UBC Theses and Dissertations

UBC Theses Logo

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

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Item Metadata

Download

Media
831-UBC_1964_A8 C5.pdf [ 7.3MB ]
Metadata
JSON: 831-1.0302540.json
JSON-LD: 831-1.0302540-ld.json
RDF/XML (Pretty): 831-1.0302540-rdf.xml
RDF/JSON: 831-1.0302540-rdf.json
Turtle: 831-1.0302540-turtle.txt
N-Triples: 831-1.0302540-rdf-ntriples.txt
Original Record: 831-1.0302540-source.json
Full Text
831-1.0302540-fulltext.txt
Citation
831-1.0302540.ris

Full Text

T H E RELATIONSHIP OF CHANGE IN DRINKING BEHAVIOUR TO CHANGE IN OTHER AREAS OF BEHAVIOUR IN A S A M P L E OF ALCOHOLIC PATIENTS by GARFIELD GRANT C L A R K E B . A , , The University of British Columbia, 1962 A THESIS SUBMITTED IN PARTIAL 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 MASTER OF ARTS in the Department of Anthropology and Sociology We accept this thesis as conforming to the required standard T H E UNIVERSITY OF BRITISH COLUMBIA A p r i l , 1964 I n p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l m e n t of the r e q u i r e m e n t s f o r an advanced degree at the U n i v e r s i t y of •' B r i t i s h Columbia, , I agree that t h e - L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r r e f e r e n c e and s t u d y . I f u r t h e r agree that p e r -m i s s i o n f o r e x t e n s i v e c o p y i n g of t h i s t h e s i s f o r s c h o l a r l y purposes may b e . g r a n t e d by the. Head of my Department or by h i s r e p r e s e n t a t i v e s . I t i s unders tood that ; c o p y i n g or p u b l i -c a t i o n of t h i s . t h e s i s f o r f i n a n c i a l g a i n s h a l l not be a l l o w e d without my w r i t t e n p e r m i s s i o n * Department of Anthropology and Sociology 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 , Vancouver 8,, Canada Date April 24. 1964  A B S T R A C T 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 t r e a t m e n t p r o g r a m m e 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 be-h a v i o u r of an 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 . T h e r e s e a r c h r e p o r t e d h e r e i s a n a t t e m p t 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 i n f a c t 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 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 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 p a t i e n t s . 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 -lua te 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 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 . 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 once 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 had 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 - and 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 found that 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 , a n d 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 to t r e a t m e n t at the F o u n d a t i o n . It w a s a l s o found 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 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 s e e n . A n u m b e r of i n d i c e s of change i n v a r i o u s a r e a s of l i f e ( h e a l t h , 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 i i i 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 with a n i n d e x of change i n d r i n k i n g b e h a v i o u r , and it was found that i m p r o v e m e n t in d r i n k i n g b e h a v i o u r tended to be a s s o c i a t e d with i m p r o v e m e n t i n other a r e a s of b e h a v i o u r . E x p e r i m e n t a l and c o n t r o l groups w e r e then c o m p a r e d to a s c e r t a i n whether t r e a t m e n t had a d i s c e r n a b l e effect on this r e -l a t i o n s h i p , and it was 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 changes 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 changes i n other a r e a s of b e h a v i o u r . It was a l s o shown 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 had a s i m i l a r effect on the r e l a t i o n s h i p . A C K N O W L E D G M E N T S I should like to express my indebtedness to those p e r s o n s whose a s s i s t a n c e substantially furthered the production of this r e -port. The generous a s s i s t a n c e of my employer, The A l c o h o l i s m Foundation of B r i t i s h Columbia, i n p r o v i d i n g s e c r e t a r i a l help and f a c i l i t i e s f o r p u b l i c a t i o n i s grat e f u l l y acknowledged. V a r i o u s m e m b e r s of the staff of the A l c o h o l i s m Foundation have been a great help and encouragement to me; in p a r t i c u l a r , I should like to thank Mr. E.D. McRae, the E x e c u t i v e D i r e c t o r . I am most indebted to three p e r s o n s who a s s i s t e d me d i r e c t l y i n the undertaking of the r e s e a r c h reported here: P r o f e s s o r R.A.H. Robson, who d i r e c t e d the o r i g i n a l project, M i s s Ingeborg Paulus, my co-worker on the p r o j e c t , and P r o f e s s o r T, Nosanchuk, who serve d as my thesis a d v i s o r . F i n a l l y , I should like to thank M i s s E v e l y n McDevitt, who typed the f i n a l draft of the report, G. Grant 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 C o l u m b i a A p r i l , 1964 T A B L E O F C O N T E N T S C H A P T E R P A G E I. T H E P R O B L E M D E F I N E D 1 I n t r o d u c t i o n 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 P r e v i o u s R e s e a r c h 10 S u m m a r y 12 II . R E S E A R C H P R O C E D U R E S 16 P u r p o s e of the R e s e a r c h P r o j e c t 16 R e s e a r c h D e s i g n 17 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 17 C o n t r o l f a c t o r s 20 I n t e r v i e w s c h e d u l e 23 L o c a t i n g and I n t e r v i e w i n g the S a m p l e 29 S u m m a r y 32 III . T H E E F F E C T O F T R E A T M E N T O N . R E H A B I L I T A T I O N 3 7 C o n t r o l F a c t o r s 3 7 I n d i c e s of R e h a b i l i t a t i o n 38 v i C H A P T E R P A G E 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 a n d C o n t r o l G r o u p s 4 2 O T C : - V J C W 4 5 A r e a s o f r e h a b i l i t a t i o n 4 7 M a t c h e d p a i r a n a l y s i s 5 3 S u m m a r y 5 3 T h e E f f e c t o f D i f f e r e n c e s o n C o n t r o l F a c t o r s 5 4 S u m m a r y 5 8 I V . A R E A S O F C H A N G E I N R E H A B I L I T A T I O N 6 2 I n t r o d u c t i o n 6 2 T h e C h o i c e o f I n d i c e s of C h a n g e 6 3 I n d i c e s o f 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 6 4 I n d i c e s o f c h a n g e i n a r e a s o f 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 6 6 C a t e g o r i e s o f C h a n g e 6 9 I n t e r r e l a t i o n s h i p s 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 O t h e r A r e a s of B e h a v i o r - -A l l S u b j e c t s 7 1 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 D e g r e e of 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 i n O t h e r A r e a s of B e h a v i o u r 7 6 v i i C H A P T E R P A G E The 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 S u m m a r y 82 V . S U M M A R Y A N D D I S C U S S I O N O F F I N D I N G S 86 The P r o b l e m U n d e r I n v e s t i g a t i o n 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 F o u n d a t i o n T r e a t m e n t 90 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 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 H y p o t h e s i s I 91 H y p o t h e s i s II 97 A n o t h e r T r e a t m e n t R e s o u r c e : A l c o h o l i c s A n o n y m o u s 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 G e n e r a l C o n c l u s i o n s 101 B I B L I O G R A P H Y 104 A P P E N D I X A : A D D I T I O N A L T A B L E S 106 A P P E N D I X B : T H E I N T E R V I E W S C H E D U L E 113 LIST O F T A B L E S T A B L E P A G E 1. Summary of C a s e s Found and Interviewed 31 2. C o n s i s t e n c y F i g u r e s Between V a r i o u s Indices of Change i n D r i n k i n g Behaviour 40 3. Percentage C o m p a r i s o n of Degree of Reh 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 43 4. Percentage D i f f e r e n c e s in Degree of Reh 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 44 5. Percentage C o m p a r i s o n of Change 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 Groups 48 6. Percentage C o m p a r i s o n of O v e r a l l Change (Inter-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 Groups A c c o r d i n g to M o t i v a t i o n 55 7. Percentage C o m p a r i s o n of O v e r a l l Change (Inter-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 Groups A c c o r d i n g to Number of A l c o h o l i c s Anonymous Meetings Attended A f t e r I n i t i a l V i s i t to the Foundation 56 8. In 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 Behaviour and Change i n Health for A l l Subjects 73 IX T A B L E P A G 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 I n t e r r e l a t i o n s h i p s B e t w een 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 A l l S u bjects 74 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 T a b l e s Showing I n t e r r e l a t i o n s h i p s B etween 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 roups 78 11. 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 'Mock T a b l e s Showing I n t e r r e l a t i o n s h i p s B e t w een 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 roups 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 At t e n d a n c e 80 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 and C o n t r o l Group and C o m p a r i s o n w i t h I960 Intake 107 13. 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 Change 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 Change i n the A r e a of W o r k 108 14. 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 Change 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 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 108 X T A B L E P A G E 15. C o m p a r i s o n o f 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 o f F o u r I n d i c e s o f 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 o f L e i s u r e T i m e A c t i v i t i e s 109 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 C h a n g e i n W o r k f o r A l l S u b j e c t s 109 17. 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 F a m i l y R e s p o n s i b i l i t y f o r A l l S u b j e c t s 110 18. 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 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 S u b j e c t s 111 19. 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 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 112 C H A P T E R I T H E P R O B L E M D E F I N E D I. Introduction. T w o i m p o r t a n t e m p h a s e s , w h i c h a r e r e l e v a n t to the subject of this t h e s i s , 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 about 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 . F i r s t , 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 cannot r e a c h a n adequate 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 as an a g g l o m e r a t i o n of s e g m e n t e d p a r t s or f u n c t i o n s , or by v i e w i n g b e h a v i o u r as a s e r i e s of r e l a t i v e l y u n r e l a t e d a c t s . F o r i n s t a n c e , 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 about the p e r s o n a l i t y , state that : . . . m o s t c o n t e m p o r a r y p e r sonal i ty 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 as o r g a n i s m i c . A s a group 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 as a to ta l , f u n c -t i o n i n g unit . T h u s A l l p o r t , A n g y a l , G o l d s t e i n , M u r p h y , M u r r a y , R o g e r s , and S h e l d o n a l l s t r e s s the fact that an 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 studied 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 i n c l u d i n g h i s b i o l o g i c a l m a k e u p . ^ 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 ) have been p a r t i c u l a r l y s t r o n g i n t h e i r i n s i s t e n c e on this a p p r o a c h . A c c o r -d i n g to m a n y p s y c h o l o g i s t s , then, we do i n fact f u n c t i o n a s " w h o l e p e r s o n s " ; the defence 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 " or " c o m p a r t -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 i ts e f f e c t i v e n e s s . T h a t i s , there i s a defini te l i m i t to the extent to w h i c h a m a n c a n act 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 ife w i l l a f f e c t i n s o m e way h i s f u n c t i o n i n g i n other a s p e c t s of e x p e r i e n c e , a l though the r e l a -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 . In s o c i o -l o g i c a l t e r m s , c o m p l e t e s e g r e g a t i o n 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 s p h e r e s of l i fe i s d i f f i c u l t , 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 c o n f l i c t " a t tests to t h i s , when 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 context i s i n c o n s i s t e n t wi th that r e q u i r e d i n another context . O r , 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 contingent on ade- . quate p e r f o r m a n c e i n a n o t h e r ; f o r i n s t a n c e , a f a m i l y m a n ' s o b l i g a t i o n s 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 and fa ther 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 s p h e r e , T h e second 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 s c i e n c e s 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 -d u a l and h i s e n v i r o n m e n t , both s o c i a l and non- s o c i a l . Indeed, some t h e o r i s t s see this a s m o r e than a n i n t e r r e l a t i o n s h i p : they b e l i e v e that one cannot r e a l l y d r a w a line s e p a r a t i n g the p e r s o n and h i s s u r r o u n -d i n g s , f o r they f e e l a h u m a n being i s best r e g a r d e d as " o p e n s y s t e m " . L e w i n and h i s f o l l o w e r s , with t h e i r e m p h a s i s on the " l i f e - s p a c e " e x e m p l i f y t h i s . A s a r e s u l t of such t h i n k i n g , the b o r d e r l i n e s between g e n e r a l m e d i c i n e , p s y c h i a t r y , p s y c h o l o g y , s o c i o l o g y , and a n t h r o p o l o g y have b e c o m e 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 , and have been l e s s z e a l o u s l y defended as b a t t l e l i n e s . A s p a r t of this t r e n d , new f i e l d s of study have been 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 f i e l d s as s o c i a l p s y c h o l o g y , s o c i a l p s y c h i a t r y , the s o c i o l o g y of m e d i c i n e , and the s o c i o l o g y of m e n t a l h e a l t h have newly b e c o m e r e c o g -n i z e d as l e g i t i m a t e 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 , p s y c h o l o g i c a l , s o c i a l , and c u l t u r a l a s p e c t s of h u m a n ex is tence a r e i n c r e a s i n g l y be ing c o n s i d e r e d t o g e t h e r . T h i s e m p h a s i s i s taken 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 health) and of " a b n o r m a l " f u n c t i o n i n g (or i l l -n e s s ) . S i m m o n s and W o l f f , i n a study of the r o l e of s o c i a l s c i e n c e i n m e d i c i n e , p r e s e n t a good d i s c u s s i o n of this t o p i c , f r o m w h i c h the f o l l o w i n g e x c e r p t i s t a k e n : If it is granted that p h y s i c a l , s o c i a l , and 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 whole 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 t h e i r p o t e n t i a l and r e l a t e d effects i n h i s u n d o i n g , whether this takes p l a c e t h r o u g h i l l n e s s , a c c i d e n t s , o r other i l l - f a t e d h a p p e n i n g s . . . . the three 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 aa both s o u r c e and 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 . Since the p h e n o m e n o n of a l c o h o l i s m is often r e g a r d e d as an " i l l n e s s , " 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 , both w i t h i n the p e r s o n h i m s e l f , and 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 . T h i s t h e s i s i s a n a t tempt to e x p l o r e the h o l i s t i c nature of the b e h a v i o u r of an i n d i v i d u a l i n h i s e n v i r o n m e n t , by l o o k i n g at a n i n s t a n c e of " a b n o r m a l " f u n c t i o n i n g , the i l l n e s s of a l c o h o l i s m . 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 c o m -m o n feature to m a n y of them i s the i n c o r p o r a t i o n of other f a c t o r s than 4 d r i n k i n g b e h a v i o u r . F o r i n s t a n c e , 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 as 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 on a l c o h o l has at tained s u c h a d e g r e e that it shows a not iceable m e n t a l d i s t u r b a n c e o r a n i n t e r f e r e n c e with t h e i r b o d i l y and m e n t a l h e a l t h , t h e i r i n t e r - p e r s o n a l r e l a t i o n s , and t h e i r s m o o t h s o c i a l and e c o n o m i c f u n c t i o n i n g ; . . . T h u s d i s t u r b a n c e i n other a r e a s of f u n c t i o n i n g i s looked upon as the m a r k of e x c e s s i v e dependence u p o n a l c o h o l ; a l c o h o l i s m is r e g a r d e d as a " s o c i o - p s y c h o s o m a t i c i l l n e s s . 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 is founded upon s u c h a b a s i c out look. T h e t e r m " 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 changes i n b e h a v i o u r , and i n v o l v e s changes not only i n d r i n k i n g b e h a v i o u r , but i n h e a l t h , w o r k p e r f o r m a n c e , s o c i a l r e l a t i o n s h i p s , and so f o r t h . One t h e r a p i s t d e s c r i b e s h i s a p p r o a c h to the a l c o h o l i c as f o l l o w s : In f o r m i n g m y own j u d g m e n t of any i n d i v i d u a l , I n e v e r en-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 . I e n -v i s a g e r a t h e r the whole m a n as a d y n a m i c entity , that i s , h i s m e n t a l , p h y s i c a l , and e m o t i o n a l s e t - u p as d e t e r m i n e d 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 and e n v i r o n m e n t . I take f u l l c o n s i d e r a t i o n , t h e r e f o r e , of h i s h i s t o r y , h i s f a m i l y , the scope of h i s w o r k and r e c r e a t i o n , h i s g e n e r a l s o c i a l b a c k g r o u n d ; i n other w o r d s , his total s i tuat ion , as K u r t L e w i n , 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 , so apt ly e m p l o y s that t e r m . A n o t h e r t h e r a p i s t d e s c r i b e s h i s t r e a t m e n t goals i n this way: 5 It i s n e c e s s a r y to 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 than a p a r t i a l g oal and can be m a i n t a i n e d only i f t h e r e i s change and i m p r o v e m e n t i n other a r e a s of the patient'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 these t h e r a p i s t s i s that t r e a t -ment m u s t i n v o l v e the whole i n d i v i d u a l 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 . The o r g a n i z a t i o n studied i n the r e s e a r c h to be r e p o r t e d below, 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 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 , and 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 to-w a r d e f f e c t i n g " d e s i r a b l e " changes 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 l i f e . The sequence of 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 i n v o l v e s f i r s t a n attempt to help the p a t i e n t to stop d r i n k i n g , and then an attempt to h e l p h i m cope m o r e ade q u a t e l y w i t h h i s t o t a l l i f e s i t u a t i o n . It i s t h i s a t t e n t i o n to other a s p e c t s of l i f e than 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 patient's chances of m a i n t a i n i n g s o b r i e t y f o r an extended t i m e , by r e d u c i n g e n v i r o n m e n t s t r a i n . The goal f o r the p a t i e n t i s a 9 " c o m f o r t a b l e s o b r i e t y , " 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 s o c i a l d i s o r d e r . The a i m s of the Foundation'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 patient'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 statement r e c e i v e d f r o m one of the Foundation's s e n i o r t r e a t -ment o f f i c i a l s . 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 upon the i n d i v i -d u a l and h i s eventual r e h a b i l i t a t i o n , we m u s t f i r s t look at the nature of t h i s a d d i c t i o n and the f o r c e s at w o r k w i t h i n the i n d i v i -d u a l that 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 seeks 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 bred and fed by h is p o o r adaptat ion to e n v i r o n -m e n t a l d e m a n d s . A l c o h o l p a m p e r s and c u s h i o n s the i n d i v i d u a l f r o m p a i n f u l r e a l i t i e s , and c r e a t e s a f a l s e sense of w e l l - b e i n g . In such a state of r e l a t i v e c o m f o r t , the need f o r s o c i a l i n t e r a c -t i o n ; f o r 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 -m e d i a t e . T h i s leads 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 , and e v e n t u a l l y s e r i o u s s o c i o - e c o n o m i c i m p o v e r i s h m e n t . R e h a b i l i t a t i o n h a s , then, a b r o a d f ront of m a l a d j u s t m e n t to n e u t r a l i z e . 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 is s o c i a l s tanding through 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 at t i tudes and e n c o u r a g i n g c o n s t r u c t i v e r e l a t i o n s h i p s . H e m u s t a l s o seek d i r e c t i o n or r e - d i r e c t i o n into a v o c a t i o n a l f i e l d that exploi ts h is talents and p r o v i d e s o p p o r t u n i t i e s f o r s e l f - e x p r e s s i o n . 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 sphere and a t tempt , 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 m o r e 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 . R e s e n t m e n t s 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 and steps taken 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 i s c o n t i n u o u s , and 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 study i s to e s t a b l i s h e m p i r i c a l l y whether or not a r e l a t i o n s h i p e x i s t s between d r i n k i n g b e h a v i o u r and be-h a v i o u r i n other a r e a s of l i f e , a n d , if so, what i s the p r e c i s e nature of that r e l a t i o n s h i p . A n at tempt 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 a r e m o r e d i r e c t l y i n t e r c o n n e c t e d than others and i n w h i c h a r e a s change c a n be m o r e e a s i l y and q u i c k l y ef fec ted . F u r t h e r , 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 changes 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 . T h u s 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 as p a r t i a l tests 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 of the A l c o -h o l i s m F o u n d a t i o n . 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 and the other b e h a v i o u r of a n a l c o h o l i c f r o m a t h e o r e t i c a l standpoint , there s e e m s to be a t w o - s i d e d r e l a t i o n s h i p , 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 other a r e a s of l i fe can be both cause and effect 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 sees it as a m e c h a n i s m of t e n s i o n r e d u c t i o n , that i s , a s a m e a n s of c o p i n g with s o m e f o r m of p s y c h o l o g i c a l s t r e s s . Some a u t h o r i t i e s def ine a l c o h o l i s m i n one way and some i n a n o t h e r . W h a t e v e r d e f i n i t i o n or 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 , t rouble i n r e l a t i o n s with f a m i l y o r f r i e n d s - - a n e s s e n t i a l p a r t 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 has b e c o m e a c o m p u l s i v e 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 . S u c h s t r e s s c a n , of c o u r s e , a r i s e f r o m a d e f i n a b l e p h y s i c a l o r p s y c h o -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 , but can often be (at leas t i n part ) 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 . Often at least the i n c i p i e n t cause of a d e v e l o p i n g d r i n k i n g p r o b l e m i s a n u n f a i t h f u l wif e , a b u s i n e s s m i s -for tune , or the l i k e . T o a c e r t a i n extent these f a c t o r s a r e beyond a p e r s o n ' s i m -m e d i a t e c o n t r o l , of c o u r s e , but m o r e c o m m o n l y , the m o r e s i g n i f i c a n t f a c t o r i s the p e r s o n ' s own f a i l u r e to cope with the p r o b l e m s of h i s en-v i r o n m e n t . F o r e x a m p l e , the m a r i t a l p r o b l e m s w h i c h have " d r i v e n a m a n to d r i n k " a r e often 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 with 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 beset a m a r r i a g e . 8 T h e r e f o r e , to the extent that such 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 , then any gains w h i c h the pat ient c a n m a k e i n l e a r n i n g to cope m o r e adequate ly with p r o b l e m s i n these other a r e a s 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 other side of the c o i n , it i s c l e a r that a m a n cannot d r i n k e x c e s s i v e l y f o r any p e r i o d of t ime without h i s f u n c t i o n i n g i n other a r e a s of l ife be ing a d v e r s e l y a f f e c t e d . In this c a s e , d i f f i c u l t i e s i n other 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 , r a t h e r than a cause of a b n o r m a l d r i n k i n g . T o the extent that damage i s r e p a r a b l e , 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 i n c r e a s e s the l i k e l i h o o d of an i m p r o v e m e n t i n other b e h a v i o u r . In any i n d i v i d u a l c a s e , e i t h e r or both s i d e s of the r e l a t i o n s h i p could be i n v o l v e d . T h i s t w o - s i d e d r a t i o n a l e gives r i s e to H y p o t h e s i s I. 