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ABSTRACT
FACTORS RELATED TO CONTINUANCE AND

ATTRITION AMONG HEROIN ADDICTS
IN RESIDENTIAL TREATMENT

By

Frank H. Barron

Although heroin addiction has been a problem of major concern
for many years, little research has been conducted which focuses upon
the factors related to the termination of addiction. In addition,
there has been little research which has specifically addressed itself
to the related problem of client attrition from treatment for drug de-
pendence despite the fact that this has been a major problem for most
treatment programs. Due to the lack of such research, the present
study has undertaken to examine the relationship of a number of selected
variables to attrition from residential treatment. The variables in-
cluded in the present study were selected on the basis of hypotheses
derived from the Commitment to Deviance model. The central thesis of
this model is that an individual's decision to terminate or continue
his enactment of a deviant role is based upon the balance of social
penalties that confront him. This balance consists of the continuation
penalties, those aversive outcomes the individual incurrs through con-
tinuing in his deviant role, and the economic and interpersonal renun-
ciation penalties which he confronts as a result of attempting to

renounce his deviant role and establish a non-deviant identity.

Frank H. Barron

According to this model, a change in role commitment will occur if the
individual is motivated to abandon the deviant role due to the actual
or potential operation of continuation penalities and the extent to
which he is able to circumvent the renunciation penalities. Once the
renunciation penalties are circumvented the individual is able to ob-
tain access to reinforcement for the enactment of the non-deviant role.

In the context of the present study, the relationship of the
continuation penalties (eg. legal pressure to terminate heroin use)
and the individual's ability to circumvent the renunciation penalties
(eg. success is securing employment and frequency of social contact
with non—addicts) to length of stay in treatment was examined. In
addition, a number of demographic (eg. education, employment history,
and criminal record) and addiction history characteristics (eg. age at
which heroin use was begun, length of addiction, and cost per day of
the habit) were examined in terms of their relationship to the addict's
ability to circumvent the renunciation penalties and his length of
stay in treatment. These pre—treatment characteristics were studied
~to determine if they were potentially useful as predictors of attrition
from treatment.

A sample of thirty-four heroin addicts, all of whom had been
randomly assigned to treatment in a therapeutic community, were the
subjects of the present study. Information concerning the demographic
and addiction history characteristics of these individual's was obtained
by means of a questionnaire administered during the intake procedure.
The variables consisting of in—treatment behaviors such as success in

securing employment; the use of drugs and length of stay in treatment

Frank H. Barron

were obtained from the client records of the Multi-Lodge. In addition,
data concerning the frequency of the subject's social contacts with
non-addicts and the frequency of his employment-seeking behavior while
in treatment were obtained through the utilization of staff ratings.

A correlational analysis of legal pressure, success in securing employ-
ment and frequency of social contacts with non-addicts indicated that
these three variables were significantly related to length of stay in
treatment. These results provide support for the hypothesized relation-
ship of continuation and renunciation penalties to attrition. However,
when the relationship of these three variables to length of stay in
treatment were considered jointly through multivariate analysis, it

was found that the addict's success in securing employment accounted
for almost all of the observed variation in length of stay in treatment.
In addition, no significant relationships were found between any of the
pre-treatment demographic and addiction history characteristics and
either the addict's ability to circumvent the renunciation penalties

or his length of stay in treatment. Further analysis indicated the
existence of a significant relationship between the addict's frequency
of job-seeking behavior in treatment and the frequency of his social
contacts with non-addicts, success in securing employment, extent of
drug use prior to termination and length of stay in treatment. The
possibility that the relationship between the individual's frequency

of job-seeking behavior and length of stay in treatment and other in-
treatment behaviors reflects a relationship between treatment outcome

and a more general activity-passivity dimension of the addict's

Frank H. Barron

behavioral style was suggested. The parallels between this activity-
passivity dimension of the addict's behavior in treatment and the con-
cept of "learned helplessness" was discussed and some implications for

future research were noted.

FACTORS RELATED TO CONTINUANCE AND
ATTRITION AMONG HEROIN ADDICTS
IN RESIDENTIAL TREATMENT

By

:I a i
Frank H. Barron

A DISSERTATION

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

Department of Psychology

1974

DEDICATION

To Lori, for all the help and hassles that have contributed

to growth.

ii

ACKNOWLEDGMENTS

I would like to express my appreciation to Dr. Robert Zucker,
chairman of my dissertation committee, for his guidance and encourage-
ment not only in this research but throughout my years at MSU. He
has often proven a friend and supporter when friendship and support
were most needed.

I would also like to thank Dr. William Crano, Dr. Albert Rabin
and Dr. Dozier Thornton for their participation as members of my com-
mittee and Dr. Thomas Stachnik for the time he devoted to the supervision
of my activities at the Multi-Lodge.

Special thanks to Lori Ross who spent incredibly long hours
typing this dissertation through all its stages and revisions and still
had the strength to provide the emotional support I needed.

And most of all, thanks to Bob Zucker, Lance Harris, Bill
Kell, Sam Plyler, Joann Hamachek and Bill Mueller for being there in

their own way and helping me to become. I have been fortunate.

TABLE OF CONTENTS

ACKNOWLEDGMENTS . ......................
LIST OF TABLES .......................

CHAPTER

I. INTRODUCTION .....................
Literature Review ..................
Statement of the Problem ..............
Hypotheses . . . . . . . . . ............

II. METHOD . . ......................

Treatment Setting ..................
Instruments . . ...................

III. RESULTS AND DISCUSSION ................
IV. GENERAL DISCUSSION ..................

Commitment to Deviance: The Relationship of
Continuation and Renunciation Penalties to

Attrition .....................

Addict Characteristics, Renunciation Penalties

and Attrition from Treatment ...........

Some Speculations Concerning Job-seeking Be-

havior, Helplessness and Success in Treatment . . . .

V. SUMMARY ........................
LIST OF REFERENCES .....................
APPENDICES .........................

1. DESCRIPTION OF THE MULTI-LODGE PROGRAM AND MODIFI-

CATIONS FROM PROTOTYPE LODGE ............
II. MULTI-LODGE PROGRAM MANUAL ..............

iv

Page

iii

vi

25
3O

37

37
4O

45
6l

6]
66
7l
Bl
85

89
93

III.
IV.

VI.

VII.

INTAKE QUESTIONNAIRE ............... . . . 105
SOCIAL CONTACTS RATING SCALE .............. ll9
JOB-SEEKING BEHAVIOR RATING SCALE . . . ......... 120
TABLE OF MEANS AND STANDARD DEVIATIONS FOR ALL

INDEPENDENT AND DEPENDENT VARIABLES . . . . . ..... lZl

SUMMARY TABLES FOR THE ANALYSES OF MULTIPLE
REGRESSION . ..................... l22

Table

VI.l

VII.l

LIST OF TABLES

Summary table of means on all demographic variables
for male and female subjects .......... . . .

Intercorrelation matrix of independent and depend—
ent variables . . . . ........... . . . . .

Analysis of variance for the overall regression of
legal pressure, success in obtaining employment
and frequency of social contacts on length of
stay in treatment .......... . . . . . . . .

Beta weights, F statistic and significance levels
for legal pressure, success in obtaining em-
ployment and frequency of social contacts in
estimation of length of stay in treatment .......

Summary table of correlations obtained between
three general demographic characteristics of
addiction and success in securing employment
and length of stay in treatment ...........

Means and computed t for race and sex on length
of stay in treatment .................

Table of means and standard deviations for all
independent and dependent variables .........

Analysis of variance for the overall regression
of age of first heroin use, length of addic-
tion and cost per day of the heroin habit prior
to treatment on success in securing employment
while in treatment ..................

VII.2 Analysis of variance for the overall regression

of age of first heroin use, length of addic-

tion and cost per day of the heroin habit prior

to treatment on the frequency of the addict's

social contacts with non-deviant individuals

while in treatment ..................

vi

Page

38

46

51

SI

60

l22

122

Table Page

VII.3 Analysis of variance for the overall regression
of age of first heroin use, length of addiction
and cost per day of the heroin habit prior to
treatment on length of stay in treatment ....... l23

VII.4 Analysis of variance for the overall regression
of education, employment history and criminal
record on success in securing employment while
in treatment ..................... 123

VII.5 Analysis of variance for the overall regression
of education, employment history, and criminal
record on length of stay in treatment ......... l23

CHAPTER I
INTRODUCTION

Since the late 1960's this country has witnessed an enormous
growth in the number of facilities which direct their treatment efforts
toward the problem of drug abuse and addiction. In 1968 the National
Institute of Mental Health undertook a national survey to identify or-
ganizations which focused upon the treatment of drug addiction. The
results of this survey indicated that there were 183 programs located
in forty-one states and that more than three quarters of them had been
operating less than five years (Glasscote, et;_gl,, 1972).

One form of treatment for drug dependence which has displayed
a correspondingly rapid growth is the residential therapeutic community.
Basically there are two fairly distinct approaches to this kind of
residential treatment which may be characterized as the transitional
facility or half-way house and the more long term therapeutic community
based upon the Synanon-Daytop model. While there are differences in
the goals and program structure of these two types of programs; they
share a common problem in terms of retention of their client population.
Without exception, the residential facilities for drug dependent per-
sons lose up to seventy-five percent of their residents, most of whom
drop out within a month of entering the program (Glasscote, gt_al., 1972).

The reasons for such high client attrition rates are still

largely a matter of conjecture. It is possible that the type of client

serviced by these programs have difficulty making the kind of commit-
ment demanded of him in a therapeutic community. There is also some
data which indicates that a large proportion of these terminations may
be due to the client's renewed involvement in drug use which begins
while he is a resident of the "community" (Geis, 1966a). However,
whatever the reasons for this phenomenon, it is clear that the high
rate of attrition is a major problem for these programs. One possible
approach to coping with this problem is to select residents for the
therapeutic community on the basis of characteristics which are pre-
dictive of length of stay and performance while in treatment. Unfor-
tunately, little research effort has been expended in an attempt to
identify client characteristics which might serve this predictive
function.

A major reason for the limited amount of research in the
area of client attrition and addiction outcomes in general may be linked
to the fact that there has been relatively little theoretical interest
in the question of why some addicts are able to terminate their use of
heroin while others continue in a reoccurring cycle of abstinence and
relapse into addiction. Nhat appears necessary to advance the study
of career outcomes of addicts is a theoretical model which addresses
itself to the question of what factors determine the continuation or
termination of heroin addiction.

The current research study has a two-pronged purpose, the
first of which is that of evaluating the adequacy of one potentially
viable model as a conceptual framework for understanding addiction

outcomes. This model, which was developed by Stebbins (1971), focuses

upon the social penalties associated with both the continuation and
termination of the deviant career as the major factor in determining
the individual's commitment to his role. The second purpose of the
current study is to investigate, within the framework of this model,
model related demographic and drug use history characteristics of ad-
dicts entering treatment to attrition with the intent of developing

predictors of attrition.

Literature Review

The review of the literature presented below is designed to
focus on a number of topics which are relevant to the purpose of the
proposed study. The first section will present a brief review of the
history of the therapeutic community for the treatment of drug addiction
and a description of the goals and treatment processes which are repre-
sentative of this type of approach. Following this discussion will be
a review of the information available concerning client attrition from
these residential treatment programs and the attempts that some of
these programs have made to cope with this problem.

The third section of the review of the literature focuses
upon research which has attempted to relate demographicficharacteristics
to addiction outcomes. This research has been conducted in the frame-
work of follow-up studies of institutional treatment andis designed
to examine the relationship between characteristics of the addict prior
to his entrance into treatment and his addiction status at some speci-
fied time following his return to the community. The results of these

studies are of some importance to the aims of the current research since

characteristics of the addict are isolated which bear a relationship
to his role enactment within the community following an attempt to
terminate heroin use. Following this review of the research literature

a discussion of the commitment to deviance model will be presented.

Iherapeutic Communities and the
Treatment ofrDrug Dependence

The commonly accepted origins of the therapeutic community
approach to the treatment of drug dependent people began in early 1958
with Charles Dederich and several members of Alcoholics Anonymous
(Glasscote, §t_al., 1972). This early treatment took the form of dis-
cussion groups which emphasized confrontation and honesty. Under
Dederich's leadership a club was formed and a store front building
rented as a focus for the group's activities. In late 1958 the first
contacts with heroin addicts began which ultimately led to a schism
among the original members and the incorporation of Synanon. From this
point the organization began to grow and with the acquisition of resi-
dential quarters the development of the Synanon social system as an
approach to the treatment of addiction was established (Yablonsky,
1968). Since this time the Synanon foundation has been established in
several other locations both within and outside Of California.

The second such residential community, Daytop Village, was
established in New York City in 1963 as a treatment center for male
addicts on probation. Daytop was created in imitation of Synanon and
drew much of its early leadership and direction from former members of

Synanon's staff. Daytop was beset by internal difficulties until 1969

when the organization stabilized. Since that time Daytop has estab-
lished several additional locations in the New York City area and in
other states (Glasscote et_gl,, 1972).

Both Synanon and Daytop regard drug abuse as a symptom of a
character disorder and as a result define their treatment goal as the
production of major changes in the addicts character structure in order
to prevent his relapse into drug dependency. Both programs attempt
the re-socialization of the addict through the social system of the
therapeutic community (Casriel, 1971; Glasscote, gt_al., 1972;
Yablonsky, 1968). In terms of the treatment structure of these pro-
grams, resocialization begins with the addicts entrance into the com-
munity when he is isolated from the outside world. He is deprived of
all his usual activities and such privileges as receiving mail, using
the telephone or leaving the residence are denied to him. All efforts
are made to completely segregate him physically and interpersonally
from his previous drug-taking environment. This isolation and depri-
vation is coupled with the assumptiOn of a low status role in the com-
munity's social system. He is provided with maximum supervision and
minimal responsibility during this period. He is expected to perform
the simplest tasks with complete diligence and is afforded only the
minimum in privileges and privacy.

An addict will continue in this low status within the com-
munity until such time as his behavior displays changes in what is
defined as a positive direction by the program. As the individual's
time in the program increases he achieves higher status and with it

increased responsibilities and benefits which are conditional based

upon his continued good performance. Typically this rise in status in-
volves the addict working his way up the established hierarchy of the
program until he is a senior resident. At this point the individual

is expected to function within the program as a role model for other
residents who are new or have not progressed as far. After elevation
to the status of senior resident, the individual may be expected to
graduate from the program or to continue in it or a similar community
as a staff member (Glasscote, et_gl,, 1972).

A major part of the Synanon-Daytop type of therapeutic com-
munity is the group therapy program in which each resident is required
to participate. This therapy program is considered by these programs
to be a vital tool in the resocialization of the drug dependent indi-
vidual. The initial goal of these groups and the key to this resocial-
ization is the addict's denunciation of this previous behavior and
life-style. With the aid of the more established members of the group,
he is expected to realize that his behavior as an addict has not only
been worthless but destructive to himself and others. Once this goal
is reached then the group functions to assist the addict in the develop-
ment of more mature ways of relating to others. These groups are fre-
quently characterized by intense confrontation of any form of "junkie"
behavior on the part of the individual such as "street talk", the
shirking of personal responsibility or the violation of program rules
(Casriel, 1971; Glasscote, gt_al., 1972; Shelly, 1966; Yablonsky, 1968).

Vocational training is often considered to be an integral
part of the therapeutic community's over-all program. This training

is provided by the community itself or in conjunction with a public

vocational rehabilitation program and is designed to equip the residents
with job skills they can utilize to make a living after graduation.

This job training is frequently utilized in such a way as to provide

a source of labor for the business operation which provides financial
support for the program. The extent to which these communities empha-
size vocational training and the continuation of formal education

varies between different programs. In this regard Synanon appears to
place a relatively strong emphasis upon it while Daytop tends not to
have its residents involved in such training beyond that required to
perform tasks within the program (Glasscote, gt_al,, 1972).

Most therapeutic communities which have adopted the model
provided by Synanon and Daytop expect that residents will remain in
their program for six months to two years. This expectancy often
varies with the individual community and is tailored to the addict's
progress in treatment (Glasscote, §t_gl,, 1972). However it would
appear that these who do not drop out of these programs tend to remain
considerably more than six months. In a sense this may be due to the
major task that these communities have set for themselves in their goal
of resocialization of the addict. An additional factor which contri-
butes to the often extended length of treatment may reside in the at-
titude of therapeutic communities such as Synanon which often see con-
tinued residence in the community as being preferable to life in the
larger society (Glasscote, gt_al., 1972; Yablonsky, 1968).

A second form of residential treatment that typically lasts
six months or less is also available for the drug dependent person

through transitional facilities or "half-way houses". The use of the

half-way house in the rehabilitation of the narcotics addict is based
upon the observation that a high percentage of addicts have been found
to return to drug use within six weeks to six months after their release
from a treatment or correctional institution. This resumption of drug
use appears to be prompted by the return of the newly released addict
to his old environment where he is able to obtain drugs readily through
his old acquaintances. This fact coupled with the observation that
under intensive supervision a higher percentage of addicts do not re-
turn to drug use for an extended period of time following release has
prompted the utilization of the half-way house in the treatment of drug
dependency (Carrick, 1966).

Unlike the therapeutic communities of the Synanon or Daytop
model, the half-way house does not address itself to the long term goal
of character change in the addict. Its purpose lies mainly in the
provision of living arrangements which are supportive of abstinence
from drug use. This type of residence also decreases the probability
of readdiction through the opportunity it affords for closer parole
supervision and urine monitoring. This form of residential treatment
also makes personal counseling, both individually and in a group set-
ting, available to the addict in an attempt to ease the inevitable
problems of readjustment to society following release from an institu-
tional setting. In addition, these facilities have typically attempted
to aid their residents in obtaining employment and vocational training
as an integral part of their overall rehabilitation program (Carrick,

1966; Geis, 1966a).

Therapeutic Communities and Client
Attrition

In spite of the fact that therapeutic communities and transi-
tional facilities represent very different types of programs in terms
of treatment goals and process; they share a common problem in terms of
client attrition. The fact that clients frequently terminate treatment
for drug abuse prematurely has long been recognized as a problem, how-
ever the magnitude of this problem has only recently been clarified by

the publication of The Treatment of Drungbuse. In this book Glasscote

 

and his colleagues have compiled a great deal of information about the
therapeutic communities and have documented the difficulties that these
programs have with client retention. Unfortunately they were unable
to obtain reliable statistics on Daytop Lodge in New York or the Synanon
programs. However, in terms of Daytop Lodge, they described client
retention as being its largest problem. This contention was supported
by a review of Daytop's residential capacity, the number of graduates
from it and the number of yearly screened admissions. This data indi-
cates that the attrition rate is well over fifty percent.

