the luck of âbidirectiona1ityâin social support models. Data from a study of heroin addicted women is used to illustrate how refinements in the coping aspect of the ...
Journal of Social Issues, Vol. 38, No. 2, 1982, pp. I 17-I37
Social Support and Coping: Applications for the Study of Female Drug Abuse M. Belinda Tucker University of California, Los Angeles
This paper addresses two issues: (a) the utility of applying the social support-stress-coping paradigm to the study of substance abuse, and (b) refinements needed in conceptualization of the coping aspect of the model. A brief review of the more recent theoretical and methodological treatments of social support is followed by an examination of two limitations of current perspectives. The first limitation considered is the failure of previous work to address the behavioral components of the hypothesized connection between social support and stress reduction, and the second is the luck of “bidirectiona1ity”in social support models. Data from a study of heroin addicted women is used to illustrate how refinements in the coping aspect of the model, in particular, may help clarify the role of social support in stress reduction. Findings included the indication that, f o r heroin addicted women, the absence of social support is associated with the use of non-social, potentially dysfunctional coping strategies. A similar pattern did not exist f o r men. The role of social relations in drug taking has been widely recognized in scientific writings and in numerous popular and personal accounts of drug experiences. This concern has been restricted, however, to cursory examinations of the extent to which friends and family encourage or
This work was supported by grants from the National Institute on Drug Abuse (numbers H81 DA 01496 and H81 DA 01939) and an Institute of American Cultures award through the UCLA Center for Afro-American Studies. The author is appreciative of comments on earlier drafts of this article by the other issue editors, the journal editor and advisors, and Toni Antonucci. Correspondence regarding this article may be addressed to Dr. M. Belinda Tucker, Center for Afro-American Studies, University of California, 3 105 Campbell Hall, LOS Angeles, CA 90024. 117 0022 4537/82/0600-01 l7%3.00/1 a 1 The Society for the Psychological Study of Social Issues
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discourage the initiation and continuation of use (e.g., Goldstein, 1976; Kandel, Kessler, & Margulies, 1978; Lettieri, Sayers, & Pearson, 1980; Mellinger, Somers, & Manheimer, 1976) and more recently, the supportive functions of intimates in the election and course of treatment (Farkas, 1976; Gerstein, Judd, & Rovner, 1979). Research on the process of social involvement in drug taking or cessation (i.e., the behavioral specifics of social influence) is virtually absent. Existing work is limited even further by the nearly exclusive focus on male drug abuse, with female study samples either nonexistent or too small for meaningful analysis. With respect to methodology, the work has proceeded in mainly a descriptive and correlational vein for the purpose of demonstrating associations between a given social milieu and present or later drug taking behavior. The field has not generally benefited from the more sophisticated directions being pursued by researchers who specialize in the study of social support, stress, and/or coping. This deficiency is rather surprising considering the widely held belief that one primary motivation for drug use is the desire to reduce stress. This paper addresses two issues: (a) the utility of applying the social support-stress-coping paradigm to the study of substance abuse, and (b) refinements needed in the conceptualization of the coping aspect of the model. Results from a study of heroin addicted women will be used to illustrate how such refinements may help clarify the role of social support in stress reduction. The discussion begins with a review of the more recent theoretical and methodological treatments of social support. THE SOCIAL SUPPORT PARADIGM While the term “social support” has found popular usage in academic as well as lay circles, definitions are still quite varied and imply a wide range of characteristics and functions. Models have focused variously on information and material exchange, cognitions, and expression of affect among other features, and have been built upon quite diverse disciplinary perspectives. The differences have been noted and discussed by some (R. Caplan, 1979; House, 1980; Pinneau, 1976), but no real movement toward consensus is apparent. Despite these inconsistencies, the notion of social support enjoys one widely shared functional element. That is, most writers and researchers begin with the assumption that relationships with others can be beneficial, resulting, ultimately, in a greater resilience to stress-induced psychological and physical disorder. This congruence is perhaps most evident from the terminology used to describe the field of study--the impact of social relations has been assumed a priori to be “supportive.”
