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Alcoholic family interaction McGee, Daniel R. 1991

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ALCOHOLIC FAMILY INTERACTION by DANIEL R. MCGEE B.ED., University of V i c t o r i a , 1979 THESIS SUBMITTED IN PARTIAL FULFILMENT THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in THE FACULTY OF GRADUATE STUDIES THE FACULTY OF EDUCATION (Department of Counselling Psychology) We accept t h i s thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA September 1991 © Daniel R. McGee, 1991 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. The University of British Columbia Vancouver, Canada Department DE-6 (2/88) ABSTRACT A repeated case study design was used that combined data from the application of the Q-technique and semi-structured family interviews, to examine the e f f e c t s of alcohol on family i n t e r a c t i o n . Two families were selected on the basis that they represented examples of binge or alternating patterns of drinking and sobriety as defined by Steinglass (1987) . The f a m i l i e s were i d e n t i f i e d and referred to the project through an Alcohol and Drug Outpatient Treatment Program. Individual family members Q-sorted 60 items drawn from the McMaster Family Assessment Device developed by Epstein, Baldwin and Bishop (198 3) into seven categories that ranged from most l i k e , to least l i k e , t h e i r p a r t i c u l a r family, during both drinking and non-drinking times. The family as a group then together Q-sorted the items. Q-sort r e s u l t s for each sorting occasion were made into a c o r r e l a t i o n a l matrix, then subjected to a p r i n c i p a l components analysis. The r e s u l t s were analyzed to i d e n t i f y s i m i l a r themes or patterns. - i i i -TABLE OF CONTENTS ABSTRACT i i LIST OF TABLES V LIST OF FIGURES v i i LIST OF APPENDICES v i i i ACKNOWLEDGEMENTS i x CHAPTER I INTRODUCTION 1 Purpose of the Study 2 Interactional Cybernetic Systemic View 2 Research Questions 3 CHAPTER II REVIEW OF THE LITERATURE 4 Alcoholism and the Family 4 Family Paradigm 12 Alternator (Binge) Pattern 16 Influence 17 CHAPTER III METHODOLOGY 18 Single Case Studies 18 Case Subjects 22 Screening and Selection 22 Case Subject Descriptions 2 3 Case Study Investigator 28 Instruments 29 McMaster Family Assessment Device 31 Data C o l l e c t i o n 32 Semi-Structured Interview 34 Data Analysis 35 Q-Technique 3 6 Subjects of Judgements for Q-sorts 37 Q-Sort Items 37 Q-Sorting 38 CHAPTER IV RESULTS 41 Introduction 41 Screening and Assessment Instrument Results 41 Preliminary Analysis of Q-Sorts 43 Family A (Non-drinking) 45 Family A (Drinking) 54 Family B (Non-drinking) 58 Family B (Drinking) 62 THE SEMI-STRUCTURED FAMILY INTERVIEWS 66 Case Study A 66 The Family's Experience of the Q-Sort 66 - i v -Family Interaction (Drinking) 67 Family Interaction (Non-drinking) 70 Case Study B 71 The Family's Experience of the Q-Sort 71 Family Interaction (Drinking) 73 Family Interaction (Non-drinking) 75 CHAPTER V SUMMARY AND DISCUSSION 77 Q-Sort Results 79 Family A 81 Family B 83 Theoretical Implications 84 Limitations of the Study 86 Implications for Family Treatment of Alcoholism 88 Research Questions: Conclusions 88 Future Research Implications 91 REFERENCES 95 - v -LIST OF TABLES Non-drinking: C o r r e l a t i o n a l M a t r i x Non-drinking: Eigen Values TABLE 4.1 MAST Scores f o r I d e n t i f i e d Problem D r i n k e r s In F a m i l i e s S t u d i e d TABLE 4.2 Q u a n t i t y and Frequency of E p i s o d i c D r i n k i n g TABLE 4.3 Family A TABLE 4.4 Family A and % of Va r i a n c e TABLE 4.5 Family A Non-drinking: Unrotated P r i n c i p a l Component S o l u t i o n TABLE 4.6 Family A Non-drinking: Rotated P r i n c i p a l Component S o l u t i o n TABLE 4.7 Dimensions (items) which D i f f e r e n t i a t e PCI from PC2 f o r Family A F u n c t i o n i n g f o r Non-drinking P e r i o d s TABLE 4.8 Dimensions (items) which D i f f e r e n t i a t e PCI as More C h a r a c t e r i s t i c of Family A F u n c t i o n i n g than PC2 f o r Non-drinking P e r i o d s TABLE 4.9 Dimensions (items) which D i f f e r e n t i a t e PCI as Less C h a r a c t e r i s t i c of Family A F u n c t i o n i n g than PC3 f o r Non-drinking P e r i o d s TABLE 4.10 Dimensions (items) which D i f f e r e n t i a t e C h a r a c t e r i s t i c of Family Non-drinking P e r i o d s TABLE 4.11 Dimensions (items) which D i f f e r e n t i a t e C h a r a c t e r i s t i c of Family Non-drinking P e r i o d s TABLE 4.12 Family A D r i n k i n g : C o r r e l a t i o n a l M a t r i x TABLE 4.13 Family A D r i n k i n g : Eigen Values and % of V a r i a n c e TABLE 4.14 Family A D r i n k i n g : Unrotated P r i n c i p a l Component S o l u t i o n TABLE 4.15 Family A D r i n k i n g : Rotated P r i n c i p a l Component S o l u t i o n PC2 as More A F u n c t i o n i n g than PC3 f o r PC2 as Less A F u n c t i o n i n g than PC3 f o r 42 42 45 45 46 47 48 50 51 52 53 54 54 55 56 - v i -TABLE 4.16 Dimensions (items) which D i f f e r e n t i a t e PCI as More 57 Cha r a c t e r i s t i c of Family A Functioning than PC2 for Drinking Periods TABLE 4.17 Dimensions (items) which D i f f e r e n t i a t e PCI as Less 58 Ch a r a c t e r i s t i c of Family A Functioning than PC2 f o r Drinking Periods TABLE 4.18 Family B Non-drinking: Correlational Matrix 59 TABLE 4.19 Family B Non-drinking: Eigen Values 59 and % of Variance TABLE 4.20 Family B Non-drinking: 60 Unrotated P r i n c i p a l Component Solution TABLE 4.21 Dimensions (items) which Constitute PCI for 61 Family A Functioning for Non-drinking Periods TABLE 4.22 Family B Drinking: Correlational Matrix 62 TABLE 4.23 Family B Drinking: Eigen Values 62 and % of Variance TABLE 4.24 Family B Drinking: 63 Unrotated P r i n c i p a l Component Solution TABLE 4.25 Dimensions (items) which Constitute PCI for 64 Family B Functioning for Drinking Periods - v i i -LIST OF FIGURES FIGURE 3.1 Procedural Flow Chart FIGURE 3.2 Q-Sort D i s t r i b u t i o n - v i i i -LIST OF APPENDICES APPENDIX A Letters of Introduction APPENDIX B Consent Forms APPENDIX C The Michigan Alcoholism Screening Test APPENDIX D Q-Sort Items APPENDIX E McMaster Family Assessment Device APPENDIX F Assignment of FAD items to Sub-Scales APPENDIX 6 The Semi-Structure Family Interview APPENDIX H Present Drinking Pattern Chart APPENDIX I Episodic Pattern Chart - i x -ACKNOWLEDGEMENTS There are a number of people who have played a s i g n i f i c a n t r o l e i n the production of t h i s t h e s i s , and I would l i k e to take t h i s opportunity to acknowledge them. Dr. John Friesen, the chairperson of my the s i s committee, has been a source of a great deal of encouragement. Dr. Walter Boldt p a t i e n t l y guided me through the methodology which at times I found quite confusing and whose enthusiasm for the data was contagious. I want to thank my frie n d and colleague A l l a n who has provided me with numerous opportunities to enter into conversations that continue to remind me of the wonder of i t a l l . I also want to acknowledge the families that p a t i e n t l y sorted the cards and answered a l l my questions with such openness. Their willingness to share t h e i r l i v e s with me made t h i s project possible. And f i n a l l y I want to thank you Kathleen, you have been there to do everything else while I was parked i n front of the word processor. I love you, and I have missed you. - 1 -CHAPTER I INTRODUCTION This study examined how, i n families with an a l c o h o l i c member, family interaction during drinking periods d i f f e r e d from family interaction during non-drinking periods. Data were gathered i n two ways; (i) The Q-sort, a s e l f - r e p o r t measure of t y p i c a l family interaction, and, ( i i ) A semi-structured family interview. In addition, the Q-sort was completed by each individual family member and by the e n t i r e family as a group task. The relationship between the r e s u l t s of the family Q-sort (which acts as a hypothetical individual) and the i n d i v i d u a l Q-sort was examined and a measure of influence was inferred. Central to t h i s family perspective on alcoholism i s that families conserve t h e i r shared conceptions of the world not through individual memory - the agency f a m i l i a r to psychologists - but through regular patterns of t h e i r own i n t e r a c t i o n (Reiss, 1981). The central question explored i n t h i s study i s : what i s the difference i n terms of how i n d i v i d u a l family members perceive t h e i r interactions and hence conserve and constitute the family paradigm during periods of drinking and non-drinking? The quantitative l e v e l of t h i s study was intended to examine who i n the family contributes to t h i s p o t e n t i a l s h i f t i n g of the family paradigm, and i n what ways. - 2 -Purpose of the Study The purpose of t h i s study has been to reveal some noteworthy differences i n the way a family functions during drinking and non-drinking periods, to contribute to a better understanding of family functioning and alcoholism as well as to enrich the e x i s t i n g knowledge base by adding to the l i t e r a t u r e the indigenous knowledge of families coping with problems related to alcohol. In addition, as the Q-sort items were obtained from the McMaster Family Assessment device, t h i s study i s expected to expand the knowledge that exists regarding t h i s widely used instrument. Interactional Cybernetic Systemic View In 1967, Jackson, Watzlawick, and Beavin (Bavelas), published Pragmatics of Human Communication. This work challenged the psychodynamic approach that focused on the i n d i v i d u a l as the "container" of pathology. The writers f e l t that t h i s view ignored the extent to which the r e l a t i o n s h i p context contributed to the problem behaviour; one of the main r e l a t i o n s h i p contexts being the family. Their view suggested that i f the i n t e r a c t i o n a l patterns i n the family could change so would the problem behaviour. The i n t e r a c t i o n a l view of the a l c o h o l i c family would suggest i t i s the i n t e r a c t i o n a l patterns of behaviour that f a c i l i t a t e alcohol r e l a t e d problem behaviour. - 3 -R e s e a r c h Q u e s t i o n s Do d e s c r i p t i o n s of f a m i l y f u n c t i o n i n g (the f a m i l y s e l f -image or paradigm) d i f f e r , f o r d r i n k i n g and n o n - d r i n k i n g p e r i o d s ? Do responses t o s p e c i f i c q u e s t i o n s p u r p o r t e d t o e v a l u a t e such s a l i e n t dimensions of f a m i l y f u n c t i o n i n g as problem s o l v i n g , communication, r o l e s , a f f e c t i v e r e s p o n s i v e n e s s , a f f e c t i v e involvement, behaviour c o n t r o l , and g e n e r a l f u n c t i o n i n g d i f f e r f o r p e r i o d s of d r i n k i n g and ab s t i n e n c e ? Do d e s c r i p t i o n s r e g a r d i n g f a m i l y f u n c t i o n i n g d e r i v e d from the f a m i l y as a group d i f f e r from i n d i v i d u a l d e s c r i p t i o n s ? Who i n the f a m i l y c o n t r i b u t e s the most t o the a l c o h o l i c f a m i l y paradigm? Does the a l c o h o l i c c o n t r i b u t e t o the f a m i l y paradigm or i s s/he more d i s t a n t and l e s s i n f l u e n t i a l i n the f a m i l y as much of the l i t e r a t u r e p r e d i c t s ? - 4 -CHAPTER II REVIEW OF THE LITERATURE Alcoholism and the Family Much of the l i t e r a t u r e (popular and professional) written about families where alcohol i s misused suggests that a l c o h o l i c s are more distant and less i n f l u e n t i a l with t h e i r spouses than are non-alcoholics (Al-anon, 1971; A l c o h o l i c s Anonymous, 1986; Woititz, 1983). According to Jacob and Seilhamer (1987) the l i t e r a t u r e relevant to family influences on alcoholism has l a r g e l y focused on the status of individuals within the family. This l i t e r a t u r e has, for the most part, been i n d i v i d u a l l y focused and psychodynamically based. Studies done by Futterman, (1953) , Kalashian, (1959), and Lewis, (1937) i n i t i a l l y described spouses of a l c o h o l i c s as "disturbed p e r s o n a l i t i e s " who sought to s a t i s f y t h e i r unconscious needs by dominating a male whose a l c o h o l i c drinking rendered him weak and dependent (cited i n Jacob and Seilhamer, 1987). With the advent of environmental or systemic perspectives, the wives of a l c o h o l i c s were recast as "victims" rather than " v i l l a i n s " and t h e i r psychological disturbances were considered a reaction to the stress associated with l i v i n g with an a l c o h o l i c spouse according to Jackson, and Jacob and Seilhamer, (1982) , (cited i n Jacob and - 5 -Seilhamer, 1987). More recently, e f f o r t s have focused on i n d i v i d u a l -environmental associations i n attempts to describe and categorize t y p i c a l coping strategies as they r e l a t e to the husband's drinking behaviour, however the data of most importance to exploring such relationships has been absent: the actual interactions between spouses that potentiate or maintain abusive drinking. However, t h i s l i t e r a t u r e has c l e a r l y implied that the a l c o h o l i c and h i s or her spouse ex h i b i t unique relationship patterns, that these patterns are r e p e t i t i v e and i d e n t i f i a b l e , and that such interchanges are relevant to the emergence and perpetuation of problem drinking (Jacob and Seilhamer, 1987). Similar to the l i t e r a t u r e on depression and drug addiction, and i n contrast with studies of schizophrenia and childhood disorder, the study of family i n t e r a c t i o n i n the alcoholism l i t e r a t u r e has been a r e l a t i v e l y neglected area u n t i l the past decade. The reason for t h i s neglect can be r e l a t e d to various h i s t o r i c a l trends i n the alcoholism domain, most important, the repeatedly emphasized view of alcoholism as an i n d i v i d u a l problem. Largely stimulated by the general i n t e r e s t i n family interaction and psychopathology during the 1950s and 1960s, several preliminary reports on i n t e r a c t i o n a l views of a l c o h o l i c s and on the treatment within the family context began to appear i n the late 1960s and early 1970s; soon thereafter, scattered observational studies of a l c o h o l i c -- 6 -spouse interactions appeared i n the l i t e r a t u r e , as well as the i n i t i a t i o n of several programs of research on family influences on alcoholism. However, the accumulated l i t e r a t u r e to date i s s t i l l an extremely small one, i n f a c t there have been less than 10 reported studies i n t h i s area since 1974, most of which can be considered preliminary and/or p i l o t e f f o r t s (Jacob and Seilhamer, 1987). In Jacob and Seilhamer*s review of alcoholism and family i n t e r a c t i o n research (1987) they describe the p o t e n t i a l importance of an int e r a c t i o n a l perspective to alcohol studies and the contributions that interaction research can make i n untangling the admittedly complex association between alcoholism and the family matrix. Of f i r s t importance are empirically based descriptions of family i n t e r a c t i o n s . These can be viewed as necessary building blocks f o r t h e o r e t i c a l treatment and prevention e f f o r t s . Second, the i d e n t i f i c a t i o n of s i g n i f i c a n t patterns of interaction characterizing (at le a s t some) alcoholics and t h e i r families would provide a mechanism by which detailed interaction processes can be rel a t e d to current or future states of the family or of in d i v i d u a l members. The course of the a l c o h o l i c ' s problem drinking and the status of the alcoholic's o f f s p r i n g could be re l a t e d to the nature of his or her interactions with other family members. Third, the description and c a r e f u l examination of interactions involving a l c o h o l i c s and t h e i r f a m i l i e s should provide data and insights that can be - 7 -transformed into relevant treatment and prevention programs. Jacob and Seilhamer reviewed several studies that attempted to move beyond individual studies to descriptions of marital dyads involving an a l c o h o l i c spouse. In one such " t r a n s i t i o n a l study" by M i t c h e l l (cited i n Jacob and Seilhamer, 1987) each spouse was required to complete a "personality questionnaire" under two conditions; s e l f -appraisal and appraisal of partner. Although experimental and control couples were found to be quite s i m i l a r on most measures, there did appear to be important differences i n areas concerned with control, dominance, and s e n s i t i v i t y ; that i s the a l c o h o l i c was most l i k e l y to describe h i s wife as dominating, whereas she did not report herself i n t h i s manner, and the a l c o h o l i c was l i k e l y to report himself as e a s i l y hurt whereas the wife did not share t h i s perception of him. Other t r a n s i t i o n a l studies generally focused on how the a l c o h o l i c and non-drinking partners saw each other along various dimensions. In one study by Drewery and Ray (cited i n Jacob and Seilhamer, 1987) the findings revealed that "control wives describe t h e i r husbands i n a way that accords well with the husband's s e l f - d e s c r i p t i o n while the wives of patients do not". In another study by Tamerin, Toler, DeWolfe, Packer and Newman (cited i n Jacob and Seilhamer, 1987) which focused on differences i n perception of the a l c o h o l i c during sober and intoxicated states, the findings suggest both the a l c o h o l i c and the spouse describe the a l c o h o l i c i n generally p o s i t i v e - 8 -terms when the a l c o h o l i c was sober, with a s i g n i f i c a n t increase for both i n negativism and depression when intoxicated. Jacob and Seilhamer also looked at research that moved in t e r e s t from in d i v i d u a l descriptions to outcomes and processes associated with the ongoing interchanges of the a l c o h o l i c and her or his intimates. Gorad (cited i n Jacob and Seilhamer, 1987) conducted an analysis of the a l c o h o l i c s i n t e r a c t i o n a l s t y l e based on a communications-system framework emanating from the work of the Palo Alto group. Gorad tested the hypothesis that suggested that drunkenness was used as a manoeuvre whose function i s to gain control of the s e t t i n g of rules i n a rela t i o n s h i p and found that both the a l c o h o l i c and h i s or her spouse were f i g h t i n g hard to be one up i n a highly competitive b a t t l e . Another study done by Cobb and McCourt looked at problem solving, and one done by Kennedy explored cooperative and competitive patterns i n a l c o h o l i c couples. However these works were inconclusive (cited i n Jacob and Seilhamer, 1987). Jacob and Seilhamer also suggest that work based on structured laboratory tasks and game outcome ra i s e s questions regarding the v a l i d i t y and g e n e r a l i z a b i l i t y of the completeness of the emergent characterizations of a l c o h o l i c -spouse re l a t i o n s h i p s . There has been considerable inte r e s t directed toward the patterns of interaction that characterize f a m i l i e s with an a l c o h o l i c member. Family interaction research i n t h i s area - 9 -has focused on the variables that are associated with the persistence of alcohol misuse rather than i t s etiology. (Jacob, Ritchey, Cvitkovic, and Blane, 1981). A number of studies have examined the r e l a t i o n s h i p between alcohol misuse and family i n t e r a c t i o n by comparing and contrasting various aspects of family functioning during periods of drinking and abstinence. Most recently Liepman et a l . (1989) looked at the family functioning of 20 male alc o h o l i c veterans and t h e i r female partners during drinking and abstinent i n t e r v a l s . Using repeated measures analysis on the McMaster Family Assessment Device (FAD) they determined that a l c o h o l i c s and t h e i r partners perceive family functioning to be better during dry than wet periods on a l l 7 scales of the FAD (Problem Solving, Communication, Roles, A f f e c t i v e Responsiveness, A f f e c t i v e Involvement, Behaviour Control, and General Functioning). However, i n contrast to the male a l c o h o l i c , female partners gave heal t h i e r ratings on a l l FAD scales except Roles i n the wet condition and A f f e c t i v e Involvement i n