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Athy has been accepted towards fulfillment of the requirements for Pth. degree in Counseling Psychology WW Major professor / Date 4—18-86 MS U is an Affirmative Action/Equal Opportunity Institution 0-12771 u _ IlllllllllllWilllllfilfliflllflllflllflll t 3 1293 10700 4131 IV1ESI_J RETURNING MATERIALS: Place in book drop to usamuss remove this checkout from .‘.-nzs-I-L. your record. FINES will be charged if‘book is returned after the date stamped below. THE DEVELOPMENTAL CHARACTERISTICS OF MALE ALCOHOLICS AS MANIFESTED ON THE ASSESSMENT OF ADULT ADJUSTMENT PATTERNS BY JAY E. ATHY A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Counseling, Educational Psychology and Special Education 1986 ABSTRACT THE DEVELOPMENTAL CHARACTERISTICS OF MALE ALCOHOLICS AS MANIFESTED ON THE ASSESSMENT OF ADULT ADJUSTMENT PATTERNS By Jay E. Athy The purpose of the study was to examine the ego characteristics of male alcoholics as measured by the Assessment of Adult Adjustment Patterns (AAAP) and to clarify the relationship that dependency may have with alcoholism. The AAAP was developed to operationalize‘ the ego stages proposed by Erik Erikson. The Succorance and Autonomy scales of the Personality Research Fbrm. Form E (PRF—E) were used to measure dependency and were hypothesized to be related to Erikson's first two stages of development. There were 202 subjects consisting of 162 male veterans who were receiving treatment for alcohol abuse and no male members of a church who did not have a history of alcohol abuse. There were differences between the two groups along a number of demographic variables, e.g., lower income and less education for male alcoholics. Male alcoholics were found to have significantly (p‘<.05) lower scores on all eight stages of the AAAP in comparison to male nonalcoholics. However, no differ- ences were found between the two sample groups on either PRFaE scales of Succorance or Autonomy. High scores on Succorance did not significantly differentiate among male alcoholics on Stage 1 of the AAAP. Low scores on Autonomy did not significantly differentiate among male alcoholics on Stage 2 of the AAAP. PRFLE scores associated with dependency (combination of high Succorance and low Autonomy) failed to reveal any differences among male alcoholics with regard to mean score performance on the AAAP (Stages 1-8) or with regard to mastery of individual stages (Stages 1 and 2). Finally, demographic variables showed no significant influence on the outcome of the AAAP results for male alcoholics with the exception of degree of satisfaction with personal relationships (Stages 1-8), age (Stage 7) and prior history of alcohol treatment (Stage 4). There was no supportive evidence found for dependency as a personality trait associated with alcoholism. There were strong findings, however, for the presence of ego deficits in male alcoholics. Future research regarding the characterological antecedents and correlates of alcoholism may do better to focus on a comprehensive appraisal of ego functioning than attempting to isolate single personality traits. DEDICATION To my father he would be proud ii ACKNOWLEDGEMENTS I wish to express my sincere thanks to the following people: Dr. William Farquhar for his commitment to me to see that I finish this study. Dr. Robert Griffore whose personal support and thoughtful reading of the text proved to be instrumental in the preparation of the final draft and oral defense. Dr. Alton Kirk and Dr. William Hinds for their service on my dissertation committee. Dr. Richard Ramsey who facilitated data collection at the Lexington VAMC and whose friendship bolstered me during times of need and doubt. My colleagues at the Comprehensive Care Centers in Lexington and Winchester, KY, whose unfailing belief in me that I was meant to be a "doctor" helped transform a tired dream into a fresh reality. Ms. Reva Schultz for a peerless job of manu- script preparation. My friends, who continued to find something worth knowing and appreciating in me when I could give them so little in return (thanks Kelly, Hugh, Jack and Jackie). And finally, I wish to express my deepest gratitude and love to my wife Carolyn whose patience and loving support ultimately made the difference. iii TABLE OF CONTENTS Page LIST OFTABIIES O0.0000000000000000.0.0.000.IO..000 Vi LIST OF FIGURES .... ....... .... ..... ............... viii LIST OF APPENDICES ............................... ix Chapter I THE PROBLEM Need for the Study . .................... .. 2 Purpose of the Study ..................... b Hypotheses ............................... A Theory ................................... 5 Overview ................................. 12 II REVIEW OF THE LITERATURE Alcoholic Personality Traits ............. 13 Personality Research Form Studies ........ 22 sumlnary O0.0.0..........OOOOOOOOOOOOOOOOO. 29 III DESIGN OF THE STUDY Population ............................... 34 Sample ................................... 35 Measures ................................. 45 Assessment of Adult Adjustment Patterns .......................... #5 AAAP Scale Reliabilities ............ 50 Personality Research Form ........... 5# Procedures ............................... 55 Design ................................... 56 Testable Hypotheses ...................... 57 Analysis ................................. 58 Summary .................................. 60 IV RESULTS OF THE DATA ANALYSIS Hypotheses about AAAP Stages Discriminating Between Alcoholics and Nonalcoholics ... 61 Hypotheses about PRF-E Succorance Scale Scores Discriminating Between Alcoholics and Nonalcoholics ...................... 63 iv TABLE OF CONTENTS (cont.) Page Hypotheses about PRF-E Autonomy Scale Scores Discriminating Between Alcoholics and Nonalcoholics ........... 63 Hypotheses about PRF-E Succorance Scores of Alcoholics Discriminating Mean Score Performance on AAAP Stage 1 ............ 64 Hypotheses about PRF-E Autonomy Scores of Alcoholics Discriminating Mean Score Performance on AAAP Stage 2 ............ 65 Hypotheses about the PRF-E Dependency Factor (High Succorance, Low Autonomy) Discriminating Mean Score Performance Among Alcoholics on AAAP Stages 1-8 .......... 68 Hypotheses about the PRF-E Dependency Factor (High Succorance, Low Autonomy) Discrim- inating Between Mastery and Nonmastery on AAAP Stages 1 and 2 .................. 70 Demographic Variables ..................... 73 Summary ................................... 76 V SUMMARY AND CONCLUSIONS sumryOf the Study ......OOOOOOOOOOOOIOO 80 Conclusions .............................. 83 DiscuSSion O O O O O O I I O O I O O O O O O I O O I O O O O O O O O O O 85 Implications for Future Research ......... 9O APPENDICES . ...... . ..... . ...... ....... ........ .... 93 REFERENCES .............. . ......... . ...... ........ 110 3.12 3-13 3.14 3-15 3.16 u.1 4.2 u.3 4.1» 4.5 4.6 LIST OF TABLES Personality Research Form Scales ... ..... ... Age of Male Subjects ....................... Race of Male Subjects ...................... Birthorder of Male Subjects ................ Marital Status of Male Subjects ............ Number of Marriages of Male Subjects ....... Number of Years Education Completed by Male Subjects ................ ......... Academic Degrees Obtained by Male Subjects Income of Male Subjects .................... Members of Family of Origin who had an Alcohol Abuse Problem .................... Subject Satisfaction with Personal Relationships ............................ Number of Years with Alcohol Problem (Male Alcoholic Subjects) ...................... Number and Percentage of Male Alcoholics and Nonalcoholics Achieving Mastery on AAAP Stages 1-8 .......................... Stage and Scale Statistics for the Assessment of Adult Adjustment Patterns ............. The Factors Emerging From the Assessment of Adult Adjustment Patterns ....... ....... Means, Standard Deviations, and Reliabilities for the Eight Stages of the AAAP ......... Comparison Between the Normal and Psychiatric Samples on the Ego Stage Scales of the Assessment of Adult Adjustment Patterns .. F-Test Comparisons Between Male Alcoholics and Nonalcoholics on.AAAP Stages 1-8 ..... F-Test Comparison Between Male Alcoholics and Nonalcoholics on PRF-E Succorance Scale F-Test Comparison Between Male Alcoholics and Nonalcoholics on PRF-E Autonomy Scale .... AAAP F-Test Comparisons Between Male Alcoholics Who Score Either Above or Below the Median on the PRF-E Succorance Scale ..................................... AAAP F-Test Comparisons Between Male Alcoholics Who Score Either Above or Below the Median on the PRF-E Autonomy Scale .... AAAP F-Test Comparisons Between Male Alcoholics Who Have PRF-E Dependency Scores and Those Who Don't ...................... vi Page 24 37 38 39 39 40 42 43 44 45 A7 48 A9 52 53 62 63 64 66 67 69 LIST OF TABLES (cont.) Table Page 4.7 Chi-Square Analyses of Male Alcoholics AAAP Stage Mastery and PRF-E Dependency Scores . 71 4.8 F Probabilities for Demographic Variables Discriminating Among Male Alcoholics on the AAAP ................................. 