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There exists quite a few in-depth reviews of the literature on social support (R. Caplan, 1979; Cassel, 1976; Cobb, 1976; Gore, 1978; House, 1980; Kahn & Antonucci, 1980; Pinneau, 1976.) Rather than repeating these substantial efforts, I will simply note the predominant directions related to this area of study, stressing their particular relevance to the problem of substance abuse. Associational Aspects of Social Support A number of researchers have been concerned with the direct effects of social relations on the physical and psychological state of the individual. Marital status, social disorganization, acculturation and intimacy, among other variables, have been shown to be associated with various indicators of distress, including cardio-vascular disease, mental health, and death (Cassel, 1976; Gurin, Veroff, & Feld, 1960; Lowenthal & Haven, 1968; Moriyama, Krueger, & Stamler, 1971; Srole, Langner, Michael, Opler, & Rennie, 1962). Typically, individuals lacking in critical areas of support show greater impairment than those with the relevant social ties. Such work has been criticized mainly for its failure to determine causality. Does an inadequate support system leave an individual more vulnerable to undesirable states or are persons who are considered to be mentally or physically “sub par” simply rejected as partners or objects of interaction by “normal” others? Findings from at least two studies designed to address this question directly appear to suggest that the relations between social ties and impairment are independent of earlier health status, SES, and health practices (Berkman & Symes, 1979; Korbrin & Hendershot, 1977). In a related vein, more clinically oriented scientists have explored associations between individual well-being and the absence of a relationship, as represented by loneliness, isolation, and loss (Fischer & Phillips, in press; Peplau, Russell, & Heim, 1979; Weeks, Michela, Peplau, & Bragg, 1980; Wenz, 1977). While the empirical efforts and results in this area parallel in many ways the associational work being done on social support, the lines of inquiry seem virtually independent and writings in one area seldom contain reference to the other. A more collaborative approach could help clarify some of the major conceptual issues confronting the study of social support. For example, researchers concerned with the absence of a relationship distinguish between the states of being “alone” and feeling “lonely.” The methods used to study this distinction (e.g., Fischer & Phillips, in press) could be usefully applied to the examination of objective versus subjective social support (e.g., R. Caplan, 1979). The findings from these associational studies suggest that the level of social support experienced by substance abusers may be of some
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significance for treatment and prevention, when drug use is indicative of or is causing distress. An earlier examination of a subsample of the data used in the present investigation had indicated that heroin addicted women have significantly less social support on a number of dimensions and feel lonelier than socioeconomically similar nonaddicted women (Tucker, 1979). The more recent findings from the associational line of research would suggest, then, that an insufficient relationship structure may be a causal factor in our sample’s abuse of drugs. The Therapeutic Function of Social Support
With impetus mainly from the community mental health movement, research has focused on the role of social support in the alleviation of mental distress. The literature on one hand is devoted to the analysis of mutual support groups, such as Weight Watchers and Alcoholics Anonymous, in which members help each other overcome debilitating conditions or crises (Caplan & Killilea, 1976; G. Caplan, 1974). The other line of inquiry concerns helping behavior as an indicator of social support. This model centers on the extent to which an individual’s support group or social network facilitates problem solving activities (Gurin et al., 1960; Kulka, Note 1; Warren & Clifford, Note 2; Warren, Note 3). Compared to other work, research from this perspective has come closest to examining the process of supportive interactions. The approach is mainly crisis oriented, however, and can obscure critical interactions that are not tied to a specific event or problem state, but contribute to the individual’s total, more general supportive social structure. When the help-seeking paradigm was used with a subsample of the respondents who participated in the present study, patterns of support sought by heroin addicted women as well as men differed substantially from patterns observed for nonaddicted women (Tucker, 1979). For example, addicts were more likely than the comparison women to seek no help for interpersonal difficulties and turned to friends rather than relatives for financial worries. More intensive investigation of such issues could result in a better understanding of the social maintenance of the drug abusing lifestyle and the kinds of interventions required to counteract it. Social Support and Stress Reduction Most of the investigations involving social support have been concerned with the buffering or mediational properties of the construct. Under conditions of job stress, unemployment, economic crisis, loss, bereavement, illness, psychological distress, and a host of other undesirable
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circumstances, researchers have tested for psychological and physical differences between individuals having, versus those lacking, crucial social ties (e.g., R . Caplan, 1979; Cobb, 1976; Gore, 1978; House, 1980; Lowenthal & Haven, 1968; Miller & Ingham, 1976; Pattison, Llamas, & Hurd, 1979; Pinneau, 1976). While at present empirical evidence of the stress buffering effect of social support must be considered equivocal at best, the intuitive logic of the model continues to propel an expansion of research on this particular question. Although socially facilitated stress reduction may be the basic concern of much of the work in this area, even when findings support the phenomenon varied interpretations result. For example, a study by Gore (1978) of the physical and mental consequences of job loss is presented as evidence for a deleterious effect of non-support rather than for the beneficial effects of significant others. Theoretical development in the area of social support has been chiefly the result of work on the stress reduction model (Antonovsky, 1974; R . Caplan, 1979; Dean & Lin, 1977; House, 1980). As such, although particular features and emphases may vary, there exists essentially only one basic model of the role of social support in everyday life. As indicated in Figure 1 , social support is presumed to have possible direct effects on the occurrence of a stressor, the strain felt by the individual, and the person’s mental and physical well-being. Support also can mzdiate (see dotted lines) between stressor and strain and between strain and individual outcome, thereby moderating the effects of one on the other. House (1980) has been particularly influential in the elaboration of the distinctions between the “direct” and “buffer” effects of social support. It should be emphasized that the extent to which any one aspect of this model is elaborated does differ by theorists. For example, the support structure itself is much more clearly delineated by Kahn and Antonucci (1980). Likewise, stress and strain, as conceived in terms of the personenvironment fit paradigm, receives a much fuller treatment by R . Caplan (1979).
