Social Adjustment

Social adjustment is defined as the individual's success at fulfilling age-appropriate roles according to expectations (Barrabee, Barrabee, & Finesinger, 1955). The measurement domains encompass social support, social roles, social skills, peer affiliations, school and vocational adjustment, and recreation and leisure activities.

Social Functioning/Social Support

As previously discussed, the Addiction Severity Index (McLellan et al., 1980) profiles the individual's problems, including social support, along with psychological, legal, family, and vocational status. The Substance Abuse Problem Checklist (SAPC; Carroll, 1983) assesses social functioning in relation to treatment planning. An especially useful feature of the SAPC is its capacity to determine the client's readiness to initiate substance abuse treatment. The SAPC evaluates health status, personality, social relationships, vocational status, use of leisure time, religious orientation, and legal status. The Social Relationship Scale (SRS; McFarlane, Neale, Norman, Roy, & Steiner, 1981) is one of only a few instruments developed with the specific intention to measure social support. It assesses three facets of social support: (1) total number of individuals who make up the social support network, (2) type of relationships, and (3) quality of relationships. These facets of social adjustment are integral to prognosis following treatment for substance use disorders (see McLellan, 1986; Woody et al., 1983).

Peer Affiliations

A social network in which drug use is commonplace increases the likelihood that the individual will adopt this behavior. Ameliorating a substance abuse problem may thus require abandoning long-standing peer affiliations. Whether the quality of peer relationships is embedded in an antisocial behavior disposition needs to be evaluated. Antisociality impedes work, school, and family adjustment. One self-report measure, the revised Drug Use Screening Inventory (Tarter, 1990), described earlier, quantifies deviancy in both the individual and friendships.

Because the social environment is a major source of reinforcement, it is essential to identify the reward contingencies, role models, and contextual factors associated with alcohol or drug use. It should be recognized that the individual not only responds to the particular social environment but also seeks out an environment that has reinforcing value. Hence, during the course of the psychological assessment, an attempt should be made to learn why the substance abusing client seeks out social interactions that have maladaptive consequences.

Social Skills

Social skills deficits are common among substance abusers (Van Hasselt, Hersen, & Milliones, 1978). Deficiencies in assertiveness skills, refusal skills, and compliment-giving skills have all been documented. Poor ability to manage conflict in interpersonal situations may also be linked to a propensity for substance abuse. Moreover, the exacerbation of poor social skills by stress or anxiety potentiates the risk for substance use as a coping strategy. Consequently, describing the person's coping style also needs to be an integral component of the social skills assessment.

There are currently no standardized instruments for evaluating social skills. Various self-rating scales, although lacking in normative scores, have been employed for identifying the presence and severity of deficits and for targeting behaviorally focused interventions. The same limitations exist with respect to coping style; however, two measures that have been found to be informative are the Ways of Coping Scale (Folkman & Lazarus, 1980) and the Constructive Thinking Inventory (Epstein, 1987).

In conjunction with a social skills evaluation, it is important to document the individual's capacity to exercise the competencies required for everyday living. As society becomes more technologically complex, it is valuable to learn whether the individual is capable of performing the everyday tasks that are required for successful adjustment. For example, it is important to determine whether the individual can manage a bank account, use bankcard machines, access the Internet, obtain services information, utilize public transportation, and attend to personal needs with respect to food and clothing. Deficiencies in any of these areas exacerbate stress that in turn promotes the risk for substance use.

School Adjustment

The school is the primary social environment during adolescence. It is important to document school adjustment and academic performance of adolescent substance abusers. Drug accessibility and the adolescent's peer affiliation network are especially influential determinants of drug use initiation. Conduct problems and social deviance are also commonly associated with both poor school adjustment and substance abuse. The teacher version of the Child Behavior Checklist (CBCL; Achenbach & Edelbrock, 1983) affords the opportunity to identify and quantify severity of behavioral problems in the school environment. Also, comparing the findings to the parallel parent version enables the clinician to ascertain whether adjustment problems are confined to the school or are also present in the home.

Assessing the teacher's perceptions of a child's behavior in the classroom is a highly desired component of a comprehensive evaluation. The Disruptive

Behavior Rating Scale (Pelham & Murphy, 1987), based on DSM-III-R criteria (American Psychiatric Association, 1987), quantifies severity of conduct, and attention-deficit/hyperactivity and oppositional defiant disturbance. Another brief symptom rating scale that can be completed by the teacher is the Iowa Conners Teachers Rating Scale (Loney & Milich, 1982).

One important aspect of school adjustment pertains to the extent to which the child participates in athletics and other extracurricular activities. These activities indicate how well the person is socially integrated and accepted by peers. In addition, it is essential to evaluate academic achievement and learning aptitude in the basic skill areas. For example, learning disability compounded by low self-esteem may be a major factor propelling a youngster toward drug use, as well as other non-normative behaviors. Standardized learning and achievement tests can readily document whether a learning deficit is present.

Vocational Adjustment

Stress in the workplace fosters substance use as a coping strategy. Inability to meet work performance standards, conflicts with other employees or supervisors, an inconsistent work schedule, and low job satisfaction exemplify the common proximal causes of substance use. The impact of unemployment and underemployment as a source of stress also needs to be evaluated. In addition, extensive travel and associated social obligations may frequently place the individual in situations where alcohol consumption is expected. Over the long term, social drinking may lead to problems controlling intake.

Besides evaluating the job demands and workplace environment, it is essential to evaluate the client's behavioral disposition. For example, premorbid personality disorders contribute to job failure, which in turn predisposes the individual to substance abuse. Furthermore, it is important to evaluate substance abuse in the context of specific circumstances of the job. Access to addictive substances places the person at heightened risk simply by virtue of facile availability. Not surprisingly, bartenders have a high rate of alcohol abuse. The vocational evaluation must therefore identify the specific job-related characteristics that predispose the individual to substance abuse.

Recreation/Leisure Activities

Substance use is commonly circumscribed to recreational activities. Furthermore, an individual who does not have socially satisfying leisure activities may use alcohol or drugs to cope with the stress of boredom. This may be particularly problematic among members of the elderly population who have not developed a rewarding goal directed lifestyle following retirement. A somewhat similar problem may confront adolescents who have substantial unstructured time. Presently, there are no standardized procedures to evaluate recreation and leisure activities. As noted above, however, the DUSI-R (Tarter, 1990) screens for severity of problems related to leisure and recreation.

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