74 4.9 Summary of Results on Statistical Tests of Hypotheses ................ 78 A1 Corrected Item-Total Correlation and Alpha If Item Deleted for AAAP Stage 1 ......... 93 A2 Corrected Item-Total Correlation and Alpha If Item Deleted for AAAP Stage 2 ......... 94 A3 Corrected Item-Total Correlation and Alpha If Item Deleted for AAAP Stage 3 ...... 95 A4 Corrected Item-Total Correlation and Alpha If Item Deleted for AAAP Stage 4 ......... 96 A5 Corrected Item-Total Correlation and Alpha If Item Deleted for AAAP Stage 5 ....... 97 A6 Corrected Item-Total Correlation and Alpha If Item Deleted for AAAP Stage 6 ......... 98 A7 Corrected Item-Total Correlation and Alpha If Item Deleted for AAAP Stage 7 ......... 99 A8 Corrected Item-Total Correlation and Alpha If Item Deleted for AAAP Stage 8 ......... 100 vii LIST OF FIGURES Figure Page 1.1 Elaboration of Erikson's Epigenetic Model ... 10 viii LIST OF APPENDICES Appendix Page A Corrected Item-Total Correlation and Alpha If Item Deleted for AAAP Stage 1 ......... 93 B Corrected Item-Total Correlation and Alpha If Item Deleted for AAAP Stage 2 ......... 94 C Corrected Item—Total Correlation and Alpha If Item Deleted for AAAP Stage 3 ......... 95 D Corrected Item-Total Correlation and Alpha If Item Deleted for AAAP Stage 4 ......... 96 E Corrected Item-Total Correlation and Alpha If Item Deleted for AAAP Stage 5 ......... 97 F Corrected Item-Total Correlation and Alpha If Item Deleted for AAAP Stage 6 ......... 98 G Corrected Item-Total Correlation and Alpha If Item Deleted for AAAP Stage 7 ......... 99 H Corrected Item-Total Correlation and Alpha If Item Deleted for AAAP Stage 8 ......... 100 I Demographic Questionnaire .................. 101 J Consent Form for Male Veteran Alcoholic Sample ......OOOIOOOOOOOOOO 106 Consent Form for Unitarian Universalist Church Sample ix OOOOOOOOOOOIOIOOOOOOIO 108 CHAPTER I THE PROBLEM Alcoholism is a complex problem. An extensive research literature has been generated to understand the nature and extent of what one author has described as society's "bane since the earliest days of recorded history" (Chafetz. 1975). Special emphasis has been placed upon identifying who is most susceptible to alcoholism. The most widely used research approach has been to thoroughly examine the alcoholic, himself, and attempt to delineate what personality traits all alcoholics have in common. Unfortunately, the results of the majority of these studies are best summarized by Keller (1972) " . . . the investigation of any trait in alcoholics will show that they have either more or less of it" (p. 1147). The clear identification of an alcoholic personality type has been unsuccessful and attempts to operationalize and quantify the motivational characteristics of alcoholics remains problematic. Difficulty exists in the meaningful interpretation of research with alcoholics as various personality patterns have been hypothesized without compelling empirical support. Blum (1966) and Sanford (1968) have criticized specific alcoholic personality studies as too often investigating variables that are 1 2 isolated out of context of their supporting. multivariate theories. Sadava (1978) has argued that an understanding of alcoholism must come from a developmental approach that addresses personality beyond the context of just situational determinants. mmmm The theoretical construct of dependency forms the basis for a predominant theory regarding the existence of a motivational predisposition toward alcoholism in men. It is grounded in the rich conceptualization of psychoanalytic theory which uses a developmental perspective in focusing upon personality. The successful resolution of conflict arising from thwarted dependency needs is a primary task in personality development. unfortunately, operationalizing and assessing dependency needs for empirical study has been a difficult. if not elusive, undertaking. As a result, much of what has to be said about dependency needs in the development of alcoholism has been relegated to purely theoretical discussion or is based upon inference from methods of assessment that have very little to do with dependency and the role it plays in personality development. Erik Erikson's theory of psychosocial maturation provides a theoretical perspective from which personality growth that focuses on the ego is seen in combination with both biological and social factors. "A human being, thus, is at all times an organism, an ego, and a member of 3 society and is involved in all three processes of organization" (Erikson, 1963, p. 36). It is both develop- mental and multivariate in its theoretical approach. FUrthermore, it provides specific assumptions at each stage of ego development, some of which theoretically address the issue of dependency. Until recently. however, there was no standardized means of assessment that could demonstrate the requisite reliability and validity for all eight ego stages of his developmental model. The Assessment of Adult Adjustment Patterns (AAAP) has shown promise in providing a dependable and accurate measure of Erikson's ego stages (Farquhar, Wilson. & Azar. 1982). What has been needed in the field of alcohol studies is a means of assessment that could dependably and accurately discriminate between alcoholics and non— alcoholics along some meaningful dimension(s) of personality. e.g., ego characteristics addressed from a developmental perspective. Such discriminative power may allow for prediction of potential alcohol problems in those individuals with predisposing traits and may enable treatment approaches to be more effective by providing a structural overview within which specific interventions may be matched with trait-specific alcoholics. An elucidation of the impact that dependency needs have in the development of excessive drinking patterns would be particularly useful in helping to clarify the disparate literature which regards it as a a motivational predisposition in male alcoholics. Purpose 2; the Study The purpose of this study is to examine the ego characteristics of male alcoholics from the theoretical perspective of Erik Erikson's epigenetic model of ego development. An emphasis will be placed upon clarifying the influence that dependency needs may have as a motivational factor in alcoholism. The use of the AAAP will also provide an opportunity to further substantiate the psychometric properties of this scale on a well- defined. pathological population, i.e., male alcoholics. Hypotheses Dependency is positively related to alcohol abuse. Unresolved dependency conflicts may effect an individual's ability to establish a sense of continuity and trust with significant others. It may also compromise autonomous functioning because of shame and doubt. As a result, males who abuse alcohol manifest impairment on stages of ego development that focus on trust and autonomy. Personality traits of a high need for succorance and a low need for autonomy are positively related to male alcohol abusers who fail to master these stages of ego development.1 lSpecific hypotheses are staged in testable form in Chapter III. Design of the Study. 5 1112221 Sigmund Freud (1977) theorized that personality was comprised of three psychic structures, i.e.. id, ego. and superego. Man developed through an invariant sequence of stages that were psychosexual in nature. Although development was by no means a static process, it remained a closed, intrapsychic system in which the individual's personality was largely determined by an early age. Erik Erikson (1963) expanded upon traditional Freudian theory by emphasizing the individual's inter- action with the environment as being a critical determinant in personality development. Focusing on the ego, Erikson hypothesized eight stages of development that were psychosocial in nature. No longer was personality development essentially a closed system, but an epigenetic system that allowed for an ongoing dynamic interplay between the individual and the environment throughout the cycle. His theory identified critical tasks at each stage of development that facilitated continued growth contin- gent upon both personal and interpersonal (societal) resolution of them. Although ego development was conceived as occuring in a stepwise fashion, complete mastery of any given stage was not necessary for progres— sion to ego tasks of higher stages. Ego stages did, however, represent optimal periods for the development of positive traits and remediation at a later date was 6 considered as being considerably more difficult than initial resolution. In fact, ego growth could lead to the development of a negative ego identity with accompany- ing ego-characteristics of mistrust. dependency facilitated by shame and doubt, guilt, inferiority, role diffusion, isolation, stagnation, and despair (Erikson, 1956). Rosenmann (1955) hypothesized, with regard to alcoholism, that the alcoholic has developed a negative self-image which controls his behavior in a self-destructive fashion. Dependency is a primary developmental task which has been implicated as a motivational factor in the development of alcoholism (Alexander. 