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Alcoholic family interaction McGee, Daniel R. 1991

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ALCOHOLIC FAMILY INTERACTION by DANIEL R. MCGEE B.ED., U n i v e r s i t y o f 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 o f C o u n s e l l i n g  We accept  Psychology)  t h i s t h e s i s as conforming  to the r e q u i r e d  standard  THE UNIVERSITY OF BRITISH COLUMBIA September 1991 © D a n i e l R. McGee, 1991  In  presenting this  degree at the  thesis in  University of  partial  fulfilment  of  of  department  this thesis for or  by  his  or  requirements  British Columbia, I agree that the  freely available for reference and study. I further copying  the  representatives.  an advanced  Library shall make it  agree that permission for extensive  scholarly purposes may be granted her  for  It  is  by the  understood  that  head of copying  my or  publication of this thesis for financial gain shall not be allowed without my written permission.  Department The University of British Columbia Vancouver, Canada  DE-6 (2/88)  ABSTRACT  A repeated case study d e s i g n was used t h a t combined data from the a p p l i c a t i o n of the Q-technique  and 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 , t o examine the e f f e c t s of a l c o h o l on f a m i l y interaction.  Two  f a m i l i e s were s e l e c t e d  on the b a s i s  that  they r e p r e s e n t e d examples of binge or a l t e r n a t i n g p a t t e r n s of d r i n k i n g and  s o b r i e t y as d e f i n e d by S t e i n g l a s s  (1987) .  f a m i l i e s were i d e n t i f i e d and r e f e r r e d t o the p r o j e c t an A l c o h o l and Drug O u t p a t i e n t Treatment Program. family  members Q-sorted  60  items  drawn  Family Assessment Device developed Bishop like,  (198 3) to  least  into  seven  like,  by  Epstein,  categories that  their  t o g e t h e r Q-sorted the items.  through  Individual  the  McMaster  Baldwin  ranged  and  from  most  during  both  The f a m i l y as a group  then  particular  d r i n k i n g and n o n - d r i n k i n g times.  from  The  family,  Q-sort r e s u l t s f o r each  sorting  o c c a s i o n were made i n t o a c o r r e l a t i o n a l matrix, then s u b j e c t e d to a p r i n c i p a l components a n a l y s i s . to  The r e s u l t s were a n a l y z e d  i d e n t i f y s i m i l a r themes or p a t t e r n s .  - iii  -  TABLE OF CONTENTS ABSTRACT LIST OF TABLES LIST OF FIGURES LIST OF APPENDICES ACKNOWLEDGEMENTS CHAPTER I INTRODUCTION Purpose of the Study I n t e r a c t i o n a l C y b e r n e t i c Systemic View Research Questions  i i V v i i viii ix 1 2 2 3  CHAPTER I I REVIEW OF THE LITERATURE A l c o h o l i s m and the Family Family Paradigm A l t e r n a t o r (Binge) P a t t e r n Influence  4 4 12 16 17  CHAPTER I I I METHODOLOGY S i n g l e Case S t u d i e s Case Subjects Screening and S e l e c t i o n Case Subject D e s c r i p t i o n s Case Study I n v e s t i g a t o r Instruments McMaster Family Assessment Device Data C o l l e c t i o n Semi-Structured Interview Data A n a l y s i s Q-Technique S u b j e c t s of Judgements f o r Q-sorts Q-Sort Items Q-Sorting  18 18 22 22 23 28 29 31 32 34 35 36 37 37 38  CHAPTER IV RESULTS Introduction Screening and Assessment Instrument R e s u l t s P r e l i m i n a r y A n a l y s i s o f Q-Sorts Family A (Non-drinking) Family A (Drinking) Family B (Non-drinking) Family B (Drinking) THE SEMI-STRUCTURED FAMILY INTERVIEWS Case Study A The Family's Experience of the Q-Sort  41 41 41 43 45 54 58 62 66 66 66  - iv Family I n t e r a c t i o n (Drinking) Family I n t e r a c t i o n (Non-drinking) Case Study B The Family's Experience of t h e Q-Sort Family I n t e r a c t i o n (Drinking) Family I n t e r a c t i o n (Non-drinking)  67 70 71 71 73 75  CHAPTER V SUMMARY AND DISCUSSION Q-Sort R e s u l t s Family A Family B Theoretical Implications L i m i t a t i o n s of the Study I m p l i c a t i o n s f o r Family Treatment o f A l c o h o l i s m Research Questions: Conclusions Future Research I m p l i c a t i o n s  77 79 81 83 84 86 88 88 91  REFERENCES  95  -  v  -  LIST OF TABLES TABLE 4.1 MAST S c o r e s f o r I d e n t i f i e d P r o b l e m In F a m i l i e s Studied  Drinkers  42  Q u a n t i t y and Frequency o f E p i s o d i c D r i n k i n g  42  TABLE 4.2 TABLE 4.3  Family  TABLE 4.4  A Non-drinking:  Family A Non-drinking: and % o f V a r i a n c e  Correlational Eigen  Matrix  Values  45 45  TABLE 4.5  Family A Non-drinking: U n r o t a t e d P r i n c i p a l Component S o l u t i o n  46  Family A Non-drinking: R o t a t e d P r i n c i p a l Component S o l u t i o n  47  D i m e n s i o n s (items) which D i f f e r e n t i a t e PCI from PC2 f o r F a m i l y A F u n c t i o n i n g f o r N o n - d r i n k i n g Periods  48  D i m e n s i o n s ( i t e m s ) w h i c h D i f f e r e n t i a t e P C I a s 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 Non-drinking Periods  50  Dimensions (items) which D i f f e r e n t i a t e PCI as L e s s 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 PC3 f o r Non-drinking Periods  51  D i m e n s i o n s ( i t e m s ) w h i c h D i f f e r e n t i a t e PC2 a s 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 PC3 f o r Non-drinking Periods  52  D i m e n s i o n s ( i t e m s ) w h i c h D i f f e r e n t i a t e PC2 a s L e s s 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 PC3 f o r Non-drinking Periods  53  Family A Drinking: Correlational  54  TABLE 4.6  TABLE 4.7  TABLE 4.8  TABLE 4.9  TABLE 4.10  TABLE 4.11  TABLE 4.12 TABLE 4.13  Family A Drinking: Eigen and % o f V a r i a n c e  Matrix  Values  54  TABLE 4.14  Family A Drinking: U n r o t a t e d P r i n c i p a l Component S o l u t i o n  55  Family A Drinking: R o t a t e d P r i n c i p a l Component S o l u t i o n  56  TABLE 4.15  - vi TABLE 4.16 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 Drinking Periods 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 F u n c t i o n i n g than PC2 f o r Drinking Periods TABLE 4.18 Family B Non-drinking: C o r r e l a t i o n a l M a t r i x TABLE 4.19 Family B Non-drinking: Eigen Values and % of V a r i a n c e TABLE 4.20 Family B Non-drinking: Unrotated P r i n c i p a l Component S o l u t i o n TABLE 4.21 Dimensions (items) which C o n s t i t u t e PCI 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 4.22 Family B 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 4.23 Family B D r i n k i n g : Eigen Values and % of V a r i a n c e TABLE 4.24 Family B 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 4.25 Dimensions (items) which C o n s t i t u t e PCI f o r Family B F u n c t i o n i n g f o r D r i n k i n g P e r i o d s  57  58  59 59 60 61 62 62 63 64  - viiLIST OF FIGURES FIGURE 3.1 P r o c e d u r a l Flow Chart FIGURE 3.2 Q-Sort D i s t r i b u t i o n  - viii LIST OF APPENDICES APPENDIX A L e t t e r s of Introduction APPENDIX B Consent Forms APPENDIX C The Michigan A l c o h o l i s m Screening T e s t APPENDIX D Q-Sort Items APPENDIX E McMaster Family Assessment Device APPENDIX F Assignment of FAD items t o Sub-Scales APPENDIX 6 The Semi-Structure Family Interview APPENDIX H Present D r i n k i n g P a t t e r n Chart APPENDIX I E p i s o d i c P a t t e r n Chart  - ix -  ACKNOWLEDGEMENTS There a r e a number o f people who have p l a y e d a s i g n i f i c a n t r o l e i n the p r o d u c t i o n of t h i s t h e s i s , and I would l i k e t o take t h i s o p p o r t u n i t y t o acknowledge them. Dr. John F r i e s e n , the c h a i r p e r s o n o f my t h e s i s committee, has been a source of a great d e a l o f encouragement. Dr. Walter B o l d t p a t i e n t l y guided me through the methodology which a t times I found q u i t e c o n f u s i n g and whose enthusiasm f o r t h e data was contagious. I want t o thank my f r i e n d and c o l l e a g u e A l l a n who has provided me with numerous o p p o r t u n i t i e s t o e n t e r into c o n v e r s a t i o n s t h a t continue t o remind me o f t h e wonder o f i t all. I a l s o want t o acknowledge t h e f a m i l i e s t h a t p a t i e n t l y s o r t e d t h e cards and answered a l l my q u e s t i o n s w i t h such openness. T h e i r w i l l i n g n e s s t o share t h e i r l i v e s w i t h me made this project possible. And f i n a l l y I want t o thank you Kathleen, you have been t h e r e t o do e v e r y t h i n g e l s e while I was parked i n f r o n t o f t h e word p r o c e s s o r . I l o v e you, and I have missed you.  - 1 CHAPTER I INTRODUCTION  This  study examined how,  member, f a m i l y from  family  were  gathered  measure  i n f a m i l i e s w i t h an a l c o h o l i c  i n t e r a c t i o n during  i n t e r a c t i o n during  of  i n two  ways;  typical  semi-structured  drinking periods d i f f e r e d  non-drinking  ( i ) The  family  periods.  Q-sort,  interaction,  family interview.  a self-report and,  (ii)  In a d d i t i o n , the Q-sort  completed by each i n d i v i d u a l f a m i l y member and f a m i l y as a group task.  Data  A was  by the e n t i r e  The r e l a t i o n s h i p between the r e s u l t s  of the f a m i l y Q-sort (which a c t s as a h y p o t h e t i c a l i n d i v i d u a l ) and  the  i n d i v i d u a l Q-sort  i n f l u e n c e was  was  examined  and  a  measure  of  i n f e r r e d . Central to t h i s family perspective  on  a l c o h o l i s m i s t h a t f a m i l i e s conserve t h e i r shared c o n c e p t i o n s of  the  world  not  through  f a m i l i a r to psychologists t h e i r own The the  i n d i v i d u a l memory - but  -  the  through r e g u l a r p a t t e r n s  c e n t r a l q u e s t i o n explored  difference  family  drinking? to  of  i n t e r a c t i o n (Reiss, 1981).  in  terms  of  how  i n t h i s study i s : what i s individual family  p e r c e i v e t h e i r i n t e r a c t i o n s and hence conserve and the  agency  paradigm The  examine who  during  periods  of  constitute  drinking  q u a n t i t a t i v e l e v e l of t h i s study was i n the  family contributes  s h i f t i n g of the f a m i l y paradigm, and  members  and  non-  intended  to t h i s p o t e n t i a l  i n what ways.  -  2  -  Purpose of the Study The  purpose  of  this  study  has  noteworthy d i f f e r e n c e s i n the way d r i n k i n g and non-drinking understanding to  enrich  been  to  reveal  a family functions  some during  periods, to contribute to a better  of f a m i l y f u n c t i o n i n g and a l c o h o l i s m as w e l l as  the  l i t e r a t u r e the  existing indigenous  knowledge  base  by  adding  to  knowledge of f a m i l i e s c o p i n g  the with  problems r e l a t e d t o a l c o h o l . In a d d i t i o n , as the Q-sort  items were o b t a i n e d  McMaster Family Assessment d e v i c e , t h i s study expand the knowledge t h a t e x i s t s r e g a r d i n g  from the  i s expected t o  t h i s widely  used  instrument.  I n t e r a c t i o n a l C y b e r n e t i c Systemic View In  1967,  published challenged  Jackson,  Pragmatics the  of  Watzlawick, Human  psychodynamic  and  Beavin  Communication.  approach  that  i n d i v i d u a l as the " c o n t a i n e r " of pathology. t h a t t h i s view ignored the extent  (Bavelas), This  focused  on  work the  The w r i t e r s f e l t  t o which the r e l a t i o n s h i p  c o n t e x t c o n t r i b u t e d t o the problem behaviour; r e l a t i o n s h i p contexts being the f a m i l y .  one of the main  T h e i r view suggested  t h a t i f the i n t e r a c t i o n a l p a t t e r n s i n the f a m i l y c o u l d change so would the problem behaviour. alcoholic  family  would  The i n t e r a c t i o n a l view of the  suggest  it  is  the  interactional  p a t t e r n s of behaviour t h a t f a c i l i t a t e a l c o h o l r e l a t e d problem behaviour.  Research  3  Questions  Do d e s c r i p t i o n s o f f a m i l y image  -  o r paradigm)  differ,  functioning  f o r drinking  (thefamily and  self-  non-drinking  periods? Do r e s p o n s e s t o s p e c i f i c q u e s t i o n s such  salient  solving, affective  dimensions  communication, involvement,  functioning differ  of  family  roles,  functioning  affective  behaviour  for periods  purported t o evaluate as  problem  responsiveness,  control,  and  general  o f d r i n k i n g and a b 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 the  family  as a group  differ  from  individual  from  descriptions?  Who i n t h e f a m i l y c o n t r i b u t e s t h e most t o t h e a l c o h o l i c f a m i l y paradigm? Does t h e a l c o h o l i c c o n t r i b u t e is  s / h e more d i s t a n t  much o f t h e l i t e r a t u r e  and l e s s  t o the family  influential  predicts?  paradigm o r  i n the family  as  -  4  -  CHAPTER I I REVIEW OF THE  Alcoholism  and  LITERATURE  the Family  Much of the l i t e r a t u r e (popular and p r o f e s s i o n a l ) w r i t t e n about  families  where  alcohol  is  a l c o h o l i c s are more d i s t a n t and spouses than  are  Anonymous, 1986; According relevant focused  to  that  less i n f l u e n t i a l with  their  (Al-anon,  1971;  Alcoholics  W o i t i t z , 1983). t o Jacob and  family  Seilhamer  influences  on  (1987) the  alcoholism  literature  has  largely  on the s t a t u s of i n d i v i d u a l s w i t h i n the f a m i l y .  l i t e r a t u r e has, and  suggests  non-alcoholics  misused  This  f o r the most p a r t , been i n d i v i d u a l l y focused  psychodynamically based. S t u d i e s done by Futterman, (1953) , K a l a s h i a n ,  Lewis,  (1937) i n i t i a l l y  "disturbed  described  personalities"  unconscious  needs  by  who  spouses of sought  dominating  a  to  male  d r i n k i n g rendered him weak and dependent Seilhamer,  1987).  With  the  advent  (1959), and  alcoholics satisfy  whose  as  their  alcoholic  ( c i t e d i n Jacob  and  environmental  or  of  s y s t e m i c p e r s p e c t i v e s , the wives of a l c o h o l i c s were r e c a s t as "victims"  rather  disturbances  were  than  "villains"  considered  a  and  their  reaction  to  psychological the  stress  a s s o c i a t e d w i t h l i v i n g with an a l c o h o l i c spouse a c c o r d i n g  to  Jackson, and Jacob and Seilhamer, (1982) , ( c i t e d i n Jacob and  - 5 Seilhamer, 1987). More  recently,  environmental  efforts  associations  categorize  typical  coping  husband's  drinking  have in  focused  attempts  s t r a t e g i e s as  behaviour,  on to  describe  actual  maintain  however  the  data  of  the most  been absent:  i n t e r a c t i o n s between spouses t h a t p o t e n t i a t e  abusive  clearly  and  they r e l a t e t o  importance t o e x p l o r i n g such r e l a t i o n s h i p s has the  individual-  implied  drinking. that  the  However,  this  a l c o h o l i c and  literature  his  or  her  or has  spouse  e x h i b i t unique r e l a t i o n s h i p p a t t e r n s , t h a t these p a t t e r n s  are  r e p e t i t i v e and  are  identifiable,  and  t h a t such i n t e r c h a n g e s  r e l e v a n t t o the emergence and p e r p e t u a t i o n of problem d r i n k i n g (Jacob and  Seilhamer, 1987).  Similar a d d i c t i o n , and childhood  the  the  the  literature past  literature  on  depression  and  drug  i n c o n t r a s t with s t u d i e s of s c h i z o p h r e n i a  disorder,  alcoholism until  to  study of  has  decade.  family  interaction in  been a r e l a t i v e l y  The  and  neglected  reason f o r t h i s n e g l e c t  the area  can  be  r e l a t e d t o v a r i o u s h i s t o r i c a l trends i n the a l c o h o l i s m domain, most important, the r e p e a t e d l y as an i n d i v i d u a l problem.  emphasized view o f  alcoholism  L a r g e l y s t i m u l a t e d by the  general  i n t e r e s t i n f a m i l y i n t e r a c t i o n and psychopathology d u r i n g  the  1950s and 1960s, s e v e r a l p r e l i m i n a r y r e p o r t s on i n t e r a c t i o n a l views of context  a l c o h o l i c s and  on  the  began t o appear i n the  treatment w i t h i n late  1960s and  the  family  e a r l y 1970s;  soon t h e r e a f t e r , s c a t t e r e d o b s e r v a t i o n a l s t u d i e s of a l c o h o l i c -  -  6  -  spouse i n t e r a c t i o n s appeared i n the l i t e r a t u r e , as w e l l as t h e initiation  of  several  programs  i n f l u e n c e s on a l c o h o l i s m . t o date i s s t i l l  of  o f which  efforts  on  family  However, the accumulated l i t e r a t u r e  an extremely s m a l l one, i n f a c t t h e r e have  been l e s s than 10 r e p o r t e d s t u d i e s most  research  can be c o n s i d e r e d  i n t h i s area s i n c e 1974, preliminary  and/or  pilot  (Jacob and Seilhamer, 1987).  In Jacob and Seilhamer*s review of a l c o h o l i s m and f a m i l y interaction  research  (1987)  they  describe  the  potential  importance of an i n t e r a c t i o n a l p e r s p e c t i v e t o a l c o h o l and  the contributions  untangling  the  alcoholism  that  i n t e r a c t i o n r e s e a r c h can make i n  admittedly  and the f a m i l y  complex  matrix.  e m p i r i c a l l y based d e s c r i p t i o n s can  association  Of f i r s t  of f a m i l y  be viewed as necessary b u i l d i n g  treatment and p r e v e n t i o n e f f o r t s . of  s i g n i f i c a n t patterns  least  some) a l c o h o l i c s  mechanism related  by which  to current  i n d i v i d u a l members. drinking  interactions.  blocks  detailed  for theoretical  characterizing  families  interaction  or f u t u r e  states  would  (at  provide a  processes  can be  of the family  The course o f the a l c o h o l i c ' s  o r of problem  and t h e s t a t u s of the a l c o h o l i c ' s o f f s p r i n g c o u l d be  members.  examination families  These  Second, t h e i d e n t i f i c a t i o n  of i n t e r a c t i o n and t h e i r  between  importance a r e  r e l a t e d t o t h e nature of h i s or her i n t e r a c t i o n s family  studies  Third,  the  of interactions  should  provide  description  involving  data  and  and  alcoholics  insights  with  other  careful  and t h e i r  that  can be  - 7 transformed i n t o r e l e v a n t treatment and p r e v e n t i o n programs. Jacob  and  Seilhamer  reviewed  several  studies  that  attempted t o move beyond i n d i v i d u a l s t u d i e s t o d e s c r i p t i o n s of marital  dyads  "transitional Seilhamer,  involving study"  1987)  "personality  an  by  each  alcoholic Mitchell  spouse  was  spouse. (cited  two  such  Jacob  and  in  required  q u e s t i o n n a i r e " under  In one  to  complete  conditions;  a  self-  a p p r a i s a l and a p p r a i s a l of p a r t n e r . Although e x p e r i m e n t a l and control  couples  measures,  were  found  t h e r e d i d appear  to  be  t o be  quite  similar  important  on  most  differences  in  areas concerned w i t h c o n t r o l , dominance, and s e n s i t i v i t y ; t h a t is  the  alcoholic  was  most  likely  to describe h i s wife  as  dominating, whereas she d i d not r e p o r t h e r s e l f 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 t o r e p o r t h i m s e l f as e a s i l y h u r t  whereas the w i f e d i d not share t h i s p e r c e p t i o n of him. transitional and  s t u d i e s g e n e r a l l y focused on how  non-drinking  dimensions.  partners  saw  each  other  In one study by Drewery and Ray  the along  Other  alcoholic various  ( c i t e d i n Jacob  and Seilhamer, 1987) the f i n d i n g s r e v e a l e d t h a t " c o n t r o l wives d e s c r i b e t h e i r husbands i n a way husband's not".  self-description  while  t h a t accords w e l l w i t h the the wives  of  patients  do  In another study by Tamerin, T o l e r , DeWolfe, Packer and  Newman ( c i t e d i n Jacob and Seilhamer, 1987)  which focused on  differences  i n p e r c e p t i o n of the a l c o h o l i c d u r i n g sober  intoxicated  s t a t e s , the f i n d i n g s suggest both the  and the spouse d e s c r i b e the a l c o h o l i c  i n generally  and  alcoholic positive  - 8 terms  when  increase  the  for  alcoholic both  in  was  sober,  negativism  with  and  a  significant  depression  when  intoxicated. Jacob and Seilhamer a l s o looked a t r e s e a r c h t h a t moved interest  from  individual  processes  associated  descriptions  w i t h the  ongoing  a l c o h o l i c and her or h i s i n t i m a t e s . Seilhamer,  1987)  conducted  an  to  outcomes  i n t e r c h a n g e s of  and the  Gorad ( c i t e d i n Jacob and  analysis  of  the  alcoholics  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 P a l o A l t o group.  Gorad t e s t e d  the h y p o t h e s i s t h a t suggested t h a t drunkenness was used as a manoeuvre whose f u n c t i o n i s t o g a i n c o n t r o l of the s e t t i n g of r u l e s i n a r e l a t i o n s h i p and found t h a t 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 t o be one up i n a h i g h l y competitive b a t t l e .  Another study done by Cobb and  looked a t problem s o l v i n g , cooperative  and  and one done by Kennedy e x p l o r e d  competitive  patterns  However t h e s e works were i n c o n c l u s i v e Seilhamer, 1987).  McCourt  i n a l c o h o l i c couples. (cited  i n Jacob  and  Jacob and Seilhamer a l s o suggest t h a t work  based on s t r u c t u r e d l a b o r a t o r y t a s k s and game outcome r a i s e s q u e s t i o n s r e g a r d i n g 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 t h e completeness of the emergent  c h a r a c t e r i z a t i o n s of a l c o h o l i c -  spouse r e l a t i o n s h i p s . There has been c o n s i d e r a b l e i n t e r e s t d i r e c t e d toward the patterns  of i n t e r a c t i o n  a l c o h o l i c member.  that  characterize  families  w i t h an  Family i n t e r a c t i o n r e s e a r c h i n t h i s a r e a  - 9 has  focused  on  the  persistence  of  alcohol  (Jacob, R i t c h e y , A  number  variables that misuse  studies  associated  rather  C v i t k o v i c , and of  are  than  with  its  the  etiology.  Blane, 1981).  have  examined  the  relationship  between a l c o h o l misuse and f a m i l y i n t e r a c t i o n by comparing and contrasting periods  various  aspects  of d r i n k i n g and  of  family  functioning  abstinence.  Most r e c e n t l y Liepman et a l . (1989) looked functioning partners  of  20  during  during  a t the  family  their  female  intervals.  Using  male a l c o h o l i c veterans and drinking  and  abstinent  r e p e a t e d measures a n a l y s i s on the McMaster Family Assessment Device  (FAD)  they  determined  that  alcoholics  partners  perceive  than wet  p e r i o d s on a l l 7 s c a l e s of the FAD  Communication, Involvement,  and  f a m i l y f u n c t i o n i n g t o be b e t t e r d u r i n g  Roles,  Affective  Behaviour  Control,  Responsiveness, and  gave h e a l t h i e r r a t i n g s on a l l FAD  dry  (Problem S o l v i n g ,  General  Affective  Functioning).  