Bgical
in Fig. 1. Social support-stress paradigm
, -Outcome - ..,sical
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One conceptual development that goes beyond the confines of the “stressof’ to “outcome” continum is that presented by Kahn and Antonucci (1980). They conceive of social support as a dynamic phenomenon (or set of phenomena) that is in continual flux over the course of one’s lifetime. This is a critical break from the other, seemingly static concepts and has significant implications for measurement. Considering the elegance of many of the social support theories, the lack of research designs that truly test these notions cannot come as a surprise. Nevertheless, the notions incorporated by these theories seem particularly relevant to the study of substance abuse. Since stress can serve as both an impetus to and as a consequence of drug use, the determination of the precise role of supportive relations in the process has both therapeutic and preventative implications.
Social Support Model Refinements: Coping and Bidirectionality Previous work in this field is characterized by two limitations: (a) the failure to conceptualize adequately the role of coping in the social supportstress-coping paradigm, and @) the failure to appreciate fully the existence of bidirectionality in the model. The specifics of these two deficiencies are discussed below.
Coping While nearly all writers allude to coping mechanisms in their discussions of the stress reduction functions of social support, neither their theories nor their methods address the behavioral components of that hypothesized sequence. In one rare attempt to control for both coping style and social support, Andrews, Tennant, Hewson, and Valliant (1978) examined the effects of those two variables and of life events stress on psychological impairment. Importantly, however, the specifically social dimensions of coping behavior (i.e., those representative of social support) were not addressed. To the extent that coping behaviors represent stress reduction techniques, research to examine the buffering effect of social support must observe relevant coping strategies and mechanisms. Research to date has not fulfilled this requirement; hence, the most critical link has not been established. We do not know how social support mediates or buffers life stress. There is an extensive literature on coping processes. But, alas, the same lack of cross-fertilization evident with regard to the lonelinessholation area is also apparent here. Nevertheless, there are some important recent advances in coping research that are worth reporting here.
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Coping theory has long been primarily in the domain of clinical psychology and psychiatry, therefore tending to be centered more on maladaptive processes and intrapsychic interpretation than on how the average person handles problems common to daily life. Lazarus (Note 4) and Pearlin and Schooler (1978), however, have developed models that describe the process of coping by “normal” individuals, engaged in everyday pursuits. Pearlin and Schooler dwelled specifically on marriage, parenting, household economics, and occupation. They studied the particular coping mechanisms used by individuals, the extent to which the behaviors successfully reduced perceived strain, and apparent background constraints on the ability to use specific mechanisms. They found, for example, that selfreliance was more effective in the reduction of stress due to marital problems and parenting problems than was advice seeking. On the other hand, occupational difficulties seemed to be resistant to alleviation by coping of any sort. They further found that the efficacy of any particular coping strategy was independent of the intensity of the problem. Perhaps most provocative among the Pearlin and Schooler findings was the indication that women, lower income groups, and the less educated were significantly less likely to use coping strategies with demonstrated efficacy and more likely to use less effective strategies than were men, and those better off financially and educationally. For example, women were more likely than men to use “selective ignoring” (a strategy that tended to exacerbate stress) to cope with marital and parenting problems. Likewise, those with greater wealth and education were more likely than those less well off to use the strategies of positive comparisons (i.e., viewing their problems as less or no worse than those of others) and optimistic faith, for all categories of difficulties. As the authors point out, however, such strategies were more available for use by the advantaged, since the disadvantaged had more tenacious problems and fewer resources with which to address them. It is interesting to note that neither Pearlin and Schooler (1978) nor Lazarus (Note 4) concentrate in a significant way on the utility of social supports in their formulations. Pearlin and Schooler draw distinctions between social resources, psychological resources, and specific coping responses as dimensions of the coping process (the notion of social resources appears to be synonymous with our concept of social support). But the research described focused only on measures of psychological resources and coping responses, and only one coping response, “selfreliance vs. advice seeking,” was indicative in any way of the role of social relations in stress reduction. Lazarus (Note 4) also distinguishes between intrapsychic and interpersonal coping strategies, but likewise places no special emphasis on the latter. It is apparent, then, that while social support researchers have generally failed to conceptualize and measure coping as the critical link between social support and well-being, coping theorists have