the dry condition. A l c o h o l i c s as a group viewed t h e i r wet and dry family functioning as unhealthy, although the female group saw the family's dry problem solving and behaviourial control as healthy. Steinglass (1987) proposes that there are (at least) three types of a l c o h o l i c families; the stable wet a l c o h o l i c family, the stable dry a l c o h o l i c family and the alternator - 10 -a l c o h o l i c family. The stable wet pattern i s one i n which drinking occurs on a regular and predictable basis from day to day or weekend to weekend. The stable dry pattern f a m i l i e s have not only ceased drinking but family members are convinced that t h i s i s a r e l a t i v e l y permanent state of a f f a i r s even i f occasional " s l i p s " occur. For the stable dry f a m i l i e s the past has included a period of at least f i v e years during which the family has been i n the stable wet pattern. An alternator pattern i s the one commonly described as binging,. In t h i s pattern the drinker t y p i c a l l y alternates between periods of several weeks to several months when active drinking i s occurring (wet periods) and periods of weeks to months when no drinking i s occurring. The distinguishing feature of t h i s pattern i s that alternating between wet and dry periods w i l l have occurred multiple times during the l i f e h i s t o r y of the family. Steinglass (1987) suggests that "a comparable d u a l i t y or c y c l i n g e x i s t s for i n t e r a c t i o n a l behaviour patterns within the A l c o h o l i c Family. Off-on cycl i n g of drinking behaviour i s p a r a l l e l e d by alt e r a t i o n s i n behavioral patterns within the family. He and his colleagues f i r s t observed differences i n fa m i l i e s during wet and dry conditions and subsequently d i f f e r e n t i a t e d several a l c o h o l i c family i n t e r a c t i o n a l s t y l e s based on the drinking status of the a l c o h o l i c . The Stable Dry fam i l i e s appeared to have the most f l e x i b l e patterns of behaviour. These families express a broad range of a f f e c t , i n - l i -the area of allowing disagreement to be expressed and engaged i n more decision making behaviour (Liepman et a l , 1989) . In the Stable Dry a l c o h o l i c family, family members may be "on guard" against relapse by becoming involved i n A.A. or Alanon etc. This kind of behaviour tends to keep alcohol the focus of attention i n these families (Steinglass, 1987). They also tend to spend time together as well as have time independent of each other. The stable-wet families show s i g n i f i c a n t l y less v a r i a b i l i t y i n t h e i r verbal interactions i n content, purpose, and a f f e c t i v e l e v e l than do stable-dry f a m i l i e s . Interestingly, Steinglass (1987) also reported no differences along gender l i n e s . Families of women al c o h o l i c s developed s i m i l a r patterns of behaviour. Research done by Steinglass looked at changes i n family dynamics during a drinking episode. On at least one occasion the husband who seemed emotionally distant and unconnected when sober, appeared to change dramatically a f t e r consuming 6-12 oz. of 100 proof alcohol. He became more animated, and more involved i n the family. Steinglass proposes that f a m i l i e s use alcohol to achieve another state, t h i s other state may provide the family with a whole new range of behaviours to draw upon. According to Jacob and Seilhamer, (1987) the key i n f r a s t r u c t u r e of Steinglass's t h e o r e t i c a l developments i s that i n t e r a c t i o n a l events are d i f f e r e n t i n intoxicated versus sober states and that the intoxicated-relevant patterns are - I n -s u f f i c i e n t l y r e i n f o r c i n g to perpetuate or maintain cycles of abusive drinking. Inspection of Steinglass's work, however, indicates that these are assumptions drawn from h i s c l i n i c a l observations of the early, small samples of dyads and couples and that these observations were best viewed as hypotheses that had not yet been tested i n a c a r e f u l , s c i e n t i f i c a l l y rigorous design (Jacob and Seilhamer, 1987). The question of why certain i n t e r a c t i o n a l patterns should p e r s i s t (alcoholism, for example) has been pursued by David Riess (1981) among others (Handel, 1967; Ford and Herric, 1974; Jackson, 1965; Riskin, 1963; and F e r r e i r a , 1966) i n t h e i r studies of family paradigm, family themes, family rules, and family myths (cited i n Steinglass et a l . , 1987). Each of these studies have focused on the somewhat d i f f e r e n t , but also overlapping world of the shared b e l i e f systems that f a m i l i e s hold. I t has been suggested by Reiss and E l s t e i n , (cited i n Steinglass 1987) that the family's shared view of i t s environment (family paradigm), i n turn, shapes family behaviour. F a m i l y Paradigm Working together, Steinglass and Reiss (1987) have applied the concepts of "family paradigm" and "general systems theory" to alcoholism and suggest the following; - 13 -1. A l c o h o l i c Families are behaviourial systems i n which alcoholism and alcohol related behaviours have become cen t r a l organizing p r i n c i p l e s around which family l i f e i s structured. 2. The introduction of alcoholism into family l i f e has the po t e n t i a l to profoundly a l t e r the balance that e x i s t s between growth and regulation within the family. This a l t e r a t i o n most t y p i c a l l y skews the family i n the d i r e c t i o n of an emphasis on short-term s t a b i l i t y (regulation) at the expense of long-term growth. 3. The impact of alcoholism and alcohol r e l a t e d behaviours on family systemic functioning i s most c l e a r l y seen i n the types of changes that occur i n regulatory behaviours as the family gradually accommodates l i f e to the coexistent demands of alcoholism. 4. The types of alterations that occur i n regulatory behaviours can i n turn be seen to profoundly influence the o v e r a l l shape of family growth and development -changes i n the normal family l i f e cycle that (Steinglass and Reiss) l a b e l l e d "developmental d i s t o r t i o n s " (Steinglass, 1987). From Michael White's perspective, problems develop i n - 14 -f a m i l i e s with the activation of vicious cycles of family i n t e r a c t i o n following the mishandling of problematic s i t u a t i o n s , random events, or family stressors according to Durrant, (cited i n Selekeman, 1989). Over time the family becomes lim i t e d i n t h e i r a b i l i t y to a f f e c t the problem and i n t e r a c t with one another. This leads to i n t e r a c t i o n a l cycles of blaming and g u i l t i n the family. The family becomes increasingly restrained i n t h e i r a b i l i t y to i n t e r a c t around the problem. I t i s the restrained p a r t i c i p a t i o n that i s considered to be the d i f f i c u l t y . This view tends to remove the need for establishing the popular family therapy idea of the "function of the symptom". The family therapist views the family r e s t r a i n t s as the problem, not the symptomatic person or some s t r u c t u r a l i r r e g u l a r i t y i n the family system according to Durrant, (cited i n Selekeman, 1989). The family as a whole i s oppressed by the problem. White (1986) suggests that r e s t r a i n t s e s t a b l i s h a threshold or bias for the s e l e c t i o n of information about difference and l i m i t the family's a b i l i t y to undertake the necessary t r i a l - a n d - e r r o r search for new solutions. Old ideas continue; new information becomes blurred. White suggests that conversations are shaped by these biases, which further propels these conversations, or s t o r i e s along. New information, that doesn't f i t into the family bias or dominant story gets l e f t behind, or missed e n t i r e l y . Research and treatment approaches i n the area of - 15 -alcoholism and family interaction have suggested a r e c i p r o c a l systemic rel a t i o n s h i p between the two. I n i t i a l studies suggested the a l c o h o l i c was more distant and less i n f l u e n t i a l i n the family than were non-alcoholics (Ablon, 1976), however more recent studies have begun to question t h i s popular idea. Extensive observations of conjointly h o s p i t a l i z e d a l c o h o l i c s and t h e i r spouses by Steinglass, Davis, and Berensen, (1977) indicated that communication often became "enriched" and more emotional with the onset of drinking, changes which often preceded the alcoholic's actual, physiological i n t o x i c a t i o n . Steinglass et a l . (1971) concluded that drinking may be an i n d i c a t i o n of d i s t r e s s within the interpersonal system as well as an i n t e g r a l s t a b i l i z i n g component of the r e l a t i o n s h i p (in B i l l i n g s , Kessler, Gomberg, and Weiner, 1979). Reiss (1981) suggested three concepts c e n t r a l to h i s Family Paradigm model. F i r s t , the family's shared conception of the world i n which i t l i v e s plays a central regulatory r o l e i n family l i f e . Second, c r i s i s plays a mutative and generative r o l e i n family l i f e ; i n p a r t i c u l a r , i t i n i t i a t e s change i n the family's shared concepts of i t s world. Third, intimate s o c i a l groups conserve t h e i r shared conceptions of the outside world not through i n d i v i d u a l memory - the agency f a m i l i a r to psychologists - but through regular patterns of t h e i r own interaction. S i m i l a r l y , White suggests that f a m i l i e s become constrained from enacting alternate behaviours by previously - 16 -e x i s t i n g dominant s t o r i e s (narrative). With (alcoholic) f a m i l i e s being studied through the lens of i n t e r a c t i o n , and more recently through narrative and discourse (Bavelas, 1990 Personal Communication), i t would seem important to continue to gather information on the family's experience of alcoholism. Both Reiss and White appear to be suggesting that how i n d i v i d u a l s within families describe themselves and other family members (in White's language, "the s t o r i e s " they t e l l or i n Reiss* work the "patterns of interaction") i s co n s t i t u t i v e of that p a r t i c u l a r family. I t i s i n "the t e l l i n g " that the family i d e n t i t y i s r e a l i z e d . Some studies seem to suggest that drinking offers some "benefit" to the family system, perhaps t h i s benefit might be understood i n terms of Reiss' second concept of family paradigm, alcohol (the c r i s i s ) plays a mutative and generative r o l e i n family l i f e . Alcohol intoxication (and sobriety) generates a new dominant story, one with new opportunities (and l i m i t a t i o n s ) . A l t e r n a t o r ( B i n g e ) P a t t e r n By studying Alternator Pattern (Binge) f a m i l i e s , one i s able to compare and contrast accounts of family i n t e r a c t i o n during periods of drinking and sobriety i n the same family. The Q-sort methodology seems uniquely suited to in v e s t i g a t i n g t h i s phenomena. When comprised of items that tend to evaluate important aspects of family functioning, the Q-sort can provide a "picture" of the family story or i n t e r a c t i o n - 17 -pattern, and when done as a family group i t can provide the r e s u l t s of a dynamic real-time negotiation of family i d e n t i t y . I n f l u e n c e In a study done by Ferreira and Winter (1965) an attempt was made to measure the difference between normal and abnormal f a m i l i e s . They were interested i n how much agreement existed among family members (on what they l i k e d and what they did not l i k e ) , how much time the family took to reach a decision, and how appropriate were these family decisions i n terms of f u l f i l l i n g the wishes of the i n d i v i d u a l family members. The family members were asked to choose between a number of s i t u a t i o n s , the three choices they l i k e d the most and the three they l i k e d the least. They were then asked to complete the same questionnaire as a family, whatever they chose for each s i t u a t i o n would apply to a l l of them. The group r e s u l t s were then compared to the individual r e s u l t s and a measure of "influence" was inferred. The i n d i v i d u a l whose r e s u l t s were most l i k e the group's re s u l t s was said to have had the most influence i n the family. U t i l i z i n g these p r i n c i p l e s a s i m i l a r measure of influence w i l l be inferred from the i n d i v i d u a l and group Q-sort tasks. This influence w i l l be measuring the extent to which in d i v i d u a l views of the family paradigm are embraced by the family as a group. - 18 -Chapter III METHODOLOGY The nature of t h i s study has c a l l e d f or the use of q u a l i t a t i v e and quantitative methods. The data c o l l e c t i o n has focused on the Q-sort methodology u t i l i z i n g items drawn from the McMaster Family Assessment Device, and, a semi-structured interview with a retrospective focus. In addition, the Michigan Alcoholism Screening Test (Seltzer, 1971), a standardized instrument was used along with the Diagnostic and S t a t i s t i c a l Manual of Mental Disorders (1987) and portions of the Comprehensive Drinker P r o f i l e Interview Booklet (Marlet and M i l l e r , 1984) to screen the subjects for the study. The data analysis, u t i l i z i n g the Q-technique has resulted i n a view of family interaction based on an i n t e r a c t i o n a l cybernetic systemic view and Reiss 1 (1981) concept of family paradigm. Individual and family views of family i n t e r a c t i o n were subjected to further analysis so as to e s t a b l i s h the extent to which individual family members contribute to the family paradigm as well as the s p e c i f i c nature of t h e i r contribution. S i n g l e Case S t u d i e s In using the case study as the guiding methodology, t h i s study was limited i n i t s a b i l i t y to e s t a b l i s h a causal r e l a t i o n s h i p and thereby making i t impossible to ru l e out - 19 -a l t e r n a t i v e explanations to account for the r e s u l t s observed (Kazdin, 1980). Individual views of the family paradigm may not influence group views, for example. While i t may not be possible to generalize about the findings i t i s also c l e a r that a large number of cases does not always increase generality. The difference between extensive and intensive study i s that extensive design usually involves a large number of subjects to which the observer has a casual r e l a t i o n s h i p while the intensive design i s usually associated with a comparatively lengthy relationship with a small number of case subjects (Bass and Brown 1973). The problems associated with an extensive approach to t h i s p a r t i c u l a r kind of inquiry i s that s i g n i f i c a n t findings based on the averaging of heterogeneous groups i s not h e l p f u l i n understanding the actual e f f e c t s as they may r e l a t e to i n d i v i d u a l families (Chassan, 1979). However according to Baas and Brown (1973) i t i s possible to enhance p r e d i c t a b i l i t y on the basis of multiple observations within the boundaries of an i n d i v i d u a l person or group (in t h i s case a family group). Further, i t has been noted by Herbst (1970) that the s t a t i s t i c a l procedures and analysis are most h e l p f u l when the type of s c i e n t i f i c law applied f i t s with the issue researched. Herbst defined three such laws. Type A law applies where both functions and parameters are constant. Averaging across a group i s not a problem, - 20 -since units of analysis are r e l a t i v e l y s i m i l a r . This law i s most h e l p f u l i n the study of inactive substances. As an example Baas and Brown (1973) give Boyle's Law: pv/t=R. The parameter R remains constant because of the functional r e l a t i o n s h i p s between temperature (t) , volume (v) and pressure (p) . Since gases act a l i k e , one may use averaging techniques. Type B law applies where the r e l a t i o n s h i p of factors i s constant but the parameters are s p e c i f i c . Analysis of circumstances f i t t i n g these conditions requires i n i t i a l s i n g l e case study, i . e . , cases where the boundary values are the same, may be averaged together. Baas and Brown (1973) give the example: "Y=JLX" might be the r e l a t i o n s h i p between heat (X) and length of "rod (Y) where ( X ) i s the heat relevant c h a r a c t e r i s t i c s p e c i f i c to each metal. In order to c o r r e c t l y analyze the event, one would have to use single case analysis since averaging a l l metals together would mask the existence of type B laws and the v a r i a b i l i t y of i n d i v i d u a l metals. Only those metals with the same heat related c h a r a c t e r i s t i c s (JL) could be averaged together. Baas and Brown suggest that t h i s type of law i s found infrequently i n the s o c i a l sciences. Type C law i s most applicable i n the s o c i a l sciences where events frequently demonstrate a d i f f e r e n t kind of invariance. Here both functional relationships and parameters are s p e c i f i c , but the generating rules of possible functional r e l a t i o n s h i p s are constant. A generating r u l e i s u n i v e r s a l l y but i d i o s y n c r a t i c a l l y applicable. Therefore, research attempting to reveal the generating rules for a s p e c i f i c s o c i a l behaviour (problem drinking), must use an i n d i v i d u a l case approach. In t h i s case, averaging procedures should not be used since ideas vary, families are i d i o s y n c r a t i c and there may be any number of r a t i o n a l i z a t i o n s , however some themes may be u n i v e r s a l l y applicable i d i o s y n c r a t i c a l l y . To apply either Type A or Type B laws t h i s study would not be appropriate. The unit of analysis, f a m i l i e s , do not behave homogeneously as required for Type A law and i n t e r a c t i o n a l patterns are too complex to be described i n terms of a l i n e a r relationship as required by Type B Law. While i t i s to be expected that the family's concept of themselves during drinking and non-drinking times w i l l be necessarily i d i o s y n c r a t i c , an invariant r u l e may be suggested by the r e l a t i o n s h i p between relevant variables. This suggests the a p p l i c a b i l i t y of Type C law to t h i s study. This study assumes that drinking and non-drinking a f f e c t s f a m i l i e s i n terms of how they view themselves i n the context of t h e i r relationships and that these views are l i v e d out i n everyday conversations and behaviour. The s p e c i f i c nature of these views and who contributes them to the family paradigm i s expected to reveal i d i o s y n c r a t i c patterns from which common themes may emerge. As Type C law i s expected to be operative, intensive case study i s appropriately u t i l i z e d . - 22 -C a s e S u b j e c t s As i s appropriate to intensive case studies i t i s important to select a diverse sample so as to develop an understanding of any major patterns represented (Chassan, 1979) . In t h i s study, what i s of intere s t i s the s h i f t i n g of family and indi v i d u a l self-concepts between periods of drinking and non-drinking, the kinds of concepts influenced, and the rol e s of i n f l u e n t i a l individuals. S c r e e n i n g a n d S e l e c t i o n In order to give some d i f f e r i n g views to the phenomenon being studied, two families were selected through contacts within an Alcohol and Drug Program Outpatient C l i n i c . C r i t e r i a for the inclusion of alc o h o l i c subjects were male, age 21-60, who are presently l i v i n g i n an i n t a c t family, who score 5 or greater (an indication of alcoholism) on the Michigan Alcoholism Screening Test (Selzer, 1971), meet DSM III c r i t e r i a for the diagnosis of alcoholism and have developed a binge drinking pattern that i s consistent with the binge drinking pattern p r o f i l e of the Present Drinking Pattern section of the Comprehensive Drinker P r o f i l e . As the study i s interested i n studing family interaction, a l l a l c o h o l i c s must have an available partner w i l l i n g to p a r t i c i p a t e i n the study and have at least one c h i l d aged 12 or older presently l i v i n g i n the home who w i l l also be involved i n the study. As families themselves are diverse i n nature, something - 23 -other