UBC Theses and Dissertations

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UBC Theses and Dissertations

The relationship of change in drinking behaviour to change in other areas of behaviour in a sample of… Clarke, Garfield Grant 1964

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THE  RELATIONSHIP  OF  C H A N G E IN DRINKING  T O C H A N G E IN OTHER A R E A S IN A  SAMPLE  OF  OF A L C O H O L I C  BEHAVIOUR  BEHAVIOUR PATIENTS  by GARFIELD  GRANT C L A R K E  B . A , , The University of British Columbia,  1962  A THESIS SUBMITTED IN P A R T I A L F U L F I L M E N T OF T H E REQUIREMENTS FOR T H E D E G R E E OF M A S T E R OF A R T S in the Department of Anthropology and Sociology  We accept this thesis as conforming to the required standard  T H E UNIVERSITY OF BRITISH COLUMBIA April,  1964  In presenting the  requirements  British  Columbia,,  available mission  for  for  for  I  agree  reference  extensive  representatives.  cation  of  Department  of  that  A p r i l 24.  c o p y i n g of  I  this  f u l f i l m e n t of  the U n i v e r s i t y o f •' s h a l l make i t  further thesis  agree for  for  is  understood  per-  scholarly or by  t h a t ; c o p y i n g or  f i n a n c i a l g a i n s h a l l not  permission*  freely  that  by the. Head o f my Department  Anthropology and Sociology  1964  at  the-Library  The U n i v e r s i t y of B r i t i s h C o l u m b i a , V a n c o u v e r 8,, C a n a d a Date  in partial  degree  and s t u d y .  It  this .thesis  w i t h o u t my w r i t t e n  thesis  an a d v a n c e d  p u r p o s e s may b e . g r a n t e d his  this  publi-  be a l l o w e d  ABSTRACT  T h e A l c o h o l i s m F o u n d a t i o n of B r i t i s h C o l u m b i a b a s e s i t s treatment programme  on the b e l i e f that the a b n o r m a l d r i n k i n g b e -  h a v i o u r of a n a l c o h o l i c i s i m p o r t a n t l y r e l a t e d to h i s f u n c t i o n i n g i n o t h e r a s p e c t s of l i f e .  The r e s e a r c h  reported here is an attempt  establish e m p i r i c a l l y whether i n fact a relationship exists  to  between  c h a n g e i n d r i n k i n g b e h a v i o u r a n d c h a n g e i n o t h e r b e h a v i o u r of a s a m p l e of a l c o h o l i c  patients.  T h e data w e r e g a t h e r e d a s p a r t of a p r o j e c t d e s i g n e d to e v a l u a t e t h e e f f e c t i v e n e s s of the t r e a t m e n t p r o g r a m m e Foundation.  of the A l c o h o l i s m  T h i s p r o j e c t i n v o l v e d the i n t e r v i e w i n g of a s a m p l e  of  p e r s o n s w h o h a d o n c e v i s i t e d the F o u n d a t i o n , one g r o u p of w h i c h h a d c o n t i n u e d i n t r e a t m e n t a n d one g r o u p of w h i c h h a d not c o n t i n u e d  be-  y o n d i n i t i a l i n t e r v i e w s , i n o r d e r to c o m p a r e the p r e - a n d p o s t - t r e a t m e n t b e h a v i o u r of t h e s e t w o g r o u p s .  It w a s f o u n d t h a t t h e r e w a s a  g r e a t e r p e r c e n t a g e of p e r s o n s i m p r o v e d i n the t r e a t m e n t g r o u p ,  and  a p o r t i o n of t h i s i m p r o v e m e n t w a s a t t r i b u t e d t o t r e a t m e n t at the Foundation.  It w a s a l s o f o u n d t h a t " t r e a t m e n t " r e c e i v e d  from  A l c o h o l i c s A n o n y m o u s a c c o u n t e d i n p a r t f o r the d i f f e r e n c e  seen.  A n u m b e r of i n d i c e s of c h a n g e i n v a r i o u s a r e a s of l i f e  (health,  w o r k , f a m i l y r e s p o n s i b i l i t y , f i n a n c i a l r e s p o n s i b i l i t y , and l e i s u r e  iii  t i m e a c t i v i t i e s ) w e r e c r o s s - t a b u l a t e d w i t h a n i n d e x of c h a n g e i n d r i n k i n g b e h a v i o u r , a n d i t w a s f o u n d that i m p r o v e m e n t i n d r i n k i n g b e h a v i o u r t e n d e d to be a s s o c i a t e d of b e h a v i o u r .  with i m p r o v e m e n t in other a r e a s  E x p e r i m e n t a l and c o n t r o l g r o u p s w e r e t h e n c o m p a r e d  to a s c e r t a i n w h e t h e r t r e a t m e n t h a d a d i s c e r n a b l e e f f e c t on t h i s lationship,  re-  a n d it w a s found that t r e a t m e n t at the F o u n d a t i o n i n -  c r e a s e d the l i k e l i h o o d of c h a n g e s i n d r i n k i n g b e h a v i o u r b e i n g a c c o m p a n i e d by c o r r e s p o n d i n g c h a n g e s i n o t h e r a r e a s of b e h a v i o u r . w a s a l s o s h o w n that " t r e a t m e n t "  It  received from Alcoholics Anonymous  h a d a s i m i l a r e f f e c t o n the r e l a t i o n s h i p .  ACKNOW LEDGMENTS  I should like to e x p r e s s m y  indebtedness  to those  persons  w h o s e a s s i s t a n c e s u b s t a n t i a l l y f u r t h e r e d the p r o d u c t i o n of t h i s r e port.  T h e g e n e r o u s a s s i s t a n c e of m y  Foundation  employer, The Alcoholism  of B r i t i s h C o l u m b i a , i n p r o v i d i n g s e c r e t a r i a l h e l p a n d  facilities for publication i s gratefully acknowledged. members  of the staff o f t h e A l c o h o l i s m  Foundation  Various  have been a  g r e a t h e l p a n d e n c o u r a g e m e n t t o m e ; i n p a r t i c u l a r , I s h o u l d l i k e to thank M r . E . D . M c R a e , the E x e c u t i v e D i r e c t o r . I a m m o s t i n d e b t e d t o t h r e e p e r s o n s who a s s i s t e d m e i n the u n d e r t a k i n g  o f the r e s e a r c h r e p o r t e d h e r e :  Professor  R o b s o n , w h o d i r e c t e d the o r i g i n a l p r o j e c t , M i s s I n g e b o r g my  directly R.A.H.  Paulus,  c o - w o r k e r o n the p r o j e c t , a n d P r o f e s s o r T, N o s a n c h u k ,  who  served as m y thesis advisor. F i n a l l y , I should like to thank M i s s E v e l y n M c D e v i t t , t y p e d the f i n a l d r a f t of the r e p o r t ,  G. G r a n t C l a r k e  The  U n i v e r s i t y of B r i t i s h  April,  1964  Columbia  who  TABLE  OF  CONTENTS  CHAPTER I.  II.  PAGE  THE PROBLEM DEFINED  1  Introduction  1  T h e R e h a b i l i t a t i o n of A l c o h o l i c s  4  H y p o t h e s e s and R a t i o n a l e  7  A . d d i t i o n a l A n a l y s i s of the D a t a  9  Previous Research  10  Summary  12  RESEARCH PROCEDURES P u r p o s e of the R e s e a r c h  16 Project  R e s e a r c h De sign  III.  16 17  E x p e r i m e n t a l and c o n t r o l groups  17  Control factors  20  Interview schedule  23  L o c a t i n g a n d I n t e r v i e w i n g the S a m p l e  29  Summary  32  THE E F F E C T OF T R E A T M E N T ON . REHABILITATION  37  Control Factors  37  I n d i c e s of R e h a b i l i t a t i o n  38  vi  CHAPTER  PAGE Differences  in Rehabilitation Between E x p e r i -  mental and C o n t r o l Groups  42  OTC:-VJCW  45  Areas  47  of r e h a b i l i t a t i o n  Matched pair analysis  53  Summary  53  T h e E f f e c t of D i f f e r e n c e s  on C o n t r o l F a c t o r s  54  Summary IV.  58  A R E A S OF CHANGE IN REHABILITATION  62  Introduction  62  T h e C h o i c e of I n d i c e s Indices  of c h a n g e  of C h a n g e  63  in drinking behaviour  I n d i c e s of c h a n g e i n a r e a s of  64  behaviour  other than d r i n k i n g Categories  66  of C h a n g e  Interrelationships  69  Between Change i n D r i n k i n g  B e h a v i o u r a n d i n O t h e r A r e a s of B e h a v i o r All  --  Subjects  71  C o m p a r i s o n B e t w e e n E x p e r i m e n t a l and C o n t r o l G r o u p s on D e g r e e  of I n t e r r e l a t i o n s h i p  Between  Change i n D r i n k i n g Behaviour and i n Other Areas  of B e h a v i o u r  76  vii CHAPTER  V.  PAGE T h e E f f e c t of A l c o h o l i c s A n o n y m o u s A t t e n d a n c e  79  Summary  82  S U M M A R Y A N D DISCUSSION OF FINDINGS  86  The P r o b l e m U n d e r Investigation  86  M e t h o d s of R e s e a r c h  88  T h e E x t e n t of R e h a b i l i t a t i o n A t t r i b u t a b l e t o Foundation Treatment The Interrelationship  90  of A r e a s of R e h a b i l i t a t i o n  91  M e t h o d s of f u r t h e r a n a l y s i s  91  Hypothesis I  91  H y p o t h e s i s II  97  Another Treatment Resource:  Alcoholics  Anonymous  98  R e l a t i o n s h i p of F i n d i n g s to P r e v i o u s R e s e a r c h  100  General Conclusions  101  BIBLIOGRAPHY  104  APPENDIX A:  ADDITIONAL TABLES  106  A P P E N D I X B:  THE INTERVIEW SCHEDULE  113  LIST  OF  TABLES  TABLE  PAGE  1.  S u m m a r y of C a s e s  Found and Interviewed  2.  C o n s i s t e n c y F i g u r e s B e t w e e n V a r i o u s I n d i c e s of Change i n D r i n k i n g Behaviour  3.  Percentage  Percentage Problem  6.  43  P e r c e n t a g e D i f f e r e n c e s i n D e g r e e of R e h a b i l i t a t i o n Between E x p e r i m e n t a l and C o n t r o l Groups  5.  40  C o m p a r i s o n of D e g r e e o f R e h a b i l i t a t i o n  i n E x p e r i m e n t a l and C o n t r o l Groups 4.  31  Percentage  44  C o m p a r i s o n of C h a n g e i n D r i n k i n g i n E x p e r i m e n t a l and C o n t r o l Groups  48  C o m p a r i s o n of O v e r a l l C h a n g e ( I n t e r -  viewer's A s s e s s m e n t ) i n E x p e r i m e n t a l and C o n t r o l G r o u p s A c c o r d i n g to M o t i v a t i o n 7.  Percentage  55  C o m p a r i s o n of O v e r a l l C h a n g e ( I n t e r -  viewer's A s s e s s m e n t ) i n E x p e r i m e n t a l and C o n t r o l G r o u p s A c c o r d i n g to N u m b e r of A l c o h o l i c s A n o n y m o u s Meetings Attended A f t e r Initial V i s i t to the F o u n d a t i o n 8.  56  Interrelationship Between Change i n D r i n k i n g Behaviour and Change i n Health for A l l Subjects  73  IX  TABLE 9.  PAGE Comparison  of C h i - S q u a r e d V a l u e s f o r T a b l e s  Showing Interrelationships Between Change i n D r i n k i n g B e h a v i o u r and Change i n Other  Areas  of B e h a v i o u r f o r A l l S u b j e c t s 10.  Comparison  74  of C h i - S q u a r e d V a l u e s f o r T a b l e s  Showing Interrelationships Between Change i n D r i n k i n g B e h a v i o u r a n d C h a n g e i n O t h e r A r e a s of B e h a v i o u r f o r E x p e r i m e n t a l and C o n t r o l Groups 11.  Comparison  78  of C h i - S q u a r e d V a l u e s f o r 'Mock T a b l e s  Showing Interrelationships Between Change i n D r i n k i n g B e h a v i o u r and Change i n O t h e r A r e a s of B e h a v i o u r f o r E x p e r i m e n t a l and C o n t r o l Groups A c c o r d i n g to A l c o h o l i c s A n o n y m o u s A t t e n d a n c e 12.  80  P e r c e n t a g e D i s t r i b u t i o n s of S e l e c t e d M a t c h e d C h a r a c t e r i s t i c s f o r E x p e r i m e n t a l and C o n t r o l Group and C o m p a r i s o n  13.  Comparison  w i t h I960 I n t a k e  107  of C h i - S q u a r e d V a l u e s f o r T a b u l a t i o n s  of F o u r I n d i c e s of C h a n g e i n D r i n k i n g B e h a v i o u r A g a i n s t C h a n g e i n the A r e a of W o r k 14.  Comparison  108  of C h i - S q u a r e d V a l u e s f o r T a b u l a t i o n s  of F o u r I n d i c e s of C h a n g e i n D r i n k i n g B e h a v i o u r A g a i n s t C h a n g e i n t h e A r e a of F a m i l y R e s p o n s i b i l i t y  108  X  T A B L E 15.  PAGE C o m p a r i s o n of C h i - S q u a r e d V a l u e s f o r of F o u r I n d i c e s  of C h a n g e i n D r i n k i n g  Against Change  i n the A r e a  Tabulation  of L e i s u r e  Behaviour Time  Activities 16.  Interrelationship  109 Between  Change i n D r i n k i n g  Behaviour and Change i n W o r k for A l l Subjects 17.  Interrelationship  Between  Change  in Drinking  Behaviour and Change i n F a m i l y  Responsibility  for A l l Subjects 18.  Interrelationship  109  110 Between  Change in Drinking  Behaviour and Change in F i n a n c i a l Responsibility for A l l Subjects 19.  Interrelationship  111 Between  Behaviour and Change for A l l Subjects  Change in D r i n k i n g in Leisure  Time  Activities 112  CHAPTER  THE  I.  PROBLEM  I  DEFINED  Introduction. Two important emphases,  this thesis,  which are  r e l e v a n t to the s u b j e c t  of  c a n be d i s c e r n e d i n c u r r e n t t h i n k i n g i n the b e h a v i o u r a l  s c i e n c e s a b o u t the f u n c t i o n i n g of the h u m a n i n d i v i d u a l .  First,  there  s e e m s to be c o n s i d e r a b l e a g r e e m e n t i n the body of p s y c h o l o g i c a l t h e o r y that one c a n n o t r e a c h a n a d e q u a t e  and c o m p r e h e n s i v e  u n d e r s t a n d i n g of  h u m a n b e h a v i o u r by c o n s i d e r i n g p e r s o n a l i t y a s a n a g g l o m e r a t i o n segmented p a r t s or functions, relatively unrelated acts.  of  o r by v i e w i n g b e h a v i o u r a s a s e r i e s of  F o r instance,  H a l l and L i n d z e y i n e v a l u a -  the state of k n o w l e d g e a b o u t the p e r s o n a l i t y ,  state t h a t :  . . . m o s t c o n t e m p o r a r y p e r s o n a l i t y t h e o r i s t s m a y be a c c u r a t e l y c l a s s e d a s o r g a n i s m i c . A s a g r o u p they e m p h a s i z e the i m p o r t a n c e of c o n s i d e r i n g the i n d i v i d u a l a s a t o t a l , f u n c tioning unit. Thus Allport, Angyal, Goldstein, Murphy, M u r r a y , R o g e r s , a n d S h e l d o n a l l s t r e s s the f a c t that a n e l e m e n t of b e h a v i o r i s not to be u n d e r s t o o d w h e n s t u d i e d i n i s o l a t i o n f r o m the r e m a i n d e r of the f u n c t i o n i n g p e r s o n including his biological makeup. ^ G e s t a l t p s y c h o l o g y and f i e l d t h e o r y (as i n i t i a t e d by K u r t L e w i n ) h a v e been p a r t i c u l a r l y strong i n their insistence d i n g to m a n y p s y c h o l o g i s t s ,  then,  on t h i s a p p r o a c h .  we do i n f a c t f u n c t i o n a s  p e r s o n s " ; the d e f e n c e m e c h a n i s m k n o w n a s " i s o l a t i o n " o r m e n t a l i z a t i o n " i s quite r e s t r i c t e d  i n its e f f e c t i v e n e s s .  Accor-  "whole "compart-  That is,  there  i s a d e f i n i t e l i m i t to the extent to w h i c h a m a n c a n a c t d i f f e r e n t l y i n d i f f e r e n t s i t u a t i o n s ; h i s b e h a v i o u r i n one a r e a of l i f e w i l l a f f e c t i n s o m e w a y h i s f u n c t i o n i n g i n o t h e r a s p e c t s of e x p e r i e n c e ,  a l t h o u g h the  t i o n s h i p i n m a n y c a s e s m a y be r a t h e r c o m p l e x i n n a t u r e . logical terms,  complete  segregation  s p h e r e s of l i f e i s d i f f i c u l t , c o n f l i c t " a t t e s t s to t h i s ,  rela-  In s o c i o -  of r o l e p e r f o r m a n c e i n v a r i o u s  i f not i m p o s s i b l e .  T h e p h e n o m e n o n of " r o l e  w h e n the b e h a v i o u r d e m a n d e d of a n i n d i v i d u a l  i n one c o n t e x t i s i n c o n s i s t e n t w i t h that r e q u i r e d i n a n o t h e r c o n t e x t .  Or,  a p p r o p r i a t e r o l e p e r f o r m a n c e i n one s p h e r e m a y be c o n t i n g e n t o n a d e - . quate p e r f o r m a n c e  in another;  for instance,  a family man's  obligations  to h i s f a m i l y i n h i s r o l e a s h u s b a n d a n d f a t h e r r e q u i r e a c e r t a i n l e v e l of p e r f o r m a n c e i n the e c o n o m i c  sphere,  T h e s e c o n d i m p o r t a n t e m p h a s i s i n the b e h a v i o u r a l  sciences  r e l e v a n t h e r e i s the r e c o g n i t i o n of the i n t e r r e l a t i o n s h i p of the i n d i v i dual and h i s e n v i r o n m e n t , theorists  both s o c i a l a n d n o n - s o c i a l .  see t h i s a s m o r e t h a n a n i n t e r r e l a t i o n s h i p :  Indeed,  some  t h e y b e l i e v e that  one c a n n o t r e a l l y d r a w a l i n e s e p a r a t i n g the p e r s o n a n d h i s s u r r o u n dings,  f o r they f e e l a h u m a n b e i n g i s best r e g a r d e d as " o p e n  L e w i n and his f o l l o w e r s , exemplify this.  with their emphasis  A s a r e s u l t of s u c h t h i n k i n g ,  general medicine, psychiatry, have become  psychology,  on the  "life-space"  the b o r d e r l i n e s  sociology,  b l u r r e d or even l a r g e l y e r r a d i c a t e d ,  z e a l o u s l y defended as b a t t l e l i n e s .  system".  between  and a n t h r o p o l o g y  and have been l e s s  A s p a r t of t h i s t r e n d ,  new f i e l d s of  s t u d y h a v e b e e n d e l i m i t e d c o m b i n i n g a s p e c t s of the o l d e r d i s c i p l i n e s - -  3  such fields as medicine,  social psychology,  the s o c i o l o g y of  a n d the s o c i o l o g y of m e n t a l h e a l t h h a v e n e w l y b e c o m e  nized as legitimate social,  social psychiatry,  f i e l d s of e n q u i r y .  T h u s the p h y s i c a l ,  a n d c u l t u r a l a s p e c t s of h u m a n e x i s t e n c e a r e  considered  recog-  psychological,  increasingly being  together.  T h i s e m p h a s i s i s t a k e n to be e q u a l l y i m p o r t a n t i n the study of " n o r m a l " f u n c t i o n i n g (or h e a l t h ) a n d of " a b n o r m a l " f u n c t i o n i n g ( o r  ill-  ness).  in  S i m m o n s a n d W o l f f , i n a s t u d y of the r o l e of s o c i a l s c i e n c e  medicine,  p r e s e n t a good d i s c u s s i o n of t h i s t o p i c ,  f r o m w h i c h the  following excerpt is taken: If it i s g r a n t e d that p h y s i c a l , s o c i a l , a n d c u l t u r a l f a c t o r s c o m bine to m a k e m a n a w h o l e p e r s o n , i t i s e q u a l l y i m p e r a t i v e to c o n s i d e r their potential and r e l a t e d effects i n h i s undoing, whether this takes place through i l l n e s s , a c c i d e n t s , or other ill-fated happenings. . . . the t h r e e f a c t o r s . . . m a y be v i e w e d s i m u l t a n e o u s l y a a both s o u r c e a n d c o n s e q u e n c e of h u m a n d i s t r e s s . S i n c e the p h e n o m e n o n of a l c o h o l i s m i s o f t e n r e g a r d e d a s "illness,"  i t . c a n p r o v i d e a u s e f u l c o n c r e t e e x a m p l e f o r a study of the  i n t e r r e l a t i o n s h i p of a r e a s of h u m a n b e h a v i o u r , himself,  an  a n d i n r e l a t i o n to h i s e n v i r o n m e n t .  to e x p l o r e the h o l i s t i c n a t u r e environment,  T h i s thesis is an attempt  of the b e h a v i o u r of a n i n d i v i d u a l i n h i s  by l o o k i n g at a n i n s t a n c e  i l l n e s s of a l c o h o l i s m .  both w i t h i n the p e r s o n  of " a b n o r m a l " f u n c t i o n i n g ,  the  II.  T h e R e h a b i l i t a t i o n of A l c o h o l i c s T h e r e a r e m a n y d i f f e r 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 ,  but a  com-  m o n f e a t u r e to m a n y of t h e m i s the i n c o r p o r a t i o n of o t h e r f a c t o r s t h a n 4 drinking behaviour.  F o r instance,  the W o r l d H e a l t h O r g a n i z a t i o n d e -  f i n e s the a l c o h o l i c a s f o l l o w s : A l c o h o l i c s a r e those e x c e s s i v e d r i n k e r s whose dependence a l c o h o l has attained mental disturbance mental health,  s u c h a d e g r e e that it s h o w s a or an interference  their i n t e r - p e r s o n a l  with their bodily and  relations,  smooth s o c i a l and e c o n o m i c functioning; Thus disturbance  on  noticeable  and their  . . .  i n o t h e r a r e a s of f u n c t i o n i n g i s l o o k e d u p o n a s  the  m a r k of e x c e s s i v e d e p e n d e n c e u p o n a l c o h o l ; a l c o h o l i s m i s r e g a r d e d a "socio-psychosomatic  as  illness.  T h e p h i l o s o p h y of t r e a t m e n t f o r a l c o h o l i s m i s f o u n d e d u p o n s u c h a basic outlook.  The term  " r e h a b i l i t a t i o n " i s u s e d to r e f e r to the i n -  d u c e m e n t of c e r t a i n d e s i r e d c h a n g e s i n b e h a v i o u r , not o n l y i n d r i n k i n g b e h a v i o u r , relationships,  a n d so f o r t h .  the a l c o h o l i c as  but i n h e a l t h ,  One t h e r a p i s t  and i n v o l v e s changes  work performance,  describes  his approach  follows:  In f o r m i n g m y own j u d g m e n t of a n y i n d i v i d u a l ,  I never  v i s a g e p r i m a r i l y the a l c o h o l i c o r p r o b l e m - d r i n k e r . visage  r a t h e r the  his mental,  whole m a n  as a d y n a m i c entity,  p h y s i c a l , and e m o t i o n a l s e t - u p as  by the i n t e r a c t i n g f o r c e s of c o n s t i t u t i o n a n d I take f u l l c o n s i d e r a t i o n , family,  the  therefore,  s o c i a l background; i n other w o r d s , Kurt Lewin,  I en-  that i s ,  determined  environment.  of h i s h i s t o r y ,  s c o p e of h i s w o r k a n d r e c r e a t i o n ,  his  his general  his total situation,  the d i s t i n g u i s h e d G e s t a l t p s y c h o l o g i s t ,  a p t l y e m p l o y s that t e r m . Another therapist  describes  en-  his t r e a t m e n t goals i n this  way:  so  as  social to  5  It i s n e c e s s a r y t o r e c o g n i z e that s o b r i e t y i s no m o r e t h a n a p a r t i a l g o a l a n d c a n be m a i n t a i n e d o n l y i f t h e r e i s c h a n g e a n d i m p r o v e m e n t i n o t h e r a r e a s of the p a t i e n t ' s l i f e . ^ In both c a s e s , the b a s i c a s s u m p t i o n of t h e s e t h e r a p i s t s i s t h a t t r e a t m e n t m u s t i n v o l v e the w h o l e i n d i v i d u a l i n r e l a t i o n t o h i s e n v i r o n m e n t . The  o r g a n i z a t i o n s t u d i e d i n the r e s e a r c h t o be r e p o r t e d b e l o w ,  T h e A l c o h o l i s m F o u n d a t i o n of B r i t i s h C o l u m b i a ,  s u b s c r i b e s to t h i s  p h i l o s o p h y of t r e a t m e n t , a n d i t s t r e a t m e n t p r o g r a m m e i s d i r e c t e d t o w a r d e f f e c t i n g " d e s i r a b l e " c h a n g e s i n s e v e r a l a s p e c t s of the a l c o h o l i c ' s life.  The  s e q u e n c e of t r e a t m e n t a t the A l c o h o l i s m F o u n d a t i o n i n v o l v e s  f i r s t a n a t t e m p t to h e l p the p a t i e n t t o s t o p d r i n k i n g , a n d t h e n a n a t t e m p t to h e l p h i m  cope m o r e a d e q u a t e l y w i t h h i s t o t a l life situation.  It i s t h i s  a t t e n t i o n to o t h e r a s p e c t s of l i f e t h a n d r i n k i n g w h i c h i s b e l i e v e d to i n c r e a s e the p a t i e n t ' s c h a n c e s of m a i n t a i n i n g s o b r i e t y f o r a n t i m e , by r e d u c i n g e n v i r o n m e n t  strain.  The  extended  g o a l f o r the p a t i e n t i s a  9 "comfortable sobriety, "  Such t r e a t m e n t c o n s t i t u t e s what R o b e r t  F,  B a l e s r e f e r r e d to, i n a d i f f e r e n t c o n n e c t i o n , as " s o c i a l t h e r a p y f o r a social disorder. T h e a i m s of the F o u n d a t i o n ' s t r e a t m e n t p r o g r a m m e i n e f f e c t i n g r e h a b i l i t a t i o n i n s e v e r a l a r e a s of the p a t i e n t ' s l i f e a r e d e t a i l e d i n the f o l l o w i n g s t a t e m e n t r e c e i v e d f r o m one of the F o u n d a t i o n ' s s e n i o r t r e a t ment officials. In o r d e r to u n d e r s t a n d the i m p a c t of a l c o h o l i s m u p o n the i n d i v i d u a l a n d h i s e v e n t u a l r e h a b i l i t a t i o n , we m u s t f i r s t l o o k a t the n a t u r e of t h i s a d d i c t i o n a n d the f o r c e s a t w o r k w i t h i n the i n d i v i d u a l t h a t nudge h i m i n the d i r e c t i o n cf a l c o h o l f o r r e l i e f . It i s  6  g e n e r a l l y c o n c e d e d that the a l c o h o l i c s e e k s r e l i e f f r o m i n t e r n a l s t r e s s e s both b r e d a n d f e d by h i s p o o r a d a p t a t i o n to e n v i r o n mental demands.  A l c o h o l p a m p e r s a n d c u s h i o n s the i n d i v i d u a l  from painful realities,  and c r e a t e s a false  In s u c h a state of r e l a t i v e  comfort,  s e n s e of w e l l - b e i n g .  the n e e d f o r s o c i a l  interac-  t i o n ; for g o a l - s e t t i n g ; and f o r s e l f - e x p l o i t a t i o n s e e m s l e s s i m mediate.  T h i s l e a d s to a g r a d u a l d e t e r i o r a t i o n i n p e r f o r m a n c e  a c r o s s m o s t of the f u n c t i o n a l a r e a s , socio-economic  serious  impoverishment.  Rehabilitation has, neutralize.  and eventually  then,  a b r o a d f r o n t of m a l a d j u s t m e n t  T h e i n d i v i d u a l m u s t be h e l p e d to r e g a i n h i s  to social  s t a n d i n g t h r o u g h c o u n s e l l i n g a i m e d at i m p r o v i n g a t t i t u d e s a n d encouraging constructive  relationships.  He must also  seek  d i r e c t i o n o r r e - d i r e c t i o n i n t o a v o c a t i o n a l f i e l d that e x p l o i t s his talents and p r o v i d e s opportunities for T h e r a p y m u s t r e a c h into the d o m e s t i c  self-expression.  sphere and attempt,  t h r o u g h i n t e r p r e t a t i o n of the i l l n e s s , to b r i n g about a w h o l e s o m e a p p r o a c h to the p r o b l e m .  Resentments  more  engen-  d e r e d by the d r i n k i n g b e h a v i o u r m u s t be a i r e d a n d s t e p s t a k e n to p r o m o t e m o r e h a r m o n i o u s r e l a t i o n s h i p s .  T h e need f o r c o n -  t i n u i n g p e r s o n a l a p p r a i s a l and s e l f | i x n p r o v e m e n t is c o n t i n u o u s , a n d m a y r e q u i r e y e a r s to a c h i e v e . T h e s p e c i f i c a i m of the p r e s e n t  s t u d y i s to e s t a b l i s h e m p i r i c a l l y  w h e t h e r o r not a r e l a t i o n s h i p e x i s t s b e t w e e n d r i n k i n g b e h a v i o u r a n d b e h a v i o u r i n o t h e r a r e a s of l i f e , that r e l a t i o n s h i p . are more change  a n d , if so,  what i s the p r e c i s e  nature  of  A n a t t e m p t w i l l be m a d e to d e t e r m i n e w h i c h a r e a s  directly interconnected  c a n be m o r e  than o t h e r s and i n w h i c h a r e a s  e a s i l y and q u i c k l y effected.  Further,  the r o l e of  t r e a t m e n t i n e f f e c t i n g c h a n g e s i n v a r i o u s a r e a s w i l l be e x a m i n e d .  Thus  the h y p o t h e s e s to be p r o p o s e d c o u l d be r e g a r d e d a s p a r t i a l t e s t s of one of the i m p o r t a n t a s s u m p t i o n s u n d e r l y i n g the p r o g r a m m e holism Foundation.  of the A l c o -  7 III.  H y p o t h e s e s and R a t i o n a l e L o o k i n g at the d r i n k i n g b e h a v i o u r a n d the o t h e r b e h a v i o u r of a n  alcoholic from a theoretical relationship,  standpoint,  t h e r e s e e m s to be a t w o - s i d e d  w h e r e d i s t u r b e d f u n c t i o n i n g i n o t h e r a r e a s of l i f e c a n be  both c a u s e a n d e f f e c t of a b n o r m a l d r i n k i n g . 1.  One t h e o r y of a b n o r m a l d r i n k i n g s e e s it a s a m e c h a n i s m  tension reduction, psychological  that i s , a s a m e a n s  of c o p i n g  of  w i t h s o m e f o r m of  stress.  S o m e a u t h o r i t i e s d e f i n e a l c o h o l i s m i n one w a y a n d s o m e i n another.  W h a t e v e r d e f i n i t i o n o r i n d e x of the c o n d i t i o n one u s e s  u s e s - - p h y s i c a l or m e n t a l i m p a i r m e n t ,  i n a b i l i t y to w o r k ,  trouble i n relations with f a m i l y or f r i e n d s - - a n e s s e n t i a l part of a l c o h o l i s m i s that the i n d i v i d u a l h a s b e c o m e  a compulsive 12  d r i n k e r i n o r d e r to q u e l l c e r t a i n i n n e r t e n s i o n s . Such s t r e s s can,  of c o u r s e ,  a r i s e f r o m a definable p h y s i c a l or psycho-  l o g i c a l i l l n e s s with v a r i o u s c a u s e s , a r e s u l t of e n v i r o n m e n t a l s t r a i n .  but c a n o f t e n be (at l e a s t i n p a r t )  O f t e n at l e a s t the i n c i p i e n t c a u s e of  a developing drinking p r o b l e m is an unfaithful wife, a business m i s fortune,  o r the  like.  T o a c e r t a i n extent these f a c t o r s a r e mediate  control,  of c o u r s e ,  f a c t o r i s the p e r s o n ' s vironment.  commonly,  the m o r e  im-  significant  own f a i l u r e to c o p e w i t h the p r o b l e m s of h i s e n -  F o r example,  m a n to d r i n k " a r e  but m o r e  beyond a p e r s o n ' s  the m a r i t a l p r o b l e m s w h i c h h a v e " d r i v e n a  o f t e n s u b s t a n t i a l l y a r e s u l t of h i s own i n a d e q u a c y i n  d e a l i n g w i t h s o m e of the i n e v i t a b l e d i f f i c u l t i e s that b e s e t a  marriage.  8 Therefore,  to the extent that s u c h f a c t o r s a r e i m p o r t a n t p a r t i a l c a u s e s  of p a t h o l o g i c a l d r i n k i n g ,  t h e n a n y g a i n s w h i c h the p a t i e n t c a n m a k e i n  l e a r n i n g to c o p e m o r e a d e q u a t e l y w i t h p r o b l e m s i n t h e s e o t h e r  areas  w i l l be h e l p f u l i n r e i n f o r c i n g s o b r i e t y . 2.  O n the o t h e r  drink excessively  s i d e of the c o i n ,  cannot  f o r a n y p e r i o d of t i m e w i t h o u t h i s f u n c t i o n i n g i n o t h e r  a r e a s of l i f e b e i n g a d v e r s e l y a f f e c t e d . a r e a s of b e h a v i o u r a r e a r e s u l t , drinking.  it i s c l e a r that a m a n  In t h i s c a s e ,  difficulties i n other  r a t h e r than a c a u s e of a b n o r m a l  T o the extent that d a m a g e  is reparable,  an improvement in  d r i n k i n g b e h a v i o u r i n c r e a s e s the l i k e l i h o o d of a n i m p r o v e m e n t i n o t h e r behaviour. In a n y i n d i v i d u a l c a s e , c o u l d be i n v o l v e d .  e i t h e r o r both s i d e s of the  T h i s two-sided rationale  H y p o t h e s i s I:  relationship  g i v e s r i s e to H y p o t h e s i s I.  T h e r e w i l l be a d i r e c t m u t u a l r e l a t i o n s h i p b e tween change i n d r i n k i n g b e h a v i o u r and i n o t h e r a r e a s of b e h a v i o u r ( h e a l t h , family relationships,  change  work,  and s o c i a l a c t i v i t i e s ) ,  the t o t a l s a m p l e of a l c o h o l i c s  in  studied.  a) A s d r i n k i n g b e h a v i o u r  improves  ( s e v e r i t y of p r o b l e m d e c r e a s e s ) ,  be-  h a v i o u r i n other a r e a s w i l l a l s o i m prove, b) If d r i n k i n g b e h a v i o u r d o e s not i m p r o v e (remains  the s a m e o r w o r s e n s ) ,  other  b e h a v i o u r w i l l a l s o not i m p r o v e . The  e v a l u a t i o n s t u d y of the F o u n d a t i o n ' s t r e a t m e n t  on w h i c h the p r e s e n t  r e s e a r c h is based,  i n d i c a t e d that a  programme,  considerable  n u m b e r of a l c o h o l i c s i m p r o v e d both i n d r i n k i n g a n d i n o t h e r a r e a s of l i f e  13 w i t h o u t r e c e i v i n g t r e a t m e n t f r o m the F o u n d a t i o n .  In s o m e c a s e s ,  the  i m p r o v e m e n t c o u l d h a v e b e e n a r e s u l t of t r e a t m e n t holics Anonymous,  received from Alco-  but m a n y h a d no s u c h t r e a t m e n t ,  i m p r o v e m e n t were unknown.  a n d the c a u s e s  It m i g h t be s u p p o s e d , h o w e v e r ,  a s s o c i a t i o n between changes i n d r i n k i n g b e h a v i o u r and i n other  of  that the areas  of b e h a v i o u r w o u l d be g r e a t e s t i n t h o s e c a s e s w h e r e the i n d i v i d u a l s h a d undergone treatment stance,  d e s i g n e d to s e c u r e  both s o r t s of c h a n g e .  For in-  i n the c a s e of " s p o n t a n e o u s " i m p r o v e m e n t ( c h a n g e e f f e c t e d by  the i n d i v i d u a l h i m s e l f ) , the i n d i v i d u a l m i g h t be a w a r e stop d r i n k i n g ,  of h i s n e e d to  but not be a w a r e of h i s n e e d to l e a r n to c o p e m o r e  q u a t e l y w i t h p r o b l e m s i n o t h e r a r e a s of l i f e .  H e w o u l d be,  ade-  therefore,  l e s s l i k e l y (to the e x t e n t that c o n s c i o u s a w a r e n e s s i s a f a c t o r ) to b r i n g a b o u t i m p r o v e m e n t i n the r e s t of h i s b e h a v i o u r c o r r e s p o n d i n g to h i s i m p r o v e m e n t w i t h r e g a r d to d r i n k i n g . t h e s i s i s as  follows:  H y p o t h e s i s II:  IV.  T h e r e f o r e , the s e c o n d h y p o -  T h e r e l a t i o n s h i p between change i n d r i n k i n g b e h a v i o u r a n d c h a n g e i n o t h e r a r e a s of b e h a v i o u r i s m o r e l i k e l y to be p r e s e n t i n t h o s e p e r s o n s w h o h a v e h a d t r e a t m e n t at the F o u n d a t i o n ( e x p e r i m e n t a l group) t h a n i n t h o s e p e r sons who h a v e not h a d s u c h t r e a t m e n t ( c o n t r o l group),  A d d i t i o n a l A n a l y s i s of the D a t a T h e data w h i c h l e d to the f o r m u l a t i o n of the a b o v e h y p o t h e s e s  a l s o s u g g e s t that the d e g r e e of a s s o c i a t i o n b e t w e e n d r i n k i n g a n d o t h e r b e h a v i o u r i s l i k e l y to d i f f e r d e p e n d i n g on the s p e c i f i c a r e a i n v o l v e d .  It  10  w o u l d p e r h a p s h a v e b e e n p o s s i b l e to h a v e c o n s t r u c t e d a set of s u b h y p o t h e s e s c o v e r i n g e a c h a r e a of b e h a v i o u r a n d to h a v e a t t e m p t e d p r e d i c t the r e l a t i v e d e g r e e s of a s s o c i a t i o n .  However,  to  consideration  of the m u l t i p l i c i t y of f a c t o r s w h i c h w o u l d h a v e to be t a k e n i n t o a c c o u n t in constructing such hypotheses, necessary  l e d to the c o n c l u s i o n that the  w o u l d be q u i t e i n v o l v e d a n d p r o b a b l y r a t h e r t e n u o u s .  