Statistics are available for a number of therapeutic communi-
ties which are affiliated with or modeled after the Daytop program.
In all cases these attrition rates are uniformly high. The Daytop
lodge program of the Connecticut Mental Health Center in New Haven has
an attrition rate of sixty percent with forty percent of all new resi-
dents leaving the program within the first two months of their residence.
Dartec, another Connecticut program modeled after Daytop, has a seventy

percent dropout rate, most of which occurs during the first three weeks

10

of residence. A similar situation is found in the Gateway Houses of
the Illinois Drug Abuse Program. The Gateway Houses have an attrition
rate of sixty-five percent prior to program completion (Glasscote,
Sngfl,, 1972).

High attrition rates are not confined only to programs which
support a strongly confrontational treatment model. A good example of
this fact is Teen Challenge of San Francisco, a private residential
treatment program begun by the Assemblies of God in 1967. This program
disavows the confrontational approach to treatment and substitutes a
spiritual emphasis which, while often strict, is also strongly support-
ive of the individual. In spite of this radical difference from those
therapeutic communities of the Daytop-Synanon model, Teen Challenge's
attrition rate prior to program completion is seventy-eight percent
(Glasscote, et_al., 1972).

The attrition rates cited above have been for programs which
can be considered relatively long—term treatment facilities. However,
very little difference can be found between the attrition rates of
these programs and that of programs which provide relatively short-term
treatment. One example of this is Archway House which is a component
of the St. Louis Drug Dependency Treatment Program. The treatment
program for residents at Archway House is designed to last a minimum
of four months with the maximum treatment period being eight months.
This is a fraction of the time of the therapeutic communities previ-
ously discussed and as such approaches the treatment time normally
expected in a half-way house. In spite of this difference the attri-

tion rate from Archway House is seventy-four percent (Glasscote et a1,

ll

1972). Another facility which emphasizes short-term treatment is the
East Los Angeles Half-way House. In this program the attrition rate
has been reported to be forty-six percent (Geis, 1966a). While this
rate is considerably lower than that of programs previously noted, it
is still quite high when one takes into consideration that most of its
residents were parolees for whom failure would normally mean violation
of parole and possible return to prison.

In order to cope with client retention problems many thera-
peutic communities have instituted various procedures designed to test
the motivation of new applicants prior to entry into the program. One
example of this process is the "motivational blockade" designed by
Daytop Lodge to test the motivation of its applicants. When an addict
wishes to enter Daytop, he is invited to attend an out-patient center
on a daily basis where he participates in group discussions, seminars
and undertakes work assignments at the center. He is expected to re-
turn every day for a period of time which might last from several days
to several months based upon the staff's assessment of his motivation.
If he maintains regular attendance he is scheduled for a "breaking
down" interview which is designed to elicit a "cry for help" and
strengthen his commitment. Following successful completion of this
interview he is officially inducted into the Daytop program. This pro-
cess may be of some use in serving as a rough gauge of the applicant's
motivation since seventy percent of all applicants who come to these
centers drop out prior to admission to Daytop. However, it is also
clear that even with this procedure, Daytop still has a retention

problem of significant magnitude (Glasscote, et a1., 1972).

12

Another example of an attempt to select residents with maxi-
mum potential and motivation is the procedure utilized by The Family,

a therapeutic community modeled after Synanon, which is affiliated with
Mendocino State Hospital in California. In this case The Family selects
its residents only from addicts who have graduated from or are currently
members of a shorter-term therapeutic community called The Awakening.
The Awakening is a four month long program similar to Synanon and has a
seventy-three percent attrition rate. Its clients are selected to go

on to The Family on the basis of their performance in The Awakening and
the fact that they did not leave that program prematurely. However

this method also provides only limited benefit since the attrition rate
for The Family is fifty-one percent (Glasscote, et_al,, 1972).

In view of the statistics cited above, it is clear that the
results of research which could relate a set of client characteristics
to attrition would provide a useful tool in selecting potential resi-
dents for these programs. To date little research has been undertaken
which attempts to isolate these characteristics despite the fact that
such information might alleviate a major problem for the therapeutic
communities. A review of the literature revealed only one study of
client characteristics and attrition from a drug treatment program and
this research was conducted with heroin addicts in a methadone detoxi-
fication program.

Chambers, Cuskey and Wieland (1970) studied a sample of
eighty-six heroin addicts participating in an outpatient detoxification
program. The authors defined attrition as the patient failing to come

to the clinic to obtain his dose of methadone and failing to respond

13

to suggestions that he continue treatment. At the end of the study
period, the authors reported that 68.6 percent of the patients termin-
ated treatment prematurely. In relating client characteristics to
attrition the authors found a significant relationship with only two
demographic variables. It was found that significantly more patients
with less than an eighth grade education terminated treatment prema-
turely than those with eighth grade education or more. Married clients
also had a significantly higher attrition rate than unmarried clients.
While not reaching the level of significance, several trends were also
reported. It was found that addicts using another drug concurrently
with heroin were more likely to remain in treatment. It was also re-
ported that older clients, averaging 35 years of age, who had become
addicted to heroin at a later age were also a lower risk in terms of
attrition.

While the findings of the Chambers study may have some
relevance for attrition from the therapeutic community; it should be
remembered that detoxification programs are usually far less demanding
of the addict. In view of this difference it seems likely that direct
application of these findings to the therapeutic community may not be

warranted.

Review of Addiction Treatment Follow¥up
Studies

In order to facilitate a review of the follow-up studies and
a discussion of these findings, the following review will take the form
of focusing in turn upon the major characteristics that have been in-
vestigated rather than presenting the total results of each research

study individually.

14

One of the most frequently studied characteristics of the
addict as it relates to his status at follow-up has been his record of
arrests prior to treatment. Zahn and Ball (1972), in a study of 108
Puerto Rican addicts who had been treated at the Public Health Hospital
at Lexington, found that those individuals who were considered absti-
nent three years after release from treatment had fewer previous arrests
and fewer arrests for narcotics violations prior to treatment than those
who were currently addicted. A similar result in terms of the number
of previous arrests was obtained by DeFleur, Ball and Snarr (1969) who
studied a sample of 53 Puerto Rican addicts discharged from Lexington
between 1955 and 1962. In both these studies addiction status was de-
termined through the use of urinalysis, a review of public records and
interviews with the subjects' associates. Similar results were also
obtained in a study of 1,843 male parolees with a history of narcotic
addiction. These individuals were released from the California Depart-
ment of Corrections in 1965 and were follow-up one year later to de-
termine parole adjustment. From the results of this investigation, the
authors concluded that a prior criminal record beyond the most recent
offense was unfavorable in terms of the prognosis for successful ad-
justment (Inciardi and Babst, 1971).

It should be noted that the relationship between arrest
record and addiction status at follow-up reported above is concerned
with the adult criminal record. In terms of juvenile delinquency, no
difference has been found between the chronic and ex-addict on this
variable prior to the onset of addiction (Bess, Janus, and Rifkin,

1972; DeFleur, Ball, and Snarr, 1969; Vaillant, 1966). However, it

15

has been reported that ex-addicts were arrested at a significantly
later age than those who were still using heroin at follow-up (DeFleur,
Ball and Snarr, 1969).

The addict's employment record prior to treatment has been
cited as a major factor in relation to addiction status at follow-up.
Vaillant (1966), in a study of 100 New York City addicts who were
followed-up twelve years after treatment at Lexington, found that em-
ployment history differentiated between a group of thirty ex-addicts
and thirty individuals with the worst post-treatment records whom he
labeled chronic addicts. In order to be classified as an ex-addict the
individual had to be abstinent over a minimum period of three years
prior to follow-up and have had no convictions for narcotic or property
offenses. The results of this comparison indicated that the individuals
in the ex-addict group had an average record of at least four years
more consistent employment prior to admission to Lexington than did the
chronic addicts. Vaillant's results received support from a study con-
ducted by DeFleur, Ball and Snarr (1969) which also determined that
ex-addicts had a better record of employment prior to treatment than
did those individuals who were currently addicted at follow-up. Inciardi
and Babst (1971) also obtained similar results in their study of Cali-
fornia male parolees with a history of narcotic addiction. They report
that those individuals who had been employed for six months or more
with one employer prior to institutionalization had a greater degree of
post-release success than those not as consistently employed.

Educational attainment has also been studied in relation to

addiction status at follow-up. Geis (1966a), in a study of narcotic

16

addicts in residence at the East Los Angeles Half-way House and on
regular parole, reported that individuals who were successful in terms
of abstaining from narcotics were more likely to have completed seven
or more years of education than were those who were unsuccessful.
Vaillant (1966), found no difference between ex-addicts and chronic
addicts in reaching the eleventh grade, however ex-addicts were more
likely to have graduated from high school.

Vaillant's results received further support from a study
which compared characteristics of addicts who successfully completed
six months of aftercare following hospitalization at Lexington versus
those who were unsuccessful (Bowden and Langenauer, 1972). For a
sample of 63 addicts, success was defined as no opiod use based upon
patient reports, counselor observations and the use of scheduled and
random urine tests. The individuals labeled as unsuccessful evidenced
opiod use for each of the six months in aftercare and required either
detoxification or were recommended for return to Lexington during this
period. The authors reported that the successful individuals were
significantly more likely to have graduated from high school than those
who were unsuccessful.

A study conducted by Stephens and Cottrell (1972) of 100
addicts six months after their release from the public health hospitals
at Lexington or Fort Worth failed to find any difference in education
below college level between individuals who were abstinent and those
addicted at follow-up. While this finding is at variance with the
studies cited above, the reason for this discrepancy may lie in the

method of determining addiction status. In the study conducted by

l7

Stephens and Cottrell addiction status was determined by the use of
questionnaire only which probably is the least reliable method used by
any of the follow-up studies. Their reliance exclusively upon the
questionnaire rather than gaining supplemental information through
public records and interviews in addition to the absence of urine test-
ing may well have resulted in a large number of active addicts being
classified within the ex-addict group.

The follow-up studies have also focused upon a number of
variables which might be considered drug use history. Perhaps the most
commonly agreed upon result to be obtained by these studies has been
that individuals who were classified as ex-addicts at follow-up began
to use heroin at a later age than those classified as currently addicted
(Bowden and Langenauer, 1972; Zahn and Ball, 1972). Vaillant (1966)
reported that the ex-addicts in his sample did not use opiates before
the age of twenty-one while the chronic addicts began heroin use sig-
nificantly earlier. Geis (1966a) reported almost twice the success
rate for addicts who were twenty-one or older at the time of first use
than for those who were twenty or younger. Similar results were ob-
tained by Kaplan and Meyerowitz (1969) who studied a sample of 71 ad-
dicts released from the Fort Worth PHS Hospital or the Texas Department
of Corrections. Through the use of a pre-release interview and a
follow-up interview that took place nine to twenty-two months after
release, the authors determined that the unsuccessful addicts reported
that they were "hooked" at a significantly earlier age than those sub-

jects who were abstinent at follow-up.

18

In addition to age at first use, other drug use variables
have been found to be related to addiction status at follow-up. Kaplan
and Meyerowitz (1969) also found that the unsuccessful addicts in their
sample reported a significantly shorter time interval between their
first use of heroin and the recognition that they were addicted. It
has also been reported that addicts who were abstinent at follow-up
also had a significantly lower daily cost of heroin prior to treatment
than did those who had become re-addicted (DeFleur, Ball and Snarr,
1969).

In terms of length of heroin use, Geis (1966a) found that the
longer an individual had used heroin the less likely he was to succeed
in terms of abstinence and remaining out of serious difficulty with
the police. Stephens and Cottrell (1972) failed to find any relation-
ship between length of addiction and relapse. This latter finding,
like the one previously reported concerning educational attainment, may
also be the result of their method of determining addiction status at
follow-up.

Several studies have investigated the addict's age as a vari-
able that may be related to abstinence. This possibility was pointed
out by Winick (1962) who, through a search of FBI records, concluded
that the greatest concentration of addicts becoming inactive in terms
of law enforcement contacts was within the age range of twenty-six to
forty-three. On the basis of this data he presented the hypothesis
that addicts may "mature out" of their addiction during this time in
their life. Winick's point of view has received some support from a

number of follow-up studies which have found that addicts under the

19

age of thirty become readdicted at higher rates after treatment than
those over thirty (Duvall, Locke and Brill, 1963; Hunt and Odoroff,
1962; Stephens and Cottrell, 1972).

Ball and Snarr (1969), using a sample of 242 Puerto Rican
addicts treated at Lexington between 1935 and 1962, further investi-
gated Winick's maturation hypothesis. This study was far more exten-
sive than the one conducted by Winick and used not only law enforcement
records but also medical records, urine testing and interviews with the
subjects, their family, and friends. The results obtained by Ball and
Snarr failed to support Winick's maturation hypothesis. Instead of a
general pattern of maturing-out of addiction, their data indicated the
existence of two different career patterns for the addicts in their
sample. The first of these patterns was one in which the addict be-
comes more deeply enmeshed in crime and heroin use as he gets older
rather than maturing out of these activities. The second pattern,
which is more like that described by Winick, is characterized by the
addict giving up a drug centered life as he gets older and establishing
a legitimate role in society. Based upon the data obtained in their
study, Ball and Snarr conclude that about one third of the addicts
"mature out" of their dependence upon heroin and their participation
in the deviant career associated with that drug.

Differences have been observed in abstinence rates at follow-
up between addicts who had volunteered for treatment and those treated
involuntarily. Hunt and Odoroff (1962), in a follow-up study 1,912
addicts discharges from Lexington to the New York City area between

1952 and 1955, found that those addicts who had been committed

20

involuntarily displayed a generally lower readdiction rate than the
voluntary admissions in their sample. It would appear that those ad-
dicts who were under greater legal pressure to terminate their heroin
use were able to do so more successfully than those attempting it
voluntarily. In this case the threat of further incarceration for
failure to abstain appears to have had an effect upon the readdiction
rate of these addicts. This interpretation is given further support
in a more recent study conducted by Bowden and Langenauer (1972) which
studied a sample of 63 patients who had completed six months in after-
care following hospitalization at Lexington. As a result of this re-
search the authors concluded that addicts who had legal charges pending
against them more often successfully completed the aftercare program
in terms of abstaining from opiate use than did those that did not.

In addition to those variables discussed above, a large
number of other client characteristics have been investigated in rela-
tion to addiction status at follow-up. For the most part these char-
acteristics have failed to differentiate between those individuals
addicted at follow-up and those that were found to be drug free. Of
particular interest among these negative results are the findings that
there were no significant differences in addiction status at follow-up
between the sexes (Levy, 1972) or ethnic groups (Levy, 1972; Stephens
and Cottrell, 1972). Investigation of early history variables such as
the childhood home environment also failed to differentiate between
the treatment outcomes (Bowden and Langenauer, 1972; Vaillant, 1966).
The only characteristic relating to the addict's early years which

distinguished between ex-addicts and those that had become readdicted

21

was the socioeconomic status of the home in which they grew up. In
this instance it was found that addicts that were raised in homes close
to the subsistence level were not as successful in abstaining following

treatment (Kaplan and Meyerowitz, 1969).

Commitment to Deviance: A Theoretical
Model for Deviant Career Outcomes

The Commitment to Deviance model, which focuses upon the
later stages of the deviant career, was generated by Stebbins (1971)
in the coUrse of his study of recidivists in the Canadian prison sys-
tem. The object of his research was to examine the career contingencies
of the non-professional criminal in order to identify the factors that
account for the continuation or termination of the individual's deviant
career. In order to accomplish this purpose he conducted extensive
interviews with prisoners who were identified as non-professional
criminals on the basis of their short prison terms, low-level criminal
skills and low ideological attachment to crime as a way of life.

As a result of his research, Stebbins concluded that whether
or not an individual remains deviant in relation to the larger society
depends upon the alternatives that are available to him. However the
choice to be made between these alternatives is not a simple one since
there are social penalties to which the individual becomes subject as
a result of making this choice. These penalties are essentially ines-
capable for, although they take different forms, they are applied to
both the choice of continuing in the deviant role or terminating it.
Confronted by this inevitability, the choice that the individual makes

is determined by the balance of these penalties. Therefore the

22

individual who is considered to be committed to deviance is one for
whom the costs of renouncing his deviant role are higher than the per-
sonal costs of continuing in it. In this situation the individual is,
in effect, trapped within his deviant role by the force of penalties
which are applied against him when he attempts to establish himself in
a non-deviant role.

The social penalties which the model focuses upon fall into
two classes. The first of these, the renunciation penalties, are
penalties which are applied against the individual when he attempts to
abandon the identity to which he was previously committed. In a sense
they act to discourage a change in commitment. The second class of
penalties are of equal importance and have been designated as continua-
tion penalties. These are the costs endured by the individual when he
remains committed to his established role. Since the theoretical model
under consideration is concerned with the individual's attempts to
move from a deviant to a non-deviant social role; the discussion of
social penalties is cast in such a form that continuation penalties are
penalties applied as a result of continuing in a deviant role while
renunciation penalties are those which apply when the individual at-
tempts to establish himself in a non-deviant role.

Through interviews Stebbins distinguished two types of re-
nunciation penalties; those that occur in the individual's material or
economic life and those related to his interpersonal relationships.

The material renunciation penalties that are confronted by the non-
professional criminal with a prison record are reflected in his diffi—

culty in obtaining a job which is within his personal range of

23

acceptable occupations. Frequently, when he does obtain employment it
will be in a position which is of lower prestige than his non-criminal
peers. Once this employment is located, the non-professional criminal
finds that he has difficulty retaining employment due to his own poor
work habits and generally undesirable nature of the work. In addition,
such employment as the individual is likely to obtain is often low
paying and provides a standard of living which is frequently below that
which he has achieved through deviant activities. Within the frame-
work of this model, all the above factors are considered to be aspects
of the material renunciation penalties which operate against the in-
dividual rejecting his deviant role.

The renunciation penalties which operate within the individ-
ual‘s interpersonal life are principally those involved in the manage-
ment of his identity. In regard to these penalties, Stebbins takes a
position which is quite similar to that of Goffman (1963). This man-
agement involves the individual's choice to either "own" his past
deviant identity which can then become the occasion for social embar-
rassment and rejection or attempt to "pass". Passing or playing
straight involves not acknowledging one's past deviance but rather
concealing it; often with a fictitious personal history in order to
fill the gap accounted for by the individual's participation in his
previous deviant role. Such attempts to "pass" have their own costs
in the individual's anxiety that he may be discovered as a result of
errors in the construction of his fictitious history or a chance en-
counter with someone who is aware of his previous identity. The

discomfort associated with the adoption of either of these interpersonal

24

alternatives makes participation in social relationships with non-
deviant others a difficult and often unrewarding experience. At the
same time, the individual is hesitant to interact with his previous
associates since contact with others who remain committed to a deviant
role not only may constitute a violation of parole but also frequently
confronts the individual with difficult decisions in light of his at-
tempt to assume a non-deviant role. Stebbins regards the above as
interpersonal renunciation penalties in contrast to the committed in-
dividual's status in the deviant sub-culture where his position is
accepted as a matter of course without attendant personal and social
embarrassment.