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failed to develop models that specify adequately the interpersonal components in coping behavior. Further examination of the Pearlin and Schooler results in terms of their relevance to the social support-stress-coping paradigm suggests two things. First, the use of a more elaborate coping dimension in social support research would allow a clearer determination of how social support functions to alleviate stress. And second, it seems apparent that the individual experiencing the stress often determines whether or not the support structure is activated. That is, the decision to use self-reliance versus adviceseeking, for example, is partially independent of whether or not supportive relationships exist for the individual. This suggests that social support models that focus merely on quantity or quality of support structure may overlook the factor that activates the system. It is this latter point on which the issue of bidirectionality is focused. Bidirectionality
The prevailing conception of social support, observed across the associational, therapeutic and mediational studies, is that of a structure that impacts upon the individual, primarily during periods of crisis. Underlying the model is the tacit assumption that “when the time comes” the resources available to the individual will mobilize automatically to that individual’s benefit. In reality, however (and as observed through the coping research), the activation of available support is often a function of both individual coping preferences and the situation (e.g., problem characteristics, availability of other non-social resources). Furthermore, characteristics of the support structure itself may make activation less than desirable. For example, activation implies incurring the costs, including expectations of reciprocity, associated with obtaining help from someone else. Also, as many researchers are presently noting, the support to be obtained may actually be negative in terms of the individual’s overall best interests (R. Caplan, 1979; Kahn & Antonucci, 1980). Support, for example, that encourages dependency may be welcome short term relief, but undesirable over the long haul. The equivocal nature of the mediational work may be a consequence of the failure to account for factors such as these. Bidirectionality, however, is not limited to the focal individual’s role in the activation of the system. It is also evident in the fact that the outcome variables that typify this research (i.e., psychological and physical states) can also be stressors in their own right. While many writers acknowledge this point, few attempt to control for such effects. This is particularly the case for emotional distress. While the ultimate source of the distress (e.g., a broken love relationship) may be viewed as the primary stressor, the resultant
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depression or anxiety must also be addressed as a separate stressful entity. The last point is particularly relevant to the issue of substance abuse. For example, the fact that female drug addicts are more depressed than non-addicted women, or even addicted men, has been consistently demonstrated (Colten, 1979; Cuskey, Berger, & Densen-Gerber, 1977). While drug use may be the cause of the onset and maintenance of the depressed state, any given bout of depression is not likely to be addressed as a consequence of drug abuse. In fact, the user may take more drugs to counteract the current depressed state. A final concern with direction of effect is that the stressor as well as the psychological or physical outcome will also influence the support structure. If, for instance, the stressor is actually the loss of a significant other, the roles of the remaining support system members are likely to change accordingly. Similarly, the willingness of a supporter to become involved with an individual experiencing strain is to a large extent a function of the latter’s present and expected mental and physical state. In view of the coping and bidirectionality issues discussed above, the configuration of the basic social support-stress-coping model is revised as indicated in Figure 2. The figure demonstrates the centrality of the coping response and the areas in which a focus on the bidirectionality of the system are needed.
FEMALE DRUG ABUSE SOME EVIDENCE FOR THE UTILITY OF THE SOCIAL SUPPORT-STRESS-COPING PARADIGM The social support-stress-coping paradigm appears to be an especially useful approach to the study of female substance abuse. Women are believed by many to be more dependent on external or social supports than are men (Chodorow, 1974). Popular stereotypes of the special interpersonal sensitivity of women certainly supports this conception. Women are much
Coping
Stressful Events/&> Conditions
Individual Strain
(
Psychological & Physical Outcome
Fig. 2. Revised social support-stress-coping paradigm.
