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Relationships between personality and demograhic variables and treatment outcome in an alcoholism treatment… LaRoy, Robert Wesley 1979

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RELATIONSHIPS BETWEEN PERSONALITY AND DEMOGRAPHIC VARIABLES AND TREATMENT OUTCOME IN AN ALCOHOLISM TREATMENT CENTER by ROBERT WESLEY LAROY .A., U n i v e r s i t y o f B r i t i s h Columbia, 1974 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS i n THE FACULTY OF GRADUATE STUDIES Department of C o u n s e l l i n g Psychology We accept 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 A p r i l 19, 1979 © Robert Wesley LaRoy, 1979 / In presenting th i s thesis in par t i a l fu l f i lment of the requirements for an advanced degree at the Univers ity of B r i t i s h Columbia, I agree that the Library shal l make i t f ree ly avai lable for reference and study. I further agree that permission for extensive copying of th i s thesis for scholar ly purposes may be granted by the Head of my Department or by his representatives. It i s understood that copying or publ icat ion of th i s thesis for f inanc ia l gain shal l not be allowed without my written permission. Department nf C o u n s e l l i n g Psychology The Univers ity of B r i t i s h Columbia 2075 Wesbrook Place Vancouver, Canada V6T 1W5 Date D E - 6 B P 7 5 - 5 1 I E ABSTRACT The purpose o f t h i s study was to determine the r e l a t i o n s h i p s of c l i e n t pretreatment c h a r a c t e r i s t i c s to treatment outcome (measured i n terms o f a l c o h o l d r i n k i n g behaviour 1 year a f t e r treatment) o f 141 male a l c o h o l i c s admitted to an a l c o h o l i s m treatment c e n t e r i n B r i t i s h Columbia d u r i n g the past 3 y e a r s . Data gathered p r i o r to treatment i n c l u d e d : (a) Demographic data: (i) Age, ( i i ) L e v e l of Education, ( i i i ) M a r i t a l S t a t u s ; (b) P s y c h o l o g i c a l t e s t data: (i) Minnesota M u l t i p h a s i c Per-s o n a l i t y Inventory, ( i i ) Edwards Pe r s o n a l P r e f e r e n c e Schedule, ( i i i ) S i x t e e n P e r s o n a l i t y F a c t o r s Q u e s t i o n n a i r e , (iv) A l c o h o l A d d i c t i o n Test, (v) S h i p l e y - I n s t i t u t e o f L i v i n g S c a l e ; and (c) Duration o f Treatment data. The outcome c l a s s i f i c a t i o n s (successes and f a i l u r e s ) were based on i n f o r m a t i o n from l e t t e r s , cards, and phone c a l l s made by former c l i e n t s to t h e i r c o u n s e l l o r s d u r i n g the c r i t e r i o n t i m e - p e r i o d , as w e l l as through r e t u r n v i s i t s made by c l i e n t s to co n f i r m s o b r i e t y , II II and f i n a l l y through employer and grapevine r e p o r t s . The t - t e s t f o r s i g n i f i c a n c e o f d i f f e r e n c e s between means was conducted on the v a r i a b l e s , Age, L e v e l of Education, and Duration o f Treatment, w h i l e the Chi-square t e s t o f i n -dependence was conducted on the v a r i a b l e M a r i t a l S t a t u s . The p s y c h o l o g i c a l t e s t data were put i n t o p r o p o r t i o n a l form with an A r c S i n t r a n s f o r m a t i o n , so t h a t the unique amounts of v a r i a n c e c o n t r i b u t e d by each v a r i a b l e to the t o t a l . c o u l d be p r o p e r l y compared. D i s c r i m i n a n t a n a l y s i s i n two steps was then performed on the p s y c h o l o g i c a l t e s t data, seeking to d i s c o v e r those v a r i a b l e s which c o n t r i b u t e d s i g n i f i c a n t l y to d i s c r i m i n a t i o n between the outcome groups i n a p r e d i c t i v e sense. The v a r i a b l e s chosen by the d i s c r i m i n a n t process were then c o r r e l a t e d among one another i n order to i l l u s t r a t e the nature o f r e l a t i o n s h i p s o f each s c a l e ( v a r i a b l e ) to the o t h e r s . R e s u l t s showed t h a t there were no s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e s f o r any of the demographic v a r i a b l e s , and s i m i l a r l y f o r the 'du r a t i o n of treatment' v a r i a b l e . However, the d i s c r i m i n a n t a n a l y s i s procedures r e v e a l e d f o u r p s y c h o l o g i c a l v a r i a b l e s (scales) t h a t maximally d i s c r i m i n a t e d between outcome groups, and when c o n s i d e r e d together, e x p l a i n e d 19% of the t o t a l v a r i a n c e on the c r i t e r i o n measure, and c o r r e c t l y c l a s s i f i e d 68.1% of the cases. These fo u r v a r i a b l e s were s c a l e s 'PA' (Paran o i a ) , 'MA' (Hypomania), and 'SI' ( S o c i a l I n t r o v e r s i o n ) from the MMPI, and s c a l e 'N' ( F o r t h r i g h t v s . Shrewd) from the 16 PF . C o r r e l a t i o n s among these s c a l e s r e v e a l e d a low, with d e f i n i t e but small r e l a t i o n s h i p between s c a l e s 'MA' and 'PA' (r =0.37, p < .001), 'PA' and 'SA' (r = 0.30, p < .001), and a s l i g h t , almost n e g l i g i b l e r e l a t i o n s h i p between s c a l e s 'MA' and 'N' (r = -0.16, p < .026). C o r r e l a t i o n s between 'MA' and 'SI', 'SI' and 'N', and 'N' and 'PA' were not s i g n i f i c a n t . (Thesis Chairman) i v TABLE OF CONTENTS CHAPTER PAGE A b s t r a c t i i L i s t o f Tables v i i Acknowledgements . • i x I INTRODUCTION TO THE STUDY 1 Nature of the Problem 4 Purpose of the Study 5 D e f i n i t i o n of Terms 6 A l c o h o l i s m 6 L e v e l of Education 8 M a r i t a l Status 8 Duration o f Treatment 8 Outcome C l a s s i f i c a t i o n s 9 Successes 9 F a i l u r e s 9 S i g n i f i c a n c e of the Study 10 L i m i t a t i o n s o f the Study 14 Overview of the Study 15 II REVIEW OF THE LITERATURE 17 Related Research 17 Outcome Measures of Treatment E f f e c t i v e n e s s 17 E f f e c t s of Treatment Type 19 C l i e n t Pretreatment C h a r a c t e r i s t i c s and Treatment Outcome 21 Duration o f Treatment 23 Dropping Out of Treatment 24 Summary 26 V CHAPTER PAGE The Purpose Restated 27 Research Questions 2 8 I I I METHODOLOGY 2 9 Subjects 29 Procedures 30 C l a s s i f i c a t i o n o f Subjects i n t o C r i t e r i o n Groups 30 Intake Procedures and A d m i n i s t r a t i o n of Program 31 Instruments 33 The Minnesota M u l t i p h a s i c P e r s o n a l i t y Inventory 33 The Edwards P e r s o n a l P r e f e r e n c e Schedule 35 The S i x t e e n P e r s o n a l i t y F a c t o r s Q u e s t i o n n a i r e 37 The A l c o h o l A d d i c t i o n T e s t 38 The S h i p l e y - I n s t i t u t e of L i v i n g S c a l e . . 39 Design 4 0 A n a l y s i s o f Data 42 IV RESULTS 45 Subjects 45 Demographic Data 4 5 Age, and L e v e l of Education 4 5 M a r i t a l Status 47 Durat i o n of Treatment 49 P s y c h o l o g i c a l Test Data 4 9 v i CHAPTER PAGE D i s c r i m i n a n t A n a l y s i s , Step One 51 D i s c r i m i n a n t A n a l y s i s , Step Two 57 Pearson C o r r e l a t i o n M a t r i x 60 Summary 62 V SUMMARY 64 Restatement of the Purpose and Research Questions 64 Summary of S t a t i s t i c a l Procedures Used . . . 66 I n t e r p r e t i v e Summary of Re s u l t s 67 Recommendations 7 6 Research 7 7 A c t i o n 78 REFERENCES 8 0 v i i LIST OF TABLES Table D e s c r i p t i o n Page 1. DESCRIPTIVE STATISTICS AND t-TEST RESULTS FOR VARIABLES AGE AND LEVEL OF EDUCATION . . . 46 2. DESCRIPTIVE STATISTICS AND t-TEST RESULTS FOR VARIABLE AGE: IN 5 GROUPS 4 8 3. MATRIX OF OBSERVED AND EXPECTED FREQUENCIES (X 2) OF MALE ALCOHOLICS ON VARIABLE MARITAL STATUS 4 9 4. MATRIX OF OBSERVED AND EXPECTED FRQUENCIES (X 2) OF MALE ALCOHOLICS ON VARIABLE MARITAL STATUS: COLLAPSED GROUPS 4 9 5. DESCRIPTIVE STATISTICS AND t-TEST RESULTS FOR VARIABLE DURATION OF TREATMENT 50 6. MEANS AND STANDARD DEVIATIONS FOR 141 SUBJECTS ON EACH SUBSCALE . (VARIABLE) OF THE ALCADD . . 52 7. MEANS AND STANDARD DEVIATIONS FOR 141 SUBJECTS ON EACH SUBSCALE (VARIABLE) OF THE EPPS . . . 5 3 8. MEANS AND STANDARD DEVIATIONS FOR 141 SUBJECTS ON EACH SUBSCALE (VARIABLE) OF THE SILS . . . 54 9. ' MEANS AND STANDARD DEVIATIONS FOR 141 SUBJECTS ON EACH SUBSCALE (VARIABLE) OF THE MMPI . . . 55 10. ORDER OF ENTRY OF INDEPENDENT VARIABLES INTO DISCRIMINANT FUNCTION: MMPI (STEP ONE) . . . 56 11. MMPI CLASSIFICATION MATRIX FROM STEP ONE DISCRIMINANT ANALYSIS 57 12. MEANS AND STANDARD DEVIATIONS FOR 141 SUBJECTS ON EACH SUBSCALE (VARIABLE) OF THE 16 PF . . . 58 13. VARIABLE ENTERED INTO DISCRIMINANT FUNCTION FROM THE 16 PF (STEP ONE) 59 14. 16 PF CLASSIFICATION MATRIX FROM STEP ONE DISCRIMINANT ANALYSIS 15. ORDER OF ENTRY OF INDEPENDENT VARIABLES INTO DISCRIMINANT FUNCTION: MMPI & 16 PF (STEP TWO) v i i i T able D e s c r i p t i o n Page 16. CLASSIFICATION MATRIX BASED ON VARIABLES CHOSEN THROUGH DISCRIMINANT ANALYSIS: STEP TWO (FROM THE MMPI & 16 PF) 61 17. PEARSON CORRELATION COEFFICIENTS OF VARIABLES ENTERED INTO DISCRIMINANT FUNCTION THROUGH DISCRIMINANT ANALYSIS: STEP TWO 61 i x ACKNOWLEDGEMENTS I wish to express my thanks to the f o l l o w i n g people who helped make completion o f the r e s e a r c h p r o j e c t and t h e s i s p o s s i b l e : to the Chairman of my t h e s i s committee, Dr. John F r i e s e n , f o r h i s e d i t i n g a s s i s t a n c e , a d v i c e and encourage-ment i n a l l phases of the study; to the other t h e s i s committee members, Dr. W i l l i a m Borgen f o r h i s h e l p f u l comments and c r i t i c i s m s o f the manuscript, and Dr. Har o l d R a t z l a f f f o r h i s a i d i n e d i t i n g , and guidance through the me t h o d o l o g i c a l and s t a t i s t i c a l aspect o f the study; and to Dr. Todd Rogers f o r the c o n s u l t a t i o n time r e g a r d i n g s t a t i s t i c a l i s s u e s he so w i l l i n g l y gave, and to Mr. Dwight Harley f o r hours of help with the many computer programs. I am a l s o deeply indebted to Dr. C l i f f o r d R a t z l a f f f o r h i s a s s i s t a n c e i n g a i n i n g p e r m i s s i o n f o r me to use the data f i l e s used i n t h i s p r o j e c t , as w e l l as f o r the time he and h i s w i f e Jeannette spent w i t h me d i s c u s s i n g many i s s u e s a s s o c i a t e d w i t h the study. Thanks too, are due to Mr. E r n i e Schweitzer who so ably a s s i s t e d i n the r e c o r d i n g o f the data, and who s o l v e d the problems I presented him with d u r i n g data r e c o r d i n g . L a s t , but d e f i n i t e l y not l e a s t , a very s p e c i a l thanks goes to my wife Karen f o r her p a t i e n c e , encouragement, and many forbearances d u r i n g the course of w r i t i n g t h i s t h e s i s . CHAPTER I I n t r o d u c t i o n to the Study " A l c o h o l abuse and a l c o h o l i s m are r e c o g n i z e d as major h e a l t h problems i n most developed and many de v e l o p i n g n a t i o n s " (U.S. Dept. of Health, Education, and Welfare, 1971). I t has been widely observed t h a t consumption l e v e l s of a l c o h o l i c beverages are - and have been f o r q u i t e some time - on the r i s e . Canada i s one of approximately 12 n a t i o n s which together consume roughly f o u r - f i f t h s of a l l a l c o h o l used f o r p l e a s u r e purposes throughout the world. The combined p o p u l a t i o n of these same c o u n t r i e s on the o t h e r hand, comprises l e s s than one-quarter of the world t o t a l (Sulkunen, 1976). C i t i z e n s of B r i t i s h Columbia have been the l a r g e s t consumers of a l c o h o l i c beverages i n Canada a n n u a l l y s i n c e a t l e a s t 1967. As of 1976, consumption of pure 100% a l c o h o l i s an average three g a l l o n s per year f o r everyone 15 years of age and over. T h i s r e p r e s e n t s an i n c r e a s e of 36% over 19 67 f i g u r e s , and i s equal to 1.1 ounces per day (Newsletter: Alcohol-Drug Education S e r v i c e , 1977; 1978). T h i s i s 30% more than the f i g u r e r e p o r t e d by de L i n t (1977) as being the average d a i l y consumption of i n d i v i d u a l s who seek h e l p a t a l c o h o l i s m c l i n i c s f o r t h e i r a d d i c t i o n and r e l a t e d problems. A press r e l e a s e from the B r i t i s h Columbia M i n i s t r y of 1 2 H e a l t h ( 1 9 7 8 ) s t a t e d t h a t , " a l c o h o l i s m causes 4 0 % of h o s p i -t a l admissions, 3 1 % of a l l s u i c i d e s , 6 0 % of a l l homicides, and 4 0 % o f a l l f a m i l y c o u r t problems". Hansard ( 1 9 7 6 ) records the Honourable Marc LaLonde ( M i n i s t e r of N a t i o n a l Health and Welfare, Ottawa) as r e p o r t i n g t h a t there i s no s p e c i f i c answer to the q u e s t i o n about the c o s t o f h e a l t h care due to a l c o h o l abuse i n Canada, but t h a t r e c e n t e s t i -mates i n d i c a t e d n e a r l y $ 2 b i l l i o n a n n u a l l y were being spent i n t h i s r e gard. A l c o h o l i s m i s a complex problem. There now seems to be a r e c o g n i t i o n o f t h i s f a c t by everyone working i n the f i e l d , i n c l u d i n g agreement t h a t a l c o h o l i s m i s m u l t i f a c e t e d i n i t s symptomatology and e t i o l o g y (Levinson, 1 9 7 7 ) . The evidence suggests t h a t a l c o h o l i s m i s a: product o f p o s s i b l y p h y s i o l o g i c a l and c e r t a i n l y p s y c h o l o g i c a l and s o c i o l o g i c a l [and c u l t u r a l ] f a c t o r s [a f u l l understanding of the i n t e r -r e l a t i o n s h i p s of these f a c t o r s awaits f u r t h e r s t u d y ] . T h i s complexity bears upon the problem of treatment f o r c h a r a c t e r i s t i c a l l y some t h i n g s work i n some cases, but not i n o t h e r s . (Lowe, 1 9 7 7 , p. 1 0 7 ) The l a c k of f u l l understanding o f c a u s a l and r e l a t i o n a l f a c t o r s i n v o l v e d i n a l c o h o l i s m means t h a t treatment o b v i o u s l y cannot be undertaken except on a h i t - o r - m i s s b a s i s . T h e r a p i s t s s t i l l vary i n t h e i r t r a i n i n g and t h e o r e t i c a l p e r s u a s i o n s , thereby a f f e c t i n g the nature and e f f e c t i v e n e s s of treatment programs. The b e s t r e s u l t s are u s u a l l y a t t a i n e d through programs i n v o l v i n g a combination o f p h y s i o l o g i c a l l y , p s y c h o l o g i c a l l y , and s o c i a l l y based treatments. In a d d i t i o n , 3 such programs are most e f f e c t i v e when t a i l o r e d to the p a r t i c u l a r needs and resources of the i n d i v i d u a l s who are seeking h e l p , and who are a t d i f f e r e n t stages i n t h e i r p e r s o n a l h i s t o r y o f a l c o h o l abuse. However, the h i g h c o s t a s s o c i a t e d w i t h treatment programs makes i t d i f f i c u l t (but not t o t a l l y impossible) to develop i n d i v i d u a l l y t a i l o r e d treatment programs i n every case. Group therapy ( l e s s expensive) i s o f t e n the main method used i n i n p a t i e n t or r e s i d e n t i a l s e t t i n g s . While t h i s type of treatment may or may not be e f f e c t i v e , t here s t i l l i s a need f o r a g r e a t e r number o f e f f e c t i v e treatment programs. Given the r e a l i t y then, of the i m p e r f e c t s t a t e of our knowledge and understanding of the nature of a l c o h o l i s m -and a d e r i v a t i v e o f t h i s f a c t , namely, the e x i s t e n c e of d i f f e r i n g kinds of treatment programs due to v a r i o u s t h e o r e t i c a l p ersuasions of t h e r a p i s t s - i t can be concluded t h a t the w i s e s t course of a c t i o n t o f o l l o w , i s f o r those engaged i n o f f e r i n g r e h a b i l i t a t i o n s e r v i c e s to determine what they do b e s t ( i . e . , r e s u l t s o f treatment), and w i t h whom ( i . e . , type of a l c o h o l i c ) . The other f a c t t h a t p o i n t s to such a c o n c l u s i o n , i s the r e l a t i v e l a c k of re s o u r c e s i n the f i e l d o f a l c o h o l i s m ( i . e . , treatment programs). There-f o r e the maximal use of a treatment agency becomes even more important. 