PERSONALITY CHARACTERISTICS OF ALCOHOLICS
RELATED TO AGE AND EMPLOYMENT
LINDSAY EDWARD WILSON
A DISSERTATION PRESENTED TO THE GRADUATE COUNCIL
OF THE UNIVERSITY OF FLORIDA IN
PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF DOCTOR OF PHILOSOPHY
UNIVERSITY OF FLORIDA
I would like to acknowledge the assistance and support of those who made
this project possible. The guidance of the members of my doctoral committee was
invaluable. I would like to thank Dr. Stripling for his words of wisdom; Dr. Ziller
for his support, Dr. Tolbert for being there when needed; and Dr. Gary Seller for
his humor and perspective.
I appreciate the confidence of my family and friends. My wife Elayne
struggled with me in the pursuit of this research and her dedication and love made
it possible. The family motto, from England, is Endure Fort or "Endure with
Strength." Elayne, and the children Michael, Albert, Lindsay Ann, and Jennifer did
just that and this work is dedicated to them.
TABLE OF CONTENTS
LIST OF TABLES.....................................................
ABSTRACT.... .................. ................... .
Purpose of the study....................
The Scope of the Problem ...............
Economic Impact ......................
Drinking and Driving ...... .........
The Meyers Act .......................
The Need for the Study .......................................
Substance Abuse Programs ....................................
Program Funding .......................................... .
Research Questions ......................................
Definition of Terms .......................................
Organization of the Remainder of the Study....................
REVIEW OF THE LITERATURE............................
Perspective on Beverage Alcohol...............................
Development as a Beverage .................................
Early American Drinking.....................................
Alcohol Abuse Client in Florida................................
Treatment Concepts ............................
Early Ideas ..................................
The Alcoholic Family..........................
Treatment Services ............................
Federal Program Funding ......................
Third Party Payments .........................
Alcoholic Personality Characteristics ..........................
Ageing and the Alcoholic ...................................
Employment and the Alcoholic ................................
Super's Vocational Career Development Theory ..................
e e ee w
TABLE OF CONTENTS (Continued)
III METHODOLOGY............................................ 52
Research Design ............................................. 53
Research Hypotheses ........................................ 53
Population and Selection of the Sampel......................... 54
Instrumentation .............................................. 56
The Minnesota Multiphasic Personality Inventory (MMPI)........... 58
MMPI Scales............................................... 60
MMPI Short Forms (Mini-Mult)............................... 63
MMPI-168 ................................................ 64
MMPI Special Alcoholism Scales .............................. 66
MAC Scale ............................................... 67
Statistical Analysis ...... .............. .......... ......... 68
Procedures ................................................. 69
Limitations of the Study ..................................... 71
IV RESULTS OF THE STUDY .................................. 72
Description of the Sample .................................... 72
Data Analysis....................... ....................... 75
V SUMMARY AND CONCLUSIONS............................... 90
Conclusions of the Investigation................................ 94
Limitations........................ ......... .......... ... 95
APPENDIX .......................................................... 99
REFERENCES ....................................................... 102
BIOGRAPHICAL SKETCH............. .............................. 13
List of Tables
Table I Florida Alcohol-Related Service Needs 26
Table 2 Units of Service by Component 36
Table 3 Individuals in Treatment 1979-80 37
Table 4 Family Income 38
Table 5 Means and Standard Deviations of Descriminate Function and
Percentages of Correct Classification by Age 1681 Male Alcoholics 43
Table 6 Client Characteristics of Total Sample 73
Table 7 Chi-Square Comparing Study Client Characteristics
With Estimated State Parameters 74
Table 8 Chi-Square Comparing Study Client Characteristics Within
the 3 x 2 Matrix 76
Table 9 Means and Standard Deviations of MMPI Scales by Age and
Table 10 Two-Way ANOVA Testing Employment and Age on Hysteria 79
Table I I Summary for Main Effects on Variable Hysteria Following
Non-Significant ANOVA Interaction 80
Table 12 Two-Way Analysis of Variance Testing Employment and Age
on Alcoholic MMPI Scale Social Introversion 80
Table 13 Summary for Main Effects on Variable Social Introversion
Following Non-Significant ANOVA Interaction 81
Table 14 Two-Way ANOVA Testing Employment and Age on Masculinity-
Table 15 Two-Way ANOVA Testing Employment and Age on Masculinity-
Table 16 Two-Way ANOVA Testing Employment and Age on Depression 82
Table 17 Summary for Simple Effects on Variable Depression
Following a Non-Significant ANOVA Interaction 83
Table 18 Two-Way ANOVA Testing Employment and Age on Psychasthenia 84
LIST OF TABLES (continued)
Table 19 Summary for Simple Effects on Variable Psychasthenia
Following a Significant ANOVA Interaction 85
Table 20 Two-Way ANOVA Testing Employment and Age on MAC 86
Table 21 Correlation of Age and MAC 87
Table 22 Two-Way ANOVA Testing Employment and Age on Psychopathic
Table 23 Correlation of Age and Psychopathic Deviance 88
Table 24 Two-Way ANOVA Testing Employment and Age on Scale L 89
Table 25 Correlation of Age and Scale L 89
Table 26 Two-Way ANOVA Testing Employment and Age on Scale F 99
Table 27 Two-Way ANOVA Testing Employment and Age on Scale K 99
Table 28 Two-Way ANOVA Testing Employment and Age on Paranoia 100
Table 29 Two-Way ANOVA Testing Employment and Age on Schizophrenia 100
Table 30 Two-Way ANOVA Testing Employment and Age on Hypomania 101
Abstract of Dissertation Presented to the Graduate Council of the University of Florida
in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy
PERSONALITY CHARACTERISTICS OF ALCOHOLICS
RELATED TO AGE AND EMPLOYMENT
LINDSAY EDWARD WILSON
Chairman: Gary Seiler
Major Department: Counselor Education
Employment has been identified as a contributing element in recovery
from drinking. This research examines the personality attributes of alcoholic
clients of different ages who are employed and unemployed. The prevention of
alcohol abuse by people ages 15-64 through job training is considered and discussed.
This study of 120 male alcoholics examines Minnesota Multiphasic Person-
ality Inventory-168 characteristics, including the MacAndrews scale of substance
abuse. The subjects were drawn from Florida Alcoholism programs and grouped
twenty to a cell in a 3 by 2 matrix. There were three levels of age, 15-24, 25-44,
and 45-64 according to the vocational development theory of Donald Super. Two
levels of work history, employed and unemployed, were determined from the
Florida Department of Health and Rehabilitative Services guidelines. Two-way
Analysis of Variance and correlational techniques were performed on the data.
The study concluded that there are differences in personality characteris-
tics of alcoholics of different age groups. The 15-24 group is lower than the oldest
on Hysteria. On Social Introversion the oldest group is higher than the other two
groups. Employment was also found to make a difference. The unemployed scored
higher on Hypochondriasis than those who work and lower on Masculinity-femi-
ninity. An interaction was found on Depression and Psychasthenia. Unemployment
raised depression in the middle age group but not the others. Employment
decreased psychasthenia scores of the middle group but not the others. Significant
differences were not found on MAC.
The study concludes that employment is an important part of the
rehabilitative plan for alcoholics. The vocational self-concept may be influential
in determining the degree of depression, guilt, worry, and hysteria in alcoholics.
The importance of work is emphasized for men in the 25-44 age bracket.
Vocational training programs might find greatest success when targeted at the 25-
44 age group. If such programs are aimed at younger people benefits may not be
demonstrable until they reach their late twenties.
Purpose of the Study
Alcohol abuse and alcoholism are significant problems likely to be encoun-
tered by counselors in a variety of settings (Birtman, 1980). Special emphasis has
been placed on the prevention of substance abuse by young people (Andrews, 1980;
Hoefle, 1980: Florida, 1980b; Klein, 1980; Florida Drug Abuse Trust, 1979).
Community prevention efforts emphasizing the youthful stem at least in part from
the unspoken belief that older alcoholic clients are more difficult or even beyond
help (Lynn, 1978; Myerson, 1978). However, there is reason to believe that a
number of alcoholic clients do not seek serious, intensive treatment until the
middle years of life (Apfeldorf & Hunley, 1975; Hoffman & Nelson, 1971; Sutker et
al., 1979; Vosburgh, 1975; Weissback et al., 1976; Williams & Kahn, 1964). This is the
time of life Donald Super's vocational theory suggests is normally a period of
establishment of career pattern and vocational self-concept (Super, 1953).
Clopton (1973) has identified employment as a contributing element in
recovery from drinking. Work has traditionally been a part of the treatment of
alcoholism cases by self-help groups (AA, 1953, 1973, 1975; Johnson, 1980). Institu-
tions and programs accreditation groups often mandate vocational rehabilitation
with alcohol clients (Florida 1980a ; U.S., 1974). Putting substance abusers to
work is a standard component of alcoholism treatment planning.
There also appears to be a relationship between how an individual sees
himself and the level of abuse among the substance abuse population (Johnson,
1980; Medzerian, 1979). Self-concept is recognized by many theorists to be
influenced at least in part by vocational development. Super's vocational theories
have provided a framework that is commonly in use by Florida's Department of
Health & Rehabilitative Services and his ideas have been applied to vocational
projects in the substance abuse field throughout the state (Florida Drug Abuse
The literature indicates that there are personality characteristics many
alcoholics have in common (Clopton, 1973; Hodo & Fowler, 1976; MacAndrew, 1965;
Williams & Kahn, 1964; Vosburgh, 1975). These underlying factors are stable and
resistant to change (MacAndrew, 1965). Ageing may have a way of softening the
expression of those characteristics (Apfeldorf & Hunley, 1975; Hoffman, 1970;
Hoffman & Nelson, 1971; Kratz, 1975; Sutker, 1979). Employment has been
identified as a contributing element in alcoholic recovery (Clopton, 1973, Johnson
1980). Super's developmental theory is in congruence with the question asked by
the proposed research. Working may provide structure that decreases anxiety and
reinforces a positive self-concept that is inversely correlated with alcohol abuse
Alcoholics are usually not ready to change their behaviors until they have
exhausted available alternatives (AA, 1953, 1973, 1975; Glatt, 1958). Kratz (1975)
has indicated there is a positive correlation between age and length of sobriety.
The modal age group at which change seems to occur is in the early forties
(Williams, 1964). This is the time of establishment when one normally stabilizes a
career pattern and works at maintaining an occupational position (Super, 1953;
Tolbert, 1974). Alcoholics in this age group often experience destabilization of
their career pattern and loss of vocational position Florida, 1980a). Super's theory
provides a framework for understanding age and employment factors in alcoholism
Some counselors deemphasize work and are more concerned with their
client's intrapersonal processes and self-expression. However, most current
theorists usually place some importance on a client's need and ability to maintain
employment. Certainly the clients return to work and discontinuance of reliance
on others finds favor with administrators and others who must present substance
abuse programs to funding groups and the public (Mann, 1959).
The Scope Of The Problem
Alcohol is a drug, the most abused drug in the United States (Breecher,
1972; U.S., 1971). International comparisons rank the United States 15th in percapita
consumption of all forms of alcohol and third when consumption of distilled spirits
alone is considered. A similar pattern of a preference for hard liquor instead of
beer or wine is found in the Soviet Union and Poland. The highest levels of drinking
are in Portugal, France, and Italy where wine is a part of the everyday diet.
Although Australia and New Zealand rank 9th and Ilth respectively in overall
consumption, they lead the world in beer drinking (HEW, 1978; Keller & Gurioli,
Analysis of world and American drinking patterns must consider inter-
actions of socioeconomic variables. The high consumption rate of Nevada (#1), The
District of Columbia (#2). New Hampshire (#3), Alaska (#4), Vermont (#5), and
Florida (#11) have been attributed to several factors not easily related to each
other. Nevada and Florida have large numbers of tourists who are thought to drink
more while on vacation. Florida also ranks first in proportion of residents 65 and
over in the United States and fourth in actual number of elderly persons (Cutler &
Harootyan, 1975). Among the retired group drinking often increases from pre-
retirement rates. The District of Columbia has tourists and many people working
in high pressure, transient situations. Residents of states adjacent to New
Hampshire and Vermont often purchase their alcoholic beverages as well as other
goods in those states because of favorable prices due to the tax structure. Alaskan
drinking patterns may reflect a frontier life-style that traditionally has included
heavy drinking (Keller & Guirioli,1976; U.S., 1971). "Alcohol abuse" is difficult to
determine for large groups as well as individuals.
The sterotyped "skid row bum" accounts for only 3-5% of the alcoholic
group (U.S., 1971). The majority of alcoholics are people who work and lead lives
not so different from those of non-alcoholic Americans. One-third of adult
Americans drink alcoholic beverages at least once a week and another third drink
chiefly on special occasions only. Those remaining used to drink but no longer do
or have always abstained (U.S., 1978). One out of every seven to ten adult drinkers
in the United States experiences serious problems directly related to the consump-
tion of alcoholic beverages (U.S., 1971). The Department of Health, Education, and
Welfare (1978) suggests as many as 25% of those who drink are potential problem
drinkers. A 1977 National Institute of Alcohol Abuse and Alcoholism (NIAAA)
survey by Johnson et al. indicates that 36% of all those who drink could be
classified as problem drinkers.
There is disagreement on operational definitions in the alcoholism litera-
ture and the categories described do not always usefully differentiate between
problem drinking and alcoholic drinking (Chatham, 1979; Jellinck, 1960, 1962;
Marconi, 1959). Not every problem drinker is an alcoholic, but every alcoholic is
certainly a problem drinker (Mann, 1959). Any one individual may also drink
socially at one time in his life and alcoholically at others. "Social Drinkers" are
those whose drinking is a part of their social interactions with family, friends,
neighbors, and co-workers. Alcohol is used in this context as a beverage for
relaxation and to enhance the feelings of well-being in healthy social relationships.
The health and/or social functioning of the social drinker are not impaired.
"Problem drinkers" consume alcoholic beverage in such a way that their
drinking disrupts their interpersonal relationships with family, friends, neighbors,
or employers. Alcohol abuse or problem drinking is misuse of the drug to the point
where problems are manifested or disabilities result. Such problems include those
that are psychological in nature, such as depression and anxiety; medical illness of
an acute and chronic nature, and social problems such as default of major roles in
society. An alcohol-related disability is an impairment in the physical, mental, or
social functioning of an individual that may reasonably be inferred to be caused at
least in part by alcohol consumption (U.S., 1978).
Some problems in society are related to the excessive use of alcohol but
not necessarily alcoholism. Problem drinking is excessive but relatively controlled
drinking even to the point of psychological and physical drinking damage. Alcohol-
ism is a dependence syndrome characterized by a loss of control of alcohol intake
and is recognized as an illness that will progressively get worse if not treated
(Bowman & Jellinek, 1941; Jellinek, 1960).
Economic losses are manifested in two general ways: loss of production
and an increase in health, social and criminal justice services to cope with the
consequences of heavy drinking. The Second Special Report on Alcohol and Health
indicated economic cost of 25 billion dollars in 1971, an upward revision of ten
billion dollars from losses predicted by the First Special Report by the Department
of Health, Education and Welfare. The 72% increase to 43 billion in 1971-75 is
explained by the increased costs of goods, services, and labor as well as a more
comprehensive method of analyzing cost factors; however, it does not include
unemployment compensation or welfare payments that may be related to drinking
Estimated lost production of goods and services was 19.64 billion dollars in
1975. This includes lost market production among males of 15.46 billion; lost
military production of .041 billion; lost future production from excess mortality of
3.77 billion dollars. The 15.46 billion estimate of lower earning is considered to be
conservative. Losses incurred by workers under 21 and over 50 are not included nor
are losses by unsalaried workers such as housewives (U.S., 1978).
The United States ranks near the median of all countries in hospital
admissions for alcohol-related mental illnesses (U.S., 1978). Among 70 thousand
first admissions to state mental hospitals in 1964, 22% of the males and 5.6% of the
females were diagnosed alcoholic. In nine states alcoholism led all other diagnoses
in mental hospital admissions. Maryland state hospital reported 40% of all male
mental health admisisons as alcoholism (Breecher, 1972).
In 1975, 12.74 billion dollars was spent for health and medical services
related to alcohol abuse. The alcoholic and problem drinking population of
approximately ten million Americans is thought to account for 8.4 billion dollars or
almost 20% of all hospital care expenses (U.S., 1978). The percentage of health
care costs that can be related to alcohol abuse may even be greater than that
reported (Ellis, 1978). Hospital and health care providers tend to diagnose
presented symptomatology and not the underlying illness, alcoholism (Hoefle, 1980;
Ramirez & Wells, 1978: Westie & McBride, 1974).