The renunciation penalties, both material and interpersonal,
constitute one side of the balance of penalties that confront the in-
dividual. The other side of this balance consists of the continuation
penalties. Stebbins was able to distinguish only one major continua-
tion penalty for the non-professional criminal and this was the threat
of future incarceration. Given the current legal status of his subjects,
the threat of additional imprisonment in the future was sufficient
continuation penalty to warrant some impetus toward an attempted change
in commitment. Other penalties such as health concerns, age or pres-
sure from family and spouse, while of considerable importance for some
individuals, were not of sufficient generality to be adopted as a dis-
tinct type of continuation penalty. However, for the individuals who
were subject to these latter penalties, they may be of sufficient

strength to motivate a renunciation of the deviant role.

25

Taking the two classes of penalties into account, the model
predicts that an individual will cease to remain committed to a deviant
identity when the continuation prenalties become more costly to him
than the renunciation penalties. According to the model this relation-
ship will apply as long as the negative sanctions the individual wishes
to avoid are currently in effect or have a high probability of occur-
ring at some recognizable time in the future. However, it would be
basically incorrect to assume that the individual is always able to
completely perceive and evaluate the full extent of the penalties to
which he is subject. In some cases the individual may only become aware
of the full impact of the renunciation penalties that confront him after
he has made a decision to renounce his deviant role. This situation may
institute a new assessment of the relative costs incurred by his deci-
sion. In short, this points to the fact that the balance of penalties
is not static and therefore an individual's commitment to either a
deviant or non-deviant role is subject to change in response to new
information and experiences that result in an alteration in the balance

of penalties.

Statement of the Problem

The Commitment to Deviance model, while originally designed
to address itself to the general criminal career, provides a poten-
tially viable model for research on the outcomes of the deviant career
associated with heroin addiction. While there are a number of theories
which are relevant to the phenomenon of heroin addiction, this particu-

lar one has been chosen as the theoretical base of the current research

26

due to the congruence between its postulates and my own personal ob-
servations of addicts in treatment. In a very real sense it reflects
what many addicts have had to say concerning the course and problems
associated with their attempts to terminate heroin addiction. As such
it is an apprOpriate theoretical context in which to begin the study

of attrition from treatment and the more general problem of determining
what factors are associated with successful termination of the deviant
career of addiction. In addition it has received some indirect support
from the follow-up studies of addiction status after treatment. These
research studies, which focused upon the addiction status of individuals
at follow—up after institutional treatment, tend to support the premise
that addiction career outcomes are related to the amount of pressure on
the addict to abandon his deviant role and his ability to circumvent
the renunciation penalties he has become subject to as a result of his
attempt to establish himself in a non—deviant role. Factors such as
poor employment history, a record of previous arrests, and limited edu-
cation were found to be regularly associated with higher rates of re-
addiction. These characteristics of the readdicted individuals are
those that best reflect the probable operation of material renunciation
penalties through decreased opportunities for the acquisition of employ-
ment and as such may create a situation in which renunciation of de-
viance becomes more costly to the individual than continuing in it. On
the other hand, individuals with a better record of employment, limited
arrest records and better education were more often found not to have
become readdicted. The balance of penalties for these individuals may

have remained in favor of the abandonment of the addict role since they

27

were able, in at least some degree, to circumvent the material renun-
ciation penalties as a result of personal characteristics which tend to
facilitate gaining employment.

In a similar fashion, drug use history variables which reflect
the duration and extent of the individual's involvement in this deviant
role have also served to differentiate ex-addicts from those who became
readdicted following treatment. Those individuals with shorter and less
extensive involvement in the role of an addict appear to be more suc-
cessful in abstaining following treatment than those whose drug use
history reflects a deep involvement in the addict role. These latter
individuals may be more fully subject to the material and interpersonal
renunciation penalties due to a loss or failure to develop the inter-
personal and occupational skills necessary to achieve gratification from
the enactment of a non-deviant role.

The currently proposed study seeks to assess the utility of
the Commitment to Deviance model as a framework for understanding and
predicting addiction outcomes through the study of model-related demo-
graphic and drug use history characteristics of addicts within the
context of treatment in a therapeutic community. The use of a thera-
peutic community as the setting for such a study is particularly ad-
vantageous since entrance into such a treatment program represents a
relatively clear occasion in which the individual has made a choice,
however tentative, between the alternatives of remaining addicted or
terminating his deviant role as addict. In comparison to institutional
treatment, the therapeutic community permits greater freedom of move-

ment both into and out of treatment and thus eliminates the problem

28

associated with studying a captive population in which the individual
may be required to remain in treatment beyond the point at which he is
no longer committed to terminating his use of heroin.

Within the context of the model under consideration, the
addict seeks treatment at the point at which he finds himself subjected
to penalties which make continuation of his addiction more costly than
renouncing that role. As he enters treatment the balance of penalties
is such that he seeks to establish himself in a non-deviant role.
However, depending upon the characteristics of his past history and
current interpersonal and occupational skills, he finds that he is con-
fronted to some degree by material and interpersonal renunciation pen-
alties. These renunciation penalties may shift the balance of penalties
in such a way as to decrease the attractiveness of a change in Commit-
ment and the establishment of a non-deviant role. Thus, if the indi-
vidual finds that society, in the form of employers and non-deviant
others, is not receptive to his attempts to re-define his role; the
stress generated by his unsuccessful attempts to acquire employment and
social acceptance may lead to a re-assessment of the relative costs of
the continuation and renunciation penalties to which he is subject.

The addict's re-assessment of his position vis-a-vis the
larger society, especially when he has received little reinforcement
for his attempt to terminate his deviant role, may be accompanied by
the resumption of behaviors associated with his former role. This may
be reflected in his drug taking behavior which is likely to increase
not only as a response to stress but also as part of the movement toward

a recommitment to his role as an addict. The renewed use of heroin is

29

particularly attractive at this time since detoxification prior to
treatment has served to decrease his tolerance to the action of the
drug. This period of reassessment may end with one of two possible
outcomes. The individual may find that the continuation penalties are
such that he will continue to attempt to renounce his role. In this
case the episodic drug use will be terminated and the individual will
continue in treatment until the next period of reassessment or until

he has established himself in a non-deviant role through the circumven-
tion of the renunciation penalities which have been operating against
him. On the other hand, the individual may find that in renouncing his
deviant role he has become subject to penalties which are greater than
those he initially sought to avoid. In weighing the limited gratifica-
tions currently available to him in terms of employment and interper-
sonal relationships against the positive aspects of his former deviant
role; he may continue in the use of heroin, become re-addicted and
terminate treatment. In short, he fully resumes his role as addict.

It is the primary purpose of the current study to assess the
efficacy of the Commitment to Deviance model as a framework for under-
standing addiction outcomes as reflected by attrition from residential
treatment. If Commitment to Deviance is a useful explanatory model,
then evidence of the differential operation of continuation and renune
ciation penalties should be related to length of stay in treatment.

In addition, it is expected that the operation of these penalties and
length of stay in treatment will also be related to a number of model-
related demographic and addiction history characteristics of the addict.

The second purpose of the current study is to attempt, on the basis of

30

these model-related characteristics, to develop predictors which might
prove useful in the identification of individuals who represent high

risk in terms of early attrition from residential treatment.

Hypotheses

Hypotheses l--3 presented below represent an attempt to eval-
uate the adequacy of the Commitment to Deviance model as a framework
for understanding addiction outcomes as reflected by attrition from
treatment. It is expected that if the social penalties to which the
addict is subject operate in the manner predicted by the model; then
evidence of the operation of these continuation and renunciation pen-
alties should be related to attrition from treatment.

1. Length of stay in treatment will be directly related to the
extent to which the addict is subject to legal pressure to
terminate heroin use.

Legal pressure represents the major continuation penalty which operates
against the heroin addict. The first hypothesis focuses upon the re-
lationship of this continuation penalty to the addict's length of stay
in treatment. If continuation penalties are a major factor in moti-
vating the addict to renounce his deviant role; then the operation of
legal sanctions in the form of the possibility of incarceration will

be related to addicts who are subject to such pressure remaining in
treatment for a longer period of time than addicts who are not subject
to legal pressure.

2a. Length of stay in treatment will be directly related to the
addict's ability to secure employment while in treatment.

b. Length of stay in treatment will be directly related to the
frequency of the addict's social contacts with non-deviant
individuals while in treatment.

31

Hypotheses 2a and b focus upon the effect of the material and inter-
personal renunciation penalties that confront the addict during his
attempt to renounce his deviant role and establish a non-deviant identity.
It is expected that addicts who are unable to circumvent these penalties
and thus fail to obtain employment and some degree of acceptance among
non-addicts will also fail to renounce their former role. If these re-
nunciation penalties are inescapable then the individual will redefine
the balance of penalties, terminate treatment and in the process renew
his commitment to his deviant identity.

3. The extent of the addict's drug use prior to termination of
treatment will be inversely related to length of stay in
treatment.

Hypothesis 3 focuses upon the relationship of attrition to drug use

from the perspective of attrition as an instance in the addict's career
in which he has attempted and failed to renounce his deviant role. It
is expected that if an addict's termination of treatment signifies a
resumption of his former deviant role then it will be accompanied by

the renewal of behavior patterns associated with this role. This should
be particularly apparent in regard to the drug taking behavior of in-
dividuals who terminate treatment after a relatively brief period of
time.

The hypotheses presented above are intended to examine the
relationship of the continuation and renunciation penalties to the
addict's termination of his treatment for his addiction. As such these
hypotheses represent an assessment of the extent to which the Commit-
ment to Deviance model accurately reflects the addict's attempt to re-

nounce his deviant role and the factors that effect the outcome of

32

this renunciation. The hypotheses that follow represent an effort to
assess the relationship of selected model-related demographic and drug
use history characteristics of the addict to the operation of these
social penalties and the outcome of the individual's attempted renun-
ciation of his deviant role. These latter hypotheses are an extension
of the theoretical model in that they represent an attempt to validate
a complementary general hypothesis that life history and drug use char-
acteristics associated with the addict's enactment of his deviant role
are related to the extent to which he confronted by these social penal-
ties and his ability to circumvent them. In addition, to the extent
that these characteristics are related to the operation of the renun-
ciation penalties they should also serve a predictive function in terms
of the outcome of the addict's attempt to renounce his deviant role as
reflected by attrition. Hypotheses 4a--5c focus upon the relationship
of these demographic and drug use history characteristics to the opera-
tion of the renunciation penalties.

4a. The addict's ability to secure employment while in treatment

glglnbe directly related to the age at which heroin use was

b. The addict's ability to secure employment while in treatment
will be inversely related to the length of time addicted.

c. The addict's ability to secure employment while in treatment
will be inversely related to the cost per day of his previous
heroin habit.

Hypotheses 4a--c focus upon specific addiction history characteristics
of the addict that are likely to operate against the individual's

ability to secure employment. These characteristics are considered to

be indicative of the extent to which the addict has been assimilated

33

into the heroin sub-culture and the corresponding loss of opportunity
to develop and maintain socially approved behaviors and skills. It is
expected that individuals who have become addicted at an earlier age

or have been addicted for relatively long periods of time may be con-
fronted by more severe material renunciation penalties due to a lack

of opportunity to develop and maintain the occupational skills and work
habits necessary to obtain employment and retain it for anything more
than brief period of time. A similar situation may prevail in terms of
the amount of money the addict must commit to the maintenance of his
habit. The more the individual's habit costs per day, the more time

he must spend engaged in pursuit of obtaining money and drugs to meet
the demands of that habit. The result of this is a greater involvement
in illegal activities and often a neglect of those skills and habits
necessary to secure employment.

In addition to the addiction-specific characteristics of the
individual discussed above, certain characteristics which are non—
specific to addiction may also be relevant to the addict’s employabil-
ity. These characteristics, such as level of education, previous em-
ployment history, and criminal record have been noted to operate among
the general population as factors that influence the individual's
ability to secure employment. Since these characteristics are non-
specific to addiction, they will not be formally presented as hypoth-
eses but will be studied in order to ascertain their relationship to
the addicts ability to obtain employment and thus their contribution

to the operation of the material renunciation penalties.

34

5a. The frequency of the addict's social contacts with non-deviant
others while in treatment will be directly related to the age
at which heroin use was begun.

b. The frequency of the addict's social contacts with non-deviant
others while in treatment will be inversely related to the
length of time addicted.

c. The frequency of the addict's social contacts with non-deviant
others while in treatment will be inversely related to the
cost per day of his previous heroin habit.

Hypotheses 5a--c focus upon the relationship between those character-
istics which are indicative of the extent to which the addict has been
assimilated into the heroin sub-culture and the operation of inter-
personal renunciation penalties. The more extensive the addict's
assimilation into the heroin sub-culture the more his interpersonal
contacts have become exclusively directed toward others engaged in
similar pursuits. As a result his life space becomes increasingly con-
fined to the sub-culture that surrounds the use of addictive drugs and
he experiences decreasing contact with non-addicts. This isolation
from participation in the interpersonal exchanges which characterize
conventional society may result in the loss or failure to develop those
social skills which are necessary to form and maintain interpersonal
relationships with individuals outside of the heroin sub-culture. It
is expected that, as a result of this social handicap, addicts who have
become addicted at an early age, have been addicted for relatively

long periods of time, or evidence a relatively costly heroin habit will
be subject to more severe interpersonal renunciation penalties due to
their failure to form interpersonal relationships with non-deviant

others. The failure to form these relationships will be evidenced by

the addict's limited social contact with non—deviant individuals.

35

6a. Length of stay in treatment will be directly related to the
age at which heroin use was begun.

b. Length of stay in treatment will be inversely related to the
addict's length of time addicted.

c. Length of stay in treatment will be inversely related to the
cost per day of the addict's previous heroin habit.

Hypotheses 6a--c focus upon the relationship between the addiction
history characteristics of the addict and termination of treatment.
In so far as these characteristics are related to the operation of the
renunciation penalties, they should also be related to the outcome of
the renunciation attempt. The relationship of the addict's level of
education, previous employment history, and criminal record to length
of stay in treatment will also be examined in order to determine the
contribution of these general demographic characteristics to attrition.
It is expected that, on the basis of these demographic and addiction
history characteristics, predictors can be developed which can be used
to identify those individuals who represent a high risk in terms of
early attrition from treatment.
7a. Length of stay in treatment will be inversely related to the
number of previous attempts the addict has made to terminate
his use of heroin.

b. Length of stay in treatment will be inversely related to the
duration of the addict's longest prior attempt to terminate
his use of heroin.

Hypotheses 7a and b focus upon the relationship between the addict's
previous attempts to renounce his deviant role and the outcome of his
most current attempt. These hypotheses represent an extension of the

Commitment to Deviance model in that they focus upon the effects of

the individual's previous history of role renunciation, a factor which

36

has not been explicitly considered within this model. It is expected
that individuals who have made frequent attempts at renunciation or
have initially succeeded in this attempt for a relatively long period
of time but then returned to heroin use are more likely to become dis-
couraged more quickly when confronted by renunciation penalties than
addicts who have not had this previous experience. In a sense they
may have a greater readiness to re-define the balance of penalties and
to terminate treatment based upon a belief that they will ultimately

be unsuccessful again.

CHAPTER II
METHOD

The subjects were 34 heroin addicts who had requested resi-
dential treatment for their addiction. The subjects ranged in age from
18 to 46 with 82 percent of the sample being male and 18 percent female.
In terms of racial composition, 56 percent of the subjects were white
and 44 percent black. The majority of these subjects had been referred
to the Comprehensive Drug Treatment Program through other Comnunity
Mental Health agencies and through the court system. Following this
referral but prior to assignment to a program, the subjects were inter-
viewed by the Intake Coordinator of the drug treatment programs to ob-
tain a social and drug use history. Following the interview the
individuals were assigned according to a pre-determined random sequence
to one of two residential treatment facilities associated with the
Comprehensive Drug Treatment Program. Only those individuals who were
assigned to the Multi-Lodge and accepted this assignment were included
in the present study. See Table 1 for a summary table of means on all

demographic variables for male and female subjects.

Treatment Setting

 

The Multi-Lodge program, with some modifications, was modeled
after the lodge concept of residential treatment as developed by Fair-

weather and his associates (1969b). This concept of residential

37

38

Table 1. Summary table of means on all demographic variables for male
and female subjects.

 

 

 

Variable Males (N = 27) Females (N = 7)

Age 25.41 24

Education 12.00 10.14
Employment history .19 .04
Criminal record 2.48 3.29
Age first heroin use 20.33 18.29
Length of use 33.74 48.45
Cost per day 67.47 90.00
Number of "kicks" 2.70 2.86
Length of longest "kick" 9.26 1.86

 

treatment places emphasis upon the group responsibility of its members
for the management of the living and working condition of the lodge.
The basic thrust of this concept is that the lodge, as a social sub-
system, provides its individual members with the support, opportunity
for employment and achievable social status which enables them to con-
tinue to function within the community.

The lodge approach to residential treatment, which was de-
signed to aid socially marginal individuals, has achieved considerable
success in removing chronic mental patients from institutional care
and maintaining them within the community (Fairweather gt_al,, 1969a).
This particular application of the lodge concept of treatment has been
extensively studied and is now in operation in a number of states as
an accepted method of returning the chronic mental patient to the

community. The possibility of extending the lodge concept to the

39

treatment of addiction was suggested by Sanders (1966) who believed

that addicts present problems of societal maginality similar to chronic
mental patients. This basic concept of treatment was implemented
through the Community Mental Health Board in the Lansing area and was
established as the Multi-Lodge.

The Multi-Lodge, which serves as the context for the proposed
study, can be conceived of as a mini-representation of the larger so-
ciety. It is a social sub-system implanted within the larger society
which reflects the norms and values of that society. The lodge program
structure not only requires that the resident live within a social
framework which is reflective of these norms but also encourages the
development of a set of social skills which are reinforced through the
operation of a system of achievable social status within the program.
In short, in order for the individual to achieve within the lodge pro-
gram, he must adopt behavior which is facilitative of the enactment of
a non-deviant role. During this process the lodge seeks to provide an
atmosphere which is supportive of the individual who is attempting to
cope with the stresses generated by his attempts to establish a non-
deviant role both within the social sub-system and the larger society.
A description of the Multi-Lodge program and the manner in which it
differs from the prototype lodge is presented in Appendix I. The
program manual, which presents the operation of the lodge in greater

detail, can be found in Appendix II.

40

Instruments

Three sources of data were utilized in the present study.
The first of these is the intake questionnaire (Appendix III) which
was administered to the subjects in the form of a structured interview
as part of the intake procedure of the Comprehensive Drug Treatment
Program. The second source of information consisted of the program
records of the Multi-Lodge which provided data concerning the resident's
legal status at entry, urine testing results, employment, and length
of time in residence. The third source of data was provided by staff
ratings of the frequency of the resident's social contacts with non-
addicts.