than d i v e r s i t y i n any sample seems un l i k e l y , and true to form, the families i n t h i s study were d i f f e r e n t i n terms of c o n s t e l l a t i o n (gender of s i b l i n g s ) , drinking severity, stage of "recovery", and stage of development of the family l i f e -c ycle. One family, for instance, was well along the path to "recovery", having had several months of sobriety. The same family was further along i n terms of the developmental family l i f e - c y c l e , and i n the process of launching c h i l d r e n from the home. The second family interviewed was quite young, with two children, as yet not i n school and a t h i r d c h i l d , 12 years of age. Case S u b j e c t D e s c r i p t i o n s In a l l , 6 subjects were recruited, 2 f a m i l i e s of three members each, ranging i n age from 41 to 13. In Family A the father (41) f i r s t began drinking alcohol at 12 years of age. He was the middle c h i l d of 5 s i b l i n g s and reported that i n addition to alcohol a f f e c t i n g him i t had also affected h i s father and the other surviving c h i l d r e n (male) i n the family. Two of his s i b l i n g s , the eldest (female, 29) and the youngest (male, 24) died of natural causes 14 and 13 years ago respectively. The father also reported that while growing up, punishment was often extreme and abusive and as a r e s u l t of these experiences and that of being molested by h i s grandfather, he learned to keep his feelings to himself. At 2 5 years of age he married and two years l a t e r they had a son. His wife had previously been married (at the age of 19) and had three children while i n that r e l a t i o n s h i p . She divorced i n 1973 and remarried into t h i s current r e l a t i o n s h i p . Six years l a t e r her ex-husband committed suici d e . The (current) father has since adopted a l l three chi l d r e n . The mother (41) came from a family of 3 s i b l i n g s , her brother i s 44 married and l i v e s "back east", and her s i s t e r (38) i s remarried and l i v e s nearby. She f e e l s she had a "good r e l a t i o n s h i p " with both her parents, but had a l o t of r e s p o n s i b i l i t y early i n her l i f e because her "mother had to work". The father reported that he "drank o f f and on for the past 25 years", he describes himself as a "binge drinker", that i s drinking for short episodes, periods of time usually not more than 5 or 6 hours at c l e a r l y defined i n t e r v a l s . At any one drinking occasion he might drink 8 - 1 2 drinks usually beer or wine, although reported that "occasional drinking binges have lasted as long as four or f i v e days". The father explained that he "had not been the only bread winner i n the family over the years". His wife suggested that "perhaps p a r t l y as a r e s u l t of having only achieved a grade 8 education, and p a r t l y due to the drinking", h i s employment s i t u a t i o n had fluctuated frequently. As a r e s u l t the family f i n a n c i a l s u r v i v a l could not depend on the father's income. The r e l a t i o n s h i p between the father and the eldest son was - 25 -f e l t to be c o n f l i c t u a l , p a rtly they said, as a r e s u l t of a "power struggle". The father f e l t his p o s i t i o n i n the family had been undermined by a lack of formal education, steady employment, and by alcoholism. At the time of our meeting the father had been i n "the program" (A.A.) for three years, had attended r e s i d e n t i a l alcoholism treatment, and had been involved, along with other family members, i n outpatient counselling for a s i m i l a r length of time. With the exception of the youngest son the c h i l d r e n were mostly out on t h e i r own. The eldest 21, was l i v i n g on h i s own i n a nearby community and was working as an assistan t cook at a l o c a l restaurant. The mother reported that he had a good r e l a t i o n s h i p with the children and would often represent the "kid's view" i n family discussions concerning d i s c i p l i n e or p r i v i l e g e s . I t was explained that the youngest g i r l (17) "was i n a kind of t r a n s i t i o n phase" and the family was having a d i f f i c u l t time t r y i n g to balance her needs for independence with t h e i r views of safety and respect. At the moment she too was l i v i n g independently and did not attend our meetings. The second eldest (19) was attending u n i v e r s i t y . She had apparently always done well at school, and although had a boyfriend that the mother did not approve of seemed to be doing well generally and was not very involved i n the family. The youngest (13) was involved and outspoken i n our meeting and, according to the mother, was deserving of h i s reputation - 26 -as the family "character". He also did well at school, had close friends and enjoyed sports. In Family B, alcohol had affected both parents to some extent, although both agreed the father "drank more heavily and more frequently" than did the mother. The father (32) reported that he f i r s t began drinking alcohol i n h i s l a t e teens, around the time his parents separated. Heavy drinking binges that have included blackouts have been usual occurrences over the past eleven years. The father reported that h i s father was a successful businessman who separated from h i s mother "at least p a r t l y as a r e s u l t of her drinking problems". The father explained that the q u a l i t y of the r e l a t i o n s h i p between him and his mother was affected by the alcohol misuse and t h i s "prevented them from being very close". The father comes from a family of four boys of which he i s the youngest. A previous common-law r e l a t i o n s h i p (also with alcohol problems) lasted four years. This couple have been together for the past f i v e years, following the mother's separation from her second husband of seven years. Altogether there are four children, the eldest, a g i r l (12) i s from the mother's f i r s t marriage which lasted f i v e years, the second, also a g i r l (7) , and twin boys (5) are from the second marriage. The mother reported that "each of my previous partners have had alcohol problems". The father described himself as a "binge drinker", that i s , drinking heavily for short periods at a time. At any one - 27 -drinking occasion he might drink about 4 l i t r e s , usually wine, and may repeat t h i s pattern 5 times i n a three month period. Both the mother and the father currently work, although reported that employment had been interrupted i n the past by problems related to drinking and as a r e s u l t the family finances have been unstable and unpredictable. The mother explained that she i s the eldest of f i v e ( a l l female) i n her family, her father died when she was 14 and her mother remarried to a man that also seemed to have an alcohol problem. The mother reported that she finds her family of o r i g i n to be "a source of advice", but at the same time she tends to f i n d them quite "demanding and needy", as a r e s u l t she often comes away from her v i s i t s "more drained than rejuvenated". The mother reported that she f e e l s quite influenced by her family and that t h i s i s not always something that i s pleasing to her. At the time of our meeting the father had been receiving some addit i o n a l alcohol counselling through the employee assistance program offered at his workplace, however neither he nor h i s spouse had achieved any extended periods of sobriety. With the exception of the eldest daughter, the childr e n were too young to complete the Q-sort. The eldest daughter was described as i n a kind of t r a n s i t i o n phase as she had changed schools recently and was moving towards her teens and greater independence. - 28 -The Case Study I n v e s t i g a t o r In case studies, the quality of the case study depends d i r e c t l y on the experience and expertise that the case study investigator can bring to the data c o l l e c t i o n . In the case study, data c o l l e c t i o n i s for the most part not r o u t i n i z e d as i t i s with laboratory experiments or surveys. For these reasons the case study investigator requires c e r t a i n s k i l l s (Yin 1984; p.56). Yin suggests the case study investigator should be able to ask good questions and interpret the answers, should be a good l i s t e n e r and not be trapped by h i s or her own ideologies or preconceptions, should be adaptive and f l e x i b l e so that newly encountered situations can be seen as opportunities, not threats. Yin also suggests the case study investigator must have a firm grasp of the issues being studied, whether t h i s i s a t h e o r e t i c a l or p o l i c y orientation, even i n an exploratory mode. Such a grasp reduces the relevant events and information to be sought to manageable proportions. An investigator should be unbiased by preconceived notions, included those derived from theory. Thus a case study investigator should be sensitive and responsive to contradictory evidence (p. 56-57). The investigator for t h i s project has received graduate l e v e l t r a i n i n g i n counselling psychology and i s a registered c l i n i c a l counsellor i n B.C. In addition, he has been a p r a c t i s i n g family and addictions counsellor for s i x years who - 29 -has been able to demonstrate h i s knowledge of family and addiction issues to colleagues, supervisors, and other p r a c t i t i o n e r s i n the f i e l d . Instruments The Michigan Alcoholism Screening Test (MAST) and DSM III c r i t e r i a were used to screen the subjects as appropriate for the research project. The MAST has been found to be even better than the best laboratory tests to screen f o r the presence of excessive drinking on large populations (Donovan and Marlatt, 1988 p. 121). "Bernadt et a l . (1984) compared the e f f i c a c y of b r i e f questionnaire administration with laboratory t e s t s i n screening 385 psy c h i a t r i c admissions for excessive alcohol use. On a discriminant analysis, the b r i e f MAST (Seltzer, 1971) was the best discriminator of the presence of alcoholism and of excessive drinking, followed by the CAGE (Mayfield, McLeod, and H a l l , 1974) and the Reich interview (Reich et a l . , 1975)." (Donovan and Marlatt, 1988 p. 125). A score on the MAST of 3 points or less i s considered nonalcoholic, a score of 4 points i s considered suggestive of alcoholism, and a score of 5 points or more i s i n d i c a t i v e of alcoholism (Selzer, 1971). The DSM III (1987) suggests that i n order to diagnose a substance abuse disorder a person must demonstrate; A. A pattern of pathological alcohol use: need fo r d a i l y use of alcohol for adequate functioning; i n a b i l i t y to cut - 30 -down or stop drinking; repeated e f f o r t s to control or reduce excess drinking by "going on the wagon" (periods of temporary abstinence) or r e s t r i c t drinking during c e r t a i n times of the day; binges (remaining intoxicated throughout the day for at least two days); occasional consumption of a f i f t h of s p i r i t s (or i t s equivalent i n beer or wine); amnesic periods for events occurring while intoxicated (blackouts) ; continuation of drinking despite a serious physical disorder that the i n d i v i d u a l knows i s exacerbated by alcohol use; drinking of non-beverage alcohol. B. Impairment i n s o c i a l or occupational functioning due to alcohol use: e.g., violence while intoxicated, absence from work, loss of job, legal d i f f i c u l t i e s (e.g. arrest for intoxicated behaviour, t r a f f i c accidents while intoxicated), arguments or d i f f i c u l t i e s with family or friends because of excessive alcohol use. C. Duration of disturbance of at least one month (Diagnostic and S t a t i s t i c a l Manual of Mental Disorders I I I , 1987). I t would seem clear that from the s p e c i f i c questions endorsed on the MAST and from the semi-structured family interview responses that the subjects responded i n a manner that would be consistent with the diagnosis of alcoholism. The presence of an Alternator drinking pattern (commonly described as binging) w i l l be determined by the Present Drinking Pattern section of the Comprehensive Drinker P r o f i l e (Marlatt and M i l l e r , 1984). A family with an Alternator drinking pattern would have a family member f i t t i n g the Periodic Drinker description (drinks less often than once a week and i s abstinent between drinking periods). In t h i s pattern the drinker t y p i c a l l y alternates between periods of several weeks to several months when active drinking i s occurring (wet periods) and periods of weeks to months when no drinking i s occurring. The d i s t i n g u i s h i n g - 31 -feature of t h i s pattern i s that alternating between wet and dry periods has occurred multiple times during the l i f e h i s t o r y of the family (Steinglass, p.185). A measure of binge severity was obtained from the Episodic Pattern Chart. This included the duration of the binge i n hours, t o t a l alcohol consumed, and peak alcohol l e v e l s , as well as frequency of binge episodes per 3 month period. McMaster Family Assessment Device FAD McMaster Family Assessment Device (FAD) was developed from the McMaster Model of Family Functioning which describes s t r u c t u r a l and organizational properties of the family group and the patterns of transactions among family members that have been found to distinguish between healthy and unhealthy f a m i l i e s (Epstein et a l . 1983). Six dimensions of family functioning have been i d e n t i f i e d by the McMaster model and the FAD scales were developed to r e f l e c t the content of these dimensions (Epstein et a l . 1983). The FAD i s comprised of 7 scales: Problem Solving, r e f e r s to the family's a b i l i t y to resolve every day problems that could threaten the i n t e g r i t y and functional capacity of the family. Communication, assesses the c l a r i t y and directness of verbal messages, which i s defined as the exchange of information among family members. Roles, assess the presence of resources, nurturance, and support, the support of personal - 32 -development, the maintenance and management of the family system, and the provision of adult sexual g r a t i f i c a t i o n . Assessment of the Roles dimension also includes consideration of whether tasks are c l e a r l y and equitably assigned to family members and whether tasks are responsibly performed. Affective Responsiveness assess the extent to which i n d i v i d u a l family members are able to show appropriate a f f e c t over a range of situations (affection, happiness, joy, anger, fear, anxiety, sadness, disappointment, and depression). Affective Involvement measures the extent to which family members place value on and are interested i n each other's concerns and a c t i v i t i e s . Behaviour Control measures behaviour responses i n various situations that d i f f e r s i n terms of control patterns ( f l e x i b l e , r i g i d , l a i s s e z f a i r e , and chaotic). I t i s i n t h i s way that a family maintains and constitutes family standards for i n d i v i d u a l behaviour. And f i n a l l y , General Functioning provides an assessment of the o v e r a l l health of the family. Psychometric properties of the FAD suggest high r e l i a b i l i t y and v a l i d i t y (Epstein et a l . , 1983). The FAD has been used to distinguish between c l i n i c a l and n o n - c l i n i c a l populations, and s p e c i f i c cutoff scores have been shown to d i f f e r e n t i a t e healthy from unhealthy fa m i l i e s , with lower scores indicate healthier responses ( M i l l e r , 1985). Data C o l l e c t i o n Following the procedure outlined i n Figure 3.1, two - 33 -fami l i e s were selected through an informal network of contacts within the Province of B r i t i s h Columbia's Ministry of Labour and Consumer Service's; Alcohol and Drug Outpatient Counselling Programs. Figure 3.1 Procedural Flow Chart Descriptions of the project were c i r c u l a t e d to addictions counsellors, along with guidelines for preliminary subject screening, and information for pote n t i a l subjects. i I Potential subjects were contacted by telephone and a meeting time was arranged. I i I Subject Q-sorting with 60 item sort on s a l i e n t dimensions of family functioning during drinking and non-drinking times. I ; I Semi-structured family interview. 2. 3. Addictions counsellors were given written guidelines for screening p o t e n t i a l families for the study (Appendix A), and a f i n a l screening was done u t i l i z i n g the Michigan Alcoholism Screening Test (MAST) (Appendix C) , DSM III alcoholism c r i t e r i a , and the Comprehensive Drinker P r o f i l e Interview Booklet (Appendix F). Family members complete in d i v i d u a l Q-sorts from a pool of 60 items drawn from the McMaster Family Assessment Device (Appendix D and E). Individual family members were asked to - 34 -sort the items f i r s t as they related to the family during periods of drinking, then again as the items r e l a t e d to periods of non-drinking. Then, the family was given the task of together sorting the items, again as they r e l a t e d to drinking and non-drinking periods. F i n a l l y , a semi-structured interview (Appendix G) was conducted with the family to s o l i c i t the family impressions of the e f f e c t s of drinking on family i n t e r a c t i o n and on the experience of completing the Q-sort. The interview was video-taped for further analysis. S e m i - S t r u c t u r e d I n t e r v i e w The family interview was structured to examine how the drinking had affected; family interaction, family functioning, and, the family's thinking about i t s e l f (family i d e n t i t y ) . The interview served to establish whether or not the Q-Sort adequately and accurately captured a "picture" of the family. Appendix G schedules the general themes explored. The interview was video recorded for the purposes of accurate t r a n s c r i p t i o n s . Through the semi-structured interview the fam i l i e s were asked questions that related to the e f f e c t s of alcohol on family interaction and functioning. The early part of the interview revolved around the construction of a family genogram, a useful c l i n i c a l t o o l for gathering information and exploring family dynamics (McGoldrick and Gerson, 1985) . The domains of decision making, problem solving, intimacy and closeness, and d i s c i p l i n e were discussed, as well as other - 35 -aspects that were of s p e c i f i c i n t e r e s t to the f a m i l i e s themselves. The interviews themselves took about one and one h a l f to two hours. The primary purpose of the interview was to give the family another opportunity to provide information that r e l a t e d to differences i n family functioning during periods of drinking and abstinence. Data A n a l y s i s For each sorting occasion (individual sorts of drinking and non-drinking, and, family sorts of drinking and non-drinking) the Q-sorts were correlated with the Q-sorts of every other sorting occasion to obtain a c o r r e l a t i o n a l matrix of relevant figures based on the s i m i l a r i t y of Q-sort patterns. The data was submitted to a p r i n c i p a l components analysis u t i l i z i n g the WBOL Q-analysis program (Boldt, 1991). The program was based on a paper f i r s t published by Maclean, Danbury, and Talbot i n 1964. The r e s u l t i n g p r i n c i p a l components were then submitted to a varimax r o t a t i o n . Both the c o r r e l a t i o n a l matrix and the p r i n c i p a l components solutions were examined to i d e n t i f y patterns and i m p l i c i t themes with p a r t i c u l a r attention to the c o r r e l a t i o n s of the family Q-sort patterns. The video-tapes were reviewed to i d e n t i f y comments and i n t e r a c t i o n a l patterns that related to the e f f e c t s of alcohol on the family paradigm and the i d e n t i f i c a t i o n of i n f l u e n t i a l family members with respect to s p e c i f i c aspects of the family - 36 -paradigm. The analysis of the c o r r e l a t i o n a l matrix, and the p r i n c i p a l components solutions, and the semi-structured family interview were integrated to develop a p o r t r a i t of the family paradigm and i t s key influencers during periods of drinking and non-drinking. Q-Technique Where the functional relationships and the parameters of variables are i d i o s y n c r a t i c , but where generating values of these re l a t i o n s h i p s are constant, Type C law can be assumed to be