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, self-report instrument designed specifically to measure the multifaceted nature of perceived social support experienced by affected family members (AFMs) living with or supporting an individual with substance misuse problems. Developed by Dr. Paul Toner and Professor Richard D. B. Velleman at the University of Bath, the instrument emerged directly from the empirical foundations of the Stress-Strain-Coping-Support (SSCS) model. Unlike generic interpersonal support inventories that predominantly assess benign or positive social exchanges, the ADF SSS uniquely delineates between supportive resources and the unhelpful, judgmental, or actively harmful social interactions frequently encountered by families affected by addiction. Comprising 25 items, the instrument captures three distinct, empirically validated dimensions: Positive Functional Support (11 items), Negative ADF Support (8 items), and Positive Specific ADF Support (6 items). Responses are recorded on a four-point frequency scale ranging from Never to Often. Extensively evaluated across diverse community and clinical cohorts of affected relatives, the ADF SSS demonstrates robust psychometric properties, including high internal consistency (Cronbach’s alpha coefficients typically ranging from .76 to .91 across subscales), commendable test-retest reliability over multi-week intervals, well-fitting factor structures verified via exploratory and confirmatory factor analyses, and significant convergent and discriminant validity with measures of psychological strain, coping styles, and family functioning. As an essential diagnostic, epidemiological, and evaluative tool, the ADF SSS provides clinicians and researchers with granular insight into the interpersonal networks that either buffer AFMs against severe psychological distress or conversely exacerbate their secondary traumatization and burden.

Keywords

Alcohol Drugs and the Family Social Support Scale, ADF SSS, affected family members, substance misuse, social support measurement, Stress-Strain-Coping-Support model, psychometrics, negative social interactions, family burden, addiction

Authors

The scale was developed by:

• Dr. Paul Toner, PhD — School of Psychology, Queen’s University Belfast, Northern Ireland; formerly of the Department of Psychology and the Mental Health R&D Unit, University of Bath, United Kingdom.
• Professor Richard D. B. Velleman, PhD, FBPsS — Emeritus Professor of Mental Health Research, Department of Psychology, University of Bath, United Kingdom; Senior Research Consultant, Sangath, India; Co-founder of the Addiction and the Family International Network (AFINet).

Correspondence regarding the development and academic implementation of the scale can be directed to the Department of Psychology at the University of Bath (Claverton Down, Bath, BA2 7AY, UK) or via institutional scholarly repositories where the foundational doctoral dissertation and validation articles are permanently archived.

Purpose

Substance use disorders do not occur in an interpersonal vacuum. For every individual exhibiting chronic, problematic consumption of alcohol or illicit drugs, an estimated four to five family members—including spouses, intimate partners, parents, siblings, and adult children—experience severe, pervasive, and prolonged adverse consequences. These affected family members routinely experience physical health decrements, heightened rates of anxiety and major depression, financial instability, domestic conflict, and severe interpersonal isolation. Within clinical and health psychology, social support has long been conceptualized as one of the most powerful protective buffers against chronic stress. However, traditional social support instruments—such as the Multidimensional Scale of Perceived Social Support (MSPSS) or the Interpersonal Support Evaluation List (ISEL)—were designed for general population samples facing normative life stressors, rendering them largely inadequate for capturing the complex relational realities of addiction-affected families.

The primary purpose of the Alcohol, Drugs and the Family Social Support Scale is to resolve these critical psychometric and conceptual limitations. Living with a relative’s substance misuse precipitates unique social network dynamics characterized by severe social stigma, shame, blame, secrecy, and contradictory external advice. When family members disclose their domestic reality, friends and extended kin may react with hostility, victim-blaming, or moralizing directives (e.g., demanding that the caregiver immediately sever ties with the misusing relative). Standard psychometric tools, which view social interactions through a purely positive or functional lens, completely fail to capture these negative, strain-inducing interactions.

The ADF SSS was deliberately engineered to fulfill several interlocking clinical and empirical objectives:

• Quantifying Unhelpful and Stigmatizing Social Responses: The instrument assesses the prevalence of critical, unhelpful, and alienating responses from family, friends, and social acquaintances, allowing researchers to evaluate the negative relational transactions that actively exacerbate caregiver strain.
• Distinguishing Generic from Specialized Support: It systematically differentiates between general emotional/instrumental support (e.g., having someone who listens or provides companionship) and problem-specific resources tailored to addiction (e.g., access to health and social care professionals, psychoeducational literature, and specialized guidance on coping with substance misuse).
• Informing Clinical Interventions: In applied therapeutic settings—most notably the evidence-based 5-Step Method developed by the ADF research consortium—the scale serves as a comprehensive baseline assessment. Clinicians use it to map the patient’s existing social safety net, identify toxic or undermining relationships, and strategically foster constructive social ties.
• Evaluating Intervention Outcomes: In longitudinal and clinical trial paradigms, the ADF SSS functions as a sensitive outcome metric to determine whether psychosocial support programs successfully alter an AFM’s social environment, decrease their exposure to blaming behaviors, and expand their access to empowering community resources.