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 be-tween 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 (health, w o r k , 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 ) , i n the total 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 ) , 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 -p r o v e , b) If d r i n k i n g b e h a v i o u r does not i m p r o v e ( r e m a i n s the same or 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 study 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 , on w h i c h the p r e s e n t r e s e a r c h i s b a s e d , i n d i c a t e d that a c o n s i d e r a b l e 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 and i n other a r e a s of l i fe 13 without 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 have been 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 , but m a n y had no such t rea tment , and the c a u s e s of i m p r o v e m e n t w e r e unknown. It m i g h t be s u p p o s e d , h o w e v e r , that the 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 a r e a s of b e h a v i o u r would be greates t i n those c a s e s w h e r e the i n d i v i d u a l s had u n d e r g o n e t r e a t m e n t d e s i g n e d to s e c u r e both sor ts of change . F o r i n -stance , 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 (change effected 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 of h i s need to stop d r i n k i n g , but not be a w a r e of h is need to l e a r n to cope m o r e a d e -quately with p r o b l e m s i n other a r e a s of l i f e . H e would be, t h e r e f o r e , l e s s l i k e l y (to the extent that c o n s c i o u s a w a r e n e s s i s a fac tor ) to b r i n g about 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 with r e g a r d to d r i n k i n g . T h e r e f o r e , the second h y p o -t h e s i s i s as f o l l o w s : 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 and change i n other a r e a s of be-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 those p e r s o n s who have had t r e a t m e n t at the F o u n -dat ion ( e x p e r i m e n t a l group) than i n those p e r -sons who have not had such t r e a t m e n t ( c o n t r o l group) , I V . 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 led to the f o r m u l a t i o n of the above h y p o t h e s e s a l s o suggest that the d e g r e e of a s s o c i a t i o n between d r i n k i n g and other 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 would p e r h a p s have been p o s s i b l e to have c o n s t r u c t e d a set of sub-h y p o t h e s e s c o v e r i n g each a r e a of b e h a v i o u r and to have a t tempted to 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 . H o w e v e r , c o n s i d e r a t i o n 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 would have to be taken into account i n c o n s t r u c t i n g such h y p o t h e s e s , led to the c o n c l u s i o n that the r a t i o n a l e s n e c e s s a r y would be quite i n v o l v e d and p r o b a b l y r a t h e r t e n u o u s . T h e de-c i s i o n was m a d e , t h e r e f o r e , s i m p l y to o b s e r v e these r e l a t i o n s h i p s , and then to a t tempt some s p e c u l a t i v e ex post fac to explanat ion and 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 future s tudy. V . P r e v i o u s R e s e a r c h T h e use of other c r i t e r i a than change 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 is not unique to this s tudy. 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 h e r e r e p r e s e n t a n i m p r o v e m e n t i n some r e s p e c t s o v e r p r e v i o u s w o r k , e n a b l i n g the tentative a n s w e r i n g of some q u e s t i o n s not a n s w e r e d h e r e t o -f o r e . A r e t r o s p e c t i v e f o l l o w - u p study, conducted 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 H e a l t h , found that there 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 , i m p r o v e m e n t s i n s o c i a l r e l a t i o n s h i p s , and a d e c r e a s e i n the a m o u n t of a b s e n t e e i s m f r o m w o r k , i n the s a m p l e of e x - p a t i e n t s s u r v e y e d , w h i c h p a r a l l e l e d 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 . O n l y i n the case of 11 d r i n k i n g b e h a v i o u r and heal th , , h o w e v e r , w e r e changes i n each a r e a tabu-14 lated a g a i n s t each o t h e r . A s i m i l a r study, conducted by 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 , found r e l a t i o n s h i p s between status at the t i m e of f o l l o w - u p i n t e r v i e w with r e g a r d to d r i n k i n g and status with r e g a r d to h e a l t h , w o r k p e r f o r m a n c e , 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 p a r t i c i p a t i o n . T h i s study did not m e a s u r e change between t i m e of intake and t i m e of f o l l o w - u p , h o w e v e r , except i n r e g a r d to e m p l o y m e n t status ( e m p l o y e d / u n e m p l o y e d ) . ^ S c h m i d t , a n a l y s i n g data obtained f r o m a f o l l o w - u p study u n d e r -taken 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 , c o r r e 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 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 defini te 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 f a m i l y a r r a n g e m e n t s , c h i l d - c a r e p a r t i c i p a t i o n , 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 same data p e r t a i n i n g to the a l c o -h o l i c f a t h e r ' s p a r t i c i p a t i o n i n c h i l d - c a r e a c t i v i t i e s , and a g a i n found a r e l a t i o n s h i p . ^ F i n a l l y , a r e c e n t r e p o r t on a l a r g e sca le e v a l u a t i o n of the ef-fect of a l c o h o l i s m t r e a t m e n t , 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 i n h e a l t h , s o c i a l s t a b i l i t y , i n t e r p e r s o n a l r e l a t i o n s , w o r k a d j u s t m e n t , 18 and e m p l o y m e n t s tatus . 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 change i n d r i n k i n g b e h a v i o u r and change i n the a r e a s of 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 , 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 t i m e a c t i v i -t i e s , by c r o s s - t a b u l a t i n g i n d i c e s of change i n a s i m i l a r m a n n e r to s e v e r a l of the above s tudies , but u s i n g somewhat d i f f e r e n t t e c h n i q u e s . It a l s o p r o p o s e s to study the p o s s i b l e d i f f e r e n t i a l effect 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 , by u s i n g a c o n t r o l group, w h i c h was u s e d i n none of the above s t u d i e s . V I . S u m m a r y It h a s be.en shown that there 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 nature of h u m a n be-h a v i o u r , and on 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 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 , both s o c i a l and non- s o c i a l . T h i s b e l i e f i s a l s o e m -p h a s i z e d i n t h e o r i e s about the nature of a l c o h o l i s m , r e g a r d e d as a n i n -stance of h u m a n m a l f u n c t i o n i n g . M a n y a l c o h o l i s m t r e a t m e n t p r o -g r a m m e s , 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 th is p h i l o s o p h y , and 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 b e h a v i o u r i n m a n y a s p e c t s other than i n d r i n k i n g . T h i s t h e s i s i s a n a t tempt to test this a s s u m p t i o n a s he ld 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 whether o r not changes i n d r i n k i n g b e h a v i o u r a r e r e l a t e d to changes i n other a r e a s of b e h a v i o u r . F u r t h e r , the p o s s i b l e d i f f e r e n t i a l effect 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 examined. 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 change i n other a r e a s of behaviour, and 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 these who have had t r e a t m e n t f r o m the F o u n d a t i o n than i n those who have not had such t r e a t m e n t . 14 F O O T N O T E S : Chapter I ^ C a l v i n S, H a l l and Gardne r Lindzey, T h e o r i e s of P e r s o n a l i t y (New York: John W i l e y and Sons, 1957), p. 543. 2 I b i d . , pp. 206-256. Leo W. Simmons and H a r o l d G. Wolff, S o c i a l Science i n Medic ine (New York: R u s s e l l Sage Foundation, 1954), pp. 110-111. ^ F o r a d i s c u s s i o n of some of the p r o b l e m s of f o r m u l a t i n g a defi n i t i o n of " a l c o h o l i s m , " see M a r k K e l l e r , "The D e f i n i t i o n of A l c o -h o l i s m and 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 David J. P i t t m a n and C h a r l e s R. Snyder (eds.), Society, Culture, and D r i n k i n g P a t t e r n s (New York: John W i l e y and Sons, 1962), pp. 310-317. 5 W o r l d Health Organization, E x p e r t Committee on Mental Health, A l c o h o l i s m Subcommittee, Second Report, T e c h n i c a l R eport  S e r i e s , No. 48 (August, 1952), p. 16. A. L. Beeley, " A l c o h o l i s m , S o c i a l Work, and Mental Hygiene, " Men t a l Hygiene, XLIII (October, 1959), 577-582. 7 C h a r l e s H. Durfee, T o D r i n k or Not to D r i n k (New York: Longmans, Green and Co. , 1938), pp. 17-18. 8S. Vogel, "Some A s p e c t s of Group P s y c h o t h e r a p y With A l c o h o l i c s , " International J o u r n a l of Group Psychotherapy, VII (July, 1957), 302. 9The A l c o h o l i s m Foundation of B r i t i s h Columbia, "Treatment P l a n " (Vancouver: The A l c o h o l i s m Foundation of B r i t i s h Columbia, 1962), p. 7. (Mimeographed) ^ R o b e r t F, Bales, " S o c i a l T h e r a p y for a S o c i a l D i s o r d e r , " J o u r n a l of S o c i a l Issues, I (August, 1945), 14-22. ^ P e r s o n a l Communication r e c e i v e d f r o m Mr. S. E . K e r s l a k e , Senior C o u n s e l l o r , The A l c o h o l i s m Foundation of B r i t i s h Columbia, M a r c h 1964. ^ D o r r i a n Apple (ed.), S o c i o l o g i c a l Studies of Health and Sickness (New York: M c G r a w - H i l l Book Company, I960), p. 177. 15 S o m e 42% of those 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 as 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 i m p r o v e m e n t . See 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 . 120. l 4 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 and 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 . ^ ^ C l i n i c a l P r a c t i c e and 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 . 1 6 w off gang S c h m i d t , " A Study 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 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 , 1957). ^ M . J . J a c k s o n , " A 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 and 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 Study 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 at 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: 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. C H A P T E R II R E S E A R C H P R O C E D U R E S I. P u r p o s e of T h e R e s e a r c h P r o j e c t T h e data for the p r e s e n t 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 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 . R o b s o n , a s s i s t e d by M i s s I. P a u l u s and the p r e s e n t w r i t e r . A t the t i m e this r e s e a r c h was 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 y e a r s , and had seen a total of 5, 310 pat ients d u r i n g that t i m e . S t a t i s t i c s i n d i -cated that a s of A p r i l 1962, there had been 42, 365 therapeutic i n t e r v i e w s , 3, 834 m e d i c a l e x a m i n a t i o n s , 9, 706 m e d i c a l t r e a t m e n t s , 470 p s y c h i a t r i c c o n s u l t a t i o n s , and 2, 054 group m e e t i n g s . In the s p r i n g of 1963, the 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 study should 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 of this 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 s e v e n y e a r s . T h e y , t h e r e -f o r e , 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 de -f ined as " 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 those who seek i ts 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 a l c o h o l . " A s soon as 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 s e a r c h 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 was u n d e r t a k e n , i n o r d e r to benefit f r o m the e x p e r i e n c e of o thers who had u n d e r t a k e n s i m i l a r r e s e a r c h . T h e r e w e r e a n u m b e r of r e p o r t s of f o l l o w - u p studies i n c l i n i c a l set t ings , but a l l such s tudies found s u f f e r e d f r o m one b a s i c i n a d e q u a c y of d e s i g n ; none had used a c o n t r o l group of untrea ted a l c o -h o l i c s wi th w h i c h to c o m p a r e those t r e a t e d . T h i s i s a s e r i o u s m e t h o d o -l o g i c a l i n a d e q u a c y ; it is 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 pat ient before and a f t e r t r e a t m e n t . One cannot l e g i t i m a t e l y i n f e r that any changes seen 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 patient has u n d e r g r o n e , s ince they could have o c c u r r e d i n the a b s e n c e of t reat -m e n t . T h e a u t h o r s of one or two r e p o r t s e x a m i n e d pointed out that they 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 , but fel t that the d i f f i c u l t i e s i n s e l e c -t ing a n adequate c o n t r o l group and i n l o c a t i n g p e r s o n s who had 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 use of a c o n t r o l g r o u p . T h e p r e sent inve s t i g a t o r s , h o w e v e r , c o n s i d e r e d the l a c k of a c o n t r o l group so s e r i o u s a f law i n r e s e a r c h d e s i g n that it would not be w o r t h u n d e r -t a k i n g a n e v a l u a t i o n study without one. It was , t h e r e f o r e , e s t a b l i s h e d as 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 study that i t should e m p l o y a c o n -t r o l group of " u n t r e a t e d " a l c o h o l i c s . II. R e s e a r c h D e s i g n E x p e r i m e n t a l and c o n t r o l groups A n adequate d e s i g n would 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 groups of p e r s o n s with d r i n k i n g p r o b l e m s , one of w h i c h had 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 other had not, and the c o m p a r i -son of the extent of r e h a b i l i t a t i o n i n these two groups. T h i s would be 3 done by e s t a b l i s h i n g the degree of change 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 ti 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 f o l l o w s : E x p e r i m e n t a l Group = T r e a t m e n t C o n t r o l Group = No T r e a t m e n t A n i d e a l way to i m p l e m e n t t h i s d e s i g n would be to s e l e c t p a t i e n t s 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 them to two groups, one of w h i c h would r e c e i v e t r e a t m e n t and one of w h i c h would not. A t t h i s t i m e , data would be gathered to i n d i c a t e t h e i r status w i t h r e g a r d to those a r e a s of be-h a v i o u r c o n s i d e r e d relevant.. A f t e r a p e r i o d of t i m e deemed s u f f i c i e n t f o r changes to take p l a c e , m e m b e r s of each group would be r e i n t e r -v i e w e d to a s c e r t a i n the degree of change w h i c h had taken p l a c e . Such a d e s i g n , however, was c l e a r l y not p o s s i b l e under the p o l i c y of the A l c o h o l i s m F o u n d a t i o n , w h i c h i s to r e f u s e t r e a t m e n t to no one who 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 t h e r e f o r e n e c e s s a r y . c o m p a r e d w i t h r e s p e c t to r e h a b i l i t a t i o n change i n b e h a v i o u r a l p a t t e r n s between Tl and T 2 4 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 r e s e a r c h p r o j e c t p r e c l u d e d the use of a p r o s p e c t i v e d e s i g n , w h i c h would gather i n f o r m a t i o n at one t i m e , and then gather 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 t i m e , i n o r d e r to a s c e r t a i n change . A r e t r o s p e c t i v e d e s i g n was t h e r e -f o r e s e l e c t e d , w h i c h would 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 with 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 the F o u n d a t i o n , and at the t i m e of the i n t e r v i e w . Since it 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 any p e r s o n s s e e k i n g help f r o m the F o u n d a t i o n , it was n e c e s s a r y to r a t h e r choose f o r the c o n t r o l group p e r s o n s who had v i s i t e d the F o u n d a t i o n at one t i m e o r a n o t h e r , but who had t h e m s e l v e s d e c i d e d not to c a r r y on with t r e a t m e n t . ~" Such a c o n t r o l group was fel t to be m o r e a p p r o p r i a t e than a r a n d o m s a m p l e of unt rea ted 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 ince those 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 c o n s i d e r e d to be n e c e s s a r i l y 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 , and the a i m of this p r o j e c t was to evaluate the w o r k of the F o u n d a t i o n C l i n i c i n h e l p i n g those s o r t s of p e r s o n s who a c t u a l l y do a p p r o a c h such a c l i n i c f o r h e l p . T h e e x p e r i m e n t a l and c o n t r o l groups were , d e f i n e d as f o l l o w s : 1. E x p e r i m e n t a l g r o u p : T h o s e p e r s o n s who had u n d e r g o n e at least f ive t r e a t m e n t s e s s i o n s . 2. C o n t r o l g r o u p : T h o s e p e r s o n s who had u n d e r g o n e not m o r e than f o u r t r e a t m e n t s e s s i o n s . 20 It should be pointed out that the m a x i m u m of f o u r " t r e a t m e n t s e s s i o n s " i n the c o n t r o l group does not r e p r e s e n t a s m a n y as four 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 stages 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 and a d o c t o r d u r i n g e a c h v i s i t , and each of these i n t e r v i e w s i s def ined 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 of the c o n t r o l group would have only v i s i t e d the c l i n i c once or t w i c e , and it was t h e r e f o r e 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 these p e r s o n s as h a v i n g had " n o t r e a t m e n t " f o r the p u r p o s e s of this s tudy. ^ 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 and c o n t r o l groups w e r e r e q u i r e d to have 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 t h r e e - y e a r p e r i o d f r o m J a n u a r y 1, 1959 to J a n u a r y 31, 1961. Since the f o l l o w - u p i n t e r v i e w i n g was conducted between N o v e m b e r , 1962 and F e b r u a r y , 1963, the p e r i o d of t i m e e l a p s e d since 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 was between a p p r o x i m a t e l y nine m o n t h s and three y e a r s , nine m o n t h s . T h i s length of t ime was 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 any l a s t i n g changes had t a k e n p l a c e i n the i n d i v i d u a l ' s b e h a v i o u r . C o n t r o l f a c t o r s T h e second i m p o r t a n t fea ture 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 and c o n t r o l groups i n a l l s i g n i f i c a n t r e s p e c t s , so that any 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 between the two groups 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 than the r e s u l t of some other d i f f e r e n c e . A l i s t of f a c t o r s Z l which could conceivably affect r e h a b i l i t a t i o n was there f o r e compiled; this l i s t made use of both the l i t e r a t i i r e i n the f i e l d and the in v e s t i g a -t o r s ' speculation, The f a c t o r s to be co n t r o l l e d are as follows: 1. Sex 2. A ge 3. M a r i t a l status 4. Occupation 5. E mployment status 6. Educ a t i o n 7. R e l i g i o n 8. T i m e elapsed since intake 9. Motiv a t i o n for r e h a b i l i t a t i o n 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 other than at the Foundation Ideally, it would have been p r e f e r a b l e to have matched i n d i v i -duals on a l l eleven f a c t o r s simultaneously, but because i n f o r m a t i o n was l a c k i n g for many patients at the time the two groups were selected, this was not p o s s i b l e . Simultaneous matching was c a r r i e d out, how-ever, on five f a c t o r s : age, m a r i t a l status, occupation, employment status, and time elapsed since intake. In addition, the f a c t o r of sex was c o n t r o l l e d by usin g only male patients; only 10 perce n t of the c l i n i c population a r e female, and such a s m a l l number would not allow sepa-rate c o n c l u s i o n s f o r these patients. 22 The factor of education was not used for matching, since i t was found to be c l o s e l y related to occupation. R e l i g i o n was a l s o not used fo r matching, because about 75 percent of the c l i n i c patients indicated that they were " n o n - p r a c t i c i n g " and it therefore seemed not to be a relevant v a r i a b l e . A f t e r the matching of in d i v i d u a l s , however, a check was made on the d i s t r i b u t i o n of the ex p e r i m e n t a l and con t r o l groups with r e g a r d to these f a c t o r s of education and r e l i g i o n , and they were found to be v e r y s i m i l a r . T h e r e was not sufficient i n f o r m a t i o n i n the Foundation's f i l e s to p e r m i t the use of the r e m a i n i n g three f a c t o r s (motivation, s e v e r i t y of d r i n k i n g problem, and other treatment) i n the matching p r o c e s s . Information was, therefore, c o l l e c t e d d u r i n g the interview i n o r d e r to check the s i m i l a r i t y of the two groups with r e g a r d to these charac-t e r i s t i c s . U s i n g the above procedure, 200 subjects were selected, 100 i n each of the e x p e r i m e n t a l and c o n t r o l groups. In o r d e r to see whether the two groups selected were r e p r e s e n -tative of the patients who come to the Foundation c l i n i c , they were com-pared with a l l of the patients who v i s i t e d the Foundation i n I960. The c h a r a c t e r i s t i c s f o r which i n f o r m a t i o n was av a i l a b l e f or the I960 intake were age, occupation, and employment status; and it was found that the dis t r i b u t i o n s of these c h a r a c t e r i s t i c s f or the interview sample were s i m i l a r to the Foundation intake. (See T;:.ble 12 of A P P E N D I X A). Interview schedule B e c a u s e the r e s u l t s to be obtained would depend v e r y m u c h on how c a r e f u l l y the quest ions 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 lo t ted f o r the r e s e a r c h p r o j e c t was devoted to 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 used i n p r e v i o u s f o l l o w - u p studies w e r e c o n s u l t e d , and the advantages and d i s a d v a n t a g e s of v a r i o u s m e a s u r e s w e r e w e i g h e d . T h e schedule went t h r o u g h f o u r c o m p l e t e d r a f t s and n u m e r o u s m i n o r r e v i s i o n s . A t s e v e r a l steps a l o n g the way, 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 to see how the quest ions would 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 and the quest ions to be a s k e d had been e s t a b l i s h e d , p r e -coded r e s p o n s e c a t e g o r i e s f o r I B M k e y - p u n c h i n g w e r e a d d e d . T h e i n t e r v i e w schedule was d e s i g n e d to s e c u r e three types 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 upon w h i c h the e x p e r i m e n t a l and c o n t r o l groups 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 was 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 extent of r e h a b i l i t a t i o n that had o c c u r r e d (these ques t ions 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 s c h e d u l e ) . A copy of the i n t e r v i e w schedule is 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 has a l s o been added w h i c h i n d i c a t e s the n u m b e r s of the quest ions w h i c h r e f e r to each of the three c l a s s e s of i n f o r m a t i o n m e n t i o n e d a b o v e . 1. C o n t r o l F a c t o r s 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 did not i n c l u d e adequate i n f o r m a t i o n r e g a r d i n g three of the c o n t r o l f a c t o r s . F u r t h e r -m o r e , it was s u s p e c t e d that with 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 c h a r a c t e r i s t i c s of the subjec ts , the i n f o r m a t i o n found i n the F o u n d a -t ion 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 . B e c a u s e of t h i s , it was 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 with r e g a r d to a l l e l e v e n c o n -t r o l f a c t o r s , 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 and c o n t r o l g r o u p s . 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 T h i s i n f o r m a t i o n is not r e l e v a n t to the p r e s e n t study, and t h e r e f o r e w i l l not be d i s c u s s e d h e r e . 3 . Indices 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 " or " d e t e r i o r a t i o n , " and the i n v e s t i g a t o r s w e r e a w a r e 8 that some 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 -w a r r a n t e d v a l u e j u d g m e n t s . H o w e v e r , the r e s e a r c h team was c o n -c e r n e d to evaluate m e a n s , not ends ; its task was to d e t e r m i n e 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 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 its own a i m s . T h e s e a i m s c e r t a i n l y i n v o l v e d value j u d g m e n t s , but the 25 question of t h e i r l e g i t i m a c y was not one that p r o p e r l y concerned the r e s e a r c h e r s . A c c o r d i n g l y , a def i n i t i o n of r e h a b i l i t a t i o n was not im-posed by the r e s e a r c h team, but rather the Foundation staff were asked to outline the ends they sought through t h e i r treatment. The Founda-tion staff presented an i n i t i a l l i s t of behavioural changes that were de-s i r e d i n t h e i r patients, as follows: Continuing sobriety or Longer p e r i o d s of sobriety than before treatment A s we l l as: 1. Improved s t a b i l i t y i n employment 2. R e c o n c i l i a t i o n with spouse 3. A c t i v e m e m b e r s h i p in A l c o h o l i c s Anonymous 4. Increased harmony in the home 5. Improved p h y s i c a l status 6. Improved behaviour of c h i l d r e n 7. Bet t e r s o c i a l p a r t i c i p a t i o n 8. Improved altitudes toward life 9. Re-assumption o£ domestic r e s p o n s i b i l i t i e s . 