Intake questionnaire.--The intake questionnaire (Appendix III)
was designed to elicit information concerning a broad spectrum of dem-
ographic and drug use characteristics of individuals entering the drug
treatment program. The questionnaire was administered in the form of
a structured interview by the intake coordinator prior to the subject's
entrance into treatment. The current study utilized data obtained from
this questionnaire to determine the addict's education, employment
history and arrest record as well as a number of drug use history char-
acteristics.

Data concerning the addict's employment history was obtained
through information provided by the questionnaire. A measure of the
consistency of the individual's employment for the last five years was
obtained by dividing the ratio of the number of months employed to the
total number of months in this period by the number of jobs held. For

subjects under the age of twenty-three, the denominator of the ratio

41

was determined by the total number of months employable since age eight-
een. The ratio obtained through these calculations was then utilized
to test the relationship of the addict's employment history to attrition
and the ability to secure employment while in treatment.

A record of the subject's history of arrests was compiled
through the use of the intake questionnaire in order to test the rela-
tionship of the addict's criminal record to attrition and the ability
to secure employment while in treatment. In calculating the arrest
record, arrests were linked to incarceration in order to eliminate
recording those instances in which the individual was taken into custody
for questioning but was not charged with the commission of a crime.

Data concerning the addiction history characteristics of the
subjects was obtained from the questionnaire to provide a vehicle for
the assessment of the extent of the individual's involvement in the
addict role in order to test the relationship of this variable to at-
trition, frequency of social contacts with non-deviant others and the
ability to secure employment while in treatment. The variables utilized
for this purpose were the age at which the individual began to use
heroin, the length of time addicted and the cost per day of his habit.
In addition, the number of times he had attempted to "kick the habit"
and the longest time he had abstained from the use of heroin since be-
coming addicted were utilized to provide information concerning the
individual's previous attempts at renunciation of his deviant role in
order to assess the relationship between these attempts and his most

current attempt.

42

Program records.--The program records provide data concerning
the length of residence and the urine testing records of the subjects
while in residence. Length of stay for each subject was computed from
the day in which he established residence by moving into the program
until the day of termination. However, several subjects who have been
included in the present study never actually established residence in
the program. For the purposes of this study, these individuals have
been considered residents with a length of stay of 0 days if they ac-
cepted assignment to the Multi—Lodge at Central Intake; made contact
with the Multi-Lodge staff in preparation for entering the program but
then failed to follow through by physically establishing residence.

The length of time the subjects were employed while in resi-
dence at the lodge was analyzed in order to test the relationship be-
tween the ability to secure employment and attrition. For the purposes
of the present study, this employment data is presented in the form of
a three point scale. The three points of the scale are no employment,
employment obtained but retained for less than a month, and employment
secured for one month or more. This data was also utilized to test
hypothesis four which attempts to determine if selected addiction
history characteristics are related to the addict's ability to secure
employment.

The individual's use of drugs while a resident at the Multi-
Lodge was monitored through the use of urinalysis. Each resident was
required to provide a sample of his urine three times a week under
observation of a staff member. After urine samples were obtained, they

were sent air mail to United Medical Laboratories in Portland, Oregon.

43

Upon receipt the samples were subjected to tests utilizing thin layer
chromatography to determine the presence of amphetamines, cocaine,
barbiturates, methaqualone, quinine, methadone and morphine and its
derivatives. In cases where a "positive" result was obtained on one
of the drugs, the sample was subjected to confirmation by additional
tests to determine the reliability of the initial finding. Only when
the original positive finding was confirmed by the additional tests
was that urine sample considered to be evidence of drug use. The data
obtained through the use of urinalysis for the thirty day period prior
to termination was analyzed to assess the relationship between attri-
tion and the resumption of the addict role as reflected by the subject's
drug taking behavior. (Further information concerning the urine test-
ing procedures of the Multi-Lodge can be found in the program manual
in Appendix II).

Staff ratings.--The third source of data used in the current
study consists of a staff rating of the frequency of the subject's
social contacts with non-addicts. This rating was adopted in order to
assess the operation of the interpersonal renunciation penalties as
reflected in the frequency of such contacts and its relationship to
attrition. This rating of the frequency of social contacts with non-
addicts was also used to assess the relationship between the frequency
of these contacts and the degree to which the subject was previously
involved in the addict role as reflected by the drug use history vari-
ables presented in hypothesis five. For the purpose of this study,
these social contacts were defined as face to face contacts that the

subjects had with non-addicts for the purpose of leisure activity.

44

Each subject was rated on a four point scale in terms of the frequency
at which such contacts occurred and the ratings were made by the staff
member who had the most contact with the subject to be rated. A sub-
set of these subjects who were considered to be known equally well to
both raters were selected and rated on this scale in order to assess
inter-rater reliability. A correlation coefficient of .93 was obtained
between the two sets of ratings. (See Appendix IV for a description

of the scale used in rating the frequency of the subject's social con-

tacts with non-addicts).

CHAPTER III

RESULTS AND DISCUSSION

Correlational analysis was utilized to test the hypotheses
of the current study. After a matrix of Pearson product--moment cor-
relations was obtained a multiple regression analysis using the method
of least squares was utilized to determine the extent to which selected
combinations of independent variables derived from the hypotheses
jointly predicted the addict's frequency of social contacts, ability to
obtain employment and length of stay in treatment. Since both the
correlational and the multiple regression analysis are dependent upon
the assumption of linearity being met, scatter plots were obtained be-
tween the dependent variables and all independent variables in order
to check for the existence of any significant departure from linearity.
Inspection of these scatter plots indicated that there were no signifi-
cant departures from linearity.

Prior to a discussion of the results obtained from the analy-
sis of data relating to the formal hypotheses of this study, some con-
sideration of the correlation matrix obtained between the variables
included in the current research seems appropriate. (See Table 2 for
the intercorrelation matrix of independent and dependent variables.
Table VI.I in Appendix VI contains a summary of the means and standard

deviations for all variables.) An inspection of the correlation matrix

45

46

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47

indicates that there appears to be only one cluster which is formed
among the variables. This cluster, which consists primarily of vari-
ables related to in-treatment behaviors, appears to be relatively inde-
pendent of the variables that represent the pre-treatment demographic
and addiction history characteristics of the subjects. In addition,
the demographic and addiction history variables appear to be relatively
independent of each other with few significant correlations occurring
between them. The statistically significant correlations obtained be-
tween these characteristics represent relationships which are fairly
well established in the literature. For example, the extent of the
legal pressure to which an addict is subject was found to be negatively
related to his previous employment history (-.36) and positively re-
lated to the extensiveness of his prior criminal record (.35). In
other words, legal pressure was less intense for addicts with more
consistent records of employment but more intense the more times the
addict had previously been arrested. In a similar fashion, the exten-
siveness of the addict's criminal record was found to be positively
related to the length of time addicted (.39) but negatively related to
his employment history (-.37). In addition the cost per day of the
addict's “habit" was found to be positively related to length of time
addicted (.36) and his level of education was positively related to
consistency with which he was employed (.45).

Before a discussion of the results obtained in relation to
the major hypotheses of the current study can be undertaken, a problem
pertaining to the data and its interpretation must be noted. An in-

spection of the correlation matrix will reveal that the number of

48

subjects vary in relation to the particular variable under considera-
tion. For instance, those variables which pertain to the addict's
general demographic and addiction history characteristics, as well as
the number of days in treatment, are based on a pool of thirty-four
subjects. However several other variables such as the frequency of the
addict's social contacts with non-addicts and his success in securing
employment in treatment are based upon twenty-four subjects. This
creates a problem in regard to the analyses of multiple regression
since the variables based upon twenty-four subjects are the criterion
variables used in a number of these analyses. As a result ten subjects
were eliminated from the computation of a number of the multiple re-
gression analyses. The reason for the attrition was that those subjects
eliminated were residents of the program for less than thirty days. It
was felt that to rate those individuals, in terms of the frequency of
social contacts or their ability to secure employment while in treat-
ment for such a short period of time, would bias the results more than
excluding them from the analyses. However such a large subject loss
relative to the size of the total sample has had the following effects
upon the data analysis:

a) It leaves unchanged all correlations involving relationships
among demographic and addiction history variables since the
original sample size could be used.

b) It effects some of the multiple regression analyses involving
a combination of the above factors and those variables re-
lating to behavior while in treatment since the reduced sample
(n = 24) had to be used here. Some estimate of the effect of
reduced sample size upon the simple and multiple correlations
can be made in cases where the original correlation was com-
puted on the basis of the full sample (n = 34). The specific
pattern of alteration among the correlations due to reduced
sample size and its probable effect upon the multivariate

analyses will be discussed in conjunction with each set of
results.

49

Hypothesis 1, which focused upon the relationship between
the continuation penalty of incarceration and attrition, predicted that
length of stay in treatment would be directly related to the extent to
which the addict was subjected to legal pressure to terminate heroin
use. The correlation coefficient obtained between the extent of legal
pressure and number of days in treatment was .46 which was significant
at the .01 level. *

Hypothesis 2a and b were concerned with the relationship of
the material and interpersonal renunciation penalties to attrition.
Hypothesis 2a predicted that the addict's length of stay in treatment
would be directly related to the ability to secure employment while in
treatment. A correlation of .67, which is significant at the .001
level, was obtained between the number of days in treatment and success
in securing employment while in treatment. In a similar fashion, hy-
pothesis 2b predicted that the addict's length of stay in treatment
would be directly related to the frequency of his social contacts with
non-addicts during the course of treatment. A correlation of .52,
which is significant at the .01 level, was obtained between the number
of days in treatment and the staff rating of the addict's frequency of
social contacts with non-deviant individuals during the course of treat-
ment.

The Commitment to Deviance model states that success in the
renunciation of the deviant role is the result of the balance of con-
tinuation penalties (eg. threat of incarceration), material renuncia-
tion penalties (eg. failure to secure employment) and interpersonal

renunciation penalties (eg. limited social contacts with non-deviant

50

others) confronting the individual. In order to determine the extent
to which legal pressure, success in securing employment and frequency
of social contacts, taken together, account for the variance observed
in the length of stay in treatment, an analysis of the overall regres-
sion of these three variables on the number of days in treatment was
computed. As a result of this analysis a multiple regression coeffi—
cient of .69 (p < .005) was obtained which accounted for approximately
48 percent of the observed variation. (See Table 3 for a summary of
the analysis of variance for the overall regression.) An examination
of the beta weights associated with each of the predictor variables
revealed that practically all the explained variation was accounted for
by success in securing employment while in treatment. This variable
accounted for 45 out of 48 percent of the observed variation explained
by the predictor variables while legal pressure and the frequency of
social contact with non-deviant others accounted for only an additional
3 percent. (See Table 4 for a summary of the beta weights, F statistics
and significance levels of the variables in the analysis of regression.)
The failure of legal pressure toaccount for more of the ob-
served variation in number of days in treatment is somewhat surprising
in view of the statistical significance of the simple correlation
between these two variables and the relatively low correlations obtained
between legal pressure and the other two predictor variables which
entered into the multiple regression. The fact that legal pressure
contributed so little to the multiple regression may be attributable
to the effect of subject loss which was discussed previously. This

appears particularly likely since the majority of those subjects dropped

51

Table 3. Analysis of variance for the overall regression of legal
pressure, success in obtaining employment and frequency of
social contacts on length of stay in treatment. (N = 24)

 

 

 

Source SS df MS F
Regression 103013.22 3 34337.74 6.06*
Error 113386.61 20 5669.33

Total 216399.83 23

 

*p < .005, two-tailed test.

Table 4. Beta weights, F statistic and significance levels for legal
pressure, success in obtaining employment and frequency of
social contacts in estimation of length of stay in treatment.

 

 

 

(N = 24)
Variable Beta Weight F Significance level
Legal pressure .15 .82 .38
Employment in treatment .57 6.03 .02

Freq. of social contacts .09 .16 .70

 

52

from the analysis due to their limited length of stay in treatment
were not subject to any legal pressure to terminate their heroin use.
As a result of this loss the simple correlation between legal pressure
and number of days in treatment fell from .47 to .31 while its corre-
lation with the other two predictor variables remained the same. This
would tend to attenuate the effect of legal pressure in the multiple
regression.

Hypothesis 3 predicted that the extent of the addict's drug
use prior to termination of treatment will be inversely related to the
length of stay in treatment. A Pearson correlation coefficient was
computed between the proporation of dirty urines during the last thirty
days of treatment and the number of days in treatment. A correlation
coefficient of -.62 was obtained which is significant beyond the .01
level.

Hypotheses 4a, b and c were concerned with the relationship
of selected addiction history characteristics and the operation of
material renunciation penalties as reflected in the addict's ability
to secure employment while in treatment. Hypothesis 4a predicted that
the addict's ability to secure employment would be directly related to
the age at which heroin use was begun. A correlation coefficient of
.16 was obtained between the addict's success in securing employment
and the age at which he first used heroin. While the obtained correla-
tion was in the predicted direction, it failed to reach significance
and therefore the hypothesis was not supported. Hypothesis 4b predicted
that the addict's ability to secure employment would be inversely re-

lated to the length of time addicted. A non-significant correlation

53

of -.25 was obtained between measures of these two variables; thus the
hypothesis was not supported. Hypothesis 4c predicted that the addict's
ability to secure employment while in treatment would be inversely re-
lated to the cost per day of the addict's heroin habit prior to treat-
ment. A correlation coefficient of -.32 was obtained which, while in
the predicted direction, failed to reach significance.

Although none of the simple correlations reached the level
of significance, an analysis of the overall regression of age at first
use, length of addiction and cost per day on success in securing employ-
ment while in treatment was undertaken in order to determine the extent
to which these variables are jointly predictive of the addict's ability
to secure employment. This analysis yielded a multiple regression co-
efficient of .38 which was not statistically significant and accounted
for only 15 percent of the observed variation of the dependent variable.
(See Table VII.I in Appendix VII for a summary of the analysis of vari-
ance for the overall regression.) From the results of these analyses
it must be concluded that these variables, whether considered separately
or together, fail to predict the addict's ability to secure employment
while in treatment. It should be noted that the multiple regression
coefficient obtained in the analysis was, in all probability, effected
by the subject loss. The reduction in the number of subjects available
for this analysis resulted in an increase in the size of the inter-
correlations between the independent variables while the size of their
correlations with the criterion variable remained the same. The result

of such an alteration in these intercorrelations would probably be to

54

deflate the size of the multiple regression coefficient presented here.
However, due to the relatively low order simple correlations obtained
between the independent variables and the criterion, it is unlikely that
this analysis was effected to any appreciable extent.

Hypotheses 5a, b and c were concerned with the relationship
between the selected addiction history characteristics and the frequency
of the addict's social contacts with non-deviant others during treatment.
Hypothesis 5a predicted that the frequency of these social contacts
would be directly related to the age at which heroin use was begun. A
correlation coefficient of .23 was obtained which, while in the predicted
direction, failed to reach the level of significance. Hypothesis 5b
predicted that the frequency of social contacts would be inversely re-
lated to the length of time addicted. A correlation coefficient of
-.13 was obtained between measures of these variables. This result was
not statistically significant. Hypothesis 5c predicted that the fre-
quency of social contacts with non-deviant others during treatment would
be inversely related to the cost per day of the addict's heroin habit
prior to treatment. A correlation coefficient of -.04 was obtained
which was not statistically significant. On the basis of these results
neither hypotheses 5a, b or c were supported by the data.

Although the simple correlations obtained between these
variables and the frequency of the addict's social contacts were of a
low order, an analysis of the overall regression of age at first heroin
use, length of addiction and cost per day of the heroin habit on the
frequency of social contacts was computed since their combined relation-

ship to the criterion variable was of interest. This analysis yielded

55

a multiple regression coefficient of .29 which was not statistically
significant and accounted for only 8 percent of the observed variation
in the dependent variable. The result obtained by this analysis of
multiple regression indicates that these three variables in combination
have little utility as predictors of the frequency of the addict's so-
cial contacts with non-deviant others while in treatment. It is expected
that the multiple correlation coefficient obtained in the analysis under
consideration has been effected by subject loss in the same way as the
previous analysis. However the effect is believed to be slight due to
the low order of simple correlations obtained between the independent
variables and the criterion. (See Table VII.2 in Appendix VII for a
summary of the analysis of variance for the overall regression.)
Hypotheses 6a, b and c focus on the relationship of the
selected addiction history characteristics to length of stay in treat-
ment. Hypothesis 6a predicted that length of stay in treatment would
be directly related to the age at which heroin use was begun. A cor-
relation coefficient of .13 was obtained between measures of these two
variables., Hypothesis 6b predicted that length of stay in treatment
would be inversely related to the length of time addicted. A correla-
tion coefficient of -.12 was obtained between the number of days in
treatment and length of time addicted. This correlation was not statis-
tically significant. Similarly, hypothesis 6c predicted that length of
stay in treatment would be inversely related to the cost per day of the
addict's previous heroin habit. A correlation coefficient of -.l7,

which is not statistically significant, was obtained between measures

56

on these two variables. From these results it is apparent that hypoth-
eses 6a, b and c were not supported by the data of this study.

Although none of the simple correlations reached the level
of significance, an analysis of the overall regression of age at first
use, length of addiction and cost per day on number of days in treatment
was computed since their combined relationship to the criterion variable
was of interest. This analysis yielded a multiple regression coefficient
of .22 which accounts for 5 percent of the observed variation in the
dependent variable. This multiple regression coefficient failed to
reach the level of statistical significance. (See Table VII.3 in Ap-
pendix VII for a summary of the analysis of variance for the overall
regression.) From the results of this analysis, it is concluded that
the age of first heroin use, length of addiction and cost per day of the
heroin habit prior to treatment, when taken together, have little utility
as predictors of length of stay in treatment. Since this multiple re-
gression analysis was able to utilize the full sample of subjects, its
interpretation is uneffected by the consideration of subject loss.

Hypothesis 7a and 7b are concerned with the relationship be-
tween the addict's previous attempts to terminate his addiction to heroin
and his length of stay in treatment during his most recent attempt.
Hypothesis 7a predicted that length of stay in treatment would be in-
versely related to the number of previous attempts to terminate heroin
use. A correlation coefficient of .12 was obtained between number of
days in treatment and the number of previous attempts to terminate heroin
use. This result was not statistically significant and failed to sup-

port hypothesis 7a. Hypothesis 7b, which predicted that length of stay

57

in treatment would be inversely related to the duration of the addict's
longest prior attempt to terminate heroin use, was also not supported
by the data of the current study. A correlation coefficient of -.20
was obtained between measures of these two variables which was not
statistically significant.