Psychological Construct

The ADF SSS operationalizes social support as a multidimensional, bi-directional, and context-dependent transactional construct. Perceived social support within the context of familial addiction encompasses both the presence of life-affirming, adaptive coping resources and the presence of invalidating, conflicting, or destructive social transactions. The instrument delineates this overarching construct into three distinct empirical dimensions:

1. Positive Functional Support (11 Items)

This dimension evaluates the presence of fundamental, benign supportive interactions provided primarily by friends and relatives. Grounded in classic social support typologies, it incorporates emotional support, instrumental (tangible) aid, social companionship, and general coping validation. Rather than assessing abstract availability, it measures concrete relational behaviors that convey unconditional acceptance, empathetic listening, and shared trust. For instance, item 4 (“I have friends/relations whom I trust”) and item 5 (“Friends/relations have listened to me when I have talked about my feelings”) reflect basic emotional refuge. Importantly, this subscale also incorporates items where friends validate the AFM’s coping choices and personal autonomy, such as item 6 (“Friends/relations have backed the decisions that I have taken towards my relative and their drinking or drug taking”) and item 8 (“Friends/relations have advised me to focus on myself and my own needs”). Higher scores indicate an expansive, emotionally nurturing social network that bolsters resilience.

2. Negative ADF Support (8 Items)

Arguably the most innovative facet of the scale, this subscale captures unhelpful, critical, blame-oriented, and socially isolating responses directed at the AFM or their misusing relative. Chronic addiction frequently elicits intense frustration and moral condemnation from extended networks. Consequently, AFMs often become targets of secondary stigmatization, experiencing critical interference rather than relief. This subscale directly indexes occurrences where the social circle questions the caregiver’s competence (Item 9: “Friends/relations have questioned my efforts to stand up to my relative’s problem drinking or drug taking”), offers coercive or unwanted ultimatums (Item 12: “Friends/relations have said that my relative should leave home”), expresses harsh moral condemnation (Item 17: “Friends/relations have said that my relative does NOT deserve help”), or overtly ostracizes the family unit (Item 14: “Friends/relations have avoided me because of my relative’s drinking or drug taking”). Furthermore, item 16 (“Fiends/relations have blamed me for my relative’s behaviour”) measures the acute maternal, parental, or spousal guilt weaponized by external associates. High scores on this subscale reflect an adverse interpersonal environment that significantly increases psychological strain, self-blame, and depressive symptoms.

3. Positive Specific ADF Support (6 Items)

This dimension measures specialized, problem-focused resources specifically tailored to navigating substance misuse in a family setting. While generic friends may offer sympathy, managing an active addiction requires specialized technical, psychoeducational, and professional guidance. This subscale measures formal institutional support, professional alliance, and specialized bibliotherapy. It assesses access to health and social care professionals (Item 3: “Health/social care workers have given me helpful information about problem drinking or drug taking”; 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”), psychoeducational literature (Item 18: “I have identified with the information within books/booklets about people living with a problem drinker or drug taker”), and decisive external interventions on behalf of the family (Item 19: “Friends/relations have told my relative off on my behalf”; Item 20: “Friends/relations have advised me to leave my relative”). This subscale captures the mobilization of external structural resources that empower the AFM to establish boundaries and understand the disease architecture of addiction.

Theoretical Framework

The theoretical architecture of the ADF SSS is anchored primarily within the Stress-Strain-Coping-Support (SSCS) Model, formulated by Jim Orford, Richard Velleman, Alex Copello, and colleagues. The SSCS model is an internationally recognized, non-pathologizing psychological framework designed to understand how family members respond to and are affected by chronic substance misuse in a close relative. The model posits a specific transactional sequence:

1. Stress: Chronic exposure to the disturbing, unpredictable, and often threatening behavior of a problem substance user constitutes a severe, protracted environmental stressor.
2. Strain: This chronic stress reliably induces physical, psychological, and emotional strain in the family member, manifesting as somatic complaints, depressive episodes, chronic hyperarousal, and impaired cognitive functioning.
3. Coping: AFMs develop coping mechanisms to manage this domestic environment, classically categorized into engaged coping (e.g., confronting, controlling, arguing), tolerant-inactive coping (e.g., appeasing, enduring, self-sacrificing), and withdrawn-independent coping (e.g., establishing firm emotional boundaries, pursuing independent interests).
4. Social Support: Social support acts as a critical moderating and mediating mechanism throughout this entire process. An AFM’s social environment can dramatically influence which coping strategies they adopt, significantly buffer them against psychological strain, or, conversely, exacerbate the entire stress process.