c i s i o n was m a d e ,  therefore,  t h e n to a t t e m p t s o m e  Previous  The de-  s i m p l y to o b s e r v e t h e s e r e l a t i o n s h i p s ,  and  s p e c u l a t i v e ex p o s t f a c t o e x p l a n a t i o n a n d f o r m u l a -  t i o n of f u r t h e r h y p o t h e s e s f o r f u t u r e  V.  rationales  study.  Research  T h e u s e of o t h e r c r i t e r i a t h a n c h a n g e i n d r i n k i n g b e h a v i o u r to a s s e s s the d e g r e e  of i m p r o v e m e n t i n a l c o h o l i c s a f t e r t r e a t m e n t i s not  u n i q u e to t h i s s t u d y . here  It i s c l a i m e d , h o w e v e r ,  that the m e t h o d s u s e d  represent a n i m p r o v e m e n t i n some r e s p e c t s over p r e v i o u s work,  e n a b l i n g the t e n t a t i v e  a n s w e r i n g of s o m e q u e s t i o n s not a n s w e r e d  hereto-  fore. A retrospective  f o l l o w - u p study,  c o n d u c t e d by the D i v i s i o n of  A l c o h o l i c R e h a b i l i t a t i o n , State of C a l i f o r n i a D e p a r t m e n t of P u b l i c Health,  f o u n d that t h e r e w e r e i m p r o v e m e n t s i n c e r t a i n a s p e c t s of h e a l t h ,  improvements in social relationships, absenteeism  from work,  a n d a d e c r e a s e i n the a m o u n t of  i n the s a m p l e of e x - p a t i e n t s  paralleled improvement in drinking behaviour.  surveyed, which  O n l y i n the c a s e of  11  d r i n k i n g b e h a v i o u r and health,, h o w e v e r ,  were changes i n each a r e a tabu-  14 lated against each other.  A s i m i l a r study,  C o m m i s s i o n on A l c o h o l i s m ,  c o n d u c t e d by the  Connecticut  f o u n d r e l a t i o n s h i p s b e t w e e n s t a t u s at the  of f o l l o w - u p i n t e r v i e w w i t h r e g a r d to d r i n k i n g a n d s t a t u s w i t h r e g a r d health,  work performance,  T h i s study d i d not m e a s u r e follow-up,  however,  family relationships, change  time to  and s o c i a l p a r t i c i p a t i o n .  b e t w e e n t i m e of i n t a k e a n d t i m e  of  e x c e p t i n r e g a r d to e m p l o y m e n t s t a t u s ( e m p l o y e d /  unemployed).^ Schmidt,  a n a l y s i n g d a t a o b t a i n e d f r o m a f o l l o w - u p study u n d e r -  t a k e n by the A l c o h o l i s m R e s e a r c h  F o u n d a t i o n of O n t a r i o ,  correlated  change i n d r i n k i n g b e h a v i o u r and change i n s o c i a l p a r t i c i p a t i o n ,  and  found definite r e l a t i o n s h i p s between d r i n k i n g and d o m e s t i c q u a r r e l l i n g ,  16 family arrangements,  child-care participation,  and l e i s u r e p u r s u i t s .  J a c k s o n d i d a f u r t h e r a n a l y s i s of the s a m e d a t a p e r t a i n i n g to the holic father's participation in child-care activities, relationship.  alco-  a n d a g a i n found a  ^  Finally,  a recent report  f e c t of a l c o h o l i s m t r e a t m e n t ,  on a l a r g e  s c a l e e v a l u a t i o n of the  ef-  u n d e r t a k e n by the N o r t h A m e r i c a n A s s o -  c i a t i o n of A l c o h o l i s m P r o g r a m s ,  i n d i c a t e s the p r e l i m i n a r y f i n d i n g that  there i s a r e l a t i o n between i m p r o v e m e n t i n d r i n k i n g and i m p r o v e m e n t in health,  social stability,  interpersonal relations,  work  adjustment,  18 and e m p l o y m e n t status. T h e p r e s e n t study p r o p o s e s to a n a l y s e the r e l a t i o n s h i p  between  c h a n g e i n d r i n k i n g b e h a v i o u r a n d c h a n g e i n the a r e a s of h e a l t h ,  work,  family relationships,  activi-  ties,  f i n a n c i a l r e s p o n s i b i l i t y , and l e i s u r e time  by c r o s s - t a b u l a t i n g  s e v e r a l of the a b o v e It a l s o p r o p o s e s  i n d i c e s of c h a n g e i n a s i m i l a r m a n n e r  studies,  but u s i n g s o m e w h a t  techniques.  to study the p o s s i b l e d i f f e r e n t i a l e f f e c t p r o d u c e d by  t r e a t m e n t on the h y p o t h e s i z e d r e l a t i o n s h i p , w h i c h w a s u s e d i n none of the a b o v e  VI.  different  to  by u s i n g a c o n t r o l  group,  studies.  Summary It h a s be.en s h o w n that t h e r e i s a s t r o n g e m p h a s i s i n c u r r e n t  t h i n k i n g i n the b e h a v i o u r a l s c i e n c e s on the h o l i s t i c n a t u r e of h u m a n b e haviour,  a n d on the i m p o r t a n c e  to h i s e n v i r o n m e n t ,  of c o n s i d e r i n g the i n d i v i d u a l i n r e l a t i o n  both s o c i a l a n d n o n - s o c i a l .  T h i s belief is also  p h a s i z e d i n t h e o r i e s a b o u t the n a t u r e of a l c o h o l i s m , s t a n c e of h u m a n m a l f u n c t i o n i n g . grammes,  em-  regarded as an i n -  Many alcoholism treatment pro-  i n c l u d i n g the A l c o h o l i s m F o u n d a t i o n of B r i t i s h C o l u m b i a ,  s u b s c r i b e to t h i s p h i l o s o p h y , a n d t h e r e f o r e d i r e c t t h e i r t r e a t m e n t to m o d i f y i n g the a l c o h o l i c ' s  behaviour i n m a n y a s p e c t s other than i n  drinking. T h i s t h e s i s i s a n a t t e m p t to t e s t t h i s a s s u m p t i o n a s h e l d by the A l c o h o l i s m F o u n d a t i o n of B r i t i s h C o l u m b i a , by e x a m i n i n g w h e t h e r not c h a n g e s i n d r i n k i n g b e h a v i o u r a r e of b e h a v i o u r .  Further,  or  r e l a t e d to c h a n g e s i n o t h e r a r e a s  the p o s s i b l e d i f f e r e n t i a l e f f e c t of t r e a t m e n t on  t h i s r e l a t i o n s h i p w i l l be e x a m i n e d .  It i s h y p o t h e s i z e d that t h e r e w i l l be  a d i r e c t m u t u a l r e l a t i o n s h i p between change i n d r i n k i n g b e h a v i o u r and c h a n g e i n o t h e r a r e a s of b e h a v i o u r , a n d that t h i s r e l a t i o n s h i p w i l l be m o r e l i k e l y to be p r e s e n t i n t h e s e w h o h a v e h a d t r e a t m e n t f r o m the F o u n d a t i o n t h a n i n t h o s e who h a v e not h a d s u c h t r e a t m e n t .  14  FOOTNOTES:  Chapter I  ^ C a l v i n S, H a l l a n d G a r d n e r L i n d z e y , T h e o r i e s of P e r s o n a l i t y (New Y o r k : J o h n W i l e y a n d Sons, 1957), p. 543. 2  Ibid. ,  pp. 206-256.  L e o W. S i m m o n s a n d H a r o l d G. W o l f f , S o c i a l S c i e n c e i n M e d i c ine (New Y o r k : R u s s e l l Sage F o u n d a t i o n , 1954), pp. 110-111. ^ F o r a d i s c u s s i o n of s o m e of the p r o b l e m s of f o r m u l a t i n g a d e f i n i t i o n of " a l c o h o l i s m , " s e e M a r k K e l l e r ,  " T h e D e f i n i t i o n of A l c o -  h o l i s m a n d the E s t i m a t i o n of Its P r e v a l e n c e , " i n D a v i d J . P i t t m a n a n d C h a r l e s R. S n y d e r ( e d s . ) , S o c i e t y , C u l t u r e , a n d D r i n k i n g P a t t e r n s (New Y o r k : J o h n W i l e y a n d Sons,  1962), pp. 310-317.  W o r l d H e a l t h O r g a n i z a t i o n , E x p e r t C o m m i t t e e on M e n t a l Health, A l c o h o l i s m Subcommittee, Second Report, T e c h n i c a l R e p o r t S e r i e s , No. 48 ( A u g u s t , 1952), p. 16. 5  A. L. Beeley, " A l c o h o l i s m , Social Work, and Mental Hygiene, " M e n t a l H y g i e n e , X L I I I ( O c t o b e r , 1959), 577-582. 7  C h a r l e s H. D u r f e e , T o D r i n k o r N o t t o D r i n k (New Y o r k :  Longmans,  G r e e n a n d C o . , 1938), pp. 17-18.  8S. V o g e l , " S o m e A s p e c t s of G r o u p P s y c h o t h e r a p y W i t h A l c o h o l i c s , " I n t e r n a t i o n a l J o u r n a l of G r o u p P s y c h o t h e r a p y , (July,  VII  1957), 302.  9 T h e A l c o h o l i s m F o u n d a t i o n of B r i t i s h C o l u m b i a , " T r e a t m e n t P l a n " ( V a n c o u v e r : T h e A l c o h o l i s m F o u n d a t i o n of B r i t i s h C o l u m b i a , 1962), p. 7. ( M i m e o g r a p h e d ) ^ R o b e r t F, Bales, "Social T h e r a p y for a Social D i s o r d e r , " J o u r n a l of S o c i a l I s s u e s , I ( A u g u s t , 1945),  14-22.  ^ P e r s o n a l C o m m u n i c a t i o n r e c e i v e d f r o m M r . S. E . K e r s l a k e , S e n i o r C o u n s e l l o r , T h e A l c o h o l i s m F o u n d a t i o n of B r i t i s h C o l u m b i a , M a r c h 1964. ^ D o r r i a n A p p l e (ed.), S o c i o l o g i c a l S t u d i e s of H e a l t h a n d S i c k n e s s (New Y o r k : M c G r a w - H i l l B o o k C o m p a n y , I960), p . 177.  15 S o m e 42% of t h o s e w h o d i d not h a v e t r e a t m e n t f r o m the F o u n d a t i o n w e r e r e g a r d e d a s h a v i n g s h o w n s o m e d e g r e e of o v e r a l l improvement. See R e g i n a l d A , P L R o b s o n , I n g e b o r g P a u l u s , a n d G . G r a n t C l a r k e , A n E v a l u a t i o n of the E f f e c t of T r e a t m e n t on the R e h a b i l i t a t i o n of A l c o h o l i c s ( V a n c o u v e r : T h e A l c o h o l i s m F o u n d a t i o n of B r i t i s h C o l u m b i a , 1963), p . 120. S e l e c t e d A s p e c t s of the P r o s p e c t i v e F o l l o w - U p S t u d y , " A l c o h o l i s m a n d C a l i f o r n i a , P u b l i c a t i o n N o , 2 ' B e r k e l e y : State of C a l i f o r n i a , D e p a r t m e n t of P u b l i c H e a l t h , 1959), p p . 2 2 - 3 7 . l 4  ^ ^ C l i i c a l P r a c t i c e a n d C o m m u n i t y E d u c a t i o n on A l c o h o l i s m : A R e s e a r c h R e p o r t o n the P r o g r a m of the C o n n e c t i c u t C o m m i s s i o n o n A l c o h o l i s m ( H a r t f o r d : C o n n e c t i c u t C o m m i s s i o n o n A l c o h o l i s m , 1959), pp. 19-23. n  16  w  off g a n g S c h m i d t , " A S t u d y of the R e l a t i o n B e t w e e n S o c i a l P a r t i c i p a t i o n and D r i n k i n g B e f o r e and A f t e r T r e a t m e n t i n a Sample of A l c o h o l i c P a t i e n t s " ( u n p u b l i s h e d M a s t e r ' s t h e s i s , T h e U n i v e r s i t y of T o r o n t o , T o r o n t o , 1957). ^ M . J . J a c k s o n , " A S t u d y of the R e l a t i o n B e t w e e n D r i n k i n g B e h a v i o u r a n d C h i l d - C a r e P a r t i c i p a t i o n i n a S a m p l e of A l c o h o l i c P a t i e n t s " ( u n p u b l i s h e d M a s t e r ' s t h e s i s , T h e U n i v e r s i t y of T o r o n t o , T o r o n t o , 1958). ^ G e r h a r t S a e n g e r a n d D o n a l d G e r a r d , " A F o l l o w - U p S t u d y of P a t i e n t s S e e n i n C l i n i c s A s s o c i a t e d w i t h the N o r t h A m e r i c a n A s s o c i a t i o n of A l c o h o l i s m P r o g r a m s , " i n S e l e c t e d P a p e r s D e l i v e r e d a t the F o u r t e e n t h A n n u a l M e e t i n g of the N o r t h A m e r i c a n A s s o c i a t i o n of A l c o h o l i s m P r o g r a m s ( " W a s h i n g t o n : N o r t h A m e r i c a n A s s o c i a t i o n of A l c o h o l i s m P r o g r a m s, 1963), p p . 106- 108.  CHAPTER  RESEARCH  I.  P u r p o s e of T h e R e s e a r c h The  II  PROCEDURES  Project  data f o r the p r e s e n t  study w e r e obtained f r o m a  research  p r o j e c t u n d e r t a k e n f o r T h e A l c o h o l i s m F o u n d a t i o n of B r i t i s h C o l u m b i a by D r . R . A . H . writer.  Robson, assisted  by M i s s I.  P a u l u s a n d the  A t the t i m e t h i s r e s e a r c h w a s u n d e r t a k e n ,  the A l c o h o l i s m  F o u n d a t i o n had been engaged i n t r e a t i n g a l c o h o l i c s f o r s e v e n and h a d s e e n a t o t a l of 5, 310 p a t i e n t s d u r i n g that t i m e . c a t e d that a s of A p r i l 1962, 3, 834 m e d i c a l e x a m i n a t i o n s , consultations,  a n d 2, 054  t h e r e h a d b e e n 42, 365  years,  Statistics  therapeutic  9, 706 m e d i c a l t r e a t m e n t s ,  group m e e t i n g s .  present  470  interviews, psychiatric  In the s p r i n g of 1963,  B o a r d of D i r e c t o r s of the F o u n d a t i o n d e c i d e d that a s y s t e m a t i c s h o u l d be u n d e r t a k e n to d e t e r m i n e the e f f e c t i v e n e s s  the study  of t h i s t r e a t m e n t  p r o g r a m m e w h i c h had been i n o p e r a t i o n f o r seven y e a r s . fore,  indi-  They,  there-  d i r e c t e d the e s t a b l i s h m e n t of a r e s e a r c h p r o j e c t o f f i c i a l l y d e -  f i n e d a s " a n e v a l u a t i o n of the e f f e c t i v e n e s s  of the t r e a t m e n t o f f e r e d by  the A l c o h o l i s m F o u n d a t i o n i n r e h a b i l i t a t i n g t h o s e who s e e k i t s h e l p i n o v e r c o m i n g p r o b l e m s a r i s i n g f r o m the e x c e s s i v e c o n s u m p t i o n of alcohol. " As  s o o n a s the p u r p o s e of the r e s e a r c h  was e s t a b l i s h e d ,  a  17 search  of the l i t e r a t u r e  of a l c o h o l i s m t r e a t m e n t w a s u n d e r t a k e n ,  o r d e r to b e n e f i t f r o m the e x p e r i e n c e similar research.  of o t h e r s w h o h a d u n d e r t a k e n  T h e r e w e r e a n u m b e r of r e p o r t s  in c l i n i c a l settings,  basic  none h a d u s e d a c o n t r o l g r o u p of u n t r e a t e d  h o l i c s w i t h w h i c h to c o m p a r e logical inadequacy;  of f o l l o w - u p s t u d i e s  but a l l s u c h s t u d i e s f o u n d s u f f e r e d f r o m one  i n a d e q u a c y of d e s i g n ;  in  those t r e a t e d .  This is a serious  alco-  methodo-  it i s not s u f f i c i e n t to s i m p l y c o m p a r e the b e h a v i o u r  of a p a t i e n t b e f o r e a n d a f t e r t r e a t m e n t .  One c a n n o t l e g i t i m a t e l y i n f e r  that a n y c h a n g e s  s e e n a r e the r e s u l t of the t r e a t m e n t w h i c h the p a t i e n t  has undergrone,  s i n c e t h e y c o u l d h a v e o c c u r r e d i n the a b s e n c e  ment.  T h e a u t h o r s of one o r two r e p o r t s  r e a l i z e d this w e a k n e s s i n d e s i g n , ting a n adequate  of t r e a t -  e x a m i n e d p o i n t e d out that t h e y  but f e l t that the d i f f i c u l t i e s i n s e l e c -  c o n t r o l g r o u p a n d i n l o c a t i n g p e r s o n s who h a d not  u n d e r g o n e t r e a t m e n t p r e c l u d e d the u s e of a c o n t r o l g r o u p . p r e sent i n v e s t i g a t o r s ,  however,  so s e r i o u s a f l a w i n r e s e a r c h  The  c o n s i d e r e d the l a c k of a c o n t r o l g r o u p  d e s i g n that it w o u l d not be w o r t h u n d e r -  taking a n e v a l u a t i o n study without one.  It w a s ,  therefore,  established  a s a f u n d a m e n t a l r e q u i r e m e n t of the s t u d y that i t s h o u l d e m p l o y a c o n t r o l g r o u p of " u n t r e a t e d "  II.  alcoholics.  Research Design E x p e r i m e n t a l and c o n t r o l  groups  A n a d e q u a t e d e s i g n w o u l d b a s i c a l l y i n v o l v e the s e l e c t i o n of two g r o u p s of p e r s o n s w i t h d r i n k i n g p r o b l e m s ,  one of w h i c h h a d r e c e i v e d  18  t r e a t m e n t f r o m the F o u n d a t i o n w h i l e the o t h e r h a d not, a n d the c o m p a r i son of the e x t e n t o f r e h a b i l i t a t i o n i n t h e s e t w o g r o u p s .  T h i s w o u l d be  3  done by e s t a b l i s h i n g t h e d e g r e e of c h a n g e  i n c e r t a i n b e h a v i o u r a l pat-  t e r n s d u r i n g a c o m p a r a b l e p e r i o d of t i m e .  T h i s m a y be r e p r e s e n t e d  d i a g r a m m a t i c a l l y as  follows:  Experimental Group = Treatment  Control Group =  compared with r e s p e c t to rehabilitation  change i n behavioural patterns between T and T 4  l  2  No T r e a t m e n t  A n i d e a l w a y t o i m p l e m e n t t h i s d e s i g n w o u l d be t o s e l e c t patients at the t i m e they f i r s t a p p r o a c h e d the t r e a t m e n t agency, and to r a n d o m l y a s s i g n t h e m to t w o g r o u p s , t r e a t m e n t a n d one of w h i c h w o u l d not.  one of w h i c h w o u l d r e c e i v e A t t h i s t i m e , d a t a w o u l d be  g a t h e r e d t o i n d i c a t e t h e i r s t a t u s w i t h r e g a r d to t h o s e a r e a s of beh a v i o u r c o n s i d e r e d r e l e v a n t . . A f t e r a p e r i o d of t i m e d e e m e d  sufficient  f o r c h a n g e s t o t a k e p l a c e , m e m b e r s of e a c h g r o u p w o u l d be r e i n t e r v i e w e d t o a s c e r t a i n the d e g r e e of c h a n g e w h i c h h a d t a k e n p l a c e .  Such  a d e s i g n , h o w e v e r , w a s c l e a r l y n o t p o s s i b l e u n d e r t h e p o l i c y of the A l c o h o l i s m Foundation,  w h i c h i s to r e f u s e t r e a t m e n t t o no one w h o  s i n c e r e l y d e s i r e s help.  A c o m p r o m i s e was therefore necessary.  19  F i r s t of a l l , the t i m e a v a i l a b l e f o r c o m p l e t i o n of the p r o j e c t p r e c l u d e d the u s e of a p r o s p e c t i v e i n f o r m a t i o n at one t i m e , time, fore  which would gather  a n d t h e n g a t h e r s i m i l a r i n f o r m a t i o n at a l a t e r  i n o r d e r to a s c e r t a i n c h a n g e . selected,  design,  research  A  retrospective design was  there-  w h i c h w o u l d i n v o l v e s e c u r i n g i n f o r m a t i o n at a f o l l o w - u p  i n t e r v i e w w i t h r e s p e c t to b e h a v i o u r both at the t i m e of a p p r o a c h i n g Foundation,  a n d at the t i m e of the  interview.  S i n c e i t i s not p o s s i b l e to r e f u s e t r e a t m e n t to a n y s e e k i n g h e l p f r o m the F o u n d a t i o n ,  persons  it w a s n e c e s s a r y to r a t h e r c h o o s e  f o r the c o n t r o l g r o u p p e r s o n s w h o h a d v i s i t e d the F o u n d a t i o n at time or another,  but who h a d t h e m s e l v e s  one  d e c i d e d not to c a r r y on w i t h  t r e a t m e n t . ~" S u c h a c o n t r o l g r o u p w a s f e l t to be m o r e a p p r o p r i a t e a random  sample  of u n t r e a t e d  than  a l c o h o l i c s f r o m the g e n e r a l p o p u l a t i o n ,  s i n c e t h o s e p e r s o n s a p p r o a c h i n g the F o u n d a t i o n c o u l d not be to be n e c e s s a r i l y  the  considered  r e p r e s e n t a t i v e of the w i d e r p o p u l a t i o n of a l c o h o l i c s ,  a n d the a i m of t h i s p r o j e c t w a s to e v a l u a t e the w o r k of the C l i n i c i n h e l p i n g t h o s e s o r t s of p e r s o n s  Foundation  w h o a c t u a l l y do a p p r o a c h  such  a clinic for help. The experimental 1.  and c o n t r o l groups were, defined as f o l l o w s :  E x p e r i m e n t a l group:  Those persons  who had  at l e a s t f i v e t r e a t m e n t 2.  C o n t r o l group:  undergone sessions.  T h o s e p e r s o n s who had undergone more  than four t r e a t m e n t  not  sessions.  20  It s h o u l d be p o i n t e d out that the m a x i m u m of f o u r " t r e a t m e n t  sessions"  i n the c o n t r o l g r o u p d o e s not r e p r e s e n t a s m a n y a s f o u r v i s i t s to the c l i n i c ; p e r s o n s i n the i n i t i a l s t a g e s of t r e a t m e n t u s u a l l y see a c o u n s e l l o r a n d a d o c t o r d u r i n g e a c h v i s i t , a n d e a c h of t h e s e i n t e r v i e w s i s defined as a " t r e a t m e n t s e s s i o n . "  T h u s the m e m b e r s  g r o u p w o u l d h a v e o n l y v i s i t e d the c l i n i c once o r t w i c e , therefore  of the  control  and it was  c o n s i d e r e d l e g i t i m a t e to r e g a r d t h e s e p e r s o n s a s h a v i n g  h a d " n o t r e a t m e n t " f o r the p u r p o s e s of t h i s s t u d y . ^ In a d d i t i o n , the m e m b e r s of the e x p e r i m e n t a l a n d c o n t r o l groups were three-year  r e q u i r e d to h a v e f i r s t v i s i t e d the F o u n d a t i o n d u r i n g a  period from January  1, 1959  to J a n u a r y 31,  1961.  the f o l l o w - u p i n t e r v i e w i n g w a s c o n d u c t e d b e t w e e n N o v e m b e r , and F e b r u a r y ,  1963,  Since 1962  the p e r i o d of t i m e e l a p s e d s i n c e the i n i t i a l v i s i t  to the F o u n d a t i o n w a s b e t w e e n a p p r o x i m a t e l y nine m o n t h s a n d t h r e e years,  nine m o n t h s .  T h i s l e n g t h of t i m e w a s d e e m e d s u f f i c i e n t to  e s t a b l i s h w h e t h e r o r not a n y l a s t i n g c h a n g e s h a d t a k e n p l a c e i n the individual's behaviour. Control factors The second important feature  of the r e s e a r c h  d e s i g n was  to  e n s u r e the s i m i l a r i t y of the e x p e r i m e n t a l a n d c o n t r o l g r o u p s i n a l l significant respects,  so that a n y d i f f e r e n c e s i n r e h a b i l i t a t i o n b e t w e e n  the two g r o u p s c o u l d be l e g i t i m a t e l y i n f e r r e d to be the r e s u l t of t r e a t m e n t r a t h e r t h a n the r e s u l t of s o m e  other d i f f e r e n c e .  A l i s t of f a c t o r s  Zl  which could conceivably affect rehabilitation was t h e r e f o r e  compiled;  t h i s l i s t m a d e u s e of both the l i t e r a t i i r e i n the f i e l d a n d the i n v e s t i g a tors' speculation,  T h e f a c t o r s to be c o n t r o l l e d a r e a s f o l l o w s :  1.  Sex  2.  A ge  3.  M a r i t a l status  4.  Occupation  5.  Employment  6.  Education  7.  Religion  8.  T i m e elapsed  9.  Motivation for rehabilitation  10.  S e v e r i t y of d r i n k i n g p r o b l e m  11.  T r e a t m e n t o t h e r t h a n at the F o u n d a t i o n  status  since intake  I d e a l l y , i t w o u l d h a v e b e e n p r e f e r a b l e to h a v e m a t c h e d duals on a l l e l e v e n f a c t o r s s i m u l t a n e o u s l y , was  information  l a c k i n g f o r m a n y p a t i e n t s a t the t i m e the t w o g r o u p s w e r e s e l e c t e d ,  t h i s w a s not p o s s i b l e . ever,  S i m u l t a n e o u s m a t c h i n g w a s c a r r i e d out,  on five f a c t o r s : age, m a r i t a l status, occupation,  status, and time e l a p s e d was  but b e c a u s e  indivi-  since intake.  employment  In a d d i t i o n , the f a c t o r of s e x  c o n t r o l l e d by u s i n g o n l y m a l e p a t i e n t s ;  o n l y 10 p e r c e n t  of the  p o p u l a t i o n a r e f e m a l e , a n d s u c h a s m a l l n u m b e r w o u l d not a l l o w rate c o n c l u s i o n s f o r these p a t i e n t s .  how-  clinic  sepa-  22  The  f a c t o r of e d u c a t i o n w a s not u s e d f o r m a t c h i n g ,  found to be c l o s e l y r e l a t e d to o c c u p a t i o n .  since it was  R e l i g i o n w a s a l s o not u s e d  f o r m a t c h i n g , b e c a u s e a b o u t 75 p e r c e n t of the c l i n i c p a t i e n t s i n d i c a t e d that t h e y w e r e " n o n - p r a c t i c i n g " a n d i t t h e r e f o r e s e e m e d not to be a relevant variable. was made  A f t e r the m a t c h i n g of i n d i v i d u a l s , h o w e v e r , a c h e c k  on the d i s t r i b u t i o n of the e x p e r i m e n t a l a n d c o n t r o l g r o u p s  w i t h r e g a r d to t h e s e f a c t o r s o f e d u c a t i o n a n d r e l i g i o n , a n d t h e y w e r e found to be v e r y  similar.  T h e r e w a s not s u f f i c i e n t i n f o r m a t i o n i n the F o u n d a t i o n ' s  files  to p e r m i t the u s e of the r e m a i n i n g t h r e e f a c t o r s ( m o t i v a t i o n , s e v e r i t y of d r i n k i n g p r o b l e m , a n d o t h e r t r e a t m e n t ) i n the m a t c h i n g p r o c e s s . I n f o r m a t i o n was, t h e r e f o r e , c o l l e c t e d d u r i n g t h e i n t e r v i e w i n o r d e r to c h e c k t h e s i m i l a r i t y of the two g r o u p s w i t h r e g a r d t o t h e s e  charac-  teristics. U s i n g the a b o v e p r o c e d u r e ,  200 s u b j e c t s w e r e s e l e c t e d , 100 i n  e a c h of the e x p e r i m e n t a l a n d c o n t r o l  groups.  In o r d e r to s e e w h e t h e r the two g r o u p s s e l e c t e d w e r e t a t i v e o f the p a t i e n t s who c o m e to the F o u n d a t i o n c l i n i c ,  represen-  they w e r e c o m -  p a r e d w i t h a l l of the p a t i e n t s who v i s i t e d the F o u n d a t i o n i n I960.  The  c h a r a c t e r i s t i c s f o r w h i c h i n f o r m a t i o n w a s a v a i l a b l e f o r the I960 i n t a k e w e r e a g e , o c c u p a t i o n , a n d e m p l o y m e n t s t a t u s ; a n d i t w a s found that the d i s t r i b u t i o n s of t h e s e c h a r a c t e r i s t i c s f o r the i n t e r v i e w s a m p l e w e r e s i m i l a r t o the F o u n d a t i o n i n t a k e .  (See T;:.ble 12 of A P P E N D I X A ) .  Interview Because  schedule the r e s u l t s to be o b t a i n e d w o u l d d e p e n d v e r y m u c h on  h o w c a r e f u l l y the q u e s t i o n s w e r e d e s i g n e d , a c o n s i d e r a b l e p r o p o r t i o n of the t i m e a l l o t t e d f o r the r e s e a r c h p r o j e c t w a s d e v o t e d t o the d e v e l o p m e n t of the i n t e r v i e w s c h e d u l e .  A n u m b e r of s c h e d u l e s u s e d i n  p r e v i o u s f o l l o w - u p studies were consulted, disadvantages  of v a r i o u s m e a s u r e s  a n d the a d v a n t a g e s  were weighed.  T h e s c h e d u l e went  through four complete drafts and n u m e r o u s m i n o r r e v i s i o n s . s e v e r a l s t e p s a l o n g the w a y ,  and  At  p r e t e s t i n g was c a r r i e d out i n o r d e r  see h o w the q u e s t i o n s w o u l d w o r k out i n p r a c t i c e .  W h e n the a r e a s to  be c o v e r e d a n d the q u e s t i o n s to be a s k e d h a d b e e n e s t a b l i s h e d , coded response  to  pre-  categories for I B M key-punching were added.  T h e i n t e r v i e w s c h e d u l e was d e s i g n e d to s e c u r e t h r e e t y p e s of data: 1.  I n f o r m a t i o n c o n c e r n i n g the c o n t r o l f a c t o r s u p o n w h i c h the e x p e r i m e n t a l a n d c o n t r o l g r o u p s w e r e d e s i r e d to be s i m i l a r .  2.  M i s c e l l a n e o u s i n f o r m a t i o n w h i c h w a s of i n t e r e s t  to  the F o u n d a t i o n . 3.  I n f o r m a t i o n c o n c e r n i n g the e x t e n t of r e h a b i l i t a t i o n that h a d o c c u r r e d (these q u e s t i o n s c o m p r i s e d the m a j o r p a r t of the i n t e r v i e w  schedule).  A c o p y of the i n t e r v i e w s c h e d u l e i s i n c l u d e d a s A p p e n d i x B of  this r e p o r t ;  a k e y h a s a l s o b e e n a d d e d w h i c h i n d i c a t e s the n u m b e r s of  the q u e s t i o n s w h i c h r e f e r to e a c h of the t h r e e c l a s s e s of i n f o r m a t i o n mentioned above. Control Factors  1.  It w i l l be r e c a l l e d that the F o u n d a t i o n f i l e s d i d not i n c l u d e a d e q u a t e i n f o r m a t i o n r e g a r d i n g t h r e e of the c o n t r o l f a c t o r s . more,  Further-  it w a s s u s p e c t e d that w i t h r e s p e c t to the s o c i a l b a c k g r o u n d  characteristics  of the s u b j e c t s ,  the i n f o r m a t i o n f o u n d i n the F o u n d a -  t i o n f i l e s m i g h t not a l w a y s be r e l i a b l e .  Because  of t h i s ,  it w a s  de-  c i d e d to s e c u r e data f r o m r e s p o n d e n t s w i t h r e g a r d to a l l e l e v e n c o n trol factors, control  i n o r d e r to e n s u r e the s i m i l a r i t y of e x p e r i m e n t a l a n d  groups. 2.  Miscellaneous Information T h i s i n f o r m a t i o n i s not r e l e v a n t to the p r e s e n t  therefore 3.  w i l l not be d i s c u s s e d  study,  and  here.  I n d i c e s of R e h a b i l i t a t i o n D e f i n i t i o n s of " r e h a b i l i t a t i o n " u s u a l l y i n c l u d e t e r m s l i k e  " i m p r o v e m e n t " o r " d e t e r i o r a t i o n , " a n d the i n v e s t i g a t o r s w e r e  aware  8  that s o m e w r i t e r s  have c r i t i c i z e d such c a t e g o r i e s as i n v o l v i n g u n -  warranted value judgments. c e r n e d to e v a l u a t e m e a n s , effectiveness own a i m s .  H o w e v e r , the r e s e a r c h not e n d s ;  team was con-  its t a s k w a s to d e t e r m i n e  the  of the F o u n d a t i o n t r e a t m e n t p r o g r a m m e i n a c h i e v i n g i t s  These a i m s certainly involved value judgments,  but the  25  q u e s t i o n of t h e i r l e g i t i m a c y w a s not one that p r o p e r l y c o n c e r n e d the researchers.  A c c o r d i n g l y , a d e f i n i t i o n of r e h a b i l i t a t i o n w a s not i m -  p o s e d by the r e s e a r c h t e a m , but r a t h e r the F o u n d a t i o n s t a f f w e r e a s k e d to o u t l i n e the ends t h e y sought t h r o u g h t h e i r t r e a t m e n t .  The Founda-  t i o n s t a f f p r e s e n t e d a n i n i t i a l l i s t of b e h a v i o u r a l c h a n g e s that w e r e des i r e d i n their patients, as follows: Continuing sobriety or L o n g e r p e r i o d s of s o b r i e t y t h a n b e f o r e t r e a t m e n t A s well as: 1.  Improved stability in employment  2.  R e c o n c i l i a t i o n with  3.  Active membership in Alcoholics Anonymous  4.  I n c r e a s e d h a r m o n y i n the h o m e  5.  I m p r o v e d p h y s i c a l status  6.  I m p r o v e d b e h a v i o u r of c h i l d r e n  7.  Better social participation  8.  Improved altitudes toward  9.  Re-assumption  spouse  life  o£ d o m e s t i c  responsibilities.  10.  R e t u r n to a n a c t i v e r e l i g i o u s  11.  Ivlore o p t i m i s t i c o u t l o o k  12.  M o r e r e a l i s t i c a p p r o a c h to p r o b l e m s  13.  C o n t i n u i n g u s e of c l i n i c  14.  L e s s f r e q u e n t r e c o u r s e to d r u g s o r s e d a t i v e s  life  service  26  15.  M o r e s e l f - r e l i a n c e a n d l e s s d e p e n d e n c y on c o m m u n i t y resources  16.  Improved family interrelationships  T h e r e s e a r c h t e a m t h e n h e l d d i s c u s s i o n s w i t h the staff a s to how t h e s e c o u l d be c l a s s i f i e d ,  a n d a d e f i n i t i o n of r e h a b i l i t a t i o n w a s  estab-  l i s h e d i n t e r m s of "changes i n s p e c i f i e d a s p e c t s of the s u b j e c t ' s b e h a v i o u r which had o c c u r r e d  b e t w e e n the t i m e of i n t a k e at the  t i o n a n d the t i m e of i n t e r v i e w ,  Founda-  i n the f o l l o w i n g s i x a r e a s of b e h a v i o u r :  1.  Patient's drinking behaviour  2.  P a t i e n t ' s health ( p h y s i c a l and  3.  P a t i e n t ' s b e h a v i o u r i n the a r e a of w o r k  4.  P a t i e n t ' s i n t e r a c t i o n i n the f a m i l y  5.  Patient's social  6.  P a t i e n t ' s i n s i g h t into h i s p r o b l e m s a s s o c i a t e d  emotional)  activities with  drinking W i t h i n e a c h of the a b o v e l i t a t i o n " ( c h a n g e i n the p a t i e n t ' s the F o u n d a t i o n ) w e r e u s e d . m a t i o n was gathered  six a r e a s ,  s e v e r a l i n d i c e s of " r e h a b i -  b e h a v i o u r i n the d i r e c t i o n d e s i r e d by  A l a r g e a m o u n t of f a i r l y d e t a i l e d i n f o r -  by a s k i n g v a r i o u s q u e s t i o n s c o n c e r n i n g the  p a t t e r n of b e h a v i o u r i n e a c h a r e a of l i f e m e n t i o n e d a b o v e ,  both at the  t i m e the s u b j e c t a p p r o a c h e d the F o u n d a t i o n a n d at the t i m e of i n t e r v i e w . T h i s i n f o r m a t i o n w a s t h e n u s e d to f o r m u l a t e " o b j e c t i v e " i n d i c e s of rehabilitation,  d e f i n e d a s the c h a n g e i n e a c h type of b e h a v i o u r d u r i n g  27  the p e r i o d b e t w e e n t h e s e two o c c a s i o n s . ^ In o t h e r c a s e s ,  w h e r e the k i n d s of b e h a v i o u r a l c h a n g e s  d i d not p e r m i t s u f f i c i e n t p r e c i s i o n i n the d a t a , habilitation were assessments viewer,  the m e a s u r e s  involved  of r e -  of c h a n g e i n b e h a v i o u r m a d e by the i n t e r -  b a s e d o n the d e t a i l e d i n f o r m a t i o n w h i c h h a d b e e n o b t a i n e d .  a d d i t i o n to t h e s e t w o t y p e s of m e a s u r e s own a s s e s s m e n t t i o n e d was  of r e h a b i l i t a t i o n , the  In  patient's  of the c h a n g e of b e h a v i o u r i n e a c h of the a r e a s m e n -  secured.  Some comments  s h o u l d be m a d e at t h i s p o i n t r e g a r d i n g the  c h o i c e of t h e s e t h r e e t y p e s of i n d i c e s of r e h a b i l i t a t i o n , f o r t h i s w a s one of the m a j o r m e t h o d o l o g i c a l p r o b l e m s f a c e d by the r e s e a r c h t e a m , basic question was, valid,  w h i c h one of the t h r e e t y p e s of i n d e x  the " o b j e c t i v e " i n d e x ( b a s e d ,  c o r d i n g of the f a c t s ) , himself,  however,  on the p a t i e n t ' s  the s u b j e c t i v e a s s e s s m e n t  o r the s u b j e c t i v e a s s e s s m e n t  of the  i s the  The  most  own r e -  m a d e b y the p a t i e n t  interviewer?  T h e o b j e c t i v e i n d e x h a s the a d v a n t a g e that it i s l e a s t s u b j e c t to v a r i o u s k i n d s of d i s t o r t i o n w h i c h c a n e n t e r i n t o s u b j e c t i v e j u d g m e n t s . Accordingly,  a n a t t e m p t w a s m a d e to d e v i s e a^ m a n y i n d i c e s a s p o s -  s i b l e of the o b j e c t i v e t y p e .  T h e p r o b l e m w i t h t h i s s o r t of m e a s u r e ,  however,  i s the d i f f i c u l t y i n c o n s t r u c t i n g a n i n d e x w h i c h a d e q u a t e l y  measures  what it i s p u r p o r t e d to m e a s u r e .  