4 Nature of the Problem Acc o r d i n g to H e i l b r u n (1974): the r e h a b i l i t a t i o n of the a l c o h o l i c i s not quided by any common fund o f knowledge or agreed-upon p r i n c i p l e s o f i n t e r v e n t i o n . Procedures vary w i d e l y from one agency to the next and w i t h i n an agency, from one p r a c t i t i o n e r t o the next. Under such circumstances i t i s encumbent upon the agency and i t s i n d i v i d u a l s t a f f members to c o n t i n u a l l y monitor the e f f e c t i v e n e s s of i t s approaches to r e h a b i l -i t a t i o n and to make changes where experience d i c t a t e s . A formal outcome p r e d i c t i o n system w i l l not i n i t s e l f accomplish t h i s end, but such a system c o n t a i n s the i n g r e d i e n t s which make i t s accomplishment p o s s i b l e , (p. 182) Thi s author i s a s s o c i a t e d with a Center i n the Lower Mainland of B r i t i s h Columbia t h a t p r o v i d e s treatment f o r male a l c o -h o l i c s i n a r u r a l , and r e s i d e n t i a l s e t t i n g . The major concern of the s t a f f a t t h i s Center i s to maximize the e f f e c t i v e n e s s of t h e i r e f f o r t s on b e h a l f of a l c o h o l i c s seeking h e l p f o r t h e i r a d d i c t i o n and r e l a t e d problems. T h i s concern has developed out of experience common to t h e r a p i s t s engaged i n work wi t h t h i s k i n d of p o p u l a t i o n s , t h a t i s , s t a f f working i n a l c o h o l i s m treatment c e n t e r s encounter c l i e n t e l e who are d i s i n t e r e s t e d i n overcoming t h e i r dependency on a l c o h o l . When therapy programs are i n e f f e c t i v e , c o u n s e l l o r s experience f r u s t r a t i o n , which i n t u r n leads to c o u n s e l l o r burn-out over a p e r i o d o f time (18 months to 2 years commonly). Although the doors of the Center w i t h which the author i s a s s o c i a t e d are open to a l l a p p l i c a n t s w i t h an a l c o h o l abuse problem, the s t a f f r e a l i z e t h a t t h e i r time and e f f o r t might be more w i s e l y spent w i t h some c l i e n t s r a t h e r 5 than o t h e r s . T h i s i s e s p e c i a l l y r e l e v a n t to other t h e r a p i s t s who work with a d d i c t s too, f o r "by the very nature of t h e i r d i s a b i l i t y , a high r e c i d i v i s m r a t e may be expected so t h a t the demands f o r h e l p from c h r o n i c a l c o h o l i c s . . . [ w h i c h i n Canada probably number over one m i l l i o n ] are never a t a premium" ( H e i l b r u n , 1974, p. 181). T h i s type of s e l e c t i o n process a t t h i s Center, would i n c r e a s e the o v e r a l l l e v e l of e f f e c t i v e n e s s of the treatment program and would c o n t r i -bute d i r e c t l y to r e d u c i n g the l e v e l s of c o u n s e l l o r f r u s t r a -t i o n and e v e n t u a l burn-out. T h e r e f o r e the Center s t a f f need a way to determine - or p r e d i c t - who w i l l be the most l i k e l y c andidates f o r s u c c e s s f u l r e h a b i l i t a t i o n (and who w i l l not) b e f o r e the a p p l i c a n t s a c t u a l l y e nter the treatment program. T h i s study was conceived i n order to f a c i l i t a t e the above mentioned need (goal) of the Center s t a f f . I t s purpose i s to determine the r e l a t i o n s h i p s between c l i e n t pretreatment s o c i o - p s y c h o l o g i c a l c h a r a c t e r i s t i c s and t r e a t -ment outcomes of a l c o h o l i c s who were admitted to t h i s Center over the p a s t 3 y e a r s . S i g n i f i c a n t r e l a t i o n s h i p s r e v e a l e d by the data can then be used by the Center s t a f f i n the f u t u r e , to p r e d i c t t h a t men with s i m i l a r pretreatment p r o f i l e s would most l i k e l y be good or poor candidates f o r r e h a b i l i t a t i o n from dependency on a l c o h o l through t h i s treatment program. The data from which t h i s i s to be Purpose of the Study 6 determined are the f o l l o w i n g : (a) Demographic data: (i) Age, ( i i ) M a r i t a l S t a t u s , ( i i i ) L e v e l o f Education; (b) P s y c h o l o g i c a l t e s t data from: (i) the Minnesota M u l t i -p h a s i c P e r s o n a l i t y Inventory (MMPI), ( i i ) the Edwards Per s o n a l P r e f e r e n c e Schedule (EPPS), ( i i i ) the S i x t e e n P e r s o n a l i t y F a c t o r s Q u e s t i o n n a i r e ( 1 6 P F ) , (iv) the A l c o h o l A d d i c t i o n T e s t (ALCADD), (v) the S h i p l e y - I n s t i t u t e of L i v i n g S c a l e (SILS); (c) Duration of Treatment data; and (d) t r e a t -ment outcome c l a s s i f i c a t i o n " s c o r e s " . D e f i n i t i o n of Terms S e v e r a l terms have been mentioned thus f a r i n the t h e s i s whose d e f i n i t i o n should f a c i l i t a t e understanding of the study. These d e f i n i t i o n s f o l l o w . A l c o h o l i s m L i t e r a l l y hundreds o f d e f i n i t i o n s of a l c o h o l i s m are a v a i l a b l e . Many of these are very h e l p f u l , but none has become d i s t i n g u i s h e d by u n i v e r s a l acceptance. J e l l i n e k (1960) has w r i t t e n a 246-page a n a l y s i s of over 100 of the e x i s t i n g d e f i n i t i o n s of a l c o h o l i s m . However, the main concepts of a l c o h o l i s m can be reasonably presented here, and are as f o l l o w s . A l c o h o l i s m , as i t i s g e n e r a l l y understood, i s evidenced by compulsive d r i n k i n g which occurs r e p e a t e d l y , f r e q u e n t l y , and c o n t i n u a l l y over a long p e r i o d of time. I t i s g e n e r a l l y 7 d e s c r i b e d as an a d d i c t i o n , i n which the person i s "hooked" on a l c o h o l ; t h a t i s , he craves i t , and must have i t , being unable to get along without i t . A l c o h o l i s m can t h e r e f o r e be d e f i n e d as a c o n d i t i o n i n which the i n d i v i d u a l d r i n k s compulsively ( l o s s of c o n t r o l ) to the p o i n t of i n t o x i c a t i o n , does so r e p e t i t i v e l y ( h a b i t u a t i o n ) , and continues to do so c h r o n i c a l l y . An e a r l y f o r m u l a t i o n of a d e f i n i t i o n of a l c o h o l i s m by K e l l e r (1958), i n t e r a c t i n g w i t h a d e s c r i p t i o n of a l c o h o l i s m s e t down i n the f i r s t r e p o r t of the World He a l t h O r g a n i z a t i o n expert committee on mental h e a l t h , a l c o h o l i s m subcommittee (1951), covered the v a r i o u s e p i d e m i o l o g i c a l approaches to a l c o h o l i s m by s t a t i n g t h a t a l c o h o l i s m i s : Repeated d r i n k i n g of a l c o h o l i c beverages to an extent t h a t exceeds customary d i e t a r y use or o r d i n a r y compliance w i t h the s o c i a l d r i n k i n g customs of the community and t h a t i n t e r f e r e s w i t h the d r i n k e r ' s h e a l t h , i n t e r p e r s o n a l r e l a -t i o n s or economic f u n c t i o n i n g , (p. 19) In a l a t e r f o r m u l a t i o n , he c o l l a b o r a t e d w i t h M. McCormick ( K e l l e r & McCormick, 1968), and together they produced the f o l l o w i n g important d e f i n i t i o n . A l c o h o l i s m i s : A c h r o n i c and u s u a l l y p r o g r e s s i v e d i s e a s e , or a symptom of an u n d e r l y i n g p s y c h o l o g i c a l or p h y s i c a l d i s o r d e r , c h a r a c t e r i z e d by dependence on a l c o h o l (manifested by l o s s of c o n t r o l over d r i n k i n g ) f o r r e l i e f from p s y c h o l o g i c a l or p h y s i c a l d i s t r e s s or f o r g r a t i f i c a t i o n from a l c o h o l i n t o x i c a t i o n i t s e l f , and by a consumption of a l c o h o l i c beverages s u f f i c i e n t l y g r e a t and c o n s i s t e n t to cause p h y s i c a l or mental or s o c i a l or economic d i s a b i l i t y . Or a l e a r n e d (or conditioned) dependence on a l c o h o l which i r r e s i s t i b l y a c t i v a t e s r e s o r t to a l c o h o l whenever a c r i t i c a l i n t e r n a l or environmental stimulus o c c u r s , (p. 14) 8 These d e f i n i t i o n s - from the i n i t i a l l y simple to the i n c r e a s i n g l y complex and more accurate - h e l p the reader to b e t t e r understand the nature of a l c o h o l i s m , and t h e r e -f o r e to understand something of the kinds of problems t h a t a l c o h o l i c i n d i v i d u a l s are p r e s e n t i n g to the s t a f f of t h i s p a r t i c u l a r Center. However, f o r the purpose o f t h i s study, one f i n a l d e f i n i t i o n (that of an a l c o h o l i c ) i s presented, s i n c e i t i s the d e f i n i t i o n used as a g u i d e l i n e by the Center s t a f f . An a l c o h o l i c i s one who i s unable c o n s i s t e n t l y to choose whether he s h a l l d r i n k or not, and who, i f he d r i n k s , i s unable c o n s i s t e n t l y to choose whether he s h a l l stop or not. Or, one who e x h i b i t s the c r i t e r i a of a l c o h o l i s m ( q . v . ) . ( K e l l e r & McCormick, 1968, p. 12) L e v e l of E d u c a t i o n T h i s v a r i a b l e was recorded i n terms of the number of years of s c h o o l i n g t h a t the c l i e n t had completed. M a r i t a l Status T h i s i n d i c a t e s whether a c l i e n t was c u r r e n t l y s i n g l e , married, separated, d i v o r c e d , or widowed upon e n t e r i n g treatment. Common-law s t a t u s was c o n s i d e r e d synonymous with married s t a t u s . Duration of Treatment T h i s was recorded i n terms of the number of days a 9 c l i e n t spent i n the treatment program. The f i g u r e i n c l u d e s the t o t a l of a l l days - to a maximum of 999 days -. where a c l i e n t had re t u r n e d f o r treatment one or more times, but d i d not i n c l u d e a d d i t i o n a l days i n treatment f o l l o w i n g the p o i n t a t which the c l i e n t had been out of treatment f o r one year. Outcome C l a s s i f i c a t i o n s C l i e n t s were c l a s s i f i e d i n t o one of two groups based on t h e i r r e p o r t e d a l c o h o l d r i n k i n g behaviour, 1 year a f t e r l e a v i n g treatment. The e s t a b l i s h e d g u i d e l i n e s f o r c l a s s -i f i c a t i o n d e c i s i o n s were as f o l l o w s . Successes. Those i n d i v i d u a l s who, 1 year f o l l o w i n g treatment were e i t h e r : (a) not d r i n k i n g a l c o h o l a t a l l , being a b s t i n e n t ; or (b) were d r i n k i n g a l c o h o l i n a s o c i a l l y a c c e p t a b l e , nonabusive manner, t h a t i s , t a k i n g o n l y one or two d r i n k s i n the course of an evening, perhaps up to h a l f a dozen times d u r i n g the year, and never i n v o l v i n g i n e b r i a t i o n . F a i l u r e s . Those i n d i v i d u a l s who, 1 year f o l l o w i n g treatment were e i t h e r : (a) e x h i b i t i n g binge d r i n k i n g behaviour, t h a t i s , bouts of e x c e s s i v e and steady a l c o h o l d r i n k i n g , c h a r a c t e r i z e d by c h r o n i c i n t o x i c a t i o n o f two to three weeks d u r a t i o n , i n t e r s p e r s e d with s u b s t a n t i a l p e r i o d s of s o b r i e t y ; or (b) had re t u r n e d to unmitigated, t o t a l l y r e c i d i v i s t i c a l c o h o l d r i n k i n g , s i m i l a r to or worse than t h a t 10 which p e r t a i n e d p r i o r to e n t e r i n g treatment. T h i s l a s t k i n d of a l c o h o l d r i n k i n g i s c h a r a c t e r i z e d by few, i f any, extended p e r i o d s o f s o b r i e t y . ( I t should be noted t h a t the m a j o r i t y o f i n d i v i d u a l s who entered treatment a t t h i s Center f o r the f i r s t time, were d r i n k i n g i n a manner consonant wi t h the l a t t e r m o s t d e s c r i p t i o n o f a l c o h o l d r i n k e r s , namely, f a i l u r e s . ) S i g n i f i c a n c e of the Study A concern o f any r e h a b i l i t a t i o n agency i s to improve i t s performance through the use of e v a l u a t i o n procedures. In t h i s p r o c e s s , advances i n the c u r r e n t s t a t e of knowledge i n the p a r t i c u l a r f i e l d i n q u e s t i o n are sought. T h i s i s e s p e c i a l l y t r u e when t h i n k i n g of treatment programs f o r a l c o h o l i c s . I t i s a f i e l d r i f e w i t h c o n f l i c t i n g o p i n i o n s and t h e o r i e s r e g a r d i n g the nature and e t i o l o g y of a l c o h o l i s m , which i n t u r n i n f l u e n c e the k i n d o f treatment procedures used, and determine what are to be the outcome go a l ( s ) o f treatment ( L a r k i n , 1974). Many a l c o h o l i s m s t u d i e s have been conducted. In f a c t , i n a l l the l i t e r a t u r e on a l c o h o l i s m , there are approximately 4 00 s t u d i e s which have e v a l u a t e d a l c o h o l i s m treatment programs (Emrick, 1974; 1975). However, the q u a l i t y of t h i s r e s e a r c h has not e q u a l l e d the q u a n t i t y , and t h e r e f o r e w e l l designed e v a l u a t i o n s t u d i e s are needed, t h a t i s , s t u d i e s which w i l l conform to the c r i t e r i a under-l y i n g r e l i a b l e r e s e a r c h . For example, these studies have suffered greatly from methodological weaknesses. Reviews by Baekeland and Lundwall (1975), Davidson (1974), and H i l l and Blane (1967) have shown the seriousness of the problem. This l a t t e r study has suggested that such weaknesses render inconclusive nearly a l l studies evaluating the e f f e c t s of t r a d i t i o n a l psychotherapy with alcoholics (even though most of the studies were intended primarily as descriptive rather than as research reports). Examples of the methodological weak-nesses found by the above reviews are: (a) sampling problems; (b) no, or inadequate comparison groups; (c) weaknesses i n follow-up procedures; (d) d e f i n i t i o n a l problems; and (e) incorrect or inadequate s t a t i s t i c a l analysis. Another, and most important reason (to t h i s study) for needing additional research i s the hope that evaluation findings can be employed to develop an alcoholism treatment outcome prediction system. The necessity for systems of prediction i n the f i e l d of alcoholism treatment has been recognized by Heilbrun (1974) and by Skoloda, Alterman, Cornelison, and Gottheil (1975). While there has been a history of prediction studies of success i n f i e l d s such as industry, education, vocational counselling, and others, Heilbrun emphasized the s t i l l e x i s t i n g need for prediction systems i n the f i e l d of alcoholism treatment, saying: There i s something worse than having a prediction system with a l l i t s inherent l i m i t a t i o n s and that i s having no system at a l l . The r e h a b i l i t a t i o n 12 agency which e x i s t s o n l y to render s e r v i c e to some s e c t o r of the d i s a b l e d p o p u l a t i o n and f a i l s to take advantage of i t s own experience i s mi s s i n g a r a r e o p p o r t u n i t y . T h i s o p p o r t u n i t y , i n a n u t s h e l l , i s to f i n d out what they do best and w i t h whom, and by these d i s c o v e r i e s d i v e r t the course o f t h e i r s e r v i c e s from simply being busy to being e f f e c t i v e , (p. 181) Skoloda, e t a l . (1975) a l s o f e l t t h a t , "the development o f an o b j e c t i v e p r e d i c t o r o r p r e d i c t o r s o f treatment outcome would r e p r e s e n t a c o n s i d e r a b l e advance i n the treatment o f a l c o h o l i s m " (p. 377). I t i s t h i s second reason f o r conducting a d d i t i o n a l e v a l u a t i o n s t u d i e s , namely, the p o s s i b i l i t y of dev e l o p i n g systems o f p r e d i c t i o n , t h a t i s the j u s t i f i c a t i o n f o r con-d u c t i n g the presen t study. The r e s u l t s o b t a i n e d i n t h i s study may p o t e n t i a l l y be employed by the Center to develop i t s own p r e d i c t i o n system, and thereby i n c r e a s e the e f f e c t i v e -ness and e f f i c i e n c y o f the treatment s e r v i c e s o f f e r e d each c l i e n t . There are s e v e r a l reasons why a system o f p r e d i c t i o n i s needed. F i r s t , as H e i l b r u n (1974) s t a t e d above, a pre-d i c t i o n system allows treatment, t h a t i s , r e h a b i l i t a t i o n , c e n t e r s to determine what they do b e s t (e.g., e f f e c t a bstinence; c o n t r o l l e d d r i n k i n g ; i n c r e a s e d s o c i a l f u n c t i o n -i n g ; e t c . ) , and with whom, t h a t i s , w i t h what type o f a l c o h o l i c . Secondly, s i n c e there are many more a l c o h o l i c s than treatment c e n t e r s can accomodate, a system f o r determining who they (the agency) w i l l be most e f f e c t i v e w i t h , c o u l d be 13 u t i l i z e d . However, e t h i c a l or l e g a l reasons may determine t h a t c l i e n t s be t r e a t e d on a f i r s t come, f i r s t served b a s i s . But i n such a s i t u a t i o n the value of a p r e d i c t i o n system would be of a somewhat d i f f e r e n t n a t u r e . Concern w i t h e t h i c s here i s very important and i s not to be passed over l i g h t l y . A comment made by B o l t o n (1972), i s h e l p f u l i n t h i s r egard: The o n l y m o r a l l y d e f e n s i b l e use of p r e d i c t o r procedures i s to a s s i g n c l i e n t s to d i f f e r e n t i a l treatments which maximize the p r o b a b i l i t y of s u c c e s s f u l outcome. (The use of p r e d i c t o r data f o r s e l e c t i o n purposes can o n l y be regarded as a temporary expedient. The g o a l of a l l r e h a b i l i t a -t i o n e f f o r t s i s to p r o v i d e a p p r o p r i a t e s e r v i c e s to a l l c l i e n t s , r e g a r d l e s s of t h e i r p r o b a b i l i t y of s u c c e s s . ) , (p. 53) In t h i s case, a p r e d i c t i o n system would have to be u t i l i z e d to determine which c l i e n t s should be c a r e f u l l y monitored a f t e r treatment due to the high p r o b a b i l i t y of r e c i d i v i s m . For example, those i n p a t i e n t c l i e n t s w i t h a poor prognosis f o r r ecovery c o u l d be a u t o m a t i c a l l y r e f e r r e d f o r c o n t i n u i n g treatment on an o u t p a t i e n t b a s i s (or halfway house). T h i s i d e a i s supported by the f i n d i n g s of Lemere and V o e g t l i n (1950) t h a t those most l i k e l y to be a b s t i n e n t had r e c e i v e d f u r t h e r treatment a f t e r l e a v i n g i n p a t i e n t s e r v i c e (e.g., booster s e s s i o n s ; AA attendance? halfway house care; out-p a t i e n t care; or even other i n p a t i e n t c a r e ) . That i s , those i n d i v i d u a l s who have an i n i t i a l l y poor p r o g n o s i s f o r r ecovery, can i n c r e a s e t h e i r chances f o r a t t a i n i n g a b s t i nence by engag-i n g i n f u r t h e r treatment s e r v i c e s on some k i n d of o u t p a t i e n t or i n p