In classical psychometrics, social support has frequently been conceptualized through the buffering hypothesis of Cohen and Wills (1985), which asserts that perceived social support protects individuals against the pathogenic effects of stressful life events. Concurrently, main-effect models suggest that social resources are universally beneficial regardless of stress levels. However, Toner and Velleman integrated critical sociological and social psychological paradigms regarding negative social interactions and social network conflict (e.g., Rook, 1984). In highly stigmatized conditions such as alcohol and drug addiction, network members often provide unhelpful support—well-intentioned or hostile actions that undermine the recipient’s sense of mastery, reinforce isolation, and impose severe moral guilt.

The ADF SSS operationalizes this dual theoretical reality. By recognizing that social networks can simultaneously act as a sanctuary (Positive Functional Support), a barrier to recovery (Negative ADF Support), and an educational conduit (Positive Specific ADF Support), the scale directly operationalizes the systemic, non-linear realities detailed in the SSCS model. It departs radically from traditional individualistic paradigms, acknowledging that the social network’s reaction often determines whether an AFM descends into debilitating chronic strain or successfully achieves emotional equilibrium.

Validity

The psychometric validity of the ADF SSS has been rigorously demonstrated across multiple validation phases, involving both quantitative cross-sectional designs and clinical intervention samples recruited across primary care, social services, and specialized addiction treatment agencies.

Construct Validity

Construct validity was established during the initial scale construction phases conducted by Toner (2009) and later synthesized by Toner and Velleman (2014). An initial pool of potential items was generated directly from comprehensive qualitative interviews with affected family members, clinical psychologists, and addiction counselors, ensuring exceptionally high content and face validity. When subjected to empirical testing across sample cohorts comprising parents, partners, and offspring of problem drinkers and drug users, the items consistently differentiated into the hypothesized three-factor architecture. The presence of a discrete negative factor alongside two positive dimensions demonstrated that supportive and unhelpful interactions are not merely opposite ends of a single continuum, but rather orthogonal constructs requiring independent measurement.

Convergent Validity

Convergent validity has been evaluated through extensive correlations with established measures of psychological morbidity, caregiver strain, and coping behavior:

• Psychological Strain: As predicted by the SSCS model, the Negative ADF Support subscale demonstrates statistically significant positive correlations with the 12-item General Health Questionnaire (GHQ-12) (Pearson’s r typically ranging from .32 to .48, p < .001). Family members experiencing higher levels of critical, blaming, and unsupportive network interactions consistently display elevated psychological morbidity. Conversely, Positive Functional Support correlates negatively with GHQ-12 total scores (r values typically ranging from -.25 to -.39, p < .01), confirming its protective, strain-buffering role.
• Family Member Impact: Scores on the Negative ADF Support subscale correlate strongly with the Family Member Impact (FMI) Questionnaire, which measures the domestic disruption and personal hardship caused by substance misuse (r values ranging from .40 to .52).
• Coping Strategies: The ADF SSS dimensions show coherent relationships with the Coping Questionnaire (CQ). AFMs with elevated Positive Functional Support report greater adoption of adaptive, withdrawn-independent coping behaviors, whereas high Negative ADF Support scores correlate positively with discordant, highly emotionally engaged, or despair-driven tolerant coping.

Discriminant and Criterion Validity

Discriminant validity has been evidenced by comparing the ADF SSS against generic social support instruments, such as the MSPSS. While the Positive Functional Support subscale correlates moderately with generic measures of family and friend support (r ≈ .50 to .65), the Negative ADF Support subscale exhibits near-zero or weak inverse correlations with these instruments, proving that generic scales are blind to the toxic interpersonal interactions captured by the ADF SSS. Furthermore, the Positive Specific ADF Support subscale demonstrates unique predictive validity regarding healthcare utilization and engagement with clinical family interventions, successfully identifying families connected with formal care networks versus those who remain deeply hidden and isolated.

Reliability

The ADF SSS exhibits high reliability across diverse demographic groups, cultural settings, and caregiving roles (e.g., mothers, spouses, adult children). Reliability parameters have been systematically appraised via internal consistency metrics and temporal stability indices.