alcoholism literature extremely complex,  A n extensive  r e a d i n g of the  s u g g e s t e d that the p h e n o m e n o n of a l c o h o l i s m i s a n d t h e r e f o r e d i f f i c u l t to r e d u c e to s i m p l e  measures  of s e v e r i t y of p r o b l e m .  C o n s i d e r a b l e d i f f i c u l t y was ex-  p e r i e n c e d i n the a t t e m p t to d e v i s e s u c h i n d i c e s of s e v e r i t y of d r i n k i n g , a n d e q u a l d i f f i c u l t i e s w e r e p r e s e n t w h e n d e a l i n g w i t h o t h e r a r e a s of b e haviour.  Nevertheless,  s e v e r a l i n d i c e s of t h i s t y p e w e r e u t i l i z e d .  T h e s u b j e c t i v e a s s e s s m e n t , m a d e by the i n t e r v i e w e r , h a s the a d v a n t a g e that i t c a n t a k e i n t o a c c o u n t m o r e r e a d i l y v a r i o u s a s p e c t s of c o m p l e x p a t t e r n s of h u m a n b e h a v i o u r , by m a k i n g u s e of the i n t e r v i e w e r ' s general " i n s i g h t " into such behaviour.  There is,  however,  the p o s s i b i l i t y of v a r i o u s s o r t s of b i a s e n t e r i n g i n t o t h e s e j u d g m e n t s , a l t h o u g h t h e r e i s l i k e l y l e s s d a n g e r t h a n i n the c a s e of the  patient's  own a s s e s s m e n t . T h e p a t i e n t ' s o w n a s s e s s m e n t w a s c o n s i d e r e d to be s u b j e c t to s e r i o u s b i a s a c c o r d i n g t o the p e r s o n ' s o w n v a r i o u s n e e d s .  Many  w r i t e r s c o n s i d e r the a l c o h o l i c to be p a r t i c u l a r l y p r o n e to m a n y k i n d s of d i s t o r t i o n , p a r t i c u l a r l y to m i n i m i z a t i o n of h i s d r i n k i n g p r o b l e m .  ^  D e s p i t e t h i s p r o b l e m , t h o u g h , t h e r e i s no r e a s o n to d i s c r e d i t c o m p l e t e l y the p a t i e n t ' s o w n o p i n i o n a b o u t h i s b e h a v i o u r , a n d s o m e  mea-  s u r e s of t h i s type w e r e i n c l u d e d . Because there e a c h t y p e of m e a s u r e ,  s e e m e d to be a d v a n t a g e s a n d d i s a d v a n t a g e s t o u s e of o n l y one t y p e w a s not t h o u g h t to be j u s t i -  f i e d , a n d t h e r e f o r e the i n d i c e s of r e h a b i l i t a t i o n i n c l u d e d o b j e c t i v e i n dices  a s . w e l l a s a s s e s s m e n t s m a d e by the p a t i e n t a n d the i n t e r v i e w e r .  29  III.  L o c a t i n g a n d I n t e r v i e w i n g the S a m p l e C o n s i d e r a b l e t h o u g h t w a s g i v e n to a p p r o a c h i n g a n d i n t e r v i e w i n g  the s u b j e c t s i n s u c h a w a y a s t o s e c u r e the m o s t r e l i a b l e i n f o r m a t i o n possible.  It s e e m e d a d v i s a b l e to d i s s o c i a t e the r e s e a r c h t e a m f r o m  the F o u n d a t i o n ' s c l i n i c a l o p e r a t i o n s ,  s i n c e i t w a s f e l t that t o o c l o s e a n  a s s o c i a t i o n b e t w e e n the r e s e a r c h t e a m a n d the F o u n d a t i o n m i g h t l e a d r e s p o n d e n t s to give b i a s e d a n s w e r s .  F o r instance,  m e m b e r s of the  c o n t r o l g r o u p m i g h t be a f f e c t e d by g u i l t at not h a v i n g c o n t i n u e d w i t h treatment,  o r h a v e c e r t a i n n e g a t i v e i m p r e s s i o n s of the c l i n i c w h i c h  t h e y m i g h t be r e t i c e n t to c o n v e y t o i n t e r v i e w e r s d i r e c t l y a s s o c i a t e d with it.  M e m b e r s of the e x p e r i m e n t a l g r o u p m i g h t be p r o n e t o e x a g -  g e r a t e the e f f e c t i v e n e s s  of t r e a t m e n t i n t h e i r o w n c a s e , i f they p o s -  s e s s e d g e n e r a l l y f a v o r a b l e o p i n i o n s of the t r e a t m e n t Therefore,  programme.  w h e n c o n t a c t i n g the r e s p o n d e n t s the i n t e r v i e w e r s  stressed  the f a c t t h a t t h e y w e r e p a r t of a n o u t s i d e t e a m of c o n s u l t a n t s w h o h a d b e e n c a l l e d i n t o e v a l u a t e the w o r k of the c l i n i c .  No reference was  m a d e d u r i n g the i n t e r v i e w s t o a n y i n f o r m a t i o n a b o u t the p a t i e n t w h i c h the i n t e r v i e w e r s p o s s e s s e d .  T h i s m a d e p o s s i b l e a c h e c k on j u s t h o w  t r u t h f u l e a c h r e s p o n d e n t h a d b e e n a n d w h a t f a c t s he t r i e d t o h i d e o r distort. I n o r d e r t o f u r t h e r c o n v e y the i m p r e s s i o n of the o b j e c t i v i t y of the r e s e a r c h t e a m ,  i n t e r v i e w s w e r e not h e l d i n the F o u n d a t i o n o f f i c e s .  Instead, a n attempt was made to suggest a n a s s o c i a t i o n with m e d i c a l  interests,  by h o l d i n g i n t e r v i e w s i n o f f i c e s l o a n e d b y the P r o v i n c i a l  Health Department.  It w a s f e l t that t h i s w o u l d b o t h i n c r e a s e the s u b -  j e c t ' s w i l l i n g n e s s to c o o p e r a t e a n d a l s o to be l e s s l i k e l y to r e s u l t i n his giving biased information.  H o w e v e r , i t w a s m a d e c l e a r t h a t the ' 12  r e s e a r c h w a s i n c o n n e c t i o n w i t h the r e s p o n d e n t ' s a l c o h o l p r o b l e m . A f t e r c o m p l e t i n g the i n t e r v i e w s , the i n t e r v i e w e r s f e l t that the l o c a t i o n w a s a good c h o i c e a n d c o n t r i b u t e d to the p a t i e n t ' s f e e l i n g a t e a s e . D i f f i c u l t i e s e n c o u n t e r e d i n l o c a t i n g the t w o h u n d r e d p e r s o n s c h o s e n f o r i n t e r v i e w a r e r a t h e r i n s t r u c t i v e c o n c e r n i n g the n a t u r e of the p r o b l e m d r i n k e r .  T h i s p h a s e of the p r o j e c t r e q u i r e d a t r e m e n d o u s  a m o u n t of t i m e a n d e n e r g y ;  i t i n v o l v e d the e q u i v a l e n t of one  person's  w o r k i n g t i m e , i n c l u d i n g nights and weekends f r e q u e n t l y , f o r over eight months.  T h e t h r e e i n t e r v i e w e r s t r a v e l l e d o v e r 5 , 0 0 0 m i l e s by c a r a n d  o v e r 2, 000 m i l e s by b u s , t r a i n , a n d p l a n e i n the p r o c e s s of l o c a t i n g the s u b j e c t s .  The difficulties encountered produced a r e l a t i v e l y high  c o s t - $28. 00 p e r s u b j e c t i n t e r v i e w e d .  In a d d i t i o n to t i m e s p e n t by  the i n t e r v i e w e r s o v e r a t h r e e - m o n t h p e r i o d , n u m e r o u s h o u r s of h e l p 13 w e r e r e c e i v e d f r o m l i t e r a l l y s c o r e s of o t h e r  agencies.  The e x p e r i m e n t a l and c o n t r o l groups o r i g i n a l l y contained persons,  a n d 14 s u b s t i t u t i o n s ( 9 to r e p l a c e p e r s o n s w h o h a d d i e d ,  200 and  5 to r e p l a c e p e r s o n s w h o c o u l d not be l o c a t e d ) b r o u g h t the t o t a l n u m b e r of p a t i e n t s s e l e c t e d t o 2 1 4 .  In s p i t e of the d i f f i c u l t y i n l o c a t i n g s u b -  j e c t s , i n t e r v i e w s w e r e c o m p l e t e d f o r 72% of the s a m p l e (155  persons).  There were only 9 outright refusals,  a l t h o u g h i n the c a s e of s o m e  sub-  j e c t s i t t o o k a c o n s i d e r a b l e a m o u n t of p e r s u a s i o n b e f o r e t h e y a g r e e d t o be i n t e r v i e w e d .  A s u m m a r y of c a s e s f o u n d a n d i n t e r v i e w e d i s p r e -  sented i n T A B L E  T A B L E 1:  1.  S u m m a r y of C a s e s F o u n d a n d I n t e r v i e w e d Experimental  Control  Total  Persons chosen i n original groups  100  100  200  Substitutes: to m a t c h p a i r f o r dead T o t a l Sample Chosen  5 1  4  .  4  9 5*  106  108  214  Total interviewed  91  64  155  T o t a l unable to t r a c e  11  29  40  2  7  9  2  8  10  106  108  214  86%  59%  72%  Refusals U n a b l e to i n t e r v i e w by f i n a l date f o r v a r i o u s r e a s o n s  % of G r o u p s I n t e r v i e w e d  *9 p e r s o n s d i e d a l t o g e t h e r , but 3 d i d s o d u r i n g the t i m e s p a n a l l o c a t e d f o r i n t e r v i e w i n g a n d no s u b s t i t u t e s w e r e d e e m e d n e c e s s a r y ; 1 d e a d p e r s o n c o u l d not be m a t c h e d .  IV.  Summary The data f o r this study w e r e obtained f r o m a r e s e a r c h p r o j e c t  w h i c h w a s d e s i g n e d t o e v a l u a t e the e f f e c t i v e n e s s of the t r e a t m e n t f o r a l c o h o l i s m g i v e n by the A l c o h o l i s m F o u n d a t i o n of B r i t i s h C o l u m b i a . T h e r e s e a r c h d e s i g n i n v o l v e d a c o m p a r i s o n of the e x t e n t of r e h a b i l i t a t i o n w h i c h h a d t a k e n p l a c e o v e r a p e r i o d of t i m e i n t w o g r o u p s alcoholics,  one of w h i c h h a d r e c e i v e d t r e a t m e n t f r o m the  w h i l e the o t h e r h a d not.  The e x p e r i m e n t a l  of  Foundation  group was composed  those p e r s o n s who had undergone m o r e than five treatment  of  sessions  at the F o u n d a t i o n , w h i l e the c o n t r o l g r o u p w a s s e l e c t e d f r o m p e r s o n s w h o h a d a p p r o a c h e d the F o u n d a t i o n r e g a r d i n g t r e a t m e n t ,  but w h o h a d  not r e m a i n e d f o r m o r e t h a n f o u r t r e a t m e n t s e s s i o n s . C e r t a i n factors were selected which were considered potentially affect rehabilitation,  to  w i t h a v i e w to c o n t r o l l i n g f o r t h e s e  f a c t o r s by e n s u r i n g the s i m i l a r i t y of the t w o g r o u p s i n t h e s e r e s p e c t s . T h e f i v e f a c t o r s of: occupation,  time elapsed  since intake,  age,  m a r i t a l status,  a n d e m p l o y m e n t s t a t u s w e r e c o n t r o l l e d by m a t c h i n g e a c h  m e m b e r of the e x p e r i m e n t a l  g r o u p w i t h a n o t h e r i n the c o n t r o l g r o u p .  T w o a d d i t i o n a l f a c t o r s ( e d u c a t i o n a n d r e l i g i o n ) w e r e f o u n d to h a v e s i m i l a r g r o u p d i s t r i b u t i o n s b e t w e e n the e x p e r i m e n t a l a n d c o n t r o l  group  T h e c h a r a c t e r i s t i c of s e x w a s c o n t r o l l e d by e l i m i n a t i n g w o m e n f r o m the s a m p l e .  However,  b e c a u s e of l a c k of i n f o r m a t i o n i t w a s i m p o s -  s i b l e to c o n t r o l f o r the f a c t o r s :  1.  Motivation for rehabilitation  2.  S e v e r i t y of d r i n k i n g p r o b l e m  3.  Treatment received  Therefore,  elsewhere  a n a t t e m p t w a s m a d e i n the i n t e r v i e w to s e c u r e i n f o r m a t i o n  r e g a r d i n g these f a c t o r s ,  i n o r d e r t o a s c e r t a i n the e x t e n t t o w h i c h b o t h  groups w e r e s i m i l a r i n these  respects,  A c o m p a r i s o n w a s m a d e b e t w e e n the g r o u p s c h o s e n f o r i n t e r v i e w a n d the t o t a l c l i n i c p o p u l a t i o n i n the y e a r I 9 6 0 , a n d o n the  factors  c o m p a r e d the t w o g r o u p s s e e m e d r e p r e s e n t a t i v e of the t o t a l c l i n i c population.  The r e s e a r c h data w e r e s e c u r e d i n p e r s o n a l i n t e r v i e w s  with f o r m e r patients,  by the u s e of a d e t a i l e d i n t e r v i e w s c h e d u l e .  This  s c h e d u l e c o n t a i n e d q u e s t i o n s w h i c h s o u g h t t o s e c u r e t h r e e c l a s s e s of information: T.  T h e e x t e n t of r e h a b i l i t a t i o n w h i c h h a d o c c u r r e d  2.  Data regarding control factors  3.  M i s c e l l a n e o u s i n f o r m a t i o n of i n t e r e s t to the F o u n d a t i o n  Various measures  of r e h a b i l i t a t i o n w e r e d e v e l o p e d w i t h the a i d of  c o n s u l t a t i o n w i t h t h e F o u n d a t i o n s t a f f a n d the l i t e r a t u r e on p r e v i o u s follow-up studies.  These measures  s o u g h t to a s c e r t a i n the e x t e n t to  w h i c h the r e s p o n d e n t ' s b e h a v i o u r a n d a t t i t u d e s h a d c h a n g e d b e t w e e n the t i m e of f i r s t c o n t a c t w i t h the F o u n d a t i o n a n d the t i m e of i n t e r v i e w . S i x r e l e v a n t a r e a s of b e h a v i o u r w e r e d e l i m i t e d : 1.  Drinking behaviour  34  2.  H e a l t h ( p h y s i c a l and  3.  B e h a v i o u r i n the a r e a of w o r k  4.  S o c i a l i n t e r a c t i o n i n the f a m i l y  5.  Social  6.  I n s i g h t into p r o b l e m s a s s o c i a t e d w i t h d r i n k i n g  Finally,  emotional)  activities  a b r i e f d e s c r i p t i o n was  l o c a t i n g a n d i n t e r v i e w i n g the s a m p l e , a n d the d i f f i c u l t i e s e n c o u n t e r e d . was also indicated.  g i v e n of the p r o c e s s  i n d i c a t i n g the m e t h o d s  T h e d e g r e e of s u c c e s s  of used  achieved  35 FOOTNOTES:  C h a p t e r II  R e g i n a l d A . PL R o b s o n , I n g e b o r g P a u l u s , a n d G . G r a n t C l a r k e , A n E v a l u a t i o n of the E f f e c t of T r e a t m e n t on the R e h a b i l i t a t i o n of A l c o h o l i c s ( V a n c o u v e r : T h e A l c o h o l i s m F o u n d a t i o n of B r i t i s h C o l u m b i a , 1963), p . 4 . 2  S e e , f o r e x a m p l e , the d i s c u s s i o n of t h i s q u e s t i o n by R . J . G i b b i n s a n d J . D , A r m s t r o n g , " E f f e c t s of C l i n i c a l T r e a t m e n t on B e h a v i o u r of A l c o h o l i c P a t i e n t s , " Q u a r t e r l y J o u r n a l of S t u d i e s o n A l c o h o l , X V I I I ( S e p t e m b e r , 1957), 4 3 0 - 4 3 1 . ~~ A n o t h e r i n a d e q u a c y o b s e r v e d i n s o m e of the f o l l o w - u p s t u d i e s i n the l i t e r a t u r e w a s the m e r e o b s e r v i n g of s t a t u s at f o l l o w - u p o n c e r t a i n b e h a v i o u r a l c h a r a c t e r i s t i c s , r a t h e r t h a n u s i n g m e a s u r e s of c h a n g e . F o r i n s t a n c e , see C l i n i c a l P r a c t i c e a n d C o m m u n i t y E d u c a t i o n on A l c o h o l i s m : A R e s e a r c h R e p o r t on the P r o g r a m of the C o n n e c t i c u t C o m m i s s i o n on A l c o h o l i s m ( H a r t f o r d : C o n n e c t i c u t C o m m i s s i o n on A l c o h o l i s m , 1959), p p . 1 9 - 2 3 . T ^ r e f e r s t o t i m e of i n t a k e i n t e r v i e w , a n d T 2 r e f e r s to t i m e of f o l l o w - u p i n t e r v i e w . 4  5  S t r i c t l y s p e a k i n g , t h i s w o u l d be r e f e r r e d t o a s a " p s e u d o c o n t r o l " g r o u p , but f o r e a s e of e x p r e s s i o n , i t w i l l be s u b s e q u e n t l y called a control group. 6pt i s s i g n i f i c a n t t o note that a s u b s e q u e n t f o l l o w - u p s t u d y to the p r e s e n t one h a s e m p l o y e d the s a m e d e f i n i t i o n , r e g a r d i n g t h o s e w h o attended m o r e t h a n f o u r t i m e s as " t r e a t m e n t p a t i e n t s . " Gerhart S a e n g e r a n d D o n a l d G e r a r d , " A F o l l o w - U p S t u d y of P a t i e n t s S e e n i n C l i n i c s A s s o c i a t e d v / i t h the N o r t h A m e r i c a n A s s o c i a t i o n of A l c o h o l i s m P r o g r a m s , " i n S e l e c t e d P a p e r s D e l i v e r e d at tlxe F o u r t e e n t h A n n u a l M e e t i n g of the N o r t h A m e r i c a n A s s o c i a t i o n of A l c o h o l i s m P r o g r a m s ( W a s h i n g t o n : N o r t h A m e r i c a n A s s o c i a t i o n of A l c o h o l i s m P r o g r a m s , 1 9 6 3 ) , p . 104. D e t a i l s of the p r o c e d u r e f o l l o w e d i n d e v e l o p i n g the i n t e r v i e w s c h e d u l e w i l l be f o u n d o n pp„ 2 6 - 2 9 of the p r o j e c t r e s e a r c h r e p o r t , R o b s o n , P a u l u s , and C l a r k e , op. c i t .  pp.  F o r example, 449-450.  see  G i b b i n s and A r m s t r o n g , op. c i t . ,  36 9  F o r i n s t a n c e , one of the i n d i c e s w a s " a b s t i n e n c e , " d e f i n e d a s the d i f f e r e n c e b e t w e e n the n u m b e r of w e e k s of c o m p l e t e a b s t i n e n c e i n t w o s i x - m o n t h p e r i o d s , one b e f o r e the t i m e of i n t a k e at the F o u n d a t i o n , the o t h e r b e f o r e the t i m e of f o l l o w - u p i n t e r v i e w . ^ E u g e n i a V, S m i t h , " F i e l d I n t e r v i e w i n g of P r o b l e m D r i n k e r s , " S o c i a l W o r k , I V ( O c t o b e r , 1959), 8 0 - 8 6 . ^ A c o m p a r i s o n of the r e s u l t s a c h i e v e d by the u s e of v a r i o u s s o r t s of i n d i c e s i s p r e s e n t e d i n C h a p t e r III b e l o w . 12 S m i t h ( o p . c i t . ) s t a t e s t h a t i n a C a l i f o r n i a D e p a r t m e n t of P u b l i c H e a l t h s t u d y d u r i n g 1956- 1958, the r e s p o n d e n t s w e r e i n f o r m e d t h e y w e r e t a k i n g p a r t i n a h e a l t h s u r v e y . H o w e v e r , a f t e r s o m e of t h e m r e a l i z e d the s t u d y w a s a c t u a l l y d i r e c t e d t o w a r d s t h e i r d r i n k i n g b e h a v i o u r f o r the m o s t p a r t , t h e y w e r e q u i t e a n n o y e d a n d f e l t t h a t the i n t e r v i e w e r h a d d e c e i v e d t h e m by m i s r e p r e s e n t i n g the f a c t s . The i n v e s t i g a t o r s i n the p r e s e n t r e s e a r c h p r o j e c t , t h e r e f o r e , d e c i d e d not to m a k e the s a m e m i s t a k e . 13 The p r o c e d u r e followed i n locating subjects is d e s c r i b e d i n c o n s i d e r a b l e d e t a i l i n C h a p t e r 3 of the p r o j e c t r e s e a r c h r e p o r t , R o b s o n , P a u l u s , and C l a r k e , op. cit.  CHAPTER  THE  I.  EFFECT  OF  III  TREATMENT  ON  REHABILITATION  Control Factors T h e f i r s t s t e p i n the a n a l y s i s of the d a t a w a s t o c h e c k the  l a r i t y of the e x p e r i m e n t a l a n d c o n t r o l g r o u p s o n t h o s e f a c t o r s w e r e c o n s i d e r e d to have a p o s s i b l e effect on r e h a b i l i t a t i o n .  simi-  which It w i l l be  r e m e m b e r e d that the t w o g r o u p s w e r e c o n s t r u c t e d of 100 p a i r s m a t c h e d o n a n u m b e r of s o c i o - e c o n o m i c c h a r a c t e r i s t i c s .  H o w e v e r , b e c a u s e not  a l l t h o s e s e l e c t e d c o u l d be i n t e r v i e w e d a n d a l s o b e c a u s e s o m e d a t a u s e d i n the m a t c h i n g p r o c e s s w e r e f o u n d d u r i n g the f o l l o w - u p i n t e r v i e w to be e r r o n e o u s ,  o n l y 44 m a t c h e d p a i r s w e r e o b t a i n e d f r o m the t o t a l  of 155 p e r s o n s w h o w e r e e v e n t u a l l y i n t e r v i e w e d .  This substantial re-  d u c t i o n i n the n u m b e r of m a t c h e d p a i r s w a s not a s s e r i o u s a s i t m i g h t seem,  however,  s i n c e the e x p e r i m e n t a l a n d c o n t r o l g r o u p s c o m p o s e d  of b o t h m a t c h e d a n d u n m a t c h e d p a t i e n t s w e r e f o u n d t o h a v e  comparable  d i s t r i b u t i o n s t o the m a t c h e d p a i r g r o u p s on a l l e l e v e n c o n t r o l f a c t o r s . Therefore,  the e n t i r e g r o u p of 155 s u b j e c t s w e r e u s e d f o r the  p o r t i o n of the a n a l y s i s ,  major  but a s a s a f e g u a r d , a s i m i l a r a n a l y s i s w a s  u n d e r t a k e n u s i n g o n l y the m a t c h e d p a i r s ,  since this is a m o r e  effective  m e a n s of c o n t r o l t h a n u s i n g g r o u p d i s t r i b u t i o n s . C o m p a r i s o n of the e x p e r i m e n t a l a n d c o n t r o l g r o u p s s h o w e d t h a t  38 t h e y w e r e s i m i l a r on e i g h t of the c o n t r o l f a c t o r s a n d d i f f e r e n t on o n l y three:  motivation,  seriousness  of d r i n k i n g p r o b l e m , a n d c o n t a c t w i t h  A l c o h o l i c s Anonymous after receiving Foundation treatment. i n the e x p e r i m e n t a l habilitated,  group w e r e somewhat  Those  b e t t e r m o t i v a t e d to be  re-  they had m e r e s e r i o u s d r i n k i n g p r o b l e m s ( a c c o r d i n g  t h e i r own a s s e s s m e n t ) ,  and had m o r e  to  contact with A l c o h o l i c s A n o n y -  m o u s s i n c e c o m i n g to the F o u n d a t i o n . *  C o m p a r i s o n of the e x t e n t of  r e h a b i l i t a t i o n i n the e x p e r i m e n t a l a n d c o n t r o l g r o u p s t h e r e f o r e i n cluded controls  II.  f o r the e f f e c t of t h e s e t h r e e f a c t o r s .  I n d i c e s of R e h a b i l i t a t i o n B e f o r e p r e s e n t i n g the r e s u l t s o n the c o m p a r i s o n of r e h a b i l i t a t i o n  r a t e s i n the e x p e r i m e n t a l a n d c o n t r o l g r o u p s , made  some comments  s h o u l d be  on the i n d i c e s of r e h a b i l i t a t i o n w h i c h w e r e u s e d f o r a n a l y s i s .  m e a s u r e s of r e h a b i l i t a t i o n w e r e d e f i n e d i n t e r m s of c h a n g e b e t w e e n t i m e the s u b j e c t f i r s t a p p r o a c h e d view.  of the a n a l y s i s u t i l i z e d o n l y t h r e e c a t e g o r i e s : However,  A s w i l l be r e c a l l e d ,  most  "Improved," "No Change,"  a f i n e r b r e a k d o w n was u s e d f o r  s a k e of g r e a t e r p r e c i s i o n i n s o m e  the  cases.  s i x a r e a s of r e h a b i l i t a t i o n w e r e  selected,  i n v o l v i n g both the p a t i e n t ' s d r i n k i n g b e h a v i o u r a n d h i s b e h a v i o u r i n o t h e r a r e a s of l i f e .  V a r i o u s questions were asked c o v e r i n g  a s p e c t s of b e h a v i o u r i n e a c h a r e a .  the  the F o u n d a t i o n a n d the t i m e of i n t e r -  P r i n c i p a l l y due to the r e l a t i v e l y s m a l l n u m b e r of c a s e s ,  and " D e t e r i o r a t e d , "  The  In a d d i t i o n to t h e s e  several  questions  39 c o n c e r n i n g a c t u a l b e h a v i o u r , the p a t i e n t w a s a s k e d f o r h i s o w n a s s e s s m e n t of the d e g r e e  of c h a n g e that h a d t a k e n p l a c e i n e a c h a r e a .  on a l l the a n s w e r s  o b t a i n e d i n a n y one a r e a ,  an o v e r a l l assessment  Based  the i n t e r v i e w e r t h e n m a d e  of c h a n g e i n that a r e a .  E a c h of the s i x a r e a s g e n e r a l l y i n c l u d e d b e t w e e n f i v e a n d t e n questions, analysis,  i n o r d e r to e n s u r e a d e q u a t e c o v e r a g e . however,  F o r the p u r p o s e of  c o m p a r i s o n s b e t w e e n the e x p e r i m e n t a l a n d c o n t r o l  groups i n v o l v i n g between f o r t y and fifty i n d i c e s would have been f a r unwieldy.  T h e r e f o r e , a l l indices in each a r e a were cros  too  e-tabulated  a g a i n s t e a c h o t h e r to see i f t h e y m e a s u r e d e s s e n t i a l l y the s a m e t h i n g . T o f a c i l i t a t e t h i s p o r t i o n of the a n a l y s i s ,  a measure  of the e x t e n t of  c o v a r i a n c e i n each bivariate c o m p a r i s o n was developed, c a l l e d for sake of c o n v e n i e n c e ,  "consistency. "  N u m b e r of c a s e s m o v i n g i n the CONSISTENCY  =  s  a  m  e  d i r e c t i o n on e a c h i n d e x  , O , —)  T o t a l n u m b e r of c a s e s ( e x c l u d i n g " n o answer"  The  responses)  c o n s i s t e n c y f i g u r e s c o m p u t e d b e t w e e n e a c h p a i r of i n d i c e s w i t h i n  an a r e a were examined, of e a c h c l u s t e r ,  and c l u s t e r s  of i n d i c e s i d e n t i f i e d .  In the c a s e  the i t e m w i t h the h i g h e s t c o n s i s t e n c y w i t h o t h e r s  s e l e c t e d f o r p u r p o s e s of f u r t h e r a n a l y s i s .  was  I n d i c e s w h i c h d i d not show  h i g h c o n s i s t e n c y w i t h o t h e r s i n the a r e a ( c o n s i s t e n c y f i g u r e s g e n e r a l l y l e s s t h a n . 75) w e r e i n c l u d e d i n the f u r t h e r a n a l y s i s a s  separate indices  40 of r e h a b i l i t a t i o n ,  s i n c e i t w a s f e l t that t h e y m i g h t m e a s u r e a d i f f e r e n t  a s p e c t of b e h a v i o u r . T A B L E Z s h o w s c o n s i s t e n c y f i g u r e s b e t w e e n v a r i o u s i n d i c e s of change i n d r i n k i n g behaviour, used.  a s a n e x a m p l e of the t e c h n i q u e w h i c h  I n d i c e s a r e r e f e r r e d to by t h e i r c o d e  T A B L E 2:  was  number.  C o n s i s t e n c y F i g u r e s B e t w e e n V a r i o u s I n d i c e s of C h a n g e i n Drinking Behaviour INDEX 059  059  071  0 72  143  154  Mean  . 83  . 94  . 87  . 60  . 81  . 82  . 78  . 57  . 75  .90  . 60  .81  . 64  . 80  071  . 83  I N D E X 0 72  .94  . 8Z  143  . 87  . 78  .90  154  .60  . 57  . 60  .60  . 64  I n d e x 059 i s h i g h l y c o n s i s t e n t w i t h i n d i c e s 072 a n d 143, a n d w a s a s b e i n g r e p r e s e n t a t i v e of t h e m f o r p u r p o s e s of a n a l y s i s .  chosen  I n d i c e s 154  a n d 071 show l e s s e r d e g r e e s of r e l a t i o n s h i p to o t h e r i n d i c e s a n d t o e a c h o t h e r , a n d t h e r e f o r e , they w e r e c h o s e n a s a d d i t i o n a l s e p a r a t e i n d i c e s of c h a n g e i n d r i n k i n g b e h a v i o u r . The  s a m e t e c h n i q u e s w e r e u s e d i n e x a m i n i n g i n d i c e s of r e h a b i l i -  t a t i o n i n o t h e r a r e a s of b e h a v i o u r .  This procedure  resulted i n a  41 s u b s t a n t i a l r e d u c t i o n i n the n u m b e r of i n d i c e s f o r e a c h a r e a ; the f i n a l n u m b e r u s e d to m e a s u r e  r e h a b i l i t a t i o n i n the o r i g i n a l p r o j e c t  was  thirteen. ^ D i f f e r e n c e s did occur i n m a n y instances and i n t e r v i e w e r ' s a s s e s s m e n t s .  b e t w e e n the  patient's  The interviewer's observations  g a r d i n g the p a t i e n t ' s a s s e s s m e n t  re-  w e r e that the p a t i e n t t e n d e d to m i n i -  m i z e h i s p r e s e n t (at the t i m e of f o l l o w - u p i n t e r v i e w ) d r i n k i n g p r o b l e m , and m a x i m i z e any degree  of i m p r o v e m e n t that he s a w .  For  i n the a r e a of d r i n k i n g b e h a v i o u r e v e n a v e r y s l i g h t d e g r e e  instance, of c h a n g e  ( s u c h a s the p a t i e n t d r i n k i n g s o m e w h a t l e s s p e r s i t t i n g - - o f t e n due to a physical decrease in tolerance as a substantial degree  o v e r t i m e ) w o u l d be s e e n b y the p a t i e n t  of i m p r o v e m e n t ; w h i l e to the i n t e r v i e w e r t h i s  w o u l d not r e p r e s e n t a n y s i g n i f i c a n t c h a n g e .  P e r h a p s the f a c t t h a t the  p a t i e n t h a d sought h e l p at one t i m e o r a n o t h e r l e d h i m to t h i n k that he s h o u l d h a v e s o m e h o w i m p r o v e d , a n d t h e r e f o r e he c o n c l u d e d that he had.  3  In o t h e r a r e a s t h a n d r i n k i n g ,  the d i s c r e p a n c y b e t w e e n the  p a t i e n t ' s a n d i n t e r v i e w e r ' s a s s e s s m e n t s m a y be due to a t e n d e n c y f o r the p a t i e n t to " a u t o m a t i c a l l y "  see a n i m p r o v e m e n t i n a l l o t h e r a r e a s  w h e n e v e r he saw a n i m p r o v e m e n t i n d r i n k i n g b e h a v i o u r , w h i l e the i n t e r v i e w e r w o u l d o f t e n see a n i m p r o v e m e n t i n one o r two a r e a s o n l y . In a d d i t i o n to t h e s e v a r i o u s d i s t o r t i o n s ,  the i n t e r v i e w e r s  served a c o n s i d e r a b l e difference between v a r i o u s subjects  i n the  ob-  42 d e f i n i t i o n s they e m p l o y e d f o r t h e i r j u d g m e n t s . w o u l d s u g g e s t that d u r i n g a n a l y s i s ,  4  observations  g r e a t e r v a l i d i t y w a s i m p u t e d to the  i n t e r v i e w e r ' s a s s e s s m e n t t h a n to the p a t i e n t ' s . extent.  These  T h i s i s t r u e to a l i m i t e d  W h e r e the t w o a s s e s s m e n t s w e r e h i g h l y c o n s i s t e n t w i t h one  another,  the i n t e r v i e w e r ' s a s s e s s m e n t w a s c h o s e n ,  but w h e n t h e y d i f -  f e r e d s i g n i f i c a n t l y , b o t h w e r e i n c l u d e d i n the f i n a l l i s t of r e h a b i l i t a t i o n i n d i c e s. In the a r e a of h e a l t h , h o w e v e r , was used.  o n l y the p a t i e n t ' s  assessment  The i n t e r v i e w e r s did gather as m u c h i n f o r m a t i o n as  possible,  w i t h the o b j e c t of h a v i n g the c l i n i c p h y s i c i a n m a k e a n a s s e s s m e n t . ever,  How-  the p h y s i c i a n e x p e r i e n c e d c o n s i d e r a b l e d i f f i c u l t y i n m a k i n g ' j u d g -  m e n t s o n the f r e q u e n t l y i n a d e q u a t e i n f o r m a t i o n e l i c i t e d d u r i n g t h e interview.  T h e i n t e r v i e w e r s d i d not f e e l c o m p e t e n t to m a k e a j u d g -  ment i n this p a r t i c u l a r a r e a ,  and t h e r e f o r e  o n l y the p a t i e n t ' s  assess-  5  ment was used for a n a l y s i s .  III.  D i f f e r e n c e s i n R e h a b i l i t a t i o n B e t w e e n E x p e r i m e n t a l and Control Groups T A B L E 3 presents  a. c o m p a r i s o n b e t w e e n e x p e r i m e n t a l a n d  c o n t r o l g r o u p s o n the m a j o r i n d i c e s of r e h a b i l i t a t i o n , a n d T A B L E 4 s h o w s the d i f f e r e n c e s  b e t w e e n the t w o g r o u p s .  6  T A B L E 3: Percentage C o m p a r i s o n of Dejgree of Rehabilitation i n E x p e r i m e n t a l and C o n t r o l Groups* Deg ree of Rehabilitation % Imp roved Rehabilitation Indices Change)  %  No Cha E x p e r i - Conmental trol  % Deteriorated E x p e r i - Conmental t r o l  Exp e r i me ntal  Control  Drinking PA - Drinking problem IA - Drinking problem A bstinence L i q u o r offences  72 58 62 25  61 39 58 23  14 25 36 65  25 42 39 61  14 16 2 10  14 19 3 16  Health PA - Overall  57  31  28  47  15  23  Work PA - Overall IA - Overall E m p l o y m e n t status  45 23 17  37 15 15  27 42 76  40 45 76  28 34 7  23 40 8  Family IA - Responsibility  60  49  35  46  6  6  Social A c t i v i t i e s IA - F i n a n c i a l r e s p o n s i b i l i t y IA - L e i s u r e time activities  12 61  6 53  78 38  79 45  10 1  14 2  Insight IA - Reasons for drinking  48  24  52  76  0  0  Summary IA - O v e r a l l  60  42  16  33  23  25  Statistical** Significance  . 02<p<-. 05  . 001<£p<C 01  . 001<p<, 01  . 001<p<. 01  *A11 "no answer" responses have been excluded; therefore percentages add up to 100. • • P r o b a b i l i t y estimates based on chi-squared values a r e shown when p*< 05.  44 T A B L E 4:  P e r c e n t a g e D i f f e r e n c e s i n D e g r e e of R e h a b i l i t a t i o n Between E x p e r i m e n t a l and C o n t r o l G r o u p s * D e g r e e of R e h a b i l i t a t i o n  % Improved  % No Change  % Deteriorated  +11 +19 +4 + 2  -11 -17 - 3 +4  0 -3 -1 -6  +26  -19  -8  +8 +8 +2  -13 - 3 0  +5 -6 -1  +11  -11  0  - Financial Responsibility - Leisure time activities  + 6 +8  -  - Reasons for drinking  +24  -24  0  +18  -17  -2  R e h a b i l i t a t i o n Indices (Change) 1.  Drinking PA - Drinking problem IA - D r i n k i n g p r o b l e m Abstinence L i q u o r offences  2.  Health PA - Overall  3.  Work PA - Overall IA - O v e r a l l E m p l o y m e n t status  4.  Family IA  5.  Social Activities IA IA  6.  1 7  -4 -1  Insight IA  7.  - Responsibility  Summary IA  - Overall  * (+) d i f f e r e n c e s i n d i c a t e that the p e r c e n t a g e f o r the e x p e r i m e n t a l g r o u p i s g r e a t e r t h a n t h a t f o r the c o n t r o l g r o u p , a n d (-) d i f f e r e n c e s the r e v e r s e .  45  Overview In the f i r s t p l a c e , the i n v e s t i g a t o r s w e r e s t r u c k by what w a s t h e m a s u r p r i s i n g l y h i g h p r o p o r t i o n of the t o t a l 155 shown some i m p r o v e m e n t i n t h e i r behaviour: h a d i m p r o v e d to s o m e extent, o n e - q u a r t e r h a d o n e - q u a r t e r had d e t e r i o r a t e d .  Although  s u b j e c t s who  approximately  to  had  one-half  r e m a i n e d the s a m e ,  one-half had i m p r o v e d ,  and  however,  a f i n e r breakdown i n c a t e g o r i e s shows only one-fifth w e r e rated as "much improved. " T u r n i n g to the d i f f e r e n c e s i n d e g r e e of r e h a b i l i t a t i o n b e t w e e n the two  groups,  group had  TABLE  4 s h o w s that the m e m b e r s of the  i m p r o v e d m o r e than t h o s e i n the c o n t r o l g r o u p i n a l l a r e a s ,  without a single exception. 2%  experimental  The  d i f f e r e n c e s range f r o m  an insignificant  ( i n l i q u o r o f f e n c e s a n d e m p l o y m e n t s t a t u s ) to a s u b s t a n t i a l 2 6 % ( i n  health). and  The  d i f f e r e n c e i n o v e r a l l i m p r o v e m e n t between  c o n t r o l g r o u p s on a s u m m a r y m e a s u r e , the i n t e r v i e w e r ' s a s s e s s -  m e n t of o v e r a l l c h a n g e , i s  18%.  C o n v e r s e l y the c o n t r o l g r o u p h a d  s h o w n "no c h a n g e " m o r e  the e x p e r i m e n t a l g r o u p e x c e p t i n a c o u p l e of a r e a s . here  experimental  range f r o m  1% to 24%.  The  than  differences  D e t e r i o r a t i o n s h o w s no s u b s t a n t i a l d i f -  f e r e n c e s i n a n y a r e a , the g r e a t e s t d i f f e r e n c e b e i n g 8 % i n the a r e a of health.  