a t i e n t b a s i s . A t h i r d reason f o r needing a system of outcome p r e d i c t i o n , 14 or a way of u s i n g i t , i s i n regard to c l i e n t s dropping out of treatment. The f o l l o w i n g quote from Baekeland and Lundwall (1975) i l l u s t r a t e s t h i s need s u c c i n c t l y : Thus i t i s c l e a r t h a t the treatment of many c h r o n i c c o n d i t i o n s i s hampered by so many p a t i e n t s f a i l i n g to persevere i n treatment. Such a s t a t e of a f f a i r s i s of p a r t i c u l a r concern a t the presen t time, which i s marked by a simultaneous r a p i d i n c r e a s e i n treatment e x p e c t a t i o n s and treatment c o s t s . T y p i c a l l y , most c l i n i c s have more a p p l i -cants than they can t r e a t . Hence, be f o r e t r e a t -ment s t a r t s , i t seems a l l the more important to be a b l e q u i c k l y and e f f i c i e n t l y to d i s t i n g u i s h the p a t i e n t l i k e l y to persevere from the one who i s not. (p. 739) S p e c i a l p r e c a u t i o n s might then be taken i n order to keep such c l i e n t s i n treatment. In c o n c l u d i n g t h i s s e c t i o n , i t can be s t a t e d t h a t i f the data being analysed i n t h i s study i n d i c a t e s e v e r a l v a r i a b l e s t h a t are e f f e c t i v e i n p r e d i c t i n g outcome, then the development and use of a p r e d i c t i o n system can be recommended. Consequently, the e f f i c i e n c y and e f f e c t i v e n e s s o f the treatment program i s l i k e l y to i n c r e a s e . Conversely, i f the data i n d i c a t e very few or no v a r i a b l e s are e f f e c t i v e i n p r e d i c t i n g outcome, then i t can be recommended to the Center s t a f f to d i r e c t t h e i r e f f o r t s i n f u r t h e r study toward f i n d i n g measurable c h a r a c t e r i s t i c s of the a l c o h o l i c popula-t i o n they work with , which are p r e d i c t i v e o f outcome. L i m i t a t i o n s o f the Study Although t h i s p a s t s e c t i o n was concerned w i t h the need f o r conducting adequate e v a l u a t i o n s t u d i e s , and p a r t i c u l a r l y 15 w i t h the p o s s i b i l i t i e s o f d e v e l o p i n g systems of pre-d i c t i o n based on the r e s u l t s of such s t u d i e s , i t must be s t a t e d t h a t t h i s present study i s n e i t h e r intended as an e v a l u a t i o n of the a l c o h o l i s m treatment program i n q u e s t i o n , nor does i t i n t e n d to i n c o r p o r a t e the development of a system of p r e d i c t i o n based on the f i n d i n g s of the a n a l y s i s , i n t o i t s primary t a s k . T h e r e f o r e , the immediate g o a l of t h i s study i s to determine the r e l a t i o n -ships between pretreatment c h a r a c t e r i s t i c s of male a l c o h o l i c s and posttreatment d r i n k i n g behaviour a f t e r 1 year out of treatment. The f i n d i n g s o f t h i s e x p l o r a t o r y study w i l l r e v e a l what the p o s s i b i l i t i e s are f o r f u t u r e development of a p r e d i c t i o n system f o r t h i s R e h a b i l i t a t i o n Center. The f i n d i n g s of t h i s study t h e r e f o r e , should i n d i c a t e t h a t the data t r a d i t i o n a l l y gathered by the Center are, or are not of. ^ yalue f o r the development of a p r e d i c t i o n system a t t h i s p o i n t i n time, and i f not, t h a t new c r i t e r i a f o r data g a t h e r i n g are r e q u i r e d before a p r e d i c t i o n system can l e g i t i m a t e l y be developed. Overview of the Study The t h e s i s as i n t r o d u c e d i n t h i s Chapter progresses as f o l l o w s . Chapter I I c o n t a i n s a review of the r e l e v a n t l i t e r a t u r e and i s concluded by s t a t i n g the r e s e a r c h q u e s t i o n s . T h i s i s f o l l o w e d i n Chapter I I I by a d i s c u s s i o n of the methodology employed i n the study. The t h e s i s concludes i n 16 Chapters IV and V with a p r e s e n t a t i o n of the r e s u l t s of the study, d i s c u s s i o n of the i m p l i c a t i o n s a r i s i n g out of those r e s u l t s , and suggestions f o r f u r t h e r r e s e a r c h . CHAPTER II Review o f the L i t e r a t u r e R e l a t e d Research L i t e r a l l y hundreds of s t u d i e s have been conducted on v a r i o u s aspects o f a l c o h o l i s m . With r e s p e c t to the concern of t h i s study, an attempt was made to comprehensively review the r e l e v a n t l i t e r a t u r e on a l c o h o l i s m . T h e r e f o r e only the f o l l o w i n g areas o f r e s e a r c h w i l l be focused upon i n t h i s chapter: (a) outcome measures of treatment e f f e c t i v e n e s s ; (b) the e f f e c t s o f d i f f e r e n t modes of t r e a t -ment on outcome; (c) the r e l a t i o n s h i p of pretreatment c h a r a c t e r i s t i c s to treatment outcome; (d) d u r a t i o n o f treatment; and i t s c o r o l l a r y (e) dropping out of treatment. Outcome Measures of Treatment E f f e c t i v e n e s s The t r a d i t i o n a l approach to measuring treatment e f f e c t i v e n e s s has been the comparison of abs t i n e n c e versus d r i n k i n g ( P a t t i s o n , Coe,& Rhodes, 1 9 6 9 ) . However, t h i s s t r a i g h t f o r w a r d f o r m u l a t i o n has c o n t i n u a l l y been c h a l l e n g e d ever s i n c e the r e p o r t by Davies ( 1 9 6 2 ) which i n d i c a t e d t h a t a s m a l l percentage o f t r e a t e d a l c o h o l i c s r e t u r n to normal (non-abusive) d r i n k i n g p a t t e r n s . A f u l l a p p r e c i a t i o n o f the me r i t s of both s i d e s of t h i s c o n t r o v e r s y i s presented by Kleckner ( 1 9 7 7 ) , L a r k i n ( 1 9 7 4 ) , and P a t t i s o n ( 1 9 7 6 ) . 1 7 18 Subsequently, some behaviour m o d i f i c a t i o n p r a c t i t i o n e r s i n a l c o h o l i s m have used c o n t r o l l e d d r i n k i n g as the g o a l o f treatment outcome r a t h e r than abstinence (Bigelow, Cohen, Liebson, & F a i l l a c e , 1972; L l o y d & S a l z b e r g , 1975; Lovibond & Caddy, 1970; S o b e l l & S o b e l l , 1972) . Other approaches are i l l u s t r a t e d by those who h o l d w i t h what may be termed the a b s t i n e n c e - p l u s view. T h i s i s the b e l i e f t h a t a person's d r i n k i n g behaviour i s not a f f e c t e d i n i s o l a t i o n from other s o c i a l and r e l a t i o n a l aspects of the c l i e n t s l i f e . Thus, Emrick (1974), i n h i s review of t r e a t -ment outcome s t u d i e s , was a b l e to l i s t o t h e r outcome c r i t e r i a used by r e s e a r c h e r s . These i n c l u d e d : (a).>. a f f e c t i v e -c o g n i t i v e measures; (b) work s i t u a t i o n ; (c) home s i t u a t i o n ( m a r i t a l , f a m i l i a l and r e s i d e n t i a l ) ; (d) f u r t h e r , treatment ( i n p a t i e n t , o u t p a t i e n t and A l c o h o l i c s Anonymous); (e) p h y s i c a l h e a l t h ; (f) a r r e s t s and o t h e r l e g a l problems; (b) s o c i a l s i t u a t i o n ; (h) f i n a n c i a l s i t u a t i o n ; and (i) o t h e r c r i t e r i a used very i n f r e q u e n t l y . Such measures of treatment e f f e c t i v e n e s s add an important supplement to the simple abstinence versus d r i n k i n g dichotomy, s i n c e d r i n k i n g behaviour i s not p e r f e c t l y c o r r e l a t e d w i t h a l l o ther areas of f u n c t i o n i n g (Emrick, 1974; L l o y d & S a l z b e r g , 1975). A l s o , i t i s n a t u r a l to expect t h a t the techniques used f o r t r e a t i n g a l c o h o l i c s , drawn as they are from the f i e l d of mental h e a l t h , would a f f e c t p s y c h o l o g i c a l aspects o f f u n c t i o n i n g : e.g., s e l f - c o n c e p t (image), and s o c i a l i n t e r a c t i o n . L a s t l y , one hopes t h a t p r o f e s s i o n a l s who 19 work with a l c o h o l i c s are d e s i r o u s of producing p o s i t i v e growth i n these other areas i n c o n j u n c t i o n w i t h the c e s s a t i o n of a d r i n k i n g problem. E f f e c t s of Treatment Type Emrick (1975), f o l l o w i n g up h i s 1974 review, looked a t most of the p s y c h o l o g i c a l l y - o r i e n t e d a l c o h o l i s m treatment s t u d i e s r e p o r t i n g outcomes - p u b l i s h e d between 1952 and 1973 - i n order to assess the r e l a t i v e e f f e c t i v e n e s s of d i f f e r e n t treatment methods. Some of the v a r i e t y of t r e a t -ments r e p o r t e d i n the l i t e r a t u r e reviewed by Emrick (1975) , were: (a) c l i e n t - c e n t e r e d group therapy; (b) l e a r n i n g theory groups; (c) s o c i a l d i s c u s s i o n groups; (d) p s y c h o a n a l y t i c group therapy; and (e) behaviour t h e r a p i e s (e.g., c l a s s i c a l a v e r s i v e c o n d i t i o n i n g , biofeedback mechanisms, t r a i n i n g toward s o c i a l l y a c c e p t a b l e b e h a v i o u r s ) . One of Emrick's major f i n d i n g s was t h a t d i f f e r e n c e s i n treatment methods d i d not a f f e c t long-term outcome (defined as l o n g e r than 6 months). Of the 384 s t u d i e s reviewed, 72 were chosen f o r g r e a t e r a n a l y s i s i n t h a t they alone d i r e c t l y compared two or more types of treatment. C o n c l u s i o n s r e g a r d i n g r e l a t i v e e f f e c t i v e -ness of treatment methods were l i m i t e d to d i f f e r e n c e s found more than 6 months a f t e r t e r m i n a t i o n of treatment. T h i s e l i m i n a t e d 36 s t u d i e s from a n a l y s i s . Of the remaining 36 s t u d i e s , 31 r e p o r t e d no d i f f e r e n c e s between groups. The remaining 5 s t u d i e s r e v e a l e d one s t r i k i n g c h a r a c t e r i s t i c i n 20 common. S i g n i f i c a n t differences appeared to have been derived, "at least i n part", not from one treatment approach being r e l a t i v e l y b e n e f i c i a l , but from "some aspect of one treatment plan being r e l a t i v e l y harmful by retarding improvement" (p. 91). The c r i t e r i o n adopted by Emrick (1975), that conclusions only be drawn from studies where follow-up occurred more than 6 months following treatment termination, was an important one and i s supported i n the l i t e r a t u r e . For instance, some researchers found very high rates of return to drinking i n less than 6 months following termination of treatment. A study by Davies, Shepherd and Meyers (1956),. revealed that 90% of t h e i r c l i e n t s resumed drinking i n under 6 months (nearly a l l i n under 3 months), while Vallance (1965) showed nearly 75% of inpatient c l i e n t s relapsed during t h i s period. Levy, Livingstone and C o l l i n s (1967), also reported a high drinking relapse rate during the f i r s t 6 months following discharge. Conversely, other researchers have demonstrated a s t a b i l i z a t i o n occurring i n outcome following r e h a b i l i t a t i o n treatment once 6 to 12 months have passed (Gerard & Saenger, 1959; Robson, Paulus & Clarke, 1965; and Vallance, 1965). It can be seen then that the alcoholism l i t e r a t u r e on d i f f e r e n t i a l treatment effects i s f u l l of negative findings. On the other hand, i t has been found that quite a number of c l i e n t pretreatment c h a r a c t e r i s t i c s do have an e f f e c t on treatment outcome. 21 C l i e n t Pretreatment C h a r a c t e r i s t i c s and Treatment Outcome Straus and Bacon (1951), examining the c h a r a c t e r i s t i c s of over 2000 male o u t p a t i e n t c l i e n t s , i n d i c a t e d t h a t an index of s o c i a l s t a b i l i t y ( f a m i l y , community, and o c c u p a t i o n a l i n t e g r a t i o n ) was a good p r o g n o s t i c index of r e c o v e r y from u n c o n t r o l l e d d r i n k i n g . Dorothy M i n d l i n (1959), having researched the c h a r a c t e r i s t i c s of a l c o h o l i c s as r e l a t e d to p r e d i c t i o n of t h e r a p e u t i c outcome, found the f o l l o w i n g key pretreatment c h a r a c t e r i s t i c s c o r r e l a t i n g w i t h treatment outcome: (a) m a r i t a l s t a t u s ; (b) present economic r e s o u r c e s ; (c) usual occupation; (d) a r r e s t h i s t o r y ; (e) m o t i v a t i o n i n seeking treatment; (f) c u r r e n t i n t e l l e c t u a l f u n c t i o n i n g ; (g) p s y c h i a t r i c d i a g n o s i s ; and (h) Rorschach s i g n s . A combination of these 8 items and the use of weighting gave an index which c o r r e c t l y i d e n t i f i e d 80% of a v a l i d a t i o n group of 60 cases. H e i l b r u n (1971) i d e n t i f i e d 4 of 20 v a r i a b l e s as pre-d i c t i v e of outcome, which was d e f i n e d as the amount of time i n the program. These c h a r a c t e r i s t i c s were: (a) l e n g t h of education; (b) IQ estimate (from the S h i p l e y - I n s t i t u t e of L i v i n g S c a l e , 1940); (c) S c h i z o p h r e n i a s c a l e (MMPI); and (d) Hypomania s c a l e (MMPI). I t should be noted t h a t amount of time i n the program was the outcome c r i t e r i a due to H e i l b r u n ' s b e l i e f t h a t d u r a t i o n of r e h a b i l i t a t i o n process i s r e l a t e d to q u a l i t y of outcome (e.g., subsequent d r i n k i n g behaviour; q u a l i t y of the person's c o g n i t i v e or emotional f u n c t i o n i n g ; etc.) and t h e r e f o r e would o f f e r "a simple and 22 objective basis for i n f e r r i n g the effectiveness of a t r e a t -ment program", thereby avoiding "the problems of human bias which plague quality-of-outcome decisions" (Heilbrun, 1974, p. 187). That i s , one would then be able to avoid reliance on complex inferences. Zimberg (1974) found that abstinence was not associated with treatment methods but was s i g n i f i c a n t l y related to indices of s o c i a l s t a b i l i t y . The indices which correlated s i g n i f i c a n t l y were: (a) married; (b) not being on welfare; (c) not l i v i n g i n s o c i a l i s o l a t i o n ; and (d) coming from a higher s o c i a l c l a s s . Gatschenberger (1973), and Lowe and Thomas (1973) found that the t r a d i t i o n a l practice, at the VA Hospital i n Shreveport, Louisiana, of using extensive psychological evaluation of patients seeking to enter treatment for alcoholism, was of l i t t l e predictive value. Instead, data obtained i n the intake interview seemed to o f f e r a more sat i s f a c t o r y method of selection. Both studies supported the assumption that demographic data, e a s i l y obtained at admission, are better predictors of posttreatment adjustment than are psychological data (Lowe •.:&.. Thomas, 1975). The s p e c i f i c nature of the demographic data obtained at intake were not reported. The l i t e r a t u r e c i t e d here overwhelmingly suggested that the data being analysed i n t h i s study would more l i k e l y reveal a s i g n i f i c a n t relationship between the demographic data and the outcome measures. On the other hand, i t was not 23 l i k e l y t h a t a s i g n i f i c a n t r e l a t i o n s h i p would be found between the p s y c h o l o g i c a l t e s t data and the outcome measures. Duration of Treatment Along with the f i n d i n g s on c l i e n t pretreatment c h a r a c t e r -i s t i c s has been the p e r c e p t i o n t h a t d u r a t i o n o f treatment may be p o s i t i v e l y r e l a t e d to s u c c e s s f u l treatment outcome (H e i l b r u n , 1971; 1974). In h i s review, Emrick (1975) compared c l i e n t s who r e c e i v e d l i t t l e or no treatment (minimum treatment was d e f i n e d as l e s s than 5 o u t p a t i e n t c o n t a c t s or l e s s than 2 weeks i n p a t i e n t treatment) w i t h others who r e c e i v e d maximum treatment, which was anything more than minimum treatment. While he found no s i g n i f i c a n t d i f f e r e n c e i n the r a t e of abstinence (15.9% versus 24.5% r e s p e c t i v e l y ) , he d i d f i n d a s i g n i f i c a n t d i f f e r e n c e i n the t o t a l percentage improved (41.9% versus 65.1% r e s p e c t i v e l y ) . He concluded t h a t treatment seemed to i n c r e a s e an a l c o h o l i c ' s chances of reducing h i s or her d r i n k i n g problem. However, he cautioned t h a t these c l i e n t s were not equated f o r pretreatment d i f f e r e n c e s , and t h a t i t was p o s s i b l e these r e s u l t s were ob-t a i n e d because c l i e n t s remaining i n treatment f o r longer p e r i o d s may have been those most l i k e l y to b e n e f i t from t h a t treatment as p r e d i c t e d by pretreatment v a r i a b l e s . Numerous other s t u d i e s of i n p a t i e n t treatment have r e p o r t e d a p o s i t i v e r e l a t i o n s h i p between d u r a t i o n of t r e a t -ment and long-term outcome (Bowen & Androes, 19 68; Ferneau & Desroches, 19 69; Katz, 19 66; Moore & Ramseur, 19 60; and Van Stone & G i l b e r t , 1972). S i m i l a r l y c orresponding r e s u l t s have been obtained i n s t u d i e s of o u t p a t i e n t a l c o h o l i c s (Fox & Smith, 1959; Gerard & Saenger, 1966; R i t s o n , 1969; and Thomas, Gliedman, Imber, Stone, & Freund, 1959). But a c c o r d i n g to Baekeland and Lundwall (1975), the confounding e f f e c t of dropping out o f treatment, and i t s r e l a t i o n s h i p to c l i e n t pretreatment c h a r a c t e r i s t i c s , has not been adequately c o n t r o l l e d . Dropping Out of Treatment S e v e r a l sources i n d i c a t e d t h a t between 52% and 75% of o u t p a t i