1946; Blum, 1966: Knight. 1937). The resolving of dependency conflicts that occur during the earliest stages of growth is critical to healthy interpersonal functioning and forms the basis of personality develOpment. It is a process characterized by mutual trust and the develOpment of autonomy as we gradually become less helpless and more capable of interdependence. Failure to establish a trusting environ- ment that fosters autonomy may predispose the young child to fixate at an infantile mode of behaving in which demands are made for nurturance without reciprication. Knight (1937) viewed these individuals as becoming adults who were in a constant state of frustration because their excessive demands for indulgence could not be realistically met. Alcoholism thus became a symptomatic attempt to resolve this emotional conflict. Lisansky (1960) 7 also reasoned that the alcoholic was unable to overcome the conflicts of early childhood and that his excessive drinking became symbolic of a surrender to dependency. Psychoanalytic theory has reasoned that alcoholism represents psychosexual impairment at the oral stage of development (Fenichel, 1945). Frustrated "orality" causes the individual to use the mouth as a preferred mode of gratification. Erikson (1963) concurred as he stated, "Addicts, for example, depend, as the baby once did, on the incorporation by mouth or skin of substances which make them feel both physically satiated and emotionally restored" (p. 61). A passive state is achieved in the process which provides for a relative freedom from conflict and tension. Although Erikson does not make a direct connection between this behavior and stage of ego development, issues of oral-dependency and passivity are found at the earliest stages of his psychosocial model. Blum (1966) has cited consensus among psychoanalytic writers that the stage of develop- mental arrest corresponds with the degree of alcohol consumption, i.e., the earlier the stage the more severe the problem. Therefore, alcoholism may be viewed as an unsuccessful adaptation to unresolved conflicts at the earliest stages of development. Thus Rado's (1933) view that alcoholics were individuals who doubted their ability to solve life's problems when left to rely on their own initiative. Failing to have had early childhood 8 experiences that would foster healthy self-esteem, these individuals long for a return to passively obtained gratification from the external world. Rado saw alcohol as easing the tensions of reality and recreating the experience of narcissistic pleasure during infancy. McCord and McCord (1960) expanded the theory and viewed male alcoholics as wanting to have dependency needs met that were stifled during childhood, but acting aggressive and independent to align themselves with society's expectations of masculinity. Drinking is seen as a stereotypical male behavior that allows the alcoholic to meet society's demands, but at the same time allows him to experience the warmth and security reminiscent of the mother-infant relationship. Blane (1968) suggested that male alcoholics may be divided into three distinct modalities in which they attempt to resolve their conflict between dependency and masculine role. The "openly dependent" alcoholic takes a passive stance and looks to others to satisfy his needs. The "counterdependent" alcoholic denies his intense dependency needs and attempts to avoid any expression of dependent behavior while fashioning a lifestyle based on physical prowess and self-sufficiency.. Lastly, the "dependent-independent" alcoholic fluctuates between open dependency and counter- dependency as dictated by the situation. Erikson's eight stage schema of ego development provides the researcher with specific theoretical 9 assumptions at each stage of development (See Figure 1.1). These assumptions may be transposed into hypotheses regarding the develoPmental characteristics of male alcoholics. The dependency theory may be conceptualized as correlating with impairment in Erikson's first two stages. Stage 1 (Trust vs. Mistrust) impairment, i.e., the inability to have faith in the enduring nature of one's beliefs or in the existence of significant others, may lead to excessive drinking. The goal of the alcoholic adaptation would be to recreate the warmth, nurturance, and trust of the maternal relationship in a current setting where one's needs for love and support go unfulfilled in what is seemingly a hostile and unpredictable environment. The inability to conquer shame and doubt at Stage 2 (Autonomy vs. Shame/Doubt) may also lead to ego impairment with the individual having difficulty functioning autonomously. This individual may find himself in a perpetual struggle between the seemingly safe haven of dependency and the often ego alien, but societally sanctioned autonomy of the masculine role. Excessive drinking may occur as not only a vehicle to satisfy dependency needs, but also as a way to meet societal demands for masculine behavior by masking a predominantly passive stance of interacting with the world. The utilization of the AAAP will hopefully provide a meaningful description of Eriksonian ego characteristics 10 FIGURE 1.1 ELABORATION OF‘ERIKSON'S EPIGENETIC MODEL Trust-Mistrust Ho e Age: 0 - 1; Ease of feeding Depth of sleep Mutual recognition vs Relaxation of bowel autistic isolation Let mother out of sight Capacity for faith Rely on sameness, con- Oral incorporative & sistency, constancy sadistic Trust self to cope with Assured reliance on bodily urges parent‘s integrity Basic faith in existence, law & order Autonomy-Shame & Doubt (Will) Age: 1% - 3 Control from outside is firmly reassuring Will to be oneself Stand on own feet Holding on-letting go Guidance gradually encourages independent choice Initiative—Guilt (Purpose) Age: 3 - 5 Pleasure in conquest Self-Observation Anticipation of roles Self-Guidance vs inhibition Self-Punishment Motor movement Sense of Responsibility Language Obedience Intrusive (phallic) mode Rivalry Conscience (family) Industry-Inferiority (Competence) Age: 5 - 12 Win recognition by producing things Task identification vs Renunciation of wish to sublimation of drives live forever in the family I am what I make work Apply self to tasks Identification Perseverence, diligence Trust of adults (other Submit to instruction than parents) "What works" Note. 11 FIGURE 1.1 (continued) Identit -Confusion (Fidelity) Age: 12 - 1 Trust in peers Occupational search Identification without heroes Social group pressures Ideological thought Intimac -Isolation (Love) Age: 1% - 30 Uses of identity Genital maturity Sensitivity of sex organs Mutual regulation of work, procreation, recreation Generativit -Sta ation Age: 30 - £5 Maturity Establishing and guiding next generation Productivity & creativity Integrity-Despair (Wisdom) 5+ Age: Order & meaning Fidelity tests Cliques-heroes Stereotyping self Ideological mind Rituals, creed, programs Molding identity Fusion with another Commitment to affiliation Ethical strength to honor commitment Orgastic potency Heterosexual mutuality (Care) Belief in the species Charity-Supplements but doesn't replace generativity Acceptance of one's life cycle Acceptance of others significant to it vs disgust, regret "I am what survives me" Accrued assurance of order & meaning Love of the "human ego" Defend dignity of one's own life cycle Consolidation of meaning Acceptance of death Prepared by Fredrick R. Wilson and William W. Farquhar, Michigan State University, 1977. 12 as they exist in male alcoholics. If developmental arrest can be inferred from the findings, then a more cogent articulation of the dynamic etiology and process of dependency in alcoholism may be offered. Such clarity would be welcome in the field of alcohol studies. 