A n a l y s i s t h e r e f o r e was  c o n c e n t r a t e d m a i n l y on the i m p r o v e d  c a t e g o r y , a s s u m i n g that d e t e r i o r a t i o n s h o w e d no r e a l d i f f e r e n c e s  and  46  "no c h a n g e " m o v e d r e c i p r o c a l l y w i t h i m p r o v e m e n t . E a c h h o r i z o n t a l l i n e i n T A B L E S 3 and  4 represents a bi-  v a r i a t e t a b u l a t i o n c o m p a r i n g the d e g r e e of r e h a b i l i t a t i o n b e t w e e n e x p e r i m e n t a l and i n question*  On  c o n t r o l g r o u p s on the p a r t i c u l a r i n d e x of c h a n g e o n l y f o u r cut of t h i r t e e n i n d i c e s do the  chi-squared  v a l u e s f o r t h e s e b i v a r i a t e d i s t r i b u t i o n s show d i f f e r e n c e s b e t w e e n e x p e r i m e n t a l and ficance.  As  c o n t r o l g r o u p s w h i c h r e a c h the .05  l e v e l of s i g n i -  T A B L E 4 indicates, however, there a r e s i m i l a r dif-  f e r e n c e s i n the s a m e d i r e c t i o n on o t h e r i n d i c e s , a l t h o u g h not r e a c h i n g the „05 l e v e l of s t a t i s t i c a l s i g n i f i c a n c e .  T h i s d e g r e e of c o n s i s t e n c y  b e t w e e n v a r i o u s i n d i c e s i n d i c a t i n g a g r e a t e r d e g r e e of r e h a b i l i t a t i o n i n the e x p e r i m e n t a l  g r o u p than i n the c o n t r o l g r o u p thus  that t h i s d i f f e r e n c e i s a r e a l  suggests  one.  A l t h o u g h the g e n e r a l c o n c l u s i o n a t t h i s p o i n t s e e m s to be that t h e r e i s a g r e a t e r d e g r e e of r e h a b i l i t a t i o n i n the e x p e r i m e n t a l  group, it  w i l l be n e c e s s a r y to a c c o u n t f o r the d i f f e r i n g v a l u e s on v a r i o u s i n d i c e s i n d i f f e r e n t a r e a s of b e h a v i o u r . v a l i d i t y a m o n g the i n d i c e s , tent of c h a n g e w h i c h had  T h i s c o u l d be e i t h e r due  to d i f f e r e n t i a l  o r i t c o u l d r e p r e s e n t r e a l d i f f e r e n c e s i n ex-  t a k e n p l a c e i n e a c h a s p e c t of b e h a v i o u r .  The  next s e c t i o n e x a m i n e s the d e g r e e of c h a n g e i n d i c a t e d by e a c h i n d e x i n e a c h a r e a of b e h a v i o u r . t w e e n the two  It w i l l be s e e n that a d i f f e r e n c e i s e v i d e n t be-  g r o u p s i n the e x t e n t of c h a n g e i n d r i n k i n g b e h a v i o u r ,  and  t h e r e a r e s i m i l a r d i f f e r e n c e s i n o t h e r a r e a s of b e h a v i o u r . A r e a s of r e h a b i l i t a t i o n O n the m e a s u r e s of " c h a n g e i n d r i n k i n g p r o b l e m , " the i n t e r v i e w e r ' s and patient's a s s e s s m e n t s show d i f f e r e n c e s i n the a m o u n t of i m p r o v e m e n t b e t w e e n the two g r o u p s of a b o u t 20% a n d respectively.  T h i s r e f e r s m e r e l y t o s o m e d e g r e e of i m p r o v e m e n t  whether large or s m a l l . categories  10%  T A B L E 5 s h o w s a f i n e r b r e a k d o w n of  of c h a n g e i n e x t e n t of d r i n k i n g p r o b l e m .  F i r s t of a l l , a t t e n t i o n s h o u l d be d r a w n t o t h e c a t e g o r y "no p r o b l e m " , w h i c h i n one s e n s e d e p a r t s f r o m t h e s c a l e o f c h a n g e . It r e p r e s e n t s a c o n c e p t i o n of f i n a l s t a t e , a s w e l l a s m a x i m u m p o s s i b l e d e g r e e of c h a n g e ;  possible  t h o s e r a t e d a s s u c h h a v i n g i m p r o v e d to  s u c h a n e x t e n t that t h e y now h a v e no p r o b l e m w i t h a l c o h o l . F r o m T A B L E 5 we c a n s e e t h a t a c c o r d i n g t o t h e i n t e r v i e w e r ' s assessment,  the g r e a t e s t d i f f e r e n c e i n i m p r o v e m e n t b e t w e e n t h e ex-  p e r i m e n t a l a n d c o n t r o l g r o u p s o c c u r s i n that c a t e g o r y w h i c h r e p r e s e n t s t h e s m a l l e s t d e g r e e of i m p r o v e m e n t ( l e s s s e v e r e p r o b l e m ) . N o n e t h e l e s s , a s s i g n m e n t to this c a t e g o r y stil". i n v o l v e s a s u b s t a n t i a l decrease i n alcohol consumption.  W i t h the p a t i e n t ' s a s s e s s m e n t ; t h e  l a r g e s t d i f f e r e n c e c o m e s u n d e r " m u c h l e s s s e v e r e p r o b l e m . " I n the c a s e of n e i t h e r of t h e t w o a s s e s s m e n t s , h o w e v e r , i s t h e r e a n y r e a l d i f f e r e n c e b e t w e e n the t w o g r o u p s i n t h e p e r c e n t a g e of p a t i e n t s  who  T A B L E  5:  P e r c e n t a g e C o m p a r i s o n of C h a n g e i n D r i n k i n g P r o b l e m i n E x p e r i m e n t a l and C o n t r o l G r o u p s * Degree Much No  A s s e s s m e n t and Group Interviewer's  Problem  of R e h a b i l i t a t i o n Less  (%)  Less  Severe  Severe  Problem  Problem  More  Much More  Severe  Severe  No  Problem  Problem  Problem  Answer  Same  assessment  E x p e r i m e n t a l group  24  11  23  25  9  8  0  Control  20  8  11  42  11  8  0  -17  -2  0  0  group  Difference  +4  +3  E x p e r i m e n t a l group  28  18  22  13  6  6  4  C o n t r o l group  31  6  17  22  6  6  11  +5  -9  0  0  -7  Patient's  +12  assessment  Difference  * (+)  -3  +12  d i f f e r e n c e s i n d i c a t e that the p e r c e n t a g e f o r the  t h a n t h a t f o r the c o n t r o l g r o u p ,  a n d (-)  d i f f e r e n c e s the  experimental  group is  greater  reverse.  oo  49  h a v e c h a n g e d so that t h e y now h a v e " n o p r o b l e m . " T h e o t h e r two i n d i c e s i n the a r e a of d r i n k i n g ( a b s t i n e n c e liquor offences)  show no m a r k e d d i f f e r e n c e s b e t w e e n the  and c o n t r o l g r o u p s .  D u r i n g the c o u r s e  and  experimental  of i n t e r v i e w i n g , the  inter-  v i e w e r s r e a c h e d the c o n c l u s i o n that c h a n g e i n a b s t i n e n c e d i d not to be a v e r y good i n d i c a t o r of c h a n g e i n d r i n k i n g b e h a v i o u r .  seem  This in-  d e x w a s d e f i n e d a s the d i f f e r e n c e b e t w e e n the n u m b e r of w e e k s of complete abstinence  i n two s i x - m o n t h p e r i o d s ,  one b e f o r e the t i m e of  i n t a k e at the F o u n d a t i o n , a n d one b e f o r e the t i m e of f o l l o w - u p i n t e r view.  B e c a u s e a n u m b e r cf p a t i e n t s  s e e m e d to h a v e m o d e r a t e d  their  d r i n k i n g m a r k e d l y but not to h a v e s t o p p e d c o m p l e t e l y t h i s i n d e x d i d not r e g i s t e r m a n y c h a n g e s a m o n g the s u b j e c t s .  7  A n o t h e r p r o b l e m w i t h the " a b s t i n e n c e " i n d e x a r o s e f r o m the m a t t e r of e n f o r c e d a b s t i n e n c e .  P e r i o d s i n jail or mental hospital or  t i m e s p e n t by l o g g e r s i n " d r y c a m p s " o r by f i s h e r m e n on boats w h i c h prohibit drinking,  d i d not q u a l i f y a s p e r i o d s of v o l u n t a r y  abstinence.  O n the o t h e r h a n d , i t c a n n o t be a s s u m e d e i t h e r that the p e r s o n s a r i l y would have been d r i n k i n g throughout these p e r i o d s . was d i f f i c u l t to a p p l y this m e a s u r e  in many  neces-  T h u s it  instances.  T h e r e w a s a l s o no d i f f e r e n c e b e t w e e n the t w o g r o u p s i n l i q u o r offences.  O v e r o n e - h a l f of e a c h g r o u p h a d no l i q u o r o f f e n c e s p r i o r to  c o m i n g to the F o u n d a t i o n , a n d the m a j o r i t y of t h e s e s t i l l r e p o r t e d It i s p r o b a b l e that t h i s i s not a p a r t i c u l a r l y good i n d e x ,  because  none.  arrests  50  for drinking offences are  often f o r t u i t o u s .  T h u s i n the s p h e r e of d r i n k i n g b e h a v i o u r i t s e l f ,  the two a t t e m p t s  at a r r i v i n g at c o m p l e t e l y " o b j e c t i v e " i n d i c e s of r e h a b i l i t a t i o n do not s e e m to h a v e b e e n t o o s u c c e s s f u l b e c a u s e ,  f o r the r e a s o n s j u s t g i v e n ,  t h e s e i n d i c e s d o not s h o w c h a n g e s that p a r a l l e l t h o s e on o t h e r i n d i c e s . T h e n a t u r e of p r o b l e m d r i n k i n g i s e x t r e m e l y  complex,  often i n v o l v i n g  a r a t h e r d i f f e r e n t p a t t e r n f r o m one p e r s o n to the next, a n d h e n c e investigators  r e a c h e d the c o n c l u s i o n that the i n t e r v i e w e r ' s  the  assessment  ( w h i c h a t t e m p t s to take i n t o a c c o u n t m a n y f a c t o r s s i m u l t a n e o u s l y ) w a s a m o r e a d e q u a t e m e t h o d of m e a s u r i n g c h a n g e s i n d r i n k i n g b e h a v i o u r t h a n w e r e the s i m p l e m e a s u r e  of a b s t i n e n c e a n d l i q u o r o f f e n c e s that w e r e  also used. Health Changes i n health c l o s e l y p a r a l l e l changes i n d r i n k i n g behaviour, f o r t h e r e i s a s i m i l a r d i f f e r e n c e i n i m p r o v e m e n t ( 2 6 % ) b e t w e e n the t w o g r o u p s ; a s i n the c a s e of c h a n g e s i n d r i n k i n g b e h a v i o u r a h i g h e r p r o p o r t i o n of the e x p e r i m e n t a l g r o u p s h o w s i m p r o v e m e n t , Work In the a r e a of w o r k ,  the p r o p o r t i o n of t h o s e s h o w i n g i m p r o v e -  m e n t i s s l i g h t l y g r e a t e r f o r the e x p e r i m e n t a l t h a n f o r the c o n t r o l g r o u p o n a l l t h r e e i n d i c e s , a l t h o u g h none of the d i f f e r e n c e s i s significant.  T h u s fewer patients  i n the a r e a of w o r k (by p a t i e n t ' s  statistically  (8% a s a g a i n s t 2 0 % ) show r e h a b i l i t a t i o n or i n t e r v i e w e r ' s a s s e s s m e n t ) than they  51 do w i t h r e g a r d to d r i n k i n g b e h a v i o u r .  T h i s i s s u b s t a n t i a t e d by  n a t i o n of a f i n e r b r e a k d o w n of i m p r o v e m e n t c a t e g o r i e s . s o n s who  were assessed  i m p r o v e d by the i n t e r v i e w e r ,  exami-  Of the 30  o n l y one  per-  was  r a t e d a s " m u c h i m p r o v e d " ; the r e s t w e r e r a t e d a s " s o m e w h a t i m p r o v e d . " E m p l o y m e n t status ( e m p l o y e d v e r s u s differences'between who  the two  groups,  u n e m p l o y e d ) shows no  real  C r o s s - t a b u l a t i o n s show that t h o s e  w e r e u n e m p l o y e d at i n t a k e t e n d e d to be a l s o u n e m p l o y e d a t t i m e of  i n t e r v i e w ( 7 0 % w e r e ) and  t h o s e who  w e r e e m p l o y e d t e n d e d to be  still  e m p l o y e d (80%), although t h e i r e m p l o y m e n t status m i g h t have changed d u r i n g this p e r i o d . Family In t h i s a r e a  o n l y one  i n d e x was  used:  interviewer's  of the f u l f i l l m e n t of r e s p o n s i b i l i t y to f a m i l y m e m b e r s . of q u e s t i o n s  w e r e a s k e d i n the a r e a  to both w i f e and  c h i l d r e n , and  f o r those men still-, h a d  who  t a b u l a t i o n of t h e s e a g a i n s t e a c h  number  other  e v e n b e t w e e n the p a t i e n t ' s  and  A s s e s s m e n t s i n this a r e a were made  were " m a r r i e d "  or l i v i n g " c o m m o n - l a w " and  only  who  c o n t a c t w i t h w i f e a n d / o r c h i l d r e n at the t i m e of i n t e r v i e w --  s l i g h t l y m o r e t h a n o n e - h a l f of a l l s u b j e c t s . experimental ment.  large  of f a m i l y r e l a t i o n s h i p s p e r t a i n i n g  s h o w e d a h i g h d e g r e e of c o n s i s t e n c y , interviewer's assessments.  A  assessment  Of t h e s e ,  1 1 % m o r e i n the  t h a n i n the c o n t r o l g r o u p s h o w e d s o m e d e g r e e of i m p r o v e -  52  Social Activities In t h i s a r e a t h e r e a r e d i f f e r e n c e s b e t w e e n e x p e r i m e n t a l a n d c o n t r o l groups  of 6 % a n d 8 % r e s p e c t i v e l y i n the p r o p o r t i o n of s u b j e c t s who  have i m p r o v e d  o n the two i n d i c e s , f i n a n c i a l r e s p o n s i b i l i t y a n d l e i s u r e -  time activities.  H e r e a g a i n , a s i n the a r e a s ' o f w o r k a n d f a m i l y , the  d i f f e r e n c e between e x p e r i m e n t a l and c o n t r o l groups i s r e l a t i v e l y  small.  Insight The  interviewer'sassessment  of c h a n g e of i n s i g h t w a s a n a t t e m p t  to d e t e r m i n e w h e t h e r c h a n g e s i n d r i n k i n g b e h a v i o u r a r e a c c o m p a n i e d by c o r r e s p o n d i n g c h a n g e s i n the p a t i e n t ' s u n d e r s t a n d i n g of h i s p r o b l e m s w i t h alcohol. from  Indeed,  it may  be the c h a n g e s i n b e h a v i o u r to s o m e e x t e n t r e s u l t  changes i n understanding.  p a r a l l e l one a n o t h e r ; 2 4 % m o r e t r o l group had i m p r o v e d  T h e two t y p e s of c h a n g e do i n f a c t s u b j e c t s i n the e x p e r i m e n t a l t h a n the c o n -  i n insight,  s l i g h t l y m o r e t h a n i n d r i n k i n g be-  h a v i o u r ( 1 9 % a c c o r d i n g to i n t e r v i e w e r ' s a s s e s s m e n t ) o r i n o v e r a l l behaviour (18%). Overall behaviour The  summary assessment  by the i n t e r v i e w e r s h o w s that 6 0 % of  the e x p e r i m e n t a l g r o u p a n d 4 2 % of the c o n t r o l g r o u p h a d s h o w n s o m e deg r e e of p o s i t i v e c h a n g e . .01 l e v e l .  T h i s d i f f e r e n c e i s s i g n i f i c a n t at better than the  T h i s i n d e x i s t i e d quite c l o s e l y t o d r i n k i n g , f o r d r i n k i n g w a s  the m o s t i m p o r t a n t f a c t o r t a k e n i n t o a c c o u n t i n m a k i n g t h i s  assessment.  T h u s the d i f f e r e n c e b e t w e e n the e x p e r i m e n t a l a n d c o n t r o l s u b j e c t s who h a d  improved  i n o v e r a l l b e h a v i o u r (18%) i s r o u g h l y the s a m e a s the d i f f e r e n c e  i n i m p r o v e m e n t i n d r i n k i n g ( 1 9 % by i n t e r v i e w e r ' s a s s e s s m e n t ) . Matched pair analysis Examination  of the r a t e s of r e h a b i l i t a t i o n i n the m a t c h e d  groups g  s h o w s s i m i l a r r e s u l t s , a n d t h e s e w i l l not be d i s c u s s e d h e r e i n d e t a i l . Summary There  is a consistently greater percentage  e x p e r i m e n t a l t h a n i n the c o n t r o l g r o u p who behaviour.  The  of s u b j e c t s i n the  show i m p r o v e m e n t i n t h e i r  greatest difference i n degree  of c h a n g e i s e v i d e n t i n  the a r e a m o s t c e n t r a l t o a n a l c o h o l i c ' s b e h a v i o u r , h i s d r i n k i n g ( w h e r e the i n t e r v i e w e r s saw improved),  1 9 % m o r e of the e x p e r i m e n t a l g r o u p a s h a v i n g  as w e l l as i n h e a l t h ( 2 6 % d i f f e r e n c e ) , i n insight ( 2 4 % dif-  f e r e n c e ) , and i n o v e r a l l c a s e s the  b e h a v i o u r ( 1 8 % d i f f e r e n c e ) ; i n e a c h of t h e s e  d i f f e r e n c e s i s s t a t i s t i c a l l y s i g n i f i c a n t at the .05 l e v e l of  chance probability.  S m a l l e r but c o r r e s p o n d i n g a m o u n t s of d i f f e r e n c e  i n i m p r o v e m e n t b e t w e e n the two  groups ranging f r o m  s e e n i n o t h e r a r e a s of b e h a v i o u r ( w o r k , f a m i l y , and  2 % to 1 1 % w e r e social activities).  A s a n o v e r a l l c o n c l u s i o n , r o u g h l y 2 0 % m o r e s u b j e c t s i n the e x p e r i m e n t a l t h a n i n the c o n t r o l g r o u p h a v e i m p r o v e d  in drinking  behaviour,  a n d v a r y i n g a m o u n t s of d i f f e r e n c e i n the s a m e d i r e c t i o n a r e e v i d e n t i n o t h e r a r e a s of b e h a v i o u r .  A  s u m m a r y a s s e s s m e n t of c h a n g e m a d e  by  the i n t e r v i e w e r i n d i c a t e d 1 8 % m o r e of the e x p e r i m e n t a l g r o u p a s h a v i n g improved.  54  IV.  T h e E f f e c t of D i f f e r e n c e s o n C o n t r o l  Factors  In o r d e r to see w h e t h e r the a p p r o x i m a t e l y 2 0 % h i g h e r r a t e of rehabilitation among m e m b e r s  of the e x p e r i m e n t a l g r o u p c o u l d l e g i t i -  m a t e l y be a t t r i b u t e d to the t r e a t m e n t t h e s e p a t i e n t s F o u n d a t i o n r a t h e r t h a n to a n y of the t h r e e f a c t o r s groups differed,  r e c e i v e d f r o m the  o n w h i c h the t w o  rehabilitation rates were then c o m p a r e d c o n t r o l l i n g  f o r e a c h of t h e s e t h r e e f a c t o r s i n t u r n .  T h i s a n a l y s i s s h o w e d that the  s e v e r i t y of the p a t i e n t ' s d r i n k i n g p r o b l e m d i d not s i g n i f i c a n t l y o r c o n s i s t e n t l y a f f e c t r e h a b i l i t a t i o n , ^ but that m o t i v a t i o n a n d a t t e n d a n c e  at  Alcoholics Anonymous meetings did. T A B L E 6 p r e s e n t s a c o m p a r i s o n of r e h a b i l i t a t i o n b e t w e e n  ex-  p e r i m e n t a l a n d c o n t r o l g r o u p s a c c o r d i n g to t h e i r d e g r e e of m o t i v a t i o n u p o n a p p r o a c h i n g the F o u n d a t i o n f o r t r e a t m e n t . m e a s u r e d by a t t i t u d e t o w a r d s t r e a t m e n t :  H e r e m o t i v a t i o n is  "high" motivation means  realistic attitudes,  and " l o w " m o t i v a t i o n m e a n s u n r e a l i s t i c o r m a n i -  pulative attitudes.  T h i s i n d e x w a s a n a t t e m p t to d i s t i n g u i s h b e t w e e n  those who looked upon t r e a t m e n t r e a l i s t i c a l l y , r e q u i r e s o m e e f f o r t o n t h e i r own p a r t ,  r e a l i z i n g that it w o u l d  f r o m t h o s e who e i t h e r  sought  a " m a g i c a l " s o l u t i o n to t h e i r p r o b l e m s o r w h o w a n t e d t r e a t m e n t a s a m e a n s t o s o m e end o t h e r t h a n r e h a b i l i t a t i o n . L o o k i n g at t h i s t a b l e ,  it i s e v i d e n t that m o t i v a t i o n d o e s h a v e  s o m e e f f e c t o n r e h a b i l i t a t i o n ; a s o m e w h a t g r e a t e r p r o p o r t i o n of t h o s e w i t h h i g h m o t i v a t i o n i n both e x p e r i m e n t a l a n d c o n t r o l g r o u p s i m p r o v e d ,  55 T A B L E 6: Percentage C o m p a r i s o n of O v e r a l l Change (Interviewer's A s s e s s m e n t ) i n E x p e r i m e n t a l and C o n t r o l Groups A c c o r d i n g to M o t i v a t i o n * Group and Degree of M o t i v a t i o n  Degree of Rehabilitation % Improved  % No Change  % Deteriorated  N  74 61 50  14 17 17  12 21 33  35 28 24  64 53 30  18 26 43  18 21 27  11  E x p e r i m e n t a l Group High Neutral Low C o n t r o l Group High Neutral Low  19  33 150  *AU "no answer" responses have been excluded; therefore percentages add up to 100.  compared to those with either neutral or poor motivation.  However,  when those with s i m i l a r motivation i n e x p e r i m e n t a l and c o n t r o l groups a r e compared, there i s a l s o a difference i n rehabilitation:  of those  with high motivation 74% of the e x p e r i m e n t a l group and only 6 4 % of the c o n t r o l group have improved.  T h e r e f o r e , it can be concluded that  the 2 0 % difference i n rehabilitation between experimental and c o n t r o l groups must be attributed i n part to a difference i n motivation between the two groups, rather than completely to the difference i n treatment  56 received. T A B L E 7 shows the effects of A l c o h o l i c s Anonymous attendance after coming to the Foundation upon rehabilitation for the e x p e r i m e n t a l and c o n t r o l groups.  T A B L E 7: Percentage C o m p a r i s o n of O v e r a l l Change (Interviewer's A s s e s s m e n t ) i n E x p e r i m e n t a l and C o n t r o l Groups A c c o r ding to Number of A l c o h o l i c s Anonymous Meetings Attended Attended A f t e r Initial V i s i t to the Foundation* Group and Number of Meetings  Degree of Rehabilitation % Improved  % No Change  %  Deteriorated  N  E x p e r i m e n t a l Group Over 10 meetings Under 11 meetings  71 57  7 21  22 22  31 58  70 37  15 37  15 26  13 49  C o n t r o l Group Over 10 meetings Under 11 meetings  151  *A11 "no answer" r e s p o n s e s have been excluded; therefore percentages add up to 100.  F i r s t , the above table shows that continued attendance at meetings of A l c o h o l i c s Anonymous i m p r o v e s a person's changes of rehabilitation; those who had attended m o r e than ten meetings have a  14%  h i g h e r r a t e of i m p r o v e m e n t i n the e x p e r i m e n t a l g r o u p a n d a 3 3 % h i g h e r r a t e i n the c o n t r o l g r o u p .  S e c o n d , the r a t e s of r e h a b i l i t a t i o n f o r t h o s e  h a v i n g a f a i r l y long as sociation'with A l c o h o l i c s A n o n y m o u s a r e a l m o s t i d e n t i c a l b e t w e e n the e x p e r i m e n t a l a n d c o n t r o l g r o u p s respectively).  T h u s f o r t h o s e who  ( 7 1 % and  receive "treatment" from  70%  Alco-  h o l i c s A n o n y m o u s , the a d d i t i o n a l t r e a t m e n t r e c e i v e d f r o m the F o u n d a t i o n d o e s not a p p e a r  to i n c r e a s e t h e i r c h a n c e s of b e c o m i n g r e h a b i l i t a t e d .  O n the o t h e r hand, f o r t h o s e who  d i d not h a v e a  significant  a m o u n t of c o n t a c t w i t h A l c o h o l i c s A n o n y m o u s , t r e a t m e n t a t the F o u n d a tion p r o d u c e s a 2 0 % d i f f e r e n c e i n r e h a b i l i t a t i o n ( e x p e r i m e n t a l group c o n t r o l group 37%).  Since,  however, i n some cases i m p r o v e m e n t  57%,  ap-  p e a r s t o be due t o A l c o h o l i c s A n o n y m o u s r a t h e r t h a n t o the F o u n d a t i o n , i n a s s e s s i n g the e f f e c t i v e n e s s of the F o u n d a t i o n ' s t r e a t m e n t p r o g r a m m e i t w i l l be n e c e s s a r y to t a k e t h i s i n t o a c c o u n t . It c a n be c o n c l u d e d , then, that the e x p e r i m e n t a l g r o u p  were  m o r e h i g h l y m o t i v a t e d t o be r e h a b i l i t a t e d and a l s o i n c l u d e d a h i g h e r p r o p o r t i o n of t h o s e who  had attended A l c o h o l i c s A n o n y m o u s  meetings,  a n d a p a r t of the h i g h e r r a t e of r e h a b i l i t a t i o n i n t h e e x p e r i m e n t a l g r o u p m u s t be a t t r i b u t e d to t h e s e two f a c t o r s r a t h e r t h a n t o the F o u n dation treatment.  H o w e v e r , c a l c u l a t i o n s on the c o m b i n e d e f f e c t of  t h e s e two f a c t o r s show that t h e i r c o m b i n e d e f f e c t was  only to i n c r e a s e  the r a t e of r e h a b i l i t a t i o n of the e x p e r i m e n t a l g r o u p by 7%, m e a n s that the e f f e c t of F o u n d a t i o n t r e a t m e n t was  which  s t i l l to i n c r e a s e the  58  p r o p o r t i o n who  V.  improved  by s o m e 1 0 % to  15%.  Summary  Examination  of r e s u l t s on the t h i r t e e n i n d i c e s of r e h a b i l i t a t i o n  c h o s e n f o r a n a l y s i s s h o w e d that r o u g h l y o n e - h a l f of a l l s u b j e c t s improved  t o s o m e e x t e n t b e t w e e n the t i m e t h e y f i r s t v i s i t e d the F o u n -  d a t i o n a n d the t i m e of f o l l o w - u p i n t e r v i e w ,  o n e - q u a r t e r had  the s a m e , and o n e - q u a r t e r h a d d e t e r i o r a t e d . however, were rated as "much A  had  comparison  remained  Only about one-fifth,  improved."  of r e h a b i l i t a t i o n r a t e s b e t w e e n the  experimental  a n d c o n t r o l g r o u p s r e v e a l e d that a c o n s i s t e n t l y g r e a t e r p e r c e n t a g e e x p e r i m e n t a l group subjects had i m p r o v e d . a r e a s of b e h a v i o u r (work, f a m i l y , a n d  The  of  differences i n some  social activities) were  relatively  s m a l l , w h i l e the d i f f e r e n c e s i n . d r i n k i n g b e h a v i o u r , h e a l t h , a n d i n s i g h t w e r e s o m e w h a t g r e a t e r ( r a n g i n g between 2 0 % and 2 5 % ) .  Further,  the  i n t e r v i e w e r s a s s e s s e d a p p r o x i m a t e l y 2 0 % m o r e of the e x p e r i m e n t a l g r o u p s u b j e c t s a s h a v i n g s h o w n o v e r a l l i m p r o v e m e n t , a l t h o u g h m o s t of this d i f f e r e n c e was  f o u n d i n the " s o m e w h a t i m p r o v e d "  Since d i f f e r e n c e s had  category.  b e e n found b e t w e e n e x p e r i m e n t a l a n d  con-  t r o l g r o u p s on m o t i v a t i o n a n d a t t e n d a n c e at A l c o h o l i c s A n o n y m o u s (the e x p e r i m e n t a l g r o u p w e r e s o m e w h a t b e t t e r m o t i v a t e d to be r e h a b i l i t a t e d and had attended m o r e A l c o h o l i c s A n o n y m o u s m e e t i n g s since contact), i t was  t h e n n e c e s s a r y to c o n t r o l f o r t h e s e f a c t o r s .  Foundation It was  59 found that these d i f f e r e n c e s  d i d a c c o u n t i n p a r t f o r the g r e a t e r d e g r e e  of r e h a b i l i t a t i o n i n the e x p e r i m e n t a l g r o u p , but t h a t a p p r o x i m a t e l y to 15% of the d i f f e r e n t i a l i m p r o v e m e n t c o u l d be l e g i t i m a t e l y a t t r i buted to the e f f e c t of t r e a t m e n t at the A l c o h o l i s m  Foundation.  10%  60 FOOTNOTES:  C h a p t e r III  1 R e s u l t s of t h i s c o m p a r i s o n a r e not p r e s e n t e d i n d e t a i l h e r e , but a r e d i s c u s s e d i n R e g i n a l d A . H . R o b s o n , I n g e b o r g P a u l u s , a n d G . G r a n t C l a r k e , A n E v a l u a t i o n of the E f f e c t of T r e a t m e n t o n the R e h a b i l i t a t i o n of A l c o h o l i c s ( V a n c o u v e r : T h e A l c o h o l i s m F o u n d a t i o n of B r i t i s h C o l u m b i a , 1963), C h a p t e r 4, 2 I n the p o r t i o n of a n a l y s i s u n i q u e to t h i s i n v e s t i g a t i o n , a f u r t h e r r e d u c t i o n i n the n u m b e r of i n d i c e s h a s b e e n a d o p t e d . See Chapter IV. 3 F o r a good d i s c u s s i o n of the v a r i o u s s o r t s of d i s t o r t i o n w h i c h c a n e n t e r i n t o p a t i e n t s ' r e p o r t i n g of t h e i r d r i n k i n g b e h a v i o u r , see E u g e n i a V . S m i t h , " F i e l d I n t e r v i e w i n g of P r o b l e m D r i n k e r s , " S o c i a l W o r k , IV (October, 1959),pp. 80-86. 4 F o r a n e x a m p l e of d i f f e r i n g d e f i n i t i o n s of " a b s t i n e n c e , " see " S e l e c t e d A s p e c t s of the P r o s p e c t i v e F o l l o w - U p S t u d y , " A l c o h o l i s m a n d C a l i f o r n i a , P u b l i c a t i o n N o . 2 ( B e r k e l e y : S t a t e of C a l i f o r n i a D e p a r t m e n t of P u b l i c H e a l t h , 1959), p . 4 1 . ^ O t h e r s t u d i e s u s i n g the p a t i e n t ' s a s s e s s m e n t of c h a n g e i n h e a l t h f o r s i m i l a r r e a s o n s include i b i d . , p p . 22-26, and G e r h a r t S a e n g e r a n d D o n a l d G e r a r d , " A F o l l o w - U p S t u d y of P a t i e n t s S e e n i n C l i n i c s A s s o c i a t e d w i t h the N o r t h A m e r i c a n A s s o c i a t i o n of A l c o h o l i s m P r o g r a m s, " i n S e l e c t e d P a p e r s D e l i v e r e d a t the F o u r t e e n t h A n n u a l M e e t i n g of the N o r t h A m e r i c a n A s s o c i a t i o n of A l c o h o l i s m P r o g r a m s ( W a s h i n g t o n : N o r t h A m e r i c a n A s s o c i a t i o n of A l c o h o l i s m P r o g r a m s , 1963), p . 106. ^ I n t h i s t a b l e , a n d i n s u c c e e d i n g t a b l e s , the p a t i e n t ' s a s s e s s m e n t i s r e p r e s e n t e d by the a b b r e v i a t i o n " P A " a n d t h e i n t e r v i e w e r ' s a s s e s s m e n t by " I A " . 7 One of the m a j o r i m p r e s s i o n s r e c e i v e d by the i n t e r v i e w e r s f r o m t a l k i n g to t h i s n u m b e r of s u b j e c t s w a s that a s u r p r i s i n g l y l a r g e n u m b e r s e e m e d to h a v e m a n a g e d to c o n t r o l t h e i r d r i n k i n g , to a g r e a t e r o r l e s s e r d e g r e e , w h i l e not c o m p l e t e l y a b s t a i n i n g . T h i s i s c o m p l e t e l y a t v a r i a n c e w i t h m u c h of the l i t e r a t u r e w h i c h a l m o s t u n a n i m o u s l y s u g g e s t s t h a t t h e o n l y w a y a n a l c o h o l i c c a n c o n t r o l h i s c o n s u m p t i o n of a l c o h o l i s to a b s t a i n c o m p l e t e l y . R e c e n t l y , h o w e v e r , t h i s c o n c e p t h a s  61 been questioned D.  L.  Davies,  i n the l i t e r a t u r e ; see,  f o r e x a m p l e the a r t i c l e  Q u a r t e r l y J o u r n a l of S t u d i e s on A l c o h o l , X X I I I ( M a r c h , 94-  by  "Normal Drinking in Recovered Alcohol Addicts, " 1962),  104. 8 Tables  c o n t a i n i n g the c o m p a r i s o n b e t w e e n m a t c h e d p a i r s  total experimental  and  and  c o n t r o l g r o u p s a r e i n c l u d e d i n the F o u n d a t i o n ' s  r e s e a r c h r e p o r t , R o b s o n , P a u l u s , and  Clarke,  op.  c i t . , pp.  108-111.  F o r d e t a i l s of the r e s u l t s on t h i s f a c t o r , see i b i d . , pp.  113-115.  CHAPTER  AREAS  I.  OF  CHANGE  IN  IV  REHABILITATION  Introduction T h e a n a l y s i s r e p o r t e d i n C h a p t e r III l e d to t h r e e m a j o r c o n -  c l u s i o n s w h i c h p r o v i d e d the b a s i s f o r the h y p o t h e s e s t e s t e d i n the p r e s e n t study.  First,  F o u n d a t i o n was  e f f e c t i v e i n i n c r e a s i n g the p r o p o r t i o n of a l c o h o l i c  p a t i e n t s who  i t was  s h o w n that t r e a t m e n t a t the A l c o h o l i s m  show i m p r o v e m e n t i n t h e i r d r i n k i n g b e h a v i o u r between  the t i m e of a n i n i t i a l v i s i t to the F o u n d a t i o n a n d f o l l o w - u p i n t e r v i e w . Second,  i t was  demonstrated  that t r e a t m e n t r e c e i v e d f r o m  Alcoholics  A n o n y m o u s i s a l s o effective i n producing like changes i n behaviour. In f a c t , a c e r t a i n p r o p o r t i o n of the g r e a t e r i m p r o v e m e n t i n the e x p e r i m e n t a l g r o u p m u s t be a t t r i b u t e d to A l c o h o l i c s A n o n y m o u s r a t h e r t h a n to the F o u n d a t i o n .  Third,  c h a n g e s i n o t h e r a r e a s of b e h a v i o u r t h a n  d r i n k i n g (health, work, f a m i l y r e l a t i o n s h i p s , and  social activities)  paralleled in v a r y i n g degree changes i n drinking behaviour. s i m i l a r p e r c e n t a g e s of i m p r o v e m e n t , l a c k of c h a n g e , a n d  That i s ,  deteriora-  t i o n i n d r i n k i n g a n d o t h e r b e h a v i o u r w e r e e v i d e n t i n both e x p e r i m e n t a l and c o n t r o l  groups.  These  results,  c o u p l e d w i t h the t h e o r e t i c a l i d e a s a b o u t  be-  h a v i o u r d i s c u s s e d i n C h a p t e r I, l e d to the f o r m u l a t i o n of the h y p o t h e s e s  63 that t h e r e e x i s t s a r e l a t i o n s h i p between changes i n d r i n k i n g and i n other b e h a v i o u r , a n d that t h i s r e l a t i o n s h i p w o u l d be m o r e e v i d e n t a m o n g s t t h o s e w h o h a v e h a d t r e a t m e n t f r o m the F o u n d a t i o n .  It i s i m p o r t a n t  t o note t h a t p a r a l l e l c h a n g e s i n v a r i o u s a r e a s of b e h a v i o u r of a g r o u p of s u b j e c t s d o not i n t h e m s e l v e s d e m o n s t r a t e s u c h a r e l a t i o n s h i p i n the f u n c t i o n i n g o f i n d i v i d u a l s .  The s i m i l a r percentages  suggested  t h e p o s s i b i l i t y of a r e l a t i o n s h i p , but do not s h o w that i t a c t u a l l y e x i s t s , s i n c e w e d o not k n o w t h a t t h e s a m e i n d i v i d u a l s a r e i n v o l v e d i n e a c h case. T h i s c h a p t e r t h e r e f o r e a t t e m p t s to t e s t the h y p o t h e s i z e d r e l a t i o n s h i p s , u t i l i z i n g a s e r i e s of c r o s s - t a b u l a t i o n s of i n d i c e s of c h a n g e . T h e s e c r o s s - t a b u l a t i o n s w i l l s h o w i n w h i c h c a s e s b o t h s o r t s of c h a n g e (in d r i n k i n g and other behaviour) are p r e s e n t , o r the o t h e r i s p r e s e n t ,  i n w h i c h c a s e s o n l y one  a n d i n w h i c h c a s e s n e i t h e r t y p e of c h a n g e h a s  occurred.  II.  T h e C h o i c e of I n d i c e s of C h a n g e T h e p r o b l e m of c h o o s i n g i n d i c e s t o u s e i n the a n a l y s i s w h i c h i s  t o f o l l o w w a s the s a m e a s t h a t f a c e d p r e v i o u s l y .  It i s i m p o r t a n t to e m -  p l o y e n o u g h d i f f e r e n t i n d i c e s t o a d e q u a t e l y c o v e r v a r i o u s a s p e c t s of b e haviour,  but, o n the o t h e r h a n d , the m a n i p u l a t i o n of too m a n y i n d i c e s  becomes unwieldy. <  64  I n d i c e s of c h a n g e i n d r i n k i n g b e h a v i o u r In C h a p t e r III, f o u r d i f f e r e n t i n d i c e s of c h a n g e i n d r i n k i n g a r e employed.  It was  o b s e r v e d , f i r s t of a l l ,  m e n t of c h a n g e i n d r i n k i n g p r o b l e m was  that the p a t i e n t ' s  s i m i l a r to o t h e r i n d i c e s ,  but  S i n c e the i n t e r v i e w e r s '  im-  that p e r c e n t a g e s w e r e s o m e w h a t l a r g e r . pressions  assess-  ( s u b s t a n t i a t e d by t h o s e of p r e v i o u s  investigators) suggested  that the p a t i e n t ( c o n s c i o u s l y o r o t h e r w i s e ) t e n d s to d i s t o r t h i s m e n t i n v a r i o u s w a y s c o m m e n s u r a t e w i t h h i s own  needs,  assess-  i t seemed  r e a s o n a b l e to i m p u t e l e s s v a l i d i t y to s u c h s u b j e c t i v e a s s e s s m e n t s the p a r t of the p e r s o n h i m s e l f . ment are ment.  not g r e a t l y d i f f e r e n t f r o m t h o s e of the i n t e r v i e w e r ' s  Therefore,  analysis reported The offences,  In a d d i t i o n , the r e s u l t s of t h i s  the p a t i e n t ' s a s s e s s m e n t was  on  assessassess-  not e m p l o y e d i n the  below.  