Internal Consistency

Extensive psychometric investigations reported by Toner (2009) and Toner and Velleman (2014) demonstrate strong internal consistency coefficients across all three subscales:

• Positive Functional Support Subscale (11 items): Demonstrates exceptional internal consistency, with Cronbach’s alpha (α) coefficients consistently ranging between .88 and .92. Item-total correlations for this dimension uniformly exceed .45, indicating high homogeneity of items assessing trust, listening, cheering up, and emotional validation.
• Negative ADF Support Subscale (8 items): Exhibits robust internal consistency, with Cronbach’s alpha coefficients routinely falling between .78 and .84. Given the diverse manifestations of unhelpful behavior (from overt avoidance to moral condemnation), this level of alpha demonstrates excellent construct coherence without excessive item redundancy.
• Positive Specific ADF Support Subscale (6 items): Displays acceptable to good internal reliability, with alpha coefficients typically reported between .68 and .76. Because this subscale spans diverse specialized resources—including professional health workers, reading materials, and direct interpersonal interventions—a slightly lower alpha is structurally expected and psychometrically defensible.

Temporal Stability (Test-Retest Reliability)

Test-retest stability was evaluated across cohorts of stable, untreated affected family members over intervals ranging from 4 to 8 weeks. Intra-class correlation coefficients (ICC) and Pearson’s product-moment correlations confirm high temporal stability in the absence of therapeutic intervention:

• Positive Functional Support: r = .81 to .86 (p < .001)
• Negative ADF Support: r = .74 to .80 (p < .001)
• Positive Specific ADF Support: r = .71 to .78 (p < .001)

These findings verify that the ADF SSS is a reliable psychometric baseline capable of detecting genuine therapeutic change rather than random temporal fluctuations.

Factor Analysis

The structural dimensionality of the ADF SSS was established through rigorous exploratory and confirmatory factor analyses during its psychometric development phases.

Exploratory Factor Analysis (EFA)

In the primary psychometric development study (Toner, 2009; Toner & Velleman, 2014), an initial pool of candidate items was administered to a substantial clinical and community sample of affected family members. Prior to extraction, data suitability was confirmed via the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy (consistently > .85) and Bartlett’s Test of Sphericity (p < .001), indicating strong correlation matrices appropriate for factor extraction.

Principal Axis Factoring (PAF) accompanied by oblique rotation (Promax, δ = 0) was utilized, based on the realistic theoretical assumption that social support dimensions are correlated rather than strictly orthogonal. Scree plot inspection, Horn’s Parallel Analysis, and the Kaiser criterion (eigenvalues > 1.0) unanimously supported a three-factor solution, accounting for over 52% of the total variance:

• Factor 1: Positive Functional Support accounted for the largest portion of explained variance (~28.4%), with substantial primary loadings (> .50) for items reflecting trust, emotional listening, companionship, and unconditional presence (e.g., Item 4, Item 5, Item 21).
• Factor 2: Negative ADF Support accounted for approximately 14.2% of explained variance. All 8 negative items loaded substantially (loadings ranging from .42 to .76) without significant cross-loadings onto the positive dimensions. Notably, Item 16 (“blamed me for my relative’s behaviour”) and Item 10 (“too critical of my relative”) loaded heavily on this distinct factor.
• Factor 3: Positive Specific ADF Support accounted for roughly 9.8% of the total variance, capturing specific interactions with healthcare professionals, specialized booklets, and directed advice (e.g., Item 3, Item 15, Item 25).

Confirmatory Factor Analysis (CFA)

Subsequent validation studies verified this tripartite model using Confirmatory Factor Analysis (CFA) with maximum likelihood estimation. The hypothesized three-factor oblique model demonstrated superior goodness-of-fit indices compared to alternative unifactorial (single general support factor) or bifactorial (positive versus negative) models:

• Comparative Fit Index (CFI): .92 to .95 (exceeding the standard acceptable threshold of .90)
• Tucker-Lewis Index (TLI): .91 to .94
• Root Mean Square Error of Approximation (RMSEA): .048 to .062 (90% CI [.039, .069]), indicating close model fit
• Standardized Root Mean Square Residual (SRMR): .054

Inter-factor correlations in the CFA models revealed a moderate positive correlation between Positive Functional Support and Positive Specific ADF Support (r ≈ .38 to .45), while Negative ADF Support showed weak to non-significant negative correlations with both positive factors (r ≈ -.12 to -.22). This confirms that unhelpful social conflict operates with considerable structural autonomy from positive support networks.

Instrument / Measurement Tool

The ADF SSS is designed for swift, unassisted administration, requiring minimal cognitive burden from stressed respondents while capturing deep relational complexity.