10. R e t u r n to an active r e l i g i o u s l i f e 11. Ivlore o p t i m i s t i c outlook 12. M o re r e a l i s t i c approach to p r o b l e m s 13. Continuing use of c l i n i c s e r v i c e 14. L e s s frequent r e c o u r s e to drugs or sedatives 26 15. M o r e s e l f - r e l i a n c e and l e s s d e p e n d e n c y on c o m m u n i t y r e s o u r c e s 16. I m p r o v e d f a m i l y i n t e r r e l a t i o n s h i p s T h e r e s e a r c h t e a m then h e l d d i s c u s s i o n s wi th the staff as to how these c o u l d be c l a s s i f i e d , and 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 was es tab-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 be-h a v i o u r w h i c h had o c c u r r e d between the t i m e of intake at the F o u n d a -t i o n and the t i m e of i n t e r v i e w , in 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. 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 2. P a t i e n t ' s h e a l t h ( p h y s i c a l and emotional ) 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. P a t i e n t ' s s o c i a l a c t i v i t i e s 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 wi th d r i n k i n g W i t h i n each of the above s ix 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 -l i t a t i o n " (change i n the p a t i e n t ' s 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 the Foundat ion) w e r e u s e d . 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 -m a t i o n was gathered by a s k i n g v a r i o u s quest ions 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 each a r e a of l i fe m e n t i o n e d a b o v e , both at the t i m e the subject a p p r o a c h e d the F o u n d a t i o n and 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 was then us 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 r e h a b i l i t a t i o n , def ined as the change 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 between these two o c c a s i o n s . ^ In other 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 changes i n v o l v e d did 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 data , the 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 a s s e s s m e n t s of change i n b e h a v i o u r m a d e by the i n t e r -v i e w e r , based on 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 had been obta ined . In a d d i t i o n to these two types of m e a s u r e s of r e h a b i l i t a t i o n , the p a t i e n t ' s own a s s e s s m e n t of the change of b e h a v i o u r i n each of the a r e a s m e n -t ioned was s e c u r e d . Some c o m m e n t s should be m a d e at this point r e g a r d i n g the c h o i c e of these t h r e e types 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 this was 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 , T h e b a s i c q u e s t i o n w a s , w h i c h one of the three types of index i s the m o s t v a l i d , the " o b j e c t i v e " index (based, h o w e v e r , on the p a t i e n t ' s own re-c o r d i n g of the fac ts ) , the subject ive a s s e s s m e n t m a d e by the patient h i m s e l f , or the subject ive a s s e s s m e n t of the i n t e r v i e w e r ? T h e objec t ive i n d e x has the advantage that it is least subject 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 can enter into subjec t ive j u d g m e n t s . A c c o r d i n g l y , a n at tempt was m a d e to d e v i s e a^ m a n y i n d i c e s as p o s -s ib le of the objec t ive type . T h e p r o b l e m with this sor t of m e a s u r e , h o w e v e r , 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 an index w h i c h a d e q u a t e l y m e a s u r e s what it is p u r p o r t e d to m e a s u r e . A n extensive r e a d i n g of the a l c o h o l i s m l i t e r a t u r e suggested that the p h e n o m e n o n of a l c o h o l i s m is e x t r e m e l y c o m p l e x , and 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 m e a s u r e s 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 w a s 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 be-h a v i o u r . N e v e r t h e l e s s , s e v e r a l i n d i c e s of t h i s type 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 take 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 use of the i n t e r -v i e w e r ' s g e n e r a l " i n s i g h t " i n t o s u c h b e h a v i o u r . T h e r e i s , h o w e v e r , 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 these 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 p a t i e n t ' 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 to the p e r s o n ' s own v a r i o u s n e e d s . M a n y 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 , and s o m e m e a -s u r e s of t h i s type w e r e i n c l u d e d . B e c a u s e t h e r e s e e m e d to be a d v a n t a g e s and d i s a d v a n t a g e s t o e a c h type of m e a s u r e , use of o n l y one type w a s not thought 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 -d i c e s 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 and the i n t e r v i e w e r . 2 9 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 thought w a s g i v e n to a p p r o a c h i n g and 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 to 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 p o s s i b l e . 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 too 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 and 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 g ive b i a s e d a n s w e r s . F o r i n s t a n c e , 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 t r e a t m e n t , 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 they m i g h t be r e t i c e n t to c o n v e y to 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 w i t h i t . 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 to 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 p r o g r a m m e . T h e r e f o r e , 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 s t r e s s e d the f a c t that 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 been c a l l e d i n to e v a l u a t e the w o r k of the c l i n i c . N o r e f e r e n c e w a s m a d e d u r i n g the i n t e r v i e w s to 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 had been and what f a c t s he t r i e d to h i d e o r d i s t o r t . In o r d e r to 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 . I n s t e a d , a n a t t e m p t w a s m a d e t o s u g g e s t a n a s s o c i a t i o n w i t h m e d i c a l i n t e r e s t s , 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 by the P r o v i n c i a l H e a l t h D e p a r t m e n t . It w a s fe l t that t h i s w o u l d both 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 and 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 h i s g i v i n g b i a s e d i n f o r m a t i o n . H o w e v e r , i t w a s m a d e c l e a r that 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 and 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 at 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 p e r s o n ' s w o r k i n g t i m e , i n c l u d i n g n i g h t s a n d w e e k e n d s f r e q u e n t l y , f o r o v e r e i g h t m o n t h s . 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 , and 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 . T h e d i f f i c u l t i e s e n c o u n t e r e d p r o d u c e d a r e l a t i v e l y h i g h 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 spent 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 a g e n c i e s . T h e 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 o r i g i n a l l y c o n t a i n e d 200 p e r s o n s , 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 who had d i e d , and 5 to r e p l a c e p e r s o n s who 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 214 . 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 p e r s o n s ) . T h e r e w e r e o n l y 9 o u t r i g h t r e f u s a l s , a l t h o u g h i n the c a s e of s o m e s u b -j e c t s i t took 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 to 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 and i n t e r v i e w e d i s p r e -sented i n T A B L E 1. T A B L E 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 E x p e r i m e n t a l C o n t r o l T o t a l P e r s o n s c h o s e n i n o r i g i n a l g r o u p s 100 100 200 S u b s t i t u t e s : to m a t c h p a i r 5 4 9 f o r dead 1 4 . 5 * T o t a l S a m p l e C h o s e n 106 108 214 T o t a l i n t e r v i e w e d 91 64 155 T o t a l unable t o t r a c e 11 29 40 R e f u s a l s 2 7 9 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 2 8 10 106 108 214 % of G r o u p s I n t e r v i e w e d 86% 59% 72% *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 so 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 dead p e r s o n c o u l d not be m a t c h e d . I V . S u m m a r y T h e data f o r t h i s s tudy w e r e o b t a i n e d 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 to 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 extent 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 of a l c o h o l i c s , one of w h i c h had 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 had not . T h e e x p e r i m e n t a l g r o u p w a s c o m p o s e d of those 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 t r e a t m e n t s e s s i o n s 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 had 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 f a c t o r s w e r e s e l e c t e d w h i c h w e r e c o n s i d e r e d to p o t e n t i a l l y a f f e c t r e h a b i l i t a t i o n , 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 two g r o u p s i n these r e s p e c t s . The f i v e f a c t o r s of: t i m e e l a p s e d s i n c e i n t a k e , a g e , m a r i t a l s t a t u s , o c c u p a t i o n , and 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 found 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 and c o n t r o l g r o u p T h e c h a r a c t e r i s t i c of sex 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 . H o w e v e r , 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. M o t i v a t i o n f o r r e h a b i l i t a t i o n 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. T r e a t m e n t r e c e i v e d e l s e w h e r e T h e r e f o r e , 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 to a s c e r t a i n the extent to w h i c h both g r o u p s w e r e s i m i l a r i n these r e s p e c t s , 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 and 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 I960 , and o n the f a c t o r s 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 p o p u l a t i o n . T h e 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 w i t h f o r m e r p a t i e n t s , by the use 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 . T h i s 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 sought to s e c u r e t h r e e c l a s s e s of i n f o r m a t i o n : T . T h e extent of r e h a b i l i t a t i o n w h i c h had o c c u r r e d 2 . D a t a r e g a r d i n g c o n t r o l f a c t o r s 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 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 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 the F o u n d a t i o n s ta f f and the l i t e r a t u r e on p r e v i o u s f o l l o w - u p s t u d i e s . T h e s e m e a s u r e s sought to a s c e r t a i n the extent 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 and a t t i t u d e s had 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 and 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. D r i n k i n g b e h a v i o u r 34 2. H e a l t h ( p h y s i c a l and emotional ) 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. S o c i a l a c t i v i t i e s 6. Insight into 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 F i n a l l y , a b r i e f d e s c r i p t i o n was given of the p r o c e s s of l o c a t i n g and i n t e r v i e w i n g the s a m p l e , i n d i c a t i n g the m e t h o d s used and the d i f f i c u l t i e s e n c o u n t e r e d . T h e d e g r e e of s u c c e s s a c h i e v e d was a l s o i n d i c a t e d . 35 F O O T N O T E S : 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 , and 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 See , 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 and 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 tatus 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 and 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 o n A l c o h o l i s m , 1959), p p . 1 9 - 2 3 . 4 T ^ r e f e r s to t i m e of i n t a k e i n t e r v i e w , and T2 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 . 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 to 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 ease 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 c a l l e d a c o n t r o l g r o u p . 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 those w h o a t t e n d e d 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 . " G e r h a r t S a e n g e r 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 Se e n i n C l i n i c s A s s o c i a t e d v / i th 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 , 1963), 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 on pp„ 26 -29 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 . F o r e x a m p l e , see G i b b i n s and A r m s t r o n g , op. c i t . , p p . 4 4 9 - 4 5 0 . 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 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 , 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 (op. c i t . ) s ta tes that 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 be-h a v i o u r f o r the m o s t p a r t , they w e r e qui te a n n o y e d a n d f e l t that 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 . T h e 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 T h e p r o c e d u r e f o l l o w e d i n l o c a t i n g s u b j e c t s i s 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 , a n d C l a r k e , op . c i t . C H A P T E R III T H E E F F E C T O F T R E A T M E N T O N R E H A B I L I T A T I O N I . C o n t r o l F a c t o r s The f i r s t s tep i n the a n a l y s i s of the data w a s to c h e c k 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 o n t h o s e f a c t o r s w h i c h w e r e c o n s i d e r e d to h a v e a p o s s i b l e e f f e c t o n r e h a b i l i t a t i o n . 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 on 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 and 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 . T h i s 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 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 s e e m , h o w e v e r , s i n c e the 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 c o m p o s e d of both m a t c h e d and 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 to h a v e c o m p a r a b l e 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 . T h e r e f o r e , 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 m a j o r p o r t i o n of the a n a l y s i s , 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 , s i n c e t h i s i s a m o r e e f f e c t i v e 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 and c o n t r o l g r o u p s s h o w e d that 38 they w e r e s i m i l a r on eight of the c o n t r o l f a c t o r s and d i f f e r e n t on only t h r e e : m o t i v a t i o n , s e r i o u s n e s s of d r i n k i n g p r o b l e m , and contact with A l c o h o l i c s A n o n y m o u s a f t e r r e c e i v i n g F o u n d a t i o n t r e a t m e n t . T h o s e i n the e x p e r i m e n t a l group w e r e somewhat better m o t i v a t e d to be r e -h a b i l i t a t e d , 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 to t h e i r own a s s e s s m e n t ) , and had m o r e contact wi th A l c o h o l i c s A n o n y -m o u s s ince 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 extent 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 and c o n t r o l g r o u p s t h e r e f o r e i n -c l u d e d c o n t r o l s f o r the effect of these t h r e e f a c t o r s . II. Indices 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 on 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 and c o n t r o l g r o u p s , s o m e c o m m e n t s should be m a d e 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 . T h e 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 def ined i n t e r m s of change between the t i m e the subject f i r s t a p p r o a c h e d the F o u n d a t i o n and the t i m e of i n t e r -v i e w . 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 , m o s t of the a n a l y s i s u t i l i z e d only three c a t e g o r i e s : " I m p r o v e d , " " N o C h a n g e , " and " D e t e r i o r a t e d , " H o w e v e r , a f i n e r b r e a k d o w n was u s e d f o r the sake of g r e a t e r p r e c i s i o n i n some c a s e s . A s w i l l be r e c a l l e d , 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 s e l e c t e d , 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 and h i s b e h a v i o u r i n other a r e a s of l i f e . V a r i o u s quest ions w e r e a s k e d c o v e r i n g s e v e r a l a s p e c t s of b e h a v i o u r i n each a r e a . In a d d i t i o n to these quest ions 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 pat ient was a s k e d f o r h i s own a s s e s s -m e n t of the d e g r e e of change that had t a k e n p l a c e i n e a c h a r e a . B a s e d on a l l the a n s w e r s obtained i n any one a r e a , the i n t e r v i e w e r then m a d e a n o v e r a l l a s s e s s m e n t of change i n that a r e a . E a c h of the six a r e a s g e n e r a l l y i n c l u d e d between f i v e and ten q u e s t i o n s , i n o r d e r to e n s u r e adequate c o v e r a g e . F o r the p u r p o s e of a n a l y s i s , h o w e v e r , c o m p a r i s o n s between the e x p e r i m e n t a l and c o n t r o l groups i n v o l v i n g between f o r t y and f i f t y i n d i c e s would have been f a r too u n w i e l d y . T h e r e f o r e , a l l i n d i c e s i n e a c h a r e a w e r e c r o s e - tabulated a g a i n s t e a c h other to see if they m e a s u r e d e s s e n t i a l l y the same t h i n g . T o f a c i l i t a t e this p o r t i o n of the a n a l y s i s , a m e a s u r e of the extent of c o v a r i a n c e i n e a c h b i v a r i a t e c o m p a r i s o n was d e v e l o p e d , c a l l e d f o r sake of c o n v e n i e n c e , " c o n s i s t e n c y . " N u m b e r of c a s e s m o v i n g i n the C O N S I S T E N C Y = 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 a n s w e r " r e s p o n s e s ) T h e 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 between e a c h p a i r of i n d i c e s w i t h i n a n a r e a w e r e e x a m i n e d , 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 of each c l u s t e r , the i t e m with the h i g h e s t c o n s i s t e n c y wi th o t h e r s was se lec ted 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 . Indices 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 than . 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 as separate i n d i c e s 40 of r e h a b i l i t a t i o n , since it was felt that they might m e a s u r e a different aspect of behaviour. T A B L E Z shows co n s i s t e n c y f i g u r e s between v a r i o u s i n d i c e s of change in d r i n k i n g behaviour, as an example of the technique which was used. Indices a r e r e f e r r e d to by t h e i r code number. T A B L E 2: C o n s i s t e n c y F i g u r e s Between V a r i o u s Indices of Change i n D r i n k i n g Behaviour  I N D E X 059 071 0 72 143 154 Mean 059 . 83 . 94 . 87 . 60 . 81 071 . 83 . 82 . 78 . 57 . 75 I N D E X 0 72 .94 . 8Z .90 . 60 .81 143 . 87 . 78 .90 . 64 . 80 154 .60 . 57 . 60 . 64 .60 Index 059 i s highly consistent with i n d i c e s 072 and 143, and was chosen as being r e p r e s e n t a t i v e of them f o r p u r p o s e s of a n a l y s i s . Indices 154 and 071 show l e s s e r degrees of r e l a t i o n s h i p to other i n d i c e s and to each other, and therefore, they were chosen as addit i o n a l separate i n -dices of change i n d r i n k i n g behaviour. The same techniques were used i n examining i n d i c e s of r e h a b i l i -tation i n other a r e a s of behaviour. T h i s p r o c e d u r e r e s u l t e d 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 used 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 t h i r t e e n . ^ D i f f e r e n c e s did o c c u r i n m a n y i n s t a n c e s between the p a t i e n t ' s and i n t e r v i e w e r ' s a s s e s s m e n t s . T h e i n t e r v i e w e r ' s o b s e r v a t i o n s r e -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 w e r e that the pat ient tended 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 d e g r e e of i m p r o v e m e n t that he saw. F o r i n s t a n c e , 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 even a v e r y s l ight d e g r e e of change (such as the pat ient d r i n k i n g somewhat l e s s p e r s i t t i n g - - often due to a p h y s i c a l d e c r e a s e i n t o l e r a n c e o v e r t ime) would be s e e n by the pat ient as a s u b s t a n t i a l d e g r e e of i m p r o v e m e n t ; whi le to the i n t e r v i e w e r this would not r e p r e s e n t any s i g n i f i c a n t change . P e r h a p s the fact that the patient had sought help at one t i m e or another led h i m to think that he should have s o m e h o w i m p r o v e d , and t h e r e f o r e he c o n c l u d e d that he h a d . 3 In other a r e a s than d r i n k i n g , the d i s c r e p a n c y between the p a t i e n t ' s and 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 tendency f o r the pat ient to " a u t o m a t i c a l l y " see an i m p r o v e m e n t i n a l l o ther 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 , whi le the i n -t e r v i e w e r would often see a n i m p r o v e m e n t i n one or two a r e a s o n l y . In a d d i t i o n to these 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 ob-s e r v e d a c o n s i d e r a b l e d i f f e r e n c e between v a r i o u s subjects i n the 42 4 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 . T h e s e o b s e r v a t i o n 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 , 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 . T h i s i s t r u e to a l i m i t e d e x t e n t . W h e r e the two 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 a n o t h e r , 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 , both 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 , o n l y the p a t i e n t ' s a s s e s s m e n t w a s u s e d . T h e i n t e r v i e w e r s d i d g a t h e r a s m u c h i n f o r m a t i o n a s p o s s i b l e , w i t h the ob jec 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 . H o w -e v e r , 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 on 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 the i n t e r v i e w . 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 -m e n t i n t h i s 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 a s s e s s -5 m e n t w a s u s e d f o r a n a l y s i s . I I I . 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 C o n t r o l G r o u p s  T A B L E 3 p r e s e n t s 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 and 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 , and T A B L E 4 6 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 . T A B L E 3: Percentage Comparison of Dej and Control Groups* gree of Rehabilitation in Experimental Deg ree of Rehabilitation Statistical** Significance % Imp roved % No Cha % Deteriorated Rehabilitation Indices Change) Exp e r i -me ntal Con-trol Experi-mental Con-tr o l Experi-mental Con-tr o l Drinking PA - Drinking problem IA - Drinking problem A bstinence Liquor 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 . 02<p<-. 05 Health PA - Overall 57 31 28 47 15 23 . 001<£p<C 01 Work PA - Overall IA - Overall Employment 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 Activities IA - Financial responsibility IA - Leisure 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 . 001<p<, 01 Summary IA - Overall 60 42 16 33 23 25 . 001<p<. 01 *A11 "no answer" responses have been excluded; therefore percentages add up to 100. ••Probability estimates based on chi-squared values are 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 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 *  D e g r e e of R e h a b i l i t a t i o n % N o % D e t e r i -R e h a b i l i t a t i o n I n d i c e s (Change) % I m p r o v e d C h a n g e o r a t e d 1. D r i n k i n g P A - D r i n k i n g p r o b l e m +11 - 1 1 0 IA - D r i n k i n g p r o b l e m +19 - 1 7 - 3 A b s t i n e n c e + 4 - 3 - 1 L i q u o r o f f e n c e s + 2 + 4 - 6 2 . H e a l t h P A - O v e r a l l +26 - 1 9 -8 3 . W o r k P A - O v e r a l l + 8 - 1 3 +5 IA - O v e r a l l + 8 - 3 - 6 E m p l o y m e n t s t a t u s + 2 0 - 1 4 . F a m i l y IA - R e s p o n s i b i l i t y +11 - 1 1 0 5 . S o c i a l 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 + 6 - 1 - 4 IA - L e i s u r e t i m e a c t i v i t i e s + 8 - 7 - 1 6. I n s i g h t IA - R e a s o n s f o r d r i n k i n g +24 - 2 4 0 7. S u m m a r y IA - O v e r a l l +18 - 1 7 - 2 * (+) 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 tha 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 O verview In the f i r s t place, the i n v e s t i g a t o r s were struck by what was to them a s u r p r i s i n g l y high p r o p o r t i o n of the total 155 subjects who had shown some improvement i n t h e i r behaviour: a p p r o x i m a t e l y one-half had i m p r o v e d to some extent, one-quarter had r e m a ined the same, and one-quarter had d e t e r i o r a t e d . Although one-half had improved, however, a f i n e r breakdown i n c a t e g o r i e s shows only one-fifth were 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 degree of r e h a b i l i t a t i o n between the two groups, T A B L E 4 shows that the m e m b e r s of the e x p e r i m e n t a l group had i m p r o v e d m ore than those i n the c o n t r o l group i n a l l a r e a s , without a single exception. The d i f f e r e n c e s range f r o m an i n s i g n i f i c a n t 2 % (in l i q u o r offences and employment status) to a substantial 2 6 % (in health). The d i f f e r e n c e i n o v e r a l l i mprovement between e x p e r i m e n t a l and c o n t r o l groups on a summary measure, the i n t e r v i e w e r ' s a s s e s s -ment of o v e r a l l change, i s 18%. C o n v e r s e l y the c o n t r o l group had shown "no change" m ore than the e x p e r i m e n t a l group except i n a couple of a r e a s . The d i f f e r e n c e s here range f r o m 1% to 24%. D e t e r i o r a t i o n shows no substantial dif-f e r e n c e s in any a r e a , the greatest d i f f e r e n c e being 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 concentrated m a i n l y on the i m p roved category, a s s u m i n g that d e t e r i o r a t i o n showed no r e a l d i f f e r e n c e s and 46 "no change" moved r e c i p r o c a l l y with improvement. E a c h h o r i z o n t a l line i n T A B L E S 3 and 4 r e p r e s e n t s a bi-v a r i a t e tabulation c o m p a r i n g the degree 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 on the p a r t i c u l a r index of change i n question* On only four cut of thirte e n i n d i c e s do the c h i - s q u a r e d values f o r these bi 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 between e x p e r i m e n t a l and c o n t r o l groups which r e a c h the .05 l e v e l of si g n i -f i c a n c e . A s 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 same d i r e c t i o n on other i n d i c e s , although 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 degree of c o n s i s t e n c y between 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 greater degree 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 than i n the c o n t r o l group thus suggests that this d i f f e r e n c e is a r e a l one. Although the general c o n c l u s i o n at this point seems to be that there i s a greater degree 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 account for the d i f f e r i n g v alues 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 behaviour. T h i s could be either due to d i f f e r e n t i a l v a l i d i t y among the in d i c e s , or it could r e p r e s e n t r e a l d i f f e r e n c e s in ex-tent of change which had taken place i n each aspect of behaviour. The next section examines the degree of change indicated by each index i n each a r e a of behaviour. It w i l l be seen that a d i f f e r e n c e i s evident be-tween the two groups i n the extent of change i n d r i n k i n g behaviour, and there a r e s i m i l a r d i f f e r e n c e s i n other a r e a s of behavi o u r . A r e a s of r e h a b i l i t a t i o n On the m e a s u r e s of "change 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 amount of i m p r o v e m e n t between the two groups of about 20% and 10% r e s p e c t i v e l y . T h i s r e f e r s m e r e l y to some degree of i m p r o v e m e n t whether l a r g e o r s m a l l . T A B L E 5 shows a f i n e r breakdown of c a t e g o r i e s of change i n extent 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 should be d r a w n to the c a t e g o r y "no p r o b l e m " , w h i c h i n one sense d e p a r t s f r o m the s c a l e of change. 