<%BANNER%>

Stages of Change, Self-Efficacy, Social Support, and Substance Abuse within a Gainesville, Florida Drug Court Program

xml version 1.0 encoding UTF-8
REPORT xmlns http:www.fcla.edudlsmddaitss xmlns:xsi http:www.w3.org2001XMLSchema-instance xsi:schemaLocation http:www.fcla.edudlsmddaitssdaitssReport.xsd
INGEST IEID E20101123_AAAACD INGEST_TIME 2010-11-23T11:13:19Z PACKAGE UFE0011652_00001
AGREEMENT_INFO ACCOUNT UF PROJECT UFDC
FILES
FILE SIZE 1053954 DFID F20101123_AABCXA ORIGIN DEPOSITOR PATH kovar_r_Page_11.tif GLOBAL false PRESERVATION BIT MESSAGE_DIGEST ALGORITHM MD5
5c048f49ee77f516d36a741997ec4d96
SHA-1
1678c336a2cd0f79a6b30d8a9afb620482689fa5
49086 F20101123_AABCZZ kovar_r_Page_43.pro
b6ffee642dc32f8f409563c522119b36
beac535a6fbe8abfb001700245d95f68c382a394
1493 F20101123_AABDBZ kovar_r_Page_45.txt
8421deede57a0d76eed411ebd2f6750e
5fd5ee5dc87223a1cf1ff2f8bfa3c9ccb5ee32d2
48080 F20101123_AABCSD kovar_r_Page_38.jp2
d254b8f0a7ac2d8e5716659affed3e34
58a1a8c90bb2fe0e2bc3aef2a07f1ec4bcfc6b47
F20101123_AABCXB kovar_r_Page_12.tif
36b64d0d3f79de920f66b243ee98c997
e21dd94bb28b6ae925876e5516ebff3df9488302
1626 F20101123_AABCSE kovar_r_Page_21.txt
ac7d21eb2177f52b7748119b82c2f17e
c490fe0971e996449e25e0f409420f3cd4b9e22b
F20101123_AABCXC kovar_r_Page_13.tif
e9c844e457c98445fab4546799273398
14f8cb0f8d0ff05244e8f065321bbce2fb831c02
111114 F20101123_AABCSF kovar_r_Page_55.jp2
e57292162b8c841a08bec4d2e1f1b3bb
93daec9526a28ef67cd9e1be262ac693aea5697c
6230 F20101123_AABDEA kovar_r_Page_23thm.jpg
47fa46d0471eaa143a15b8a3d47635b5
dc804ebbb2803bad6518f08775cce1cdd8e9f666
F20101123_AABCXD kovar_r_Page_14.tif
21c7f78c083de1bec14b0ffc8c34c4f8
d9c7cc7b4c15c8a046dc4ace30548341c8f84bb0
2436 F20101123_AABCSG kovar_r_Page_60thm.jpg
7d15c1f672e0658b5c3a44a60788db34
675d689eed74fc58e2da1be57794a2e6ffd798af
24457 F20101123_AABDEB kovar_r_Page_24.QC.jpg
7b2cc1f1693301e693611692fa1edd22
3dd278b119c6eaa332841a2c6b3671e7105eaadf
F20101123_AABCXE kovar_r_Page_15.tif
08e92b23a66cf56dae5f797a43af90ae
72a9a6467791470259b555165ef2f96dec605af4
F20101123_AABCSH kovar_r_Page_57.tif
8d1fce25f017d8b62cc9eeba9f48780e
705dc3fc55962d1e6dbc386d0dd97056c3de9e6b
6772 F20101123_AABDEC kovar_r_Page_24thm.jpg
0820813d52caa6ffad157074fb8c0ebf
32fa94498afe7c46e2c9bddf7c75d727abae7a53
F20101123_AABCXF kovar_r_Page_16.tif
2297e861a136bb7880d6b52b2a5952a6
a9cea9773fee96dd080a65678729273d8d9dba13
2027 F20101123_AABCSI kovar_r_Page_11.txt
9bb21dd2a3221addd43b349161ab7b7b
5d95724e65a698e8bcc1ba490c97c7433b62742b
23155 F20101123_AABDED kovar_r_Page_25.QC.jpg
f40c245f80fba4d299f71e3da308f6b0
d2e146c9e541c9efd1f512e62d361e62a9d42444
22847 F20101123_AABCSJ kovar_r_Page_54.jp2
4e3f63cb32a036f7faf5b790ad116183
2a62495f24b63989a31991cf5351d7bbc898cecc
3540 F20101123_AABDEE kovar_r_Page_26thm.jpg
09fc40e5745295f299f50a22a58b2d11
fcf192fce98d1a97ff77bec1ca8492a8d8529d12
F20101123_AABCXG kovar_r_Page_18.tif
7f94c789f15915745d80aa6c8b06b0e7
e7c3a6ac8745532fac12ec2d90abea0a925385b6
79483 F20101123_AABCSK kovar_r_Page_47.jpg
21b5e56881bf673b88fee7bacaf05af7
95aebe9949817ff55c9504a625da899798439fe0
18566 F20101123_AABDEF kovar_r_Page_27.QC.jpg
b32600deb15e38e6c9c7b7460e51fd30
e75470423d4fe1a58b629a30d488ff97b4679328
F20101123_AABCXH kovar_r_Page_19.tif
9067fdb262eb65604ac8d3e3ed43c8a9
6266984fbc83392ea9ae650eeeb0aff2bc7c3091
2648 F20101123_AABCSL kovar_r_Page_59.txt
b8e397d0e5a5c45a8091708369e6a72f
bf2aad53f9d978e37a53632f130ae8d751dbc83b
5145 F20101123_AABDEG kovar_r_Page_27thm.jpg
78a79be1e3f3a877028fc690645da49f
b92eb5a57f514c336d8b39765f38ba4a5294244f
F20101123_AABCXI kovar_r_Page_20.tif
81c61f6717983b987e9efec654bfd29d
b194ef08799b57b05fd274446da0146775e33355
107133 F20101123_AABCSM kovar_r_Page_40.jp2
7ab6cf0d2ce47b87b7254bb5986f38a1
50d83243d63e083bba51787a3d8fa549985f9304
F20101123_AABCXJ kovar_r_Page_23.tif
5fae17ac47a42df61e255c5e40ff4aac
f2f633bea9662aad5fd33f3dc3aa1c3b059502d0
20891 F20101123_AABCSN kovar_r_Page_15.QC.jpg
613b192d66ae35c16db99535f4385a32
5f03b7992ba27ff35cfbad37b578bb9b806423e5
6373 F20101123_AABDEH kovar_r_Page_28thm.jpg
c17e5cedc648678690f9d8c74236a954
3975102b09b6675029e2e14351d180f3b8d442d4
F20101123_AABCXK kovar_r_Page_24.tif
c619e3e94fafebc503afe59cb19212fc
dc322b88ee718a53ba4317b01fed143b356f6bbb
11502 F20101123_AABCSO kovar_r_Page_26.QC.jpg
eb0f2e2f91c3d62ed0f4097ce05eee02
412f2eb661684e77eeb63f64135e3b159978c0ff
6663 F20101123_AABDEI kovar_r_Page_29thm.jpg
ee5e2f9162027833b286bf0f0e15ccff
3402306a82d17a7eb957983532224233830a5a10
F20101123_AABCXL kovar_r_Page_25.tif
28f3642b379eef1fec4b49cadd452c72
59285ef7f9653d5b4a1aee7de269b11592433a50
25805 F20101123_AABCSP kovar_r_Page_60.jp2
65ee1100534a6e53d56bd59be9dfda3f
8b135020895742f878af8bcde0e45c26b4ca6e6b
23213 F20101123_AABDEJ kovar_r_Page_30.QC.jpg
6d521769e39260f60041c31dc2f0c573
10476103ae1878105b25ab4e50b36c6c973d3b1d
F20101123_AABCXM kovar_r_Page_26.tif
03029bad2e5cd1d6fca606cb13ffb2ef
2b483b86f91925e4f7993015cc512669f6d124bf
70618 F20101123_AABCSQ kovar_r_Page_40.jpg
8bac7670159e83f81c13c9ae8c9751e2
7ec72dddd033179561922cb8753b132baf4e2623
6376 F20101123_AABDEK kovar_r_Page_30thm.jpg
682232b310d9db3edbe4eb84d5a041ec
8d4ed6cd13874155a65a0405e019265e75b8f4da
F20101123_AABCXN kovar_r_Page_27.tif
011d9cb0c812a4a31630bf27b8792555
5aa95a2c926bf477df5843225814184fda7f9dda
6657 F20101123_AABCSR kovar_r_Page_31thm.jpg
3a18d7c04fcaed11d408d5eca1898683
b66f76a55d9aaeaf34c25041ff022c734927dc8d
23859 F20101123_AABDEL kovar_r_Page_31.QC.jpg
6fa419c85a9cd2435365634f8185ef82
6b56149ab68689c51ce7bba60034b3e68d99fc35
F20101123_AABCXO kovar_r_Page_28.tif
c8da04965e2abb56cd2b1b36db592250
c076476b55d5a3a2ea123faf4fe5892e304042ea
113 F20101123_AABCSS kovar_r_Page_02.txt
a7d77a07dce13913e8515f260f81e791
656a3226fd6baebc92581a77965f201a9eaaceae
23451 F20101123_AABDEM kovar_r_Page_32.QC.jpg
73956d519d398d609381414d1d44cafa
e8df051c696e162ffa033ff0b1f6b54336a88443
F20101123_AABCXP kovar_r_Page_29.tif
fbf87bf0d12f44afb60703b5ed7240c2
a03d9b1caeaf5159d69fcd10e50b0f739dd8a34b
98467 F20101123_AABCST kovar_r_Page_10.jp2
2e7c6ef0487fad86aed19b9af159872a
2ab40c3e9ec69255866d8777d12bcb09526fc9ec
6676 F20101123_AABDEN kovar_r_Page_32thm.jpg
43c83d0bc763ed06e05008174194f49e
e5ec110a72cef9c1ef8797bbaafdde6dfbb7e1c6
F20101123_AABCXQ kovar_r_Page_30.tif
fd138e39a9d61ec161994ea09b4a4045
318680f50963e5dbbac3552c0c8e503a2f3b757d
45669 F20101123_AABCSU kovar_r_Page_10.pro
91d287e06e50e80235f7a22a5b4b1f71
ad0d248ca1ea5edf416d1f334c993484bd7ffa0c
23388 F20101123_AABDEO kovar_r_Page_33.QC.jpg
5bca95a1bfe9443c7063c81543c45826
3a2dc2e435e7a9bce2b7ae7993d3a49abb793673
F20101123_AABCXR kovar_r_Page_31.tif
b4be0baa99e7d26fa927b4aff9beeccc
bc9322a4976d3073762136271cf87ff973e791d3
F20101123_AABCSV kovar_r_Page_17.tif
2fc5598bece7498350ed6a179d57b167
ab6b263e43d75c6498313c026c7f5556c65b07c4
6536 F20101123_AABDEP kovar_r_Page_33thm.jpg
548ed436045e2ca73aef74e2ca142fc1
b13fdac2047d76dd60c0e7654f0a70401b445902
F20101123_AABCXS kovar_r_Page_32.tif
83d64b48190d9e5502b272525e27c081
d1ae98ac3b1c13f0e320810a8c09411ccb7e19a7
20159 F20101123_AABDEQ kovar_r_Page_34.QC.jpg
6e71a440bedfa9b27a3d20d010a5af7e
fe252c4d095568278263e095073e473c9459da5a
F20101123_AABCXT kovar_r_Page_33.tif
f8224066a1a0ffb203fb0106e0dfb744
832538f22c89c430665df6ace7ce10a39dea3d3d
103226 F20101123_AABCSW kovar_r_Page_23.jp2
ad196769af4ad0a09f9eef4571cc1405
6e53631b70e57859d4f4921bcf9e479d6821b29b
5540 F20101123_AABDER kovar_r_Page_34thm.jpg
68458dbe81e01a4fdde786db781f9915
58a8b8b9181ca3611b4911870308c0101cddcee0
F20101123_AABCXU kovar_r_Page_34.tif
bfca8cb3ff4c3e0bf107d951f8f14232
36d3b65a644b9f770cf87582f96e551fc8511b07
91848 F20101123_AABCSX UFE0011652_00001.xml FULL
308337a73190a406d3b56e2364373def
a2fb7346b7d604f0d54b1053edf46c9739517ebc
12916 F20101123_AABDES kovar_r_Page_35.QC.jpg
a8347ee465263bc43220b565d5f3d0a4
964f16d1cf2f838ac0dd6e626f63d36b921c8dc1
F20101123_AABCXV kovar_r_Page_35.tif
5b26dab2830ce4fb553a80c4659ecd26
374858e622679efd64cae707c879a87de7313e94
3994 F20101123_AABDET kovar_r_Page_35thm.jpg
e1e3bc703931011f2e5dd651bf09be7f
7e6a6dc56419026c6c94e3555a7193aa069a1259
F20101123_AABCXW kovar_r_Page_37.tif
aad51ef7107b52b0df4af6bbb0d8bf4c
42e73ee28836200ee118e5f41e76d9df83609c80
5357 F20101123_AABCQA kovar_r_Page_21thm.jpg
0892def1d307ad6216c36840c60334ec
ee23aa58b6c373ebb1d972a8b82044ee655754ae
20983 F20101123_AABDEU kovar_r_Page_36.QC.jpg
2deb3a49f54989149eba98c6ad154532
56180b75fd3e8e48bbc826c1d5886a2ada76bfbe
F20101123_AABCXX kovar_r_Page_38.tif
7f0a4f11e445a24f7b267f03bb0b07ee
d6a9d8803e713c4c3c7e76368be39687809dcc9e
5768 F20101123_AABCQB kovar_r_Page_15thm.jpg
f55c3cbddf22c13368006a3bbe6f72ee
4bc3943e03dc1b6b0f437223ba7cda927c87cdbc
22968 F20101123_AABDEV kovar_r_Page_37.QC.jpg
cd3938a9343556f3b1d01632629fff03
273fbfc1a6615d1021a0c7914b17d06b22437b1c
F20101123_AABCXY kovar_r_Page_40.tif
5aea529bc21f7b9e68ae0c6cc7071fc3
e66366047fc5fb83931aa8842ab85b46ca2f8874
54525 F20101123_AABCQC kovar_r_Page_36.pro
6b2a94e42f3a2aef63b9e9c844c4dd2a
820b01844aa84b114943acd29221d051cfed6144
10540 F20101123_AABDEW kovar_r_Page_38.QC.jpg
8b2c014effadaaba2ffbdf1a25e0058b
016ed089ca4550c60f232cd69b69f970f40e3de2
95741 F20101123_AABCVA kovar_r_Page_03.jp2
6ce95e96ab1c7e3b9545f937460e1aed
1eb94cb7e3bd86e44849854d58d08ef0930cefb6
F20101123_AABCXZ kovar_r_Page_41.tif
dc95bbeeaae38bb3d8f15636f6d81630
0d4d5a4c7baf5c476c02f93d96c339920080b2c1
F20101123_AABCQD kovar_r_Page_02.tif
72ed335fce2b85945b5a491871738313
1067d4059a822c29a35267e83ca1b781ba813aa8
3171 F20101123_AABDEX kovar_r_Page_38thm.jpg
766ff910bc6bb2b4a626c7d7b9dc6e84
357f12f3f5af0dbc782a2766abac40e1f36dceb8
88494 F20101123_AABCVB kovar_r_Page_04.jp2
2e620e01a82a4e10bd021d9256d57288
0c6c4645ac7c2bfcfb62d29c9e94230b6a68b619
51420 F20101123_AABCQE kovar_r_Page_18.pro
1022da2541765c5bd6a78c136b796d09
051b1360429b58872130f0c5e1f2afd46152116a
2152 F20101123_AABDCA kovar_r_Page_46.txt
402fb97439ca836fdd0e023875ed6418
b24417fb852c2ec03340020c6916ff2721cf2746
23502 F20101123_AABDEY kovar_r_Page_40.QC.jpg
07587bade5f2bce419a1d499790115ab
714f2920d275f9828e7cc4a203ede720b4101224
1051969 F20101123_AABCVC kovar_r_Page_05.jp2
bc0a624320b48cfb1fb22f098bd77640
031a774bb7576102d5aeff4b6de969656859ddc4
109432 F20101123_AABCQF kovar_r_Page_31.jp2
25415766607e108e4896b85b66537089
a5d6dcb582d80b022749b4412fe5f5f187894120
1745 F20101123_AABDCB kovar_r_Page_47.txt
cbabc716d3a5cbde949eb2c47ca89e51
42bdc0b1d84f3b28c33c70747cf585999000782e
21118 F20101123_AABDEZ kovar_r_Page_41.QC.jpg
464e92c5af8bc4071ed4c90ca73eaa02
a6367054ce81db4f7cf7bcce5f0be146faf4fb37
628457 F20101123_AABCVD kovar_r_Page_06.jp2
c5e1b5e1d1479a101d1003a436b5228a
b3be8c4d115b008c8459b777eb7ada6bb083e24a
24314 F20101123_AABCQG kovar_r_Page_29.QC.jpg
67682c28de40c21bb29def41c236e0f1
7763bcf3d5716285a925c3477fa5ea2753c3d872
678 F20101123_AABDCC kovar_r_Page_48.txt
22c4640ba3c2a6a70fbffd5e70e16c99
deb867f9c2612053ea5998b0b252d3b158fd8c49
1051959 F20101123_AABCVE kovar_r_Page_07.jp2
55d7b36544249d4a4f78863a6a4d2e7b
7a2447455c2acd26250872660adfd1cd7130ee5d
63123 F20101123_AABCQH kovar_r_Page_57.pro
e8e1789ac5ac3f877544abff70e2082b
1bb3e58e6237b80720d311c6b621323867d7773f
2290 F20101123_AABDCD kovar_r_Page_49.txt
02e67f391985f766b8fdb8963dac59a8
429d3729aa219c09c3a8c7eaa8361ff7f872dd83
83528 F20101123_AABCVF kovar_r_Page_08.jp2
6b31af46bf270657bf0b2bea393d17c1
29a393918f49f46bf13994f774bb0dd1a8205183
72835 F20101123_AABCQI kovar_r_Page_11.jpg
57323824714f78984e8d517fde512a38
a7f567becec4d9d11bd6fe6343ac29841a12d006
2347 F20101123_AABDCE kovar_r_Page_50.txt
2ed05200aa8bd0729b28590afb4bd55f
92058dbcf2a3577724d4488a4ab9ac81e2b7cbed
29884 F20101123_AABCVG kovar_r_Page_09.jp2
38ddea08c8c85e79acaee538fc117c06
23b42a3907512af3112698e923f6a26df7e3a23b
61458 F20101123_AABCQJ kovar_r_Page_58.pro
8d97091f9f16d717bae7dfbb5ffaa4b8
087100e3aafc64cbf8feaa0732f9ed2898752fa6
111184 F20101123_AABCVH kovar_r_Page_11.jp2
a00dfb2be473ec40bb36b1d87de1ff24
b2a381a86fb0e673aa9e739577c40e021d595581
1837 F20101123_AABCQK kovar_r_Page_52.txt
c2746daa901e4119e358095c363b8023
9b9e1d85b0be2fa7b44f30f6d03c53133673d8f5
1782 F20101123_AABDCF kovar_r_Page_51.txt
9c60c103858fcc0b5b1e046f56e549b3
2f342758dcb3ff42987c7124543bd013f27c7879
108883 F20101123_AABCVI kovar_r_Page_12.jp2
75fdc8fd590724fe53021160640aec97
197b502b91b39d0706762c3810c5cdc251d082ab
1294 F20101123_AABCQL kovar_r_Page_53.txt
2ed9bce37734f354e9f290241610b38d
19c43656a124d649f687dcaa1d3c8440e4350943
398 F20101123_AABDCG kovar_r_Page_54.txt
469efbf929f32985f65ec2e806c4bede
97a0075bc21e62985f58c35be4b7a391c151fad5
108911 F20101123_AABCVJ kovar_r_Page_13.jp2
00842c9f730d1ed3c723f6305012f3bf
44ec591d7e4a78172f4a841932c68d8aecf0c0b5
69530 F20101123_AABCQM kovar_r_Page_22.jpg
030a351ac797a3498b6ec4f964a3f7b9
91a4441cbde951047e690e8070daad1271e3b3d4
2099 F20101123_AABDCH kovar_r_Page_55.txt
facd3a95dbfa0679f1d47ee32b15e670
4f0e1fbd563c023e40e1d56080572f2574c9e3a6
85910 F20101123_AABCVK kovar_r_Page_14.jp2
95899e2eaea3aafd86d907d46312eee5
470824e02513ac89f6028e0fb89ea2a4c4639162
F20101123_AABCQN kovar_r_Page_22.tif
2a33dc2d15265815f37a7d91a7d5d55d
cc55a5eb413a5b95ae560e61b9522de5bc1f74ce
2603 F20101123_AABDCI kovar_r_Page_56.txt
1a7baac1eaa08b02505d2f292ebb856d
feed23ac64bd643029d22f46614f3bff4534f8b4
98104 F20101123_AABCVL kovar_r_Page_15.jp2
365be4ac0e6295be6f2275fe1bc8a852
5330d37edfcef5671646cafc23d231a68690b0a3
F20101123_AABCQO kovar_r_Page_42.tif
8dc2eac8a7ea17d85fc6468815060356
c15fa884b44712a196de37e2b1a9b096076d93ab
115984 F20101123_AABCVM kovar_r_Page_16.jp2
b2d2f53c720620137d233021f089a2fb
559ff57f7234f89265fc42c12abd9d47ad98a88b
6017 F20101123_AABCQP kovar_r_Page_03thm.jpg
a5793e97b391360299cb9cdfbf474ff1
d596fe7d794d5d832c41e1e18566ea22c015417b
2553 F20101123_AABDCJ kovar_r_Page_57.txt
105aff8188f71680140a5260a9f2d4b4
ff1e3fff6b25cd0a4dc352df3c47c180e22a9956
112355 F20101123_AABCVN kovar_r_Page_18.jp2
6a1fc355d04085d0b9e6d628dc241173
71305a28f94baab368864add5cd8aa0721b623e7
38535 F20101123_AABCQQ kovar_r_Page_35.jpg
de7e01f3a194ff027c86aca0ebce405c
f59164b20c770596b982b8546e9df7805e230ce3
2487 F20101123_AABDCK kovar_r_Page_58.txt
91271f96d28fedbfba60a68b2528958c
cdc447977434ce0f385831ca5d83674b40fbe87f
107258 F20101123_AABCVO kovar_r_Page_20.jp2
e04814f7940983ff0535eeadd21af270
591a9bca871997925b9bf7c3e9d42f23745ca851
F20101123_AABCQR kovar_r_Page_21.tif
9857fb9eae47125c26a5eec966ab1dc7
ee590867561ab56c9a4866a85873d2ec73df4ab9
446 F20101123_AABDCL kovar_r_Page_60.txt
e186cb647ecce27716e747abe092b4b9
e9663a412c4fc748a393f794d743ce645eb5b070
83239 F20101123_AABCVP kovar_r_Page_21.jp2
bc328572516cffb0c996d5905b3e030f
9552157d65ef7d9ac0c2975baba0cdcd2264c7fb
15419 F20101123_AABCQS kovar_r_Page_50.QC.jpg
1be7087c461efae174c12da3ecd0b1d1
11d36068507d2050c3b46fafbc12a78a242d80d4
1139757 F20101123_AABDCM kovar_r.pdf
077e3337b26f938a145133392e934ed8
975ff5a849af12275bebf0ace6460f2d01bd72ea
104061 F20101123_AABCVQ kovar_r_Page_22.jp2
8e60b3965e61f54a76599413cee97079
ae945ab6c1bc894621273127626dfe0f4a81589c
6075 F20101123_AABCQT kovar_r_Page_41thm.jpg
6d1a48de5ee2ba5da51841dafe43dbc3
dab53f202d5e8cd4733027e405b3e77d564ac3b6
2550 F20101123_AABDCN kovar_r_Page_01thm.jpg
b05eb932e126df1ca2fd04c234c6725c
c99175f1928813d32d05ce046acb3fec9e649c06
105142 F20101123_AABCVR kovar_r_Page_25.jp2
b7396017eb1d004a246673d6b3f7ee29
3b384f07c3affea9438c3db4cc77b35c852c178b
7947 F20101123_AABDCO kovar_r_Page_01.QC.jpg
4223be974dab409344463b8e198bbfed
aa7f5fefc8881396832e33ebf49f6b2efb76941e
48288 F20101123_AABCVS kovar_r_Page_26.jp2
24d9270e8cccd9a1823a8f75426b8586
50eb9566595a72fc402f9df6842899e9bfefeb3b
48534 F20101123_AABCQU kovar_r_Page_30.pro
e57c3c1a962a73e363917194156f5188
5931e6af8605f22fb451195ab280b96536c5823e
3302 F20101123_AABDCP kovar_r_Page_02.QC.jpg
aab023624df7ff825bd75e31c51dacc4
90cd5ff9d2f1e95e42068149ba2c60e419b01db9
82357 F20101123_AABCVT kovar_r_Page_27.jp2
418799528d20bbd1b5cf2295b46b974b
7b4c8b45e30c90dedccd3a1afdc176903431d5ce
105555 F20101123_AABCQV kovar_r_Page_19.jp2
a07ddacfab5bf42ab5433c2eb1694e74
182549e7aad66c11612c92821cf1d46b6703cead
1388 F20101123_AABDCQ kovar_r_Page_02thm.jpg
ff451ce8fad0e2db9db066ab54728933
3be4170afaf600c8f7e00994d862fe33d3babfa5
103253 F20101123_AABCVU kovar_r_Page_28.jp2
cb48e908bf1de3a9fadd0c0ac590e499
14d581b2d69a4c829d09ab7eeb6a659b80e76e9b
23346 F20101123_AABCQW kovar_r_Page_20.QC.jpg
2dbdfcc8461d1c4d169da1612f59d9d0
17caa3f0dd5b41699e8891ebdd63d261c8885642
21422 F20101123_AABDCR kovar_r_Page_03.QC.jpg
472eb04e63a1d134a44f9a5c941d442a
9e931ad8f1f939f3cc6bce63951be5e2113cdfbd
111090 F20101123_AABCVV kovar_r_Page_29.jp2
fb96374fc1bfc639ea5f2bd1a8011231
6a3232dceb858ee39e94ff09c082b0eac2d6424b
5574 F20101123_AABCQX kovar_r_Page_36thm.jpg
f8ad6881ce4319a12bbd369934583226
a4c33b9afddb523e47f22114fb366104a0f7314b
20467 F20101123_AABDCS kovar_r_Page_04.QC.jpg
424191e1ac7897fc9858f8754abc65e5
eecb6f97349fa032eacb49c3168f5f9eb660d95d
105468 F20101123_AABCVW kovar_r_Page_30.jp2
bd4c82de0ea69e88cf3c4b2f27f3ad5d
4024cf6f1e9232f8d439989b4d62c1503bc1a6af
1931 F20101123_AABCQY kovar_r_Page_25.txt
8a84b3292e828069a8911e77f82a9538
bce4582f7f195ee69f8e91e37adf8be19c80e3d2
5558 F20101123_AABDCT kovar_r_Page_04thm.jpg
07f824c89118bf9a4475743d04e3f870
6e6362ea2f42c5e6e6884651aac58683d35aef2e
109499 F20101123_AABCVX kovar_r_Page_33.jp2
ba2871926a4683b2d8a136ab22e11eb5
30601bae09b96e42902dbed159f911662342798a
6345 F20101123_AABCQZ kovar_r_Page_25thm.jpg
658ddae5cd90af25ff06f3d45902aac2
b85aff7846994ed93aeb1c2558ebcf23b5a71b13
15378 F20101123_AABDCU kovar_r_Page_05.QC.jpg
89785e8668f282b47221a2a34fc116c8
7f981eab56be75748df5aec000248397e7f9406c
97379 F20101123_AABCVY kovar_r_Page_34.jp2
35d2c6b512525844f23bd06da1148bcb
03485be3cf469fec1b9393ebdbaf0d22b1490e6d
4263 F20101123_AABDCV kovar_r_Page_05thm.jpg
e947bb890722185c9c9c505bf9149661
4f52d390dab2f65a22f791b09e413075dc2efe22
8210 F20101123_AABDCW kovar_r_Page_06.QC.jpg
896e6ec38141f7440b2bdd035e55dac8
64842c1d88dcee13088e4134e0b932ac5f9d442b
26175 F20101123_AABCTA kovar_r_Page_01.jpg
a840792c47e30ca1c8867aaabdb8f7b4
4d7480360b42928f7e1288b3e1f09c43e938e80c
54885 F20101123_AABCVZ kovar_r_Page_35.jp2
542de3ded77e4cd1a62a00f73515ac08
bda1995a68f93a526fbe82ce7b9fb077dfdb63b2
2695 F20101123_AABDCX kovar_r_Page_06thm.jpg
8d52fd949867f9745824f9beebcb2c72
1a4b47e85630488451ea9452b3e668d9f454dfc6
10386 F20101123_AABCTB kovar_r_Page_02.jpg
3781c24be7249835a6bbd4f3674f1ac4
21068ab22aef2670e0aba107cbe60e20bc27708c
21116 F20101123_AABDAA kovar_r_Page_44.pro
fc10aae8a4a9dcb4220346ef85cd4ec5
965e4c7a32062ddd691252b2dea9ac0a766cd101
13319 F20101123_AABDCY kovar_r_Page_07.QC.jpg
ce74deeb1c7e7f204f84058faf3a6131
766372b856b9406398e2b5b82d645c765042f93b
65441 F20101123_AABCTC kovar_r_Page_03.jpg
ba6aa4d312ee36ccd0d1d7162c614d40
4860c63b0feffd744386092d38b8838c36da30fe
F20101123_AABCYA kovar_r_Page_43.tif
4e140d44d686cc692580c3a578567f1a
f9e6a3996cc0ca4dc58dc7a37387e57273ed1739
39493 F20101123_AABDAB kovar_r_Page_45.pro
9f657d0bdb7000b0cb6feeb47561afbd
0bd67c7fa0cf11921aeac011cd723f7e20fdbd2f
3766 F20101123_AABDCZ kovar_r_Page_07thm.jpg
9a9b1b5370d91c1a2e6a0ca5055f9506
7d5955da41af80619196c5f2bfc10f9eaf35e1e5
60668 F20101123_AABCTD kovar_r_Page_04.jpg
62e87d494226c6dd3c5a012e35a200bf
0198ca8cb5ce1e8247de4e3d062f1a502ee89383
F20101123_AABCYB kovar_r_Page_44.tif
79201ec4ad7f33cbb12d938d0846e208
d30fd0ead368e3eacb07f941f9a521ac3e8bd83d
47368 F20101123_AABDAC kovar_r_Page_46.pro
ffab2a195fd60fde16a93dcad672563e
cdd48d339b0e2600158c0034022e2436b8724b61
57107 F20101123_AABCTE kovar_r_Page_05.jpg
bbfde3697a5b0b8c49d8d4130ec84092
9a605119e39248230cf54d25fc680a1858fa2019
22396 F20101123_AABDFA kovar_r_Page_42.QC.jpg
c82f911327017018474e0da2bbae735a
224f75cdea2bdc2aeb1be51493dc53ad38133fbc
F20101123_AABCYC kovar_r_Page_45.tif
c50aacc958b051bc0fc67def914a5b3d
7f58422031d02a3485fa2940a7c0f3d19cbceb3b
27777 F20101123_AABCTF kovar_r_Page_06.jpg
e5c3f51486b53a06a4407d3286c5f39d
4c10ffe11bcfb04cb385efee2f0cdd1e89b7ab94
6333 F20101123_AABDFB kovar_r_Page_42thm.jpg
e17593606de2bfe67a165e11c9aa2210
016c3a0a4991c982de240449ba9641022f1a6b63
F20101123_AABCYD kovar_r_Page_46.tif
678b98ae9fd5ec67358ad4b2e79d198a
2b921ade925e98c1c8aa234d20852371a52ef1dd
41894 F20101123_AABDAD kovar_r_Page_47.pro
cc843087163df0bb7a4ed7cd63ab0477
04f85c6801c4aaf3896919e02b4a331f2c75c961
44154 F20101123_AABCTG kovar_r_Page_07.jpg
abc18866732909dfdfe4e7abc5407c8d
028babe1042230b7654319a91c9fba95aafa0ba3
22493 F20101123_AABDFC kovar_r_Page_43.QC.jpg
00f9879b6edbfc0e8045285f4801d55d
819812522710a2814468f2c4caa1dc9c42138b5b
F20101123_AABCYE kovar_r_Page_47.tif
967183e2e866b66264f0e25369461a6e
50954b8003bcd3270b324f9dcf290ba2c06c0658
12518 F20101123_AABDAE kovar_r_Page_48.pro
5cba199a73c0970c9efac0543df6ff20
0835d9df731dde587c20e82daf5a18d6763bd817
57701 F20101123_AABCTH kovar_r_Page_08.jpg
8a75343d9de82cc2223e2e0a525cf9c0
9ce19c08a734e3698c67e7d393f3998b1fa32eea
6398 F20101123_AABDFD kovar_r_Page_43thm.jpg
0ba1cf17aa9d71adbe15610aac3f7322
457442d7ec24fce317cdb40c28dde901bc604875
F20101123_AABCYF kovar_r_Page_48.tif
3a1d2d9c451d5418c5504103af7baf2f
5b2e9ea6b11047abd8c448e441892a9aa7d2d6b4
46257 F20101123_AABDAF kovar_r_Page_49.pro
6507a750d2ccdc99d2e75f675234ab18
38c95204b17b3df42024a35a06382db13bc6905c
23565 F20101123_AABCTI kovar_r_Page_09.jpg
d1de599fe8103acef7754860925cee32
6dd0f466fe84e58d1dbdbae2648e2036cf2099cb
11171 F20101123_AABDFE kovar_r_Page_44.QC.jpg
fcd66e6f4049e42d68685a3afe32e616
3411f9298514a9c018d4b2177624524169e15977
25271604 F20101123_AABCYG kovar_r_Page_49.tif
b9bc7b41dd70e13320934ac03ea98fc0
59c3c89c456d7e39e7aacad04c45afb27e258f15
46209 F20101123_AABDAG kovar_r_Page_50.pro
47ab3bf7c4ebc5c60758ebee65b0b267
10a743d43aabc52171f7d6280595c30b348e518e
67020 F20101123_AABCTJ kovar_r_Page_10.jpg
289fc8042c0659a7aabd794b16545c03
bca44d8fe58a88a333b2521483ae7b2462855e7a
3494 F20101123_AABDFF kovar_r_Page_44thm.jpg
f6d79764eb928a615d0caa76e5d4bc66
654e9f7b13396fb8793a3b1510c4cd46adc89bc6
F20101123_AABCYH kovar_r_Page_50.tif
73fad9149ccfaadbdf1ea0a588e7af41
7d10fb1a0ecb85d302c32f20c9c1d1a71723f481
35885 F20101123_AABDAH kovar_r_Page_51.pro
50c7226693810713c14237fa449e4b74
7afa0c117c3d9fb2add9fbdcb1d4ad2dcb758df0
71432 F20101123_AABCTK kovar_r_Page_12.jpg
f26d947514a2308975432b38039d911d
826660db4718b001419afef7f3550917dca4ce4d
F20101123_AABCYI kovar_r_Page_52.tif
6fbedce27c4cfa77a0d8867177489263
506503c27793982cb79ebd311860f25b4933d29c
35690 F20101123_AABDAI kovar_r_Page_52.pro
e4c51e1c56b6132ef04dd322c79423c2
b553a3b7551a13844f74cce069b8c98ba71b46bb
71754 F20101123_AABCTL kovar_r_Page_13.jpg
2059a59aecbce957c2581ea0d5267b18
977535f1523bbe0c4b9c81e931829505cf704fbb
21090 F20101123_AABDFG kovar_r_Page_45.QC.jpg
e084071f58a9342b82602e7bfea9e688
06af6bfebd5367981033a1393b8cfae3bc277b09
F20101123_AABCYJ kovar_r_Page_53.tif
ba6ad820a6c7ff1151e573698558888d
f6ebad17dcda45a03e4c94585d50c8e309cedfe3
29851 F20101123_AABDAJ kovar_r_Page_53.pro
bf06bca5a46d7f25b7ecb6d12318f89c
74832bd8db06aa16aa5e75b240370e99b70e4479
59112 F20101123_AABCTM kovar_r_Page_14.jpg
f0b417763318085729bdbcd2c3695c35
4d0d01d44fa2d00fbfc67b355b7a3c3d4f6aba5d
5839 F20101123_AABDFH kovar_r_Page_45thm.jpg
3940c613a879d614ece71bcf3a1434a0
1ba7ac74efdc2cbd8a4a9ababfe235480d222e22
F20101123_AABCYK kovar_r_Page_54.tif
4fc2f071c4cc08f7a3eced1e2b614e52
130b8557ba74beb603ade3fbaaac8b739dc669ab
8334 F20101123_AABDAK kovar_r_Page_54.pro
06e7699081d0f2c268a6be42687ce277
3a08afdc1ea62012c235f045ca3498efdbd8bb21
65758 F20101123_AABCTN kovar_r_Page_15.jpg
c2d4200bb632789147e2fb1f046a62e8
6e5f9e178b2818b970fa034ea5724fd1ae1ef321
F20101123_AABCYL kovar_r_Page_56.tif
ac6b3e90b3938ee19073f366ffefede4
d6012d3d5f64625892c8a09066614150fa79d81e
51533 F20101123_AABDAL kovar_r_Page_55.pro
471d8295780b7592787907397a52b359
eec57456387899c60a448f74fc82d453d2bd8d35
75189 F20101123_AABCTO kovar_r_Page_16.jpg
43c326621c1af9acf501d05c53895df3
2ce97e3eb80a9a40e523b97b84b477d85bfbdd1a
23738 F20101123_AABDFI kovar_r_Page_46.QC.jpg
92a4570cb0507ad45600cd229cf6bc37
6fb2efd87991c418269b90c6edee7ab873aba87b
F20101123_AABCYM kovar_r_Page_58.tif
e2d5c47b705b17a4c845c50d243f0c06
0414208ecc19d914fdcdd146a048de4788d66ade
64353 F20101123_AABDAM kovar_r_Page_56.pro
47ddf5690550e382dd30ea097d14497a
96fdaaff3a316854af984b5c0a9a8a01966231df
73064 F20101123_AABCTP kovar_r_Page_18.jpg
d784f280eb60b70b1a382a6beffea6a1
4c035b2fc7bc716fb03e833c4dfd4bfd0f16dd5b
6394 F20101123_AABDFJ kovar_r_Page_46thm.jpg
9b8d8cacc6b19626c50962fe4553be3c
0dc7953b1449e99fb8f56d40b2c173d237f2de48
F20101123_AABCYN kovar_r_Page_59.tif
b86ffd95e0b4cba1ea4d3079a6b5bbac
f734cb3cf221026b5d6d2b99ef8e01b430b19ca6
65255 F20101123_AABDAN kovar_r_Page_59.pro
da755d5b15979b839335aaaa504e1a1b
0dedb8fca147121a1b0976320c34de4955f71c0c
68244 F20101123_AABCTQ kovar_r_Page_19.jpg
83e1d6228464a0e3049779cb9c4d5bbb
8367b0f2e984f99c9f4ead1060a72457c2ee0454
23524 F20101123_AABDFK kovar_r_Page_47.QC.jpg
0a6605f06bfc67cfe28d2d055fdacbcb
fc22d1b11a8f33645c00b9ef6ee38c9f035d5976
F20101123_AABCYO kovar_r_Page_60.tif
fed95270777de15fa8e791f415b17100