In addition to the variables tested within the context of
the formal hypotheses presented above, the relationship of three general
demographic characteristics of the addicts to their ability to secure
employment and length of stay in treatment was examined. Pearson cor-
relations were computed between the addict's educational level, previous
employment history, and criminal record and his success in securing
employment while in treatment and length of stay in treatment. In no
instance were any of the correlations obtained statistically signifi-
cant. (See Table 5 for a summary table of the correlations obtained
between these demographic characteristics and length of stay in treat-
ment and success in securing employment. For the intercorrelations
among these demographic variables and between them and all other vari-

ables in the study see Table 2.)

Table 5. Summary table of correlations obtained between three general
demographic characteristics of addicts and success in secur-
ing employment and length of stay in treatment.

 

 

Variable Education Employ. Hist. Criminal Rec.

 

Employment in treat. (N = 24) .32 -.O7 -.15
Length of stay (N = 34) .17 -.15 -.16

 

58

Although the simple correlations obtained between the addict's
level of education, employment history and criminal record and both suc-
cess in securing employment in treatment and length of stay in treatment
failed to reach the level of statistical significance, analyses of the
overall regression of these three variables on each of the criterion
variables was computed since their combined relationship to these cri-
terion variables was of interest. The analysis of regression for these
three independent variables on success in obtaining employment yielded
a multiple regression coefficient of .38 which accounted for 15 percent
of the variance. This multiple regression coefficient failed to reach
the level of statistical significance. It should be noted that, once
again, the multiple regression coefficient obtained in the analysis was,
in all probability, effected by the subject loss. The reduction in the
number of subjects available for this analysis resulted in a decrease
in the size of the intercorrelations between the independent variables
while the size of their correlations with the criterion variable remained
the same. The result of such an alteration in these intercorrelations
would probably be to inflate the size of the multiple regression coeffi-
cient obtained in the analysis. However, due to the relatively low
simple correlations obtained between the independent variables and the
criterion, it is unlikely that this analysis was effected to any ap-
preciable extent. (See Table VII.4 in Appendix VII for a summary of
the analysis of variance for the overall regression.) The analysis of
regression on length of stay in treatment yielded a nonsignificant
multiple regression coefficient of .36 which accounted for 13 percent

of the observed variation in the number of days in treatment. Since

59

this multiple regression analysis was able to utilize the full sample
of subjects, its interpretation is uneffected by the consideration of
subject loss. (See Table VII.5 in Appendix VII for a summary of the
analysis of variance for the overall regression.) From the results of
these analyses it can be concluded that educational level, employment
history and criminal record have little utility as joint predictors of
whether or not the addict will succeed in securing employment while in
treatment or the length of stay in treatment.

The data of the present study was analyzed without a distinc-
tion being made between the race or sex of the subjects. This was done
on the basis of results obtained by the studies of addiction status at
follow-up which failed to find any significant difference in rates of
readdiction in regard to race or sex. As a check on the importance of
these variables in regard to the present sample, "t-tests" were computed
for race and sex on length of stay in treatment. The difference be-
tween white and black subjects in length of stay in treatment was found
to be statistically non-significant. Likewise, the difference between
male and female subjects on length of stay in treatment was also found
to be statistically non-significant. See Table 6 for the means and

computed t statistic for these variables.

60

Table 6. Means and computed t for race and sex on length of stay in
treatment. (N = 34)

 

 

 

Variable Mean t
Race .29
black 72.00
white 62.79
Sex .62
male 71.82

female 47.71

 

CHAPTER IV

GENERAL DISCUSSION

Commitment to Deviance:
the Relationship of Continuation and
Renunciation Penalties to Attrition

The central thesis of the Commitment to Deviance model is
that the individual's decision to terminate or continue his enactment
of a deviant role is based upon the balance of social penalties that
confront him. This balance is struck between the continuation penalties,
those aversive outcomes the individual incurrs by continuing in his
deviant role, and the economic and interpersonal renunciation penalties
which the individual confronts as a result of attempting to renounce
his deviant role and establish a non-deviant identity. According to
this model there will be no sustained movement toward a change in com-
mitment unless the individual perceives some probability of the applica-
tion of aversive consequences for continued enactment of the deviant
role. Likewise, the individual will fail to maintain his change in
commitment once it is made unless he is able to circumvent the renunci-
ation penalties that confront him and obtain some reinforcement for the
enactment of a non-deviant role.

The results of the present study indicate that the hypotheses
derived from the Commitment to Deviance model concerning the relation—

ship of the social penalties to a resumption of the deviant role as

61

62

reflected in attrition from treatment have received considerable sup-
port. Hypothesis 1 which was concerned with the relationship between
the continuation penalty represented by the amount of legal pressure
upon the addict to discontinue his heroin use and length of stay in
treatment was supported by the results of this study. A correlation of
.47 ( p < .01) was obtained between the extent of the legal pressure
and the number of days the addict remained in treatment. As was pre-
dicted, longer stays in treatment were associated with addicts who were
facing an upcoming trial for a heroin related offense or were currently
on probation or parole than with those addicts who were not subject to
the threat of impending incarceration if they failed to terminate their
heroin use. This result is congruent with the position of the Commit-
ment to Deviance model which attributes to the continuation penalties

a position of central importance as providing the impetus for the re-
definition of an individual's commitment to his social role.

The hypothesized relationship between the material and inter-
personal renunciation penalties and the individual's commitment to his
role was also supported by the results of this study. The issue which
is most central to the material renunciation penalty hypothesis is
whether or not the individual can secure employment. Hypothesis 2a
represents an attempt to assess the importance of this type of penalty
through the prediction that the addict's length of stay in treatment
would be directly related to his ability to secure employment while in
treatment. A correlation of .67 ( p < .001) was obtained between the
addict's success in securing employment and the number of days in treat-

ment which provides support for the expectation derived from the

63

Commitment to Deviance model; the addict who is able to successfully
circumvent the material renunciation penalties will maintain his com-
mitment to the establishment of a non-deviant role as reflected by his
continuation in treatment.

In a similar fashion hypothesis 2b focused upon the relation-
ship of the interpersonal renunciation penalties to the addict's main-
tenance of his commitment to the establishment of a non-deviant role.
The intent of this hypothesis was to assess the relationship of social
acceptance by non-addicts to the maintenance of a non-deviant role
through the prediction that length of stay in treatment would be related
to the frequency of the addict's social contacts with non-deviant others
while in treatment. A correlation of .52 (p < .01) was obtained be-
tween the number of days in treatment and a staff rating of the subject's
frequency of social contacts with non-addicts.

The support given to hypotheses 1, 2a and 2b indicates that:
the addict's continued commitment to the establishment of a non-deviant
role, as reflected in continued participation in treatment, is strongly
related to the operation of the continuation penalties on one hand and
his ability to circumvent the operation of renunciation penalties on
the other. This line of reasoning assumes that attrition from treat-
ment represents the resumption of the deviant role of the addict.

Some of the data support this position. For example, a strong negative
association was obtained between the number of days in treatment and
the proportion of "dirty" urines which were detected during the indi-
vidual's last 30 days in treatment. Shorter stays in treatment were

associated with a more extensive use of drugs prior to termination of

64

treatment. These data lend some credence to the assumption that attri-
tion from treatment represents an instance in which the individual has
failed to renounce his deviant role as an addict.

The role that the addict's failure to circumvent the renunci-
ation penalties plays in the resumption of deviance is given further
support on the basis of the finding that both success in securing em-
ployment and the frequency of social contacts with non-deviant others
are correlated -.70 and -.68 respectively with the proportion of dirty
urines in the last thirty days of treatment. Thus both shorter length
of stay in treatment and more extensive drug use prior to termination
are strongly associated with the addict's failure to secure employment
and limited social contacts with non-deviant others.

The fact that the Commitment to Deviance model conceptualizes
the outcome of the renunciation attempt as the result of the balance
struck between the continuation and renunciation penalties makes an
examination of the joint effects of these penalties of considerable
importance. An analysis of multiple regression of the variables associ-
ated with these penalties on length of stay in treatment was computed
to assess their joint effect upon this criterion variable. As noted
in Chapter III, the results of this analysis indicated that almost all
of the observed variance in the number of days in treatment could be
attributed to the individual's ability to circumvent the material
renunciation penalties as reflected in his success in securing employ-
ment. The contribution of the continuation penalty of legal pressure
and the interpersonal renunciation penalty of limited social contacts

with non-deviant others was relatively slight. As was previously

65

discussed, the reason for the relatively minor role that legal pressure
played in the joint prediction of length of stay appears to be related
to the effect of subject loss involved in the computation of the mul-
tiple regression analysis. The fact that the extent of legal pressure
on the addict was significantly correlated with length of stay in
treatment and had relatively low order correlations with the other two
predictor variables indicates that it probably plays a stronger role

in predicting length of stay in treatment in conjunction with the ad-
dict's success in securing employment than is indicated by the multiple
regression analysis. Inspection of the data also tends to support the
importance of legal pressure as a predictor of length of stay as can

be seen by the fact that 64 percent of those addicts entering treatment
with no legal pressure stayed less than thirty days while only 15 per-
cent of the addicts subject to any form of legal pressure terminated
treatment during the first thirty days.

While the limited contribution of legal pressure to the ex-
planation of observed variation in the number of days in treatment may
be artifactual, this does not appear to be the case in regard to the
interpersonal renunciation penalty of limited social contacts. An
examination of the correlation matrix reveals that a correlation of
.71 exists between success in securing employment and the frequency of
social contacts with non-deviant others. This indicates that it may
not be correct to think of the existence of two separate types of
renunciation penalties as such but rather two aspects of a generalized
renunciation penalty which are not independent of each other but tend

to covary. The data obtained in the current study seems to indicate

66

that individuals who fail to circumvent the material renunciation pen-
alties associated with the inability to secure employment also fail to
obtain interpersonal rewards by circumventing the interpersonal renunci-
ation penalties. In short, if the addict "loses" he tends to "lose

big'I which includes not only unemployment but also exclusion from social
interaction with those individuals with whom he is attempting to identify.
The effect of such exclusion and the disappointment of the addict's ex-
pectations upon his newly formed identity as an abstainer and his tend-

ency toward relapse has been well documented by Ray (1961).

Addict Characteristics, Renunciation Penalties
and Attrition from Treatment

 

In the past twelve years a number of research studies have
been published which focus on the addiction status of individuals fol-
lowing their release from treatment. The majority of these follow-up
studies have utilized samples of addicts drawn from patients who have
been treated at the United States Public Health Service hospitals at
Lexington and Fort Worth. These studies, which have been discussed
at some length in the literature review, have isolated a number of ad-
dict characteristics which have been associated with differential out-
comes in terms of re-addiction. Many of these variables, most of which
were demographic or addiction history characteristics of the addicts,
have been identified by a number of different studies as major corre-
lates of addiction status at follow-up.

In accordance with the Commitment to Deviance model we would

expect that individuals who were released from institutional treatment

67

for addiction would be confronted with the task of circumventing the
renunciation penalties in order to establish themselves in a non-deviant
role. The addict's failure to accomplish this task would be expected

to result in a re-commitment to his former deviant role and re-addiction.
Since the results of these follow-up studies indicated that a number of
demographic and addiction history characteristics of the addict were
related to his addiction status at follow-up, it seemed entirely pos-
sible that these same characteristics were related to differential suc-
cess in circumventing the renunciation penalties. Based on this line
of reasoning hypotheses 4a--c and 5a--c were developed to examine the
relationship between selected addiction history characteristics and the
addict's ability to circumvent the material and interpersonal renunci-
ation penalties which confront him in the context of residential treat-
ment. Hypothesis 4a--c focused upon the relationship of the age at
which heroin use was begun, the length of use, and the cost per day of
the addict's habit to the extent to which he was able to circumvent

the material renunciation penalties as reflected by success in securing
employment while in treatment. Hypotheses 5a--c examined the relation-
ship of the same characteristics to the addict's ability to circumvent
the interpersonal renunciation penalties as reflected by the frequency
of his social contacts with non-deviant individuals. In addition to
these formal hypotheses, the relationship of three general demographic
characteristics consisting of education, employment history and criminal
record to success in securing employment while in treatment was also

examined.

68

In no instance were any of these hypotheses supported by the
results obtained in the current study. No significant correlations
were found between age of first heroin use, length of use, or cost per
day of the habit and either success in securing employment or the ad-
dict's frequency of social contacts with non-deviant others. In addi-
tion, no significant correlations were obtained between the addict's
level of education, employment history or criminal record and success
in securing employment.

The results of these same studies which indicated that these
demographic and addiction history characteristics were related to addic-
tion status at follow-up also prompted the development of hypotheses
6a--c which predicted that age of first use of heroin, length of use
and cost per day would be related to attrition from treatment. These
hypotheses were predicated on the assumption that both resumption of
drug use following institutional treatment and attrition from treatment
were instances of the same phenomenon of failure to renounce the addict
role. However, unlike addiction status at follow-up, no significant
correlations were obtained between these characteristics and length of
stay in treatment. In addition, the addict's educational level, pre-
vious employment history and criminal record were also found to be un—
related to the length of stay in treatment despite the relatively strong
relationship found between these characteristics and addiction status
at follow—up by these earlier studies.

From the results obtained in relation to hypotheses 4a--6c,
it must be concluded, that these addiction history and demographic

characteristics are not related in any significant way to either the

69

operation of the material and interpersonal renunciation penalties or
the addict's length of stay in treatment. In view of these results,
the question becomes: how does one explain the lack of relationship
between these characteristics and attrition when these same character-
istics have been demonstrated to be clearly related to addiction status
at follow-up? One possible interpretation is that the resumption of
drug use that coincides with attrition from treatment represents a
different phenomenon than re-addiction following release from institu-
tional treatment for drug addiction. If this were the case then those
characteristics that were found to be related to addiction status at
follow-up may have no relevance to either the operation of the renunci-
ation penalties or length of stay in residential treatment. However,
since both phenomena basically represent a resumption of drug-taking
behaVior which was previously associated with the enactment of the
addict role it is difficult to conceive of them as anything but equiva-
lent instances of a recommitment to the former deviant role.

An alternative interpretation and one that appears to be
more plausible is based upon the observation that the follow-up studies
utilized samples in which the subjects were drawn primarily from in-
dividuals who were in treatment between 1935 and the mid 1960's with
the majority of them having been in treatment during the 1950's. The
United States has undergone massive social change since that time and
there have been noticeable shifts in attitudes toward addiction, addicts,
and the programs and services provided for their rehabilitation. Up
until the late 1960's, an addict released from treatment for addiction

would have had to depend almost entirely upon his own resources when

70

he returned to the community. In such an atmosphere it is entirely
conceivable that whether he could achieve some degree of assimilation
into conventional society and renounce his deviant identity would be
dependent upon his personal characteristics. His ability to obtain
employment might be dependent upon his level of education and previous
employment history as well as the extent of his criminal record. Simi-
larly, the extent to which he had previously been assimilated into the
heroin sub—culture in terms of the age at which he began to use heroin
and the length of time addicted may also be important. An addict with
a long history of addiction would be left with a repertoire of inter-
personal and occupational skills which were so impoverished that he
would be unable to gain access to any reinforcement for the enactment
of a non-deviant role. Thus, for the addict in the 1950's and early
1960's, such demographic and addiction history characteristics might
prove to be important predictors of whether or not he would ultimately
become re-addicted following treatment.

In contrast to the situation described above, the addict in
treatment now has a much broader range of services available to him.
Since 1968 a large amount of public funds have been committed to the
drug abuse problem and programs designed to rehabilitate the drug
dependent individual. Unlike the fictional addict described above, the
residents of the Multi-Lodge had available to them the services of the
Department of Vocational Rehabilitation, the Michigan Employment Security
Commission, and the Department of Social Services, in addition to a
number of job training and placement services associated with local

correctional institutions, community mental health, and the Youth

71

Development Corporation. While these services weren't being pushed at
the addict, they were available to those who were willing to seek them
out and follow through. The emphasis upon the importance of employment
for addicts as an integral part of their rehabilitation may well have
made those characteristics of the addict such as educational level and
previous employment history far less important in terms of obtaining

employment than they were previously.

Some Speculations Concerning Job-Seeking
Behavior, Helplessness,
and Success—in Treatment

 

The failure to find any significant relationship between
addict characteristics, the operation of renunciation penalties and
attrition from treatment leaves the question of what determines the
individual's ability to circumvent these penalties unanswered} How-
ever, it is clear that the addicts in this sample differed from each
other in terms of their success in securing employment and the frequency
of their social contacts with non-deviant individuals as well as the
length of time they remained in treatment. Some insight into the pos-
sible source of these differential outcomes may be obtained through the
consideration of an additional variable which was not part of the formal
hypotheses of the current study. This variable, the frequency of job-
seeking behavior while in treatment, was based upon staff ratings of
the frequency with which the individual actively participated in at;
tempts to obtain employment through job interviews and contacts with
vocational rehabilitation agencies for the purpose of obtaining direct

and indirect assistance in locating employment. (See Appendix V for a

72

description of the scale utilized in rating the frequency of job-
seeking behavior and information on inter-rater reliability.)

A strong relationship was found between the frequency of
job-seeking behavior and the addict's ability to circumvent the material
renunciation penalties as reflected by his success in securing employ-
ment while in treatment. The fact that a correlation of .77 (p < .001)
was found between these two variables is not particularly surprising
since it is virtually a tautology to say that the more often an indi-
vidual seeks employment the better his chances of success in obtaining
a job. However job-seeking was also found to be correlated .70 (p <
.001) with the frequency of the addict's social contacts with non-
deviant others which seems to indicate that this behavior may have
wider implications. In addition the frequency of job-seeking behavior
was found to be positively correlated with length of stay in treatment
(r = .68, p < .001) and negatively correlated with the extent of drug
use during the last thirty days prior to termination of treatment ( r =
-.61, p < .01). These results indicate that addicts who actively seek
employment while in treatment tend to remain in treatment longer and
when terminating treatment are less likely to be doing so in conjunction
with a resumption of drug-taking behavior.

The pattern of results obtained above suggests that the fre-
quency of job-seeking may be a reflection of a more general aspect of
the addict's behavior while in treatment which may represent an activity-
passivity dimension. Thus, instead of the application of renunciation
penalties and their effect upon the addict's commitment to renounce his

deviant role being related to the pre-treatment characteristics of the

73

addict, it would appear that it is the extent to which the addict takes
an active role in attempting to circumvent these penalties that deter-
mines his success. This finding appears to have some parallels to
Seligman's (1969; 1973) speculations concerning passivity and learned
helplessness which may be relevant to understanding the addict's per-
formance in treatment and its outcome.