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 state, as w e l l as m a x i m u m p o s s i b l e p o s s i b l e degree of change; those r a t e d as such h a v i n g i m p r o v e d to such a n extent that they now have 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 can see that a c c o r d i n g to the i n t e r v i e w e r ' s a s s e s s m e n t , 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 between the ex-p e r i m e n t a l and c o n t r o l groups 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 -sents the s m a l l e s t degree 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 thi s c a t e g o r y s t i l " . i n v o l v e s a s u b s t a n t i a l d e c r e a s e i n a l c o h o l consumption. W i t h the patient's a s s e s s m e n t ; the l a r g e s t d i f f e r e n c e comes under "much l e s s s e v e r e p r o b l e m . " In the case of n e i t h e r of the two a s s e s s m e n t s , however, i s there any r e a l d i f f e r e n c e between the two groups i n the 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 o f 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 a n d 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 (%) M u c h L e s s L e s s M o r e M u c h M o r e N o S e v e r e S e v e r e S a m e S e v e r e S e v e r e N o A s s e s s m e n t a n d G r o u p P r o b l e m P r o b l e m P r o b l e m P r o b l e m P r o b l e m P r o b l e m A n s w e r I n t e r v i e w e r ' s a s s e s s m e n t E x p e r i m e n t a l g r o u p 24 11 23 25 9 8 0 C o n t r o l g r o u p 20 8 11 42 11 8 0 D i f f e r e n c e +4 +3 +12 - 1 7 - 2 0 0 P a t i e n t ' s a s s e s s m e n t E x p e r i m e n t a l g r o u p 28 18 22 13 6 6 4 C o n t r o l g r o u p 31 6 17 22 6 6 11 D i f f e r e n c e - 3 +12 +5 - 9 0 0 - 7 * (+) d i f f e r e n c e s i n d i c a t e t h a t t h e p e r c e n t a g e f o r t h e 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 t h e 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 . oo 4 9 have changed so that they now have " n o p r o b l e m . " T h e other two i n d i c e s i n the a r e a of d r i n k i n g (abst inence and l i q u o r offences) show no m a r k e d d i f f e r e n c e s between the 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 u r i n g the c o u r s e of i n t e r v i e w i n g , the i n t e r -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 change i n a b s t i n e n c e d i d not s e e m to be a v e r y good i n d i c a t o r of change i n d r i n k i n g b e h a v i o u r . T h i s i n -dex was def ined a s the d i f f e r e n c e between 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 two s i x - m o n t h p e r i o d s , one before the t i m e of intake at the F o u n d a t i o n , and one before the t i m e of f o l l o w - u p i n t e r -v i e w . B e c a u s e a n u m b e r cf pat ients s e e m e d to have m o d e r a t e d t h e i r d r i n k i n g m a r k e d l y but not to have stopped c o m p l e t e l y this i n d e x d i d not r e g i s t e r m a n y changes 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 with 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 j a i l o r m e n t a l h o s p i t a l o r t i m e spent 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 p r o h i b i t d r i n k i n g , did not q u a l i f y as p e r i o d s of v o l u n t a r y a b s t i n e n c e . O n the other h a n d , i t cannot be a s s u m e d e i ther that the p e r s o n n e c e s -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 . T h u s i t was d i f f i c u l t to a p p l y this m e a s u r e i n m a n y i n s t a n c e s . T h e r e was a l s o no d i f f e r e n c e between the two g r o u p s i n l i q u o r o f f e n c e s . O v e r o n e - h a l f of e a c h group 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 , and the m a j o r i t y of these s t i l l r e p o r t e d none . It i s p r o b a b l e that th is i s not a p a r t i c u l a r l y good i n d e x , because a r r e s t s 50 f o r d r i n k i n g offences a r e often f o r t u i t o u s . T h u s i n the sphere 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 tempts 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 have been too 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 jus t g i v e n , these i n d i c e s do not show changes that p a r a l l e l those on other i n d i c e s . T h e nature 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 c o m p l e x , 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, and hence the i n v e s t i g a t o r s 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 a s s e s s m e n t (which a t tempts to take into 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 ) was a m o r e adequate m e t h o d of m e a s u r i n g changes i n d r i n k i n g b e h a v i o u r than 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 and l i q u o r offences that w e r e a l s o u s e d . H e a l t h C h a n g e s i n h e a l t h 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 b e h a v i o u r , f o r there 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 (26%) between the two g r o u p s ; a s i n the c a s e of changes 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 group shows i m p r o v e m e n t , W o r k In the a r e a of w o r k , the p r o p o r t i o n of those 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 than f o r the c o n t r o l group on a l l three i n d i c e s , a l though none of the 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 . T h u s f e w e r pat ients (8% as a g a i n s t 20%) show r e h a b i l i t a t i o n i n the a r e a of w o r k (by p a t i e n t ' s 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 with r e g a r d to d r i n k i n g behaviour. T h i s i s substantiated by exami-nation of a f i n e r breakdown of improvement c a t e g o r i e s . Of the 30 per-sons who were a s s e s s e d i m p roved by the i n t e r v i e w e r , only one was rated as "much improved"; the r e s t were rated as "somewhat i m p r o v e d . " Employment status (employed v e r s u s unemployed) shows no r e a l differences'between the two groups, C r o s s-tabulations show that those who were unemployed at intake tended to be a l s o unemployed at time of interview ( 7 0 % were) and those who were employed tended to be s t i l l employed (80%), although t h e i r employment status might have changed during this p e r i o d . F a m i l y In this a r e a only one index was used: i n t e r v i e w e r ' s a s s e s s m e n t 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 members. A l a r g e number of questions were asked in the a r e a 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 to both wife and c h i l d r e n , and tabulation of these against each other showed a high degree of consistency, even between the patient's and i n t e r v i e w e r ' s a s s e s s m e n t s . A s s e s s m e n t s i n this a r e a were made only f o r those men who were " m a r r i e d " or l i v i n g "common-law" and who still-, had contact with wife and/or c h i l d r e n at the time of i n t e r v i e w --s l i g h t l y m o r e than one-half of a l l subjects. Of these, 11% m o r e i n the e x p e r i m e n t a l than i n the c o n t r o l group showed some degree of improve-ment. 52 So c i a l A c t i v i t i e s In this a r e a there a r e d i f f e r e n c e s between e x p e r i m e n t a l and con-t r o l groups of 6% and 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 subjects who have i m p r o v e d on 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 and l e i s u r e -time a c t i v i t i e s . H e r e again, as i n the areas'of work and fa m i l y , the dif 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 s m a l l . Insight The i n t e r v i e w e r ' s a s s e s s m e n t of change of insight was an attempt to determine whether changes i n d r i n k i n g behaviour a r e accompanied by c o r r e s p o n d i n g changes i n the patient's understanding of his p r o b l e m s with a l c o h o l . Indeed, it may be the changes i n behaviour to some extent r e s u l t f r o m changes i n understanding. The two types of change do i n fact p a r a l l e l one another; 2 4 % more subjects i n the e x p e r i m e n t a l than the con-t r o l group had improved i n insight, s l i g h t l y m o r e than i n d r i n k i n g be-haviour ( 1 9 % a c c o r d i n g to int e r v i e w e r ' s assessment) or i n o v e r a l l behaviour (18%). O v e r a l l behaviour The summary a s s e s s m e n t by the i n t e r v i e w e r shows that 6 0 % of the e x p e r i m e n t a l group and 42% of the c o n t r o l group had shown some de-gree of po s i t i v e change. T h i s d i f f e r e n c e i s sig n i f i c a n t at better than the .01 l e v e l . T h i s index i s tied quite c l o s e l y to drinking, f o r d r i n k i n g was the most important f a c t o r taken into account i n making this a s s e s s m e n t . Thus the d i f f e r e n c e between the e x p e r i m e n t a l and c o n t r o l subjects who had i m p r o v e d i n o v e r a l l behaviour (18%) i s roughly the same as the d i f f e r e n c e i n i m provement 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 p a i r a n a l y s i s E x a m i n a t i o n of the rates of r e h a b i l i t a t i o n i n the matched groups g shows s i m i l a r r e s u l t s , and these w i l l not be d i s c u s s e d here i n d e t a i l . S ummary T h e r e i s a consistently greater percentage of subjects i n the e x p e r i m e n t a l than i n the c o n t r o l group who show improvement i n t h e i r behaviour. The greatest diffe r e n c e i n degree of change i s evident i n the a r e a most c e n t r a l to an a l c o h o l i c ' s behaviour, h i s d r i n k i n g (where the i n t e r v i e w e r s saw 19% m o r e of the e x p e r i m e n t a l group as having improved), as w e l l as i n health ( 2 6 % difference), i n insight ( 2 4 % dif-ference), and i n o v e r a l l behaviour ( 1 8 % d i f f e r e n c e ) ; i n each of these cases the 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 p r o b a b i l i t y . S m a l l e r but c o r r e s p o n d i n g amounts of d i f f e r e n c e i n i m provement between the two groups ranging f r o m 2% to 1 1 % were seen i n other a r e a s of behaviour (work, family, and s o c i a l a c t i v i t i e s ) . A s an o v e r a l l conclusion, roughly 2 0 % m o r e subjects i n the e x p e r i -mental than i n the c o n t r o l group have i m p r o v e d i n d r i n k i n g behaviour, and v a r y i n g amounts of d i f f e r e n c e i n the same d i r e c t i o n are evident i n other a r e a s of behaviour. A summary a s s e s s m e n t of change made by the i n t e r v i e w e r indicated 18% m o re of the e x p e r i m e n t a l group as having improved. 5 4 I V . 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 In o r d e r to see whether the a p p r o x i m a t e l y 2 0 % h i g h e r rate of r e h a b i l i t a t i o n a m o n g m e m b e r s of the e x p e r i m e n t a l group 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 these pat ients r e c e i v e d f r o m the F o u n d a t i o n r a t h e r than to any of the t h r e e f a c t o r s on w h i c h the two g r o u p s d i f f e r e d , r e h a b i l i t a t i o n ra tes w e r e 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 these three 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 showed 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 did not s i g n i f i c a n t l y or c o n -s i s t e n t l y affec 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 and at tendance at 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 d i d . 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 between ex-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 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 . H e r e m o t i v a t i o n is m e a s u r e d by atti tude t o w a r d s t r e a t m e n t : " h i g h " m o t i v a t i o n m e a n s r e a l i s t i c a t t i tudes , 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 -p u l a t i v e a t t i t u d e s . T h i s i n d e x was a n a t tempt to d i s t i n g u i s h between 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 a l i z i n g that it would r e q u i r e s o m e effor t on t h e i r own p a r t , f r o m those 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 who wanted t r e a t m e n t as a m e a n s to s o m e end other than r e h a b i l i t a t i o n . L o o k i n g at this table , it is evident that m o t i v a t i o n does have s o m e effect on r e h a b i l i t a t i o n ; a somewhat g r e a t e r p r o p o r t i o n of those wi th 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 and c o n t r o l groups i m p r o v e d , 55 T A B L E 6: Percentage Comparison of Overall Change (Interviewer's Assessment) in Experimental and Control Groups According to Motivation*  Group and Degree of Motivation Degree of Rehabilitation % Improved % No Change % Deteriorated N Experimental Group High 74 14 12 Neutral 61 17 21 Low 50 17 33 Control Group High 64 18 18 Neutral 53 26 21 Low 30 43 2 7 35 28 24 1 1 1 9 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 similar motivation in experimental and control groups are compared, there is also a difference in rehabilitation: of those with high motivation 74% of the experimental group and only 64% of the control group have improved. Therefore, it can be concluded that the 20% difference in rehabilitation between experimental and control groups must be attributed in part to a difference in motivation between the two groups, rather than completely to the difference in treatment 56 received. T A B L E 7 shows the effects of Alcoholics Anonymous atten-dance after coming to the Foundation upon rehabilitation for the experimental and control groups. T A B L E 7: Percentage Comparison of Overall Change (Interviewer's Assessment) in Experimental and Control Groups Accor-ding to Number of Alcoholics Anonymous Meetings Attended Attended After Initial Visit to the Foundation* Group and Number of Meetings  Degree of Rehabilitation  % Improved % No Change % Deteriorated Experimental Group Over 10 meetings 71 Under 11 meetings 57 Control Group Over 10 meetings 70 Under 11 meetings 37 7 21 15 37 22 22 15 26 N 31 58 13 49 151 *A11 "no answer" responses have been excluded; therefore percentages add up to 100. F i r s t , the above table shows that continued attendance at meetings of Alcoholics Anonymous improves a person's changes of re-habilitation; those who had attended more than ten meetings have a 14% higher rate of improvement i n the e x p e r i m e n t a l group and a 3 3 % higher rate in the c o n t r o l group. Second, the r a t e s of r e h a b i l i t a t i o n f o r those having a f a i r l y long as sociation'with A l c o h o l i c s Anonymous a r e a l m o s t i d e n t i c a l between the e x p e r i m e n t a l and c o n t r o l groups ( 7 1 % and 70% r e s p e c t i v e l y ) . Thus for those who r e c e i v e "treatment" f r o m A l c o -h o l i c s Anonymous, the additional treatment r e c e i v e d f r o m the Founda-tion does not appear to i n c r e a s e t h e i r chances of becoming re h a b i l i t a t e d . On the other hand, f o r those who did not have a significant amount of contact with A l c o h o l i c s Anonymous, treatment at the Founda-tion produces a 2 0 % diffe r e n c e in 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 57%, c o n t r o l group 37%). Since, however, i n some cases improvement ap-p e a r s to be due to A l c o h o l i c s Anonymous rather than to the Foundation, i n as ses sing the effectiveness of the Foundation's treatment p r o -gramme it w i l l be n e c e s s a r y to take this into account. It can be concluded, then, that the e x p e r i m e n t a l group were m o r e highly motivated to be re h a b i l i t a t e d and a l s o included a higher p r o p o r t i o n of those who had attended A l c o h o l i c s Anonymous meetings, and a p a r t of the higher rate 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 must be attributed to these two f a c t o r s rather than to the Foun-dation treatment. However, c a l c u l a t i o n s on the combined effect of these two f a c t o r s show that t h e i r combined effect was only to i n c r e a s e the rate 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 group by 7%, which means that the effect of Foundation treatment was 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 i m p r o v e d by some 10% to 15%. V. Summary Ex a m i n a t i o n 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 chosen for a n a l y s i s showed that roughly one-half of a l l subjects had i m p r o v e d to some extent between the time they f i r s t v i s i t e d the Foun-dation and the t i m e of follow-up interview, one-quarter had remained the same, and one-quarter had d e t e r i o r a t e d . Only about one-fifth, however, were rated as "much i m p r o v e d . " 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 rates between the e x p e r i m e n t a l and c o n t r o l groups revealed that a consistently greater percentage of e x p e r i m e n t a l group subjects had improved. The d i f f e r e n c e s i n some a r e a s of behaviour (work, f a m i l y , and s o c i a l a c t i v i t i e s ) were r e l a t i v e l y s m a l l , while the d i f f e r e n c e s i n .drinking behaviour, health, and insight were somewhat grea t e r (ranging between 2 0 % and 25%). F u r t h e r , 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 re of the e x p e r i m e n t a l group subjects as having shown o v e r a l l improvement, although most of this d i f f e r e n c e was found i n the "somewhat i m p r o v e d " category. Since d i f f e r e n c e s had been found between e x p e r i m e n t a l and c o n -t r o l groups on m o t i v a t i o n and attendance at A l c o h o l i c s Anonymous (the e x p e r i m e n t a l group were somewhat better motivated to be rehabilitated and had attended m o re A l c o h o l i c s Anonymous meetings since Foundation contact), i t was then n e c e s s a r y to c o n t r o l f o r these f a c t o r s . It was 59 f o u n d that t h e s e 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 that a p p r o x i m a t e l y 10% 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 F o u n d a t i o n . 60 F O O T N O T E S : 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 , and 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 : 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 , 1963), C h a p t e r 4, 2 In the p o r t i o n of a n a l y s i s un ique 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 been a d o p t e d . See C h a p t e r I V . 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 , I V ( O c t o b e r , 1 9 5 9 ) , p p . 8 0 - 8 6 . 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  and 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 . 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 change 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 i n c l u d e i b i d . , p p . 2 2 - 2 6 , 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 Study 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 at 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. ^ In t h i s t a b l e , and 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 " and 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 at 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 that the 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 i n the l i t e r a t u r e ; see, f o r example the a r t i c l e by D. L . Davies, " N o r m a l D r i n k i n g i n R e c o v e r e d A l c o h o l A d d i c t s , " Q u a r t e r l y J o u r n a l of Studies on A l c o h o l , XXIII (March, 1962), 94- 104. 8 T a b l e s containing the c o m p a r i s o n between matched p a i r s and total e x p e r i m e n t a l and c o n t r o l groups are included i n the Foundation's re s e a r c h report, Robson, Paulus, and C l a r k e , op. c i t . , pp. 108-111. F o r details of the r e s u l t s on this f actor, see i b i d . , pp. 113-115. C H A P T E R IV A R E A S O F C H A N G E IN R E H A B I L I T A T I O N I. Introduction The a n a l y s i s reported i n Chapter III led to three m a j o r con-c l u s i o n s which p r o v i d e d the basis f o r the hypotheses tested in the p r e s e n t study. F i r s t , it was shown that treatment at the A l c o h o l i s m Foundation was effective 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 patients who show improvement i n t h e i r d r i n k i n g behaviour between the time of an i n i t i a l v i s i t to the Foundation and follow-up interview. Second, i t was demonstrated that treatment r e c e i v e d f r o m A l c o h o l i c s Anonymous i s a l s o effective i n producing like changes i n behaviour. In fact, a c e r t a i n p r o p o r t i o n of the greater improvement i n the e x p e r i -m e n t a l group must be attributed to A l c o h o l i c s Anonymous rather than to the Foundation. T h i r d , changes i n other a r e a s of behaviour than 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 s o c i a l a c t i v i t i e s ) p a r a l l e l e d i n v a r y i n g degree changes i n d r i n k i n g behaviour. That i s , s i m i l a r percentages of improvement, lack of change, and d e t e r i o r a -tion i n d r i n k i n g and other behaviour were evident 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 r e s u l t s , coupled with the t h e o r e t i c a l ideas about be-haviour d i s c u s s e d i n Chapter I, led to the f o r m u l a t i o n of the hypotheses 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 b e t w e e n c h a n g e s i n d r i n k i n g and i n o t h e r 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 to note that 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 do 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 of i n d i v i d u a l s . T h e s i m i l a r p e r c e n t a g e s s u g g e s t e d the 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 show that i t a c t u a l l y e x i s t s , s i n c e we do not k n o w that the 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 c a s e . 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 tes 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 both s o r t s of change ( 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 ) a r e p r e s e n t , i n w h i c h c a s e s o n l y one o r the o t h e r i s p r e s e n t , and i n w h i c h c a s e s n e i t h e r type of change h a s o c c u r r e d . II . The C h o i c e of I n d i c e s of C h a n g e The p r o b l e m of c h o o s i n g i n d i c e s to use 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 that 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 to 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 be-h a v i o u r , 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 b e c o m e s u n w i e l d y . < 64 Indices of change i n d r i n k i n g behaviour In Chapter III, four different i n d i c e s of change i n d r i n k i n g a r e employed. It was observed, f i r s t of a l l , that the patient's a s s e s s -ment of change i n d r i n k i n g p r o b l e m was s i m i l a r to other i n d i c e s , but that percentages were somewhat l a r g e r . Since the i n t e r v i e w e r s ' im-p r e s s i o n s (substantiated by those of p r e v i o u s investigators) suggested that the patient ( c o n s c i o u s l y or otherwise) tends to d i s t o r t his a s s e s s -ment i n v a r i o u s ways commensurate with hi s own needs, i t seemed reasonable to impute l e s s v a l i d i t y to such subjective a s s e s s m e n t s on the p a r t of the p e r s o n h i m s e l f . In addition, the r e s u l t s of this a s s e s s -ment a r e not greatly d i f f e r e n t f r o m those of the i n t e r v i e w e r ' s a s s e s s -ment. T h e r e f o r e , the patient's a s s e s s m e n t was not employed i n the a n a l y s i s r e p o r t e d below. The i n d i c e s of change i n abstinence and change i n l i q u o r offences, on the other hand, did not p a r a l l e l the other i n d i c e s so c l o s e l y . F o r v a r i o u s r e a s o n s d i s c u s s e d above ( pp. 49 - 50), i t was concluded that these two i n d i c e s were not as adequate for m e a s u r i n g change as were the m o r e subjective a s s e s s m e n t s of the patient and i n t e r v i e w e r . E v e n though these i n d i c e s a r e believed to be not as sensitive to the d i s c r i m i n a t i o n of many kinds of change, however, one would not ex-pect that r e s u l t s shown by them would often c o n t r a d i c t other r e s u l t s . F o r this reason, and i n o r d e r to provide some m o r e " o b j e c t i v e " check on the i n t e r v i e w e r ' s assessment, a composite index was developed 65 u t i l i z i n g a l l three i n d i c e s , i n t e r v i e w e r ' s a s s e s s m e n t of change i n d r i n k i n g p r o b l e m , change 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 . T h e c o m p o s i t e index d e v e l o p e d a t tempts to take a c c o u n t of the weight of e v i d e n c e f r o m a l l three i n d i c e s , by u s i n g a (+), (O), and (-) r a t i n g s c h e m e as f o l l o w s : 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 whether this c o m p o s i t e i n d e x would o b s c u r e any l a t e r r e s u l t s , a check was m a d e by c h o o s i n g three m a j o r i n d i c e s of change i n other 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 of 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 , and l e i s u r e t i m e a c t i v i t i e s ) , and c r o s s - t a b u l a t i n g each of these i n d i c e s a g a i n s t each separa te i n d e x of change i n d r i n k i n g b e h a v i o u r , as 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 . 