Alcohol, Drugs and the Family Social Support Scale (ADF SSS)

Abstract

The Alcohol, Drugs and the Family Social Support Scale (ADF SSS) is a psychometrically validated, multidimensional self-report instrument designed specifically to evaluate the nuanced social support experiences of family members impacted by a relative’s problematic alcohol or illicit drug use. Developed by Patricia Toner and Richard D. B. Velleman within the conceptual architecture of the Stress-Strain-Coping-Support (SSCS) Model, the scale addresses a critical measurement void in addiction psychology: standard social support inventories routinely fail to capture the ambivalent, stigmatizing, and intrusive interactions unique to substance-affected kinship networks. The ADF SSS comprises 25 items evaluated on a 4-point response metric ranging from Never to Often. Exploratory and confirmatory factor analyses demonstrate that the measure resolves into three distinct, theoretically coherent factors: Positive Functional Support (11 items; evaluating generic emotional, instrumental, and companionship resources), Negative ADF Support (8 items; assessing unsupportive, blaming, alienating, and critical family/social reactions specifically regarding the user), and Positive Specific ADF Support (6 items; capturing targeted informational, professional, and substance-specific coping assistance). Empirical investigations confirm high internal consistency reliability, with Cronbach’s alpha coefficients spanning α = .78 to .89 across subscales, alongside rigorous convergent, construct, and discriminant validity against measures of psychological strain, coping actions, and general family functioning. The ADF SSS serves as an indispensable diagnostic and evaluative tool for clinical interventions such as the 5-Step Method, facilitating precise mapping of informal and formal relational dynamics that either buffer or exacerbate psychological strain among affected family members (AFMs).

Keywords

Alcohol Drugs and the Family Social Support Scale, ADF SSS, affected family members, Stress-Strain-Coping-Support model, substance use disorders, psychometrics, unsupportive social interactions, coping behavior, family psychology, psychological strain

Authors

The ADF SSS was developed by Dr. Patricia Toner and Emeritus Professor Richard D. B. Velleman through empirical research conducted at the Mental Health R&D Unit, Department of Psychology, University of Bath, United Kingdom, in conjunction with the international Alcohol, Drugs and the Family (ADF) Research Team.

• Patricia Toner, PhD: Clinical research psychologist whose doctoral dissertation at the University of Bath established the psychometric foundations and factor analytical properties of the instrument. Her research focuses on family-based addiction interventions, measurement design, and psychological trauma among kinship networks.
• Richard D. B. Velleman, PhD, FBPsS: Emeritus Professor of Psychology at the University of Bath and Senior Research Consultant at Sangath (Goa, India). Professor Velleman is an internationally renowned psychometrician and clinical psychologist, co-originator of the Stress-Strain-Coping-Support (SSCS) theoretical model and co-founder of the UK Focus on Families and ADF Research Groups.

Purpose

The primary purpose of the Alcohol, Drugs and the Family Social Support Scale (ADF SSS) is to capture the complex, bidirectional, and specialized interpersonal environments surrounding affected family members (AFMs) living with or supporting an individual experiencing substance misuse. For decades, psychometric research within behavioral health relied on generalized social support batteries—such as the Multidimensional Scale of Perceived Social Support (MSPSS) or the Interpersonal Support Evaluation List (ISEL). While these instruments effectively measure broad perceived emotional and instrumental availability, they systematically obscure the profound interpersonal volatility, judgment, and stigma characteristic of substance misuse environments.

Substance dependence within a domestic ecology creates unique systemic pressures: relatives are frequently subjected to unsolicited and judgmental advice, public shame, ostracization from extended kin, mutual recrimination, and discordant directives regarding whether to detach from, confront, or enable the individual with addiction. Consequently, social support in this context cannot be treated as a purely positive, linear protective factor. Informal networks frequently offer responses that, while well-intentioned, are perceived by family members as actively hostile, invalidating, or destructive to their coping strategies.

The ADF SSS resolves this diagnostic limitation by providing clinical psychologists, addiction counselors, and social workers with a standardized, dual-valence diagnostic instrument. Its clinical rationale lies in identifying: (1) functional emotional and practical resources that foster resilience, (2) destructive and blaming communications that amplify psychological strain, and (3) specialized professional and educational inputs tailored to addiction. In clinical intervention trials, such as evaluations of the evidence-based 5-Step Method, the ADF SSS is employed as both a baseline needs-assessment tool and an outcome metric to track whether therapeutic interventions help relatives restructure their social boundaries, discard toxic connections, and mobilize authentic, non-judgmental assistance.