Seligman, in a series of research studies with dogs which
investigated the relationship of previous experience with inescapable
shock to later ability to learn an escape-avoidance response, found
that those animals who had first been exposed to shock over which they
had no control later failed to learn escape responses to shock in an
entirely dissimilar learning situation (Overmier and Seligman, 1967;
Seligman and Maier, 1967; Seligman, Maier and Geer, 1968). Unlike
shock naive dogs or dogs that had been previously exposed to control-
lable shock, these animals failed to learn the response of jumping
over the barrier in a shuttle-box upon the occurrence of shock or a
discriminative stimulus signalling the onset of shock. In contrast to
"normal" dogs, these animals made no attempt to get over the barrier to
the “safe compartment" and after an initial period of normal reactivity
to the shocks would later settle down and passively accept them. When,
on rare occasions, an escape or avoidance response did occur it failed
to reliably predict future escape behavior as it does in normal animals.
Seligman believes that this passivity, which he has called "learned
helplessness", and the interference with subsequent escape-avoidance
learning was the result of the animal learning that its responses were
uncorrelated with shock and that there was no response it could make

which would make a difference (Seligman and Maier, 1967).

74

The fact that at least an experimental analogue of learned
helplessness can occur in human beings has been demonstrated in a number
of research studies. Thornton and Jacobs (1971), in a test of the
learned helplessness hypothesis, exposed two groups of human subjects
to either escapable or inescapable shock during the performance of one
task and then measured their performance in learning an avoidance re-
sponse to a discriminative stimulus signaling onset of shock during
participation on a different task. The group which had been previously
exposed to inescapable shock performed significantly fewer avoidance
responses and 65 percent of these subjects failed to make even one
escape response. When interviewed following completion of the experi-
ment, 60 percent of those subjects who had previously been exposed to
inescapable shock and failed to make a response during the second task
stated that they made no escape responses because they felt they had
no control over the occurrence of shock. Instead they spent the major-
ity of the time between the onset of the discriminative stimulus and
shock in preparation for receiving the shock.

Hiroto (cited in Seligman, 1973) conducted a similar experi-
ment with college students using loud noise as an aversive stimulus.
The subjects were divided into two groups for the initial phase of the
experiment in which one group was able to terminate exposure to loud
noise while the other group could not. In the second part of the study
a finger shuttle-box was utilized to provide a test of whether there
was any differential learning of escape responses to loud noise between
the two groups. The results of this study indicated that those sub-

jects who had previous experience with escapable noise performed

75

significantly more escape responses than those who had previously ex-
perienced inescapable noise. Equally significant as these inter-group
differences was Hiroto's finding that those subjects who were classified
as "externals", i.e., who scored high on the external end of Rotter's
locus of control scale (Rotter, 1966), were significantly more suscep-
tible to learned helplessness.

Seligman (1969; 1973) has taken the results obtained from
these laboratory studies of animal and human escape-avoidance learning
and generalized them to the phenomenon of passivity, helplessness and
reactive depression as it occurs in the general and particularly in
psychiatric populations. In humans he sees the source of the helpless-
ness syndrome, which is expressed as a generalized passivity, as occur-
ring as a result of a life time of experience in attempting to control
the interpersonal environment during which the individual has learned
that nothing he can do makes a difference in terms of producing rein-
forcing consequences or terminating aversive stimulation. In its most
extreme form, which occurs in the clinically depressed patient, not
only does the individual make fewer responses than the average person
but also appears to have a stronger set toward interpreting his own
responses as failures or as being ultimately doomed to failure. When
these individuals encounter any difficulty they tend to define their
response as a failure and abandon any further attempts at problem
solving. For them an obstacle becomes defined as an impossible barrier
and even when this individual makes a successful response he finds it

difficult to perceive his own success.

76

In less extreme form, this generalized passivity takes the
form of a behavioral style which matches the description of the indi-
vidual who scores high on external locus of control and maintains the
attitude that access to reinforcement is controlled by forces outside
of his own behavior. As Lefcourt (1966) points out, these individuals
may, in certain situations, exhibit no goal directed behavior because
they anticipate no contingency between any effort on their part and
the end result of obtaining reinforcement. This can be true despite
the fact that the individual values the available goal if he believes
that he lacks the behavior in his repertoire that would be successful
in securing that goal. In contrast, the individual who tends to score
high in terms of internal locus of control is characterized by a belief
that his own actions control access to reinforcement. His approach to
attaining a valued goal is to utilize his full repertoire of problem-
solving behaviors and to make adjustments in these behaviors in response
to the lack of reinforcing consequences.

Much of what Seligman has to say about passivity and learned
helplessness appears to be applicable to those residents who displayed
relatively infrequent job-seeking behavior. These individuals, who com-
prised the majority of the residents, gave the impression of being pas-
sive in their approach to life and the course of their rehabilitation.
In a sense they seemed to be waiting for something to happen'and were
relatively inactive in terms of self-initiated participation in activi-
ties within the Multi-Lodge or engaging in social activity and enter—
tainment in the community. Their interpersonal contacts were primarily

restricted to individuals who were living within the lodge program.

77

These individuals also tended to be troubled by periods of deep de-
pression and feelings of hopelessness in which they felt overwhelmed
by the difficulties they encountered in attempting "to get straight".
They rarely engaged in employment-seeking which was self-initiated and
those individuals who obtained employment did so only with a great deal
of assistance from the staff and public agencies. They tended to retain
this employment for only a relatively short period of time. The events
that followed the loss of employment, which generally included a sharp
rise in drug use and, in a number of cases, the termination of treat-
ment shortly afterwards are congruent with Seligman's emphasis upon the
importance of success and the negative consequences of failure for the
treatment of learned helplessness (Seligman, 1973).

The behavior described above is in contrast to that of those
individuals who displayed a relatively high frequency of job-seeking
behavior. For these residents job-seeking appeared to be one aspect
of a generally higher level of goal directed activity. These individ-
uals took greater personal responsibility for initiating contact with
community resources in order to obtain health care and other social
services and in a number of ways seemed to be more directly involved
and in the course of their own rehabilitation. At the same time they
tended to live a more active social life both within and outside of
the lodge program and appeared to be relatively successful in initiating
and maintaining social contacts. They also seemed to be less subject
to bouts of depression than the other residents and were somewhat more

resilient in times of personal crisis. In situations in which they

78

had disregarded program regulations or had used drugs, they tended to
own this behavior more readily and accept personal responsibility for
it.

The description of the difference in behavioral style be—
tween those individuals who displayed a high frequency of job-seeking
behavior and those who were relatively inactive in seeking employment
is suggestive of the existence of differences between these individuals
along a much broader dimension of activity-passivity. If this passivity
is, as Seligman suggests, associated with the individual's belief that
he is unable to effect his environment in such a way as to gain access
to reinforcement through his own behavior; then it is likely to have
important implications in terms of attrition from treatment and resump-
tion of the deviant role. For these individuals the potential rein-
forcement associated with the establishment of a non-deviant role must
appear to be, at best, a distant possibility and one they may consider
to be beyond their ability to effect by their own behavior. In com-
parison to the powerful immediate reinforcing effects of heroin, this
future reinforcement in return for abstinence must appear weak indeed.

When the addict first enters treatment the use of heroin has
generally become associated primarily with the relief of an aversive
physiological state. Due to the effects of tolerance the addict is no
longer able to shoot to get high. However, as part of the initial pro-
cess of treatment, the addict participates in a detoxification regimen
which is intended to relieve withdrawal distress but also serves to
reduce his tolerance to heroin. Thus detoxification has the effect of

restoring heroin to the position where it is once again capable of

79

serving as one of the most powerful potential reinforcers available to
the individual. For the addict who feels powerless to effect his en-
vironment in such a way as to gain access to even limited reinforcement,
the option of returning to the use of heroin, which is relatively cheap
and readily available, can be quite attractive. Since it is the nature
of this drug to build in tolerance relatively quickly, initially limited
use soon requires increasingly greater and more frequent use in order

to obtain the same effect. Once this process of escalation in use has
begun the resumption of addiction and the behavior associated with it

is relatively assured.

It must be noted that much of what has been discussed in
regard to the concepts of passivity and learned helplessness and their
relationship to readdiction and attrition from treatment is, at best,
extremely speculative. The description of characteristics associated
with addicts who display differential rates of job-seeking behavior is
based upon the most subjective of impressions and is subject to all the
errors and pitfalls inherent in this type of analysis. However these
speculations and subjective impressions do serve a heuristic purpose in
that they indicate some potential directions for further research into
the factors associated with success and failure in the treatment of
heroin addiction.

The results of the current study failed to demonstrate the
existence of any significant relationship between pre-treatment demo-
graphic or addiction history characteristics of addicts and attrition
from treatment. However the results obtained in terms of frequency of

job-seeking behavior and its relationship to positive outcome in

80

treatment suggests that an investigation of psychological factors
related to the activity dimension of the addict's behavioral style
and success in treatment might prove useful. An examination of the
relationship of the addict's self-concept, generalized expectancies
of reinforcement, and the extent to which he perceives himself as
successfully completing treatment to attrition from treatment and the
resumption of addiction may yield a reliable set of predictors of
success in treatment.

In closing a word of caution concerning the generality of
the results obtained in the current research is in order. The results
obtained and the conclusions that have been drawn from them are appli-
cable, in the strictest sense, only to the addict sample and the
treatment setting utilized in this study. A cross-validation study
with a larger sample conducted within the context of another thera-
peutic community would be desirable before an attempt is made to
generalize these findings to addict populations in other therapeutic
communities. In addition, it should be noted that the relationship
of these variables to attrition may hold only for addicts who under-
take treatment in a residential setting and may not be applicable to
other treatment modalities such as methadone maintenance or detoxifi-

cation

CHAPTER V

SUMMARY

Although heroin addiction has been a problem of major concern
for many years, little research has been conducted which focuses upon
the factors related to the termination of addiction. In addition,
there has been little research which has specifically addressed itself
to the related problem of client attrition from treatment for drug de-
pendence despite the fact that this has been a major problem for most
treatment programs. Due to the lack of such research, the present study
has undertaken to examine the relationship of a number of selected vari-
ables to attrition from residential treatment. The variables included
in the present study were selected on the basis of hypotheses derived
from the Commitment to Deviance model. The central thesis of this model
is that an individual's decision to terminate or continue his enactment
of a deviant role is based upon the balance of social penalties that
confront him. This balance consists of the continuation penalties,
those aversive outcomes the individual incurrs through continuing in
his deviant role, and the economic and interpersonal renunciation pen-
alties which he confronts as a result of attempting to renounce his
deviant role and establish a non-deviant identity. According to this
model, a change in role commitment will occur if the individual is

motivated to abandon the deviant role due to the actual or potential

81

82

operation of continuation penalties and the extent to which he is able
to circumvent the renunciation penalties. Once the renunciation pen-
alties are circumvented the individual is able to obtain access to
reinforcement for the enactment of the non-deviant role.

In the context of the present study, the relationship of the
continuation penalties (eg. legal pressure to terminate heroin use) and
the individual's ability to circumvent the renunciation penalties (eg.
success is securing employment and frequency of social contacts with
non-addicts) to length of stay in treatment was examined. In addition,
a number of demographic (eg. education, employment history, and crim-
inal record) and addiction history characteristics (eg. age at which
heroin use was begun, length of addiction, and cost per day of the
habit) were examined in terms of their relationship to the addict's
ability to circumvent the renunciation penalties and his length of stay
in treatment. These pre-treatment characteristics were studied to de-
termine if they were potentially useful as predictors of attrition from
treatment.

A sample of thirty-four heroin addicts, all of whom had been
randomly assigned to treatment in a therapeutic community, were the
subjects of the present study. Information concerning the demographic
and addiction history characteristics of these individual's was ob-
tained by means of a questionnaire administered during the intake pro-
cedure. The variables consisting of in-treatment behaviors such as
success in securing employment; the use of drugs and length of stay in
treatment were obtained from the client records of the Multi-Lodge.

In addition, data concerning the frequency of the subject's social

83

contacts with non-addicts and the frequency of his employment-seeking
behavior while in treatment were obtained through the utilization of
staff ratings. A correlational analysis of legal pressure, success in
securing employment and frequency of social contacts with non-addicts
indicated that these three variables were significantly related to
length of stay in treatment. These results provide support for the
hypothesized relationship of continuation and renunciation penalties
to attrition. However, when the relationship of these three variables
to length of stay in treatment were considered jointly through multi-
variate analysis, it was found that the addict's success in securing

employment accounted for almost all of the observed variation in length

0f stay in treatment. The fact that legal pressure contributed little
to accounting for the observed variation in length of stay in treatment
was attributed to the possible effects of subject loss for this analy-
sis. However the relatively strong relationship obtained between suc-
cess in securing employment and the frequency of social contacts with
non-addicts suggests that the material and interpersonal renunciation
‘penalties may not be separate penalties but two aspects of a general
renunciation penalty which tend to covary.

No significant relationships were found between any of the
pre-treatment demographic and addiction history characteristics and
either the addict's ability to circumvent the renunciation penalties or
his length of stay in treatment. The failure to find any relationship
between these variables, in contrast to the positive results of the

earlier addiction treatment follow-up studies, may be attributable to

84

the current emphasis upon employment and the provision of vocational
rehabilitation services for addicts. The greater availability of such
service may have had the effect of making the securing of employment,
which is a major task in the establishment of a non-deviant role, less
dependent upon the addict's characteristics than was previously the
case. Due to the failure of the pre-treatment characteristics to dis-
tinguish between differential outcomes in terms of the addict's ability
to circumvent the renunciation penalties and his length of stay in
treatment; the addict's behavior in treatment received additional at-
tention. Further analyses indicated the existence of a pattern of sig—
nificant relationships between the addict's frequency of job-seeking
behavior in treatment and the frequency of social contacts with non-
addicts, success in securing employment, extent of drug use prior to
termination and length of stay in treatment. The pattern of these
correlations suggested the possibility that frequency of job-seeking
behavior was an aspect of a more general activity-passivity dimension
of the addict's behavior while in treatment which may be related to

the extent to which he believes he can have an impact on his environ-
ment and gain access to reinforcement through the enactment of a non-
deviant role. A parallel was drawn between this activity-passivity
dimension and Seligman's (1969; 1973) concept of "learned helpless-
ness" which suggests that a study of psychological factors related to
this dimension of the addict's behavior and treatment outcome might
prove useful. More specifically, an examination of the relationship of
the addict's self concept, generalized expectancies of reinforcement,
and his own predictions concerning his success in treatment to attrition
and readdiction may yield a reliable set of predictors of treatment

outcomes.

LIST OF REFERENCES

LIST OF REFERENCES

Ball, J. C. The Reliability and Validity of Interview Data Obtained
from Fifty-nine Narcotic Drug Addicts. American Journal of
Sociology, 1967, 12, 650-654.

 

Ball, J. C. , and Snarr, R. W. A Test of the Maturation Hypothesis with

gispect to Opiate Addiction. Bulletin on Narcotics, 1969,

 

Bess, B., Janus, S., and Rifkin, A. Factors in Successful Narcotics
Renunciation. American Journal of Psychiatry, 1972, 122,
861-865.

 

Bowden, C. L., and Langenauer, B. J. Success and Failure in the NARA
Addiction Program. American Journal of Psychiatry, 1972,
122, 853-856.

Carrick, R. W. Southmore House: Use of a Halfway House and Integrated
Community Approaches in the Post Hospital/Correctional In-
stitution Rehabilitation of Narcotic Addicts. In Rehabili-
tating the Narcotic Addict. Vocational Rehabilitation Ad-
ministration. U. S. Department of Health, Education and
Welfare. New York: Arno Press, 1966.

 

Casriel, D. Daytop; Three Addicts and Their Cure. New York: Hill and
Wang, 1971.

 

Chambers, C. D., Cuskey, W. R., and Wieland, W. F. Predictors of Attri-
tion During the Outpatient Detoxification of Opiate Addicts.
Bulletin on Narcotics, 1970, 22, 43-48.

DeFleur, L. B., Ball, J. C., and Snarr, R. W. The Long-Term Social
Correlates of Opiate Addiction. Social Problems, 1969, 12,
225-234.

 

Duvall, H. J., Locke, B. Z., and Brill, L. Follow-up Study of Narcotic
Drug Addicts Five Years After Hospitalization. Public
Health Reports, 1963, 22, 185-194.

 

Fairweather, G. W., Sanders, D. H., Maynard, H., and Cressler, D. L.
Community Life for the Mentally 111. Chicago: Aldine
Publishing Company, 1969.

 

85

86

Fairweather, G. W., Sanders, D. H., Maynard, H., Cressler, D. L., and
Jennings, R. D. A Manual for Developing a Community
Treatment Prggram. Portland, Oregon: iInstitute for the
Psychological Study of Living Systems, 1969.

Geis, G. The East Los Angeles Halfway House for Narcotic Addicts.
Sacramento, California: Institute fOr the Study of Crime
and Delinquency, 1966.

Geis, G. The East Los Angeles Halfway House: Two Years Later. In
Rehabilitating the Narcotic Addict. Vocational Rehabilita-
tibn Administration. U.S. Department of Health, Education
and Welfare. New York: Arno Press, 1966.

Glasscote, R. M., Sussex, J. N., Jaffe, J. H., Ball, J. C., and Brill,
L. The Treatment of Drug Abuse. Washington, D.C.: The
Joint Information Service of the American Psychiatric Asso-
ciation and the National Association for Mental Health, 1972.

Goffman, E. Stigma: Notes on the Management of a Spoiled Identity.
Englewood Cliffs, New Jersey: Prentice-Hall,‘l963.

Hunt, G. H., and Odoroff, M. E. Follow-up Study of Narcotic Drug
Addicts After Hospitalization. Public Health Reports,
1962. 22; 41-54.

Inciardi, J. A., and Babst, D. V. Predicting the Post-Release Adjust-
ment of Institutionalized Narcotic Addicts. Bulletin on
Narcotics, 1971, 22, 33-37.

 

Kaplan, H. B., and Meyerowitz, J. H. Psychosocial Predictors of Post-
institutional Adjustment Among Male Drug Addicts. Archives
of General Psychiatry, 1969, 29, 278-284.

Langenauer, B. J., and Bowden, C. L. A Follow-up Study Narcotic Addicts
in the NARA Program. American Journal of Psychiatry, 1971,
_2§, 41-45.

 

Lefcourt, H. M. Internal vs. External Control of Reinforcement: A
Review. Psychological Bulletin, 1966, 65, 206-221.

Levy, B. S. Five Years After: A Follow-up of 50 Narcotic Addicts.
American Journal of Psychiatry, 1972, 122, 868-872.

Maddux, J. F. Treatment of Narcotic Addiction: Issues and Problems.
In Rehabilitating the Narcotic Addict. Vocational Rehabili-
tation Administration. U.S. Department of Health, Education
and Welfare. New York: Arno Press, 1966.

87

O'Donnell, J. A. The Relapse Rate in Narcotic Addiction: A Critique
of Follow-up Studies. In Wilner, D. M., and Kassebaum, G. G.
(Eds.) Narcotics. New York: McGraw-Hill, 1965.

Overmier, J. G. and Seligman, M. E. P. Effects of Inescapable Shock on
Subsequent Escape and Avoidance Learning. Journal of Com-
parative and Physiological Psychology, 1967, g2, 28-33.