operating (Herbst, 1970). According to Kerlinger (1973) Q-methodology i s useful i n the study of i d e n t i t y , i n t e r r e l a t i o n , and functioning of r e l a t i v e l y unknown variables, and that Q-methodology i s p a r t i c u l a r l y suited to intensive case study. Block (1961) suggests that the Q-sort i s useful for obtaining a quantitative description of personality i n psychodynamic terms, and the Georgia Family Q-Sort, while a newly developed observational measure, has been useful i n the study of family functioning (Wampler, Halverson, Moore and Walters, 1989) . Therefore, i t seems appropriate to u t i l i z e Q-methodology here to study family functioning during drinking and non-drinking periods. With the Q-technique of factor analysis the researcher i s interested i n the way people order items or variables and with grouping them into clusters of people who order variables i n s i m i l a r ways. In t h i s way each group of persons could be associated with a d i s t i n c t i v e common ordering of the variable s . In t h i s study the variables are s a l i e n t descriptors of family functioning and in t e r a c t i o n . The s i x t y descriptors were from the McMaster Family Assessment Device. These descriptors r e l a t e to such aspects of family functioning as; Problem Solving, Communication, Roles, A f f e c t i v e Responsiveness, A f f e c t i v e Involvement, Behaviour Control, and General Functioning. S u b j e c t s o f J u d g e m e n t s f o r Q - S o r t s As i n Liepman's study (1989) two domains of family functioning were sampled for each case subject: the family during periods of drinking and the family during periods of non-drinking. Each person as well as the family as a group task sorted the items according to these times i n family l i f e . The main difference i n t h i s study i s i n the way these two domains were explored. The ipsative nature of the Q-sort contrasted with the r e l a t i v e l y independent nature of the McMaster Family Assessment Device allows for an appreciation of the most relevant and discrimination aspects of drinking and non-drinking periods i n family l i f e . Q - S o r t I t e m s This study was b u i l t on Liepman's (1989) study i n that both studies examine the family functioning of male a l c o h o l i c s - 38 -during periods of drinking and abstinence. Further, the McMaster FAD was also used to gather comparative data for these two periods. Based on these considerations, the 60 item sample, l i s t e d i n Appendix D was drawn d i r e c t l y from the rel a t e d study by Liepman. Q - S o r t i n g The 60 items referred to i n Table 3.1 were used by subjects during the Q-sorting session. Family members sorted cards which were placed according to the extent to which that p a r t i c u l a r descriptor related to that subject's perception of t h e i r family during the period i n question (either drinking or non-drinking). Following are the instructions used for sorting the descriptors: 1) Please take the cards and notice that a good many of them are descriptive or c h a r a c t e r i s t i c of your family to a greater or lesser degree. Others are quite uncharacteristic of the way you see your family. 2) As a f i r s t step, take a moment to think about the times when drinking was (not) going on i n your family, the kinds of things that were going on and how you f e l t about yourself and other family members. 3) Now pick out the phrases you f e e l are a l o t l i k e your family during t h i s time and put them i n a p i l e on your r i g h t . 4) Now pick out the phrases that you f e e l are not at a l l l i k e your family and put them i n another p i l e on your l e f t . 5) Put the others i n a p i l e i n the middle. 6) Now you w i l l notice that there are seven pieces of paper spread out on the table i n front of you ranging from lea s t c h a r a c t e r i s t i c to most c h a r a c t e r i s t i c of your - 39 -family, and each as a number on i t . 7) On the p i l e that says Most Cha r a c t e r i s t i c you can only place 1 card. On the p i l e that says Quite C h a r a c t e r i s t i c you can only place 3 cards. On the p i l e that says F a i r l y C h a r a c t e r i s t i c you can place 14 cards, and so on. 8) Working from the f i r s t p i l e you made of cards that are a l o t l i k e your family, and drawing from the middle p i l e i f you have to, sort those cards into what you think i s the best category. Remember you have to keep to the numbers for each category. 9) Now working from the p i l e of cards on your l e f t , the leas t l i k e p i l e , place 1 card i n the Most Uncharacteristic p i l e , 3 cards i n the Quite Uncharacteristic p i l e and 14 cards i n the F a i r l y Uncharacteristic p i l e . 10) At t h i s point you should have 24 cards l e f t f or the Neutral p i l e . Take a second look at your sort and check to make sure the cards are a l l where you want them. The directions for the family Q-sort d i f f e r e d only to the extent that the family was instructed to perform the task together. The family was not t o l d how to a r r i v e at t h e i r decisions regarding the placement of the cards so as to minimize interference with the families own group decision making process. The structure of the Q-sort used i n t h i s study i s outlined i n Figure 3.2. - 40 -Figure 3.2 Q-sort D i s t r i b u t i o n . Evaluative Least Descriptive of Neutral Most Characteristic of Criteria Family during Drinking or Family during Drinking & Non-Drinking Periods Undecided & Non-Drinking Periods Frequency 1 3 14 24 14 3 1 Q-Score 1 2 3 4 5 6 7 - 41 -CHAPTER IV RESULTS Introduction In t h i s chapter data gathered from a combination of standardized instruments, Q-sort methodology, and the semi-structured interview w i l l be used to explore the following questions: Do descriptions of family functioning (the family s e l f -image or paradigm) d i f f e r , for drinking and non-drinking periods? Do responses to s p e c i f i c questions purported to evaluate such s a l i e n t dimensions of family functioning as Problem Solving, Communication, Roles, A f f e c t i v e Responsiveness, A f f e c t i v e Involvement, Behaviour Control, and General Functioning d i f f e r for periods of drinking and abstinence? Do descriptions regarding family functioning derived from the family as a group d i f f e r from i n d i v i d u a l descriptions? Who i n the family contributes the most to the a l c o h o l i c family paradigm? Does the a l c o h o l i c contribute to the family paradigm or i s s/he more distant and less i n f l u e n t i a l i n the family as much of the l i t e r a t u r e predicts? Screening and Assessment Instrument Results The use of the MAST and the Episodic Pattern Chart while - 42 -acting as a screening device for acceptance into the study also contributed some information to the general p i c t u r e of the family from the perspective of the problem drinker. Table 4.1 shows the r e l a t i v e MAST scores for the i d e n t i f i e d problem drinker i n the families studied. Table 4.1 MAST Scores for Ide n t i f i e d Problem Drinkers i n Families Studied Case A Family Case B Family Member Member MAST Score 45/54 47/54 Table 4.2 shows the r e l a t i v e responses obtained from the Episodic Pattern Chart for the families studied. Table 4.2 Quantity and Frequency of Episodic Drinking Case A Family Case B Family Total Drinks i n SEC's (# oz. X % alcohol X 2) 1200 SEC's 4000 SEC's Number of episodes/ 3 month period 5 episodes 5 episodes Although there are c l e a r l y some differences i n terms of quantity of alcohol consumed on each drinking occasion, both drinking patterns are consistent with an alternator or binge - 43 -a l c o h o l i c drinking pattern. However the source of most of the quantitative information was the Q-sort data. To examine how the items re l a t e d to each other the Q-sort for each family member and the family as a group was factor analyzed using the p r i n c i p a l components method with varimax rotation. Using an eigen value >1, the i n i t i a l factor analysis produced, i n the case of Family A, a 1-factor solution for non-drinking periods and a 2-factor solution for drinking periods. In the case of Family B, a 1-factor solution was produced for both drinking and non-drinking periods. P r e l i m i n a r y A n a l y s i s of Q-sorts For each family member i n d i v i d u a l l y , and f o r the family as a group, the Q-sort pattern of responses for drinking and non-drinking periods was correlated with the Q-sort patterns of every other pattern of responses for drinking and non-drinking periods within the family. The matrix of in t e r c o r r e l a t i o n s were run through a p r i n c i p a l components analysis, and both the rotated and unrotated solutions were examined for i n t e r p r e t a b i l i t y . Correspondences between i n d i v i d u a l family members and/or the family as a group along the dimension of drinking (or non-drinking) were understood to be i n d i c a t i v e of a sim i l a r view of the family paradigm. This addressed the research questions related to the d i f f e r i n g descriptions of family functioning including, the family as a \ - 44 -group and ind i v i d u a l descriptions, i t also provided an i n d i c a t i o n of who i n the family i s i n f l u e n t i a l i n terms of the family paradigm. Each pattern of sorting the items, associated with each p r i n c i p a l component or factor was estimated. This was done by weighing each item response of each of the persons most highly associated with a given factor (including the family as a group which acts as a hypothetical individual) by the degree to which they are loaded on that factor. The higher a person's loading on a factor, the greater was the weight. These weighted responses were summed across each item separately. This produced an item array of weighted responses for each factor i n the rotated factor analysis solution selected. The arrays of weighted responses were then converted to z-scores. The arrays of item z-scores were ordered from most accepted to most rejected for each component. This provided a hierarchy of items for each factor or p r i n c i p a l component. The arrays of items for each p r i n c i p a l component were compared by subtraction for each pair of p r i n c i p a l components. This produced arrays of difference scores for each p a i r of p r i n c i p a l components and provides the basis for d i f f e r e n t i a t i n g one type of p r i n c i p a l component from another. An examination of the s p e c i f i c items f a c i l i t a t e d an understanding of the extent questions purported to evaluate family functioning varied for periods of drinking and - 45 -abstinence. Family A (Non-drinking) Table 4.3 shows the c o r r e l a t i o n a l matrix f o r Family A during non-drinking periods. Table 4.3 Family A Non-drinking Correlational Matrix Husband Wife Child Family Husband 1.00 Wife -0.24 1.00 Child 0.21 0.16 1.00 Family 0.16 0.30 -0.16 1.00 Table 4.4 shows the eigen values and variance for each of the factors for Family A for non-drinking periods. Table 4.4 Family A Non-drinking Eigen Values and % of Variance Eigen 1.33 1.20 1.09 0.38 Values % of 33 63 90 100 Variance Using an eigen value > 1, 90.5% of the variance was accounted for i n the re s u l t i n g 3 p r i n c i p a l component solut i o n (Table 4.5). - 46 -Table 4.5 Family A Non-drinking: Unrotated P r i n c i p a l Component Solution PCI PC2 PC3 Husband Wife Child Family -0.43 0.82 -0.20 0.65 0.76 0.22 0.65 0.41 0.40 -0.39 -0. 68 0.56 The unrotated p r i n c i p a l component solution for Family A for non-drinking periods (Table 4.5) shows strong association with both PC2 and PC3 for the c h i l d , i t also shows a strong association with both PCI and PC3 for the family sort. A strong association with more than one p r i n c i p a l component i s less desirable as i t clouds i n t e r p r e t a b i l i t y . For Family A non-drinking the rotated s o l u t i o n seemed more amenable to interpretation (Table 4.6). Both the Wife and the Family pattern of Q-sort responses are associated with PCI, the Husband's pattern of Q-sort responses i s associated with PC2 and the Child i s associated (inversely) with PC3. The weights for the sorts indicate that the Family i s most representative of PCI (5.29 as compared to 1.13 for the Wife). The Husband i s most representative of PC2 (6.88) and the C h i l d i s most representative (although inversely) of PC3 (-9.74). - 47 -Table 4.6 Family A Non-drinking: Rotated P r i n c i p a l Component Solution PCI PC2 PC3 Husband 0.11 Wife 0.65 Child -0.09 Family 0.91 0.93 -0.19 0.54 -0.41 0.14 -0.95 0.20 0.20 These r e s u l t s suggest that the Family's pattern of responses are sim i l a r to the Wife's pattern of responses. This suggests that the Wife i s the most i n f l u e n t i a l family member with respect to the family paradigm as i t r e l a t e s to non-drinking periods. Table 4.7 shows the s p e c i f i c items that contributed to d i f f e r e n t i a t e PCI (Wife-Family) from PC2 (Husband). - 48 -Table 4 .7 Dimensions (items) which D i f f e r e n t i a t e PCI from P C 2 f o r Family A F u n c t i o n i n g f o r Non-drinking P e r i o d s # Item Key Difference More than PC2, PC1 considers characteristic: 41. Making a decision is a problem for our famity. Unhealthy General Functioning 4 .00 54. Even though we mean well, we intrude too much into each others lives. Unhealthy Affective Involvement 4 .40 31. There are lots of bad feelings in the famity. Unhealthy General Functioning 2 .27 49. We express tenderness. Healthy Affective 2 .14 Responsiveness 40. We discuss who is to do household jobs. Healthy Roles 1 .96 26. We can express feelings to each other. Healthy General Functioning 1 .96 17. You can easily get away with breaking the rules. Unhealthy Behaviour Control 1 .89 33. We get involved with each other only when something interests us. Unhealthy Affective Involvement 1 .85 1. Planning family activities is difficult because we misunderstand each other. Unhealthy General Functioning 1 .22 52. We don't talk to each other when we are angry. Unhealthy Communication 1 .04 35. We don't often say what we mean. Less than PC2, PC1 considers characteristic: Unhealthy Communication 1. .04 38. We resolve most emotional upsets that come up. Healthy -1, .04 Problem Solving 30. Each of us has particular duties and responsibiIi ties. Healthy Roles -1, .04 16. Individuals are accepted for what they are. Healthy General Functioning -1, .18 29. We talk to people directly rather than through go-betweens. Healthy Communication -1. .40 14. You can't tell what a person is feeling from what they are saying. Unhealthy Communication -1. .96 11. We cannot talk to each other about the sadness we feel. Unhealthy General Functioning -1. .96 7. We know what to do when an emergency comes up. Unhealthy Behaviour Control -2. .03 18. People come right out and say things instead of hinting at them. Healthy Communication -2. .1 4. When you ask someone to do something, you have to check that they did i t . Unhealthy Roles -2. .82 2. We resolve most everyday problems around our house. Healthy Problem Solving -3. .49 - 49 -The r e s u l t s indicate that m o r e than PC2 (Husband), PCI (Wife-Family) considers item #41 "Making decisions i s a problem f o r our family." (Unhealthy General Functioning) to be c h a r a c t e r i s t i c of the family for non-drinking periods. The re s u l t s also indicate that l e s s than PC2 (Husband) , PCI (Wife-Family) considers item #2 "We resolve everyday problems around our house." (Healthy Problem Solving) to be most c h a r a c t e r i s t i c of the family f or non-^drinking periods. Overall, 8 unhealthy items out of a possible 12 were found to be more representative of the family according to the Wife-Family than the Husband. In addition 6 out of a possible 10 healthy items were considered to be less c h a r a c t e r i s t i c by the Wife-Family than by the Husband for periods of non-drinking. Table 4.8 and 4.9 show the s p e c i f i c items that d i f f e r e n t i a t e PCI (Wife-Family) from PC3 (Child). The results indicate that m o r e than PC3 (Child), PCI (Wife-Family) f e e l item #36 "We f e e l accepted for what we are." (Healthy General Functioning) i s c h a r a c t e r i s t i c of the family during non-drinking periods. The resu l t s also indicate (Table 4.9) that l e s s than PC3 (Child) , PCI (Wife-Family) f e e l item #29 "We ta l k to people d i r e c t l y rather than through go-betweens." (Healthy Communication) i s c h a r a c t e r i s t i c of the family during non-drinking periods. Overall, 7 out of a possible 14 healthy items were f e l t to be more c h a r a c t e r i s t i c of the family according to the Wife-Family than the c h i l d during non-drinking periods. - 50 -Table 4.8 Dimensions (items) which D i f f e r e n t i a t e PCI as More Cha r a c t e r i s t i c of Family A Functioning than PC2 for Non-drinking Periods # Item Key Difference More than PC3, PC1 considers characteristic: 36. We feel accepted for what we are. Healthy 2. .78 General Functioning 6. In times of crisis we can turn to each other for Healthy 2. .75 support. General Functioning 60. We try to think of different ways to solve Healthy 2. .03 problems. Problem Solving 52. We don't talk to each other when we are angry. Unhealthy 1. .96 Communication 35. We don't often say what we mean. Unhealthy 1. .96 Communication 26. We can express feelings to each other. Healthy 1.96 General Functioning 17. You can easily get away with breaking the rules. Unhealthy 1. .89 Behaviour Control 59. When we don't like what someone has done, we Healthy 1. .85 tell them. Communication 45. If people are asked to do something, they need Roles 1. ,60 reminding. Unhealthy 16. Individuals are accepted for what they are. Healthy 1. .60 General Functioning 49. We express tenderness. Healthy 1. ,23 Affective Responsiveness 1. Planning family activities is difficult because Unhealthy 1. .23 we misunderstand each other. General Functioning 53. We are generally dissatisfied with the family Roles 1. ,11 duties assigned to us. Unhealthy 15. Family tasks don't get spread around enough. Unhealthy 1. ,11 Roles In addition 11 out of 15 unhealthy items were considered to be less c h a r a c t e r i s t i c by the wife-family than by the c h i l d during the same non-drinking period. - 5 1 -Table 4.9 Dimensions (items) which D i f f e r e n t i a t e PCI as Less C h a r a c t e r i s t i c of Family A F u n c t i o n i n g than P C 3 f o r Non-drinking P e r i o d s # Item Key Difference Less than PC3, PC1 considers characteristic: 30. Each of us has particular duties and respons i biIi t i es. Healthy Roles -1, .04 14. You can't tell what a person is feeling from what they are saying. Unhealthy Communication -1, .04 11. We cannot talk to each other about the sadness we feel. Unhealthy General Functioning -1 .64 39. Tenderness takes second place to other things in our famity. Unhealthy Affective Responsiveness -1 .11 18. People come right out and say things instead of hinting at them. Healthy Communication -1 .22 31. There are lots of bad feelings in the family. Unhealthy General Functioning -1, .43 2. We resolve most everyday probtems around our house. Healthy Problem Solving -1, .64 58. We don't have reasonable transport. Roles Unhealthy -1, .78 34. There's l i t t le time to explore personal interests. Unhealthy Roles -1, .78 28. We do not show our love for each other. Unhealthy Affective Responsiveness -1, .78 51. We don't get along welt together. Unhealthy General Functioning -1. .85 4. When you ask someone to do something, you have to check that they did it . Unhealthy Roles -1. .89 24. After our family tries to solve a problem, we Healthy -1. .96 usually discuss whether it worked or not. Problem Solving 42. Our family shows interest in each other only when they can get something out of i t . Unhealthy Affective Involvement -2. .03 37. We show interest in each other when we can get something out of it personally. Unhealthy Affective Involvement -2. .22 29. We talk to people directly rather than through go-betweens. Healthy Communication -2. .33 - 52 -Table 4.10 and 4.11 show the s p e c i f i c items that d i f f e r e n t i a t e PC2 (Husband) from PC3 (Child). The r e s u l t s Table 4 . 