i n d i c e s of c h a n g e i n a b s t i n e n c e  and  change i n l i q u o r  on the o t h e r hand, d i d not p a r a l l e l the o t h e r i n d i c e s so c l o s e l y .  For various reasons discussed that t h e s e two  a b o v e ( pp.  49 - 50), i t was  concluded  i n d i c e s w e r e not a s a d e q u a t e f o r m e a s u r i n g c h a n g e a s  w e r e the m o r e s u b j e c t i v e a s s e s s m e n t s of the p a t i e n t and E v e n though these i n d i c e s a r e d i s c r i m i n a t i o n of m a n y k i n d s  b e l i e v e d to be not a s  interviewer.  s e n s i t i v e to the  of c h a n g e , h o w e v e r , one  w o u l d not  ex-  p e c t that r e s u l t s s h o w n by t h e m w o u l d o f t e n c o n t r a d i c t o t h e r r e s u l t s . For  this r e a s o n , and  i n o r d e r to p r o v i d e  some m o r e "objective" check  on the i n t e r v i e w e r ' s a s s e s s m e n t , a c o m p o s i t e i n d e x was  developed  65 utilizing a l l three indices, i n t e r v i e w e r ' s a s s e s s m e n t drinking problem,  change i n a b s t i n e n c e ,  of c h a n g e i n  and change i n l i q u o r o f f e n c e s .  T h e c o m p o s i t e i n d e x d e v e l o p e d a t t e m p t s to take a c c o u n t of the w e i g h t of e v i d e n c e f r o m a l l t h r e e i n d i c e s , by u s i n g a (+), (-)  r a t i n g scheme as  (O), and  follows:  C o m p o s i t e Index +  O t h e r Indiee s =  +,  -5-, +  J-  -i- _  + , 0, 0  =  —  0  +,  0,  -  0,  0,  0  " > - » " " »  -, o -, -, + -, 0, 0  In o r d e r to see w h e t h e r t h i s c o m p o s i t e i n d e x w o u l d o b s c u r e a n y later results,  a c h e c k w a s m a d e b y c h o o s i n g t h r e e m a j o r i n d i c e s of  c h a n g e i n o t h e r a r e a s of b e h a v i o u r ( i n t e r v i e w e r ' s a s s e s s m e n t s change i n w o r k , f a m i l y r e s p o n s i b i l i t y ,  of  and l e i s u r e time a c t i v i t i e s ) ,  c r o s s - t a b u l a t i n g e a c h of t h e s e i n d i c e s a g a i n s t e a c h s e p a r a t e  and  i n d e x of  c h a n g e i n d r i n k i n g b e h a v i o u r , a s w e l l a s a g a i n s t the c o m p o s i t e i n d e x . The individual tables were e x a m i n e d , and c h i - s q u a r e d values c o m p a r e d . R e s u l t s o n e a c h i n d e x of c h a n g e i n d r i n k i n g b e h a v i o u r w e r e  2  g e n e r a l l y the s a m e , but w e r e l e s s m a r k e d i n the c a s e s of c h a n g e i n a b s t i n e n c e and change i n l i q u o r o f f e n c e s .  The  composite  index showed  q u i t e s i m i l a r r e s u l t s to t h o s e of the i n t e r v i e w e r ' s a s s e s s m e n t , r e l a t i o n s h i p was assessment  less strong.  o r the c o m p o s i t e  but the  A l l d i s t r i b u t i o n s u s i n g the i n t e r v i e w e r ' s i n d e x w e r e s i g n i f i c a n t at the .05  level,  h o w e v e r , w h i l e m o s t of t h o s e u s i n g the c h a n g e i n a b s t i n e n c e o r c h a n g e i n l i q u o r o f f e n c e s , i n d i c e s w e r e not s t a t i s t i c a l l y Since g r e a t e s t v a l i d i t y was m e n t , a n d the c o m p o s i t e  significant.  a t t r i b u t e d to the i n t e r v i e w e r ' s a s s e s s -  i n d e x g i v e s s i m i l a r r e s u l t s , the c o m p o s i t e i n -  d e x a p p e a r s t o a d e q u a t e l y i n c o r p o r a t e the i n t e r v i e w e r ' s a s s e s s m e n t , w h i l e g i v i n g the a d d e d c h e c k p r o v i d e d ' b y a l s o i n c l u d i n g the o t h e r objective indices.  In a d d i t i o n , u s e of the c o m p o s i t e  the i n t e r v i e w e r ' s a s s e s s m e n t  two  index rather than  alone, w i l l p r o v i d e a m o r e r i g o r o u s test  w h e n a n a l y s i s i s b r o k e n d o w n m o r e f i n e l y i n l a t e r s t a g e s of the a n a l y s i s , s i n c e the r e l a t i o n s h i p i s not a s g r e a t w h e n the c o m p o s i t e  index i s used.  I n d i c e s of c h a n g e i n a r e a s of b e h a v i o u r o t h e r t h a n d r i n k i n g F o u r a r e a s of b e h a v i o u r o t h e r t h a n d r i n k i n g w e r e c h o s e n d u r i n g p r e p a r a t i o n of the i n t e r v i e w s c h e d u l e f o r i n v e s t i g a t i o n : f a m i l y r e l a t i o n s h i p s , and. s o c i a l a c t i v i t i e s . was  of the a n a l y s i s of C h a p t e r III.  r e d u c e d to s e v e n  These indices were as  follows: 1.  Health:  work,  Change i n these four a r e a s  m e a s u r e d by a l a r g e n u m b e r of i n d i c e s , w h i c h was  f o r the p u r p o s e s  health,  Patient's o v e r a l l a s s e s s m e n t  of c h a n g e  67 2.  Work:  a) P a t i e n t ' s o v e r a l l a s s e s s m e n t of c h a n g e b) I n t e r v i e w e r ' s o v e r a l l a s s e s s m e n t of c h a n g e c) C h a n g e i n e m p l o y m e n t  status  3.  F a m i l y : I n t e r v i e w e r ' s a s s e s s m e n t of c h a n g e i n the f u l f i l l m e n t of r e s p o n s i b i l i t y t o w a r d s f a m i l y m e m b e r s  4.  S o c i a l A c t i v i t i e s : a) I n t e r v i e w e r ' s a s s e s s m e n t of c h a n g e i n the f u l f i l l m e n t of f i n a n c i a l r e s p o n sibility in paying for accommodation b) I n t e r v i e w e r ' s a s s e s s m e n t of c h a n g e i n leisure time activities  T h e a n a l y s i s of t h i s c h a p t e r u t i l i z e s the s a m e f o u r a r e a s of b e h a v i o u r , but the n u m b e r of i n d i c e s i s r e d u c e d to f i v e .  A brief dis-  c u s s i o n of the i n d i c e s c h o s e n f o l l o w s . 1.  Health  In t h i s a r e a ,  o n l y the p a t i e n t ' s a s s e s s m e n t i s u s e d , s i n c e i t  s e e m e d to be m o r e u s e f u l , f o r r e a s o n s d i s c u s s e d a b o v e III, p .  (Chapter  42). 2.  Work  T h e i n t e r v i e w e r ' s a s s e s s m e n t of c h a n g e w a s c h o s e n to be r e p resentative  of t h i s a r e a f o r the s u b s e q u e n t a n a l y s i s .  It i s b e l i e v e d  that a s i m i l a r d i s t o r t i o n e n t e r e d i n t o the p a t i e n t ' s a s s e s s m e n t of c h a n g e i n w o r k a s a f f e c t e d h i s a s s e s s m e n t of c h a n g e i n d r i n k i n g p r o b l e m , l e a d i n g the p a t i e n t to see m o r e i m p r o v e m e n t t h a n w a s a p p a r e n t to the i n t e r v i e w e r , a n d t h e r e f o r e the i n t e r v i e w e r ' s a s s e s s m e n t w i l l be u s e d r a t h e r t h a n the p a t i e n t ' s .  C h a n g e i n e m p l o y m e n t s t a t u s w a s f o u n d to be  68  negligible, or f r o m  s i n c e few p e r s o n s h a d c h a n g e d f r o m  u n e m p l o y e d to e m p l o y e d  e m p l o y e d to u n e m p l o y e d b e t w e e n the t i m e s of i n t a k e at the F o u n -  d a t i o n a n d f o l l o w - u p i n t e r v i e w , and t h i s i n d e x w a s (see p.  therefore omitted  51). 3.  Family  The  interviewer's assessment  of f u l f i l l m e n t of r e s p o n s i b i l i t y to  f a m i l y m e m b e r s ( w h i c h a p p l i e s to t h o s e m a r r i e d o r l i v i n g c o m m o n - l a w ) was  found to be the b e s t i n d e x t o r e p r e s e n t the l a r g e n u m b e r of q u e s t i o n s  a s k e d i n t h i s a r e a of b e h a v i o u r , a n d i t i s u s e d a g a i n i n the f o l l o w i n g analysis. 4. Two  Social activities i n d i c e s w e r e f o u n d to be r e p r e s e n t a t i v e of r a t h e r d i f f e r e n t  a s p e c t s of t h i s b r o a d a r e a of b e h a v i o u r . of f i n a n c i a l r e s p o n s i b i l i t y was  based  The  interviewer's assessment  on w h e t h e r o r not the i n d i v i d u a l  was  a s s e l f - s u p p o r t i n g i n p a y i n g f o r r e s i d e n t i a l a c c o m m o d a t i o n a s he c o u l d be.  In o t h e r w o r d s , i f a p e r s o n was  f i n a n c i a l l y d e p e n d e n t on s o c i a l  a s s i s t a n c e , a w i f e , o r r e l a t i v e s w h e n he a p p e a r e d m o r e i n d e p e n d e n t i n t h i s r e g a r d , t h i s w o u l d he viewer as being "poor". b e t w e e n T± The  a n d T^,  If the i n d i v i d u a l h a d  he was  to be c a p a b l e of b e i n g  r e g a r d e d by the i n t e r become m o r e  rated as improved,  and c o n v e r s e l y .  s e c o n d i n d e x of g e n e r a l s o c i a l f u n c t i o n i n g was  change i n l e i s u r e time a c t i v i t i e s . d r i n k i n g to a b r o a d e r r a n g e  Change f r o m  independent  based  on  activities dominated  by  of s a t i s f y i n g a c t i v i t i e s w i t h i n c r e a s e d s o c i a l  69 p a r t i c i p a t i o n was rated as  improvement.  T h e f i n a l l i s t of i n d i c e s of c h a n g e i n a r e a s of b e h a v i o u r  other  than d r i n k i n g is therefore as f o l l o w s :  III.  1.  Health (PA)  2.  W o r k (IA)  3.  F a m i l y r e s p o n s i b i l i t y (IA)  4.  F i n a n c i a l r e s p o n s i b i l i t y (IA)  5.  Leisure time activities  Categories  (IA)  of C h a n g e  T h e c a t e g o r i e s o r i g i n a l l y s c o r e d o n the a b o v e i n d i c e s i n c l u d e d b e t w e e n t h r e e a n d s i x d e g r e e s of c h a n g e ,  but the m a j o r p o r t i o n of the  a n a l y s i s of C h a p t e r III u t i l i z e d o n l y t h r e e c a t e g o r i e s : " N o Change, " and " D e t e r i o r a t e d . "  "Improved,"  P r e l i m i n a r y a n a l y s i s of r e l a t i o n -  ships between change i n d r i n k i n g b e h a v i o u r and change i n other a r e a s of b e h a v i o u r u s e d t h e s e s a m e t h r e e c a t e g o r i e s ,  but i t w a s s o o n e v i d e n t  that the s m a . l l n u m b e r of s u b j e c t s (N=155) w o u l d r e s u l t i n m a n y c e l l s with s m a l l expected frequencies,  making conclusions unreliable,  t i c u l a r l y w h e n the c h i - s q u a r e d t e s t w a s u s e d .  Categories were  parthere-  f o r e f u r t h e r c o l l a p s e d by c o m b i n i n g " N o C h a n g e " a n d " D e t e r i o r a t e d , " i n t o a c a t e g o r y of " N o t I m p r o v e d . "  It w a s f e l t that t h i s w a s  legitimate,  s i n c e i t w a s n o t e d a b o v e that t h e r e w e r e f e w d i f f e r e n c e s i n d e t e r i o r a t i o n , a n d " N o C h a n g e " t e n d e d to m o v e r e c i p r o c a l l y w i t h i m p r o v e m e n t (p.  45).  70 C r o s s - t a b u l a t i o n s thus r e s u l t e d i n f o u r - f o l d t a b l e s ,  w h i c h h a v e many-  a d v a n t a g e s i n t e r m s of e a s e of h a n d l i n g , a n d w h i c h m a k e c e r t a i n  more  3 p r e c i s e tests p o s s i b l e . One m o r e  remark  s h o u l d be m a d e about c a t e g o r i e s of c h a n g e .  T h e r e a r e a n u m b e r of c a s e s w h e r e i m p r o v e m e n t w a s not p o s s i b l e , s i n c e t h e r e w a s no need f o r i m p r o v e m e n t i n p a r t i c u l a r a r e a s of b e h a v i o u r on the p a r t of c e r t a i n i n d i v i d u a l s . assume  that a l t h o u g h a l l the p e r s o n s  It s e e m s r e a s o n a b l e  to  c o m i n g to the A l c o h o l i s m F o u n d a -  t i o n f o r t r e a t m e n t m a y not h a v e d e v e l o p e d d r i n k i n g p r o b l e m s to the  ex-  tent that t h e y c o u l d be p r o p e r l y d e f i n e d a s " a l c o h o l i c s , " a l l w o u l d be c a p a b l e of s o m e i m p r o v e m e n t i n d r i n k i n g b e h a v i o u r . c a s e w i t h r e g a r d to o t h e r a r e a s of b e h a v i o u r ,  though.  T h i s i s not the Many individuals  i n the s a m p l e h a d not a l l o w e d t h e i r d r i n k i n g to i n t e r f e r e m a r k e d l y w i t h their p e r f o r m a n c e bility,  i n w o r k o r i n the m a n a g e m e n t  for example,  and t h e r e f o r e  of f a m i l y r e s p o n s i -  w o u l d not be e x p e c t e d to i m p r o v e  in these a r e a s if their d r i n k i n g behaviour i m p r o v e d .  It w i l l be i m p o r -  tant to b e a r t h i s f a c t i n m i n d w h e n e x a m i n i n g the r e l a t i o n s h i p s E v e n i f the h y p o t h e s i z e d r e l a t i o n s h i p w e r e t r u e i n e v e r y c a s e i m p r o v e m e n t was p o s s i b l e , pondence,  o u r data w o u l d not show p e r f e c t  below. where  corres-  s i n c e t h e r e i s no w a y of d i s c r i m i n a t i n g b e t w e e n t h o s e c a s e s  w h e r e p o s i t i v e c h a n g e i s a n d i s not p o s s i b l e .  4  71  IV.  Interrelationships Between Change i n D r i n k i n g B e h a v i o u r a n d i n O t h e r A r e a s of B e h a v i o u r - A l l S u b j e c t s The f i r s t h y p o t h e s i s of t h i s s t u d y s t a t e d t h a t : T h e r e w i l l be a d i r e c t m u t u a l r e l a t i o n s h i p b e t w e e n c h a n g e in d r i n k i n g behaviour a n d c h a n g e i n o t h e r a r e a s of b e h a v i o u r ( h e a l t h , w o r k , f a m i l y r e l a t i o n s h i p s , a n d s o c i a l a c t i v i t i e s ), i n the t o t a l s a m p l e of a l c o h o l i c s studied, a) A s d r i n k i n g b e h a v i o u r i m p r o v e s ( s e v e r i t y o f p r o b l e m decreases), behaviour i n other areas w i l l also improve. b) I f d r i n k i n g b e h a v i o u r d o e s not i m p r o v e ( r e m a i n s t h e s a m e o r w o r s e n s ) , o t h e r b e h a v i o u r w i l l a l s o not improve.  It m a y be h e l p f u l t o l o o k a t t h e s e e x p e c t a t i o n s i n t e r m s o f the f o u r - f o l d t a b l e s w h i c h w i l l be u s e d f o r a n a l y s i s :  OTHER  BEHAVIOUR  Improved  A  B  Not I m p r o v e d  C  D  DRINKING BEHAVIOUR  If t h e r e w e r e p e r f e c t c o r r e s p o n d e n c e , a l l c a s e s w o u l d f a l l i n t o c e l l s A a n d D.  T h i s , however, i s u n l i k e l y to o c c u r i n r e a l i t y , and l e s s e r  d e g r e e s of r e l a t i o n s h i p w o u l d be e x p e c t e d a s f o l l o w s : '  72 A  B N  A  + B  /  A + B  A  C \  A  + C s  A  D  C \  D  +  c s w  D  D D  + C  + c B  B  /  D  + B  E x a m i n a t i o n of the d a t a f o r a l l s u b j e c t s t o g e t h e r  (experimental  and c o n t r o l groups combined) shows a c l e a r - c u t tendency f o r change i n d r i n k i n g b e h a v i o u r a n d c h a n g e i n o t h e r a r e a s of b e h a v i o u r (on a l l f i v e indices) to v a r y together.  F o r e x a m p l e , ° the r e l a t i o n s h i p b e t w e e n  change i n d r i n k i n g b e h a v i o u r and change i n h e a l t h a p p e a r s a s f o l l o w s :  73  T A B L E 8:  I n t e r r e l a t i o n s h i p Between Change i n D r i n k i n g B e h a v i o u r  HEALTH Improved  Not I m p r o v e d  Total  Improved  55  (43)*  39  (51)  94  Not I m p r o v e d  12  (24)  41  (29)  53  Total  67  DRINKING BEHAVIOUR  X  2  = 16. 9 * * d . f .  80  147  1: p < . 001  -'•Expected f r e q u e n c i e s enclosed in parentheses.  i f the n u l l h y p o t h e s i s w e r e t r u e  are  2 * * X v a l u e s computed f o r this table and a l l s u c c e e d i n g t a b l e s w e r e computed u s i n g a f o r m u l a i n c o r p o r a t i n g Yates* c o r r e c t i o n for continuity, since i n many cases expected frequencies were s m a l l . This f o r m u l a is given in J . P . Guilford, Fundamental Statistics i n P s y c h o l o g y and E d u c a t i o n (New Y o r k : M c G r a w - H i l l Book C o m p a n y , 1956), p . 2 3 7 .  It c a n be s e e n that the c e l l s w h e r e c h a n g e i n e a c h c a s e i s i n the s a m e d i r e c t i o n a r e l a r g e r t h a n e x p e c t e d a c c o r d i n g to the n u l l hypothesis,  a n d the o t h e r c e l l s s m a l l e r t h a n e x p e c t e d .  This  difference  i s s i g n i f i c a n t at b e t t e r t h a n the . 0 5 l e v e l , w h i c h h a s b e e n c h o s e n a s l e v e l of c e r t a i n t y .  the  T h u s i t c a n be c o n c l u d e d t h a t a p e r s o n w h o i m p r o v e s  i n d r i n k i n g b e h a v i o u r i s m o r e l i k e l y t o i m p r o v e i n h e a l t h t h a n one w h o does not, a n d v i c e v e r s a .  S i m i l a r l y , a p e r s o n w h o d o e s not i m p r o v e  74  i n one a r e a i s not a s l i k e l y to i m p r o v e i n the o t h e r . The  s a m e r e l a t i o n s h i p i s e v i d e n t i n the c r o s s - t a b u l a t i o n s of  change i n d r i n k i n g behaviour a g a i n s t change i n work, f a m i l y r e s p o n sibility, and l e i s u r e time activities.  B e c a u s e these r e s u l t s a r e so  s i m i l a r , the a c t u a l t a b l e s a r e not p r e s e n t e d h e r e , T A B L E S 16 -19 of A P P E N D I X A .  but i n c l u d e d a s  In o r d e r t o c o m p a r e the s t r e n g t h of 2  relationship i n each case, however, T A B L E  9 compares X  values for  these tables.  T A B L E 9: C o m p a r i s o n of C h i - S q u a r e d  V a l u e s * f o r T a b l e s Showing  Interrelationships Between Change i n D r i n k i n g Behaviour and Change i n Other A r e a s Area  of B e h a v i o u r  Chi-Squared  of B e h a v i o u r f o r A l l S u b j e c t s Value  Probability**  1)  Health  16.9  ' p < . 001  2)  Work  11.8  p<.001  3)  Family  responsibility  9.5  Financial responsibility  5)  L e i s u r e time activities  **X  148 148  p<.01  18.0*** 4)  N  86 148  4.6  p < .05  148  46.5  p<,001  148  values were computed using a formula  incorporating  Yates' c o r r e c t i o n for continuity, * * T h i s i s the p r o b a b i l i t y of s u c h a d i s t r i b u t i o n o c c u r r i n g by chance. * * * T h e s e a r e m o c k e d v a l u e s , a s s u m i n g the s a m p l e s i z e f o r t h i s i n d e x to be the s a m e a s f o r o t h e r i n d i c e s . of t h i s i n the next s e c t i o n b e l o w .  See the d i s c u s s i o n  It i s c l e a r f r o m the a b o v e t a b l e that a s t a t i s t i c a l  relationship  e x i s t s i n e a c h c a s e , t a k i n g the . 0 5 l e v e l a s the l e v e l of c o n f i d e n c e . It i s a l s o e v i d e n t t h a t t h e r e a r e d i f f e r e n c e s i n the d e g r e e of r e l a t i o n s h i p b e t w e e n the v a r i o u s a r e a s of r e h a b i l i t a t i o n .  The greatest degree  of r e l a t i o n s h i p i s s e e n b e t w e e n c h a n g e i n d r i n k i n g b e h a v i o u r a n d i n l e i s u r e t i m e a c t i v i t i e s (X  change  = 46, 5), a l e s s e r d e g r e e of r e l a t i o n s h i p  a p p e a r s i n the c a s e s of h e a l t h , w o r k , a n d f a m i l y r e s p o n s i b i l i t y (X  = 16.9,  11.8,  and 18.0  (mocQ  , respectively).  A  s t i l l l e s s e r de-  g r e e of r e l a t i o n s h i p i s i n d i c a t e d b e t w e e n c h a n g e i n d r i n k i n g b e h a v i o u r and change i n f i n a n c i a l r e s p o n s i b i l i t y ( X note,  however,  = 4. 6).  It i s i m p o r t a n t to  that the u s e of c h i - s q u a r e d v a l u e s d o e s not p e r m i t a  p r e c i s e n u m e r i c a l c o m p a r i s o n b e t w e e n d e g r e e s of r e l a t i o n s h i p i n e a c h case;  i t m e r e l y e n a b l e s u s to see the r e l a t i v e s t r e n g t h of a s s o c i a t i o n .  We cannot say,  for instance,  that the r e l a t i o n s h i p b e t w e e n c h a n g e s i n  d r i n k i n g behaviour and l e i s u r e t i m e a c t i v i t i e s (X  = 4 6 . 5) i s t e n t i m e s  that b e t w e e n c h a n g e s i n d r i n k i n g b e h a v i o u r a n d f i n a n c i a l r e s p o n s i 2 bility (X  - 4. 5),  O n the o t h e r h a n d , w e c a n be f a i r l y c e r t a i n that the  f o r m e r i s m o r e p r o n o u n c e d t h a n the  latter.  W h e t h e r t h e s e a p p a r e n t d i f f e r e n c e s i n the s t r e n g t h of r e l a t i o n ship between change i n d r i n k i n g b e h a v i o u r and change i n v a r i o u s a r e a s of f u n c t i o n i n g a r e i n f a c t r e a l d i f f e r e n c e s ,  o r m i g h t be  other  accounted  f o r by the n a t u r e of the i n d i c e s u s e d , o r the p o s s i b i l i t y of c h a n g e i n e a c h a r e a (see p . 70) w i l l be d i s c u s s e d i n C h a p t e r V , w h e r e a n a t t e m p t  76 i s m a d e to i n t e r p r e t the r e s u l t s  of a n a l y s i s .  T h e c o n c l u s i o n of t h i s p o r t i o n of the a n a l y s i s i s t h e r e f o r e we m u s t r e j e c t the n u l l h y p o t h e s i s ,  a n d r e g a r d H y p o t h e s i s I,  that  which  suggests a r e l a t i o n s h i p between change i n d r i n k i n g b e h a v i o u r and c h a n g e i n o t h e r a r e a s of b e h a v i o u r , appears  as  substantiated.  Further,  there  to be a d i f f e r e n t d e g r e e of r e l a t i o n s h i p d e p e n d i n g o n the  s p e c i f i c a r e a of b e h a v i o u r i n v o l v e d ,  V.  C o m p a r i s o n B e t w e e n E x p e r i m e n t a l and C o n t r o l G r o u p s on Degree  of I n t e r r e l a t i o n s h i p  Between Change in D r i n k i n g  B e h a v i o u r a n d i n O t h e r A r e a s of B e h a v i o u r T h e a n a l y s i s now p r o c e e d s  to e x a m i n e the p o s s i b l e d i f f e r e n t i a l  e f f e c t s of t r e a t m e n t at the F o u n d a t i o n o n the r e l a t i o n s h i p s above.  established  It w a s h y p o t h e s i z e d that s u c h t r e a t m e n t w o u l d tend to  increase  the d e g r e e of r e l a t i o n s h i p : T h e r e l a t i o n s h i p between change i n d r i n k i n g b e h a v i o u r and c h a n g e i n o t h e r a r e a s of b e h a v i o u r i s m o r e  l i k e l y to be  p r e s e n t i n t h o s e p e r s o n s who h a v e h a d t r e a t m e n t at Foundation (experimental  the  group) than i n those p e r s o n s  h a v e not h a d s u c h t r e a t m e n t ( c o n t r o l  who  group).  T h i s r e l a t i o n s h i p w i l l be t e s t e d i n the s a m e m r n n e r a s a b o v e ,  by c o n -  s t r u c t i n g a n d e x a m i n i n g f o u r - f o l d t a b l e s a n d by c o m p a r i n g c h i - s q u a r e d values.  One d i f f i c u l t y s h o u l d be p o i n t e d out,  however.  Sub-sample  s i z e s of the e x p e r i m e n t a l a n d c o n t r o l g r o u p s a r e not e q u a l , a n d t h e r e f o r e it i s not l e g i t i m a t e to c o m p a r e these different sized s u b - g r o u p s .  c h i - s q u a r e d v a l u e s c o m p u t e d on Theoretically,  the s a m e  relationship  could exist i n two c a s e s ,  but i n one of t h e m the s a m p l e s i z e m i g h t not  be s u f f i c i e n t t o e s t a b l i s h 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 l l therefore  be p r e s e n t e d :  T w o g r o u p s of f i g u r e s  c h i - s q u a r e d values computed on r e a l  f i g u r e s (to e s t a b l i s h s t a t i s t i c a l s i g n i f i c a n c e ) , a n d c h i - s q u a r e d v a l u e s c o m p u t e d on m o c k t a b l e s c o n s t r u c t e d by i n f l a t i n g e a c h t a b l e t o the s a m e s i z e (to e n a b l e c o m p a r i s o n of d e g r e e of r e l a t i o n s h i p ) .  Thus  T A B L E 10 p r e s e n t s a c o m p a r i s o n of r e a l a n d m o c k c h i - s q u a r e d v a l u e s f o r e x p e r i m e n t a l and c o n t r o l groups separately,  f o r t a b l e s s h o w i n g the  i n t e r r e l a t i o n s h i p b e t w e e n c h a n g e i n d r i n k i n g a n d i n o t h e r a r e a s of b e haviour: L o o k i n g f i r s t of a l l a t the r e a l v a l u e s , T A B L E 10 s h o w s that w h e n the s a m p l e i s b r o k e n d o w n i n t o e x p e r i m e n t a l a n d c o n t r o l g r o u p s , and r e l a t i o n s h i p s a r e e x a m i n e d f o r each group s e p a r a t e l y ,  the d i s t r i -  b u t i o n s a r e not s i g n i f i c a n t at the . 0 5 l e v e l of c o n f i d e n c e i n s e v e r a l cases.  E x a m i n a t i o n of the i n d i v i d u a l f o u r - f o l d t a b l e s ,  however, in-  d i c a t e s t h a t i n e v e r y c a s e t h e r e i s a t e n d e n c y i n the d i r e c t i o n e x p e c t e d 7  i n the l i g h t of H y p o t h e s i s L C o m p a r i n g the e x p e r i m e n t a l a n d c o n t r o l g r o u p s u t i l i z i n g the m o c k v a l u e s s h o w s d i f f e r e n c e s i n the d e g r e e of r e l a t i o n s h i p i n the pected d i r e c t i o n .  ex-  T h a t i s , t h e r e i s a l e s s e r d e g r e e of r e l a t i o n s h i p i n  the c o n t r o l g r o u p on e v e r y i n d e x , a l t h o u g h i n a c o u p l e of c a s e s ( f a m i l y r e s p o n s i b i l i t y a n d f i n a n c i a l r e s p o n s i b i l i t y ) the d i f f e r e n c e i s not l a r g e . R e a l c h i - s q u a r e d v a l u e s f o r the c o n t r o l g r o u p i n d i c a t e a s t a t i s t i c a l l y  78  T A B L E  10:  C o m p a r i s o n of C h i - S q u a r e d V a l u e s * f o r Showing Interrelationships  Between  D r i n k i n g B e h a v i o u r and Change  Tables  Change  in Other  in  Areas  of B e h a v i o u r f o r E x p e r i m e n t a l a n d C o n t r o l G r o u p s Area  of B e h a v i o u r  Chi-Squared  Values  Experimental Group Real  x  Mock  N_  2  17. 3 86  1) H e a l t h  Control Group Real  N_  21.5  100-  x  2  Mock  _N  (0.8)** 61  x  _N  2  100  1.2  88  •10. 8 100  (1.6)  59  5. 0 51  12. 5 100  (2.8)  35  10.9  100  (2.3) 89  2. 8 100  (0.2)  59  1.5  100  87  37. 6 100  13. 2  61  2) W o r k  8.9  3. 1 100  3) F a m i l y responsibility 4) F i n a n c i a l re sponsibility 5) L e i s u r e  time  31.7  activitie s  *X  values were  correction for  computed using a formula incorporating  Yates  1  continuity.  * * V a l u e s i n p a r e n t h e s e s ( i n the s i g n i f i c a n t at the  , 05  l e v e l of  c a s e s of r e a l v a l u e s ) a r e  not  confidence.  s i g n i f i c a n t r e l a t i o n s h i p i n o n l y one i n s t a n c e , Thus,  24. 3 100  leisure  time  activities.  i t w o u l d a p p e a r a t t h i s p o i n t t h a t H y p o t h e s i s II i s c o n f i r m e d ,  t r e a t m e n t at the F o u n d a t i o n d o e s m a k e  a difference  in increasing  that  the  l i k e l i h o o d that a p e r s o n w i l l i m p r o v e i n both d r i n k i n g behaviour and i n o t h e r a r e a s of b e h a v i o u r a t t h e  same  time.  79 VI.  T h e E f f e c t of A l c o h o l i c s A n o n y m o u s A t t e n d a n c e It i s n o t l e g i t i m a t e t o m a k e  this point, however.  such an inference  It w i l l b e r e m e m b e r e d  f r o m the d a t a  f r o m C h a p t e r III t h a t  of the i m p o r t a n t v a r i a b l e s f o u n d t o a c c o u n t f o r p a r t of the  at A l c o h o l i c s A n o n y m o u s ,  one  difference  i n the extent of r e h a b i l i t a t i o n b e t w e e n e x p e r i m e n t a l a n d c o n t r o l was attendance  at  More members  groups  of the  p e r i m e n t a l group had attended A l c o h o l i c s A n o n y m o u s r e g u l a r l y ,  exand  p a r t of the d i f f e r e n c e h a d to be a t t r i b u t e d to t h i s f a c t o r r a t h e r t h a n to treatment  at the F o u n d a t i o n .  shown to have  S i n c e the t w o t y p e s of t r e a t m e n t  s i m i l a r effects on r e h a b i l i t a t i o n , it i s quite  that t h e y m i g h t h a v e a s i m i l a r effect on the r e l a t i o n s h i p s  were  conceivable demonstrated  above. It w i l l b e n e c e s s a r y ,  then,  to b r e a k d o w n the a b o v e  comparison  o n the a d d i t i o n a l v a r i a b l e of A l c o h o l i c s A n o n y m o u s a t t e n d a n c e . c a u s e the s u b - s a m p l e s  p r o d u c e d by t h i s d i v i s i o n a r e  i n s i z e ( r a n g i n g f r o m 6 to 58), the  same  sub-sample  computed on these, since they are  rather  Be-  different  m o c k t a b l e s w i l l be c o n s t r u c t e d  size within each index,  and chi-squared  These values m u s t only l e  considered  with values  relative,  inflated and statistical significance levels cannot  m a t e l y be a t t a c h e d t o t h e m ,  T A B L E  11 p r e s e n t s  this  legiti-  comparison:  80  TABLE  11:  C o m p a r i s o n of C h i - S q u a r e d  Values* for Mock Tables  Showing Interrelationships Between Change i n D r i n k i n g B e h a v i o u r and Change i n Other A r e a s  of B e h a v i o u r f o r  E x p e r i m e n t a l and C o n t r o l G r o u p s A c c o r d i n g to A l c o h o l i c s Anonymous Attendance Areas  of B e h a v i o u r  Chi-Squared Experi-  Experi-  mental,  mental,  A. 1) H e a l t h  A.**  2) W o r k  Control,  Non-A.A.  17.0  Values (Mock Tables)  A,  8.2  A.  Control, Non-A.A.  N  11.2  0.1  56  5.2  2. 8  5.9  0.3  57  5.3  0.8  8.5  1.7  32  0.0  1.3  1.3  0,1  58  33.1  14.2  51.6  7.7  57  3) F a m i l y responsibility 4) F i n a n c i a l responsibility 5) L e i s u r e t i m e activities  2 *X Yates  1  values were computed using a formula  incorporating  c o r r e c t i o n for continuity. * * T h o s e r e g a r d e d as h a v i n g A.  h a d a t t e n d e d m o r e t h a n 10 A .  A,  A.  treatment a r e those  who  m e e t i n g s s i n c e f i r s t c o m i n g t o the  Foundation.  In e x a m i n i n g  the a b o v e t a b l e , i t m u s t f i r s t of a l l be noted that  t h e s e d a t a m u s t be a p p r o a c h e d the s a m p l e i n t h i s way  with s p e c i a l caution, since p a r t i t i o n i n g  produces  quite s m a l l s u b - s a m p l e s with s m a l l  expected f r e q u e n c i e s i n m a n y c e l l s . p e r s o n s i n the c o n t r o l g r o u p who  F o r i n s t a n c e , t h e r e a r e o n l y 12  attended A l c o h o l i c s A n o n y m o u s ,  and  81 o n l y 6 of t h e s e r e g i s t e r on the i n d e x " f a m i l y r e s p o n s i b i l i t y , "  It w o u l d  not be p r o p e r , t h e r e f o r e , to a t t a c h too m u c h w e i g h t to i n d i v i d u a l figures,  but o v e r a l l t e n d e n c i e s c a n s a f e l y be e x a m i n e d .  An  e x a m i n a t i o n of the i n d i v i d u a l f o u r - f o l d t a b l e s i n d i c a t e s that  7 t h e r e i s a d i f f e r e n c e i n the e x p e c t e d d i r e c t i o n i n 18 out of 20 c a s e s , a l t h o u g h i n s e v e r a l c a s e s the d i f f e r e n c e i s s m a l l . a r e p a r t i c u l a r l y s m a l l f o r t h o s e who  The  differences  d i d not h a v e t r e a t m e n t  from  e i t h e r the F o u n d a t i o n o r A l c o h o l i c s A n o n y m o u s ( c o n t r o l g r o u p , A.  A.).  TABLE  non-  11 s h o w s that the c h i - s q u a r e d v a l u e s f o r t a b l e s  e a c h i n d e x f o r t h e s e p e r s o n s w i t h no t r e a t m e n t f r o m  on  either resource  a r e s m a l l e r t h a n v a l u e s f o r t h o s e p e r s o n s h a v i n g one type of t r e a t m e n t a n d / o r the o t h e r .  Thus having some treatment,  either from  the  F o u n d a t i o n o r f r o m A l c o h o l i c s A n o n y m o u s , a p p e a r s t o i n c r e a s e the l i k e l i h o o d of p e r s o n s  s h o w i n g c h a n g e s i n o t h e r a r e a s of b e h a v i o u r  which p a r a l l e l changes i n d r i n k i n g behaviour. L o o k i n g at t h i s t a b l e f o r the e f f e c t of t r e a t m e n t f r o m  Alcoholics  A n o n y m o u s , i t c a n be s e e n that t h i s t r e a t m e n t a p p e a r s to i n c r e a s e the d e g r e e of r e l a t i o n s h i p b e t w e e n c h a n g e i n drinV.ing b e h a v i o u r a n d i n o t h e r a r e a s of b e h a v i o u r , i n both the e x p e r i m e n t a l and groups,  change  control  e x c e p t i n the c a s e of f i n a n c i a l r e s p o n s i b i l i t y , w h e r e v a l u e s a r e  too s m a l l t o d r a w r e l i a b l e c o n c l u s i o n s . Foundation treatment,  on the o t h e r hand, a p p e a r s to a f f e c t the  d e g r e e of r e l a t i o n s h i p o n l y i n the c a s e of t h o s e p e r s o n s who  do not a l s o  82 attend A l c o h o l i c s A n o n y m o u s .  No c o n s i s t e n t t r e n d c a n he e s t a b l i s h e d  i n c o m p a r i n g t h o s e i n the e x p e r i m e n t a l a n d c o n t r o l g r o u p s w h o a l s o a t t e n d e d A . A.  meetings  regularly.  have  H o w e v e r , f o r t h o s e who d i d  not a t t e n d A . A . , t r e a t m e n t r e c e i v e d f r o m the F o u n d a t i o n s s e e m s t o i n c r e a s e the d e g r e e of r e l a t i o n s h i p , e x c e p t i n the c a s e of f a m i l y r e s p o n s i b i l i t y , w h e r e the c h i - s q u a r e d v a l u e s a r e t o o s m a l l t o d r a w r e liable conclusions. T h i s f i n d i n g , t h a t F o u n d a t i o n t r e a t m e n t i n c r e a s e s the l i k e l i h o o d t h a t i n d i v i d u a l s w i l l s h o w c h a n g e s i n o t h e r a r e a s of t h e i r beh a v i o u r w h i c h p a r a l l e l c h a n g e s i n d r i n k i n g b e h a v i o u r , i s a n a l o g o u s to the f i n d i n g r e p o r t e d i n C h a p t e r III, t h a t F o u n d a t i o n t r e a t m e n t  appeared  t o be e f f e c t i v e i n i n c r e a s i n g the d e g r e e of r e h a b i l i t a t i o n o n l y i n t h o s e c a s e s w h e r e the i n d i v i d u a l i n v o l v e d d i d not a l s o a t t e n d A l c o h o l i c s Anonymous. T h u s s o m e of the r e l a t i o n s h i p w h i c h w a s  a t t r i b u t e d a b o v e to  the e f f e c t of F o u n d a t i o n t r e a t m e n t m u s t be a l l o w e d t o be a r e s u l t of t r e a t m e n t r e c e i v e d f r o m A l c o h o l i c s A n o n y m o u s r a t h e r t h a n of t r e a t m e n t f r o m the A l c o h o l i s m F o u n d a t i o n .  