However, i n c o n t r a s t t o the male a l c o h o l i c , female  wet  their  partners  s c a l e s except R o l e s i n the  c o n d i t i o n and A f f e c t i v e Involvement i n the dry c o n d i t i o n .  Alcoholics  as  a  group  viewed  their  f u n c t i o n i n g as unhealthy, although the family's  dry  problem  solving  and  wet  and  dry  family  female group saw  behaviourial  control  the as  healthy. Steinglass three  (1987) proposes  that  types of a l c o h o l i c f a m i l i e s ; the  family,  the  s t a b l e dry  there  are  s t a b l e wet  a l c o h o l i c family  and  the  (at  least)  alcoholic alternator  - 10 alcoholic  family.  The s t a b l e wet p a t t e r n  i s one  i n which  d r i n k i n g occurs on a r e g u l a r and p r e d i c t a b l e b a s i s from day t o day  o r weekend  t o weekend.  The s t a b l e d r y p a t t e r n  families  have not o n l y ceased d r i n k i n g but f a m i l y members a r e c o n v i n c e d t h a t t h i s i s a r e l a t i v e l y permanent s t a t e of a f f a i r s even i f occasional  "slips"  occur.  For the s t a b l e d r y f a m i l i e s the  p a s t has i n c l u d e d a p e r i o d of a t l e a s t f i v e y e a r s d u r i n g which the f a m i l y has been i n the s t a b l e wet p a t t e r n . pattern  i s the one commonly d e s c r i b e d  pattern  the d r i n k e r t y p i c a l l y  several  weeks  to  several  An a l t e r n a t o r  as binging,.  In t h i s  a l t e r n a t e s between p e r i o d s  months  when  active  drinking  of is  o c c u r r i n g (wet periods) and p e r i o d s of weeks t o months when no drinking pattern  i s occurring.  The d i s t i n g u i s h i n g f e a t u r e  of t h i s  i s t h a t a l t e r n a t i n g between wet and d r y p e r i o d s  have o c c u r r e d  m u l t i p l e times d u r i n g  will  the l i f e h i s t o r y o f t h e  family. S t e i n g l a s s (1987) suggests t h a t "a comparable d u a l i t y or c y c l i n g e x i s t s f o r i n t e r a c t i o n a l behaviour p a t t e r n s w i t h i n the Alcoholic  Family.  paralleled family. families  Off-on c y c l i n g of d r i n k i n g  by a l t e r a t i o n s i n b e h a v i o r a l  He and h i s c o l l e a g u e s during  wet  and  dry  first  behaviour i s  patterns  w i t h i n the  observed d i f f e r e n c e s i n  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 t h e d r i n k i n g s t a t u s of the a l c o h o l i c . The S t a b l e Dry families  appeared  behaviour.  t o have  the most  flexible  patterns  of  These f a m i l i e s express a broad range of a f f e c t , i n  - l i the area of a l l o w i n g disagreement t o be expressed and  engaged  i n more d e c i s i o n making behaviour  (Liepman e t a l , 1989) .  the  f a m i l y members may  Stable  Dry  a l c o h o l i c family,  guard" a g a i n s t r e l a p s e by becoming i n v o l v e d i n A.A. etc.  each other.  less  The  variability  purpose, and  They a l s o  f a m i l i e s show  verbal  significantly  interactions  in  Steinglass  (1987)  d i f f e r e n c e s along gender l i n e s . developed s i m i l a r p a t t e r n s  also  reported  of behaviour. a t changes i n f a m i l y  dynamics d u r i n g a d r i n k i n g episode.  On a t l e a s t one  the  d i s t a n t and  husband who  seemed e m o t i o n a l l y  when sober, appeared t o change d r a m a t i c a l l y 6-12  oz. of 100  more  involved  may  use  proof in  alcohol  provide  alcohol.  the  the  unconnected  a f t e r consuming  Steinglass  achieve family  occasion  He became more animated,  family. to  no  F a m i l i e s of women a l c o h o l i c s  Research done by S t e i n g l a s s looked  state  content,  a f f e c t i v e l e v e l than do s t a b l e - d r y f a m i l i e s .  Interestingly,  families  focus  as w e l l as have time independent  stable-wet  in their  "on  or Alanon  of a t t e n t i o n i n these f a m i l i e s ( S t e i n g l a s s , 1987).  of  be  T h i s k i n d of behaviour tends t o keep a l c o h o l the  tend t o spend time together  In  another  with  a  proposes  state,  whole  this  new  and that  other  range  of  b e h a v i o u r s t o draw upon. According infrastructure  to of  Jacob  and  Steinglass's  Seilhamer,  (1987)  the  t h e o r e t i c a l developments  key is  t h a t 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 i n t o x i c a t e d v e r s u s sober s t a t e s and  t h a t the  intoxicated-relevant patterns  are  -Ins u f f i c i e n t l y r e i n f o r c i n g t o perpetuate or m a i n t a i n c y c l e s of abusive d r i n k i n g .  Inspection  of S t e i n g l a s s ' s work, however,  i n d i c a t e s t h a t these are assumptions drawn from h i s observations and  that  that  of the e a r l y , small samples of dyads and  these observations  had  not  yet  rigorous design  were best  been t e s t e d  (Jacob and  The q u e s t i o n of why persist  clinical  (alcoholism,  in a careful,  hypotheses  scientifically  Seilhamer, 1987).  certain i n t e r a c t i o n a l patterns  f o r example) has  Riess  (1981) among others  1974;  Jackson,  1965;  viewed as  couples  (Handel,  Riskin,  been pursued by  1967;  1963;  should  and  Ford  and  David  Herric,  F e r r e i r a , 1966)  in  t h e i r s t u d i e s of f a m i l y paradigm, f a m i l y themes, f a m i l y r u l e s , and  f a m i l y myths ( c i t e d i n S t e i n g l a s s et a l . , 1987).  Each of  t h e s e s t u d i e s have focused on the somewhat d i f f e r e n t , but a l s o overlapping  world of the shared b e l i e f systems t h a t f a m i l i e s  hold. It  has  Steinglass environment  been suggested by 1987)  that  (family  the  Reiss  and  family's  paradigm),  in  Elstein,  shared turn,  (cited  view  of  shapes  in its  family  behaviour.  Family  Paradigm  Working  together,  Steinglass  and  Reiss  (1987)  a p p l i e d the concepts of " f a m i l y paradigm" and " g e n e r a l theory"  t o a l c o h o l i s m and  suggest the  following;  have  systems  - 13 1.  Alcoholic  Families  alcoholism  are b e h a v i o u r i a l  and a l c o h o l  systems  i n which  r e l a t e d behaviours have  become  c e n t r a l o r g a n i z i n g p r i n c i p l e s around which f a m i l y l i f e i s structured.  2.  The i n t r o d u c t i o n of a l c o h o l i s m  i n t o f a m i l y l i f e has the  potential  the balance t h a t  t o profoundly  alter  exists  between growth and r e g u l a t i o n w i t h i n the f a m i l y . alteration direction  most of  typically  an  skews  emphasis  on  the  family  short-term  in  This the  stability  ( r e g u l a t i o n ) a t the expense of long-term growth.  3.  The impact of a l c o h o l i s m  and a l c o h o l r e l a t e d behaviours  on f a m i l y systemic f u n c t i o n i n g  i s most c l e a r l y  seen i n  the types of changes t h a t occur i n r e g u l a t o r y behaviours as  the  family  gradually  accommodates  life  to  the  c o e x i s t e n t demands of a l c o h o l i s m .  4.  The  types  of  alterations  that  occur  in  regulatory  behaviours can i n t u r n be seen t o p r o f o u n d l y the  o v e r a l l shape  of f a m i l y  growth  and  development  changes i n the normal f a m i l y l i f e c y c l e t h a t and  Reiss)  labelled  "developmental  influence -  (Steinglass  distortions"  ( S t e i n g l a s s , 1987).  From M i c h a e l White's p e r s p e c t i v e ,  problems develop i n  - 14 families  with  the  interaction situations, Durrant,  -  a c t i v a t i o n of  following  the  vicious  cycles  mishandling  of  of  family  problematic  random events, or f a m i l y s t r e s s o r s a c c o r d i n g  (cited  i n Selekeman, 1989).  becomes l i m i t e d i n t h e i r  ability  Over time the  t o a f f e c t the  to  family  problem  and  i n t e r a c t w i t h one another.  T h i s leads t o i n t e r a c t i o n a l c y c l e s  of  the  blaming  and  guilt  in  family.  The  increasingly restrained in their a b i l i t y the  problem.  considered  It  i s the  restrained  t o be the d i f f i c u l t y .  family  to  becomes  i n t e r a c t around  p a r t i c i p a t i o n that  is  T h i s view tends t o remove  the need f o r e s t a b l i s h i n g the popular f a m i l y therapy i d e a of the " f u n c t i o n of the symptom".  The f a m i l y t h e r a p i s t views the  f a m i l y 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 f a m i l y system  according  t o Durrant, ( c i t e d i n Selekeman, 1989).  The f a m i l y as a whole  is  (1986)  oppressed  by  the  problem.  White  suggests  that  r e s t r a i n t s e s t a b l i s h a t h r e s h o l d or b i a s f o r the s e l e c t i o n of i n f o r m a t i o n about d i f f e r e n c e and l i m i t the f a m i l y ' s a b i l i t y t o undertake  the  solutions.  necessary  Old  ideas  trial-and-error continue;  new  search  for  information  new  becomes  blurred. White suggests t h a t  conversations  are  shaped by  b i a s e s , which f u r t h e r p r o p e l s these c o n v e r s a t i o n s , along.  New  these  or s t o r i e s  i n f o r m a t i o n , t h a t doesn't f i t i n t o the f a m i l y b i a s  or dominant s t o r y gets l e f t behind, or missed Research  and  treatment  approaches  in  entirely. the  area  of  - 15  -  a l c o h o l i s m and f a m i l y i n t e r a c t i o n have suggested a r e c i p r o c a l systemic  relationship  between  suggested the a l c o h o l i c was  the  two.  Initial  more d i s t a n t and  i n the f a m i l y than were n o n - a l c o h o l i c s  studies  less influential  (Ablon,  1976), however  more r e c e n t s t u d i e s have begun t o q u e s t i o n t h i s p o p u l a r i d e a . Extensive and  observations  of c o n j o i n t l y h o s p i t a l i z e d a l c o h o l i c s  t h e i r spouses by S t e i n g l a s s , Davis,  and  Berensen,  (1977)  i n d i c a t e d t h a t communication o f t e n became " e n r i c h e d " and more emotional  with  the  onset  of  drinking,  changes which  often  preceded the a l c o h o l i c ' s a c t u a l , p h y s i o l o g i c a l i n t o x i c a t i o n . Steinglass  e t a l . (1971) concluded t h a t  d r i n k i n g may  be  an  i n d i c a t i o n of d i s t r e s s w i t h i n the i n t e r p e r s o n a l system as w e l l 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 ( i n B i l l i n g s , K e s s l e r , Gomberg, and Weiner, 1979). Reiss  (1981)  suggested  Family Paradigm model.  three  concepts  central  F i r s t , the f a m i l y ' s shared  to  his  conception  of the world i n which i t l i v e s p l a y s a c e n t r a l r e g u l a t o r y r o l e in  family  life.  generative  Second,  r o l e i n family  crisis  life;  plays  a  mutative  in particular, i t initiates  change i n the f a m i l y ' s shared concepts of i t s world. intimate  the o u t s i d e world not through i n d i v i d u a l memory - the  t h e i r own  Third,  s o c i a l groups conserve t h e i r shared c o n c e p t i o n s  f a m i l i a r to psychologists  - but  and  of  agency  through r e g u l a r p a t t e r n s  of  interaction.  Similarly, constrained  White  from e n a c t i n g  suggests  that  families  a l t e r n a t e behaviours by  become  previously  - 16 existing  dominant  f a m i l i e s being  stories  (narrative).  With  s t u d i e d through t h e l e n s o f i n t e r a c t i o n , and  more r e c e n t l y through n a r r a t i v e and d i s c o u r s e Personal to  (alcoholic)  (Bavelas,  1990  Communication), i t would seem important t o c o n t i n u e  gather  information  alcoholism.  on  the  family's  experience  Both R e i s s and White appear t o be s u g g e s t i n g  of that  how i n d i v i d u a l s w i t h i n f a m i l i e s d e s c r i b e themselves and other f a m i l y members ( i n White's language, "the s t o r i e s " they or  in  Reiss*  constitutive  work  of that  the  "patterns  particular  of  interaction")  family.  family  system, perhaps t h i s  terms o f R e i s s '  life.  Alcohol  b e n e f i t might be understood i n paradigm,  a mutative and g e n e r a t i v e  i n t o x i c a t i o n (and s o b r i e t y )  dominant s t o r y , one with new o p p o r t u n i t i e s  Alternator  (Binge)  Some s t u d i e s  o f f e r s some " b e n e f i t " t o t h e  second concept of f a m i l y  (the c r i s i s ) p l a y s  is  I t i s i n "the  t e l l i n g " t h a t the f a m i l y i d e n t i t y i s r e a l i z e d . seem t o suggest t h a t d r i n k i n g  tell  alcohol  r o l e i n family generates a new  (and l i m i t a t i o n s ) .  Pattern  By s t u d y i n g A l t e r n a t o r P a t t e r n  (Binge) f a m i l i e s , one i s  a b l e t o compare and c o n t r a s t accounts o f f a m i l y i n t e r a c t i o n during  periods  of d r i n k i n g and s o b r i e t y i n t h e same  The Q-sort methodology seems u n i q u e l y t h i s phenomena. important provide  suited to investigating  When comprised of items t h a t tend t o e v a l u a t e  aspects a  family.  of  "picture"  family of  the  functioning, family  story  t h e Q-sort or  can  interaction  - 17 pattern,  and  -  when done as a f a m i l y group i t can  provide  the  r e s u l t s of a dynamic r e a l - t i m e n e g o t i a t i o n of f a m i l y i d e n t i t y .  Influence  In a study done by F e r r e i r a and Winter (1965) an attempt was made t o measure the d i f f e r e n c e between normal and abnormal families.  They were i n t e r e s t e d i n how  much agreement e x i s t e d  among f a m i l y members (on what they l i k e d and what they d i d not l i k e ) , how how  much time the f a m i l y took t o reach a d e c i s i o n ,  appropriate  were  these  family  decisions  in  terms  f u l f i l l i n g the wishes of the i n d i v i d u a l f a m i l y members. family  members  situations,  the  were  asked  three  choices  t h r e e they l i k e d the l e a s t . the  to  same q u e s t i o n n a i r e  choose they  between  liked  the  a  number  most  and  and of The of the  They were then asked t o complete  as a f a m i l y , whatever they chose f o r  each s i t u a t i o n would apply t o a l l of them.  The group r e s u l t s  were then compared t o the i n d i v i d u a l r e s u l t s and a measure of " i n f l u e n c e " 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 r e s u l t s was i n f l u e n c e i n the f a m i l y .  s a i d t o have had  the most  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 i n f l u e n c e w i l l be i n f e r r e d from the i n d i v i d u a l and group Q-sort extent  tasks.  This  influence w i l l  t o which i n d i v i d u a l views of the  embraced by the f a m i l y as a group.  be  measuring  the  f a m i l y paradigm  are  - 18 Chapter I I I METHODOLOGY  The  nature  of t h i s  study  has c a l l e d  q u a l i t a t i v e and q u a n t i t a t i v e methods.  f o r t h e use o f  The data c o l l e c t i o n has  focused on t h e Q-sort methodology u t i l i z i n g items drawn from the McMaster Family Assessment Device, and, a s e m i - s t r u c t u r e d interview Michigan  with  a r e t r o s p e c t i v e focus.  Alcoholism  Screening  Test  In a d d i t i o n , the (Seltzer,  1971),  a  s t a n d a r d i z e d instrument was used along w i t h the D i a g n o s t i c and S t a t i s t i c a l Manual o f Mental D i s o r d e r s (1987) and p o r t i o n s o f the Comprehensive D r i n k e r P r o f i l e and M i l l e r , data  of  utilizing  family  t h e Q-technique has r e s u l t e d  interaction  based  c y b e r n e t i c systemic view and R e i s s paradigm.  (Marlet  1984) t o screen t h e s u b j e c t s f o r t h e study.  analysis,  view  Interview B o o k l e t  1  on  an  The ina  interactional  (1981) concept  of family  I n d i v i d u a l and f a m i l y views o f f a m i l y i n t e r a c t i o n  were s u b j e c t e d  t o f u r t h e r a n a l y s i s so as t o e s t a b l i s h t h e  e x t e n t t o which i n d i v i d u a l f a m i l y members c o n t r i b u t e t o t h e family  paradigm  as w e l l  as t h e s p e c i f i c  nature  of t h e i r  contribution.  S i n g l e Case  Studies  In u s i n g t h e case study as t h e g u i d i n g methodology, t h i s study  was  limited  relationship  in i t sability  and thereby  making  to establish  i t impossible  a  causal  t o r u l e out  - 19 a l t e r n a t i v e explanations (Kazdin, not  1980).  -  t o account f o r the r e s u l t s observed  I n d i v i d u a l views of the f a m i l y paradigm  i n f l u e n c e group views, f o r example.  possible that  a  to  generalize  large  number  about the of  cases  While i t may  findings does  not  i t i s also  not  always  may be  clear  increase  generality. The that  d i f f e r e n c e between extensive  extensive  design  usually  and  i n t e n s i v e study i s  involves  a  large  number  of  s u b j e c t s t o which the observer has a c a s u a l r e l a t i o n s h i p w h i l e the  intensive  design  is  usually  associated  with  a  c o m p a r a t i v e l y lengthy r e l a t i o n s h i p w i t h a s m a l l number of case subjects The  (Bass and  Brown 1973).  problems a s s o c i a t e d  with an  extensive  approach  t h i s p a r t i c u l a r k i n d of i n q u i r y i s t h a t s i g n i f i c a n t  to  findings  based on the averaging of heterogeneous groups i s not h e l p f u l in  understanding  individual  the  families  actual  e f f e c t s as  (Chassan,  1979).  they  may  relate  However a c c o r d i n g  to to  Baas and Brown (1973) i t i s p o s s i b l e t o enhance p r e d i c t a b i l i t y on the b a s i s of m u l t i p l e observations  w i t h i n the boundaries of  an i n d i v i d u a l person or group ( i n t h i s case a f a m i l y Further,  it  has  been  noted  by  Herbst  (1970)  group).  that  the  s t a t i s t i c a l procedures and a n a l y s i s are most h e l p f u l when the type of s c i e n t i f i c Herbst d e f i n e d Type A are  law  constant.  law a p p l i e d f i t s w i t h the i s s u e r e s e a r c h e d .  t h r e e such laws. a p p l i e s where both f u n c t i o n s Averaging  across  a group  and  i s not  parameters a  problem,  -  20  -  s i n c e u n i t s of a n a l y s i s are r e l a t i v e l y s i m i l a r . most  helpful  i n the  example Baas and parameter  R  study  of  inactive  substances.  Brown (1973) g i v e Boyle's Law:  remains  constant  This  because  of  law  is  As  an  pv/t=R.  the  The  functional  r e l a t i o n s h i p s between temperature (t) , volume (v) and p r e s s u r e (p) .  S i n c e gases a c t a l i k e , one may Type B law  constant  but  use a v e r a g i n g t e c h n i q u e s .  a p p l i e s where the r e l a t i o n s h i p of f a c t o r s i s the  parameters  are  specific.  Analysis  of  c i r c u m s t a n c e s f i t t i n g these c o n d i t i o n s r e q u i r e s i n i t i a l s i n g l e case  study,  same, may  i . e . , cases where the  be  averaged t o g e t h e r .  boundary v a l u e s  Baas and  are  the  Brown (1973) g i v e  the example: "Y=JLX" might be the r e l a t i o n s h i p between heat and  length  of  "rod  (Y)  where  (X)  is  c h a r a c t e r i s t i c s p e c i f i c t o each metal.  the  heat  relevant  In o r d e r t o c o r r e c t l y  a n a l y z e the event, one would have t o use  s i n g l e case  s i n c e a v e r a g i n g a l l metals together would mask the  analysis 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 m e t a l s . those metals w i t h the  where  law  events  invariance.  i n the  i s most a p p l i c a b l e  frequently  demonstrate  social  i n the a  sciences.  social  different  sciences kind  of  Here both f u n c t i o n a l r e l a t i o n s h i p s and parameters  are s p e c i f i c , but the g e n e r a t i n g r u l e s of p o s s i b l e r e l a t i o n s h i p s are constant. but  (JL)  Baas and Brown suggest t h a t t h i s  i s found i n f r e q u e n t l y  Type C  Only  same heat r e l a t e d c h a r a c t e r i s t i c s  c o u l d be averaged t o g e t h e r . type of law  (X)  idiosyncratically  functional  A generating r u l e i s u n i v e r s a l l y  applicable.  Therefore,  research  attempting  to  reveal  s o c i a l behaviour case approach.  the  generating r u l e s  for a  (problem d r i n k i n g ) , must use an  specific individual  In t h i s case, averaging procedures should not  be used s i n c e ideas vary, f a m i l i e s are i d i o s y n c r a t i c and t h e r e 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 a p p l i c a b l e  idiosyncratically.  To a p p l y e i t h e r Type A or Type B laws t h i s study would not be a p p r o p r i a t e . behave  homogeneously  interactional terms of a While  The u n i t of a n a l y s i s , required  p a t t e r n s are too  linear  i t i s to  themselves  as  be  relationship expected  during drinking  complex  Type to  be  as r e q u i r e d  that and  for  f a m i l i e s , do  the  A  law  not and  described i n  by  Type B  f a m i l y ' s concept  n o n - d r i n k i n g times  will  Law. of be  n e c e s s a r i l y i d i o s y n c r a t i c , an i n v a r i a n t r u l e may be suggested by the r e l a t i o n s h i p between r e l e v a n t v a r i a b l e s .  T h i s suggests  the a p p l i c a b i l i t y of Type C law t o t h i s study. T h i s study assumes t h a t d r i n k i n g and n o n - d r i n k i n g 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 c o n t e x t  of t h e i r r e l a t i o n s h i p s and t h a t these views are l i v e d out i n everyday c o n v e r s a t i o n s and behaviour.  The s p e c i f i c n a t u r e of  these views and who c o n t r i b u t e s them t o the f a m i l y paradigm i s expected t o r e v e a l i d i o s y n c r a t i c p a t t e r n s from which common themes may  emerge.  As Type C law i s expected t o be o p e r a t i v e ,  i n t e n s i v e case study i s a p p r o p r i a t e l y  utilized.  - 22 Case  Subjects  As  i s appropriate  important  to select  understanding  to intensive  a diverse  o f any major  case  sample  patterns  studies  i t  is  so as t o develop an represented  (Chassan,  1979) .  I n t h i s study, what i s o f i n t e r e s t i s t h e s h i f t i n g o f  family  and  individual  self-concepts  d r i n k i n g and non-drinking,  and  periods  of  t h e kinds o f concepts i n f l u e n c e d ,  and t h e r o l e s o f i n f l u e n t i a l  Screening  between  individuals.  Selection  In order t o g i v e some d i f f e r i n g views t o t h e phenomenon being  studied,  within  an  Criteria age  two f a m i l i e s were s e l e c t e d through  Alcohol  Drug  Program  Outpatient  Clinic.  