f379cb488c6bd7cc6d15013d002e09be68ee6e55
9979 F20101123_AABDAO kovar_r_Page_60.pro
c87cd3663d665ccd0e88f748d0b36225
10889922a23763525952c77c88d101002a599348
70569 F20101123_AABCTR kovar_r_Page_20.jpg
6ece1f644944acc720586a29cd3ca679
344d3bde2de4699480607ec1271c53e83676da1d
6178 F20101123_AABDFL kovar_r_Page_47thm.jpg
e0dde39d3a22e57294acc9647cda17cb
26c7f9991f95a85aba3c59e34c5b490bfc3fdcb3
8612 F20101123_AABDFM kovar_r_Page_48.QC.jpg
b88a5de7a6b4cbb84c06546faf9f0ae7
5f8c222516608a086af522dbbdd79efed64df391
9127 F20101123_AABCYP kovar_r_Page_01.pro
9c360733a603762dc5e11782f756e4e6
487d285e89f7b2ecca07b8c9a40320019691f97d
489 F20101123_AABDAP kovar_r_Page_01.txt
3be734f074dc6e7df32244ebf7e91df6
32f151b275f1d2260a6035b0c47dee2e31d02426
56049 F20101123_AABCTS kovar_r_Page_21.jpg
379a6d8493d824e8b721fe6ad1eec58d
4bd3a810f45afb6655e82f63d5904986585454a8
2779 F20101123_AABDFN kovar_r_Page_48thm.jpg
6a85b1a29c53e68f3ad2b912dab88c3d
c23755b850ac9f1002fd5e19e3e1f9d0b9cba337
1198 F20101123_AABCYQ kovar_r_Page_02.pro
4fa615db698724aa2258daf19c5b9ea3
4bebb9f6be7af813f88f2d3ef80dcc03db19639b
1825 F20101123_AABDAQ kovar_r_Page_03.txt
33f2eea5e876e906df0a57b9e9d27db3
16cd8c9f3ca370e645174db6bcc893cb4bc8cb2d
68834 F20101123_AABCTT kovar_r_Page_23.jpg
856443fa8fcb21a248708a65dd816969
e97ce3a9bf6701d8bf08aa80614d71a3424ca580
15762 F20101123_AABDFO kovar_r_Page_49.QC.jpg
6bdebbff79bcbf6bb896521a1aa36a48
314cf1d3a8be8514fe603cd96703cd1d26012fc2
45480 F20101123_AABCYR kovar_r_Page_03.pro
88bfc39d27e43c2a08f423033f41107f
d292fd6537f0c658859483db514eaebdc0076577
1650 F20101123_AABDAR kovar_r_Page_04.txt
4407616bff367379184db6c1f595fd01
7b4dd576a4c4f0d46c95ba24c669cd959f5b6c54
69326 F20101123_AABCTU kovar_r_Page_25.jpg
02dd74b9d7f89829da1b5492ea73e12c
4366b7c0349e20449d5596c2e9715c07f629f227
4368 F20101123_AABDFP kovar_r_Page_50thm.jpg
b1c8b8cc5b53a7a154b39c387c44cae0
9cf075b39cfa519cc839f017b92183e643a4841a
41453 F20101123_AABCYS kovar_r_Page_04.pro
85b01501e40f6175ade06426d19aa1e4
874a496502ac52af4a90b25cc61e3a715644f876
3206 F20101123_AABDAS kovar_r_Page_05.txt
4d2dd874851cd1305bab488e510c1a63
2db293ad31f7421903ab328385d8a81ffee6b6a5
34675 F20101123_AABCTV kovar_r_Page_26.jpg
4e0a22f3e662db66cd5933e26a31080d
e01b127afc6469d0a2b9e36fffd6b95708659efc
15361 F20101123_AABDFQ kovar_r_Page_51.QC.jpg
5953b5a6a897b1cade385aa88d1f91cf
30d3f4797256dd5e9f662f6b7d395350c49010e7
77335 F20101123_AABCYT kovar_r_Page_05.pro
cc0ff1c0f6cf205d39ae82c3a6ad689f
bdf83e0a7c00601bbdb3f6f8b13f9d55d2093c69
1201 F20101123_AABDAT kovar_r_Page_07.txt
a35f080f1ebff3e85260d5de9c5760a2
5c4a9e39c9b3415eb2fc0de818fa26342ff5b1fb
57425 F20101123_AABCTW kovar_r_Page_27.jpg
aa47eda0bfc16199dd80e702416e1f82
0da76ad3bf3f14d8153828ec0414911f8b472575
4405 F20101123_AABDFR kovar_r_Page_51thm.jpg
582097380445c25b0d43f84b4c824ff0
ee08793608f2a97b1edeb5ba53b6b515725f80d7
18515 F20101123_AABCYU kovar_r_Page_06.pro
40ff591096beb692b3af1c5e69bf5aa4
44ce62eeab11e9dae371374e17ec3f5c1f0701c2
1613 F20101123_AABDAU kovar_r_Page_08.txt
877c810a6c8d91c13d3cdc120d3cdc39
b8fafc2148c728331d33f81d301e73bdeac5eb0a
14115 F20101123_AABDFS kovar_r_Page_52.QC.jpg
f62b3fe012488d0229fc87afebd23099
c96c3148a7a69b62beab058cf75d49802f96e5c7
28890 F20101123_AABCYV kovar_r_Page_07.pro
d8c947b5bed056f35038686b16a1f879
77d8012222e7569713c05a75fbb874fe7d6bec6c
490 F20101123_AABDAV kovar_r_Page_09.txt
04d60ac0f89c759b7245508052284746
d6016d49334caa18903521df043ed3bef439d5a6
69527 F20101123_AABCTX kovar_r_Page_28.jpg
ac3d6e7b68d6a251597c46fd80fe5a9d
3090704080ce1a5da02f3b31c998a5e3a0bfc091
4067 F20101123_AABDFT kovar_r_Page_52thm.jpg
961062a5d56bc28f72701b6f51c7d44a
4c5c23ef99d2e54ed197562e861a241c0b1529fa
36507 F20101123_AABCYW kovar_r_Page_08.pro
24fee585c63813ce606ca3bce22a45b0
e7127e1b25745afe2659fee81fbba4fd173d4fd2
1880 F20101123_AABDAW kovar_r_Page_10.txt
cf04fb16255c7b1b6e690e092d0902b0
26f0c2f300b5bdb0fc014c98c3b27c7e7faaadac
F20101123_AABCRA kovar_r_Page_36.tif
869ed9199451975461102f14f390cb6c
017b995583a6947ad175173c93d8150b1e7f0905
72483 F20101123_AABCTY kovar_r_Page_31.jpg
63170a020f33c7a00bb854e93444da5b
6345dd0618d52f35a47dc6f3f2e86361f1f82c9c
14892 F20101123_AABDFU kovar_r_Page_53.QC.jpg
6cb7fc61c27beb5f78a38fc2a3466020
6bf0e72c94b2a627344cc59fa342cb496b27a06e
12111 F20101123_AABCYX kovar_r_Page_09.pro
3aafb3c016ec6d144df8945c8a7d6e7a
8a1578f3a47bebe235257a5ed4e960da83135a88
1983 F20101123_AABDAX kovar_r_Page_12.txt
8b453799b60b38c3ea837413ebacdd20
dd516e3de9cfa778b0021f539fbde3087b86c229
6691 F20101123_AABCRB kovar_r_Page_58thm.jpg
d10600d719e0313da6f86533a0f699f7
7203f33870d555a16d734eeae5a44743fb4e6d54
71418 F20101123_AABCTZ kovar_r_Page_32.jpg
e6ceb9d8cfdb7312bff71c445ca57e9c
835acc82c24ae31376b8b907c146e77e6c2afce8
4560 F20101123_AABDFV kovar_r_Page_53thm.jpg
adee4952bad1a71cfe9b545be594a455
f65620fe3e3bda21922879cc8b0a71733500fd69
51559 F20101123_AABCYY kovar_r_Page_11.pro
e2de787cd6dcd6d193b3597f11a3edee
3fd70a52db1bbf7f43c18e7472146450c3c7e769
2045 F20101123_AABDAY kovar_r_Page_13.txt
c9029ca2aa7eb7a43979b10a7bc7ee95
0cd4ec28b4bb947e5cd68def7afe06dd47a12060
22840 F20101123_AABCRC kovar_r_Page_28.QC.jpg
61824e86f4846193bd53f5216faa3b9a
aa5b598e40899c6c9cd8b12de987b4e755eb5100
6582 F20101123_AABDFW kovar_r_Page_54.QC.jpg
ade994673cd4b96f8f8d3ae3190d04d4
947c51f78ecf5f095503877835c49e4ab1fb6227
50214 F20101123_AABCYZ kovar_r_Page_12.pro
57627c13961e02767c0b0ae4f42a44c8
4649c8432952d637bf89a345960915e06760c5a7
1598 F20101123_AABDAZ kovar_r_Page_14.txt
2973bccb773a4c71066911badf463731
d741afb726e9c30c0016cb4516c0bb4e56f5c423
1051953 F20101123_AABCRD kovar_r_Page_49.jp2
d6ef2206a3c794f814ae94f93338fdf7
934cda91d92b0adbc0d5b7b36e7c23f03e4e2545
106410 F20101123_AABCWA kovar_r_Page_36.jp2
d96d94d92bf861a1ac04c677774c1ca5
07783e73c335a6aa438b44d67a48691215c52196
2256 F20101123_AABDFX kovar_r_Page_54thm.jpg
844815d3132c18d51259df691405e4de
952ded32ceb145e153769dc1fdf8717afe2c125a
72668 F20101123_AABCRE kovar_r_Page_17.jpg
bc8f496cd193346f765eb9a620ce1168
4b9d68d1958fbfd197534ed384a1bca0e0be619d
113973 F20101123_AABCWB kovar_r_Page_37.jp2
a4fd74768589ab3c8f4fe70f31a15d21
e1daf5a4e59822ba042b83249b52b2f2c1d6eab1
21601 F20101123_AABDFY kovar_r_Page_55.QC.jpg
e91082ca2052dc3341bd961f5b38e09b
2c88123c0d4fdf02c908716428ad8beebc0a8819
6591 F20101123_AABCRF kovar_r_Page_13thm.jpg
f1e2f59bcb5366c1dfb2796c599b1c2d
f287d01e906c4def7928fec796f65b18f2fc296b
17886 F20101123_AABDDA kovar_r_Page_08.QC.jpg
30a097d09c0adb0475f39c438c6939b1
e7380fc95561059ea114f67dd5a04c0265d1b43d
92147 F20101123_AABCWC kovar_r_Page_39.jp2
7a43c0de12f828624f03ea89233757a7
ef2e395d03c2da068f556f7d9cd78bda17b5978e
5774 F20101123_AABDFZ kovar_r_Page_55thm.jpg
1de81a42c30ee45d390ba3f4b578c732
ad5a41d515674f3c4dd950611cd5955683196f0b
721 F20101123_AABCRG kovar_r_Page_06.txt
44ad9c8501b3a3e3f24cce32ca215a40
53647abe0f71f54f220ee40c5b80d467828c02a4
5075 F20101123_AABDDB kovar_r_Page_08thm.jpg
bbd5ee87a6d64d4420f5118152a7f0fc
09561921f0603af979af6ba08627fd38a4b1fa16
98957 F20101123_AABCWD kovar_r_Page_41.jp2
20497478657a292b374c01113d725985
713824ae49bbd00c30083adaad1df103a21e3edb
F20101123_AABCRH kovar_r_Page_07.tif
36afd9bbe4bff46bab74c80c417166bb
a1bc2f3bf97e56a84fcd68e924d4d03056bb0486
7923 F20101123_AABDDC kovar_r_Page_09.QC.jpg
00eb45dbe5d8a0bc671a8c0ad4da1318
079f816c604d5b9da129652100b682df888684c1
103234 F20101123_AABCWE kovar_r_Page_42.jp2
bfc65d1dd7f5f30ea982e521f0c6d0e7
b781f81553d6d868fdc139d90e18db27971b7e19
840 F20101123_AABCRI kovar_r_Page_44.txt
e01bbae6c965e28bef94ecea38f1b746
5a15b83db39252daeb1b3ad78c08b2e91eac4e7a
2467 F20101123_AABDDD kovar_r_Page_09thm.jpg
9281d8e72dcda5c4c15a038eda98356c
ba0aeaf7eed692f4d954f00c1fc789071d49177c
107069 F20101123_AABCWF kovar_r_Page_43.jp2
bf6e9b6f0a38b824527f55f9f3dc6731
7fe9f0546d03709b74da6a29a374319ffbb1abc6
2824 F20101123_AABCRJ kovar_r_Page_37.txt
fc3d0c7763ca74f8a68cd0860cfd3f65
4605a48bb7997b973043ddeacb2c97968cff89db
21686 F20101123_AABDDE kovar_r_Page_10.QC.jpg
1fd0764a980cad933bd0a208e46c2c8d
9fb66f18f5c143743d8cacf2d68950425f1b7c78
48195 F20101123_AABCWG kovar_r_Page_44.jp2
04e40fd65dae3780910a16647a28bf94
b683ba38a043aec7cc8e928feaa026f2b61760f3
113348 F20101123_AABCRK kovar_r_Page_24.jp2
64f6534c22f66704b28c2b1cce5bb89e
88daab252b906318e94f7cfaf1ed03110b38abf6
6104 F20101123_AABDDF kovar_r_Page_10thm.jpg
4bb8018d1e03f800ed82ea7bb36488aa
801d0e960207786180fc784cae8cccebf94e1b07
83445 F20101123_AABCWH kovar_r_Page_45.jp2
f97afd6c8512a069c95b8b5024fee991
a996f13c9261bd8109f071fec14d28dc3a7aeacf
44617 F20101123_AABCRL kovar_r_Page_41.pro
a5f20f36a5cbee66df5a8ebe08ab4565
8a98f07e17c180a0905a9aa3809c4537e128bce4
90847 F20101123_AABCWI kovar_r_Page_46.jp2
968fedb99c9ac0c5e9a2bd503ff7fa8f
5b8ac01976f5bedb3c6586dfb929efdadb2f5e9a
6380 F20101123_AABCRM kovar_r_Page_37thm.jpg
75d31c75e6b78712196466d343e8ff7f
76a7741e81a033f4cfbe9b50b764b7b66478c8e9
23714 F20101123_AABDDG kovar_r_Page_11.QC.jpg
b38d3c13fe22e8b1986bf030cfa7f03b
1d1f293b64db559bdec1e46d7f6854caeac5eaee
25049 F20101123_AABCWJ kovar_r_Page_48.jp2
ce1ec24586986a35e8b05cfb0719aad8
112441ff3a0f08f66edc69ec4dbbb2ea20110868
51775 F20101123_AABCRN kovar_r_Page_34.pro
d9cc390ac875cfe31606e67a80ea21f5
75cd460d51cedda7c3fe8d2f3e1004be24bbdbd5
6559 F20101123_AABDDH kovar_r_Page_11thm.jpg
04e82a68fa97be55567a0e056883514c
70d2c10756897246526360e590129927e0de39ae
1051738 F20101123_AABCWK kovar_r_Page_50.jp2
f05e88c52de1a15fedd482f56ca02c05
0a6168aaf59c0a801e60c6d7d2514497fb26e524
23426 F20101123_AABDDI kovar_r_Page_12.QC.jpg
f4733fe752c574a6db4942b7358e2767
6bed52fda51e50530b83ffc9b27d29a9359b714f
1051982 F20101123_AABCWL kovar_r_Page_51.jp2
0d463c642b2bc85cd3f9b795e0882d26
7dbc3b1a934f8b2baece0414a44ac00350df797d
6641 F20101123_AABCRO kovar_r_Page_40thm.jpg
3c0dbc03a72bad5a07dd924f9ae43fee
e96caaa09f6757cb65678c755539fe7f6e972e5e
6606 F20101123_AABDDJ kovar_r_Page_12thm.jpg
8b83eafa7b573b948694a946e7b3b09c
b20cc318af3ad40c40eb0ba0777eda9853868277
1051925 F20101123_AABCWM kovar_r_Page_52.jp2
5b3ec4091e0f8fded35db1ee99cdd91a
3c2d0dcea819355d943dbc35d60463904d852b82
74607 F20101123_AABCRP kovar_r_Page_24.jpg
10e515a1b62ddc72665b4742582e0293
766a15b5288932ede8d7970c5b0ecc5534e0999e
23244 F20101123_AABDDK kovar_r_Page_13.QC.jpg
3ca6318696c7f2bfbaff2011f155d82c
9a0e8916b9f5ffc67fda579d3931916326318992
64309 F20101123_AABCWN kovar_r_Page_53.jp2
4b45ec33d1b9c3a1901054d94428676b
383f221de43f8c1575a56036e2568c42d92868ff
85713 F20101123_AABCRQ kovar_r_Page_47.jp2
c06af6323c720ce5e34ecc8bb296766f
4a4be3bd985447355e5e6194763c3799109e4512
18169 F20101123_AABDDL kovar_r_Page_14.QC.jpg
123febbf418797c49731bf7ce1c5a2af
7364040cf4ccb606088bbf52d559af8d247339d0
136418 F20101123_AABCWO kovar_r_Page_56.jp2
8e4042472549af802548e3fca2a2fcf5
322a79defe365fcfc3c7e2129719c8c63c2d72f9
F20101123_AABCRR kovar_r_Page_39.tif
5b6165ab597f78f38a1b1014be3187d1
79375c842704d31c2d7a1d220826e16c465945e5
5084 F20101123_AABDDM kovar_r_Page_14thm.jpg
e2445ac15566e25b31f3a5c30c05b89d
26e78c1d59bebdd5b230bb4d1e88ea58b46105c9
133902 F20101123_AABCWP kovar_r_Page_57.jp2
f4484897f8d488575d58c93f684546e8
e3e7de452333818a4cdbdc3555be01f2618bf33c
F20101123_AABCRS kovar_r_Page_55.tif
1260f25a1dda87cc4c90c9e8d3acae07
24b81162378e8c05bdc498643ce35b29ae214922
24376 F20101123_AABDDN kovar_r_Page_16.QC.jpg
97ae60f3fb1c19d61214bd1f2c125400
8bf80d0399fb76f04f601965d1157cbc0d249ca3
131829 F20101123_AABCWQ kovar_r_Page_58.jp2
fd0f10901a0e9c53d755a4c292e4afd9
be38101b427c021d8c638be90746dd823b814f43
73849 F20101123_AABCRT kovar_r_Page_29.jpg
7b52b11aa6f5eb480de599ab8da845a1
1c0a84a96c28be40ec4ce3153845c59abedf89ab
6817 F20101123_AABDDO kovar_r_Page_16thm.jpg
8e3eb907050358237107e7fb1fdf4151
94ed8fa1c4b66779c7292f44e2b717a508f9647e
138253 F20101123_AABCWR kovar_r_Page_59.jp2
fd4adf5cd2b493f88c70af340c8a7c17
7a3fe624c106d1c3a961dd5049cdeec2e5bf4fd2
5676 F20101123_AABCRU kovar_r_Page_39thm.jpg
1e92f9b030ab5e049e7d7c6e704c63c4
1167cd5b1d1cac2dec09f7ebca21a4108a74254f
24081 F20101123_AABDDP kovar_r_Page_17.QC.jpg
e3d1d928a779127bc5d6b688161ffc82
a64607431fa5ee19b2213b4b4ff5280d4371ae73
F20101123_AABCWS kovar_r_Page_01.tif
058466b282e9835bf017e121362051a9
9c77a41017ebd99d6c51a5e413e98f63fde89746
6573 F20101123_AABDDQ kovar_r_Page_17thm.jpg
cbc16ab4cfe6d2d40e1ff38681151bfe
eef7cf310843108093db1de050e0c289a9a36ed4
F20101123_AABCWT kovar_r_Page_03.tif
497ee3256e018e5cb224ae6d00f4d4f6
8482a8f0d7ba7f7bccbaa53779eec41d463f3a37
4445 F20101123_AABCRV kovar_r_Page_49thm.jpg
511747cbac16fe793617fed1f03c3f09
451a6691158579d2104297b61d0b762bd71f3b76
24121 F20101123_AABDDR kovar_r_Page_18.QC.jpg
3529c145e0701e4437ff01432973bf40
bc4d4c357607fb86954eb87f37359a451c00d121
F20101123_AABCWU kovar_r_Page_04.tif
d2a145bbdafbd35b130ef967a612ab66
e0d84937bbed90eaa2392502226f11ab992c10d7
1973 F20101123_AABCRW kovar_r_Page_29.txt
4291c1f06a885150125f17bb954f8916
5a7363e7a79a0731fc2acf812a6092db8469eb93
6478 F20101123_AABDDS kovar_r_Page_18thm.jpg
59d31f6b54a4ebc0e430784f6cec81ef
cf8f2835221c49aec91f4b64560515cf301d17d2
F20101123_AABCWV kovar_r_Page_05.tif
885979a9eafc480118296b951380022d
f8c40bdadaff7826e209ba5e14d8cd2028e56955
19935 F20101123_AABCRX kovar_r_Page_39.QC.jpg
2446c87c5333b85f89cb0a6e48cd45e3
22e443ed543376f8146037e96f22b84f36b86f5b
22829 F20101123_AABDDT kovar_r_Page_19.QC.jpg
84c65e359428b05c1f70b212d250426a
fbadefe8f716ea31fa7dcdad2fc404951f597559
F20101123_AABCWW kovar_r_Page_06.tif
e874201669d462033cdda67c09814e13
450e6fa424a9ad7705b19352dbf860bba2864200
F20101123_AABCRY kovar_r_Page_51.tif
f8b8994bf801a0b7a56509985030e45e
3d96148c19e156730667af76b05e05daefbd1862
6320 F20101123_AABDDU kovar_r_Page_19thm.jpg
a06cbf70feac42d281950e0782c36451
e53a57bb0c3b19271e27b532b88d80dbb3918432
F20101123_AABCWX kovar_r_Page_08.tif
90d68d4e5d4f225738967d47ca140308
928428d0b5c7da94810780faaa381d0850ce9f95
F20101123_AABCRZ kovar_r_Page_17.jp2
b951c71fd9ae446d9f8fa6b2f8014b3e
0cec166f1525aa133e35ce4f6ff0cb8cd560bb36
6508 F20101123_AABDDV kovar_r_Page_20thm.jpg
17eecd7a79161461aa0efb7c5b5c1fc8
2d0f8bd491529a5bfd3cbe803003fdd0317db93c
F20101123_AABCWY kovar_r_Page_09.tif
599b75937fa0b9bcebd95ae257c56256
5cd5856285080f5152394c2d3d7a978b0789690f
18073 F20101123_AABDDW kovar_r_Page_21.QC.jpg
e34de1dde3df333402e31c7778d36e71
7f4057d6ad8e9823a28565315c65d01a3eb96a06
71880 F20101123_AABCUA kovar_r_Page_33.jpg
64c66a626eb5d58843291bfaba6e944c
579ea81efcc4555c5f8483752e2c64ce68757883
F20101123_AABCWZ kovar_r_Page_10.tif
b904ce77196ee936b0ba50649e8ac681
a08469b09c43fe6eb110359d04bf5605262948d9
22999 F20101123_AABDDX kovar_r_Page_22.QC.jpg
77aca148d3a7e623a2cd708aebe9ddd8
28ce8f290cfdd022b5a4ae218cc993aefb48b493
69561 F20101123_AABCUB kovar_r_Page_34.jpg
f8299714f79b7f3ec27e6730eb8b3fe4
b89762116fcd1d7ddc47ce1c283a8666f3012f2c
6506 F20101123_AABDDY kovar_r_Page_22thm.jpg
3e2df17d158914fde5bcd0623859bcc4
11e4ccb94a3452363866d244951fa35fc444a7ea
75264 F20101123_AABCUC kovar_r_Page_36.jpg
902e8ecd1318e5c42047f43e35f539e5
05514355c1e4e2845995dda4e1c6f88586accaf4
1840 F20101123_AABDBA kovar_r_Page_15.txt
2e8f5b38e49ffbf584bd51d1be5d2200
bd3329a86ffe0b8e1e55694a578f0ddb0df0a1e0
22453 F20101123_AABDDZ kovar_r_Page_23.QC.jpg
de0fa4f234b28ecf8ddce4c260cdeaf3
5fc02a1544f071e67692a22acf6bfe429eba9abb
81068 F20101123_AABCUD kovar_r_Page_37.jpg
5b43d9029f6ec5538f1721161b20b667
d8fb833d33db79bd1e69e6d9a9d6bb1a0c5e80ea
50230 F20101123_AABCZA kovar_r_Page_13.pro
c4140f0c23d1275ae8092b5e3e20ee13
a504b806c7a61052758c8496bffccd3af2760740
2128 F20101123_AABDBB kovar_r_Page_16.txt
aaa025eb1774e35a4f7bda70ab916777
d200724204d3a3295668d1330f25744f0017c51e
36899 F20101123_AABCUE kovar_r_Page_38.jpg
d0476a93ed92e6390c8f35dde18d9832
c9a2af51789c02038c212c1136861ff7462f074f
39262 F20101123_AABCZB kovar_r_Page_14.pro
d980e4f45fd17d94ebf52d882eec360f
9037a1ff8bf9dda8201413b26500329dcbaddf7e
2042 F20101123_AABDBC kovar_r_Page_17.txt
3b1b85d9eb650cfae0067469a5323444
d56f9fae0a21673d3c10a5ad34b72cad488b73e4
25773 F20101123_AABDGA kovar_r_Page_56.QC.jpg
945dfd80ac10ea1a78cc362a54ee3abd
2fedea1aeb584f0d18ddfe7431deccc17b49b66a
62715 F20101123_AABCUF kovar_r_Page_39.jpg
cdd0ef8158399a05e7199194c3ff3c9a
e305d7afc1ab3c31383bef02bd502d24fbf6ccd3
44016 F20101123_AABCZC kovar_r_Page_15.pro
bd095a182d1886cf5b70bfaa2ac31ef8
3caf0a2643a328771656f326927f5ed1820a4519
2025 F20101123_AABDBD kovar_r_Page_18.txt
8964641bfceb44f9a2cb23df68b6b7e7
cdf2ed3f54e886356b60250aa8d119d879471176
7167 F20101123_AABDGB kovar_r_Page_56thm.jpg
cca33cf587a8e89c286ef076a318e9e1
798be040fade30273a7e60522d29c7cd9990f017
64450 F20101123_AABCUG kovar_r_Page_41.jpg
fa5cec3487782cd8da1dc691a9951607
5e8cb918adfdfacee80eb341e983df2cc7aaa323
53443 F20101123_AABCZD kovar_r_Page_16.pro
42600496f1a4b618abb6a6e01a2b18c0
fc86ea760d893b6d305de366299f5cbfbebfea25
25661 F20101123_AABDGC kovar_r_Page_57.QC.jpg
75e95372cdc3fe85fc8a0abc4dcfe606
d0bec21d191e8620a69d351494ebfe3457bd407b
67555 F20101123_AABCUH kovar_r_Page_42.jpg
30c135cc96df77229f8242978813e9d9
6bd741323d80254b959f0e2ddcec83c1dea576d2
50848 F20101123_AABCZE kovar_r_Page_17.pro
4cff52453d45baa5315698079c490d8f
774344f36f2e5f580df90ec9b5ef772bd65dc38c
1975 F20101123_AABDBE kovar_r_Page_19.txt
d639e54e41ab2a20ffe877206aee1613
9eb5d2204bba78bb6e3ce0c9d3e4bd0cb0529dde
6831 F20101123_AABDGD kovar_r_Page_57thm.jpg
d4b973b4af489b5857a76226d5e743ef
8bd07bdc5c64a086d997fe6d04807a27f52ca146
69803 F20101123_AABCUI kovar_r_Page_43.jpg
e8e8613927a67ed2b803bf19d12ec118
b747211e995fea0a90e2aba4653ab4d8048935ea
48186 F20101123_AABCZF kovar_r_Page_19.pro
f7438abb3a212884c983058d48327c13
50c1f1305120063ebe59e7a5f9398f0bcfa30412
1913 F20101123_AABDBF kovar_r_Page_20.txt
9192ea2c94de6a3aa9b4dfec13f091fe
ec4e4af3b1cf36a25b418854f120f6f01dc995f4
24839 F20101123_AABDGE kovar_r_Page_58.QC.jpg
d953fe8c40c2f86928171c782962ac9c
9a8c21bc94261f30696a061e93806cc22ee06f1e
34683 F20101123_AABCUJ kovar_r_Page_44.jpg
cdc4fd38076cc2008c05eb87cc678cbb
d5c51204f1881e2b2240c740b6b2552fd3150533
48506 F20101123_AABCZG kovar_r_Page_20.pro
7fc881dd89643539490d6b81c816a0fd
f8453545470ea0fb674f4145161f3cb6cbf1086d
1925 F20101123_AABDBG kovar_r_Page_22.txt
9d9657e8405ea202430991345bcf49e6
3c9e7ae94913be4113005e5be7d8fbd0e4797d30
26283 F20101123_AABDGF kovar_r_Page_59.QC.jpg
03ec4481bab74e1d4e4fd0588774e4a6
f3b5bae7d49e08cbbf5c95f0c9b0c3f4b738acbc
37162 F20101123_AABCZH kovar_r_Page_21.pro
66e7a3c26964f895f895386b46e2ad7b
c3e566950eded6f64f38d8e56ee450ee7a452358
1870 F20101123_AABDBH kovar_r_Page_23.txt
d20d9161e73f0c7f8c01c4b4c4f39247
9aa31de0e27964fe2f21fc682c705a050c4d981f
72358 F20101123_AABCUK kovar_r_Page_45.jpg
fea24bf75f2cb8e32db923ef128284dc
94ac45b6d1216f013237ce65e0c2664f6590dd54
6829 F20101123_AABDGG kovar_r_Page_59thm.jpg
470d916414c29210106241a9e3ce6bc6
10d5cf94e1d6865d93717f0a093f459b28228494
47419 F20101123_AABCZI kovar_r_Page_22.pro
da183c8c5cb6daee764267b26ce826f3
71d0bb3106ef6458aaeebe1912cc7207a066421a
2028 F20101123_AABDBI kovar_r_Page_24.txt
d72feb49a8a0094b00c0a0ddeb180a90
d1cfdb8cbb997874e59d1a2eb78bf05aac858273
85150 F20101123_AABCUL kovar_r_Page_46.jpg
b0deac3b58d109ef34cde071300c1ee4
ebe189070ceed5d9531adf2ec5fc46dcf250fc46
7172 F20101123_AABDGH kovar_r_Page_60.QC.jpg
290abbc4a8af3cc2bd14ffc74d1584a1
aae8980f509cf4716df9fa27dd431258ab62e833
47280 F20101123_AABCZJ kovar_r_Page_23.pro
a943aa4d9f846018f484816fbd1d21a7
ecf32dae79d533ae2cf20adf471e6a2acae1ee29
852 F20101123_AABDBJ kovar_r_Page_26.txt
a32551401529db3a13db7363691e1f3f
0b01efee8ae8c85fba958b9cccf709c1e0eb047c
27796 F20101123_AABCUM kovar_r_Page_48.jpg
d2daf79e3ae068ca8e147b28f8c1f58f
ddea32e381d4b1334d1262c68a83b70161fdd194
71341 F20101123_AABDGI UFE0011652_00001.mets
2232d15b5eef23cf2fe33eca776c2b68
41ff21e74f17c4cd028725e9194835b76913eef9
51398 F20101123_AABCZK kovar_r_Page_24.pro
fbc3440ff5e5900224b18c5ed6f32d62
447172e88bb8712de31990d2d9b4f035bc00449d
1562 F20101123_AABDBK kovar_r_Page_27.txt
4e4199011d7dc4c1c4445283890ce311
1ebe6af0ee6050e970027c57bce34262599dcd74
58319 F20101123_AABCUN kovar_r_Page_49.jpg
80bc9b07a81a8f20f24bd0bf82f4e9ef
154cdf91998c2a36ab56844e67f33ada0dcb83d1
48114 F20101123_AABCZL kovar_r_Page_25.pro
171342a7a7c69f4262334f86eee668fc
c03df472277674e0b2270ff2700b79327d77223a
1839 F20101123_AABDBL kovar_r_Page_28.txt
6e0d457a5745b71e811a7e181a349b52
8844d4cea940b98cf713fac473772f04fca15b32
58552 F20101123_AABCUO kovar_r_Page_50.jpg
eb38b45fec1f91d936468da553c9c7ef
7c89e0c6e8c10f846bdc8fb5678d8c1707eb2a46
20094 F20101123_AABCZM kovar_r_Page_26.pro
a4950dcaf764a8df8f0ad23be0acfcdb
92d8c3ce69c97afc374275a5ce61fce0382f80d6
1940 F20101123_AABDBM kovar_r_Page_30.txt
8154f56167fb578159dd2636fec9c055
8ee9c7202c417b63a1b30a40622048e319547979
54779 F20101123_AABCUP kovar_r_Page_51.jpg
a42c80ae90db4f6608367fa0f741c265
55e56cc396095ce9b58be41ec4b3a30a0300e636
36283 F20101123_AABCZN kovar_r_Page_27.pro
536448f2db769a240cf31f3db79919c4
5699a86ea98ceb2087809e4bbf6762e09df027a4
1957 F20101123_AABDBN kovar_r_Page_31.txt
d59e071b461c604463c3dee52355e31a
b6ff2fa668c707ca4452b7778b94d6304cd74a86
52419 F20101123_AABCUQ kovar_r_Page_52.jpg
f0b285eb9d527dcffe1addf81132a7be
ff2fb1482e8f7fd5ef2925bb2a131b697a8d8300
46173 F20101123_AABCZO kovar_r_Page_28.pro
a23be5c1e5ee1099bf417a4c6cc67956
8f0011a6a36c3fcc0e78097a43cd33064fa129ee
1899 F20101123_AABDBO kovar_r_Page_32.txt
790a3ab9e5cefffa02ed467e201a211a
8d1d4b6224451980a227fb7244f2de80126b709f
45996 F20101123_AABCUR kovar_r_Page_53.jpg
4d1b0f3bf8ab6b99d6357389ae1a85fd
ae01111fe3ac402ee2e27109db3882760ed1a9a2
49940 F20101123_AABCZP kovar_r_Page_29.pro
64b89a01581f0d534226f290750a1c9c
c1352dc08df49a615eda9713ffd8ce8a40cb11f5
1877 F20101123_AABDBP kovar_r_Page_33.txt
494bb39faa03f29c986adb6d297959dd
f67ad823f29d6ed2908075ff4563ce97a5cd424d
76104 F20101123_AABCUS kovar_r_Page_55.jpg
fdb2c4d06a8669c3b0fcd3578b8ca4a3
7f1b08c30d44b1ee319fcd00a4e3574f464d12a0
49297 F20101123_AABCZQ kovar_r_Page_31.pro
f79a335eb0f8f01d05d51f47ae670a74
036a4678cb4383538f4cc93d2b9267523dfb594a
2353 F20101123_AABDBQ kovar_r_Page_34.txt
0d1526cd442d03a7055d0238b83a7a0f
22cc6468aca5204194333a4a3d336c45ca3585e8
88625 F20101123_AABCUT kovar_r_Page_56.jpg
449a39232e78250d95b400d92900f110
4586e50651acb774eaefe65783325ba37419e983
48157 F20101123_AABCZR kovar_r_Page_32.pro
ff8b857f0b5536264c5fe67693e5490f
1b7a91fcef8777e332bb74fe6f4cd2893a42c7f9
2053 F20101123_AABDBR kovar_r_Page_35.txt
e1266a56117926d2edbc792cef7b1681
46217e89963428b53c22c9b1bab0cc04640a4db7
85491 F20101123_AABCUU kovar_r_Page_57.jpg
574f0a51fa4c5e2f4ac669bdba073347
f98240c2a6f3449db94d931646419bbe847889cb
47616 F20101123_AABCZS kovar_r_Page_33.pro
df3cda2f41b2a403e130905f927877b4
bfc6975153bf741378aed18a9025a3d188dc86a1
2526 F20101123_AABDBS kovar_r_Page_36.txt
1c363d4cc437ada716769d36ac06ca61
c9fd6f1f81d2b51d69b6f62482ae45fc7cc8143e
85730 F20101123_AABCUV kovar_r_Page_58.jpg
6d033515f8c0702844a97c00ce39546e
88a6ab4792cfe579fe50cd68d44423fcabeea975
33581 F20101123_AABCZT kovar_r_Page_35.pro
c338db3017e2dff4f2236a35341f1077
40bd2e2ff543a6856e264c6f7d3675155e5ee351
1117 F20101123_AABDBT kovar_r_Page_38.txt
455c4a82c0e11a8194739c8b2156d1b9
2e295aa8875dd3e24522fda8c236724f63c7bb66
92341 F20101123_AABCUW kovar_r_Page_59.jpg
df3ffff3c413eb88af5f9cfd739c33c7
12aa47d4fbfcca74c32ba834334c9920913ab8de
61682 F20101123_AABCZU kovar_r_Page_37.pro
53393ec863422d0f6d60a9a0e9a1d994
62393da566c7dad5259187c2e330e28e200df49c
1764 F20101123_AABDBU kovar_r_Page_39.txt
ae63cfa3eb7d7623cfa10b30480932d7
3cc348c92d9397393e24347ee92515d5eba404c0
22032 F20101123_AABCUX kovar_r_Page_60.jpg
78938a18419d73d8dd4cf54132733327
4033f2e4a40d4fd5d8708248870043285ef0a2b7
24324 F20101123_AABCZV kovar_r_Page_38.pro
5ef702561653d29da71ab58292cd2d0f
40eb14bca64d1ce3be59fb972eb02a2ad71aeea0
1982 F20101123_AABDBV kovar_r_Page_40.txt
9a20dfe82326fc21eac542aa0a1cb06c
10ad2dbca44e80b7b198880529b3a6bb2a83dcb6
41635 F20101123_AABCZW kovar_r_Page_39.pro
81c39aa0219af4ba144d677b63661731
2ceb2ba00d1265209aff6e55cd9252e6438a231c
1785 F20101123_AABDBW kovar_r_Page_41.txt
66102c96363590bdd7c64e1622531aae
15524767eaa702fb3c4cb594855ba3e4d27b95a7
69825 F20101123_AABCSA kovar_r_Page_30.jpg
3e647d8e843251f65c7be887d1a6dc8d
64ddc9eeb14ff74d181faf40dda842f2aa7e15b1
26622 F20101123_AABCUY kovar_r_Page_01.jp2
64eb1f71f6061eb506c2a42de7e8ab68
1836fde1c50706b84f1cac57d1af3404aa02aa38
49282 F20101123_AABCZX kovar_r_Page_40.pro
69788df2c053f6fe0878efc47563869b
2ce507f1deab42be8aa9408302f7bd4e7e9e45ed
1868 F20101123_AABDBX kovar_r_Page_42.txt
97268668451b09505a37929c74555ea5
dd25c17def9866b1b3710f46ebcf5e7e1cc2a99f
20428 F20101123_AABCSB kovar_r_Page_54.jpg
c816c8c3298039cba1c66dd3eef83453
8dec587125d633ba48f430edf2ffd44a983cb067
5799 F20101123_AABCUZ kovar_r_Page_02.jp2
b82731e9950c6a65dc536898dd371622
8caeb59b83a5b0f759bf2e3f21044d71713cbde6
46957 F20101123_AABCZY kovar_r_Page_42.pro
ed94f736683df10eded203530fe4e743
48de45ac330f96d158794f570fbe0b40c4e43170
2006 F20101123_AABDBY kovar_r_Page_43.txt
efc5f2033f2741c645c40e4b3c181e79
97ef6992ec69cc79387ace96a7649df47cbb53ab
108390 F20101123_AABCSC kovar_r_Page_32.jp2
7d29d8ae195bf189a227e765644121e3
850675d784edc3a2182cc8a46143c5d35d39ab07