2 T h e i n d i v i d u a l tables w e r e e x a m i n e d , and c h i - s q u a r e d v a l u e s c o m p a r e d . R e s u l t s on each index of change i n d r i n k i n g b e h a v i o u r w e r e g e n e r a l l y the same, but were l e s s m a r k e d i n the cases of change i n abstinence and change i n liqu o r offences. The composite index showed quite s i m i l a r r e s u l t s to those of the i n t e r v i e w e r ' s assessment, but the r e l a t i o n s h i p was l e s s strong. 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 a s s e s s m e n t or the composite index were significant at the .05 l e v e l , however, while most of those u s i n g the change i n abstinence or change in l i q u o r offences, i n d i c e s were not s t a t i s t i c a l l y s ignificant. Since greatest v a l i d i t y was attributed to the i n t e r v i e w e r ' s a s s e s s -ment, and the composite index gives s i m i l a r r e s u l t s , the composite i n -dex appears to adequately i n c o r p o r a t e the interviewer's assessment, while giving the added check provided'by a l s o i n c l u d i n g the other two objective i n d i c e s . In addition, use of the composite index r a t h e r than the i n t e r v i e w e r ' s a s s e s s m e n t alone, w i l l p rovide a m o r e r i g o r o u s test when a n a l y s i s is broken down m o r e f i n e l y i n l a t e r stages of the a n a l y s i s , since the r e l a t i o n s h i p i s not as great when the composite index i s used. Indices of change i n a r e a s of behaviour other than d r i n k i n g F o u r a r e a s of behaviour other than d r i n k i n g were chosen 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 schedule for investigation: health, work, 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 . Change i n these four a r e a s was m e a s u r e d by a large number of i n d i c e s , which was reduced to seven f o r the p u r p o s e s of the a n a l y s i s of Chapter III. These i n d i c e s were as follows: 1. Health: Patient's o v e r a l l a s s e s s m e n t of change 67 2 . W o r k : 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 change 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 change c) C h a n g e i n e m p l o y m e n t s t a t u s 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 change 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 change 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 -s i b i l i t y i n p a y i n g f o r a c c o m m o d a t i o n b) I n t e r v i e w e r ' s a s s e s s m e n t of change i n l e i s u r e t i m e a c t i v i t i e s The 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 b r i e f d i s -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. H e a l t h 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 ( C h a p t e r III, p . 4 2 ) . 2 . W o r k 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 change w a s c h o s e n to be r e p -r e s e n t a t i v e 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 change 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 change 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 than 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 ta tus w a s f o u n d to be 68 negligible, since few p e r s o n s had changed f r o m unemployed to employed or f r o m employed to unemployed between the times of intake at the Foun-dation and follow-up interview, and this index was t h e r e f o r e omitted (see p. 51). 3. F a m i l y The i n t e r v i e w e r ' s a s s e s s m e n t 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 (which appli e s to those m a r r i e d or l i v i n g common-law) was found to be the best index to r e p r e s e n t the large number of questions asked in this a r e a of behaviour, and it i s used again i n the following a n a l y s i s . 4. S o c i a l a c t i v i t i e s Two i n d i c e s were found to be r e p r e s e n t a t i v e of rather different aspects of this broad a r e a of behaviour. The i n t e r v i e w e r ' s a s s e s s m e n t 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 on whether or not the i n d i v i d u a l was as s e l f - s u p p o r t i n g i n paying for r e s i d e n t i a l accommodation as he could be. In other words, if a p e r s o n was f i n a n c i a l l y dependent on s o c i a l a s s i s t a n c e , a wife, or r e l a t i v e s when he appeared to be capable of being m o r e independent i n this r egard, this would he r e g a r d e d by the i n t e r -v i e w e r as being "poor". If the i n d i v i d u a l had become m o r e independent between T± and T^, he was rated as improved, and c o n v e r s e l y . The second index of general s o c i a l functioning was based on change i n l e i s u r e time a c t i v i t i e s . Change f r o m a c t i v i t i e s dominated by d r i n k i n g to a broader range of s a t i s f y i n g a c t i v i t i e s with 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 w a s r a t e d a s i m p r o v e m e n t . T h e f i n a l l i s t of i n d i c e s of change 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 i s t h e r e f o r e a s f o l l o w s : 1. H e a l t h ( P A ) 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. L e i s u r e t i m e a c t i v i t i e s (IA) III . C a t e g o r i e s 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 on 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 and 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 : " 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 . " 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 -s h i p s 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 a n d change i n o t h e r 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 w i t h s m a l l e x p e c t e d f r e q u e n c i e s , m a k i n g c o n c l u s i o n s u n r e l i a b l e , p a r -t i c u l a r l y w h e n the c h i - s q u a r e d tes t w a s u s e d . C a t e g o r i e s w e r e t h e r e -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 l e g i t i m a t e , s i n c e i t w a s noted a b o v e that t h e r e w e r e few 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 , and " 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 have many-advantages i n t e r m s of ease of h a n d l i n g , and w h i c h m a k e c e r t a i n m o r e 3 p r e c i s e tests p o s s i b l e . One m o r e r e m a r k should be m a d e about c a t e g o r i e s of change . 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 was not p o s s i b l e , s ince there was 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 be-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 . It s e e m s r e a s o n a b l e to a s s u m e that a l though a l l the p e r s o n s 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 ion f o r t r e a t m e n t m a y not have 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 they c o u l d be p r o p e r l y def ined as " a l c o h o l i c s , " a l l would be capable 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 . T h i s is not the case with r e g a r d to other a r e a s of b e h a v i o u r , though. M a n y i n d i v i d u a l s i n the s a m p l e had 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 with t h e i r p e r f o r m a n c e i n w o r k or i n the m a n a g e m e n t of f a m i l y r e s p o n s i -b i l i t y , f o r e x a m p l e , and t h e r e f o r e would not be expected to i m p r o v e i n these a r e a s i f t h e i r d r i n k i n g b e h a v i o u r 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 this fact i n m i n d when e x a m i n i n g the r e l a t i o n s h i p s b e l o w . 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 true i n e v e r y case w h e r e i m p r o v e m e n t was p o s s i b l e , our data would not show p e r f e c t c o r r e s -p o n d e n c e , s ince there i s no way of d i s c r i m i n a t i n g between those c a s e s 4 w h e r e p o s i t i v e change i s and is not p o s s i b l e . 7 1 IV. I n t e r r e l a t i o n s h i p s B etween Change i n D r i n k i n g B e h a v i o u r and i n Other A r e a s of B e h a v i o u r - A l l Subjects  The f i r s t h y p o t h e s i s of t h i s study stated 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 in d r i n -k i n g behaviour and change i n other a r e a s of be h a v i o u r (h e a l t h , work, 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 ), 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 other a r e a s w i l l a l s o i m p r o v e . b) If d r i n k i n g b e h a v i o u r does not i m p r o v e ( r e m a i n s the same or 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 . It m a y be h e l p f u l to look at these e x p e c t a t i o n s i n t e r m s of 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 used f o r a n a l y s i s : O T H E R B E H A V I O U R D R I N K I N G B E H A V I O U R I m p r o v e d A B Not I m p r o v e d C D 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 would f a l l i n t o c e l l s A and 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 would be expected as f o l l o w s : ' 72 A N B A + / B A + B A \ C A + C s A + C D \ C D + c s w D + c D B D B / D + B E x a m i n a t i o n of the data f o r a l l s u b j e c t s t o g e t h e 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 c o m b i n e d ) s h o w s a c l e a r - c u t t e n d e n c y f o r 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 (on a l l f i v e i n d i c e s ) t o v a r y t o g e t h e r . 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 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 D R I N K I N G B E H A V I O U R H E A L T H I m p r o v e d N o t I m p r o v e d T o t a l I m p r o v e d 55 (43)* 39 (51) 94 Not I m p r o v e d 12 (24) 41 (29) 53 T o t a l 67 80 147 X 2 = 16. 9 * * d . f . 1: p < . 001 -'•Expected 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 e n c l o s e d i n p a r e n t h e s e s . 2 * * X v a l u e s c o m p u t e d f o r t h i s t a b l e and a l l s u c c e e d i n g t a b l e s w e r e c o m p u t e d 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 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 , s i n c e i n m a n y c a s e s e x p e c t e d f r e q u e n c i e s w e r e s m a l l . T h i s f o r m u l a i s g i v e n i n J . P . G u i l f o r d , F u n d a m e n t a l S t a t i s t i c s  i n P s y c h o l o g y and E d u c a t i o n ( N e w 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 , 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 change 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 h y p o t h e s i s , and 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 . 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 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 been c h o s e n as the l e v e l of c e r t a i n t y . T h u s i t c a n be c o n c l u d e d that a p e r s o n who 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 to i m p r o v e i n h e a l t h t h a n one w h o d o e s 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 who d o e s not i m p r o v e 74 in one a r e a i s not as l i k e l y to improve i n the other. The same re l a t i o n s h i p i s evident 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 against change i n work, f a m i l y respon-s i b i l i t y , and l e i s u r e time a c t i v i t i e s . Because these r e s u l t s a r e so s i m i l a r , the act u a l tables a r e not presented here, but included as T A B L E S 16 -19 of A P P E N D I X A. In or d e r to compare the strength of 2 re l a t i o n s h i p 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 Chi-Squared V a l u e s * f o r T a b l e s Showing In t e r r e l a t i o n s h i p s 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 Behaviour for A l l Subjects A r e a of Behaviour Chi-Squared Value P r o b a b i l i t y * * N 1) Health 16.9 ' p < . 001 148 2) Work 11.8 p<.001 148 3) F a m i l y r e s p o n s i b i l i t y 9.5 p<.01 86 18.0*** 148 4) F i n a n c i a l r e s p o n s i b i l i t y 4.6 p < .05 148 5) L e i s u r e time a c t i v i t i e s 46.5 p<,001 148 **X values were computed us 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, * * T h i s is the p r o b a b i l i t y of such a d i s t r i b u t i o n o c c u r r i n g by chance. ***These a r e mocked values, a s s u m i n g the sample size for this index to be the same as for other i n d i c e s . See the d i s c u s s i o n of this i n the next section below. It i s c l e a r f r o m the above t a b l e that a s t a t i s t i c a l r e l a t i o n s h i p 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 that 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 . 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 i s s e e n 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 a n d change i n l e i s u r e t i m e a c t i v i t i e s (X = 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 , and f a m i l y r e s p o n s i b i l i t y ( X = 1 6 . 9 , 1 1 . 8 , a n d 1 8 . 0 ( m o c Q , r e s p e c t i v e l y ) . A s t i l l l e s s e r d e -gree 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 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 ( X = 4. 6). It i s i m p o r t a n t to note , h o w e v e r , that the use of c h i - s q u a r e d v a l u e s does 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 c a s e ; i t m e r e l y e n a b l e s us 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 . W e cannot s a y , f o r i n s t a n c e , 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 b e h a v i o u r and l e i s u r e t i m e a c t i v i t i e s ( X = 46 . 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 and f i n a n c i a l r e s p o n s i -2 b i l i t y ( X - 4. 5), O n the o t h e r h a n d , we 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 l a t t e r . 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 -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 a n d change i n v a r i o u s o t h e r 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 a c c o u n t e d 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 change 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 this p o r t i o n of the a n a l y s i s is t h e r e f o r e that 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 , and r e g a r d H y p o t h e s i s I, w h i c h 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 change i n other a r e a s of b e h a v i o u r , as substant ia ted . F u r t h e r , t h e r e a p p e a r s 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 on 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 D e g r e e of I n t e r 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 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 effects of t r e a t m e n t at the F o u n d a t i o n on 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 . It was h y p o t h e s i z e d that such t r e a t m e n t would tend 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 : 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 change i n other 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 those p e r s o n s who have had 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) than i n those p e r s o n s who have not had such t r e a t m e n t ( c o n t r o l group) . T h i s r e l a t i o n s h i p w i l l be tested i n the same 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 and e x a m i n i n g f o u r - f o l d tables and by c o m p a r i n g c h i - s q u a r e d v a l u e s . One d i f f i c u l t y should be pointed out, h o w e v e r . S u b - s a m p l e s i z e s of the e x p e r i m e n t a l and c o n t r o l groups a r e not e q u a l , and t h e r e -f o r e it is not l e g i t i m a t e to c o m p a r e 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 these d i f f e r e n t s i z e d s u b - g r o u p s . T h e o r e t i c a l l y , the s a m e r e l a t i o n s h i p c o u l d e x i s t i n t w o 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 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 . T w o g r o u p s of f i g u r e s w i l l t h e r e f o r e be p r e s e n t e 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 o n 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 to the s a m e s i z e (to enab le 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 ) . T h u s 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 and 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 g r o u p s s e p a r a t e l y , 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 change i n d r i n k i n g and i n o t h e r a r e a s of be-h a v i o u r : L o o k i n g f i r s t of a l l at 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 and 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 e a c h g r o u p 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 c a s e s . 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 , h o w e v e r , i n -d i c a t e s that 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 ex -p e c t e d d i r e c t i o n . 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 and 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 T a b l e s S h o w i n g I n t e r r e l a t i o n s h i p s 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 o f 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 A r e a o f B e h a v i o u r C h i - S q u a r e d V a l u e s E x p e r i m e n t a l G r o u p C o n t r o l G r o u p R e a l M o c k R e a l M o c k x 2 N_ N_ x 2 _ N x 2 _N 1) H e a l t h 17. 3 86 21.5 100- (0.8)** 61 1.2 100 2) W o r k 8.9 88 •10. 8 100 (1.6) 59 3. 1 100 3) F a m i l y -r e s p o n s i b i l i t y 5. 0 51 12. 5 100 (2.8) 35 10.9 100 4) F i n a n c i a l r e s p o n s i b i l i t y (2.3) 89 2. 8 100 (0.2) 59 1.5 100 5) L e i s u r e t i m e a c t i v i t i e s 31.7 87 37. 6 100 13. 2 61 24. 3 100 * X v a l u e s w e r e c o m p u t e d 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 Y a t e s 1 c o r r e c t i o n f o r c o n t i n u i t y . * * V a l u e s i n p a r e n t h e s e s ( i n t h e c a s e s of r e a l v a l u e s ) a r e not s i g n i f i c a n t a t t h e , 05 l e v e l of c o n f i d e n c e . 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 o n e i n s t a n c e , l e i s u r e t i m e a c t i v i t i e s . T h u s , 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 I I i s c o n f i r m e d , t h a t t r e a t m e n t a t t h e F o u n d a t i o n d o e s m a k e a d i f f e r e n c e i n i n c r e a s i n g t h e l i k e l i h o o d t h a t a p e r s o n w i l l i m p r o v e i n b o t h 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 o f b e h a v i o u r a t t h e s a m e t i m e . 79 V I . T h e E f f e c t o f 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 s u c h a n i n f e r e n c e f r o m t h e d a t a a t t h i s p o i n t , h o w e v e r . It w i l l be r e m e m b e r e d f r o m C h a p t e r I I I t h a t o n e o f t h e 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 o f t h e d i f f e r e n c e i n t h e e x t e n t o f 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 g r o u p s w a s a t t e n d a n c e a t A l c o h o l i c s A n o n y m o u s , M o r e m e m b e r s o f t h e e x -p e r i m e n t a l g r o u p 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 p a r t o f t h e d i f f e r e n c e h a d t o b e a t t r i b u t e d t o t h i s f a c t o r r a t h e r t h a n t o t r e a t m e n t a t t h e F o u n d a t i o n . S i n c e t h e t w o t y p e s o f t r e a t m e n t w e r e s h o w n t o h a v e s i m i l a r e f f e c t s o n r e h a b i l i t a t i o n , i t i s q u i t e c o n c e i v a b l e t h a t t h e y m i g h t h a v e a s i m i l a r e f f e c t o n t h e r e l a t i o n s h i p s d e m o n s t r a t e d a b o v e . It w i l l be n e c e s s a r y , t h e n , t o b r e a k d o w n t h e a b o v e c o m p a r i s o n o n t h e a d d i t i o n a l v a r i a b l e o f 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 . B e -c a u s e t h e s u b - s a m p l e s p r o d u c e d b y t h i s d i v i s i o n a r e r a t h e r d i f f e r e n t i n s i z e ( r a n g i n g f r o m 6 t o 5 8 ) , 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 w i t h t h e s a m e s u b - s a m p l e s i z e w i t h i n e a c h i n d e x , 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 o n t h e s e , T h e s e v a l u e s m u s t o n l y l e c o n s i d e r e d r e l a t i v e , s i n c e t h e y a r e i n f l a t e d a n d s t a t i s t i c a l s i g n i f i c a n c e l e v e l s c a n n o t l e g i t i -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 t h i s c o m p a r i s o n : 80 T A B L E 11: C o m p a r i s o n of Chi-Squared V a l u e s * for Mock T a b l e s Showing I n t e r r e l a t i o n s h i p s Between Change i n D r i n k i n g Behaviour and Change i n Other A r e a s of Behaviour 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 Anonymous Attendance  A r e a s of B e h a v i o u r Chi-Squared Values (Mock Tables) E x p e r i - E x p e r i -mental, mental, C o n t r o l , C o n t r o l , A. A.** Non-A.A. A, A. Non-A.A. N 1) Health 17.0 8.2 11.2 0.1 56 2) Work 5.2 2. 8 5.9 0.3 57 3) F a m i l y r e s p o n s i b i l i t y 5.3 0.8 8.5 1.7 32 4) F i n a n c i a l r e s p o n s i b i l i t y 0.0 1.3 1.3 0,1 58 5) L e i s u r e time a c t i v i t i e s 33.1 14.2 51.6 7.7 57 2 *X values were 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 1 c o r r e c t i o n for continuity. **Those regarded as having A. A. treatment are those who had attended m o r e than 10 A. A, meetings since f i r s t c o ming to the Foundation. In examining the above table, i t must f i r s t of a l l be noted that these data must be approached with s p e c i a l caution, since p a r t i t i o n i n g the sample i n this way produces quite s m a l l sub-samples with s m a l l expected f r e q u e n c i e s i n many c e l l s . F o r instance, there a r e only 12 p e r s o n s i n the c o n t r o l group who attended A l c o h o l i c s Anonymous, and 81 only 6 of these r e g i s t e r on the index " f a m i l y r e s p o n s i b i l i t y , " It would not be p r o p e r , therefore, to attach too much weight to i n d i v i d u a l f i g u r e s , but o v e r a l l tendencies can safely be examined. A n examination of the i n d i v i d u a l f o u r - f o l d tables indicates that 7 there i s a d i f f e r e n c e i n the expected d i r e c t i o n i n 18 out of 20 cases, although 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 is s m a l l . The d i f f e r e n c e s a r e p a r t i c u l a r l y s m a l l f o r those who did not have treatment f r o m either the Foundation or A l c o h o l i c s Anonymous (con t r o l group, non-A. A . ) . T A B L E 11 shows that the c h i - s q u a r e d values for tables on each index for these p e r s o n s with no treatment f r o m either r e s o u r c e a r e s m a l l e r than values f o r those p e r s o n s having one type of treat-ment and/or the other. Thus having some treatment, either f r o m the Foundation or f r o m A l c o h o l i c s Anonymous, appears to i n c r e a s e the li k e l i h o o d of p e r s o n s showing changes i n other a r e a s of behaviour 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 this table for the effect of treatment f r o m A l c o h o l i c s Anonymous, it can be seen that this treatment appears to i n c r e a s e the degree of r e l a t i o n s h i p between change i n drinV.ing behaviour and change i n other a r e a s of behaviour, i n both the e x p e r i m e n t a l and c o n t r o l groups, except i n the case of f i n a n c i a l r e s p o n s i b i l i t y , where values are too s m a l l to draw r e l i a b l e c o nclusions. Foundation treatment, on the other hand, appears to affect the degree of r e l a t i o n s h i p only i n the case of those 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 Anonymous. 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 those i n the e x p e r i m e n t a l and c o n t r o l groups who have a l s o attended A. A. m e e t i n g s r e g u l a r l y . H o w e v e r , f o r those who d i d not attend 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 seems to i n c r e a s e the degree of r e l a t i o n s h i p , except i n the case of f a m i l y r e -s p o n s i b i l i t y , w h ere the c h i - s q u a r e d v a l u e s a r e too s m a l l to d r a w r e -l i a b l e c o n c l u s i o n s . T h i s f i n d i n g , that 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 -hood that i n d i v i d u a l s w i l l show changes i n other a r e a s of t h e i r be-h a v i o u r w h i c h p a r a l l e l changes i n d r i n k i n g b e h aviour, i s analogous 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, that F o u n d a t i o n t r e a t m e n t a p p e a r e d 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 of r e h a b i l i t a t i o n only i n those c a s e s where 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 attend A l c o h o l i c s A n onymous. Thus some of the r e l a t i o n s h i p w h i c h was a t t r i b u t e d above to the effect 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 to 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 than of t r e a t -ment 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 concluded, 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 on 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 . V I I . S u m m a r y The p r e c e d i n g c h a p t e r has p r e s e n t e d the r e s u l t s of a n examinat ion, of the 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 o t h e r a r e a s of b e h a v i o u r , by a n a l y z i n g a s e r i e s of f o u r -fold c r o s s - t a b u l a t i o n s . T h e f o u r i n d i c e s of change i n d r i n k i n g be-h a v i o u r us ed p r e v i o u s l y were r e d u c e d to one c o m p o s i t e i n d e x , by t a k i n g the weight of e v i d e n c e on three i n d i c e s . F i v e i n d i c e s w e r e t a k e n as r e p r e s e n t a t i v e of change i n other s p h e r e s of l i f e , and the c o m p o s i t e i n d e x of change i n d r i n k i n g b e h a v i o u r was tabulated agains t t h e m . Since it was d e s i r a b l e to use f o u r - f o l d t a b l e s , the c a t e g o r i e s of " I m p r o v e d , " " N o C h a n g e , " and " D e t e r i o r a t e d " u s e d e a r l i e r w e r e c o m b i n e d into two c a t e g o r i e s , " 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 tables and 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 each substant ia ted H y p o t h e s i s I. T a k i n g the total s a m p l e , 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 . 