f o r t h e i n c l u s i o n of a l c o h o l i c s u b j e c t s were male,  21-60, who a r e p r e s e n t l y l i v i n g i n an i n t a c t f a m i l y , who  score  5 or greater  Michigan Alcoholism III  and  contacts  criteria  (an i n d i c a t i o n Screening  Test  f o r the diagnosis  of a l c o h o l i s m )  on t h e  ( S e l z e r , 1971), meet DSM of  alcoholism  and  have  developed a binge d r i n k i n g p a t t e r n t h a t i s c o n s i s t e n t w i t h the binge d r i n k i n g p a t t e r n p r o f i l e o f the Present D r i n k i n g P a t t e r n s e c t i o n o f the Comprehensive Drinker P r o f i l e .  As t h e study i s  i n t e r e s t e d i n s t u d i n g f a m i l y i n t e r a c t i o n , a l l a l c o h o l i c s must have an a v a i l a b l e p a r t n e r w i l l i n g t o p a r t i c i p a t e i n t h e study and have a t l e a s t one c h i l d aged 12 o r o l d e r p r e s e n t l y l i v i n g i n t h e home who w i l l a l s o be i n v o l v e d i n t h e study. As f a m i l i e s themselves a r e d i v e r s e i n nature,  something  - 23  -  other than d i v e r s i t y i n any sample seems u n l i k e l y , and t r u e t o form, the  f a m i l i e s i n t h i s study were d i f f e r e n t i n terms of  constellation of  (gender of s i b l i n g s ) , d r i n k i n g s e v e r i t y , stage  "recovery",  and  stage of development of the  family  life-  cycle. One  family,  "recovery",  having had  f a m i l y was  instance,  was  well  along  the  s e v e r a l months of s o b r i e t y .  path The  to  same  f u r t h e r along i n terms of the developmental f a m i l y  l i f e - c y c l e , and home.  for  i n the process of launching  The second f a m i l y interviewed was  c h i l d r e n from the  q u i t e young, w i t h  c h i l d r e n , as y e t not i n school and a t h i r d c h i l d ,  two  12 y e a r s of  age.  Case S u b j e c t  In a l l ,  Descriptions  6 s u b j e c t s were r e c r u i t e d , 2 f a m i l i e s of  members each, ranging  i n age  from  In Family A the f a t h e r (41) a t 12 y e a r s of age.  He was  41 t o  three  13.  f i r s t began d r i n k i n g a l c o h o l  the middle c h i l d of 5 s i b l i n g s and  r e p o r t e d t h a t i n a d d i t i o n t o a l c o h o l a f f e c t i n g him i t had  also  a f f e c t e d h i s f a t h e r and the other s u r v i v i n g c h i l d r e n (male) i n the f a m i l y .  Two  of h i s s i b l i n g s , the e l d e s t (female, 29)  the youngest (male, 24) d i e d of n a t u r a l causes 14 and ago r e s p e c t i v e l y . up,  punishment was  of  these  he  13 y e a r s  The f a t h e r a l s o r e p o r t e d t h a t w h i l e growing o f t e n extreme and  experiences  grandfather,  and  and  that  of  abusive and being  as a r e s u l t  molested  learned t o keep h i s f e e l i n g s t o  by  himself.  his  At had  2 5 y e a r s of age  a son.  he married and  two  years l a t e r  H i s w i f e had p r e v i o u s l y been m a r r i e d  they  (at the  age  of 19) and had t h r e e c h i l d r e n w h i l e i n t h a t r e l a t i o n s h i p .  She  d i v o r c e d i n 1973 Six  years  and remarried  later  (current)  her  f a t h e r has  into t h i s current r e l a t i o n s h i p .  ex-husband  committed  suicide.  The  children.  The  s i n c e adopted a l l t h r e e  mother (41)  came from a f a m i l y of 3 s i b l i n g s , her b r o t h e r  is  44  and  is  married  remarried  lives  and  relationship"  lives with  "back east", nearby.  both  her  r e s p o n s i b i l i t y e a r l y i n her  and  She  her  feels  parents,  life  sister  she  but  had  had  because her  (38) a  a  "good lot  of  "mother had  to  work". The past  25  father reported years",  he  t h a t he  describes  "drank o f f and  himself  t h a t i s d r i n k i n g f o r s h o r t episodes,  as  on  a "binge  periods  for  the  drinker",  of time u s u a l l y  not more than 5 or 6 hours a t c l e a r l y d e f i n e d  intervals.  any one d r i n k i n g o c c a s i o n he might d r i n k 8 - 1 2  drinks usually  beer  or  wine,  although  reported  that  "occasional  At  drinking  binges have l a s t e d as long as f o u r or f i v e days". The f a t h e r e x p l a i n e d t h a t he "had not been the o n l y bread winner i n the f a m i l y over the years".  His w i f e suggested t h a t  "perhaps p a r t l y as a r e s u l t of having o n l y achieved education,  and  s i t u a t i o n had financial The  p a r t l y due  t o the  drinking",  fluctuated frequently.  employment  As a r e s u l t the  s u r v i v a l c o u l d not depend on the  r e l a t i o n s h i p between the  his  a grade 8  f a t h e r and  the  father's  family income.  e l d e s t son  was  - 25 felt  t o be  conflictual,  "power s t r u g g l e " . had  The  been undermined  employment, and  by  -  p a r t l y they s a i d , as  f a t h e r f e l t h i s p o s i t i o n i n the  by  a  lack  of  formal  (A.A.)  a  family  education,  steady  alcoholism.  At the time of our meeting the program"  a r e s u l t of  for  three  years,  f a t h e r had had  been i n  attended  "the  residential  a l c o h o l i s m treatment, and had been i n v o l v e d , along w i t h  other  f a m i l y members, i n o u t p a t i e n t c o u n s e l l i n g f o r a s i m i l a r l e n g t h 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 e l d e s t 21, was  i n a nearby community and was a l o c a l restaurant.  The  l i v i n g on h i s  own  working as an a s s i s t a n t cook a t  mother r e p o r t e d  t h a t he  had  a good  r e l a t i o n s h i p w i t h the c h i l d r e n and would o f t e n r e p r e s e n t " k i d ' s view" i n f a m i l y d i s c u s s i o n s privileges. in  a kind  difficult  I t was  concerning  the  time t r y i n g t o balance her  eldest  apparently boyfriend  (19)  was  attending  always done w e l l that  the  youngest  (13)  at  having  At the moment she  was  university.  school,  mother d i d not  doing w e l l g e n e r a l l y and was  and,  "was  l i v i n g independently and d i d not a t t e n d our meetings.  second  The  f a m i l y was  or  and  a c c o r d i n g t o the mother, was  approve of  too The had  had  seemed t o  outspoken i n our  deserving  She  although  not very i n v o l v e d i n the  i n v o l v e d and  a  needs f o r independence  w i t h t h e i r views of s a f e t y and r e s p e c t . was  discipline  e x p l a i n e d t h a t the youngest g i r l (17)  of t r a n s i t i o n phase" and  the  a be  family. meeting  of h i s r e p u t a t i o n  - 26 as the  family  "character".  c l o s e f r i e n d s and In Family B, extent, and  also d i d well at school,  a l c o h o l had  a f f e c t e d both p a r e n t s t o some  although both agreed the  reported  that  he  father  than d i d the  first  "drank more h e a v i l y  mother.  began d r i n k i n g  The  father  (32)  alcohol  in his  late  around the time h i s parents separated.  binges  that  have  included  blackouts  h i s f a t h e r was  Heavy d r i n k i n g  have  o c c u r r e n c e s over the past eleven years. that  The  been  father  a s u c c e s s f u l businessman who  The  father  r e l a t i o n s h i p between him alcohol  misuse  close".  The  and  this  explained and  that  separated  h i s mother was  "prevented  f o l l o w i n g the mother's s e p a r a t i o n  The  a f f e c t e d by  the  from  being  very  f o r the p a s t  five  years,  from her second husband of  i s from the mother's f i r s t marriage which l a s t e d  from the second marriage. previous  the  A l t o g e t h e r there are f o u r c h i l d r e n , the e l d e s t ,  f i v e y e a r s , the second, a l s o a g i r l  my  of  years.  T h i s couple have been together  (12)  quality  A previous common-law r e l a t i o n s h i p ( a l s o  w i t h a l c o h o l problems) l a s t e d four  a girl  them  drinking  f a t h e r comes from a f a m i l y of f o u r boys of which  he i s the youngest.  seven y e a r s .  the  usual  reported  from h i s mother "at l e a s t p a r t l y as a r e s u l t of her problems".  had  enjoyed s p o r t s .  more f r e q u e n t l y "  teens,  He  -  partners  (7) , and t w i n boys (5)  The mother r e p o r t e d  have had  are  t h a t "each of  a l c o h o l problems".  father described himself  as a "binge d r i n k e r " ,  i s , d r i n k i n g h e a v i l y f o r s h o r t p e r i o d s a t a time.  At any  that one  -  27  -  d r i n k i n g o c c a s i o n he might d r i n k about 4 l i t r e s , u s u a l l y wine, and may  repeat  t h i s p a t t e r n 5 times i n a t h r e e month p e r i o d .  Both the mother and the f a t h e r c u r r e n t l y work, a l t h o u g h reported  t h a t employment had been i n t e r r u p t e d i n t h e p a s t  problems  related  to  drinking  f i n a n c e s have been unstable  and  and  as  a  result  the  by  family  unpredictable.  The mother e x p l a i n e d t h a t she i s the e l d e s t of f i v e ( a l l female) i n her f a m i l y , her f a t h e r d i e d when she was 14 and her mother remarried problem.  t o a man t h a t a l s o seemed t o have an a l c o h o l  The mother r e p o r t e d  that  o r i g i n t o be "a source of advice",  she f i n d s her f a m i l y  but a t the same time she  tends t o f i n d them q u i t e "demanding and needy", she  often  comes  rejuvenated".  away The  from  mother  her  of  visits  reported  as a r e s u l t  "more  that  drained  than  feels  quite  she  i n f l u e n c e d by her f a m i l y and t h a t t h i s i s not always something t h a t i s p l e a s i n g t o her. At t h e time of our meeting the f a t h e r had been r e c e i v i n g some  additional  alcohol  counselling  through  the  employee  a s s i s t a n c e program o f f e r e d a t h i s workplace, however n e i t h e r he  nor  his  spouse  had  achieved  any  extended  periods  of  sobriety. With the exception  of the e l d e s t daughter, the c h i l d r e n  were t o o young t o complete the Q-sort. was  described  as i n a k i n d  The e l d e s t daughter  of t r a n s i t i o n  phase  as she  had  changed s c h o o l s r e c e n t l y and was moving towards her teens and greater  independence.  - 28 The  Case Study  In  Investigator  case s t u d i e s , the q u a l i t y of the case study depends  d i r e c t l y on the experience and e x p e r t i s e t h a t the case study i n v e s t i g a t o r can b r i n g t o 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 f o r the most p a r t not r o u t i n i z e d as it  i s with  laboratory  experiments  or  surveys.  For  reasons the case study i n v e s t i g a t o r r e q u i r e s c e r t a i n (Yin  1984; Yin  to  skills  p.56).  suggests the case study i n v e s t i g a t o r s h o u l d be a b l e  ask good q u e s t i o n s and i n t e r p r e t the answers,  s h o u l d be a  good l i s t e n e r and not be trapped by h i s or her own or  these  p r e c o n c e p t i o n s , should be a d a p t i v e and  ideologies  flexible  so  that  newly encountered s i t u a t i o n s can be seen as o p p o r t u n i t i e s , not threats.  Y i n a l s o suggests the case study i n v e s t i g a t o r must  have a f i r m grasp of the i s s u e s being s t u d i e d , 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 o r i e n t a t i o n , mode.  Such  information investigator included  a  to  be  reduces  sought  should  those  investigator  grasp  be  from  be  relevant  manageable  unbiased  derived should  to  the  even i n an e x p l o r a t o r y  by  theory.  sensitive  events  and  proportions.  An  preconceived Thus and  a  notions,  case  study  responsive  to  c o n t r a d i c t o r y evidence (p. 56-57). The i n v e s t i g a t o r f o r t h i s p r o j e c t has r e c e i v e d  graduate  l e v e l t r a i n i n g i n c o u n s e l l i n g psychology and i s a r e g i s t e r e d clinical  counsellor  i n B.C.  In  addition,  he  has  been  p r a c t i s i n g f a m i l y and a d d i c t i o n s c o u n s e l l o r f o r s i x y e a r s  a who  - 29 has  been  able  addiction  t o demonstrate  issues  to  h i s knowledge  colleagues,  o f f a m i l y and  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 A l c o h o l i s m Screening T e s t (MAST) and DSM I I I c r i t e r i a were used t o screen t h e s u b j e c t s as a p p r o p r i a t e the  research  better  project.  than  t h e best  for  The MAST has been found t o be even laboratory  tests  t o screen  for  presence o f e x c e s s i v e d r i n k i n g on l a r g e p o p u l a t i o n s  the  (Donovan  and M a r l a t t , 1988 p. 121). "Bernadt e t a l . (1984) compared t h e e f f i c a c y questionnaire screening use.  with  385 p s y c h i a t r i c admissions  On a d i s c r i m i n a n t  1971) and  administration  laboratory  of b r i e f tests  f o r excessive  analysis, the b r i e f  in  alcohol  MAST ( S e l t z e r ,  was the best d i s c r i m i n a t o r o f the presence o f a l c o h o l i s m of excessive  drinking, followed  by t h e CAGE  (Mayfield,  McLeod, and H a l l , 1974) and the Reich i n t e r v i e w (Reich e t a l . , 1975)." (Donovan and M a r l a t t , 1988 p. A  score  125).  on t h e MAST o f 3 p o i n t s o r l e s s i s c o n s i d e r e d  n o n a l c o h o l i c , a score of 4 p o i n t s i s c o n s i d e r e d alcoholism, alcoholism The  suggestive of  and a score of 5 p o i n t s or more i s i n d i c a t i v e o f ( S e l z e r , 1971).  DSM I I I (1987) suggests t h a t i n order t o diagnose a  substance abuse d i s o r d e r a person must demonstrate; A.  A p a t t e r n o f p a t h o l o g i c a l a l c o h o l use: need f o r d a i l y use of a l c o h o l f o r adequate f u n c t i o n i n g ; i n a b i l i t y t o c u t  -  30  -  down or stop d r i n k i n g ; repeated e f f o r t s t o c o n t r o l or reduce excess d r i n k i n g by "going on the wagon" ( p e r i o d s of temporary abstinence) or r e s t r i c t d r i n k i n g d u r i n g c e r t a i n times of the day; binges (remaining i n t o x i c a t e d throughout the day f o r at l e a s t two days); o c c a s i o n a l consumption of a f i f t h of s p i r i t s (or i t s e q u i v a l e n t i n beer or wine); amnesic p e r i o d s f o r events o c c u r r i n g w h i l e i n t o x i c a t e d (blackouts) ; c o n t i n u a t i o n of d r i n k i n g d e s p i t e a s e r i o u s p h y s i c a l d i s o r d e r t h a t the i n d i v i d u a l knows i s exacerbated by a l c o h o l use; d r i n k i n g of non-beverage alcohol. B.  Impairment i n s o c i a l or o c c u p a t i o n a l f u n c t i o n i n g due t o a l c o h o l use: e.g., v i o l e n c e w h i l e i n t o x i c a t e d , absence from work, l o s s of job, l e g a l d i f f i c u l t i e s (e.g. a r r e s t for i n t o x i c a t e d behaviour, t r a f f i c accidents while i n t o x i c a t e d ) , arguments or d i f f i c u l t i e s w i t h f a m i l y or f r i e n d s because of e x c e s s i v e a l c o h o l use.  C.  D u r a t i o n of d i s t u r b a n c e of at l e a s t one month ( D i a g n o s t i c and S t a t i s t i c a l Manual of Mental D i s o r d e r s I I I , 1987). It  would  endorsed interview  on  seem c l e a r t h a t  the  MAST  and  from  from  responses t h a t the  the  the  specific  questions  semi-structured  subjects  responded i n a manner  t h a t would be c o n s i s t e n t with the d i a g n o s i s  of  alcoholism.  The presence of an A l t e r n a t o r d r i n k i n g p a t t e r n described  as  binging)  will  be  determined  by  (commonly  the  D r i n k i n g P a t t e r n s e c t i o n of the Comprehensive D r i n k e r (Marlatt  and  Miller,  drinking  pattern  P e r i o d i c Drinker week and  1984).  would  have  A a  family  family family  with  an  member  Present Profile  Alternator fitting  the  d e s c r i p t i o n ( d r i n k s l e s s o f t e n than once a  i s a b s t i n e n t between d r i n k i n g p e r i o d s ) .  In t h i s p a t t e r n the d r i n k e r t y p i c a l l y a l t e r n a t e s between periods  of  several  drinking i s occurring months when no  weeks (wet  drinking  to  several  periods)  and  i s occurring.  months periods The  when  active  of weeks t o  distinguishing  - 31 f e a t u r e of t h i s p a t t e r n dry  periods  has  A  measure  Episodic binge  in  levels,  of  Pattern hours,  as w e l l  i s t h a t a l t e r n a t i n g between wet  occurred  h i s t o r y of the f a m i l y  multiple  times  during  the  and life  ( S t e i n g l a s s , p.185).  binge  Chart. total as  -  severity This  was  included  alcohol  obtained the  consumed,  from  duration and  of  the the  peak  alcohol  frequency of binge episodes per  3 month  period.  McMaster F a m i l y Assessment Device  McMaster  FAD  Family Assessment Device  (FAD)  was  developed  from the McMaster Model of Family F u n c t i o n i n g which d e s c r i b e s s t r u c t u r a l and and  the  o r g a n i z a t i o n a l p r o p e r t i e s of the f a m i l y group  patterns  of t r a n s a c t i o n s  among f a m i l y  have been found t o d i s t i n g u i s h between h e a l t h y families  members t h a t and  unhealthy  ( E p s t e i n e t a l . 1983).  S i x dimensions of f a m i l y f u n c t i o n i n g have been i d e n t i f i e d by  the  McMaster model and  the  FAD  s c a l e s were developed  to  r e f l e c t the content of these dimensions ( E p s t e i n e t a l . 1983). The  FAD  i s comprised of 7 s c a l e s : Problem Solving,  r e f e r s to  the f a m i l y ' s a b i l i t y t o r e s o l v e every day problems t h a t c o u l d t h r e a t e n the i n t e g r i t y and f u n c t i o n a l c a p a c i t y of the Communication,  assesses the c l a r i t y and d i r e c t n e s s of  messages, which among  family  resources,  family.  i s defined  members.  nurturance, and  as  the  Roles,  exchange of assess  support, the  the  verbal  information presence  support of  of  personal  - 32 development, system,  t h e maintenance  and t h e p r o v i s i o n  and management o f t h e f a m i l y  of a d u l t  sexual  gratification.  Assessment o f the Roles dimension a l s o i n c l u d e s  consideration  of whether t a s k s a r e c l e a r l y and e q u i t a b l y a s s i g n e d members  and  Affective  Responsiveness  family  whether  tasks  are  responsibly  to family performed.  assess t h e extent t o which i n d i v i d u a l  members a r e able  t o show a p p r o p r i a t e  a f f e c t over a  range o f s i t u a t i o n s ( a f f e c t i o n , happiness, j o y , anger, f e a r , a n x i e t y , sadness, disappointment, and d e p r e s s i o n ) . Involvement value  measures the extent t o which f a m i l y members p l a c e  on and a r e i n t e r e s t e d  activities.  Affective  Behaviour  Control  i n each  other's  concerns and  measures behaviour responses i n  v a r i o u s s i t u a t i o n s t h a t d i f f e r s i n terms of c o n t r o l ( 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 c h a o t i c ) .  patterns  I t i s i n this  way t h a t a f a m i l y maintains and c o n s t i t u t e s f a m i l y  standards  for  Functioning  i n d i v i d u a l behaviour.  provides  And f i n a l l y ,  General  an assessment of the o v e r a l l h e a l t h o f t h e f a m i l y .  Psychometric  properties  r e l i a b i l i t y and v a l i d i t y  of  the  FAD  ( E p s t e i n e t a l . , 1983).  been used t o d i s t i n g u i s h between c l i n i c a l populations,  and s p e c i f i c  differentiate scores  healthy  suggest  c u t o f f scores  from  unhealthy  high  The FAD has  and n o n - c l i n i c a l  have been shown t o  f a m i l i e s , with  i n d i c a t e h e a l t h i e r responses ( M i l l e r ,  lower  1985).  Data C o l l e c t i o n  Following  the procedure  outlined  i n Figure  3.1, two  - 33 f a m i l i e s were s e l e c t e d through an i n f o r m a l network of c o n t a c t s w i t h i n t h e Province of B r i t i s h Columbia's M i n i s t r y of Labour and  Consumer  Service's;  Alcohol  and  Drug  Outpatient  C o u n s e l l i n g Programs. F i g u r e 3.1 Procedural Flow Chart D e s c r i p t i o n s of the p r o j e c t were c i r c u l a t e d to a d d i c t i o n s c o u n s e l l o r s , along w i t h guidelines f o r preliminary subject screening, and i n f o r m a t i o n f o r p o t e n t i a l s u b j e c t s . i I  2.  P o t e n t i a l s u b j e c t s were c o n t a c t e d by telephone and a meeting time was arranged.  I i I  3.  Subject Q - s o r t i n g with 60 item s o r t on 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 d u r i n g d r i n k i n g and n o n - d r i n k i n g times.  I ; I  Semi-structured  family interview.  A d d i c t i o n s c o u n s e l l o r s were g i v e n w r i t t e n g u i d e l i n e s f o r s c r e e n i n g p o t e n t i a l f a m i l i e s f o r the study  (Appendix A ) , and  a f i n a l s c r e e n i n g was done u t i l i z i n g the M i c h i g a n A l c o h o l i s m Screening  Test  criteria,  and the Comprehensive  Booklet  (MAST)  (Appendix  C) ,  DSM  Drinker  III  Profile  alcoholism Interview  (Appendix F ) .  Family members complete i n d i v i d u a l Q-sorts from a p o o l of 60  items  drawn  from  (Appendix D and E ) .  the McMaster Family  Assessment  Device  I n d i v i d u a l f a m i l y members were asked t o  -  sort  t h e items  periods  first  of drinking,  together  then  sorting  solicit  again  the items,  (Appendix  as t h e items  during  related to  Then, t h e f a m i l y was g i v e n t h e t a s k  d r i n k i n g and non-drinking interview  -  as they r e l a t e d t o t h e f a m i l y  p e r i o d s o f non-drinking. of  34  again  periods.  G) was  as they  related to  F i n a l l y , a semi-structured  conducted  with  the family  to  t h e f a m i l y impressions of t h e e f f e c t s o f d r i n k i n g on  f a m i l y i n t e r a c t i o n and on t h e experience o f completing t h e Qsort.  The i n t e r v i e w was video-taped f o r f u r t h e r a n a l y s i s .  Semi-Structured  The  family  Interview  i n t e r v i e w was s t r u c t u r e d t o examine how t h e  d r i n k i n g had a f f e c t e d ; f a m i l y i n t e r a c t i o n , f a m i l y f u n c t i o n i n g , and, The  the family's interview  thinking  served  about  G  interview  schedules  was video  transcriptions.  (family  identity).  t o e s t a b l i s h whether o r not t h e Q-Sort  adequately and a c c u r a t e l y captured Appendix  itself  a " p i c t u r e " of the family.  the general  recorded  themes  explored.  f o r t h e purposes  Through t h e s e m i - s t r u c t u r e d  f a m i l i e s were asked questions  of  The  accurate  interview the  that related t o the e f f e c t s of  a l c o h o l on f a m i l y i n t e r a c t i o n and f u n c t i o n i n g .  The e a r l y p a r t  of t h e i n t e r v i e w r e v o l v e d around t h e c o n s t r u c t i o n o f a f a m i l y genogram, a u s e f u l c l i n i c a l t o o l f o r g a t h e r i n g i n f o r m a t i o n and e x p l o r i n g f a m i l y dynamics (McGoldrick and Gerson, 1985) . The domains  of decision  closeness,  making,  and d i s c i p l i n e  problem  solving,  were d i s c u s s e d ,  intimacy  as w e l l  and  as other  - 35 aspects  that  themselves.  