1 0 Dimensions (items) which D i f f e r e n t i a t e PC2 as More Ch a r a c t e r i s t i c of Family A Functioning than PC3 f o r Non-drinking Periods # Item Key Difference More than PC3, PC2 considers characteristic: 36. We feel accepted for what we are. Healthy 2, .78 General Functioning 60. We try to think of different ways to solve Healthy 2, .78 problems. Problem Solving 16. Individuals are accepted for what they are. Healthy 2. .78 General Functioning 7. We know what to do when an emergency comes up. Unhealthy 2, .78 Behaviour Control 66. In times of crisis we can turn to each other for Healthy 2. .78 support. General Functioning 59. When we don't like what someone has done, we Healthy 1, .85 tell them. Communication 45. If people are asked to do something, they need Unhealthy 1. .85 reminding. Roles 2. We resolve most everyday problems around our Healthy 1. .85 house. Problem Solving 12. We usually act on our decisions regarding Healthy 1. .85 problems. Problem Solving indicate that more than PC3 (Child) , PC2 (Husband) f e e l s item #3 6 "We f e e l accepted for what we are." (Healthy General Functioning) i s c h a r a c t e r i s t i c of the family during non-drinking periods. The res u l t s also indicate (Table 4.11) that less than PC3 (Child), PC2 (Husband) fe e l s item #31 "There are a l o t of bad feelings i n the family." (Unhealthy General Functioning) i s c h a r a c t e r i s t i c of the family during non-- 53 -drinking periods. Table 4.11 Dimensions (items) which D i f f e r e n t i a t e PC2 as Less C h a r a c t e r i s t i c of Family A Functioning than PC3 for Non-drinking Periods Item Key Difference tess than PC3, PC2 considers characteristic: 48. Anything goes in our family. 40. We discuss who is to do household jobs. 28. We do not show our love for each other. 24. After our family tries to solve a problem, we usually discuss whether it worked or not. 51. We don't get along well together. 42. Our family shows interest in each other only when they can get something out of it . 37. We show interest in each other when we can get something out of it personally. 54. Even though we mean well, we intrude too much into each others lives. 33. We get involved with each other only when something interests us. 32. We have rules about hitting people. 41. Making a decision is a problem for our family. 31. There are lots of bad feelings in the family. Unhealthy Behaviour Control Healthy Roles Unhealthy Affective Responsiveness Healthy Problem Solving Unhealthy General Functioning Unhealthy Affective Involvement Unhealthy Affective Involvement Unhealthy Affective Involvement Unhealthy Affective Involvement Healthy Behaviour Control Unhealthy General Functioning Unhealthy General Functioning 1.85 1.85 1.85 1.85 1.85 1.85 1.85 2.78 2.78 2.78 3.70 3.70 Overall, 7 out of a possible 9 healthy items were f e l t to be more c h a r a c t e r i s t i c of the family according to the husband than the c h i l d during non-drinking periods. In addition 9 out of 12 unhealthy items were considered to be less c h a r a c t e r i s t i c by the husband than by the c h i l d during the same non-drinking period. - 54 -F a m i l y A ( D r i n k i n g ) Table 4.12 shows the c o r r e l a t i o n a l matrix for Family A for drinking periods. T a b l e 4 . 1 2 Family A Drinking Correlational Matrix Husband Wife Child Family Husband 1.00 Wife 0.57 1.00 Child 0.01 0.30 1.00 Family 0.16 0.20 0.20 1.00 Table 4.13 shows the eigen values and variance for each of the factors for Family A during drinking periods. T a b l e 4 . 1 3 Family A Non-drinking Eigen Values and % of Variance Eigen 1.50 1.03 0.77 0.70 Values % of 38 63 83 100 Variance Using an eigen value > 1, 63.2% of the variance was accounted for i n the re s u l t i n g 2 p r i n c i p a l component solution (Table 4.14). - 55 -T a b l e 4 . 1 4 Family A Drinking: Unrotated P r i n c i p a l Component Solution PCI PC2 Husband Wife Child Family 0.30 0.71 0.69 0. 65 0.86 -0.26 -0.37 0.28 The unrotated p r i n c i p a l component so l u t i o n for Family A for drinking periods (Table 4.14) shows association with PCI for the Wife, Child and Family. PC2 shows association with the Husband only. The rotated solution (Table 4.15) c l a r i f i e s the association indicating that the Wife and Child are associated with PCI and the Husband and Family are associated with PC2. The weights for the sorts indicate that the C h i l d i s only s l i g h t l y more representative of PCI (2.10 as compared to 1.71 for the wife) . The Husband i s the most representative of PC2 (5.29 as compared to .67 for the Family). These r e s u l t s suggest that the Husband i s i n f l u e n t i a l with respect to the family paradigm for periods of drinking, and that the Wife and Child are more l i k e each other i n t h e i r view of the family than l i k e the Husband and h i s view of the family f o r drinking periods. - 56 -Table 4.15 Family A Drinking: Rotated P r i n c i p a l Component Solution PCI PC2 Husband Wife Child Family -0.10 0.75 0.79 0.46 0.91 0.08 -0.03 0.54 Table 4.16 and 4.17 show the s p e c i f i c items that contributed to d i f f e r e n t i a t e PCI (Child-Wife) from PC2 (Husband-Family). The res u l t s indicate that more than PC2 (Husband-Family), PCI (Child-Wife) considers item #52 "We don't t a l k to each other when we are angry." (Unhealthy Communication) to be c h a r a c t e r i s t i c of the family f o r drinking periods. The r e s u l t s also indicate (Table 4.17) that less than PC2 (Husband-Family), PCI (Wife-Child) considers item #48 "Anything goes i n our family." (Unhealthy Behaviour Control) i s c h a r a c t e r i s t i c of the family for drinking periods. Overall, 7 out of a possible 13 unhealthy items were f e l t to be more c h a r a c t e r i s t i c of the family according to the Child-Wife than the Husband-Family during non-drinking periods. In addition 7 out of a possible 12 Healthy items were f e l t to be less c h a r a c t e r i s t i c by the Child-Wife than by the Husband-Family for drinking periods. - 57 -T a b l e 4 . 1 6 Dimensions ( items) which D i f f e r e n t i a t e PCI as More C h a r a c t e r i s t i c o f F a m i l y A F u n c t i o n i n g t h a n PC2 f o r D r i n k i n g P e r i o d s # Item Subscale Difference More than PC2, PC1 considers characteristic: 52. We don't talk to each other when we are angry. Unhealthy 3 .97 Communication 58. We don't have reasonable transport. Roles 2 .69 Unhealthy 56. We confide in each other. Healthy 2 .30 General Functioning 35. We don't often say what we mean. Unhealthy 2 .29 Communication 57. We cry openly. Healthy 1 .91 Affective Responsiveness 4. When you ask someone to do something, you have Unhealthy 1 .90 to check that they did i t . Roles 26. We can express feelings to each other. Healthy 1, .64 General Functioning 47. If the rules are broken, we don't know what to Unhealthy 1. .54 expect. Behaviour Control 51. We don't get along well together. Unhealthy 1 .53 General Functioning 50. We confront problems involving feelings. Healthy 1, .39 Problem Solving 19. Some of us just don't respond emotionally. Unhealthy 1, .28 Affective Responsiveness 24. After our family tries to solve a problem, we Healthy 1. .05 usually discuss whether it worked or not. Problem Solving 40. We discuss who is to do household jobs. Healthy 1. .03 Roles - 58 -Table 4.17 Dimensions (items) which D i f f e r e n t i a t e PCI as Less C h a r a c t e r i s t i c of Family A Functioning than PC2 for Drinking Periods Item Key Difference tess than PC2, PC1 considers characteristic: 30. Each of us has particular duties and responsibiIi ties. 46. We are able to make decisions about how to solv problems. 5. If someone is in trouble the others become too involved. 3. When someone is upset the others know why. 43. We are frank with each other. 20. We know what to do in an emergency. 31. There are lots of bad feelings in the family. 33. We get involved with each other only when something interests us. 12. We usually act on our decisions regarding problems. 10. We make sure members meet their family responsibiIities. 22. It is difficult to talk to each other about tender feelings. 48. Anything goes in our family. Healthy -1. .02 Roles Healthy -1, .02 General Functioning Unhealthy -1. .03 Affective Involvement Healthy -1, .03 Communication Healthy -1.03 Communication Healthy -1. .03 Behaviour Control Unhealthy -1, .14 General Functioning Unhealthy -1. .15 Affective Involvement Healthy -1, .40 Problem Solving Healthy -1. .40 Roles Unhealthy -3. .45 Communication Unhealthy -4. .71 Behaviour Control F a m i l y B (Non-drinking) Table 4.18 shows the c o r r e l a t i o n a l matrix f o r Family B during non-drinking periods. - 59 -Table 4.18 Family B Non-drinking Co r r e l a t i o n a l Matrix Husband Wife Child Family Husband 1.00 Wife 0.17 1.00 Child 0.16 • 0.27 1.00 Family 0.50 0.29 0.43 1.00 Table 4.19 shows the eigen values and variance for each of the factors for Family B for non-drinking periods. Table 4.19 Family B Non-drinking Eigen Values and % of Variance Eigen 1.93 0.91 0.75 0.41 Values % of 48 71 90 100 Variance Using an eigen value > 1, 48.3% of the variance was accounted for i n the r e s u l t i n g 1 p r i n c i p a l component solut i o n (Table 4.20). As only one factor was retained no r o t a t i o n was done. The unrotated p r i n c i p a l component solut i o n for Family B for non-drinking periods (Table 4.20) shows a f a i r l y strong association with PCI for a l l of the family members and the family as a group. - 60 -Table 4.2 0 Family B Non-drinking: Unrotated P r i n c i p a l Component Solution PCI Husband Wife Child Family 0.67 0.58 0.67 0.84 The weights for the sorts indicate that the Family i s most representative of PCI (2.85 as compared to 1.22 f o r both the Husband and the Child, and 0.87 for the Wife) . These r e s u l t s suggest that the family paradigm as perceived by the Husband and the Child i s more l i k e PCI than the Wife's view for non-drinking periods. This suggests that the Husband and Ch i l d are perhaps s l i g h t l y more i n f l u e n t i a l i n terms of c o n s t i t u t i n g the family paradigm for non-drinking periods than the Wife. Table 4.21 shows the s p e c i f i c items that contributed to t h i s mostly shared view (dominated by the Family sort) of the family paradigm during non-drinking periods. The r e s u l t s indicate that the Family, and to a lesser extent other family members consider item #2 3 "We have trouble meeting our b i l l s . " (Unhealthy Communication) to be more c h a r a c t e r i s t i c of the family for non-drinking periods. - 61 -Table 4.21 Dimensions (Items) which Constitute PCI for Family A Functioning for Non-drinking Periods u Item Key z-•score 23. We have trouble meeting bur b i l ls . Unhealthy 3, .48 Roles 52. We don't talk to each other when we are angry. Unhealthy 2, .06 Communication 8. We sometimes run out of things that we need. Unhealthy 1, .91 Roles 22. It is difficult to talk to each other about Unhealthy 1. .46 tender feelings. Communication 10. We make sure members meet their family Healthy 1, .24 respons i t>i Lit i es. Roles 29. We talk to people directly rather than through Healthy 1. .15 go-betweens. Communication 33. We get involved with each other only when Unhealthy -1. .06 something interests us. Affective Involvement 13. You only get the interest of others when Unhealthy -1.33 something is important to them. Affective Involvement 44. We don't hold to any rules or standards. Unhealthy -1. .42 Behaviour Control 42. Our family shows interest in each other only Unhealthy -1. .57 when they can get something out of it . Affective Involvement 17. You can easily get away with breaking the rules . Unhealthy -2. .20 Behaviour Control 48. Anything goes in our family. Unhealthy -3. .12 Behaviour Control The r e s u l t s also indicate that the Family, and to a lesser extent in d i v i d u a l family members f e e l item #48 "Anything goes i n our family." i s less c h a r a c t e r i s t i c of the family for non-drinking periods. Overall, 4 out of a po t e n t i a l 6 Unhealthy items are endorsed as more c h a r a c t e r i s t i c of the family, and 6 out of a p o t e n t i a l 6 Unhealthy items are endorsed as less c h a r a c t e r i s t i c of the family during periods of non-drinking. - 62 -F a m i l y B (Drinking) Table 4.22 shows the c o r r e l a t i o n a l matrix for Family B for drinking periods. Table 4.22 Family B Drinking Correlational Matrix Husband Wife Child Family Husband 1.00 Wife 0.19 1.00 Child 0.19 0.19 1.00 Family 0.06 0.41 0.24 1.00 Table 4.23 shows the eigen values and variance for each of the factors for Family B during drinking periods. Table 4.23 Family B Non-drinking Eigen Values and % of Variance Eigen 1.66 0.97 0.81 0.55 Values % of 41 66 86 100 Variance Using an eigen value > 1, 41.5% of the variance was accounted for i n the r e s u l t i n g 1 p r i n c i p a l component solut i o n (Table 4.24). - 63 -Table 4.24 Family B Drinking: Unrotated P r i n c i p a l Component Solution PCI Husband Wife Child Family 0.44 0.75 0. 60 0.73 As only one factor was retained no r o t a t i o n was done. The unrotated p r i n c i p a l component solution for Family B for non-drinking periods (Table 4.24) shows a f a i r l y strong association with PCI for the Wife, Child, and the Family as a group. The weights for the sorts indicate that the Wife i s most representative of PCI (1.71 as compared to 1.56 for the Family, 0.94 for the Child, and 0.01 for the Husband). These r e s u l t s suggest that the family paradigm as perceived by the Wife i s more l i k e PCI than i s the view perceived by the Child or the Husband. This suggests that the Wife i s more i n f l u e n t i a l i n terms of constituting the family paradigm for drinking periods than any other family member. Table 4.25 shows the s p e c i f i c items that contributed to t h i s view (dominated by the Wife's sort) of the family paradigm during drinking periods. - 6 4 -Table 4.25 Dimensions (items) which Constitute PCI for Family Functioning for Family B for Drinking Periods Item Key 23. We have trouble meeting our b i l ls . 51. We don't get along well together. 8. We sometimes run out of things that we need. 35. We don't often say what we mean. 52. We don't talk to each other when we are angry. 22. It is difficult to talk to each other about tender feelings. 28. We do not show our love for each other. 11. We cannot talk to each other about the sadness we feel. 47. If the rules are broken, we don't know what to expect. 46. We are able to make decisions about how to solve problems. 43. We are frank with each other. 42. Our family shows interest in each other only when they can get something out of it . 26. We can express feelings to each other. 58. We don't have reasonable transport. 37. We show interest in each other when we can get something out of it personally. 48. Anything goes in our family. Unhealthy Roles Unhealthy General Functioning Unhealthy Roles Unhealthy Communication Unhealthy Communication Unhealthy Communication Unhealthy Affective Responsiveness Unhealthy General Functioning Unhealthy Behaviour Control Healthy General Functioning Healthy Communication Unhealthy Affective Involvement Healthy General Functioning Unhealthy Roles Unhealthy Affective Involvement * Unhealthy Behaviour Control 3.24 2.44 2.22 1.53 1.43 1.24 1.19 •1.01 •1.06 •1.20 •1.24 •1.29 •1.39 •1.52 •1.76 •2.49 The r e s u l t s indicate that the Wife, and to a lesser extent the Family consider item #23 "We have trouble- meeting our b i l l s . " (Unhealthy Communication) to be more c h a r a c t e r i s t i c of the family for drinking periods. The r e s u l t s also indicate that the Family, and to a lesser extent i n d i v i d u a l family members f e e l item #48 "Anything goes i n our - 65 -family." i s less c h a r a c t e r i s t i c of the family for drinking periods. Overall, 7 out of a potential 7 Unhealthy items are endorsed as more c h a r a c t e r i s t i c of the family, and 4 out of a p o t e n t i a l 6 Unhealthy items are endorsed as less c h a r a c t e r i s t i c of the family during periods of drinking. For Family B, there are a number of s i m i l a r l y endorsed items for both drinking and non-drinking periods. Trouble meeting b i l l s , d i f f i c u l t y i n ta l k i n g , were themes endorsed for drinking and non-drinking periods. S i m i l a r l y , anything goes, and s e l f - i n t e r e s t , were themes that were unlike the family for both states. - 66 -T H E S E M I - S T R U C T U R E D F A M I L Y I N T E R V I E W S An important part of reason for doing the interview i n addition to gathering the Q-sort data was i n order to enhance the v a l i d i t y of the study. As a r e s u l t t h i s researcher f e l t i t would be useful to gather data that related d i r e c t l y to the family's experience of the Q-sort by posing questions that required the family to draw upon t h e i r expertise regarding the relevance of the Q-sort items and the sorting process. C a s e S t u d y A T h e F a m i l y ' s E x p e r i e n c e o f t h e Q - S o r t In t h i s case the mother described the Q-sort experience as "mind boggling" and the father remarked "I enjoyed i t , i t got my mind working." When t h i s researcher asked i f they also thought that the items were relevant to t h e i r family they a l l nodded and the father expanded saying he f e l t "they were precise and r i g h t to the point too". When asked i f they could think of other items that should have been included i n the Q-sort that would have resulted i n a more complete picture of t h e i r family the mother r e p l i e d that " i t was generally pretty good" and the other family members nodded i n agreement. In addition a l l family members participated f u l l y i n the discussion, responding to questions e n t h u s i a s t i c a l l y , and remarked that they enjoyed the process. Possibly relevant to the data i s the comment that the - 67 -family f e l t the discussion and Q-data "might have been more negative i f (the eldest daughter) were here, as she has d e f i n i t e ideas". The family was also involved i n a process of r e c a l l i n g the times i n the family when periods of drinking and periods of non-drinking were a f f e c t i n g t h e i r r e l a t i o n s h i p s and tended to consider the non-drinking questions as rela t e d to t h e i r present family s i t u a t i o n and the drinking questions as rel a t e d to the past. While e f f o r t was made i n the discussion to remind and focus the family members on the past periods of non-drinking, c l e a r l y the family was enthusiastic regarding the many changes they had been able to undertake, and as a r e s u l t tended to view the past as "drinking" and the present as "non-drinking". F a m i l y I n t e r a c t i o n (Drinking) Early i n the interview the son explained that he f e l t that during drinking periods decisions were made on an in d i v i d u a l basis. He explained that "instead of asking, we'd jus t do i t " and when prompted by h i s mom for the "other (non-drinking) times" he re p l i e d (pointing at h i s parents) "we'd ask dad and they'd decide together." The mother explained that when drinking was going on she would "do nothing and the whole family would suffer". The father added (nodding at his wife) "she would go to her room and read or sleep". Here, the father, mother, and son seem to be saying that when drinking was occurring family members tended to withdraw - 68 -from each other. The children would tend to do things more on t h e i r own without consulting either parent. The parents would stop t a l k i n g to each other, the father would drink, and the mother would often withdraw to her room and sleep or read. The general consensus was that a l l were " s u f f e r i n g " and that people i n the family f e l t a lack of personal confidence and confidence i n themselves as a family. The son reported that "You just f e e l bad". Decisions were made on an i n d i v i d u a l basis and family members generally fended for themselves. At these times family members looked outside the family for s o c i a l contact or tended to i s o l a t e themselves. There were a number of s t o r i e s that family reported that speak to the kind of e f f e c t alcohol had on the view family members held of themselves during periods of drinking, perhaps the most relevant have to do with the theme of i n t e r a c t i o n a l closeness and distance. The father t o l d a p a r t i c u l a r l y s t r i k i n g story of his youth and the abuse he suffered while growing up as a way of explaining his d i f f i c u l t y with closeness and how he came to r e l y on alcohol. "I f i n d i t hard to s o c i a l i z e outside the (immediate) family. I've l i v e d most of my l i f e i n a big family. The drinking began when I was 12, I guess that's 26 years, I was