Alcohol may be implicated in illnesses, deaths, and accidents. In the
United States in 1975 between 61,034 to 95,003 deaths were reported related to
alcohol abuse. Alcohol abuse is cited as the direct cause of 18,218 to 35,295 deaths
drinking was implicated in 1975 in 6,766 to 10,013 suicides, 10,442 to 14,917
homicides; 6,614 accidental falls; 1,572 fires, and 13,756 to 22,926 motor vehicle
accidents (Day, 1977; NCHS, 1975, U. S., 1971, 1975). Alcohol is said to be involved
in as many as 64% of the homocides, 60% of the child abuse, and 56% of the
assaults in U. S. homes. (Florida, 1980 b).
Drinking and Driving
The relationship of drinking and driving to traffic fatalities has been
repeatedly documented (Bako et al., 1977; Florida, J979; U. S., 1971). Economic
costs associated with driving while drunk were estimated at 5.14 billion dollars in
1975. The net percentage of alcohol related accidents of the total motor vehicle
accidents in the United States is 41.5 with the percentage increasing with the
severity of the crash (U.S. 1978). Among those age 16 to 24 the percentage of
alcohol involvement in traffic fatalities is 60% (U.S., 1971). Of those 16 to 24 years
of age, 15.9% admit to driving after having a "good bit to drink" (Florida, 1980b,
p 6). The problem drinker represents less than 10% of the general population yet may
be involved in nearly two-thirds of the related traffic fatalities in the state of New
York (New York, 1979).
Driving while intoxicated (DWI) or under the influence of alcohol (DUI)
accounted for 250 thousand arrests nationwide as early as 1965. Another 490
thousand were charged with disorderly conduct and 1,535 thousand for public
intoxication. If all drinking related arrests are considered, 40% of the reported 5
million arrests in the United States in 1965 may be linked to the excessive
consumption of alcoholic beverages (Breecher, 1972; U. S. 1971 & 1975). The
extent of the problem in the early nineteen-sixties elicited a legislative response in
the early nineteen-seventies. Although alcoholism has been decriminalized, the
behavior of those who drink excessively remains a serious problem in the nation and
State of Florida (Florida, 1980d). This is not always reflected in official reports
since drinking behaviors are no longer equated with illegal activity.
The Meyers Act
Only recently has alcohol abuse been considered an emotional or medical
disorder (Cross, 1968; Mann 1959; Public Law 91-616; Tarter & Sugarman, 1976).
During the 1960's there was a legislative movement towards dealing with alcohol
abuse that culminated in the Uniform Alcoholism and Intoxication Act drafted by
the National Conference of Commissioners on Uniform State Laws and recommen-
ded for enactment by all the states (Florida 1976, 1977; Lewis, 1955). The 1971
session of the Florida legislature passsed.the "Comprehensive Alcoholism, Preven-
tion, Control and Treatment Act" (Chapter 396 of the Florida Statutes) modeled
after the federal act. Florida Law Relating to Alcohol Offenses and the Rehabili-
tation of the Alcoholics. or "The Meyers Act" as it is commonly called, was fully
implemented January I, 1975, and amended by the 1976 legislature (Florida, 1977).
Florida statutes clearly mandate recognition of the alcoholic as an ill
individual who needs treatment and emphasizes early diagnosis and prevention.
Section 396.022 (Findings and Declaration of Purposes) includes the following
Alcohol abuse and alcoholism are increasing throughout the country
and in Florida. Alcohol abuse can seriously impair health and lead
to chronic and habitual alcoholism. Alcoholism is recognized as an
illness or disease that requires attention and treatment through health
and rehabilitative services.
The criminal law is not an appropriate device for preventing or
controlling health problems. Dealing with public inebriates as
criminals has proved expensive, unproductable, burdensome, and
futile. The recognition of this fact and the concurrent establishment
of modern public health programs for the medical management of
alcohol abuse and alcoholism will facilitate early detection and
prevention of alcoholism and effective treatment and rehabilitation
An alcoholic, except in specified instances enumerated herein,
shall be treated as a sick person and provided adequate and appropriate
medical, psychiatric, and other humane rehabilitative treatment
services for his illness. (p. I).
The Need For The Study
It has been suggested that a significant number of the American and
Floridian populations may be considered alcoholic or may demonstrate problems in
the use of alcoholic beverages in their lives. These individuals are recognized by
law as needing treatment services rather than moral chastisement or incarceration
(Florida, 1977). Treatment in cases under the supervision of federal and state
agencies includes a plan to return the person to productive work. (Florida, 1980e;
U.S., 1971, 1978).
Employment and related counseling services are viewed by policy makers
in the state and federal regulatory agencies as an integral part of the rehabili-
tation of alcoholics. Specific HRS rules require such services for state licensing as
a treatment unit. Accreditation of such programs for the receipt of third party
payments in cases where it is applicable necessitates the inclusion of vocational
rehabilitation in mandatory counseling treatment plans (U. S./JCHA, 1974; HRS,
There are likely to be continued interest and special projects involving
vocational rehabilitation with substance abuse clients because of (I) A reported
positive correlation between unemployment and substance abuse (Andrews, 1980;
Florida Drug Abuse Trust, 1979); (2) A self-help tradition within the field
independent of professional counseling services and emphasizing "common sense"
treatment approaches (AA, 1953; Johnson, 1980); and (3) The need for greater self-
support by treatment programs in the face of dwindling federal dollars. Third
party payments by non-government entities and self-supportive cottage industries
or sheltered businesses are increasing by being looked at by program fiscal
administrators (Florida Drug Abuse Trust, 1979; Let's Make it Work, 1980, Budget,
Substance Abuse Programs
Alcohol and drug abuse programs existed prior to the 1964 Community
Mental Health Services Act outside the traditional mental health services com-
munity. Originally separate, there has been a movement towards combining
alcohol and drug services under substance abuse programs within a community
mental health center (HEW, 1979; Ozarin & Wolfe, 1979). These programs have in
the past been staffed not by professional counselors but by former abusers applying
mostly self-help methods. Many substance abuse treatment centers continue to be
staffed much the same way today.
A typical staffing pattern of a treatment unit may be drawn from data
gathered by the National Drug and Alcoholism Treatment Utilization Survey
(NDATUS) of April, 1979; social worker BA and above 9.4%; degree counselors BA
and above 16.9%; degree counselors at the AA level 4.0%; and non-degreed or
formal training are widely utilized at a full time equivalent rate of 35.4% (U.S.,
While many alcohol programs staff with recovering clients, this is not the
accepted procedure with other mental health services who generally hire college
trained counselors. Because the number of degree counselors is limited in
substance abuse programs professional techniques are usually used adjunctly to
self-help methods developed and fostered by Alcoholics Anonymous and others (AA,
1953, 1975). Such self-help methods in the field may be expected to stress common
sense ideas such as a return to work as an important step in the rehabilitation
process (Johnson, 1980).
Funding counseling services is expected to be increasingly difficult in the
years ahead in most areas of the field (Let's All Make It Work, 1980; Decisions,
1980). Substance abuse programs are expected to face the prospects of diminished
federal and local financial support to a perhaps greater degree that other mental
health and social service providers. A proposed federal budget for Fiscal Year 1981
would mean cutbacks of $50.9 million by NIAAA and $35.9 million by National
Institute of Drug Abuse (NIDA). Although the need for services may be real and
significant, programs view themselves in competition with other possibly more
attractive groups (Budget, 1980; Seidley, 1980). With funding becoming a problem,
it is unlikely federal, state, or local communities will give priority to alcohol and
drug programs over those programs for the handicapped or disadvantaged.
Substance abuse programs find themselves in need of demonstrable
treatment modalities and methods that can have reasonable success rates and
impact on their client population (Malfetti, 1979). Efforts that return the abuser to
productive living and remove the client from reliance on public support are popular
both with those in and outside the field (Florida Drug Abuse Trust, 1979).
Treatment services that appear frivolous or expensive while not leading to a
lifestyle that includes work are less likely to receive administrative or community
Federal support in the form of Title XX, 409, 410, and other funding is not
sufficient to operate substance abuse programs at their current levels (Budget,
1980). Third party payments following accreditation is hoped for but not achieved
as yet on a large scale. The collection of client fees and funds-producing client
activities such as cottage industries are under consideration by those responsible
for the fiscal management of programs. The expectation of collection of fees for
services rendered has not met with success (Trust, 1979). The ability of clients to
produce something of value while in treatment is a necessary and traditional part
of such operations as Goodwill Suncoast, Inc. and the Pinellas Association for
Retarded Children in Florida. Whether such projects are businesses for the benefit
of the sponsoring program or part of the treatment of rehabilitation for the client
has emerged as an issue in the alcohol and drug abuse field. In any case, the trend
is towards more wide spread implementation of the cottage industry concept in the
future (Florida Drug AbuseTrust, 1979).
Implications are expected for further research on the progressive nature
of alcoholism, treatment program planning and funding, and treatment approaches
for substance abuse clients. The findings of the study may be limited to alcoholics
among the drinking population of the state of Florida and not be applicable to
alcoholics in other areas.
Alcoholism is viewed by modern theoreticians as a progressive disease
entity (APA, 1980, Jellinek, 1960; Kissin & Begletier, 1977). There could
be expected deterioration or negative changes on personality measures and
characteristics according to the theory. The progressiveness of the illness may
justify, as presently formulated, focusing attention on the early and middle stages
of the illness and the withdrawing of limiting efforts at the end or terminal phases.
Younger clients generally receive more attention than older ones in the form of
grant monies, special projects, and publicity (Hoefle, 1980).
Directing attention to young clients does not take into consideration the
traditional theoretical curve of alcoholism recovery that predicts the individual
will "hit bottom" and then make the changes that lead to recovery (Glatt, 1958).
Another way of expressing this is that an alcoholic must reach a point where he is
willing to enter into a therapeutic relationship before he is going to change. Any
efforts towards treatment before the client reaches that motivational point are
going to have limited success (AA, 1953; Brozek, 1950; Glatt, 1958; Menninger,
1959). The effectiveness of treatment may not depend upon the age of the person
but on the clients readiness to enter a helping relationship and to change personal
Employment would appear to have face validity as an important element
of the alcohol abuser's treatment and is supported in a general way by studies with
this population. However, more needs to be done to explain what differences
employment makes in the personalities of these clients. Research in this area is
acknowledged difficult and of uneven quality. Personality studies with this group
attempt to delve into psychological framework of clients who are skillful in
preventing others from entering their intrapersonal world (AA, 1953; Berne, 1964,
The federal and state regulations under which the alcohol counselor works
with the client imply values the counselor should attempt to instill in the client for
the client's own good. While this is not a new idea in counseling, it is an issue in
the substance abuse field usually not found to the same degree in other areas of
counseling practice. Control of behavior and the fostering of commonly accepted
values among alcohol and drug abusers often deals with habilitation, not rehabili-
tation counseling as traditionally formulated Hill & Blane, 1967; Malfetti, 1979;
Florida Drug Abuse Trust, 1979).
Exploratory related research was conducted regarding the conceptions of
the hypotheses and applicable research methods and materials in 1979 and 1980.
The usefulness of sheltered workshops or "cottage industries" was studied through-
out the state for the Florida Drug Abuse Education and Prevention Trust. The
Work Values Inventory (Super 1973) was used to examine intrinsic and extrinsic
work values as well as provide information about some aspects of the work self-
concept of substance abusers. The results pointed out the desirability of a
vocational training and placement component as a supplement to counseling in a
residential drug treatment center. The cottage industry project was presented at
the 1979 National Drug Abuse Conference in New Orleans.
A related examination of the Minnesota Multiphasic Personality Inventory
(MMPI) in 71 item Mini-Mult format (Kincannon, 1968) was completed in 1980 on
data gathered over a four year period at an alcoholism treatment facility in
Florida. The large sample (N = 349) yielded theoretical and practical information
concerning the application of the materials used in this research.
Participation in this study by alcoholism treatment programs in Florida
may lead to increased awareness of the characteristics of their clients and the
importance of age and employment factors in rehabilitation planning. The data
gathered may be useful to program administrators and planners for policy making
regarding substance abuse treatment procedures. The results may provide a
framework for understanding related substance abuse studies and projects in
Florida and other areas.
It is often alluded by those in the alcohol field that there is a progressive
degeneration of personality among alcoholics who continue to drink as they grow
older. While physiological changes associated with continued alcohol ingestion are
well known the concomitant emotional aspects are less understood. The literature
suggests that specific alcoholic personality characteristics may be constant no
matter the client's age or changes on other measures of personality.
Working has been an important part of the treatment of alcoholics by non-
professionals, often recovered drinkers themselves. Medzerian (1979), the Florida
Drug Abuse Trust (1979) and others have shown a strong relationship between self-
concept and substance abuse. That is, a poor self-concept may be highly correlated
with substance abuse.
If work is important in the formation of self-concept, then we would
expect employment to be linked with less abusive drinking levels and a more
healthy personality profile. This study examines personality characteristics of
alcoholics of different age groups suggested by Super (1953) in relation to their
recent work history.
This study addresses the following research hypotheses:
I. There are no differences in the personality characteristics (MMPI scores) of
alcoholics of different age groups.
2. There are no differences in the personality characteristics (MMPI scores) of
alcoholics who work and those who do not work.
3. There is no interaction of age and employment related to the personality
characteristics (MMPI scores) among different age groups of alcoholics.
4. There is no difference in the potential for alcohol abuse (MAC score) among
different age groups of alcoholics.
5. There is no difference in the potential for alcohol abuse (MAC score) among
alcoholics who work and those who do not work.
6. There is no interaction of age and employment related to the potential for
alcohol abuse (MAC score).
Definition Of Terms
The following list refers to terms which are frequently referred to
throughout the study:
Alcoholic: A person determined by an alcoholism treatment program
licensed by the Department of Health & Rehabilitative Services of the State of
Florida to meet the Diagonistic and Statistical Manual of Mental Disorder
categories (DSM-III): 303.9X or 305.0X
Alcohol Abuse: (DSM Ill 305.0X A.) Pattern of pathological alcohol use
e.g., need for daily use of alcohol for adequate functioning; inability to cut down or
stop drinking; repeated efforts to control or reduce excess drinking by "going on
the wagon" (periods of temporary abstinence) or restricting drinking to certain
times of the day; binges (remaining intoxicated throughout the day for at least two
to three days); occasional consumption of a fifth of spirits (or its equivalent in
wine or beer); amnesic periods for events occurring while intoxicated (blackouts);
continuation of drinking despite a serious physical disorder that the individual
knows is exacerbated by alcohol use; drinking of non-beverage alcohol. B.)
Impairment in social or occupational functioning due to alcohol use, e. g., violence
while intoxicated, absence from work, loss of job, legal difficulties (e.g., arrest for
intoxicated behavior, traffic accidents while intoxicated), arguments or difficulties
with family or friends because of excessive alcohol use. C.) Duration of
disturbance of at least one month.
Alcoholism: Excessive dependence on or addiction to the point the
person's physical and mental health is threatened or harmed (Freedman, 1972)
characterized by a compulsion to take alcoholic beverages to experience its
psychological and physical effects and to avoid the discomfort of its absence (HEW,
Alcohol Dependence (DSM 303.9X): All of the characteristics described
as Alcohol Abuse DSM 305.0X as well as either tolerance or withdrawal. Tolerance
is the need for markedly increased amounts of alcohol to achieve the desired
effect, or markedly diminished effect with regular use of the same amount.
Withdrawal is the development of "alcohol withdrawal" (e.g., morning, "shakes" and
malaise relieved by drinking) after cessation of or reduction in drinking.
Alcohol Detoxification Center: Also known as "Alcoholism Receiving
Center," or "Detox." An inpatient setting licensed by the Department of Health
and Rehabilitative Services of the State of Florida to provide a five day medical
and counseling procedure to prevent withdrawal complication in persons who have
consumed alcoholic beverages to excess.
Department of Health & Rehabilitation Services (DHRS or HRS): The
state wide organization that provides a variety of services aimed at promoting the
health, social and economic well being of Florida residents.
Department of Vocational Rehabilitation (DRV or VR): An agency of the
Department of Health & Rehabilitative Services charged with providing vocational
rehabilitative services to vocationally hancicapped Florida residents.
Employed: The determination of employment status "employed" or
"unemployed" will be made according to Social Security Administration classifi-
cation. The 1980 DHRS Vocational Rehabilitation Counselor's Manual (HRS Manual
170-2, Chapter 10, page 2) defines employment as "substantial gain activity.