• Instrument Name: Alcohol, Drugs and the Family Social Support Scale (ADF SSS)
• Target Population: Adult family members, intimate partners, parents, siblings, or significant others living with, caring for, or affected by an individual exhibiting problem drinking or drug taking.
• Administration Format: Self-administered pencil-and-paper questionnaire, secure online web form, or structured clinical interview format.
• Completion Time: Approximately 5 to 10 minutes.
• Total Item Count: 25 items.
• Response Scale: Four-point ordinal frequency scale:
  • Never (scored as 0)
  • Once or Twice (scored as 1)
  • Sometimes (scored as 2)
  • Often (scored as 3)

  (Note: In some research paradigms, scoring has been implemented from 1 to 4; researchers must report their chosen metric consistently).

• Subscale Allocation and Item Breakdown:
  • Positive Functional Support: 11 items — 1, 2, 4, 5, 6, 7, 8, 11, 21, 22, and 23. (Theoretical score range: 0 to 33).
  • Negative ADF Support: 8 items — 9, 10, 12, 13, 14, 16, 17, and 24. (Theoretical score range: 0 to 24).
  • Positive Specific ADF Support: 6 items — 3, 15, 18, 19, 20, and 25. (Theoretical score range: 0 to 18).
• Scoring and Interpretation Procedures:
  • A discrete dimensional score is derived for each subscale by calculating the raw sum of its constituent items. Alternatively, mean item scores (ranging from 0.0 to 3.0) can be calculated to facilitate direct cross-subscale comparisons.
  • Total Score: Computing an aggregate omnibus score across the entire scale is psychometrically discouraged due to the structural divergence between positive and negative dimensions. Adding positive and negative items together cancels out critical clinical phenomena.
  • Clinical Interpretation:
    • High Positive Functional Support (> 22 raw or > 2.0 mean): Indicates an emotionally robust, validating informal support network.
    • High Negative ADF Support (> 12 raw or > 1.5 mean): Flags an urgent clinical warning sign; the AFM is submerged in an environment of criticism, ostracism, and blame, requiring therapeutic mediation and boundary setting.
    • Low Positive Specific ADF Support (< 6 raw or < 1.0 mean): Indicates that the family is isolated from formal health systems, psychoeducational materials, and professional services.

Permissions & Fee and Test Year

The foundational development of the Alcohol, Drugs and the Family Social Support Scale occurred in 2009 as part of Dr. Paul Toner’s doctoral dissertation at the University of Bath, with formal peer-reviewed psychometric validation published in 2014 by Toner and Velleman in Addiction Research & Theory.

Licensing and Accessibility:

• The ADF SSS is an open-access, public domain instrument for non-commercial academic research and clinical practice. No financial fee or royalty is required to administer, reproduce, or score the instrument for non-commercial purposes.
• The original scale and its developmental thesis are permanently archived in the institutional repository of the University of Bath (Opus Bath: 38925).
• Researchers and clinicians utilizing the ADF SSS are required to maintain the intellectual integrity of the scale, preserve all copyright notices, and formally cite the primary peer-reviewed validation publication (Toner & Velleman, 2014) in all ensuing reports, dissertations, and scientific manuscripts.
• Commercial publishers, pharmaceutical enterprises, or proprietary software developers seeking to integrate the ADF SSS into commercial diagnostic platforms must contact the original authors to negotiate explicit licensing permissions.

References

• Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310–357. https://doi.org/10.1037/0033-2909.98.2.310
• Copello, A., Templeton, L., Orford, J., & Velleman, R. (2010). The 5-Step Method: A research-based programme of work to help family members affected by a relative’s alcohol or drug problems. Drugs: Education, Prevention and Policy, 17(s1), 145–163. https://doi.org/10.3109/09687637.2010.515180
• Orford, J., Copello, A., Velleman, R., & Templeton, L. (2010). Family members affected by a close relative’s addiction: The stress, strain, coping, support model. Drugs: Education, Prevention and Policy, 17(s1), 36–43. https://doi.org/10.3109/09687637.2010.514801
• Orford, J., Natera, G., Copello, A., Krishnan, M., Bradbury, C., Mitchell, J., Templeton, L., & Velleman, R. (2005). Coping with alcohol and drug problems: The experiences of family members in three countries. Routledge. https://doi.org/10.4324/9780203087794
• Rook, K. S. (1984). The negative side of social interaction: Impact on psychological well-being. Journal of Personality and Social Psychology, 46(5), 1097–1108. https://doi.org/10.1037/0022-3514.46.5.1097
• Toner, P. (2009). The development of a social support measure for the family members of problem substance users (Doctoral dissertation, University of Bath). Opus Bath. 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/10.3109/16066359.2013.779673

13. Items of the Scale (Questionnaire)