not very close, I would push everyone away, I t o l d myself I was not going to cry, I r e a l l y held a l o t back. A l o t of hate can build up over 26 years i f you don't l e t i t out. Broken dishes over my head, getting i n f i g h t s - 6 9 -and things and getting my hand burnt with l i g h t e r f l u i d . I had a temper and that was my punishment. . . and then having my grandfather doing things when I was 4 or 5 and t r y to carry on when I got older... that's the f i r s t time I ever said that, I've never even t o l d (counsellor)." Although t h i s story c l e a r l y points to many possible "explanations" for the onset and persistence of an alcohol problem, namely physical, emotional, and sexual abuse, i t also shows something more revealing i n terms of i n t e r a c t i o n a l intimacy. The father was c l e a r l y t a l k i n g about h i s discomfort with closeness, and went on to t a l k about how the sexual abuse kept him distant from his own children. "Something l i k e that, I mean you hear about abused people abusing t h e i r own kids. You don't think i t w i l l make you do something l i k e that, but you s t i l l worry. Now my kids are older, and I've gotten r i d of a l o t of garbage, i t ' s getting better, I'm more comfortable now." The alcoholism, the unemployment, the physical, emotional, and sexual abuse, a l l contributed to a lack of self-confidence and invited the father to move himself to the s i d e l i n e s of family l i f e . The comments were remarkable because they were so c l e a r l y i n the d i r e c t i o n of sharing personal experience and of making closeness. These opportunities did not seem to be available to the family while they were operating under the "alcoholic family" paradigm. - 70 -F a m i l y I n t e r a c t i o n (Non-drinking) During non-drinking periods i n the family the father reported that he often f e l t "even more distant from the mother", and found himself "going along" with other family members while not having a sense of how he might r e a l l y contribute to the l i f e of the family on his own i n i t i a t i v e . "I f e l t useless to r e a l l y do anything r i g h t . " During these times he explained that "I would just stay out of arguments and keep my feelings to myself". The father's p a r t i c i p a t i o n i n open disagreements was unlikely, and strong f e e l i n g s were generally kept private. At these times s o c i a l i z i n g outside the immediate family was not as l i k e l y , t h i s included v i s i t s with extended family. Members i n the family had a sense of being "on guard" with each other, and persons often found themselves involved i n patterns of blaming, c r i t i c i s m and defensiveness with respect to each other. The son reported that "Except for dad who was just kinda out of i t , we'd f i g h t a l l the time, but wouldn't get anywhere except for (youngest s i s t e r ) who would just take o f f " . In addition there was a sense i n the family of not being able to "get things done" or to resolve interpersonal c o n f l i c t s . This contributed to a sense of f r u s t r a t i o n and hopelessness with respect to the family as a working team, and a p o s i t i v e place to be. The mother remarked that "During the drinking periods I would leave (emotionally), but when no drinking was going on I was there a l l the time doing everything. I t was kind of l i k e I wanted to get i n everything I could before the drinking would s t a r t up again. I think i t would have been better i f I had not been as distant when the drinking was going on, because everyone suffered." The mother reported that "since the drinking stopped the youngest daughter has been the most trouble". The son explained that "now she can't get away with s t u f f any more 'cause dad's involved too". The father explained that "I use to get r e a l l y worked up with that kind of thing (problems with the children). I'd be out the door with a 40 pounder under my belt, but now I t e l l her (pointing to h i s wife) not to get worked up". He explained, "On the occasions when I do get a l i t t l e hot under the c o l l a r , I won't say anything I ' l l just go for a walk to cool down". The family experience considerable difference i n terms of family i n t e r a c t i o n with respect to drinking and non-drinking periods but perhaps the son expressed i t best when he said "things were s t i l l not that great when dad wasn't drinking i n the past (during the times of binge drinking a l t e r n a t i n g with periods of sobriety) but now they are way better". To t h i s the mother nodded i n agreement and added "I'm so confident now I went out and bought a car". Case Study B The F a m i l y ' s Experience of the Q-Sort Family members were asked how they f e l t about completing the Q-sort, and i f i t allowed them to accurately present how t h e i r family functions during drinking and non-drinking times. To t h i s a l l family members nodded vigorously. When further prompted regarding the completeness of the questions the father responded that he f e l t i t was "average". When asked i f they could think of any other items that should have been included that would have resulted i n a more complete picture of t h e i r family, the mother responded "No, I think i t was pretty good" and the daughter echoed "Yeah, i t was pretty good". In addition a l l family members present p a r t i c i p a t e d f u l l y i n the discussion, responding to questions e n t h u s i a s t i c a l l y , and the father remarked that they "learned some things" i n the process, while the res t of the family nodded t h e i r assent. When the family was asked i f they f e l t the discussion and Q-data would have been d i f f e r e n t i f the other c h i l d r e n were here, a l l the family members nodded. The daughter explained that "the kids would have just put the cards anywhere because they can't read, maybe i f mom or dad explained each card to them they could do i t " . Although i t seemed cle a r that what they were r e f e r r i n g to was the p o s s i b i l i t y that the other child r e n would not have understood what the cards meant and would have sorted randomly as a r e s u l t during t h e i r own sort, the family also f e l t that they could have contributed to the family sort by d i r e c t i n g the parents where to put the cards. As drinking periods were s t i l l a ( r e l a t i v e l y ) recent occurrence for t h i s family they seemed to have a cleare r - 73 -perspective on the differences i n family functioning during drinking and non-drinking occasions than the f i r s t family interviewed. F a m i l y I n t e r a c t i o n (Drinking) The daughter reported that "they are way less s t r i c t when drinking i s going on, i t ' s l i k e mom i s l i k e o f f i n f a i r y land". The mother responded by saying "Yeah, when drinking i s going on I give i n to everything. I t ' s l i k e I become t h i s pushover". The dad remarked "What about that time I threw your book into the f i r e p l a c e when you wouldn't study?" to which the daughter responded "Well yeah, but generally..." and a l l family members nodded i n agreement. There were a number of s t o r i e s that family reported with respect to the kind of e f f e c t alcohol has on the view family members hold of themselves during periods of drinking, perhaps the most relevant, again had to do with the theme of i n t e r a c t i o n a l closeness and distance. The daughter reported that "Mom and dad's r e l a t i o n s h i p i s the most affected by drinking, i t makes them further apart 'cause they f i g h t " . The father explained that "the kids w i l l be affected more i n the long term 'cause t h e y ' l l remember the f i g h t i n g , but i t ' s us at the moment". Both parents reported that when drinking was occurring, family members tended to become more involved with each other. The daughter r e c a l l e d "Remember the incident with the garbage bags? (Brother) went with you against dad." The father - 74 -responded "Well yeah, kids always side with t h e i r mother". The father also reported that "The kids are l i k e a l i t t l e unit when drinking i s going on, huddled together t a l k i n g and watching us." The children would tend to draw closer to each other and t h e i r mother. The parents would argue and c o n f l i c t would escalate. The general consensus i n the family i s that drinking t r i g g e r s or i s triggered by a lack of attention and the r e s u l t i n g erosion i n personal confidence and confidence i n themselves as a couple and family. The mother reported that "I think he drinks and me too sometimes because we don't get enough attention, and s t a r t to f e e l l i k e there's something wrong with him or me and things get shaky". Decisions were reported to s t i l l be made by the father although there was some debate as to the extent of h i s decision making influence. While the father asked "Don't you agree that I make the f i n a l decisions about s t u f f ? " , i t seemed clea r that t h i s was a kind of a formality on most occasions. "Well, yeah but that's usually af t e r mom has decided, l i k e for supper when she asks i f chicken would be OK or l i k e when we get a video." The family described that they would generally ask the father i f he "agreed" with the plans the mother had discussed with the children or i f he wanted to have chicken fo r dinner, for example. In t h i s way they seemed to have the understanding that the father had "veto powers" that he seldom exercised. At drinking times family members looked outside the - 75 -family for s o c i a l contact but i t was unclear as to whether t h i s was more to " a t t r a c t " attention from family members or because indivi d u a l s actually wanted more distance from each other. F a m i l y I n t e r a c t i o n (Non-drinking) During non-drinking periods i n the family the mother reported "Mostly I f e e l even less confident, cause I f e e l I'm not doing enough, you know as a mother or h i s partner or something, and I'd be thinking of a l l the mistakes I've made, and I can get pretty hopeless". The daughter reported " Yeah, she's always t r y i n g to be the strong one, doing everything and a l l that s t u f f " . At these times she would f i n d she was thinking c r i t i c a l l y of herself, often focusing on past mistakes and questioning her and the family's a b i l i t y to maintain any p o s i t i v e d i r e c t i o n . During these times she reported that she f e l t drawn to her parents and s i s t e r s but would stay away f e e l i n g they would only be c r i t i c a l , drawing her into c o n f l i c t remarking "Yeah, I get the urge to go and see them but I just know they'd s t a r t i n on me". The daughter reported that the parents were more s t r i c t with the children during non-drinking times, and she described her parents as, "not as casual with each other or the kids". The daughter also explained (amid much laughter) that "I don't think that they're as romantic with each other without - 76 -some wine". This gave r i s e to some s t o r i e s of drinking occasions that were not excessive. "Like the time we went hiking, and we had a bottle of wine", according to the mother. I t would seem however, that drinking could not be counted on to "produce romance" on every drinking occasion, and was i n t h i s way troublesome and unpredictable. The mother reported "We went to Vancouver to see t h i s concert and. .. (Father interrupting) I had some drinks i n the hotel room and got a l i t t l e loud with the usher 'cause I couldn't f i n d our seats." The mother continued, "Well anyway we were asked to leave and spent the res t of the time i n our hotel room f i g h t i n g " . - 77 -CHAPTER V SUMMARY AND D I S C U S S I O N This project was based on the premise that f a m i l i e s conserve and constitute t h e i r shared conceptions of themselves (the family paradigm) and the world around them through regular patterns of t h e i r own i n t e r a c t i o n . I t further proposed that the patterns of interaction i n f a m i l i e s with an alternator or bingeing a l c o h o l i c would vary from drinking to non-drinking periods. The primary purpose of t h i s study was to examine t h i s expected difference i n d e t a i l by focusing on the following questions; Do descriptions of family functioning (the family s e l f -image or paradigm) d i f f e r , for drinking and non-drinking periods? Do responses to s p e c i f i c questions purported to evaluate such s a l i e n t dimensions of family functioning as Problem Solving, Communication, Roles, A f f e c t i v e Responsiveness, A f f e c t i v e Involvement, Behaviour Control, and General Functioning d i f f e r for periods of drinking and abstinence? Do descriptions regarding family functioning derived from the family as a group d i f f e r from i n d i v i d u a l descriptions? Who i n the family contributes the most to the a l c o h o l i c family paradigm? Does the a l c o h o l i c contribute to the family paradigm or i s s/he more distant and less i n f l u e n t i a l i n the family as - 78 -much of the l i t e r a t u r e predicts? By focusing on these questions t h i s researcher examined the s p e c i f i c aspects of family functioning that i n the case of two s p e c i f i c families were the most important differences between drinking and non-drinking family i n t e r a c t i o n . I t also examined who i n the family contributed these ideas to the family paradigm. While the Q-sort methodology u t i l i z i n g items from the McMaster Family Assessment Device guided the quantitative data c o l l e c t i o n , a semi-structured interview guided by an i n t e r a c t i o n a l cybernetic systemic model i n v i t e d the family to contribute t h e i r indigenous knowledge d i r e c t l y . This model deals with the stories and ideas that i n d i v i d u a l family members and the family as a group f e e l conserve and constitute the family paradigm. This has enriched the knowledge base i n the area of al c o h o l i c family i n t e r a c t i o n . The comparison of the Q-sorts offered an opportunity to understand how ind i v i d u a l family members and the family as a group d i f f e r i n t h e i r family interaction for drinking and non-drinking periods. Correlations and p r i n c i p a l components analysis for ind i v i d u a l Q-sorts and the family as a group offered an opportunity to understand who may be the most i n f l u e n t i a l i n t h e i r contribution to the family paradigm. In addition, by examining the s p e c i f i c items that contributed to the d i f f e r e n t i a t i o n of clustered Q-sorts the most s i g n i f i c a n t differences between drinking and non-drinking periods were revealed. - 79 -The Q-Sort R e s u l t s Do descriptions of family functioning (the family s e l f -image or paradigm) d i f f e r , for drinking and non-drinking periods? Do descriptions regarding family functioning derived from the family as a group d i f f e r from i n d i v i d u a l descriptions? As reported i n Chapter IV, the r e s u l t s of the Q-sort showed correspondences between certa i n p r i n c i p a l components for both drinking and non-drinking periods for c e r t a i n family members. In family A for example, the Wife saw the family one way, the Husband saw the family d i f f e r e n t l y than the Wife and the C h i l d saw the family d i f f e r e n t l y from either h i s mother or hi s father for periods of non-drinking. The same was true for drinking periods. Yet the second family studied saw the family s i m i l a r l y between individuals (and as a group) and for both drinking and non-drinking periods. This suggests that the members of Family A f e l t that t h e i r family functioning was d i f f e r e n t for non-drinking periods than for drinking periods, and that family members do not necessarily agree on what those differences are. These re s u l t s also suggested that the "consensually" derived group description can d i f f e r s i g n i f i c a n t l y from individual descriptions. The members of Family B viewed t h e i r family s i m i l a r l y , i n d i v i d u a l l y and between states, indicating a consistent perspective of family functioning regardless of state. Who i n the family contributes the most to the a l c o h o l i c - 80 -family paradigm? Does the al c o h o l i c contribute to the family paradigm or i s s/he more distant and less i n f l u e n t i a l i n the family as much of the l i t e r a t u r e predicts? To the extent that there was a difference between drinking and non-drinking periods, i n family A the data suggests the Wife was the most i n f l u e n t i a l with respect to the non-drinking periods and the Husband the most i n f l u e n t i a l for the drinking periods. In family B i t was the Husband's, (tie d with the Child's) influence that was the most f e l t regarding the non-drinking periods, and the Wife's influence f o r the drinking periods. Do responses to s p e c i f i c questions purported to evaluate such s a l i e n t dimensions of family functioning as Problem Solving, Communication, Roles, A f f e c t i v e Responsiveness, A f f e c t i v e Involvement, Behaviour Control, and General Functioning d i f f e r for periods of drinking and abstinence? S p e c i f i c items clustered together i n ways that suggest that the families did not always agree with the FAD's c l a s s i f i c a t i o n system. Family A for example, f e l t i t was healthy to not t a l k when you were angry and endorsed the item along with other healthy (according to the FAD) items. From the semi-structured interview the family explained t h i s as a p a r t i c u l a r strength. They reported that when fe e l i n g s are p a r t i c u l a r l y "hot", family members may "go for a walk to cool down", yet i n the FAD, t h i s item i s suggested to be i n d i c a t i v e of unhealthy communication, and i s scored accordingly. The r e s u l t s indicate family members endorsed both healthy and unhealthy items for periods of drinking and non-drinking. There was also evidence that suggested that while these fa m i l i e s had some mixing of endorsed sub-scales i n the factor components, s p e c i f i c sub-scales tended to c l u s t e r together. There were also s i m i l a r i t i e s between s p e c i f i c i n d i v i d u a l Q-sorts and the Q-sorts the family did as a group task. If understood as indicators of leadership or influence i n terms of the family paradigm, the s i m i l a r i t i e s between i n d i v i d u a l and family Q-sorts could be suggestive of the kinds of ideas or conversations p a r t i c u l a r family members might have ava i l a b l e to them at any given moment. F a m i l y A Combining the information gathered from the Q-sort data and from the semi-structured family interview suggested some in t e r e s t i n g p o s s i b i l i t i e s . From the interview i t would seem cl e a r that t h i s i s a family that has been profoundly affected by alcohol. Years of alcohol misuse were reported to have severely affected the family's a b i l i t y to generate a r e l i a b l e income, and i t prevented them from appreciating each other's good q u a l i t i e s as they were recruited into cycles of blaming and g u i l t . However, while the Q-sort data suggests there are some s i m i l a r i t i e s between Q-sorts, generally the Q-sorts were quite d i f f e r e n t for drinking periods as compared with non-drinking periods. This suggest that while there are aspects - 82 -of family functioning that are not affected one way or another by drinking and non-drinking periods, generally the family sees t h e i r functioning as quite d i f f e r e n t for these two states. I t was also clear that the family members endorsed more healthy items for periods of non-drinking than for drinking periods. Perhaps as a r e s u l t of the treatment the family had already received p r i o r to entering into t h i s study, or perhaps r e l y i n g on t h e i r own experience, the family had noticed that while some problems existed even during periods of non-drinking (as did strengths during periods of drinking), generally, family functioning was much improved during periods of abstinence. In addition, as previously mentioned, the family had some trouble separating the past non-drinking occasions from the present r e l a t i v e l y extended period of sobriety. I t was also interesting to note that the family's placement of some items (talking when angry) was for them an in d i c a t i o n of health, yet according to the FAD would have scored as an