"Earnings averaging more that $230 per month deemed to demonstrate the ability
to engage in SGA." Continued work at this level for nine continuous months
demonstrates the ability to hold a job for purposes of DHRS case closure.
Unemployed: A person not meeting the requirements established under
Florida Alcoholism Treatment Center (FATC) The 28-day intensive
alcoholism treatment program sponsored by the State of Florida located in Avon
Park. It. has served as the model for other programs of this type throughout the
Minnesota Multiphasic Personality Inventory (MMPI): A 566 item person-
ality test with four validity and ten clinical scales yielding a configuration of score
plotted as a polygon.
Minnesota Multiphasic Personality Inventory Short Form (Mini-Mult): In
the interest of clinical utility, the original 66 item test has been shortened by
several different workers-beginning with Kincannon in 1968-into formats as short as
71 items in length while upholding inventory integrity.
Minnesota Multiphasic Personality Inventory Special Scales: Scales later
developed upon the original item pool that may be scored independently of the four
validity and ten clinical scales commonly in use.
National Institute of Alcohol Abuse and Alcoholism (NIAAA) The office
of the U. S. Department of Health, Education, and Welfare charged with gathering
and disseminating information on alcohol and alcoholism.
United States Department of Health, Education, and Welfare (HEW,
DHEW): The cabinet level department of the U. S. government that oversees
national, state, and local substance abuse programs.
Organization Of The Remainder of the Study
The remainder of the study will be presented in four additional chapters.
Chapter II provides a review of the literature directly related to the proposed
research. Chapter III describes the research design and procedures. The results of
this study and analysis of data will be reported in Chapter IV. Chapter V will
present a summary of the study, as well as a discussion of the findings, implications
and limitation of the research.
REVIEW OF THE LITERATURE
Perspective On Beverage Alcohol
The consumption of alcoholic beverages can be traced from the beginning
of recorded history in the Neolithic era to the present in most cultures. Alcohol
use in America today involves aspects of production, marketing and use in beverage
form that imply cultural variability of drinking patterns.
The term "alcohol" refers to any of the oxygen containing organic
chemical compounds with typical formulae C2H5OH (ethyl alcohol), CH2OH
(methyl alcohol), and CH3CHOHCH3 (Isopropyl alcohol). A wide variety of
industrial uses have been found for alcohols. Methyl alcohol is used in preparations
and rubbing alcohol. Only ethyl alcohol, also called ethanol or "grain alcohol," is
fit for human consumption and has the properties of euphoria, sedation, intoxi-
cation, when consumed in a limited quality. A concentration of half of one percent
of alcohol in the blood stream is within the lethal range; 0.55 is fatal in most cases.
Development as a Beverage
There are three common methods of producing alcoholic beverages that
require different levels of technological skills and parallel concomitant cultural
differences in drinking behaviors: fermentation, brewing, distillation. The source
materials for the sugar and starch include the sap of trees, wild berries, grapes,
citrus, rice, potatoes, and grains. It is presumed that fermented alcoholic drinks
were discovered, rather than invented at least 10,000 years ago during the Neolithic
period. Brewing developed along with agriculture and distillation of spirits came
into use around the tenth century A. D.
The fermentation of beverages was a time-consuming, unmanaged process
that made supply irregular. When available, alcohol would be consumed by males
only under sanction of the elders, priests, or leaders of the community to celebrate
an event of significance. In many cultures alcoholic drinks replaced other fluids in
religious ritual as a libation. Early civilizations used alcohol to impart a sanctity
to events. A drink was used to ratify compacts, complete crownings, solemnify
formal councils, confirm rights of passage, commemorate festivals and important
occasions, and to display hospitality (Florida, 1922; U. S. 1971).
Ancient peoples were characterized by simple living and general sobriety
punctuated by heavy drinking during feast days. Orginally, women did not drink at
all and drunkenness at inappropriate times was viewed as a sin or vice of the lower
classes. Concomitant with development ancient people often increased intem-
perance. An Egyptian wall painting encouraged all, including women to "Drink to
drunkenness, do not spoil the entertainment" (Florida, 1972, p. 24). The Romans ran
the gamut from moderate drinking to severe abuse.
During the Feudal period and the developing industrialization Europe
traded in agricultural products including wines and beers. Alcoholic beverages
were considered a food staple and medicinal agent. The early colonists who settled
America brought with them the cultural traits of their countries of origin,
including their drinking practices (Brown, 1966: Morrison, 1965).
Early American Drinking
The two basic social institutions of colonial America were the church and
the tavern. The taverns of the times served as a meeting house where matters of
public concern were expressed. During the revolution taverns served as court
rooms, barracks, officer's headquarters and secret meeting places of patriots. The
Green Dragon Inn, according to Daniel Webster, became the headquarters of the
revolution (Brown, 1966; Lender, 1973: Tarter & Sugarman, 1976).
As agriculture grew in the West, transportation to the Eastern markets
became a serious problem. Distillation became an integral part of farming
communities as farmers found it expedient to transform their bulky corn harvest
into corn whiskey. A horse could carry four bushels of grain or twenty-four bushels
which had been converted to whiskey. Whiskey became a medium of exchange and
an important part of the economy in the interior of our developing country. The
"Whiskey Rebellion" was one of the first crucial tests facing the administration of
George Washington and its resolution established the right of the federal govern-
ment to levy an excise and control the sale and manufacture of goods, including
alcoholic beverages (Florida, 1972).
The United States Temperance Union founded in 1833, was primarily
interested in the proper management of alcohol rather than the total abstinence
from drinking. Their position changed to denouncing drinking as a crime against
society in the late 1830's. Illustrated books graphically portrayed the decay of the
individual who indulged in drink and the "educational" campaign was highly
successful. Churches set more rigorous standards of conduct for the clergy and
laity and excessive drinking fell into disrepute.
The state was charged with the duty of protecting the morals of the
people and laws were demanded to license the liquor traffic, heavily tax it,-and to
prohibit its use. Beginning with Maine in 1848, a dozen northern states enacted
prohibition laws. During the Civil War most of the prohibition laws were repealed
largely because of the need for revenue a tax would provide. The formation of the
Anti-Saloon League in 1893 was successful in making drinking a political issue of
importance, it spent 400 thousand dollars in the year 1903 for candidates who
On October 28, 1919, the Volstead Act prohibiting sales of alcoholic
beverages containing over one-half of one percent alcohol was passed over
President Woodrow Wilson's veto.
The new law made no great change in national drinking levels and
enforcement was quite difficult. The 18th Ammendment was repealed fourteen
years later by the 21st Amendment and the "noble experiment" came to an end
(U. S., 1978).
U. S. beverage sales increased from 1850 to just after the turn of the
century and remained high until Prohibition in 1919. By the beginning of World War
II per capital sales returned to their per 1919 levels and remained there for almost
twenty years. Total per capital sales began to rise sharply about 1960 increasing
30% between 1961 and 1971. Since 1971, levels have been the highest recorded since
1850 ranging from 2.63 to 2.69 gallons of absolute alcohol per person 14 years of age
and older. Current overall drinking levels now seem stable; however, sales of
distilled spirits are down 11% from 1975-76 and sales of beer are up 8% during the
same period (U. S., 1978; Keller & Gurioli, 1976). Significant changes in the relative
proportion of abstainers to heavy drinkers have not been observed. Heavy drinkers
did increase from 15 to 20% in 1971-76 for males. Men generally drink heavily three
to six times the rate reported for women (U. S., 1978).
In our society drinking to modify mood or behavior is generally accepted
as normal and appropriate under the proper circumstances. (APA, 1980). Individual
clients will consume alcoholic beverages according to their own concepts of
usefulness and morality within the framework of community standards and be-
havioral expectations. What the counselor might call problem drinking could be
seen by the client and others in his social group as acceptable activity within the
limits of normalacy. Drinking, even heavy drinking, is acceptable to some
individual and groups of people as long as the drinker maintains useful and
productive work (Jellinck, 1960: Johnson, 1980).
"You take all the drunks out of history and you take out almost all the
poets, genius....What kind of poem do you think you'd get from a glass of ice water?"
Clarence Darrow (Fincher, 1976, p. 339)
Jellinck (1960) believes there is not just one form of alcoholism, but
several: Alpha, Beta, Gamma, and Delta alcoholism. The first two are variants of
social drinking with no signs of dependence. In Gamma alcoholism both psycholog-
ical and physical dependence are observed and is characterized by "loss of control."
In Delta alcoholism the same is true except the user retains the ability to abstain
Because what constitutes "normal" and "heavy" drinking is not always
agreed upon it is difficult to interpert some of the data presented by various
groups, including the National Institute of Alcohol Abuse and Alcoholism (NIAAA).
A "normal" drinker in the general population is considered by Chatham (1979) to be
one who consumes the equivalent of I oz. of alcohol per day. In beverage form this
is two 12 oz. cans of beer, two 4 oz. glasses of wine, I or I 3/4 shots of hard liquor.
The new DSM III (APA, 1980) regards "occasional consumption of a fifth of spirits
or its equivalent in wine or beer" as a significant level indicating probable alcohol
A report prepared for NIAAA by Johnson, Armor, Polich and Stambul,
(1977) under contract number ADM 281-76-0020 is often used as a resource by those
gathering data for publications and presentation, including the United States
government. Table 4 of the report, Trends in Alcohol Consumption 1971-76, defines
the "heavy" drinker as one who consumes the equivalent of I oz. of alcohol in
beverage form per day. Obviously, this narrow definition inflates the number of
those considered "heavy" drinkers in comparison to the definition of Chatham. It
also does not take into consideration individual differences as body weight, mood,
The number of drinks of an alcoholic beverages consumed during a given
time frame is usually used to describe the amount of alcohol consumption by on
individual or population. While more convenient for those who collect such data
this method is inferential and does not accurately measure an individual's level of
intoxication. When it is important to exactly determine the state of intoxication,
the most widely used practical method is measurement of blood alcohol concentration
(BAC) by breathalyzer.
A blood alcohol level of 0.03% is generally sufficient to intensify mood
and effect perception and judgment. Eight one hundreths percent lessens
inhibitions, elicits impulsive behavior and emotions, and decreases fine coordina-
tion. It is also illegal to drive in Canada and two states at this blood level. It is
illegal to drive in Florida and 41 other states at 0.10% which produces confusion,
staggering, and slurred speech. A serious impairment of physical and mental
functioning occurs at 0.15%, the legal level of intoxication in six states and
Washington, D. C. A blood alcohol level of 0.50% indicates stupor, "blind drunk"
and sometimes coma and subsequent death (U. S., 1971).
Although the exact definition of alcoholism is not precise it is necessarily
drawn by those usually charged with the responsibility in the community treatment
programs for alcoholism, the counselor. The basis for diagnosis in these programs
is or is based on The Third Edition of the Diagnostic and Statistical Manual (DSM
III) of the American Psychiatric Association (1980). The criterion for alcohol abuse
and alcohol dependence may be found in Chapter I, Definition of Terms of this
Alcohol Abuse Clients In Florida
An estimation of alcohol problems and related service needs in Florida
(see table I) was based on field surveys by Dr. George Warheit, Department of
Psychiatry, University of Florida and issued by HRS (Birtman, 1980). The surveys
included a series of questions regarding uses of alcohol.
The data on alcohol use and mental health showed two highly correlated
but basically independent phenomenon. T-tests and analysis of variance revealed
a statistically significant relationship between alcohol use and mental health
treatment needs. However, regression analysis indicated one could not be
predicted from the other and they emerged as related but separate conditions.
There are a sufficient number of differences between mental health and alcohol
clients to warrant separate service needs estimates.
The Florida State Plan for Alcoholism Fiscal Year 1980-81 by the Mental
Health Program Office of the Department of Health and Rehabilitative Services,
Tallahassee, is among the most current of information available concerning the
alcohol problem in the State (see Table I). HRS estimates there are now 489.903
people over 18 years of age who are in possible need of alcohol treatment services
and another 350,877 among all age groups in probable need. The total number of
individuals in need in the state of Florida Fiscal 1980-81 is considered to be 840,000
The Florida Center of Children and Youth, Inc. (FCCY) is a state-wide
volunteer child advocacy group concerned about the impact of alcohol abuse on the
lives of children. On February I, 1979, the Florida Department of Health and
Rehabilitative Services (DHRS) Alcoholic Rehabilitation Program contracted
FCCY to coordinate a 12 month Youth and Alcohol Abuse Project in association
Florida Alcohol-Related Service Needs
STATE OF FLORIDA
High School -3
with a NIAAA Task Force. The study took place in nine communities: Pensacola,
Gainesville, Orlando, St. Petersburg, West Palm Beach, Ft. Lauderdale, Jackson-
ville, Tallahassee, and Miami (Florida, 1980b).
The project's local task forces met with resistance from school adminis-
trators when attempting to randomly survey students. Partial surveys and
previously gathered data were used in some cases. The FCCY concluded that there
is a real youth alcohol problem in Florida paralleling national proportions.
Nationally there are an estimated 3.3 million problem drinkers in the 14-17 age
group, or 19% of the total youth in this age group (U. S., 1978).
The first experience with alcoholic beverages by Florida youths is
between 12 and 13 years of age with a tendency for children to begin drinking at a
slightly younger age than in the past. Drinking to intoxication takes place with
four out of five high school seniors with no difference between males and females.
L By the senior year 40% of the boys and 21% of the girls report they have been in
trouble with family, school or police because of their excessive drinking. In
addition, young people who use alcohol to excess are also more likely to use other
drugs (Wechsler, 1976). The FCCY observes that early drinking behavior may be
predictive of drinking later in life. Those adolescents who learn to use alcoholic
beverages to cope with problems and emotional pressures may continue such
behavior or return to it at a later date.
In Pensacola a 1977 questionnaire indicated alcohol abuse in Florida high
schools is more extensive than in junior highs. Of the seniors surveyed the males
thought 30% of peers and the girls 39.6% of their peers had problems with alcohol.
Sixty-one percent of the Pensacola students said their parents know about their
drinking. Eighty percent drink alcoholic beverages, 45% on a regular basis. In
Gainesville a 1975-76 survey of 1,549 middle school students indicated 63% of these
students had their first experience with alcohol with parents or other adults.
Key informant survey information from professionals and informed
citizens was gathered from those in law enforcement, alcohol and drug counseling,
youth services, liquor stores, runaway shelters and others. These individuals
thought 50% of all adolescents drink and that the rate is increasing. As many as
30% of young people who drink are seen as problem drinkers. The main reasons for
adolescent drinking are thought to be by this group: peer pressure, to act older, to
A Jacksonville survey of medical and helping professionals indicates 72%
of those asked perceive a problem with young people drinking but only 18% have
been asked to directly help or make a referral. Seventy percent believe the extent
of the problem among young people is denied or not recognized by the young person
or parents. In St. Petersburg 20% of the professionals asked had ten or more
patient contacts with parents who said their adolescents were abusing alcohol.
Sixty percent know young people who drink before school and 22% said they had
contact with ten or more such individuals.
The project's specific recommendations regarding youth prevention re-
source need in Florida make direct reference to the personality factors identified
as related to alcohol abuse: low self-concept; inability to accept responsibility for
one's own behavior; lack of social coping and decision making skills; the desire to
alter reality; the need for increased stimulation; uncertainty over the future; and
Environmental factors identified as affecting youthful alcohol abusers
include employment opportunities, ignorance about responsible social drinking,non-
involvement in healthy community activities, media presentation of alcoholic
beverages in a favorable light, availability due to the lowered drinking age,
changing social morals, peer pressure, breakdown in families, schools, and
The behavior of parents and other adults can be seen as contributing to
the young abuser's problem. Implicated by the FCC the FCCY report are the lack
of responsible role models; overindulgent parents; permissive society; divorced
and/or working parents; and the legal and social acceptance of alcohol use (Florida,
Social drinking and "partying" among the college population are con-
sidered by some to be an accepted tradition of the higher educational experience.
Increasingly the reality of students problem drinking and alcoholism is being
recognized. A 1979 survey by the Boston Medical Foundation of 7,000 students at
34 colleges and universities found that 95% of the undergraduates drink on
occasion. University of Florida Student Services Director Tom Goodale says, "1
don't think there are any more students drinking now than there were ten or twenty
years ago; they're just drinking a lot more" (Klein, 1980). T-Shirts with "UF is the
#I Party School" were sold out the first day according to the university's Alcohol
Abuse Prevention Program.