e n t a l c o h o l i s m c l i e n t s drop out of treatment by the f o u r t h s e s s i o n (Baekeland, Lundwall & Shanahan, 1973; Blane & Meyers, 1963; 1964; Chafetz, Blane, Abram, Golner, Lacy, McCourt, C l a r k & Meyers, 1962; Gerard & Saenger, 1966; Storm & C u t l e r , 1968; and Wilby & Jones, 1962). The i n c i d e n c e of i n p a t i e n t - c l i e n t treatment drop-outs was lower, with an approximate range o f 14% to 40%, w i t h a mean of 28% (Bowen & Androes, 1968; Hoy, 1969; Knox, 1972; Pokorny, M i l l e r & C l e v e l a n d , 1968; Rohan, 1970; Simpson & Webber, 1971; Tomsovic, 1968; and W i l k i n s o n , Prado, W i l l i a m s & Schnadt, 1971). The c h a r a c t e r i s t i c s of c l i e n t s who drop out of treatment were c l o s e l y r e l a t e d to the pretreatment c h a r a c t e r -i s t i c s commonly a s s o c i a t e d with poor treatment outcome. Thus, a person was more l i k e l y to drop out of treatment 25 i f he/she: (a) was i n an advanced s t a t e of a l c o h o l i s m (Baekeland & Lundwall, 1975); (b) had hig h MMPI score s ; was h o s t i l e and a g g r e s s i v e ; had low se l f - e s t e e m ; and was s o c i a l l y i s o l a t e d o r u n a f f i l i a t e d ( G o l d f r i e d , 1969; M i l l e r , Pokorny & Hanson, 1968; W i l k i n s o n , e t a l . , 1971; Zax, Marsey & Biggs, 1961); (c) was of lower socioeconomic s t a t u s (Baekeland, Lundwall & Shanahan, 1973; K i s s i n , R o s e n b l a t t & Machover, 1968; P i s a n i & Motansky, 1970); (d) had ambivalent or n egative a t t i t u d e s toward treatment (Baekeland, e t a l . , 1973; Blane & Meyers, 1963; Zax, 1962); (e) had poor moti-v a t i o n ( G o l d f r i e d , 1969; Zax, e t a l . , 1961); and (f) had a h i s t o r y o f a r r e s t s ( G o l d f r i e d , 1969) . Baekeland & Lundwall (1975) concluded t h e i r review o f a l c o h o l i c o u t p a t i e n t drop-out c h a r a c t e r i s t i c s by s t a t i n g : In sum, the composite p i c t u r e o f the a l c o h o l i c o u t p a t i e n t who i s most l i k e l y to drop out of treatment i s t h a t o f a f i e l d - d e p e n d e n t , counter-dependent, h i g h l y symptomatic, s o c i a l l y i s o l a t e d lower c l a s s person o f poor s o c i a l s t a b i l i t y who i s h i g h l y ambivalent about treatment and has psychopathic f e a t u r e s . The s k i d row a l c o h o l i c i s the most extreme example of t h i s k i n d o f p a t i e n t , (p. 751) The l i t e r a t u r e d e a l i n g w i t h d u r a t i o n o f treatment ( i n c l u d i n g the review on dropping out of treatment) suggests t h a t the e f f e c t o f l e n g t h of treatment on outcome i s con-founded by c l i e n t pretreatment c h a r a c t e r i s t i c s . Three other r e f e r e n c e s f u r t h e r questioned the l e n g t h of treatment e f f e c t . Tomsovic (197 0) r e p o r t e d t h a t l e n g t h o f stay p r e d i c t e d out-come only f o r drop-outs. R i t s o n (1969) r e p o r t e d t h a t when drop-outs were excluded from h i s a n a l y s i s , l e n g t h of i n -p a t i e n t treatment d i d not p r e d i c t outcome. L a s t l y , Mosher, Davis, M u l l i g a n , and Iber, (1975) found no d i f f e r e n c e i n outcome between a 9-day and a 30-day i n p a t i e n t program of treatment. Again, c i t i n g Baekeland and Lundwall (1975), i t appears t h a t the q u e s t i o n o f the e f f e c t o f l e n g t h o f t r e a t -ment on outcome i s s t i l l an open one due to the confounding problem of pretreatment p r o g n o s t i c i n d i c a t o r s i n both i n p a t i e n t and o u t p a t i e n t s e t t i n g s . Summary In summarizing the major f i n d i n g s r e l e v a n t to t h i s t h e s i s , i t can be s t a t e d t h a t : (a) treatments are e q u a l l y e f f e c t i v e , r e g a r d l e s s o f modality; (b) c l i e n t pretreatment c h a r a c t e r i s t i c s are r e l a t e d to treatment outcome; and (c) the e f f e c t o f l e n g t h o f treatment on outcome has not been adequately determined. The preceding knowledge can be p r o f i t a b l y a p p l i e d to the concerns o f the present study i n the f o l l o w i n g manner: (a) time w i l l not have to be spent i n d i s c o v e r i n g how the s p e c i f i c mode of treatment i n use a t t h i s Center a f f e c t s the a l c o h o l d r i n k i n g behaviour outcome of the c l i e n t s because i t w i l l not be expected to be any d i f f e r e n t i n i t s e f f e c t from any oth e r type of treatment; (b) conf i d e n c e i s i n c r e a s e d t h a t some p o s i t i v e ( s i g n i f i c a n t ) r e s u l t s w i l l be obtained through the s t a t i s t i c a l a n a l y s i s , and t h e r e f o r e the Center s t a f f may be encouraged toward the f u r t h e r develop-ment of a system of p r e d i c t i o n ; and (c) the nature of the r e s u l t s o f c o r r e l a t i o n between d u r a t i o n of treatment and treatment outcome w i l l i n d i c a t e whether or not f u r t h e r a n a l y s i s beyond the immediate task o f t h i s study i s warranted, and i f so, i t should suggest how to regroup the data so t h a t f u r t h e r a n a l y s i s becomes meaningful. The Purpose Restated The purpose of t h i s study was to determine the r e l a t i o n -s h i p s of c l i e n t pretreatment c h a r a c t e r i s t i c s to treatment outcomes of male a l c o h o l i c s who were admitted to a B r i t i s h Columbia a l c o h o l i s m treatment c e n t e r over the past 3 y e a r s . The pretreatment data were the f o l l o w i n g : (a) Demographic data: (i) Age, ( i i ) M a r i t a l S t a t u s , ( i i i ) L e v e l of Education; (b) P s y c h o l o g i c a l t e s t data: (i) The Minnesota M u l t i p h a s i c P e r s o n a l i t y Inventory, ( i i ) The Edwards P e r s o n a l P r e f e r e n c e Schedule, ( i i i ) the S i x t e e n P e r s o n a l i t y F a c t o r s Q u e s t i o n n a i r e , (iv) the A l c o h o l A d d i c t i o n T e s t , (v) the S h i p l e y - I n s t i t u t e of L i v i n g S c a l e ; and (c) D u r a t i o n of Treatment data. The outcome data were e s t a b l i s h e d through Center s t a f f c o n s u l t a t i o n s about c l i e n t s ' a l c o h o l d r i n k i n g behaviour f o r a p e r i o d of 1 year a f t e r l e a v i n g treatment. T h i s i n f o r m a t i o n would hope-f u l l y be used as the b a s i s f o r the development of a p r e d i c t i o n system f o r t h i s Center. 28 Research Questions T h i s was an e x p l o r a t o r y study, and was not experimental i n d e s i g n . Consequently, i t was more a p p r o p r i a t e to pose what may be r e f e r r e d to as r e s e a r c h q u e s t i o n s r a t h e r than formal hypotheses. The s p e c i f i c r e s e a r c h q u e s t i o n s i n v e s t i g a t e d through the means of the s t a t i s t i c a l analyses were: 1. Which demographic and p s y c h o l o g i c a l v a r i a b l e s , t h a t i s , pretreatment c h a r a c t e r i s t i c s , s i g n i f i c a n t l y r e l a t e to treatment success as determined 1 year a f t e r treatment? 2. What i s the nature of the c o r r e l a t i o n s among the v a r i a b l e s chosen through step-wise d i s c r i m i n a n t a n a l y s i s ? 3. What i s the nature of the r e l a t i o n s h i p between 'duration o f treatment' and . treatment outcome? 4. Do the f i n d i n g s from r e s e a r c h q u e s t i o n 3 support H e i l b r u n ' s (1971) b e l i e f t h a t time i n treatment i s h i g h l y r e l a t e d to q u a l i t y of outcome, t h a t i s , subsequent d r i n k i n g behaviour? 5. W i l l the demographic and/or p s y c h o l o g i c a l data pro-v i d e the b a s i s f o r the development of a system of p r e d i c t i o n of treatment e f f e c t i v e n e s s ? CHAPTER I I I Methodology Subjects The sample c o n s i s t e d o f s u b j e c t s who met a t w o - f o l d c r i t e r i o n f o r s e l e c t i o n . C l i e n t s were i n c l u d e d i n the sample i f : (a) they had complete data records ( p s y c h o l o g i c a l t e s t s and demographic d a t a ) , and (b) i f they had been out of treatment f o r one f u l l year. The f i r s t c r i t e r i o n was necessary because of the type of s t a t i s t i c a l a n a l y s i s pro-posed. The second c r i t e r i o n was necessary i n order to o b t a i n a s t a b l e measure of outcome. The sample was c h a r a c t e r i z e d by: (a) having been pre-dominantly m i d d l e - c l a s s i n o r i g i n ; (b) having experienced p e r s o n a l and s o c i a l d i s i n t e g r a t i o n due to a l c o h o l dependency; and by (c) a r r i v a l a t the a l c o h o l i s m treatment c e n t e r mainly through d e t o x i f i c a t i o n / r e c o v e r y c e n t e r s (some o t h e r s were r e f e r r e d from the business and i n d u s t r i a l community, and others a r r i v e d as s e l f - r e f e r r a l s ) . The sample s i z e was 141 s u b j e c t s (278 i n d i v i d u a l s a c t u a l l y f i t the above c r i t e r i a , but j u s t under one h a l f were not i n c l u d e d i n the sample due to l a c k of follow-up i n f o r m a t i o n ) . 29 30 Procedures C l a s s i f i c a t i o n o f s u b j e c t s i n t o c r i t e r i o n groups. There was no d i v i s i o n o f the sample i n t o experimental and c o n t r o l groups s i n c e no experimental c o n d i t i o n s were imposed. However, a l l s u b j e c t s were c l a s s i f i e d with regard to t h e i r a l c o h o l d r i n k i n g behaviour one year f o l l o w i n g treatment. The f i r s t group - l a b e l l e d Successes - were those who were e i t h e r c o n s i s t e n t l y a b s t a i n i n g from d r i n k i n g a l c o h o l ; or were those who drank i n a s o c i a l l y a c c e p t a b l e manner, t h a t i s , t a k i n g o n l y one or two d r i n k s i n the course of an evening, perhaps up to h a l f a dozen times d u r i n g the year, and never i n v o l v i n g i n e b r i a t i o n . The second group - l a b e l l e d F a i l u r e s - were those s u b j e c t s who e i t h e r e x h i b i t e d binge d r i n k i n g behaviour, t h a t i s , e x c e s s i v e a l c o h o l d r i n k i n g over two to three week p e r i o d s a t a time with s u b s t a n t i a l p e r i o d s of s o b r i e t y i n between; or were those who had r e t u r n e d to unmitigated, t o t a l l y r e c i d i v i s t i c d r i n k i n g , s i m i l a r to or worse than t h a t which p e r t a i n e d p r i o r to e n t e r i n g treatment. These d e s c r i p t i o n s of success and f a i l u r e seemed reasonable and a p p r o p r i a t e , even though the treatment program conducted by the R e h a b i l i t a t i o n Center p r e d i c a t e d success s o l e l y ' o n . b e i n g t o t a l l y a b s t i n e n t (and t h e r e f o r e those who drank any amount of a l c o h o l a t a l l were c o n s i d e r e d f a i l u r e s ) , s i n c e i t may be thought t h a t there i s a more n a t u r a l d i v i s i o n between those who can d r i n k a sma l l amount w h i l e s t i l l b eing able to m a i n t a i n p e r s o n a l and s o c i a l i n t e g r a t i o n , and those who engage i n binge d r i n k i n g behaviour o r worse. The r e f o r e those who drank i n a s o c i a l l y a c c e p t a b l e manner (maintaining p e r s o n a l and s o c i a l i n t e g r a t i o n ) were a l s o i n c l u d e d as treatment successes f o r the purposes o f t h i s study. Although the Center s t a f f d i d not use formal follow-up procedures w i t h c l i e n t s who had been through the r e h a b i l i -t a t i o n program, s u b j e c t s were c l a s s i f i e d w i t h r e s p e c t to t h e i r a l c o h o l d r i n k i n g behaviour one year f o l l o w i n g treatment, based on the r e s u l t s o f c o n s u l t a t i o n by and agreement among the treatment s t a f f about each c l i e n t ' s s t a t u s . The informa-t i o n used to determine t h i s s t a t u s i n l i e u of formal follow-up procedures came from l e t t e r s , c a r d s , and phone c a l l s made by former c l i e n t s t o t h e i r c o u n s e l l o r s d u r i n g the c r i t e r i o n t i m e - p e r i o d , as w e l l as through r e t u r n v i s i t s made by many c l i e n t s to the Center to co n f i r m s o b r i e t y , and f i n a l l y II II through employer and grapevine r e p o r t s . Intake procedures and a d m i n i s t r a t i o n o f program. Upon entry to the R e h a b i l i t a t i o n Center the men were g i v e n thorough medical examinations, and as f u l l a case h i s t o r y as p o s s i b l e was c o l l e c t e d f o r each. Depending on the s t a t e of the person, s u f f i c i e n t time was pro v i d e d f o r him to experience c e s s a t i o n o f a l c o h o l withdrawal symptoms ( u s u a l l y 10 days to 2 weeks) b e f o r e e n t e r i n g treatment events. A l s o d u r i n g t h i s time, an i n t a k e c o u n s e l l o r i n t e r v i e w e d a l l new and r e t u r n i n g r e s i d e n t s to complete l i f e - d a t a i n f o r m a t i o n sheets. The b a t t e r y o f f i v e p s y c h o l o g i c a l t e s t s was a d m i n i s t e r e d a t the end of 3 weeks, and the r e s u l t a n t scores recorded i n a card f i l e . When the i n f o r m a t i o n g a t h e r i n g process had been com-p l e t e d , the men were assigned to a c o u n s e l l o r . The c o u n s e l -l o r , w i t h the a i d of the t e s t and l i f e data now a v a i l a b l e to him, i n t e r v i e w e d each r e s i d e n t a s s i g n e d to him i n order to determine an i n d i v i d u a l l y based treatment program. The a c t i v i t i e s and amount o f time to be spent i n them were s e l e c t e d from three c a t e g o r i e s of treatment events: (a) s o c i a l m i l i e u events; (b) core-compulsory events; and (c) non-compulsory, but h i g h l y advised treatment events ( a l l r e s i d e n t s r e c e i v e d a modal treatment r e g a r d l e s s of t h e i r p s y c h o l o g i c a l symptoms, which was group t h e r a p y ) . S o c i a l m i l i e u events were f r e e l y p a r t i c i p a t e d i n b y . a l l r e s i d e n t s . They r e p r e s e n t the v a r i o u s aspects of communal l i f e experienced a t the Center: e.g., r e c r e a t i o n , meals, r e s t , r e a d i n g , f i l m s , and ot h e r n o n - s t r u c t u r e d s o c i a l i z a t i o n a c t i v i t i e s . Core-compulsory events were c o n s i d e r e d e s s e n t i a l and hence compulsory. These were d i s c u s s e d by the c o u n s e l l o r s with each r e s i d e n t a t the i n i t i a l i n t e r v i e w so t h a t they were f u l l y understood. The v o l u n t a r y , h i g h l y advised events were a l s o e x p l a i n e d and a committment f o r involvement was sought ( t h i s was the onl y category of events where i n d i v i d u a l s c o u l d e x e r c i s e c h o i c e s ) . Thus the treatment events t h a t a l l men were i n v o l v e d i n were: (a) d a i l y formal group therapy s e s s i o n s ; (b) d i d a c t i c l e c t u r e s on v a r i o u s aspects of a l c o -h o l i s m (minimum, twice/week); (c) one-to-one c o u n s e l l i n g a t l e a s t once a week; (d) p s y c h o l o g i c a l t e s t i n g and t e s t i n t e r p r e t a t i o n ; and (e) B i b l e s t u d i e s , d e v o t i o n a l p e r i o d s and Chapel s e r v i c e s . The e n t i r e program focused on a form of the "twelve s t e p s " of A l c o h o l i c s Anonymous which stood as a statement of the philosophy and view of man as h e l d by the R e h a b i l i -t a t i o n Center. A l l aspects of the treatment program were seen as a n c i l l i a r y to the e f f e c t i v e n e s s of t h i s s p i r i t u a l l y based o r i e n t a t i o n to b r i n g i n g hope and recovery to men d e b i l i t a t e d by a l c o h o l dependency. Instruments The e x i s t i n g data from the b a t t e r y of p s y c h o l o g i c a l t e s t s a d m i n i s t e r e d by the Center s t a f f s i n c e 1975 were analyzed. In t h i s study, each of the instruments i n t h a t b a t t e r y i s reviewed below by c i t i n g one or two comments made by reviewers as contained i n v a r i o u s volumes of O.K. Buros' Mental Measurements Yearbook. More d e t a i l e d i n f o r m a t i o n can be obtained by r e a d i n g those reviews i n t h e i r e n t i r e t y , and by r e a d i n g the p a r t i c u l a r t e s t Manuals. The Minnesota M u l t i p h a s i c P e r s o n a l i t y Inventory. The MMPI can be c o n s i d e r e d the major s t a n d a r d i z e d p s y c h o l o g i c a l t e s t i n use a t the present time f o r the purposes o f o b j e c t i v e c l i n i c a l assessment of i n t r a p s y c h i c pathology, t h a t i s , "assessment of some of the major p e r s o n a l i t y c h a r a c t e r i s t i c s t h a t a f f e c t p e r s o n a l and s o c i a l adjustment" (Hathaway and McKinley, 1967, p. 7). I t i s a s c r e e n i n g d e v i c e used to a i d i n the i d e n t i f i c a t i o n o f abnormal emotional s t a t e s by e l i c i t i n g a wide range of s e l f - d e s c r i p t i o n s from each t e s t s u b j e c t . Using standard s c o r i n g procedures ( T - s c o r e s ) , a c l i n i c a l t e s t p r o f i l e i s generated, i l l u s t r a t i n g the nature and degree o f emotional upset. T h i s p r o f i l e i s composed of four " v a l i d i t y i n d i c a t o r " s c a l e s and ten c l i n i c a l ( p e r s o n a l i t y ) s c a l e s . The s c a l e s c o n s i s t o f items which d i f f e r e n t i a t e d between s p e c i f i e d c l i n i c a l groups of about 50 persons each (per t r a d i t i o n a l p s y c h i a t r i c d i a g n o s t i c groups) and a normal c o n t r o l group o f approximately 700 persons. Quoting Buros 1 T h i r d Mental Measurements Yearbook, from a d e s c r i p t i v e review o f the MMPI by Rotte r (p. 109, 110) , " T e s t - r e t e s t r e l i a b i l i t i e s f o r the separate s c a l e s are re p o r t e d as ranging from .71 to .83. V a l i d i t y measures are f o r s i n g l e s c a l e s and are u s u a l l y i n terms of o v e r l a p between p a t i e n t s of a giv e n nosology, u n s e l e c t e d p a t i e n t s , and normals. S a t i s f a c t o r y d i f f e r e n t i a t i o n i s r e p o r t e d i n most i n s t a n c e s " . However, i t i s worth n o t i n g t h a t , " i t s r e l i a b i l i t y and v a l i d i t y are dependent on the r e l i a b i l i t y and v a l i d i t y o f d i a g n o s i s o f d i s e a s e e n t i t i e s themselves" (Rotter, 1949, p. 110). I t appears t h a t when v a l i d i t y of the MMPI i s r e f e r r e d t o , authors are u s u a l l y concerned with the ap p r o p r i a t e n e s s or a c c e p t a b i l i t y of any one admin-i s t r a t i o n of the t e s t - which i s determined from the v a l i d i t y i n d i c a t o r s o f the t e s t i t s e l f , namely, the L, F, K, and ? 