It c a n be c o n c l u d e d , t h e r e -  f o r e , that t r e a t m e n t f r o m these two r e s o u r c e s a p p e a r s to have a s i m i l a r e f f e c t o n the r e l a t i o n s h i p h y p o t h e s i z e d i n t h i s p a p e r .  VII.  Summary T h e p r e c e d i n g c h a p t e r h a s p r e s e n t e d the r e s u l t s of a n  e x a m i n a t i o n , of the r e l a t i o n s h i p b e t w e e n c h a n g e i n d r i n k i n g b e h a v i o u r a n d c h a n g e i n o t h e r a r e a s of b e h a v i o u r , fold c r o s s - t a b u l a t i o n s .  by a n a l y z i n g a s e r i e s of f o u r -  T h e f o u r i n d i c e s of c h a n g e i n d r i n k i n g b e -  h a v i o u r u s e d p r e v i o u s l y w e r e r e d u c e d to one c o m p o s i t e i n d e x , t a k i n g the w e i g h t of e v i d e n c e on t h r e e i n d i c e s . taken as representative  of c h a n g e i n o t h e r  by  Five indices were  spheres  of l i f e ,  a n d the  c o m p o s i t e i n d e x of c h a n g e i n d r i n k i n g b e h a v i o u r w a s t a b u l a t e d them.  S i n c e i t w a s d e s i r a b l e to u s e f o u r - f o l d t a b l e s ,  the  against  categories  of " I m p r o v e d , " " N o C h a n g e , " a n d " D e t e r i o r a t e d " u s e d e a r l i e r c o m b i n e d into two c a t e g o r i e s ,  were  " I m p r o v e d " and "Not I m p r o v e d . "  A n e x a m i n a t i o n of the i n d i v i d u a l t a b l e s a n d c a l c u l a t i o n of c h i s q u a r e d v a l u e s f o r e a c h s u b s t a n t i a t e d H y p o t h e s i s I. sample,  T a k i n g the  those who i m p r o v e d i n d r i n k i n g b e h a v i o u r ( i . e .  their  total  severity  of p r o b l e m d e c r e a s e d ) w e r e m o r e l i k e l y to i m p r o v e i n o t h e r a r e a s of b e h a v i o u r t h a n t h o s e who d i d not; a n d c o n v e r s e l y i f t h e y d i d not i m prove.  Further,  t h i s d e g r e e of i n t e r r e l a t i o n s h i p w a s f o u n d to v a r y  d e p e n d i n g o n the s p e c i f i c a r e a of b e h a v i o u r i n v o l v e d . i n the c a s e of l e i s u r e t i m e a c t i v i t i e s ,  somewhat  It w a s  greatest  less i n health,  work,  and f a m i l y r e s p o n s i b i l i t y , and s t i l l l e s s i n f i n a n c i a l r e s p o n s i b i l i t y . In o r d e r to t e s t H y p o t h e s i s II, groups were examined separately.  the e x p e r i m e n t a l a n d c o n t r o l  T h i s h y p o t h e s i s was c o n f i r m e d i n  that t h e r e w a s a g r e a t e r d e g r e e of the a b o v e r e l a t i o n s h i p s h o w n i n the e x p e r i m e n t a l t h a n i n the c o n t r o l  group.  84 S i n c e it h a d b e e n f o u n d e a r l i e r that the e x p e r i m e n t a l a n d c o n t r o l g r o u p s d i f f e r e d on the p r o p o r t i o n of t h e i r m e m b e r s  who h a d a t -  t e n d e d A l c o h o l i c s A n o n y m o u s r e g u l a r l y , a n d s i n c e it was  conceivable  that A . A . t r e a t m e n t c o u l d h a v e a s i m i l a r e f f e c t to F o u n d a t i o n t r e a t ment,  the s a m p l e w a s t h e n b r o k e n d o w n f u r t h e r a c c o r d i n g to A l c o -  holics A n o n y m o u s attendance,  It w a s f o u n d that t h i s d i f f e r e n c e d i d i n  p a r t a c c o u n t f o r the d i f f e r e n c e b e t w e e n e x p e r i m e n t a l a n d c o n t r o l g r o u p s . Specifically,  t h e r e w a s no d i f f e r e n c e a t t r i b u t a b l e to F o u n d a t i o n t r e a t -  m e n t i n the c a s e w h e r e the p e r s o n h a d a t t e n d e d a s u b s t a n t i a l n u m b e r of A l c o h o l i c s A n o n y m o u s m e e t i n g s  s i n c e c o m i n g to the F o u n d a t i o n .  In t h o s e p e r s o n s w h o d i d not a t t e n d A . A . r e g u l a r l y ,  though,  Founda-  t i o n t r e a t m e n t d i d a p p e a r to i n c r e a s e the r e l a t i o n s h i p b e t w e e n i m p r o v e m e n t i n d r i n k i n g b e h a v i o u r a n d i m p r o v e m e n t i n o t h e r a r e a s of b e h a v i o u r . T h u s i t w a s c o n c l u d e d that the two t r e a t m e n t r e s o u r c e s ,  the A l c o h o l i s m  F o u n d a t i o n a n d A l c o h o l i c s A n o n y m o u s , o p e r a t e i n a s i m i l a r w a y to i n c r e a s e the h y p o t h e s i z e d r e l a t i o n s h i p . C h a p t e r V w i l l e x a m i n e f u r t h e r the m e a n i n g s a n d i m p l i c a t i o n s of the r e s u l t s  reported  above.  85 FOOTNOTES:  Chapter IV  (+) r e f e r s to " i m p r o v e d , " (0) r e f e r s to " n o c h a n g e , " a n d r e f e r s to " d e t e r i o r a t e d . "  (—)  T A B L E S 13 - 1 5 of A P P E N D I X A l i s t the c h i - s q u a r e d v a l u e s for each individual c r o s s - t a b u l a t i o n , 2  I n s p i t e of u s i n g o n l y t w o c a t e g o r i e s of c h a n g e , s o m e e x pected f r e q u e n c i e s w e r e s t i l l v e r y s m a l l , and f o u r - f o l d tables made p o s s i b l e the u s e of Y a t e s ' c o r r e c t i o n f o r c o n t i n u i t y , e m p l o y e d e x t e n sively below. ^ S o m e v e r y r e c e n t f o l l o w - u p r e s e a r c h s i m i l a r to that r e p o r t e d h e r e , w h i c h i s not w r i t t e n up i n d e t a i l y e t , u s e s c a t e g o r i e s w h i c h d i s c r i m i n a t e b e t w e e n t h e s e t w o t y p e s of " N o C h a n g e . " G e r h a r t S a e n g e r a n d D o n a l d G e r a r d , " A F o l l o w - U p S t u d y of P a t i e n t s . S e e n i n C l i n i c s A s s o c i a t e d W i t h the N o r t h A m e r i c a n A s s o c i a t i o n of A l c o h o l i s m P r o g r a m s , " i n S e l e c t e d P a p e r s D e l i v e r e d a t the F o u r t e e n t h A n n u a l M e e t i n g o f the N o r t h A m e r i c a n A s s o c i a t i o n of A l c o h o l i s m P r o g r a m s ( W a s h i n g t o n : N o r t h A m e r i c a n A s s o c i a t i o n of A l c o h o l i s m P r o g r a m s , 1963). ^ A n o t h e r w a y of s t a t i n g t h e s e e x p e c t a t i o n s w o u l d be t h a t p e r c e n t a g e - w i s e ( d i s c o u n t i n g the e f f e c t of m a r g i n a l t o t a l s ) A\> B , A^>C, D >C, D >B. ^ S i n c e the d a t a c o m p r i s e a l a r g e n u m b e r of t a b l e s , r e p r e s e n t a t i v e e x a m p l e s a r e i n c l u d e d i n the b o d y of t h i s c h a p t e r , a n d o t h e r t a b l e s given i n A p p e n d i x A , ' S i n c e r e l a t i o n s h i p s i n e a c h c a s e a r e i n the s a m e d i r e c t i o n , i n d i v i d u a l c r o s s - t a b u l a t i o n s a r e not p r e s e n t e d h e r e .  CHAPTER  SUMMARY  I,  The P r o b l e m  AND  V  DISCUSSION  OF  FINDINGS  Under Investigation  T h e f r a m e of r e f e r e n c e f o r t h e p r e s e n t r e s e a r c h e n d e a v o u r i n v o l v e d t w o i m p o r t a n t e m p h a s e s i n t h e t h i n k i n g of s o c i a l s c i e n t i s t s about h u m a n behaviour.  T h e f i r s t of t h e s e e m p h a s e s w a s on t h e  h o l i s t i c n a t u r e of p e r s o n a l i t y , a n d t h e r e f o r e o n the i n t e g r a t i o n of t h o s e m a n y d i v e r s e a c t s w h i c h go t o g e t h e r t o m a k e up a n i n d i v i d u a l ' s behaviour.  M a n y p s y c h o l o g i c a l t h e o r i s t s s t r e s s t h e i m p o r t a n c e of  c o n s i d e r i n g the w a y i n w h i c h a p e r s o n ' s b e h a v i o u r i n one a r e a of l i f e i m p i n g e s u p o n a l l other a s p e c t s of h i s e x p e r i e n c e .  The second r e -  l a t e d e m p h a s i s i s t h a t m a n m u s t be c o n s i d e r e d not a s a c l o s e d but a s a n o p e n s y s t e m i n r e l a t i o n t o h i s e n v i r o n m e n t , and n o n - s o c i a l a s p e c t s .  system,  both i n i t s s o c i a l  A n d both o f t h e s e e m p h a s e s a r e t a k e n t o be  e q u a l l y i m p o r t a n t i n the s t u d y of " n o r m a l " f u n c t i o n i n g ( o r h e a l t h ) a n d of " a b n o r m a l "  functioning (or illness).  Since a l c o h o l i s m i s often c o n s i d e r e d an i l l n e s s , these  same  p r i n c i p l e s s h o u l d be i m p o r t a n t i n t h e u n d e r s t a n d i n g o f t h i s p h e n o m e n o n . V a r i o u s t h e o r i e s a b o u t the n a t u r e of a l c o h o l i s m , a n d t h e r e f o r e d i f f e r e n t treatment approaches  a r e based upon this point of view.  It i s t h o u g h t to  87  be q u i t e i m p o r t a n t t o t h i n k of the a l c o h o l i c not m e r e l y a s a p e r s o n d r i n k s to e x c e s s , but a s a c o m p l e x i n d i v i d u a l w h o s e p h y s i c a l a n d  who mental  h e a l t h m u s t be t a k e n i n t o a c c o u n t , a s w e l l a s h i s f u n c t i o n i n g i n v o c a t i o n a l p u r s u i t s , f a m i l y a c t i v i t i e s , and i n g e n e r a l s o c i a l r e l a t i o n s h i p s . T h u s t r e a t m e n t p r o g r a m m e s f o r the a l c o h o l i c s e e k to do m a n y t h i n g s i n a d d i t i o n t o i n d u c i n g h i m to s t o p d r i n k i n g ;  h i s whole nature and  j u s t m e n t to l i f e i n v a r i o u s s p h e r e s c o m e s i n t o p u r v i e w .  The  z a t i o n s t u d i e d h e r e , the A l c o h o l i s m F o u n d a t i o n of B r i t i s h  ad-  organi-  Columbia,  i s a c a s e i n p o i n t of a t r e a t m e n t c l i n i c w h i c h s u b s c r i b e s t o t h i s philosophy. The  g e n e r a l a i m of the r e s e a r c h r e p o r t e d h e r e w a s  u n d e r l y i n g a s s u m p t i o n a b o u t the n a t u r e of a l c o h o l i s m , by  to test t h i s examining  t h e e x t e n t t o w h i c h c h a n g e s p r o d u c e d i n a n a l c o h o l i c ' s d r i n k i n g beh a v i o u r a r e a c c o m p a n i e d by (and p o s s i b l y r e l a t e d to) s i m i l a r c h a n g e s i n o t h e r a s p e c t s of b e h a v i o u r .  The f i r s t h y p o t h e s i s was  as follows:  H y p o t h e s i s I: T h e r e w i l l be a d i r e c t m u t u a l r e l a t i o n s h i p bet w e e n change i n d r i n k i n g b e h a v i o u r and change i n o t h e r a r e a s of b e h a v i o u r ( h e a l t h , w o r k , f a m i l y r e l a t i o n s h i p s , a n d s o c i a l a c t i v i t i e s), i n the t o t a l s a m p l e of a l c o h o l i c s s t u d i e d . a) A s d r i n k i n g b e h a v i o u r i m p r o v e s ( s e v e r i t y of p r o b l e m d e c r e a s e s ) , b e h a v i o u r i n o t h e r areas will also improve. b) If d r i n k i n g b e h a v i o u r d o e s not i m p r o v e ( r e m a i n s the s a m e o r w o r s e n s ) , o t h e r b e h a v i o u r w i l l a l s o not i m p r o v e . F u r t h e r , i t was  t h o u g h t t h a t a l t h o u g h a n u m b e r of a l c o h o l i c s s h o w  i m p r o v e m e n t i n t h e i r b e h a v i o u r o v e r a p e r i o d of t i m e w i t h o u t h a v i n g  88  treatment,  the t e n d e n c y f o r t h i s i m p r o v e m e n t i n d r i n k i n g b e h a v i o u r to  be a s s o c i a t e d w i t h the o t h e r c h a n g e s h y p o t h e s i z e d w o u l d be g r e a t e s t i n t h o s e c a s e s w h e r e the i n d i v i d u a l h a d u n d e r g o n e t r e a t m e n t d e s i r e d to secure as  both s o r t s of c h a n g e .  T h u s a f u r t h e r h y p o t h e s i s was  constructed  follows: H y p o t h e s i s II:  T h e r e l a t i o n s h i p between change i n d r i n k i n g b e h a v i o u r a n d c h a n g e i n o t h e r a r e a s of b e h a v i o u r i s m o r e l i k e l y to be p r e s e n t i n t h o s e p e r s o n s w h o h a v e h a d t r e a t m e n t at the  Foun-  dation ( e x p e r i m e n t a l group) than i n those p e r s o n s w h o h a v e not h a d s u c h  treatment  (control group),  II.  M e t h o d s of R e s e a r c h T h e d a t a c h o s e n f o r u s e i n t e s t i n g the a b o v e h y p o t h e s e s  o b t a i n e d f r o m a f o l l o w - u p s t u d y d e s i g n e d to e v a l u a t e the  were  effectiveness  of the t r e a t m e n t p r o g r a m m e of the A l c o h o l i s m F o u n d a t i o n of B r i t i s h Columbia. T h e r e s e a r c h d e s i g n i n v o l v e d a c o m p a r i s o n of the e x t e n t of r e h a b i l i t a t i o n w h i c h h a d t a k e n p l a c e o v e r a p e r i o d of t i m e i n two g r o u p s of a l c o h o l i c s , one of w h i c h h a d r e c e i v e d t r e a t m e n t f r o m the F o u n d a t i o n w h i l e the o t h e r h a d not.  T h e e x p e r i m e n t a l group was  c o m p o s e d of p e r s o n s w h o h a d u n d e r g o n e m o r e t h a n f i v e  treatment  s e s s i o n s at the F o u n d a t i o n , a n d the c o n t r o l g r o u p w a s s e l e c t e d f r o m p e r s o n s w h o h a d a p p r o a c h e d the F o u n d a t i o n r e g a r d i n g t r e a t m e n t who h a d not r e m a i n e d f o r m o r e t h a n f o u r t r e a t m e n t  sessions.  but  The  89  study was  r e t r o s p e c t i v e , i n that a s a m p l e of a l c o h o l i c s who  had  once  a t t e n d e d the F o u n d a t i o n w e r e i n t e r v i e w e d , and w e r e q u e s t i o n e d r e g a r d i n g t h e i r b e h a v i o u r both at the t i m e t h e y f i r s t c a m e to the F o u n d a t i o n a n d a t the t i m e of i n t e r v i e w . I n t e r v i e w s w e r e d e s i g n e d to s e c u r e two m a j o r t y p e s of data, i n f o r m a t i o n c o n c e r n i n g the e x t e n t of r e h a b i l i t a t i o n w h i c h h a d a n d i n f o r m a t i o n r e g a r d i n g c o n t r o l f a c t o r s on w h i c h the and c o n t r o l g r o u p s w e r e d e s i r e d to be s i m i l a r . r e h a b i l i t a t i o n b e t w e e n the two on the s i m i l a r i t y of p e r s o n s s c h e d u l e was  Any  experimental  c o m p a r i s o n of  g r o u p s w o u l d , of c o u r s e ,  contained i n each.  A  be d e p e n d e n t  detailed interview  c o n s t r u c t e d i n c o n s u l t a t i o n w i t h the F o u n d a t i o n  and v a r i o u s m e a s u r e s of r e h a b i l i t a t i o n w e r e c o n s t r u c t e d . m e a s u r e s sought t o a s c e r t a i n the e x t e n t to w h i c h the b e h a v i o u r and a t t i t u d e s had  occurred,  staff,  These  respondent's  c h a n g e d b e t w e e n the t i m e of f i r s t c o n t a c t  w i t h the F o u n d a t i o n a n d the t i m e of i n t e r v i e w .  Six relevant  areas  of b e h a v i o u r w e r e d e l i m i t e d : 1.  Drinking  behaviour  2.  H e a l t h ( p h y s i c a l and  3.  Behaviour  4.  S o c i a l i n t e r a c t i o n i n the f a m i l y  5.  Social activities  6.  Insight in p r o b l e m s a s s o c i a t e d with d r i n k i n g  The  s a m p l e to be i n t e r v i e w e d w a s  emotional)  i n the a r e a of w o r k  comprised  of 214  persons,  90 a n d a n e x t e n s i v e p r o c e d u r e of t r a c i n g f i n a l l y e n a b l e d i n f o r m a t i o n to be g a t h e r e d on 155 of t h e s e .  III.  T h e E x t e n t of R e h a b i l i t a t i o n A t t r i b u t a b l e t o F o u n d a t i o n Treatment W i t h the a i d of I B M k e y - p u n c h i n g a n d c o m p u t e r t a b u l a t i o n ,  interview results were analyzed.  the  E x a m i n a t i o n of the r e s u l t s o n t h i r -  t e e n i n d i c e s of r e h a b i l i t a t i o n c h o s e n f o r e x a m i n a t i o n s h o w e d t h a t r o u g h l y o n e - h a l f of a l l s u b j e c t s h a d i m p r o v e d to s o m e e x t e n t b e t w e e n the t i m e t h e y f i r s t v i s i t e d the F o u n d a t i o n a n d t i m e of i n t e r v i e w . W h e n e x p e r i m e n t a l and c o n t r o l g r o u p s w e r e c o m p a r e d , it w a s f o u n d that a c o n s i s t e n t l y g r e a t e r p e r c e n t a g e of e x p e r i m e n t a l g r o u p s u b j e c t s had i m p r o v e d .  These differences were f a i r l y s m a l l i n some  a r e a s of b e h a v i o u r ( w o r k , f a m i l y , a n d s o c i a l a c t i v i t i e s ) a n d w e r e l a r g e r i n other a r e a s ( d r i n k i n g b e h a v i o u r , h e a l t h , and i n s i g h t ) .  An  a s s e s s m e n t of o v e r a l l i m p r o v e m e n t m a d e by the i n t e r v i e w e r s i n d i c a t e d t h a t a p p r o x i m a t e l y 20% m o r e of the s u b j e c t s i n the  experimental  t h a n i n the c o n t r o l g r o u p h a d i m p r o v e d . It w a s f o u n d , h o w e v e r ,  that a c e r t a i n p r o p o r t i o n of t h i s  greater  i m p r o v e m e n t i n the e x p e r i m e n t a l g r o u p m u s t be a t t r i b u t e d to t w o m a j o r differences  b e t w e e n the t w o g r o u p s .  M e m b e r s of the  experimental  g r o u p w e r e s o m e w h a t b e t t e r m o t i v a t e d to be r e h a b i l i t a t e d , a n d h a d attended m o r e A l c o h o l i c s A n o n y m o u s meetings  since Foundation contact.  91 A f t e r c o n t r o l l i n g for these f a c t o r s ,  i t w a s f o u n d t h a t the e x t e n t of r e -  h a b i l i t a t i o n a t t r i b u t a b l e to t r e a t m e n t at the A l c o h o l i s m F o u n d a t i o n w a s b e t w e e n 10% a n d 15%.  That i s ,  F o u n d a t i o n t r e a t m e n t w a s f o u n d to i n -  c r e a s e a n i n d i v i d u a l ' s c h a n c e s of s h o w i n g s o m e i m p r o v e m e n t i n h i s b e h a v i o u r by 10% to  IV.  15%.  T h e I n t e r r e l a t i o n s h i p of A r e a s of R e h a b i l i t a t i o n M e t h o d s of f u r t h e r a n a l y s i s T h e t h i r t e e n i n d i c e s of r e h a b i l i t a t i o n u s e d e a r l i e r w e r e  re-  d u c e d to s i x , one i n d e x of c h a n g e i n d r i n k i n g b e h a v i o u r , a n d f i v e i n d i c e s of c h a n g e i n o t h e r a r e a s of b e h a v i o u r , a s f o l l o w s : 1.  Health  2.  Work  3.  Family responsibility  4.  Financial responsibility  5.  Leisure time activities  T w o c a t e g o r i e s of c h a n g e on e a c h i n d e x w e r e u s e d , p r o v e d " and " N o t I m p r o v e d . "  "Im-  T h i s p e r m i t t e d the u s e of f o u r - f o l d  t a b l e s to e x a m i n e the i n t e r r e l a t i o n s h i p b e t w e e n c h a n g e i n d r i n k i n g b e h a v i o u r a n d c h a n g e i n o t h e r a r e a s of b e h a v i o u r . tion was e x a m i n e d , and c h i - s q u a r e d values w e r e  Each  cross-tabula-  calculated.  Hypothesis I C r o s s - t a b u l a t i o n s u t i l i z i n g the t o t a l s a m p l e ( e x p e r i m e n t a l a n d  92 c o n t r o l g r o u p s c o m b i n e d ) s u b s t a n t i a t e d H y p o t h e s i s I. proved in drinking behaviour (i.e.  Those who i m -  t h e i r s e v e r i t y of p r o b l e m d e c r e a s e d )  w e r e m o r e l i k e l y to i m p r o v e i n a l l o t h e r a r e a s of b e h a v i o u r t h a n t h o s e who d i d not.  S i m i l a r l y , t h o s e w h o d i d not i m p r o v e i n d r i n k i n g b e -  h a v i o u r w e r e m o r e l i k e l y not to i m p r o v e i n o t h e r a r e a s of b e h a v i o u r . T h u s the t a b u l a t i o n of v a r i o u s i n d i c e s of r e h a b i l i t a t i o n a g a i n s t c h a n g e i n d r i n k i n g b e h a v i o u r i n d i c a t e d t h a t the p a r a l l e l c h a n g e s i n v a r i o u s a r e a s w h i c h h a d b e e n s e e n i n the t o t a l g r o u p of s u b j e c t s w e r e i n f a c t p a r a l l e l c h a n g e s i n the b e h a v i o u r of i n d i v i d u a l s . course,  It i s ,  of  a f u r t h e r s t e p i n r e a s o n i n g to d r a w f r o m t h i s the i n f e r e n c e  t h e s e c h a n g e s a r e c a u s a l l y r e l a t e d t o one a n o t h e r .  that  That i s , it i s con-  c e i v a b l e that a n i n d i v i d u a l m i g h t i m p r o v e i n d r i n k i n g b e h a v i o u r and m i g h t a l s o i m p r o v e i n h i s g e n e r a l l e v e l of o c c u p a t i o n a l for instance, two.  performance,  w i t h o u t t h e r e b e i n g a n e c e s s a r y r e l a t i o n s h i p b e t w e e n the  H o w e v e r , a t h e o r e t i c a l u n d e r s t a n d i n g of h u m a n b e h a v i o u r a s  d o c u m e n t e d i n the i n t r o d u c t o r y c h a p t e r h a s l e d t o the c o n c l u s i o n t h a t t h i s s t a t i s t i c a l a s s o c i a t i o n m a y i n d e e d i n d i c a t e s o m e d e g r e e of r e lationship.  It i s u n l i k e l y that i n e v e r y c a s e i m p r o v e m e n t i n h e a l t h ,  or w o r k , or f a m i l y r e l a t i o n s h i p s ,  e t c . , w o u l d be r e l a t e d a s c a u s e o r  e f f e c t to c h a n g e i n d r i n k i n g b e h a v i o u r , a r e i n no i n s t a n c e  related.  but i t i s a l s o u n l i k e l y that t h e s e  The a l c o h o l i s m l i t e r a t u r e suggests m a n y  w a y s i n w h i c h a n a l c o h o l i c ' s d r i n k i n g b e h a v i o u r c a n be r e l a t e d to h i s functioning i n other spheresof l i f e , either as cause or effect .  93 Thus it seems reasonable substantiated:  to r e g a r d H y p o t h e s i s I a s  being  that a p e r s o n ' s i n t e r n a l i n t e g r a t i o n a n d r e l a t i o n s h i p to  h i s e n v i r o n m e n t i m p i n g e u p o n h i s d r i n k i n g b e h a v i o u r , a n d the d r i n k i n g p a t t e r n w h i c h d e v e l o p s i n t u r n i m p i n g e s u p o n h i s f u n c t i o n i n g both i n t e r n a l and e x t e r n a l .  A l c o h o l i s m i s h e r e v i e w e d a s a n e x a m p l e of the  i n t e r r e l a t i o n s h i p s p o s i t e d by K a r l M e n n i n g e r i n s p e a k i n g a b o u t m e n t a l illness in general: W e c a n n o t r e l y u p o n a p a t i e n t to t e l l u s j u s t w h a t i s w r o n g or wherein his integration i s failing, . . . A person's r e l a t i o n s h i p w i t h the o u t s i d e w o r l d h a s b e g u n to f a i l , a n d t h i s f a i l u r e i s r e l a t e d to h i s i n t e r n a l i n t e g r a t i o n s , w h i c h ought to be a b l e to m a n a g e t h i n g s , but c a n ' t . If he l o s e s h i s j o b , he m a y l o s e h i s w i f e ; i f he l o s e s h i s w i f e h i s h e a r t m a y b r e a k . If he k e e p s h i s j o b he m a y d e v e l o p a n u l c e r , a n d i f he d e v e l o p s a n u l c e r he m a y s t r i k e d o w n h i s n e i g h b o u r a n d go to jail. S u c h i s the c o m p l i c a t e d a n d d e l i c a t e n e t w o r k of i n t e r d e p e n dence/. ^ It w a s a l s o o b s e r v e d t h a t a l t h o u g h t h e r e w a s a r e l a t i o n s h i p bet w e e n d r i n k i n g b e h a v i o u r a n d e a c h of the f i v e o t h e r a r e a s of b e h a v i o u r distinguished,  there were considerable differences  this r e l a t i o n s h i p .  i n the s t r e n g t h of  T h e g r e a t e s t d e g r e e of r e l a t i o n s h i p w a s s e e n w i t h  r e g a r d to l e i s u r e t i m e a c t i v i t i e s ,  a l e s s e r d e g r e e of r e l a t i o n s h i p a p -  p e a r e d i n the c a s e s of h e a l t h , w o r k , a n d f a m i l y r e s p o n s i b i l i t y , a n d a s t i l l l e s s e r d e g r e e of r e l a t i o n s h i p w a s s h o w n w i t h r e s p e c t t o f i n a n c i a l responsibilities. however.  C a u t i o n i s w a r r a n t e d i n i n t e r p r e t i n g these  results,  94 F i r s t of a l l , the r e l a t i v e s t r e n g t h s d i c a t e d by the u s e of c h i - s q u a r e d v a l u e s , numerical comparison.  of i n t e r r e l a t i o n s h i p w e r e i n w h i c h do not p e r m i t a p r e c i s e  C e r t a i n c o n c l u s i o n s a b o u t the n a t u r e of d a t a  a v a i l a b l e s u g g e s t e d t h a t the u s e of m o r e s o p h i s t i c a t e d t e c h n i q u e s w a s not w a r r a n t e d .  statistical  F o r one t h i n g , a s m e n t i o n e d  earlier,  the d e g r e e of c h a n g e o b s e r v e d i n e a c h a r e a of b e h a v i o u r w a s d e p e n d e n t u p o n the p o t e n t i a l c h a n g e w h i c h c o u l d t a k e p l a c e i n that Although it s e e m s reasonable  area.  to a s s u m e t h a t a l l s u b j e c t s h a d a d r i n k i n g  p r o b l e m w h i c h c o u l d b e a r s o m e d e g r e e of i m p r o v e m e n t , n e c e s s a r i l y the c a s e i n o t h e r a r e a s of b e h a v i o u r .  t h i s i s not  F o r instance,  a  m a n ' s d r i n k i n g b e h a v i o u r m i g h t not h a v e y e t r e a c h e d the p o i n t w h e r e i t had s e r i o u s l y affected h i s o c c u p a t i o n a l p e r f o r m a n c e , of f a m i l i a l r e s p o n s i b i l i t y .  or his fulfilment  In s u c h c a s e s , i m p r o v e m e n t i n d r i n k i n g b e -  h a v i o u r w o u l d not be a c c o m p a n i e d by i m p r o v e m e n t i n t h e s e o t h e r a r e a s , s i n c e t h e r e w a s no d i s c e r n a b l e  scope for i m p r o v e m e n t i n these a r e a s .  A n o t h e r d i f f i c u l t y i n c o m p a r i n g the d e g r e e of r e l a t i o n s h i p bet w e e n c h a n g e i n d r i n k i n g b e h a v i o u r and c h a n g e i n o t h e r a r e a s f r o m the n a t u r e of the i n d i c e s u s e d .  stems  E a c h i n d e x of c h a n g e w a s c o n -  s t r u c t e d s e p a r a t e l y w i t h a v i e w to a d e q u a t e l y m e a s u r i n g b e h a v i o u r i n the p a r t i c u l a r a r e a i n v o l v e d , a n d t h e r e i s no w a y of k n o w i n g w h e t h e r o r not d i f f e r e n t i n d i c e s a r e c o m p a r a b l e t o one a n o t h e r .  Examination  of one i n d e x i n p a r t i c u l a r , c h a n g e i n l e i s u r e t i m e a c t i v i t i e s ,  indicates  that t h i s i n d e x m a y h a v e a b u i l t - i n b i a s t o w a r d s i n d i c a t i n g a r e l a t i o n s h i p  95 with drinking behaviour.  One of the major indications of an unsatis-  factory use of leisure time was the predominance of drinking,  It is  not surprising, therefore, that this was the index which seemed to be most related to drinking behaviour. These kinds of considerations suggest that the data available in this study do not permit the drawing of any reliable conclusions regarding differential degrees of relationship between change in drinking behaviour and change in other aspects of life.  It is not possible to con-  clude with any degree of certainty that the specific differences seen are real differences. On the other hand, certain theoretical considerations would suggest that the effects of drinking would be differentially distributed between various areas of life.  Certain aspects of behaviour might be  susceptible to deterioration sooner than others in the process of alcoholism.  Similarly, when an individual begins to recover from alco-  holism, some areas of f u n c t i o n i n g might be more easily recoverable than others.  The area of health might be the most immediate area of  change, for here the patient is not as dependent upon external factors a s in other areas.  Unless long-term brain damage or other physical  deterioration has taken place, an individual's health usually responds fairly quickly to the cessation of heavy drinking, particularly if medical treatment has been received. In the other four areas of behaviour delimited above, work, family  relationships, other factors  financial responsibility and leisure time activities, i n v o l v e d could m a k e positive change  more difficult.  f i r s t f a c t o r i s that a p e r s o n ' s f u n c t i o n i n g i n these s p h e r e s r e s u l t of a t t i t u d e s a n d h a b i t s w h i c h h a v e d e v e l o p e d o v e r of t i m e a n d w o u l d , i n the a r e a come  therefore,  period  For  instance,  an alcoholic who has  be-  o v e r a p e r i o d of m a n y y e a r s ' h e a v y d r i n k i n g s u s p i c i o u s a n d i n -  t o l e r a n t of o t h e r s ,  and v e r y isolated socially,  c o u l d not e a s i l y  t h i s p a t t e r n e v e n i f he w e r e to stop d r i n k i n g f o r s o m e The other factor changes  involved.  tive changes alcoholic. sobriety,  F o r instance,  change  l e n g t h of t i m e .  c o n t r i b u t i n g to the d i f f i c u l t y of  i n t h e s e o t h e r a r e a s of l i f e i s the d e g r e e  sons a r e  effecting  to w h i c h other  per-  an unforgiving wife can make posi-  i n f a m i l y r e l a t i o n s h i p s v e r y d i f f i c u l t f o r the  recovered  One p a t i e n t k n o w n to the a u t h o r h a s a c h i e v e d s e v e r a l a n d a l t h o u g h h i s w i f e l i v e s i n the  still refuses more  The  of l i f e i s a  some  be q u i t e d i f f i c u l t t o c h a n g e .  of r e l a t i o n s h i p s w i t h o t h e r p e o p l e ,  two  same house with h i m  years' she  to cohabit with h i m or even acknowledge his existence  than a perfunctory way.  S i m i l a r l y , if an alcoholic has  in  estab-  l i s h e d h i m s e l f w i t h a v e r y p o o r w o r k r e c o r d a.fter h a v i n g b e i n g d i s m i s s e d f r o m m a n y j o b s a s a r e s u l t of h e a v y d r i n k i n g ,  it is v e r y diffi-  c u l t f o r h i m t o e v e n o b t a i n a n y s o r t of w o r k . T h e d i f f e r e n t i a l e f f e c t s of t h e s e f a c t o r s v a r i o u s a s p e c t s of l i f e e x p e r i e n c e  and p o s s i b l y others  w o u l d l e a d to d i f f e r e n t d e g r e e s  relationship with drinking behaviour.  T h e d a t a of the p r e s e n t  in of  study  w e r e not s u f f i c i e n t l y p r e c i s e t o d r a w a n y c o n c l u s i o n s o n s u c h f a c t o r s , but t h i s w o u l d be a f r u i t f u l a r e a f o r f u r t h e r r e s e a r c h .  For example,  a n a n a l y s i s of c a s e h i s t o r i e s m i g h t d i s c e r n a t y p i c a l s e q u e n c e of e v e n t s i n the r e h a b i l i t a t i o n of a n a l c o h o l i c . H y p o t h e s i s II T h e s e c o n d h y p o t h e s i s s t a t e d t h a t the r e l a t i o n s h i p e s t a b l i s h e d a b o v e w o u l d be g r e a t e r i n t h o s e c a s e s w h e r e the i n d i v i d u a l h a d u n d e r gone t r e a t m e n t f o r h i s a l c o h o l p r o b l e m ( e x p e r i m e n t a l g r o u p ) t h a n w h e n he h a d not ( c o n t r o l g r o u p ) .  In the s a m e m a n n e r a s a b o v e , f o u r - f o l d  tables w e r e c o n s t r u c t e d and c h i - s q u a r e d v a l u e s w e r e c o m p a r e d , separately for members  of e x p e r i m e n t a l a n d c o n t r o l g r o u p s .  but  This  a n a l y s i s s h o w e d t h a t H y p o t h e s i s II w a s a l s o c o n f i r m e d , f o r e a c h c a s e t h e r e w a s a g r e a t e r r e l a t i o n s h i p e v i d e n t i n the e x p e r i m e n t a l g r o u p . C o n t r o l l i n g f o r the e f f e c t of d i f f e r e n t a m o u n t s of A l c o h o l i c s A n o n y m o u s attendance,  however,  s h o w e d that the g r e a t e r r e l a t i o n s h i p c o u l d be a t -  t r i b u t e d t o t r e a t m e n t f r o m the F o u n d a t i o n o n l y i n t h o s e c a s e s w h e r e the p e r s o n h a d not a l s o a t t e n d e d A l c o h o l i c s A n o n y m o u s r e g u l a r l y . f o r t h o s e p e r s o n s w h o h a d no o t h e r t r e a t m e n t ;  But  t r e a t m e n t at the A l c o -  h o l i s m F o u n d a t i o n d o e s a p p e a r to be e f f e c t i v e i n i n c r e a s i n g the  degree  to w h i c h p a t i e n t s i m p r o v i n g i n d r i n k i n g b e h a v i o u r a l s o s h o w o t h e r p o s i t i v e c h a n g e s i n o t h e r a s p e c t s of t h e i r l i v e s .  T h u s , i f the F o u n d a t i o n i s  c o n c e r n e d to a c h i e v e o v e r a l l r e h a b i l i t a t i o n r a t h e r than j u s t p e r se,  sobriety  a s i s i t s s t a t e d a i m , t h e n i t a p p e a r s t o be e f f e c t i v e to  some  98 extent i n a c h i e v i n g  V.  this.  Another Treatment The  Resource:  Alcoholics Anonymous  d a t a w h i c h t e s t e d the e f f e c t of t r e a t m e n t a t t h e  and "treatment" received  Foundation  f r o m A l c o h o l i c s A n o n y m o u s (the  result  of  r e g u l a r a t t e n d a n c e at A . A , m e e t i n g s ) i n d i c a t e a s i m i l a r e f f e c t on the hypothesized increased  relationships.  That is,  d e g r e e of c o r r e s p o n d e n c e  e a c h s e e m s to c o n t r i b u t e  in emphasis, members  certain  since  s i m i l a r beliefs  and professionals  engaged  an  between i m p r o v e m e n t i n drinking  b e h a v i o u r a n d i m p r o v e m e n t i n o t h e r a r e a s of b e h a v i o u r . s u r p r i s i n g t h a t t h i s i s the c a s e ,  to  It i s  despite v a r i o u s other  not  differences  a r e h e l d by A l c o h o l i c s A n o n y m o u s in alcoholism treatment.  The  p h i l o s o p h y of A l c o h o l i c s A n o n y m o u s i n v o l v e s a v i e w of " r e c o v e r y "  as  being m o r e  on  than m e r e  sobriety alone.  the c h a n g i n g of a t t i t u d e s ,  There is a strong emphasis  a n d t h e r e f o r e of b e h a v i o u r .  This  emphasis  c a n be s e e n i n t h e T w e l v e S t e p s w h i c h e x p o u n d t h e b a s i c p r i n c i p l e s A.  A . 1.  W e a d m i t t e d we w e r e p o w e r l e s s that our l i v e s had b e c o m e  2.  C a m e to b e l i e v e ourselves  3.  over  alcohol--  unmanageable.  that a P o w e r  greater  c o u l d r e s t o r e us to  sanity.  