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more influenced by intimates (usually male) in the initiation, continuation, and cessation of drug use than are men (Gerstein et al., 1979; Suffet & Brotman, 1976). At the same time, coping theorists and drug abuse researchers recognize that under certain conditions, many individuals in our society will use substances to cope with stress (Marlatt, 1976; Pearlin & Radabaugh, 1976). Drug abusing women are subjected to (or perceive themselves as subjected to) more stressful situations than are other relevant groups. In recent studies, for example, heroin addicted women report more problems, especially those of a medical nature, than do either addicted men or socioeconomically similar non-addicted women (Tucker, 1979; Andersen, Note 5 ) . The social support-stress-coping model would imply that addicted women, under greater strain, would have more reason to abuse substances, and would have a greater need for social resources than either non-addicted women or addicted men. The research to be presented here, while not originally designed to do so, provides a partial test of the model by examining: 1. the extent to which the availability of social relationships is related to the use of social coping mechanisms; 2. the extent to which the unavailability of social relationships is related to the reported use of non-social and potentially dysfunctional coping strategies (including substance use); 3. the patterns of relations between coping strategies and support availability as differentiated by gender. The focus on type of coping mechanism preferred, as related to support availability, is viewed as an indirect (and admittedly limited) indication of the degree of bias involved in the use of any measure of social support alone when studying support effects. This test then only addresses one aspect of the paradigm--the inter-relation between social support and coping style. The analysis is also directed toward examination of possible gender differences in the pattern of interrelationships. Inasmuch as drug abuse treatment and prevention are still fashioned largely after models developed for males, the determination of distinctive gender based patterns in the operation of the social support-stress-coping paradigm is critical. While the general literature would suggest that women, and therefore their coping preferences, are more influenced by the social environment, the Pearlin and Schooler (1978) results demonstrate a female preference for an ineffective, non-social coping behavior (i.e., selective ignoring). The present analyses may also help to clarify this apparent discrepancy. Background and Methods This research was conducted in conjunction with a much larger project on women’s drug addiction and treatment funded by the National Institute on Drug Abuse. It consisted of an examination of selected psycho-social
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and demographic aspects of the lives of substance-dependent women. Data were collected in 1975-1976 through persona1 interviews with 170 women and 202 men entering the currently-admitting publicly-funded heroin addiction treatment programs in Miami, Detroit, and Los Angeles. Mean ages of study participants were, 25.8 and 27.5 years for females and males, respectively. Ethnic distributions were 56% Black, 35% White, and 9% other (e.g., Asian, Latin) for women and 55% Black, 33% White, and 12% other for men. All respondents were interviewed by study staff upon entry to treatment. Although all entering clients were requested to participate in the study, individuals were free to refuse without jeopardizing their entry status. Interviews lasted approximately 2- 1 /2 hours, and all participants were remunerated at the rate of $4.50 per hour upon completion. Questionnaires were used to obtain information on family and personal background, psychological states, attitudes, personal relationships, parenting, drug use, and demographic characteristics. Results of three sets of measures (listed in Table 1) were analyzed for the present Table 1. Social Support and Coping Questionnaire Items
A. Social Sumort .. 1. Think of the people (including relatives) that you feel are really good friends- that is, people you feel free to talk with about personal things-would you say that you have many, a few, or no friends like that? 2. Do you feel that you have as many good friends as you want or would you like to have more? 3. How many people (including relatives) in your neighborhood do you think of as your friends? Only count the people that do not live in your home. Do you think of none, a few, many, or nearly everyone as your friends? 4. Most of the time, are you able to get people (other than those in the treatment program) to do little important things for you-things like giving you a ride when youneed one, giving you medicine or food when you’re sick, or going someplace with you that you don’t want to go alone? (yes or no) 5 . Is there one main person in your life that you share a deep and meaningful relationship with-someone that you might be in love with? (yes or no) 6 . Compared to most other couples you know, how well would you say that the two of you get along? Do you get along very well, fairly well, or not well at all? 7 Do you have a very close woman/male friend-someone that you think of as your best friend? (yes or no) B. Coping When you really get (upset or angry/depressed or feel down), what do you do about it? Do you . . . (yes or no) a. lose temper and yell (angry)/go to bed (depressed) b. talk over things with your mother or some other female relative? c. talk over things with your father or some other male relative? d. get away from where you are or go off by yourself? e . talk over things with your partner or husbandlwife? f. talk over things with a friend or neighbor? g. just stick it out? h. take it out on your children (like by punishing or yelling at them)? i. drink alcohol? j. take drugs? k. do s6mething else? (What is it?)