Preble, E., and Casey, J. J. Taking Care of Business--The Heroin Users
Life on the Street. International Journal of the Addictions,
1969: 19 1'24.

Ray. M. B. The Cycle of Abstinence and Relapse Among Heroin Addicts.
Social Problems, 1961, 2, 132-140.

Rotter, J. B. Internal vs. External Control of Reinforcement. Psycho-
1ggical Monographs, 1966, 29, 1-28.

 

Rubington, E. Drug Addiction as a Deviant Career. International Jour-
nal of the Addictions, 1967, 2, 3-20.

Sanders, D. H. The Effect of Group Membership on Community Adjustment.
In Rehabilitatin the Narcotic Addict. Vocational Rehabili-
tation Administrat on. U.S. Department of Health, Education
and Welfare. New York: Arno Press, 1966.

Seligman, M. E. P. For Helplessness: Can We Immunize the Weak?
Psychology Today, 1969, 2, 42-44.

Seligman, M. E. P. Fall into Helplessness. Psychology Today, 1973,
Z, 43-48.

Seligman, M. E. P., and Maier, S. F. Failure to Escape Traumatic
Shock. Journal of Experimental Psychology, 1967, 14, 1-9.

Seligman, M. E. P., Maier, S. F., and Geer, J. H. Alleviation of Learned
Helplessness in the Dog. Journal of Abnormal Psychology,
1968..1§, 256-262.

Shelly, J. Daytop Lodge: A Two Year Report. In Rehabilitating the
Narcotic Addict. Vocational Rehabilitation Administration.
U.S. Department of Health, Education and Welfare. New York;
Arno Press, 1966.

 

Stebbins, R. Commitment to Deviance: The Non-Professional Criminal
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Stephens, R., and Cottrell, E. A Follow-up Study of 200 Narcotic Ad-
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Rehabilitation Act. British Journal of Addiction, 1972,
1967, 45-53.

88

Stephens, R., and Levine, S. The "Street.Addict Role": Implications
for Treatment. Psychiatry, 1971, 22, 351-357.

 

Thornton, J. W., and Jacobs, P. D. Learned Helplessness in Human Sub-
jects. Journal of Experimental Psychology, 1971, 21, 367-
372.

Vaillant, G. E. A Twelve Year Follow-up of New York Narcotic Addicts.
IV. Some Characteristics and Determinants of Abstinence.
American Journal of Psychiatry, 1966, 122, 573-583.

Winick, C. Maturing Out of Narcotic Addiction. Bulletin On Narcotics.
1962, 14, 1-7.

Yablonsky, L. Synanon: The Tunnel Back. Baltimore, Maryland: Penguin
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Zahn, M. A., and Ball, J. C. Factors Related to Cure of Opiate Addic-
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the Addictions, 1972, 1, 237-245.

APPENDICES

APPENDIX I

DESCRIPTION OF THE MULTI-LODGE PROGRAM
AND MODIFICATIONS FROM PROTOTYPE LODGE

APPENDIX I
DESCRIPTION OF MULTI-LODGE PROGRAM AND
MODIFICATIONS FROM PROTOTYPE LODGE

The Multi-Lodge was designed in accordance with the tradi-
tional lodge concept and as such bases its program upon group process
and decision making. The daily management of the house in terms of
maintenance, menu planning, cooking and determination of equipment and
supply needs are placed in the hands of the residents. Problems that
arise in the functioning of the residence are presented to the residents
at daily house meetings for consideration and feedback is provided as
to the success or failure of their solutions. The residents are also
encouraged to extend their responsibility beyond the consideration of
the immediate needs of the program and involve themselves in long range
planning. This is particularly evident in the selection, planning and
implementation of a lodge business which is designed to not only pro-
vide financial assistance for the program itself but also to employ a
proportion of the residents in the management and operation of the
business and to develop skills and habits associated with these activi-
ties. This emphasis upon performing as a group with the ultimate
supervision and leadership eventually emerging from that group is one
of the distinguishing characteristics of the lodge system of residen-

tial treatment.

89

90

From the time an individual enters the lodge he is given a
voice in the operation of the program. He is expected to participate
and function as a member of the group but is initially given only
minimal responsibility and functions at a lower level of autonomy in
comparison to residents of longer standing. Through the operation of
a vertical organizational structure the new resident is able to achieve
upward mobility within the lodge community based upon his performance,
ability and aspiration. Such increases in status are accompanied by
increased rewards and responsibilities which culminates in the assump-
tion of a role within the program which is equivalent of a staff posi-
tion. At this point the resident may elect to remain in the program
as a resident-staff member or leave the program and enter the community.
However, there is no predetermined length of treatment and any resident
may elect to remain at the lodge indefinitely.

While the Multi-Lodge adheres to the basic program structure
of earlier lodges, there were several modifications due to the status
of the program as a Community Mental Health agency and the differences
in the service population being treated. Those differences necessi-
tated by the position of the lodge as a CMH agency involve the pattern
of professional staffing which was required by CMH procedures concern-
ing program administration and fiscal responsibility. As a result the
staff assumed primary responsibility for all liaison with the parent
agency and in the financial administration of the program. Despite
the inevitable role conflict this situation created, the major program
emphasis remained upon the residents making decisions as a group with

the staff functioning in an advisory capacity. Group decisions were

91

subject to staff veto only when it was clear that the decision would
adversely effect either the operation of the program, individuals with-
in the program or were in violation of Community Mental Health regula-
tions or procedures. Ultimately this resulted in greater staff activity
and responsibility than would normally be the case in the original

lodge programs.

Some modifications have also been made in the basic lodge
concept due to what the staff perceived as special needs of individuals
in treatment for addiction. Principally these modifications consisted
of the provision of group therapy sessions and the availability of in-
dividual counseling upon request. The group therapy program was de-
veloped to provide an opportunity for more systematic feedback on how
the individuals were relating to each other. It was also considered
to be of importance as a forum where interpersonal difficulties which
arose between the residents could be discussed in an atmosphere that en-
couraged constructive resolution of the problem. It was believed
that this type of approach would tend to decrease the tension between
the residents and thus decrease the probability of violent confronta-
tions which are a potential problem with this particular client
population.

The availability of individual counseling was considered to
be a necessary part of the program due to the massive social, legal
and interpersonal problems that these individuals typically presented
during the course of residence. Much of this counseling was conducted
in such a way as to assist the individuals in coping with these prob-

lems and the anxiety generated by them. Particular attention was

92

directed toward how the anxiety generated by these problems have
effected the individual's drug taking behavior and his ability to make
progress in treatment. Relatively minor emphasis was placed upon in-
depth psychotherapy unless it was clear that the individual wished to
pursue this. The combination group and individual counseling in con-
junction with peer-oriented management of the program places the
Multi-Lodge as somewhat of a compromise between the typical residential

treatment program for addicts and the prototype lodge.

APPENDIX II

MULTI-LODGE PROGRAM MANUAL

APPENDIX II
MULTI-LODGE PROGRAM MANUAL

Welcome to the Multi-Lodge. This is the Multi-Lodge Manual
which is designed to tell you about the program and its regulations.
It is also a contract. Read it carefully and if you understand it and
are willing to accept its terms then sign your name in the space pro-
vided at the end of the manual.

Probably you are wondering what the Multi-Lodge is all about.
Well, on paper it looks something like this:

The Multi-Lodge program is a residential community which at
capacity will be able to house 24 clients. It is open to both males
and females.

While the live-in capacity is 24, other people may be involved
in the program in other ways. Basically there are four ways that a
person may be a member of the Multi-Lodge.

1. He may live in the lodge and work in the Multi-Lodge business.

2. He may live in the lodge and work in a job outside of the
lodge. (In which case he would be expected to rovide a por-
tion of his wages for the support of the lodge.)

3. He may live outside of the lodge but work in the business and
take part in the Multi-Lodge government and recreation.

4. He may live outside of the lodge and work outside of the lodge
business. In this case he would take part in the lodge pro-
gram at night or on weekends.

A member may switch from one type of living-working arrange-
ment to another if he desires and that is acceptable to the lodge peer
government. In the beginning of the Multi-Lodge program, its members
will be encouraged to both live and work within the lodge. However,
other arrangements can be worked out if necessary.

THE LODGE BUSINESS

 

A substantial portion of the program will be concerned with
the development and operation of the lodge business. The members, with
the assistance of the staff, will choose a business to develop Which

93

94

will be able to generate enough profit to provide a source of income
for the members of the lodge. As the business grows, it is expected
that the money it provides will be sufficient to support the existence
of the lodge after the withdrawal of government funds. It should also
provide salaries for those members that participate in the business or
the management of the lodge. Initially, however, the income from the
business will probably only be large enough to provide for some living
expenses for the members.

LODGE GOVERNMENT

The lodge will be governed by the lodge members with the aid
of the paid staff serving as advisors. It is expected that most of
the rules and day to day decisions will be made by the Multi-Lodge gov-
erning body. The staff will be available to assist them but will over-
rule a decision made by the lodge members only when it is clear that
the decision would be harmful to the lodge members themselves or would
result in the destruction of the Multi-Lodge program.

COUNSELING

Currently the counseling program consists of two different
parts. The first is a group for all residents which currently meets
once a week. Individual counseling is also available if you desire it.
The lodge staff will be available at all times to provide individual
counseling to any lodge member if that is his wish. This type of
counseling can be set up on a weekly basis or a stop in and talk basis
when you feel like you need it.

It is also possible to get referred to a therapist at St.
Lawrence or Ingham Community Mental Health Centers if you want that
type of help.

 

The basic philosophy of the Multi-Lodge is that the person who
abuses drugs, whether it's heroin or alcohol, does so for many differ-
ent reasons. But once he begins to abuse these drugs he gets put in a
place by both himself and society which is difficult to escape from.

He is labeled an "alkie", "junkie", a "speed freak", and only the worst
is expected from him. He is expected to fail and this failure is as-
sured by a society which never gives him a chance to experience success.

It is the purpose of the Multi-Lodge to provide its members
with an opportunity to experience success and to learn the skills not
only to make it in the lodge but in society itself. It is the task of
the lodge to help the members develop both living and business skills.
However, its most important purpose is to help its members discover

95

that they have.abi1ities and skills which society has been telling them
they do not have. The aim of the program is for the members to stop
looking at themselves as "junkies" and start seeing themselves as per-
sons. The extent to which the Multi-Lodge succeeds as a program will
depend upon the extent to which the Multi-Lodge members recognize that
they are men and women. If it fails, it will fail because its members
have lacked the determination and committment to be a person.

All this sounds fairly serious and it is. You are going to
be facing many struggles trying to stay clean and getting yourself to-
gether. But living as a group can also be fun. Hopefully the growth
we gen all experience working together will be both enjoyable and re-
war ng.

 

Since you are a newcomer to the program you will be at level
1 for at least the first two weeks if you stay at the lodge. At this
level you will have the heaviest restrictions on your freedom. You
will also experience the most supervision at this level and be given
the least amount of responsibility in the lodge. If you stay with us,
this will change as you work your way up through the levels. With each
increase in status comes more freedom but also more responsibility.
Hopefully, you will come to enjdy both.

Basically, the four different levels and what is expected of
the residents at each level appears below. These guidelines are for

those residents who live in the lodge but do not have outside employ-
ment.

LEVEL l--All new residents start here.

1. You are responsible to keep your room clean. This will be checked
several times a week.

2. You are responsible to attend all house meetings.
3. You are responsible to attend all group sessions.

4. You are responsible to drop three urine samples a week on the days
requested by the staff.

5. You are responsible to attend dinner every night.

6. You must be awake and out of your room by 9 A.M. every weekday.

7. You are responsible to be in the house at all times except from
6 P.M. to 9 P.M. during the weekdays. On weekends (Friday night,

Saturday and Sunday till 9 P.M.) your time is yours to do as you
wish.

96

8. You are responsible to complete and get approval of your daily task
assignment. This assignment will be given to you by a staff member
or a level 3 resident.

Your progress and promotion to a level 2 will be dependent

upon your performance of your responsibilities. Failure to comply with
these responsibilities will result in your termination from the program.

LEVEL 2

To be eligible for this level you must have had clean urines
for 15 consecutive days and performed your responsibilities at level 1
satisfactory.
1. You are responsible for items 1-5 under level 1.
2. You are responsible to be up by 9:30 A.M. every weekday.

3. You are responsible to take attendance at dinner every evening and
report it.

4. You are responsible to complete and get approval of your daily
tasks. These tasks must be completed during the hours of 9 A.M.
to 5 P.M. In most cases you will be paid for this work.

5. You are expected to be in the house at all times with the exception
of 6 P.M. to 12 P.M., unless you have special permission from the
staff.

Your progress and promotion to level 3 will be dependent upon
your performance of your responsibilities.

LEVEL 3

To be eligible for this level you must have had clean urines
for 45 consecutive days and have performed your responsibilities at
level 2 satisfactory.

1. You are responsible for items 1-4 under level 1.

2. You are responsible to be awake and in the house from 10 A.M. to
5 P.M. every weekday.

3. You are responsible to plan daily task assignments.

4. You are responsible to supervise and report on all assigned tasks.

97

5. You are responsible for supervising and reporting on the completion
of the responsibilities of all level 1 residents.

6. You are responsible for orienting all new residents.
7. You are eligible for supervisory positions in the business.

8. You are expected to participate in Night Supervisor responsibili-
ties.

Your progress and promotion to level 4 will be dependent
upon the performance of your responsibilities.

LEVEL 4

To be eligible for this level you must have had clean urines
for 90 consecutive days.

1. You are responsible for items 1-4 under level 1.

2. You share the responsibility of the administration of the house
with the staff.

Wake-up level 1 residents.

Collect urine samples.

Prepare agendas for house meetings.

Lead house meetings.

Collect and review resident's work reports.

Prepare and review house budgets and expenditures.
Co-lead group sessions with staff.

Function as problem-solvers for the residents' individual
problems.

I. Work to assure normal functioning of the house

I‘D'fll‘flUOW)

The four levels above apply to those residents who are not
employed outside of the lodge. For those residents who are employed
at the.time they first enter the lodge or become employed while living
in the lodge, the following guidelines are in effect.

LIVE-IN, WORK-OUT GUIDELINES

 

These guidelines apply only for full-time employment. What
is expected of residents with part-time employment will be settled
individually between that resident and the staff.

98

LEVEL 1 (Employed)

1.

You are responsible to drop three urine samples a week on days
requested by the staff.

2. You are responsible to keep your room clean.
3. You are responsible to attend:
A. House meetings.
B. Group sessions.
C. Dinner
(If they do not conflict with your hours of employment.)

4. You are required to arrange and attend an individual session with
a staff member or level 4 resident to discuss your progress in
the house.

5. You are given three hours free-time per day. This time is to be
arranged with the staff or a level 4 resident and remain the same
while you are at level 1. Outside of these hours you are expected
to be either in the house or at work.

6. You are expected to complete and get approval of all assigned tasks.
The amount of work required of you and the type will be determined
by a level 3 resident or staff.

LEVEL 2

To be eligible for this level you must have had clean urines

for 15 consecutive days.

1.
2.

You are responsible for items 1-4 of level 1 (employed).

You are responsible for completion and approval of all assigned
tasks.

The amount of your free-time will be based upon your work schedule
and negotiated with a staff member. All other times you will be
expected to be at work or available at the lodge.

You are expected to participate in Ni ht Supervisor responsibilities
unless it conflicts with your work so edule.

99

LEVEL 3

To be eligible for this level you must have had clean urines

for 45 consecutive days.

1. You are responsible for items 1-4 of level 1 (employed).

2. You will be expected to fulfill responsibilities which contribute
to the lodge. The exact nature of these responsibilities will be
determined by the Judicial Review Board.

3. You are expected to participate in Night Supervisor responsibili-
ties unless it conflicts with your work schedule.

LEVEL 4

To be eligible for this level you must have had 90 consecu-

tive days of clean urines.

1.
2.
3.

You are responsible for items 1-4 of level 1 (employed).
You will participate as a member of the Judicial Review Board.

You are expected to participate in Night Supervisor responsibili-
ties unless it conflicts with your work schedule.

GENERAL CONDITIONS AND REQUIREMENTS FOR EMPLOYMENT

1.

If you enter the lodge without employment, you must first get per-
mission from the Judicial Review Board before you begin to look
for a job. This permission will be granted if the Board believes
it is in your best interest to have a job. It will probably not
be granted if you are having difficulty staying "clean" or are not
fulfilling your responsibilities to the house.

If you enter the lodge with a job, you will be permitted to keep
it as long as you stay clean and fulfill your responsibilities to
the house. If you fail to live up to your obligations the board
may direct you to end your employment as a condition to remaining
in the program.

To be eligible for employment status you must provide the Judicial
Review Board with the name and location of employment and the name
of your supervisor.

The employed resident must offer proof of employment on a regular
basis. This proof must be in the form of uncashed paychecks at
the end of each pay period.

100

5. The employed resident must contribute a portion of his paycheck for
room and board. The exact amount will be determined by the staff
on the basis of his ability to pay. In no case will his room and
board exceed the current Department of Social Services rate.

The following sections deal with various policies and pro-
cedures of the lodge. Please read them carefully. If you do not under-
stand them, feel free to ask.

HOUSE MEETINGS

House meetings are held in the morning on weekdays and at-
tendance is required of all residents. The purpose of these meetings
is to bring the residents and staff together to provide an opportunity
to:

Make announcements.

Plan activities for the day.

Discuss problems that have arisen between individual residents.
Discuss problems that have occurred in the relation to the func-
tioning of the house.

Make decisions as a group concerning the lodge program.

01 noon—-

These meetings are only open to the residents and staff and
all discussion and decisions made in the meetings are to be kept con-
fidential.

GROUP SESSIONS

Group sessions are required of all residents. Basically,
they are an opportunity for you to get some help with problems you may
be having. It is also an opportunity for you to help other residents
with their problems. This is the time for you to talk about your con-
cerns without punishment for what you say. Nothin that you reveal
about your self or others in the group will Be usea against you in any
way.

JUDICIAL REVIEW BOARD

 

The Judicial Review Board will be comprised of the staff and
all residents who have reached level 4 status.

This board has the following responsibilities:

1. To decide the promotion or demotion of residents from one level to
another based upon their review of that resident's performance.

101

2. To determine the eligibility of a resident for outside employment
based upon his performance in the program.

3. To hear and resolve any disputes between residents or between resi-
dents and staff which are referred to them from a housemeeting.
In these cases the decision of the board will be final.

GENERAL URINE TESTING POLICY

You are required to provide three urine samples a week on
the days requested by the staff. The days you are required to drop a
urine are determined every week on a random basis. Each Monday the
staff draw a card for each resident. Those cards have the days of the
week on them in which you will be required to provide the urine sample.
Since the exact days you must drop are selected by chance, you may be
asked to drop urines on different days each week.