unhealthy response. Not t a l k i n g when angry, and not saying what people r e a l l y mean, was considered a good idea for the family members i n t h i s case, as i t was protective of others. In terms of the family's perception of family functioning during non-drinking periods the Q-sort data suggested that the Wife was the most i n f l u e n t i a l . This f i t with the information gathered i n the family interview. In the interview the wife was the voice for a l l the wonderful opportunities the family - 83 -had r e a l i z e d as a r e s u l t of the new non-drinking l i f e s t y l e , the new car she had been able to purchase as well as the new sense of f i n a n c i a l and emotional security the family was now experiencing. The father was the voice for the t e r r i b l e e f f e c t s alcohol had on them and him personally and t h i s was also r e f l e c t e d i n the Q-sort data. F a m i l y B The information presented from both the Q-sort data and the family interview suggested that t h i s family viewed i t s e l f p r i m a r i l y along one dimension, ir r e s p e c t i v e of drinking and non-drinking periods. There was one important difference however, i n terms of how the family defined a drinking period. This family f e l t that a drinking period a c t u a l l y began p r i o r to alcohol consumption. The family explained that even though things may be going well i n the family with respect to alcohol consumption, at some point tension begins to develop, and family members begin to withdraw from each other. The Q-sort data c l e a r l y supports the information gathered i n the family interview. In t h i s family, there are considerable s i m i l a r i t i e s between Q-sorts that r e l a t e to drinking periods and those that r e l a t e to non-drinking periods. Trouble with b i l l s , and d i f f i c u l t y with communication are endorsed for both states. While the husband seems to be more i n f l u e n t i a l than the Wife i n terms of the family paradigm during non-drinking periods, the wife i s more i n f l u e n t i a l during drinking periods. - 84 -This i s opposite to the f i r s t family studied, and seems according to t h i s researcher to be less desirable. In t h i s p o s i t i o n he i s recruited into negatively connoting the family during periods of non-drinking (perhaps due to the negative connotation applied to the periods of drinking f o r which he f e e l s responsible), while the Wife i s r e c r u i t e d into negatively connoting the family during drinking periods. In t h i s way the family (paradigm) r e a l i z e s few opportunities for p o s i t i v e connotation. T h e o r e t i c a l I m p l i c a t i o n s The findings have relevance to theory i n the domain of alcoholism and the family i n the following ways. F i r s t l y , by focusing on the r e c o l l e c t i o n s of the kinds of conversations, interactions, and a c t i v i t i e s , family members engage i n during periods of drinking and non-drinking, an examination of the actual process by which family members conserve and constitute the family paradigm i s f a c i l i t a t e d . These findings suggest that while some family members seem to have more influence i n terms of how the family thinks about i t s e l f (the shared family view or family paradigm) a great deal of agreement or mutual influence seems part of the process. As a r e s u l t the findings would seem to support a systemic view of alcoholism, i n that while there are c l e a r l y key players i n terms of the family's perception of the problems and strengths within the family, a l l family members contribute to the story of the family - 85 -paradigm. The findings also suggest these f a m i l i e s f e e l problems are present during periods of non-drinking as well as drinking periods as i s consistent with generally distressed couples and the work of B i l l i n g s et a l . (1979) who found that drinking exerted no s i g n i f i c a n t impact on couple i n t e r a c t i o n when compared with generally distressed couples. Much of the e x i s t i n g popular information on alcoholism and the family has suggested that a l c o h o l i c s are more distant and less i n f l u e n t i a l i n the family (Al-anon, 1971; A l c o h o l i c s Anonymous, 1986; Woititz, 1983), yet t h i s research suggests that a l l family members including the a l c o h o l i c can be i n f l u e n t i a l i n terms of how the family sees i t s e l f and therefore shape important aspects of family r e l a t i o n s h i p s and functioning. These re s u l t s however do not c l e a r l y support Steinglass's notion of the family as a biphasic e n t i t y o s c i l l a t i n g between drinking and non-drinking modes. Steinglass's work i s based on the notion that i n t e r a c t i o n a l events are d i f f e r e n t i n intoxicated versus sober states and that the intoxication-relevant patterns are s u f f i c i e n t l y r e i n f o r c i n g to perpetuate or maintain cycles of abusive drinking. However Steinglass's work was based on small samples of family dyads and couples of a decidedly c l i n i c a l nature. The r e a l i t y of his research, however, i s that no s c i e n t i f i c a l l y sound, empirical studies were ever conducted to t e s t most of the key impressions formed from t h i s early work (Jacob and Seilhamer, 1987) . Yet i n t h i s research many of the - 86 -same items, (healthy and unhealthy) were associated with periods of drinking and non-drinking. These r e s u l t s indicate that much of what constitutes a family paradigm for these p a r t i c u l a r families remain constant regardless of alcohol consumption. In other words, the families studied did not always see themselves as that d i f f e r e n t between drinking and non-drinking states. L i m i t a t i o n s of the Study I t has been noted by Jacob and Seilhamer (1987) that c l i n i c a l theory and practice have been based on descriptions generated from s e l f and spouse reports obtained within c l i n i c a l contexts involving samples of unknown r e l i a b i l i t y , v a l i d i t y , and representativeness. To what extent these "pictures" of alcoholic-family relationships correspond to observed patterns of interchange i s unknown, although there i s l i t t l e reason to believe that reports of interchanges i n which the reporter i s a participant can be obtained i n a s c i e n t i f i c a l l y sound manner. Beyond many s e l f - s e r v i n g biases, memory d i s t o r t i o n s , and inattention to c r i t i c a l aspects of the f i e l d , s e l f report data, by t h e i r very nature emphasize r e l a t i v e l y global, imprecisely defined constructs rather than a set of discrete behaviours that are emitted and responded to over time. For these reasons, as family r e c o l l e c t i o n s were used to construct the family paradigm for drinking and non-drinking periods rather than d i r e c t observation we were l e f t with the subjective impressions of the family members from which to base the data. In addition, as the fam i l i e s were " i n recovery" i t was not possible to have the family describe the family paradigm (Q-sort or verbal description) while i n an intoxicated state or observe i t d i r e c t l y as was possible to do with the sober state. I t i s also quite possible that families " i n recovery" are somehow d i f f e r e n t than a l c o h o l i c families not i n recovery. Correlations are limited i n t h e i r a b i l i t y to e s t a b l i s h c a u s a l i t y (Glass and Stanley, 1970), i n that we do not know for example that the family A husband's view of the family caused the family paradigm to s h i f t i n the d i r e c t i o n of h i s view of the family paradigm, only that t h i s i s one possible explanation. I t i s also quite possible that the family paradigm somehow shapes (causes) the i n d i v i d u a l paradigm or that through some reci p r o c a l i n t e r a c t i v e process both shape each other. In addition t h i s study did not illuminate the mechanism by which the shaping of the family paradigm i s achieved other than by pointing to the general domain of "conversational remembering" or s t o r i e s . The q u a l i t a t i v e portion of the data revealed that i t i s with much d e t a i l and subtlety with respect to the family paradigm that meanings and understandings are negotiated, family B's discussion regarding who makes decisions for example. In addition, while drinking and non-drinking periods can be c l e a r l y delineated for binge or alternator pattern drinkers, the family dynamics of - 88 -alcoholism might be better understood i f the area of focus was s h i f t e d to the changes that occur i n families j u s t p r i o r to the onset of recurring periods of drinking or those changes that occur just p r i o r to the cessation of drinking. Implications for the Family Treatment of Alcoholism. As with family case A, i n d i v i d u a l family members had been able to s h i f t the r e s p o n s i b i l i t y for who speaks (contributes) to which aspects of the family paradigm. In the past the family reported that the wife had the r e s p o n s i b i l i t y of t a l k i n g about the troubles alcohol was causing, and the husband presumably had the impossible task of presenting information that supported a p o s i t i v e story of family functioning during a binge or at least a negative story of the non-drinking periods. The family's a b i l i t y to s h i f t and have the wife present the "new story" and the husband the "old story" seems to have created new opportunities f o r t h e i r p a r t i c u l a r s i t u a t i o n . I t may be useful for counsellors and therapists working i n the f i e l d of the family treatment of alcoholism to be aware of who i n the family i s "responsible" for contributing the various aspects of the family's experience to the family paradigm. Research Questions: Conclusions Do descriptions of family functioning (the family s e l f -image or paradigm) d i f f e r , for drinking and non-drinking - 89 -periods? I t seems clear that for some families and for i n d i v i d u a l family members these descriptions d i f f e r , however i t also seems cle a r that a great deal remains constant, through the cycles of drinking and abstinence. Do responses to s p e c i f i c questions purported to evaluate such s a l i e n t dimensions of family functioning as Problem Solving, Communication, Roles, A f f e c t i v e Responsiveness, A f f e c t i v e Involvement, Behaviour Control, and General Functioning d i f f e r during periods of drinking and abstinence? While there i s some cl u s t e r i n g of responses to s p e c i f i c dimensions of family functioning as proposed i n the FAD, family members are able to see strength and purpose i n some behaviours that are often seen more generally as indicators of unhealthy functioning. While t h i s a b i l i t y may at times be problematic for the researcher and psychometrician i t generally seemed that negative descriptions of family functioning were associated with, yet preceded actual drinking behaviour. I t would also seem that looking at family i n t e r a c t i o n a f t e r the actual intake of alcohol can r e s u l t i n missed opportunities to observe important dynamics that occur during the t r a n s i t i o n from non-drinking to drinking and back again. Do descriptions regarding family functioning derived from - 90 -the family as a group d i f f e r from i n d i v i d u a l descriptions? While i n d i v i d u a l descriptions of family functioning d i f f e r from family consensus descriptions, i t i s not c l e a r l y always along the drinking/non-drinking continuum. This suggests that considerable overlap of behaviour e x i s t s between both drinking and non-drinking periods, at le a s t i n some fa m i l i e s . By asking questions i n the semi-structured interview and to a lesser extent the family Q-sort task, by implication, focused our conversation on the f i n d i n g of differences between drinking and non-drinking periods. To some extent the questions aimed at the "f i n d i n g " of t h i s d ifference may actually be creating the differences (or the awareness of a difference) i n the conversations between family members. Does the a l c o h o l i c contribute to the family paradigm or i s s/he more distant and less i n f l u e n t i a l i n the family as much of the l i t e r a t u r e predicts? I t seemed as though the al c o h o l i c was i n f l u e n t i a l i n terms of the family paradigm, yet t h i s influence varied between drinking and non-drinking periods, and between the two fami l i e s studied. I t also seemed more p o s i t i v e for one family when the a l c o h o l i c was a c t i v e l y contributing to the family paradigm as i t related to the drinking periods. I t seemed that with the voice of "alcohol as problematic" taken care of, other family members were able to t a l k p o s i t i v e l y about the - 91 -family during non-drinking periods, and a story of the family as transcending d i f f i c u l t i e s was able to be integrated into the family paradigm. F u t u r e Research I m p l i c a t i o n s This study endeavoured to r e c r u i t the indigenous knowledge of families experiencing troubles r e l a t e d to alcohol. I t was interested i n the domain of ideas, and how these ideas might influence family i n t e r a c t i o n i n two very s p e c i f i c f a m i l i e s . I t did not examine the actual i n t e r a c t i o n from the objective viewpoint of a detached observer, nor did i t develop any s t a t i s t i c a l power to generalize beyond the fam i l i e s studied. Family members base t h e i r responses to behaviour on the meaning they assign to those behaviours. I t pointed to the p o s s i b i l i t y that when an a l c o h o l i c family member takes or i s recruited into taking a c e r t a i n p o s i t i o n or stand (positive or negative) with respect to describing the family during drinking or non-drinking states, i t i s the position/stand i t s e l f that i s i n f l u e n t i a l i n terms of the constraint of, or f a c i l i t a t i o n of, c e r t a i n kinds of conversations. As such t h i s study represents another c o l l e c t i o n and reporting of a small, p o t e n t i a l l y unrepresentative sample. Jacob and Seilhamer (1987) suggest large samples that include p s y c h i a t r i c and/or medical as well as undisturbed control groups are necessary i n order to cross-validate emergent - 92 -findings and to j u s t i f y the application of more powerful and c l a r i f y i n g multivariant techniques. The addition of more fami l i e s from these groups p a r t i c u l a r l y with respect to other biphasic symptoms (drug addiction, depression, bipolar disorders, etc.) could f a c i l i t a t e the discovery of d i s t i n c t i o n s that separate a l c o h o l i c families from other fa m i l i e s experiencing problems. Continued attention should be devoted to the children involved i n a l c o h o l i c families. While t h i s study did not c l e a r l y see the children as i n f l u e n t i a l on t h e i r own i n terms of the family paradigm, (they saw the family s i m i l a r l y to the mother for non-drinking periods and l i k e the father or i n t h e i r own way for drinking periods) . The r o l e of the children i n the family may c l a r i f y the family's r o l e i n maintaining the dysfunctional behaviour. Furthermore, the c h i l d ' s future i s t h e o r e t i c a l l y and empirically linked to contemporary patterns of family l i f e - a relationship of p a r t i c u l a r importance given the "high-risk" nature of alco h o l i c s ' o f f s p r i n g (Jacob and Seilhamer, 1987). Research aimed at revealing detailed i n t e r a c t i o n process i n a l c o h o l i c families as well as larger views including the examination of the d i f f e r e n t stages of drinking and associated family i n t e r a c t i o n i s also indicated. Of p a r t i c u l a r i n t e r e s t to t h i s researcher would be a detailed examination of the kinds of conversations that occur as family members negotiate descriptions of the status quo for drinking and non-drinking - 93 -states. More research i n the area of gender difference with respect to family interaction i s also indicated. Research i n t h i s area according to Jacob and Seilhamer (1987) suggests the al c o h o l i c ' s impact on family functioning i s l i k e l y to be markedly d i f f e r e n t for male and female a l c o h o l i c s . I t would be i n t e r e s t i n g to see the extent to which women are i n f l u e n t i a l i n terms of the family paradigm fo r drinking and non-drinking states. In addition, there seem to be many d i f f e r e n t s t y l e s of problem drinking; i n home drinkers, and out of home drinkers, binge drinkers, steady drinkers, recovered drinkers, lone drinkers, and so on. Research into d i f f e r e n t s t y l e s of drinking would also seem indicated and may shed l i g h t on p a r t i c u l a r i n t e r a c t i o n a l exchanges s p e c i f i c to p a r t i c u l a r patterns of problem drinking. This study points toward further examination of the actual conversations families have regarding t h e i r p a r t i c u l a r s i t u a t i o n s . I t also supports the systemic notion that further information regarding the kinds of i n t e r a c t i o n a l forces that propel an in d i v i d u a l toward drinking may not be found by looking at the family during drinking periods, but rather during periods of sobriety. Further examination of how certa i n conversations with respect to al c o h o l i c interaction constrain persons into t a l k i n g i n ce r t a i n ways or to taking a p a r t i c u l a r p o s i t i o n would seem indicated. - 95 -R e f e r e n c e s Ablon, J . (1976) Family structure and behaviour i n alcoholism: A review of the l i t e r a t u r e . In B. K i s s i n and H. Begleiter (Eds.), The biology of alcoholism: Vol. 4. Social aspects of alcoholism. New York Plenum Press. Al-Anon Family Treatment Tool i n Alcoholism. (1969) (Pamphlet) Al-Anon Family Group Headquarters Inc. New York, 1971. Alc o h o l i c s Anonymous. The Big Book, 3rd Edition, Alcoholics Anonymous. Alcoholics Anonymous World Services. New York. American Psyc h i a t r i c Association (1987). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington D.C.: Author. Baas, L.R. and Brown, S.R. (1973) . Generating rules for intensive analysis: the study of transformations. Psychiatry, 36, 172-183. B i l l i n g s , A.G., Kessler, M., Gomberg, C.A., and Weiner, S. (1979). Marital C o n f l i c t Resolution of A l c o h o l i c and Nonalcoholic Couples during Drinking and Nondrinking Sessions. Journal of Studies on Alcohol, Vol 40, No. 3. Block, J. (1961). The Q-Sort Method in Personality Assessment and Psychiatric Research. Charles C. Thomas, S p r i n g f i e l d I l l i n o i s . Boldt, W. (1991). Q-Analysis [Computer Program]. Vancouver, B.C.: University of B r i t i s h Columbia. (ID No. CCID EP01 WBOL) Chassan, J.B. (1979). Research design on clinical psychology and psychiatry. New York: Irvington Publishers. Donovan, D.M., and Marlatt, A.G. (1988). Assessment of Addictive Behaviours. Guilford Press, New York, N.Y. E l l i s , D.C. (1986). When Strategies F a i l : The Chemically Dependent Family System. Journal of Strategic and Systemic Therapies. Vol 5 #3. 50-58. Epstein, N.B., Baldwin, L.M. and Bishop, D.S. (1983). The McMaster Family Assessment Device. Journal of Marital and Family Therapy 9: 171-180. F e r r e i r a , A.J., and Winter, W.D. (1956). Family Interaction and Decision-Making. Archives of General Psychiatry, Vol 13, 214-223. - 96 -F e r r e i r a , A.J. (1966). Family Myths Psychiatric Research Reports, 20, 85-90. Glass, G.V. and Stanley, J. (1970) . Statistical methods in education and psychology. Englewoods C l i f f s , New Jersey: Prentice-Hall Inc. Herbst, P.G. (1970). Behaviourial Worlds: the study of single cases London: Tavistok. Jacob, T. , Ritchey, D. , Cvitkovic, J.F., and Blane, H.T. (1981). Communication styles of a l c o h o l i c and nonalcoholic fa m i l i e s when drinking and not drinking. Journal of Studies on Alcohol 42: 466-482. Jacob, T. , and Seilhamer, R.A. (1987) Alcoholism and family i n t e r a c t i o n . In T. Jacob (Ed.), Family Interaction and Pathology: Theories, Methods, and Findings (pp. 535-580). New York: Plenum Press. Kazdin, A.E. (1980). Research design in clinical psychology, (the case study in clinical psychology). New York: Harper and Row Publishers. Kerlinger, F.N. (1973). Foundations of behaviourial research. New York: Holt, Rinehart, and Winston, Inc. Liepman, M., Nirenberg, T., D o o l i t t l e , R., Begin, A., Broffman, T., Babich, M. (1989). Family functioning of male a l c o h o l i c s and t h e i r female partners during periods of drinking and abstinence. Family Process, Vol 28 No. 2, 239-249. Maclean, Danbury, and Talbot, D. (1964). Civil Defense Belief Patterns: (VII) Technical Summary. East Lansing: Department of Communication, Michigan State University, OCD report, March. Marlett, A., and M i l l e r , W. (1984) Comprehensive Drinker Profile. F l o r i d a , Psychological Assessment Resources, Inc. McGoldrick, M. , and Gerson, R. , (1985) Genograms in Family Assessment. New York: W.W. Norton and Company, Inc. M i l l e r , I.W., Epstein, N.B., Bishop, D.S. and Keitner, G.I. (1985). The McMaster Family Assessment Device: R e l i a b i l i t y and v a l i d i t y . Journal of Marital and Family Therapy. 