PAGE 1

STAGES OF CHANGE, SELF-EFFICACY, SOCIAL SUPPORT, AND SUBSTANCE ABUSE WITHIN A GAINESVILLE, FLORIDA DRUG COURT PROGRAM By REBECA LAU KOVAR A THESIS PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLOR IDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF HEALTH SCIENCE UNIVERSITY OF FLORIDA 2005

PAGE 2

Copyright 2005 by Rebeca Lau Kovar

PAGE 3

ACKNOWLEDGMENTS First and foremost, I would like to thank my family. I thank my parents, Rosa and Miguel, for all the help and patience they have given me throughout my life. I thank my grandparents, Rebeca and Angel, for inspiring me to be all that I can be and to never accept less than the best in anything I do; may they rest in peace. I thank my husband, James, and son, James Jr., for all the understanding they have had for me throughout this process when I could not go out and play at the park. To my husband in particular, I would like to say thank you for all of the love and support, in the good times and the bad times. To my son, I would like to say thank you for all the hugs and kisses at just the right times. I thank God for giving me the perseverance to follow through and finish things no matter how difficult they may appear to be. I would also like to thank all my friends who have given me constant support and have cheered me on as much as was necessary to get the job done. I would like to thank my best friend, Gigi, in particular for always being there to push me forward. I would like to thank the Corner Drug Store, Inc. (CDS) first for hiring me as a counselor and second for allowing me to use their facility for my research. Without CDS this would have been a much harder journey. I would also like to thank all the wonderful clients whose hardships have brought me a deeper understanding of their disease. Thanks to the clients who volunteered to participate in this study despite receiving no compensation. I would like to take this time to express my deepest thanks to my supervisor, Lanard, for his understanding of my stress and allowing me to take off all the iii

PAGE 4

time I needed to complete this thesis. I would like to thank both my fellow counselors, Nancy and Christie, for helping with my research and taking time out of group to distribute my measures. I would like to thank Nancy for being a sounding board for my complaints, frustrations, and joy when it was all over. I would not be where I am today if it were not for all my teachers along the way. For those whom I may leave out I am sorry but they have helped to mold my mind and shape my future. I would like to thank in particular those professors on my committee for all being part of my inspiration. I would like to thank Dr. Linda Shaw for always making me feel like I belong at the top of everything that I do. I would also like to extend my deepest thanks to Dr. Martin Heesacker for being there when life seemed at its hardest, for helping me to find the rehabilitation counseling program, and for taking such a genuine interest in my life. I met him, as my professor, during my pregnancy and he really took me under his wing so that I would not give up on my dream of graduate school. Without him I may not have had the drive to complete this thesis. Lastly, but definitely not least, I would like to thank Dr. Steven Pruett, who agreed to be my committee chair without ever meeting me. I thank him for all his help and direction. I have enjoyed working with him and know that even though I might have driven him crazy at times he still helped me do the best that I could do. I know that he will always be connected to one of my proudest accomplishments. Thanks again. iv

PAGE 5

TABLE OF CONTENTS page ACKNOWLEDGMENTS.................................................................................................iii LIST OF TABLES............................................................................................................vii ABSTRACT.....................................................................................................................viii CHAPTER 1 INTRODUCTION........................................................................................................1 Statement of the Problem..............................................................................................4 Significance of the Study..............................................................................................4 2 LITERATURE REVIEW.............................................................................................6 Stages of change...........................................................................................................6 Self-efficacy..................................................................................................................7 Social Support...............................................................................................................8 Program.......................................................................................................................10 Demographics.............................................................................................................10 3 METHODOLOGY.....................................................................................................12 Research Design.........................................................................................................12 Participants.................................................................................................................12 Measures.....................................................................................................................13 Data Collection Procedure..........................................................................................16 Data Analysis..............................................................................................................17 4 RESULTS...................................................................................................................18 Results for Question One............................................................................................18 Results for Research Question 2.................................................................................21 5 DISCUSSION.............................................................................................................30 Summary.....................................................................................................................30 Findings......................................................................................................................31 Limitations..................................................................................................................34 v

PAGE 6

Further Research.........................................................................................................34 APPENDIX A STAGES OF CHANGE-SUBSTANCE ABUSE.......................................................36 B ADAPTED ALCOHOL ABSTINENCE SELF-EFFICACY SCALE.......................40 C MULTIDIMENSIONAL SCALE OF PERCEIVED SOCIAL SUPPORT...............44 D DEMOGRAPHICS QUESTIONNAIRE....................................................................45 LIST OF REFERENCES...................................................................................................46 BIOGRAPHICAL SKETCH.............................................................................................51 vi

PAGE 7

LIST OF TABLES Table page 4-1 MSPSS and Subscales Analyses of Variance for Phase in Treatment.......................25 4-2 SCS-SA Subscales Analyses of Variance for Phase in Treatment.............................25 4-3 Adapted AASE Subscales Analyses of Variance for Phase in Treatment.................25 4-4 Two-Tail Inter-Correlation Matrix between Demographic Variables and Three Measures...................................................................................................................26 4-5 MSPSS and Subscales Analyses of Variance for Drug of Choice.............................27 4-6 SCS-SA Subscales Analyses of Variance for Drug of Choice...................................28 4-7 Adapted AASE Subscales Analyses of Variance for Drug of Choice.......................28 4-8 MSPSS and Subscales Analyses of Variance for Ethnicity.......................................28 4-9 SCS-SA Subscales Analyses of Variance for Ethnicity.............................................28 4-10 Adapted AASE Subscales Analyses of Variance for Ethnicity................................29 vii

PAGE 8

Abstract of Thesis Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Master of Health Science STAGES OF CHANGE, SELF-EFFICACY, SOCIAL SUPPORT, AND SUBSTANCE ABUSE WITHIN A GAINESVILLE, FLORIDA DRUG COURT PROGRAM By Rebeca Lau Kovar August 2005 Chair: Steven R. Pruett Major Department: Rehabilitation Counseling Drug abuse and alcohol abuse are growing problems in todays society. Effective treatment helps to reduce the already huge costs to society, the individual, and families of the alcohol or substance abuser. Advancing through the various stages of change, self-efficacy, and increased social support have been found to be integral parts of effective substance abuse treatment. The purpose of the study was to measure social supports, self-efficacy, and stages of change for clients within Corner Drug Stores Outpatient Services that are criminal drug offenders. An ex-post facto cross-sectional research design was applied to a convenience sample drawn from clients participating in a drug-court treatment program at the Corner Drug Store in Gainesville, FL. Scales used in this study were as follows: the Stages of Change Scale-Substance Abuse, the Adapted Alcohol Abstinence Self-Efficacy Scale, the Multidimensional Scale of Perceived Social Support, and a Demographics Questionnaire. viii

PAGE 9

A series of Analyses of Variances (ANOVAs) and a Pearson product-moment correlation were conducted. No significant relationships were found between the participants phase in treatment and the various stages of change. Significant relationships were found between ethnicity and select subscales in each of the three scales. The amount of time using illicit substances also appeared to have a relationship with several of the stages of change subscales. ix

PAGE 10

CHAPTER 1 INTRODUCTION Alcohol and drug use is a common occurrence in todays society, with such use often associated with a variety of medical, psychological, and social problems (Frances & Miller, 1991). In the 2003 National Survey on Drug Use and Health (Substance Abuse Mental Health Services Adiministration [SAMHSA], 2004) a variety of data about adult drug use in the United States was collected. These data include overall prevalence of use during the preceding year and preceding month for different drugs, including alcohol and tobacco cigarettes. In this case use means the respondent used the drug in question at least once during the time period in question. Several of these findings stand out. There are reportedly an estimated 19.5 million illicit drug users aged 12 or older. Marijuana heads the list of illicit drug use at 75.2 percent. These relationships hold up both for use in the past year and for use in the past month. There are reportedly an estimated 119 million current drinkers of alcohol in the survey (SAMHSA, 2004). The prevalence of drug use differs with characteristics of people. An example of this would be the prevalence of drug use in the past month varies as a function of age. Individuals between the ages of 18-20 have the highest illicit drug use at 23.3 percent. Rates of alcohol use in the past month were highest among individuals between the ages of 21-25, used by approximately 70 percent (SAMHSA, 2004). Substance use during the past month also varies according to ethnic/racial group and gender. Men, 10 percent, were more likely than to report illicit drug use than women, 6.5 percent, and were considerably more likely to report any use of alcohol (62.4 1

PAGE 11

2 percent versus 46 percent). For ethnic/racial differences, whites, 54.4 percent more frequently reported any alcohol use than did Hispanics, 39.8 percent, and, blacks, 37.9 percent. In respect to illicit drug use rates were 8.7 percent for blacks, 8.0 percent for whites, and 8.0 percent for Hispanics (SAMHSA, 2004). According to the 2003 National Survey on Drug Use and Health (SAMHSA, 2004) among the estimated 1.4 million adults aged 18 or older on parole or other supervised release from prison during the past year, 24.3 percent were current illicit drug users compared with 7.7 percent among adults not on parole or supervised release. Also, among the estimated 4.8 million adults on probation at some time in the past year, 28 percent reported illicit drug use in 2003. This compares with a rate of illicit drug use at 7.4 percent among adults not on probation in 2003 (SAMHSA, 2004). Treatment reduces costs to society, largely in savings from the criminal justice system (Gerstein, Johnson, Harwood, Fountain, Sutter, & Malloy, 1994). Treatment also enhances the overall functioning of individuals and families. Substance abuse increases morbidity and mortality, reduces overall mental and physical health, disrupts neighborhoods, and reduces productivity. Even individuals other than the users themselves are affected. Other external problems increased by substance abuse include drug-related crimes and the spread of contagious diseases (Harwood, Hubbard, Collins, Rachal, 1995; Hubbard, Craddock, Flynn, Anderson, Etheridge, 1997). Illicit drug use isresponsible for over 250,000 deaths annually. In 1992, total costs, including health care expenditures, lost productivity, crime-associated costs, and other factors, were estimated to be 97 billion dollars. The category lost productivity, the largest at 69 billion dollars, includes the value of time lost due to premature death, institutionalization, incarceration,

PAGE 12

3 and victimization by crime. Crime-related cost is the second biggest cost category, at almost 18 billion dollars. Health care expenses constitute the third major category, which is estimated to cost society about 10 billion dollars (Harwood, Fountain, & Livermore, 1997). Miller and Rollnick (2002) found that substance abusers often recognize the risks, costs, and harm involved in their behavior. Yet for a variety of reasons are to attached and attracts to the behavior to change. The individuals are stuck in a state of ambivalence; they want to use but they dont want to, they want to change but they dont want to. The authors find this ambivalence to be a natural phase of the process of change as long as they continue to move through it. When an individual gets stuck in ambivalence their problems may persist and intensify (Miller & Rollnick, 2002). The Transtheoretical Model (DiClemente & Prochaska, 1985, 1998) is based on the notion that behavior change occurs in increments and it involves detailed and varied tasks. This model offers a framework for understanding the process of behavior change. In this model change is viewed as a progression from the precontemplation stage, where no change is considered; to contemplation, where the individual weighs the pros and cons of change; and then to preparation, where planning and commitment are secured. Successful accomplishment of these initial stages lead to taking action and making specific behavior change; if successful in the action stage the individual moves into the final stage, maintenance, in which the person works to maintain and continue long-term change (DiClemente & Prochaska, 1998; Prochaska, DiClemente, & Norcross, 1992). Miller and Rollnick (2002) have found self-efficacy, individuals belief in their ability to carry out and succeed with a specific task, to be a key element in motivation for

PAGE 13

4 change. Self-efficacy was also found to be a reasonably good predictor of treatment outcome. The authors state that if that if the individual perceives no hope or possibility for change, no effort will be made towards change (Miller & Rollnick, 2002). Sobell, Sobell, Toneatto, and Leo (1993) found that the greatest single factor with maintaining recoveries for alcohol abusers is that of social support, particularly from family and friends. Social support has been found to be a crucial component in a successful drug treatment program, as it allowed individuals to adapt to stressful life situations (Caplan & Killilea, 1976). In terms of relapse potential, Havassy, Hall, and Wasserman (1991) found that social integration and abstinence-specific functional support predicted lower risk of relapse to tobacco, alcohol, and opiates. Statement of the Problem Substance abuse treatment is complicated and intricate. Substance use harms society by reducing users physical and mental health and productivity, reducing family and social functioning, and by increasing crime. Without effective treatment programs these problems will continue to escalate (Sindelar & Fiellin, 2001). Development of effective treatment programs must consist of awareness of addiction, the stages of change, developing social supports, and increased motivation. There is a need to measure how individuals are progressing through treatment and to make sure they are moving through as intended. There is a need to know if individuals need increased treatment in the above-mentioned areas. There is also a need for more effective measurement in treatment, which may aid in the overall effectiveness of programs. Significance of the Study This study has taken a sample of individuals that are currently involved in a substance abuse treatment and measured their progress with regard to social support, self

PAGE 14

5 efficacy, and stages of change. It is important for substance abuse treatment facilities to be able to track their clients progress and to determine the effectiveness of the overall treatment. Additionally, this study may aid in the identification of individuals in need of increased treatment. This research would be beneficial to program participants because in theory as the participants advance in treatment they should gain more social supports, have a higher self-efficacy, and should move through the stages of change. The program may choose to use the measures studied in this research as part of treatment in the future to identify problem areas for their clients, which would in turn allow the treatment outcome to be a more successful one. The purpose of the study is to measure social supports, self-efficacy, and stages of change for clients within Corner Drug Stores Outpatient Services that are criminal drug offenders. The research questions to be addressed in this study are as follows: 1. Are there relationships between the scores on the Stages of Change Scale-Substance Abuse (SCS-SA), the Adapted Alcohol Abstinence Self-Efficacy Scale (Adapted AASE), the Multidimensional Scale of Perceived Social Support (MSPSS), and the phase of treatment at Corner Drug Store, Inc. 2. Are there relationships between a set of demographic variables (i.e., ethnicity, age, drug of choice, length of use, length of time in the program) and the scales discussed in question one.