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report: a) social support, b) coping with anger, and c) coping with depression. Social Support
The social support items include questions referring to relationships in general and questions concerning specific dyadic ties. The items used here are the ones that were most consistently related to many of the other important study variables. A summary index was created by standardizing and summing all items except number 6 (i.e., how well couple gets along). Coping with Anger and Depression
The coping items asked how the respondents usually acted under situations of commonplace emotional distress. The focus was on stressful circumstances that are examined routinely as consequences or outcomes in the social support-stress-coping paradigm. As such they have not often been studied from the perspective of system activation. Of course, these situations only represent one particular kind of stress. Furthermore, the emphasis here is on verbal based interpersonal strategies, plus a few nonsocial behaviors (responses from the “other” category were too few in specific areas for inclusion in the analysis). Nevertheless, it is important to determine what an individual‘s reported coping tendencies are, among the strategies listed with respect to the two general affective states that many people face frequently. A focus on depression is especially critical in the study of female addiction, since drug abusing women characteristically evidence a greater than “normal” number of depressive symptoms (Colten, 1979). While heroin addicted women may be justifiably more depressed than others, the fact that depression must be addressed either more often or more intently by these women underscores a need to determine the kinds of coping strategies that they are most likely to use to deal with it. The use of both the emotions of anger and depression permits an assessment of the differential use of mechanisms for active as opposed to passive emotional states.
Results A series of t-tests were completed on the social support index for men and women who did and did not report use of each of the listed coping stategies. As shown in Table 2, there was much congruence between genders for anger. Women as well as men were more likely to use discussion as a coping strategy for anger when social support was available. However, both sexes were more selective about the kind of person they chose to hold
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Table 2. Relations Between Use of Coping Items and Social Support Index: Means and t-test Results Standardized total social support index means' Women
Men
Yes ( n ) A. Anger items talk to female relatives talk to male relatives talk to friend talk to mate go off alone stick it out drink alcohol take drugs take out on kids (parents only)b lose temper
.14(89) .24(7 1) .08(99) .17(114) .17( 139) 1.34( 1 17) .62(43) .91(134) 2.35( 24) .64(102)
1.70(81)** 1.35(99)* 2.00(71)** 2.34(56)** 2.34(30) - .12(53)** .98( 127) .78(36)** 1.05(94)* 1.25(68)
.04( 108) - .27(72) - .07(113) . I6( 154) .16( 153) .77( 137) .62(70) .57( 160)
B. Depression items talk to female relative talk to male relative talk to friend talk tomate go off alone stick it out drink alcohol take drugs take out on kids (parents only)b go to bed
.27(81) .38(62) .19(88) .18( 102) 1.08( 146) 1.3 I ( 120) .74(46) .94( 141) 2.43(22) .89(82)
1.49(88)** 1.17(108) 1.63(82)** 1.94(68)** - .31(24)* - .18(49)** .94( 124) .62(29) 1.06(96)* .90(88)
- .O 1 ( 1 14) - .40(72)
-
.44(99)
- .15(108)
.23(15 1) .58(159) .69( 145) .78(65) .64(169) .68(56)
1.10(94)* .98(130)** 1.30(88)** 1.76(48)** 1.76(48) .03(63) .49(132) .44(41) .63( 103) 1.25(128)** 1.09( 129)** 1.35(93)** 1.44(51)* .38(43) .20(56) .42(137) - .01(33) .48(146)
"The social support index is scaled with fewer supports as higher scores. bMale cell sizes for "yes" too small for analysis. *p < .05, t-test. * p < .Ol,t- test.
depression-related conversations with, with women unlikely to talk with male relatives and men less apt to talk with mates. Perhaps more importantly, though, in the absence of support, women but not men tended to use non-social and dysfunctional strategies to deal with both depression and anger. In no case was male use of non-social strategies dependent upon global accessability of social alternatives. In an attempt to better understand the relation between specific sources of support and reported coping behavior, separate chi-square tests were performed on the individual items comprising the support index and the additional question about the quality of interactions with mate, for each coping strategy. Examination of the results presented in Tables 3 and 4 reveaIs the following trends:
1. For anger as well as depression, for both sexes, the existence of support was strongly related to the use of such ties when needed. However, neither existence of support- nor quality of relationship with mate guaranteed the utilization of that tie in order to cope.