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 other a r e a s of b e h a v i o u r than those who did not; and c o n v e r s e l y i f they did not i m -p r o v e . F u r t h e r , this d e g r e e of i n t e r r e l a t i o n s h i p was found to v a r y d e p e n d i n g on 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 . It was greates t i n the case of l e i s u r e t i m e a c t i v i t i e s , somewhat l e s s i n h e a l t h , w o r k , 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 test H y p o t h e s i s II, the e x p e r i m e n t a l a n d c o n t r o l groups w e r e e x a m i n e d s e p a r a t e l y . 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 there was a g r e a t e r degree of the above r e l a t i o n s h i p shown i n the e x p e r i m e n t a l than i n the c o n t r o l g r o u p . 84 Since it had been found e a r l i e r that the e x p e r i m e n t a l and c o n -t r o l groups 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 had at-tended 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 , and s ince it was c o n c e i v a b l e that A . A . t r e a t m e n t could have a s i m i l a r effect to F o u n d a t i o n t r e a t -m e n t , the s a m p l e was then b r o k e n down f u r t h e r 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 at tendance , It was found that this d i f f e r e n c e did 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 between e x p e r i m e n t a l and c o n t r o l groups. S p e c i f i c a l l y , there was 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 reat -m e n t i n the case w h e r e the p e r s o n had attended 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 ince c o m i n g to the F o u n d a t i o n . In those p e r s o n s who did not attend A . A . r e g u l a r l y , though, F o u n d a -t ion t r e a t m e n t did 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 between 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 and i m p r o v e m e n t i n other a r e a s of b e h a v i o u r . T h u s it was 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 and A l c o h o l i c s A n o n y m o u s , operate i n a s i m i l a r way 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 and i m p l i c a t i o n s of the r e s u l t s r e p o r t e d a b o v e . 85 F O O T N O T E S : C h a p t e r I V (+) 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 . " 2 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 f o r e a c h 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 , I n sp i te of u s i n g o n l y two c a t e g o r i e s of c h a n g e , some ex -p e c t e d 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 t a b l e s m a d e 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 -s i v e l y b e l o w . ^ 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 ye 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 these two 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 and D o n a l d G e r a r d , " A F o l l o w - U p S tudy of P a t i e n t s . Se 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). ^ 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 that 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 fec 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 data 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 body of t h i s c h a p t e r , and o t h e r t a b l e s g i v e n 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 . C H A P T E R V S U M M A R Y A N D D I S C U S S I O N O F F I N D I N G S I, The P r o b l e m Under I n v e s t i g a t i o n The f r a m e of r e f e r e n c e f o r the p r e s e n t r e s e a r c h endeavour i n v o l v e d two i m p o r t a n t emphases i n the 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 human be h a v i o u r . The f i r s t of these emphases was on the h o l i s t i c nature of p e r s o n a l i t y , and t h e r e f o r e on the i n t e g r a t i o n of those many d i v e r s e a c t s w h i c h go to g e t h e r to make up a n i n d i v i d u a l ' s b e h a v i o u r . Many 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 the i m p o r t a n c e of c o n s i d e r i n g the way 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 upon 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 -lated e m p h a s i s i s that m a n m u s t be c o n s i d e r e d not as a c l o s e d s y s t e m , but as a n open s y s t e m 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 , both i n i t s s o c i a l and n o n - s o c i a l a s p e c t s . A n d both of these emphases a r e ta 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 health) and of " a b n o r m a l " f u n c t i o n i n g (or i l l n e s s ) . 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 should be i m p o r t a n t i n the u n d e r s t a n d i n g of t h i s phenomenon. V a r i o u s t h e o r i e s about the nature of a l c o h o l i s m , and t h e r e f o r e d i f f e r e n t t r e a t m e n t a p p r o a c h e s a r e based upon t h i s point of view. It i s thought to 87 be quite i m p o r t a n t to think of the a l c o h o l i c not m e r e l y as a p e r s o n who d r i n k s to e x c e s s , but as a c o m p l e x i n d i v i d u a l whose p h y s i c a l and m e n t a l h e a l t h m u s t be t a k e n i n t o account, as w e l l as 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 hus 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 seek to do many things i n a d d i t i o n to i n d u c i n g h i m to stop d r i n k i n g ; h i s whole nature and ad-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 into p u r v i e w . The o r g a n i -z a t i o n studied 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 C o l u m b i a , i s a case 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 to t h i s p h i l o s o p h y . 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 was to t e s t t h i s u n d e r l y i n g a s s u m p t i o n about the nature of a l c o h o l i s m , by e x a m i n i n g the extent to w h i c h changes 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 be-h 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 changes i n other 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 a s f o l l o w s : 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 be-tween 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 (health, work, 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), i n the t o t a l s ample 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 other a r e a s w i l l a l s o i m p r o v e . b) If d r i n k i n g b e h a v i o u r does not i m p r o v e ( r e m a i n s the same or 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 . F u r t h e r , i t was thought that although a number of a l c o h o l i c s show 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 without h a v i n g 88 t r e a t m e n t , the tendency f o r this 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 with the other changes h y p o t h e s i z e d would be greates t i n those c a s e s w h e r e the i n d i v i d u a l had 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 s e c u r e both s o r t s of change . T h u s a f u r t h e r h y p o t h e s i s was c o n s t r u c t e d as f o l l o w s : 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 and change i n other a r e a s of be-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 those p e r s o n s who have had t r e a t m e n t at the F o u n -dat ion ( e x p e r i m e n t a l group) than i n those p e r s o n s who have not had such t r e a t m e n t ( c o n t r o l group) , II. M e t h o d s of R e s e a r c h T h e data c h o s e n f o r use i n t e s t i n g the above h y p o t h e s e s w e r e obtained f r o m a f o l l o w - u p study d e s i g n e d to evaluate 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 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 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 extent of r e h a b i l i t a t i o n w h i c h had taken p l a c e o v e r a p e r i o d of t i m e i n two groups of a l c o h o l i c s , one of w h i c h had 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 whi le the other had 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 who had u n d e r g o n e m o r e than f ive t r e a t m e n t s e s s i o n s at the F o u n d a t i o n , and the c o n t r o l group was s e l e c t e d f r o m p e r s o n s who had 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 who had not r e m a i n e d f o r m o r e than f o u r t r e a t m e n t s e s s i o n s . T h e 89 study was r e t r o s p e c t i v e , in that a sample of a l c o h o l i c s who had once attended the Foundation were interviewed, and were questioned re-garding their behaviour both at the time they f i r s t came to the Foun-dation and at the time of interview. Interviews were designed to secure two m a j o r types of data, i n f o r m a t i o n c o n c e r n i n g the extent of r e h a b i l i t a t i o n which had o c c u r r e d , and 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 which the e x p e r i m e n t a l and c o n t r o l groups were d e s i r e d to be s i m i l a r . A n y c o m p a r i s o n of re h a b i l i t a t i o n between the two groups would, of course, be dependent on the s i m i l a r i t y of p e r s o n s contained in each. A detailed i n terview schedule was constructed i n consultation with the Foundation staff, 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 were constructed. These m e a s u r e s sought to a s c e r t a i n the extent to which the respondent's behaviour and attitudes had changed between the time of f i r s t contact with the Foundation and the time of interview. Six relevant a r e a s of behaviour were de l i m i t e d : 1. D r i n k i n g behaviour 2. Health ( p h y s i c a l and emotional) 3. Behaviour i n the a r e a of work 4. S o c i a l i n t e r a c t i o n in the f a m i l y 5. S o c i a l a c t i v i t i e s 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 sample to be interviewed was c o m p r i s e d of 214 persons, 90 and 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 to F o u n d a t i o n T r e a t m e n t  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 , the i n t e r v i e w r e s u l t s w e r e a n a l y z e d . E x a m i n a t i o n of the r e s u l t s on 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 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 h a d i m p r o v e d to s o m e extent 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 and 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 , i t w a s found 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 . T h e s e d i f f e r e n c e s w e r e f a i r l y s m a l l i n s o m e 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 s o c i a l a c t i v i t i e s ) and w e r e l a r g e r i n o t h e r 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 ) . A n 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 that 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 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 had 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 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 t w o m a j o r d i f f e r e n c e s b e t w e e n the two g r o u p s . 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 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 a t tended 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 s i n c e F o u n d a t i o n c o n t a c t . 91 A f t e r c o n t r o l l i n g f o r these f a c t o r s , i t w a s f o u n d that the extent 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% and 15%. T h a t i s , F o u n d a t i o n t r e a t m e n t w a s found 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 15%. I V . 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 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 u s e d e a r l i e r w e r e r e -d u c e d to s i x , one i n d e x of change i n d r i n k i n g b e h a v i o u r , and f i v e i n -d i c e s of change 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. H e a l t h 2 . W o r k 3. F a m i l y r e s p o n s i b i l i t y 4. F i n a n c i a l r e s p o n s i b i l i t y 5. L e i s u r e t i m e a c t i v i t i e s T w o c a t e g o r i e s of change on e a c h i n d e x w e r e u s e d , " I m -p r o v e d " and " N o t I m p r o v e d . " T h i s p e r m i t t e d the use 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 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 . E a c h c r o s s - t a b u l a -t i o n w a s e x a m i n e d , a n d c h i - s q u a r e d v a l u e s w e r e c a l c u l a t e d . H y p o t h e s i s 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 and 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 . T h o s e w h o 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 . 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 those who d i d not . S i m i l a r l y , those w h o d i d not i m p r o v e i n d r i n k i n g be-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 change 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 that 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 had been 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 . It i s , of c o u r s e , a f u r t h e r step 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 that these 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 to one a n o t h e r . T h a t i s , i t i s c o n -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 a n d 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 p e r f o r m a n c e , f o r i n s t a n c e , 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 t w o . 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 to the c o n c l u s i o n that 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 -l a t i o n s h i p . 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 , o r w o r k , o r 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 fec t to change i n d r i n k i n g b e h a v i o u r , but i t i s a l s o u n l i k e l y that t h e s e a r e i n no i n s t a n c e r e l a t e d . The a l c o h o l i s m l i t e r a t u r e s u g g e s t s 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 f u n c t i o n i n g i n o t h e r s p h e r e s o f l i f e , e i t h e r a s c a u s e o r e f fec t . 93 T h u s i t s e e m s r e a s o n a b l e to r e g a r d H y p o t h e s i s I as b e i n g s u b s t a n t i a t e d : 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 and 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 a n d 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 as 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 about m e n t a l i l l n e s s i n g e n e r a l : W e cannot r e l y u p o n a p a t i e n t to t e l l us j u s t what i s w r o n g o r w h e r e i n h i s i n t e g r a t i o n i s f a i l i n g , . . . A p e r s o n ' 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 begun to f a i l , and 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 , and 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 j a i l . S u c h i s the c o m p l i c a t e d and 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 that 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 be-t w e e n d r i n k i n g b e h a v i o u r and 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 d i s t i n g u i s h e d , t h e r e w e r e c o n s i d e r a b l e d i f f e r e n c e s i n the s t r e n g t h of t h i s r e l a t i o n s h i p . The 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 seen 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 , and 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 to f i n a n c i a l r e s p o n s i b i l i t i e s . 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 r e s u l t s , h o w e v e r . 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 of i n t e r r e l a t i o n s h i p w e r e i n -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 , w h i c h do 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 . C e r t a i n c o n c l u s i o n s about the n a t u r e of data a v a i l a b l e s u g g e s t e d that the use of m o r e s o p h i s t i c a t e d s t a t i s t i c a l t e c h n i q u e s w a s not w a r r a n t e d . F o r one t h i n g , a s m e n t i o n e d e a r l i e r , the d e g r e e of change 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 -dent u p o n the p o t e n t i a l change w h i c h c o u l d take p l a c e i n that a r e a . A l t h o u g h i t s e e m s r e a s o n a b l e to a s s u m e that 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 , t h i s i s not 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 . F o r i n s t a n c e , 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 ye 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 a f f e c t e d 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 , o r h i s f u l f i l m e n t of f a m i l i a l r e s p o n s i b i l i t y . 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 be-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 these 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 f o r i m p r o v e m e n t i n t h e s e 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 be-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 o t h e r a r e a s s t e m 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 . E a c h i n d e x of change 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 , and 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 to one a n o t h e r . E x a m i n a t i o n of one i n d e x i n p a r t i c u l a r , change i n l e i s u r e t i m e a c t i v i t i e s , i n d i c a t e s 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 regar-ding differential degrees of relationship between change in drinking be-haviour 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 alco-holism. 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 r e l a t i o n s h i p 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 t i m e a c t i v i t i e s , t w o o t h e r f a c t o r s i n v o l v e d c o u l d m a k e p o s i t i v e c h a n g e m o r e d i f f i c u l t . T h e f i r s t f a c t o r i s t h a t a p e r s o n ' s f u n c t i o n i n g i n t h e s e s p h e r e s o f l i f e i s a r e s u l t o f 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 s o m e p e r i o d of t i m e a n d w o u l d , t h e r e f o r e , be q u i t e d i f f i c u l t t o c h a n g e . F o r i n s t a n c e , i n t h e a r e a o f 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 , a n a l c o h o l i c w h o h a s b e -c o m e o v e r a p e r i o d o f 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 o f o t h e r s , a n d v e r y i s o l a t e d s o c i a l l y , c o u l d n o t e a s i l y c h a n g e t h i s p a t t e r n e v e n i f h e w e r e t o s t o p d r i n k i n g f o r s o m e l e n g t h of t i m e . T h e o t h e r f a c t o r c o n t r i b u t i n g t o t h e d i f f i c u l t y o f e f f e c t i n g c h a n g e s i n t h e s e o t h e r a r e a s o f l i f e i s t h e d e g r e e t o w h i c h o t h e r p e r -s o n s a r e i n v o l v e d . F o r i n s t a n c e , a n u n f o r g i v i n g w i f e c a n m a k e p o s i -t i v e c h a n g e s 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 t h e r e c o v e r e d a l c o h o l i c . O n e p a t i e n t k n o w n t o t h e a u t h o r h a s a c h i e v e d s e v e r a l y e a r s ' s o b r i e t y , 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 t h e s a m e h o u s e w i t h h i m s h e s t i l l r e f u s e s t o c o h a b i t w i t h h i m o r e v e n a c k n o w l e d g e h i s e x i s t e n c e i n m o r e t h a n a p e r f u n c t o r y w a y . S i m i l a r l y , i f a n a l c o h o l i c h a s e s t a b -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 . f t e r 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 o f h e a v y d r i n k i n g , i t i s v e r y d i f f i -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 o f t h e s e f a c t o r s a n d p o s s i b l y o t h e r s i n 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 w o u l d l e a d t o d i f f e r e n t d e g r e e s o f r e l a t i o n s h i p w i t h d r i n k i n g b e h a v i o u r . T h e d a t a o f t h e p r e s e n t s t u d y w e r e not s u f f i c i e n t l y p r e c i s e to d r a w a n y c o n c l u s i o n s on 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 . F o r e x a m p l e , 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 ta ted 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 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 group) t h a n w h e n he had 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 t a b l e s 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 , but s e p a r a t e l y f o r m e m b e r s of 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 . T h i s a n a l y s i s s h o w e d that 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 a t t e n d a n c e , h o w e v e r , 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 to 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 tended 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 . B u t f o r those 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 ; 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 d e g r e e 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 t h a n j u s t s o b r i e t y p e r s e , a s i s i t s s ta ted a i m , t h e n i t a p p e a r s to be e f f e c t i v e to s o m e 98 e x t e n t i n a c h i e v i n g t h i s . V . A n o t h e r T r e a t m e n t R e s o u r c e : A l c o h o l i c s A n o n y m o u s T h e d a t a w h i c h t e s t e d t h e e f f e c t of t r e a t m e n t a t t h e F o u n d a t i o n a n d " 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 ( t h e r e s u l t o f r e g u l a r a t t e n d a n c e a t 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 o n t h e 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 . T h a t i s , e a c h s e e m s t o c o n t r i b u t e t o a n i n c r e a s e d d e g r e e o f c o r r e s p o n d e n c e 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 . It i s n o t s u r p r i s i n g t h a t t h i s i s t h e c a s e , s i n c e d e s p i t e v a r i o u s o t h e r d i f f e r e n c e s i n e m p h a s i s , c e r t a i n s i m i l a r b e l i e f s a r e h e l d b y A l c o h o l i c s A n o n y m o u s m e m b e r s a n d p r o f e s s i o n a l s e n g a g e d i n a l c o h o l i s m t r e a t m e n t . T h e p h i l o s o p h y o f 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 " a s b e i n g m o r e t h a n m e r e s o b r i e t y a l o n e . T h e r e i s a s t r o n g e m p h a s i s o n t h e c h a n g i n g o f a t t i t u d e s , a n d t h e r e f o r e o f b e h a v i o u r . T h i s e m p h a s i s 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 o f A . A . 1. W e a d m i t t e d w e w e r e p o w e r l e s s o v e r a l c o h o l - -t h a t o u r l i v e s h a d b e c o m e u n m a n a g e a b l e . 2. C a m e t o b e l i e v e t h a t a P o w e r g r e a t e r t h a n o u r s e l v e s c o u l d r e s t o r e u s t o s a n i t y . 3. M a d e a d e c i s i o n t o t u r n o u r w i l l a n d o u r l i v e s o v e r t o t h e c a r e o f G o d a s w e 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 a n d f e a r l e s s m o r a l i n v e n t o r y of o u r s e l v e s . 99 5. A d m i t t e d to G o d , to o u r s e l v e s , and to a n o t h e r h u m a n being the exact nature of our 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 defec ts of c h a r a c t e r . 7. H u m b l y a s k H i m to r e m o v e our s h o r t c o m i n g s . 8. M a d e a l i s t of a l l p e r s o n s we had h a r m e d , and b e c a m e w i l l i n g to m a k e a m e n d s to 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 such people w h e r e v e r p o s s i b l e , except when to do so would i n j u r e t h e m or o t h e r s . 10. 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 and when we w e r e w r o n g p r o m p t l y a d m i t t e d i t , 11. Sought t h r o u g h p r a y e r and m e d i t a t i o n to i m p r o v e our c o n s c i o u s contact with God as we u n d e r s t o o d H i m , p r a y i n g only f o r knowledge of H i s w i l l f o r us and the p o w e r to c a r r y that out. 1Z, H a v i n g had a s p i r i t u a l a w a k e n i n g as the r e s u l t of these s teps , we t r i e d to c a r r y this m e s s a g e to a l c o h o l i c s , and to p r a c t i c e these p r i n c i p l e s i n a l l our 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 out l ined i n these twelve steps i s the i m p o r t a n c e of put t ing a r i g h t s o c i a l r e l a t i o n -s h i p s . T h e r e i s a s t r e s s , too, on the n e c e s s i t y f o r se l f e x a m i n a t i o n with r e f e r e n c e to g e n e r a l at t i tudes to l i f e . A l t h o u g h th is 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 than would 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 such as that of the A l c o h o l i s m F o u n d a -t ion , i t c a n be seen that there is a def ini te e m p h a s i s on 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 "the whole m a n , " It should be pointed out, h o w e v e r , that the data at hand 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 these two t r e a t m e n t r e s o u r c e s , A. A. and the Foundation. E a c h seems to be effective to some degree 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 between change in d r i n k i n g behaviour and change in other a r e a s of behaviour, but no c o m p a r i s o n can l e g i t i m a t e l y be made between them. One obvious r e a s o n for the lack of c o m p a r a b i l i t y is that equal amounts of treatment f r o m each are not being compared; in fact, it would be rather d i f f i c u l t to deter-mine what would constitute equal amounts of treatment f r o m such dif-ferent therapeutic organizations. But just as each r e s o u r c e seemed to be effective i n i n c r e a s i n g the degree of r e h a b i l i t a t i o n i n the sample of patients interviewed, there appears to be a s i m i l a r effect with re-gard to the r e l a t i o n s h i p s established above. VI. Relationship 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 It was noted i n the f i r s t chapter that there had been p r e v i o u s studies which had used c r i t e r i a other than d r i n k i n g behaviour to a s s e s s improvement i n a l c o h o l i c s as a r e s u l t of treatment, and which had at-tempted to relate these changes to d r i n k i n g behaviour. Although the methodology i n each case v a r i e d , s i m i l a r findings were reported i n 3 each of the five studies cited, that change i n the other a r e a s of behaviour m e a s u r e d corresponded to change in drinking, i . e . , that i f a p e r s o n i m p r o v e d i n d r i n k i n g behaviour he was m o r e l i k e l y to im-prove i n other spheres than one who had not improved in d r i n k i n g be-4 haviour, and c o n v e r s e l y . In only one study, which has not been 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 p o s t -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 range of b e h a v i o u r tabulated a g a i n s t change i n d r i n k i n g b e h a v i o u r , as was done h e r e . T h e u n i q u e n e s s of the p r e s e n t study s tems not only f r o m the use 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 group of pat ients exposed to t r e a t m e n t i n a d i f f e r e n t sett ing, but a l s o f r o m the e x t e n s i o n of this a n a l y s i s to a c o m p a r i s o n between t r e a t e d and untrea ted p a t i e n t s , by 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 and c o n t r o l g r o u p s . It was found 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 between i m p r o v e m e n t i n d r i n k i n g and i n other b e h a v i o u r w a s m o r e l i k e l y to be p r e s e n t i n those p e r s o n s who had had 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 . In a d d i t i o n , it was found 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 have a s i m i l a r effect . 