PAGE 15

CHAPTER 2 LITERATURE REVIEW Stages of change Cessation of problem behavior and initiation or better responses does not occur in one abrupt action (Abellanas & McLellan, 1993). Prochaska and DiClemente (1982,1986) developed the Transtheoretical Model depicting a sequence of stages through which people progress as they initiate and maintain behavior change. These stages have been used to understand the process of stopping problem behaviors, such as cessation of smoking and other addictive behaviors (Snow, Prochaska, & Rossi, 1992) as well as overeating and unsafe sexual behaviors (Prochaska et al., 1992) The Transtheoretical Model hypothesizes that the cessation of high-risk behaviors and the acquisition of healthier alternatives involves progression through five stages of change: precontemplation, contemplation, preparation, action, and maintenance (Abellanas & McLellan, 1993). The first of these stages is called precontemplation, a state of unawareness of a problem or a need for change (Miller & Rollnick, 1991). In this stage the individual is not intending to change the behavior in the foreseeable future (Grimley, Prochaska, Velicer, Blais, & DiClemente, 1994). As awareness of the problem increases, the individual enters a state of ambivalence or contemplation, in which the individual weighs the possible pros and cons (Miller & Rollnick, 1991). The individual in this stage may intend to change but has not made a serious commitment to that change (Grimley et al.). Over time, the decisional balance my tip in favor of change, as the adverse consequences (cons) outweigh the perceived advantages (pros). This point has 6

PAGE 16

7 been termed bottoming out, it suggests a developmental point at which the individual shifts from unmotivated to motivated status by having endured a sufficient volume of suffering to instigate change (Janis & Mann, 1977). In the original model Prochaska and DiClemente (1986) termed this point in which the balance shifts the determination stage but subsequently deleted the stage and then more recently reinstated it, renaming this transition period as a preparation phase (Prochaska & DiClemente 1992; Prochaska et al., 1992). Following this transition the individual moves into an action stage in which efforts are made to change the behavior. If the initial efforts are successful the individual moves into the maintenance stage, which involves relapse prevention (Marlatt & Gordon, 1985). Relapse prevention involves taking steps to protect against falling back into the old pattern of behavior. Given that behavior is usually not maintained on the first try in most cases, Prochaska and DiClemente (1986) also describe a relapse stage, in which the individual may revert back to action or cycle back through contemplation, determination-preparation, action, and maintenance in order to achieve lasting behavior. Self-efficacy The concept of self-efficacy has played a major role in the understanding and treatment of addictive behaviors. Bandura (1986) defined perceived self-efficacy as peoples judgments of their capabilities to organize and execute courses of action required to attain designated types of performances (pp.391). Self-efficacy is how individuals deal with prospective situations that contain many ambiguous, unpredictable, and often stressful, elements. Self-efficacy is a cognitive process because it deals with perceived judgments individuals make about their competency to perform adequately in a specific task situation (Marlatt, 1985). Individuals may perform poorly, adequately, or extremely well depending on the individual variations in perceived self-efficacy

PAGE 17

8 (Bandura, 1995). Perceived self-efficacy affects peoples choice of activities and behavioral settings, how much effort they expend, and how long they will persist in the face of obstacles and aversive experiences. The stronger the individuals perceived self-efficacy, the stronger the coping skills. Those individuals who continue in threatening activities will eventually eliminate their inhibitions through their experiences, whereas those who avoid what they fear, or who cease their coping efforts early, will retain their defensive behavior (Bandura & Adams, 1977). DiClemente (1986) noted that self-efficacy, as it relates to substance abuse treatment, is manifested by an individuals perceptions of his or her ability to mobilize necessary motivation, knowledge, and behavior to control or abstain from use of alcohol or other drugs. Efficacy beliefs are thought to affect all the phases of personal change from whether to change the behavior at all, to whether the individual succeeds at initiating the change, to whether the change is successfully maintained. In the case of addictive behaviors maintaining the change over time is the major problem (Bandura, 1992). Successful coping with prospective high-risk situations increases ones sense of self-efficacy and decreases the probability of relapse, whereas failure experiences have the opposite effect (Marlatt, 1985). There is a substantial body of research that supports the relationship between self-efficacy and treatment outcome (Annis & Davis, 1989; Burling, Reilly, Moltzen, & Ziff, 1989; DiClemente, 1981; McKay, Maisto, & OFarrell, 1993; Rychtarik, Prue, Papp, & King, 1992). Social Support According to McCrady (2004), people seek out intimate and supportive relationships, and such relationships are common among couples, parents and children, siblings, and friends. There are many things that can lead to better or worse outcomes

PAGE 18

9 following substance abuse treatment. Being involved with others and receiving high levels of support from even one person prior to treatment, having a spouse, being more socially connected or involved (Havassy et al., 1991), having more people to go to with problems (Rosenberg, 1983), and having more friends who do not use substances (Zywiak, Longabaugh, & Wirtz, 2002) all predict more positive treatment outcomes. For women in particular having a larger social network also facilitates a more positive outcome (McCrady, 2004). There are also certain aspects of the way a social network functions that lead to better treatment outcomes. These predictors of success include families that are more cohesive, have an active, shared recreational focus, disagree less (Moos, Bromet, Tsu, & Moos, 1979), and provide the individual with more reassurance of worth (Booth, Russell, Soucek, Laughlin, 1992). Having a better functioning marriage prior to treatment also predicts less frequent relapse and less frequent readmission to treatment (McCrady, Hayaki, Epstein, & Hirsch, 2002). Just as there are aspects of the social network that may lead to better outcomes with treatment, there are also those that may lead to negative outcomes. Some of these include having friends in the network that use and maintaining those friendships after treatment (Mohr, Averne, Kenny, & Delboca, 2001), greater marital dissatisfaction (McCrady, Epstein, & Sell, 2003), the presence of higher levels of expressed emotion (i.e., criticism, hostility, and emotional over involvement; OFarrell, Hooley, Fals-Stewart, & Cutter, 1998); and experiencing more stress from friends (Gordon & Zrull, 1991). In the case of criminal justice-mandated clients, those supported by a strong network of affective ties tend to have a greater stake in conformity. Some factors that seem to be important to their treatment success are satisfaction with the family life

PAGE 19

10 (Slaught, 1999) and encouragement from the partner or spouse to enter treatment (Tucker, 1979). Just as with noncriminal justice-mandated clients, there are factors that will also hinder treatment success for these clients. These factors are problems with significant others, having little or no family/emotional support (Lang & Benko, 2000), and those whose close relationships consist of other addicts (Sung, Belenko, Feng, & Tabachnick, 2004). Program While in operation only since 1989, drug treatment courts are considered to be the most innovative, comprehensive, and successful alternatives to incarceration yet developed (Hennessey, 2001). The drug courts grew from a realization that the system was not working for drug offenders. The offenders were in and out of jail and were simply clogging the system and costing millions of dollars in ineffective efforts to rehabilitate chronic offenders. The Miami-Dade County Circuit Court was the first to implement a mandatory treatment component into the supervisory responsibilities of the court. The court relied upon the authority of the judge to develop and supervise a comprehensive, community-based rehabilitation and supervision program that intended to use the coercive powers of the court to compel offenders to abide by the treatment plan in order to avoid incarceration. The essence of drug courts today continues to be the coercive power of the court to impose sanctions, including incarceration, on participants who deviate from the treatment plan (Hennessey, 2001). Demographics Age. Research has consistently shown that in the United States criminal behavior peaks in adolescence and gradually declines thereafter. Most explanations for this note that adolescents and young adults most likely seek autonomy through involvement with

PAGE 20

11 deviant peer groups, whereas deviant peer involvement behavior diminishes as the individual ages (Hirschi & Gottfredson, 1983). Correspondingly it is conceivable that older persons will be more receptive to rehabilitative policy interventions such as drug courts. Another explanation for this among the substance-abusing population may be that over time individuals become tired of their addicted lifestyles (Saxon, Wells, Fleming, Jackson, & Calsyn, 1996). Several studies report that older participants stay in treatment longer than younger participants (Mammo & Weinbaum, 1991; Sansone, 1980; Saxon et al., 1996). Race/Ethnicity. Studies assessing race and treatment outcome have produced different results. Several conclude that race is a significant factor (Steer, 1980; Sansone, 1980; Saxon et al., 1996), while others do not support any relationship (Condelli & Hubbard, 1994; McFarlain, Cohen, Yoder, & Guirdy, 1977). Mammo and Weinbaum (1993) found that it is more likely for white and other race/ethnic groups than black and Hispanics to complete treatment. However, as with their gender research they found that when confounding variables such as, social, demographic, and economic variables were controlled, race is no longer significant. Substance Abuse History. Remple and DeStefano (2001) found that addiction severity based on self-reported amount, duration, and frequency of use of multiple illegal drugs had no effect on whether the individuals were more likely to drop out of treatment. The researchers did, however, find that the primary drug of choice did have a significant effect. The researchers found that individuals with the primary drug being heroin were more likely to drop out while a primary drug of crack was significant in predicting retention, not dropout (Remple & DeStefano, 2001).

PAGE 21

CHAPTER 3 METHODOLOGY This chapter will discuss the methods used in the present study to measure the various constructs described earlier and show any relationships between them. The topics that are addressed are research design, participants, instrumentation, procedures and data analysis, and statistical analysis methods. Research Design This was an ex-post facto cross-sectional research design using a convenience sample at the Corner Drug Store, Inc outpatient services Drug Court program. Participants were asked to complete the SCS-SA, MSPSS, the Adapted AASE, and a demographic questionnaire. Participants The study consisted of 40 participants currently receiving treatment services at Corner Drug Store, an outpatient treatment center contracted with the Alachua County Drug Court program, in Gainesville, FL. The participants are nonviolent drug offenders. The Drug Court program is a pretrial intervention that offers the participants the chance to get their charges dropped by completing the program. Participation in the study was voluntary. Historically, most of the participants seem to fall within two ethnic groups: European-American and African-American. However, because there were no Hispanics or Native Americans self-identified, ethnicity was grouped as white or non-white. The age of the participants ranged from 19 to 51 (M = 29.98, SD = 9.49). Length of time in 12

PAGE 22

13 the program ranged from 21 to 910 days (M = 204.58, SD = 194.36). Participants reported abusing substances from 0 years to 32 years (M = 11.73, SD = 8.61). The treatment consists of three phases with the participants advancing from phase to phase by meeting certain goals and standards. The first phase serves as a detoxification period and is a minimum of 30 to 45 days. Phase 1 consists of four, one-hour group sessions per week, case management, urinalysis drops, acupuncture, and individual sessions on an as needed basis. To move from the first phase to the second the participant must maintain twenty-one days continuous, drug-free urine drops, and receives approval from the treatment team. The second phase is the primary treatment phase in which the participant has reached a basic level of sobriety and can focus on the issues identified in treatment. Phase 2 is a minimum of six months and consists of two, one-hour group sessions per week, case management, urinalysis drops, and individual sessions as needed. To move from Phase 2 to Phase 3 the participant must remain continually drug free for ninety days, be gainfully employed or in an educational program, meet their treatment goals, and be compliant with all program requirements. The third phase is the transition phase where the participant is given more freedom and personal responsibility. Phase 3 is a minimum of four months and consists of one, one-hour group session, case management, urinalysis drops, and individual sessions as needed. To be eligible to graduate from the program the participant must maintain six months of continued sobriety. Measures Stages of Change Scale-Substance Abuse (SCS-SA). The SCS-SA scale was developed to measure the stages of change identified by DiClemente and Prochaska

PAGE 23

14 (Cardoso, Chan, Berven & Thomas, 2003). The scale consists of 37 items, with responses given on a five-point Likert scale. See Appendix A. The SCS-SA consisted of four subscales: Participation, Relapse, Determination, and Precontemplation, determined by exploratory factor analysis. The alpha coefficients for the four subscales were calculated. For the Participation, Relapse, Determination, and Precontemplation factors the values were as follows: .93, .73, .85, and .79, respectively. For the SCS-SA, support for the validity of the instrument was derived by means of exploratory factor analysis and cluster analysis (Cardoso et al.). Internal consistency for the subscales of the SCS-SA for this study was demonstrated to be acceptable. Cronbachs alpha for the Participation, Relapse, Determination, and Precontemplation factors were as follows: .85, .75, .87, and .71, respectively. Alcohol Abstinence Self-Efficacy Scale (AASE). The scale consists of 49 items related to drinking (DiClemente, Carbonari, Montgomery, & Hughes, 1993). Participants are asked to answer how tempted they would be to drink in each situation on a five-point Likert scale (not at all = 1 to extremely = 5). The participants are also asked to rate how confident they are that they would not drink in a particular situation on a similar 5-point Likert scale. Scores are added separately for self-efficacy and temptation. Similar scales have been developed for smoking and other addictive behaviors have demonstrated relevance and solid psychometric properties (DiClemente, 1986). Initial reliability and validity estimates for this scale demonstrated high internal consistency (.95) and a substantial negative correlation (r=-.58) between temptation and self-efficacy (DiClemente et al.).

PAGE 24

15 Hiller, Broome, Knight, and Simpson (2000) adapted the AASE so that it could be used for the general use of drugs rather than solely for alcohol use. The Adapted AASE contains 40 items. The inventory measures self-rated confidence and temptation for 20 high-risk situations, comprising four conceptual categories (i.e., Negative Affect, Social/Positive, Physical, and Other Concerns, and Cravings and Urges). See Appendix B. Exploratory and confirmatory factor analysis were involved in the validation of the Adapted AASE. Internal consistency for the subscales ranged from .72 to .92. Hiller et al. used a multi-trait, multi-method matrix design to evaluate the Adapted AASEs construct validity. They found strong inverse relationships between the efficacy and temptation scales lending credence to the construct validity of this scale. Internal consistency for the subscales of the Adapted AASE for this study was demonstrated to be acceptable. Cronbachs alpha for the Temptation subscales of Negative Affect, Social/Positive, Physical and Other Concerns, and Cravings and Urges were as follows: .85, .83, .73, and .82, respectively. Cronbachs alpha for the Confidence subscales of Negative Affect, Social/Positive, Physical and Other Concerns, and Cravings and Urges were as follows: .94, .84, .87, and .92, respectively. Multidimensional Scale of Perceived Social Support (MSPSS). The MSPSS is a 12 item, self-report measure that addresses the subjective assessment of social support adequacy (Zimet, Dahlem, Zimet, & Farley, 1988). The MSPSS also assess perceptions of social support adequacy from three specific sources: Family, Friends and Significant Other. Each of the groups consists of four items and is answered on a seven-point Likert scale. See Appendix C. Cronbachs coefficient alpha was found for the scale as a whole as well as for each individual subscale. For the Significant Other, Family, and Friends

PAGE 25

16 subscales, the values were .91, .87, and .85, respectively. The reliability of the total scale was .88. Zimet et al. retested 69 of 275 subjects 2 to 3 months after having initially completed the questionnaire. The test-retest reliability for the Significant Other, Family, and Friends were .72, .85, and .75, respectively. For the whole scale, the value obtained was .85. Similar findings concerning the MSPSS were found by Zimet, Powell, Farley, Werkman, and Berkoff (1990). Zimet et al. (1990) found evidence of the predictive validity of MSPSS subscales by administering the MSPSS to various sets (e.g., married participants reflected higher significant other scores than single participants). Internal consistency for the MSPSS and subscales for this study were demonstrated to be acceptable. Cronbachs alpha for the subscales of Significant Others, Family, and Friends were as follows: .76, .96, and .84, respectively. Cronbachs alpha for the MSPSS total was .86. Demographics. There were several demographic items that participants were asked pertaining to age, ethnicity, gender, phase in program, length of time in the program and how long they have been using. See Appendix D. Data Collection Procedure The instruments were given to the participants while they were in their treatment groups. The participants were observed while answering the instruments by the researcher or another Corner Drug Store counselor. The participants were not allowed to talk to one another while answering the instrument questions. There was no identifying data collected. Informed consent forms with signatures were separated from the answered instruments. All instruments will be numbered in order to keep track of which measures go together. It took approximately 3040 minutes to answer all four measures

PAGE 26

17 to be completed. The researcher or the counselor collected the instruments in order to be analyzed. Data Analysis Analyses related to Research Question One A series of ANOVAs were conducted to calculate the relationship of treatment phase to the SCS-SA, MSPSS, and Adapted AASE scores. Analyses related to Research Question Two For demographic data that are continuous, such as age, length of time in the program, and length of time using drugs or alcohol, Pearson product-moment correlation coefficients were calculated to show the relationships between the demographic variables and the three measures. A series of ANOVAs were conducted to calculate the relationships of the categorical data such as, drug of choice, and ethnicity to the three measures.

PAGE 27

CHAPTER 4 RESULTS Results for Question One Stages of change. A series of one-way ANOVAs conducted for the subscales of the SCS-SA (Precontemplation, Determination, Participation, Relapse) in regards to the phase of treatment yielded no significant differences (see Table 4.2). Scores on the SCS-SA Precontemplation subscale did not differ between Phase I (M=2.13, SD=.81), Phase II (M=2.01, SD=.64), and Phase III (M=1.85, SD=.52; F(2,35)=.44, p=.65, ns). Scores on the SCS-SA Determination subscale did not differ between Phase I (M=3.80, SD=.80), Phase II (M=4.22, SD=.64), and Phase III (M=4.19, SD=.363; F(2,35)=1.60, p=.21, ns). Scores on the SCS-SA Participation subscale did not differ between Phase I (M=3.44, SD=.67), Phase II (M=3.86, SD=.43), and Phase III (M=3.96, SD=.46; F(2,31)=2.79, p=.08, ns). Scores on the SCS-SA Relapse subscale did not differ between Phase I (M=2.24, SD=.70), Phase II (M=2.13, SD=.77), and Phase III (M=1.80, SD=.33; F(2,33)=1.11, p=.34, ns). The variable phase in treatment thus appeared to have no direct relationship with the stage of change the individual is in. It was hypothesized that the higher the phase of treatment the individual was in the further along in the stages of change the individual would be in. No significant relationship was found between the scores on the SCS-SA subscales and the phase in treatment. 18

PAGE 28

19 Social support. A series of one-way ANOVAs conducted for the MSPSS and subscales (Significant Others, Family, Friends, MSPSS total) in regards to the phase in treatment yielded no significant differences (see Table 4.1). Scores on the MSPSS Significant Other subscale did not differ between Phase I (M=5.75, SD=1.20), Phase II (M=5.64, SD=1.46), and Phase III (M=6.25, SD=.58; F(2,37)=.90, p=.42, ns). Scores on the MSPSS Family subscale did not differ between Phase I (M=4.75, SD=2.30), Phase II (M=5.57, SD=1.87), and Phase III (M=5.57, SD=.975; F(2,36)=.77, p=.47, ns). Scores on the MSPSS Friend subscale did not differ between Phase I (M=4.83, SD=1.73), Phase II (M=4.61, SD=1.51), and Phase III (M=5.07, SD=1.18; F(2,37)=.34, p=.71, ns). Scores on the MSPSS total scale did not differ between Phase I (M=5.11, SD=1.27), Phase II (M=5.29, SD=1.22), and Phase III (M=5.63, SD=.60; F(2,36)=.62, p=.54, ns). The variable of phase in treatment thus appeared to have no direct relationship with the amount of social support the individual perceived. It was hypothesized that the higher the phase of treatment the individual was in the more social support the individual would perceive in their life. No significant relationship was found between the scores on the MSPSS and the phase in treatment. Self-efficacy. A series of one-way ANOVAs conducted for the subscales of the Adapted AASE (TemptationNegative Affect, TemptationSocial/Positive, TemptationPhysical and Other Concerns, TemptationCravings and Urges, ConfidenceNegative Affect, ConfidenceSocial/Positive, ConfidencePhysical and Other Concerns, ConfidenceCravings and Urges) in regards to the phase of treatment also yielded no differences (see Table 4.3).

PAGE 29

20 Scores on the adapted AASE TemptationNegative Affect subscale did not differ between Phase I (M=2.69, SD=1.29), Phase II (M=2.35, SD=1.14), and Phase III (M=2.20, SD=.74; F(2,34)=.53, p=.59, ns). Scores on the adapted AASE TemptationSocial/Positive subscale did not differ between Phase I (M=2.57, SD=1.20), Phase II (M=2.09, SD=1.17), and Phase III (M=2.42, SD=1.06; F(2,37)=.69, p=.51, ns). Scores on the adapted AASE TemptationPhysical and Other Concerns subscale did not differ between Phase I (M=1.70, SD=.69), Phase II (M=1.89, SD=.96), and Phase III (M=1.85, SD=.79; F(2,37)=.17, p=.84, ns). Scores on the adapted AASE TemptationCravings and Urges subscale did not differ between Phase I (M=2.18, SD=1.15), Phase II (M=1.84, SD=.79), and Phase III (M=2.15, SD=.84; F(2,37)=.63, p=.54, ns). Scores on the adapted AASE ConfidenceNegative Affect subscale did not differ between Phase I (M=2.73, SD=1.54), Phase II (M=2.82, SD=1.43), and Phase III (M=3.70, SD=.87; F(2,36)=1.91, p=.16, ns). Scores on the adapted AASE ConfidenceSocial/Positive subscale did not differ between Phase I (M=2.87, SD=1.20), Phase II (M=2.91, SD=1.37), and Phase III (M=3.67, SD=1.01; F(2,36)=1.55, p=.23, ns). Scores on the adapted AASE ConfidencePhysical and Other Concerns subscale did not differ between Phase I (M=2.77, SD=1.55), Phase II (M=2.91, SD=1.45), and Phase III (M=3.61, SD=.95; F(2,36)=1.24, p=..30, ns). Scores on the adapted AASE ConfidenceCravings and Urges subscale did not differ between Phase I (M=3.02, SD=1.47), Phase II (M=2.88, SD=1.48), and Phase III (M=3.40, SD=1.02; F(2,35)=.51, p=.61, ns). The variable of phase in treatment thus appeared to have no direct relationship with the self-efficacy of the individual. It was hypothesized that the higher the phase of treatment the individual was in the more self-efficacy would be found. No significant

PAGE 30

21 relationship was found between the scores on the Adapted AASE and the phase in treatment. Results for Research Question 2 Age. There were no significant correlations found between age and the MSPSS or its subscales. A significant correlation was found between age and the SCS-SA Participation subscale, r = .398, n = 34, p < .05, two tails. Older age was associated with being in the Participation subscale. There were no other significant correlations found within the SCS-SA. The only significant correlation found within the Adapted AASE was found on the ConfidenceCravings and Urges subscale, r = .346, n = 38, p < .05, two tails. Older age was associated with a higher confidence against cravings and urges. Correlations reported in Table 4.4. Length of time using drugs or alcohol. There were no significant correlations found between length of time using drugs or alcohol and the MSPSS or its subscales. A correlation for the data revealed that the length of time using drugs and alcohol and the SCS-SA Participation subscale were significantly correlated, r = .476, n = 34, p < .01, two tails. The longer an individual has used drugs or alcohol was associated with the higher Participation subscale score. A correlation for the data revealed that the length of time using drugs and alcohol and the SCS-SA Determination subscale were significantly related, r = .389, n = 38, p < .05, two tails. The longer an individual has used drugs or alcohol was associated with the higher Determination subscale score. The only significant correlation found within the Adapted AASE was found on the TemptationCravings and Urges subscale, r = .346, n = 38, p < .05, two tails. Older age was associated with a higher temptation to use when in situations concerning cravings and urges. Correlations reported in Table 4.4.

PAGE 31

22 Length of time in the program. There were no significant correlations found between length of time in the program and the MSPSS or its subscales, the SCS-SA, or the Adapted AASE. Correlations are reported in Table 4.4. Drug of Choice. A series of one-way ANOVAs conducted for the MSPSS and its subscales in regards to the individuals drug of choice yielded no significant differences (see Table 4.5). The variable of drug of choice thus appeared to have no direct relationship with the amount of perceived social support. No significant relationship was found between the scores on the SCS-SA and the individuals drug of choice. A series of one-way ANOVAs conducted for the subscales of the SCS-SA in regards to the individuals drug of choice yielded a significant difference in the Participation subscale F(3,30) = 11.809, p < .01(see Table 4.6). Post-hoc comparisons using a Bonferroni correction indicated that the mean score for Alcohol (M = 3.06, SD = .421) was significantly different from Coke/Crack (M = 4.23, SD = .343). Alcohol also was significantly different from Heroin/Opiates (M = 4.06, SD = .289). Alcohol did not differ significantly from Marijuana (M = 3.56, SD = .419); neither did Coke/Crack differ significantly from Heroin/Opiates or Marijuana. The mean score for Marijuana was significantly different from Coke/Crack. Marijuana was not, however, significantly different from Heroin/Opiates. A series of one-way ANOVAs yielded a significant difference in the Determination stage of change F(3,34) = 3.400, p <.05. A Bonferroni post-hoc analysis did not yield any significant differences between the particular drug of choice and the SCS-SA Determination subscale. A series of one-way ANOVAs conducted for the subscales of the Adapted AASE in regards to the individuals drug of choice also yielded no differences (see Table 4.7).