9.2121121! In Chapter II there is a review of the literature that has attempted to demonstrate personality traits that are characteristic of male alcoholics. Specific emphasis will be placed upon empirical research addressing the role of dependency in the development of alcoholism. The design of the study, a description of the Assessment of Adult Adjustment Patterns (AAAP) and other measures, and the proposed analysis will be the focus of Chapter III. In Chapter IV there is a descriptive analysis of the AAAP data to delineate the ego characteristics that alcohol abusers share in common. Comparisons will then be made with a sample of men who do not abuse alcohol. Scales from the Personality Research Form (Jackson, 1967, 1974) that suggest dependency as a personality trait will also be correlated with the AAAP results. Chapter V is devoted to integrating the results of the research, drawing conclusions, and discussing the implications of the findings. CHAPTER II A REVIEW OF THE LITERATURE The major goal within this chapter is to review the studies that have suggested dependency as a personality trait in male alcoholics. The review entails a cursory examination of the findings that have attempted to identify general personality characteristics of male alcoholics as well as a more thorough examination of the specific research regarding dependency. Several promising studies that have used the Personality Research Fbrm (PRF) as a means of personality assessment are also presented. Alcoholic Personality Traits The behavior exhibited by alcoholics has frequently been labeled with personality characteristics, e.g., inadequate, impulsive, dependent, etc., by both professional and lay observers. A prevalent research question has been whether or not there actually are specific person- ality characteristics indigenous to alcoholics. Many have been hypothesized (most notably dependency by psychoanalytic writers), but none have demonstrated clear empirical substantiation. In a 1950 review of the existing literature regarding alcoholic personality traits, Sutherland, Schroeder, 13 l4 and Tordella concluded that there was no sound evidence which suggested that individuals of one personality type would be more likely to become alcoholics than individuals of any other personality type. Leonard Syme (1957) concurred with this finding in his review of all relevant literature published from 1936 to 1956. Both reviews cited methodological flaws as having severely compromised prior research attempts and both called for further studies to be undertaken. Syme specifically criticized the use of projective tests which yielded results that were subjective and ambiguous. He viewed the use of nonprojective tests as being more satisfactory methodologically, but failing to meaningfully integrate theoretical consideration. Another criticism of research that has attempted to focus upon personality characteristics of alcoholics is that all too often inferences are made about premorbid personality disposition from assessments of individuals who are already alcoholic (Neuringer, 1982: Williams, 1977). There has been a strong argument made by vaillant (1983) that the personality manifestations in the alcoholic are primarily attributable to the vitiating effects of the alcohol itself. Once abstinence is achieved there is a remitting of the personality characteristics that were falsely assumed to have functioned as precursors to the addiction. William and Joan McCord (1960) attempted to address 15 this methodological concern by undertaking a longitudinal study. They began with a sample of 325 boys who were part of an urban project to prevent delinquency in 1935. Comprehensive observations were made on the boys and their families by trained social workers for five years. A follow-up was conducted in 1956 on 255 subjects from the original sample who were then 30 to 35 years of age. The behavior and attitudes of 29 subjects who had become alcoholics were then compared with 158 subjects who had no history of alcoholism or criminal offense. The McCords believed that the design of their study, thus, allowed for an examination of the prealcoholic personality. The McCords interpreted the results from their study as showing prealcoholics to be relatively "self- contained" when compared to their normal peers. These researchers thought that prealcoholics tended to deny feelings of dependency at an early age, but that the suggestion of a dependency conflict was present in their preoccupation with sexual matters. Adult alcoholics, in comparison, to their normal peers, tended to feel victimized by society and were socially withdrawn. They appeared to show compensatory feelings of grandiosity and exhibited more aggressive behavior. Finally, openly dependent behavior was a cardinal feature of their functioning. To answer the discrepancies between the basic characteristics they identified in prealcoholics and adult alcoholics, the McCords theorized that traits like 16 dependency and gradiosity were latent and repressed in the prealcoholics. They reasoned that society places demands on males to act independent and aggressive, but that attempts to fulfill such a role by the prealcoholic leaves little Opportunity for him to satisfy his heightened dependency needs. A compromise solution is thus wrought wherein the individual assuages his dependency conflict under the guise of the masculine ritual of excessive drinking. Once alcoholism becomes a protracted pattern of functioning, however, latent traits such as dependency become more clearly evident in the individual's behavior as his defenses collapse. Another longitudinal study provides corroborating evidence for the McCord's findings. Mary Jones (1968) followed 66 males from junior high school through their mid-forties. She categorized her sample into the following groups: problem drinkers, heavy drinkers, moderate drinkers, light drinkers, and nondrinkers. Comparisons (t tests) were made between individuals in these groups based on personality and behavior. The California Q set, an assessment procedure that involved the sorting of responses to 100 items generated from extensive interviews with the subjects, was the instrument used for personality measurement. Results showed that adult problem drinkers differed significantly'(‘<.05) from their moderate and nondrinking counterparts along dimensions of undercontrolled and 1? extroverted behavior. They tended to be disorganized under stress, emotionally labile, rebellious, openly hostile, and self-indulgent. Furthermore, they demonstrated overconcern with functioning in a male role. The data also supported the assertion that there is a continuity between personality characteristics of the preproblem drinker and the adult problem drinker. Items dealing with uncontrolled impulsivity, extroverted behavior, and masculine role concerns reliably differentiated between the subjects when they were assessed as boys. Finally, Jones noted that nonproblem drinkers in her sample were observed to have few difficulties with dependent relation— ships. On the contrary, they were found to be able to function comfortably within them and could form close, intimate ties with others. The problem drinkers, however, were often described as being overly dependent and unable to maintain adequate interpersonal relationships. Jones concluded that her data supported the existence of predisposing factors to problem drinking: most notably acting-out and aggressive behavior. The ratings taken of boys who would later deve10p into problem drinkers indicated the existence of ambivalent feelings toward authority and problems in functioning comfortably in dependency relationships. This finding is cited as being suggestive of the McCord's hypothesis that the denial of dependency needs are at the root of alcoholism. The overemphasizing of masculine behavior by preproblem 18 drinkers is also interpreted as being potentially indicative of defensive behavior related to dependency conflicts. In a discussion of Jones' study, Gomberg (1968) noted the "challenging areas of agreement" between Jones and the McCords' research. Gomberg was hopeful that a more meaningful definition of the roles of oral fixation and the develOpment of trust would be in the offing as a result. Psychological predisposition, contrary to some critics, was apparently a primary factor in the etiology of alcoholism. Nevitt Sanford (1968) was some- what more guarded in another discussion of Jones' work as he cautioned against overgeneralizing from results suggesting underlying dependence as the sole personality precursor of problem drinking. He argued for an increased focus upon theory in future studies. Kammeier, Hoffman, and LOper (1973) compared Nfinnesota Multiphasic Personality Inventory (MMPI) scores of 38 men from when they were college freshmen with when they were first admitted for residential treatment of alcoholism. Two-tailed tests of significance were performed with mean differences (-< .01) emerging in the direction of the group in treatment on scales F, D, Hy, Pd, Pa and Si. These results were interpreted as suggesting that alcoholic behavior was accompanied by an increase in irritability, depression, hostility, impulsivity, resentment and problems with interpersonal relationships. A neurotic style of functioning becomes l9 apparent when these scales are viewed in combination. The researchers also noted that scales MF and Ma were elevated on both sets of profiles which may indicate that excessive drinking is a reaction formation to having difficulty with passive, sensitive, "feminine" feelings. Finally, when individual profiles from both sampling periods were analyzed it was found that scales D, Pd, Sc, and Ma showed the highest frequency of elevation. It was concluded that there might be a relationship between these scales and dependency problems, but that the evidence could only support an interpretation regarding a general lifestyle of dependency as opposed to any specific inferences regarding particular types of dependency. These same authors (Loper, Kammeier, & Hoffman, 1973) compared the MMPI scores of 32 college freshmen who were later hospitalized for alcoholism with 148 of their