Fall quarter, 1978, 1823 students were surveyed from four different
institutions of higher learning in Florida: Florida State University, Tallahassee:
University of Florida, Gainesville; University of South Florida, Tampa; and Florida
Atlantic University, Boca Raton. This group represents a cross section of higher
education facilities in Florida. Gonzalez & Conover (1979) reported in this state-
wide study that 81% of the students said they drink. School level at time of first
drink was Elementary 16.1%; middle 34.7%; high school 42.2%; and
college 7.0%. They had their first drink at home (44.3%) or at a friend's home
(25.3%). Now they drink less at home (27.4%) and more at bars (51.3%) usually
with friends (63.6%). Mainly the students drink to relax (88.7%) and prefer
highballs (48%) over beer (37.7%) and wine (18.9%). They most often report
drinking once a week or less (63.6%) with 36.4 drinking two times a week or more.
There were significant sex differences in the responses with males drinking a
greater quantity more often (p .001).
The use of alcohol by 483 students at the University of Florida was
reported by Gonzalez (1980) separate from the larger state-wide study. Eighty-
four percent of the students said they drink. The school level of first time drinkers
was also similar to the larger study: elementary, 19.1%, middle, 40.3%, high
school, 35.0% and college, 5.5%. First drink was also at home and nearly half
(47.8%) prefer bars. Highballs (53.9%) were favored over beer (32.0%) and wine
(11.1%). They drink to relax (89.8%) with 61.9% drinking one time per week or
less. Slightly more than in the overall study drank two or more times per week
The two reports acknowledge a significant amount of student problem
drinking and alcoholism in higher education in the State of Florida. They
recommend such action as incorporating alcohol information into orientation
programs for incoming students; education and training programs for university
staff; and a substantial commitment by Student Mental Health to provide specific
treatment modalities for alcohol abuse. Working against this effort is the fact that
the majority of students who drink learned to drink at home with the full
knowledge of their parents. Parents and university staff are aware of heavy
student drinking on campus. Drinking, even heavy drinking, within the context of
college life is acceptable behavior.
The Florida Alcoholism Treatment Center, the State's inpatient treatment
center at Avon Park, no longer has the mission of gathering research data and is
primarily a treatment facility. A 1964 study of all 941 alcoholics admitted during
a sixteen month period in 1962-63 attempted to present a description of the
characteristics of that sample (Williams & Kahn, 1964). It remains the most
complete description of alcohol sample description available from FATC (Thomas,
1980). More recent material by Vosburgh (1975) and others indicate the character-
istics appear to be stable over time and different sample groups.
Seventy-two percent of the clients were male and 28% were female.
Most of the clients were in their middle years with the average age 45. They were
either lower-middle class or upper-lower class (78%) on the McGuire-White Index
of Value Orientation. Almost all (93%) came from urban centers as defined by the
United States census of 1960. Forty-six percent were married and 27% divorced,
15% separated, and 6% were widowed or never married. Thirty-nine percent
reported they were employed just before entering the 28 day treatment program
and 61% said they were unemployed. Regarding the occupational level of their last
job, 30% listed professional, managers, officials, or proprietors as their occu-
pational level, while 24% reported craftsmen, foremen. Twenty-two percent listed
service or unskilled labors as their last occupational level. They worked an average
of 5 months on their last job for an average of 49 hours per week during the year
proceeding treatment. They held an average of two jobs and worked 34 weeks.
The age of first drink was 17 with frequent drinking at the age of 30. The
first blackouts or loss of consciousness occurred with regularity at the age of
thirty-five. They became uncontrolled drinkers at 37, experienced their first
delirium tremens at 39 and first seriously sought alcoholism treatment at age 42.
In 1971 the American Medical Association stated that alcoholism is a
"complex disease" with biological, psychological components" (Kissin & Betleiter,
1977, p. I) Alcoholism, as distinct from common or even heavy drinking has only
recently been recognized as proper subject matter for academic and therapeutic
inquiry rather than the clergy or criminal justice system (Cross, 1968; U. S., 1971;
Mann, 1959; Public Law 91-616; Tarter & Sugerman, 1976).
It was not until Benjamin Rush published Inquiry into the Effects of
Ardent Spirits on the Human Body and Mind in 1785 (Rush, 1943) that the idea of
"addiction" and "disease" became associated with problem drinking. Rush
conceptualized alcoholism as a progressive disease that develops slowly and was
aware of the phenomenon of tolerance. Therapeutic measures- recommended by
Rush included compassion and whippings, bleeding, and shaming. "The association
of the idea of ardent spirits, with a painful or disagreeable impression of some sort
upon the body, has sometimes cured the love of strong drink" (Tarter et al. p. 17;
Lender, 1973; Rush, 1943).
In 1838 Esquirol saw drunkenness as a mental illness. In 1852 Magnus Huss
observed that there was not a definite boundary between the symptoms of
alcoholism and mental illness in general and made use of the term "chronic
alcoholism." The work of Esquirol and Huss opened the door to physicians who had
in the past felt the subject was not properly within the realm of medicine. Magnan
believed in 1891 the causative factor was an underlying psychoses. Gaupp in 1901
identified the periodic depression of an epileptic origin as the most important
clinical feature. Gaupp postulated damage to the hypothalamas. In 1901 Kurtz and
Kraepelin applied the term "alcohol addiction." Medical doctors of the era
suspected central nervous system causative factors which are no longer believed to
be of significant importance in the majority of alcoholism cases (Marconi, 1959).
The most important contribution of the 19th and early 20th century theories was
the utilization of the medical model for the treatment of the "disease" of
alcoholism (Tarter & Sugerman, 1976; U. S., 1971).
The Laboratory of Applied Physiology was established at Yale University
in 1923 for collecting scientific information on the effects of alcohol and searching
for causes. By 1930 Yale had organized archives of the world literature on
alcoholism. In 1944, two clinics called the Yale Plan Clinics for alcoholics were
established in New Haven and Hartford, Connecticut. They provided models for
other rehabilitation centers throughout the country. In 1962 with the help of
National Institute of Health and private funding the Yale Center of Alcohol Studies
were moved to Rutgers--The State University of New Jersey in New Brunswick
(Tarter &Sugerman, 1976). A National Committee on Education emerged from the Yale
Center supported by a five year grant. This committee became The National
Council on Alcoholism; independent of the university since 1950 (Cross, 1968).
In 1935 the fellowship of Alcoholics Anonymous was formed through the
efforts of a New York stockbroker and an Akron, Ohio, physician known as "Dr.
Bob." Alcoholics Anonymous (AA) and its derivitive programs AI-Anon and Ala-
Teen is now a world wide organization with as many as one million members. It
believes that alcoholic must admit his life is unmanageable; must rely on a power
greater than himself; pray for strength to the power; and follow a set program of
"steps" in order to recover from illness. These twelve steps include taking a moral
inventory of one's self and rescuing other alcoholics by getting them involved in the
AA program (AA, 1953, 1973, 1975).
The AA literature states the alcoholic must reach a point where there is a
willingness to take the first step, admission of a need for help (Glatt, 1958). This
is commonly referred to as "hitting bottom" before beginning to get well. Not
everybody goes down to the depths of alcoholism that are often stereotyped but
every alcoholic must reach a point that is bottom for them (Brozek, 1950). This
point is independent of age, status and other variables.
This concept is important in the treatment of alcoholism within the
medical model. In sincerely seeking help alcoholics identify themselves as patients
with an illness who will follow the doctor's instructions (Menninger, 1959).
Psychotherapy within the medical model has generally been considered unsuccess-
ful with alcoholic clients. The psychotherapeutic model is based on a treatment
model for neurotics and may not be appropriate for those alcoholic clients who may
have character disorder traits (Hill & Blane, 1967; Siddons, 1978). The treatment
of alcoholism may not mean just abstinence. Clients may show continued
deterioration in their lives even though they no longer drink. There is evidence
for a relatively stable underlying personality trait in alcoholism that persists after
treatment (Apfeldorf, 1974; Larchar, et al, 1976).
Bowman and Jellinek (1941) distinguished between two types of alcoholism,
chronic alcoholism and alcohol addiction. The former covers all the physical and
psychological changes resulting from the prolonged use of the drug. The latter is
characterized by an urgent craving for alcohol. These addicted individuals have
lost control of the situation and are not able to give up drinking even with a sincere
desire to do so. Jellinek later revised his theory recognizing two main patterns:
Alcohol addiction which is a progressive disorder accessible to medical-psychiatric
treatment and other forms of excessive drinking which can best be managed
through social control including law enforcement (Jellinek, 1960, 1962).
Jellinek's ideas were popular and were assimilated by the public and lay
self-help groups such as AA. The common understanding of his work is that a
heavy drinker drinks by choice, an alcoholic does not; alcoholism is a progressive
disease, which left untreated grows worse; if left untreated alcoholism leads to
either insanity or death; and alcoholism can be arrested (Mann, 1959).
The Alcoholic Family
The effect of the early environment has been examined to determine
possible influences on later behavior. Family conditions that negatively influence
the emotional bonding between parent and child are implicated. An inordinate
number of alcoholics are believed to have experienced disrupted childhoods related
to the death, separation, or instability of the parents. The male alcoholic is often
closer to his dominant mother and has a poor relationship with his openly uncaring
father. Children of alcoholics have a greater than expected number of incidents of
alcohol abuse, hyperactivity, psychopathic deviant behaviors, and neurotic sympto-
matology (U. S., 1978).
Goodwin (1971) has suggested hereditary factors among some alco-
holic patients. Children of alcoholic parents may react to alcohol differently than
children of nonalcoholic parents. That is, physiological responses to a stimulus of a
measured dosage of alcohol are different among the children of alcoholics and the
children of non-alcoholics. Onset of problem drinking for alcoholics' children may
be more immediate and the progression to alcoholism more rapid. Jones and Smith
(1973) have reported a "fetal alcohol syndrome" characterized by neurological
dysfunction in infants caused by excessive alcohol use by the mother. Infants of
addicted mothers are sometimes born with withdrawal symptoms demonstrating
physical dependence on alcohol in the womb. Animal studies have suggested an
increased potential to reactivate such a dependency at a later time (Branchey et
al., 1971; Goodwin & Guze, 1974; Kissin & Begleiter, 1977).
Family treatment of the alcoholic conceptualizes the alcoholic family
with a marriage highly resistant to change. The parental behavior is complimentary
and any attempt to change the behavior of one partner threatens the equilibrium of
the marriage and elicits resistance from the other person. Traditionally, the
family as well as significant others such as friends, employers, and co-workers are
includedin the client's treatment whenever possible. Not only is the alcoholic ill,
but the illness pervades the style of relations with others (AA, 1953, 1973; Berne,
1964; Janzen, 1978).
A series of reports called the National Drug Abuse Treatment Utilization
Survey (NDATUS) by the National Institute of Drug Abuse (NIDA) measures the
scope and use of treatment services in the United States and its territories. The
April 1979, Series F, Number 7 NADTUS report is the first of the series to reflect
a joint NIDA and National Institute of Alcohol Abuse and Alcoholism Treatment
Utilization Survey (NIAAA) effort. This survey included 9,101 facilities consisting
of 6,411 treatment units and 2,690 other units providing services such as preven-
tion, education, administration. Of the treatment oriented facilities, 2,821 were
alcohol, and 1,398 were combined drug and alcohol abuse treatment (U. S., 1979).
Service utilization studies measure one service unit as one person in
treatment one day. In Florida Fiscal Year 1979-80 the following rates were
reported by the HRS Mental Health Program Office, July, 1980:
Units of Treatment Service by Component
NOTE: The numbers are higher than the reported number of client in the state
(70,449) because of some clients' high rates of multiple treatment experiences.
Alcoholism treatment is being increasingly associated with drug abuse
treatment in a substance abuse department within a community mental health
program (Ferguson, 1979; Wynne, 1975). Drugs and Alcohol treatment modalities
parallel each other and have similar program rules for detoxification, outpatient
and residential treatment services. Detoxification, is a five day procedure for
alcohol, 21 days for opiate drugs, whereby an individual is medically withdrawn
from the addicting chemical. Outpatient treatment is individual and group
counseling one or more times per week with or without supportive chemotherapy
for an unspecified duration. Residential treatment is an inpatient treatment
modality lasting from three to eighteen months.
There are more than seventy thousand people in treatment in Florida for
alcohol abuse and alcoholism by 271 publicly supported programs in eleven HRS
districts (Florida, 1977, 1980b). Fiscal 1979-80 ending July I, 1980, supplies the
most recent period for which data are available on treatment services in Florida
(see table 3).
Individuals in Treatment 1979 1980
American Indian 161
Under 18 906
65 and over 3,449
Those in treatment in the State of Florida for Alcohol problems are
largely male, white, and between the ages of 25 to 54. The reported family income
of Florida Alcoholism Clients is decidedly low. (See Table 4).
No Income 28,816
$1 2,999 10,476
$3,000- 5,199 9,066
$5,200 7,800 7,825
7,800 10,399 5,713
10,400 15,599 4,679
$15,600 + 3,875
Florida/HRS, July, 1980b
It should be remembered that publicly supported treatment programs
provide services based on a sliding scale for fees and some clients may not present
their income level in a favorable light. It is certainly not true that alcoholism only
troubles poor people. However, alcoholic drinking progressively deteriorates job
effectiveness. Alcoholics in treatment in Florida seem to be middle aged men in
Super's Establishment stage who have not solidified their career pattern or self-
concept. It may be that male alcoholics who appear to be firmly established in
their careers do not really feel that way and are not successfully implementing their
vocational self-concept. Treatment invariably includes employment and improve-
ment in self-esteem.
The real, general lack of vocational stability and financial security by
many alcohol clients has implications other than theory and treatment. The future
support of community alcohol treatment programs is unlikely to come from client
fees since many of the most seriously ill clients are unable to pay more than a
Federal Program Funding
The National Institute on Alcohol Abuse and Alcoholism was established in
1970 (NIAAA). It funds program services through federal formula grants to the
states totaling $126,030,000 in 1976. In 1974, special funds were made available to
serve as incentives to individual states to adopt the Uniform Alcoholism Treatment
Intoxication Act. Additional monies from agencies such as the Department of
Defense, $2,693,000, the Veterans' Administration, $14,109,000, and the Depart-
ment of Transportation, $62,286,000, bring the total of federal expenditures for
Alcoholism treatment to $206,587,000 to 1976 (U. S., 1978).
Third Party Payments
The average financial resources available to alcoholism programs are
formula grants 13%, other NIAAA funding 17%, local funds 17% and state and
other federal monies 53%. Third party payments are seen as important for the
fiscal management of alcoholism programs in the future. In the past, those with
drinking problems received treatment for symptomatology of their illness, alco-
holism, via third party payors indirectly. As part of efforts to curb rising health
care costs in the late 1960's, payors moved to limit coverage of patients whose
chief problem was alcoholism.
In 1976, Blue Cross-Blue Shield undertook a nation wide study concerning
the feasibility of offering direct benefits for alcoholism treatment. Some
individual Blue Cross-Blue Shield plans have implemented such coverage. Begin-
ning in 1974, Capital Blue Shield of Maryland pays benefits of non-hospital
residential settings and out-patient treatment (U. S., 1978).
American labor unions such as the AFL-CIO, United Mine Workers and
United Auto Workers have sought health insurance coverage for treatment of
alcoholism and drug abuse. Blue Cross-Blue Shield of Michigan now offers benefits
for alcohol and other drug abuse treatment to one million United Auto Workers
Union members and their families. The major commercial insurance carriers
appear to be dropping their exclusions on coverage of alcoholism treatment with
specified limitations dropping from 16.5 in 1972 to 13 percent of all policies in
1975 (U. S., 1978).
The Social Security Administration Medicare program for those age 65
and above views alcohol and drug abuse treatment as mental health services and
pays less than for physical illness. Medicaid, for lower income persons age 21-64,
leaves it up to individual states to decide if alcoholism treatment should be
included. Most states reimburse for inpatient treatment of physical illnesses
related to alcoholism and 85% will pay for out-patient treatment. Reimbursement
is lower for direct treatment of alcoholism; 66% for treatment at a community
health center; 33% for treatment at an alcoholism center; 10% for half-way house
residency (U. S., 1978).
Title XX, the 1975, amendment to the Social Security Act may include
alcoholism services depending on the state's required comprehensive plan. Ten
states provide direct alcohol services, another eleven related services, and 16
specific mental health services with Title XX funding. In 1975, Title XX
contributed 2.7 billion dollars to the states.
The Civilian Health and Medical Program of the Uniformed Service
(Champus) insurance program for active and retired military personnel and their
dependents covers in patient and outpatient care for alcoholism. Inpatient
treatment beyond detoxification is limited to three admissions for any one person.