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 enabled some tentative 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 effects of t r e a t m e n t , f r o m v a r i o u s s o u r c e s , on the r e l a t i o n s h i p w h i c h had been e s t a b l i s h e d p r e v i o u s l y . V I I . G e n e r a l C o n c l u s i o n s T h e two m a j o r h y p o t h e s e s of this study have been s u b s t a n -t i a t e d . It was found that there i s a n i n t e r r e l a t i o n s h i p 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 and i n the other a s p e c t s of h i s l i fe w h i c h w e r e m e a s u r e d . 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 those c a s e s w h e r e the p e r s o n had u n d e r g o n e t r e a t m e n t 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 or A l c o h o l i c s A nonymous. It i s evident, however, that the data w h i c h were a v a i l a b l e f o r t h i s p r e s e n t study p e r m i t t e d the r e a c h i n g of only 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 o b s e r v e d that t h e r e w e re 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 depending on 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 was 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 . T h i s 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 other 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 s t e m m i n g f r o m the above c o n c l u s i o n , w h i c h c o u l d make 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 such a v a s t t o p i c a s has been 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 that any 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 would be m o r e l o n g - t e r m and s t a b l e i f a c c o m -panied by changes i n other 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 c o u l d speculate that the degree 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 reakdown than " i m p r o v e d " v e r s u s "not i m p r o v e d " as was used h e r e ) , would be g r e a t e r i n those c a s e s where there was i m p r o v e m e n t evident i n other a r e a s . A s i s so often the c a r e w i t h such r e s e a r c h a s has been u n d e r t a k e n h e r e , the number of f u r t h e r q u e s t i o n s r a i s e d out-w e i g h the number of q u e s t i o n s a n s w e r e d . 103 F O O T N O T E S : C h a p t e r 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 , The V i t a l 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), p . 9 5 . T h e i t a l i c s a r e m i n e . ^ A l c o h o l i c s A n o n y m o u s ( N e w Y o r k : A l c o h o l i c s A n o n y m o u 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 S e e f o o t n o t e s 14-18 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 Study 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 at 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. B I B L I O G R A P H Y A l c o h o l i c s Anonymous. New York: A l c o h o l i c s Anonymous W o r l d S e r v i c e s , Inc., 1955. Apple, D o r r i a n (ed. ). S o c i o l o g i c a l Studies of Health and Sickness. New York: M c G r a w - H i l l Book Company, I960. Bales, Robert F. " 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  S o c i a l Issues, I (August, 1945), 14-22. Beeley, A. L. " A l c o h o l i s m , S o c i a l Work, and M e n t a l Hygiene, " Mental Hygiene, XLIII (October, 1 9 5 9 ) , 577-582. C l i n i c a l P r a c t i c e and Community Ed u c a t i o n on A l c o h o l i s m : A Re s e a r c h  Report on the P r o g r a m of the Connecticut 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 : Connecticut C o m m i s si o n on A l c o h o l i s m , 1959. Davies, D. L. " N o r m a l D r i n k i n g in R e c o v e r e d A l c o h o l A d d i c t s , " Q u a r t e r l y J o u r n a l of Studies on A l c o h o l , XXIII (March, 1962), 94-104. Durfee, C h a r l e s H. T o D r i n k or Not to D r i n k . New York: Longmans, Green, and Co. , 1938. Gibbins, R. J . and 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 Behaviour 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  Studies on A l c o h o l , XVIII (September, 1957), 429-450. H a l l , C a l v i n S. and Gardner Lindzey, T h e o r i e s of P e r s o n a l i t y . New York: John W i l e y and Sons, 1957. Jackson, M. J. "A Study of the R e l a t i o n Between D r i n k i n g Behaviour and 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 Sample 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 Toronto, Toronto, 1958. K e l l e r , Mark. "The D e f i n i t i o n of A l c o h o l i s m and the E s t i m a t i o n of Its P r e v a l e n c e . " Society, Culture, and D r i n k i n g Patterns, ed. David J . P i t t m a n and C h a r l e s R. Snyder. New York: John Wi l e y and Sons, 1962. 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 . T h e V i t a l  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. R o b s o n , R e g i n a l d A . H . , 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 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 Se 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 at 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 . 9 8 - 1 1 6 . S c h m i d t , W o l f g a n g . " A Study 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 and 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 . " U n p u b l i s h e d 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 , 1957. " 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 and  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. S i m m o n s , L e o W . and 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 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 , 1954. 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 . ) V o g e l 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 , 1957), 3 0 2 - 3 0 9 . 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 , S e c o n d 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). A P P E N D I X A A D D I T I O N A L T A B L E S T A B L E 12: Percentage D i s t r i b u t i o n s of Selected Matched 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 Groups and C o m p a r i s o n with I960 Intake Group Age Group M a r i t a l Status Occupation Employment Status 21-30 31-40 41 - 50 51 - 60 60+ Single Married Separated Divorced Widowed Common Law Professional White Collar Skilled Unskilled Unemployed Employed C o n t r o l and Exp e r i m e nta 1 N = 100 each % of I960 Intake 8 45 27 20 -8 36 32 20 4 19 52 24 3 2 (not reported) 23 56 21 3 19 54 24 58 42 61 39 108 T A B L E 13: Comparison of Chi-Squared Values for Tabulations of Four Indices of Change in Drinking Behaviour Against Change in the Area of Work Index Experimental Control Total Drinking problem -- IA 16. 2 14. 5 28. 1 Abstinence 4.. 3 ( 0.6)* 4.6 Liquor offences ( 3. 1) ( 3.2) ( 0.2) Composite index 10. 0 4. 8 14. 5 ^Figures in parentheses indicate a non-significant distribution, taking the . 05 level of significance. T A B L E 14: Comparison of Chi-Squared Values for Tabulations of Four Indices of Change in Drinking Behaviour Against Change in the Area of Family Responsibility  Index Expe rim e ntal Control Total Drinking problem - - IA 13. 0 7. 3 19. 3 A bstine nee ( 3.5)* ( 0.5) ( 0.2) Liquor offences 7. 0 ( LO) ( 2.6) Composite index 6. 4 4. 6 10. 8 *Figures in pa re nthe se s indicate a non-significant distribution, taking the .05 level of significance. 109 T A B L E 15: 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 L e i s u r e T i m e A c t i v i t i e s Index E x p e r i m e n t a l C o n t r o l . T o t a l D r i n k i n g p r o b l e m - - IA 43. 5 26. 3 72. 3 Abstine nee 30. 4 ( 2.6)* 27. 1 L i q u o r offences ( 1.0) ( 1.7) ( 0.2) Composite index 34. 4 16. 7 50.0 ^ F i g u r e s i n parentheses indicate a non-significant d i s t r i b u t i o n , taking the . 05 l e v e l of s i g n i f i c a n c e . T A B L E 16: In 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 DRINKING B E H A V I O U R WORK Improved Not Improved T o t a l Improved 27 (19)* 67 (75) 94 Not Improved 2 (10) 51 (43) 53 T o t a l 67 80 147 = 11.8**: d.f. 1: p< . 001 *Expected f r e q u e n c i e s i f the null hypothesis were true a r e enclosed i n parentheses. 2 **X values for this table were computed u s i n g a fo r m u l a incor-p o r a t i n g 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 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 F a m i l y R e s p o n s i b i l i t y f o r A l l S u b j e c t s  F A M I L Y R E S P O N S I B I L I T Y D R I N K I N G B E H A V I O U R I m p r o v e d Not I m p r o v e d T o t a l I m p r o v e d 41 (34)* 20 (27) 61 N o t I m p r o v e d 7 (14) 18 (11) 25 T o t a l 48 38 86 9 , 5 * * : d.f. 1: p < . 0 1 * 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 e n c l o s e d i n p a r e n t h e s e s , 2 * * X v a l u e s f o r t h i s tab le w e r e c o m p u t e d 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 Y a t e s 1 c o r r e c t i o n f o r c o n t i n u i t y , I l l T A B L E 18: 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 and C h a n g e 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 S u b j e c t s F I N A N C I A L R E S P O N S I B I L I T Y D R I N K I N G B E H A V I O U R I m p r o v e d N o t I m p r o v e d T o t a l I m p r o v e d 14 (10)* 82 (86) 96 N o t I m p r o v e d 1 ( 5) 51 (47) 52 T o t a l 15 133 148 = 4 - 6 * * : d . f . 1: p < . 0 5 ^ 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 e n c l o s e d i n p a r e n t h e s e s . * * X ^ v a l u e s f o r t h i s tab le w e r e c o m p u t e d 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 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 . 112 T A B L E 19: 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 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 L E I S U R E T I M E A C T I V I T I E 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 d Not I m p r o v e d T o t a l I m p r o v e d 76 (56)* 18 (38) 94 N o t I m p r o v e d 12 (32) 42 (22) 54 T o t a l 88 60 148 X 2 . = 46 . 5 * * : d . f . 1: 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 e n c l o s e d i n p a r e n t h e s e s . 2 * * X v a l u e s f o r t h i s t a b l e w e r e c o m p u t e d 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 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 . A P P E N D I X B T H E I N T E R V I E W S C H E D U L E Key t o Q u e s t i o n s I C o n t r o l F a c t o r s 1 . S o c i o - e c o n o m i c : 2. M o t i v a t i o n : 3 . S e v e r i t y , o f p r o b l e m : 4'. T r e a t m e n t o t h e r t h a n a t t h e F o u n d a t i o n : I I E x t e n t o f R e h a b i l i t a t i o n 1 . D r i n k i n g b e h a v i o u r : 2. H e a l t h : 3 . W o r k : 4 . F a m i l y : 5 . S o c i a l a c t i v i t i e s : 6 . I n s i g h t : 7 . Summary : I I I T r e a t m e n t a t t h e F o u n d a t i o n f a c e s h e e t , 3 7 , 40 , 44 4 , 5 , 6 , 7 , 8, 10 2 1 , 2 2 , 2 3 , 30 , 3 5 , 4 2 , 4 6 , 7 0 , 7 4 , 7 7 , 7 9 , 81 83 1 9 , 2 0 , 34 1 8 , 2 5 , 2 6 , 2 7 , 30 , 3 1 , 35 , 36 , 86 13 , 1 4 , 1 5 , 1 6 , 1 7 , 3 2 , 33 , 84 37 , 38 , 39 , 4 0 , ^ 1 , 4 2 , 43 , 4 4 , 4 5 , 4 6 , 4 7 , 85 48 , 4 9 , 5 2 , 53 , 63 , 6 4 , 65 , 66 , 6 7 , 68 , 69 , 7 0 , 73 , 7 4 , 7 5 , 7 6 , 7 7 , 7 8 , 79 , 80 , 8 1 , 8 2 , 83 , 89 , 90 50 , 5 1 , 5 4 , 55 , 56 , 5 7 , 58 , 59 , 6 1 , 6 2 , 8 7 , 88 7 1 , 7 2 , 91 92 IV D e s c r i p t i v e I n f o r m a t i o n f o r t h e F o u n d a t i o n 1 , 2 , 11 , 12 , 28 , 29 , 93 1. PART I INTERVIEW SCHEDULE FACE SHEET 001 Code: Group 0. No answer 1. Experimental 2. Control 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 Period 0. No -answer 1. 1961 2. 1960 3. ' 1959 00 7 Code: Age • 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: Marital Status 0. No answer 1. Single 2. Married 3. Common Law 4. Separated 5. Divorced 6. "Widowed 7. Married more than once 009 Code: Religion 0. No answer 1. Protestant 2. Catholic 3. Other or no r e l i g i o n 11. 010 Code: Occupational Category 0. No answer 1. Professional 2. White Collar 3. S k i l l e d 4. Unskilled 5. Unemployable 011 Code: Occupational Status 0. No answer 012 Code: 1. Employed 2. Unemployed 3. Unemployable, pensioned, etc, Education 0. No answer 1. Less than 8 years 2. 8 - 1 1 3. 12 - 13 4. University 013 Code; Family History of Alcoholism 0. No answer 1. Yes 2. No 014 Code Court Record 0. No answer 1. Yes 2. No 015 Code Source of Referral 0. No answer 1. Physician 2. Wife, r e l a t i v e s or friends 3. A. A. 4. Ex-patient 5. Self 6. Oakalla or P . M . H . 7. Social Assistance 8. Employer 9. Other Treatment at Foundation (for check) No From-To a. Medical b. Counselling • ^_ c. Residence d. Group Therapy e. Psychiatric Eval. f. Antabuse or Temp. 1. PART II I. CONTACT WITH FOUNDATION AND OTHER RESOURCES (1) F i r s t I would l i k e to ask you a few questions about your contact 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 did you fin d out that there was such a place as the Foundation? 016 Code: How patient heard about Foundation? (1) 0. No answer 1. Physician 2: Wife or parents 3. Other r e l a t i v e s or friends 4. A. A. 5 . Ex-patient 6. Advertisement 7. Other (2) You heard about the Foundation for 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 actually came to the Foundation; that i s , d i d some-one introduce you to them, did someone recommend you go there, or what happened? 017 Code: How patient came to Foundation? (2) 0. No answer 1. Physician 2. Wife, r e l a t i v e s or friends 3. A, A, 4. Ex-patient 5. S e l f - r e f e r r a l 6. Oakalla S P.M.H. 7. Social Assistance 8. Employer 9. Other (3) When was this? i 2. C+) Could you t e l l me some of your reasons for coming to the Foundation? Areas of personal concern: Seriousness of Condition Areas Mild Threat Severe Threat Mild Dis-integration Severe Dis-integration a. Work b. Family c. Phys. Health d. Emot. Health e. Other ( 5 ) In addition to these reasons, what pressures were put upon you to come to the Foundation? a. None b. Specify Degree of Pressure Source Slight- Moderate Severe a. Wife b. Employer c. Social Asst. d. Other Welfare Agencies e. Probation Of f i c e r f. Other 3. 018 Code: interviewer's assessment of degree of s e l f - i n s t i g a t i o n (4 S 51 0. No answer 1. None, apart from external pressures 2. Slight (some awareness, but pressures mainly external) 3. Moderate ( r e l a t i v e l y equal s e l f - and other-pressures 4. Great (only s l i g h t external pressures) 5. Complete (no external pressures) (6) You have given me some of your reasons for going to the Foundation; could you now t e l l me what you expected to hap-pen at the Foundation? ; (probe) 019 Code.: Interviewer's assessment of attitudes (6) 0. No answer 1. Manipulative (was looking for handout, etc.) 2. U n r e a l i s t i c (was looking for "magical" solution) 3. Neutral (did not know - - no e x p l i c i t expectations) 4. R e a l i s t i c ( w i l l i n g to "do his part") 7) How much did you r e a l l y think the Foundation would be able to help you with your alcohol problem? 0 2 0 Code: Extent of help expected (7) 0. No answer 1. To a great extent 2. To some extent 3. To no extent 4. (6) At the time you f i r s t contacted the Foundation, suppose the doctor or counsellor had suggested you be admitted to a Provincial Hospital for a s p e c i f i c drying out period, of, let ' s say,'30 days; would you have been w i l l i n g to accept this as part of your treatment? a. Yes b. No If no, for what reasons: a. Involved i n other treatment (h) b. Could not leave work (h) c. Could not leave family (h or 1 - probe) d. Important persons did not want me to go to such a place (1) 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 (neutral) g. Thought they could not help me (1) h. Would not l i k e to go to such a place because of "stigma" (1) i . Had heard too many adverse reports about such a place (1) j . Did not want to be associated with persons at such a place (1) k. Did not think my problem was big enough to warrant treatment (1) 1. Other 021 Code: Interviewer's assessment of motivation (8) 0. No answer 1. High (yes, or no because, of physical i m p o s s i b i l i t y ) 2. Low (no for other reasons) 5 (9) Could you now t e l l me what kind of treatments you received at the Foundation. Treatment: Year Period Number of Treatments a. Medical b, Counselling c. Psychiatric d. Residence. • . e. Group Sessions f. Antabuse or Tempos!1 X i 02 2 Code: Length of Treatment (9) 0. No answer 1. Less than 2 weeks 2 . 2-4 weeks 3. 1-3 months 4, 4-6 months 5 , 6-12 months 6 . over 12 .months Code: Type and Number of Treatments (9) 0. 1. I 2 . 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. A. None 1-4 5-9 10-14 15-19 20 S over 028 Antabuse N.A. None under 2-4 1-3 4-6 6 mos . or Temp. 2 wks wks mos mos £ over 6 . (10) (Most people aft e r they have been i n treatment for some time) (Some people aft e r thet have come to the Foundation once or twice) stop coming for a variety of reasons. For instance, some move away, some return to t h e i r old place' of work, while some others f e e l they (have benefited enough) (could not benefit) from the programme offered. I wonder, could you t e l l me what prevented you from (continuing treatment) (undergoing treatment)? a. S t i l l i n treatment (1) b. Counsellor f e l t intensive treatment no longer needed (L) c. Leaving town - work reasons (L) d. Leaving town - family reasons (L or F - probe) e. Could not get time off work (L or F - probe) f. Important persons did not l i k e my coming (L or F - probe) g. Was inconvenient to t r a v e l to c l i n i c (F) h. Thought I had benefited enough (Could not benefit) (F) i . Did not l i k e services offered (If pt. went to other place L, i f not F) j . Did not l i k e c l i n i c personnel (F) k. Did not think my problem was big enough to need treatment (F) 1. Did not l i k e to come without paying b i l l (F) m. Other 029 Code: Reasons for Stopping Treatment (10) 0. No answer 1. S t i l l i n treatment 2. Legitimate reasons for stopping treatment 3. Fabricated excuses for stopping treatment (11) (12) (11) 030 031 032 033 034 035 Most people who come to the Foundation at one time or another have certain feelings about the helpfulness of the kind of treatment they received. 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? F i r s t , the treatment i t s e l f , apart from the people who gave i t Code: Patient's Feelings re Treatment (11) 0. 1. 2 . 3. 4. No Very Somewhat Not Not'' Answer Helpful Helpful Helpful Applicable 7. Medical Counsel. . Psychiat, Interview Residence Group Sessions , Antabuse or Temp. Could you give me some of your reasons for saying this? (12) 036 037 038 039 040 When you came to the Foundation you probably met a variety of people. What were your feelings about them? Code: Feelings re People (12) 0 . No Answer 1. Very Helpful 2 . Somewhat 3 . Not 4. Not Doctor Counsellor P s y c h i a t r i s t Housekeeper C l e r i c a l S:• Could you explain why you say this? 8 . (13) Could you look back to the time before you came to the Foundation, and t e l l me something about your general physical health? Did you suffer from: Yes No Details Frequency Duration Severity a. Headaches b. Gen. Fatigue c. Sleeplessness d. Stomach Upsets e. Sudden Weight Changes f. Liver Disease g« Acute Illnesses h. Chronic I l l n . i . Symptoms assoc. w, heavy drinkg. Blackouts Shakes Halluzinations D. T's. Convulsions Head Injuries 0 41 Code: Patient' s Assessment (13) (see page 13) 042 Code: Doctor's Assessment of physical health T l (13) o. No answer 1. Very good 2 . Good 3, Poor 4. Very poor 9 . (14) Now I wonder i f you could also t e l l me a few things about your emotional health at the time you came to the. Foundation. Were you bothered by: Yes No Details Frequency Duration Severity a. Nervousness b. Tensions c. Worries Anxieties & Fears d. Unmanageable Moods (Depres-sions , etc.) e. Restlessness f. Loss of o r i -entation (Explain) Other 043 Code: Patient's Assessment (.14) (Seepage 13) 044 Code: Doctor's Assessment of emotional health T l (14) 0 . No answer' 1. Very good 2. Good 3. Poor 4. Very poor 10. (15) A t the present time do you suffer from: Yes No Details Frequency Duration Severity a. Headaches b. Gen. Fatigue c. Sleeplessness d. Stomach Upsets e. Sudden Weight Changes f. Liver Disease Acute Illnesses h. Chronic I l l n . . i . .Symptoms assoc. w. heavy drinkg. Blackouts Shakes Hallucinations D.T's. Convulsions Head Injuries 045 Code: Patient's Assessment (15) (See page 13) 0 46 Code: Doctor's Assessment of physical health T2 (15) 0. No answer 1. Very good 2. Good 3. Poor 4. Very poor (16) At the present time, are you bothered by: Yes No Details Frequency Duration Severity a. Nervousness b. Tensions c. Worries, Anxieties S Fears d. Unmanageable Moods (Depres-sions , etc.) e. Restlessness f\ Loss of o r i -entation (Explain) g. Other 04-7 Code: Patient's Assessment (16) (See page 13) 048 Code: Doctor's Assessment of emotional health T2 (16) 0. No answer 1. Very good 2. Good Poor 4. Very poor 0 49 Code: Patient 4s Assessment of Change i n Health 050 (13 £ 15) (14 £ 16) (See page 13) 12. Doctor's Assessment 051 Code: Assessment of change i n Physical Health (13 S 15) 0. No answer 1. Much better 2. Somewhat better 3. Same 4. Somewhat worse 5. Much worse 052 Code: Assessment of change i n Emotional Health (14 & 16) 0. No answer 1. Much better 2. Somewhat better 3. Same 4. Somewhat worse 5. Much worse 0 53. Code: Assessment of relationship between present drinking behaviour and change i n physical and emotional health. (13, 14, 15, 16) 0. No answer 1. To a great extent 2. To some extent 3. To no extent 13. Patient's Assessment 041 Code: Assessment of Physical Health at T l (13) 0. No answer 1. Very good 2. . Good 3. Poor 4. Very poor 0 4 3 Code: Assessment of Emotional Health at T l (14) 0. No answer 1. Very good 2. Good 3. Poor 4. Very poor 045 Code: Assessment of Physical Health at T2 (15) 0. No answer 1. Very good 2. Good 3. Poor 4. Very poor 047 Code: Assessment of Emotional Health at T2 (16) 0. No answer 1. Very good 2. Good 3. Poor 4. Very poor 0 49 Code: Assessment of Change i n Physical Health (13 S 15) 0. No answer 1. Much better 2. Somewhat better 3. Same 4. Somewhat worse 5. Much worse 0 50 Code: Assessment o f Change i n Emotional Health (14 $ 16) 0. No answer 1. Much better 2. Somewhat better 3. Same 4. Somewhat worse 5. Much worse 14. 054 Code: Change in Physical Health (T1-T2), Patient's Assessment (13 S 15) 0. 1. 2. 3. 4. 5. 6. 7. No ans.+3 +2 +1 0 -1 -2 -3 055 Code: Change i n Emotional Health (T1-T2), Patient's Assessment (14 £ 16) 0. 1. 2. 3. 4. 5. 6. 7. No ans. +3 +2 +1 0 -1 -2 -3 056 Code: Change i n Physical Health (T1-T2), Doctor's Assessment (13 £ 15) O i l . 2. 3. 4. 5. 6. 7. No ans. +3 + 2 + 1 0 -1 -2 -3 057 Code? Change i n Emotional Health (T1-T2), Doctor's Assessment (14 S 16) 0. 1. 2. 3. 4. 5.. 6. 7. No ans. +3 +2 +1 0 -1 -2 -3 (17) To what extent dc you think that your f e e l i n g . . . . now has something to do with your present drinking behaviour? 058 Code.: Patient's Assessment of relationship between drinking and health (17) 0. No answer 1. To a great extent 2. To some extent 3. To no extent (18) To what extent i s drinking presently a problem to you as compared to the time you f i r s t came to the Foundation? 0 59 Code: Patient's Assessment of Change i n Drinking Problem (18) 0. No answer 1. Much more severe problem 2. More severe problem 3. Same problem 4. Less severe problem 5. Much less severe problem 6. No problem (19) (20) (19) 060 061 062 (20) 063 064 065 Other than the Foundation, have you ever gone to a doctor or any other agency or place regarding problems with alcohol: Treatment Before T 1 a, Yes If Yes: b. No c. Don't remember/No answer a. Priv. Hosp. (Holwd) b. Gen, Hosp. (det. svs.) c. Prov.' Hosp, (Al. Ward) d. Private Physician e. Clergyman f. Therapist (Ind.or Grp) g. A. A. Code: Treatment before Tj (19) Year Period No, of Treatments 1 „ I j 0, 1. 2 . No answer None Very l i t t l e Moderate Extensi In-patient (a-c) Out-patient (d-f) A. A. (g) 1 1-5 1-5 2-3 4 or more 6-10 11 or more 6-10 11. or more Treatment between T-| and T, a. Yes b. No c Don 1 1 remeir her/No ans If Yes: Year Period No o.t Treatments; a. Priv. Hosp, (Holwd) b. Gen, Hosp. (det, svs,) c. Prov, Hosp, (Ale Ward) d, Private Physician e. Clergyman j f. Therapist (Ind., or Grp) g. A, A . Code: Treatment between T^ £- T 9 (20) 0. 1. No answer None 2 . 3 .. Very l i t t l e Moderate 4 „ Extensive In-patient (a-c) 1 2-3 4 or more Out-patient (d-f) 1-5 6-10 11 or more A . A, ( 1-5 6-10 .11 or more 16. II DRINKING HISTORY A. Drinking (21) You came to the Foundation because thought the Foundation might be help f u l to you. Did you at that time con-sider your drinking a problem? a. Yes b. No How serious did you think i t was? Perhaps you could t e l l me a l i t t l e more about this? 066 Code: Insight into extent of problem at T-^  (21) 0. No answer 1. Serious problem 2. Moderate problem 3. No problem (22) I f problem: Since when did you consider your drinking a problem? 067 Code: Length of drinking problem (22) 0. No answer 1. Under 1 year 2. 1 - 2 years 3. 3 - 5 years 1. 