nonalcoholic, male classmates. Prealcoholics scored significantly (‘4..01) higher on scales Pd and Ma which suggested that they were more gregarious, impulsive, and less conforming than their peers. These findings were noted to be similar to those characteristics that were identified by Jones in her preproblem drinker sample. Conflicting results emerge from two studies under- taken to isolate factors that may be indicative of oral- dependent behavior. Wolowitz and Baker (1967) constructed a food preference inventory (FPI) based on the rationale 20 that infants during the "oral-passive" stage of develop- ment have a diet consisting of wet, soft, bland foods which are rich and smooth in consistency. Their inventory was administered to 30 male alcoholics and to 30 male, nonalcoholic controls. High scores on the FPI were to indicate oral—passive preferences for food with low scores being indicative of oral-aggressive preferences. Results were in the expected direction and the authors concluded that alcoholics were passive and dependent. vaillant (1980) used vignettes of oral behavior based upon his subjects' backgrounds that included traits of pessimism, passivity, self-doubt, fear of sex, suggestibility, and dependence. His sample consisted of 184 men who were periodically followed from the time they were sophomores in college until they were approx- imately 50 years of age. Ratings of childhood environment, psychological stability in college, childhood and adult adjustment, and ego defenses were obtained along with information regarding physical health, extent of alcohol use, extent of other substance abuse, and family history of alcoholism. TWenty-six problem drinkers were identified, but none showed any significant correlation with the measure of oral-dependency employed. A harsh childhood environment and personality disturbances in both college and adult life correlated with oral-dependent behavior, but not with alcohol abuse. Vaillant concluded that alcohol abuse is not caused by an inadequate home life 21 and/or a premorbid personality disorder, but that the symptomology observed in alcoholics was more than likely due to the disabling affects of sustained drinking. HOffman (1976) challenged the expectation that alcoholic personality traits should be articulated in terms of cause and effect of excessive drinking when similar criteria are not required for the description of other psychiatric entities. FUrthermore, he questioned the validity of searching for only a single personality indigenous to alcoholics when there was no evidence to suggest that there was a personality unique to any other particular group of individuals. Zimering and Calhoun (1976) commented that an alcoholic personality may be characterized by certain predisposing traits, e.g., dependency, but may only become manifest when environmental pressures act as a catalyst. This is not to say that personality traits which may function as motivational predispositions to alcoholism are not worthwhile areas of investigation. On the contrary, more than one author has remarked that the point of differential assessment with alcoholics is to accurately identify the etiological dynamics so that more effective treatment may be rendered (Miller, 1976: Sanford, 1968). Nor is it to say that there is no consensus about the existence of discriminating personality factors. A 1979 review of the literature by Cox revealed that passivity and dependency were the most salient 22 characteristics of alcoholics. Alcoholics were also found to be governed by external locus of control, have low self-worth, and manifest a significant discrepancy between their real-self and ideal-self. Sadava (1978) identified six general themes or patterns of individual differences based on his review of alcoholic personality studies. These themes were dependency, denial, depression, sex role identity problems, inadequate impulse control, and personal dissatisfaction. The findings of these reviews are encouraging as specific personality traits such as dependency are reliably emerging as either precursors or companions to alcoholism. Further investi- gation of them is warranted. Personality Research Form Studies Henry Murray (1938) theorized that personality was observable through recurring and enduring aspects of behavior. He emphasized the role of motivation as a dynamic property and hypothesized a variety of manifest and latent needs. In Murray's theory of personality, a need represents a response to a mental construct of disequilibrium. The need functions to organize action that will reduce this dynamic tension and is shaped, in part, by the situational demands of the environment. Based on his work, the Edwards Personality Preference Schedule (EPPS) (Edwards, 1959) and the Personality Research Form (PRF) (Jackson, 1967, 1974) have been 23 deveIOped as objective measures of personality traits. Douglas Jackson's PRF has been given favorable reviews for its rigorous test construction (Anastasi, 1980: Cronbach, 1970) and several studies using it with alcoholics have shown interesting results regarding dependency. The PRF yields 20 separate personality traits and two measures of test taking validity (See Table 2.1). Each personality trait has been shown to be sufficiently distinct that the use and interpretation of them as individual scales is warranted. Intuitively, scales that could be seen as indicative of dependency needs would be Succorance (high scorers are described as needing and seeking a great deal of support from others) and Abase— ment (high scorers are described as being self-effacing, subservient, and self-subordinating). A low score on Ibminance (low scorers are described as ngg_wanting to control one's environment by dominating and influencing others) would also be consistent with a pattern of dependency as would a low score on Autonomy (low scorers are described as being dependent on others, constrained, compliant, and conforming). Helmut Hoffman (1970) administered Form AA of the PRF to 377 hospitalized male alcoholics. The purpose of his study was to provide normative data on the PRF for alcoholics. He found that his sample differed from a nonalcoholic control group on 16 of the 22 PRF scales at the .05 level of significance (higher on Abasement, 24 TABLE 2.1 PERSONALITY RESEARCH FORM SCALES Scale Descriptive Characteristics Abasement Self-critical, humble, self- blaming, accepts blame and criticism even when not deserved, subserviant. Achievement Accomplishing, ambitious, competitive, industrious. Affiliation Friendly, affiliative, cooper- ative, warm. Aggression Easily annoyed, aggressive, argumentative, hostile. Autonomy Independent, rebellious, nonconforming, self-reliant, unattached. Change Unpredictable, dislikes routine. Cognitive Structure Defendence Dominance Endurance Exhibition Harmavoidance likes new and different exper- iences, vacillating. Unambiguous, precise, rigid, seeks certainty, needs structure, perfectionistic. Defensive, suspicious of others, easily offended, secretive. Controlling, enjoys leadin , dominant, powerful, author1ta- tive. Persevering, determined, tire- less, relentless, enduring. Center of attention, pretentious, conspicuous, entertaining, exhibitionistic. Fearful, cautious, avoids risks, vigilant, seeks to maximize personal safety. 25 TABLE 2.1 (Continued) Impulsivity Nurturance Order Play Sentience Social Recognition Succorance Understanding Desirability Infrequency Impatient, impulsive, reckless, uninhibited, excitable. Gives sympathy and comfort, helpful, encouraging, caring. Deliberate, organized, neat, tidy, consistent, dislikes confusion. Fun-loving, playful, joking, carefree. Feeling, sensitive, aware, enjoys physical sensations, open to experience, perceptive. Seeks recognition, approval seeking, prOper, accomodating, desirous of credit. Dependent, seeks support, help- ‘1ess, craves affection. Curious, analytical, intellectual, inquiring, logical. Describes self in desirable terms, attempts to present favorable picture of self. Responds in haphazard manner which may be due to inattention, confusion, poor comprehension, or marked pathology. 