Out patient treatment is limited to psychiatric services. Civilian Health and
Medical Programs of the uniformed Services Veteran's Administation (CHAMPVA)
is a similar program available to dependents and survivors of disabled veterans.
The NIAAA has worked with different interested groups including the
third party payors to demonstrate the practicality of alcoholism treatment benefit
insurance. Standards have been developed that lead to accreditation and concom-
mittant increase in likelihood of third party reimbursement for treatment services.
The Joint Commission on Accreditation of Hospitals (JCAH) has accredited more
than 200 programs across the country (U. S., 1978).
Florida Statute 627, 669 effective January I, 1980, stipulates that group
health insurance carriers in the state must offer as an option coverage for
treatment of alcoholism. This has been interpreted by HRS in administrative rule
IOE-3.60 State Approval for insurance eligibility and the revised Definitions Rule
HRS Rule No. IOE-714 implementing Florida Statutes 397 concerns
residential services to drug clients. It specifies "The following supportive services
must be made available: a. Educational; b. Vocational Counseling, and c. Job
Development." HRS Rule No. 0IE-3.46 implementing Florida Statute 396.062
regarding alcoholism services specifies, "Rehabilitation services shall be provided
to every client. These services may include vocational counseling. ." Out-
patient alcohol services must include rehabilitative services "related to preparing
to training a person to function within the limits of a disability or disabilities by
the acquisition of skills." Under this directive "Vocational rehabilitation and
counseling.... shall be provided."
The Joint Commission on Accreditation for Hospitals accreditation man-
ual for alcoholism programs specifies:
"The intermediate care component shall be
designed to facilitate the rehabilitation of
the alcoholic person by placing him in an
organized therapeutic environment in which he
may receive diagnostic services, counseling,
vocational rehabilitation and/or work therapy
while benefitting from the support which a full
or partial residential setting can provide
(Human Service Horizons, 1978, p. 7)
Alcoholic Personality Characteristics
Alcoholism research with the MMPI generally approaches alcoholism in
one of two ways. Either it is seen as a major disorder in itself with distinctive
personality characteristics and pattern or alcoholism is subsumed under the
psychological symptomatology of other mental disorders (Uecker, 1969). Many
diagnose neuroses or psychoses rather than alcoholism as the primary problem
(Apfeldorf, 1974; Hoefle, 1980).
When alcoholic MMPI scores are grouped, the highest scores are usually on
Scale 2 Depression and 4 Psychopathic deviance (MacAndrew & Gertsma, 1963).
While other distinct highpoint pairs are common either scale 2 or 4 will usually be
included in the profile peaks (Clopton, 1973; MacLachlan, 1975; Williams, 1974;
Vosburgh, 1975). The 2-4 and 4-2 codetypes account for about 21% of all alcohol
cases with 73% of the cases involving either 2 or 4 according to a study by
Hodo & Fowler (1976). There was also a relative frequent occurrence of 4-9/9-4
and 2-7/-2 codetypes reported.
Hodo and Fowler's study of 1,009 Caucasian inpatient alcoholics concluded
that a primary or consistent alcoholic profile does not exist and fails to support the
concept of an alcoholic personality. Clopton (1973) makes the point that alcoholics
are a heterogeneous group and that grouping the data may obscure important
differences and relationships. It has been suggested that there may be two basic
groups of alcoholics: one of psychopathic individuals with poor impulse control
whose unconventional behavior gets them into trouble when drinking even moder-
ately; and another group of neurotic-depressive persons who use alcohol with much
greater control and so are able to regularly consume large amounts of alcohol.
Clopton (1973) suggests that there is a great similarity in group average
MMPI profiles of alcoholics and drug abuses with both groups having essentially the
same personality characteristics. Neither group is homogeneous in personality
traits, he says, but in general drug abusers seem to be more sociopathic and less
depressed and anxious than alcoholics. A 1979 study by Sutker et. al. of 175 male
alcoholics and 135 male heroin addicts found more neurotic symptomatology such
as depression, anxiety, guilt, emotional liability, and somatic preoccupation among
the alcoholics. The addicts were higher on defensiveness, activity, ego strength,
and seemed more self-confident, energetic and free of neuroses. Both groups
shared sociopathic characteristics of impulsivity, restlessness, and nonconformity
with addicts scoring the highest. Alcoholics combined neurotic characteristics of
impulsivity, restlessnes, and nonconformity with addicts scoring the highest.
Alcoholics combined neurotic characteristics with social deviance whereas the
heroin addicts were simply social deviants. Alcoholics, speculated Sutker et al., abuse
alcohol for tension reduction and heroin addicts are motivated by pleasure seeking.
Overall et al. 1973 computed a descriminant function to separate alcoholics
from narcotics addicts with 85% accuracy. MacLachlan (1975) replicated the study
and found the two groups could be distinguished from each other with 65%
accuracy. Overall descriminant function (DF) is calculated by weighing the MMPI
scales in a simple formula. The formula was computed from a sample of 1681
males and 519 females of average age 45.6 years admitted from 1968 to 1972 to an
inpatient alcoholism treatment center. A product-moment correlation of .78
between first and second admission scores suggests the DF is stable.
Ageing and The Alcoholic
The value of Overall's descriminant function decreased with age (F=l 1.5,
p .001) as indicated in the following abridged table from McLahlan, 1975, page
Means and Standard Deviations of Discriminant Functions and Percentage of
Correct classifications by age of 1681 Male Alcoholics
Age N Mean SD Percentage
Under 30 83 17.08 3.80 74
30 39 375 16.31 3.59 64
40-49 647 15.88 3.70 62
50-59 449 15.68 3.24 61
Above 50 128 15.49 2.96 59
As the value of the function decreases with age concomitant misclassi-
fication increases. There appears to be a decline in symtomatological personality
characteristics associated with ageing in alcoholic persons (Apfeldorf & Hunley,
1975). Apfeldorf and Hunley (1975) refute MacAndrew's contention that the MAC
scale has no correlation with age. They found a correlation of -.61 in their sample
of alcoholics with no comparable correlation in the control group. They state, "The
findings of a negative correlation of the MacAndrew scale with age in alcoholics
suggests that the personality traits and symptoms identified by the MacAndrew
may diminish with advancing age" (p. 652).
The 1969 work of Goodwin and Schai demonstrated decreasing anxiety
and increasing introversion as a function of age as measured by the 16PF (in
Hoffman, 1970). The Personality Research Form was given by Hoffman (1970) to
337 hospitalized male alcoholics one week after admission. Change, Dominance,
Exhibition, Impusliveness and Play decreased with increasing age. In scales relating
to employment such as Achievement, Endurance, and Play the alcoholics scored
lower than a control group of nonalcoholics. "They appear to function at a lower
level of aspiration or activity in terms of maintaining high standards, willingness to
work for distant goals, being persistent, and enjoying activities just for fun"
(Hoffman, 1970, p. 170).
Hoffman and Nelson (1971) studied 148 alcoholic patients with a mean age
of 43 years ranging from 18 to 67 administering the MMPI, EPPS, and Shipley-
Hartford Intelligence scale one week after admission. They found fewer dif-
ferences between alcoholics and nonalcoholics than between alcoholics of different
ages. There also was indication that alcoholics and non-alcoholics may be more
alike than alcoholics of different intelligence levels. "Alcoholics show a significant
decrease in abstract reasoning with an increase in age. Also, with an increase in
age, alcoholics show an increase in Deference, Order, Nurturance, and Endurance,
and a decrease in Dominance, Change, Heterosexuality, Psychopathic Deviance, and
Psychastenia" (p. 145).
Sutker et al. (1979) have succinctly stated the concept of personality
changes in alcoholics related to age: "The motives for drug or alcohol use could be
significantly related to life stages defined by age. Covarying for age eliminated
unadjusted mean differences between alcoholics and opiate addicts on the Pd scale,
and age was clearly the most powerful predictor of group classification (pp.
Psychosocial stress related to age such as retirement, loss of family and
friends, a change in identity and living patterns as well as organic changes
contribute to problem drinking with some clients. The functional loss of neuro-
logical tissues in older people has been hypothesized to make them more sensitive
to drugs in the sedative-hypnotic class such as alcohol. It is known that many
drugs, including alcohol, do have prolonged clinical and toxic effects on older
persons (Myerson, 1978; Zimber, 1978).
Men and women appear to differ in the relationship of age to excessive
drinking. Women 35 to 49 show a trend towards increased consumption to a
moderate level. Women in this age group are often reentering the labor force and
are more likely to be employed. There are more drinkers and more moderate and
heavy drinkers among younger women. The drinking peak for women is 21 to 34
and declines thereafter. Men display an age-specific trend although not as well
defined. Among men drinking peaks in the 21 age range and declines steadily
thereafterwards. After the age of 50 heavy drinking and alcohol related physical
and mental problems seen to decline rapidly for both sexes and there is an attrition
of older alcoholics from treatment (Lynn, 1978; U. S., 1978; Westie & McBride,
Kratz (1975) found length of sobriety was positively correlated with age.
It has been suggested that there may be a greater feeling of internal control
associated with ageing among alcoholics (Weissback et al., 1976). The early forties
appear to be a time of life when an alcoholic person may decide to seek serious,
intensive treatment (Apfeldorf & Hunley, 1975; Hoffman & Nelson,
1971; Kratz, 1975; Sutker et al., 1979; Vosburgh, 1975; Weissback et al., 1976;
Williams & Kahn, 1964).
Employment and the Alcoholic
Not only is the alcoholic ill, but the illness pervades the style of
interpersonal relationships. Traditionally the family as well as significant others
such as friends, employers and co-workers are included in the client's treatment
(AA, 1953, Berne, 1964; Janzen, 1973; Johnson, 1980). Work is seen as important
in the formation and maintenance of self-concept by most development and needs
theorists including Holland, 1963, 1973; Roe 1954, 1956, 1957; Samler, 1954; Super,
1953; and Tiedeman and O'Hara 1963 (Tolbert, 1974). The theory of Super (1953)
has been utilized in this study because of the importance he places on vocational
self-concept and vocational life stages.
Poor self-concept as measured by the Tennessee Self-Concept Scale, has
been shown by Medzerian (1979) to be highly correlated with increased levels of
medication requested by substance abusers. The Flordia Drug Abuse Education and
Prevention Trust utilized the Work Values Inventory, a vocational develop-
ment instrument by Super, in a 1979 study of substance abusers in sheltered
workshops. Positive changes in the work self-concept were linked to rehabilitative
success Both Studies by Medzerian and The Trust indicate poor self-concept are
related to a desire for licit and/or illicit medication by substance abusers.
Employment as an integral part of the treatment of alcoholics has been
supported by the U.S. Department of Labor Employment and Training Administra-
tion in such projects as a vocational resource center in Olympia, Washington, under
contract 82-51-70-09 completed in 1973. Community resources were utilized to
ensure jobs for alcoholics after MDTA training. The project reported a rate of
rehabilitation five times greater than other efforts with comparable clientele (4-
030, ETA, 1979). A supported employment project by the Vera Institute of Justice
in New York City under grants 92-36-72-02 and 92-36-72-12 was completed in
1978. This effort examined the feasibility and potential of such projects to make
an impact on individuals with addiction, alcoholic and offender backgrounds (3-196,
Drug treatment programs such as Synanon, Daytop Delancey Street, and
Phoenix House were the forerunners in the attempt to incorporate in-the-
community skills activity with their treatment activity. The early attempts by
these therapeutic communities demonstrated that not only was it possible to
provide opportunities for clients to practice their newly acquired life-skills in the
community, but it was vital to provide these activities for effective treatment
(Florida Drug Abuse Trust, 1979).
During 1977 the Florida Drug Abuse Education and Prevention Trust
conducted national site visits to existing drug abuse treatment and vocational
training programs with supportive work programs (i.e., "cottage industries"). These
site visits, which studied programs from New York to Hawaii, led the Trust to the
conclusion that it would be beneficial to existing substance abuse treatment
programs if similar training work environments were provided to clients undergoing
treatment within the residential treatment programs in Florida. Funding was
provided to Village South in Miami for a picture framing project and Disc Village in
Tallahassee for a greenhouse project. The one year project concluded that if
substance abuse treatment is to be effective, it should provide the client with
those skills necessary to function in the day-to-day world. Traditional residential
treatment was found not to be as effective as residential treatment plus job
training and placement (Florida Drug Abuse Trust, 1979).
Super's Vocational Career Development Theory
The vocational career development theory of Donald Super (1953) is
widely utilized by the Department of Health and Rehabilitative Services and has
been applied by HRS, CETA, and the Florida Drug Abuse Trust to the study of
substance abusers. The importance of his theory in this study is Super's linkage of
self-concept to employment. Self-concept has been shown to be associated with
substance abuse. A positive employment experience may contribute to the
recovery and continued abstinence of alcoholic clients. There are four main points
to Super's theory: vocational life stages, vocational maturity, vocational self-
concept, and career patterns. A person masters specific development behaviors as
vocational and personal maturity are acquired.
Super (1953) envisions four life stages of vocational development and
concomitant personal maturity. In the Growth stage from birth to age 14, the self-
concept develops through identification with key figures in the family unit and
school. Although needs and fantasy are most important in the beginning, interests
and capacities of the individual become more dominant with increased social
participation and reality testing. There are three substages: A) Fantasy from age
4 to 10 when the child's needs are dominant and role-playing in fantasy is
prevalent; B) Interest from age II to 12 when personal tastes determine activities;
and C) Capacity from age 13 to 14 when individual abilities are given weight and
job requirements are considered.
The second main stage is Exploration from age 15 to 24. Self examination
in occupational exploration in school, leisure, and part-time work takes place.
There are three substages: A) Tentative from 15 to 17 when needs, interests, as
well as capacities, values and opportunities are considered. Tentative occupational
choices are made and tried out in discussion, school courses, and work; B)
Transition from age 18 to 21 when reality is given more weight as the person
actually enters the world of work or post high school training in an attempt to
implement a self-concept; C) Trial from age 22 to 24 when a choice is made and
tried out in the real world.
The third main stage is Establishment from age 25 to 44 when the person
makes an effort to find a place in the chosen field wifh some trial and error. There
are substages: Trial from age 24 to 30 when changes may be made before a
vocational area is determined; Stabilization from age 30 to 44 when the career
pattern becomes clear and an effort is made to solidify one's position. Main-
tenance continues from age 45 to 64 with few changes in career pattern or
It is within the stabilization and maintenance substages of Super's estab-
lishment period that many alcohol clients seriously seek treatment for the first
time (Appeldorf & Hunley, 1975; Hoffman & Nelson, 1971; Sutker et al, 1979;
Vosburgh, 1975; Weissback et al., 1976; Williams & Kahn, 1964. At a time others
have theoretically solidified their position in the world, alcoholics may find
themselves much less secure in their careers and self-concept. The reported
family income of Florida alcohol clients is very low (See Table 4) suggesting low
vocational attainment for middle aged men. Medzerian (1979) has shown a high
positive correlation between low self-concept and increased levels of substance
Super's fourth stage is Decline from age 64 on when physical and/or
mental capacities of ten decrease and occupational activity changes and eventually
ceases. There is one substage, Deceleration from age 65 to 70 which is basically the
transition into retirement when work demands decrease with declining capacity to
work (Tolbert, 1974).
Of the coping behaviors Super discusses, three are positive: trial,
instrumental, and establishing; and two are negative: floundering and stagnating.
This study suggests that behaviors viewed by the alcoholic individual as frustrating
and given inordinate significance because of the personality characteristics of the
person may lead to increased rates of alcohol consumption.
Super's development theory is in congruence with the question asked by
the proposed research. The literature indicates that there are personality
characteristics many alcoholics have in common (Clopton, 1973; Hodo & Fowler,
1976; MacAndrew, 1965; Williams & Lewis, 1973; Vosburgh, 1975). These under-
lying factors are stable and resistant to change (MacAndrew, 1965). Ageing may
have a way of softening the expression of those characteristics (Apfeldorf &
Hunley, 1975; Hoffman, 1970; Hoffman & Nelson, 1971; Kratz, 1975; Sutker et al.,
1979). Employment has been identified as a contributing element in alcoholic
recovery (Clopton, 1973, Johnson, 1980). Working may provide structure that
decreases anxiety and reinforces a positive self-concept that is inversely cor-
related with alcohol abuse (Medzerian, 1979).
Alcoholics are usually not ready to change their behaviors until they have
exhausted available alternatives (AA, 1953, 1973, 1975; Glatt, 1958). The modal
age group at which this seems to occur is in the early forties (Williams & Kahn,
1964). This is the time of establishment when one normally stablizes a career
pattern and works at maintaining an occupational position (Super, 1953; Tolbert,
1974). Alcoholics in this age group often experience destabilization of their career
pattern and loss of vocational position (Florida, 1980). Super's theory provides a
framework for understanding age and employment factors in alcoholism treatment.