were The  h a l f t o two  of  -  specific  interest  hours.  related  periods  Data  families  to  one  The primary purpose of the i n t e r v i e w  differences  of d r i n k i n g and  in  to provide  family  was  information  functioning  during  abstinence.  Analysis  For each s o r t i n g o c c a s i o n and  the  i n t e r v i e w s themselves took about one and  t o g i v e the f a m i l y another o p p o r t u n i t y that  to  non-drinking,  drinking)  the  and,  ( i n d i v i d u a l s o r t s of d r i n k i n g  family  sorts  of  drinking  Q-sorts were c o r r e l a t e d w i t h  the  and  non-  Q-sorts  of  every other s o r t i n g o c c a s i o n t o o b t a i n a c o r r e l a t i o n a l m a t r i x of  relevant  patterns.  figures  The  based  data was  on  the  similarity  of  Q-sort  submitted t o a p r i n c i p a l components  a n a l y s i s u t i l i z i n g the WBOL Q - a n a l y s i s program ( B o l d t , 1991). The  program was  Danbury,  and  based on a paper f i r s t p u b l i s h e d Talbot  in  1964.  The  by Maclean,  resulting principal  components were then submitted t o a varimax r o t a t i o n . the  correlational  solutions  matrix  were examined  to  and  the  identify  principal patterns  themes w i t h p a r t i c u l a r a t t e n t i o n t o the  components  and  implicit  c o r r e l a t i o n s of  the  v i d e o - t a p e s were reviewed t o i d e n t i f y comments  and  f a m i l y Q-sort The  Both  patterns.  i n t e r a c t i o n a l p a t t e r n s t h a t r e l a t e d t o the e f f e c t s of a l c o h o l on the f a m i l y paradigm and the i d e n t i f i c a t i o n of  influential  f a m i l y members w i t h r e s p e c t t o s p e c i f i c a s p e c t s of the  family  - 36  -  paradigm. The  analysis  of  the  correlational  matrix,  and  the  p r i n c i p a l components s o l u t i o n s , and the s e m i - s t r u c t u r e d  family  i n t e r v i e w were i n t e g r a t e d t o develop a p o r t r a i t of the  family  paradigm and and  i t s key  influencers during  periods  of  drinking  non-drinking.  Q-Technique  Where the f u n c t i o n a l r e l a t i o n s h i p s and the parameters of v a r i a b l e s are  i d i o s y n c r a t i c , but  where g e n e r a t i n g  values  of  these r e l a t i o n s h i p s are constant, Type C law can be assumed t o be o p e r a t i n g  (Herbst, 1970).  According to K e r l i n g e r  (1973) Q-  methodology i s u s e f u l 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  f u n c t i o n i n g of r e l a t i v e l y unknown v a r i a b l e s , and  methodology i s p a r t i c u l a r l y s u i t e d t o i n t e n s i v e case B l o c k (1961) suggests t h a t the Q-sort i s u s e f u l f o r a  quantitative  description  of  personality  that  Q-  study.  obtaining  i n psychodynamic  terms, and the Georgia Family Q-Sort, w h i l e a newly developed o b s e r v a t i o n a l measure, has been u s e f u l i n the study of  family  functioning  1989) .  Therefore,  (Wampler, Halverson, i t seems a p p r o p r i a t e  Moore and  Walters,  t o u t i l i z e Q-methodology here  t o study f a m i l y f u n c t i o n i n g d u r i n g d r i n k i n g and  non-drinking  periods. With the Q-technique of f a c t o r a n a l y s i s the r e s e a r c h e r i n t e r e s t e d i n the way  is  people order items or v a r i a b l e s and w i t h  grouping them i n t o c l u s t e r s of people who  order v a r i a b l e s i n  similar  ways.  associated  In t h i s way each group o f persons c o u l d be  with  variables.  In  a  distinctive  this  study  common  ordering  the v a r i a b l e s  of the  are  d e s c r i p t o r s o f f a m i l y f u n c t i o n i n g and i n t e r a c t i o n .  salient  The s i x t y  d e s c r i p t o r s were from t h e McMaster Family Assessment Device. These d e s c r i p t o r s r e l a t e t o such aspects o f f a m i l y f u n c t i o n i n g as;  Problem  Solving,  Communication,  Roles,  Affective  Responsiveness, A f f e c t i v e Involvement, Behaviour C o n t r o l , and General  Functioning.  Subjects  As  of  Judgements  i n Liepman's  functioning during  for  study  were sampled  periods  non-drinking.  Q-Sorts  (1989)  two domains  of  family  f o r each case s u b j e c t :  the family  of d r i n k i n g and t h e f a m i l y d u r i n g  p e r i o d s of  Each person as w e l l as t h e f a m i l y as a group  t a s k s o r t e d the items according t o these times i n f a m i l y The  main d i f f e r e n c e i n t h i s  domains were explored. contrasted  with  study  i s i n t h e way these two  The i p s a t i v e nature  the r e l a t i v e l y  life.  independent  McMaster Family Assessment Device allows  o f t h e Q-sort nature  of the  f o r an a p p r e c i a t i o n  of t h e most r e l e v a n t and d i s c r i m i n a t i o n a s p e c t s o f d r i n k i n g and  non-drinking  Q-Sort  periods  i n family  life.  Items  This  study was b u i l t  on Liepman's (1989) study i n t h a t  both s t u d i e s examine the f a m i l y f u n c t i o n i n g o f male a l c o h o l i c s  - 38 during  periods  McMaster  of drinking  FAD was a l s o used  these two p e r i o d s .  and abstinence. t o gather  Further,  comparative  Based on these c o n s i d e r a t i o n s ,  the  data f o r t h e 60  item sample, l i s t e d i n Appendix D was drawn d i r e c t l y from t h e r e l a t e d study by Liepman.  Q-Sorting  The  60  items  referred  t o i n Table  subjects during the Q-sorting session.  3.1 were  used  by  Family members s o r t e d  c a r d s which were p l a c e d a c c o r d i n g t o t h e extent t o which t h a t p a r t i c u l a r d e s c r i p t o r r e l a t e d to that subject's perception of t h e i r family during the period i n question non-drinking).  ( e i t h e r d r i n k i n g or  F o l l o w i n g are the i n s t r u c t i o n s used f o r s o r t i n g  the d e s c r i p t o r s : 1)  P l e a s e take t h e cards and n o t i c e t h a t a good many o f them are d e s c r i p t i v e or c h a r a c t e r i s t i c o f your f a m i l y t o a greater or lesser degree. Others are quite u n c h a r a c t e r i s t i c o f the way you see your f a m i l y .  2)  As a f i r s t step, take a moment t o t h i n k about t h e times when d r i n k i n g was (not) going on i n your f a m i l y , t h e k i n d s o f t h i n g s t h a t were going on and how you f e l t about y o u r s e l f and other f a m i l y members.  3)  Now p i c k out t h e phrases you f e e l a r e a l o t l i k e your f a m i l y d u r i n g t h i s time and put them i n a p i l e on your right.  4)  Now p i c k out t h e phrases t h a t you f e e l a r e not a t a l l l i k e your f a m i l y and put them i n another p i l e on your left.  5)  Put t h e others  6)  Now you w i l l n o t i c e t h a t t h e r e a r e seven p i e c e s o f paper spread out on t h e t a b l e i n f r o n t o f you r a n g i n g from l e a s t c h a r a c t e r i s t i c t o most c h a r a c t e r i s t i c o f your  i n a p i l e i n t h e middle.  - 39 f a m i l y , and each as a number on i t . 7)  On t h e p i l e t h a t says Most C h a r a c t e r i s t i c you can o n l y p l a c e 1 c a r d . On t h e p i l e t h a t says Q u i t e C h a r a c t e r i s t i c you can o n l y p l a c e 3 c a r d s . On the p i l e t h a t says F a i r l y C h a r a c t e r i s t i c you can p l a c e 14 cards, and so on.  8)  Working from t h e f i r s t p i l e you made o f cards t h a t a r e a l o t l i k e your f a m i l y , and drawing from t h e middle p i l e i f you have t o , s o r t those cards i n t o what you t h i n k i s t h e b e s t category. Remember you have t o keep t o t h e numbers f o r each category.  9)  Now working from t h e p i l e of cards on your l e f t , t h e least like pile, place 1 card i n the Most Uncharacteristic pile, 3 cards in the Quite Uncharacteristic pile and 14 cards i n the F a i r l y Uncharacteristic p i l e .  10)  A t t h i s p o i n t you should have 24 cards l e f t f o r t h e N e u t r a l p i l e . Take a second look a t your s o r t and check t o make sure t h e cards a r e a l l where you want them. The d i r e c t i o n s f o r t h e f a m i l y Q-sort d i f f e r e d o n l y t o t h e  extent  t h a t t h e f a m i l y was i n s t r u c t e d  t o perform  the task at their  together.  The f a m i l y was not t o l d  how t o a r r i v e  decisions  regarding  o f t h e cards  minimize  t h e placement  i n t e r f e r e n c e with  the f a m i l i e s  so as t o  own group  decision  i n this  study i s  making p r o c e s s . The  s t r u c t u r e of t h e Q-sort  o u t l i n e d i n F i g u r e 3.2.  used  -  40 -  F i g u r e 3.2 Q-sort Evaluative Criteria  Distribution.  Least Descriptive of Family during Drinking & Non-Drinking Periods  Neutral or Undecided  Most Characteristic of Family during Drinking & 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  this  standardized structured  chapter  data  gathered  from  a  combination  instruments, Q-sort methodology, and interview  will  be  used t o e x p l o r e  the  the  of  semi-  following  questions: 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 image  or  paradigm)  differ,  for  drinking  (the f a m i l y and  self-  non-drinking  periods? Do responses t o s p e c i f i c questions p u r p o r t e d t o such  salient  Solving,  dimensions  Communication,  Affective  Involvement,  Functioning  of  family  Roles,  Affective  Behaviour  d i f f e r f o r periods  functioning  as  evaluate Problem  Responsiveness,  Control,  of d r i n k i n g and  and  General  abstinence?  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  family Who  as  a group d i f f e r  from  individual  descriptions?  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  alcoholic  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 is  s/he  more d i s t a n t and  less  influential  i n the  family  as  much of the l i t e r a t u r e p r e d i c t s ?  Screening  and Assessment Instrument  Results  The use of the MAST and the E p i s o d i c P a t t e r n Chart w h i l e  - 42 acting  as a s c r e e n i n g d e v i c e  f o r acceptance i n t o t h e study  a l s o c o n t r i b u t e d some i n f o r m a t i o n t o t h e g e n e r a l p i c t u r e o f the f a m i l y from t h e p e r s p e c t i v e o f t h e problem d r i n k e r . Table  4.1  shows  the r e l a t i v e  MAST  scores  f o r the  i d e n t i f i e d problem d r i n k e r i n t h e f a m i l i e s s t u d i e d .  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 i n F a m i l i e s Studied Case A Family Member MAST Score  Case B Family Member  45/54  47/54  T a b l e 4.2 shows the r e l a t i v e responses o b t a i n e d from t h e E p i s o d i c P a t t e r n Chart f o r t h e 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 Case A Family  Case B Family  T o t a l Drinks i n SEC's (# oz. X % a l c o h o l X 2)  1200 SEC's  4000 SEC's  Number o f episodes/ 3 month p e r i o d  5 episodes  5 episodes  Although  t h e r e a r e c l e a r l y some d i f f e r e n c e s i n terms o f  q u a n t i t y o f a l c o h o l consumed on each d r i n k i n g o c c a s i o n ,  both  d r i n k i n g p a t t e r n s a r e c o n s i s t e n t with an a l t e r n a t o r o r binge  -  alcoholic drinking However information  43  -  pattern.  the  source  of  most  was t h e Q-sort data.  r e l a t e d t o each other  of  quantitative  To examine how t h e items  t h e Q-sort f o r each f a m i l y member and  the f a m i l y as a group was f a c t o r analyzed components method with varimax r o t a t i o n . >1, t h e i n i t i a l  the  factor  analysis  using the p r i n c i p a l Using an e i g e n  produced,  i n t h e case o f  Family A, a 1 - f a c t o r s o l u t i o n f o r n o n - d r i n k i n g 2-factor s o l u t i o n f o r drinking periods.  value  periods  and a  In t h e case o f Family  B, a 1 - f a c t o r s o l u t i o n was produced f o r both d r i n k i n g and nondrinking  periods.  Preliminary  Analysis  of Q-sorts  For each f a m i l y member i n d i v i d u a l l y , and f o r t h e f a m i l y as a group, t h e Q-sort p a t t e r n o f responses f o r d r i n k i n g and non-drinking of  every  drinking  p e r i o d s was c o r r e l a t e d w i t h t h e Q-sort  other  pattern  periods  intercorrelations  of responses  within were  the  f o r drinking  family.  run through  The  patterns and non-  matrix  of  a p r i n c i p a l components  analysis,  and both t h e r o t a t e d and u n r o t a t e d  examined  for interpretability.  s o l u t i o n s were  Correspondences  between  i n d i v i d u a l f a m i l y members and/or t h e f a m i l y as a group  along  the dimension of d r i n k i n g (or non-drinking) were understood t o be i n d i c a t i v e o f a s i m i l a r view of t h e f a m i l y paradigm. addressed  the research  questions  related  This  to the d i f f e r i n g  d e s c r i p t i o n s o f f a m i l y f u n c t i o n i n g i n c l u d i n g , t h e f a m i l y as a  \  - 44 -  group  and  individual  descriptions,  i t also  provided  an  i n d i c a t i o n of who i n the f a m i l y i s i n f l u e n t i a l i n terms of the f a m i l y paradigm. Each p a t t e r n of s o r t i n g the items, a s s o c i a t e d w i t h each p r i n c i p a l component or f a c t o r was estimated.  T h i s was done by  weighing each item response of each of the persons most h i g h l y associated  with  a given  factor  (including  the f a m i l y as a  group which a c t s as a h y p o t h e t i c a l i n d i v i d u a l ) by t h e degree to  which  person's These  they  on  l o a d i n g on a f a c t o r ,  weighted  separately. for  a r e loaded  responses  that  factor.  The  the g r e a t e r was  were  summed  higher  the weight.  across  each  T h i s produced an item a r r a y of weighted  each  factor  selected.  The  i n the r o t a t e d arrays  of  factor  weighted  a  responses  analysis  responses  item  solution  were  then  from  most  c o n v e r t e d t o z-scores. The  arrays  of  item  z-scores  were  ordered  accepted t o most r e j e c t e d f o r each component.  This provided  a h i e r a r c h y of items f o r each f a c t o r or p r i n c i p a l  component.  The a r r a y s of items f o r each p r i n c i p a l component were compared by s u b t r a c t i o n f o r each p a i r of p r i n c i p a l components. produced  arrays  principal  of  difference  components  and  scores  f o r each  provides  the  pair  basis  This of 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  understanding family  of  the  specific  items  facilitated  of the extent questions purported  functioning  varied  f o r periods  of  an  to evaluate  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 C o r r e l a t i o n a l Matrix  Husband Wife Child Family  Husband  Wife  1.00 -0.24 0.21 0.16  1.00 0.16 0.30  Child  1.00 -0.16  Family  1.00  T a b l e 4.4 shows the eigen v a l u e s and v a r i a n c e f o r each o f the f a c t o r s  f o r Family A f o r non-drinking p e r i o d s . Table 4.4 Family A Non-drinking Eigen Values and % o f V a r i a n c e Eigen Values  1.33  % of Variance  Using  an eigen  33  value  1.20  1.09  0.38  63  90  100  > 1, 90.5% of t h e v a r i a n c e  accounted f o r i n the r e s u l t i n g 3 p r i n c i p a l component (Table 4.5).  was  solution  - 46 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  PCI Husband Wife Child Family  -0.43 0.82 -0.20 0.65  PC2  PC3  0.76 0.22 0.65 0.41  0.40 -0.39 -0. 68 0.56  The u n r o t a t e d p r i n c i p a l component s o l u t i o n f o r Family A f o r n o n - d r i n k i n g p e r i o d s (Table 4.5) shows s t r o n g a s s o c i a t i o n w i t h both PC2 and PC3 f o r the c h i l d , association  with  both  PCI and PC3  i t a l s o shows a s t r o n g  f o r the f a m i l y s o r t .  A  s t r o n g a s s o c i a t i o n with more than one p r i n c i p a l component i s l e s s d e s i r a b l e as i t clouds For  interpretability.  Family A non-drinking the r o t a t e d s o l u t i o n  more amenable t o i n t e r p r e t a t i o n  (Table 4.6).  seemed  Both the Wife  and t h e Family p a t t e r n of Q-sort responses a r e a s s o c i a t e d w i t h PCI,  t h e Husband's p a t t e r n of Q-sort responses i s a s s o c i a t e d  w i t h PC2 and the C h i l d i s a s s o c i a t e d ( i n v e r s e l y ) w i t h PC3. The weights f o r the s o r t s  i n d i c a t e t h a t the Family i s  most r e p r e s e n t a t i v e of PCI (5.29 as compared t o 1.13 f o r the Wife).  The Husband i s most r e p r e s e n t a t i v e of PC2  (6.88) and  the C h i l d i s most r e p r e s e n t a t i v e (although i n v e r s e l y ) of PC3 (-9.74).  - 47 -  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 PCI Husband Wife Child Family  These responses This  results  0.11 0.65 -0.09 0.91  suggest  are s i m i l a r  PC2  PC3  0.93 0.54 0.14 0.20  that  the Family's  t o the Wife's  suggests t h a t the Wife  -0.19 -0.41 -0.95 0.20  p a t t e r n of  p a t t e r n o f responses.  i s the most i n f l u e n t i a l  member w i t h r e s p e c t t o the f a m i l y paradigm  family  as i t r e l a t e s t o  non-drinking periods. T a b l e 4.7 shows the s p e c i f i c items t h a t c o n t r i b u t e d t o 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 Functioning f o r Non-drinking Periods #  Item  More than PC2, PC1 considers characteristic: 41. Making a decision is a problem for our famity. 54. 31. 49. 40. 26. 17. 33. 1. 52. 35. 38. 30. 16. 29. 14. 11. 7. 18. 4. 2.  Key  Difference  Unhealthy 4 .00 General Functioning Even though we mean well, we intrude too much Unhealthy 4 .40 into each others lives. Affective Involvement There are lots of bad feelings in the famity. Unhealthy 2 .27 General Functioning We express tenderness. Healthy 2 .14 Affective Responsiveness We discuss who is to do household jobs. Healthy 1 .96 Roles We can express feelings to each other. 1 .96 Healthy General Functioning You can easily get away with breaking the Unhealthy 1 .89 rules. Behaviour Control We get involved with each other only when Unhealthy 1 .85 something interests us. Affective Involvement Planning family activities is difficult because Unhealthy 1 .22 we misunderstand each other. General Functioning We don't talk to each other when we are angry. Unhealthy 1 .04 Communication We don't often say what we mean. Unhealthy 1..04 Communication Less than PC2, PC1 considers characteristic: We resolve most emotional upsets that come up. Healthy -1, .04 Problem Solving Each of us has particular duties and Healthy -1, .04 responsibiIi ties. Roles Individuals are accepted for what they are. Healthy -1, .18 General Functioning We talk to people directly rather than through Healthy -1. .40 go-betweens. Communication You can't tell what a person is feeling from Unhealthy -1. .96 what they are saying. Communication We cannot talk to each other about the sadness Unhealthy -1. .96 we feel. General Functioning We know what to do when an emergency comes up. Unhealthy -2..03 Behaviour Control People come right out and say things instead Healthy -2..1 of hinting at them. Communication When you ask someone to do something, you have Unhealthy -2..82 to check that they did i t . Roles We resolve most everyday problems around our Healthy -3..49 house. Problem Solving  - 49 The  r e s u l t s i n d i c a t e t h a t m o r e than PC2 (Husband), PCI  (Wife-Family)  considers  item  #41 "Making  decisions  isa  problem f o r our f a m i l y . " (Unhealthy General F u n c t i o n i n g ) t o be c h a r a c t e r i s t i c o f t h e f a m i l y f o r n o n - d r i n k i n g p e r i o d s . The r e s u l t s a l s o i n d i c a t e t h a t l e s s than PC2 (Husband) , PCI (WifeFamily) c o n s i d e r s item #2 "We r e s o l v e everyday problems around our  house."  (Healthy  characteristic  Problem  of the family  Solving)  to  be  f o r non-^drinking  most  periods.  O v e r a l l , 8 unhealthy items out o f a p o s s i b l e 12 were found t o be more r e p r e s e n t a t i v e o f t h e f a m i l y a c c o r d i n g t o t h e WifeFamily than t h e Husband.  In a d d i t i o n 6 out o f a p o s s i b l e 10  h e a l t h y items were c o n s i d e r e d t o be l e s s c h a r a c t e r i s t i c by t h e Wife-Family than by t h e Husband f o r p e r i o d s o f n o n - d r i n k i n g . 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 ( C h i l d ) . The r e s u l t s i n d i c a t e t h a t m o r e than PC3 ( C h i l d ) , PCI (Wife-Family)  feel  item #36 "We f e e l accepted f o r what we a r e . " (Healthy General Functioning)  i s characteristic  drinking periods.  of the family  d u r i n g non-  The r e s u l t s a l s o i n d i c a t e (Table 4.9) t h a t  less  than PC3 (Child) , PCI (Wife-Family)  talk  t o people  directly  rather  than  feel  through  item #29 "We go-betweens."  (Healthy Communication) i s c h a r a c t e r i s t i c o f the f a m i l y d u r i n g non-drinking periods. healthy  items  were  felt  Overall,  7 out o f a p o s s i b l e  t o be more c h a r a c t e r i s t i c  of  14 the  f a m i l y a c c o r d i n g t o the Wife-Family than the c h i l d d u r i n g nondrinking periods.  - 50 -  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 #  Item  Key  Difference  More than PC3, PC1 considers characteristic: 36. We feel accepted for what we are.  Healthy General Functioning 6. In times of crisis we can turn to each other for Healthy support. General Functioning 60. We try to think of different ways to solve Healthy problems. Problem Solving 52. We don't talk to each other when we are angry. Unhealthy Communication Unhealthy 35. We don't often say what we mean. Communication 26. We can express feelings to each other. Healthy General Functioning 17. You can easily get away with breaking the rules. Unhealthy Behaviour Control 59. When we don't like what someone has done, we Healthy tell them. Communication 45. If people are asked to do something, they need Roles reminding. Unhealthy 16. Individuals are accepted for what they are. Healthy General Functioning Healthy 49. We express tenderness. Affective Responsiveness 1. Planning family activities is difficult because Unhealthy we misunderstand each other. General Functioning 53. We are generally dissatisfied with the family Roles duties assigned to us. Unhealthy 15. Family tasks don't get spread around enough. Unhealthy Roles  2..78 2..75 2..03 1..96 1..96 1.96 1..89 1..85 1.,60 1..60 1.,23 1..23 1.,11 1.,11  In a d d i t i o n 11 out of 15 unhealthy items were c o n s i d e r e d t o be l e s s c h a r a c t e r i s t i c by the w i f e - f a m i l y than by t h e c h i l d d u r i n g the same n o n - d r i n k i n g p e r i o d .  -  51  -  Table 4.9 Dimensions (items) which D i f f e r e n t i a t e PCI a s L e s s C h a r a c t e r i s t i c of Family A Functioning than P C 3 f o r Non-drinking Periods #  Item  Key  Difference  Less than PC3, PC1 considers characteristic: -1, .04 Healthy Roles Unhealthy -1, .04 Communication Unhealthy -1 .64 General Functioning -1 .11 Tenderness takes second place to other things in Unhealthy Affective our famity. Responsiveness People come right out and say things instead of Healthy -1 .22 Communication hinting at them. Unhealthy -1, .43 There are lots of bad feelings in the family. General Functioning We resolve most everyday probtems around our Healthy -1, .64 house. Problem Solving Roles We don't have reasonable transport. -1, .78 Unhealthy There's l i t t l e time to explore personal Unhealthy -1, .78 Roles interests. Unhealthy -1, .78 We do not show our love for each other. Affective Responsiveness We don't get along welt together. Unhealthy -1. .85 General Functioning -1. .89 When you ask someone to do something, you have Unhealthy to check that they did i t . Roles After our family tries to solve a problem, we Healthy -1. .96 usually discuss whether it worked or not. Problem Solving Our family shows interest in each other only Unhealthy -2..03 when they can get something out of i t . Affective Involvement We show interest in each other when we can get Unhealthy -2..22 Affective something out of it personally. Involvement We talk to people directly rather than through Healthy -2..33 go-betweens. Communication  30. Each of us has particular duties and respons i biIi t i es. 14. You can't t e l l what a person is feeling from what they are saying. 11. We cannot talk to each other about the sadness we feel. 39. 18. 31. 2. 58. 34. 28. 51. 4. 24. 42. 37. 29.  - 52 -  Table  4.10  differentiate  PC2  and  4.11  show  the  (Husband) from PC3  specific (Child).  items The  that  results  Table 4 . 1 0 Dimensions (items) which D i f f e r e n t i a t e PC2 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 PC3 f o r Non-drinking P e r i o d s #  Item  Key  Difference  More than PC3, PC2 considers characteristic: 36. We feel accepted for what we are. 60. 16. 7. 66. 59. 45. 2. 12.  Healthy 2,.78 General Functioning We try to think of different ways to solve Healthy 2,.78 problems. Problem Solving Individuals are accepted for what they are. Healthy 2..78 General Functioning We know what to do when an emergency comes up. Unhealthy 2,.78 Behaviour Control In times of crisis we can turn to each other for Healthy 2..78 support. General Functioning When we don't like what someone has done, we Healthy 1,.85 t e l l them. Communication If people are asked to do something, they need Unhealthy 1..85 reminding. Roles We resolve most everyday problems around our Healthy 1..85 house. Problem Solving We usually act on our decisions regarding Healthy 1..85 problems. Problem Solving  i n d i c a t e t h a t more than PC3 (Child) , PC2 (Husband) f e e l s item #3 6  "We  feel  Functioning)  accepted  f o r what  i s characteristic  drinking periods.  we  a r e . " (Healthy  of the f a m i l y  General  during  non-  The r e s u l t s a l s o i n d i c a t e (Table 4.11) t h a t  l e s s than PC3 ( C h i l d ) , PC2 (Husband) f e e l s item #31 "There a r e a  l o t of bad  Functioning)  feelings  i n the f a m i l y . "  i s characteristic  of the  (Unhealthy family  General  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 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 Key  Item  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 i t . 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  O v e r a l l , 7 out o f a p o s s i b l e 9 h e a l t h y items were f e l t t o be more c h a r a c t e r i s t i c of the f a m i l y a c c o r d i n g t o t h e husband than t h e c h i l d d u r i n g non-drinking p e r i o d s . of  12  unhealthy  characteristic  items  were  considered  by the husband than  same n o n - d r i n k i n g p e r i o d .  In a d d i t i o n 9 out to  by t h e c h i l d  be  less  during the  - 54 -  Family  A  (Drinking)  T a b l e 4.12 shows the c o r r e l a t i o n a l m a t r i x  f o r Family A  for drinking periods.  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  Husband Wife Child Family  Husband  Wife  1.00 0.57 0.01 0.16  1.00 0.30 0.20  Child  1.00 0.20  Family  1.00  T a b l e 4.13 shows the eigen v a l u e s and v a r i a n c e f o r each of t h e f a c t o r s f o r Family A d u r i n g d r i n k i n g p e r i o d s . Table  4.13  Family A Non-drinking Eigen Values and % o f V a r i a n c e Eigen Values  1.50  % of Variance  Using  an eigen  38  value  1.03  0.77  0.70  63  83  100  > 1, 63.2% o f t h e v a r i a n c e  was  accounted f o r i n the r e s u l t i n g 2 p r i n c i p a l component s o l u t i o n (Table 4.14).  - 55 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 PCI Husband Wife Child Family  The u n r o t a t e d  0.30 0.71 0.69 0. 65  (Table 4.14) shows a s s o c i a t i o n w i t h PCI  t h e Wife, C h i l d and Family.  the Husband The  0.86 -0.26 -0.37 0.28  p r i n c i p a l component s o l u t i o n f o r Family A  for drinking periods for  PC2  PC2 shows a s s o c i a t i o n w i t h  only.  rotated  solution  (Table  4.15)  clarifies  the  a s s o c i a t i o n i n d i c a t i n g t h a t the Wife and C h i l d a r e a s s o c i a t e d w i t h PCI and the Husband and Family are a s s o c i a t e d w i t h PC2. The weights f o r the s o r t s i n d i c a t e t h a t the C h i l d i s o n l y s l i g h t l y more r e p r e s e n t a t i v e of PCI (2.10 as compared t o 1.71 f o r t h e wife) . (5.29  The Husband i s the most r e p r e s e n t a t i v e of PC2  as compared t o .67 f o r the F a m i l y ) . These r e s u l t s suggest t h a t  the Husband  is  w i t h r e s p e c t t o the f a m i l y paradigm f o r p e r i o d s  influential  of d r i n k i n g ,  and t h a t the Wife and C h i l d are more l i k e each other  in their  view o f the f a m i l y 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 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  Husband Wife Child Family  Table  4.16  contributed  to  and  PCI  PC2  -0.10 0.75 0.79 0.46  0.91 0.08 -0.03 0.54  4.17  show  differentiate  (Husband-Family).  The r e s u l t s  (Husband-Family),  PCI  don't  talk  t o each  the  PCI  when  we  items  (Child-Wife)  from  t h a t more than  indicate  (Child-Wife)  other  specific  considers  item  a r e angry."  #52  that PC2 PC2 "We  (Unhealthy  Communication) t o be c h a r a c t e r i s t i c of the f a m i l y f o r d r i n k i n g periods.  The r e s u l t s  also indicate  than PC2 (Husband-Family),  (Table 4.17)  that  less  PCI (Wife-Child) c o n s i d e r s item #48  "Anything goes i n our f a m i l y . " (Unhealthy  Behaviour  Control)  i s c h a r a c t e r i s t i c of the f a m i l y f o r d r i n k i n g p e r i o d s . O v e r a l l , 7 out of a p o s s i b l e 13 unhealthy items were f e l t to  be more  Child-Wife periods.  characteristic than  the  of the f a m i l y a c c o r d i n g  Husband-Family  during  t o the  non-drinking  In a d d i t i o n 7 out of a p o s s i b l e 12 Healthy  items  were f e l t t o be l e s s c h a r a c t e r i s t i c by t h e C h i l d - W i f e than by the Husband-Family f o r d r i n k i n g p e r i o d s .  - 57 -  Table  4.16  D i m e n s i o n s ( i t e m s ) w h i c h D i f f e r e n t i a t e P C I a s 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 for Drinking Periods #  Item  Subscale  Difference  More than PC2, PC1 considers characteristic: 52. We don't talk to each other when we are angry. 58. We don't have reasonable transport. 56. We confide in each other. 35. We don't often say what we mean. 57. We cry openly. 4.  When you ask someone to do something, you have to check that they did i t . 26. We can express feelings to each other. 47. If the rules are broken, we don't know what to expect. 51. We don't get along well together. 50. We confront problems involving feelings. 19. Some of us just don't respond emotionally. 24. After our family tries to solve a problem, we usually discuss whether it worked or not. 40. We discuss who is to do household jobs.  Unhealthy Communication Roles Unhealthy Healthy General Functioning Unhealthy Communication Healthy Affective Responsiveness Unhealthy Roles Healthy General Functioning Unhealthy Behaviour Control Unhealthy General Functioning Healthy Problem Solving Unhealthy Affective Responsiveness Healthy Problem Solving Healthy Roles  3 .97 2 .69 2 .30 2 .29 1 .91 1 .90 1,.64 1..54 1 .53 1,.39 1,.28 1..05 1..03  - 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 F u n c t i o n i n g 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.  Family  B  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  (Non-drinking)  T a b l e 4.18 shows the c o r r e l a t i o n a l m a t r i x during non-drinking periods.  f o r Family B  - 59 Table  4.18  Family B Non-drinking Matrix  Husband Wife Child Family  T a b l e 4.19  Husband  Wife  1.00 0.17 0.16 0.50  1.00 • 0.27 0.29  Correlational Child  1.00 0.43  Family  1.00  shows the eigen v a l u e s and v a r i a n c e f o r each of the  f a c t o r s f o r Family B f o r n o n - d r i n k i n g p e r i o d s . Table  4.19  Family B Non-drinking Eigen Values and % of V a r i a n c e Eigen Values  1.93  % of Variance  Using  an  48  eigen value  0.91  0.75  71  > 1,  90  48.3%  0.41 100  of the  variance  was  accounted f o r i n the r e s u l t i n g 1 p r i n c i p a l component s o l u t i o n (Table 4.20).  As o n l y one f a c t o r was r e t a i n e d no r o t a t i o n  was  done. The u n r o t a t e d p r i n c i p a l component s o l u t i o n f o r Family B f o r non-drinking periods association  w i t h PCI  f a m i l y as a group.  (Table 4.20)  shows a f a i r l y  strong  f o r a l l of the f a m i l y members and  the  - 60 -  Table 4.2 0 Family B Non-drinking: Unrotated P r i n c i p a l Component S o l u t i o n PCI Husband Wife Child Family  The  weights  0.67 0.58 0.67 0.84  f o r the s o r t s  most r e p r e s e n t a t i v e of PCI the Husband and  the  i n d i c a t e t h a t the  (2.85 as compared t o 1.22  Child,  and  0.87  Family i s f o r both  f o r the Wife) .  These  r e s u l t s suggest t h a t the f a m i l y paradigm as p e r c e i v e d by the Husband and the C h i l d  i s more l i k e PCI than the Wife's  for non-drinking periods. Child  are  perhaps  view  T h i s suggests t h a t the Husband and  slightly  more  influential  in  terms  of  c o n s t i t u t i n g the f a m i l y paradigm f o r n o n - d r i n k i n g p e r i o d s than the  Wife. T a b l e 4.21  shows the s p e c i f i c items t h a t c o n t r i b u t e d t o  t h i s mostly shared view (dominated  by the Family s o r t ) of the  f a m i l y paradigm d u r i n g non-drinking p e r i o d s . The  results  i n d i c a t e t h a t the Family,  and  e x t e n t o t h e r f a m i l y members c o n s i d e r item #2 3 "We meeting  our  bills."  (Unhealthy  Communication)  to a  lesser  have t r o u b l e to  be  c h a r a c t e r i s t i c of the f a m i l y f o r n o n - d r i n k i n g p e r i o d s .  more  - 61 4.21  Table  Dimensions (Items) which C o n s t i t u t e PCI 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 u  Item  Key  z-•score  23. We have trouble meeting bur b i l l s . 52. 8. 22. 10. 29. 33. 13. 44. 42. 17. 48.  The lesser  Unhealthy 3,.48 Roles Unhealthy We don't talk to each other when we are angry. 2,.06 Communication We sometimes run out of things that we need. Unhealthy 1,.91 Roles Unhealthy 1..46 It is difficult to talk to each other about tender feelings. Communication We make sure members meet their family Healthy 1,.24 respons i t>i Lit i es. Roles We talk to people directly rather than through Healthy 1..15 go-betweens. Communication Unhealthy We get involved with each other only when -1. .06 something interests us. Affective Involvement You only get the interest of others when Unhealthy -1.33 something is important to them. Affective Involvement We don't hold to any rules or standards. Unhealthy -1. .42 Behaviour Control Our family shows interest in each other only Unhealthy -1. .57 when they can get something out of i t . Affective Involvement You can easily get away with breaking the rules . Unhealthy -2..20 Behaviour Control Anything goes in our family. Unhealthy -3..12 Behaviour Control  results extent  also  indicate  individual  that  family  t h e Family,  members  feel  and t o a item  #48  "Anything goes i n our f a m i l y . " i s l e s s c h a r a c t e r i s t i c o f t h e family  f o r non-drinking  potential  6  characteristic Unhealthy  items  Unhealthy  periods. items  Overall, are  4  endorsed  out as  of  more  of the f a m i l y , and 6 out o f a p o t e n t i a l a r e endorsed  as l e s s c h a r a c t e r i s t i c  f a m i l y d u r i n g p e r i o d s of n o n - d r i n k i n g .  a  6  of the  - 62 Family  B  (Drinking)  T a b l e 4.22 shows the c o r r e l a t i o n a l m a t r i x  f o r Family B  for drinking periods.  Table  4.22  Family B 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  Husband Wife Child Family  Husband  Wife  1.00 0.19 0.19 0.06  1.00 0.19 0.41  Child  1.00 0.24  Family  1.00  T a b l e 4.23 shows the eigen v a l u e s and v a r i a n c e f o r each of t h e f a c t o r s f o r Family B d u r i n g d r i n k i n g p e r i o d s . Table  4.23  Family B Non-drinking Eigen Values and % o f V a r i a n c e Eigen Values  1.66  % of Variance  Using  an e i g e n  41  value  0.97  0.81  0.55  66  86  100  > 1, 41.5% o f t h e v a r i a n c e  was  accounted f o r i n the r e s u l t i n g 1 p r i n c i p a l component s o l u t i o n (Table 4.24).  - 63  -  Table 4.24 Family B 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 PCI Husband Wife Child Family  As o n l y one The  f a c t o r was  unrotated  f o r non-drinking  0.44 0.75 0. 60 0.73  r e t a i n e d no r o t a t i o n was  done.  p r i n c i p a l component s o l u t i o n f o r Family B periods  (Table  4.24)  shows a f a i r l y  a s s o c i a t i o n with PCI f o r the Wife, C h i l d , and  strong  the Family as a  group. The weights f o r the s o r t s i n d i c a t e t h a t the Wife i s most representative Family, 0.94  of  PCI  (1.71  as  compared  f o r the C h i l d , and 0.01  to  1.56  for  f o r the Husband).  r e s u l t s suggest t h a t the f a m i l y paradigm as p e r c e i v e d Wife i s more l i k e PCI than i s the view p e r c e i v e d or  the  Husband.  This  suggests  that  the  the  These by  the  by the C h i l d  Wife  is  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 f a m i l y paradigm f o r d r i n k i n g p e r i o d s than any T a b l e 4.25 this  view  other  f a m i l y member.  shows the s p e c i f i c items t h a t c o n t r i b u t e d  (dominated  by  paradigm d u r i n g d r i n k i n g  the  Wife's  periods.  sort)  of  the  to  family  -  64  -  Table 4.25 Dimensions (items) which C o n s t i t u t e PCI f o r Family F u n c t i o n i n g f o r Family B f o r D r i n k i n g P e r i o d s Key  Item  3.24 Unhealthy Roles Unhealthy 2.44 We don't get along well together. General Functioning Unhealthy 2.22 We sometimes run out of things that we need. Roles 1.53 Unhealthy We don't often say what we mean. Communication 1.43 Unhealthy We don't talk to each other when we are angry. Communication 1.24 Unhealthy It is difficult to talk to each other about Communication tender feelings. 1.19 Unhealthy We do not show our love for each other. Affective Responsiveness •1.01 Unhealthy We cannot talk to each other about the sadness General we feel. Functioning •1.06 If the rules are broken, we don't know what to Unhealthy expect. Behaviour Control We are able to make decisions about how to solve Healthy •1.20 General problems. Functioning •1.24 We are frank with each other. Healthy Communication •1.29 Our family shows interest in each other only Unhealthy when they can get something out of i t . Affective Involvement •1.39 We can express feelings to each other. Healthy General Functioning We don't have reasonable transport. •1.52 Unhealthy Roles We show interest in each other when we can get •1.76 Unhealthy something out of it personally. Affective Involvement * Unhealthy •2.49 Anything goes in our family. Behaviour Control  23. We have trouble meeting our b i l l s . 51. 8. 35. 52. 22. 28. 11. 47. 46. 43. 42. 26. 58. 37. 48.  The  results  indicate  that  the Wife,  and t o a  lesser  e x t e n t t h e Family c o n s i d e r item #23 "We have trouble- meeting our  bills."  characteristic  (Unhealthy of  Communication)  the f a m i l y  to  be  f o r drinking periods.  more The  r e s u l t s a l s o i n d i c a t e t h a t the Family, and t o a l e s s e r e x t e n t i n d i v i d u a l f a m i l y members f e e l item #48 "Anything goes i n our  - 65 family." periods.  i s l e s s c h a r a c t e r i s t i c of the f a m i l y  f o r drinking  O v e r a l l , 7 out of a p o t e n t i a l 7 Unhealthy items a r e  endorsed as more c h a r a c t e r i s t i c of the f a m i l y , and 4 out of a potential  6  Unhealthy  items  are  endorsed  c h a r a c t e r i s t i c of the f a m i l y d u r i n g p e r i o d s For  Family B, there  items f o r both d r i n k i n g  less  of d r i n k i n g .  are a number of s i m i l a r l y and non-drinking  as  periods.  endorsed Trouble  meeting b i l l s , d i f f i c u l t y i n t a l k i n g , were themes endorsed f o r d r i n k i n g 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 t h a t were u n l i k e t h e f a m i l y f o r both s t a t e s .  - 66 THE  SEMI-STRUCTURED FAMILY  INTERVIEWS  An important p a r t of reason f o r doing t h e i n t e r v i e w i n a d d i t i o n t o g a t h e r i n g the Q-sort data was i n o r d e r t o 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 r e s e a r c h e r f e l t  i t would be u s e f u l t o gather data t h a t r e l a t e d d i r e c t l y t o t h e family's  experience of the Q-sort  by p o s i n g q u e s t i o n s  that  r e q u i r e d t h e f a m i l y t o draw upon t h e i r e x p e r t i s e r e g a r d i n g t h e r e l e v a n c e o f t h e Q-sort items and the s o r t i n g p r o c e s s .  Case The  Study  A  Family's  In  Experience  of  the  Q-Sort  t h i s case the mother d e s c r i b e d the Q-sort e x p e r i e n c e  as "mind b o g g l i n g " and the f a t h e r remarked " I enjoyed i t , i t got my mind working."  When t h i s r e s e a r c h e r asked i f they a l s o  thought t h a t the items were r e l e v a n t t o t h e i r f a m i l y they a l l nodded  and t h e f a t h e r  expanded  s a y i n g he f e l t  p r e c i s e and r i g h t t o t h e p o i n t too".  "they  were  When asked i f they c o u l d  t h i n k o f o t h e r items t h a t should have been i n c l u d e d i n t h e Qs o r t t h a t would have r e s u l t e d  i n a more complete p i c t u r e of  t h e i r f a m i l y t h e mother r e p l i e d t h a t " i t was g e n e r a l l y p r e t t y good" and t h e other f a m i l y members nodded i n agreement. addition  a l l family  discussion,  responding  members  participated  t o questions  fully  In  i n the  enthusiastically,  and  remarked t h a t they enjoyed the p r o c e s s . Possibly  r e l e v a n t t o the data i s the comment t h a t the  - 67 -  family f e l t negative  t h e d i s c u s s i o n and Q-data "might have been more  i f (the e l d e s t daughter) were  d e f i n i t e ideas".  here,  as she has  The f a m i l y was a l s o i n v o l v e d i n a p r o c e s s of  r e c a l l i n g t h e times i n the f a m i l y when p e r i o d s of d r i n k i n g and p e r i o d s o f n o n - d r i n k i n g 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 t o c o n s i d e r t h e non-drinking q u e s t i o n s as r e l a t e d t o t h e i r p r e s e n t f a m i l y s i t u a t i o n and the d r i n k i n g q u e s t i o n s as r e l a t e d t o the past.  While e f f o r t was made i n t h e d i s c u s s i o n  to remind and focus the f a m i l y members on t h e p a s t p e r i o d s o f non-drinking,  c l e a r l y the f a m i l y was e n t h u s i a s t i c r e g a r d i n g  the many changes they had been a b l e t o undertake,  and as a  r e s u l t tended t o view the past as " d r i n k i n g " and t h e p r e s e n t as  "non-drinking".  Family  I n t e r a c t i o n (Drinking)  Early that  i n the i n t e r v i e w the son e x p l a i n e d t h a t he  during  drinking  individual basis.  periods  decisions  were  made  felt  on an  He e x p l a i n e d t h a t " i n s t e a d o f a s k i n g , we'd  j u s t do i t " and when prompted by h i s mom f o r t h e "other (nond r i n k i n g ) times" he r e p l i e d ask  dad and they'd  decide  ( p o i n t i n g a t h i s parents) together."  The mother  "we'd  explained  t h a t when d r i n k i n g was going on she would "do n o t h i n g and the whole f a m i l y would s u f f e r " . wife)  The f a t h e r added (nodding a t h i s  "she would go t o her room and read o r s l e e p " . Here, t h e f a t h e r , mother, and son seem t o be s a y i n g t h a t  when d r i n k i n g was o c c u r r i n g f a m i l y members tended t o withdraw  - 68 from each other.  -  The c h i l d r e n would tend t o do t h i n g s more on  t h e i r own without c o n s u l t i n g e i t h e r parent. stop  t a l k i n g t o each other,  the  f a t h e r would d r i n k ,  mother would o f t e n withdraw t o her The  general  consensus was  The p a r e n t s would  room and  sleep  that  confidence "You  individual  i n themselves as a f a m i l y .  just  feel  bad".  basis  and  family  themselves.  or  the read.  t h a t a l l were " s u f f e r i n g " and  t h a t people i n the f a m i l y f e l t a l a c k of p e r s o n a l and  and  The  Decisions members  were  generally  confidence  son  reported  made  on  an  fended  for  At these times f a m i l y members looked o u t s i d e  the  f a m i l y f o r s o c i a l c o n t a c t or tended t o i s o l a t e themselves. There were a number of s t o r i e s t h a t f a m i l y r e p o r t e d speak t o the  kind  of e f f e c t a l c o h o l had  on  the  view  that  family  members h e l d of themselves d u r i n g p e r i o d s of d r i n k i n g , perhaps the most r e l e v a n t have t o do with the theme of i n t e r a c t i o n a l closeness  and  distance.  The  father  striking  s t o r y of h i s youth and  growing  up  closeness "I  as  a  and how find  way  not very  myself I was  abuse he  explaining  to  socialize  l i v e d most of my  d r i n k i n g began when I was was  a  his  particularly  suffered while  difficulty  with  he came t o r e l y on a l c o h o l .  i t hard  f a m i l y . I've  of  the  told  12,  outside  the  (immediate)  l i f e i n a big family. I guess t h a t ' s 26 y e a r s ,  The I  c l o s e , I would push everyone away, I t o l d not going t o c r y , I r e a l l y h e l d a l o t back.  A l o t of hate can b u i l d up over 26 y e a r s i f you don't l e t it  out.  