35 s c a l e s - r a t h e r than the k i n d o f v a l i d i t y t h a t i s of more common concern to p r a c t i t i o n e r s . T h i s k i n d of v a l i d i t y i s t h a t which looks f o r s t a t i s t i c a l evidence t h a t the instrument has about i t , a prop e r t y which " l e g i t i m i z e s the p a r t i c u l a r s u b s t a n t i v e p s y c h o l o g i c a l i n f e r e n c e s t h a t may be drawn from score v a l u e s generated by a p p r o p r i a t e a d m i n i s t r a t i o n of t h a t s c a l e " (Dahlstrom, Welsh, and Dahlstrom, 1972, p. 99). The MMPI was used by the s t a f f a t the Center as a t o o l to d e f i n e the ways f o r each c l i e n t i n which h i s p e r s o n a l i t y was s i m i l a r to known d e s c r i p t i o n s of abnormal behaviour. In a d d i t i o n to p r o f i l e a n a l y s i s , an item a n a l y s i s was conducted on the v a r i o u s s c a l e s f o r s p e c i f i c i n f o r m a t i o n not r e v e a l e d by the p r o f i l e a n a l y s i s . T h i s i n f o r m a t i o n was i n v e s t i g a t e d with the c l i e n t i n i n d i v i d u a l c o u n s e l l i n g s e s s i o n s , so t h a t f u l l e s t understanding o f pe r s o n a l dys-f u n c t i o n c o u l d occur. The Edwards Personal P r e f e r e n c e Schedule. T h i s i s a t e s t designed to measure an i n d i v i d u a l ' s m o t i v a t i o n s f o r behaviour. In other words, i t f i n d s to what extent one i s d r i v e n by needs and press u r e s ( i n 15 s e l e c t e d d r i v e s ) . Scores on each s c a l e can be eval u a t e d i n terms o f both p e r c e n t i l e and T-score norms f o r c o l l e g e men and women (based on 760 men and 749 women t e s t e d i n 29 c o l l e g e s a c r o s s the United States) with a d d i t i o n a l p e r c e n t i l e norms d e r i v e d from a ge n e r a l a d u l t sample (based on 4,031 men and 4,932 women t e s t e d i n both urban and r u r a l areas across 4 8 s t a t e s ) . The s i g n i f i c a n t mean d i f f e r e n c e s found between these two groups i l l u s t r a t e s the need f o r s p e c i f i c group norms on t h i s p e r s o n a l i t y t e s t . T h i s has been attempted i n the case of a l c o h o l i c s by F i t z g e r a l d , Pasewark and Tanner (1967); Goss, Morosko, and Sheldon (1968) ; Manaugh and S c o t t (1976); and Pryer and D i s t e f a n o (1970) . However, an important c a u t i o n to bear i n mind i s t h a t the EPPS makes use of i p s a t i v e s c o r e s . In other words, the s t r e n g t h of each need i s expressed i n r e l a t i o n to the s t r e n g t h of the i n d i v i d u a l ' s o t h e r needs, and not i n a b s o l u t e terms. Because of t h i s f a c t , the use of normative scores f o r any group may be questioned. In a d d i t i o n , the combina-t i o n of normative and i p s a t i v e scores serves to make the i n t e r p r e t a t i o n of t e s t scores c o n f u s i n g ( A n a s t a s i , 1976, p. 512). On matters of t e s t r e l i a b i l i t y and v a l i d i t y , the review a r t i c l e by H e i l b r u n i n Buros' Seventh Mental Measurements  Yearbook i s i l l u m i n a t i n g . He s t a t e d t h a t , " s c a l e r e l i a b i l -i t i e s are s a t i s f a c t o r y [.74 to .88 r e t e s t , and .60 to .87 s p l i t - h a l f ] , norms are based on s t a b l e samples, and i n t e r -s c a l e c o r r e l a t i o n s are reasonably low". However, he c r i t i -c i z e d the EPPS f o r a continued l a c k of v a l i d i t y evidence s i n c e i t s i n i t i a l appearance i n 1954. He a l s o s t a t e d t h a t , "the EPPS served as a u s e f u l c a t a l y s t f o r r e s e a r c h and psychometric debate over the r o l e of s o c i a l d e s i r a b i l i t y response s e t and the e f f e c t of i p s a t i v e s c a l i n g " , but w h i l e 37 there i s n e i t h e r evidence f o r or a g a i n s t the EPPS having p r e d i c t i v e v a l i d i t y , " i t b o i l s down to the amount of prudence which the user f e e l s i m p e l l e d to e x e r c i s e w i t h the t e s t r e s u l t s " ( H e i l b r u n , 1972, p. 148, 149) . The Center s t a f f used each i n d i v i d u a l ' s p r o f i l e d t e s t r e s u l t s i n i n d i v i d u a l c o u n s e l l i n g s e s s i o n s to f a c i l i t a t e understanding of how the t e s t e d person was motivated, as compared with others w i t h i n the same age grouping. The S i x t e e n P e r s o n a l i t y F a c t o r s Q u e s t i o n a i r e . T h i s p e r s o n a l i t y i n v e n t o r y was c o n s t r u c t e d on the b a s i s of f a c t o r i a l r e s e a r c h by Raymond B. C a t t e l l and co-workers (1949).-The 16PF attempts to d e f i n e p e r s o n a l i t y by d e l i n e a t i n g the uniqueness of each i n d i v i d u a l on 16 d e s c r i p t i v e p e r s o n a l i t y c h a r a c t e r i s t i c s . I t has been found to be extremely u s e f u l i n promoting g r e a t e r depth i n the i n d i v i d u a l and group c o u n s e l l i n g processes a t the Center. A n a s t a s i (1976), r e p o r t e d t h a t : R e l i a b i l i t i e s o f f a c t o r scores f o r any s i n g l e form of the 16PF are g e n e r a l l y low ... p a r a l l e l -form r e l i a b i l i t i e s c e n t e r i n the .50's and r e t e s t s a f t e r a week or l e s s o f t e n f a l l below .80 .... i n f o r m a t i o n on normative samples and othe r aspects o f t e s t c o n s t r u c t i o n i s inadequate. E m p i r i c a l v a l i d a t i o n data i n c l u d e average p r o f i l e s f o r more than 50 o c c u p a t i o n a l groups and about the same number of p s y c h i a t r i c syndromes. " S p e c i f i c a -t i o n equations" are pr o v i d e d f o r a number of occu p a t i o n s , i n the form Of m u l t i p l e r e g r e s s i o n equations f o r p r e d i c t i n g an i n d i v i d u a l ' s c r i t e r i o n performance from scores on the 16PF. (p. 509) Rorer (1972), reviewed the 16PF i n Buros' Seventh Mental Measurements Yearbook. He s t a t e d t h a t data which would 38 allow the instrument to be p r o p e r l y evaluated, w h i l e pres e n t i n the Manual, were not r e p o r t e d i n "coherent and usable form", and furthermore, the 1970 handbook to the 16PF l e f t the p r a c t i t i o n e r with an "overwhelming impression ... of d i s o r g a n i z a t i o n , c o n t r a d i c t i o n , and c o n f u s i o n " (p. 332, 333). "There i s a l s o some q u e s t i o n about the f a c t o r i a l homogeneity of items w i t h i n each s c a l e , as w e l l as the f a c t o r i a l independence of s c a l e s " ( A n a s t a s i , 1976, p. 509). I t seems t h e r e f o r e , to be d i f f i c u l t to accept the r e s u l t s of an a d m i n i s t r a t i o n of t h i s t e s t w i t h co n f i d e n c e , where s c a l e or p r o f i l e i n t e r p r e t a t i o n i s d e s i r e d . The A l c o h o l A d d i c t i o n Test. The ALCADD t e s t was designed to be able to i d e n t i f y a l c o h o l i c a d u l t s and i n d i v i d u a l s with problems r e l a t e d to the use of a l c o h o l . The Center s t a f f use i t because they f i n d t h a t i t helps to c o n f i r m to the doubter or denyer t h a t he i s indeed d r i n k i n g i n a p a t t e r n l i k e t h a t o f known a l c o h o l i c s . I t has a l s o been found to be u s e f u l i n p o i n t i n g out ways or areas i n which the a l c o h o l d r i n k e r ' s behaviour s t i l l d i f f e r s from those o f known a l c o h o l i c s . A r e l i a b i l i t y c o e f f i c i e n t of .92 f o r males i s r e p o r t e d by the author of t h i s t e s t , and one i n v e s t i g a t o r found t h a t by u s i n g the ALCADD's c u t - o f f s c o r e s , 80-100% of fo u r groups t e s t e d ( a c t i v e a l c o h o l i c s , members of AA, s o c i a l d r i n k e r s , and a b s t a i n e r s ) were c o r r e c t l y i d e n t i f i e d . However, " s i n c e no sy s t e m a t i c work has been r e p o r t e d f o r t h i s t e s t ... c r i t i c i s m s made i n the o r i g i n a l Mental Measurements Yearbook reviews [the f i v e t r a i t s are s u b j e c t i v e conceptions and have no o b j e c t i v e a n a l y s i s to warrant them, and i t i s not known how w e l l the t e s t w i l l work wit h s u b j e c t s who do not admit to a l c o -holism] remain unanswered" (Campbell, 1965, p. 149). D i s c r e e t l y used on known a l c o h o l i c s i n a treatment s e t t i n g , r e s u l t s s i m i l a r to those d i s c u s s e d i n the manual can be expected; and i t may w e l l be a v a l u a b l e a d d i t i o n t o c l i n i c a l methods. The S h i p l e y - I n s t i t u t e of L i v i n g S c a l e . T h i s t e s t i s used f o r measuring i n t e l l e c t u a l impairment by a s s e s s i n g the r e l a t i v e i n t a c t n e s s of a b s t r a c t reasoning and v e r b a l a b i l i t i e s . Score values are generated i n the areas o f A b s t r a c t Reasoning ( A b s t r a c t i o n s ) , V e r b a l A b i l i t y (Vocabulary), Mental Age ( c a l l e d the T o t a l score, and can be matched to a Wechsler a d u l t i n t e l l i g e n c e IQ e q u i v a l e n t [Bortz & Loy, 1970]), and l a s t l y , the p r i n c i p a l score of the instrument, a s c a l e known as the Conceptual Quotient. T h i s l a s t score - the "CQ" - i s intended t o be an index o f i n t e l l e c t u a l impairment which has oc c u r r e d as a r e s u l t o f the p a r t i c u l a r d i s t u r b a n c e i n q u e s t i o n . A review by Yates i n Buros 1 Seventh Mental Measurements  Yearbook c r i t i c i z e d t h i s t e s t f o r i t s f a i l u r e to c o n t r o l f a c t o r s o f age, sex, and e d u c a t i o n a l l e v e l when producing the s t a n d a r d i z a t i o n data; and s t a t e d t h a t subsequent attempts to improve the t e s t by doing s t u d i e s on r e l i a b i l i t y and 40 v a l i d i t y "have not been p a r t i c u l a r l y encouraging o r c o n s i s t e n t " . S t i l l , the SILS has remained a popular c l i n i c a l instrument, probably due to i t s b r e v i t y ; and i s "a u s e f u l s c r e e n i n g d e v i c e or i n d i c a t o r of change where more i n t e n s i v e or d i r e c t experimental i n v e s t i g a t i o n i s not p o s s i b l e " (Yates, 1972, p. 322) . Design The data analysed i n t h i s study were gathered on the b a s i s of the b e l i e f t h a t each item was c o n t r i b u t i n g some unique i n f o r m a t i o n toward the c o m p i l a t i o n of a complete p r o f i l e on each c l i e n t (note t h a t a b a t t e r y of f i v e p s y c h o l o g i c a l t e s t s were a d m i n i s t e r e d ) . In other words, a l l t h i s i n f o r m a t i o n was b e l i e v e d to be necessary to enable the Center s t a f f to g a i n a f u l l , and accurate understanding of the nature of each i n d i v i d u a l ' s emotional, i n t e l l e c t u a l and b e h a v i o u r a l impairments; and f u r t h e r , from t h i s data, the Center s t a f f might be a b l e to p r e d i c t the l i k e l i h o o d of each c l i e n t ' s s u c c e s s f u l r e h a b i l i t a t i o n through t r e a t -ment. The s t a t i s t i c a l a n a l y s i s t h a t was c a r r i e d out was intended to show whether or not t h i s b e l i e f c o u l d be supported; and i f not, how then to a p p r o p r i a t e l y modify the i n f o r m a t i o n g a t h e r i n g process so t h a t o n l y the most r e l e v a n t v a r i a b l e s are d e a l t w i t h (e.g., the Center s t a f f might riot, have to g i v e a l l the t e s t s ) . \ , T h i s was a d e s c r i p t i v e and e x p l o r a t o r y study u s i n g 41 t e s t s f o r s i g n i f i c a n c e as w e l l as c o r r e l a t i o n a l and d i s -c r i m i n a n t f u n c t i o n procedures. I t i n v o l v e d the a n a l y s i s o f e x i s t i n g data i n order to determine the nature and degree of r e l a t i o n s h i p s among v a r i a b l e s . A l t o g e t h e r , the r e l a t i o n -s h i p s among 60 v a r i a b l e s were i n v e s t i g a t e d . Data were gathered and recorded by the Center s t a f f p r i o r to t h i s author's a s s o c i a t i o n w i t h the Center. The author put the data i n t o usable form so t h a t a computer a n a l y s i s c o u l d be conducted. No c l i e n t names were i n c l u d e d s i n c e i d e n t i -f i c a t i o n o f i n d i v i d u a l s was not necessary. T h i s was because a l l summary s t a t i s t i c s were to be presented as group summary s t a t i s t i c s . T o t a l c o n f i d e n t i a l i t y o f c l i e n t names and a s s o c i a t e d data were thus ensured. The data recorded and analyzed i n c l u d e d 59 independent v a r i a b l e s : (a) Age; (b) L e v e l o f Education; (c) M a r i t a l S t a t u s ; and (d) Duration of Treatment; p l u s t e s t s cores from (e) the MMPI (10 c l i n i c a l s c a l e s p l u s 3 of the 4 v a l i d i t y s c a l e s ) ; (f) the EPPS (16 s c a l e s ) ; (g) the 16PF (16 s c a l e s ) ; (h) the SILS (4 s c a l e s ) ; and (i) the ALCADD t e s t (6 s c a l e s ) . There was one dependent v a r i a b l e : a l c o h o l d r i n k i n g behaviour, measured 1 year a f t e r treatment. T h i s measure of treatment out-come was d i v i d e d i n t o two groups: (a) s u c c e s s f u l d r i n k e r s ( s u c c e s s e s ) ; and (b) u n s u c c e s s f u l d r i n k e r s ( f a i l u r e s ) . One of the s t a t i s t i c a l procedures used took i n t o account the l a r g e number of independent v a r i a b l e s and the r e l a t i v e l y s m a l l number, by comparison, of s u b j e c t s i n the sample. T h i s procedure was e f f e c t i v e l y a data r e d u c t i o n technique (employed to remove redundant v a r i a b l e s and thereby improve the r a t i o of the number of independent v a r i a b l e s to the number of sub j e c t s ) which looked f o r the most s a l i e n t independent v a r i a b l e s i n the sense of which of them had the g r e a t e s t p r e d i c t i v e c a p a b i l i t y . Step-wise m u l t i p l e r e g r e s s i o n a n a l y s i s would normally be used, except f o r the f a c t t h a t t h i s k i n d of a n a l y s i s r e q u i r e d the dependent v a r i a b l e to be both normally d i s t r i b u t e d and continuous i n nature. These c r i t e r i a were not met by the outcome (dependent) v a r i a b l e i n t h i s study. Therefore the a p p r o p r i a t e s t a t i s t i c a l procedure to use i n such a case as t h i s was a form of m u l t i p l e r e g r e s s i o n a n a l y s i s known as step-wise d i s c r i m i n a n t f u n c t i o n a n a l y s i s . D i s c r i m i n a n t a n a l y s i s then was the c e n t r a l i n f e r e n t i a l procedure f o l l o w e d f o r data a n a l y s i s i n t h i s study. A n a l y s i s of Data There were two types of s t a t i s t i c s rendered by a n a l y s i s : (a) d e s c r i p t i v e ; and (b) i n f e r e n t i a l . The d e s c r i p t i v e s t a t i s t i c s r e p o r t e d were: (a) means and standard d e v i a t i o n s (on each v a r i a b l e f o r each outcome category except f o r the one v a r i a b l e - m a r i t a l s t a t u s - where t h i s was i n a p p r o p r i a t e ) ; and (b) c o r r e l a t i o n c o e f f i c i e n t s : c r o s s - i n s t r u m e n t subscales (using those subscales chosen by d i s c r i m i n a n t a n a l y s i s . The i n f e r e n t i a l s t a t i s t i c s r e p o r t e d were: (a) Step One -d i s c r i m i n a n t a n a l y s i s o f the data r e s u l t i n g from the use of each instrument; (b) Step Two - d i s c r i m i n a n t a n a l y s i s of chosen subscales from the procedure, conducted under Step One; and (c) t - t e s t s and a Chi-square t e s t conducted on the a p p r o p r i a t e demographic data. Due to the l i m i t e d sample s i z e , the r e g r e s s i o n a n a l y s i s was c a r r i e d out i n s t a g e s . That i s , s e v e r a l step-wise d i s c r i m i n a n t f u n c t i o n analyses were conducted i n order to determine t h a t