Psychological Construct

The ADF SSS operationalizes social support not as an abstract, universally beneficial psychological resource, but as a contextualized, multidimensional transactional process encompassing both affirmative support and deleterious interpersonal friction. The instrument delineates three primary dimensions:

1. Positive Functional Support

This dimension encompasses 11 items assessing general emotional validation, empathetic listening, unconditional positive regard, and practical instrumental assistance provided by friends and non-problematic relations. It operationalizes foundational coping resources that are not necessarily contingent on the relative’s substance use, yet provide essential psychological buffering. Prototypical indicators include having trusted confidants (Item 4: “I have friends/relations whom I trust”), receiving affective soothing (Item 2: “Friends/relations have helped to cheer me up”), experiencing practical aid during crises (Item 7: “Friends/relations have put themselves out for me when I needed practical help”), and receiving explicit encouragement to prioritize one’s own well-being (Item 8: “Friends/relations have advised me to focus on myself and my own needs”).

2. Negative ADF Support

Comprising 8 items, this subscale captures the counterproductive, critical, alienating, and stigmatizing behaviors emitted by the social ecology in direct reaction to the substance misuse. Rather than measuring the mere absence of positive support, this dimension measures the active presence of interpersonal strain, unhelpful conflict, and social undermining. AFMs frequently report that extended family members scrutinize their parenting or spousal behaviors, issue unconstructive ultimatums, or abandon them entirely. Typical items measure systemic boundary violations (Item 10: “Friends/relations have been too critical of my relative”), victim-blaming attributions (Item 16: “Fiends/relations have blamed me for my relative’s behaviour”), social exclusion (Item 14: “Friends/relations have avoided me because of my relative’s drinking or drug taking”), and moral condemnation (Item 17: “Friends/relations have said that my relative does NOT deserve help”).

3. Positive Specific ADF Support

This 6-item dimension reflects targeted informational, professional, and practical coping interventions tailored specifically to navigating the realities of addiction. It captures resources derived from professional health and social care providers, specialized bibliotherapy, and focused informal interactions designed to empower family agency. Prototypical manifestations include receipt of psychoeducational literature (Item 3: “Health/social care workers have given me helpful information about problem drinking or drug taking”), professional accessibility and alliance (Item 15: “Health/social care workers have made themselves available for me”; Item 25: “I have confided in my health/social care worker about my situation”), and resonance with peer experiences (Item 18: “I have identified with the information within books/booklets about people living with a problem drinker or drug taker”).

Theoretical Framework

The structural underpinnings of the ADF SSS are firmly rooted in the Stress-Strain-Coping-Support (SSCS) Model, developed collaboratively by Jim Orford, Richard Velleman, Alex Copello, Lorna Templeton, and their associates across cross-cultural settings spanning the UK, Mexico, Italy, and Australia. The SSCS model posits that living with an individual experiencing substance misuse represents a condition of chronic, pervasive environmental stress. This ambient stress induces severe psychological, physical, and emotional strain (e.g., depressive symptomatology, somatic illnesses, generalized anxiety).

Within this architecture, the trajectory from stress to strain is profoundly mediated and moderated by two key psychological mechanisms: the AFM’s coping strategies (categorized broadly into engaged coping, tolerant coping, and supportive/assertive withdrawal coping) and their accessed social support systems. The SSCS theoretical paradigm asserts that social support cannot be conceptualized as an invariant buffer. Instead, the model acknowledges that an AFM’s social environment can act as a catalyst for resilience or as a powerful vector of secondary traumatization.

Drawing concurrently from Lazarus and Folkman’s transactional theory of stress and social undermining theory, the ADF framework recognizes that unsupportive interactions often exert a stronger statistical impact on mental health deterioration than supportive interactions exert on psychological preservation. When relatives encounter negative social reactions—such as condemnation, ostracism, or dismissive advice—their cognitive appraisal of helplessness deepens, reinforcing dysfunctional coping strategies (e.g., extreme self-sacrifice or severe confrontational conflict). Conversely, when specific and functional support systems are activated, cognitive reappraisal is facilitated, enabling the relative to establish assertive coping boundaries, seek evidence-based clinical aid, and mitigate psychological strain.