than  M a d e a d e c i s i o n to t u r n o u r w i l l and o u r l i v e s  over  to the c a r e of G o d a s we u n d e r s t o o d H i m . 4.  M a d e a s e a r c h i n g and f e a r l e s s m o r a l inventory o u r s e l v e s.  of  of  99 5.  A d m i t t e d to G o d , to o u r s e l v e s ,  a n d to a n o t h e r h u m a n  b e i n g the e x a c t n a t u r e of o u r w r o n g s . 6.  W e r e e n t i r e l y r e a d y to have God r e m o v e a l l these defects  7. 8.  of c h a r a c t e r .  H u m b l y a s k H i m to r e m o v e o u r  shortcomings.  M a d e a l i s t of a l l p e r s o n s we h a d h a r m e d ,  and  became  w i l l i n g to m a k e a m e n d s t o t h e m a l l . 9.  M a d e d i r e c t a m e n d s to s u c h p e o p l e w h e r e v e r p o s s i b l e , e x c e p t w h e n to do so w o u l d i n j u r e t h e m o r  10.  others.  C o n t i n u e d to take p e r s o n a l i n v e n t o r y a n d w h e n we w e r e w r o n g p r o m p t l y admitted it,  11.  Sought t h r o u g h p r a y e r a n d m e d i t a t i o n to i m p r o v e o u r c o n s c i o u s c o n t a c t w i t h G o d a s we u n d e r s t o o d H i m , p r a y i n g o n l y f o r k n o w l e d g e of H i s w i l l f o r us a n d the p o w e r to c a r r y that out.  1Z,  H a v i n g h a d a s p i r i t u a l a w a k e n i n g a s the r e s u l t of t h e s e steps,  we t r i e d to c a r r y t h i s m e s s a g e  to a l c o h o l i c s ,  a n d to p r a c t i c e t h e s e p r i n c i p l e s i n a l l o u r a f f a i r s .  2  One of the b a s i c e l e m e n t s of the " s p i r i t u a l " p r o g r a m m e o u t l i n e d i n t h e s e t w e l v e s t e p s i s the i m p o r t a n c e of p u t t i n g a r i g h t s o c i a l r e l a t i o n ships.  There is a stress,  with reference  too,  o n the n e c e s s i t y f o r s e l f e x a m i n a t i o n  to g e n e r a l a t t i t u d e s to l i f e .  A l t h o u g h t h i s i s stated i n  r a t h e r d i f f e r e n t t e r m s t h a n w o u l d be the t h e r a p e u t i c p r i n c i p l e s of a p r o f e s s i o n a l t r e a t m e n t c l i n i c s u c h a s that of the A l c o h o l i s m F o u n d a tion,  i t c a n be s e e n that t h e r e i s a d e f i n i t e e m p h a s i s o n the i m p o r t a n c e  of the r e f o r m a t i o n of " t h e w h o l e m a n , " It s h o u l d be p o i n t e d out, h o w e v e r ,  that the d a t a at h a n d do not  p e r m i t a c o m p a r i s o n of the r e l a t i v e e f f e c t i v e n e s s of t h e s e two t r e a t m e n t  r e s o u r c e s , A. A.  a n d the F o u n d a t i o n .  Each  s e e m s t o be e f f e c t i v e t o  s o m e d e g r e e i n i n c r e a s i n g the r e l a t i o n s h i p b e t w e e n c h a n g e i n d r i n k i n g b e h a v i o u r a n d c h a n g e i n o t h e r a r e a s of b e h a v i o u r , but no c a n l e g i t i m a t e l y be m a d e b e t w e e n t h e m .  One  comparison  o b v i o u s r e a s o n f o r the  l a c k of c o m p a r a b i l i t y i s that e q u a l a m o u n t s of t r e a t m e n t f r o m are  not b e i n g c o m p a r e d ;  each  i n f a c t , i t w o u l d be r a t h e r d i f f i c u l t to d e t e r -  m i n e what w o u l d c o n s t i t u t e e q u a l a m o u n t s of t r e a t m e n t f r o m ferent therapeutic organizations.  such dif-  But just as each r e s o u r c e seemed  to be e f f e c t i v e i n i n c r e a s i n g the d e g r e e  of r e h a b i l i t a t i o n i n the s a m p l e  of p a t i e n t s i n t e r v i e w e d , t h e r e a p p e a r s to be a s i m i l a r e f f e c t w i t h r e g a r d t o the r e l a t i o n s h i p s e s t a b l i s h e d a b o v e .  VI.  R e l a t i o n s h i p of F i n d i n g s to P r e v i o u s It was  noted i n the f i r s t  Research  c h a p t e r that t h e r e h a d b e e n p r e v i o u s  s t u d i e s w h i c h h a d u s e d c r i t e r i a o t h e r t h a n d r i n k i n g b e h a v i o u r to a s s e s s i m p r o v e m e n t i n a l c o h o l i c s a s a r e s u l t of t r e a t m e n t , a n d w h i c h h a d a t t e m p t e d t o r e l a t e t h e s e c h a n g e s to d r i n k i n g b e h a v i o u r . methodology i n each case varied, e a c h of the f i v e s t u d i e s c i t e d ,  3  A l t h o u g h the  s i m i l a r findings were reported i n  that c h a n g e i n the o t h e r a r e a s of  b e h a v i o u r m e a s u r e d c o r r e s p o n d e d t o c h a n g e i n d r i n k i n g , i . e . , that i f a person improved  i n d r i n k i n g b e h a v i o u r he was  p r o v e i n o t h e r s p h e r e s t h a n one who haviour, and c o n v e r s e l y .  m o r e l i k e l y to i m -  h a d not i m p r o v e d  In o n l y one  study,  4  i n d r i n k i n g be-  w h i c h h a s not b e e n  101 r e p o r t e d i n d e t a i l yet,  was change between p r e - t r e a t m e n t and post-  t r e a t m e n t p e r i o d s o v e r a b r o a d r a n g e of b e h a v i o u r t a b u l a t e d change i n d r i n k i n g b e h a v i o u r ,  a s w a s done  T h e u n i q u e n e s s of the p r e s e n t  here.  s t u d y s t e m s not o n l y f r o m the  of a s i m i l a r m o d e of a n a l y s i s on a d i f f e r e n t g r o u p of p a t i e n t s to t r e a t m e n t i n a d i f f e r e n t s e t t i n g ,  against  use  exposed  but a l s o f r o m the e x t e n s i o n of t h i s  a n a l y s i s to a c o m p a r i s o n b e t w e e n t r e a t e d a n d u n t r e a t e d p a t i e n t s , the u t i l i z a t i o n of e x p e r i m e n t a l a n d c o n t r o l g r o u p s .  by  It w a s f o u n d that  the r e l a t i o n s h i p e s t a b l i s h e d b e t w e e n i m p r o v e m e n t i n d r i n k i n g a n d i n other behaviour was m o r e  l i k e l y to be p r e s e n t i n t h o s e p e r s o n s  h a d h a d t r e a t m e n t f r o m the A l c o h o l i s m F o u n d a t i o n of B . C .  who  In a d d i t i o n ,  it w a s f o u n d that " t r e a t m e n t " r e c e i v e d f r o m A l c o h o l i c s A n o n y m o u s s e e m e d to h a v e a s i m i l a r e f f e c t .  T h u s the r e s e a r c h r e p o r t e d h e r e  has  e n a b l e d s o m e t e n t a t i v e c o n c l u s i o n s to be d r a w n r e g a r d i n g the d i f f e r e n t i a l e f f e c t s of t r e a t m e n t ,  from various  sources,  o n the  relationship  which had been e s t a b l i s h e d p r e v i o u s l y .  VII.  General Conclusions T h e two m a j o r h y p o t h e s e s  tiated.  of t h i s s t u d y h a v e b e e n  It w a s f o u n d that t h e r e i s a n i n t e r r e l a t i o n s h i p  substan-  between changes  w h i c h take p l a c e i n a n a l c o h o l i c ' s d r i n k i n g b e h a v i o u r a n d i n the a s p e c t s of h i s l i f e w h i c h w e r e m e a s u r e d .  other  T h i s r e l a t i o n s h i p was found  to be g r e a t e r i n t h o s e c a s e s w h e r e the p e r s o n h a d u n d e r g o n e  treatment  102 f o r h i s a l c o h o l p r o b l e m , e i t h e r f r o m the A l c o h o l i s m F o u n d a t i o n Alcoholics Anonymous.  or  It i s e v i d e n t , h o w e v e r , t h a t the d a t a w h i c h  w e r e a v a i l a b l e f o r t h i s p r e s e n t s t u d y p e r m i t t e d the r e a c h i n g of o n l y the m o s t g e n e r a l c o n c l u s i o n s .  F o r i n s t a n c e , i t was  observed  that  t h e r e w e r e v e r y d i f f e r e n t d e g r e e s of i n t e r r e l a t i o n s h i p d e p e n d i n g o n the s p e c i f i c a r e a of b e h a v i o u r i n v o l v e d , but i t w a s  not c o n s i d e r e d  l e g i t i m a t e to d r a w any d e f i n i t e c o n c l u s i o n s about t h i s .  This would  be one f r u i t f u l a r e a f o r f u r t h e r r e s e a r c h . M a n y o t h e r r e s e a r c h q u e s t i o n s c o u l d be e n v i s a g e d  stemming  f r o m the a b o v e c o n c l u s i o n , w h i c h c o u l d m a k e a f u r t h e r c o n t r i b u t i o n to the u n d e r s t a n d i n g of s u c h a v a s t t o p i c a s h a s b e e n a p p r o a c h e d h e r e . F o r i n s t a n c e , one c o u l d h y p o t h e s i z e t h a t a n y m e a s u r e of s o b r i e t y a c h i e v e d by a n a l c o h o l i c w o u l d be m o r e l o n g - t e r m a n d s t a b l e i f a c c o m p a n i e d by c h a n g e s i n o t h e r a r e a s of b e h a v i o u r .  S i m i l a r l y , one  could  s p e c u l a t e t h a t t h e d e g r e e of i m p r o v e m e n t i n d r i n k i n g b e h a v i o u r ( u s i n g a f i n e r b r e a k d o w n t h a n " i m p r o v e d " v e r s u s "not i m p r o v e d " a s w a s h e r e ) , w o u l d be g r e a t e r i n t h o s e c a s e s w h e r e t h e r e w a s evident i n other areas.  As  used  improvement  i s so o f t e n the c a r e w i t h s u c h r e s e a r c h a s  h a s b e e n u n d e r t a k e n h e r e , the n u m b e r of f u r t h e r q u e s t i o n s r a i s e d outweigh  t h e n u m b e r of q u e s t i o n s a n s w e r e d .  103 FOOTNOTES:  Chapter V  K a r l M e n n i n g e r , P a u l W . P r u y s e r , and M a r t i n M a y m a n , T h e V i t a l B a l a n c e ( N e w Y o r k : T h e V i k i n g P r e s s , 1963), p . 9 5 . T h e italics are mine. ^ A l c o h o l i c s Anonymous (New Y o r k : A l c o h o l i c s W o r l d S e r v i c e s , I n c . , 1955), p p . 5 9 - 6 0 . 3  Anonymous  S e e f o o t n o t e s 1 4 - 1 8 of C H A P T E R I .  ^ G e r h a r t S a e n g e r a n d D o n a l d G e r a r d , " A F o l l o w - U p S t u d y of P a t i e n t s Seen i n C l i n i c s A s s o c i a t e d w i t h the N o r t h A m e r i c a n A s s o c i a t i o n of A l c o h o l i s m P r o g r a m s , " i n S e l e c t e d P a p e r s D e l i v e r e d a t t h e F o u r t e e n t h A n n u a l M e e t i n g of the N o r t h A m e r i c a n A s s o c i a t i o n of A l c o h o l i s m P r o g r a m s ( W a s h i n g t o n : N o r t h A m e r i c a n A s s o c i a t i o n of A l c o h o l i s m P r o g r a m s , 1 9 6 3 ) , p p . 106- 108.  BIBLIOGRAPHY  Alcoholics Anonymous.  New  S e r v i c e s , Inc., Apple,  D o r r i a n (ed. ). New  Alcoholics Anonymous World  S o c i o l o g i c a l S t u d i e s of H e a l t h and  York: M c G r a w - H i l l Book Company,  Bales, Robert F.  A.  L.  Sickness.  I960.  " S o c i a l T h e r a p y f o r a S o c i a l D i s o r d e r , " J o u r n a l of  Social Issues, Beeley,  York:  1955.  I (August,  "Alcoholism,  1945),  14-22.  S o c i a l W o r k , and 1959),  M e n t a l Hygiene, XLIII (October, C l i n i c a l P r a c t i c e and  Mental Hygiene, " 577-582.  C o m m u n i t y E d u c a t i o n on A l c o h o l i s m :  A  R e p o r t on the P r o g r a m  of the C o n n e c t i c u t C o m m i s s i o n  Alcoholism.  Connecticut C o m m i s s i o n on  Hartford:  Re s e a r c h on  Alcoholism,  1959. Davies,  D.  L.  "Normal Drinking in Recovered Alcohol Addicts, "  Q u a r t e r l y J o u r n a l of S t u d i e s on A l c o h o l , X X I I I ( M a r c h ,  1962),  94-104. Durfee,  C h a r l e s H. G r e e n , and  G i b b i n s , R.  J . and  T o D r i n k o r Not to D r i n k . Co. ,  1938.  J , D.  Armstrong.  on B e h a v i o u r of A l c o h o l i c  C a l v i n S. and York:  Jackson,  M.  and  J.  "A  Longmans,  P a t i e n t s , " Q u a r t e r l y J o u r n a l of  Gardner Lindzey,  J o h n W i l e y and  York:  " E f f e c t s of C l i n i c a l T r e a t m e n t  S t u d i e s on A l c o h o l , X V I I I ( S e p t e m b e r , Hall,  New  Sons,  1957), 429-450.  T h e o r i e s of P e r s o n a l i t y .  New  1957.  Study of the R e l a t i o n B e t w e e n D r i n k i n g B e h a v i o u r  C h i l d - C a r e P a r t i c i p a t i o n i n a S a m p l e of A l c o h o l i c P a t i e n t s , "  Unpublished  Master's thesis,  The  U n i v e r s i t y of T o r o n t o ,  Toronto,  1958. Keller,  Mark.  "The  Prevalence."  D e f i n i t i o n of A l c o h o l i s m and  D a v i d J . P i t t m a n and and  Sons,  the E s t i m a t i o n of Its  S o c i e t y , C u l t u r e , and D r i n k i n g P a t t e r n s ,  1962.  C h a r l e s R.  Snyder.  New  York:  ed.  John  Wiley  105 M e n n i n g e r , K a r l , P a u l W . P r u y s e r , and M a r t i n M a y m a n . B a l a n c e . N e w Y o r k : The V i k i n g P r e s s , 1963. Robson,  The V i t a l  Reginald A . H . , Ingeborg P a u l u s , and G . Grant C l a r k e . A n E v a l u a t i o n of the E f f e c t of T r e a t m e n t o n the P . e h a b i l i t a t i o n of A l c o h o l i c s . V a n c o u v e r : T h e A l c o h o l i s m F o u n d a t i o n of B r i t i s h C o l u m b i a , 1963,  S a e n g e r , G e r h a r t and D o n a l d G e r a r d , " A F o l l o w - U p Study of P a t i e n t s S e e n i n C l i n i c s A s s o c i a t e d w i t h the N o r t h A m e r i c a n A s s o c i a t i o n of A l c o h o l i s m P r o g r a m s . " S e l e c t e d P a p e r s D e l i v e r e d a t the F o u r t e e n t h A n n u a l M e e t i n g of the N o r t h A m e r i c a n A s s o c i a t i o n of A l c o h o l i s m P r o g r a m s . Washington: North A m e r i c a n A ssoc i a t i o n of A l c o h o l i s m P r o g r a m s , 1 9 6 3 . P p . 9 8 - 1 1 6 . S c h m i d t , W o l f g a n g . " A S t u d y of the R e l a t i o n B e t w e e n S o c i a l P a r t i c i p a t i o n a n d D r i n k i n g B e f o r e a n d A f t e r T r e a t m e n t i n a S a m p l e of A l c o h o l i c P a t i e n t s . " Unpublished M a s t e r ' s t h e s i s , The U n i v e r s i t y of T o r o n t o , T o r o n t o , 1 9 5 7 . " S e l e c t e d A s p e c t s of t h e P r o s p e c t i v e F o l l o w - U p S t u d y , " A l c o h o l i s m a n d C a l i f o r n i a , P u b l i c a t i o n N o . 2 . B e r k e l e y : S t a t e of C a l i f o r n i a D e p a r t m e n t of P u b l i c H e a l t h , 1 9 5 9 . S i m m o n s , L e o W . and H a r o l d G . Wolff. Social Science i n M e d i c i n e . N e w Y o r k : R u s s e l l Sage F o u n d a t i o n , 1 9 5 4 . S m i t h , E u g e n i a V . " F i e l d I n t e r v i e w i n g of P r o b l e m D r i n k e r s , " S o c i a l W o r k , I V ( O c t o b e r , 1959), 8 0 - 8 6 . " T r e a t m e n t P l a n . " V a n c o u v e r : T h e A l c o h o l i s m F o u n d a t i o n of B r i t i s h C o l u m b i a , 1962. ( M i m e o g r a p h e d . ) Vogel  s  S. " S o m e A s p e c t s of G r o u p P s y c h o t h e r a p y W i t h A l c o h o l i c s , " I n t e r n a t i o n a l J o u r n a l of G r o u p P s y c h o t h e r a p y , V I I ( J u l y , 1 9 5 7 ) , 302-309.  W o r l d H e a l t h O r g a n i z a t i o n , E x p e r t C o m m i t t e e on M e n t a l H e a l t h , A l c o h o l i s m S u b c o m m i t t e e , Second R e p o r t . T e c h n i c a l R e p o r t S e r i e s , N o . 48 ( A u g u s t , 1952).  APPENDIX  ADDITIONAL  A  TABLES  TABLE  12:  P e r c e n t a g e D i s t r i b u t i o n s of S e l e c t e d M a t c h e d C h a r a c t e r i s t i c s f o r E x p e r i m e n t a l a n d C o n t r o l G r o u p s a n d C o m p a r i s o n w i t h I960 Intake  Employment  Employed  60+  Unemployed  Widowed 2  Unskilled  Divorced 3  Skilled  Separated  Law Married  24  Common  Single  52  60 51  50 41  3 1 - 4 0  2 1 - 3 0  19  Status  White Collar  Occupation  M a r i t a l Status  Group  Professional  Age  Group  23  56  21  58  42  19  54  24  61  39  Control and E x p e r i m e nta 1 N = 100 e a c h %  8  45 27 20  -  8  36  4  o f I960  Intake  32 20  (not  reported)  3  108 T A B L E 13: C o m p a r i s o n of Chi-Squared Values for Tabulations of F o u r Indices of Change i n D r i n k i n g Behaviour A g a i n s t Change i n the A r e a of W o r k Index D r i n k i n g problem -- IA Abstinence  Experimental  Control  Total  16. 2  14. 5  28. 1  4.. 3  L i q u o r offences  ( 3. 1)  Composite index  10. 0  ( 0.6)*  4.6  ( 3.2)  ( 0.2)  4. 8  14. 5  ^ F i g u r e s i n parentheses indicate a non-significant distribution, taking the . 05 l e v e l of significance.  T A B L E 14: C o m p a r i s o n of Chi-Squared V a l u e s f o r Tabulations of F o u r Indices of Change i n D r i n k i n g Behaviour A g a i n s t Change i n the A r e a of F a m i l y R e s p o n s i b i l i t y Index D r i n k i n g p r o b l e m - - IA A bstine nee  Expe r i m e ntal  Control  Total  13. 0  7. 3  19. 3  ( 0.5)  ( 0.2)  (  ( 2.6)  ( 3.5)*  L i q u o r offences  7. 0  Composite index  6. 4  LO) 4. 6  10. 8  * F i g u r e s i n pa re nthe se s indicate a non-significant distribution, taking the .05 l e v e l of significance.  109  TABLE  15: C o m p a r i s o n of C h i - S q u a r e d V a l u e s f o r T a b u l a t i o n s of F o u r I n d i c e s of C h a n g e i n D r i n k i n g B e h a v i o u r A g a i n s t C h a n g e i n the A r e a of L e i s u r e T i m e A c t i v i t i e s  Index  Experimental  Drinking problem  - - IA  43. 5  A b s t i n e nee  26. 3  (  1.0)  (  34. 4  Composite index  72. 3  ( 2.6)*  30. 4  L i q u o r offences  Total  Control .  27. 1 ( 0.2)  1.7)  50.0  16. 7  ^ F i g u r e s i n parentheses indicate a non-significant distribution, t a k i n g the . 05 l e v e l of s i g n i f i c a n c e .  TABLE  16: I n t e r r e l a t i o n s h i p B e t w e e n C h a n g e i n D r i n k i n g B e h a v i o u r a n d  WORK Improved Improved  Not  Improved  Total  27 ( 1 9 ) *  67  (75)  94  2 (10)  51  (43)  53  DRINKING BEHAVIOUR Not  Improved  Total =  67  80  147  11.8**: d.f. 1: p < . 001  * E x p e c t e d f r e q u e n c i e s if the null h y p o t h e s i s w e r e t r u e a r e enclosed i n parentheses. 2 **X  v a l u e s f o r this table w e r e computed u s i n g a f o r m u l a incor-  porating Yates  1  c o r r e c t i o n f o r continuity.  110  T A B L E 17:  I n t e r r e l a t i o n s h i p Between Change i n D r i n k i n g B e h a v i o u r and Change i n F a m i l y R e s p o n s i b i l i t y for A l l Subjects FAMILY  RESPONSIBILITY  Improved Improved  41  Not I m p r o v e d  Total  (34)*  20  (27)  61  (14)  18  (11)  25  DRINKING BEHAVIOUR Not I m p r o v e d  Total  7  48 9,5**:  d.f. 1:  38  86  p<.01  * E x p e c t e d f r e q u e n c i e s i f the n u l l h y p o t h e s i s w e r e t r u e enclosed in parentheses,  are  2 * * X values f o r this table were computed u s i n g a f o r m u l a i n c o r porating Yates correction for continuity, 1  Ill  T A B L E 18:  Interrelationship Between Change i n D r i n k i n g B e h a v i o u r and Change i n F i n a n c i a l R e s p o n s i b i l i t y f o r A l l Subjects FINANCIAL  RESPONSIBILITY  Imp roved Improved  14  Not I m p r o v e d  Total  (10)*  82  (86)  96  (  51  (47)  52  DRINKING BEHAVIOUR 1  Not I m p r o v e d  Total =  5)  4-6**:  d.f.  148  133  15 1:  p<  .05  ^ E x p e c t e d f r e q u e n c i e s i f the n u l l h y p o t h e s i s enclosed in parentheses.  were true  are  * * X ^ values for this table w e r e computed u s i n g a f o r m u l a i n c o r porating Yates' correction for continuity.  112  T A B L E 19:  Interrelationship Between Change i n D r i n k i n g B e h a v i o u r and C h a n g e i n L e i s u r e T i m e A c t i v i t i e s f o r A l l S u b j e c t s LEISURE TIME ACTIVITIES Improved  Not I m p r o v e d  Total  Improved  76  (56)*  18  (38)  94  Not I m p r o v e d  12  (32)  42  (22)  54  Total  88  DRINKING • BEHAVIOUR  X . = 2  46. 5 * * :  d.f.  60 1:  148  p < . 001  * E x p e c t e d f r e q u e n c i e s i f the n u l l h y p o t h e s i s w e r e t r u e a r e enclosed in parentheses. 2 * * X values f o r this table were computed u s i n g a f o r m u l a i n c o r porating Yates' correction for continuity.  APPENDIX  THE  INTERVIEW  B  SCHEDULE  Key  I  to  Control 1.  II  III  IV  Questions  Factors  Socio-economic:  2.  Motivation:  3.  Severity,  4'.  Treatment other than at the Foundation:  Extent  of  of  face 5,  4, problem:  sheet, 6 ,  7,  21, 46, 83  22, 70,  23, 74,  19,  20,  34  18, 35 ,  25, 36 ,  37,  40 ,  44  10  8, 30 , 77,  35, 79,  42, 81  26, 86  27,  30 ,  31,  Rehabilitation  1.  Drinking  2.  Health:  13 , 33 ,  14, 84  15,  16,  17,  32,  3.  Work:  37 , 43 ,  38 , 44,  39 , 45,  40, 46,  ^1, 47,  42, 85  4.  Family:  48 65 73 79 90  , , , ,  49, 66 , 74, 80 ,  52, 67, 75, 81,  53 , 68 , 76, 82,  63 , 69 , 77, 83 ,  64, 70, 78, 89 ,  5.  Social  50 , 58 ,  51, 59 ,  54, 61,  55 , 62,  56 , 87,  57, 88  71,  72,  91  activities:  6.  Insight:  7.  Summary:  Treatment  behaviour:  at  Descriptive  92  the  Foundation  Information  for  the  Foundation 1 ,  2 ,  11 ,  12 ,  28 ,  29 ,  93  1.  PART I INTERVIEW SCHEDULE FACE SHEET 001  Code:  Group  0.  No answer  1.  Experimental  2.  002-004 Code:  I d e n t i f i c a t i o n Number  00 5  Code:  Card Number 1  005  Code:  Time P e r i o d  Code:  0. 1. 2. 3. ' Age  00 7  No -answer 1961 1960 1959 •  0. No answer 1. Under 2 0 2. • 21 - 30 3. 31 - 40 4. 41 - 50 5. 51 - 60 6. 60 S over 008  Code:  M a r i t a l Status 0. 1. 2. 3. 4. 5. 6. 7.  009  Code:  No answer Single Married Common Law Separated Divorced "Widowed M a r r i e d more than once  Religion 0. 1. 2. 3.  No answer Protestant Catholic Other or no r e l i g i o n  (  )  Control  11.  010  Code:  Occupational 0. 1. 2. 3. 4. 5.  011  Code:  012  Code:  013  Code;  Code  0. 1. 2.  No answer Employed Unemployed  3.  Unemployable, pensioned, e t c ,  Education 0. No answer 1. Less than 8 years 2. 8-11 3. 12 - 13 4. University Family H i s t o r y of A l c o h o l i s m  Code  No answer Yes No  Court 0. 1. 2.  015  No answer Professional White C o l l a r Skilled Unskilled Unemployable  O c c u p a t i o n a l Status  0. 1. 2. 014  Category  Record  No answer Yes No  Source  of R e f e r r a l  0. 1. 2. 3. 4. 5.  No answer Physician Wife, r e l a t i v e s or f r i e n d s A. A. Ex-patient Self  6.  O a k a l l a or  7. 8. 9.  P.M.H.  Social Assistance Employer Other  Treatment at Foundation ( f o r check) No a.  Medical  b.  Counselling  c.  Residence  d.  Group Therapy  e.  Psychiatric Eval.  f.  Antabuse  or Temp.  •  From-To  ^_  1.  PART I I I. (1)  OTHER RESOURCES  F i r s t I would l i k e to ask you a few q u e s t i o n s about your c o n t a c t with the Foundation. Could you look back to the very f i r s t time you heard about the Foundation, and t e l l me how you heard about i t ; i n other words, how d i d you f i n d out that there was such a p l a c e as the Foundation? 016  (2)  Code:  How  p a t i e n t heard about Foundation?  0. 1. 2: 3. 4. 5. 6. 7.  No answer Physician Wife or parents Other r e l a t i v e s or f r i e n d s A. A. Ex-patient Advertisement Other  (1)  You heard about the Foundation f o r the f i r s t time from , . , could you now t e l l me a l i t t l e more how you a c t u a l l y came to the Foundation; that i s , d i d someone i n t r o d u c e you t o them, d i d someone recommend you go t h e r e , or what happened? 017  (3)  CONTACT WITH FOUNDATION AND  Code:  How  p a t i e n t came t o Foundation?  0. 1. 2. 3. 4. 5. 6. 7. 8. 9.  No answer Physician Wife, r e l a t i v e s or f r i e n d s A, A, Ex-patient Self-referral O a k a l l a S P.M.H. Social Assistance Employer Other  When was  (2)  this?  i  2.  C+)  Could you t e l l me some of your reasons f o r coming t o the Foundation?  Areas of p e r s o n a l concern: Areas  M i l d Threat  Seriousness of C o n d i t i o n Severe Threat Mild Disintegration  Severe D i s integration  a. Work b. Family c. Phys. Health d. Emot. Health e.  Other  (5)  In a d d i t i o n t o these reasons, what p r e s s u r e s were put upon you to come to the Foundation? a.  None  b.  Specify  Degree of Pressure Source  a. Wife b. Employer c. S o c i a l A s s t . d. Other Welfare Agencies e. Probation Officer f.  Other  Slight-  Moderate  Severe  3. 018  Code:  i n t e r v i e w e r ' s assessment of degree o f s e l f - i n s t i g a t i o n 0. 1. 2. 3. 4. 5.  (6)  No answer None, apart from e x t e r n a l pressures S l i g h t (some awareness, but pressures mainly e x t e r n a l ) Moderate ( r e l a t i v e l y equal s e l f - and o t h e r - p r e s s u r e s Great (only s l i g h t e x t e r n a l p r e s s u r e s ) Complete (no e x t e r n a l p r e s s u r e s )  You have given me some of your reasons f o r going t o the Foundation; could you now t e l l me what you expected t o happen at the Foundation?  ;  (probe)  019  Code.:  Interviewer's assessment o f a t t i t u d e s (6) 0. 1. 2. 3. 4.  7)  No answer M a n i p u l a t i v e (was l o o k i n g f o r handout, e t c . ) U n r e a l i s t i c (was l o o k i n g f o r "magical" s o l u t i o n ) N e u t r a l ( d i d not know - - no e x p l i c i t e x p e c t a t i o n s ) R e a l i s t i c ( w i l l i n g t o "do h i s p a r t " )  How much d i d you r e a l l y t h i n k the Foundation h e l p you with your a l c o h o l problem? 0 2 0  Code:  Extent of help expected (7) 0. 1. 2. 3.  (4 S 51  No To To To  answer a great extent some extent no extent  would be able t o  4.  (6)  At the time you f i r s t contacted the Foundation, suppose the doctor or c o u n s e l l o r had suggested you be admitted t o a P r o v i n c i a l H o s p i t a l f o r a s p e c i f i c d r y i n g out p e r i o d , o f , l e t ' s say,'30 days; would you have been w i l l i n g to accept t h i s as part of your treatment? a.  Yes  b.  No  I f no, f o r what reasons:  021  a.  Involved i n other treatment  b.  Could not leave work (h)  c.  Could not leave f a m i l y  d.  Important  e.  Would not have been admitted (h or 1 - probe)  f.  Have t r i e d before and treatment f a i l e d  g.  Thought they could not help me  h.  Would not l i k e t o go t o such a p l a c e because  i.  Had heard too many adverse r e p o r t s about such a place (1)  j.  Did not want t o be a s s o c i a t e d with persons at such a p l a c e (1)  k.  Did not think my problem was  1.  Other  Code:  (h or 1 - probe)  persons d i d not want me to go to such a place (1)  I n t e r v i e w e r ' s assessment 0. 1. 2.  (h)  (neutral)  (1) of "stigma"  (1)  b i g enough to warrant treatment  of m o t i v a t i o n (8)  No answer High (yes, or no because, of p h y s i c a l Low (no f o r other reasons)  impossibility)  (1)  5 (9)  Could you now t e l l me what kind of treatments you r e c e i v e d at the Foundation.  Treatment:  Year  Period  Number of Treatments  a. M e d i c a l  b,  Counselling  c. P s y c h i a t r i c d. Residence. • . e. Group Sessions  X  i  f. Antabuse or Tempos!1  02 2  Code:  Length o f Treatment 0. 1. 2. 3. 4, 5, 6.  Code:  (9)  No answer Less than 2 weeks 2-4 weeks 1-3 months 4-6 months 6-12 months over 12 .months  Type and Number of Treatments 0.  1.  2.  I  (9) 3.  4.  5.  6.  023  Medical  N. A.  None  1-4  5-9  10-14 15-19 20 S over  024  Counse1.  N. A.  None  1-4  5-9  10-14 15-19 2 0 & over  025  Psychi.  N .A.  No  Yes  026  Resid.  N. A.  No  Yes  027  Gp. Sess.  N.  None  1-4  5-9  10-14 15-19 20 S over  028  Antabuse or Temp.  N.A.  A.  None under 2 wks  2-4 wks  1-3 mos  4-6 mos  6 mos . £ over  6.  (10)  (Most people a f t e r they have been i n treatment f o r some time) (Some people a f t e r thet have come t o the Foundation once or twice) stop coming f o r a v a r i e t y of reasons. For i n s t a n c e , some move away, some r e t u r n to t h e i r o l d place' of work, while some others f e e l they (have b e n e f i t e d enough) (could not b e n e f i t ) from the programme o f f e r e d . I wonder, could you t e l l me what prevented you from ( c o n t i n u i n g treatment) (undergoing treatment)? a.  Still  b.  Counsellor f e l t  c.  Leaving town - work reasons (L)  d.  Leaving town - f a m i l y reasons  e.  Could not get time o f f work (L or F - probe)  f.  Important  g.  Was i n c o n v e n i e n t t o t r a v e l t o c l i n i c (F)  h.  Thought I had b e n e f i t e d enough (Could not b e n e f i t ) (F)  i.  D i d not l i k e s e r v i c e s o f f e r e d ( I f p t . went t o other place L, i f not F) D i d not l i k e c l i n i c personnel (F)  j. k.  029  i n treatment (1) i n t e n s i v e treatment no longer needed (L)  (L or F - probe)  persons d i d not l i k e my coming (L or F - probe)  1.  Did not t h i n k my problem was b i g enough to need treatment (F) D i d not l i k e t o come without paying b i l l (F)  m.  Other  Code:  Reasons f o r Stopping Treatment 0. 1. 2. 3.  (10)  No answer S t i l l i n treatment L e g i t i m a t e reasons f o r s t o p p i n g treatment F a b r i c a t e d excuses f o r s t o p p i n g treatment  (11) (12)  Most people who come t o the Foundation at one time or another have c e r t a i n f e e l i n g s about the h e l p f u l n e s s of the k i n d of treatment they r e c e i v e d . Could you t e l l me a l i t t l e about how you f e l t , f i r s t about the treatment and then about the people you met?  (11)  F i r s t , the treatment i t s e l f , Code:  P a t i e n t ' s F e e l i n g s re Treatment (11) 0. No Answer  030  Medical  031  Counsel. . Psychiat, Interview  032 033 034 035  apart from the people who gave i t  1. Very Helpful  2. 3. 4. Somewhat Not Not'' Helpful Helpful Applicable  Residence Group Sessions , Antabuse or Temp. Could you give me some of your reasons f o r s a y i n g t h i s ?  When you came t o the Foundation you probably met a v a r i e t y of people. What were your f e e l i n g s about them?  (12)  Code:  F e e l i n g s re People (12) 0. No Answer  036  Doctor  037  Counsellor  038  Psychiatrist  039  Housekeeper  040  C l e r i c a l S:•  2.  1.  Very Helpful  Somewhat  Could you e x p l a i n why you say t h i s ?  3. Not  4. Not  7.  8.  (13)  Could you look back t o the time before you came t o the Foundation, and t e l l me something about your general p h y s i c a l health? Did you s u f f e r from: Yes No D e t a i l s  a.  Headaches  b.  Gen.  c.  Sleeplessness  d.  Stomach Upsets  e.  Sudden Weight Changes  f.  Liver  g«  Acute I l l n e s s e s  h.  Chronic  i.  Symptoms assoc. w, heavy d r i n k g . Blackouts  Frequency  Duration  Severity  Fatigue  Disease  Illn.  Shakes Halluzinations D. T's. Convulsions Head I n j u r i e s  0 41  Code:  042  Code:  P a t i e n t ' s Assessment (13) Doctor's o. 1. 2. 3, 4.  (see page 13)  Assessment of p h y s i c a l h e a l t h T l (13)  No answer Very good Good Poor Very poor  9.  (14)  Now I wonder i f you could a l s o t e l l me a few things about emotional h e a l t h at the time you came t o the. Foundation.  your  Were you bothered by: Yes No D e t a i l s a.  Nervousness  b.  Tensions  c.  Worries Anxieties & Fears  d.  Unmanageable Moods (Depressions , e t c . )  e.  Restlessness  f.  Loss of o r i entation (Explain)  Frequency  Duration  Severity  Other  043  Code:  P a t i e n t ' s Assessment  044  Code:  Doctor's Assessment 0. 1. 2. 3. 4.  No answer' Very good Good Poor Very poor  (.14)  (Seepage  13)  of emotional h e a l t h T l (14)  10. (15)  A  t  the present time do you s u f f e r from: Yes No D e t a i l s  a.  Headaches  b.  Gen.  c.  Sleeplessness  d.  Stomach Upsets  e.  Sudden Weight Changes  f.  L i v e r Disease  Frequency  Duration  Severity  Fatigue  Acute I l l n e s s e s h. i.  Chronic  Illn..  .Symptoms assoc. w. heavy d r i n k g . Blackouts Shakes Hallucinations D.T's. Convulsions Head  Injuries  045  Code:  P a t i e n t ' s Assessment (15)  0 46  Code:  Doctor's Assessment of p h y s i c a l h e a l t h T2 (15) 0. 1. 2. 3. 4.  No answer Very good Good Poor Very poor  (See page  13)  (16)  At the present time, are you bothered Yes No D e t a i l s  a.  Frequency  by: Duration  Severity  Nervousness  b.  Tensions  c.  Worries, Anxieties S Fears  d.  Unmanageable Moods (Depressions , etc.)  e.  Restlessness  f\  Loss of o r i entation (Explain)  g.  Other  04-7  Code:  P a t i e n t ' s Assessment  048  Code:  Doctor's Assessment of emotional h e a l t h T2 0. 1. 2. 4.  0 49 050  Code:  (16)  (See page  13) (16)  No answer Very good Good Poor Very poor  P a t i e n t s Assessment of Change i n Health (13 £ 15) (14 £ 16) (See page 4  13)  12. Doctor's Assessment 051  Code:  Assessment of change i n P h y s i c a l Health 0. 1. 2. 3. 4. 5.  052  Code:  Code:  No answer Much b e t t e r Somewhat b e t t e r Same Somewhat worse Much worse  Assessment of change i n Emotional Health (14 & 16) 0. 1. 2. 3. 4. 5.  0 53.  (13 S 15)  No answer Much b e t t e r Somewhat b e t t e r Same Somewhat worse Much worse  Assessment of r e l a t i o n s h i p between present d r i n k i n g behaviour and change i n p h y s i c a l and emotional h e a l t h . (13, 14, 15, 16) 0. 1. 2. 3.  No To To To  answer a great extent some extent no extent  13. P a t i e n t ' s Assessment 041  Code:  Assessment of P h y s i c a l Health a t T l (13) 0. No answer 1. Very good 2. . Good 3. Poor 4. Very poor  0 4 3  Code:  Assessment o f Emotional Health a t T l (14) 0. 1. 2. 3. 4.  045  Code:  Assessment of P h y s i c a l Health at T2 (15) 0. 1. 2. 3. 4.  047  Code:  Code:  Code:  No answer Very good Good Poor Very poor  Assessment of Change i n P h y s i c a l Health 0. 1. 2. 3. 4. 5.  0 50  No answer Very good Good Poor Very poor  Assessment of Emotional Health a t T2 (16) 0. 1. 2. 3. 4.  0 49  No answer Very good Good Poor Very poor  No answer Much b e t t e r Somewhat b e t t e r Same Somewhat worse Much worse  Assessment o f Change i n Emotional Health 0. 1. 2. 3. 4. 5.  (13 S 15)  No answer Much b e t t e r Somewhat b e t t e r Same Somewhat worse Much worse  (14 $ 16)  14. 054  Code:  Change i n P h y s i c a l Health (T1-T2), P a t i e n t ' s Assessment (13 S 15) 0.  055  Code:  1.  2.  3.  4.  5.  6.  7.  No ans.+3  +2  +1  0  -1  -2  -3  Change i n Emotional Health (T1-T2), P a t i e n t ' s Assessment (14 £ 16) 0.  056  Code:  1.  2.  3.  4.  5.  6.  7.  No ans. +3  +2  +1  0  -1  -2  -3  Change i n P h y s i c a l Health (T1-T2), Doctor's Assessment O i l . No ans. +3  057  Code?  2.  3.  +2+1  (13 £ 15)  4.  5.  6.  7.  0  -1  -2  -3  Change i n Emotional Health (T1-T2), Doctor's Assessment (14 S 16) 0.  (17) 058  0 59  2.  3.  4.  5..  6.  7.  