combination of v a r i a b l e s which l e d to maximum d i s c r i m i n a t i o n between the outcome groups i n a p r e d i c t i v e sense. In Step One, each of the instruments was examined s e p a r a t e l y to i d e n t i f y those t e s t s u b s c ales ( v a r i a b l e s ) t h a t c o n t r i b u t e d maximally to the s e p a r a t i o n . In Step Two, those v a r i a b l e s i d e n t i f i e d by the Step One process were combined together f o r a f u r t h e r d i s c r i m i n a n t f u n c t i o n a n a l y s i s to see f i n a l l y , which among them maximally d i s -c r i m i n a t e d between outcome groups, thereby o b t a i n i n g the most parsimonious s o l u t i o n . T h i s i n f e r e n t i a l procedure, i n a d d i t i o n to the d e s c r i p t i v e procedures: (a) e f f e c t i v e l y reduced the i n i t i a l number of independent v a r i a b l e s (59) to a much lower number (4) through e l i m i n a t i n g those o t h e r v a r i a b l e s t h a t , w h i l e not n e c e s s a r i l y redundant, d i d not c o n t r i b u t e i n any s i g n i f i c a n t degree to d i s c r i m i n a t i o n between outcome groups; and (b) because of the improved r a t i o of number of v a r i a b l e s to s u b j e c t s , i n c r e a s e d the a b i l i t y to d e t e c t r e a l d i f f e r e n c e s where they t r u l y e x i s t e d ( a v o i d i n g Type I e r r o r ) . T h i s a n a l y s i s c o n s t r u c t e d a l i n e a r combination of the s e t of v a r i a b l e s t h a t maximally d i s c r i m i n a t e d between the outcome groups w i t h the e f f e c t s of the l e s s r e l e v a n t v a r i a b l e s removed (Tatsuoka, 1970, p. 3 , 4 ) . CHAPTER IV Re s u l t s The data c o l l e c t e d d u r i n g the study were analysed s t a t i s t i c a l l y . R e s u l t s o f the analyses are r e p o r t e d i n t h i s chapter i n terms of the r e s e a r c h q u e s t i o n s t h a t were i n v e s t i g a t e d . Subjects Data were gathered f o r a n a l y s i s on 141 male a l c o h o l i c s These s u b j e c t s were assigned to one of two groups (success or f a i l u r e ) on the outcome ( c r i t e r i o n ) v a r i a b l e , namely, a l c o h o l d r i n k i n g behaviour 1 year a f t e r treatment. There were 65 s u b j e c t s c l a s s i f i e d as successes, and 76 s u b j e c t s c l a s s i f i e d as f a i l u r e s . Demographic Data Age, and l e v e l o f edu c a t i o n . The age range of the sample was 20 to 64 ye a r s . L e v e l o f educ a t i o n ranged from zero (no years o f s c h o o l i n g completed) to 7 years of Univer s i t y t r a i n i n g (19 years o f s c h o o l i n g completed). A t - t e s t f o r s i g n i f i c a n c e of the d i f f e r e n c e between the means was conducted f o r these two v a r i a b l e s . These were both two-t a i l e d t e s t s , and were c a r r i e d out at the .05 l e v e l of-s i g n i f i c a n c e . A c c o r d i n g to the r e s u l t , there was no 46 s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e f o r the age v a r i a b l e , nor was there a s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e f o r the l e v e l of education v a r i a b l e - Table 1 prese n t s these r e s u l t s , as w e l l as the means (X) and standard d e v i a t i o n s (s.d.) f o r the two v a r i a b l e s . TABLE 1 DESCRIPTIVE STATISTICS AND _t-TEST RESULTS FOR VARIABLES AGE AND LEVEL OF EDUCATION Va r i a b l e s Age L e v e l of Education X s.d. X s.d. 10.89 2.86 9.95 3.10 Outcome Success (65) a 41.97 8.42 Groups F a i l u r e (76) 41.29 11.11 t-Test df 139 139 t-value 0.40 1.89 2 - t a i l Prob. 0.69* 0.06 f i g u r e s i n parentheses are the numbers of subjects c l a s s i f i e d i n t o the r e s p e c t i v e outcome categories * a = 0.05 Due to the wide range of ages (20-64) r e p r e s e n t e d i n t h i s sample, and the l a c k o f s t a t i s t i c a l s i g n i f i c a n c e on the t - t e s t f o r t h i s v a r i a b l e , i t was thought t h a t by b r e a k i n g the . ages i n t o s m a l l e r groupings and running t - t e s t s on each of the refo r m u l a t e d groups, s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e s between the means might be found i n one or more of these groups. However, no s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e s between means were found on any of the f i v e age groups. These r e s u l t s are r e p o r t e d i n Table 2. M a r i t a l s t a t u s . A Chi-square t e s t of independence was c a r r i e d out on t h i s data (a = 0.05). When no s t a t i s -t i c a l l y s i g n i f i c a n t d i f f e r e n c e was found between the observed and expected f r e q u e n c i e s of the o r i g i n a l f i v e groups ( S i n g l e , M a r r i e d , Divorced, Separated, Widowed), these groups were c o l l a p s e d i n t o two groups ( S i n g l e , M a r r i e d , Widowed; and Divorced, Separated), and a second Chi-square a n a l y s i s was conducted. T h i s was done because i t was thought t h a t a p o s s i b l e , major reason f o r the p a r t i c u l a r m a r i t a l s t a t u s of the d i v o r c e d or separated men, was t h a t o f t h e i r e x h i b i t e d dependency on a l c o h o l . In other words, i t was supposed t h a t those who had experienced m a r i t a l a f f i l i a t i o n and l o s t i t due to a l c o h o l i s m , were more l i k e l y to be the f a i l u r e s on the outcome measure. T h i s c o n j e c t u r e was not supported by the second Chi-square a n a l y s i s . That i s , no s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e was found between the r e f o r m u l a t e d groups. These r e s u l t s are r e p o r t e d i n Tables 3 and 4. 48 TABLE 2 DESCRIPTIVE STATISTICS AND jt-TEST RESULTS FOR VARIABLE AGE: IN 5 GROUPS Age Outcome Groups _t-Test Groups Success F a i l u r e df t-value 2 - t a i l Prob. 1. £25 ( l ) a (8) X 25.00 22.75 7 1.16 0.29* s.d. 0.00 1.83 2. >25, £35 (14) (16) X 31.07 30.19 28 0.79 0.44 s.d. 2.81 3.27 3. >35, £45 (27) (24) X 40.52 41.50 49 -1.31 0.20 s.d. 2.77 2.55 4. >45, £55 (19) (20) X 49.63 50.60 37 -1.15 0.26* s.d. 2.54 2.72 5. >55, £65 (4) (8) X 57.75 58.13 10 -0.26 0.80* s.d. 1.26 2.70 .figures In parentheses are the number of subjects f a l l i n g into each age group by respective outcome category a = 0.05 49 TABLE 3 MATRIX OF OBSERVED AND EXPECTED FREQUENCIES ( x 2 ) OF MALE ALCOHOLICS ON VARIABLE MARITAL STATUS Groups S i n g l e Married Divorced Separated Widowed Row T o t a l Success 22(24) 12(9) 12(13) 16(17) 3(2) 65 F a i l u r e 31(29) 8(11) 16(15) 20(19) 1(2) 76 Column t o t a l 53 20 28 36 141 f i g u r e s i n parentheses are the c a l c u l a t e d expected frequencies X 2 = 3.51 w i t h 4 df p = 0.48 (a = 0.05) TABLE 4 MATRIX OF OBSERVED AND EXPECTED FREQUENCIES ( x 2 ) OF MALE ALCOHOLICS ON VARIABLE MARITAL STATUS: COLLAPSED GROUPS Groups 1. S i n g l e , Married, Widowed 2. Divorced, Separated Row t o t a l Success 37(36)' 28(29) 65 F a i l u r e 40(41) 36(35) 76 Column t o t a l 77 64 141 f i g u r e s i n parentheses are the c a l c u l a t e d expected frequencies X 2 = 0.12 w i t h 1 df p = 0.73 (a = 0.05) 50 Duration of Treatment There was a wide range i n the time spent i n treatment by the. s u b j e c t s (13 to 698 days). However, the t - t e s t (two-t a i l e d , a = .05) f o r s i g n i f i c a n c e o f d i f f e r e n c e between the means of the two groups on the outcome v a r i a b l e d i d not r e v e a l a s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e ( t - v a l u e o f 0.38 a s s o c i -ated with a p r o b a b i l i t y of 0.71). The r e s u l t s are r e p o r t e d i n Table 5. TABLE 5 DESCRIPTIVE STATISTICS AND t-TEST RESULTS FOR VARIABLE DURATION OF TREATMENT Variable Duration of Treatment X s.d. Outcome Groups Success (65)' Failure (76) 133.72 119.22 126.80 98.40 t-Test df _t-value 2-tail Prob. 139 0.38 0.71'' figures in parentheses are the numbers of subjects classified into the respective outcome categories a = 0.05 P s y c h o l o g i c a l Test Data The data which was generated through the use of each p s y c h o l o g i c a l instrument was recorded i n raw score form. (Raw scores were used f o r a n a l y s i s of the demographic data, the v a r i a b l e D uration of Treatment, and f o r the Pearson c o r r e l a t i o n s . ) However, i n order to make stepwise d i s -c r i m i n a n t f u n c t i o n a n a l y s i s of t h i s data meaningful, each s c a l e score was transformed i n t o a p r o p o r t i o n (because the m a j o r i t y of the s c a l e s had d i f f e r e n t score ranges). That i s , t h i s t r a n s f o r m a t i o n was made necessary i n order to be a b l e to make comparisons among the amounts of t o t a l unique v a r i a n c e c o n t r i b u t e d by each s c a l e ( v a r i a b l e ) , to the t o t a l system v a r i a n c e (of a l l independent v a r i a b l e s c o n s i d e r e d t o g e t h e r ) . Changing the raw scores i n t o meaningful p r o p o r t i o n s was accomplished by means of the A r c S i n t r a n s f o r m a t i o n (x^ = 2 [ A r c S i n (/x7) ]) , so t h a t one of the u n d e r l y i n g assump-t i o n s made when us i n g parametric t e s t s (that of a normal d i s t r i b u t i o n ) was not v i o l a t e d . Means and standard d e v i a t i o n s are r e p o r t e d i n p r o p o r t i o n a l form i n the s e c t i o n s which f o l l o w . D i s c r i m i n a n t a n a l y s i s , step one. A d i s c r i m i n a n t a n a l y s i s was performed on each of the f i v e p s y c h o l o g i c a l t e s t s . T h i s was done to improve the r a t i o of independent v a r i a b l e s to the sample N f o r the purpose of i n c r e a s i n g the a b i l i t y of the s t a t i s t i c a l analyses to d e t e c t r e a l d i f f e r e n c e s where they t r u l y e x i s t e d ( a v o i d i n g Type I e r r o r ) . The F-value to enter a v a r i a b l e i n t o the l i n e a r combination of the s e t of v a r i a b l e s d i s c r i m i n a t i n g between outcome groups was s e t a t 3 . 9 2 ( a = . 0 5 , df 1 and 1 4 0 ) . There were no v a r i a b l e s found to c o n t r i b u t e s i g n i f i c a n t l y t o d i s c r i m i n a t i o n between outcome groups f o r three of the f i v e 52 p s y c h o l o g i c a l t e s t s : (a) the A l c o h o l A d d i c t i o n Test (ALCADD); (b) the Edwards Personal P r e f e r e n c e Schedule (EPPS); and (c) the S h i p l e y - I n s t i t u t e of L i v i n g S c a l e (SILS). The means and standard d e v i a t i o n s of the two outcome groups f o r each v a r i a b l e w i t h i n these three t e s t s are r e p o r t e d i n Table 6, 7, and 8. These d e s c r i p t i v e s t a t i s t i c s i l l u s t r a t e how s i m i l a r the outcome groups are, throughout the su b s c a l e s of the t e s t s , and t h e r e f o r e why d i s c r i m i n a n t a n a l y s i s d i d not r e v e a l any v a r i a b l e ( s ) c o n t r i b u t i n g to s t a t i s t i c a l l y ' s i g n i f i c a n t d i s c r i m i n a t i o n between outcome groups (a - 0 . 0 5 ) . TABLE 6 MEANS AND STANDARD DEVIATIONS FOR 141 SUBJECTS ON EACH SUBSCALE (VARIABLE) OF THE ALCADD Groups Means Success F a i l u r e Standard Success Deviations F a i l u r e Subscales 1. Total 0.63 a 0.62 0.16 0.15 2. A 0.64 0.65 0.24 0.22 3. , B 0.66 0.66 0.22 0.21 4. C 0.67 0.65 0.16 0.16 5. D 0.56 0.57 0.22 0.20 6. E 0.57 0.59 0.21 0.17 N' 65 76 65 76 3 figures f o r the means and standard deviations are expressed i n proportional form 53 TABLE 7 MEANS AND STANDARD DEVIATIONS FOR 141 SUBJECTS ON EACH SUBSCALE (VARIABLE) OF THE EPPS Groups Means Success F a i l u r e Standard Deviations Success F a i l u r e Subscales 1. Achievement 0.52 a 0.51 2. Deference 0.44 0.46 3. Order 0.41 0.43 4. E x h i b i t i o n 0.46 0.44 5. Autonomy 0.53 0.56 6. A f f i l i a t i o n 0.43 0.44 7. I n t r a c e p t i o n 0.56 0.52 8. Succorance 0.37 0.37 9. Dominance 0.48 0.43 10. Abasement 0.52 0.56 11. Nurturance 0.54 0.53 12. Change 0.55 0.57 13. Endurance 0.56 0.58 14. H e t e r o s e x u a l i t y 0.64 0.58 15. Aggression 0.46 0.49 16. Consistency Score 0.76 0.76 0.15 0.13 0.16 0.14 0.17 0.15 0.16 0.18 0.20 0.20 0.18 0.18 0.17 0.20 0.17 0.16 0.15 0.13 0.17 0.14 0.15 0.15 0.18 0.16 0.17 0.16 0.20 0.15 0.20 0.22 0.17 0.13 65 76 65 76 f i g u r e s f o r the means and standard d e v i a t i o n s are expressed i n p r o p o r t i o n a l form 54 TABLE 8 MEANS AND STANDARD DEVIATIONS FOR 141 SUBJECTS ON EACH SUBSCALE (VARIABLE) OF THE SILS Groups Means Success F a i l u r e Standard D e v i a t i o n Success F a i l u r e Subscales 1. Vocabulary 0.76 a 0.73 0.13 0.17 2. A b s t r a c t i o n s 0.55 0.50 0.24 0.26 3. Wechsler IQ 0.75 0.71 0.12 0.16 4. Conceptual Quotient 0.47 0.45 0.08 0.12 N 65 76 65 76 a f i g u r e s f o r the means and standard d e v i a t i o n s are expressed i n p r o p o r t i o n a l form The d i s c r i m i n a n t a n a l y s i s performed on the Minnesota M u l t i p h a s i c P e r s o n a l i t y Inventory (MMPI) allowed three of the t h i r t e e n v a r i a b l e s to enter the d i s c r i m i n a n t f u n c t i o n ( e q u a t i o n ) . That i s , three v a r i a b l e s (subscales) were found to c o n t r i b u t e s i g n i f i c a n t l y (a = 0.05) to d i s c r i m i n a t i o n between the two outcome groups on the c r i t e r i o n v a r i a b l e . They were: (a) 'PA' - Paranoia; (b) 'MA'- Hypomania; and (c) 'Si' - S o c i a l I n t r o v e r s i o n . Table 9 r e p o r t s the means and standard d e v i a t i o n s of the outcome groups on a l l the su b s c a l e s o f t h i s t e s t . The r e s u l t s of the d i s c r i m i n a n t a n a l y s i s are r e p o r t e d i n Table 10, wit h the three v a r i a b l e s chosen by the 55 TABLE 9 MEANS AND STANDARD DEVIATIONS FOR 141 SUBJECTS ON EACH SUBSCALE (VARIABLE) OF THE MMPI Means Standard D e v i a t i o n Success F a i l u r e Success F a i l u r e Subscales 1. L 0.42 a 0.40 0.07 0.06 2. F 0.56 0.59 0.12 0.14 3. K 0.38 0.37 0.07 0.06 4. Hypochondriasis 0.50 0.51 0.13 0.14 5. Depression 0.58 0.59 0.14 0.13 6. Conversion H y s t e r i a 0.54 0.51 0.09 0.10 7. Psychopathic Deviate 0.61 0.61 0.10 0.09 8. M a s c u l i n i t y - F e m i n i n i t y 0.53 0.52 0.08 0.08 9. Paranoia 0.53 0.52 0.11 0.11 10. Psychasthenia 0.52 0.54 0.14 0.14 11. Schizophrenia 0.54 0.57 0.17 0.17 12. Hypomania 0.53 0.58 0.09 0.09 13. S o c i a l I n t r o v e r s i o n 0.46 0.49 0.10 0.11 N 65 76 65 76 f i g u r e s f o r the means and standard d e v i a t i o n s are expressed i n p r o p o r t i o n a l form d i s c r i m i n a n t a n a l y s i s l i s t e d i n the order of t h e i r d i s -c r i m i n a t o r y power. The U - s t a t i s t i c s (Wilk's Lambda) are a l s o r e p o r t e d i n t h i s Table, to c l a r i f y the r e l a t i o n s h i p between the independent v a r i a b l e s c o n s i d e r e d c o n c u r r e n t l y , and the c r i t e r i o n measure. These f i g u r e s r e p r e s e n t the r e s i d u a l v a r i a n c e ( 1 - R 2 ) . A c l a s s i f i c a t i o n m a t r i x i n d i -c a t i n g the percent of cases c o r r e c t l y i d e n t i f i e d (on the b a s i s of these three v a r i a b l e s ) when o r i g i n a l l y assigned an outcome "score" , i s r e p o r t e d i n Table 11. TABLE 10 ORDER OF ENTRY OF INDEPENDENT VARIABLES INTO DISCRIMINANT FUNCTION: MMPI (STEP ONE) Step V a r i a b l e Approximate Number Entered U - s t a t i s t i c F - s t a t i s t i c * df 1. (12) MA 0.92 12.07 1, 139 2. (13) SI 0.89 8.75 2, 138 3. (9) PA 0.83 9.19 3, 137 An F-value of 3.92 (a = 0.05) was required to enter (or remove) a v a r i a b l e i n t o (or from) the d i s c r i m i n a n t f u n c t i o n . The d i s c r i m i n a n t a n a l y s i s performed on the S i x t e e n P e r s o n a l i t y F a c t o r s Q u e s t i o n n a i r e (16 PF) allowed one of the s i x t e e n v a r i a b l e s to enter the d i s c r i m i n a n t f u n c t i o n ( e q u a t i o n ) . That i s , one v a r i a b l e (subscale) was found to c o n t r i b u t e s i g n i f i c a n t l y (a = 0 . 0 5 ) to d i s c r i m i n a t i o n between the 57 TABLE 11 MMPI CLASSIFICATION MATRIX FROM STEP ONE DISCRIMINANT ANALYSIS Group % c o r r e c t l y No. of cases c l a s s i f i e d i n t o group i d e n t i f i e d _ „ ., Success F a i l u r e Success 60.0 39 26 F a i l u r e 73.7 20 56 To t a l 67:4 59 82 two outcome groups on the c r i t e r i o n v a r i a b l e . I t was: ' N ' - F o r t h -r i g h t n e s s vs. Shrewdness. Table 12 r e p o r t s the means and standard d e v i a t i o n s o f the outcome groups on each v a r i a b l e i n t h i s t e s t . The r e s u l t s o f the d i s c r i m i n a n t a n a l y s i s are r e p o r t e d i n Table 13 (the U - s t a t i s t i c i s i n c l u d e d a g a i n ) . Table 14 i s the c l a s s i f i c a t i o n matrix based on the d i s -c r i m i n a t o r y power of v a r i a b l e ' N' from t h i s t e s t . D i s c r i m i n a n t a n a l y s i s , step two. In t h i s second step of the d i s c r i m i n a n t a n a l y s i s , a more parsimonious s o l u t i o n was sought. That i s , d i s c r i m i n a n t a n a l y s i s was performed on the four v a r i a b l e s entered through the Step One d i s c r i m i n a n t a n a l y s i s (MMPI: PA, MA, and SI; 16 PF : N) to see which of the f o u r v a r i a b l e s ( i f not a l l four) were r e t a i n e d as TABLE 12 MEANS AND STANDARD DEVIATIONS FOR 141 SUBJECTS ON EACH SUBSCALE (VARIABLE) OF THE 16 PF Groups Means Standard Deviations Success F a i l u r e Success F a i l u r e Subscales 1. A 0.58 a 0.58 0.23 0.25 2. B 0.63 0.62 0.20 0.19 3. C 0.38 0.37 0.20 0.20 4. E 0.56 0.59' 0.22 0.22 5. F 0.48 0.56 0.22 0.24 6. G 0.57 0.57 0.21 0.22 7. H 0.48 0.47 0.22 0.26 8. I 0.74 0.70 0.17 0.19 9. L 0.70 0.75 0.22 0.20 10. M 0.60 0.55 0.22 0.22 11. N 0.67 0.58 0.19 0.20 12. 