Addiction, families and treatment: A critical realist search for theories that can improve practice

Abstract

The stress–strain-coping-support (SSCS) model and the social-ecological (SE) model were analysed in a search for theories that can serve as a foundation for improving the assistance and support provided to families affected by addiction and alcohol and drug (AOD) problems. The basis for the analyses was a critical realist one, viewing addiction as a multilayered and necessarily laminated phenomenon. The two models approach two different layers of reality: the SSCS model highlights the importance of dealing with mechanisms at the psychological level for affected family members, while the SE model emphasizes the importance of intervening in relationships and systems at the social level of reality. Both models are highlighted as essential for dealing with the complexity of the phenomenon of addiction in families: the SSCS model by providing agency for a neglected group of affected family members and developing a method to address their needs, and the SE model by advocating the relative position of social solutions in the field of AOD treatment and developing a framework for conducting joint sessions and family therapy. Both models and their respective practical guidelines for interventions could work in a complementary way in a clinical setting, as useful tools in different types of case and at different stages of treatment – combining the level and emergence in the interaction between agency and structure – for the betterment of families and individuals.