6 - 1 0 years 5. Over 10 years 17. (23) Now I would l i k e to ask you two things: 1. What did you think were some of the reasons for your drink-ing at the time you f i r s t came to the Foundation? and (24) 2. What do you now think some of your reasons were. (23) What did you think your.reasons were at the time you came to the Foundation? Elaborate: (24) What do you now think some of your reasons were? 068 Code: Interviewer's assessment of patient's i n s i g h t , T]_ (23) 0. No answer 1. Great insight 2. Slight insight 3. No insight 069 Code: Interviewer's assessment of patient's i n s i g h t , T 2 (24) 0. No answer 1. Great insight 2. Slight insight 3. No insight 070 Code: Change 0. 1. 2. 3.' 4. 5. No answer +2 + 1 0 -1 -2 18. (25) I'd now l i k e to ask you a few things about your drinking pattern, both at the time you came to the Foundation and at the present. (26) In order to help you describe i t , I have a few s p e c i f i c questions (25) F i r s t , around the time you came to the Foundation: A. With whom: a. So l i t a r y b. Group c. Both B. Where: a. At home b. Outside home c. Both C. When: a. Daily b. Weekends c. Periodic D. Mornings: a. Never b. Seldom c. Frequently-E. What: a. Hard liquor b. Beer c. Wine d. Commercial products F. Quantity: G. To what extent: a. S l i g h t l y intoxicated b. Drunk c. Unconscious H. Consequences: a. Blackouts b. Shakes c. Hallucinations d. D. T.»s e. Convulsions Other Details: 1 9 . (26) What i s your drinking pattern now? f\. With whom: a. Sol i t a r y b. Group c. Both B. "Where: a« At home b. Outside home c. Both When: a. Daily b. Weekends c. Periodic D. Mornings: a. Never b. Seldom c. Frequently E . What: a. Hard liquor b. Beer c, Wine d. Commercial products F. Quantity: O « To what extent: a. S l i g h t l y intoxicated b. Drunk c. Unconscious Consequences: a, Blackouts b. Shakes c. Hallucinations d. D. T's e. Convulsions 1. Completely sober Other Details: 0 71 Code: Interviewer's assessment of change i n drinking problem (25 S 26) 0. No answer 1. Much more severe problem 2. More severe problem 3. Same problem 4. Less severe problem 5. Much less severe problem 6. No problem (completely sober) 20. (27) How would you compare your drinking problem now with that you had at the time you came to the Foundation? 072 Code: Patient's assessment of own drinking problem (27) 0. No answer 1. Much more severe problem 2. More severe problem 3. Same problem 4. Less severe problem 5. Much less severe problem 6. No problem (28) I f changes, what would you say has mainly brought about these changes ? Code: Patient's assessment of most important agent of change (28) 0. No answer 1. In-patient treatment other than Foundation 2. Out-patient treatment other than Foundation 3. A. A. 4. Foundation 5. Self 6. Wife, family 7. Other 8. Not applicable (29) I f changes, what would you say was next most important? 0 74 Code: Patient's assessment of second most important agent of change (29) 0. No answer 1. In-patient treatment other than Foundation 2 . Out-patient treatment other than Foundation 3 . A. A. 4. Foundation 5. Self 6 . Wife, family 7. Other 8. Not applicable If others how did these help? If s e l f , how have these changes come about? 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 periods of complete abstinence you have had since then? (That i s s t a r t i n g i n January 19 55) From To Length (wks) Reasons (look for enforcement) 075 (N.B:) Complete abstinence means periods of at least one week without drinking. Mark d i v i s i o n between T]_ S T o . Code: No. of weeks abstinent during a 6-month period before (30) 154 Code:  0. No answer 1. None 2. 1-4 3. 5-9 4. 10-14 5 . 15-19 6. 20 S over No. of weeks 0. No answer 1. None 2 . 1-4 3. 5-9 4. 10-14 5. 15-19 6. 20 £ over Change 0 76 Code: f abstinent during a 6-month period before Tj (31) 0. 1. 2. 3. 4. 5. 6. 7. 8. 9. No answer +4 +3 +2 +1 0 -1 -2 -3 -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 , etc., to help you stop drinking? a. Yes b. No If Yes , a. Of what kind and type was the medication? b. How often did you take i t ? c. Who prescribed i t ? d. When was this? (33) Do you now take drugs of any kind? a. Yes b. No If yes, a. Of what kind and type are they? b. How often do you take them? c. Who prescribes these drugs for you? d. Why do you take these drugs? e. Are they necessary for you to stay sober? a. Yes b. No 077 Code: Interviewer's assessment of patient's use of drugs at T 0 (32 £ 33) 0. No answer 1. Takes no drugs 2. Takes t r a n q u i l l i z e r s occasionally 3. Takes t r a n q u i l l i z e r s routinely, but i s not dependent 4. Dependent on t r a n q u i l l i z e r s 5. Dependent on other drugs (34) Have you ever taken Antabuse or Temposil including the A. or T. you took at the A. F. ( i f applicable) 0 78 Code: Patient's use of Antabuse or Temposil (34) 0. No answer 1. Yes 2. No 23. D. Court Record (35) Have you ever been arrested? (36) a. Yes b. No If yes, (If over 10 arrests, l i s t only major offences and No. of liquor offences i n 6-month periods preceding and T 2 ) Date Charge Drinking Involved Penalties Yes No (N.B: Mark d i v i s i o n between T1 £ T 2) 079 Code: No. of offences T l (35) 0. No answer 1. None 2. 1-2 3. 3-5 "4. 6 and over 080 Code: No. of offences T2 (36) 0 . No answer 1. None 2 . 1-2 3. 3-5 4. 6 and over 155 Code: Change 0. 1. 2. 3. 4. 5. 6. 7. No answer +3 +2 +1 0 -1 -2 -3 0 81 Code: I d e n t i f i c a t i o n and Card No. 085 I l l WORK HISTORY (37) (38) (39) What i s your usual occupation As what are you employed Since when? at the moment? Spe c i f i c Occup. Specific Occup. a. Prof. Prof. b. W. C. W. C. c. S k i l l e d S k i l l e d d. Unsk. Unsk. e. Unemploy- Unemploy-able (why) able (why) Unemployed 0 86 Code: Employment status T 2 (38 S 39) 0. No answer 1. Employed 2. Unemployed 3. Unemployable, pensioned, etc. (40) (41) At the time you f i r s t came to the How long have you held this Foundation, as what were you em- job? ployed then? a. Professional b. White Collar c. S k i l l e d d. Unskilled e. Unemployable (why)_ f. Unemployed 0 87 Code: Employment Status T± (40 £- 41) 0. No answer 1. Employed 2. Unemployed 3. Unemployable, pensioned, etc 159 Code: Change 0. 1. 2. 3. NA +1 0 -1 25. (42) I have already asked you about your occupation at the present and at the time you came to the Foundation. Could I now ask (43) you for a b r i e f rundown of your employment history. (42) Before Foundation Contact From To Type of Job Reasons for' Changing • Getting along with fellow workers S boss Sa t i s f a c t i o n was job i n accordance with a b i l i t i e s -(N.B.) If eight or more jobs held, l i s t only major ones and number held of others) 26. (43) After Foundation Contact From To Type of Job Reasons for Changing Getting along with fellow workers £ boss Satisfaction -was job i n accordance witi a b i l i t i e s ( 4 4 ) How many years of schooling did you have: ( 4 5 ) Have you had any sp e c i a l vocational training? Elaborate: 27. (46) How would you evaluate your own s a t i s f a c t i o n regarding your work experience before you contacted the Foundation? 0 88 Code: Patient's evaluation of work experience before T-j_ (46) No answer Very s a t i s f a c t o r y Satisfactory Unsatisfactory Very unsatisfactory State Reasons 0. 1 X • 2. 3. 4. (47) How would you rate your work s a t i s f a c t i o n since you came to the Foundation? 0 89 Code: Patient's evaluation of work experience after T-^  (47) 0. No answer 1. Very s a t i s f a c t o r y 2. Satisfactory 3. Unsatisfactory 4. Very unsatisfactory State Reasons 0 . 1. 2-. 3. 4. 090 Code: Change No answer +3 +2 +1 0 5 . 6. 7. -2 -3 28. 091 Code: Interviewer's Assessment of Employment S t a b i l i t y before ~ T X (37, 40, 41 8 42) 0. No answer 1. Very stable 2. Stable 3. Unstable 4. Very unstable (1 maj. occupation with few changes and without periods of enemployment.) (1-3 maj. occupations, but several d i f f e r e n t jobs held within each one.) (Several maj. occupations, many d i f -ferent jobs, many shorter periods of unemployment.) (No maj. occupation, many d i f f . jobs, many prolonged periods of unemployment. 092 Code: Interviewer's Assessment of Employment S t a b i l i t y a f t e r Tj_ (37, 38, 39 £ 43) 0. No answer 1. Very stable 2. Stable 3. Unstable 4. Very unstable 09 3 Code: Change 1. No answer +3 2. + 2 3 . + 1 4, 0 5 . -1 -2 7. -3 094 Code: Interviewer's assessment of appropriateness of jobs held in 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. No answer 1. Appropriate 2. Not appropriate 09 5 Code: Interviewer's assessment of appropriateness of jobs a f t e r T-j_ (37, 38, 43 £ 45) 0. No answer 1. Appropriate 2. Not appropriate 096 Code: Change 0. 1., 2. 3. No answer +1 0 -1 29. 097 Code: Interviewer's Assessment of Relationships with fellow workers and boss before T-^  (4-3) 0. No answer 1. Good 2. Poor 098 Code: Interviewer's assessment of relationships with fellow workers and boss aft e r Tj_ (44) 0. No answer 1. Good 2. Poor 099 Code: Change 0, 1. 2. 3., No answer +1 0 -1 100 Code: Interviewer :s o v e r a l l comparison of patient's working history from before T i to aft e r T-, , taking into consideration: (a) S t a b i l i t y , ('bt Appropriateness of job, (c) Relationships on job, (d) Patient's assess-ment of work s a t i s f a c t i o n . 0. No answer 1. Greatly improved 2. Improved 3. No change 4. Deteriorated 5. Greatly deteriorated 30. IV FAMILY HISTORY A. General I would now l i k e to ask you a few questions regarding your family and l i v i n g arrangements. (For the following 4 questions do present f i r s t , then go back and ask about past) What i s your present marital status? Present (48) Past (49) a. Single a. Single b. Married b. Married c. Common-law c. Common-law d. Separated di Separated e. Divorced e. Divorced f. Widowed - f. Widowed In what type of accommodation are you presently l i v i n g ? Present (50) Past (51) a. Own house a. Own House b. Parent's accommodation bi Parent's accommodation c. Rented house c. Rented house d. Apartment or suite d. Apartment or suite e. Rooming or Boarding house e. Rooming or Boarding house f. Hotel f. Hotel g. Other Other With whom are you l i v i n g at this place? Present (52) Past (53) f. g. h. b. d. a. e. c. Wife £ Children Wife only Children only Parents Other r e l a t i v e s Friends Alone Other f g h b d a c Wife S children Wife only Children only Parents Other r e l a t i v e s Friends Alone Other 31. Who i s presently paying for the place i n which you are li v i n g ? Present (54) Past (55) a. Self a. Self b. Wife b. Wi f e c. Self S Wife c. Self S Wife d. Parents and/or other r e l . d. Parents and/or other r e l . e. Friends e. Friends f. S. A. f. S. A. g. Other g. Other Could you now look back to the time just immediately before you came to the Foundation and t e l l me What your marital status then was? In what, type of accommodation you were then l i v i n g ? With whom ycu were then l i v i n g ? Who was then paying for the accommodation? Roughly into what category does your own personal income f a l l at the present time? Into what category did your personal income f a l l at the time you came to the Foundation? Present (56) Past (57) a. Under $1,000 a • Under $1,000 b. 1,000 - 1,499 b. 1,000 - 1,499 c. 1,500 - 1,959 c. 1,500 - 1,999 d. 2,000 - 2 ,499 d. 2,000 - 2,499 e. 2,500 - 2,999 e. 2,500 - 2,999 f. 3,000 - 3,999 f. 3,000 - 3,999 g- 4,000 - 4,999 4,000 - 4,999 h. 5,000 £ over h. 5,000 S over 32. (58) At the present time, does someone help you to meet your f i n a n c i a l needs? That i s , does your wife work, do you have outstanding loans, etc. (59) At the time you came to the Foundation, did someone help you to meet your f i n a n c i a l needs? (Probe) Present (58) Past (59) a. No one a. No one b. Wife (work) b. Wifa (work) c. Wife (independent income) c. Wife (independent income) d. Parents d. Parents e. Children e. Children f. Other r e l a t i v e s or friends f. Other r e l a t i v e s or friends g. Loans of any kind g. Loans of any kind h. Unemployment Ins. h. Unemployment Ins. i . S o cial Assistance i . S o cial Assistance j • Other j • Other Reasons: (probe) (60) During the time you went to the Foundation, what was the re-action of your family members or closest friends to your going there; that i s , how did they support you emotionally? Elaborate: 101 Code: Patient's assessment of support received (60) 0. No answer 1 , Strong support 2. Mild support 3. Neutral 4. Opposition 33. Interviewer's Assessment 102 Code: Marital Status (48 £ 49) taking into consideration (75) as well. 0. No answer 1. Improved (was separated, now reconciled; was separated, now divorced because wife's behaviour was detrimental to rehabi-l i t a t i o n l i v e d common-law, now married) 2. Same or (no value judgement involved - was "neutral" widowed, now remarried was single, change now married was divorced, now re-married) 3. Deteriorated (was married, now separated due to drinking, was married, now divorced due to man's drink., was married or divorced, now l i v i n g c l . ) 103 Code: Accommodation (50 £ 51) 0. No answer 1. Improved (value judgement - better quali t y , movement from non-ownership to ownership) 2. Same or (no value judgement) "neutral" chinge 3. Deteriorated (value judgement - poorer quali t y , movement from ownership to non-ownership ) 10 4 Code: Living with whom (52 S 53) 0. No answer 1. Improved (value judgement - applies to married men mostly) 2. Same or (no value judgement) "neutral" change 3. Deteriorated (value judgement - applies to married men mostly) 34. 10 5 Code: Who i s paying for accommodation (54 S 55) 0. No answer 1. Improved (value judgement - was unnecessarily dependent, now independent) 2. Same or (no value judgement "neutral" change 3. Deteriorated (value judgement - was independent, now unnecessarily dependent) 105 Code: Personal Income (56 £ 57) 0. No answer 1. Improved (value judgement - marked upward change) 2. Same or (no value judgement "neutral" change 3. Deteriorated (value judgement - marked downward change) 107 Code: 3eing able to meet expenses by oneself (58 S 59) 0. No answer 1. Improved (If help needed i n past, now help not needed) 2 = Same or (No change - change i n help from "neutral" others not needed) change 3. Deteriorated (If no help needed i n past, but help now needed (61) I would now l i k e to ask you a few general questions about the way you spend your time. I wonder, could you give me a b r i e f rundown of the major things you do during a typica month including days, evenings and the weekend? A c t i v i t i e s Specify When How Often With Whom a. Work b. House S Garden 1 c, .Children d. Hobbies e. T. V. f. Reading g. Entertainment at home h. Sports i . Sports or Social Clubs j . Community Club Work; Relig. A c t i v i t i e s k. Entertainment outside home 1. Driving m. V i s i t i n g n. Drinking o. Other 1 j i Additional Details: 36 * (62) Could you now look back to the time you f i r s t came to the Foundation and t e l l me how you spent your time then? A c t i v i t i e s Specify When How Often With Whom a. Work b. House £ Garden c. Children d. Hobbies • e. T. V. f. Reading g. Entertainment at home h. Sports i , Sports or Social Clubs j . Community Club • Work; Relig. A c t i v i t i e s k. Entertainment outside home 1. Driving m. V i s i t i n g n. Drinking o. Other Additional Details: 37. 10 8 Code: Typical month's a c t i v i t i e s , with emphasis on " l e i s u r e " time pursuits, at T 2 (61) 0. No answer 1. Constructive 2. Non-constructive 3. Destructive (balance of various a c t i v i t i e s , including s o c i a l i nteraction (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 drinking) (Drinking i s the major s o c i a l a c t i v i t y ) 109 Code: Typical month's a c t i v i t i e s with emphasis on " l e i s u r e " time pursuits before T]_ (62) 0. No answer 1. Constructive 2. Non-constructive 3. Destructive 110 Code: Change i n a c t i v i t i e s : (61 £ 62) 0. 1. 2. 3. 4. 5. No answer +2 +1 0 -1 -2 38. ^" For married or once married men only So far we have covered quite a few areas i n your l i f e . May I now ask you a few questions about your relationships with your wife and children. (63) How many children do you have? , (Check question) No. Sex Ages 111 Code: Children 0. No answer 1. Yes 2. No (64-) Do you get to see much of your children? Yes: (Elaborate) No: (Elaborate) (65) Has this changed since before you came to the Foundation? How 39 . For children l i v i n g with father (66) Are your children l i v i n g with you? 112 Code: Children l i v i n g with father (66) 0. No answer 1. Yes 2. No (67) There are certain general areas i n t h e i r children's l i v e s i n which father and mother share a general con-cern, and others which they f e e l are more the concern of one than the other. Who, at the present time, looks af t e r the following areas in your home? Areas Husband Wife Both N/A a. D i s c i p l i n e b. Affections c. A c t i v i t i e s £ companions d. School a c t i v i t i e s (68) At the time immediately p r i o r to your coming to the Foundation, who looked af t e r the following areas then? Areas Husband Wife Both N/A a. D i s c i p l i n e b. Affections c. A c t i v i t i e s d. School a c t i v i t i e s 40. (69) How would you say your relationship between you and your children i s at the present? (70) At the time you came to the Foundation, how was your re-lationship then? 113 Code: Father :s assessment of relationship with children at T 2 (69) 0. No answer 1. Very good 2. Good 3. Poor 4. Very poor 114 Code: Father's assessment of relationship with children at T-L (70) 0. No answer 1. Very good 2. Good 3. Poor 4. Very poor 115 Code: Change (69 S 70) 0. 1. 2, 3. 4. 5. 6. 7. No answer +3 +2 +1 0 -1 -2 T 3 (71) Would you say that your present drinking behaviour has anything to do with the relationship between you and your children? a. Yes b, Mo c. Can't say (72) Would you say that at the time you came to the Foundation your drinking behaviour had anything to do with the re-lationship between you and your children? a, Yes b, No c. Can't say 116 Code: Interviewer ?s assessment of degree of insight at T 2 (71 S 72) 0, No answer 1,, Great insight (Yes-Yes) 2. Slight insight (can't say, can't say) 3. No insight (no-no) (73) In a t y p i c a l week, how many hours do you r e a l l y involve yourself with your children; that i s , take them for a drive, to a sports a c t i v i t y , play with them, look over t h e i r homework, etc.) (74) How was this at the time you came to the Foundation? 117 Code: Hours spent with children at Tj (73) 0. No answer 1. None (hours) 2. 1-4 3. 5-9 4. 10-14 5. 15-19 6. 20 £ over 118 Code: Hours spent with children at T x (74) 0. No answer 1. None (hours) 2. 1-4 3. 5-9 4. 10-14 5. 15-19 6. 20 S over 15 8 Code: Change 0. 1. 2. 3. 4, 5. 6. 7. 8. 9. No answer +4 +3 +2 +1 0 -1 -2 -3 -4 119 Code: Interviewer's assessment of father's relationship with children, taking into account, (1) areas in-volved, (2) degree of i n s i g h t , (3) time spent with children at T 2 (64, 67, 69, 71-73) 0. No answer 1. Very good 2. Good 3. Poor 4. Very poor 120 Code: Interviewer's assessment of father's relationship with children, taking into account, (1) areas in-volved, (2) degree of i n s i g h t , (3) time spent with children at T1 (65, 68, 70, 71, 72, 74) 0. No answer 1. Very good 2. Good 3. Poor 4. Very poor 121 Code: Change 0. 1. 2. 3. 4. 5. 6. 7. No answer +3 + 2 +1 0 -1 -2 -3 42. Husband-Wife Relationships (75) A l i t t l e while ago you t o l d me that you are now (married) (separated), (divorced), ( l i v i n g common-law), (widowed). Have there been any changes i n your marital status over the past ten years, including periods of short (although not legal) separations? a. Yes b. No If yes, could you t e l l me when you changed your status, what the reasons were, etc. Changed Status Time Period Reasons Wife Supported From To | Yes No N/A A. T " ' B. C. B. (76) (77) At the present time, how would you sum up your r e l a t i o n -ship with your wife, taking into consideration a l l areas of l i f e . In the month pr i o r to your coming to the Foundation, how would you have then summed up your relationship with your wife. 12 2 Code 123 Code 124 Code Patient's assessment of rel a t i o n s h i p with wife at T 2 (76) 0. No answer 1. Very good 2. Good 3. Poor 4. Very poor Patient's as sessment of relationship with wife at T l (77) 0. No answer i Very good 2 . Good 3. Poor 4. Very poor Difference between relationship with wife at T]_ £ T 2(76S7' 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 interests o you and your wife have in. common and share. In other words, what sort of things do you do together? (79) Just p r i o r to your coming to the Foundation, what i n -terests did you then have i n common and share? T 2 (78) Tn (79) a. Work around home a. Work around home b. Recreation i n home b. Recreation i n home c. Recreation outside home c. Recreation outside home d. Community and/or r e l i g i o u s a c t i v i t i e s d. Community and/or r e l i g i o u s a c t i v i t i e s e. Other e. Other er of areas i n common at T2 (78) No answer None 1 2 3 4 5 er of areas in common at T-^  (79) No answer None 1 2 3 4 5 ge 1. ' 2. 3. 4. 5. 6. 7. 8. 9, 12 5 Code: Numb 0 . 1. 2. • 3. 4. 5. 6 . 12 6 Code: Numb 0 . 1. 2. 3. 4 . 5. 6 . 127 Code: Chan 0 . No answer +4 +3 +2 +1 0 -1 -2 -3 -4 44. (80) (81) Just as people have certain things i n common and share, they also do have strong disagreements about certain issues. I wonder could you t e l l me over what issues you and your wife strongly disagree at the present time? At the time just p r i o r to your f i r s t contact with the Foundation, over what issues did you then strongly d i s -agree? ~ T 9 (80) Yes No N/A Yes No N/A a. Work b. Leisure c. Children d. Relatives e. Friends f. Sex g. Drinking h. Other 128 Code: Percentage of disagreements i n applicable, areas, T 2 (80) 0. No answer 1. None 2. 0-25% 3 . 2 6 - 5 0 % 4. 51-75% 5. 76-100% a. Work b. Leisure c. Children d. Relatives e. Friends f. Sex _• Drinking h. Other 129 Code Percentage of disagreements in applicable areas, T i (81) 0. No answer 1. None 2. 0-25% 3. 26-50% 4. 51-75% 5. 76-100% 130 Code Change (80 5 81) 0. 1. 2. 3. 4. 5. 6. 7. 8. 9. No answer + 4 +3 +2 +1 0 -1 -2 -3 -4 (82) When people l i v e together for a while they tend to take each other for granted and sooner or l a t e r one or the other feels he or she i s not getting enough attention from the other. How do you f e e l about the amount of attention you are getting from your wife at the present? How does your wife f e e l about the amount of attention she i s getting from you? (83) HOVJ were things i n this regard around the time you came to the Foundation? 131 Code: Patient's assessment of attention received from wife at T 2 (82) 0 . No answer 1, Enough 2 . Not enough 13 2 Code: Patient's assessment of attention received from wife at T1 (83) 0. No answer 1. Enough 2. Not enough 160 Code: Change 0. 1. 2. 3. No answer +1 0 -1 13 3 Code: Patient's assessment of how wife feels about attention she i s getting from husband at Tj (32) 0. No answer 1. Enough 2 . Not enough 13 4- Code: Patient's assessment of how wife feels about attention she i s getting from husband at T-j_ (83) 0. No answer 1. Enough 2. Not enough 161 Code: Change 0. 1. 2. 3. No answer +1 0 -1 Details: 46 . Interviewer's assessment of relationship between husband and wife; taking into consideration (1) marital status, (2) patient's, assessment of rela t i o n s h i p ; (3) common int e r e s t s ; (4) areas disagreed upon; (5) attention; at T 2 (75,76,78,80,82) 0, No answer 1, Very good 2, Good 3, Poor 4, Very poor Interviewer's assessment of relationship between husband and wife; at T1 ( 75 , 77 , 79 ,8.1 ,83 ) 0. No answer 1i Very good 2. Good 3. Poor 4. Very poor Change Q. 1. 2. 3. 4. 5. 6. 7. No answer +3 + 2 +1 0 -1 -2 -3 Interviewer's assessment of patient's overall responsi-b i l i t v towards family members at T o (50,54,56,58,64,67, 73 , 75") 0. No answer 1. Very responsible 2. Somewhat responsible 3 « Very irresponsible Interviewer's assessment of patient's o v e r a l l responsi-b i l i t y towards family members at T] (51,55,57,59,66,68, 74,75) 0. 1 No answer 1. Very responsible 2. Somewhat responsible 3. Very irresponsible 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 just l i k e to ask you one more question. Taking into account a l l the areas we have now talked about, looking back to the time when, you came to the Foundation and comparing i t with the present time, in what areas would you say there has been a change i n your l i f e , regardless of what has brought about this change. Patient's o v e r a l l assessment: 141 Code: General Health (84) 0. No answer 1 . Improved 2 . Same 3. Deteriorated 142 Code : Work History (85) 0 . No answer 1 . Improved 2 . Same 3 . Deteriorated 143 Code: Drinking History (86) 0. No answer 1. Improved 2. Same 3 . Deteriorated 144 Code: Leisure Time Pursuits (87) 0. No answer 1 . Improved 2 . Same 3. Deteriorated 145 Code: Relationships with 0. No answer other people (88) 1. Improved 2 . Same 3 . Deteriorated 146 Code: Relationship with 0. No answer wife (89) 1. Improved 2. Same 3. Deteriorated 147 Code : Relationship with 0. No answer children (90) 1 J - 4 Improved 2 . Same 3. Deteriorated 48. 148 Code: Interviewer's assessment of patient's change in overall insight (91) 0 . No answer 1. Much improved 2. Somewhat improved 3 . S a me 4. Somewhat worse 5. Much worse 149 Code: Interviewer's assessment of ov e r a l l change (92) 0 . No answer 1. Much improved 2. Somewhat improved 3. Same 4. Somewhat worse 5. Much worse 15 0 Code: Interviewer's assessment of part played by Foundation i n change (93) 0 . No answer 1. Great 2. Moderate 3. None (94) Well, we have covered a large number of questions and quite a few areas of your l i f e . Is there s t i l l anything important that you would l i k e to t e l l me? If not, I have asked you a l l I need to ask. I certa i n l y would l i k e to thank you very much for coming here and tal k i n g with me. Of course, as I have said before, a l l information contained i n this interview schedule w i l l be treated c o n f i d e n t i a l l y , and w i l l not be released to anyone, other than i n s t a t i s t i c a l form. 49. INTERVIEWER'S COMMENTS Name of interviewer: Date of interview: Hour of interview: Length of interview (to nearest 5 min.): Place of interview: 151 Code: Rating on cooperation: 0. No answer 1. Excellent 2. Good 3. F a i r 4. Poor 5. Inaccessible 152 Code: Rating on frankness: 0. No answer 1. Very frank 2. Moderately frank 3. Not frank I f cooperation i s : f a i r , poor, or inaccessible, give conditions of respondent/affecting 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, specify Other comments: 15 3 Code: Interview Completion: 0. No answer 1. Complete 2. In complete If incomplete, which sections Why? 50 . 156 Code: Person interviewed 0. No answer 1. Self 2. Wife 3. Other c o l l a t e r a l 15 7 Code: Place of interview 0 . No answer 1. Respondent's home 2. Offices or hotel rooms 3. J a i l L r . Mental Hospital 5. Other 

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
http://iiif.library.ubc.ca/presentation/dsp.831.1-0302540/manifest

Comment

Related Items