The review was conducted with the help of the University of South Florida
Library Computer Searches Center in Tampa. A comprehensive effort was made to
retrieve previous studies in English related to the topic appearing in professional
journals, government publications, and other resources. The data collections and
time frames of search were Educational Resources Information Center (ERIC)
1966 to May 1, 1980; Dissertation Abstracts 1861 to May 1, 1980; Psychological
Abstracts 1967 to January 1980: Sociological Abstracts 1963 to December 1979:
Social Science Citation Index 1972 to May 1980; The Monthly Catalog of Govern-
ment Publications 1976 to May I, 1980; and the National Clearinghouse for Mental
The review of the literature indicates much remains to be learned about
alcohol abuse and alcoholism counseling. There is a long history of alcohol use
in the United States and its present use is entrenched as an acceptable social
behavior. It becomes unacceptable when the individual loses control of alcohol intake
and/or fails to be able to continue productive functioning such as work. Counseling
such clients has traditionally centered on the struggle for control, improvement
in self-concept, and a return to work.
Limited research has been conducted regarding the relationship between
age, employment and personality patterns of alcoholics (Apfeldorf & Hunley, 1975;
Hoffman, 1970; Hollman & Nelson, 1971; Kratz, 1975; MacLachlan, 1975; Sutker et
al., 1979; Vosburgh, 1975; Williams & Kahn, 1964). More research would be useful
in this area since program planning for the treatment of alcohol abuse and
alcoholism makes assumptions regarding age and employment as factors in rehabili-
tative treatment. The study will also serve to add to the body of literature on
Minnesota Multiphasic Personality Inventory applications to this important aspect
of rehabilitation counseling.
Previous work and related research has been completed by the researcher
to develop testing concepts and materials used in this study (Florida Drug Abuse
Trust, 1979). This study involves a comparison of clients diagnosed alcoholic and
currently in treatment in the State of Florida by publicly supported programs.
Three levels of age are compared with two levels of employment. The design of
the study, hypotheses, population and selection of sample, instrumentation, re-
search procedures and timeline, statistical analyses and limitations of the study are
discussed in this chapter.
The development research design is a 3 x 2 table of three levels of age
and two levels of work history as independent variables. Age is divided into three
groups, 15-24 Exploration; 25-44 Establishment; and 45-64 Maintenance according
to Super's theory of career development (Super, 1953; Tolbert, 1974). Work history
of the previous nine months is separated into two categories termed employed and
unemployed as determined by the HRS Department of Vocational Rehabilitation
(1980). The dependent variables are the validity and clinical scales of the
Minnesota Multiphasic Personality Inventory in 168 item format (Overall & Gomez-
Mont, 1974) and the MacAndrew (1965) special scale of substance abuse. The MMPI
clinical scales will be examined for nomothetic or absolute scale level differences
and group configurational differences as suggested by Clopton (1973) so that
important relationships due to the diversity of alcoholic profiles are not obscured.
Attention with this type of research is necessary so that differences
among the cells on the dependent variables are not overlapped with other
differences between the groups (Campbell & Stanley, 1966; Isaac & Michael, 1977).
In order to control for this a "Client Characteristics" form will be collected. The
groups will be compared with the Chi-Square Test of Independence and the data used
for a descriptive comparison of the groups.
This study addresses the following hypothses and tests them at the
.05 level of significance (C= .05).
I. There is no significant difference in the personality characteristics (MMPI
scores) of alcoholics of different age groups.
2. There is no significant difference in the personality characteristics
(MMPI scores) of alcoholics who are employed and those who are
3. There is no significant interaction of age and employment in relation
to the personality characteristics (MMPI scores) of alcoholics.
4. There is no significant difference in the potential for alcohol abuse (MAC)
score among alcoholics who are employed and those who are unemployed.
6. There is no significant interaction of age and employment in relation to
potential for alcohol abuse (MAC score.
Population and Selection of Sample
The population addressed in this study consists of Florida alcoholic clients
with primary diagnosis of DSM III categories 303.0X Alcohol Abuse or 303.9x
Alcohol Dependence (APA, 1980). The diagnosis will be determined by staff
charged with the responsibility by licensed alcoholism treatment facilities under
the supervision of the Department of Health and Rehabilitative Services of the
State of Florida.
The subjects are drawn from those currently in treatment in outpatient,
residential and detoxification modalities. No one known to be under the influence
of alcohol or the effects of alcohol withdrawal was admitted to the study. Those
clients in treatment at a detoxification center were in the final day of treatment
and determined by medical personnel to have successfully completed detoxification
and be pending discharge (Ramirez & Wells, 1978; Williams, 1966).
The sample is further limited to English speaking males between the ags
of 15 and 64 inclusive with at least six years of formal education. Most of the
research and normative data available is based on males who outnumber women in
treatment nearly four to one (U. S., 1980). The role of women in the world of work
has changed greatly in recent years. The inclusion of females in this study might
lead to differences on the dependent variables attributable to sex or other actors
and not the independent variables age and employment. Fifteen years of age is
about the lower limit of the MMPI as is a sixth grade education and knowledge of
the English language (Dahlstrom, et al., 1972).
The determination of employment status will be made according to Social
Security Administration classification. The 1980 Florida Department of HRS
Vocational Rehabilitation Counselor's Manual (HRS Manual 170-2), Chapter 10,
page 2, defines employment as "substantial gain activity (SGA)." "Earnings
averaging more than $230 per month are deemed to demonstrate the ability to
engage in SGA." Continued work at this level for nine months demonstrates ability
to hold a job according to the Department of Health and Rehabilitation Services.
For the purpose of this study, an "employed" person will be someone
who has engaged in work for an unspecified number of hours for nine continuous
months previous to admittance to the study at a pay of at least $230 per month.
This is understood to have three criterion elements: I. the subject must have
worked; 2. the work must have been for nine consecutive months; and 3. the rate
of pay must have been $230 per month (or $2,760 annually) or greater. Those
not meeting these criterion will be considered "unemployed."
Two Florida alcoholism programs regulated by the state have agreed
to participate in the study: The Alcohol and Substance Abuse Program of the
Human Development Center of Pasco, Inc. and the Pinellas Comprehensive Alcoholism
Services. Both programs are located in the Tampa Bay area and draw clients
from their respective catchment areas. Pasco County is rural, Pinellas County
The participants were informed of the general nature of the research.
Alcohol clients have been know to give socially desirable responses to MMPI
questions (Dahlstrom et al., 1962; Newton, 1971; Thomas 1980). The participants
were told that the study is on drinking patterns and that it is voluntary. Few
clients declined to participate since MMPI testing and data collection are an
established part of program procedures at many facilities. Each participant was
given a "Consent to Research" form. A two dollar gratuity was given to each
person when the materials were returned to the program staff.
The sample for this study consists of a minimum of 120 members of the
total population pool of alcoholism clients meeting the previously specified
criteria. A table of random numbers and "Participant List" was used by the
coordinator at each site to admit approximately 60 clients, or 10 for each cell of
the 3 x 2 table. When the data from the two programs were combined the sample size
per cell was 20 or more.
The study participants are compared on age, race, education, and income
with the latest date published by the Mental Health Program Office or HRS,
Tallahassee. Similarity was considered to further indicate representatives of the
sample to the state population of alcohol clients (Medzerian, 1979). Significant
differences (.05) on the comparison variables may limit the extent the study can be
generalized. A second comparison was made within the matrix as a check on
internal validity. The data for the basis of the two comparisons were collected on a
"client characteristics" form with the information filled out by the staff coordin-
ating the study at each field setting.
The Minnesota Multiphasic Personality Inventory has an extensive history
of use by alcohol treatment programs nationally and in Florida. The MMPI is the
standardized testing instrument of personality characteristics in this study. The
MMPI has four validity scales "L", "F", "K", and ?. The ten clinical scales are
Hypochondriasis, Depression, Hysteria, Psychopathic Deviance, Masculinity-Femin-
inity, Paranoia, Psychastenia, Schizophrenia, Hypomania, and Social Introversion.
The MMPI scales contain different numbers of items to be marked "yes"
or "no" with a pencil according to whether or not they apply to the person at the
time of test administration. It is permissible to not answer at all, so long as a
large number of responses are not left incomplete. The scales may be plotted
together or a profile form with mean values of each scale established at fifty with
raw score deviations equivalent to a standard deviation of ten on T-score values.
There are several different presentations currently available. This
study used the MMPI Mini-Mult 168 Form R matched to the hardboard step-down
board copyrighted in 1948 by The Psychological Corporation. The Mini=Mult
format of only the first 168 items is administered by instructing the client to stop
at the bottom of page seven (Overall & Gomez-Mont, 1974). This version is
considered most appropriate for use with an alcohol population (Hoffman &
Butcher, 1975; Newmark, Newmark & Cook, 1975; Overall, Higgins & De
Schweinitz, 1976). It is anticipated that clients will be able to complete the MMPI
168 in thirty minutes or less.
In addition to the MMPI 168 validity and clinical scales a special measure
of substance abuse proneness was administered. The MAC scale (MacAndrew,
1965) is the most widely used special scale of the MMPI for the detection of
substance abuse in general and is noted for its stability over time (Burke & Marcus,
1977; DeGroot & Adamson, 1973; Rhodes, 1969; Rhodes & Chany, 1978; Rosen-
berg, 1972. As usually administered the MAC consists of fifty-one items ranging
from item number 6 to number 562 (Dahlstrom et al., 1975, p. 284). MacAndrew
(1979) says it correctly identifies alcoholics approximately 84.6% of the time.
Test-retest differences are one to two points, smaller differences than for the
regular MMPI scales (MacAndrew, 1979). In his 1979 study, MacAndrew demonstra-
ted the efficacy of administering the MAC scale independent from the full scale
The Minnesota Multiphasic Personality Inventory (MMPI)
Alcoholism treatment programs are encouraged by federal and state
authorities to evaluate their clients and prescribe and appropriate individualized
treatment plan. Evaluation and screening usually includes some psychological
testing. The Minnesota Miltiphasic Personality Inventory (MMPI) was selected for
use in this study because it is one of the most widely used personality inventories
and it is common usage in alcoholism treatment programs throughout the United
States (Apfeldorf, 1974; Clopton, 1973; Huber & Danahy, 1975; Sukerman & Sola,
1975; Vosburgh, 1975; Williams & Kahn, 1964). The instrument has drawn some
controversy. (Bavernfeind, 1956; Butcher & Tellesen, 1966; Fiske, 1968; Green-
spoon & Gursten, 1967). This is to be expected of a test in use by
a variety of workers in different settings for forty years. The widely accepted
MMPI remains a useful, well studied assessment of personality characteristics and
tool of research (Dahlstrom et al., 1972, 1975; Marks & Seeman, 1974).
The MMPI was originally published in 1943. In 1939 Starke R. Hathaway
and J. Charnley McKinley began development of an empirical criterion keyed
diagnostic objective aid and measure of therapeutic change over time. A set of
504 items was selected of 1000 statements from clinical reports, manuals, forms,
case histories and other sources. A sample of 299 men and 425 women adult
medical patients and visitors at the University of Minnesota Hospital was admin-
istered the early form of the instrument. This sample corresponded to the
Minnesota population according to the 1930 census on age, sex, and marital status.
The performance of this normative group is the basis for comparison of any
individual taking the test.
In 1940, such a Minnesota normal adult was about thirty-five
years old, was married, lived in a small town or rural area,
had had eight years of general schooling, and worked at a
skilled or semi-skilled trade (or was married to a man with
such an occupational level. (Dahlstrom et al., 1972, p.8).
In 1957 Hathaway and Briggs used a revised sample of 266 males and 315
females to add additional scales to the original instrument.
Theoretical concerns regarding personality inventories may be reduced by
the use of special instructions (Fink, 1972) or examination of the instrument by
factor analysis (Astin, 1959; Eichman, 1962). When the MMPI is properly used in
conjunction with psychosocial information that can support the projections of the
clinical code-types (Kostlan, 1954). It is particularly important to be familiar with
the instrument in the setting and client populations to which it will be applied
(Erickson & O'Leary, 1977; Gaines et al., 1974; Thomas, 1980).
The test is available in three forms: individual or card form, group or
paper and pencil, and audiotape. The most common is a form of the standard
booklet published in 1947 by the Psychological Corporation and suitable for
individual or group administration. Form R is a step-down, hardboard format with
566 items presenting the basic clinical and validity scales within the first 399
Test subjects must be sixteen years of age or older with at least six years
of formal education. An IQ score below 80 on either the Verbal or Full-Scale
Wechsler Adult Intelligence Scale (WAIS) suggests the client will not be able to
successfully complete the MMPI in booklet form. Those with IQ's 65 or less or with
less than three years formal .education have great difficulty completing any form
of the test including oral. Sixty to ninety minutes is the amount of time it takes
most people to complete the test.
The scales of the MMPI contain different numbers of items to be marked
yes or no according to whether they apply to the person at the time of test
administration. Scores are profiled so that each scale may be viewed in context to
other scales. The scales may be interpreted nomethically (absolute scale level) or
idiographically (configural pattern. The latter analysis is preferred for clinical use.
The following description of the MMPI scales is drawn chiefly from
Dahlstrom et al., 1972, and Gilberstadt & Duker, 1965. The basic clinical scales are
# I Hypochondriasis (Hs), #2 Depression (D), #3 Hysteria (Hy), #/4 Psychopathic
deviance (Pd), #5 Masculinity-femininity (Mf), #6 Paranoia (Pa), #7 Psychasthernia
(Pt), #8 Schizophrenia (Sc), #9 Hypomania (Ma), #10 Social introversion (Si).
Scale # I Hyponchondriasis indicates an abnormal concern for bodily
functions. Worries and preoccupations with physical symptomatology persists
despite evidence to the contrary. The 33 items concern themselves with general
aches and pains and specific complaints about digestion, breathing, thinking, vision,
sleep, and sensation.
Scale #2: Depression is characterized by feelings of hopelesness, a
slowing of thought and movement, and frequently thoughts of suicide. The sixty
items deal with apathy, unsatisfactory work performance, sleep disturbances,
appetite, and mood.
Scale #3: Hysteria identifies those clients using physical symptoms as a
means of avoiding responsibility under stress. The sixty items include twenty in
common with the hypochondriases scale that make reference to somatic com-
Scale #4: Psychopathic deviance measures a personality pattern whose
characteristics include repeated disregard for community standards, shallow and
unstable relationships with others, and an inability to profit from experience. The
fifty items tap alienation from family, difficulty and authority figures and social
Scale #5: Masculinity-femininity was designed to measure male sexual
inversion or feminine personality characteristics, values, interests, and style of
expression in interpersonal relationships. The Fm scale is an unsuccessful attempt
to develop a corresponding scale more appropriate for women covering social
activities, personal sensitivities, and sexual material.
Scale #6: Paranoia involves suspicious delusional beliefs and overly
sensitive misinterpretations of personal situations out of proportion with the
client's ability and intelligence. The thirty-nine items are about delusional and
referential ideas in relationships with others.
Scale #7: Psychasthenia is an out-of-date term for obsessive-compulsive
personality characteristics such as difficulty in concentration, rumination, and
working. The forty-eight items include reference to anxiety, immobilization and
Scale #8: Schizophrenia refers to bizzare or unusual thoughts or
behavior. The seventy-eight items reflect lack of deep interests, poor family
relationships, and bizzare ideation.
Scale #9: Hypomania features overactivity, emotional liability, and flight
of ideas in conjunction with a lack of concommitant productivity. The forty-six
items search activity levels, sociability and agiation.
Scale #10: Social introversion examines withdrawal from contact with
others and responsibilities. The seventy items indicate the degree to which a client
withdraws from others in response to emotional needs and related patterns of
There are three validity scales on the MMPI: "?', "L", "F". Validity in the
sense that it is reported by these scales indicates the acceptability of anyone
administration of the test. These built in checks also imply sources of any
invalidity by elevation and configuration of pattern.
The Cannot Say or "?' score is the number of items placed in that
category by client as well as those skipped or deliberately omitted. This allows the
client to skip items that seem inappropriate and decreases the restrictiveness of
the instrument. A continuum of test evasiveness is not presumed. The most likely
reason for an elevated Cannot Say score is inability to comprehend the question or
confusion (Brown, 1950).
The "L" score is a fifteen item scale designed to identify dishonesty
in answering the test questions. It is often called "the lie scale." As one would
expect, high scores on L tend to suppress elevation on the clinical scale profile.