0 0.77 0.78 0.22 0.22 13. Qx 0.64 0.66 0.23 0.20 14. Q 2 0.77 0.78 0.22 0.18 15. Q 3 0.60 0.54 0.19 0.21 16. Q 4 0.79 0.84 0.20 0.17 N 65 76 65 76 a f i g u r e s f o r the means and standard d e v i a t i o n s are expressed i n p r o p o r t i o n a l form 59 TABLE 13 VARIABLE ENTERED INTO DISCRIMINANT FUNCTION FROM THE 16 PF (STEP ONE) Step V a r i a b l e Approximate^ Number Entered U - s t a t i s t i c F - s t a t i s t i c df 1. (11) N 0.95 7.41 1, 139 An F-value of 3.92 (a = 0.05) was required to enter (or remove) a v a r i a b l e i n t o (or from) the d i s c r i m i n a n t f u n c t i o n . TABLE 14 16 PF CLASSIFICATION MATRIX FROM STEP ONE DISCRIMINANT ANALYSIS Group % c o r r e c t l y i d e n t i f i e d No. of cases c l a s s i f i e d i n t o group Success F a i l u r e Success F a i l u r e 35.4 76.3 23 18 42 58 T o t a l 57.4 41 100 c o n t r i b u t i n g to s t a t i s t i c a l l y s i g n i f i c a n t (a = 0 . 0 5 ) d i s c r i m i n a t i o n between the two outcome groups. A l l fo u r v a r i a b l e s were i n f a c t r e t a i n e d ( e n t e r e d ) . R e s u l t s o f t h i s a n a l y s i s are r e p o r t e d i n Table 1 5 , with the fo u r independent v a r i a b l e s chosen by the a n a l y s i s l i s t e d i n the order of t h e i r 60 d i s c r i m i n a t o r y power. Note t h a t the U - s t a t i s t i c s i n d i c a t e t h a t when the fou r independent v a r i a b l e s are co n s i d e r e d c o n c u r r e n t l y , they e x p l a i n 19.4% of the t o t a l v a r i a n c e on the c r i t e r i o n measure. F i n a l l y , Table 16 i s the c l a s s -i f i c a t i o n m a t r i x o f the perc e n t of cases c o r r e c t l y c l a s s i f i e d based on the d i s c r i m i n a t o r y power of these f o u r v a r i a b l e s . TABLE 15 ORDER OF ENTRY OF INDEPENDENT VARIABLES INTO DISCRIMINANT FUNCTION: MMPI & 16 PF (STEP TWO) Step Number V a r i a b l e Entered U - s t a t i s t i c s Approximate, * F - s t a t i s t i c df 1. (MMPI:12)MA 0.92 12.07 1, 139 ' 2. (16PF:11)N 0.89 8.80 2, 138 3. (MMPI:13)SI 0.85 7.90 3, 137 4. (MMPI: 9) PA 0.81 8.17 4, 136 An F-value of 3.92 (a = 0.05) was required to enter (or remove) a v a r i a b l e i n t o (or from) the d i s c r i m i n a n t f u n c t i o n . Pearson c o r r e l a t i o n m a t r i x . Pearson c o r r e l a t i o n co-e f f i c i e n t s were computed among.... the f o u r v a r i a b l e s (sub-sc a l e s ) entered i n t o the d i s c r i m i n a n t f u n c t i o n (equation). These c o e f f i c i e n t s were based on the obtained raw scores o f the 141 s u b j e c t s . The r e s u l t s of the c o r r e l a t i o n - r e p o r t e d i n Table 17 - i l l u s t r a t e the nature of the r e l a t i o n s h i p s i o f one s c a l e to another. Three of the c o r r e l a t i o n s are s i g n i f i c a n t , 61 TABLE 16 CLASSIFICATION MATRIX BASED ON VARIABLES CHOSEN THROUGH DISCRIMINANT ANALYSIS: STEP TWO (FROM THE MMPI & 16 PF) Group % c o r r e c t l y i d e n t i f i e d No. of cases c l a s s i f i e d into group Success F a i l u r e Success F a i l u r e 64.6 71.1 42 22 23 54 Total 68.1 64 77 but not s t r o n g (one of which i s i n a negative d i r e c t i o n ) , w h i l e the remaining three c o r r e l a t i o n s are not s i g n i f i c a n t ( a = 0 . 0 5 ) . . TABLE 17 PEARSON CORRELATION COEFFICIENTS OF VARIABLES ENTERED INTO DISCRIMINANT FUNCTION THROUGH DISCRIMINANT ANALYSIS: STEP TWO Variables PA MA SI PA MA SI N 0.37 0.30" 0.04 * - 0 . 0 6 - 0 . 1 6 0.03 S t a t i s t i c a l l y s i g n i f i c a n t (a " 0 .05) . 62 Summary None o f the demographic (independent) v a r i a b l e s r e v e a l e d any s t a t i s t i c a l s i g n i f i c a n c e w i t h regard to the c r i t e r i o n v a r i a b l e . That i s , the v a r i a b l e s of Age, and L e v e l of E d u cation, d i d not i n d i c a t e any s i g n i f i c a n t d i f f e r e n c e s between the means of the outcome groups through use of t - t e s t s . In a d d i t i o n , the Chi-square a n a l y s i s of the v a r i a b l e M a r i t a l S t a t u s , r e v e a l e d t h a t there was i n s u f f i c i e n t evidence to suggest t h a t the observed f r e q u e n c i e s were s i g n i f i c a n t l y d i f f e r e n t from the expected f r e q u e n c i e s . S i m i l a r to the r e s u l t s of a n a l y s i s of the demographic data, was the r e s u l t of the t - t e s t f o r s i g n i f i c a n c e of the d i f f e r e n c e between the means, performed on the v a r i a b l e D u r a t i o n of Treatment. That i s , no s i g n i f i c a n t d i f f e r e n c e between the means was d i s c o v e r e d . D i s c r i m i n a n t a n a l y s i s of the p s y c h o l o g i c a l t e s t s r e -vealed t h a t 4 of the 55 v a r i a b l e s were s i g n i f i c a n t l y r e l a t e d to treatment success, as measured by a l c o h o l d r i n k i n g behaviour 1 year a f t e r treatment. That i s , f o u r v a r i a b l e s (Paranoia, Hypomania, and S o c i a l I n t r o v e r s i o n - from the MMPI; and F o r t h r i g h t n e s s v s . Shrewdness - from the 16 PF ) c o n t r i b u t e d to s t a t i s t i c a l l y s i g n i f i c a n t (a.= 0.05) d i s c r i m i n a t i o n between the outcome groups on the c r i t e r i o n v a r i a b l e . These fo u r v a r i a b l e s , c o n s i d e r e d together, e x p l a i n e d approximately 20% of the t o t a l - v a r i a n c e on the c r i t e r i o n measure. They were a l s o able to c o r r e c t l y i d e n t i f y approximately 65% and 71% of the successes and f a i l u r e s r e s p e c t i v e l y . 63 Pearson c o r r e l a t i o n of the f o u r v a r i a b l e s entered i n t o the d i s c r i m i n a n t f u n c t i o n (equation) i l l u s t r a t e d the nature of the r e l a t i o n s h i p s among these s c a l e s . Two of the c o r r e l -a t i o n s were "low with a d e f i n i t e [ s i g n i f i c a n t ] but small r e l a t i o n s h i p " , and a t h i r d was " s l i g h t w i t h almost n e g l i g i b l e r e l a t i o n s h i p " ( G u i l f o r d , 1956, p. 145). The remaining three c o r r e l a t i o n s were not s i g n i f i c a n t . CHAPTER V Summary I t i s the purpose o f t h i s f i n a l chapter to present a b r i e f overview of the study conducted by r e s t a t i n g the purpose and the r e s e a r c h q u e s t i o n s , and by d e s c r i b i n g the s t a t i s t i c a l procedures used. The r e s u l t s o f the study as r e p o r t e d i n the p r e v i o u s chapter w i l l then be summarized, accompanied by an i n t e r p r e t i v e d i s c u s s i o n . Recommendations f o r f u r t h e r r e l a t e d r e s e a r c h or a c t i o n conclude the chapter. Restatement of the Purpose and Research Questions The purpose o f t h i s study was to determine the r e l a t i o n -s h i p o f c l i e n t pretreatment c h a r a c t e r i s t i c s to treatment outcome (measured i n terms of a l c o h o l d r i n k i n g behaviour 1 year a f t e r treatment) o f male a l c o h o l i c s who were admitted to a B r i t i s h Columbia a l c o h o l i s m treatment c e n t e r over the past 3 y e a r s . The data gathered p r i o r to treatment were the f o l l o w i n g : (a) Demographic data: (i) Age, ( i i ) M a r i t a l S t a t u s , ( i i i ) Level- o f E d u c a t i o n ; (b) P s y c h o l o g i c a l t e s t : d a t a : (i) the Minnesota M u l t i p h a s i c P e r s o n a l i t y Inventory, ( i i ) the Edwards P e r s o n a l P r e f e r -ence Schedule, ( i i i ) the S i x t e e n P e r s o n a l i t y F a c t o r s Q u e s t i o n n a i r e ; (iv) the A l c o h o l A d d i c t i o n T e s t , (v) the 64 S h i p l e y - I n s t i t u t e of L i v i n g S c a l e ; and (c) Duration o f Treatment,data. The outcome data were d e r i v e d from a l c o h o l i s m treatment c e n t e r s t a f f c o n s u l t a t i o n s about c l i e n t s ' a l c o h o l d r i n k i n g behaviour f o r a p e r i o d of 1 year a f t e r l e a v i n g treatment. I t was hoped t h a t the i n f o r m a t i o n r e s u l t i n g from s t a t i s t i c a l a n a l y s i s o f the data c o u l d be used as the b a s i s f o r development of a p r e d i c t i o n system f o r the Center. The r e s e a r c h q u e s t i o n s i n v e s t i g a t e d by means o f s t a t i s -t i c a l analyses were: 1. Which demographic and p s y c h o l o g i c a l v a r i a b l e s , t h a t i s , pretreatment c h a r a c t e r i s t i c s , s i g n i f i c a n t l y r e l a t e to treatment success as determined 1 year a f t e r treatment? 2. What i s the nature o f the c o r r e l a t i o n among the v a r i a b l e s chosen through step-wise d i s c r i m i n a n t a n a l y s i s ? 3. What i s the nature o f the r e l a t i o n s h i p between 'd u r a t i o n o f treatment' and treatment outcome? 4. Do the f i n d i n g s from r e s e a r c h q u e s t i o n 3 support H e i l b r u n ' s (1971) b e l i e f t h a t time i n treatment i s h i g h l y r e l a t e d to q u a l i t y of outcome, t h a t i s , subsequent d r i n k i n g behaviour? 5. W i l l the demographic and/or the p s y c h o l o g i c a l data p r o v i d e the b a s i s f o r the development of a system o f pr e -d i c t i o n of treatment e f f e c t i v e n e s s ? Summary of S t a t i s t i c a l Procedures Used 66 The r e l a t i o n s h i p o f c l i e n t pretreatment c h a r a c t e r i s t i c s to a l c o h o l d r i n k i n g behaviour 1 year a f t e r treatment was determined by conducting the f o l l o w i n g s t a t i s t i c a l a n a l y s e s . The t - t e s t s t a t i s t i c ( f o r s i g n i f i c a n c e of d i f f e r e n c e s between means) was c a l c u l a t e d f o r the v a r i a b l e s Age, L e v e l o f Education, and D u r a t i o n o f Treatment. The Chi-square t e s t of independence was conducted on the v a r i a b l e M a r i t a l S t a t u s , s i n c e t h i s was i n the form of frequency data. An A r c S i n t r a n s f o r m a t i o n was performed on the p s y c h o l o g i c a l t e s t data due to d i f f e r i n g score ranges (so t h a t the unique amounts of v a r i a n c e c o n t r i -buted by each v a r i a b l e to the t o t a l c o u l d be p r o p e r l y compared). Step-wise d i s c r i m i n a n t a n a l y s i s was then c a r r i e d out on the f i v e p s y c h o l o g i c a l t e s t s . T h i s was done i n two steps i n order to improve the r a t i o of number of v a r i a b l e s to number of sub-j e c t s . Step One d i s c r i m i n a n t analyses were conducted on the data from each p s y c h o l o g i c a l t e s t i n d i v i d u a l l y , t o see which v a r i a b l e s ( i f any) would be found to be c o n t r i b u t i n g to s t a t i s t i c a l l y s i g n i f i c a n t (a = 0.05) d i s c r i m i n a t i o n between outcome groups. Any v a r i a b l e s found to r e l a t e t o the outcome measure i n t h i s way (there were four) were then analysed i n a second d i s c r i m i n a n t a n a l y s i s (Step Two) seeking the most parsimonious s o l u t i o n . F i n a l l y , Pearson c o r r e l a t i o n c o e f f i -c i e n t s were c a l c u l a t e d among the v a r i a b l e s t h a t were entered i n t o the d i s c r i m i n a n t f u n c t i o n by means of the second step d i s c r i m i n a n t a n a l y s i s . 67 I n t e r p r e t i v e Summary of R e s u l t s The f i r s t r e s e a r c h q u e s t i o n was: Which demographic and p s y c h o l o g i c a l v a r i a b l e s , t h a t i s , pretreatment c h a r a c t e r i s t i c s , s i g n i -f i c a n t l y r e l a t e to treatment success as determined 1 year a f t e r treatment? On the b a s i s of the Chi-square and t - t e s t s performed on the demographic data, none of the demographic v a r i a b l e s were found to have a s i g n i f i c a n t r e l a t i o n s h i p w i t h the outcome measure ( a l c o h o l d r i n k i n g behaviour) . T h i s was somewhat s u r p r i s i n g when the l i t e r a t u r e c i t e d i n Chapter IT i s c o n s i d e r e d . While none of the r e p o r t e d s t u d i e s found c l i e n t ' s age to be s i g n i f i c a n t l y r e l a t e d to outcome, being married was found to r e l a t e s i g n i f i c a n t l y to outcome ( M i n d l i n , 1959; and Zimberg, 1974), as was l e v e l of e d u c a t i o n (H e i l b r u n , 1971). The d i s c r i m i n a n t analyses c a r r i e d out on the r e s u l t s of the p s y c h o l o g i c a l t e s t s g i v e the answer to the second h a l f of the r e s e a r c h q u e s t i o n . Only f o u r p s y c h o l o g i c a l v a r i a b l e s were found to s i g n i f i c a n t l y r e l a t e to the outcome measure, and i n f a c t , were able to d i s c r i m i n a t e s i g n i f i c a n t l y between the outcome groups. Three of these v a r i a b l e s were from the MMPI (MA, PA, & SI) and one from the 16 PF (N). None of the data from the three other t e s t s (the EPPS, ALCADD, or the SILS) r e v e a l e d any subscales r e l a t i n g s i g n f i c a n t l y to the outcome measure. This l a t t e r outcome may seem reasonable i n the case of 68 the EPPS, s i n c e i t i s a t e s t designed f o r use on normal p o p u l a t i o n s , not f o r p o p u l a t i o n s t h a t may be m a n i f e s t i n g some s o r t o f p e r s o n a l i t y d y s f u n c t i o n . While attempts have been made to e s t a b l i s h norms f o r a l c o h o l i c p o p u l a t i o n s w i t h t h i s t e s t ( F i t z g e r a l d , Pasewark, & Tanner, 1967; Goss, Morosko, & Sheldon, 1968; Manaugh & S c o t t , 1976; and Pryer & Di s t e f a n o , 1970), accomplishing t h i s does not n e c e s s a r i l y mean t h a t the EPPS s c a l e s w i l l be able to p r e d i c t treatment outcome f o r a l c o h o l i c s . On the b a s i s of the use of the EPPS i n t h i s study, i t can be s t a t e d t h a t a l c o h o l i c s who are successes or f a i l u r e s with regard to t h e i r a l c o h o l d r i n k i n g behaviour a f t e r treatment, do not d i f f e r s i g n i f i c a n t l y i n terms of t h e i r m o t i v a t i o n s f o r behaviour. I t i s i n t e r e s t i n g then to c o n s i d e r the f i n d i n g t h a t s c a l e 1N 1 ( F o r t h r i g h t vs. Shrewd) from the 16 PF was found to a i d i n d i s c r i m i n a t i n g between the outcome groups. L i k e the EPPS, the 16 PF i s intended f o r use with a normal p o p u l a t i o n . When Table 17 i s looked a t , i t can be seen t h a t s c a l e 1N' c o r r e l a t e s s i g n i f i c a n t l y , but wit h a v i r t u a l l y n e g l i g i b l e r e l a t i o n s h i p (r = -0.16, p < .05), w i t h o n l y one of the three MMPI s c a l e s (MA) t h a t are s i g n i f i c a n t l y r e l a t e d to the outcome measure. I t i s p o s s i b l e t h a t t h i s i s a chance r e s u l t . Note too, t h a t i t i s a neg a t i v e c o r r e l a -t i o n , which might p r o p e r l y be expected when comparing the kinds of p o p u l a t i o n s the two t e s t s were designed f o r (16PF - normal p o p u l a t i o n ; MMPI - p a t h o l o g i c a l p o p u l a t i o n ) . 69 In a d d i t i o n , the d e s c r i p t i o n s of s c a l e 'N' (I.P.A.T., 1972) do not seem to be the k i n d of d e s c r i p t o r s t h a t are a p p l i c a b l e to an a l c o h o l i c p o p u l a t i o n . For example, on one end of the s c a l e , a ' F o r t h r i g h t ' i n d i v i d u a l may be d e s c r i b e d as u n s o p h i s t i c a t e d , n a t u r a l , s e n t i m e n t a l , simple, spontaneous and e a s i l y contented; w h i l e at the other end of the s c a l e , a 'Shrewd' i n d i v i d u a l may be d e s c r i b e d as c a l c u l a t i n g , s o c i a l l y aware, experienced, w o r l d l y , a n a l y t i c a l , u nsentimental, and almost c y n i c a l . With the ex c e p t i o n of s c a l e 'N' then, the r e s u l t s of t h i s study i n d i c a t e t h a t a l c o h o l i c s who are suc-cesses or f a i l u r e s i n terms of a l c o h o l d r i n k i n g behaviour a f t e r treatment, do not d i f f e r s i g n i f i c a n t l y on measures of unique p e r s o n a l i t y c h a r a c t e r i s t i c s t h a t are u s u a l l y employed to d e s c r i b e a "normal" person. None of the subscales ( v a r i a b l e s ) from the ALCADD were found to r e l a t e s i g n i f i c a n t l y to the outcome measure. While t h i s t e s t was s p e c i f i c a l l y designed to be abl e to i d e n t i f y a l c o h o l i c s , there i s no evidence from Buros' Mental  Measurements Yearbooks t h a t attempts have been made, succe s s -f u l l y or otherwise, to determine whether or not t h i s t e s t can be used e f f e c t i v e l y to p r e d i c t treatment outcomes. The r e s u l t s of t h i s study r e g a r d i n g the i n a b i l i t y of the ALCADD to d i s c r i m i n a t e between outcome groups, t h a t i s , to p r e d i c t treatment outcome i n terms of a l c o h o l d r i n k i n g behaviour, must then be taken as r e p r e s e n t a t i v e o f the c u r r e n t s t a t e o f knowledge i n t h i s area. None of the subscales of the SILS were found to r e l a t e 70 s i g n i f i c a n t l y to the outcome measure e i t h e r . T h i s t e s t was designed to provide an index of i n t e l l e c t u a l impairment r e s u l t i n g from a p a r t i c u l a r d i s t u r b a n c e i n q u e s t i o n ( i n t h i s case, a l c o h o l i s m ) . T h e r e f o r e , on the b a s i s of the f i n d i n g s of t h i s study, i t can be s t a t e d t h a t a l c o h o l i c s who are successes or f a i l u r e s i n terms of t h e i r a l c o h o l d r i n k i n g behaviour a f t e r treatment, do not d i f f e r s i g n i f i c a n t l y on the measures of i n t e l l e c t u a l impairment. The f i n d i n g s of t h i s study r e g a r d i n g the SILS can be compared with those of H e i l b r u n ' s study (1971), i n which he found the Wechsler IQ e q u i v a l e n t a s s o c i a t e d with the SILS t e s t scores to be p r e d i c t i v e of outcome. T h i s IQ estimate assesses a b s t r a c t i o n and vocabulary a b i l i t i e s , on the b a s i s of comparing an a b i l i t y ( a b s t r a c t i o n ) assumed.