Validity

Empirical validation of the ADF SSS has established robust psychometric properties across clinical and non-clinical cohorts of affected family members:

• Construct and Factorial Validity: During scale development, Patricia Toner and Richard Velleman conducted extensive item-generation procedures grounded in qualitative interviews with family members, followed by factor analytic extraction. Confirmatory analyses verify that a three-factor latent structure provides an exceptional fit to the data, markedly outperforming unifactorial or generalized two-factor models.
• Convergent Validity: The ADF SSS subscales exhibit statistically significant and theoretically predictable correlations with established psychological inventories:
• Positive Functional Support correlates positively with generic social support measures (such as the MSPSS, r ≈ .65 to .72, p < .001) and measures of family cohesion.
• Negative ADF Support demonstrates robust positive correlations with AFM psychological strain, measured via the General Health Questionnaire (GHQ-12) and the Symptom Rating Test (SRT), yielding correlation coefficients ranging between r = .38 and r = .49 (p < .01). Furthermore, high negative support scores associate significantly with tolerant, self-blaming, and highly distressed coping profiles on the Coping Questionnaire (CQ).
• Positive Specific ADF Support correlates moderately with professional service engagement, empowerment indexes, and active-assertive coping dimensions on the CQ.
• Discriminant Validity: The divergence between Positive Functional Support and Negative ADF Support (which typically correlate weakly or orthogonally, r ≈ −.12 to −.22) confirms that negative social interaction is not merely the low pole of positive support, but an independent ecological dimension requiring dedicated measurement.

Reliability

The ADF SSS demonstrates high internal consistency and operational stability across varied samples of family members, including parents, spouses, siblings, and adult children of substance users:

• Internal Consistency: In primary validation studies (Toner, 2009; Toner & Velleman, 2014), the 25-item battery exhibited excellent reliability coefficients across all extracted dimensions:
• Positive Functional Support: Cronbach’s alpha (α) consistently ranges from .86 to .89, indicating superior internal item coherence and minimal redundancy.
• Negative ADF Support: Cronbach’s alpha ranges from .78 to .83, reflecting robust scale homogeneity across items capturing interpersonal friction and stigma.
• Positive Specific ADF Support: Cronbach’s alpha ranges from .76 to .81, an optimal reliability range for a specialized 6-item domain combining formal care and self-directed informational resources.
• Item-Total Correlations: Corrected item-total correlations for individual items within their designated subscales routinely exceed the standard psychometric threshold of .35, with the majority falling between .45 and .74.
• Temporal Stability: Test-retest reliability analyses over a 4-to-6-week intervention baseline interval reveal acceptable intra-class correlation coefficients (ICCs > .75), demonstrating that the scale captures stable environmental dynamics while remaining appropriately sensitive to therapeutic changes over time.

Factor Analysis

The structural composition of the ADF SSS was developed through a rigorous psychometric pipeline involving exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA):

• Exploratory Factor Analysis: Principal axis factoring with oblique (promax/oblimin) rotation was executed on candidate items derived from qualitative family studies. The analysis yielded an unmistakable three-factor solution based on Kaiser’s criterion (eigenvalues > 1.0) and visual inspection of Cattell’s scree plot. The three extracted factors accounted for a substantial proportion of the total explained variance (> 48% across developmental samples).
• Factor Loadings:
• Factor 1 (Positive Functional Support): Salient loadings range from .48 to .82. Items such as Item 5 (listening when talking about feelings), Item 21 (being there for me), and Item 22 (support for coping) load heavily onto this generalized socio-emotional factor.
• Factor 2 (Negative ADF Support): Salient loadings span from .42 to .76. Items evaluating external blame (Item 16: .69), social avoidance (Item 14: .63), and unmerited criticism (Item 10: .58; Item 24: .71) load uniquely onto this dimension with negligible cross-loadings (< .20).
• Factor 3 (Positive Specific ADF Support): Loadings range between .44 and .79, anchoring items related to health and social care access (Item 15, Item 25) and targeted literature identification (Item 18).
• Confirmatory Model Fit: Subsequent CFA modeling confirmed that the theoretical three-factor correlated model achieves acceptable to good fit indices across independent validation cohorts (χ²/df ≤ 2.14, Comparative Fit Index [CFI] ≥ .93, Tucker-Lewis Index [TLI] ≥ .91, and Root Mean Square Error of Approximation [RMSEA] ≤ .058, 90% CI [.049, .067]), outperforming competing unidimensional models.

