Alcohol Surveys, 2000–2015

    Substance Abuse: Research and Treatment

    (2015)
  • H. Jiang et al.

    Correlates of caring for the drinkers and others among those harmed by another's drinking: Caring for others

    Drug and Alcohol Review

    (2015)
  • R.G. Laforge et al.

    Comparison of five stage methods for alcohol abuse among college students

  • K.M.T. Lee et al.

    Stress-coping morbidity among family members of addiction patients in Singapore: Stress-coping among relatives of the addicted

    Drug and Alcohol Review

    (2011)
  • D.P. MacKinnon et al.

    Evaluating treatment mediators and moderators

  • L.K. Muthén et al.

    Mplus: Statistical analysis with latent variables. User's guide

    (2017)
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