The sixty four item "F" scale detects unusual reponses to certain
questions. It is often called "the validity scale" as if it alone were sufficient to
measure invalidity. It picks up pervasive personality disorganization,the presence
of current drug effects on the client, and an inability to understand and reliably
answer the test questions.
The "K" scale was added to the other three validity scales after workers
had gained experience with the test in the field. Experience suggested the original
indicators were measuring gross protocol invalidation while not detecting sources
of invalidity. In 1947 the MMPI was supplemented with the K scale and corrections
for K on the clinical scales. This suppressor factor was incorporated by The
Psychological Corporation into the scoring procedures to improve the discrimin-
ation of normal form abnormal records.
MMPI Short Forms (Mini-Mult)
The full scale MMPI format of 566 items takes about one and one-half
hours to complete for the average client. This length of time makes administration
of the test difficult in clinical situations with some clients, including many
substance abusers. They may see little face validity to the MMPI questions and
doubt the efficacy of such psychological testing. Resistance and defensiveness to
what may be perceived as unwarranted personal intrustion are encountered with
regularity. The poorly motivated client sometimes rushes through the test or even
randomly completes it. (Erickson & O'Leary), 1977; Hoffman & Butcher, 1975;
Newmark, Newmark & Cook, 1975). As many as 25% of alcohol client full scale
MMPI test reports may be invalid for this reason (Overall, Higgins & DeSchweinitz,
In 1968 Kincannon introduced his 71 items which were chosen as
representative of the content clusters of the standard validity and clinical scales.
Kincannon's "Mini-Mult" was estimated to lose only 9% reliability and 14% corres-
pondence in comparison with readministration of the standard length instrument.
The mean scale values correspond well with the standard test but underestimated
extreme scores and yielded narrower score ranges (Dahlstrom et al., 1972).
Although scales F, I, and 9 tend to be underestimated by the Mini-Mult
the product-moment correlatons between the short and long forms ranged from .80
to .93 for the validity and clinical scales with a median correlation of .87
(Kincannon, 1968). Correlations of initial Mini-Mult scores retested with the
standard MMPI ranged from .60 on F to .89 on scale seven. Correlations on two
administrations of the long form ranged from .62 to .91 with the same two scales
being lowest and highest (Dahlstrom et al., 1972).
Armentrout and Rouzer (1974) have pointed out a weakness of some Mini-
Mult formats with character disorder and psychotic clients. They stressed the
importance of experience with short forms of the MMPI in the context in which
they are to be used. Newton (1971) investigated Kincannon's early Mini-Mult
format with male alcoholics. His findings do not support more optimistic
suggestions that the 71 item short form closely approximates the long form of the
MMPI. Correlations ranged from .28 on scale 9 to .63 on L. Newton also found
that on a second administration alcoholic clients gave more socially desirable
After the initial appearance of Kincannon's short form other Mini-Mults
were developed by Hugo in 1971, Graham and Schroeder in 1972, Fachingbaurer in
1973, and others. A study of these short forms by Hoffman and Butcher (1975)
found all of them to correlate highly with the standard length test (.74 to .96). The
success in predicting code type was not considered acceptable, however. The 168
item format was judged the better of the studies examined although the authors
preferred the full scale MMPI.
Overall and Gomez-Mont (1974) devised an abbreviated MMPI form
utilizing the first 168 items of the test, or up to the last item on the bottom of
page seven of Form R. Correlations between scales on the short form and
traditional long form ranged from .79 on scale 9 to .96 on scale three with a mean
of .88 for all scales. Newmark, Newmark and Cook (1975) found the 168 to:
Correspond fairly accurately to the standard MMPI
for psychiatric patients as a group. The only
apparent difficulty occurs with the MMPI-168
tendency to underestimate significantly the Si scale
for both sexes. It should be emphasized that the
correlation obtained in this study are as high as
any that have been obtained with abreviated MMPI
scales to date. The MMPI-168 proved to be a
remarkably accurate substitute for the MMPI. (pp. 63-64)
Overall, Higgins and DeSchweinitz (1976) strongly support the MMPI-168.
In fact they mention the tendency to accept the standard form of the instrument
as an infallible criterion and to find fault with the short form when there are
discrepancies. They maintain:
The fact that the diagnostic group discrimination
based on the abbrevitated MMPI-168 was equal
to that for the longer MMPI seems to confirm that,
in fact, an extra element of unreliability, is intro-
duced, at least for some Ss. by the excessive length
of the standard form. This can be reasoned from the
fact that the shorter test length should be expected
to produce less reliable scores if the item reliabilities
remain constant throughout A less reliable instrument
also would be expected to be less valid. On the other
hand, if fatigue, boredom, resentment, or distractability
changes the quality of responses in latter portions of
the test, an increase in scale score reliability might
not result from use of the longer form. (p. 243).
Gaines, Abrams, Toel, and Miller (1974) as well as Erickson and O'Leary (1977)
stress the importance of being familiar with a particular setting when applying the
Mini-Mult. This is good advice for applying any instrument to a clinical setting but
takes on particular significance in the substance abuse population. Almost by
definition substance abusers demonstrate the behaviors and personality character-
istics that decrease the quality of the responses during a lengthy test administra-
tion. The two programs participating in this study went to Mini-Mult formats,
several years ago for precisely the reasons discussed in this section. The Mini-Mult
MMPI is a reasonably accurate substitute for the full-scale instrument that is more
practical in clinical use with an alcoholic client population.
There is a possibility of withdrawal effects influencing the test responses
of alcohol clients who are or have recently been drinking. From the time of last
ingestion, five full days are necessary before the client who has been drinking
heavily may be considered detoxified. Administration of any instrument during the
first five days following an alcoholic drinking episode could be invalid. Theoreti-
cally a case can be made that much longer periods of time are necessary for
sufficient recovery from drinking to warrant valid psychological testing; perhaps up
to one year (Brozek, 1950; Libb & Taulbee in Clopton, 1973; Mayer & Garcia-Mullin,
1972; Williams, 1966).
MMPI Special Scales
Three special scales of significance have been developed upon the body of
MMPI items as aids in the diagnosis of alcoholism. (Atsaides et al., 1977;
Rosenberg, 1972; MacAndrew & Gerstma, 1964). Hampton attempted in 1954 to
develop an instrument to differentiate not only alcoholics from non-alcoholics but
different levels within the alcoholic category. Hampton drew a sample of men who
were members of Alcoholics Anonymous in Minnesota, Iowa, Kentucky, and Ohio
who had been determined to be "alcoholic" by medical personnel or the criminal
justice system. A later scale constructed by Holmes is chiefly concerned with
prealcoholic states and was based on 72 men hospitalized for "chronic alcoholism
without psychosis" in a California state mental institution. The Hoyt and Sedlacek
(1958) scale drew 98 Caucasian "chronic alcoholic" men from the Mental Health
Institute in Independence, Iowa. It is designed to identify the personality
characteristics of alcoholics which separate them from nonalcoholics. All the
scales contrasted a diagnosed alcoholic group with a normal sample.
MacAndrew and Gertsma (1964) have taken the position that these three
alcoholism scales based on the MMPI are not measures of alcoholism so much as
measures of general maladaption. Of the 191 items included in the three scales
only seven were common to all three scales. MacAndrew's conclusion is "The
manifest content of these seven items indicated that relative to normals, people
diagnosed as alcoholics describe their alcohol intake as excessive rather than
moderate, tend to accept the responsibility for their past failures and transgres-
sions, and while not consistent church-goers, profess to believe in miracles"
(MacAndrew, 1964, p. 76). Alcoholism scales based on MMPI items, including the
MAC Scale to some degree, seem to tap traits alcoholics share with offenders in
the criminal justice system (Apfeldorf & Hunley, 1975). This suggests that there is
an aspect to alcoholism that is simply social maladaption.
MacAndrew's MAC Scale (1965) remains the most widely used special
scale of the MMPI for the detection of substance abuse in general whether alcohol
or drug abuse (Burke & Marcus, 1977; DeGroot & Adamson, 1973; Rhodes, 1969;
Rhodes & Chany, 1978; Rosenberg, 1972). It was designed to distinguish between
a general psychiatric sample and alcoholics rather than between normals and
alcoholics. The 49 item scale (together with MMPI items 215 and 460) appears to
measure a relatively stable personality configuration independent of current
behaviors or levels of functioning. That is, it is common for MAC scores to remain
the same whether an alcoholic is drinking or not drinking. This is true even if
sustained abstinence is accompanied by a decrease in score elevation on the other
MMPI scales (Apfeldorf, 1974; Lachar et al., 1976).
This is particular important in this study since there is no interest in
measuring the potential for substance abuse independent of other personality
In 1976 Lachar studies the MAC scale in relation to alcohol and drug
abuse with 165 male alcohol and drug abuse cases and 165 male control patients.
Each group of abusers scored significantly higher than the controls at the .05 level
for alcoholics and the .01 level for the polydrug abusers. The cutting score of 23
correctly classified 86 percent of the self-identified addicts. Apparent errors in
classification may be attributed in part, according to Lachar, in that the MAC
scale identified a potential for substance misuse among those who have not yet
expressed that potential in abusive behaviors.
Test-retest administration of the MAC average 1.02 points mean difference
which compares favorably with test-retest differences on the MMPI clinical
scales of 1.49 points with a range of 0.3 to 2.5 in a 1979 study by Mac Andrew.
Originally it was recommended that MMPI protocals with an F scale
score of 15 or more should be considered to invalidate the MAC. MacAndrew
(1979) and Apfeldorf & Hunley (1975) now indicate an L scale of 9 or more may
be considered as the invalidation criterion.
After administration the data were prepared for statistical analysis. The
"Client Characteristics" form was used to describe the sample with mean and
standard deviation of the groups of the 3 x 2 matrix will be reported. This form
was compared with the most recently published HRS Mental Health Program data
on age, race, education, and income to ensure representativeness of the sample.
The comparison is of the total sample collected to the state data through the
means of the chi-square test for goodness of fit. The requirements for this test are
that the data be in the form of frequencies; observations are independent of each
other; and a minimum of five expected observations per cell (Isaac & Michael,
1977; Roscoe, 1975). This serves as an indicator of external validity and
generalizability of the data.
As an indicator of internal reliability a second comparison of client
characteristics will be made between the cells of the 3 x 2 matrix. The chi-square
test of independence will be used to determine if there are significant differences
among the cells. The requirements are the same as for other chi-square tests
(Isaac & Michael, 1977; Roscoe, 1975).
The statistical procedure used for determining significant differences of
the MMPI validity, clinical, and MAC scales is the two-factor analysis of variance
(ANOVA). The underlying assumptions of ANOVa are randomly selected subjects
from normally distributed populations, approximately equal variances, and indepen-
dence of observations (Issac & Michael, 1977; Roscoe, 1975). The assumptions
have been taken into consideration and the proper allowances made.
To insure information was not lost by partitioning the variable age, it was
also treated as continuous. An overall age to MMPI scale and within groups
correlation was made when ANOVA failed to reach significant alpha levels.
I. The researcher contacted responsible administrative personnel at the
participating treatment programs to explain and discuss the purpose and
intended procedure of the study. The researcher met with the staff at
each facility who collected the data and administered the research
materials. The procedures were discussed in detail.Anonymity of client
records and adherence to ethical principles were given particular atten-
tion. The "Participant List" form in the Appendix was developed for use
by the programs to protect the client's right to privacy.
2. The sample selection and collection of data began: a) Client
Characteristics form; b) MMPI-168; c) MAC scale.
3. The researcher contacted the coordinator to determine the status of
the data collection at each facility.
4. The collection of data was completed and the materials mailed to the
researcher in the provided stamped envelopes.
5. The MMPI-168 was scored by hand and individual profiles returned to
the programs. All materials were screened for errors such as the
inclusion of inappropriate participants or misunderstanding of the admin-
istration of the instruments. Those records with an L score of 9 or more
or an F score of 16 or greater were invalidated as recommended by the
MMPI Revised Manual (1967) and Mac Andrew (1979). The data were
grouped along the lines of the 3 x 2 matrix.
6. The data were prepared for computer analysis. The analysis includes:
a) Descriptive statistics of the sample drawn from the "Client
b) Chi-square goodness of fit test comparing client characteristics of
U. S. state-wide alcohol population data with the sample on age, race,
education, and income. This allows more precise discussion on the
extent the data may be generalized.
c) Chi-square test of independence on client characteristics within
the cells of the 3 x 2 matrix to aid the examination of internal
d) A two-factor ANOVA with three levels of one independent
variable (age) and two levels of a second (work history) was computed
on MMPI T-scores on validity and clinical scales. The absolute scale
value and the most common two point code type configural patterns
will be examined.
e) A two factor ANOVA with three levels of one independent variable
(age) and two levels of a second (work history) was computed on MAC
f) Treating age as a continuous variable product moment correlations
within and between groups was made on MMPI and MAC scales.
g) The hypotheses were tested.
7. The report of the results of the study and analysis of data may be
found in Chapter IV. A summary of the study, discussion of findings,
implications and limitations of the study are in Chapter 5.
Limitations of the Study
An important factor in developmental research mentioned by Isaac and
Michael (1977) is that the subjects at each age level should be comparable.
Differences between the cells on the dependent variable should be attributed to the
independent variable, not some other factor. The use of the "Client Character-
istics" form as a descriptor of each cell attempts to address this issue.
In regards to the external validity and generalizability of the study,
reasonable attempts are made to insure the participating programs are represen-
tative of alcoholism treatment programs throughout the state and perhaps the
country. Florida U. S. rules are based on state statutes formulated on federal
regulations issued by the U.S. Department of Health, Education, and Welfare, the
National Institute of Mental Health, and the National Institute on Alcohol Abuse
and Alcoholism. Health and Rehabilitative Services requirements ensure minimum
standards in eight areas of substance abuse programs operation. The data
pertaining to client characteristics will be used to compare the total sample to
HRS alcohol population estimates for the State of Florida.
The study is designed to examine the importance of employment with
different age groups of men and not both sexes. The issue may be more clear-cut
with men than women whose role in the world of work has undergone great
changes. Any differences between the sexes in this area might make it more
difficult to determine effects attributable to the variables under study. Extrapola-
tion of the data to individuals or groups not adequately represented in the study
should be done with care, if at all.
RESULTS OF THE STUDY
In this chapter the results of the study are presented based on the
methodology and statistical procedures described in Chapter III. The chapter is
divided into two sections. The first is a description of the sample with comparisons
to the estimated state alcohol population and within the design matrix. The second
is the data analysis determining relationships among variables and testing the
Description of the Sample
The 120 subjects were selected randomly from the client populations of
two alcoholism treatment programs in west central Florida. Three levels of age
based on the vocational theory of Donald Super (1953) and two levels of employ-
ment determined by Florida HRS standards were used as independent variables.
The design is a 3X2 matrix with an n of 20 subjects in each cell.
The characteristics of the total sample are presented in Table 6.
Participants were diagnosed by the programs as Alcohol Dependent (93%) or
Alcohol Abuse (7%) cases. The sample is similar to the state population on age,
race, and educational level. Regarding income, there are discrepancies between
how much the clients tell the programs they make and what they tell a researcher,
as anticipated in Chapter Two. If the entire range of income reported to the
researcher is compared to state estimates, a significant difference is found. If the
lowest and highest are disregarded as inaccurate, there is no significant difference
(See Table 7). It is believed that the clients in this study are representative of the
male alcoholic population in the State of Florida.
Client Characteristics of the Total Sample
I. Age: X = 44.9. Range = 17-64 s.d. = 13,986
2. Race: White = 99%, Black = 1%, Other 0%
3. Marital Status: Single = 37%, Married = 10%
Separated = 10%, Divorced = 38%
4. Client's Usual Type of Work:
Unskilled Labor = 37%
Skilled Labor = 42%
White Collar = 21%
5. Last school grade completed: X = 12.03
6. Last year family income from all sources:
$ 0 2,999 26.6%
3,000- 5,199 18 %
5,200 7,799 9.4%
7,800 10,399 14.6%
10,400 15,599 7 %
7. Alcohol Abuse (DSM I I 305.OX) = 7%
7. Alcohol Abuse (DSM 11 305.0X) = 7%
Alcohol Dependence (DSM III 303.9X) = 93%
8. Number of years drinking a serious problem:
Less than 5 years = 20%
5 to 10 years = 26%
More than 10 years = 54%
Chi-Square Goodness of Fit Test Comparing Study Client Characteristics With
Estimated State Parameters
Estimated State Paramaters
Income 0 2,999
NOTE: Chi-Square equals 98.14, significant at = .001. Chi-Square for Age,
Race, and Eduation Level alone is .929 which is not significant. Chi-Square
disregarding lowest and highest levels of income is 8.94 which is not
The internal validity of the study was examined by applying the Chi-
Square Test to client characteristics within the matrix (See Table 8). Differences
on two areas of work history and three areas of marital status were found due
to the structured differences in age and employment built into the research design.