F
-no
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75.4. 88.6
58.0.. 66.3
71.1. 33.3
80.6*** 42.6
88.0
16.1*** 84.0
78.7. 66.7
71.3*** 90.4
68 9 * * * 463
61.1 84.0
84.0'. 62.1 64.0
Takes Out On Kids F M
M
44
65
108 61
142 27
50 95 25
127 75
76 91
I50 52
155 46
30 136 36
46 156
148 52
68 102
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88.4 68.0
66.0***
72. I 83.3
81.8. 66.7
F
90
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16.7. 39.0 33.3
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Takes Drugs
417
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F
Drinks Alcohol
64 3."
55.6 72.2
40.0*** 40.0.'.
52.3. 67.3
Sticks it Out F M
16.7, 27.4 0.0
85.3. 69.7
Talks l o Friend F M
48.0" 48.4 76.0
31.3'; 48.1
Talks to Mate F M
12.8. 25.4
47.3.'. 71.2
Goes Off Alone F M
Coping behaviors: % o f sample reporting that they engaged in listed behavior
64.7*** M.1
48.9. 66.7
Talks to Male Relative F M
"Only significant results are presented. *When cell sizes numbered 16 or less, they were collapsed with adjacent categories. *p < .lo. **p < .05. ***p < .01.
Has romantic involvement? -yes -no How gets along with mate?b -very well - f a i r h o t well Has best friend? - ves -no
M
Loses Temper
No. good friends?b -none/few -many Enough friends? -enough 67.5. -wants more 54.9 No. friends in neighborhood? -none -few - manylnearly everyone Can get people lo d o things? -yes
Social support items
Talks to Female Relative F M
Table. 3. Results of Chi-square Tests of Association Between Anger Coping Behaviors and Social Support Items for Each Sex"
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566 69.4
68.0
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Talks to Male Relative F M 91.2*** 63.6
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56
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TakesOut On Kids F M
26 I
56.542.2
36.7" 52 9 71.4
Sticks It Out M
63.2' 76 2
F
82.0***
42.0'. 50.5 70.6
48.7'. 68.6
Talks to Friend F M
53.8
70.7'' 86 5
Talks LO Mate F M
"Only significant results are presented. bWhen cell sizes numbered 16 or less, they were collapsed with adjacent categories. *p < .lo. * p < .05. ***p < .01.
How gets along with mate?l -very well -fair/not well Has best friend? -yes -no
-no
-none/few -many Enough friends? -enough -wants more No. friends in neighborhood? -none -few -many/nearly everyone Can get people to do things? -yes -no Has romantic involvement? -yes
No. good friends?b
Social support items
Coping behaviors: To of sample reporting that they engaged in listed behavior Drinks Alcohol F M
76.5' 87.3
85.4' 72.7
Takes Drugs F M
Table 4. Results of Chi-square Tests of Association Between Reported Depression Coping Behaviors and Social Support Items for Each Sex"
Ill$ hl
27
142
68 I02
137 33
F
n
I?? 7'
92
76
I?' 46
I ?h 36
30
46 I56
14R 52
M
M.Belinda Tucker
132
2. Lack of support was especially related to the use of dysfunctional coping strategies for women (e.g., withdrawal, substance use, taking it out on kids). 3. Distinctive male and female patterns of alcohol use as a coping mechanism were evident. Among women, the use of drinking to cope occured only when relations with one’s mate were not optimal, while men also drank when support in general was lacking. 4.The pattern of coping by using drugs also differed for women and men. A curvilinear relationship between drug use for both depression and anger was observed for women, while male drug use bore no association with the measures of social support included here.