PAGE 32

23 The variable of drug of choice thus appeared to have no direct relationship with the self-efficacy of the individual. No significant relationship was found between the scores on the Adapted AASE and the individuals drug of choice. Ethnicity. Ethnicity, for the purpose of this study was reported as either white or non-white. A series one-way ANOVAs for the MSPSS and its subscales (Significant Others, Family, Friends, and MSPSS total) and ethnicity were conducted (see Table 4.8). No significance was found between white and non-white groups with the Family subscale. A significant difference was found between White (M=6.26, SD=.65) and Non-White (M=5.37, SD=.1.51; F(1,38) = 6.131, p < .05) in the MSPSS Significant Others subscale scores. A significant difference was also found between White (M=5.61, SD=1.24) and Non-White (M=3.88, SD= 1.13; F(1,38) = 21.001, p < .01) in the MSPSS Friends subscale scores. A significant difference was also found between White (M=5.86, SD=.82) ands Non-White (M=4.74, SD=1.07; F(1,37)= 13.712, p < .01) in the MSPSS total scale scores. It appeared that White participants were more likely to have higher scores on the MSPSS Significant Others and Friends subscales, as well as the MSPSS total score. A series of one-way ANOVAs for the SCS-SA subscales (Precontemplation, Determination, Participation, and Relapse) and ethnicity were conducted. No significance was found between white and non-white groups with the Precontemplation, Determination, and Participation scores. A significant difference was found between White (M=1.83, SD=.55) and Non-White (M=2.34, SD=.71; F(1,34) = 5.838, p < .05) in the SCS-SA Relapse subscale scores (see Table 4.9). It appeared that Non-White participants were more likely to have higher scores on the SCS-SA Relapse subscale.

PAGE 33

24 A series of one-way ANOVAs for the Adapted AASE subscales (TemptationNegative Affect, TemptationSocial/Positive, TemptationPhysical and Other Concerns, TemptationCravings and Urges, ConfidenceNegative Affect, ConfidenceSocial/Positive, ConfidencePhysical and Other Concerns, ConfidenceCravings and Urges) and ethnicity were conducted. No significance was found between white and non-white groups with the Temptation-Negative Affect, TemptationSocial/Positive, or TemptationCravings and Urges subscales. A significant difference was found between White (M=2.08, SD=.88) and Non-White (M=1.56, SD=.72; F(1,38) = 4.12, p < .05) in the adapted AASE TemptationPhysical and Other Concerns subscale scores. A significant difference was found between White (M=3.56, SD=1.13) and Non-White (M=2.50, SD=1.39; F(1,37) = 6.87, p < .05) in the adapted AASE ConfidenceNegative Affect subscale scores. A significant difference was found between White (M=3.50, SD=1.21) and Non-White (M=2.70, SD=1.20; F(1,37) = 4.28, p < .05) in the adapted AASE ConfidenceSocial/Positive subscale scores. A significant difference was found between White (M=3.49, SD=1.08) and Non-White (M=2.57, SD=1.52; F(1,37) = 4.815, p < .05) in the adapted AASE ConfidencePhysical and Other Concerns subscale scores. A significant difference was found between White (M=3.47, SD=1.17) and Non-White (M=2.61, SD=1.41; F(1,36) = 4.223, p < .05) in the adapted AASE ConfidenceCravings and Urges subscale scores (see Table 4.10). It appeared that White participants were more likely to have higher scores on the Adapted AASE TemptationPhysical and Other Concerns, ConfidenceNegative Affect, ConfidenceSocial/Positive, ConfidencePhysical and Other Concerns, and ConfidenceCravings and Urges subscales

PAGE 34

25 Gender. Analyses of gender were not calculated due to the small number of females in the study. Table 4-1 MSPSS and Subscales Analyses of Variance for Phase in Treatment Source Df F 2 p MSOTH 39 .898 .05 .416 MSFAM 38 .771 .04 .470 MSFRND 39 .341 .02 .713 MSTOT 38 .618 .03 .544 Note: MSPSS = Multidimensional Scale of Perceived Social Support; MSOTH = Significant Others; MSFAM = Family; MSFRND = Friends; MSTOT = Total p < .05, ** p < .01 Table 4-2 SCS-SA Subscales Analyses of Variance for Phase in Treatment Source Df F 2 p SOCPART 33 2.790 .15 .077 SOCRELPS 35 1.106 .06 .343 SOCDETER 37 1.595 .08 .217 SOCPREC 37 .440 .03 .647 Note: SCS-SA = Stages of Change Scale-Substance Abuse; SOCPART = Participation; SOCRELPS = Relapse; SOCDETER = Determination; SOCPREC = Precontemplation p < .05, ** p < .01 Table 4-3 Adapted AASE Subscales Analyses of Variance for Phase in Treatment Source Df F 2 p TEMPNEG 36 .529 .03 .594 TEMPPOS 39 .692 .04 .507 TEMPPHY 39 .172 .01 .843 TEMPCRV 39 .634 .03 .536 CONFNEG 38 1.906 .10 .163 CONFPOS 38 1.548 .08 .227 CONFPHY 38 1.236 .06 .303 CONFCRV 37 .509 .03 .605 Note: Adapted AASE = Adapted Alcohol Abstinence Self-Efficacy Scale; TEMPNEG = TemptationNegative Affect; TEMPPOS = TemptationSocial/Positive; TEMPPHY = TemptationPhysical and Other Concerns; TEMPCRV = TemptationCravings and Urges; CONFNEG = ConfidenceNegative Affect; CONFPOS = ConfidenceSocial/Positive; CONFPHY = ConfidencePhysical and Other Concerns; CONFCRV = ConfidenceCravings and Urges; p < .05, ** p < .01

PAGE 35

26 Table 4-4 Two-Tail Inter-Correlation Matrix between Demographic Variables and Three Measures Variable Age Use Time Time Use Time .704* (.000) 40 Time .154 .151 (.344) (.353) 40 40 MSOTH -.185 -.192 .007 (.254) (.234) (.968) 40 40 40 MSFAM -.087 -.212 .064 (.600) (.195) (.700) 39 39 39 MSFRND .163 .141 -.080 (.316) (.386) (.622) 40 40 40 MSTOT -.035 -.112 .006 (.834) (.496) (.970) 39 39 39 SOCPART .398* .476** .232 (.020) (.004) (.187) 34 34 34 SOCRELPS -.161 -.199 -.076 (.349) (.244) (.659) 36 36 36 SOCDETER .309 .389* .015 (.059) (.016) (.929) 38 38 38 SOCPREC .117 .114 -.016 (.486) (.495) (.924) 38 38 38 TEMPNEG .174 .322 -.195 (.303) (.052) (.247) 37 37 37 TEMPPOS .015 .207 -.029 (.929) (.200) (.857) 40 40 40 TEMPPHY .147 .262 -.098 (.366) (.103) (.548) 40 40 40

PAGE 36

27 Table 4-4 Continued Variable Age Use Time Time TEMPCRV .116 .351* -.024 (.474) (.026) (.885) 40 40 40 CONFNEG .243 .100 .162 (.136) (.546) (324) 39 39 39 CONFPOS .259 .058 .135 (.111) (.727) (.413) 39 39 39 CONFPHY .255 .135 .145 (.117) (.411) (.379) 39 39 39 CONFCRV .346* .158 .029 (.033) (.345) (.862) 38 38 38 Note: p-values are in parentheses: *p<.05, **p
PAGE 37

28 Table 4-6 SCS-SA Subscales Analyses of Variance for Drug of Choice Source df F 2 p SOCPART 33 11.809 .55 .000** SOCRELPS 35 1.927 .15 .145 SOCDETER 37 3.400 .23 .029* SOCPREC 37 .022 .00 .995 Note: SCS-SA = Stages of Change Scale-Substance Abuse; SOCPART = Participation; SOCRELPS = Relapse; SOCDETER = Determination; SOCPREC = Precontemplation p < .05, ** p < .01 Table 4-7 Adapted AASE Subscales Analyses of Variance for Drug of Choice Source df F 2 p TEMPNEG 36 1.079 .09 .371 TEMPPOS 39 1.264 .10 .301 TEMPPHY 39 .873 .07 .464 TEMPCRV 39 1.050 .08 .382 CONFNEG 38 1.981 .14 .135 CONFPOS 38 1.962 .14 .138 CONFPHY 38 2.743 .19 .058 CONFCRV 37 1.207 .10 .322 Note: Adapted AASE = Adapted Alcohol Abstinence Self-Efficacy Scale; TEMPNEG = TemptationNegative Affect; TEMPPOS = TemptationSocial/Positive; TEMPPHY = TemptationPhysical and Other Concerns; TEMPCRV = TemptationCravings and Urges; CONFNEG = ConfidenceNegative Affect; CONFPOS = ConfidenceSocial/Positive; CONFPHY = ConfidencePhysical and Other Concerns; CONFCRV = ConfidenceCravings and Urges; p < .05, ** p < .01 Table 4-8 MSPSS and Subscales Analyses of Variance for Ethnicity Source df F 2 p MSOTH 39 6.131 .14 .018* MSFAM 38 1.712 .04 .199 MSFRND 39 21.001 .36 .000** MSTOT 38 13.712 .27 .001** Note: MSPSS = Multidimensional Scale of Perceived Social Support; MSOTH = Significant Others; MSFAM = Family; MSFRND = Friends; MSTOT = Total p < .05, ** p < .01 Table 4-9 SCS-SA Subscales Analyses of Variance for Ethnicity Source df F 2 p SOCPART 33 .782 .02 .383 SOCRELPS 35 5.838 .14 .021* SOCDETER 37 3.345 .08 .076 SOCPREC 37 1.967 .05 .169 Note: SCS-SA = Stages of Change Scale-Substance Abuse; SOCPART = Participation; SOCRELPS = Relapse; SOCDETER = Determination; SOCPREC = Precontemplation p < .05, ** p < .01

PAGE 38

29 Table 4-10 Adapted AASE Subscales Analyses of Variance for Ethnicity Source df F 2 p TEMPNEG 36 .492 .01 .488 TEMPPOS 39 3.114 .08 .086 TEMPPHY 39 4.124 .10 .049* TEMPCRV 39 .716 .02 .403 CONFNEG 38 6.871 .16 .013* CONFPOS 38 4.282 .10 .046* CONFPHY 38 4.815 .12 .035* CONFCRV 37 4.223 .10 .047* Note: Adapted AASE = Adapted Alcohol Abstinence Self-Efficacy Scale; TEMPNEG = TemptationNegative Affect; TEMPPOS = TemptationSocial/Positive; TEMPPHY = TemptationPhysical and Other Concerns; TEMPCRV = TemptationCravings and Urges; CONFNEG = ConfidenceNegative Affect; CONFPOS = ConfidenceSocial/Positive; CONFPHY = ConfidencePhysical and Other Concerns; CONFCRV = ConfidenceCravings and Urges; p < .05, ** p < .01

PAGE 39

CHAPTER 5 DISCUSSION Summary Prochaska and DiClemente (1982, 1986) developed the Transtheoretical Model to depict the process of change. It was hypothesized that the cessation of a problem behavior and therefore the acquisition of a healthier behavior involved a progression through five stages: precontemplation, contemplation, preparation, action, and maintenance (Abellanas & McLellan, 1993). The change is believed to happen in increments and involves detailed and varied tasks throughout the process (DiClemente and Prochaska, 1985, 1998). These stages have been used to understand the process of stopping problem behaviors, such as cessation of smoking and other addictive behaviors (Snow et al., 1992). Sobell et al. (1993) found that the greatest single factor with maintaining recoveries for alcohol abusers is that of social support, particularly from family and friends. Social support also has been found to be a crucial component in a successful drug treatment program (Caplan & Killilea, 1976). In terms of relapse potential, Havassy et al. (1991) found that social integration and abstinence-specific functional support predicted lower risk of relapse to tobacco, alcohol, and opiates. DiClemente (1986) showed self-efficacy to pertain to an individuals perceptions of his or her ability to mobilize necessary motivation, knowledge, and behavior to control or abstain from use of alcohol or other drugs. Efficacy beliefs are thought to affect all the phases of personal change from whether to change the behavior at all, to whether the 30

PAGE 40

31 individual succeeds at initiating the change, to whether the change is successfully maintained. In the case of addictive behaviors maintaining the change over time is the major problem (Bandura, 1992). Findings Research Question One. It was hypothesized that as a participant moved through the phases of treatment they should also be moving through the various stages of change as theorized by Prochaska and DiClemente (1982, 1986). The other hypotheses explored in this study were that as the participants moved through the phases of treatment they should also gain more motivation (self-efficacy) to change and build a more positive social support system. The evidence in this study does not support any of the three hypotheses. There are many reasons for which these hypotheses may not have been proven. The participants in this study could have simply been answering the questions, as they believed they should be. Another possibility is the scales may not have been appropriate for this particular treatment program. Practically, clients that undergo a relapse generally are not returned to an earlier phase of treatment (for example, if an individual relapses while in Phase 3 they remain in Phase 3, albeit they may stay in that phase longer than initially expected. Research Question Two. The second question in this study sought out to find any relationships between demographic variables and the three measures. Age. For the variable of age a significant correlation was found with the Participation stage of change. This appears to signify that the older a participant is and the longer he or she has been using, the more they are actually working on making changes to their substance use problem. The participants in the Participation stage of change have moved past their denial of a problem and into a movement towards change.

PAGE 41

32 There may be many reasons for this finding, such as Janis and Manns (1977) concept of bottoming out following long-time use and experiences of personal failure lead to increased desire for treatment. Additional research is needed for clarification between these variables. A significant correlation could not be found between age and the MSPSS or its subscales, however the findings are not conclusive and additional research may be able to find a relationship. As expected, age was not significantly correlated to the temptation to use. A significant correlation was also found between age and having confidence against cravings and urges. The older participants appear to deal more effectively with cravings and urges to use than the younger participants. Length of time using drugs or alcohol. There were no significant correlations between length of time using drugs or alcohol and the MSPSS or its subscales. As discussed earlier, a significant correlation was found between age and the Participation stage of change. There are similar correlations between length of use and the Participation and Determination subscales. There is a strong relationship between age and length of time using drugs or alcohol. This is consistent with the notion that older individuals with substance use problems have used those substances for a longer period of time than younger substance-using individuals. There were no significant correlations between the length of time using drugs or alcohol and the confidence subscales on the adapted AASE. A significant correlation was found between the length of time using drugs or alcohol and the TemptationCravings and Urges subscale.

PAGE 42

33 Length of time in the program. There were no significant correlations between length of time in the program and any of the three scales. This finding was unexpected and could be due to response bias, inappropriateness of scales, or lack of effective treatment. Drug of choice. A significant relationship was found between drug of choice and both the Participation and Determination stage of change. When looking at the differences between stages of change and substance abuse three significant differences were found in the Participation stage of change, alcohol and heroin/opiates, alcohol and crack/cocaine, and between marijuana and crack/cocaine. This current study does not account for this finding; further exploration of this topic appears to be needed. There were no significant differences between the individual groups in the Determination stage of change however, overall there appears to be a statistical difference. A reason for this may be a small effect size for the scale. This study found no evidence of any relationship between drug of choice and the MSPSS and its subscales, as well as between drug of choice and the adapted AASE and subscales. This finding shows that the participants drug of choice appears to have no bearing on how much social support they perceive themselves to have. Ethnicity. A significant relationship was found between ethnicity and Significant Others, Friends, and the MSPSS total score. It appears that Non-White participants reported lower perceived social support than the White participants with regard to significant others, friends and social support in general. There were no statistically significant differences between White and Non-White participants pertaining to family-related social support scores.

PAGE 43

34 A significant relationship was found between ethnicity and the SCS-SA Relapse subscale. According to this study it appears that Non-White participants reported a higher relapse potential than White participants. There were no statistically significant differences between White and Non-White participants regarding the Precontemplation, Determination, and Participation subscales. Limitations Some of the limitations to this study include the use of a convenience sample, a small sample size, and possible response bias (non-forthright responses by participants). It is not possible to make any assumptions about the effectiveness of the treatment program due to the size of the sample and because different results may be found with another future group of participants. There may be difference between counselors and the clients (counselors are female and White, clients are mostly male and equally divided between White and Non-White). There is no attempt to control for dual-diagnosis or socioeconomic status so it is uncertain what kind of effect they have on the variables studied. There was not a large enough gender difference to do analyses. The results may not be generalizable to other Drug Court programs because of the small sample size. No statements of causality could be made. Further Research Future research may want to use a larger sample to have a greater effect size. More questions could also be added to the Demographics Questionnaire to control for even more variables such as, number of prior treatment admissions, socioeconomic status, and how long they spent in each individual phase. Future research can look at the effect of dual diagnosis on the variables studied. Also, analyses of gender could not be correlated in this study due to the small number of females; it would be beneficial to find a sample

PAGE 44

35 that could use gender as a variable. This study could also be repeated at Corner Drug Store with a new sample of clients to see if the findings can be reproduced. Research could also be conducted at other drug treatment centers to find out if the data is generalizable. It was noted that there were differences in scores with regards to ethnicity, additional research might want to control for ethnic differences. Additional research is needed to study the differences between and within ethnic groups. Similarly, it was noted that there were differences between groups that used particular substances. Additional research is needed to study the differences between and within groups that use distinct substances. Future research can look at the effect of dual diagnosis on the variables studied.

PAGE 45

APPENDIX A STAGES OF CHANGE-SUBSTANCE ABUSE Please indicate the extent to which you tend to agree or disagree with each statement. In each case, make your choice in terms of how you feel right now, not what you have felt in the past or would like to feel. For all the statements that refer to your problem, answer in terms of your alcohol or other drug problem. And here refers to the place of treatment of the program. There are FIVE possible responses to each of the items in the questionnaire: 1-Strongly Disagree (SD) 2-Disagree (D) 3-Undecided (U) 4-Agree(A) 5-Strongly Agree (SA) Circle the number that best describes how much you agree or disagree with each statement. 1) I think I am ready to work on my alcohol and other drug problem. 1 2 3 4 5 2) I am working on my alcohol and other drug problem, which has been bothering me. 1 2 3 4 5 3) I am gathering information about support groups that will help me stay clean. 1 2 3 4 5 4) I worry that I may slip back to my old habits of t aking alcohol and other drugs that I have worked on in t reatment; therefore, I am going to continue working on my alcohol and other drug problems. 1 2 3 4 5 5) I am now working on my alcohol and other drug problem. 1 2 3 4 5 6) I have started working on my alcohol and other drug problem but I am not sure that I can do it without help. 1 2 3 4 5 Ag ree Undecided Disa g ree Stron g l y A g ree Stron g l y Disa g ree 36

PAGE 46

37 7) I feel that my alcohol or other drug problems are serious, I really need to change my ways. 1 2 3 4 5 8) I hope that treatment will help me understand my alcohol or other drug problem. 1 2 3 4 5 9) I may have some alcohol or other drug problems, but there is no reason to change them. 1 2 3 4 5 10) I am socializing less with friends who use alcohol or other drugs. 1 2 3 4 5 11) Sometimes I fail to stay clean and I am here to prevent a relapse. 1 2 3 4 5 12) Although at times, I am unable to change my alcohol or other drug problem, I still continue to work on it. 1 2 3 4 5 13) I feel more positive about treatment. 1 2 3 4 5 14) I hope that I can find a way to solve my alcohol or other drug problem. 1 2 3 4 5 15) Although I have started taking some steps toward working on my alcohol or other drug problem, I may need help from a counselor to continue my progress. 1 2 3 4 5 16) This treatment program may help me with my alcohol or other drug problem. 1 2 3 4 5 17) I need additional support to help me stick with the changes that I have made on my alcohol or other drug problem. 1 2 3 4 5 18) I may be part of the alcohol or other drug problem, but I don't think so. 1 2 3 4 5 19) I hope that the counselors in this program will help me with my alcohol or other drug problem. 1 2 3 4 5 20) All this talk about changing my alcohol or other drug problem is boring. I just want everyone to leave me alone. 1 2 3 4 5 21) I am beginning to explore the best way to change my alcohol or other drug problem. 1 2 3 4 5 Ag ree Undecided Disa g ree Stron g l y A g ree Stron g l y Disa g ree

PAGE 47

38 22) I have problems but so do other people. Why waste the time worrying? 1 2 3 4 5 23) I would rather live with my alcohol or other drug problems than try to change them. 1 2 3 4 5 24) I am surprised that my friends and family think that I have an alcohol or other drug problem. 1 2 3 4 5 25) I had begun to make changes about my alcohol or other drug problem but recently I started using drugs again. 1 2 3 4 5 26) Because I often experienced a relapse, I am not sure that I can ever stay clean for a long period of time. 1 2 3 4 5 27) I have been capable of working on my alcohol or other drug problem but I am not sure I can stay clean on my own. 1 2 3 4 5 28) Although it is hard to work on my alcohol or other drug problem, I continue to work on my problems. 1 2 3 4 5 29) I am trying to build new friendship with people who do not use alcohol or other drugs. 1 2 3 4 5 30) I would like to work on my alcohol or other drug problems but I find it hard to do. 1 2 3 4 5 31) I have been working on changing my alcohol or other drug behaviors but recently I relapsed. This makes me feel that I do not have the skills to stay clean. 1 2 3 4 5 32) It is upsetting, but I think I may have an alcohol or other drug problem againI thought it was under control. 1 2 3 4 5 33) I am now working on my alcohol or other drug problem. 1 2 3 4 5 34) It may be helpful to work on my alcohol or other drug problem. 1 2 3 4 5 Ag ree Undecided Disa g ree Stron g l y A g ree Stron g l y Disa g ree

PAGE 48

39 Ag ree Undecided Disa g ree Stron g l y A g ree Stron g l y Disa g ree 35) I am preparing myself to change my problem by listening to other people discuss how they stay clean. 1 2 3 4 5 36) I am beginning to understand the benefits of being in treatment. 1 2 3 4 5 37) I am serious about changing my alcohol or other drug problem. 1 2 3 4 5

PAGE 49

APPENDIX B ADAPTED ALCOHOL ABSTINENCE SELF-EFFICACY SCALE 40

PAGE 50

41

PAGE 51

42

PAGE 52

43

PAGE 53

APPENDIX C MULTIDIMENSIONAL SCALE OF PERCEIVED SOCIAL SUPPORT Please indicate, using the scale below, your opinion on each of the 12 statements that follow. There are no right or wrong answers. We are simply looking for your opinion (i.e., whether you personally agree or disagree with each statement). 1=strongly disagree, 2=disagree, 3=mildly disagree, 4=neither agree nor disagree 5=mildly agree, 6=agree, 7=strongly agree 1. _____ There is a special person who is around when I am in need. 2. _____ There is a special person with whom I can share my joys and sorrows. 3. _____ My family really tries to help me. 4. _____ I get the emotional help and support I need from my family. 5. _____ I have a special person who is a real source of comfort to me. 6. _____ My friends really try to help me. 7. _____ I can count on my friends when things go wrong. 8. _____ I can talk about my problems with my family. 9. _____ I have friends with whom I can share my joys and sorrows. 10._____ There is a special person in my life who care about my feelings. 11._____ My family is willing to help me make decisions. 12._____ I can talk about my problems with friends. 44

PAGE 54

APPENDIX D DEMOGRAPHICS QUESTIONNAIRE 1. What is your age? 2. What is your ethnicity? (circle one) White Hispanic African-American Other________ 3. What phase of the program are you in? 4. How long have you been in the program? 5. Male or Female (circle one) 6. How many years have you bee using drugs or alcohol? 45

PAGE 55

LIST OF REFERENCES Abellanas, L. & McLellan, T. (1993). Stage of change by drug problem in concurrent opioid, cocaine, and cigarette users. Journal of Psychoactive Drugs, 25, 307-313. Annis, H. M., & Davis, C. S. (1989). Relapse prevention: A cognitive-behavioral approach based on self-efficacy theory. Journal of Chemical Dependency, 2, 81-103. Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, New Jersey: Prentice Hall, Inc. Bandura, A. (1992). Self-efficacy mechanism in psychobiologic functioning. In R. Schwarzer (Ed.), Self-efficacy: Thought control of action (pp.355-394). Washington, DC: Hemisphere. Bandura, A. (1995). Exercise of personal and collective efficacy in changing societies. In A. Bandura (Ed.), Selfefficacy in changing societies. (pp.1-45). New York: Cambridge University Press. Bandura, A. & Adams, N. E. (1977). Analysis of self-efficacy theory of behavioral change. Cognitive Therapy and Research, 1, 287-310. Booth, B. M., Russell, D. W., Soucek, S., & Laughlin, P. R. (1992). Social support and outcome of alcoholism treatment: An exploratory analysis. American Journal of Drug and Alcohol Abuse, 18, 87-101. Burling, T. A., Reilly, P. M., Moltzen, J. O., & Ziff, D. C. (1989). Self-efficacy and relapse among inpatient drug and alcohol abusers: A predictor of outcome. Journal of Studies on Alcohol, 50, 354-360. Caplan, G., & Killilea, M. (1976). Support systems and mutual help. New York: Grune and Stratton. Cardoso, E. D, Chan, F. Berrven, N. L., & Thomas K. R. (2003). Measuring readiness for change in individuals in residential treatment community programs for treatment of substance abuse. Rehabilitation Counseling Bulletin, 47, 34-44. Condelli, W. S. & Hubbard, R. L. (1994). Relationship between time spent in treatment and client outcomes from therapeutic communities. Journal of Substance Abuse Treatment, 11, 25-33. 46

PAGE 56

47 DiClemente, C. C. (1981). Self-efficacy and smoking cessation maintenance. Cognitive Therapy Research, 5, 175-187. DiClemente, C. C. (1986). Self-efficacy and the addictive behaviors. Journal of Social and Clinical Psychology, 4, 302-315. DiClemente, C. C., Carbonari, J. P., Montgomery, R. P., & Hughes, S. O. (1993). The Alcohol Abstinence Self-Efficacy scale. Journal of Studies on Alcohol, 55, 141-148 DiClemente, C. C. & Prochaska, J. O. (1985). Processes and stages of change: Coping and competence in smoking behavior change. In S.Shiffman & T. A Wills (Eds.), Coping and substance abuse. (pp.319-342). New York: Academic Press. DiClemente, C. C. & Prochaska, J. O. (1998). Toward a comprehensive, transtheoretical model of change: Stages of change and addictive behaviors. In W. R. Miller & N. Heather (Eds.), Treating addictive behaviors (2 nd ed., pp. 3-24). New York: Plenum Press. Frances, R. J. & Miller, S. I. (Eds.). (1991). Clinical textbook of addictive disorders. New York: Guilford Press. Gerstein, D.R., Johnson, R. A., Harwood, H., Fountain, D. Sutter, N. Malloy, K. (1994). Evaluating recovery series. The California Drug and Alcohol Treatment Assessment (CALDATA). Sacramento, CA: State of California, Dependency Drug and Alcohol Program. Gordon, A. J., & Zrull, M. (1991). Social networks and recovery: One year after inpatient treatment. Journal of Substance Abuse Treatment, 8, 143-152. Grimley, D., Prochaska, J. O., Velicer, W. F., Blais, L. M., & DiClemente, C. C. (1994). The Transtheoretical Model of Change. In T. M. Brinthaupt and R. P. Lipka (Eds.), Changing the self: Philosophies, Techniques, and Experiences. (pp.201-227) Albany, New York: State University of New York. Harwood, H., Fountain, D., Livermore, G. (1997). The economic costs of alcohol and drug abuse in the US, 1992. NIDA/NIAAA Sponsored Report. Rockville, MD: Lewin Group. Harwood, H. J., Hubbard, R. L., Collins, J., Rachal, J. V. (1995). A cost-benefit analysis of drug abuse treatment. Research in Law and Public Policies, 3, 191-214. Havassy, B. E., Hall, S. M., & Wasserman, D. A. (1991). Social support and relapse: Commonalities among alcoholics, opiate users and cigarette smokers. Addictive Behaviors, 16, 235-246. Hennessey, J. J. (2001). Introduction: drug courts in operation. In J. J. Hennessey & N. J. Pallone (Eds.), Drug Courts in operation: Current research. (pp.1-10). New York: Haworth Press.

PAGE 57

48 Hiller, M. L., Broome, K. M., Knight, K, & Simpson, D. D. (2000). Measuring selfefficacy among drug-involved probationers. Psychological Reports, 86, 529-538. Hirschi, T. & Gottfredson, M (1983). Age and the explanation of crime. American Journal of Sociology, 89, 552-584. Hubbard, R. L., Craddock, S. G., Flynn, P. M., Anderson, J., & Etheridge, R. M. (1997). Overview of 1-year follow-up outcomes in the Drug Abuse Treatment Outcome Study (DATOS). Psychology of Addictive Behaviors, 11, 261-278. Janis, I. L., & Mann, L. (1977). Decision-making: A psychological analysis of conflict, choice, and commitment. New York: Free Press. Lang, M. A., & Belenko, S. (2000). Predicting retention in a residential drug treatment Alternative to prison program. Journal of Substance Abuse Treatment, 19, 145-160. Marlatt, G. A. (1985). Relapse Prevention: Theoretical rationale and overview of the model. In G. A. Marlatt & J. R. Gordon (Eds.), Relapse Prevention (pp.3-70). NewYork: Guilford Press. Marlatt, G. A., & Gordon, J. R. (Eds.). (1985). Relapse Prevention. New York: Guillford Press. Mammo, A. & Weinbaum, D. F. (1993). Some factors that influence dropping out from outpatient alcoholism treatment facilities. Journal of Studies on Alcohol, 54, 92-101. McCrady, B. S. (2004). To have but one true friend: Implications for practice of research on alcohol use disorders and social networks. Psychology of Addictive Behaviors, 18(2), 113-121. McCrady, B. S., Epstein, E. E., & Sell, R. D. (2003). Theoretical bases of family approaches to substance abuse treatment. In F. Rotgers, D. S. Keller, & J. Morgenstern (Eds.), Treatment of substance abusers: Theory and technique (2 nd ed., pp. 112-139). New York: Guilford Press. McCrady, B. S., Hayaki, J., Epstein, E. E., & Hirsch, L. S. (2002). Testing hypothesized predictors of change in conjoint behavioral alcoholism treatment for men. Alcoholism: Clinical and Experimental Research, 26, 463-470. McFarlain, R. A., Cohen, G. H., Yoder, J., & Guirdy, L. (1977). Psychological test and demographic variables associated with retention of narcotic addicts in treatment. International Journal of Addictions, 12, 399-410 McKay, J. R., Maisto, S. A., & OFarrell, T. J. (1993). End of treatment self-efficacy, aftercare, and drinking outcomes of alcoholic men. Alcoholism: Clinical and Experimental Research, 17, 1078-1083.