Fewer young people may be expected to hold white collar jobs than those middle-
aged or older. The same is true for marital status; the young clients are more
likely to be single and less likely to have yet separated or divorced. There were no
differences on race, diagnosis, or education. The cells are considered to be similar
allowing a test of hypotheses to reflect real differences on the research variables.
The MMPI-168 and MAC protocols were graded and grouped according to
the research design. The means and standard deviations of scores may be found in
Table 9. The scores are corrected for K and put in correspondence with full scale
scoring according to Overall and Gomez-Mont (1975).
A Two-Way Analysis of Variance was performed on the MMPI validity
(L,F,K) clinical (Hs, D, Hy, Pd, Mf, Pa, Pt, Sc, Hy, Si) and MAC scales. In all cases
0.05 was used as the significant alpha level. A significant interaction was found on
Depression (p = .001) and Psychasthenia (p = .002). Significant main effect
emerged on Hyponchondriasis (employment, p = .05), Hysteria (age, p = .01),
Masculinity-Feminity (employment, p = .038), and Social Introversion (age, p = .008).
Of interest but not statistically significant at alpha equals .05 were the validity
scale L (employment, p = .057) and MAC (interaction, p = .056).
The significant F ratios were tested for simple effects in the case of
interaction and main effects in cases where there was no interaction. Scale L and
MAC because of their near significance on ANOVA were further examined by the
Chi-Square Test of Independence Comparing Participant Characteristics Within
the 3 x 2 Matrix
Characteristic Chi-Square Significance
303.0X Alcohol Abuse 11.04
303.9X Alcohol Dependence 1.12
Unskilled 57.91 .001
White Collar 42.74 .001
Single 12.515 .05
Separated 17.18 .01
Divorced 56.12 .001
Means and Standard Deviations of Alcoholic Scores on MMPI Scales by Age and
MMPI Age 15-24 Age 24-44 Age 45-64
Scale X S.D. X S.D. X S.D.
L 2.815 1.814 4.860 2.501 3.295 2.006
F 8.865 3.869 8.140 3.056 9.150 4.601
K 11.010 4.154 12.330 5.538 12.215 4.184
Hs 14.505 6.543 14.770 7.514 15.045 4.269
D 25.170 5.810 20.235 5.565 26.895 6.270
Hy 22.840 6.267 22.700 6.450 26.620 6.757
Pd 29.175 4.708 25.350 3.792 28.355 5.279
Mf 28.055 3.622 28.045 7.047 27.970 7.148
Pa 13.890 2.529 11.260 3.653 12.300 3.045
Pt 32.020 6.724 24.410 10.055 33.935 6.618
Sc 32.535 8.762 28.785 10.045 35.280 8.972
Hy 24.270 4.839 22.995 4.268 22.915 5.629
Si 24.870 7.581 21.755 9.437 33.365 13.247
MAC 29.950 5.306 29.100 3.810 29.100 4.553
Table 9 continued
MMPI Age 15-24 Age 25-44 Age 45-64
Scale X S.D. X S.D. X S.D.
application of a product-moment correlation within the cells of the design.
The results of the analyses were then used in the consideration of the research
Hypothesis I. There are no differences in the personality characteristics of
alcoholics of different age groups. The data analysis indicated there is a
difference on Hysteria (< = .01) and Social Inversion ( o( = .08). Hypothesis I was
therefore rejected. Tables 10, I 12 and 13 provide information about this
Two-Way Analysis of Variance Testing Employment and Age on Alcoholic MMPI Scale
Source of Sum of Mean F
Variation D.F. Squares Squares Ratio P
Employment I 103.324 103.324 2.210 .136
Age 2 390.118 195.059 4.173 .018
Interaction 2 8.659 4.325 .093
Error 114 5329.178 46.757
Total 119 5831.270
Summary Table for Main Effects on Variable Hysteria Following Non-Significant
Source of Sum of Mean F
Variation D.F. Squares Squares Ratio P
Age 2 371.702 185.851 3.978 .021
Error 117 5466.639 46.723
Total I19 5838.341
Two-Way Analysis of Variance Testing Employment and Age on Alcoholic MMPI Scale
Source of Sum of Mean F
Variation D.F. Squares Squares Ratio P
Employment 1 .901 .901 .008
Age 2 1171.712 585.856 5.037 .008
Interaction 2 551.091 275.546 2.369
Error 114 13259.656 116.313
Total 119 14983.360
Summary Table for Main Effects on Variable Social Introversion Following Non-
Significant ANOVA Interaction
Source of Sum of Mean F
Variation D.F. Squares Squares Ratio P
Age 2 1500.506 750.253 6.563 .002
Error 117 13373.984 114.308
Total I19 14874.490
Hypothesis 2. There are no differences in the personality characteristics
of alcoholics who work and those who do not work. The analysis determined
a difference on Hypochondriasis (o< = .05) Masculinity -Feminity ( Q< = 0.38).
Hypothesis 2 was rejected. Tables 14 and 15 show the ANOVA on the two variables.
Two-Way Analysis of Variance Testing Employment and Age on Alcoholic MMPI
Source Sum of Mean F
Variation D.F. Squares Squares Ratio P
Employment I 174.484 174.484 3.841 0.50
Age 2 57.318 28.659 .631
Interaction 2 30.270 15.135 .333
Error 114 5178.426 45.425
Total I19 5440.498
Two-Way Analysis of Variance Testing Employment and Age on Alcoholic MMPI
Source of Sum of Mean F
Variation D.F. Squares Squares Ratio P
Employment I 185.008 185.008 4.324 .038
Age 2 9.465 4.733 .111
Interaction 2 10.705 5.353 .125
Error 114 4977.922 42.789
Total I19 5083.100
Hypothesis 3. There is no interaction of age and employment related to
personality characteristics among different age groups of alcoholics. Significant
interaction was found on Depression (-o= .001) and Psychasthenia ( o( = .002).
Hypothesis 3 is therefore rejected. Tables 16, 17, 18, and 19 provide more
Two Way Analysis of Variance Testing
MMPI Scale Depression
Employment and Age on Alcoholic
Source of Sum of Mean F
Variation D.F. Squares Squares Ratio P
Employment I 106.220 106.220 2.896 .088
Age 2 26.061 13.031 .355
Interaction 2 710.096 355.048 9.680 .001
Error 114 4181.473 36.680
Total 119 5023.850
Summary Table for Simple Effects on Variable Depression Following A Significant
Source Sum Mean F
Variation D.F. Squares Squares Ratio P.
Employed 2 477.903 238.912 6.890 .002
Error 47 1976.897 34.682
Total 59 2454.800
Unemployed 2 281.637 140.819 3.411 0.39
Error 57 2353.232 41.285
Total 59 2634.869
Age Group I 3.600 3.600 0.84
Error 38 1638.124 43.109
Total 39 1641.724
Age Group I 589.824 589.824 21.454 .001
Error 38 1044,691 27.492
Total 39 1634.515
Age Group I 59.292 59.292 1.420 .239
Error 38 1586.257 41.744
Total 39 1645.550
Two Way Analysis of Variance Testing Employment and Age on Alcoholic
MMPI Scale Psychasthenia
Source of Sum of Mean F
Variation D.F. Squares Squares Ratio P
Employment I 273.008 273.008 3.948 .047
Age 2 432.978 216.489 3.13 .046
Interaction 2 917.003 458.902 6.63 .002
Error 114 7884.063 69.158
Total I19 9507.852
Summary Table for Simple Effects on Variable Psychasthenia. Following a Significant
Source of Sum of Mean F
Variation D.F. Squares Squares Ratio P
Employed 2 1015.366 507.683 8.011 .001
Error 57 3612.436 63.736
Total 59 4627.802
Unemployed 2 334.749 167.375 2.234 .115
Error 57 4270.575 74.922
Total 59 4605.324
15-24 Age Group I 48.620 48.620 .912
Error 38 2025.477 53.302
Total 39 2074.098
25-44 Age Group I 1107.756 1107.756 15.707 .001
Error 38 2680.041 70.527
Total 39 3787.798
45-64 Age Group I 3.481 3.481 .043
Error 38 3089.103 81.292
Total 39 3092.584
Hypotheses 4, 5, and 6 all involve tests of the MacAndrews (MAC) scale of
substance abuse and are accordingly considered as follows:
Hypothesis 4. There is no difference in the potential for alcohol abuse
among different age groups of alcoholics. Age was not found to be a significant
variable in terms of interaction or main effects on the MAC scale. Hypothesis 4
was therefore retained. More information may be found in Tables 20 and 21.
Hypothesis 5. There is no difference in the potential for alcohol abuse
among alcoholics who work and those who do not work. Employment was not found
to be a significant variable in terms of interaction of main effects on the MAC
scale. Hypothesis 5 was therefore retained. More information may be
found in Tables 20 & 21.
Hypothesis 6. There is no interaction of age and employment related
to the potential for alcohol abuse. No significant interaction was found with
the variables age or employment on the MAC scale by the analysis and Hypothesis
6 was retained. Table 20 describes the ANOVA. A product-moment correlation
was computed for the cells of the matrix and may be found in Table 21.
Two-way Analysis of Variance Testing Employment and Age on Alcoholic MMPI
Source of Sum of Mean F
Variation D.F. Squares Squares Ratio P
Employment I 7.500 7.500 .353
Age 2 28.467 14.234 .669
Interaction 2 2.400 1.200 .056
Error 114 2425.500 21.276
Total I19 2463.867
Correlation of Age and MAC score
Age Group Employed Unemployed
15-24 .157 .398
25-44 .280 .572
45-64 .221 .671
The MMPI Psychopathic Deviance scale (Pd) is associated with maladaptive
behavior. It is not as clear a measure of addictive proneness as the MAC scale.
The ANOVA of Pd may be found in Table 22. No interaction of age and employment
is proved. A correlational matrix (See Table 23) indicates that the employed
men's Pd score may be related to age in a curvilinear way. A second-degree
polynomial describing a single bend in the regression curve yielded polynomial
coefficients of A (0) = 52.894, A (I) = 1.507, A (2) = .020. The determination
coefficient was R = .222, the correlation coefficient R = .471, and the standard
estimated error 4.373.
The information collected in this study on scales Pd and L does not
reach statistical significance and does not directly bear on the research hypotheses.
It is presented in Tables 22 and 23 for Pd and Tables 24 and 25 for Scale L. It
is of interest to note a simliar pattern regarding these two scales: a curvilinear
relationship on the scale with age among employed males. A tendency for employed
males to be more truthful about their socially unacceptable feelings may be found
in further research.
Two-Way Analysis of Variance Testing Employment and Age on Alcoholic MMPI
Scale Psychopathic Deviance
Source of Sum of Mean F
Variation D.F. Squares Squares Ratio P
Employment 1 2.552 2.552 .105
Age 2 72.129 36.065 1.480 .231
Interaction 2 141.796 70.898 2.909 .057
Error 114 2778.422 24.372
Total I19 2994.699
Correlation of Age and Pd Score
Age Groups Employed Unemployed
15-24 .395 .084
25-44 .073 .163
45-64 .431 .056
The differences on the lie scale are not statistically significant (o( = .057)
but seem worthy of further research. (See Table 24). The employed men's L score
appears to be related to their age in a curvilinear fashion. (See Table 25.) A
second-degree polynominal describing a single bend in the regression curve found
polynominal coefficients of A (0) = 4.864, A (I) = 4.72, A (2) = 6.288. The
determination coefficient was R = .129, the correlation of coefficient R = .360, and
the standard estimated error 1.915.
Two-Way Analysis of Variance Testing Employment and Age on Alcoholic MMPI
Source of Sum of Mean F
Variation D.F. Squares Squares Ratio P
Employment I 22.188 22.188 3.596
Age 2 4.954 2.477 .401
Interaction 2 26.340 13.170 2.134 .121
Error 114 703.539 6.171
Total I19 757.012
Correlation of Age and L Score
Age Group Employed Unemployed
15-24 .375 .124
15-44 .275 .176
45-64 .404 .123
Data collected on MMPI scales F, K, Paranoia, Schizophrenia, and
Hypomania were not found to be of signifance and did not bear on the research
hypotheses. The data may be found in the Appendix.
Summary and Conclusions
The review of the literature in Chapter II suggests that alcohol abuse and
alcoholism are significant problems likely to be encountered by counselors in a
variety of settings. Community prevention efforts emphasizing the youthful stem
at least in part from the unspoken belief that older alcoholics are beyond help.
However, there is some reason to question this as pointed out in several studies
that indicate it is the middle aged alcoholic who seeks serious treatment and wants
to change his behaviors. The importance of employment has been recognized by
self-help groups and professionals in the field. The relationship between work and
self-concept has been theorized by Super (1953) in his vocational theories. The
linkage between self-concept and substance abuse has been documented by
Medzerian (1979) and others.
In October, 1981, 120 alcoholics in Pasco and Pinellas counties in the
State of Florida completed questionnaires regarding their background, the MMPI -
168, and the MacAndrews scale of substance abuse. These people were clients
participating in community agency programs licensed and supervised by the
Department of Health and Rehabilitative Services of the State of Florida. All
were diagnosed alcoholic by the program staff according to DSM III categories 305.Ox
alcohol abuse or 303.9x alcohol dependence.
The subjects responses were statistically examined by the Chi-Square
Tests of Independence to check internal validity of the study. It was determined
that the cells of the design were equivalent and statistical analysis should indicate
differences attributable to the research variables. The Chi-Square Test of Goodness
of Fit compared the study sample to state estimates of the alcohol population
and found the sample to be representative of alcoholic men in Florida.
A Two-Way Analysis of Variance with two levels of employment (employed
and unemployed) and three levels of age (15-24, 25-44, 45-64) was performed
on MMPI validity and clinical scales as well as the special scale MAC. A statistical
analysis of the data yielded significant F ratios for the variable age on Hysteria
and Social Introversion. There were significant F ratios for the variable employment
on Hypochrondriasis and Masculinity-Feminity. Significant interaction of age
and employment was determined on Depression and Psychasthenia. Correlations
were done following ANOVA on the MAC and L scales.
In summary, the results obtained from the study hypotheses are:
(I) There are significant differences in the personality character-
istics of alcoholics of different age groups. The youthful age group is lower than
the oldest on Hysteria. On Social Introversion the oldest group is higher than the
young and middle groups.
(2) There are significant differences in two of the measured MMPI
characteristics of alcoholics who work and those who do not work. Those who are
unemployed score higher on Hypochondriasis than those who work and lower on
(3) There is a significant interaction of age and employment related to
personality chacteristics among alcoholics, on Depression and Psychasthenia.
Unemployment raises depression in the middle age group, but not the youngest and
oldest. Employment decreases Psychasthenia scores of the middle age group but
not the others.
(4) There is no significant difference in the potential for alcohol abuse
among different age groups of alcoholics as measured by the MacAndrews scale.
(5) There is no significant difference in the potential for alcohol abuse
among alcoholics who work and those who do not as measured by the MAC scale.
(6) There is no significant interaction of age and employment related to
the potential for alcohol abuse as measured by the MAC scale. Increases in
Depression and Psychasthenia associated with unemployment as well as corre-
lational data on the MAC qualify this finding.
Differences were found between the youngest alcoholics and the oldest on
Hysteria. These differences should not necessarily indicate a change in physical
well-being related to ageing. It may represent a real difference in the use of a
neurotic conversion defense by the older clients by giving physical symptomatology
as a means of dealing with conflicts or avoiding responsibilities. The Hy MMPI
scale is designed to measure the inordinate use of such a defense distinguishable
from use in a normal population. Not making excuses and meeting responsibilities
is a cornerstone of traditional alcohol treatment.
Older alcoholics are socially introverted. They tend to withdraw from
social contacts and responsibilities. Isolation and self-depreciation are associated
with higher scores on the Social Introversion scale of the MMPI. It is understand-
able that self-help groups and professionals in the field stress the need for group
and family counseling. Until fairly recently it has been largely middle-aged and
older alcoholics who have sought help through lay support groups. It may be that a
prime contribution of such groups is the fellowship and sense of belonging that new
members find that enables them to turn their attention to others and relationships
instead of themselves. It is understandable that many find they must maintain
contact with the groups in order to preserve their sobriety.