Broken d i s h e s  over my  head, g e t t i n g i n f i g h t s  69  -  -  and t h i n g s and g e t t i n g my hand burnt w i t h l i g h t e r f l u i d . I had  a temper and  h a v i n g my  t h a t was  my  punishment. . . and  then  4 or 5  grandfather doing t h i n g s when I was  and  t r y t o c a r r y on when I got o l d e r . . . t h a t ' s the f i r s t time I ever s a i d t h a t , I've Although  this  "explanations"  story  f o r the  never even t o l d clearly  onset and  points  (counsellor)." to  persistence  many of  possible  an  alcohol  problem, namely p h y s i c a l , emotional, and sexual abuse, i t a l s o shows  something  intimacy.  more  revealing  The f a t h e r was  with closeness, kept him  in  terms  of  interactional  c l e a r l y t a l k i n g about h i s  and went on t o t a l k about how  d i s t a n t from h i s own  discomfort  the s e x u a l abuse  children.  "Something l i k e t h a t , I mean you hear about abused people abusing t h e i r own  kids.  You don't t h i n k i t w i l l make you  do something l i k e t h a t , but you s t i l l worry. are o l d e r , and  alcoholism,  emotional,  and  sexual  s e l f - c o n f i d e n c e and sidelines because personal  of  they  kids  more comfortable the  now."  unemployment,  abuse,  the  a l l contributed  to  physical, a  lack  i n v i t e d the f a t h e r t o move h i m s e l f t o  family were  my  I've gotten r i d of a l o t of garbage, i t ' s  g e t t i n g b e t t e r , I'm The  Now  life.  so  experience  The  clearly and  of  comments  i n the making  were  the  remarkable  d i r e c t i o n of closeness.  of  sharing These  o p p o r t u n i t i e s d i d not seem t o be a v a i l a b l e t o the f a m i l y w h i l e they were o p e r a t i n g  under the  " a l c o h o l i c f a m i l y " paradigm.  -  Family  Interaction  During reported  periods  he o f t e n  felt  mother", and found h i m s e l f members  while  not having  contribute t o the l i f e "I  felt  useless  i n the f a m i l y  "even  "going along" a sense  with  of how  from the  other  family  he might  really  of the f a m i l y on h i s own  that  the father  more d i s t a n t  t o r e a l l y do anything  times he e x p l a i n e d and  -  (Non-drinking)  non-drinking  that  70  right."  initiative. During these  "I would j u s t s t a y out o f arguments  keep my f e e l i n g s t o myself".  The f a t h e r ' s  participation  i n open disagreements was u n l i k e l y , and s t r o n g  f e e l i n g s were  g e n e r a l l y kept p r i v a t e .  A t these times s o c i a l i z i n g  outside  the immediate f a m i l y was not as l i k e l y , t h i s i n c l u d e d  visits  w i t h extended f a m i l y .  Members i n the f a m i l y had a sense of  being  each other,  "on guard" with  themselves  involved  i n patterns  defensiveness with respect  and persons  o f blaming,  t o each other.  often  found  criticism  and  The son r e p o r t e d  t h a t "Except f o r dad who was j u s t kinda out of i t , we'd f i g h t a l l t h e time, but wouldn't get anywhere except f o r (youngest sister)  who would j u s t take o f f " .  In a d d i t i o n t h e r e  was a  sense i n t h e f a m i l y of not being able t o "get t h i n g s done" o r to  resolve  sense  interpersonal  of f r u s t r a t i o n  conflicts.  This  contributed  and hopelessness w i t h  respect  family  as a working team, and a p o s i t i v e p l a c e  mother  remarked  that  "During  the d r i n k i n g  to a  to the  t o be. The  periods  I would  leave  ( e m o t i o n a l l y ) , but when no d r i n k i n g was going on I was  there  a l l t h e time doing e v e r y t h i n g .  I t was k i n d o f l i k e I  wanted t o g e t i n e v e r y t h i n g s t a r t up again. not  I think  I c o u l d before t h e d r i n k i n g would  i t would have been b e t t e r  i f I had  been as d i s t a n t when the d r i n k i n g was going on, because  everyone  suffered."  drinking  stopped  trouble". stuff  of t h i n g  t h e youngest  reported  daughter  that  " s i n c e the  has been  t h e most  The son e x p l a i n e d t h a t "now she can't g e t away w i t h  any more  explained  The mother  'cause  dad's  involved  too".  The  father  t h a t "I use t o get r e a l l y worked up w i t h t h a t (problems with the c h i l d r e n ) .  kind  I'd be out t h e door  w i t h a 40 pounder under my b e l t , but now I t e l l her ( p o i n t i n g t o h i s wife) not t o g e t worked up".  He e x p l a i n e d ,  "On t h e  o c c a s i o n s when I do get a l i t t l e hot under t h e c o l l a r , I won't say anything  I ' l l j u s t go f o r a walk t o c o o l down".  The f a m i l y experience c o n s i d e r a b l e d i f f e r e n c e i n terms of f a m i l y i n t e r a c t i o n with r e s p e c t t o d r i n k i n g and periods  but perhaps the son expressed  i t best  non-drinking when he s a i d  " t h i n g s were s t i l l not t h a t great when dad wasn't d r i n k i n g i n the p a s t periods  (during the times of binge d r i n k i n g a l t e r n a t i n g w i t h o f s o b r i e t y ) but now they a r e way b e t t e r " .  To t h i s  the mother nodded i n agreement and added "I'm so c o n f i d e n t now I went out and bought a c a r " .  Case Study B The  F a m i l y ' s Experience o f t h e Q-Sort  Family members were asked how they f e l t about completing the Q-sort, and i f i t allowed them t o a c c u r a t e l y p r e s e n t  how  t h e i r f a m i l y f u n c t i o n s d u r i n g d r i n k i n g and n o n - d r i n k i n g To t h i s a l l f a m i l y members nodded v i g o r o u s l y . prompted  regarding  t h e completeness  When f u r t h e r  of the questions  f a t h e r responded t h a t he f e l t i t was "average". they  could  think  o f any other  times.  items t h a t  the  When asked i f  should  have been  i n c l u d e d t h a t would have r e s u l t e d i n a more complete p i c t u r e of  their  pretty  family,  t h e mother responded  good" and t h e daughter  echoed  "No, I t h i n k "Yeah,  i t was p r e t t y  good".  I n a d d i t i o n a l l f a m i l y members p r e s e n t  fully  in  the  discussion,  responding  participated  to  questions  e n t h u s i a s t i c a l l y , and t h e f a t h e r remarked t h a t they some t h i n g s "  i n t h e process,  nodded t h e i r  assent.  i t was  "learned  while the r e s t of the family  When the f a m i l y was asked i f they f e l t the d i s c u s s i o n and Q-data would have been d i f f e r e n t i f t h e other here, a l l t h e f a m i l y members nodded.  c h i l d r e n were  The daughter  explained  t h a t "the k i d s would have j u s t put t h e cards anywhere because they can't  read,  maybe i f mom or dad e x p l a i n e d  them they c o u l d do i t " . they  each c a r d t o  Although i t seemed c l e a r t h a t what  were r e f e r r i n g t o was t h e p o s s i b i l i t y  that  t h e other  c h i l d r e n would not have understood what t h e c a r d s meant and would have s o r t e d randomly as a r e s u l t d u r i n g t h e i r own s o r t , the f a m i l y a l s o f e l t t h a t they c o u l d have c o n t r i b u t e d t o t h e f a m i l y s o r t by d i r e c t i n g t h e parents where t o p u t t h e c a r d s . As  drinking  occurrence  periods  for this  were  family  still  they  a  seemed  (relatively) t o have  recent  a clearer  -  perspective drinking  on  and  -  73  the d i f f e r e n c e s i n f a m i l y non-drinking  occasions  functioning  than  the  first  during family  interviewed.  Family  Interaction  (Drinking)  The daughter r e p o r t e d t h a t "they are way drinking  i s going  on,  i t ' s like  mom  l e s s s t r i c t when  is like  off  in  fairy  l a n d " . The mother responded by s a y i n g "Yeah, when d r i n k i n g i s going on  I give  i n to everything.  It's like  I become t h i s  pushover". The dad remarked "What about t h a t time I threw your book i n t o the f i r e p l a c e when you wouldn't s t u d y ? " t o which the daughter  responded  "Well  yeah,  but  generally..."  f a m i l y members nodded i n agreement. stories effect  that  family  alcohol  themselves  has  during  relevant,  again  closeness  and  reported on  the  periods  had  to  distance.  with  of  do  with  The  family  drinking, the  all  There were a number of respect  view  and  to  the  kind  of  members  hold  of  perhaps  theme of  daughter r e p o r t e d  the  most  interactional t h a t "Mom  and  dad's 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 , i t makes them f u r t h e r apart  'cause they f i g h t " .  The  father  explained  t h a t "the k i d s w i l l be a f f e c t e d more i n the long term t h e y ' l l remember the f i g h t i n g , but Both p a r e n t s r e p o r t e d  'cause  i t ' s us a t the moment".  t h a t when d r i n k i n g was  occurring,  f a m i l y members tended t o become more i n v o l v e d w i t h each o t h e r . The daughter r e c a l l e d "Remember the i n c i d e n t w i t h the garbage bags?  (Brother)  went  with  you  against  dad."  The  father  - 74 -  responded  "Well yeah, k i d s  always s i d e w i t h t h e i r  mother".  The f a t h e r a l s o r e p o r t e d t h a t "The k i d s a r e l i k e a l i t t l e u n i t when  drinking  i s going  watching us."  on, huddled  together  talking  and  The c h i l d r e n would tend t o draw c l o s e r t o each  other and t h e i r mother. would e s c a l a t e .  The parents would argue and c o n f l i c t  The g e n e r a l  consensus i n t h e f a m i l y i s t h a t  d r i n k i n g t r i g g e r s o r i s t r i g g e r e d by a l a c k o f a t t e n t i o n and the r e s u l t i n g e r o s i o n i n p e r s o n a l confidence themselves as a couple and f a m i l y .  and c o n f i d e n c e i n  The mother r e p o r t e d  that  "I t h i n k he d r i n k s and me t o o sometimes because we don't g e t enough a t t e n t i o n , and s t a r t  to feel  like  there's  something  wrong w i t h him or me and t h i n g s get shaky". Decisions although  there  were r e p o r t e d was  some  d e c i s i o n making i n f l u e n c e .  to s t i l l  debate  be made by t h e f a t h e r  as t o t h e extent  of h i s  While t h e f a t h e r asked "Don't you  agree t h a t I make t h e f i n a l d e c i s i o n s about s t u f f ? " , i t seemed c l e a r t h a t t h i s was a k i n d of a f o r m a l i t y on most  occasions.  "Well, yeah but t h a t ' s u s u a l l y a f t e r mom has decided, supper when she asks i f chicken get a v i d e o . " ask  would be OK o r l i k e when we  The f a m i l y d e s c r i b e d t h a t they would g e n e r a l l y  t h e f a t h e r i f he "agreed" with t h e p l a n s  discussed  t h e mother had  w i t h t h e c h i l d r e n or i f he wanted t o have  f o r dinner,  like for  f o r example.  chicken  In t h i s way they seemed t o have t h e  u n d e r s t a n d i n g t h a t the f a t h e r had "veto powers" t h a t he seldom exercised. At  drinking  times  family  members  looked  outside  the  family  for social  t h i s was  75  c o n t a c t but  i t was  u n c l e a r as t o whether  more t o " a t t r a c t " a t t e n t i o n from  f a m i l y members or  because i n d i v i d u a l s a c t u a l l y wanted more d i s t a n c e from  each  other.  Family  Interaction  During  (Non-drinking)  non-drinking  periods  i n the  f a m i l y the  mother  r e p o r t e d "Mostly I f e e l even l e s s c o n f i d e n t , cause I f e e l not  doing  enough, you  know as  a mother  or  I'm  h i s partner  or  something, and I'd be t h i n k i n g of a l l the mistakes I've made, and I can get p r e t t y hopeless".  The daughter r e p o r t e d " Yeah,  she's always t r y i n g t o be the s t r o n g one, doing e v e r y t h i n g and all  that  stuff".  At  thinking  critically  mistakes  and  these of  herself,  q u e s t i o n i n g her  m a i n t a i n any p o s i t i v e  times  and  she  would  often the  find  focusing  she  was  on  past  family's a b i l i t y  to  direction.  During these times she r e p o r t e d t h a t she f e l t  drawn t o  her p a r e n t s and s i s t e r s but would s t a y away f e e l i n g they would o n l y be c r i t i c a l ,  drawing her i n t o c o n f l i c t remarking  "Yeah,  I get the urge t o go and see them but I j u s t know they'd i n on  start  me". The daughter  r e p o r t e d t h a t the parents were more s t r i c t  w i t h the c h i l d r e n d u r i n g n o n - d r i n k i n g times, and she d e s c r i b e d her p a r e n t s as, "not as c a s u a l with each other or the k i d s " . The daughter a l s o e x p l a i n e d (amid much l a u g h t e r ) t h a t "I don't t h i n k t h a t they're as romantic with each o t h e r  without  - 76 -  some wine". occasions  that  This  gave  rise  t o some  were not e x c e s s i v e .  stories  "Like  of d r i n k i n g  t h e time we went  h i k i n g , and we had a b o t t l e of wine", a c c o r d i n g t o t h e mother. I t would seem however, t h a t d r i n k i n g c o u l d not be counted on t o "produce romance" on every  drinking occasion,  t h i s way troublesome and u n p r e d i c t a b l e . "We  went  t o Vancouver  interrupting)  t o see t h i s  and was i n  The mother r e p o r t e d  concert  and. ..  (Father  I had some d r i n k s i n the h o t e l room and g o t a  l i t t l e loud w i t h the usher 'cause I c o u l d n ' t f i n d our s e a t s . " The mother continued,  "Well anyway we were asked t o l e a v e and  spent t h e r e s t of the time i n our h o t e l room f i g h t i n g " .  -  77  -  CHAPTER SUMMARY AND  This  project  was  based  V  DISCUSSION  on  the  premise  that  families  conserve and c o n s t i t u t e t h e i r shared c o n c e p t i o n s of themselves (the  family  regular  paradigm)  patterns  of  and  the  their  own  world  around  them  through  interaction.  It  further  proposed t h a t the p a t t e r n s of i n t e r a c t i o n i n f a m i l i e s w i t h an a l t e r n a t o r or b i n g e i n g  a l c o h o l i c would vary  non-drinking  The  periods.  from d r i n k i n g t o  primary purpose of t h i s study  was  t o examine t h i s expected d i f f e r e n c e i n d e t a i l by f o c u s i n g the f o l l o w i n g  questions;  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 image  or  on  paradigm)  differ,  for  drinking  (the f a m i l y and  self-  non-drinking  periods? Do responses t o s p e c i f i c questions such  salient  Solving,  dimensions  Communication,  Affective  Involvement,  Functioning  of  family  Roles,  functioning  Affective  Behaviour  d i f f e r f o r periods  purported to as  evaluate Problem  Responsiveness,  Control,  of d r i n k i n g and  and  General  abstinence?  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  family Who  as  a group d i f f e r  from  individual descriptions?  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 is  s/he  more d i s t a n t and  less influential  i n the  family  as  -  78 -  much o f t h e l i t e r a t u r e p r e d i c t s ? By  f o c u s i n g on these questions  t h i s researcher  examined  the s p e c i f i c aspects o f f a m i l y f u n c t i o n i n g t h a t i n t h e case o f two  specific  f a m i l i e s were the most  between d r i n k i n g and non-drinking examined who  i n the family  f a m i l y paradigm. from  the  differences  family i n t e r a c t i o n . I t also  contributed  these  ideas  to the  While the Q-sort methodology u t i l i z i n g items  McMaster  quantitative  important  data  Family  Assessment  collection,  a  Device  guided  semi-structured  the  interview  guided by an i n t e r a c t i o n a l c y b e r n e t i c systemic model i n v i t e d the f a m i l y t o c o n t r i b u t e t h e i r indigenous knowledge d i r e c t l y . T h i s model d e a l s w i t h the s t o r i e s and ideas t h a t i n d i v i d u a l f a m i l y members and the f a m i l y constitute  the f a m i l y  as a group f e e l  paradigm.  This  has  conserve and enriched  the  knowledge base i n t h e area of a l c o h o l i c f a m i l y i n t e r a c t i o n . The  comparison of the Q-sorts o f f e r e d an o p p o r t u n i t y t o  understand how i n d i v i d u a l f a m i l y members and t h e f a m i l y as a group d i f f e r i n t h e i r f a m i l y i n t e r a c t i o n f o r d r i n k i n g and nondrinking  periods.  analysis  f o r i n d i v i d u a l Q-sorts  offered  Correlations  an o p p o r t u n i t y  and p r i n c i p a l and t h e f a m i l y  t o understand  who  may  components as a group  be t h e most  i n f l u e n t i a l i n t h e i r c o n t r i b u t i o n t o the f a m i l y paradigm. In a d d i t i o n , by examining the s p e c i f i c items t h a t c o n t r i b u t e d t o the d i f f e r e n t i a t i o n of c l u s t e r e d Q-sorts t h e most s i g n i f i c a n t differences revealed.  between d r i n k i n g  and non-drinking  periods  were  - 79 The  Q-Sort  Results  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 image  o r paradigm)  periods? from  differ,  f o r drinking  (the f a m i l y and  self-  non-drinking  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  the  family  as  a  group  differ  from  individual  descriptions? As  reported  i n Chapter  IV, t h e r e s u l t s o f t h e Q-sort  showed correspondences between c e r t a i n p r i n c i p a l components f o r both d r i n k i n g and non-drinking members.  periods f o r c e r t a i n family  In f a m i l y A f o r example, the Wife saw t h e f a m i l y one  way, t h e Husband saw the f a m i l y d i f f e r e n t l y than t h e Wife and the C h i l d saw t h e f a m i l y d i f f e r e n t l y from e i t h e r h i s mother o r h i s f a t h e r f o r p e r i o d s o f non-drinking. drinking  periods.  Yet the second  The same was t r u e f o r  family  studied  saw t h e  f a m i l y s i m i l a r l y between i n d i v i d u a l s (and as a group) and f o r both d r i n k i n g and non-drinking  periods.  T h i s suggests t h a t  the members o f Family A f e l t t h a t t h e i r f a m i l y f u n c t i o n i n g was d i f f e r e n t f o r non-drinking  p e r i o d s than f o r d r i n k i n g p e r i o d s ,  and t h a t f a m i l y members do not n e c e s s a r i l y agree on what those differences  are.  "consensually" significantly Family  B  These  derived  results group  also  suggested  description  from i n d i v i d u a l d e s c r i p t i o n s .  viewed  their  family  similarly,  that  can  the  differ  The members o f i n d i v i d u a l l y and  between s t a t e s , i n d i c a t i n g a c o n s i s t e n t p e r s p e c t i v e o f f a m i l y f u n c t i o n i n g r e g a r d l e s s of s t a t e . Who i n t h e f a m i l y c o n t r i b u t e s the most t o t h e a l c o h o l i c  - 80 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 ? To drinking  the  extent  and  that  there  non-drinking  was  a  periods,  in  difference family  A  between  the  data  suggests the Wife was the most i n f l u e n t i a l w i t h r e s p e c t t o the n o n - d r i n k i n g p e r i o d s and the Husband the most i n f l u e n t i a l f o r the d r i n k i n g p e r i o d s .  In f a m i l y B i t was the Husband's,  w i t h the C h i l d ' s ) i n f l u e n c e t h a t was the  non-drinking  p e r i o d s , and  the most f e l t  (tied  regarding  the Wife's i n f l u e n c e f o r the  drinking periods. 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  salient  dimensions  Solving,  Communication,  Affective  Involvement,  of  family  Roles,  f u n c t i o n i n g as  Affective  Behaviour  Responsiveness,  Control,  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 Specific that  the  items c l u s t e r e d t o g e t h e r  families  classification  did  system.  not  always  Family  A  and  General  abstinence?  i n ways t h a t  agree  with  f o r example,  (according t o the FAD)  suggest  the felt  h e a l t h y t o n o t t a l k when you were angry and endorsed a l o n g w i t h other h e a l t h y  Problem  FAD's it  was  the item  items.  From  the s e m i - s t r u c t u r e d i n t e r v i e w the f a m i l y e x p l a i n e d t h i s as a particular  strength.  They r e p o r t e d t h a t when f e e l i n g s  p a r t i c u l a r l y "hot", f a m i l y members may down", y e t i n the FAD, of  unhealthy  are  "go f o r a walk t o c o o l  t h i s item i s suggested t o be  indicative  communication, and i s scored a c c o r d i n g l y .  The r e s u l t s i n d i c a t e f a m i l y members endorsed both h e a l t h y and unhealthy There  was  items f o r p e r i o d s of d r i n k i n g and n o n - d r i n k i n g .  also  evidence  that  suggested  f a m i l i e s had some mixing of endorsed components, s p e c i f i c  that  and the Q-sorts  understood  these  sub-scales i n the f a c t o r  sub-scales tended  to cluster  There were a l s o s i m i l a r i t i e s between s p e c i f i c sorts  while  together.  individual  the f a m i l y d i d as a group t a s k .  QIf  as i n d i c a t o r s of l e a d e r s h i p o r i n f l u e n c e i n terms  of t h e f a m i l y paradigm, the s i m i l a r i t i e s between  individual  and f a m i l y Q-sorts c o u l d be suggestive of t h e k i n d s o f ideas or  conversations  particular  family  members  might  have  a v a i l a b l e t o them a t any g i v e n moment.  Family  A  Combining t h e i n f o r m a t i o n gathered and  from t h e Q-sort  data  from 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 suggested  some  interesting possibilities.  From the i n t e r v i e w i t would seem  c l e a r t h a t t h i s i s a f a m i l y t h a t has been p r o f o u n d l y by  alcohol.  Years  affected  of a l c o h o l misuse were r e p o r t e d t o have  s e v e r e l y a f f e c t e d the f a m i l y ' s a b i l i t y t o generate a r e l i a b l e income, and i t prevented them from a p p r e c i a t i n g each o t h e r ' s good q u a l i t i e s as they were r e c r u i t e d i n t o c y c l e s o f blaming and g u i l t .  However, while the Q-sort data suggests t h e r e a r e  some s i m i l a r i t i e s between Q-sorts, g e n e r a l l y t h e Q - s o r t s were quite  different  f o r d r i n k i n g p e r i o d s as compared w i t h non-  drinking periods.  T h i s suggest t h a t w h i l e t h e r e a r e a s p e c t s  -  82  -  of f a m i l y f u n c t i o n i n g t h a t a r e not a f f e c t e d one way o r another by  drinking  sees  their  states. more  and non-drinking functioning  periods,  as q u i t e  generally  different  the family  f o r these  two  I t was a l s o c l e a r t h a t the f a m i l y members endorsed  healthy  items  drinking periods.  