26 Affiliation, Cognitive Structure, Harm-avoidance, Nurturance, Order and Succorance: lower on Achievement, Aggression, Autonomy, Change, Ibminance, Endurance, Exhibition, Play, and Sentience). Hoffman viewed the high scores on Affiliation, Nurturance, and Succorance as being indicative of a need for personal contact with others: a need that may be difficult to fulfill because of social inhibition and feelings of inferiority (low Exhibition, high Abasement). He also interpreted low scores on Aggression, Autonomy, and.Ibminance as expressing a marked dependency need in these individuals who were describing themselves as generally noncombative, dependent, and passive. Hoffman concluded with the interpretative hypothesis that alcoholics have strong dependency needs which contribute to both a low self-esteem and the desire to form intimate relationships. As a result, they are placed in perpetual conflict between their need for self- actualization and a passive-submissive interpersonal stance. Vincent Nerviano (1976) administered both the PRF and the 16 Personality Factor Questionnaire (l6 PRF) to 366 male alcoholics who were inpatients at a veteran's hospital. Five, distinct factors emerged from a factor analysis of the PRF data. Factor 1 was labeled Impulse Control and contrasted scales suggesting spontaneity (Impulsivity, +.79: Play, +.63) with those reflecting restraint and inhibition (Cognitive Structure, -.79: 27 Order, -.72). Other scales that were loaded on this factor were Endurance (—.52), Achievement (—.51), and Harmavoid- ance (-.44). The second PRF factor was labeled Social Ascendency and was comprised of scales reflecting social participation and extroversion (Exhibition, +.75: Affiliation, +.73: Dominance, +.59). The Desirability (+.55) and the Nurturance (+.45) scales were also loaded on this factor. Defendency was the label used for Factor 3 in attempting to describe a response style to perceived threat (Defendence, +.81; Aggression, +.70: Abasement, -.66). Factor 4, labeled Intellectual/Aesthetic Interests, focused on the degree of "refined or civilized interests" (Understanding, +.72; Sentience, +.65; Achievement, +.57; Nurturance, +.50: Change +.49). Finally, Factor 5 was labeled Dependency as it contrasted the need for Succorance (+.81) with the need for Autonomy (-.64). Nerviano furthered his examination of the data by using a correlational clustering procedure that involved the 12 scales from the PRF that contributed the most, in terms of clinical significance, from the original factor analysis. Seven subtypes were obtained and labeled to correspond with common personality disorders (obsessive— compulsive, impulsive, aggressive, passive—dependent, schizoid, asthenic, and narcissistic). The passive- dependent subtype ("Type D") comprised 6% of the sample and manifested the notable features of being submissive (low on Ibminance), intropunitive (low on Dependence and 28 Aggression, high on Abasement). and seeking out control from others (low Autonomy). Nerviano concluded that alcoholism was inadequate as a primary diagnosis because it masked the underlying existence of distinct types of clinical syndromes. John Zivich (1981) attempted to replicate the Nerviano study with a sample of 102 males, alcoholic inpatients which had substantially different demographic character- istics from Nerviano's sample. Furthermore, Zivich used a shorter form of the PRF (Form B) than had Nerviano (Form AA). Form E had been designed by Jackson (1974) in response to its use by other researchers with populations different than college students for which it had been originally normed. All five of Nerviano's factors were- replicated by Zivich as were five of the seven subtypes that were manifested when using a cluster analysis (schizoid and narcissistic were the exceptions). Particulary germane to this dissertation was the replication of the rependency Factor (Succorance, +.77: Autonomy, -.61) and the Type D, passive-dependent alcoholic (low on Ibminance and Autonomy, high on Abasement) which accounted for 3.9% of the sample. Zivich also suggested the existence of an obsessive-dependent subtype and argued for the inclusion of separate categories for mixed profiles (correlating to more than one subtype) and pure no-types. He concluded that the replication of Nerviano's results gave strong empirical substantiation to the postulated 29 presence of distinct personality patterns that can be found among diverse alcoholic populations. The PRF factors and subtypes identified by Nerviano and later replicated by Zivich offer promising areas of investigation regarding the role of personality in alcoholism. Both studies suggested dependency as a trait for some alcoholics. These findings are consistent with Hoffman's interpretation of dependency motivation based upon his analysis contrasting alcoholics and non-alcoholics on the PRF. In summary, the PRF has a demonstratable factor validity with alcoholic populations that may provide an empirical measure of dependency motivation. Summary The role of personality in the development of alcoholism has been a topic of considerable theorizing, research, and debate. Several early reviews of the literature concluded that there was no substantive evidence to suggest the predominance of any one personality type over another in individuals who became alcoholic (Suther- land, et. al., 1950: Syme, 1957). vaillant (1983) has argued that the manifestation of personality disturbance in alcoholics is directly attributable to the damaging effects of alcohol, itself, and not due to the premorbid personality of these individuals. Others have begged the question of what role personality may play in the development of alcoholism, but have sharply criticized 3O alcoholic personality studies for failing to base their investigations in a multivariate theoretical framework (Blum, 1966; Sanford, 1968) or for having focused upon situation determinants at the eXpense of a developmental perspective (Sadava, 1978). Nonetheless, research on alcoholic personality traits has proliferated and not without some consensus in findings. A more recent review of the literature by Cox (1979) revealed that dependency and passivity were the most salient characteristics of alcoholics. Sadava (1978) also found dependency to be one of six general themes to emerge from his review of alcoholic personality studies. It is interesting to note that dependency is cited as a prevalent personality factor in both of these literature reviews. The positing of dependency as both a personality trait and a motivational predisposition has been the basis for a predominant theory regarding the develOpment of alcoholism. The McCords (1960) concluded in a longitudinal study of 235 males who later became alcoholic that dependency conflicts were latent in their subjects as adolescents. These unfulfilled dependency needs would later compromise their subjects' ability to function as adults as society's demands to adopt an independent and aggressive male role increased. Alcohol abuse became a compromise solution that eventually led to protracted problems. Jones (1968) also found continuity between the personality organization 31 of prealcoholic and alcoholic in another longitudinal study. Difficulty with dependency relationships and an overconcern with the male role were evident in her subjects before and after developing a drinking problem. Once alcohol abuse had become established, however, there was an increase in openly dependent behavior. Unfortunately, neither study used a standardized means of personality testing. A pair of studies using the MMPI (Kammeier, et. a1., 1973; Loper, et. al., 1973) suggested the possibility of the existence of dependency problems in alcoholics and Wolowitz and Baker (1967) found evidence for dependency using a food preference inventory with alcoholics and a control group. vaillant (1980), however, showed no correlation between alcoholics and dependency as measured by rating their responses to vignettes containing oral- dependent behavior. Several studies using the Personality Research Form (PRF) found dependency as a trait in alcoholics. Hoffman (1970) showed alcoholics to differ from controls on 16 of the 22 PRF scales. High scores on Affiliation, Nurturance, Succorance, and Abasement were coupled with low scores on Aggression, Autonomy, and Dominance suggest- ing strong dependency needs which contributed to both low self-esteem and a frustrated desire to form intimate relationships. Nerviano (1976) found the PRF to have five distinct factors for alcoholics, one of which 32 contrasted the need for Succorance (+.81) with the need for Autonomy (-.64). This factor was labeled Iependency. Zivich (1981) replicated Nerviano's findings thus further substantiating the factor validity of the PRF with alcoholics. The Dependency factor emerged again with Succorance (+.77) and Autonomy (-.61) its principle components. The research literature has shown evidence of dependency as being a personality trait in male alcoholics. The question of whether it forms the developmental basis for an alcoholic personality type may not be totally germane to the more immediate concern of how to most effectively treat the alcoholic. Hoffman (1976) has questioned the need for supportive evidence of this nature when an articulation of cause and effect is not expected for the description of other psychiatirc entities. Furthermore, the question of whether dependency forms the basis for the only personality type found in alcoholics is probably misguided as there is no evidence to suggest that there is a unique personality to be found in any other large, diverse group of individuals. Nerviano (1976) and Zivich (1981) have shown that alcoholics may be comprised of numerous personality types with dependency being the salient trait of only one type. What is important is the reliable and valid identification of any given personality trait in alcoholics so that treat- ment and prognosis concerns may be responsibly addressed. 