Instrument / Measurement Tool

The operational administration standards and clinical attributes of the ADF SSS are detailed below:

• Test Construct: Multidimensional Perceived Social Support for Affected Family Members.
• Test Format: Self-report questionnaire; available in pencil-and-paper format or digital interactive web platforms.
• Target Population: Adult family members, spouses, domestic partners, parents, siblings, or significant others impacted by a relative’s problematic alcohol or drug use.
• Item Count: 25 items.
• Response Scale: 4-point Likert-type frequency scale:
  • Never (scored 0)
  • Once or Twice (scored 1)
  • Sometimes (scored 2)
  • Often (scored 3)
• Subscale Allocation and Scoring:
  • Positive Functional Support (11 items): Calculate the sum or mean of Items 1, 2, 4, 5, 6, 7, 8, 11, 21, 22, and 23. (Theoretical score range: 0–33). Higher scores reflect robust informal emotional and practical support.
  • Negative ADF Support (8 items): Calculate the sum or mean of Items 9, 10, 12, 13, 14, 16, 17, and 24. (Theoretical score range: 0–24). Higher scores indicate destructive interpersonal friction, stigma, judgment, and social undermining.
  • Positive Specific ADF Support (6 items): Calculate the sum or mean of Items 3, 15, 18, 19, 20, and 25. (Theoretical score range: 0–18). Higher scores reflect effective utilization of specialized addiction-specific and professional resources.
• Clinical Interpretation Guidelines: A global composite score is generally discouraged by psychometricians because summing positive and negative dimensions cancels out critical pathological friction. Instead, profiles should be evaluated across all three distinct subscale scores: elevated Negative ADF Support coupled with low Positive Functional Support signals high vulnerability to clinical depression, severe chronic strain, and isolation.

Permissions & Fee and Test Year

The ADF SSS was developed through academic doctoral research at the University of Bath completed in 2009 by Dr. Patricia Toner, with definitive peer-reviewed psychometric validation published in 2014 in Addiction Research & Theory by Toner and Velleman. The instrument is considered an Open Access, free-to-use clinical and research instrument. It is made available to the global academic and therapeutic community under fair academic use principles to facilitate family-centered addiction research, non-commercial intervention evaluation, and routine clinical monitoring. Researchers and clinical practitioners may administer the instrument without royalty fees, provided full academic attribution is granted to the developers and the University of Bath. Any commercial reproduction, for-profit software distribution, or modification of item phrasing requires formal written permission from the copyright holders.

References

• Copello, A., Templeton, L., Orford, J., & Velleman, R. (2010). The 5-Step Method: Evidence of gains for affected family members. Drugs: Education, Prevention and Policy, 17(s1), 100–112. https://doi.org/10.3109/09687631003689408
• Orford, J., Copello, A., Velleman, R., & Templeton, L. (2010). Family members affected by a close relative’s addiction: The prevalence, conditions and strategy for intervention. Drugs: Education, Prevention and Policy, 17(s1), 36–43. https://doi.org/10.3109/09687631003689390
• Orford, J., Natera, G., Copello, A., Krishnan, M., Bradbury, C., Allen, D., & Velleman, R. (2005). Coping with Alcohol and Drug Problems: The Experiences of Family Members in Three Different Countries. Routledge. https://doi.org/10.4324/9780203087268
• Toner, P. (2009). The development of a social support measure for the family members of problem substance users (Doctoral dissertation, University of Bath). University of Bath Opus Repository. http://opus.bath.ac.uk/38925/
• Toner, P., & Velleman, R. D. B. (2014). Initial reliability and validity of a new measure of perceived social support for family members of problem substance users. Addiction Research & Theory, 22(2), 147–157. https://doi.org/10.3109/16066359.2013.793313
• Velleman, R., & Templeton, L. (2016). Impact of parents’ substance misuse on children: An update. BJPsych Advances, 22(2), 108–117. https://doi.org/10.1192/apt.bp.114.014449

13. Items of the Scale (Questionnaire)