f o r periods  of n o n - d r i n k i n g  than f o r  Perhaps as a r e s u l t of t h e treatment t h e  f a m i l y had a l r e a d y r e c e i v e d p r i o r t o e n t e r i n g i n t o t h i s study, or perhaps r e l y i n g  on t h e i r  own experience,  t h e f a m i l y had  n o t i c e d t h a t w h i l e some problems e x i s t e d even d u r i n g of n o n - d r i n k i n g  (as d i d strengths d u r i n g p e r i o d s o f d r i n k i n g ) ,  g e n e r a l l y , f a m i l y f u n c t i o n i n g was much improved d u r i n g of  abstinence.  family  periods  In a d d i t i o n ,  had some  trouble  as p r e v i o u s l y  separating  the present  mentioned, t h e  the p a s t  relatively  periods  extended  non-drinking  occasions  from  period  of  sobriety.  I t was a l s o i n t e r e s t i n g t o note t h a t t h e f a m i l y ' s  placement o f some items ( t a l k i n g when angry) was f o r them an indication  of h e a l t h ,  yet according  scored as an unhealthy response.  t o t h e FAD would  have  Not t a l k i n g when angry, and  not s a y i n g what people r e a l l y mean, was c o n s i d e r e d  a good i d e a  f o r t h e f a m i l y members i n t h i s case, as i t was p r o t e c t i v e o f others. In terms of the f a m i l y ' s p e r c e p t i o n of f a m i l y f u n c t i o n i n g during non-drinking  p e r i o d s the Q-sort data suggested t h a t t h e  Wife was t h e most i n f l u e n t i a l .  This f i t with the information  gathered i n t h e f a m i l y i n t e r v i e w .  In the i n t e r v i e w t h e w i f e  was t h e v o i c e f o r a l l the wonderful o p p o r t u n i t i e s t h e f a m i l y  -  had  realized  the new  83  as a r e s u l t of the new  c a r she had  experiencing.  non-drinking  lifestyle,  been able t o purchase as w e l l as the  sense of f i n a n c i a l and The  emotional s e c u r i t y the f a m i l y was  father  e f f e c t s a l c o h o l had  was  new now  the  voice  for  the  terrible  him  personally  and  this  was  presented from both the Q-sort data  and  on them and  a l s o r e f l e c t e d i n the Q-sort  Family  -  data.  B  The  information  the f a m i l y i n t e r v i e w suggested t h a t t h i s f a m i l y viewed i t s e l f p r i m a r i l y along non-drinking  one  dimension, i r r e s p e c t i v e of d r i n k i n g  periods.  however, i n terms of how  There was  one  important  and  difference  the f a m i l y d e f i n e d a d r i n k i n g p e r i o d .  T h i s f a m i l y f e l t t h a t a d r i n k i n g p e r i o d a c t u a l l y began p r i o r t o a l c o h o l consumption. t h i n g s may  The f a m i l y e x p l a i n e d t h a t even though  be going w e l l i n the f a m i l y w i t h r e s p e c t t o a l c o h o l  consumption,  at  some p o i n t  tension  begins  to  develop,  f a m i l y members begin t o withdraw from each other. data c l e a r l y supports the i n f o r m a t i o n interview.  In  this  family,  The  Q-sort  gathered i n the  family  there  are  considerable  s i m i l a r i t i e s between Q-sorts t h a t r e l a t e t o d r i n k i n g and  those t h a t r e l a t e t o non-drinking  and  periods.  periods  Trouble with  b i l l s , and d i f f i c u l t y w i t h communication are endorsed f o r both states.  While the husband seems t o be more i n f l u e n t i a l than  the Wife i n terms of the f a m i l y paradigm d u r i n g  non-drinking  p e r i o d s , the w i f e i s more i n f l u e n t i a l d u r i n g d r i n k i n g p e r i o d s .  -  This  i s opposite  according  to  the  84  -  first  t o t h i s researcher  family  studied,  and  t o be l e s s d e s i r a b l e .  seems  In t h i s  p o s i t i o n he i s r e c r u i t e d i n t o n e g a t i v e l y c o n n o t i n g t h e f a m i l y during  periods  connotation feels  of non-drinking  (perhaps due t o the  a p p l i e d t o the p e r i o d s  responsible),  while  the  negative  of d r i n k i n g f o r which he Wife  is  recruited  into  n e g a t i v e l y connoting the f a m i l y d u r i n g d r i n k i n g p e r i o d s .  In  t h i s way the f a m i l y (paradigm) r e a l i z e s few o p p o r t u n i t i e s f o r positive  connotation.  Theoretical  Implications  The f i n d i n g s have relevance  t o theory  i n the domain  a l c o h o l i s m and the f a m i l y i n the f o l l o w i n g ways. f o c u s i n g on the r e c o l l e c t i o n s of the kinds  of  of  F i r s t l y , by  conversations,  i n t e r a c t i o n s , and a c t i v i t i e s , f a m i l y members engage i n d u r i n g periods  of d r i n k i n g and non-drinking,  an examination of the  a c t u a l p r o c e s s by which f a m i l y members conserve and c o n s t i t u t e the  f a m i l y paradigm i s f a c i l i t a t e d .  These f i n d i n g s  suggest  t h a t w h i l e some f a m i l y members seem t o have more i n f l u e n c e i n terms o f how the f a m i l y t h i n k s about i t s e l f  (the shared f a m i l y  view o r f a m i l y paradigm) a great d e a l of agreement or mutual i n f l u e n c e seems p a r t of the process.  As a r e s u l t t h e f i n d i n g s  would seem t o support a systemic view of a l c o h o l i s m ,  i n that  w h i l e t h e r e are c l e a r l y key p l a y e r s i n terms of t h e f a m i l y ' s perception all  family  of the problems and s t r e n g t h s members c o n t r i b u t e  w i t h i n the f a m i l y ,  t o the s t o r y  of the  family  - 85 paradigm.  The  findings  -  also  suggest  these  families  feel  problems are present d u r i n g p e r i o d s of n o n - d r i n k i n g  as w e l l as  drinking periods  i s consistent with g e n e r a l l y  distressed  c o u p l e s and the work of B i l l i n g s e t a l . (1979) who  found t h a t  d r i n k i n g exerted  as  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 g e n e r a l l y d i s t r e s s e d Much of the  couples.  e x i s t i n g popular i n f o r m a t i o n  on  alcoholism  and the f a m i l y has suggested t h a t a l c o h o l i c s are 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 (Al-anon, 1971;  Anonymous, 1986; that  a l l family  influential  in  Alcoholics  W o i t i t z , 1983), y e t t h i s r e s e a r c h members terms  including  of  how  the  the  suggests  alcoholic  family  sees  can  itself  be and  t h e r e f o r e shape important aspects of f a m i l y r e l a t i o n s h i p s and functioning.  These r e s u l t s however do  Steinglass's  notion  oscillating  between  of  the  family  drinking  not  clearly  support  a  biphasic  entity  as  and  non-drinking  modes.  S t e i n g l a s s ' s work i s based on the n o t i o n t h a t 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 i n t o x i c a t e d v e r s u s sober s t a t e s that  the  intoxication-relevant  reinforcing drinking.  to  perpetuate  However  The  reality  maintain  Steinglass's  samples of f a m i l y dyads and nature.  or  patterns  work  are cycles  was  sufficiently of  based  couples of a d e c i d e d l y  of h i s r e s e a r c h ,  however,  and  abusive on  small  clinical  i s that  no  s c i e n t i f i c a l l y sound, e m p i r i c a l s t u d i e s were ever conducted t o t e s t most of the key  impressions formed from t h i s e a r l y work  (Jacob and Seilhamer, 1987) .  Yet i n t h i s r e s e a r c h many of the  - 86 same  items,  (healthy  and  unhealthy)  were  p e r i o d s of d r i n k i n g and n o n - d r i n k i n g . that  much of what c o n s t i t u t e s  particular  families  consumption.  remain  a  These r e s u l t s  f a m i l y paradigm  constant  In other words, the  always see themselves  associated  indicate  for  r e g a r d l e s s of  families  with  these  alcohol  s t u d i e d d i d not  as t h a t d i f f e r e n t between d r i n k i n g and  non-drinking states.  L i m i t a t i o n s of the  It  has  clinical  Study  been noted  by  Jacob  and  Seilhamer  (1987) t h a t  t h e o r y and p r a c t i c e have been based on d e s c r i p t i o n s  generated clinical  from  self  and  spouse  reports  obtained  c o n t e x t s i n v o l v i n g samples of unknown  validity,  and  "pictures"  of  representativeness. alcoholic-family  To  what  relationships  within  reliability, extent  these  correspond  to  observed p a t t e r n s of interchange i s unknown, a l t h o u g h t h e r e i s l i t t l e reason t o b e l i e v e t h a t r e p o r t s of i n t e r c h a n g e s i n which the  reporter  is  a  participant  can  be  obtained  in  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 b i a s e s , memory d i s t o r t i o n s , and i n a t t e n t i o n t o c r i t i c a l a s p e c t s of the field,  self  report  data,  by  their  very  nature  emphasize  r e l a t i v e l y g l o b a l , i m p r e c i s e l y d e f i n e d c o n s t r u c t s r a t h e r than a s e t of d i s c r e t e behaviours t h a t are emitted and responded over time. used  For these reasons,  to  as f a m i l y r e c o l l e c t i o n s were  t o c o n s t r u c t the f a m i l y paradigm f o r d r i n k i n g and  non-  d r i n k i n g p e r i o d s r a t h e r than d i r e c t o b s e r v a t i o n we were  left  with the subjective  impressions o f t h e f a m i l y  which t o base t h e data. recovery" family  members from  In a d d i t i o n , as t h e f a m i l i e s were " i n  i t was not p o s s i b l e t o have t h e f a m i l y d e s c r i b e t h e  paradigm  (Q-sort  or v e r b a l  description)  while  i n an  i n t o x i c a t e d s t a t e o r observe i t d i r e c t l y as was p o s s i b l e t o do w i t h t h e sober s t a t e . " i n recovery" not  I t i s also quite possible that families  a r e somehow d i f f e r e n t than a l c o h o l i c f a m i l i e s  i n recovery. C o r r e l a t i o n s are l i m i t e d i n t h e i r a b i l i t y  causality for  (Glass and Stanley,  to establish  1970), i n t h a t we do not know  example t h a t t h e f a m i l y A husband's view o f t h e f a m i l y  caused t h e f a m i l y paradigm t o s h i f t  i n the d i r e c t i o n of h i s  view o f t h e f a m i l y paradigm, only t h a t t h i s explanation.  I t i s also  paradigm somehow shapes  quite  possible  i s one p o s s i b l e that  the family  (causes) t h e i n d i v i d u a l paradigm o r  t h a t through some r e c i p r o c a l i n t e r a c t i v e p r o c e s s both shape each o t h e r . mechanism achieved  In a d d i t i o n t h i s  by which other  "conversational  than  study d i d not i l l u m i n a t e t h e  t h e shaping by p o i n t i n g  remembering"  of t h e f a m i l y  paradigm i s  t o the general  or s t o r i e s .  domain of  The q u a l i t a t i v e  p o r t i o n o f t h e data r e v e a l e d t h a t i t i s w i t h much d e t a i l and s u b t l e t y w i t h r e s p e c t t o t h e f a m i l y paradigm t h a t meanings and understandings are negotiated, f a m i l y B's d i s c u s s i o n r e g a r d i n g who makes d e c i s i o n s f o r example. and  non-drinking  or  alternator  In a d d i t i o n , w h i l e d r i n k i n g  p e r i o d s can be c l e a r l y d e l i n e a t e d pattern  drinkers,  the family  f o r binge  dynamics  of  -  -  88  a l c o h o l i s m might be b e t t e r understood i f the area of focus  was  s h i f t e d t o the changes t h a t occur i n f a m i l i e s j u s t p r i o r  to  the  onset of r e c u r r i n g p e r i o d s  of d r i n k i n g or those changes  t h a t occur j u s t p r i o r t o the c e s s a t i o n of d r i n k i n g .  Implications  f o r the Family Treatment of  Alcoholism.  As w i t h f a m i l y case A, i n d i v i d u a l f a m i l y members had been a b l e t o s h i f t the r e s p o n s i b i l i t y f o r who t o which a s p e c t s of family  reported  that  talking  about  husband  presumably  information  the  the  that  family  the  paradigm.  wife  had  the  impossible  the  wife  story"  periods.  present  seems  to  The  the  task  positive  of  particular situation.  alcoholism for  story"  created I t may  t h e r a p i s t s working i n the  the  and  new  and  the  presenting  story  of  family  s t o r y of the  the  husband  opportunities  the for  "old their  be u s e f u l f o r c o u n s e l l o r s  field  t o be aware of who  contributing  of  f a m i l y ' s a b i l i t y t o s h i f t and have  "new  have  the  causing,  f u n c t i o n i n g d u r i n g a binge or a t l e a s t a n e g a t i v e non-drinking  past  was  had  a  In  responsibility  alcohol  supported  (contributes)  the  troubles the  speaks  of the  family  treatment  and of  i n the f a m i l y i s " r e s p o n s i b l e "  various  aspects  of  the  family's  e x p e r i e n c e t o the f a m i l y paradigm.  Research Questions:  Conclusions  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 image  or  paradigm)  differ,  for  drinking  (the f a m i l y and  self-  non-drinking  - 89 periods? I t seems c l e a r t h a t f o r some f a m i l i e s and f o r i n d i v i d u a l family  members  these  descriptions  differ,  however  seems c l e a r t h a t a great d e a l remains constant,  i t also  through t h e  c y c l e s o f d r i n k i n g and abstinence.  Do responses t o s p e c i f i c questions p u r p o r t e d t o e v a l u a t e such  salient  Solving,  dimensions  Communication,  Affective  Involvement,  of family Roles,  functioning  Affective  Behaviour  as  Problem  Responsiveness,  Control,  and  General  F u n c t i o n i n g d i f f e r d u r i n g p e r i o d s o f d r i n k i n g and a b s t i n e n c e ? While t h e r e i s some c l u s t e r i n g o f responses t o s p e c i f i c dimensions  of family  functioning  as proposed  f a m i l y members a r e a b l e t o see s t r e n g t h  i n t h e FAD,  and purpose i n some  behaviours t h a t a r e o f t e n seen more g e n e r a l l y as i n d i c a t o r s o f unhealthy problematic generally  functioning. f o r the seemed  that  While t h i s researcher negative  ability and  may a t times be  psychometrician  descriptions  of  i t  family  f u n c t i o n i n g were a s s o c i a t e d with, y e t preceded a c t u a l d r i n k i n g 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 t h e a c t u a l i n t a k e of a l c o h o l can r e s u l t i n missed o p p o r t u n i t i e s t o observe important dynamics t h a t occur d u r i n g t h e t r a n s i t i o n from non-drinking  t o d r i n k i n g and back  again.  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  - 90 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 ? While  individual  descriptions  of  family  functioning  d i f f e r from f a m i l y consensus d e s c r i p t i o n s , i t i s n o t c l e a r l y always  along  the drinking/non-drinking  continuum.  This  suggests t h a t c o n s i d e r a b l e o v e r l a p of behaviour e x i s t s between both  drinking  families. interview  and non-drinking  By  asking  questions  and t o a l e s s e r extent  implication, differences some extent  focused  periods,  i n the  t h e questions  semi-structured  on  the f i n d i n g of  and non-drinking  aimed  i n some  t h e f a m i l y Q - s o r t t a s k , by  our c o n v e r s a t i o n  between d r i n k i n g  at least  periods.  To  a t the " f i n d i n g " of t h i s  d i f f e r e n c e may a c t u a l l y be c r e a t i n g t h e d i f f e r e n c e s awareness o f a d i f f e r e n c e ) i n the c o n v e r s a t i o n s  (or t h e  between f a m i l y  members.  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 o r is  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 t h e f a m i l y as  much o f t h e l i t e r a t u r e p r e d i c t s ? It terms  seemed  as though  of the family  t h e a l c o h o l i c was  paradigm,  between d r i n k i n g and non-drinking families studied.  yet this  influential in  influence  varied  p e r i o d s , and between t h e two  I t a l s o seemed more p o s i t i v e f o r one f a m i l y  when t h e a l c o h o l i c was a c t i v e l y c o n t r i b u t i n g t o t h e f a m i l y paradigm as i t r e l a t e d t o the d r i n k i n g p e r i o d s . t h a t w i t h t h e v o i c e of " a l c o h o l as p r o b l e m a t i c " other  I t seemed  taken c a r e o f ,  f a m i l y members were able t o t a l k p o s i t i v e l y about t h e  - 91 f a m i l y d u r i n g non-drinking as t r a n s c e n d i n g  p e r i o d s , and a s t o r y o f t h e f a m i l y  d i f f i c u l t i e s was able t o be i n t e g r a t e d  into  the f a m i l y paradigm.  Future Research  This  study  knowledge  of  alcohol. these  Implications  endeavoured  families  to  recruit  experiencing  the  troubles  indigenous related  I t was i n t e r e s t e d i n t h e domain o f i d e a s ,  ideas  might  influence family  specific families.  to  and how  i n t e r a c t i o n i n two very  I t d i d not examine t h e a c t u a l i n t e r a c t i o n  from t h e o b j e c t i v e viewpoint of a detached observer, nor d i d it  develop  families  any s t a t i s t i c a l  studied.  Family  power t o g e n e r a l i z e members base  their  beyond t h e  responses t o  behaviour on t h e meaning they a s s i g n t o those b e h a v i o u r s . pointed  t o the p o s s i b i l i t y  that  when  an a l c o h o l i c  It  family  member takes o r i s r e c r u i t e d i n t o t a k i n g a c e r t a i n p o s i t i o n o r stand  ( p o s i t i v e o r negative) with r e s p e c t  family  during  position/stand constraint  drinking itself  of,  or  or non-drinking that  t o d e s c r i b i n g the states,  i s influential  facilitation  of,  i t i s the  i n terms  certain  of the  kinds  of  conversations. As  such  reporting  this  study  of a s m a l l ,  represents  another  c o l l e c t i o n and  p o t e n t i a l l y unrepresentative  sample.  Jacob and Seilhamer (1987) suggest l a r g e samples t h a t  include  psychiatric  control  groups  and/or medical  a r e necessary  as w e l l  i n order  as u n d i s t u r b e d  to cross-validate  emergent  - 92 f i n d i n g s and t o j u s t i f y the a p p l i c a t i o n o f more powerful and clarifying  The a d d i t i o n  o f more  f a m i l i e s from these groups p a r t i c u l a r l y w i t h r e s p e c t  t o other  biphasic  multivariant  symptoms  (drug  etc.)  could  disorders, distinctions  that  Continued  addiction,  depression,  facilitate  separate  f a m i l i e s experiencing  involved  techniques.  the  alcoholic  bipolar  discovery  families  from  of other  problems.  attention  should  i n alcoholic families.  be devoted While  to the c h i l d r e n  t h i s study  d i d not  c l e a r l y see t h e c h i l d r e n as i n f l u e n t i a l on t h e i r own i n terms of t h e f a m i l y paradigm, (they saw the f a m i l y s i m i l a r l y t o t h e mother  f o r non-drinking  periods  and l i k e  t h e i r own way f o r d r i n k i n g periods) .  the father  or i n  The r o l e o f t h e c h i l d r e n  i n t h e f a m i l y may c l a r i f y the f a m i l y ' s r o l e i n m a i n t a i n i n g t h e dysfunctional  behaviour.  Furthermore, t h e c h i l d ' s f u t u r e i s  t h e o r e t i c a l l y and e m p i r i c a l l y l i n k e d t o contemporary  patterns  of f a m i l y l i f e - a r e l a t i o n s h i p o f p a r t i c u l a r importance g i v e n the  "high-risk"  nature  of a l c o h o l i c s ' o f f s p r i n g  (Jacob and  Seilhamer, 1987). Research aimed a t r e v e a l i n g d e t a i l e d i n t e r a c t i o n p r o c e s s i n a l c o h o l i c f a m i l i e s as w e l l as l a r g e r views i n c l u d i n g t h e examination o f t h e d i f f e r e n t stages o f d r i n k i n g and a s s o c i a t e d family interaction i s also indicated. to  t h i s researcher  would  Of p a r t i c u l a r i n t e r e s t  be a d e t a i l e d  examination  k i n d s o f c o n v e r s a t i o n s t h a t occur as f a m i l y members descriptions  of the  negotiate  o f the s t a t u s quo f o r d r i n k i n g and n o n - d r i n k i n g  - 93 states. More  research  i n the area  of gender  difference  respect t o family i n t e r a c t i o n i s also indicated.  with  Research i n  t h i s area a c c o r d i n g t o Jacob and Seilhamer (1987) suggests t h e alcoholic's  impact  on f a m i l y  functioning  i s likely  markedly d i f f e r e n t f o r male and female a l c o h o l i c s . be  interesting  to  see t h e extent  to  which  t o be  I t would  women a r e  i n f l u e n t i a l i n terms o f t h e f a m i l y paradigm f o r d r i n k i n g and non-drinking  states.  In a d d i t i o n , there  seem t o be many d i f f e r e n t s t y l e s o f  problem d r i n k i n g ; i n home d r i n k e r s , and out o f home d r i n k e r s , binge  drinkers,  drinkers, drinking  particular  also  study  situations. information  points  toward  lone  d i f f e r e n t s t y l e s of  and may shed specific  light  on  to particular  further  examination  of the  f a m i l i e s have r e g a r d i n g t h e i r p a r t i c u l a r  regarding  t h e kinds o f i n t e r a c t i o n a l f o r c e s t h a t  an i n d i v i d u a l toward a t the family  Further  talking  indicated  drinkers,  I t a l s o supports the systemic n o t i o n t h a t f u r t h e r  during periods  respect  seem  into  i n t e r a c t i o n a l exchanges  a c t u a l conversations  looking  Research  recovered  o f problem d r i n k i n g .  This  propel  drinkers,  and so on. would  patterns  steady  during  drinking  may not be found by  drinking  periods,  but r a t h e r  of s o b r i e t y .  examination  to alcoholic  of how c e r t a i n c o n v e r s a t i o n s  interaction  constrain  i n c e r t a i n ways or t o t a k i n g  persons  with into  a particular position  would seem i n d i c a t e d .  - 95 References  Ablon, J . (1976) Family s t r u c t u r e and behaviour i n a l c o h o l i s m : A review o f t h e l i t e r a t u r e . In B. K i s s i n and H. B e g l e i t e r (Eds.), The biology of alcoholism: Vol. 4. Social aspects of alcoholism. New York Plenum P r e s s . Al-Anon Family Treatment T o o l i n A l c o h o l i s m . (1969) (Pamphlet) Al-Anon Family Group Headquarters Inc. New York, 1971. A l c o h o l i c s Anonymous. The Big Book, 3rd Edition, Alcoholics Anonymous. A l c o h o l i c s Anonymous World S e r v i c e s . New York. American Psychiatric Association (1987). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington D.C.: Author. Baas, L.R. and Brown, S.R. (1973) . G e n e r a t i n g i n t e n s i v e a n a l y s i s : t h e study of t r a n s f o r m a t i o n s . 36, 172-183.  rules f o r Psychiatry,  B i l l i n g s , A.G., K e s s l e r , M., Gomberg, C.A., and Weiner, S. (1979). Marital Conflict R e s o l u t i o n o f A l c o h o l i c and N o n a l c o h o l i c Couples d u r i n g D r i n k i n g and Nondrinking S e s s i o n s . Journal of Studies on Alcohol, Vol 40, No. 3. Block, J . (1961). The Q-Sort Method in Personality and Psychiatric Research. C h a r l e s C. Thomas, Illinois.  