PAGE 58

49 Miller, W. R., & Rollnick, S. (1991). Motivational interviewing: Preparing people to change addictive behavior. New York: Guilford Press. Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people to change addictive behavior (2 nd ed.). New York: Guilford Press. Mohr, C. D., Averne, S., Kenny, D. A, & Delboca, F. (2001). Getting by (or getting high) with a little help from my friends: An examination of adult alcoholics friendships. Journal of Studies on Alcohol, 62, 637-645. Moos, R. H., Bromet, E., Tsu, V., & Moos, B. (1979). Family characteristics and the outcome of treatment for alcoholism. Journal of Studies on Alcohol, 40, 78-88. OFarrell, T. J., Hooley, J., Fals-Stewart, W. & Cutter, H. Q. (1998). Expressed emotion and relapse in alcoholic patients. Journal of Consulting and Clinical Psychology, 66, 744-752. Prochaska, J. O., & DiClemente, C. C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research, and Practice, 19, 276-288. Prochaska, J. O., & DiClemente, C. C. (1986). Toward a comprehensive model of change. In W.R. Miller & N. Heather (Eds.), Treating addictive behaviors: Processes of change (pp.3-27). New York: Plenum Press. Prochaska, J. O., & DiClemente C. C. (1992). Stages of change in the modification of problem behaviors. Progress in Behavior Modification, 28, 183-218. Prochaska, J. O., DiClemente C. C., & Norcross, J. C. (1992). In search of how people change: Applications to addictive behaviors. American Psychologist, 47, 1102-1114. Remple, M. & DeStefano, C. D. (2001). Predictors of engagement in court-mandated treatment: Findings at the Brooklyn treatment court, 1996-2000. In J. J. Hennessy & N. J. Pallone (Eds.), Drug Courts in operation: Current research (pp.87-123). New York: Haworth Press. Rosenberg, H. (1983). Relapsed versus non-relapsed alcohol abusers: Coping skills, life events, and social support. Addictive Behaviors, 8, 183-186. Rychtarik, R. G., Prue, D. M., Rapp, S. R., & King, A. C. (1992). Self-efficacy, aftercare, and relapse in a treatment program for alcoholics. Journal of Studies on Alcohol, 53, 435-440. Sansone, J. (1980). Retention patterns in a therapeutic community for the treatment of drug abuse. International Journal of Addictions, 15, 711-736.

PAGE 59

50 Saxon, A., Wells, E., Fleming, C., Jackson, T., & Calsyn, D. (1996). Pre-treatment characteristics, program philosophy and level of ancillary services as predictors of methadone maintenance treatment outcome. Addictions, 91, 1197-1209. Sindelar, J. L. & Fiellin, D. A. (2001). Innovations in treatment for drug abuse: Solutions to a public health problem. Annual Review of Public Health, 22, 249-272. Slaught, E. (1999). Focusing on the family in the treatment of substance abusing criminal offenders. Journal of Drug Education, 29, 53-62. Snow, M.G., Prochaska, J.O., & Rossi, J.S. (1992) Stages of change for smoking cessation among former problem drinkers: A cross-sectional analysis. Journal of Substance Abuse Treatment, 4, 107-116. Sobell, L. C., Sobell, M. B., Toneatto, T. & Leo, G. I. (1993). Recovery from alcohol problems without treatment. In N. Heather, W. R. Miller, & J. Greeley (Eds.). Self-control and the addictive behaviors (pp.198-242). New York: Maxwell/Mac Millan. Steer, R. A. (1980). Psychosocial correlates of retention in methadone maintenance. International Journal of Addictions, 15, 1003-1009. Substance Abuse and Mental Health Services Administration (SAMHSA). (2004). Results from the 2003 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H-25, DHHS Publication No. SMA 04-394). Rockville, MD. Sung, H., Belenko, S., Fend, M. A., & Tabachnick, M. A. (2004). Predicting treatment noncompliance among criminal justice-mandated clients: A theoretical and empirical exploration. Journal of Substance Abuse Treatment, 26, 13-26. Tucker, M. B. (1979). A descriptive and comparative analysis of the social support structure of heroin-addicted women. In Addicted women: Family dynamics, self-perception and support systems. Rockville, MD: Department of Health and Human Services. Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 52, 30-41. Zimet, G. D., Powell, S. S., Farley, G. K., Werkman, S. Berkoff, K. A. (1990). Psychometric characteristics of the Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 55, 610-617. Zywiak, W. H., Lognabaugh, R., & Wirtz, P. W. (2002). Decomposing the relationship between pretreatment social network characteristics and alcohol treatment outcome. Journal of Studies on Alcohol, 63, 114-121.

PAGE 60

BIOGRAPHICAL SKETCH Rebeca Lau Kovar is a student in the rehabilitation counseling masters program at the University of Florida. She has a Bachelor of Science degree in psychology, also from the University of Florida. Currently she is employed as an Addictions Counselor at Corner Drug Store-Outpatient Services working with the federal and county probation population. 51


Permanent Link: http://ufdc.ufl.edu/UFE0011652/00001

Material Information

Title: Stages of Change, Self-Efficacy, Social Support, and Substance Abuse within a Gainesville, Florida Drug Court Program
Physical Description: Mixed Material
Copyright Date: 2008

Record Information

Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
System ID: UFE0011652:00001

Permanent Link: http://ufdc.ufl.edu/UFE0011652/00001

Material Information

Title: Stages of Change, Self-Efficacy, Social Support, and Substance Abuse within a Gainesville, Florida Drug Court Program
Physical Description: Mixed Material
Copyright Date: 2008

Record Information

Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
System ID: UFE0011652:00001


This item has the following downloads:


Full Text












STAGES OF CHANGE, SELF-EFFICACY, SOCIAL SUPPORT, AND SUBSTANCE
ABUSE WITHIN A GAINESVILLE, FLORIDA DRUG COURT PROGRAM
















By

REBECA LAU KOVAR


A THESIS PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF HEALTH SCIENCE

UNIVERSITY OF FLORIDA


2005


































Copyright 2005

by

Rebeca Lau Kovar















ACKNOWLEDGMENTS

First and foremost, I would like to thank my family. I thank my parents, Rosa and

Miguel, for all the help and patience they have given me throughout my life. I thank my

grandparents, Rebeca and Angel, for inspiring me to be all that I can be and to never

accept less than the best in anything I do; may they rest in peace. I thank my husband,

James, and son, James Jr., for all the understanding they have had for me throughout this

process when I could not go out and play at the park. To my husband in particular, I

would like to say thank you for all of the love and support, in the good times and the bad

times. To my son, I would like to say thank you for all the hugs and kisses at just the

right times. I thank God for giving me the perseverance to follow through and finish

things no matter how difficult they may appear to be. I would also like to thank all my

friends who have given me constant support and have cheered me on as much as was

necessary to get the job done. I would like to thank my best friend, Gigi, in particular for

always being there to push me forward.

I would like to thank the Corner Drug Store, Inc. (CDS) first for hiring me as a

counselor and second for allowing me to use their facility for my research. Without CDS

this would have been a much harder journey. I would also like to thank all the wonderful

clients whose hardships have brought me a deeper understanding of their disease. Thanks

to the clients who volunteered to participate in this study despite receiving no

compensation. I would like to take this time to express my deepest thanks to my

supervisor, Lanard, for his understanding of my stress and allowing me to take off all the









time I needed to complete this thesis. I would like to thank both my fellow counselors,

Nancy and Christie, for helping with my research and taking time out of group to

distribute my measures. I would like to thank Nancy for being a sounding board for my

complaints, frustrations, and joy when it was all over.

I would not be where I am today if it were not for all my teachers along the way.

For those whom I may leave out I am sorry but they have helped to mold my mind and

shape my future. I would like to thank in particular those professors on my committee

for all being part of my inspiration. I would like to thank Dr. Linda Shaw for always

making me feel like I belong at the top of everything that I do. I would also like to

extend my deepest thanks to Dr. Martin Heesacker for being there when life seemed at its

hardest, for helping me to find the rehabilitation counseling program, and for taking such

a genuine interest in my life. I met him, as my professor, during my pregnancy and he

really took me under his wing so that I would not give up on my dream of graduate

school. Without him I may not have had the drive to complete this thesis. Lastly, but

definitely not least, I would like to thank Dr. Steven Pruett, who agreed to be my

committee chair without ever meeting me. I thank him for all his help and direction. I

have enjoyed working with him and know that even though I might have driven him

crazy at times he still helped me do the best that I could do. I know that he will always

be connected to one of my proudest accomplishments. Thanks again.
















TABLE OF CONTENTS

page

A C K N O W L E D G M E N T S ......... ................................................................................... iii

L IST O F T A B L E S ................................................................... ..................... vii

A B STR A C T ................................................................................ ..................... viii

CHAPTER

1 IN TR O D U C T IO N ............................................................. .. ......... ...... .....

State ent of the P problem ............................................................................. ........ .4
Significance of the Study ............................................................ ............4

2 LITER A TU R E R EV IEW ............................................................... ...................... 6

Stages of change ................................................................. 6
S e lf-e ffic a cy ................................................................................. 7
Social Support.................................................. 8
P ro g ra m .................................................................................................................. 1 0
D e m o g ra p h ic s ........................................................................................................ 1 0

3 METHODOLOGY ................................................................. .... ........12

R research D design ....................................................... 12
P a rtic ip a n ts ............................................................................................................ 1 2
M e a su re s .......................................................................................................1 3
D ata C collection P procedure ..................................................................................... 16
D ata A n a ly sis ............................................................................................1 7

4 R E S U L T S ........................................................................................................1 8

R results for Q question O ne .............................................................................. 18
R results for R research Q question 2...................................................... 21

5 D ISC U S SIO N ............................................................................... 30

S u m m a ry ...................................................................................................... 3 0
F in d in g s ................................................................ 3 1
L im itatio n s .......................................................................................3 4


v









F u rth er R research .............................................................................. ..................... 3 4

APPENDIX

A STAGES OF CHANGE-SUBSTANCE ABUSE....................................................36

B ADAPTED ALCOHOL ABSTINENCE SELF-EFFICACY SCALE.....................40

C MULTIDIMENSIONAL SCALE OF PERCEIVED SOCIAL SUPPORT ..............44

D DEMOGRAPHICS QUESTIONNAIRE......................................... .....................45

L IST O F R E F E R E N C E S .................... ..... ..................................................................46

BIOGRAPHICAL SKETCH ............... ... ..................... ...............51
















LIST OF TABLES


Table p

4-1 MSPSS and Subscales Analyses of Variance for Phase in Treatment.....................25

4-2 SCS-SA Subscales Analyses of Variance for Phase in Treatment.............................25

4-3 Adapted AASE Subscales Analyses of Variance for Phase in Treatment .................25

4-4 Two-Tail Inter-Correlation Matrix between Demographic Variables and Three
M easures................................................... ............. .................. 26

4-5 MSPSS and Subscales Analyses of Variance for Drug of Choice ............................27

4-6 SCS-SA Subscales Analyses of Variance for Drug of Choice...............................28

4-7 Adapted AASE Subscales Analyses of Variance for Drug of Choice .......................28

4-8 MSPSS and Subscales Analyses of Variance for Ethnicity .....................................28

4-9 SCS-SA Subscales Analyses of Variance for Ethnicity ................... .....................28

4-10 Adapted AASE Subscales Analyses of Variance for Ethnicity.............................29















Abstract of Thesis Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Master of Health Science

STAGES OF CHANGE, SELF-EFFICACY, SOCIAL SUPPORT, AND SUBSTANCE
ABUSE WITHIN A GAINESVILLE, FLORIDA DRUG COURT PROGRAM

By

Rebeca Lau Kovar

August 2005

Chair: Steven R. Pruett
Major Department: Rehabilitation Counseling

Drug abuse and alcohol abuse are growing problems in today's society. Effective

treatment helps to reduce the already huge costs to society, the individual, and families of

the alcohol or substance abuser. Advancing through the various stages of change, self-

efficacy, and increased social support have been found to be integral parts of effective

substance abuse treatment. The purpose of the study was to measure social supports,

self-efficacy, and stages of change for clients within Corner Drug Store's Outpatient

Services that are criminal drug offenders.

An ex-post facto cross-sectional research design was applied to a convenience

sample drawn from clients participating in a drug-court treatment program at the Corer

Drug Store in Gainesville, FL. Scales used in this study were as follows: the Stages of

Change Scale-Substance Abuse, the Adapted Alcohol Abstinence Self-Efficacy Scale, the

Multidimensional Scale of Perceived Social Support, and a Demographics Questionnaire.









A series of Analyses of Variances (ANOVAs) and a Pearson product-moment

correlation were conducted. No significant relationships were found between the

participants' phase in treatment and the various stages of change. Significant

relationships were found between ethnicity and select subscales in each of the three

scales. The amount of time using illicit substances also appeared to have a relationship

with several of the stages of change subscales.














CHAPTER 1
INTRODUCTION

Alcohol and drug use is a common occurrence in today's society, with such use

often associated with a variety of medical, psychological, and social problems (Frances &

Miller, 1991). In the 2003 National Survey on Drug Use and Health (Substance Abuse

Mental Health Services Adiministration [SAMHSA], 2004) a variety of data about adult

drug use in the United States was collected. These data include overall prevalence of use

during the preceding year and preceding month for different drugs, including alcohol and

tobacco cigarettes. In this case "use" means the respondent used the drug in question at

least once during the time period in question. Several of these findings stand out. There

are reportedly an estimated 19.5 million illicit drug users aged 12 or older. Marijuana

heads the list of illicit drug use at 75.2 percent. These relationships hold up both for use

in the past year and for use in the past month. There are reportedly an estimated 119

million current drinkers of alcohol in the survey (SAMHSA, 2004).

The prevalence of drug use differs with characteristics of people. An example of

this would be the prevalence of drug use in the past month varies as a function of age.

Individuals between the ages of 18-20 have the highest illicit drug use at 23.3 percent.

Rates of alcohol use in the past month were highest among individuals between the ages

of 21-25, used by approximately 70 percent (SAMHSA, 2004).

Substance use during the past month also varies according to ethnic/racial group

and gender. Men, 10 percent, were more likely than to report illicit drug use than

women, 6.5 percent, and were considerably more likely to report any use of alcohol (62.4









percent versus 46 percent). For ethnic/racial differences, whites, 54.4 percent more

frequently reported any alcohol use than did Hispanics, 39.8 percent, and, blacks, 37.9

percent. In respect to illicit drug use rates were 8.7 percent for blacks, 8.0 percent for

whites, and 8.0 percent for Hispanics (SAMHSA, 2004).

According to the 2003 National Survey on Drug Use and Health (SAMHSA, 2004)

among the estimated 1.4 million adults aged 18 or older on parole or other supervised

release from prison during the past year, 24.3 percent were current illicit drug users

compared with 7.7 percent among adults not on parole or supervised release. Also,

among the estimated 4.8 million adults on probation at some time in the past year, 28

percent reported illicit drug use in 2003. This compares with a rate of illicit drug use at

7.4 percent among adults not on probation in 2003 (SAMHSA, 2004).

Treatment reduces costs to society, largely in savings from the criminal justice

system (Gerstein, Johnson, Harwood, Fountain, Sutter, & Malloy, 1994). Treatment also

enhances the overall functioning of individuals and families. Substance abuse increases

morbidity and mortality, reduces overall mental and physical health, disrupts

neighborhoods, and reduces productivity. Even individuals other than the users

themselves are affected. Other external problems increased by substance abuse include

drug-related crimes and the spread of contagious diseases (Harwood, Hubbard, Collins,

Rachal, 1995; Hubbard, Craddock, Flynn, Anderson, Etheridge, 1997). Illicit drug use

isresponsible for over 250,000 deaths annually. In 1992, total costs, including health care

expenditures, lost productivity, crime-associated costs, and other factors, were estimated

to be 97 billion dollars. The category "lost productivity," the largest at 69 billion dollars,

includes the value of time lost due to premature death, institutionalization, incarceration,









and victimization by crime. Crime-related cost is the second biggest cost category, at

almost 18 billion dollars. Health care expenses constitute the third major category, which

is estimated to cost society about 10 billion dollars (Harwood, Fountain, & Livermore,

1997).

Miller and Rollnick (2002) found that substance abusers often recognize the risks,

costs, and harm involved in their behavior. Yet for a variety of reasons are to attached

and attracts to the behavior to change. The individuals are stuck in a state of

ambivalence; they want to use but they don't want to, they want to change but they don't

want to. The authors find this ambivalence to be a natural phase of the process of change

as long as they continue to move through it. When an individual gets stuck in

ambivalence their problems may persist and intensify (Miller & Rollnick, 2002).

The Transtheoretical Model (DiClemente & Prochaska, 1985, 1998) is based on the

notion that behavior change occurs in increments and it involves detailed and varied

tasks. This model offers a framework for understanding the process of behavior change.

In this model change is viewed as a progression from the precontemplation stage, where

no change is considered; to contemplation, where the individual weighs the pros and cons

of change; and then to preparation, where planning and commitment are secured.

Successful accomplishment of these initial stages lead to taking action and making

specific behavior change; if successful in the action stage the individual moves into the

final stage, maintenance, in which the person works to maintain and continue long-term

change (DiClemente & Prochaska, 1998; Prochaska, DiClemente, & Norcross, 1992).

Miller and Rollnick (2002) have found self-efficacy, individuals' belief in their

ability to carry out and succeed with a specific task, to be a key element in motivation for









change. Self-efficacy was also found to be a reasonably good predictor of treatment

outcome. The authors state that if that if the individual perceives no hope or possibility

for change, no effort will be made towards change (Miller & Rollnick, 2002).

Sobell, Sobell, Toneatto, and Leo (1993) found that the greatest single factor with

maintaining recoveries for alcohol abusers is that of social support, particularly from

family and friends. Social support has been found to be a crucial component in a

successful drug treatment program, as it allowed individuals to adapt to stressful life

situations (Caplan & Killilea, 1976). In terms of relapse potential, Havassy, Hall, and

Wasserman (1991) found that social integration and abstinence-specific functional

support predicted lower risk of relapse to tobacco, alcohol, and opiates.

Statement of the Problem

Substance abuse treatment is complicated and intricate. Substance use harms

society by reducing user's physical and mental health and productivity, reducing family

and social functioning, and by increasing crime. Without effective treatment programs

these problems will continue to escalate (Sindelar & Fiellin, 2001). Development of

effective treatment programs must consist of awareness of addiction, the stages of

change, developing social supports, and increased motivation. There is a need to measure

how individuals are progressing through treatment and to make sure they are moving

through as intended. There is a need to know if individuals need increased treatment in

the above-mentioned areas. There is also a need for more effective measurement in

treatment, which may aid in the overall effectiveness of programs.

Significance of the Study

This study has taken a sample of individuals that are currently involved in a

substance abuse treatment and measured their progress with regard to social support, self-









efficacy, and stages of change. It is important for substance abuse treatment facilities to

be able to track their clients' progress and to determine the effectiveness of the overall

treatment. Additionally, this study may aid in the identification of individuals in need of

increased treatment. This research would be beneficial to program participants because in

theory as the participants advance in treatment they should gain more social supports,

have a higher self-efficacy, and should move through the stages of change. The program

may choose to use the measures studied in this research as part of treatment in the future

to identify problem areas for their clients, which would in turn allow the treatment

outcome to be a more successful one.

The purpose of the study is to measure social supports, self-efficacy, and stages of

change for clients within Corer Drug Store's Outpatient Services that are criminal drug

offenders.

The research questions to be addressed in this study are as follows:

1. Are there relationships between the scores on the Stages of Change Scale-
Substance Abuse (SCS-SA), the Adapted Alcohol Abstinence Self-Efficacy Scale
(Adapted AASE), the Multidimensional Scale of Perceived Social Support
(MSPSS), and the "phase" of treatment at Corer Drug Store, Inc.

2. Are there relationships between a set of demographic variables (i.e., ethnicity, age,
drug of choice, length of use, length of time in the program) and the scales
discussed in question one.














CHAPTER 2
LITERATURE REVIEW

Stages of change

Cessation of problem behavior and initiation or better responses does not occur in

one abrupt action (Abellanas & McLellan, 1993). Prochaska and DiClemente

(1982,1986) developed the Transtheoretical Model depicting a sequence of stages

through which people progress as they initiate and maintain behavior change. These

stages have been used to understand the process of stopping problem behaviors, such as

cessation of smoking and other addictive behaviors (Snow, Prochaska, & Rossi, 1992) as

well as overeating and unsafe sexual behaviors (Prochaska et al., 1992)

The Transtheoretical Model hypothesizes that the cessation of high-risk behaviors

and the acquisition of healthier alternatives involves progression through five "stages of

change": precontemplation, contemplation, preparation, action, and maintenance

(Abellanas & McLellan, 1993). The first of these stages is called precontemplation, a

state of unawareness of a problem or a need for change (Miller & Rollnick, 1991). In this

stage the individual is not intending to change the behavior in the foreseeable future

(Grimley, Prochaska, Velicer, Blais, & DiClemente, 1994). As awareness of the problem

increases, the individual enters a state of ambivalence or contemplation, in which the

individual weighs the possible pros and cons (Miller & Rollnick, 1991). The individual

in this stage may intend to change but has not made a serious commitment to that change

(Grimley et al.). Over time, the decisional balance my tip in favor of change, as the

adverse consequences (cons) outweigh the perceived advantages (pros). This point has









been termed "bottoming out," it suggests a developmental point at which the individual

shifts from unmotivated to motivated status by having endured a sufficient volume of

suffering to instigate change (Janis & Mann, 1977). In the original model Prochaska and

DiClemente (1986) termed this point in which the balance shifts the determination stage

but subsequently deleted the stage and then more recently reinstated it, renaming this

transition period as a preparation phase (Prochaska & DiClemente 1992; Prochaska et

al., 1992). Following this transition the individual moves into an action stage in which

efforts are made to change the behavior. If the initial efforts are successful the individual

moves into the maintenance stage, which involves relapse prevention (Marlatt & Gordon,

1985). Relapse prevention involves taking steps to protect against falling back into the

old pattern of behavior. Given that behavior is usually not maintained on the first try in

most cases, Prochaska and DiClemente (1986) also describe a relapse stage, in which the

individual may revert back to action or cycle back through contemplation, determination-

preparation, action, and maintenance in order to achieve lasting behavior.

Self-efficacy

The concept of self-efficacy has played a major role in the understanding and

treatment of addictive behaviors. Bandura (1986) defined perceived self-efficacy as

"people's judgments of their capabilities to organize and execute courses of action

required to attain designated types of performances" (pp.391). Self-efficacy is how

individuals deal with prospective situations that contain many ambiguous, unpredictable,

and often stressful, elements. Self-efficacy is a cognitive process because it deals with

perceived judgments individuals make about their competency to perform adequately in a

specific task situation (Marlatt, 1985). Individuals may perform poorly, adequately, or

extremely well depending on the individual variations in perceived self-efficacy









(Bandura, 1995). Perceived self-efficacy affects people's choice of activities and

behavioral settings, how much effort they expend, and how long they will persist in the

face of obstacles and aversive experiences. The stronger the individual's perceived self-

efficacy, the stronger the coping skills. Those individuals who continue in threatening

activities will eventually eliminate their inhibitions through their experiences, whereas

those who avoid what they fear, or who cease their coping efforts early, will retain their

defensive behavior (Bandura & Adams, 1977).

DiClemente (1986) noted that self-efficacy, as it relates to substance abuse

treatment, is manifested by an individual's perceptions of his or her ability to mobilize

necessary motivation, knowledge, and behavior to control or abstain from use of alcohol

or other drugs. Efficacy beliefs are thought to affect all the phases of personal change

from whether to change the behavior at all, to whether the individual succeeds at

initiating the change, to whether the change is successfully maintained. In the case of

addictive behaviors maintaining the change over time is the major problem (Bandura,

1992). Successful coping with prospective high-risk situations increases one's sense of

self-efficacy and decreases the probability of relapse, whereas failure experiences have

the opposite effect (Marlatt, 1985). There is a substantial body of research that supports

the relationship between self-efficacy and treatment outcome (Annis & Davis, 1989;

Burling, Reilly, Moltzen, & Ziff, 1989; DiClemente, 1981; McKay, Maisto, & O'Farrell,

1993; Rychtarik, Prue, Papp, & King, 1992).

Social Support

According to McCrady (2004), people seek out intimate and supportive

relationships, and such relationships are common among couples, parents and children,

siblings, and friends. There are many things that can lead to better or worse outcomes









following substance abuse treatment. Being involved with others and receiving high

levels of support from even one person prior to treatment, having a spouse, being more

socially connected or involved (Havassy et al., 1991), having more people to go to with

problems (Rosenberg, 1983), and having more friends who do not use substances

(Zywiak, Longabaugh, & Wirtz, 2002) all predict more positive treatment outcomes. For

women in particular having a larger social network also facilitates a more positive

outcome (McCrady, 2004). There are also certain aspects of the way a social network

functions that lead to better treatment outcomes. These predictors of success include

families that are more cohesive, have an active, shared recreational focus, disagree less

(Moos, Bromet, Tsu, & Moos, 1979), and provide the individual with more reassurance

of worth (Booth, Russell, Soucek, Laughlin, 1992). Having a better functioning marriage

prior to treatment also predicts less frequent relapse and less frequent readmission to

treatment (McCrady, Hayaki, Epstein, & Hirsch, 2002).

Just as there are aspects of the social network that may lead to better outcomes with

treatment, there are also those that may lead to negative outcomes. Some of these include

having friends in the network that use and maintaining those friendships after treatment

(Mohr, Averne, Kenny, & Delboca, 2001), greater marital dissatisfaction (McCrady,

Epstein, & Sell, 2003), the presence of higher levels of expressed emotion (i.e., criticism,

hostility, and emotional over involvement; O'Farrell, Hooley, Fals-Stewart, & Cutter,

1998); and experiencing more stress from friends (Gordon & Zrull, 1991).

In the case of criminal justice-mandated clients, those supported by a strong

network of affective ties tend to have a greater stake in conformity. Some factors that

seem to be important to their treatment success are satisfaction with the family life









(Slaught, 1999) and encouragement from the partner or spouse to enter treatment

(Tucker, 1979). Just as with noncriminal justice-mandated clients, there are factors that

will also hinder treatment success for these clients. These factors are problems with

significant others, having little or no family/emotional support (Lang & Benko, 2000),

and those whose close relationships consist of other addicts (Sung, Belenko, Feng, &

Tabachnick, 2004).

Program

While in operation only since 1989, drug treatment courts are considered to be the

most innovative, comprehensive, and successful alternatives to incarceration yet

developed (Hennessey, 2001). The "drug courts" grew from a realization that the system

was not working for drug offenders. The offenders were in and out of jail and were

simply clogging the system and costing millions of dollars in ineffective efforts to

rehabilitate chronic offenders. The Miami-Dade County Circuit Court was the first to

implement a mandatory "treatment" component into the supervisory responsibilities of

the court. The court relied upon the authority of the judge to develop and supervise a

comprehensive, community-based rehabilitation and supervision program that intended to

use the "coercive powers" of the court to compel offenders to abide by the treatment plan

in order to avoid incarceration. The essence of drug courts today continues to be the

coercive power of the court to impose sanctions, including incarceration, on participants

who deviate from the treatment plan (Hennessey, 2001).

Demographics

Age. Research has consistently shown that in the United States criminal behavior

peaks in adolescence and gradually declines thereafter. Most explanations for this note

that adolescents and young adults most likely seek autonomy through involvement with









deviant peer groups, whereas deviant peer involvement behavior diminishes as the

individual ages (Hirschi & Gottfredson, 1983). Correspondingly it is conceivable that

older persons will be more receptive to rehabilitative policy interventions such as drug

courts. Another explanation for this among the substance-abusing population may be that

over time individuals become tired of their addicted lifestyles (Saxon, Wells, Fleming,

Jackson, & Calsyn, 1996). Several studies report that older participants stay in treatment

longer than younger participants (Mammo & Weinbaum, 1991; Sansone, 1980; Saxon et

al., 1996).

Race/Ethnicity. Studies assessing race and treatment outcome have produced

different results. Several conclude that race is a significant factor (Steer, 1980; Sansone,

1980; Saxon et al., 1996), while others do not support any relationship (Condelli &

Hubbard, 1994; McFarlain, Cohen, Yoder, & Guirdy, 1977). Mammo and Weinbaum

(1993) found that it is more likely for white and "other" race/ethnic groups than black

and Hispanics to complete treatment. However, as with their gender research they found

that when confounding variables such as, social, demographic, and economic variables

were controlled, race is no longer significant.

Substance Abuse History. Remple and DeStefano (2001) found that addiction

severity based on self-reported amount, duration, and frequency of use of multiple illegal

drugs had no effect on whether the individuals were more likely to drop out of treatment.

The researchers did, however, find that the primary drug of choice did have a significant

effect. The researchers found that individuals with the primary drug being heroin were

more likely to drop out while a primary drug of crack was significant in predicting

retention, not dropout (Remple & DeStefano, 2001).














CHAPTER 3
METHODOLOGY

This chapter will discuss the methods used in the present study to measure the

various constructs described earlier and show any relationships between them. The topics

that are addressed are research design, participants, instrumentation, procedures and data

analysis, and statistical analysis methods.

Research Design

This was an ex-post facto cross-sectional research design using a convenience

sample at the Corner Drug Store, Inc outpatient services Drug Court program.

Participants were asked to complete the SCS-SA, MSPSS, the Adapted AASE, and a

demographic questionnaire.

Participants

The study consisted of 40 participants currently receiving treatment services at

Corner Drug Store, an outpatient treatment center contracted with the Alachua County

Drug Court program, in Gainesville, FL. The participants are nonviolent drug offenders.