The urine samples will be collected daily between the hours
of 9 A.M. and 4:30 P.M. You are expected to inquire daily to find out
if you have to drop a urine that day. If for any reason you fail to
produce a urine sample on the day it is requested, you have collected
a "missed urine". You will be permitted only 3 "missed urines" over
a 6 month period. On the occurrence ofithe fourth miss you will be
terminatederom theyprogram.

 

DIRTY URINE POLICY

A. What is a dirty urine?

1. The presence of a drug in the urine for which you do not have
a prescription.

2. You are also considered to be "dirty" if you are "high" in the
house to the point that your own behavior is impaired or you
are interfering with the functioning of the house. This judge-
ment will be made by the staff.

B. What happens if you come up with a dirty urine?
1. You will be notified by the staff that you are "dirty".

2. You will be required to complete a task in the house which will
be assigned by the staff.

3. You will be expected to discuss the circumstances of this
"dirty" in the next group meeting.

102

4. The presence of a dirty urine results in your demotion to the
next lower level. If you are dirty a second time within 30
days you are demoted to level 1 no matter what level you are
currently at.

C. Continuous dirty urines will result in your termination from the
program. Here is how it works.

On your first dirty urine you begin a 30 day probation period.
If in this period of time you have a second dirty urine, then the 30
day probation period begins again. If during this new period you have
your third dirty urine you are in real trouble.‘ This is true because
your fourth dirty urine within 30 days results in your termination from
the program.

 

The purpose of this 30 day probation period is to give you
a chance to remove a dirty urine from your record. .If you remain clean
for 30 days after a dirty urine then if you are dirty again, it only
counts as the first towards termination. If you don't make it through
the probation periods, your dirty urines will pile up until you reach
your fourth. When you accumulate four you will be terminated. There
are no exceptions.

TERMINATION

 

The following are the ways you can get yourself terminated from the
lodge automatically.

1. Any physical violence will result in automatic termination.

2. Any use of illegal drugs in the house will result in automatic
termination.

3. Possession of any weapons in the house will result in automatic
termination.

Of course you can also get yourself terminated for:
1. Dirty urines.
Missed urines.

Non-compliance with lodge rules.

#OJN

Non-compliance with the decisions of the Judicial Review Board.

103

What termination means:
FOR THE REST OF THE DRUG PROGRAMS:

You will not be provided with services by any of the other
drug programs, except crisis centers, for the period of 90 days follow-
ing termination; This 90 day period can only be shortened or elimin-
ated by the lodge staff. This is a policy of the Comprehensive Drug
Treatment Program.

FOR THE LODGE ITSELF:

If you are terminated for the first time, this period lasts
30 days. During that time you are not permitted to have contact with
the lodge program.

At the end of three weeks you may apply for readmission to
the lodge. If your readmission to the lodge is acceptable to the Multi-
Lodge staff and residents, then you begin a week long trial status in
which you are required to drop urines and be at the Lodge from 9 A.M.
to 5 P.M; each day;' During this time you are required to perform non-
paid tasks assigned by the staff and/or level 4 residents. If you
complete this trial week to the satisfaction of the Judicial Review
Board, you will be admitted to the program and allowed to move in.

Similar provisions are made for subsequent terminations should
they occur. However, the second termination results in an out of the
program period of 60 days. The third termination results in a period
of 90 days.

THE 0N-CALL SYSTEM AND NIGHT SUPERVISORS

Since the staff are at the Lodge only during weekday working
hours; an on-call system has been developed. If a personal or house
problem arises which a resident feels needs immediate staff attention
he may call the emergency phone number located by each phone. After
he dials the number he will have approximately 30 seconds to state his
message. A staff member will then immediately return his call to find
out the details of the problem. If this staff member feels it is neces-
sary he will come to the Lodge and assist in correcting the problem.
This system is in operation from 5 P.M. to 8 A.M. on weekdays and on a
24 hour basis on the weekends.

Each evening there will also be a Night Supervisor on duty
at the Lodge. These supervisors will be level 2 or above residents.
It will be the supervisor's responsibility to be aware of what is hap-
pening within the house and he should be prepared to call the staff if

104

he feels it is necessary. In order to enforce the curfew rules for
level l'and 2 residents, the staff will periodically call in to deter-

mine if those residents have returned to the house on time. It is the
responsibility of the.Night Supervisor to answer the phone at the cur-
:ew time and be able to report whether or not a resident is in the
ouse.

VACATION POLICY

Residents are eligible to take a vacation after they have
reached level 3 status. At this point they are eligible for two weeks
of vacation in a calendar year. This vacation may be taken in a two
week block or in two separate 1 week vacations.

The staff must be notified of your intention to take a vaca-
tion at least one week prior to the date you wish it to start.

All vacations must be taken away from the house.

VISITOR POLICY

Visitors are not permitted in the house during the working
hours of 9 A.M. to 5 P.M. Monday through Friday.

The residents are permitted to have visitors in the house in
the evenings and on weekends. However these visitors must be accom-
panied by a resident who will take responsibility for their behavior.

While in the house, visitors are restricted to the downstairs
recreation area, living room, dining room and TV room. They are not
permitted upstairs in the residents' living area unless they are with
a resident at all times.

All visitors are to be out of the house by 2 A.M.

Ex-Residents as Visitors:

 

A special set of rules have been established for those visi-
tors who were residents of the Lodge but were terminated for dirty
urines or non-compliance with Lodge rules.

These ex-residents are not permitted in the house except to
visit the staff. These visits must be made by appointment.

* If an ex-resident wishes to visit a lodge resident he may
meet that resident at the house but both of them must leave the house
immediately. They may not remain in the house for this visit.

An ex-resident may not wait in the house if the person he
wishes to visit is not in the house at the time.

APPENDIX III

INTAKE QUESTIONNAIRE

APPENDIX III
INTAKE RECORD

Patient's Name

 

Address

 

 

Tel. Number

 

Social Security Number

 

Admission Date

 

Termination Date

 

Name of parent or next of kin to be contacted in case of emergency:

Name Relationship

 

Address

 

Tel. Number

 

How often do you see this person?

 

When was the last time you say this person?

 

Program Assignment: Multi-Lodge Half-way House

 

Outpatient aftercare (specify facility)

 

IF NON-VOLUNTEER: Specify program recommendation

 

 

Who referred you to us?

DEC Mason CMH

North Side Crisis Lansing CMH
West Side Crisis Charlotte CMH
Listening Ear St. John's CMH
Ingham County Jail Program Sparrow Hospital
Kalamazoo State Hospital Ingham Medical
Methadone Program Other (specify):

105

106

2

Patient's program number

 

 

 

 

 

1. Date of admission ,/ /
day month year

2. Date of birth / /

day month year
3. Age at admission
4. Sex: 1. M 2. F
5. Race: 1. B 2. W 3. Mex-Am 4. Other
6. Marital Status:

1. Single (never married) 3. Separated 5. Widow or Widower

2. Married 4. Divorced 6. Remarried
7. IF MARRIED: Does your spouse work? If so, what does he
or she do?

 

8. What was the highest grade in school completed by your spouse?

 

9. What is the highest grade you completed?

 

 

 

OMIT T_HE NEXT QUE—T__S ION AT —CENT'LRAL INTAKE

10. Why did you leave school. Was it for:

1. Voluntary reasons 2. Involuntary reasons

11. How many children do you have?

 

12. What are their ages and where are they living?

13.

14.

15.

16.

17.

18.

107

With whom are you living now?

1. Parents only or parents and other family
2. Spouse 3. Other family
4. Friends 5. Alone

How many times have you changed residence in the last year?

OMIT THE NEXT THREE QUESTIONS AT CENTRAL INTAKE

What is the name of the last school you attended?

 

 

Address

 

Would you be interested in completing high school?
1. Yes 2. No
What subjects did you like best in school?

 

 

 

What is your present religion?

1. None 4. Jewish
2. Protestant 5. Muslim
3. Catholic 6. Other

FAMILY BACKGROUND

1.

Where were you born? City State

 

 

Country

 

(IN
ARE

108

Where did you grow up?

 

When you were growing up, who were the adults you were living with?

I would like to know their ages and marital status also:

ANSWERING THE FOLLOWING QUESTIONS, IF IDENTITY OF MOTHER AND FATHER
UNKNOWN, USE THE OCCUPATIONS OF THE ADULTS IN QUESTION #3)

While you were growing up, what was the highest grade completed by

your: 1. Father 2. Mother

 

 

While you were growing up, what were the occupations of your:

1. Father

 

2. Mother

 

While you were growing up, what language was spoken at home?

 

What language do you prefer to speak?

 

How many brothers and sisters do you have? For each,

what is their sex, age, marital status, and number of children?

OMIT THE NEXT FOUR QUESTIONS AT CENTRAL INTAKE
What is your feeling towards your family at present?
1. Distant 3. Close

2. Warm 4. Family deceased

10.

ll.

12.

109

IF MARRIED: What is your feeling towards your spouse and children
(if any)?

1. Distant 2. Warm 3. Close

00 you have any close friends now? 1. Yes 2. No

IF YES: How many?

 

What was the economic status of your household while you were
growing up?
1. Mostly on welfare 3. Average

2. Poor 4. Above average

EMPLOYMENT BACKGROUND

1.
2.

Are you presently employed? 1. Yes 2. No
IF YES:

Who is your employer?

 

What do you do there?

 

How long have you been employed there?

 

What is your gross income?

 

IF NO: What is your source of income?
1. Welfare 3. Veterans'

2. ADC 4. Other

 

FOR THOSE WORKING: Do you receive any income other than from your
job? 1. Yes 2. No

If so, what type? (use categories from question #3)

 

Do you support anyone else? 1. Yes 2. No If so, how many

(include yourself)?

 

110

6. How many jobs have you held in the past 5 years?

 

For each job, I want you to tell me the nature of the job, how
long you worked there, and the reason for leaving (were you fired,
laid off, or did you just change jobs:):

DURATION OF
TYPE OF JOB EMPLOYMENT FIRED LAID OFF QUIT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

111

OMIT THE NEXT QUESTION AT CENTRAL INTAKE
7. What kind of work would you like to do?

MILITARY HISTORY
1. Have you ever served in the armed forces? 1. Yes 2. No

IF YES: How long?

 

Rank

 

Date and type of discharge

 

Any specialized training? 1. Yes 2. No

01 0'1 -D (A) N
o o o o 0

IF YES: What type?

 

ARREST RECORD (USE TABLE ON NEXT PAGE)

1. Have you ever been arrested? 1. Yes 2. No

IF YES:

2. How many times were you in jail before you started using drugs,

and afterwards? BEFORE AFTER

 

 

3. How much time did you spend in jail before you started using

drugs, and afterwards? BEFORE AFTER

 

4. How many arrests and convictions have you had for each of the
crimes listed below before you started using drugs? After?

(See table on next page.)

112

CRIME ARRESTS CONVICTIONS
fBEFORE AFTER BEFORE AFTER

IWILLFUL HOMICIDE ‘ '

 

 

FORCIBLE RAPE

 

Rog-m

 

GGRAVATED ASSAULT
)BURGLARY

ILARCENY (S50 AND OVER)
OTOR VEHICLE THEFT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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113

 

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10.

B.

9.

3.

IF PATIENT HAS USED ALCOHOL:

1.
2.

3.

How many times a week do you drink?

115

 

How many glasses of beer or wine, or shots of whiskey do you

usually drink at one sitting?

What is the maximum you drink at any one sitting?

 

IF PATIENT HAS USED AN OPIATE:

1.

Do you use it currently?

2.

Her
0p
Morph
Dem

Meth

1.
1.
1.
l.
1.

Yes
Yes
Yes
Yes

Yes

NNN

No
No
No
No
No

When you last used, was it

to get straight or high?'

Her

5.

Morp
Dem

Meth

1.

S

1. S

h 1.

1“

1.

(DUI

S

2.

NNNN

H

II

. H

How old were you when

you first tried it?

Her

 

0p

 

Morph

Dem

Meth

 

 

 

2.

 

IF NO: When was the
last time you used?

Her

 

0p

 

Morph

 

Dem

 

Meth

 

Who first introduced you
to the drug?
Her"

0p

 

Morph

 

Dem

 

Meth

 

6. How did you first do it up?

Her
013
Morph
Dem

Meth

snort pop shoot smoke other
snort pop shoot smoke other
snort pop shoot smoke other
snort pop shoot smoke other

snort pop shoot smoke other

11.

10.

12.

13.

116

How long did you spend skin-popping, snorting, and

mainlining each drug?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Her pop snort
Op pop snort
Morph pop snort
Dem pop snort
Meth pop snort
Do you mainline?
Her
Op
Morph
Dem
Meth
Ever use any other route?
Her 1. yes 2. no
Op 1. yes 2. no
Morph 1. yes 2. no
Dem 1. yes 2. no
Meth 1. yes 2. no
How much per day do you use:
Her
Op
Morph
Dem
Meth

 

How do you support your habit?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

shoot
shoot
shoot
shoot
shoot
9. IF YES: how long?
Her
OP
Morph
Dem
Meth
11. How long have you been
addicted?
Cost: in dollars per day
Her
Op
Morph
Dem
Meth

 

12.
14.

15.

16.

17.

10.

11.
12.

13.

117

Have you ever tried to kick the habit on your own?
1. Yes 2. No
IF YES: How many times?

 

How?

 

What was the longest time you stayed clean?

 

What was the shortest time you stayed clean?

 

What was the first drug you used?

 

How old were you when you first used it?

 

Has anyone in your immediate family, or with whom you are living,
ever used any of the drugs listed in question #1?

1. Yes 2. No

IF YES:

1. Person 2. Drugs

 

 

 

 

 

 

 

118
13.
1. Have you ever been treated for personal problems or drug use?

1. Yes 2. No

2. IF YES:
REASON FOR
TERMINATION
REASON FOR AGE AT (voluntary or
SEEKING TREAT- involuntary)
TREATMENT TYPE* MENT LENGTH VOL :7 INVOL

 

1

 

 

 

 

i:
l

 

 

 

 

 

 

twp u—n—fiPMP “mi? -——-—J}a—-_{'

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*TYPES: Hospital
Out-Patient

Transitional

 

APPENDIX IV
SOCIAL CONTACTS RATING SCALE

APPENDIX IV
SOCIAL CONTACTS RATING SCALE

The following is the scale which was utilized to rate the subject's
frequency of social contact with non-addicts while in residence. This
rating was made only for those subjects who were in residence for a
period of one month or more. The ratings are based on an estimate of
the average number of times per week the subject engaged in leisure

activity of any kind with individuals with no known history of addic-

tion.
Rating Criterion
0 Subject had no social contact with non-addicts.
1 Subject had infrequent social contacts with

non-addicts which occurred at a rate of less
than once per week.

2 Subject had occasional social contacts with
non-addicts which occurred at a rate of no
more than twice a week.

3 Subject had regular social contacts with non-

addicts which occurred at a rate of three or
more times a week.

119

APPENDIX V

JOB-SEEKING BEHAVIOR RATING SCALE

APPENDIX V
JOB-SEEKING BEHAVIOR RATING SCALE

The following is the scale which was utilized to rate the
subject's frequency of job-seeking behavior while in treatment. The
ratings are based on an estimate of the average number of times per
week the subject engaged in seeking employment as defined by contacts
with employers or with social service agencies for the purpose of
eliciting direct or indirect assistance in obtaining employment. Only
those subjects who were in residence for a period of one month or more

were rated.

Rating Criterion

0 Subject did not actively seek employment
while in treatment.

1 Infrequent job-seeking behavior at a rate of
less than once per week

2 . Occasional job-seeking behavior at a rate of
at least once a week but less than three times
a week.

3 Frequent job-seeking behavior at a rate of at

least three times a week.

The rating for each subject was done by the staff member
who was considered to have the most contact with that individual.
Inter-rater reliability was assessed through the computation of a
Pearson product-moment correlation which yielded a correlation coef-
ficient of .79.

120

APPENDIX VI

TABLE OF MEANS AND STANDARD DEVIATIONS FOR
ALL INDEPENDENT AND DEPENDENT VARIABLES

APPENDIX VI

Table V1.1 Table of means and standard deviations for all independ-
ent and dependent variables.

 

 

 

Variable N Mean Std. Dev.
Education 34 11.62 1.95
Employment history 34 .22 .30
Criminal record 34 2.65 - 2.26
Age first heroin use 34 19.91 3.77
Length of use 34 38.62 37.17
Cost per day 34 85.41 89.09
Number of "kicks" 34 2.65 1.61
Length of longest "kick" 34 9.94 18.27
Legal pressure 34 .97 .92
Employ. in treatment 24 .67 .82
Freq. of social contacts 24 .79 .93
Prop. dirty urines 24 .34 .22
Number of days in treat. 34 66.85 90.96

Freq. of job-seeking 22 1.14 1.13

 

121

APPENDIX VII

SUMMARY TABLES FOR ANALYSES
0F MULTIPLE REGRESSION

Table VII.1

APPENDIX VII
SUMMARY TABLES FOR ANALYSIS
OF MULTIPLE REGRESSION
Analysis of variance for the overall regression of age
of first heroin use, length of addiction and cost per

day of the heroin habit prior to treatment on success in
securing employment while in treatment. (N = 24)

 

 

 

Source SS df MS F
Regression 2.26 3 .75 1.15
Error 13.08 20 .65

Total 15.33 23

 

Table VII.2

Analysis of variance for the overall regression of age
of first heroin use, length of addiction and cost per
day of the heroin habit prior to treatment on the fre-
quency of the addict's social contacts with non-deviant
individuals while in treatment. (N = 24)

 

 

 

Source SS df MS F
Regression 1.66 3 .55 .60
Error 18.30 20 .92

Total 19.96 23

 

122

123

'Table VII.3 Analysis of variance for the overall regression of age
of first heroin use, length of addiction and cost per
day of the heroin habit prior to treatment on length of
stay in treatment. (N = 34)

 

 

 

Source SS df MS F
Regression 13183.36 3 4394.45 .68
Error 259848.91 30 8661.63

Total 273032.27 33

 

Table VII.4 Analysis of variance for the overall regression of edu-
cation, employment history and criminal record on success
in securing employment while in treatment. (N = 24)

 

 

 

Source SS df MS F
Regression 2.24 3 .75 1.14
Error 13.09 20 .66

Total 15.33 23

 

Table VII.5 Analysis of variance for the overall regression of edu-
cation, employment history, and criminal record on length
of stay in treatment. (N = 34)

 

 

 

Source SS df MS F
Regression 35493.28 3 11831.10 1.49
Error 237538.98 30 7917.97

Total 273032.27 33

 

 

1‘; Typed and Printed in the U.S.A.

‘ Professional Thesis Preparation
Cliff and Paula Haughey
’ 144 Maplewood Drive
' East Lansing, Michigan 48823
Telephone (517) 337-1 527

   

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