-to.'.disintegrate s e r i o u s l y and r a p i d l y i n the face of mental d e t e r i o r a t i o n , w i t h an a b i l i t y (vocabulary) b e l i e v e d to be but s l i g h t l y a f f e c t e d . Since the present study shows t h a t the outcome groups do not d i f f e r s i g n i f i c a n t l y i n terms of i n t e l l e c t u a l impairment, t h i s r e s u l t may simply be s u p p o r t i v e of the f a c t t h a t the MMPI (a t e s t designed to assess i n t r a p s y c h i c pathology, and not i n t e l l e c t u a l impairment) does have s e v e r a l s c a l e s t h a t s u c c e s s f u l l y d i s c r i m i n a t e between the outcome groups. (In other words, i f the outcome groups i n t h i s study are d i f f e r i n g i n terms of i n t r a p s y c h i c pathology, t h a t i s , p e r s o n a l i t y d y s f u n c t i o n , then i t i s probably t r u e t h a t they would not d i f f e r i n terms of i n t e l l e c t u a l f u n c t i o n i n g . ) The f a c t t h a t 71 these r e s u l t s d i f f e r from H e i l b r u n ' s f i n d i n g s may t h e r e f o r e be due to h i s p o p u l a t i o n d i f f e r i n g i n terms o f i n t e l l e c t u a l f u n c t i o n i n g . Three s c a l e s of the MMPI were found to be c o n t r i b u t i n g to s i g n i f i c a n t (a =.0.0.5) d i s c r i m i n a t i o n between the outcome groups. These s c a l e s were: (a) 'MA' -Hypomania; (b) 'PA' - Paranoia; and (c) 'SI' - S o c i a l I n t r o v e r s i o n . They are d e s c r i b e d as f o l l o w s : (a) Hypomania - c h a r a c t e r i z e d by o v e r a c t i v i t y , emotional excitement, and f l i g h t of id e a s ; the a c t i v i t y i s f r e q u e n t l y i n e f f i c i e n t and unproductive; these people can be e m o t i o n a l l y euphoric or i r r i t a b l e , and temper outbursts are frequent; the enthusiasm and overoptimism leads to t a k i n g on more than they can handle; (b) Paranoia - i n v o l v e s a s e t of d e l u s i o n a l b e l i e f s , showing m i s p e r c e p t i o n s or m i s i n t e r p r e t a t i o n s o f t h e i r l i f e s i t u a t i o n s t h a t are markedly out of keeping w i t h t h e i r a b i l i t y and i n t e l l i g e n c e ; and (c) S o c i a l I n t r o v e r i o n -d e s c r i p t i v e o f a person's ease or uneasiness i n s o c i a l s i t u a t i o n s o r i n t e r p e r s o n a l r e l a t i o n s , c o v e r i n g a v a r i e t y o f s e n s i t i v i t i e s , i n s e c u r i t i e s , and w o r r i e s ; high scores tend to be made up of s o c i a l i s o l a t i o n components and/or m a l a d j u s t -ment and s e l f - d e p r e c i a t o r y components ( i n t r o v e r s i o n ) . In support o f the f i n d i n g s of t h i s study w i t h regard to the MMPI, H e i l b r u n (1971) a l s o found t h a t the MMPI s c a l e , Hypomania, was p r e d i c t i v e of outcome. However, a l l the oth e r sources c i t e d i n the review of the l i t e r a t u r e r e l e v a n t to t h i s study (Straus & Bacon, 1951; M i n d l i n , 1959; Gatschenberger/ 197 3; Lowe & Thomas, 1973; and Zimberg, 19 74), r e v e a l e d t h a t i n d i c e s of s o c i a l s t a b i l i t y ( b u i l t on demographic data) were more commonly the b e s t p r o g n o s t i c i n d i c a t o r s of treatment outcome, r a t h e r than p s y c h o l o g i c a l t e s t d ata. T h i s study has found j u s t the o p p o s i t e . T h i s i s probably due to the f a c t t h a t the other s t u d i e s s e t out i n the f i r s t i n s t a n c e to d i s c o v e r v a r i a b l e s t h a t would be p r e d i c t i v e of outcome, and t h e r e f o r e l i k e l y b u i l t t h e i r systems, which they then t e s t e d , based on those v a r i a b l e s which the l i t e r a t u r e suggested to them would most l i k e l y have p r e d i c t i v e c a p a b i l i t i e s . T h i s study on the other hand, took a p r e - e x i s t i n g s e t of data which was being used f o r t h e r a p e u t i c purposes, and examined i t to determine whether or not p r e d i c t i v e c a p a b i l i t i e s were i n h e r e n t i n the data. The data r e p o r t e d i n Table 15 of Chapter IV, r e v e a l s t h a t these f o u r p s y c h o l o g i c a l t e s t v a r i a b l e s (MA, N, SI, and PA), c o n s i d e r e d together, e x p l a i n 19% of the t o t a l v a r i a n c e of the c r i t e r i o n measure. T h i s seems to be supported by the data r e p o r t e d i n Table 16, which i n d i c a t e s t h a t a l t o g e t h e r , approximately 68% of the s u b j e c t s were c o r r e c t l y c l a s s i f i e d on the b a s i s of the d i s c r i m i n a t o r y power of these f o u r v a r i a b l e s . Since i t c o u l d be expected t h a t 50% of the s u b j e c t s would have been c o r r e c t l y c l a s s i f i e d on the b a s i s of chance alone, the 19% of v a r i a n c e e x p l a i n e d by these v a r i a b l e s f i t s with the improved percentage of c o r r e c t c l a s s i f i c a t i o n s o f approximately 18% over the 50% e x p e c t a t i o n by chance. I t should be f u r t h e r noted t h a t when the Table 16 data i s more c l o s e l y examined, i t i s seen t h a t these f o u r v a r i a b l e s were able to c o r r e c t l y c l a s s i f y the f a i l u r e group on the c r i t e r i o n v a r i a b l e , s l i g h t l y more o f t e n than the successes ( 7 1 . 1 % vs. 6 4 . 6 % r e s p e c t i v e l y ) . The second r e s e a r c h q u e s t i o n was: What i s the nature of the c o r r e l a t i o n among the v a r i a b l e s chosen through step-wise d i s c r i m i n a n t a n a l y s i s ? There were s i x Pearson c o r r e l a t i o n c o e f f i c i e n t s which r e s u l t e d from c o r r e l a t i n g the four v a r i a b l e s w i t h one another (PA, MA, SI, N );; Three of the s i x c o r r e l a t i o n s were s i g n i f i -cant but the r e l a t i o n s h i p wasnot s t r o n g (Table -17 > Chapter" IV). This i n d i c a t e d t h a t the v a r i a b l e s were rankin g the s u b j e c t s d i f f e r e n t l y and may. i n v o l v e the measuring at d i v e r g e n t or d i f f e r e n t c o n s t r u c t s . From the MMPI, the s c a l e s 'MA' and 'PA* c o r r e l a t e d w i t h a v a l u e of 0 . 3 7 (p < . 0 0 1 ) . T h i s i s supported by Marks, Seeman and H a l l e r ( 1 9 7 4 ) , and Good and Brantner ( 1 9 7 4 ) who have r e p o r t e d t h a t these two s c a l e s are o f t e n a s s o c i a t e d with one another i n c l i n i c a l p r o f i l e s . S c a l e s 'PA' and 'SI' c o r r e l a t e d with a v a l u e of 0 . 3 0 (p < . 0 0 1 ) . These are not r e p o r t e d as a s s o c i a t e d with one another i n c l i n i c a l p r o f i l e s , but there i s no r e a l evidence on the matter s i n c e the SI s c a l e was not i n c l u d e d i n e a r l y code frequency t a b u l a t i o n s s u f f i c i e n t l y o f t e n to enable c l i n i c i a n s to g a i n an a p p r e c i a t i o n of i t s occurrence i n v a r i o u s p o p u l a t i o n s (Dahlstrom, Welsh & Dahlstrom, 1 9 7 2 ) . However, s u b j e c t i v e thought may e a s i l y c o n c e p t u a l i z e a r e l a t i o n s h i p , though not n e c e s s a r i l y a s t r o n g one (as per the present d a t a ) , between s o c i a l i n t r o v e r s i o n and p a r a noia. The s c a l e s 'MA' (from the MMPI) and 'N' (from the 16 PF ) a l s o c o r r e l a t e d . The c o r r e l a t i o n c o e f f i c i e n t was -0.16(p < .026). I t was suggested e a r l i e r t h a t t h i s s i g n i -f i c a n t , though v i r t u a l l y n e g l i g i b l e r e l a t i o n s h i p , may i n r e a l i t y be a s i g n i f i c a n t c o r r e l a t i o n by chance. In o t h e r words, i t was f e l t t h a t t h i s s c a l e (N), as w i t h the o t h e r s from the 16 PF would be more e f f e c t i v e when a p p l i e d to a normal p o p u l a t i o n such as i t was o r i g i n a l l y intended. The o t h e r three c o r r e l a t i o n s were not s i g n i f i c a n t . The c o r r e l a t i o n c o e f f i c i e n t (r) between 'N' and 'PA' was 0.04 (p < .315); between 'SI' and 'MA', -0.06(p < .234); and between 'N' and 'SI', 0.03 (p < .339). A few moments c o n s i d e r a t i o n of the d e s c r i p t i o n s of persons who score h i g h l y on these p a i r s of s c a l e s , does not r e a d i l y suggest reasons why these s c a l e s might have been expected to c o r r e l a t e s i g n i f i c a n t l y . In o t h e r words, i t appears f u l l y reasonable t h a t they might not c o r r e l a t e s i g n i f i c a n t l y w i t h one another. The Pearson c o r r e l a t i o n s should not be expected to add support to the f i n d i n g s which r e s u l t e d from the d i s c r i m i n a n t a n a l y s e s . That i s , these c o r r e l a t i o n c o e f f i c i e n t s do not n e c e s s a r i l y support the r e s u l t s of the d i s c r i m i n a n t a n a l y s e s . I t i s o n l y p o s s i b l e to s t a t e what the nature of the r e l a t i o n -s h i p s are. The t h i r d and f o u r t h r e s e a r c h q u e s t i o n s were: What i s the nature of the r e l a t i o n s h i p between 'duration of treatment' and treatment outcome? and, Do the f i n d i n g s from r e s e a r c h q u e s t i o n 3 support H e i l b r u n ' s (1971) b e l i e f t h a t time i n treatment i s h i g h l y r e l a t e d to q u a l i t y of outcome, t h a t i s , subsequent d r i n k i n g behaviour? The t - t e s t f o r s i g n i f i c a n c e o f d i f f e r e n c e between the means of the outcome groups on the Duration o f Treatment v a r i a b l e , r e v e a l e d no s i g n i f i c a n t r e l a t i o n s h i p . T h i s f i n d i n g was i n v e s t i g a t e d f u r t h e r by means of a hand-check of the raw data, w i t h the purpose of determining whether or not extreme scores a t e i t h e r end of the d i s t r i b u t i o n may have a f f e c t e d the t - t e s t r e s u l t s (the range was 13 to 698 days, and the means of the two groups were 134, and 127 da y s ) . T h i s search proved negative as i t became c l e a r t h a t the v a r i o u s amounts of time spent i n treatment were f a i r l y evenly d i s t r i b u t e d . While the f i n d i n g o f no s i g n i f i c a n t d i f f e r e n c e between the means of the two outcome groups f o r the v a r i a b l e , D u ration o f Treatment, do not l e n d support to H e i l b r u n ' s b e l i e f t h a t time i n treatment i s h i g h l y r e l a t e d to q u a l i t y of outcome ( i n t h i s case, subsequent d r i n k i n g b e h a v i o u r ) , i t does not negate h i s b e l i e f e i t h e r . I t i s p o s s i b l e t h a t both the e a r l y drop-outs from treatment at the a l c o h o l i s m treatment c e n t e r ( < 60 days) as w e l l as the long term remainers ( > 200 days) are s e l f - s e l e c t i n g on some other b a s i s such as d i f f e r e n c e s i n some p a t h o l o g i c a l sense (as compared to being d i f f e r e n t i a t e d on the b a s i s of q u a l i t y of outcome). In other words then, extreme s c o r e r s i n t h i s sample may be p a t h o l o g i c a l l y d i f f e r e n t from those who c l u s t e r e d c l o s e r to the means of time spent i n treatment by the two outcome group 76 The f i n a l r e s e a r c h q u e s t i o n was: W i l l the demographic and/or the p s y c h o l o g i c a l data p r o v i d e the b a s i s f o r the development of a system of p r e d i c t i o n of treatment e f f e c t i v e n e s s ? I t i s d i f f i c u l t to answer t h i s q u e s t i o n w i t h an unqual-i f i e d yes or no. The s t a t i s t i c a l procedures conducted on the data d i d i n f a c t r e v e a l four p s y c h o l o g i c a l v a r i a b l e s c o n t r i b u t i n g to s i g n i f i c a n t ( a = 0 . 0 5 ) d i s c r i m i n a t i o n between outcome-groups. Therefore i t can be s t a t e d t h a t a b a s i s f o r the development of a system of p r e d i c t i o n may e x i s t . But a caveat must accompany t h i s statement. The s t a f f at the a l c o h o l i s m t r e a t -ment ce n t e r must c a r e f u l l y c o n s i d e r how good a b a s i s these four v a r i a b l e s do i n f a c t p r o v i d e when i t i s known t h a t the f o u r v a r i a b l e s together can only e x p l a i n 19% of the t o t a l v a r i a n c e on the c r i t e r i o n measure. Recommendations The r e s u l t s of t h i s study are important i n t h a t they have shown t h a t i t i s p o s s i b l e to f i n d pretreatment c h a r a c t e r -i s t i c s of male a l c o h o l i c s t h a t are capable of d i s c r i m i n a t i n g between groups of successes and f a i l u r e s i n terms of t h e i r a l c o h o l d r i n k i n g behaviour, 1 year a f t e r treatment. These c h a r a c t e r i s t i c s can be employed f o r the purpose of d e v e l o p i n g a system of p r e d i c t i o n of the l i k e l i h o o d of f u t u r e candidates f o r treatment being s u c c e s s f u l l y r e h a b i l i t a t e d from t h e i r dependency or a l c o h o l , or not. The r e s u l t s of t h i s study then, are s u p p o r t i v e of the f i n d i n g s of other s t u d i e s t h a t have attempted to develop systems of p r e d i c t i o n (Straus & Bacon, 1951; M i n d l i n , 1959; H e i l b r u n , 1971; Gatschenberger, 1973; Lowe & Thomas, 1973; and Zimberg, 1974), although they may have d i f f e r e d i n the s p e c i f i c c h a r a c t e r i s t i c s found to be most p r e d i c t i v e of posttreatment adjustment. At the same time, the r e s u l t s of t h i s study are important i n t h a t they suggest areas f o r f u r t h e r r e s e a r c h or a c t i o n . These i n c l u d e the f o l l o w i n g recommendations. (The purpose of the f i r s t two r e s e a r c h recommendations which f o l l o w i s to d i s c o v e r pretreatment c h a r a c t e r i s t i c s , t h a t when used i n a system of p r e d i c t i o n , w i l l be able to e x p l a i n a s u b s t a n t i a l l y i n c r e a s e d p r o p o r t i o n of the t o t a l v a r i a n c e on the outcome measure.) Research: (a) expand the pretreatment i n f o r m a t i o n g a t h e r i n g process to i n c l u d e a broader spectrum of i n d i c e s of s o c i a l , f a m i l i a l , and economic f u n c t i o n i n g ( i n i n t e r a c t i o n w i t h l i t e r a t u r e which have shown other items to be p r e d i c t i v e l y u s e f u l ) , i n order to d i s c o v e r demographic c h a r a c t e r i s t i c s t h a t have power to d i s c r i m i n a t e between outcome groups, and which t h e r e f o r e c o u l d be i n c l u d e d i n the development of a system of p r e d i c t i o n f o r use w i t h the p o p u l a t i o n of a l c o h o l i c s being served by the a l c o h o l i s m treatment c e n t e r . (A d e c i s i o n must be made by the s t a f f a t the Center as to the u t i l i t y of the i n f o r m a t i o n from the present demographic and p s y c h o l o g i c a l t e s t data being gathered. I f the purpose of g a t h e r i n g i n f o r m a t i o n p r i o r to treatment i s to be focused on the development of a system o f 78 p r e d i c t i o n , then t h i s study has shown 4 of the t o t a l of 59 v a r i a b l e s t h a t may be u s e f u l to t h a t end, and t h e r e f o r e time need not be spent i n g a t h e r i n g data on the remaining 55 v a r i a b l e s . ) (b) r e p e t i t i o n of t h i s study u s i n g other p s y c h o l o g i c a l instruments which might p o s s i b l y have power to d i s c r i m i n a t e between outcome groups. (c) the d e s i g n i n g of a study to i n c l u d e both s h o r t and long term treatments of p r e d i c t e d successes, where c l i e n t s are randomly assigned to one of the treatments, i n order to f u r t h e r i n v e s t i g a t e H e i l b r u n ' s (1971) b e l i e f t h a t time i n treatment i s h i g h l y r e l a t e d to q u a l i t y of outcome. (d) whereas t h i s study has used a compensatory model of step-wise d i s c r i m i n a n t a n a l y s i s (that allowed any two i n -d i v i d u a l s to vary g r e a t l y i n t h e i r raw scores on the f o u r v a r i a b l e s which c o n t r i b u t e d maximally to d i s c r i m i n a t i o n between outcome groups, and y e t both be p r e d i c t e d as successes or f a i l u r e s ) , f u r t h e r r e s e a r c h designed to produce s p e c i f i c c u t - o f f p o i n t s ( c o n j u n c t i v e model) on these v a r i a b l e s (above or below which a person i s c o n s i d e r e d a success or f a i l u r e ) i s d e s i r a b l e . 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