33 A shortcoming of much of the research that has attempted to identify dependency as a personality trait has been the lack of objective, psychometrically sound measures of assessment. Both the AAAP in theory and the PRF in practice offer a solution to this problem. Impairment at early stages of ego development (AAAP) and a low need for autonomy coupled with a high need for succorance (PRF) are both suggestive of dependency. A significant relationship may exist between the two. CHAPTER III DESIGN OF THE STUDY In Chapter III the population, sample, measures, procedure, design, testable hypotheses, and analysis procedures are presented and discussed. Population Alcoholism is a multifaceted problem and what constitutes someone being labeled an alcoholic is often dependent on who is doing the labeling. For the sake of operational uniformity, male alcoholics in this study were defined as meeting the diagnostic criteria set forth for Alcohol Abuse in the Diagnostic and Statistical Manual of Mental Disorders (Third Edition): a. Pattern of pathological alcohol use: need for daily use of alcohol for adequate functioning: inability to cut down or stop drinking: repeated efforts to control or reduce excess drinking by "going on the wagon" (periods of temporary abstinence) or restrictin drinking to certain times of the day: binges %remaining intoxicated throughout the day for at least two days): occasional consumption of a fifth of spirits (or its equivalent in wine or beer): amnesic periods for events occurring while intoxicated (blackouts): continuation of drinking despite a serious physical disorder that the individual knows is exacerbated by alcohol use: drinking of non-beverage alcohol. b. Im airment in social or occu ational functionin due to aIcohol use: e.g., vioIence while intoxicated, absence from work, loss of job, legal difficulties with family or friends because of excessive alcohol use. 34 35 0. Duration of disturbance of at least one month. DSM-III’ 19 0, pp. 1 9-170 0 Sample There were 162 patients from the Alcohol Dependence Treatment Program (ADTP) at the veteran's Administration Medical Center (VAMC) in Lexington, Kentucky who comprised the male alcoholic sample for the study. The ADTP is a five week, residential program that screens and selects referrals based on the following criteria: 1. The veteran accepts that he has a problem with alcohol use great enough to damage physical health, personal or social functioning, or is . a prerequisite to normal social functioning. 2. The veteran is willing to participate in the five week program. 3. The veteran is sober or is unlikely to have serious withdrawal problems. 4. The veteran has sufficient intelligence to understand films shown and group therapy sessions. 5. The veteran is physically able to participate in all aspects of the ADTP. (Physical handicaps do not rule out admission to the program). 6. The veteran is not actively psychotic. 7. The veteran can verify his eligibility for VAMC services. 8. The veteran does not have any pending legal charges. The ADTP focuses on both educational and psychosocial aspects of alcoholism in attempting to ameliorate the problem. Lectures and films on the harmful effects of alcohol, group psychotherapy, Alcoholics Anonymous meetings, 36 and vocational counseling are some of the treatment modalities employed. Referral sources include private physicians, other VAMC's in the region, and the patients themselves. The sample of nonalcoholics in the study was comprised of 40 men who were members of the Uhitarian Universalist Church in Lexington, Kentucky. Unitarian Universalism is considered to be a mainstream, but liberal religion in the united States. These individuals did not have a history of alcohol abuse. Initially, a comparable sample of nonalcoholic males was sought from the VAMC as well. Unfortunately, a series of complications beset this sampling endeavor making it not practical. It was found that (a) very few veterans solicited had no prior history of alcohol abuse, (b) medical complications frequently prevented the taking of the instruments used, and (c) a successful completion rate of 4 out of 38 (10.52%). After eight months this plan was abandoned and the Unitarian Universalist Church was sampled. The men comprising the alcoholic sample ranged in age from 20 to 67 with a mean of 43.03 and a median of 41.75. Their nonalcoholic counterparts had a mean age of 40.98 and median age of 37.50 with a range from 19 to 70. Both groups were predominantly caucasian (94.4%, alcoholics; 92.5%, nonalcoholics) with a small percentage of Blacks accounting for the remainder (5.6%, alcoholics: 7.5%, nonalcoholics). Birthorder position in an 37 individual's family of origin showed the highest percentage of alcoholics (30.9%) and nonalcoholics (30.0%) to be oldest or only children. This information can be found in Tables 3.1 to 3.3. TABLE 3.1 AGE OF MALE SUBJECTS . Standard Sample p_ Mean Median Deviation Range Alcoholics 162 43.03 41.75 11.59 20 - 67 Nonalcoholics 40 40.98 37.50 14.74 19 - 70 TABLE 3.2 RACE OF MALE SUBJECTS 9.192.119.1429: W Race 119.- i 9.9.- i Caucasian 153 94.4 37 92.5 Black 9 5-6 3 7-5 Total 162 100.0 40 100.0 38 TABLE 3.3 BIRTHORDER OF MALE SUBJECTS Alcoholics Nonalooholics Birthorder 112- 2 212- z Oldest/Only so 30 .9 12 30.0 Youngest 31 19.1 4 10.0 Second 29 17.9 9 ‘ 22.5 Third 23 14.2 7 17.5 Fourth 9 5.6 4 10.0 Fifth 7 4.3 l 2.5 Sixth 4 2.5 l 2.5 Seventh 3 1.9 l 2.5 Other 6 3.7 l 2.5 Total 162 100.0 40 100.0 Alcoholic men responded that they were predominantly divorced or separated (56.2%) at the time of data collection with only 25% of the nonalcoholics responding in kind. Both groups averaged over one marriage per subject (E 1.45, alcoholics: E 1.08, nonalcoholics). Further information about marital status can be found in Tables 3.4 and 3.5 39 TABLE 3.4 MARITAL STATUS OF MALE SUBJECTS Marital Alcoholics Nonalcoholics Status 22’ E. 32: ,2 Never 26 16.0 17.5 Married 44 27.2 22 55.0 Separated 17 10.5 2 5.0 Divorced 74 45.7 8 20.0 Widowed l 0.6 1 2.5 Total 162 100.0 40 100.0 TABLE 3.5 NUMBER OF MARRIAGES OF‘MALE SUBJECTS . Standard Sample p Mean Median . Deviation Range Alcoholics 162 1.45 1.32 .99 0 - 4 Nonalcoholics 40 1.08 1.04 .66 0 - 3 The mean number of years of education for the male alcoholic sample was 10.91 with only 53.1% completing 12 or more years of education and just 6.2% receiving a Bachelor of Arts degree or higher. This compares to the nonalcoholic male sample having 15.30 mean number of years of education with 92.5% completing at least 12 years of education and 57.5% having obtained a Bachelor of Arts degree (See Tables 3.6 and 3.7). Nonalcoholics 40 TABLE 3.6 NUMBER OF'YEARS EDUCATION COMPLETED BY MALE SUBJECTS Alcoholics Years of Education 05005500050505550 02002200575702220 1 l 1 1 2 01001100103634.1518 65216054514051.6000 100.0 40 100.0 162 Total 41 TABLE 3.? ACADEMIC DEGREES OBTAINED BY MALE SUBJECTS Alcoholics Nonalcoholics Degree 22» i: 22» 5 None 48 29.6 3 7.5 GED 35 21.6 3 7.5 High School 54 33.3 14 35.0 Associate of Arts/Science 15 9.3 0 0.0 Bachelor of Arts/Science 9 5.6 4 10.0 Master of Arts/Science 0 0.0 13 32.5 Ph.D. 1 0.6 3 7.5 Total 162 100.0 40 100.0 A sizeable percentage (43.2%) of the alcoholics in this study reported incomes of less than $4,000 for the preceeding 12 months with 5.6% reporting an income of greater than $20,000. The mean income range for male alcoholics was between $6,000 and $10,000. The nonalco- holic group showed only 12.5% making less than $4,000 with 55.0% earning more than $20,000. The mean income range for male nonalcoholics was between $15,000 and $20,000. Table 3.8 expands upon this information. 42 TABLE 3.8 INCOME 0F MALE SUBJECTS Alcoholics Nonalcoholics Income “——"—‘————- as» 2 9.2- a Under $4,000 70 43.2 5 12.5 ‘ 6,000 3"" 2100 3 705 6- 10,000 18 11.1 8 20.0 0- 5,000 20 12.3 2 5.0 15- 20,000 11 6.8 8 20.0 0- 25,000 5 3.1 6 15.0 25- 30,000 2 1.2 3 7.5 30- 0,000 l 0.6 2 5.0 Over $40,000 1 0.6 3 7.5 Total 162 100.0 40 100.0 A prior history of treatment for alcohol related problems was reported by 60.0% (n=107) of the alcoholic group while there was no incident of having sought treatment by the nonalcoholic group. Alcoholics cited having grown up with a family member who had an alcohol abuse problem in 51.9% (n=84) of the cases. Nonalcoholics responded in kind in only 22.5% (n=9) of the cases. Who these family members were are delineated in Table 3.9. 43 TABLE 3.9 MEMBERS OF FAMILY OF ORIGIN WHO HAD AN ALCOHOL ABUSE PROBLEM Family Alcoholics Nonalcoholics Member 3 fl IE I: None 3 Father 6 Mother 7 Brother 0 Sister 1 l 0 u 0 U) I—‘l—‘OOOONUIF’ th o mmooooomm OVQ en: NNOOOOU’INV l-' Grandfather Grandmother Aunt/Uncle Friend of family 0 O O O O ONOOOOC’OU‘ O OU‘OO‘lChNUNIl-J Total 162 ...: O c- O l-' O O Both groups rated on a nine point Likert scale how satisfied they were with their personal relationships. Male alcoholics had a mean of 5.01 and a median of 5.00. Male nonalcoholics had a mean of 6.83 and a median of 7.42. In Table 3.10 the results are depicted. 