ans. +3dc you +2 t h i +1n k that 0 your -1 f e-2 To whatNo extent e l i n g-3 . . . . now has something to do with your present d r i n k i n g behaviour? Code.:  P a t i e n t ' s Assessment of r e l a t i o n s h i p between d r i n k i n g and h e a l t h (17) 0. 1. 2. 3.  (18)  1.  No To To To  answer a great extent some extent no extent  To what extent i s d r i n k i n g p r e s e n t l y a problem t o you as compared t o the time you f i r s t came to the Foundation? Code:  P a t i e n t ' s Assessment of Change i n D r i n k i n g Problem 0. 1. 2. 3. 4. 5. 6.  No answer Much more severe problem More severe problem Same problem Less severe problem Much l e s s severe problem No problem  (18)  (19) (20)  Other than the Foundation, have you ever gone t o a doctor or any other agency o r place r e g a r d i n g problems with a l c o h o l :  (19)  Treatment Before T a,  1  Yes  b.  No  c.  Don't remember/No answer  Year  I f Yes:  Period  No, of Treatments 1  a.  P r i v . Hosp. (Holwd)  b.  Gen, Hosp. (det. s v s . )  c.  Prov.' Hosp, ( A l .  d.  Private  e.  Clergyman  f.  Therapist  g.  A. A.  Code:  „  Ward)  Physician  (Ind.or Grp)  I j  Treatment before T j (19) 0, 2 . 1. No answer None Very l i t t l e  060 061 062 (20)  I n - p a t i e n t (a-c) Out-patient ( d - f ) A. A. (g)  Moderate E x t e n s i  1 1-5 1-5  2-3 6-10 6-10  4 or more 11 or more 11. or more  Treatment between T-| and T, a.  Yes  b.  No  I f Yes:  1  Year  a.  P r i v . Hosp,  b.  Gen, Hosp. (det,  c.  Prov, Hosp, (Ale Ward)  d,  Private  e.  Clergyman  f.  Therapist  g.  A, A.  Code:  Don 1  c  Period  remeir her/No ans No o.t Treatments;  (Holwd) svs,)  Physician j (Ind., or Grp)  Treatment between T^ £- T 9 (20) 0. 1. 2. 3 .. 4„ No answer None Very l i t t l e Moderate Extensive  063 064 065  I n - p a t i e n t (a-c) Out-patient ( d - f ) A.  A,  (  1 1-5 1-5  2-3 6-10 6-10  4 or more 11 or more .11 or more  16.  II  DRINKING HISTORY  A. D r i n k i n g (21)  You came t o the Foundation because Foundation might be h e l p f u l to you. s i d e r your d r i n k i n g a problem? a.  Yes  b.  thought the Did you a t that time con-  No  How s e r i o u s d i d you t h i n k i t was?  Perhaps you could t e l l  066  Code:  more about t h i s ?  I n s i g h t i n t o extent of problem at T-^ (21) 0. 1. 2. 3.  (22)  me a l i t t l e  No answer Serious problem Moderate problem No problem  I f problem: Since when d i d you c o n s i d e r your d r i n k i n g a problem? 067  Code:  Length of d r i n k i n g problem (22) 0. 1. 2. 3. 1. 5.  No answer Under 1 year 1 - 2 years 3 - 5 years 6 - 1 0 years Over 10 years  17. (23)  Now I would l i k e t o ask you two t h i n g s : 1. What d i d you t h i n k were some of the reasons f o r your d r i n k i n g at the time you f i r s t came t o the Foundation? and 2. What do you now t h i n k some o f your reasons were.  (24) (23)  What d i d you t h i n k your.reasons were a t the time you came t o the Foundation? Elaborate:  (24)  What do you now t h i n k some of your reasons were?  068  Code:  I n t e r v i e w e r ' s assessment of p a t i e n t ' s i n s i g h t , T]_ (23) 0. 1. 2. 3.  069  Code:  I n t e r v i e w e r ' s assessment of p a t i e n t ' s i n s i g h t , T 2 (24) 0. 1. 2. 3.  070  Code:  No answer Great i n s i g h t Slight insight No i n s i g h t  No answer Great i n s i g h t Slight insight No i n s i g h t  Change 0.  1.  2.  3.'  4.  5.  No answer  +2  +1  0  -1  -2  18.  (25) (26)  I'd now l i k e t o ask you a few things about your d r i n k i n g p a t t e r n , both a t the time you came t o the Foundation and a t the p r e s e n t . In order t o h e l p you d e s c r i b e i t , I have a few s p e c i f i c q u e s t i o n s  (25)  F i r s t , around the time you came t o the Foundation: A.  With whom:  B.  Where:  C.  When:  D.  Mornings:  E.  What:  F.  Quantity:  G.  To what e x t e n t :  H.  Consequences:  Other D e t a i l s :  a. b. c. a. b. c. a. b. c. a. b. c. a. b. c. d.  Solitary Group Both At home Outside home Both Daily Weekends Periodic Never Seldom FrequentlyHard l i q u o r Beer Wine Commercial products  a. b. c. a. b. c. d. e.  Slightly intoxicated Drunk Unconscious Blackouts Shakes Hallucinations D. T.»s Convulsions  19.  (26)  What i s your d r i n k i n g p a t t e r n now? f\.  With whom:  B.  "Where:  b. c. a. b. c. a. b. c. a. b. c, d.  Solitary Group Both At home Outside home Both Daily Weekends Periodic Never Seldom Frequently Hard l i q u o r Beer Wine Commercial products  a. b. c. a, b. c. d. e.  Slightly intoxicated Drunk Unconscious Blackouts Shakes Hallucinations D. T's Convulsions  a«  When: D.  Mornings:  E.  What:  F.  Quantity:  O «  To what e x t e n t : Consequences:  1.  a. b. c.  Completely sober  Other D e t a i l s :  0 71  Code:  I n t e r v i e w e r ' s assessment of change i n d r i n k i n g (25 S 26) 0. 1. 2. 3. 4. 5. 6.  No answer Much more severe problem More severe problem Same problem Less severe problem Much l e s s severe problem No problem (completely sober)  problem  20. (27)  How would you compare your d r i n k i n g problem now had at the time you came to the Foundation? 072  Code:  P a t i e n t ' s assessment 0. 1. 2. 3. 4. 5. 6.  (28)  I f changes, changes ? Code:  (29)  Code:  these  of most important agent of change  No answer I n - p a t i e n t treatment other than Foundation Out-patient treatment other than Foundation A. A. Foundation Self Wife, f a m i l y Other Not a p p l i c a b l e  P a t i e n t ' s assessment change (29) 0. 1. 2. 3. 4. 5. 6. 7. 8.  (27)  what would you say has mainly brought about  I f changes, what would you say was 0 74  d r i n k i n g problem  you  No answer Much more severe problem More severe problem Same problem Less severe problem Much l e s s severe problem No problem  P a t i e n t ' s assessment 0. 1. 2. 3. 4. 5. 6. 7. 8.  of own  with that  next most important?  of second most important agent of  No answer I n - p a t i e n t treatment other than Foundation Out-patient treatment other than Foundation A. A. Foundation Self Wife, f a m i l y Other Not a p p l i c a b l e  I f others how d i d these help? I f s e l f , how have these changes come about?  (28)  21. B,  Abstinence  I wonder i f you could go back i n your mind about 8 years and t e l l me how many p e r i o d s of complete abstinence you have had s i n c e then? (That i s s t a r t i n g i n January 19 55) From  (N.B:) 075  Code:  To  Length (wks)  Reasons (look f o r enforcement)  Complete abstinence means p e r i o d s of a t l e a s t one week without d r i n k i n g . Mark d i v i s i o n between T]_ S T o . No. of of weeks a b s t i n e n t d u r i n g a 6-month p e r i o d before  (30)  0. No answer 1. None 2. 1-4 3. 5-9 4. 10-14 5 . 15-19 6. 20 S over 0 76  Code:  No. of of weeks a b s t i n e n t d u r i n g a 6-month p e r i o d before T j (31) 0. 1. 2. 3. 4. 5. 6.  154  Code:  No answer None 1-4 5-9 10-14 15-19 20 £ over  Change 0. No answer  1. +4  2. +3  3. +2  4. +1  5. 0  6. -1  7. -2  8. -3  9. -4  22. C. Drugs (32)  Have you ever taken any drugs, t r a n q u i l l i z e r s , e t c . , t o help you stop d r i n k i n g ? a.  Yes  b.  No  I f Yes ,  (33)  a.  Of what k i n d and type was  b.  How  c.  Who  d.  When was  Do you now a.  the medication?  o f t e n d i d you take i t ? prescribed i t ? this?  take drugs of any kind?  Yes  b.  No  I f yes,  077  Code:  a.  Of what k i n d and type are they?  b.  How  o f t e n do you take them?  c.  Who  prescribes  d.  Why  do you take these  e.  Are they necessary f o r you to stay  a.  Yes  these drugs f o r you?  b.  drugs? sober?  No  I n t e r v i e w e r ' s assessment T (32 £ 33)  of p a t i e n t ' s use of drugs at  0  0. 1. 2. 3. 4. 5. (34)  No answer Takes no drugs Takes t r a n q u i l l i z e r s o c c a s i o n a l l y Takes t r a n q u i l l i z e r s r o u t i n e l y , but i s not dependent Dependent on t r a n q u i l l i z e r s Dependent on other drugs  Have you ever taken Antabuse or Temposil i n c l u d i n g the A. or T. you took at the A. F. ( i f a p p l i c a b l e )  0 78  Code:  Patient's 0. 1. 2.  use of Antabuse or Temposil  No answer Yes No  (34)  23. D.  Court  Record  (35)  Have you ever been a r r e s t e d ?  (36)  a.  Yes  b.  I f yes,  ( I f over 10 a r r e s t s , l i s t only major offences and No. of l i q u o r o f f e n c e s i n 6-month periods preceding and T 2 )  Date  079  Charge  D r i n k i n g Involved Yes No  (N.B:  Mark d i v i s i o n between T  Code:  No. of o f f e n c e s T l (35)  1  0. 1. 2. 3. "4. 080  No  Code:  £ T ) 2  No answer None 1-2 3-5 6 and over  No. of o f f e n c e s (36) 2 T  0 . No answer 1. None 2 . 1-2 3. 3-5 4. 6 and over 155  Code:  Change 0.  0 81 085  Code:  1.  2.  3.  4.  5.  6.  7.  No answer +3  +2  +1  0  -1  -2  -3  I d e n t i f i c a t i o n and Card  No.  Penalties  Ill  WORK HISTORY  (37)  (38)  What i s your u s u a l occupation S p e c i f i c Occup.  As what are you employed at the moment? S p e c i f i c Occup.  a.  Prof.  Prof.  b.  W. C.  W. C.  c.  Skilled  Skilled  d.  Unsk.  Unsk.  e.  Unemployable (why)  Unemployable (why)  0 86  Code: 0. 1. 2. 3.  Employment  2  No answer Employed Unemployed Unemployable, pensioned, e t c . (41)  At the time you f i r s t came to the Foundation, as what were you employed then? a.  Professional  b.  White C o l l a r  c.  Skilled  d.  Unskilled  e.  Unemployable (why)_  f.  Unemployed  159  Since when?  Unemployed status T (38 S 39)  (40)  0 87  (39)  Code:  Code:  Employment  Status T  How long have you h e l d job?  ±  (40 £- 41)  0. 1. 2.  No answer Employed Unemployed  3.  Unemployable, pensioned, e t c  Change 0. 1. NA +1  2. 0  3. -1  this  25. (42) (43)  I have a l r e a d y asked you about your occupation at the present and at the time you came t o the Foundation. Could I now ask you f o r a b r i e f rundown of your employment h i s t o r y .  (42)  Before Foundation From  To  Contact  Type of Job  Reasons f o r ' G e t t i n g along Changing with f e l l o w workers S boss •  Satisfaction was job i n accordance with abilities  -  (N.B.)  I f e i g h t or more jobs h e l d , l i s t number h e l d of others)  only major ones and  26.  (43)  A f t e r Foundation From  To  Contact  Type of Job  Reasons f o r G e t t i n g along with f e l l o w Changing workers £ boss  (44)  How  many years of s c h o o l i n g d i d you have:  (45)  Have you had any s p e c i a l v o c a t i o n a l t r a i n i n g ? Elaborate:  Satisfaction was job i n accordance w i t i abilities  27. (46)  How would you e v a l u a t e your own s a t i s f a c t i o n r e g a r d i n g your work experience before you contacted the Foundation? 0 88  Code:  P a t i e n t ' s e v a l u a t i o n of work experience before T-j_ (46) 0. 1 X •  2. 3. 4.  No answer Very s a t i s f a c t o r y Satisfactory Unsatisfactory Very u n s a t i s f a c t o r y  State Reasons  (47)  How would you r a t e your work s a t i s f a c t i o n s i n c e you came t o the Foundation? 0 89  Code:  P a t i e n t ' s e v a l u a t i o n of work experience a f t e r T-^ (47) 0. 1. 2. 3. 4.  No answer Very s a t i s f a c t o r y Satisfactory Unsatisfactory Very u n s a t i s f a c t o r y  State Reasons  090  Code:  Change  0.  1.  2-.  3.  4.  No answer  +3  +2  +1  0  5.  6.  7.  -2  -3  28. 091  092  Code: ~  Code:  Interviewer's Assessment of Employment S t a b i l i t y T (37, 40, 41 8 42) X  0.  No answer  1.  Very s t a b l e  2.  Stable  3.  Unstable  4.  Very unstable  Code:  Code:  096  Code:  Code:  No answer Very s t a b l e Stable Unstable Very unstable  1.  2.  3.  4,  5.  +3  +2  +1  0  -1  7. -2  -3  I n t e r v i e w e r ' s assessment of appropriateness of jobs h e l d i n accordance with a b i l i t i e s , education and t r a i n i n g , before T]_ (37 , 40 , 42 , 44 £ 45) 0. 1. 2.  09 5  a f t e r Tj_  Change  No answer 094  (1 maj. occupation with few changes and without periods of enemployment.) (1-3 maj. occupations, but s e v e r a l d i f f e r e n t jobs h e l d w i t h i n each one.) ( S e v e r a l maj. occupations, many d i f f e r e n t j o b s , many s h o r t e r p e r i o d s of unemployment.) (No maj. o c c u p a t i o n , many d i f f . jobs, many prolonged periods of unemployment.  Interviewer's Assessment of Employment S t a b i l i t y (37, 38, 39 £ 43) 0. 1. 2. 3. 4.  09 3  before  No answer Appropriate Not a p p r o p r i a t e  Interviewer's assessment of appropriateness (37, 38, 43 £ 45) 0. 1.  No answer Appropriate  2.  Not a p p r o p r i a t e  Change  0. No answer  1., +1  2. 0  3. -1  of jobs a f t e r T-j_  29. 097  Code:  Interviewer's Assessment of R e l a t i o n s h i p s with workers and boss before T-^ (4-3) 0. 1. 2.  098  099  100  Code:  fellow  No answer Good Poor  Interviewer's assessment of r e l a t i o n s h i p s with workers and boss a f t e r Tj_ (44) 0. 1.  No answer Good  2.  Poor  Code:  Change  0,  1.  2.  fellow  3.,  No answer +1 0 -1 Code: I n t e r v i e w e r s o v e r a l l comparison of p a t i e n t ' s working h i s t o r y from before T i t o a f t e r T-, , t a k i n g i n t o consideration: (a) S t a b i l i t y , ('bt Appropriateness of job, (c) R e l a t i o n s h i p s on j o b , (d) P a t i e n t ' s assessment of work s a t i s f a c t i o n . :  0. 1. 2. 3. 4. 5.  No answer G r e a t l y improved Improved No change Deteriorated Greatly deteriorated  30. IV FAMILY HISTORY A. General I would now l i k e t o ask you a few questions r e g a r d i n g your f a m i l y and l i v i n g arrangements. (For the f o l l o w i n g 4 questions do present f i r s t , then go back and ask about past) What i s your present m a r i t a l s t a t u s ? Present (48) a. b. c. d. e. f.  Single Married Common-law Separated Divorced Widowed  Past (49) a. b. c. di e. - f.  Single Married Common-law Separated Divorced Widowed  In what type of accommodation are you p r e s e n t l y l i v i n g ? Present (50) a. b. c. d. e. f. g.  Past (51)  Own house Parent's accommodation Rented house Apartment or s u i t e Rooming or Boarding house Hotel Other  a. bi c. d. e. f.  With whom are you l i v i n g at t h i s Present (52) a.  b.  c. d. e. f. g. h.  Wife £ C h i l d r e n Wife only C h i l d r e n only Parents Other r e l a t i v e s Friends Alone Other  Own House Parent's accommodation Rented house Apartment or s u i t e Rooming or Boarding house Hotel Other  place? Past (53)  a b c d f g h  Wife S c h i l d r e n Wife only C h i l d r e n only Parents Other r e l a t i v e s Friends Alone Other  31. Who i s p r e s e n t l y paying f o r the place i n which you are l i v i n g ? Present a. b. c. d. e. f. g.  (54)  Past (55)  Self Wife S e l f S Wife Parents and/or other r e l . Friends S. A. Other  a. b. c. d. e. f. g.  Self Wi f e S e l f S Wife Parents and/or other r e l . Friends S. A. Other  Could you now look back t o the time j u s t immediately came t o the Foundation and t e l l me  before you  What your m a r i t a l s t a t u s then was? In what, type of accommodation you were then With whom ycu were then  living?  living?  Who was then paying f o r the accommodation? Roughly i n t o what category does your own p e r s o n a l income at the present time?  Into what category d i d your p e r s o n a l income f a l l you came t o the Foundation? Present a. b. c. d. e. f. g-  h.  Under 1,000 1,500 2,000 2,500 3,000 4,000 5,000  Past  (56)  $1,000 1,499 1,959 2 ,499 2,999 3,999 4,999 £ over  a• b. c. d. e. f. h.  Under 1,000 1,500 2,000 2,500 3,000 4,000 5,000  at the time  (57) S  fall  $1,000 1,499 1,999 2,499 2,999 3,999 4,999 over  32. (58)  At the present time, does someone h e l p you t o meet your f i n a n c i a l needs? That i s , does your wife work, do you have o u t s t a n d i n g loans, e t c .  (59)  At the time you came t o the Foundation, d i d someone h e l p you to meet your f i n a n c i a l needs? (Probe) Present  (58)  a. No one b. Wife (work) c. Wife (independent income) d. Parents e. C h i l d r e n Other r e l a t i v e s or f r i e n d s f. g. Loans of any k i n d h. Unemployment Ins. Social Assistance i. j • Other Reasons:  (60)  Past a. b. c. d. e. f. g. h. i. j •  (59)  No one Wifa (work) Wife (independent income) Parents Children Other r e l a t i v e s or f r i e n d s Loans of any k i n d Unemployment Ins. Social Assistance Other  (probe)  During the time you went t o the Foundation, what was the r e a c t i o n of your f a m i l y members or c l o s e s t f r i e n d s to your going t h e r e ; t h a t i s , how d i d they support you e m o t i o n a l l y ? Elaborate:  101  Code:  P a t i e n t ' s assessment of support r e c e i v e d 0. 1 , 2. 3. 4.  No answer Strong support M i l d support Neutral Opposition  (60)  33. I n t e r v i e w e r ' s Assessment 102  103  10 4  Code:  M a r i t a l Status as w e l l .  (48 £ 49) t a k i n g i n t o c o n s i d e r a t i o n (75)  0.  No answer  1.  Improved  (was separated, now r e c o n c i l e d ; was separated, now d i v o r c e d because wife's behaviour was d e t r i m e n t a l t o r e h a b i litation l i v e d common-law, now married)  2.  Same or "neutral" change  (no value judgement i n v o l v e d - was widowed, now remarried was s i n g l e , now married was d i v o r c e d , now r e married)  3.  Deteriorated  (was married, now separated due to d r i n k i n g , was married, now d i v o r c e d due t o man's drink., was married o r d i v o r c e d , now l i v i n g c l . )  Code:  Code:  Accommodation  (50 £ 51)  0.  No answer  1.  Improved  (value judgement - b e t t e r q u a l i t y , movement from non-ownership t o ownership)  2.  Same or "neutral" chinge  (no value judgement)  3.  Deteriorated  (value judgement - poorer q u a l i t y , movement from ownership t o nonownership )  L i v i n g with whom (52 S 53) 0.  No answer  1.  Improved  (value judgement - a p p l i e s to married men mostly)  2.  Same or "neutral" change  (no value  3.  Deteriorated  (value judgement - a p p l i e s t o married men mostly)  judgement)  34. 10 5  105  107  Code:  Code:  Code:  Who i s paying f o r accommodation  (54 S 55)  0.  No answer  1.  Improved  (value judgement - was u n n e c e s s a r i l y dependent, now independent)  2.  Same or "neutral" change  (no value  3.  Deteriorated  (value judgement - was independent, now u n n e c e s s a r i l y dependent)  judgement  Personal Income (56 £ 57) 0.  No answer  1.  Improved  (value judgement - marked upward change)  2.  Same or "neutral" change  (no value  3.  Deteriorated  (value judgement - marked downward change)  judgement  3eing able t o meet expenses by o n e s e l f (58 S 59) 0.  No answer  1.  Improved  ( I f h e l p needed i n p a s t , now h e l p not needed)  2=  Same or "neutral" change  (No change - change i n help from others not needed)  3.  Deteriorated  ( I f no help needed i n past, but help now needed  (61)  I would now l i k e t o ask you a few g e n e r a l questions about the way you spend your time. I wonder, c o u l d you give me a b r i e f rundown of the major t h i n g s you do during a t y p i c a month i n c l u d i n g days, evenings and the weekend?  Activities  Specify  When  How Often  a. Work 1  b. House S Garden c, .Children d.  Hobbies  e. T. V. f.  Reading  g. Entertainment at home h. Sports i. j.  Sports or S o c i a l Clubs Community Club Work; R e l i g . Activities  k. Entertainment outside home 1. D r i v i n g m. V i s i t i n g n. D r i n k i n g 1 j  o. Other Additional  i  Details:  With Whom  36 * (62)  Could you now look back t o the time you f i r s t came to the Foundation and t e l l me how you spent your time then?  Activities  Specify  How Often  When  a. Work b. House £ Garden c. C h i l d r e n •  d.  Hobbies  e. T. V. f.  Reading  g. Entertainment at home h. Sports i,  Sports or S o c i a l Clubs j . Community Club • Work; R e l i g . Activities  k. Entertainment outside home 1. D r i v i n g m. V i s i t i n g n. D r i n k i n g o. Other Additional  Details:  With Whom  37.  10 8  Code:  T y p i c a l month's a c t i v i t i e s , with emphasis on time p u r s u i t s , a t T (61)  "leisure"  2  0.  No answer  1.  Constructive  2.  3.  109  Code:  Code:  Non-constructive  Destructive  (no balance of various a c t i v i t i e s , not enough s o c i a l i n t e r a c t i o n , but no heavy d r i n k i n g ) ( D r i n k i n g i s the major activity)  T y p i c a l month's a c t i v i t i e s with emphasis on time p u r s u i t s before T]_ (62) 0.  No answer  1.  Constructive  2.  Non-constructive  3.  110  (balance of v a r i o u s a c t i v i t i e s , including social interaction  Destructive  Change i n a c t i v i t i e s : 0. No answer  (61 £ 62)  1.  2.  3.  4.  5.  +2  +1  0  -1  -2  social  "leisure"  38. ^"  For married or once married men only So f a r we have covered q u i t e a few areas i n your l i f e . May I now ask you a few questions about your r e l a t i o n s h i p s with your wife and c h i l d r e n .  (63)  How many c h i l d r e n do you have? No.  111  Code:  Ages  No answer Yes No  Do you get t o see much of your c h i l d r e n ? Yes:  No:  (65)  Sex  (Check question)  Children 0. 1. 2.  (64-)  ,  (Elaborate)  (Elaborate)  Has t h i s changed s i n c e before you came t o the Foundation? How  39 .  For c h i l d r e n l i v i n g with (66)  Are your c h i l d r e n l i v i n g with you? 112  Code:  Children 0. 1. 2.  (67)  father  l i v i n g with f a t h e r  No answer Yes No  There are c e r t a i n g e n e r a l areas i n t h e i r c h i l d r e n ' s l i v e s i n which f a t h e r and mother share a general conc e r n , and others which they f e e l are more the concern of one than the other. Who, at the present time, looks a f t e r the f o l l o w i n g areas i n your home? Areas  Husband Wife Both  a.  Discipline  b.  Affections  c.  Activities  d.  School a c t i v i t i e s  (68)  (66)  N/A  £ companions  At the time immediately Foundation, who Areas  a.  Discipline  b.  Affections  c. d.  Activities School a c t i v i t i e s  p r i o r t o your coming to the  looked a f t e r the f o l l o w i n g areas Husband Wife Both  N/A  then?  40. (69)  How would you say your r e l a t i o n s h i p between you and your c h i l d r e n i s at the present?  (70)  At the time you came t o the Foundation, how was your r e l a t i o n s h i p then? 113  Code:  F a t h e r s assessment at T (69) :  of r e l a t i o n s h i p with  children  of r e l a t i o n s h i p with  children  2  0. 1. 2. 3. 4. 114  Code:  Father's assessment at T-L (70) 0. 1. 2. 3. 4.  115  Code:  No answer Very good Good Poor Very poor  No answer Very good Good Poor Very poor  Change (69 S 70) 0. No answer  (71)  1.  2,  3.  4.  5.  6.  7.  +3  +2  +1  0  -1  -2 T 3  Would you say that your present d r i n k i n g behaviour has anything t o do with the r e l a t i o n s h i p between you and your c h i l d r e n ? a.  (72)  Yes  b,  Mo  c.  Can't say  Would you say that at the time you came t o the Foundation your d r i n k i n g behaviour had anything t o do with the r e l a t i o n s h i p between you and your c h i l d r e n ? a, 116  Yes  Code:  b,  No  I n t e r v i e w e r s assessment (71 S 72) ?  0, 1,, 2. 3.  c.  Can't say  of degree of i n s i g h t a t T  No answer Great i n s i g h t (Yes-Yes) S l i g h t i n s i g h t (can't say, can't say) No i n s i g h t (no-no)  2  (73)  In a t y p i c a l week, how many hours do you r e a l l y i n v o l v e y o u r s e l f with your c h i l d r e n ; t h a t i s , take them f o r a d r i v e , t o a s p o r t s a c t i v i t y , play with them, look over t h e i r homework, e t c . )  (74)  How was t h i s at the time you came to the Foundation? 117  Code:  Hours spent with c h i l d r e n at T j (73) 0. 1. 2. 3. 4. 5. 6.  118  Code:  No answer None (hours) 1-4 5-9 10-14 15-19 20 £ over  Hours spent with c h i l d r e n at T 0. 1. 2. 3. 4. 5. 6.  15 8  Code:  No answer None (hours) 1-4 5-9 10-14 15-19 20 S over  Change 0. No answer  119  Code:  (74)  x  1.  2.  3.  4,  5.  +4  +3  +2  +1  0  6. -1  7. -2  8. -3  9. -4  I n t e r v i e w e r ' s assessment of f a t h e r ' s r e l a t i o n s h i p with c h i l d r e n , t a k i n g i n t o account, (1) areas i n v o l v e d , (2) degree of i n s i g h t , (3) time spent with c h i l d r e n a t T (64, 67, 69, 71-73) 2  120  Code:  0.  No  1. 2. 3. 4.  Very good Good Poor Very poor  answer  I n t e r v i e w e r ' s assessment of f a t h e r ' s r e l a t i o n s h i p with c h i l d r e n , t a k i n g i n t o account, (1) areas i n v o l v e d , (2) degree of i n s i g h t , (3) time spent with c h i l d r e n a t T (65, 68, 70, 71, 72, 74) 1  0. 1. 2. 3. 4. 121  Code:  No answer Very good Good Poor Very poor  Change 0. No answer  1.  2.  3.  4.  5.  6.  7.  +3  +2  +1  0  -1  -2  -3  42. Husband-Wife R e l a t i o n s h i p s (75)  A l i t t l e while ago you t o l d me t h a t you are now (married) ( s e p a r a t e d ) , ( d i v o r c e d ) , ( l i v i n g common-law), (widowed). Have there been any changes i n your m a r i t a l s t a t u s over the past ten y e a r s , i n c l u d i n g p e r i o d s of s h o r t (although not l e g a l ) s e p a r a t i o n s ? a.  Yes  b.  No  I f yes, could you t e l l me when you changed your s t a t u s , what the reasons were, e t c . Changed Status From  Time P e r i o d To  | T  "  Reasons  Wife Supported Yes No N/A  '  A. B. C. B. (76)  At the present time, how would you sum up your r e l a t i o n s h i p with your w i f e , t a k i n g i n t o c o n s i d e r a t i o n a l l areas of life.  (77)  In the month p r i o r t o your coming to the Foundation, how would you have then summed up your r e l a t i o n s h i p with your w i f e . 12 2  P a t i e n t ' s assessment of r e l a t i o n s h i p with wife at T (76)  Code  2  0. 1. 2. 3. 4. 123  Code  P a t i e n t ' s as sessment of r e l a t i o n s h i p with wife at T l (77) 0. i  2. 3. 4. 124  Code  No answer Very good Good Poor Very poor  No answer Very good Good Poor Very poor  D i f f e r e n c e between r e l a t i o n s h i p with wife at T]_ £ T (76S7' 2  0.  1.  2.  3.  4.  5.  6.  7.  No answer  -1-3  +2  +1  0  -1  -2  -3  43. (78)  At the present time, what i n t e r e s t s o you and your wife have in. common and share. In other words, what s o r t o f t h i n g s do you do together?  (79)  J u s t p r i o r t o your coming t o the Foundation, what i n t e r e s t s d i d you then have i n common and share? T  12 5  2  (78)  T (79) n  a.  Work around home  a.  Work around home  b.  R e c r e a t i o n i n home  b.  R e c r e a t i o n i n home  c.  R e c r e a t i o n o u t s i d e home  c.  R e c r e a t i o n o u t s i d e home  d.  Community religious  d.  Community religious  e.  Other  e.  Other  Code:  and/or activities  and/or activities  Numb er o f areas i n common a t T2 (78) 0 . No answer 1. None 2. •1 3. 2 4. 3 5. 4 6. 5  12 6  Code:  Numb er o f areas i n common a t T-^ (79) 0. 1. 2. 3. 4. 5. 6.  127  Code:  No answer None 1 2 3 4 5  Chan ge 0. No answer  1. ' 2. +4  +3  3. +2  4. +1  5. 0  6. -1  7. -2  8. -3  9, -4  44.  (80)  J u s t as people have c e r t a i n t h i n g s i n common and share, they a l s o do have s t r o n g disagreements about c e r t a i n issues. I wonder could you t e l l me over what i s s u e s you and your wife s t r o n g l y d i s a g r e e at the present time?  (81)  At the time j u s t p r i o r to your f i r s t contact with the Foundation, over what i s s u e s d i d you then s t r o n g l y d i s agree? ~ T  (80)  9  Yes No N/A  128  Yes No N/A  a. Work  a. Work  b. L e i s u r e  b. L e i s u r e  c.  c.  Children  Children  d. R e l a t i v e s  d. R e l a t i v e s  e. F r i e n d s  e. F r i e n d s  f.  f.  Sex  g. D r i n k i n g  _•  Drinking  h. Other  h. Other  Sex  Code:  Percentage of disagreements i n applicable, areas, T (80) 2  0. 1. 2. 3. 4. 5. 129  Code  Percentage of disagreements i n a p p l i c a b l e a r e a s , T i (81) 0. 1. 2. 3. 4. 5.  130  Code  No answer None 0-25% 26- 50% 51-75% 76-100%  No answer None 0-25% 26-50% 51-75% 76-100%  Change (80 5 81) 0. No answer  1.  2.  3.  4.  5.  6.  7.  +4  +3  +2  +1  0  -1  -2  8. -3  9. -4  (82)  When people l i v e t o g e t h e r f o r a while they tend t o take each other f o r granted and sooner or l a t e r one or the other f e e l s he or she i s not g e t t i n g enough a t t e n t i o n from the o t h e r . How do you f e e l about the amount of a t t e n t i o n you are g e t t i n g from your wife at the present? How does your w i f e f e e l about the amount of a t t e n t i o n she i s g e t t i n g from you?  (83)  HOVJ were t h i n g s i n t h i s regard around the time you came t o the Foundation? 131  Code:  P a t i e n t ' s assessment wife a t T (82)  of a t t e n t i o n r e c e i v e d  from  of a t t e n t i o n r e c e i v e d  from  2  0. 1, 2. 13 2  Code:  No answer Enough Not enough  P a t i e n t ' s assessment wife at T (83) 1  0. 1. 2. 160  Code:  No answer Enough Not enough  Change 0.  1.  No answer +1 13 3  Code:  Code:  0  -1  No answer Enough Not enough  P a t i e n t ' s assessment of how w i f e f e e l s about a t t e n t i o n she i s g e t t i n g from husband at T-j_ (83) 0. 1. 2.  161  3.  P a t i e n t ' s assessment of how w i f e f e e l s about a t t e n t i o n she i s g e t t i n g from husband at Tj (32) 0. 1. 2.  13 4- Code:  2.  No answer Enough Not enough  Change 0.  1.  No answer +1 Details:  2.  3.  0  -1  46 . Interviewer's assessment of r e l a t i o n s h i p between husband and w i f e ; t a k i n g i n t o c o n s i d e r a t i o n (1) m a r i t a l s t a t u s , (2) patient's, assessment of r e l a t i o n s h i p ; (3) common i n t e r e s t s ; (4) areas disagreed upon; (5) a t t e n t i o n ; at T (75,76,78,80,82) 2  0, 1, 2, 3, 4,  No answer Very good Good Poor Very poor  I n t e r v i e w e r ' s assessment of r e l a t i o n s h i p between husband and w i f e ; at T ( 75 , 77 , 79 ,8.1 ,83 ) 1  0. 1i 2. 3. 4.  No answer Very good Good Poor Very poor  Change Q.  1.  2.  3.  4.  5.  6.  7.  No answer  +3  +2  +1  0  -1  -2  -3  I n t e r v i e w e r ' s assessment of p a t i e n t ' s o v e r a l l r e s p o n s i b i l i t v towards f a m i l y members at T o (50,54,56,58,64,67, 73 , 75") 0. 1. 2. 3«  No answer Very r e s p o n s i b l e Somewhat r e s p o n s i b l e Very i r r e s p o n s i b l e  Interviewer's assessment of p a t i e n t ' s o v e r a l l r e s p o n s i b i l i t y towards f a m i l y members at T] (51,55,57,59,66,68, 74,75) 0. No answer 1. Very r e s p o n s i b l e 2. Somewhat r e s p o n s i b l e 3. Very i r r e s p o n s i b l e 1  Change 0.  1„  2.  3.  4.  5.  6.  7.  No answer +3  +2  +1  0  -1  -2  -3  47, (84)  General Assessment (to be asked of a l l respondents) Nov; I would j u s t l i k e to ask you one more q u e s t i o n . Taking i n t o account a l l the areas we have now t a l k e d about, l o o k i n g back t o the time when, you came t o the Foundation and comparing i t with the present time, i n what areas would you say there has been a change i n your l i f e , r e g a r d l e s s of what has brought about t h i s change. P a t i e n t ' s o v e r a l l assessment: 141  Code:  General Health (84)  0. 1. 2 .  3. 142  Code :  Work H i s t o r y (85)  0. 1.  143  Code:  D r i n k i n g H i s t o r y (86)  0. 1. 2. 3.  144  Code:  L e i s u r e Time P u r s u i t s (87)  0.  No answer Improved Same Deteriorated  No answer Improved 2 . Same 3 . Deteriorated No answer Improved Same Deteriorated  No answer Improved 2 . Same 3. D e t e r i o r a t e d 1.  145  Code:  R e l a t i o n s h i p s with other people (88)  0. 1. 2. 3.  No answer Improved Same Deteriorated  146  Code:  R e l a t i o n s h i p with wife (89)  0. 1. 2. 3.  No answer Improved Same Deteriorated  147  Code :  R e l a t i o n s h i p with c h i l d r e n (90)  0.  No answer Improved Same Deteriorated  1 J-  2.  4  3.  48. 148  Code:  Interviewer's assessment of p a t i e n t ' s change i n o v e r a l l i n s i g h t (91) 0. 1. 2. 3. 4. 5.  149  Code:  I n t e r v i e w e r ' s assessment of o v e r a l l change (92) 0. 1. 2. 3. 4. 5.  15 0  Code:  No answer Much improved Somewhat improved Same Somewhat worse Much worse  Interviewer's assessment of p a r t played by i n change (93) 0. 1. 2. 3.  (94)  No answer Much improved Somewhat improved S a me Somewhat worse Much worse  Foundation  No answer Great Moderate None  W e l l , we have covered a l a r g e number of questions and q u i t e a few areas of your l i f e . Is there s t i l l anything important t h a t you would l i k e t o t e l l me?  I f n o t , I have asked you a l l I need t o ask. I c e r t a i n l y would l i k e t o thank you very much f o r coming here and t a l k i n g with me. Of course, as I have s a i d b e f o r e , a l l i n f o r m a t i o n contained i n t h i s i n t e r v i e w schedule w i l l be t r e a t e d c o n f i d e n t i a l l y , and w i l l not be r e l e a s e d t o anyone, other than i n s t a t i s t i c a l form.  49. INTERVIEWER'S COMMENTS Name o f i n t e r v i e w e r : Date of i n t e r v i e w : Hour of i n t e r v i e w : Length of i n t e r v i e w (to nearest  5 min.):  Place o f i n t e r v i e w : 151  Code:  Rating on c o o p e r a t i o n : 0. 1. 2. 3. 4. 5.  152  Code:  No answer Excellent Good Fair Poor Inaccessible  Rating on frankness: 0. 1. 2. 3.  No answer Very frank Moderately frank Not frank  I f cooperation i s : f a i r , poor, or i n a c c e s s i b l e , give c o n d i t i o n s of r e s p o n d e n t / a f f e c t i n g i n t e r v i e w a b i l i t y : Too drunk Too i l l Too h o s t i l e Other, s p e c i f y Other comments:  15 3  Code:  Interview 0. 1. 2.  Completion:  No answer Complete In complete  I f incomplete, Why?  which s e c t i o n s  50 . 156  15 7  Code:  Code:  Person  interviewed  0. 1. 2.  No answer Self Wife  3.  Other  collateral  Place of i n t e r v i e w 0. 1. 2. 3. r. 5. L  No answer Respondent's home O f f i c e s or h o t e l rooms Jail Mental H o s p i t a l Other  

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