DISCUSSION
The primary purpose of this paper was to demonstrate the utility of the social support-stress-coping paradigm for understanding substance abuse in women. Data from this examination of reported coping behavior in male and female heroin addicts suggest that the model can indeed serve as a conceptual aid that has the potential for isolating specific social structural influences on drinking and drug taking. The paper’s secondary goal, to demonstrate the centrality of coping in social support effects, was also achieved in as much as reported coping preferences differed according to social support availability. Clearly, these results must be qualified, since the study samples are not representative of the addicted population (or even the treated population) generally, and the measures of social support and coping are quite limited. Nevertheless, the research does indicate that a more intensive investigation along these lines could make substantial contributions to our understanding of the drug abuse process. I will turn now to a discussion of the specific results of the research. The analyses were concerned with the extent to which available social relationships were tapped by drug-using women and men when confronted with the aversive emotional states of anger and depression. Clearly, among both males and females, perceived social relations are used when individuals are distressed. Importantly, however, neither relationship existence nor quality (for interactions with mate) insured use in these particular stressful circumstances. That is, having support, even very good support, does not mean that the support will be utilized in times of emotional distress. Again, this analysis is limited in that degree of support offered by significant others was not assessed. But it suggests that whether or not social support effects are observed depends ultimately upon system activation. Activation, in
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133
turn, is probably controlled by a wide range of factors, one of which is individual coping preference. The research also explored the extent to which the absence of support would be associated with the use of non-social, potentially dysfunctional coping strategies. The findings demonstrate the existence of such an effect for women. Among men, the pattern was clear only for drinking, and then mainly in relation to the quality of interactions with mate. These results provide support for Gore’s (1978) assertion about the critical role in individual well-being that is played by support absence rather than presence. While her findings seem to indicate that the absence of critical ties exacerbates life stress, the results presented here imply that persons without support tend to engage in activities that either do not add to problem resolution or that may create other stresses (e.g., drinking, drug taking, taking out feelings on children). There are causal considerations here. While the tendency to view coping preferences as a consequence of social support availability is seductive, it is possible that persons with non-social or dysfunctional coping behaviors discourage the establishment of social ties. Whatever the direction, however, a greater understanding of the associations between these factors as related to substance abuse can have important therapeutical implications. The fact that the pattern of relations between variables was quite distinct for women and men is notable. Taking the results at face value, they strongly support the proposition that women are more driven by social considerations than are men, at least as reflected in drug abusing samples. Since measures of both social support and coping in this study are quite limited, however, it may be that men also use more negative strategies in the absence of support, but that those strategies were simply not tapped, or that some crucial aspects of male relationships went unmeasured. The data also demonstrate that use of alcohol or drugs as coping mechanisms is situation-specific. This refutes the belief that drug abuse for chronically addicted persons becomes indiscriminate. That is, both women and men in this sample reported use of substances to deal with emotional distress only under specific social conditions. Perhaps most noteworthy with respect to treatment, alcohol use was directly related to the quality of interactions with mate for men and women whose preferred drug of abuse is heroin. Substance abuse specialists long ago noted an increased rate of alcoholism among heroin addicts who undergo treatment (Gearing, 1972). At the same time, research has indicated that the support of a critical tie in the form of a spouse or opposite-sex partner is an important factor in successful treatment (Farkas, 1976; Gerstein, et al., 1979). If the use of alcohol is linked to the quality of the relationship considered to be most critical for treatment, therapy that does not directly address this problem undermines its primary goals.
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This study also indicates that children can become the targets of emotionally distressed women when other critical supports are lacking. The fact that behavior against children was most strongly related to both the ability to get people to do little things for you when needed and to nearby relations (i.e., with mate and neighbors) suggests that children are especially vulnerable when the everyday needs of their caretakers are not being satisfied. These results are subject to qualification on two points, however. First, while the analyses were limited only to those respondents who indicated that they were parents of children (whether or not they shared a domicile with children), certain cell sizes were quite small. Relatively few women (n = 22-24) reported that they “took it out on the kids”. If the incidence is actually higher, the unwillingness of addicted women to admit their actions is not at all surprising in light of rather vehement attacks on the parental adequacy of substance abusers (e.g., Densen-Gerber & Rohrs, 1973). Second, even though a number of the same statistical relations held for men, the findings were based on such a small number of cases that it was not possible to report them.
CONCLUSION
The results of this investigation have at least two significant implications. They demonstrate that further conceptual and methodological refinement of the coping component of the social support-stress-coping paradigm is necessary, and they suggest that a better understanding of drug taking behavior and treatment may be obtained through application of the social support-stress-coping paradigm. As noted earlier, the present study is limited in a number of critical ways, in terms of both sampling and measurement. Pearlin and Radabaugh (1976) have cautioned, too, that the functions of substance abuse recognized by the user may not necessarily be those that are actually performed. It is hoped, nevertheless, that these results will spur more cross-fertilization among the areas of study considered here (i.e., drug abuse, social support, coping, isolation) and will lead to the development of more refined theories, research methods, and clinical practice.
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the 86th Annual Convention of the American Psychological Association, Toronto, Ontario, Canada, August 1978. 2. Warren, D. I., & Clifford, D. L. Help seeking behavior and the neighborhood context: Some preliminary findings on a study of helping networks in the urban community. Unpub-
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lished manuscript, Institute of Labor and Industrial Relations, University of Michigan, 1975. 3. Warren, R. B. The work role andproblem coping: Sex differentials in the use of helping sys-
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