44 TABLE 3.10 SUBJECT SATISFACTION WITH PERSONAL RELATIONSHIPS Scale Alcoholics Nonalcoholics P01nts £12. . i .2: E Dissat- isfied 1 12 7.4 l 2.5 2 13 8.0 0 0.0 Average 4 21 13.0 3 7.5 5 38 23.5 l 2-5 6 18 11.1 1 2.5 Satisfied 7 19 11.7 12 30.0 9 10 6.2 10.0 Total 162 100.0 40 100.0 Finally, the alcoholic sample was asked to report the number of years that they had an alcohol problem as defined by the DSM-III guidelines outlined earlier in this chapter. These men reported a mean range of 11 to 15 years of having had an alcohol problem. The results are presented in Table 3.11. 45 TABLE 3.11 NUMBER OF YEARS WITH ALCOHOL PROBLEM (MALE ALCOHOLIC SUBJECTS) Number of Years Np. % Less than 6 months 2 1.2 6 months - 1 year 3 1.9 l - 2 years 8 4.9 3 - 4 years 4 2.5 5 - 6 years 12 7.4 7 - 10 years 22 13.6 11 - 15 years 39 24.1 16 — 20 years 20 12.3 21 - 25 years 23 14.2 26 - 30 years 17 10.5 31 - 35 Years 6 3.7 More than 35 years 6 3.7 Measures Erik Erikson's theory of ego development has been an impetus for research and clinical application. Several attempts have been made to make it amenable to empirical assessment. Assessment of Adult Adjustment Patterns The Assessment of Adult Adjustment Patterns (AAAP) (Farquhar, Wilson, & Azar, 1982) is an objective, self- report instrument that is based on Erikson's eight stage theory of ego deve10pment. Its rigorous test construction and its attempts to measure all eight of Erikson's ego stages makes it unique among other Erik- sonian assessment techniques currently reported in the literature (Azar, 1982; Farquhar, 1983). It consists of 46 320 items which measure mastery or nonmastery of each of the eight stages as well as the inclusion of two validity scales to check for deviant responding (F Scale) and attempts to present oneself in a favorable light (Social Desirability Scale). The format of the AAAP requires that subjects rate themselves on a four point scale ranging from (1) definitely true of me, to (4) definitely not true of me. Intermediate points are labelled (2) true of me, and (3) not true of me. Mastery or nonmastery for each of the eight stages is measured by the AAAP as individual items are assigned weighted values with regard to whether they represent resolution or not of particular ego stages. Responding in the direction of resolution a specified percentage of the time for a given stage is considered to represent mastery. The normative sample of the AAAP was comprised of 322 staff and.faculty from Michigan State University. Azar (1982) found that this sample mastered the eight stages in the following proportions: Stage 1 - 66%; Stage 2 - 73%: Stage 3 - 5M%; Stage 4 - 68%; Stage 5 - 76%; Stage 6 - 74%: Stage 7 — 46%; and Stage 8 - 51%. His initial research approach had been to use the 80% standard adapted from the mastery learning model (Bloom, 1968). The mastery levels were manipulated, however, in an attempt to have the scales reflect an ascending order of mastery from Stage 1 to Stage 8. The more traditional 80% mastery standard 47 is the one used in this study. The number and percentage of male alcoholics and nonalcoholics achieving mastery are presented in Table 3.12. TABLE 3.12 NUMBER AND PERCENTAGE OF MALE ALCOHOLICS AND NONALCOHOLICS ACHIEVING MASTERY ON AAAP STAGES 1-8 Stage Alofigplics (n=é62) Nongépoholics n§40) 1. Trust 23 14.2 22 55.0 2. Autonomy 50 30.8 32 80.0 3. Initiative 28 17.2 22 55.0 4. Industry 57 35.1 28 70.0 5. Identity 52 32.1 31 77.5 6. Intimacy 80 49.3 29 72.5 7. Generativity 30 18.5 15 37.5 8. Integrity 49 30.2 29 72.5 Note. Mastery was defined as responding in the direction of resolution to over 80% of the items. The ego stages of the AAAP yield high internal consistency (See Table 3.13) and a factor analysis has delineated 23 factors that are consistent with Erikson's theory (See Table 3.14). 48 TABLE 3.13 STAGE AND SCALE STATISTICS FOR THE ASSESSMENT OF ADULT ADJUSTMENT PATTERNS Cronbach's E18222“ oiu‘i‘iiis $233 Wise? 1:333:33. Rel 133;), 1. Trust 18 54.01 54.71 7.33 .88319 2. Autonomy 36 108.86 134.24 11.59 .90717 3. Initiative 26 75.27 79.29 8.90 .87019 4. Industry 63 190.56 440.53 20.99 .95076 5. Identity 33 100.08 108.39 10.41 .90255 6. Intimacy 28 88.09 116.72 10.08 .90126 7. Generativity 29 84.37 116.03 10.77 .88837 8. Integrity 25 74.23 75.83 8.71 .85431 *Based upon individual items weighted one to four summed across the scale. Note. From "Assessment of Adult Adjustment Patterns (AAAP) Research Instrument: Farquhar, Unpublished Report, 1983. First Report" by William 49 TABLE 3 .14 THE FACTORS EMERGING FROM THE ASSESSMENT OF ADULT ADJUSTMENT PATTERNS No. of Cron- Items bach's p;354.. Alpha Erikson Stage Name of Factor 1. Trust vs. Mistrust Basic trust 18 .88 2. Autonomy vs. Shame and Doubt Will to be oneself 23 .89 Solitude ll .82 Holding on, letting go 13 .82 3. Initiative vs. Guilt Self-punishment & guilt 23 .86 Anticipation of roles by parents 4 .81 4. Industry vs. Inferiority Apply self to risk 26 .92 5. Identity vs. Identity Confusion Trust in peers 16 .86 Ideological thought 8 .79 Molding identity 13 .84 Fidelity tests 10 .79 6. Intimacy vs. Isolation Commitment to affiliation 19 .90 Genital maturity 11 .83 Fusion with another 7 .68 7. Generativity vs. Self-Absorption Establishing & guiding next generation 17 .68 Charity 15 .84 50 TABLE 3.14 (Continued) No . of Cron- Erikson Stage Name of Factor Items bach's a=354 Alpha 8. Integrity vs. Disgust, Despair Order and Meaning 1? .83 Accepting one's life cycle 13 .80 Note. From "Assessment of Adult Adjustment Patterns (AAAP) Research Instrument: First Report" by William Farquhar, Unpublished Report, 1983. Assessment of Adult Adjustment Patterns: Scale Rgliabilities Reliability estimates of the eight stage scales on the AAAP were computed for both the alcoholic and non- alcoholic samples of this study. Although the alcoholic sample showed greater deviation than did the nonalcoholics from the reliability coefficients reported by Azar (1982), both groups were notably consistent. The greatest discrepancy between the alcoholic sample of this study and Azar's normative sample occurred on the first three stages (Stage l=.80 for alcoholics, .88 for Azar sample: Stage 2=.83 for alcoholics, .91 for Azar sample; Stage 3: .77 for alcoholics, .87 for Azar sample). These early stages of ego deve10pment are ones that this study has hypothesized alcoholics to have a greater degree of difficulty with than their nonalcoholic counterparts. Such internal deviation may be indicative of some degree 51 of instability in ego deve10pment. (See Appendices A-H for item-total correlations for Stages 1-8 of the male veteran alcoholic sample). The demographics of the AAAP normative sample are in marked contrast to the alcoholic sample used in this study (Azar, 1982). Two dimensions in particular illustrate this point. The normative sample had 77.9% of its members showing incomes for greater than $15,000 compared to only 12.3% of the alcoholic sample. Azar reported only 1.7% of his group having an income of less than $4,000 where 43.2% of the alcoholics sampled made less. Finally, 87.4% of the normative sample had a Bachelor of Arts degree or higher (50.3% having a Ph.D. or M.D.) in comparison to 6.2% of the alcoholics. Nonetheless, the approximate similarities between the reliability coefficients of these two very different samples speaks well of the internal consistency of the AAAP across populations tested. See Table 3.15 for a comprehensive presentation of scale statistics for alcoholic, nonalcoholic, and AAAP normative samples. Thirty-two psychiatric inpatients at Pine Rest Christian Hospital in Grand Rapids, Michigan were used as a comparison of construct validity. The normative sample showed significantly higher means on each stage than did the psychiatric group with the exception of Stage 6 (See Table 3.16). The AAAP represents a comprehensive effort by 52 mm. mm. mm. so.m mo.m :m.oH “p.35 ma.os mm.mc SpouMmch mm. am. no. 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Analysis of variance procedures showed significant differences on the variables of number of marriages (.020) and number of years of education (.0001). No difference was found with regard to age (.343)- Analysis of variance procedures were also used to examine the influence that the above demographic variables may have had upon mean stage score performance on the AAAP. No differences were found among male alcoholics for any of the variables with three exceptions. Degree of satisfaction with personal relationships was significant 2‘: .05) for all eight stages, chronological age was significant (f;.02) for stage 7, and prior history of alcohol treatment was significant (‘5. .01) for stage 4. These findings are presented in Table h.8. 7a 8809mHm 88. 80. 88. 88. 80. 88. 88. 88. 888 888088888 8080088 ... ... ... ... ... 8. 8.. ... 88.88.88.888 88. 88. 88. 88. 88. 08. 88. 80. 888 888888 :8 088080088 mm. on. on. 8H. 8N. mm. mH. 8:. NwH mEoosH Hm. Hm. Hm. mm. mm. 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