The Drug Court program is a pretrial intervention that offers the participants the chance

to get their charges dropped by completing the program. Participation in the study was

voluntary. Historically, most of the participants seem to fall within two ethnic groups:

European-American and African-American. However, because there were no Hispanics

or Native Americans self-identified, ethnicity was grouped as white or non-white. The

age of the participants ranged from 19 to 51 (M= 29.98, SD = 9.49). Length of time in









the program ranged from 21 to 910 days (M= 204.58, SD = 194.36). Participants

reported abusing substances from 0 years to 32 years (M= 11.73, SD = 8.61).

The treatment consists of three phases with the participants advancing from phase

to phase by meeting certain goals and standards. The first phase serves as a

detoxification period and is a minimum of 30 to 45 days. Phase 1 consists of four, one-

hour group sessions per week, case management, urinalysis drops, acupuncture, and

individual sessions on an as needed basis. To move from the first phase to the second the

participant must maintain twenty-one days continuous, drug-free urine drops, and

receives approval from the treatment team.

The second phase is the primary treatment phase in which the participant has

reached a basic level of sobriety and can focus on the issues identified in treatment.

Phase 2 is a minimum of six months and consists of two, one-hour group sessions per

week, case management, urinalysis drops, and individual sessions as needed. To move

from Phase 2 to Phase 3 the participant must remain continually drug free for ninety days,

be gainfully employed or in an educational program, meet their treatment goals, and be

compliant with all program requirements.

The third phase is the transition phase where the participant is given more freedom

and personal responsibility. Phase 3 is a minimum of four months and consists of one,

one-hour group session, case management, urinalysis drops, and individual sessions as

needed. To be eligible to graduate from the program the participant must maintain six

months of continued sobriety.

Measures

Stages of Change Scale-Substance Abuse (SCS-SA). The SCS-SA scale was

developed to measure the stages of change identified by DiClemente and Prochaska









(Cardoso, Chan, Berven & Thomas, 2003). The scale consists of 37 items, with

responses given on a five-point Likert scale. See Appendix A. The SCS-SA consisted of

four subscales: Participation, Relapse, Determination, and Precontemplation, determined

by exploratory factor analysis. The alpha coefficients for the four subscales were

calculated. For the Participation, Relapse, Determination, and Precontemplation factors

the values were as follows: .93, .73, .85, and .79, respectively. For the SCS-SA, support

for the validity of the instrument was derived by means of exploratory factor analysis and

cluster analysis (Cardoso et al.).

Internal consistency for the subscales of the SCS-SA for this study was

demonstrated to be acceptable. Cronbach's alpha for the Participation, Relapse,

Determination, and Precontemplation factors were as follows: .85, .75, .87, and .71,

respectively.

Alcohol Abstinence Self-Efficacy Scale (AASE). The scale consists of 49 items

related to drinking (DiClemente, Carbonari, Montgomery, & Hughes, 1993). Participants

are asked to answer how "tempted" they would be to drink in each situation on a five-

point Likert scale (not at all = 1 to extremely = 5). The participants are also asked to rate

how "confident" they are that they would not drink in a particular situation on a similar 5-

point Likert scale. Scores are added separately for self-efficacy and temptation. Similar

scales have been developed for smoking and other addictive behaviors have demonstrated

relevance and solid psychometric properties (DiClemente, 1986). Initial reliability and

validity estimates for this scale demonstrated high internal consistency (.95) and a

substantial negative correlation (r=-.58) between temptation and self-efficacy

(DiClemente et al.).









Hiller, Broome, Knight, and Simpson (2000) adapted the AASE so that it could be

used for the general use of drugs rather than solely for alcohol use. The Adapted AASE

contains 40 items. The inventory measures self-rated confidence and temptation for 20

"high-risk" situations, comprising four conceptual categories (i.e., Negative Affect,

Social/Positive, Physical, and Other Concerns, and Cravings and Urges). See Appendix

B. Exploratory and confirmatory factor analysis were involved in the validation of the

Adapted AASE. Internal consistency for the subscales ranged from .72 to .92. Hiller et

al. used a multi-trait, multi-method matrix design to evaluate the Adapted AASE's

construct validity. They found strong inverse relationships between the efficacy and

temptation scales lending credence to the construct validity of this scale.

Internal consistency for the subscales of the Adapted AASE for this study was

demonstrated to be acceptable. Cronbach's alpha for the Temptation subscales of

Negative Affect, Social/Positive, Physical and Other Concerns, and Cravings and Urges

were as follows: .85, .83, .73, and .82, respectively. Cronbach's alpha for the Confidence

subscales of Negative Affect, Social/Positive, Physical and Other Concerns, and Cravings

and Urges were as follows: .94, .84, .87, and .92, respectively.

Multidimensional Scale of Perceived Social Support (MSPSS). The MSPSS is a

12 item, self-report measure that addresses the subjective assessment of social support

adequacy (Zimet, Dahlem, Zimet, & Farley, 1988). The MSPSS also assess perceptions

of social support adequacy from three specific sources: Family, Friends and Significant

Other. Each of the groups consists of four items and is answered on a seven-point Likert

scale. See Appendix C. Cronbach's coefficient alpha was found for the scale as a whole

as well as for each individual subscale. For the Significant Other, Family, and Friends









subscales, the values were .91, .87, and .85, respectively. The reliability of the total scale

was .88. Zimet et al. retested 69 of 275 subjects 2 to 3 months after having initially

completed the questionnaire. The test-retest reliability for the Significant Other, Family,

and Friends were .72, .85, and .75, respectively. For the whole scale, the value obtained

was .85. Similar findings concerning the MSPSS were found by Zimet, Powell, Farley,

Werkman, and Berkoff (1990). Zimet et al. (1990) found evidence of the predictive

validity of MSPSS subscales by administering the MSPSS to various sets (e.g., married

participants reflected higher significant other scores than single participants).

Internal consistency for the MSPSS and subscales for this study were demonstrated

to be acceptable. Cronbach's alpha for the subscales of Significant Others, Family, and

Friends were as follows: .76, .96, and .84, respectively. Cronbach's alpha for the MSPSS

total was .86.

Demographics. There were several demographic items that participants were asked

pertaining to age, ethnicity, gender, phase in program, length of time in the program and

how long they have been using. See Appendix D.

Data Collection Procedure

The instruments were given to the participants while they were in their treatment

groups. The participants were observed while answering the instruments by the

researcher or another Corner Drug Store counselor. The participants were not allowed to

talk to one another while answering the instrument questions. There was no identifying

data collected. Informed consent forms with signatures were separated from the

answered instruments. All instruments will be numbered in order to keep track of which

measures go together. It took approximately 30- 40 minutes to answer all four measures









to be completed. The researcher or the counselor collected the instruments in order to be

analyzed.

Data Analysis

Analyses related to Research Question One

A series of ANOVAs were conducted to calculate the relationship of treatment

phase to the SCS-SA, MSPSS, and Adapted AASE scores.

Analyses related to Research Question Two

For demographic data that are continuous, such as age, length of time in the

program, and length of time using drugs or alcohol, Pearson product-moment correlation

coefficients were calculated to show the relationships between the demographic variables

and the three measures. A series of ANOVAs were conducted to calculate the

relationships of the categorical data such as, drug of choice, and ethnicity to the three

measures.














CHAPTER 4
RESULTS

Results for Question One

Stages of change. A series of one-way ANOVAs conducted for the subscales of

the SCS-SA (Precontemplation, Determination, Participation, Relapse) in regards to the

phase of treatment yielded no significant differences (see Table 4.2).

Scores on the SCS-SA Precontemplation subscale did not differ between Phase I

(M=2.13, SD=.81), Phase II (M=2.01, SD=.64), and Phase III (M=1.85, SD=.52;

F(2,35)=.44, p=.65, ns). Scores on the SCS-SA Determination subscale did not differ

between Phase I (M=3.80, SD=.80), Phase II (M=4.22, SD=.64), and Phase III (M=4.19,

SD=.363; F(2,35)=1.60,p=.21, ns). Scores on the SCS-SA Participation subscale did not

differ between Phase I (M=3.44, SD=.67), Phase II (M=3.86, SD=.43), and Phase III

(M=3.96, SD=.46; F(2,31)=2.79, p=.08, ns). Scores on the SCS-SA Relapse subscale did

not differ between Phase I (M=2.24, SD=.70), Phase II (M=2.13, SD=.77), and Phase III

(M=1.80, SD=.33; F(2,33)=1.11, p=.34, ns).

The variable phase in treatment thus appeared to have no direct relationship with

the stage of change the individual is in. It was hypothesized that the higher the phase of

treatment the individual was in the further along in the stages of change the individual

would be in. No significant relationship was found between the scores on the SCS-SA

subscales and the phase in treatment.









Social support. A series of one-way ANOVAs conducted for the MSPSS and

subscales (Significant Others, Family, Friends, MSPSS total) in regards to the phase in

treatment yielded no significant differences (see Table 4.1).

Scores on the MSPSS Significant Other subscale did not differ between Phase I

(M=5.75, SD=1.20), Phase II (M=5.64, SD=1.46), and Phase III (M=6.25, SD=.58;

F(2,37)=.90, p=.42, ns). Scores on the MSPSS Family subscale did not differ between

Phase I (M=4.75, SD=2.30), Phase II (M=5.57, SD=1.87), and Phase III (M=5.57,

SD=.975; F(2,36)=.77, p=.47, ns). Scores on the MSPSS Friend subscale did not differ

between Phase I (M=4.83, SD=1.73), Phase II (M=4.61, SD=1.51), and Phase III

(M=5.07, SD=1.18; F(2,37)=.34, p=.71, ns). Scores on the MSPSS total scale did not

differ between Phase I (M=5.11, SD=1.27), Phase II (M=5.29, SD=1.22), and Phase III

(M=5.63, SD=.60; F(2,36)=.62, p=.54, ns).

The variable of phase in treatment thus appeared to have no direct relationship with

the amount of social support the individual perceived. It was hypothesized that the

higher the phase of treatment the individual was in the more social support the individual

would perceive in their life. No significant relationship was found between the scores on

the MSPSS and the phase in treatment.

Self-efficacy. A series of one-way ANOVAs conducted for the subscales of the

Adapted AASE (Temptation- Negative Affect, Temptation- Social/Positive, Temptation-

Physical and Other Concerns, Temptation- Cravings and Urges, Confidence- Negative

Affect, Confidence- Social/Positive, Confidence- Physical and Other Concerns,

Confidence- Cravings and Urges) in regards to the phase of treatment also yielded no

differences (see Table 4.3).









Scores on the adapted AASE Temptation- Negative Affect subscale did not differ

between Phase I (M=2.69, SD=1.29), Phase II (M=2.35, SD=1.14), and Phase III

(M=2.20, SD=.74; F(2,34)=.53, p=.59, ns). Scores on the adapted AASE Temptation-

Social/Positive subscale did not differ between Phase I (M=2.57, SD=1.20), Phase II

(M=2.09, SD=1.17), and Phase III (M=2.42, SD=1.06; F(2,37)=.69,p=.51, ns). Scores on

the adapted AASE Temptation- Physical and Other Concerns subscale did not differ

between Phase I (M=1.70, SD=.69), Phase II (M=1.89, SD=.96), and Phase III (M=1.85,

SD=.79; F(2,37)=. 17, p=.84, ns). Scores on the adapted AASE Temptation- Cravings

and Urges subscale did not differ between Phase I (M=2.18, SD=1.15), Phase II (M=1.84,

SD=.79), and Phase III (M=2.15, SD=.84; F(2,37)=.63, p=.54, ns).

Scores on the adapted AASE Confidence- Negative Affect subscale did not differ

between Phase I (M=2.73, SD=1.54), Phase II (M=2.82, SD=1.43), and Phase III

(M=3.70, SD=.87; F(2,36)=1.91, p=.16, ns). Scores on the adapted AASE Confidence-

Social/Positive subscale did not differ between Phase I (M=2.87, SD=1.20), Phase II

(M=2.91, SD=1.37), and Phase III (M=3.67, SD=1.01; F(2,36)=l.55,p=.23, ns). Scores

on the adapted AASE Confidence- Physical and Other Concerns subscale did not differ

between Phase I (M=2.77, SD=1.55), Phase II (M=2.91, SD=1.45), and Phase III

(M=3.61, SD=.95; F(2,36)=1.24, p=..30, ns). Scores on the adapted AASE Confidence-

Cravings and Urges subscale did not differ between Phase I (M=3.02, SD=1.47), Phase II

(M=2.88, SD=1.48), and Phase III (M=3.40, SD=1.02; F(2,35)=.51, p=.61, ns).

The variable of phase in treatment thus appeared to have no direct relationship with

the self-efficacy of the individual. It was hypothesized that the higher the phase of

treatment the individual was in the more self-efficacy would be found. No significant









relationship was found between the scores on the Adapted AASE and the phase in

treatment.

Results for Research Question 2

Age. There were no significant correlations found between age and the MSPSS or

its subscales. A significant correlation was found between age and the SCS-SA

Participation subscale, r = .398, n = 34,p < .05, two tails. Older age was associated with

being in the Participation subscale. There were no other significant correlations found

within the SCS-SA. The only significant correlation found within the Adapted AASE

was found on the Confidence- Cravings and Urges subscale, r = .346, n = 38, p < .05, two

tails. Older age was associated with a higher confidence against cravings and urges.

Correlations reported in Table 4.4.

Length of time using drugs or alcohol. There were no significant correlations

found between length of time using drugs or alcohol and the MSPSS or its subscales. A

correlation for the data revealed that the length of time using drugs and alcohol and the

SCS-SA Participation subscale were significantly correlated, r = .476, n = 34, p < .01,

two tails. The longer an individual has used drugs or alcohol was associated with the

higher Participation subscale score. A correlation for the data revealed that the length of

time using drugs and alcohol and the SCS-SA Determination subscale were significantly

related, r = .389, n = 38, p < .05, two tails. The longer an individual has used drugs or

alcohol was associated with the higher Determination subscale score. The only

significant correlation found within the Adapted AASE was found on the Temptation-

Cravings and Urges subscale, r = .346, n = 38,p < .05, two tails. Older age was

associated with a higher temptation to use when in situations concerning cravings and

urges. Correlations reported in Table 4.4.









Length of time in the program. There were no significant correlations found

between length of time in the program and the MSPSS or its subscales, the SCS-SA, or

the Adapted AASE. Correlations are reported in Table 4.4.

Drug of Choice. A series of one-way ANOVAs conducted for the MSPSS and its

subscales in regards to the individual's drug of choice yielded no significant differences

(see Table 4.5). The variable of drug of choice thus appeared to have no direct

relationship with the amount of perceived social support. No significant relationship was

found between the scores on the SCS-SA and the individual's drug of choice.

A series of one-way ANOVAs conducted for the subscales of the SCS-SA in

regards to the individual's drug of choice yielded a significant difference in the

Participation subscale F(3,30) = 11.809, p < .01(see Table 4.6). Post-hoc comparisons

using a Bonferroni correction indicated that the mean score for Alcohol (M = 3.06, SD=

.421) was significantly different from Coke/Crack (M= 4.23, SD = .343). Alcohol also

was significantly different from Heroin/Opiates (M= 4.06, SD = .289). Alcohol did not

differ significantly from Marijuana (M= 3.56, SD = .419); neither did Coke/Crack differ

significantly from Heroin/Opiates or Marijuana. The mean score for Marijuana was

significantly different from Coke/Crack. Marijuana was not, however, significantly

different from Heroin/Opiates. A series of one-way ANOVAs yielded a significant

difference in the Determination stage of change F(3,34) = 3.400, p <.05. A Bonferroni

post-hoc analysis did not yield any significant differences between the particular drug of

choice and the SCS-SA Determination subscale.

A series of one-way ANOVAs conducted for the subscales of the Adapted AASE

in regards to the individual's drug of choice also yielded no differences (see Table 4.7).









The variable of drug of choice thus appeared to have no direct relationship with the self-

efficacy of the individual. No significant relationship was found between the scores on

the Adapted AASE and the individual's drug of choice.

Ethnicity. Ethnicity, for the purpose of this study was reported as either white or

non-white. A series one-way ANOVAs for the MSPSS and its subscales (Significant

Others, Family, Friends, and MSPSS total) and ethnicity were conducted (see Table 4.8).

No significance was found between white and non-white groups with the Family

subscale. A significant difference was found between White (M=6.26, SD=.65) and Non-

White (M=5.37, SD=. 1.51; F(1,38) = 6.131, p < .05) in the MSPSS Significant Others

subscale scores. A significant difference was also found between White (M=5.61,

SD=1.24) and Non-White (M=3.88, SD= 1.13; F(1,38) = 21.001, p <.01) in the MSPSS

Friends subscale scores. A significant difference was also found between White

(M=5.86, SD=.82) ands Non-White (M=4.74, SD=1.07; F(1,37)= 13.712,p < .01) in the

MSPSS total scale scores. It appeared that White participants were more likely to have

higher scores on the MSPSS Significant Others and Friends subscales, as well as the

MSPSS total score.

A series of one-way ANOVAs for the SCS-SA subscales (Precontemplation,

Determination, Participation, and Relapse) and ethnicity were conducted. No

significance was found between white and non-white groups with the Precontemplation,

Determination, and Participation scores. A significant difference was found between

White (M=1.83, SD=.55) and Non-White (M=2.34, SD=.71; F(1,34) = 5.838, p < .05) in

the SCS-SA Relapse subscale scores (see Table 4.9). It appeared that Non-White

participants were more likely to have higher scores on the SCS-SA Relapse subscale.









A series of one-way ANOVAs for the Adapted AASE subscales (Temptation-

Negative Affect, Temptation- Social/Positive, Temptation- Physical and Other Concerns,

Temptation- Cravings and Urges, Confidence- Negative Affect, Confidence-

Social/Positive, Confidence- Physical and Other Concerns, Confidence- Cravings and

Urges) and ethnicity were conducted. No significance was found between white and non-

white groups with the Temptation-Negative Affect, Temptation- Social/Positive, or

Temptation- Cravings and Urges subscales. A significant difference was found between

White (M=2.08, SD=.88) and Non-White (M=1.56, SD=.72; F(1,38) = 4.12, p < .05) in

the adapted AASE Temptation- Physical and Other Concerns subscale scores. A

significant difference was found between White (M=3.56, SD=1.13) and Non-White

(M=2.50, SD=1.39; F(1,37) = 6.87, p < .05) in the adapted AASE Confidence- Negative

Affect subscale scores. A significant difference was found between White (M=3.50,

SD=1.21) and Non-White (M=2.70, SD=1.20; F(1,37) = 4.28, p < .05) in the adapted

AASE Confidence- Social/Positive subscale scores. A significant difference was found

between White (M=3.49, SD=1.08) and Non-White (M=2.57, SD=1.52; F(1,37) = 4.815,

p < .05) in the adapted AASE Confidence- Physical and Other Concerns subscale scores.

A significant difference was found between White (M=3.47, SD=1.17) and Non-White

(M=2.61, SD=1.41; F(1,36) = 4.223,p < .05) in the adapted AASE Confidence- Cravings

and Urges subscale scores (see Table 4.10). It appeared that White participants were

more likely to have higher scores on the Adapted AASE Temptation- Physical and Other

Concerns, Confidence- Negative Affect, Confidence- Social/Positive, Confidence-

Physical and Other Concerns, and Confidence- Cravings and Urges subscales









Gender. Analyses of gender were not calculated due to the small number of

females in the study.

Table 4-1 MSPSS and Subscales Analyses of Variance for Phase in Treatment
Source Df F q 2 p
MSOTH 39 .898 .05 .416
MSFAM 38 .771 .04 .470
MSFRND 39 .341 .02 .713
MSTOT 38 .618 .03 .544
Note: MSPSS = Multidimensional Scale of Perceived Social Support; MSOTH=
Significant Others; MSFAM = Family; MSFRND = Friends; MSTOT = Total *p < .05,
**p< .01

Table 4-2 SCS-SA Subscales Analyses of Variance for Phase in Treatment
Source Df F q 2 p
SOCPART 33 2.790 .15 .077
SOCRELPS 35 1.106 .06 .343
SOCDETER 37 1.595 .08 .217
SOCPREC 37 .440 .03 .647
Note: SCS-SA = Stages of Change Scale-Substance Abuse; SOCPART = Participation;
SOCRELPS = Relapse; SOCDETER = Determination; SOCPREC = Precontemplation
*p< .05, **p< .01

Table 4-3 Adapted AASE Subscales Analyses of Variance for Phase in Treatment
Source Df F rp2 t
TEMPNEG 36 .529 .03 .594
TEMPPOS 39 .692 .04 .507
TEMPPHY 39 .172 .01 .843
TEMPCRV 39 .634 .03 .536
CONFNEG 38 1.906 .10 .163
CONFPOS 38 1.548 .08 .227
CONFPHY 38 1.236 .06 .303
CONFCRV 37 .509 .03 .605
Note: Adapted AASE = Adapted Alcohol Abstinence Self-Efficacy Scale; TEMPNEG =
Temptation- Negative Affect; TEMPPOS = Temptation- Social/Positive; TEMPPHY =
Temptation- Physical and Other Concerns; TEMPCRV = Temptation- Cravings and
Urges; CONFNEG = Confidence- Negative Affect; CONFPOS = Confidence-
Social/Positive; CONFPHY = Confidence- Physical and Other Concerns; CONFCRV =
Confidence- Cravings and Urges; *p < .05, **p < .01









Table 4-4 Two-Tail Inter-Correlation Matrix between Demographic Variables and Three
Measures
Variable Age Use Time Time
Use Time .704*
(.000)
40
Time .154 .151
(.344) (.353)
40 40
MSOTH -.185 -.192 .007
(.254) (.234) (.968)
40 40 40
MSFAM -.087 -.212 .064
(.600) (.195) (.700)
39 39 39
MSFRND .163 .141 -.080
(.316) (.386) (.622)
40 40 40
MSTOT -.035 -.112 .006
(.834) (.496) (.970)
39 39 39
SOCPART .398* .476** .232
(.020) (.004) (.187)
34 34 34
SOCRELPS -.161 -.199 -.076
(.349) (.244) (.659)
36 36 36
SOCDETER .309 .389* .015
(.059) (.016) (.929)
38 38 38
SOCPREC .117 .114 -.016
(.486) (.495) (.924)
38 38 38
TEMPNEG .174 .322 -.195
(.303) (.052) (.247)
37 37 37
TEMPPOS .015 .207 -.029
(.929) (.200) (.857)
40 40 40
TEMPPHY .147 .262 -.098
(.366) (.103) (.548)
40 40 40









Table 4-4 Continued
Variable Age Use Time Time
TEMPCRV .116 .351* -.024
(.474) (.026) (.885)
40 40 40
CONFNEG .243 .100 .162
(.136) (.546) (324)
39 39 39
CONFPOS .259 .058 .135
(.111) (.727) (.413)
39 39 39
CONFPHY .255 .135 .145
(.117) (.411) (.379)
39 39 39
CONFCRV .346* .158 .029
(.033) (.345) (.862)
38 38 38
Note: p-values are in parentheses: *p<.05, **p (n) for specific correlation. Use Time = length of time using drugs or alcohol; Time =
length of time in the program; MSPSS = Multidimensional Scale of Perceived Social
Support; MSOTH = MSPSS Significant Others; MSFAM = MSPSS Family; MSFRND=
MSPSS Friends; MSTOT = MSPSS Total; SCS-SA = Stages of Change Scale-Substance
Abuse; SOCPART = SCS-SA Participation; SOCRELPS = SCS-SA Relapse;
SOCDETER = SCS-SA Determination; SOCPREC = SCS-SA Precontemplation;
Adapted AASE = Adapted Alcohol Abstinence Self-Efficacy Scale; TEMPNEG =
Adapted AASE Temptation- Negative Affect; TEMPPOS = Adapted AASE Temptation-
Social/Positive; TEMPPHY = Adapted AASE Temptation- Physical and Other Concerns;
TEMPCRV = Adapted AASE Temptation- Cravings and Urges; CONFNEG = Adapted
AASE Confidence- Negative Affect; CONFPOS = Adapted AASE Confidence-
Social/Positive; CONFPHY = Adapted AASE Confidence- Physical and Other Concerns;
CONFCRV = Adapted AASE Confidence- Cravings and Urges

Table 4-5 MSPSS and Subscales Analyses of Variance for Drug of Choice
Source cdf F r2 p
MSOTH 39 .721 .06 .546
MSFAM 38 2.237 .16 .101
MSFRND 39 2.058 .14 .123
MSTOT 38 1.733 .02 .178
Note: MSPSS = Multidimensional Scale of Perceived Social Support; MSOTH=
Significant Others; MSFAM = Family; MSFRND = Friends; MSTOT = Total *p < .05,
**p< .01









Table 4-6 SCS-SA Subscales Analyses of Variance for Drug of Choice
Source cdf F r2 P
SOCPART 33 11.809 .55 .000**
SOCRELPS 35 1.927 .15 .145
SOCDETER 37 3.400 .23 .029*
SOCPREC 37 .022 .00 .995
Note: SCS-SA = Stages of Change Scale-Substance Abuse; SOCPART = Participation;
SOCRELPS = Relapse; SOCDETER = Determination; SOCPREC = Precontemplation
*p< .05, ** p< .01

Table 4-7 Adapted AASE Subscales Analyses of Variance for Drug of Choice
Source cdf F P
TEMPNEG 36 1.079 .09 .371
TEMPPOS 39 1.264 .10 .301
TEMPPHY 39 .873 .07 .464
TEMPCRV 39 1.050 .08 .382
CONFNEG 38 1.981 .14 .135
CONFPOS 38 1.962 .14 .138
CONFPHY 38 2.743 .19 .058
CONFCRV 37 1.207 .10 .322
Note: Adapted AASE = Adapted Alcohol Abstinence Self-Efficacy Scale; TEMPNEG =
Temptation- Negative Affect; TEMPPOS = Temptation- Social/Positive; TEMPPHY =
Temptation- Physical and Other Concerns; TEMPCRV = Temptation- Cravings and
Urges; CONFNEG = Confidence- Negative Affect; CONFPOS = Confidence-
Social/Positive; CONFPHY = Confidence- Physical and Other Concerns; CONFCRV =
Confidence- Cravings and Urges; *p < .05, **p < .01

Table 4-8 MSPSS and Subscales Analyses of Variance for Ethnicity
Source df F r2 p
MSOTH 39 6.131 .14 .018*
MSFAM 38 1.712 .04 .199
MSFRND 39 21.001 .36 .000**
MSTOT 38 13.712 .27 .001**
Note: MSPSS = Multidimensional Scale of Perceived Social Support; MSOTH =
Significant Others; MSFAM = Family; MSFRND = Friends; MSTOT = Total *p < .05,
**p< .01

Table 4-9 SCS-SA Subscales Analyses of Variance for Ethnicity
Source cdf F r2 P
SOCPART 33 .782 .02 .383
SOCRELPS 35 5.838 .14 .021*
SOCDETER 37 3.345 .08 .076
SOCPREC 37 1.967 .05 .169
Note: SCS-SA = Stages of Change Scale-Substance Abuse; SOCPART = Participation;
SOCRELPS = Relapse; SOCDETER = Determination; SOCPREC = Precontemplation
*p< .05, ** p< .01









Table 4-10 Adapted AASE Subscales Analyses of Variance for Ethnicity
Source cdf F rq p
TEMPNEG 36 .492 .01 .488
TEMPPOS 39 3.114 .08 .086
TEMPPHY 39 4.124 .10 .049*
TEMPCRV 39 .716 .02 .403
CONFNEG 38 6.871 .16 .013*
CONFPOS 38 4.282 .10 .046*
CONFPHY 38 4.815 .12 .035*
CONFCRV 37 4.223 .10 .047*
Note: Adapted AASE = Adapted Alcohol Abstinence Self-Efficacy Scale; TEMPNEG =
Temptation- Negative Affect; TEMPPOS = Temptation- Social/Positive; TEMPPHY =
Temptation- Physical and Other Concerns; TEMPCRV = Temptation- Cravings and
Urges; CONFNEG = Confidence- Negative Affect; CONFPOS = Confidence-
Social/Positive; CONFPHY = Confidence- Physical and Other Concerns; CONFCRV =
Confidence- Cravings and Urges; *p < .05, **p < .01














CHAPTER 5
DISCUSSION

Summary

Prochaska and DiClemente (1982, 1986) developed the Transtheoretical Model to

depict the process of change. It was hypothesized that the cessation of a problem

behavior and therefore the acquisition of a healthier behavior involved a progression

through five stages: precontemplation, contemplation, preparation, action, and

maintenance (Abellanas & McLellan, 1993). The change is believed to happen in

increments and involves detailed and varied tasks throughout the process (DiClemente

and Prochaska, 1985, 1998). These stages have been used to understand the process of

stopping problem behaviors, such as cessation of smoking and other addictive behaviors

(Snow et al., 1992).

Sobell et al. (1993) found that the greatest single factor with maintaining recoveries

for alcohol abusers is that of social support, particularly from family and friends. Social

support also has been found to be a crucial component in a successful drug treatment

program (Caplan & Killilea, 1976). In terms of relapse potential, Havassy et al. (1991)

found that social integration and abstinence-specific functional support predicted lower

risk of relapse to tobacco, alcohol, and opiates.

DiClemente (1986) showed self-efficacy to pertain to an individual's perceptions of

his or her ability to mobilize necessary motivation, knowledge, and behavior to control or

abstain from use of alcohol or other drugs. Efficacy beliefs are thought to affect all the

phases of personal change from whether to change the behavior at all, to whether the









individual succeeds at initiating the change, to whether the change is successfully

maintained. In the case of addictive behaviors maintaining the change over time is the

major problem (Bandura, 1992).

Findings

Research Question One. It was hypothesized that as a participant moved through

the phases of treatment they should also be moving through the various stages of change

as theorized by Prochaska and DiClemente (1982, 1986). The other hypotheses explored

in this study were that as the participants moved through the phases of treatment they

should also gain more motivation (self-efficacy) to change and build a more positive

social support system. The evidence in this study does not support any of the three

hypotheses. There are many reasons for which these hypotheses may not have been

proven. The participants in this study could have simply been answering the questions,

as they believed they should be. Another possibility is the scales may not have been

appropriate for this particular treatment program. Practically, clients that undergo a

relapse generally are not returned to an earlier phase of treatment (for example, if an

individual relapses while in Phase 3 they remain in Phase 3, albeit they may stay in that

phase longer than initially expected.