Assessment Springfield  B o l d t , W. (1991). Q-Analysis [Computer Program]. Vancouver, B.C.: U n i v e r s i t y of B r i t i s h Columbia. (ID No. CCID EP01 WBOL) Chassan, J.B. (1979). Research design on clinical and psychiatry. New York: I r v i n g t o n P u b l i s h e r s . Donovan, Addictive  psychology  D.M., and M a r l a t t , A.G. (1988). Assessment Behaviours. G u i l f o r d Press, New York, N.Y.  of  E l l i s , D.C. (1986). When S t r a t e g i e s F a i l : The C h e m i c a l l y Dependent Family System. Journal of Strategic and Systemic Therapies. Vol 5 #3. 50-58. E p s t e i n , 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 I n t e r a c t i o n and Decision-Making. A r c h i v e s of General Psychiatry, Vol 13, 214-223.  - 96 F e r r e i r a , A . J . (1966). Reports, 20, 85-90.  Family  Myths  Psychiatric  G l a s s , G.V. and S t a n l e y , J . (1970) . Statistical education and psychology. Englewoods C l i f f s , P r e n t i c e - H a l l Inc. Herbst, P.G. (1970). Behaviourial cases London: T a v i s t o k .  Research methods in New J e r s e y :  Worlds: the study  of  single  Jacob, T. , R i t c h e y , D. , C v i t k o v i c , J.F., and Blane, H.T. (1981). Communication s t y l e s of a l c o h o l i c and n o n a l c o h o l i c f a m i l i e s when d r i n k i n g and not d r i n k i n g . Journal of Studies on Alcohol 42: 466-482. Jacob, T. , and Seilhamer, R.A. (1987) A l c o h o l i s m and f a m i l y interaction. In T. Jacob (Ed.), Family Interaction and Pathology: Theories, Methods, and Findings (pp. 535-580). New York: Plenum P r e s s . Kazdin, A.E. (1980). Research design in clinical psychology, (the case study in clinical psychology). New York: Harper and Row P u b l i s h e r s . K e r l i n g e r , F.N. (1973). Foundations of behaviourial New York: H o l t , R i n e h a r t , and Winston, Inc.  research.  Liepman, M., Nirenberg, T., Doolittle, R., Begin, A., Broffman, T., Babich, M. (1989). Family f u n c t i o n i n g of male a l c o h o l i c s and t h e i r female p a r t n e r s d u r i n g p e r i o d s o f d r i n k i n g and a b s t i n e n c e . Family Process, Vol 28 No. 2, 239-249. Maclean, Danbury, and T a l b o t , D. (1964). Civil Defense Belief Patterns: (VII) Technical Summary. East L a n s i n g : Department of Communication, Michigan S t a t e U n i v e r s i t y , OCD r e p o r t , March. M a r l e t t , A., and M i l l e r , W. (1984) Comprehensive Drinker Profile. F l o r i d a , P s y c h o l o g i c a l Assessment Resources, Inc. McGoldrick, M. , and Gerson, R. , (1985) Genograms in Assessment. New York: W.W. Norton and Company, Inc.  Family  M i l l e r , I.W., E p s t e i n , N.B., Bishop, D.S. and K e i t n e r , 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. R e i s s , D. (1981). The Family's Construction Cambridge, M.A. Harvard U n i v e r s i t y P r e s s .  of  Reality.  - 97 S e l t z e r , M. (1971). The Michigan A l c o h o l i s m S c r e e n i n g T e s t (MAST): The quest f o r a new d i a g n o s t i c instrument. American Journal of Psychiatry 127: 1653-1658. S t e i n g l a s s , P., Bennet, L.A. Steven, S.J., and R e i s s , D. (1987). The Alcoholic Family. B a s i c Books Inc. New York:. S t e i n g l a s s , P., Davis,, D.I., and Berensen, D. (1977). O b s e r v a t i o n s of c o n j o i n t l y h o s p i t a l i z e d " a l c o h o l i c c o u p l e s " d u r i n g s o b r i e t y and i n t o x i c a t i o n , i m p l i c a t i o n s f o r t h e o r y and t h e r a p y . Family Process 16: 1-16. S t e i n g l a s s , P., Weiner, S., and Mendelson, J.H. (1971). A systems approach t o a l c o h o l i s m ; 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 . A r c h i v e s of General Psychiatry. 24: 401-408. Selekman, M. Taming (1989). Chemical Monsters: C y b e r n e t i c - S y s t e m i c Therapy with A d o l e s c e n t Substance Abusers. Journal of Strategic and Systemic Therapies Vol 8, # 2 . T a l b o t , A.D., (1964). Q-Methodology. Paper p r e s e n t e d a t the meeting of the American E d u c a t i o n a l Research A s s o c i a t i o n . S e a t t l e , WA. Wampler, K.S., Halverson, C.F., Moore, J . J . , W a l t e r s , L.H. (1989). The Georgia Family Q-Sort: An O b s e r v a t i o n a l Measure of Family F u n c t i o n i n g . 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 E x p l a n a t i o n , R e s t r a i n t , and Double D e s c r i p t i o n : A Template f o r Family Therapy, Family Process Vol. 25, No. 2, 171. W o i t i t z , J.G. (1983). Adult Children Communication Inc. Pompano Beach:. Yin, R. (1986). Case Study Research: B e v e r l y H i l l s , CA: Sage P u b l i c a t i o n s .  of Alcoholics. Design  and  Health Methods.  -  The  Thank you  99  -  Guidelines for therapists introducing A l c o h o l i c Family I n t e r a c t i o n Research P r o j e c t  f o r c o n s i d e r i n g the p r o j e c t .  P l e a s e keep i n mind t h a t you do not have t o be c e r t a i n r e g a r d i n g the s u i t a b i l i t y of a f a m i l y f o r my p a r t i c u l a r r e s e a r c h i n t e r e s t s . The f i r s t p a r t of the p r o j e c t w i l l i n e f f e c t determine the f a m i l i e s s u i t a b i l i t y t o the p r o j e c t . You  might i n t r o d u c e  the p r o j e c t i n the f o l l o w i n g  way;  "One of my c o l l e a g u e s here i n the c l i n i c i s doing some r e s e a r c h . He i s i n t e r e s t e d i n understanding more about the e f f e c t s of problem d r i n k i n g on f a m i l y r e l a t i o n s h i p s . " "I have here some i n f o r m a t i o n (Give c l i e n t  the  about the p r o j e c t . "  letter)  " I f you t h i n k you might be i n t e r e s t e d perhaps I c o u l d g i v e your name and number, or i n t r o d u c e you t o him?"  Dan  The c l i e n t may want t o (and probably should) t a l k i t over w i t h h i s / h e r f a m i l y . In which case you might respond w i t h something like; "Of  course, perhaps you  c o u l d l e t me  know."  And f o l l o w i t up i n your next s e s s i o n . Keep i n mind t h a t I need t h r e e f a m i l i e s t o v o l u n t e e r . You may be somewhat reassured t h a t the f a m i l i e s t h a t I've " t e s t e d " the p r o c e s s on have r e p o r t e d t h a t they enjoyed the p r o c e s s and found t h a t i t was i n t e r e s t i n g f o r them. Thanks Dan  again.  -  101 -  APPENDIX B Consent Forms SUBJECT'S  CONSENT FORM  I agree t o p a r t i c i p a t e i n a r e s e a r c h p r o j e c t , 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 d i f f e r e n c e s d u r i n g p e r i o d s o f d r i n k i n g and a b s t i n e n c e i n f a m i l i e s where a l c o h o l i s a problem. I understand t h a t p a r t i c i p a t i o n i s v o l u n t a r y and t h a t I may withdraw a t any time or r e f u s e t o answer any q u e s t i o n s . I understand t h a t I w i l l be i n t e r v i e w e d as w e l l as be r e q u i r e d to complete a q u e s t i o n n a i r e , and a t a s k d e s c r i b i n g our f a m i l y . T h i s p r o c e s s w i l l take about t h r e e hours. I do t h i s w i t h t h e understanding t h a t t h e i n f o r m a t i o n w i l l be kept c o n f i d e n t i a l , used f o r r e s e a r c h purposes only, and d e s t r o y e d a t t h e end o f i t s usefulness.  - 102 APPENDIX C The Michigan A l c o h o l i s m Screening  Test  The MAST C i r c l e each q u e s t i o n e i t h e r Yes o r No 1. Do you f e e l you are a normal d r i n k e r ?  YES  NO  2. Have you ever awakened the morning a f t e r some d r i n k i n g the n i g h t before and found t h a t you c o u l d not remember a p a r t of t h e evening before?  YES  NO  3. Does any member o f your f a m i l y (wife, husband, parents, e t c . ) ever worry o r complain about your d r i n k i n g ?  YES  NO  YES  NO  YES  NO  4. Can you stop d r i n k i n g without  a struggle  a f t e r one o r two d r i n k s ? 5. Do you ever f e e l bad about your d r i n k i n g ? 6. Do f r i e n d s or r e l a t i v e s t h i n k you a r e a normal d r i n k e r ? 7. Are you always able t o stop d r i n k i n g when you want t o ?  YES  NO  YES  NO  8. Have you ever attended a meeting o f A l c o h o l i c s Anonymous (AA)?  YES  NO  9. Have you ever gotten drinking? .  YES  NO  10. Has d r i n k i n g ever c r e a t e d problems with you and your spouse (husband/wife)?  YES  NO  11. Has your spouse (or other f a m i l y member) ever gone t o anyone f o r help about your drinking?  YES  NO  12. Have you ever l o s t f r i e n d s or l o v e r s because of your d r i n k i n g ?  YES  NO  13. Have you ever gotten i n t o t r o u b l e a t work because o f d r i n k i n g ?  YES  NO  14. Have you ever l o s t a j o b because o f drinking?  YES  NO  i n t o f i g h t s when  - 103  -  15. Have you ever n e g l e c t e d your o b l i g a t i o n s , your f a m i l y , or your work f o r two or more days i n a row because you were d r i n k i n g ?  YES  NO  16. Do you ever d r i n k b e f o r e noon?  YES  NO  17. Have you ever been t o l d t h a t you have l i v e r trouble?  YES  NO  18. Have you ever had s e r i o u s shaking a f t e r heavy d r i n k i n g ?  YES  NO  19. Have you ever heard v o i c e s or seen t h i n g s t h a t weren't t h e r e a f t e r heavy d r i n k i n g ?  YES  NO  20. Have you ever gone t o anyone f o r h e l p about your d r i n k i n g ?  YES  NO  21. Have you ever been i n a h o s p i t a l of d r i n k i n g ?  YES  NO  22. Have you ever been a p a t i e n t i n a p s y c h i a t r i c h o s p i t a l or on a p s y c h i a t r i c ward of a g e n e r a l h o s p i t a l where d r i n k i n g was p a r t of the problem?  YES  NO  23. Have you ever been seen a t a p s y c h i a t r i c or mental h e a l t h c l i n i c , or gone t o a d o c t o r , s o c i a l worker, or clergyman f o r h e l p w i t h an emotional problem i n which d r i n k i n g had p l a y e d a p a r t ?  YES  NO  24. Have you ever been a r r e s t e d , even f o r a few hours because of drunken behaviour (other than d r i v i n g ) ?  YES  NO  25. Have you ever been a r r e s t e d f o r drunk d r i v i n g or d r i v i n g a f t e r d r i n k i n g ?  YES  NO  because  -  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 house. -  Healthy Problem Solving  3. When someone is upset the others know why.  Healthy Communication  4. When you ask someone to do something, you have to check that they did i t .  Unhealthy Roles  5.If someone is in trouble the others become too involved.  Unhealthy Affective Involvement  6.In times of c r i s i s 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 responsibilities.  Healthy Roles  11. We cannot talk to each other about the sadness we feel.  Unhealthy General Functioning  12. We usually act on our decisions regarding problems.  Healthy Problem Solving  13. You only get the interest of others when something is important to them.  Unhealthy Affective Involvement  14. You can't t e l l what a person is feeling from what they are saying.  Unhealthy 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 d i f f i c u l t to talk to each other about tender feelings.  Unhealthy Communication  23.We have trouble meeting our b i l l s .  Unhealthy Roles  24.After our family tries to solve a problem, we usually discuss whether it worked or not.  Healthy Problem Solving  25. We are too self centred.  Unhealthy Affective Involvement  26. We can express feelings to each other. 27. We have no clear expectations about toilet habits.  Healthy General Functioning Unhealthy Behaviour Control  28. We do not show our love for each other.  Unhealthy Affective Responsiveness  29.We talk to people directly rather than through go-betweens.  Healthy Communication  30.Each of us has particular duties and respons i biIi t i es.  Healthy Roles  31.There are lots of bad feelings in the family.  Unhealthy General Functioning  32. We have rules about hitting people.  Healthy Behaviour Controt  33. We get involved with each other only when something interests us. •34.There's l i t t l e time to explore personal interests.  Unhealthy Affective Involvement Unhealthy Roles  35. We don't often say what we mean.  Unhealthy Communication  36. We feel accepted for what we are.  Healthy General Functioning  37.We show interest in each other when we can get something out of it personally.  Unhealthy 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 when they can get something out of i t .  Unhealthy Affective Involvement  43. We are frank with each other.  Healthy Communication  44. We don't hold to any rules or standards.  Unhealthy Behaviour Control  - 106 45.If people are asked to do something, they need reminding.  Unhealthy Roles  46.We are able to make decisions about how to solve Healthy General Functioning problems. 47.If the rules are broken, we don't know what to expect.  Unhealthy Behaviour Control  48. Anything goes in our family.  Unhealthy Behaviour Control  49. We express tenderness.  Healthy Affective Responsiveness  50. We confront problems involving feelings.  Healthy Problem Solving  51. We don't get along well together. 52. We don't talk to each other when we are angry.  Unhealthy General Functioning Unhealthy Communication  53. We are generally dissatisfied with the family duties assigned to us.  Unhealthy Roles  54. Even though we mean well, we intrude too much into each others lives.  Unhealthy Affective Involvement  55. There are rules about dangerous situations.  Healthy Behaviour Control  56. We confide in each other.  Healthy General Functioning  57. We cry openly.  Healthy Affective Responsiveness  58. We don't have reasonable transport.  Unhealthy Roles  59. When we don't like what someone has done, we t e l l them.  Healthy Communication  60. We try to think of different ways to solve problems.  Healthy Problem Solving  - 107 APPENDIX E McMaster Family Assessment Device 1. P l a n n i n g misunderstand  family a c t i v i t i e s each other.  2. We r e s o l v e most everyday  is  difficult  because  we  problems around our house.  3. When someone i s upset the others know why. 4. When you ask someone t o do something, you have t o check t h a t they d i d i t . 5. I f someone i s i n t r o u b l e the o t h e r s become t o o i n v o l v e d . 6. In times of c r i s i s we can t u r n t o each o t h e r f o r support. 7. We know what t o do when an emergency comes up. 8. We sometimes run out of t h i n g s t h a t we need. 9. We a r e r e l u c t a n t t o show our a f f e c t i o n f o r each o t h e r . 10. We make sure members meet t h e i r f a m i l y r e s p o n s i b i l i t i e s . 11. We cannot t a l k t o each other about t h e sadness we  feel.  12. We u s u a l l y a c t on our d e c i s i o n s r e g a r d i n g problems. 13. You o n l y g e t the i n t e r e s t important t o them.  of o t h e r s when something i s  14. You c a n ' t t e l l what a person i s f e e l i n g from what they a r e saying. 15. Family t a s k s don't get spread around enough. 16. I n d i v i d u a l s a r e accepted f o r what they a r e . 17. You can e a s i l y get away with b r e a k i n g t h e r u l e s . 18. People come r i g h t out and say t h i n g s i n s t e a d o f h i n t i n g a t them. 19. Some of us j u s t don't respond e m o t i o n a l l y . 20. We know what t o do i n an emergency. 21. We a v o i d d i s c u s s i n g our f e a r s and concerns.  - 108 22. I t i s d i f f i c u l t feelings.  to talk  t o each  other  about  tender  23. We have t r o u b l e meeting our b i l l s . 24. A f t e r our f a m i l y t r i e s t o s o l v e d i s c u s s whether i t worked or not. 25. We a r e t o o s e l f  a problem,  we u s u a l l y  centred.  26. We can express f e e l i n g s t o each o t h e r . 27. We have no c l e a r e x p e c t a t i o n s about t o i l e t  habits.  28. We do not show our love f o r each o t h e r . 29. We talk go-betweens.  to  people  directly  rather  than  through  30. Each o f us has p a r t i c u l a r d u t i e s and r e s p o n s i b i l i t i e s . 31. There a r e l o t s of bad f e e l i n g s i n the f a m i l y . 32. We have r u l e s about h i t t i n g people. 33. We g e t i n v o l v e d i n t e r e s t s us.  with  each  other  only  34. There's l i t t l e time t o e x p l o r e p e r s o n a l  when  something  interests.  35. We don't o f t e n say what we mean. 36. We f e e l accepted f o r what we a r e . 37. We show i n t e r e s t i n each other when we can g e t something out o f i t p e r s o n a l l y . 38. We r e s o l v e most emotional upsets t h a t come up. 39. Tenderness family.  takes second  place  t o other things  i n our  40. We d i s c u s s who i s t o do household j o b s . 41. Making a d e c i s i o n i s a problem f o r our f a m i l y . 42. Our f a m i l y shows i n t e r e s t i n each o t h e r o n l y when they can get something out o f i t . 43. We a r e frank w i t h each other. 44. We don't h o l d t o any r u l e s or standards.  - 109 45. I f people are asked t o do something, they need reminding. 46. We a r e a b l e t o make d e c i s i o n s about how t o s o l v e problems. 47. I f the r u l e s are broken, we don't know what t o expect. 48. A n y t h i n g goes i n our f a m i l y . 49. We  express tenderness.  50. We c o n f r o n t problems i n v o l v i n g  feelings.  51. We don't get along w e l l t o g e t h e r . 52. We don't t a l k t o each other when we are angry. 53. We are g e n e r a l l y a s s i g n e d t o us.  dissatisfied  54. Even though we mean w e l l , we others l i v e s .  with  the  family  duties  i n t r u d e too much i n t o each  55. There are r u l e s about dangerous  situations.  56. We c o n f i d e i n each other. 57. We c r y openly. 58. We don't have reasonable t r a n s p o r t . 59. When we don't l i k e what someone has done, we t e l l  them.  60. We t r y t o t h i n k of d i f f e r e n t ways t o s o l v e problems.  -  110  -  APPENDIX F Assignment of FAD Items t o Sub-Scales  Problem CommuniSolving cation  Healthy Functioning Items  Unhealthy Functioning Items  2 12 24 38 50 60  Roles  Affective Affective Behaviour General ResponInvolve- Control Functionsi veness ment ing  3 18 29 43 59  10 30 40  49 57  14 22 35 52  4 8 15 23 34 45 53 58  9 19 28 39  5 13 25 33 37 42 54  20 32 55  6 16 26 36 46 56  7 17 27 44 47 48  1 11 21 31 41 51  -  I l l -  APPENDIX 6 Schedule and g u i d e f o r t h e Semi-Structured Family Interview C o n s t r u c t i o n o f f a m i l y genogram a n d r e l a t e d q u e s t i o n s ( e g . a g e of a l l children, marriage/divorce dates and reasons, r e l a t i o n s h i p s w i t h extended f a m i l y ) . -Did t h e Q-Sort t a s k a l l o w picture of what y o u r f a m i l y i s l i k e ? Family  Interaction  you t o g i v e  a  fairly  accurate  Questions  -Ranking type questions would be asked e . g . ; Which relationship i s the most a f f e c t e d by d r i n k i n g ( m o t h e r - f a t h e r , mother-daughter etc.)? W h i c h i s t h e n e x t most a f f e c t e d ? Which r e l a t i o n s h i p i s t h e most a f f e c t e d by s o b r i e t y ? and s o o n . - C o n f i r m a t i o n t y p e q u e s t i o n s w o u l d be a s k e d mother agree (with p r e v i o u s answer)?  e.g.;  Would  your  - T r i a d i c q u e s t i o n s w o u l d be a s k e d ( q u e s t i o n s t h a t a s k one person t o comment on t h e r e l a t i o n s h i p b e t w e e n two o t h e r s ) e . g . ; Would y o u s a y t h a t y o u r p a r e n t s a r e a s c l o s e when y o u r mother i s d r i n k i n g ? Family Functioning Questions -How a r e i m p o r t a n t d e c i s i o n s made i n y o u r same when y o u r f a t h e r i s d r i n k i n g ?  family? Is t h i s the  - I f t h e f a m i l y were t o t r y t o d e c i d e what show t o s e e o r what k i n d o f t a k e - o u t f o o d t o g e t how w o u l d t h e d i s c u s s i o n g o ? I f Mom/Dad h a d b e e n d r i n k i n g how w o u l d t h e d i s c u s s i o n g o ? -Who i s c l o s e , a n d how do p e o p l e 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 h a s been d r i n k i n g who i s c l o s e ? - A r e Mom a n d Dad r o m a n t i c enough? How w o u l d Mom/Dad s a y t h a t t h e m a r r i a g e p a r t o f t h e i r m a r r i a g e i s g o i n g ? When Mom/Dad i s drinking who i s more r o m a n t i c ? -Do r u l e s / r e s p o n s i b i l i t i e s How? Family -Tell  Identity  change when t h e r e i s no d r i n k i n g ?  Questions  me a b o u t t h i s f a m i l y ' s s t r e n g t h s ? What do y o u l i k e  best  -  about  being  i n this  112 -  family?  -What's t h e most important t h i n g t h a t your p a r e n t s have t r i e d to teach you? -What's t h e most important t h i n g you have t r i e d t o t e a c h your children? -Would you d e s c r i b e y o u r s e l v e s  as a c l o s e  family?  -Do your f e e l i n g s about your f a m i l y change when d r i n k i n g i s g o i n g on? How? -Who i s c l o s e s t t o t h e i r f a m i l y of o r i g i n ? I s t h i s f a m i l y c l o s e s t t o Mom's s i d e o f t h e f a m i l y or Dad's? Does t h i s change when Mom/Dad i s d r i n k i n g ?  - 113 -  APPENDIX H Present Present Drinking  Drinking  Drinking  Pattern  Pattern  (check  one)  Determine which of the following clients current drinking pattern: (P)  (C)  categories best describes  the  ! |  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 Is a b s t i n e n t between d r i n k i n g e p i s o d e s  !  Complete  ] ! ] ] ] ] ]  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 a m o u n t every 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 heavier drinking. (A h e a v y e p i s o d e is d e f i n e d as one o r more d a y s i n w h i c h the pattern fluctuates from the steady p a t t e r n by 5 o r more S E C s . )  ]  Complete  (S) '  Pattern  Episodic Pattern  Steady  Pattern  Chart  Chart  ] ] ]  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 weekly p a t t e r n , but a l s o has h e a v i e r e p i s o d e s as d e f i n e d above.  j  Complete  both  Steady  & Episodic  Charts  -  114  -  APPENDIX I Episodic  Pattern Chart  jType and Amount o f Beverage Consumed:  *Number o f i episodes i n | p a s t 3 months: | * T o t a l SECs per e p i s o d e ]*Hours:  *Peak BAC:  x  != episodes per 3 mo.  SECs/ 3 mo.  ' |  mg%  !Type and Amount o f Beverage Consumed:  *Number o f | episodes i n | p a s t 3 months: | x  * T o t a l SECs per episode |*Hours:  *Peak BAC:  ]= episodes per 3 mo.  mg%  j j  SECs/ 3 mo.  |Type and Amount o f Beverage Consumed:  •Number o f j episodes i n j p a s t 3 months: | * T o t a l SECs per episode J *Hours:  *Peak BAC:  x  mg%  j= episodes per 3 mo.  j ]  Formula f o r c a l c u l a t i n g SECs: # oz. X % a l c o h o l X 2 = SECs S t a n d a r d E t h a n o l Content u n i t = .5 o z . (15 ml.) o f pure e t h y l 10 o z . beer (5% a l c o h o l ) 4 o z . wine (12% a l c o h o l ) 2.5 o z . o f f o r t i f i e d wine (20% a l c o h o l ) 1.25 o z . o f 80 p r o o f s p i r i t s (40% a l c o h o l ) 1.00 o z . o f 100 p r o o f s p i r i t s (50% a l c o h o l )  SECs/ 3 mo.  alcohol.  

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