11: 345-356. Reiss, D. (1981). The Family's Construction of Reality. Cambridge, M.A. Harvard University Press. - 97 -Seltzer, M. (1971). The Michigan Alcoholism Screening Test (MAST): The quest for a new diagnostic instrument. American Journal of Psychiatry 127: 1653-1658. Steinglass, P., Bennet, L.A. Steven, S.J., and Reiss, D. (1987). The Alcoholic Family. Basic Books Inc. New York:. Steinglass, P., Davis,, D.I., and Berensen, D. (1977). Observations of conjointly hospitalized " a l c o h o l i c couples" during sobriety and intoxication, implications f o r theory and therapy. Family Process 16: 1-16. Steinglass, P., Weiner, S., and Mendelson, J.H. (1971). A systems approach to alcoholism; a model and i t s c l i n i c a l a p p l i c a t i o n . Archives of General Psychiatry. 24: 401-408. Selekman, M. Taming (1989). Chemical Monsters: Cybernetic-Systemic Therapy with Adolescent Substance Abusers. Journal of Strategic and Systemic Therapies Vol 8, #2. Talbot, A.D., (1964). Q-Methodology. Paper presented at the meeting of the American Educational Research Association. Seattle, WA. Wampler, K.S., Halverson, C.F., Moore, J. J . , Walters, L.H. (1989). The Georgia Family Q-Sort: An Observational Measure of Family Functioning. Family Process 28: 228-238. Watzlawick, P., Beavin, J.H., and Jackson, D.D. (1967) Pragmatics of Human Communication. New York: W.W. Norton. White, M. (1986) Negative Explanation, Restraint, and Double Description: A Template for Family Therapy, Family Process Vol. 25, No. 2, 171. Woititz, J.G. (1983). Adult Children of Alcoholics. Health Communication Inc. Pompano Beach:. Yin, R. (1986). Case Study Research: Design and Methods. Beverly H i l l s , CA: Sage Publications. - 99 -Guidelines for therapists introducing The A l c o h o l i c Family Interaction Research Project Thank you for considering the project. Please keep i n mind that you do not have to be c e r t a i n regarding the s u i t a b i l i t y of a family for my p a r t i c u l a r research i n t e r e s t s . The f i r s t part of the project w i l l i n e f f e c t determine the families s u i t a b i l i t y to the project. You might introduce the project i n the following way; "One of my colleagues here i n the c l i n i c i s doing some research. He i s interested i n understanding more about the e f f e c t s of problem drinking on family r e l a t i o n s h i p s . " "I have here some information about the project." (Give c l i e n t the l e t t e r ) " I f you think you might be interested perhaps I could give Dan your name and number, or introduce you to him?" The c l i e n t may want to (and probably should) t a l k i t over with his/her family. In which case you might respond with something l i k e ; "Of course, perhaps you could l e t me know." And follow i t up i n your next session. Keep i n mind that I need three families to volunteer. You may be somewhat reassured that the families that I've "tested" the process on have reported that they enjoyed the process and found that i t was interesting for them. Thanks again. Dan - 101 -APPENDIX B Consent Forms SUBJECT'S CONSENT FORM I agree to pa r t i c i p a t e i n a research project, i n v e s t i g a t i n g the s i m i l a r i t i e s and differences during periods of drinking and abstinence i n families where alcohol i s a problem. I understand that p a r t i c i p a t i o n i s voluntary and that I may withdraw at any time or refuse to answer any questions. I understand that I w i l l be interviewed as well as be required to complete a questionnaire, and a task describing our family. This process w i l l take about three hours. I do t h i s with the understanding that the information w i l l be kept c o n f i d e n t i a l , used f o r research purposes only, and destroyed at the end of i t s usefulness. - 102 -APPENDIX C The Michigan Alcoholism Screening Test The MAST C i r c l e each question either Yes or No 1. Do you f e e l you are a normal drinker? YES NO 2. Have you ever awakened the morning a f t e r some drinking the night before and found that you could not remember a part of the evening before? YES NO 3. Does any member of your family (wife, husband, parents, etc.) ever worry or complain about your drinking? YES NO 4. Can you stop drinking without a struggle a f t e r one or two drinks? YES NO 5. Do you ever f e e l bad about your drinking? YES NO 6. Do friends or r e l a t i v e s think you are a normal drinker? YES NO 7. Are you always able to stop drinking when you want to? YES NO 8. Have you ever attended a meeting of Alcoho l i c s Anonymous (AA)? YES NO 9. Have you ever gotten into fi g h t s when drinking? . YES NO 10. Has drinking ever created problems with you and your spouse (husband/wife)? YES NO 11. Has your spouse (or other family member) ever gone to anyone for help about your drinking? YES NO 12. Have you ever l o s t friends or lovers because of your drinking? YES NO 13. Have you ever gotten into trouble at work because of drinking? YES NO 14. Have you ever l o s t a job because of drinking? YES NO - 103 -15. Have you ever neglected your obligations, your family, or your work for two or more days i n a row because you were drinking? YES NO 16. Do you ever drink before noon? YES NO 17. Have you ever been t o l d that you have l i v e r trouble? YES NO 18. Have you ever had serious shaking a f t e r heavy drinking? YES NO 19. Have you ever heard voices or seen things that weren't there after heavy drinking? YES NO 20. Have you ever gone to anyone for help about your drinking? YES NO 21. Have you ever been i n a hospital because of drinking? YES NO 22. Have you ever been a patient i n a p s y c h i a t r i c hospital or on a p s y c h i a t r i c ward of a general hospital where drinking was part of the problem? YES NO 23. Have you ever been seen at a p s y c h i a t r i c or mental health c l i n i c , or gone to a doctor, s o c i a l worker, or clergyman for help with an emotional problem i n which drinking had played a part? YES NO 24. Have you ever been arrested, even for a few hours because of drunken behaviour (other than driving)? YES NO 25. Have you ever been arrested for drunk d r i v i n g or dr i v i n g after drinking? YES NO - 104 -APPENDIX D Q-Sort Items No Item Key 1. Planning family activities is difficult because Unhealthy General we misunderstand each other. Functioning 2. We resolve most everyday problems around our Healthy house. - Problem Solving 3. When someone is upset the others know why. Healthy Communication 4. When you ask someone to do something, you have Unhealthy to check that they did i t . Roles 5.If someone is in trouble the others become too Unhealthy involved. Affective Involvement 6.In times of crisis we can turn to each other for Healthy support. General Functioning 7. We know what to do when an emergency comes up. Unhealthy Behaviour Control 8. We sometimes run out of things that we need. Unhealthy Roles 9. We are reluctant to show our affection for each Unhealthy Affective other. Responsiveness 10. We make sure members meet their family Healthy responsibilities. Roles 11. We cannot talk to each other about the sadness Unhealthy we feel. General Functioning 12. We usually act on our decisions regarding Healthy problems. Problem Solving 13. You only get the interest of others when Unhealthy something is important to them. Affective Involvement 14. You can't tell what a person is feeling from Unhealthy what they are saying. Communication 15. Family tasks don't get spread around enough. Unhealthy Roles 16.Individuals are accepted for what they are. Healthy General Functioning 17. You can easily get away with breaking the rules. Unhealthy Behaviour Control 18. People come right out and say things instead of Healthy hinting at them. Communication 19.Some of us just don't respond emotionally. Unhealthy Affective Responsiveness 20. We know what to do in an emergency. Healthy Behaviour Control 21. We avoid discussing our fears and concerns. Unhealthy General Functioning - 105 -22.It is diff icult to talk to each other about tender feelings. 23.We have trouble meeting our b i l ls . Unhealthy Communication Unhealthy Roles 24.After our family tries to solve a problem, we Healthy usually discuss whether it worked or not. Problem Solving 25. We are too self centred. 26. We can express feelings to each other. 27. We have no clear expectations about toilet habits. 28. We do not show our love for each other. Unhealthy Affective Involvement Healthy General Functioning Unhealthy Behaviour Control Unhealthy Affective Responsiveness 29.We talk to people directly rather than through Healthy go-betweens. 30.Each of us has particular duties and respons i biIi t i es. Communication Healthy Roles 31.There are lots of bad feelings in the family. Unhealthy General Functioning 32. We have rules about hitting people. 33. We get involved with each other only when something interests us. •34.There's l i t t le time to explore personal interests. 35. We don't often say what we mean. 36. We feel accepted for what we are. Healthy Behaviour Controt Unhealthy Affective Involvement Unhealthy Roles Unhealthy Communication Healthy General Functioning 37.We show interest in each other when we can get Unhealthy something out of it personally. Affective Involvement 38. We resolve most emotional upsets that come up. Healthy Problem Solving 39. Tenderness takes second place to other things in Unhealthy Affective our family. Responsiveness 40. We discuss who is to do household jobs. Healthy Roles 41.Making a decision is a problem for our family. Unhealthy General Functioning 42.Our famity shows interest in each other only Unhealthy when they can get something out of i t . 43. We are frank with each other. 44. We don't hold to any rules or standards. Affective Involvement Healthy Communication Unhealthy Behaviour Control - 106 -45.If people are asked to do something, they need Unhealthy reminding. Roles 46.We are able to make decisions about how to solve Healthy problems. General Functioning 47.If the rules are broken, we don't know what to Unhealthy expect. 48. Anything goes in our family. 49. We express tenderness. 50. We confront problems involving feelings. 51. We don't get along well together. Behaviour Control Unhealthy Behaviour Control Healthy Affective Responsiveness Healthy Problem Solving Unhealthy General Functioning 52. We don't talk to each other when we are angry. Unhealthy Communication 53. We are generally dissatisfied with the family Unhealthy duties assigned to us. Roles 54. Even though we mean well, we intrude too much Unhealthy into each others lives. Affective Involvement 55. There are rules about dangerous situations. 56. We confide in each other. 57. We cry openly. 58. We don't have reasonable transport. 59. When we don't like what someone has done, we tell them. 60. We try to think of different ways to solve problems. Healthy Behaviour Control Healthy General Functioning Healthy Affective Responsiveness Unhealthy Roles Healthy Communication Healthy Problem Solving - 107 -APPENDIX E McMaster Family Assessment Device 1. Planning family a c t i v i t i e s i s d i f f i c u l t because we misunderstand each other. 2. We resolve most everyday problems around our house. 3. When someone i s upset the others know why. 4. When you ask someone to do something, you have to check that they did i t . 5. I f someone i s i n trouble the others become too involved. 6. In times of c r i s i s we can turn to each other f o r support. 7. We know what to do when an emergency comes up. 8. We sometimes run out of things that we need. 9. We are reluctant to show our a f f e c t i o n for each other. 10. We make sure members meet t h e i r family r e s p o n s i b i l i t i e s . 11. We cannot t a l k to each other about the sadness we f e e l . 12. We usually act on our decisions regarding problems. 13. You only get the interest of others when something i s important to them. 14. You can't t e l l what a person i s f e e l i n g from what they are saying. 15. Family tasks don't get spread around enough. 16. Individuals are accepted for what they are. 17. You can e a s i l y get away with breaking the ru l e s . 18. People come r i g h t out and say things instead of h i n t i n g at them. 19. Some of us just don't respond emotionally. 20. We know what to do i n an emergency. 21. We avoid discussing our fears and concerns. - 108 -22. I t i s d i f f i c u l t to ta l k to each other about tender f e e l i n g s . 23. We have trouble meeting our b i l l s . 24. Afte r our family t r i e s to solve a problem, we usually discuss whether i t worked or not. 25. We are too s e l f centred. 26. We can express feelings to each other. 27. We have no clear expectations about t o i l e t habits. 28. We do not show our love for each other. 29. We t a l k to people d i r e c t l y rather than through go-betweens. 30. Each of us has p a r t i c u l a r duties and r e s p o n s i b i l i t i e s . 31. There are l o t s of bad feelings i n the family. 32. We have rules about h i t t i n g people. 33. We get involved with each other only when something in t e r e s t s us. 34. There's l i t t l e time to explore personal i n t e r e s t s . 35. We don't often say what we mean. 36. We f e e l accepted for what we are. 37. We show intere s t i n each other when we can get something out of i t personally. 38. We resolve most emotional upsets that come up. 39. Tenderness takes second place to other things i n our family. 40. We discuss who i s to do household jobs. 41. Making a decision i s a problem for our family. 42. Our family shows interest i n each other only when they can get something out of i t . 43. We are frank with each other. 44. We don't hold to any rules or standards. - 109 -45. I f people are asked to do something, they need reminding. 46. We are able to make decisions about how to solve problems. 47. I f the rules are broken, we don't know what to expect. 48. Anything goes i n our family. 49. We express tenderness. 50. We confront problems involving f e e l i n g s . 51. We don't get along well together. 52. We don't t a l k to each other when we are angry. 53. We are generally d i s s a t i s f i e d with the family duties assigned to us. 54. Even though we mean well, we intrude too much into each others l i v e s . 55. There are rules about dangerous s i t u a t i o n s . 56. We confide i n each other. 57. We cry openly. 58. We don't have reasonable transport. 59. When we don't l i k e what someone has done, we t e l l them. 60. We t r y to think of d i f f e r e n t ways to solve problems. - 1 1 0 -APPENDIX F Assignment of FAD Items to Sub-Scales Problem Communi- Roles Affective Affective Behaviour General Solving cation Respon- Involve- Control Function-si veness ment ing 2 3 10 49 20 6 Healthy 12 18 30 57 32 16 Functioning 24 29 40 55 26 Items 38 43 36 50 59 46 60 56 14 4 9 5 7 1 Unhealthy 22 8 19 13 17 11 Functioning 35 15 28 25 27 21 Items 52 23 39 33 44 31 34 37 47 41 45 42 48 51 53 54 58 - I l l -APPENDIX 6 Schedule and guide f o r the Semi-Structured Family I n t e r v i e w C o n s t r u c t i o n of f a m i l y genogram and r e l a t e d q u e s t i o n s (eg. age of a l l c h i l d r e n , m a r r i a g e / d i v o r c e dates and reasons, r e l a t i o n s h i p s with extended f a m i l y ) . -Did the Q-Sort t a s k a l l o w you t o g i v e a f a i r l y a c c u r a t e p i c t u r e of what your f a m i l y i s l i k e ? F a mily I n t e r a c t i o n Questions -Ranking type q u e s t i o n s would be asked e.g.; Which r e l a t i o n s h i p i s the most a f f e c t e d by d r i n k i n g (mother-father, mother-daughter e t c . ) ? Which i s the next most a f f e c t e d ? Which r e l a t i o n s h i p i s the most a f f e c t e d by s o b r i e t y ? and so on. - C o n f i r m a t i o n type q u e s t i o n s would be asked e.g.; Would your mother agree (with p r e v i o u s answer)? - T r i a d i c q u e s t i o n s would be asked (questions t h a t ask one person t o comment on the r e l a t i o n s h i p between two others) e.g.; Would you say t h a t your parents are as c l o s e when your mother i s d r i n k i n g ? Family F u n c t i o n i n g Questions -How are important d e c i s i o n s made i n your f a m i l y ? I s t h i s the same when your f a t h e r i s d r i n k i n g ? - I f t he f a m i l y were t o t r y t o decide what show t o see or what k i n d of take-out food t o get how would the d i s c u s s i o n go? I f Mom/Dad had been d r i n k i n g how would the d i s c u s s i o n go? -Who i s c l o s e , and how do people s i g n a l t h e i r need f o r c l o s e n e s s ? I f Mom/Dad has been d r i n k i n g who i s c l o s e ? -Are Mom and Dad romantic enough? How would Mom/Dad say t h a t the marriage p a r t of t h e i r marriage i s going? When Mom/Dad i s d r i n k i n g who i s more romantic? -Do r u l e s / r e s p o n s i b i l i t i e s change when t h e r e i s no d r i n k i n g ? How? Family I d e n t i t y Questions - T e l l me about t h i s f a m i l y ' s s t r e n g t h s ? What do you l i k e b e s t - 112 -about being i n t h i s family? -What's the most important thing that your parents have t r i e d to teach you? -What's the most important thing you have t r i e d to teach your children? -Would you describe yourselves as a close family? -Do your feelings about your family change when drinking i s going on? How? -Who i s closest to t h e i r family of origin? Is t h i s family c l o s e s t to Mom's side of the family or Dad's? Does t h i s change when Mom/Dad i s drinking? - 113 -APPENDIX H P r e s e n t D r i n k i n g P a t t e r n P r e s e n t D r i n k i n g P a t t e r n D r i n k i n g P a t t e r n ( c h e c k one) D e t e r m i n e w h i c h o f t h e f o l l o w i n g c a t e g o r i e s b e s t d e s c r i b e s t h e c l i e n t s c u r r e n t d r i n k i n g p a t t e r n : (P) P E R I O D I C DRINKER ! D r i n k s l e s s o f t e n t h a n o n c e a week | I s a b s t i n e n t b e t w e e n d r i n k i n g e p i s o d e s ! C o m p l e t e E p i s o d i c P a t t e r n C h a r t (S) STEADY DRINKER ] D r i n k s a t l e a s t o n c e p e r week ' ! D r i n k s a b o u t t h e same amount e v e r y ] week w i t h o u t p e r i o d i c e p i s o d e s o f ] h e a v i e r d r i n k i n g . (A h e a v y e p i s o d e i s ] d e f i n e d a s on e o r m o r e d a y s i n w h i c h ] t h e p a t t e r n f l u c t u a t e s f r o m t h e s t e a d y ] p a t t e r n by 5 o r m o r e S E C s . ) ] C o m p l e t e S t e a d y P a t t e r n C h a r t (C) COMBINATION P A T T E R N DRINKER ] D r i n k s a t l e a s t o n c e p e r week w i t h a ] r e g u l a r w e e k l y p a t t e r n , b u t a l s o h a s ] h e a v i e r e p i s o d e s a s d e f i n e d a b o v e . j C o m p l e t e b o t h S t e a d y & E p i s o d i c C h a r t s - 114 -APPENDIX I Episodic P a t t e r n Chart jType and Amount of Beverage Consumed: *Number of i episodes i n | past 3 months: | *Total SECs x ! = SECs/ ]*Hours: per episode *Peak BAC: mg% episodes ' per 3 mo. | 3 mo. !Type and Amount of Beverage Consumed: *Number of | episodes i n | past 3 months: | *Total SECs x ] = SECs/ |*Hours: per episode *Peak BAC: mg% episodes j per 3 mo. j 3 mo. |Type and Amount of Beverage Consumed: •Number of j episodes i n j past 3 months: | *Total SECs x j = SECs/ J *Hours: per episode *Peak BAC: mg% episodes j per 3 mo. ] 3 mo. Formula f o r c a l c u l a t i n g SECs: # oz. X % alcohol X 2 = SECs Standard Ethanol Content unit = .5 oz. (15 ml.) of pure e t h y l a l c o h o l . 10 oz. beer (5% alcohol) 4 oz. wine (12% alcohol) 2.5 oz. of f o r t i f i e d wine (20% alcohol) 1.25 oz. of 80 proof s p i r i t s (40% alcohol) 1.00 oz. of 100 proof s p i r i t s (50% alcohol) 

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