Research Question Two. The second question in this study sought out to find any

relationships between demographic variables and the three measures.

Age. For the variable of age a significant correlation was found with the

Participation stage of change. This appears to signify that the older a participant is and

the longer he or she has been using, the more they are actually working on making

changes to their substance use problem. The participants in the Participation stage of

change have moved past their denial of a problem and into a movement towards change.









There may be many reasons for this finding, such as Janis and Mann's (1977) concept of

"bottoming out" following long-time use and experiences of personal failure lead to

increased desire for treatment. Additional research is needed for clarification between

these variables.

A significant correlation could not be found between age and the MSPSS or its

subscales, however the findings are not conclusive and additional research may be able to

find a relationship. As expected, age was not significantly correlated to the temptation to

use.

A significant correlation was also found between age and having confidence

against cravings and urges. The older participants appear to deal more effectively with

cravings and urges to use than the younger participants.

Length of time using drugs or alcohol. There were no significant correlations

between length of time using drugs or alcohol and the MSPSS or its subscales.

As discussed earlier, a significant correlation was found between age and the

Participation stage of change. There are similar correlations between length of use and

the Participation and Determination subscales. There is a strong relationship between age

and length of time using drugs or alcohol. This is consistent with the notion that older

individuals with substance use problems have used those substances for a longer period

of time than younger substance-using individuals.

There were no significant correlations between the length of time using drugs or

alcohol and the confidence subscales on the adapted AASE. A significant correlation

was found between the length of time using drugs or alcohol and the Temptation-

Cravings and Urges subscale.









Length of time in the program. There were no significant correlations between

length of time in the program and any of the three scales. This finding was unexpected

and could be due to response bias, inappropriateness of scales, or lack of effective

treatment.

Drug of choice. A significant relationship was found between drug of choice and

both the Participation and Determination stage of change. When looking at the

differences between stages of change and substance abuse three significant differences

were found in the Participation stage of change, alcohol and heroin/opiates, alcohol and

crack/cocaine, and between marijuana and crack/cocaine. This current study does not

account for this finding; further exploration of this topic appears to be needed. There

were no significant differences between the individual groups in the Determination stage

of change however, overall there appears to be a statistical difference. A reason for this

may be a small effect size for the scale.

This study found no evidence of any relationship between drug of choice and the

MSPSS and its subscales, as well as between drug of choice and the adapted AASE and

subscales. This finding shows that the participant's drug of choice appears to have no

bearing on how much social support they perceive themselves to have.

Ethnicity. A significant relationship was found between ethnicity and Significant

Others, Friends, and the MSPSS total score. It appears that Non-White participants

reported lower perceived social support than the White participants with regard to

significant others, friends and social support in general. There were no statistically

significant differences between White and Non-White participants pertaining to family-

related social support scores.









A significant relationship was found between ethnicity and the SCS-SA Relapse

subscale. According to this study it appears that Non-White participants reported a

higher relapse potential than White participants. There were no statistically significant

differences between White and Non-White participants regarding the Precontemplation,

Determination, and Participation subscales.

Limitations

Some of the limitations to this study include the use of a convenience sample, a

small sample size, and possible response bias (non-forthright responses by participants).

It is not possible to make any assumptions about the effectiveness of the treatment

program due to the size of the sample and because different results may be found with

another future group of participants. There may be difference between counselors and the

clients (counselors are female and White, clients are mostly male and equally divided

between White and Non-White). There is no attempt to control for dual-diagnosis or

socioeconomic status so it is uncertain what kind of effect they have on the variables

studied. There was not a large enough gender difference to do analyses. The results may

not be generalizable to other Drug Court programs because of the small sample size. No

statements of causality could be made.

Further Research

Future research may want to use a larger sample to have a greater effect size. More

questions could also be added to the Demographics Questionnaire to control for even

more variables such as, number of prior treatment admissions, socioeconomic status, and

how long they spent in each individual phase. Future research can look at the effect of

dual diagnosis on the variables studied. Also, analyses of gender could not be correlated

in this study due to the small number of females; it would be beneficial to find a sample









that could use gender as a variable. This study could also be repeated at Corner Drug

Store with a new sample of clients to see if the findings can be reproduced. Research

could also be conducted at other drug treatment centers to find out if the data is

generalizable. It was noted that there were differences in scores with regards to ethnicity,

additional research might want to control for ethnic differences. Additional research is

needed to study the differences between and within ethnic groups. Similarly, it was noted

that there were differences between groups that used particular substances. Additional

research is needed to study the differences between and within groups that use distinct

substances. Future research can look at the effect of dual diagnosis on the variables

studied.














APPENDIX A
STAGES OF CHANGE-SUBSTANCE ABUSE

Please indicate the extent to which you tend to agree or disagree with each
statement. In each case, make your choice in terms of how you feel right now,
not what you have felt in the past or would like to feel. For all the statements
that refer to your problem, answer in terms of your alcohol or other drug
problem. And here refers to the place of treatment of the program.


There are FIVE


possible responses to each of the items in the questionnaire:
1-Strongly Disagree (SD)
2-Disagree (D)
3-Undecided (U)
4-Agree(A)
5-Strongly Agree (SA)


Circle the number that best describes how much you agree or disagree with each
statement.


1) I think I am ready to work on my alcohol and other 1 2 3 4 5
drug problem.
2) I am working on my alcohol and other drug 1 2 3 4 5
problem, which has been bothering me.
3) I am gathering information about support groups 1 2 3 4 5
that will help me stay clean.
4) I worry that I may slip back to my old habits of 1 2 3 4 5
taking alcohol and other drugs that I have worked on in
treatment; therefore, I am going to continue working on
my alcohol and other drug problems.
5) I am now working on my alcohol and other drug 1 2 3 4 5
problem.
6) I have started working on my alcohol and other 1 2 3 4 5
drug problem but I am not sure that I can do it without
help.















T)
c 0)
70) <

08 )- 0 hte 50
C 0) )
0 -0 0
0 D < 0

7) I feel that my alcohol or other drug problems are 1 2 3 4 5
serious, I really need to change my ways.
8) I hope that treatment will help me understand my 1 2 3 4 5
alcohol or other drug problem.
9) I may have some alcohol or other drug problems, 1 2 3 4 5
but there is no reason to change them.
10) I am socializing less with friends who use alcohol 1 2 3 4 5
or other drugs.
11) Sometimes I fail to stay clean and I am here to 1 2 3 4 5
prevent a relapse.
12) Although at times, I am unable to change my 1 2 3 4 5
alcohol or other drug problem, I still continue to work
on it.
13) I feel more positive about treatment. 1 2 3 4 5

14) I hope that I can find a way to solve my alcohol or 1 2 3 4 5
other drug problem.
15) Although I have started taking some steps toward 1 2 3 4 5
working on my alcohol or other drug problem, I may
need help from a counselor to continue my progress.
16) This treatment program may help me with my 1 2 3 4 5
alcohol or other drug problem.
17) I need additional support to help me stick with the 1 2 3 4 5
changes that I have made on my alcohol or other
drug problem.
18) I may be part of the alcohol or other drug 1 2 3 4 5
problem, but I don't think so.
19) I hope that the counselors in this program will 1 2 3 4 5
help me with my alcohol or other drug problem.
20) All this talk about changing my alcohol or other 1 2 3 4 5
drug problem is boring. I just want everyone to leave
me alone.
21) I am beginning to explore the best way to change 1 2 3 4 5
my alcohol or other drug problem.














70)

0) 0)
0 _D < 0


22) I have problems but so do other people. Why 1 2 3 4 5
waste the time worrying?
23) I would rather live with my alcohol or other drug 1 2 3 4 5
problems than try to change them.
24) I am surprised that my friends and family think 1 2 3 4 5
that I have an alcohol or other drug problem.
25) I had begun to make changes about my alcohol 1 2 3 4 5
or other drug problem but recently I started using
drugs again.
26) Because I often experienced a relapse, I am not 1 2 3 4 5
sure that I can ever stay clean for a long period of
time.
27) I have been capable of working on my alcohol or 1 2 3 4 5
other drug problem but I am not sure I can stay clean
on my own.
28) Although it is hard to work on my alcohol or other 1 2 3 4 5
drug problem, I continue to work on my problems.
29) I am trying to build new friendship with people 1 2 3 4 5
who do not use alcohol or other drugs.
30) I would like to work on my alcohol or other drug 1 2 3 4 5
problems but I find it hard to do.
31) I have been working on changing my alcohol or 1 2 3 4 5
other drug behaviors but recently I relapsed. This
makes me feel that I do not have the skills to stay
clean.
32) It is upsetting, but I think I may have an alcohol or 1 2 3 4 5
other drug problem again- I thought it was under
control.
33) I am now working on my alcohol or other drug 1 2 3 4 5
problem.
34) It may be helpful to work on my alcohol or other 1 2 3 4 5
drug problem.











0)


0)
0 U 0




listening to other people discuss how they stay clean.
36) am beginning to understand the benefits of 1 2 3 4 5



being in treatment.
35) I am preparing myself to change my problem by 1 2 3 4 5
listening to other people discuss how they stay clean.

36) I am beginning to understand the benefits of 1 2 3 4 5
being in treatment.

37) I am serious about changing my alcohol or other 1 2 3 4 5
drug problem.






















APPENDIX B

ADAPTED ALCOHOL ABSTINENCE SELF-EFFICACY SCALE











TCU DCJTC SELF-EFFICACY FORM

Adaptation of the Alcohol-Efficacy Measure (DiClemente)


'Ti' .iF il'll F -'i PI. \T N iF


'p I0. 0 A 1tjT It li.i'i.iJ 7T| iA' .'' D fF:

_I__I _1 1__I- !_ _I_ IP PI l_1 I L L_ __LI

,.I ,'T~tI,-,p (DB" I | I __ _1__-i I',, riii : | I-! I _I- 1_ _1._I I I:-"-



..II Lf.I l=iN\'.ke := .T.' I I.J -l r =.''NT, u IE>JT) I IW |. I",



PART A: DRUG OF CHOICE

What is your drug of choice? [PLEASE CIRCLE ONLY ONE OF THE FOLLOWING]

1. Alcohol 2. Cocaine 3. Heroin 4. Marijuana 5. Other (specify)
or Crack or other [3s]
opiates


PART B: TEMPTATION TO USF

INSTRUCTIONS: Listed below are a number of situations that tempt some people to use drugs.
Based on the drug you listed above, circle only the number that best describes
how tempted you would feel to use that drug of choice in each situation at the present time.


NOT.
How temted would you feel ALI
to use that drue of choice TEMP'

I. When you are in agony because
of stopping or withdrawing
from drug use.................................... 1

2. When you have a headache............... 1

3. When you are feeling depressed......... 1

4. When you are on vacation and
want to relax ................................ ... 1

5. When you are concerned
about someone....................................


AT NOT MODER-
VERY ATELY VERY EXTREMELY
TED TEMPTED TEMPTED TEMPTED TEMPTED



2 3 4 5 [391

2 3 4 5 [40o

2 3 4 5 [41]


2 3 4 5 [42]


2 3 4 5 [43]


Continue Io Net Page


TCUFORMS/DCJTC/EFFICACY (6/98)


_C_ __


i


fTf,-.k C" r. %.5 ,,


1 of 4








41









SELF EFFIC ACY FORM (Contiu s d)


How templed would \ou feel
ro use Ihar drug of choice --

6. When you are very worried................

7. When you have the urge to try drugs
just once to see what happens.............

8. When you arc heing offered drugs
in I ,:i.al iruat:ion ..... ......... .

9. When you dreamn about using dru ..

10. When you want to test your
Millpo er 'rr er us;i drugs...........

11. When l -.u are feeling a physical need
or craving for drugs...........................

12. W'ien o'I ire ph. s;cllu tired .......

13. When you are experiencing some
physical pain or injury........................

14. When you feel like blowing up
because of frustration........................

15. When you see others using drugs
at a bar or at a party ..........................

16. When \..ou .en c e.erithm. i L
iOj n !',, L; fgo,," .? .]u .....

17. Whei people ou used w' aiie drugs
with enc.:uraLI.c .u it, use drugs .......

18. When ,ou ir. Itfehng angr iniJe. .

19. When you experience an urge or
Smrpulse to iiic drgj. ihbii i:uches
you unprepared .................................

20. When you are excited or celebrating
with others........................................


NOT AT
ALL
TiIMPTEDL

1


NOT
VERY
TIMPTED
2


MODER-
ATELY
iF i I P Fl D
FD1m


VERY EXTREMELY
rEMPPffD i tE:MPi-t

4 5 rFa4


1 2 3 4 5


1 2 3 4 5

1 2 3 4 5


1 2 3 4 5


1 2 3 4 5

1 2 3 4 5


1 2 3 4 5


1 2 3 4 5


1 2 3 4 5


1 2 3 4 5


1 2 3 4 5

1 2 3 4 5



1 2 3 4 5


1 2 3 4 5


Continue to Next Page


TCU FORMS/DCJTC/EFFICACY (69)


2 of 4


I--








42









SELF-EFFICA.CY FORM! (Ce'tin.:ued!)


PART C: CONFIDENCE NOT TO USE

INSIRUC'IONS: Based on the drug ihar you lhlr d aboe. circle only the number ihat besi
describes bho, confident you are that you would not iu that drug ofchoice in each situation
at the present nne.


How confident are you that you
would not use that drug or choice--


1. When you are in agony because
of stpping or % ithdrawing
frolm ru ue .. ..........

2. When you have a headache.................

3. When ,ou are feeling dJpresed .

4. When you are on vacation and
want to relax ................................

5. When you are concerned
about someone..................................

6. When you are very worried.................

7. When you have the urge to try drugs
just once to see what happens.............

8. Whrn ,.ou are being offered drugs
in a -'cial iuation .............

9. When you dream about using drugs....

10. When you v ant iC teq .,our %' I!lpow,:r
over using drugs .............................


NOT AT NOT MODER-
ALL VERY ATELY VERY EXTREMELY
CONFIDENT CONFIDENT CONFIDENT CONFIDENT CONFIDENT


1 2 3 4 5


1 2 3 4 5


1 2 3 4 5

1 2 3 4 5


1 2 3 4 5


1 2 3 4 5

1 2 3 4 5


1 2 3 4 5


I Continue to Net Page
j


TCU FORMS/DCJTC/EFFICACY (6/98)


3 of 4








43









SELF-EFFFICAC 'OR!M Cotinued)i *


How confident a rr )ou that sou
uould not use thai drug of choice -

11. 'hern .'u are reeling a phi sicjl ne d
,r cra-, ing for drug ....

12. When you are physically tired ............

13. When y a'u are experiening some
ph sical pair. -,r injury ....................

14. When you feel like blowing up
because of frustration ........................

15. When .:,u see others using drugs
at a bJ r or at a part; .............. ..........

16. When you sense everything is
going wrong for you......................

17. When people you used to use drugs
with encourage you to use drugs ......

18. When youi are feeling an .r. inside.....

19. When you experience an urge or
Impule 1., u rif tho --h atlcilice
you unprepared ................................

20. \1wien .,ou are e\tled o.r celhrntlmg
v ith others ......... ...


NOT AT NOT MODER-
ALL VERY ATELY VERY EXTREMELY
ONTIrE' ti.'ENT -Nif.NI :.NTTiENT C-iNFIDENT CONFIDENT


1 2 3 4 5 [69]

1 2 3 4 5 [70]


1 2? 3 4 5 [71]


1 2 3 4 5 [72]


1 2 3 4 5 [73


1 2 3 4 5 [741


1 2 3 4 5 [75]

1 2 3 4 5 76]



1 2 3 4 5 [77]


1 2 3 4 5 [78


End of Form


TCU FORMS/DCJTC/EFFICACY (6/98)


4 of 4














APPENDIX C
MULTIDIMENSIONAL SCALE OF PERCEIVED SOCIAL SUPPORT

Please indicate, using the scale below, your opinion on each of the 12 statements that
follow. There are no "right" or "wrong" answers. We are simply looking for your opinion
(i.e., whether you personally agree or disagree with each statement).

strongly disagree, 2=disagree, 3=mildly disagree, 4=neither agree nor disagree
5=mildly agree, 6=agree, 7=strongly agree


1. There is a special person who is around when I am in need.

2. There is a special person with whom I can share my joys and sorrows.

3. My family really tries to help me.

4. I get the emotional help and support I need from my family.

5. I have a special person who is a real source of comfort to me.

6. My friends really try to help me.

7. I can count on my friends when things go wrong.

8. I can talk about my problems with my family.

9. I have friends with whom I can share my joys and sorrows.

10. There is a special person in my life who care about my feelings.

11. My family is willing to help me make decisions.

12. I can talk about my problems with friends.














APPENDIX D
DEMOGRAPHICS QUESTIONNAIRE

1. What is your age?

2. What is your ethnicity? (circle one) White Hispanic African-American

Other

3. What phase of the program are you in?

4. How long have you been in the program?

5. Male or Female (circle one)

6. How many years have you bee using drugs or alcohol?















LIST OF REFERENCES


Abellanas, L. & McLellan, T. (1993). "Stage of change" by drug problem in concurrent
opioid, cocaine, and cigarette users. Journal of Psychoactive Drugs, 25, 307-313.

Annis, H. M., & Davis, C. S. (1989). Relapse prevention: A cognitive-behavioral
approach based on self-efficacy theory. Journal of Chemical Dependency, 2, 81-
103.

Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory.
Englewood Cliffs, New Jersey: Prentice Hall, Inc.

Bandura, A. (1992). Self-efficacy mechanism in psychobiologic functioning. In R.
Schwarzer (Ed.), Self-efficacy: Thought control of action (pp.355-394).
Washington, DC: Hemisphere.

Bandura, A. (1995). Exercise of personal and collective efficacy in changing societies. In
A. Bandura (Ed.), Self- efficacy in changing societies. (pp. 1-45). New York:
Cambridge University Press.

Bandura, A. & Adams, N. E. (1977). Analysis of self-efficacy theory of behavioral
change. Cognitive Therapy and Research, 1, 287-310.

Booth, B. M., Russell, D. W., Soucek, S., & Laughlin, P. R. (1992). Social support and
outcome of alcoholism treatment: An exploratory analysis. American Journal of
Drug and AlcoholAbuse, 18, 87-101.

Burling, T. A., Reilly, P. M., Moltzen, J. O., & Ziff, D. C. (1989). Self-efficacy and
relapse among inpatient drug and alcohol abusers: A predictor of outcome. Journal
of Studies on Alcohol, 50, 354-360.

Caplan, G., & Killilea, M. (1976). Support systems and mutual help. New York: Grune
and Stratton.

Cardoso, E. D, Chan, F. Berrven, N. L., & Thomas K. R. (2003). Measuring readiness
for change in individuals in residential treatment community programs for
treatment of substance abuse. Rehabilitation Counseling Bulletin, 47, 34-44.

Condelli, W. S. & Hubbard, R. L. (1994). Relationship between time spent in treatment
and client outcomes from therapeutic communities. Journal of Substance Abuse
Treatment, 11, 25-33.









DiClemente, C. C. (1981). Self-efficacy and smoking cessation maintenance. Cognitive
Therapy Research, 5, 175-187.

DiClemente, C. C. (1986). Self-efficacy and the addictive behaviors. Journal of Social
and Clinical Psychology, 4, 302-315.

DiClemente, C. C., Carbonari, J. P., Montgomery, R. P., & Hughes, S. O. (1993). The
Alcohol Abstinence Self-Efficacy scale. Journal of Studies on Alcohol, 55, 141-148

DiClemente, C. C. & Prochaska, J. O. (1985). Processes and stages of change: Coping
and competence in smoking behavior change. In S.Shiffman & T. A Wills (Eds.),
Coping and substance abuse. (pp.319-342). New York: Academic Press.

DiClemente, C. C. & Prochaska, J. O. (1998). Toward a comprehensive, transtheoretical
model of change: Stages of change and addictive behaviors. In W. R. Miller & N.
Heather (Eds.), Treating addictive behaviors (2nd ed., pp. 3-24). New York: Plenum
Press.

Frances, R. J. & Miller, S. I. (Eds.). (1991). Clinical textbook of addictive disorders. New
York: Guilford Press.

Gerstein, D.R., Johnson, R. A., Harwood, H., Fountain, D. Sutter, N. Malloy, K. (1994).
Evaluating recovery series. The California Drug and Alcohol Treatment
Assessment (CALDATA). Sacramento, CA: State of California, Dependency Drug
and Alcohol Program.

Gordon, A. J., & Zrull, M. (1991). Social networks and recovery: One year after inpatient
treatment. Journal of Substance Abuse Treatment, 8, 143-152.

Grimley, D., Prochaska, J. O., Velicer, W. F., Blais, L. M., & DiClemente, C. C. (1994).
The Transtheoretical Model of Change. In T. M. Brinthaupt and R. P. Lipka (Eds.),
Changing the self: Philosophies, Techniques, and Experiences. (pp.201-227)
Albany, New York: State University of New York.

Harwood, H., Fountain, D., Livermore, G. (1997). The economic costs of alcohol and
drug abuse in the US, 1992. NIDA/NIAAA Sponsored Report. Rockville, MD:
Lewin Group.

Harwood, H. J., Hubbard, R. L., Collins, J., Rachal, J. V. (1995). A cost-benefit analysis
of drug abuse treatment. Research in Law andPublic Policies, 3, 191-214.

Havassy, B. E., Hall, S. M., & Wasserman, D. A. (1991). Social support and relapse:
Commonalities among alcoholics, opiate users and cigarette smokers. Addictive
Behaviors, 16, 235-246.

Hennessey, J. J. (2001). Introduction: drug courts in operation. In J. J. Hennessey & N. J.
Pallone (Eds.), Drug Courts in operation: Current research. (pp. 1-10). New York:
Haworth Press.









Hiller, M. L., Broome, K. M., Knight, K, & Simpson, D. D. (2000). Measuring self-
efficacy among drug-involved probationers. Psychological Reports, 86, 529-538.

Hirschi, T. & Gottfredson, M (1983). Age and the explanation of crime. American
Journal of Sociology, 89, 552-584.

Hubbard, R. L., Craddock, S. G., Flynn, P. M., Anderson, J., & Etheridge, R. M. (1997).
Overview of 1-year follow-up outcomes in the Drug Abuse Treatment Outcome
Study (DATOS). Psychology of Addictive Behaviors, 11, 261-278.

Janis, I. L., & Mann, L. (1977). Decision-making: A psychological analysis of conflict,
choice, and commitment. New York: Free Press.

Lang, M. A., & Belenko, S. (2000). Predicting retention in a residential drug treatment
Alternative to prison program. Journal of Substance Abuse Treatment, 19, 145-160.

Marlatt, G. A. (1985). Relapse Prevention: Theoretical rationale and overview of the
model. In G. A. Marlatt & J. R. Gordon (Eds.), Relapse Prevention (pp.3-70).
NewYork: Guilford Press.

Marlatt, G. A., & Gordon, J. R. (Eds.). (1985). Relapse Prevention. New York: Guillford
Press.

Mammo, A. & Weinbaum, D. F. (1993). Some factors that influence dropping out from
outpatient alcoholism treatment facilities. Journal of Studies on Alcohol, 54, 92-
101.

McCrady, B. S. (2004). To have but one true friend: Implications for practice of research
on alcohol use disorders and social networks. Psychology ofAddictive Behaviors,
18(2), 113-121.

McCrady, B. S., Epstein, E. E., & Sell, R. D. (2003). Theoretical bases of family
approaches to substance abuse treatment. In F. Rotgers, D. S. Keller, & J.
Morgenstern (Eds.), Treatment of substance abusers: Theory and technique (2nd
ed., pp. 112-139). New York: Guilford Press.

McCrady, B. S., Hayaki, J., Epstein, E. E., & Hirsch, L. S. (2002). Testing hypothesized
predictors of change in conjoint behavioral alcoholism treatment for men.
Alcoholism: Clinical and Experimental Research, 26, 463-470.

McFarlain, R. A., Cohen, G. H., Yoder, J., & Guirdy, L. (1977). Psychological test and
demographic variables associated with retention of narcotic addicts in treatment.
International Journal ofAddictions, 12, 399-410

McKay, J. R., Maisto, S. A., & O'Farrell, T. J. (1993). End of treatment self-efficacy,
aftercare, and drinking outcomes of alcoholic men. Alcoholism: Clinical and
Experimental Research, 17, 1078-1083.









Miller, W. R., & Rollnick, S. (1991). Motivational interviewing: Preparing people to
change addictive behavior. New York: Guilford Press.

Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people to
change addictive behavior (2nd ed.). New York: Guilford Press.

Mohr, C. D., Averne, S., Kenny, D. A, & Delboca, F. (2001). "Getting by (or getting
high) with a little help from my friends': An examination of adult alcoholics"
friendships. Journal of Studies on Alcohol, 62, 637-645.

Moos, R. H., Bromet, E., Tsu, V., & Moos, B. (1979). Family characteristics and the
outcome of treatment for alcoholism. Journal of Studies on Alcohol, 40, 78-88.

O'Farrell, T. J., Hooley, J., Fals-Stewart, W. & Cutter, H. Q. (1998). Expressed emotion
and relapse in alcoholic patients. Journal of Consulting and Clinical Psychology,
66, 744-752.

Prochaska, J. O., & DiClemente, C. C. (1982). Transtheoretical therapy: Toward a more
integrative model of change. Psychotherapy: Theory, Research, and Practice, 19,
276-288.

Prochaska, J. O., & DiClemente, C. C. (1986). Toward a comprehensive model of
change. In W.R. Miller & N. Heather (Eds.), Treating addictive behaviors:
Processes of change (pp.3-27). New York: Plenum Press.

Prochaska, J. O., & DiClemente C. C. (1992). Stages of change in the modification of
problem behaviors. Progress in Behavior Modification, 28, 183-218.

Prochaska, J. O., DiClemente C. C., & Norcross, J. C. (1992). In search of how people
change: Applications to addictive behaviors. American Psychologist, 47, 1102-
1114.

Remple, M. & DeStefano, C. D. (2001). Predictors of engagement in court-mandated
treatment: Findings at the Brooklyn treatment court, 1996-2000. In J. J. Hennessy
& N. J. Pallone (Eds.), Drug Courts in operation: Current research (pp.87-123).
New York: Haworth Press.

Rosenberg, H. (1983). Relapsed versus non-relapsed alcohol abusers: Coping skills, life
events, and social support. Addictive Behaviors, 8, 183-186.

Rychtarik, R. G., Prue, D. M., Rapp, S. R., & King, A. C. (1992). Self-efficacy, aftercare,
and relapse in a treatment program for alcoholics. Journal of Studies on Alcohol,
53, 435-440.

Sansone, J. (1980). Retention patterns in a therapeutic community for the treatment of
drug abuse. International Journal ofAddictions, 15, 711-736.









Saxon, A., Wells, E., Fleming, C., Jackson, T., & Calsyn, D. (1996). Pre-treatment
characteristics, program philosophy and level of ancillary services as predictors of
methadone maintenance treatment outcome. Addictions, 91, 1197-1209.

Sindelar, J. L. & Fiellin, D. A. (2001). Innovations in treatment for drug abuse: Solutions
to a public health problem. Annual Review of Public Health, 22, 249-272.

Slaught, E. (1999). Focusing on the family in the treatment of substance abusing criminal
offenders. Journal ofDrug Education, 29, 53-62.

Snow, M.G., Prochaska, J.O., & Rossi, J.S. (1992) Stages of change for smoking
cessation among former problem drinkers: A cross-sectional analysis. Journal of
Substance Abuse Treatment, 4, 107-116.

Sobell, L. C., Sobell, M. B., Toneatto, T. & Leo, G. I. (1993). Recovery from alcohol
problems without treatment. In N. Heather, W. R. Miller, & J. Greeley (Eds.). Self-
control and the addictive behaviors (pp. 198-242). New York: Maxwell/Mac
Millan.

Steer, R. A. (1980). Psychosocial correlates of retention in methadone maintenance.
International Journal ofAddictions, 15, 1003-1009.

Substance Abuse and Mental Health Services Administration (SAMHSA). (2004).
Results from the 2003 National Survey on Drug Use and Health: National Findings
(Office of Applied Studies, NSDUH Series H-25, DHHS Publication No. SMA 04-
394). Rockville, MD.

Sung, H., Belenko, S., Fend, M. A., & Tabachnick, M. A. (2004). Predicting treatment
noncompliance among criminal justice-mandated clients: A theoretical and
empirical exploration. Journal of Substance Abuse Treatment, 26, 13-26.

Tucker, M. B. (1979). A descriptive and comparative analysis of the social support
structure of heroin-addicted women. In Addicted women: Family dynamics, self-
perception and support systems. Rockville, MD: Department of Health and Human
Services.

Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The
Multidimensional Scale of Perceived Social Support. Journal ofPersonality
Assessment, 52, 30-41.

Zimet, G. D., Powell, S. S., Farley, G. K., Werkman, S. Berkoff, K. A. (1990).
Psychometric characteristics of the Multidimensional Scale of Perceived Social
Support. Journal ofPersonality Assessment, 55, 610-617.

Zywiak, W. H., Lognabaugh, R., & Wirtz, P. W. (2002). Decomposing the relationship
between pretreatment social network characteristics and alcohol treatment outcome.
Journal of Studies on Alcohol, 63, 114-121.















BIOGRAPHICAL SKETCH

Rebeca Lau Kovar is a student in the rehabilitation counseling master's program at

the University of Florida. She has a Bachelor of Science degree in psychology, also from

the University of Florida. Currently she is employed as an Addictions Counselor at

Corner Drug Store-Outpatient Services working with the federal and county probation

population.