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Personality characteristics of alcoholics related to age and employment

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Personality characteristics of alcoholics related to age and employment
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Wilson, Lindsay Edward, 1949-
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Age groups ( jstor )
Alcohol abuse ( jstor )
Alcoholic beverages ( jstor )
Alcoholism ( jstor )
Employment ( jstor )
Labor ( jstor )
Minnesota Multiphasic Personality Inventory ( jstor )
Psychometrics ( jstor )
Self concept ( jstor )
Substance abuse ( jstor )
Alcoholism -- Florida ( lcsh )
Alcoholism -- Psychological aspects ( lcsh )
Alcoholism and employment -- Florida ( lcsh )
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bibliography ( marcgt )
non-fiction ( marcgt )

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Thesis (Ph. D.)--University of Florida, 1982.
Bibliography:
Includes bibliographical references (leaves 102-112).
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Typescript.
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Vita.
Statement of Responsibility:
by Lindsay Edward Wilson.

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Copyright [name of dissertation author]. Permission granted to the University of Florida to digitize, archive and distribute this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder.
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PERSONALITY CHARACTERISTICS OF ALCOHOLICS
RELATED TO AGE AND EMPLOYMENT




BY



LINDSAY EDWARD WILSON


A DISSERTATION PRESENTED TO THE GRADUATE COUNCIL
OF THE UNIVERSITY OF FLORIDA IN
PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF DOCTOR OF PHILOSOPHY


UNIVERSITY OF FLORIDA
1982













ACKNOWLEDGEMENTS


I would like to acknowledge the assistance and support of those who made

this project possible. The guidance of the members of my doctoral committee was

invaluable. I would like to thank Dr. Stripling for his words of wisdom; Dr. Ziller

for his support, Dr. Tolbert for being there when needed; and Dr. Gary Seller for

his humor and perspective.

I appreciate the confidence of my family and friends. My wife Elayne

struggled with me in the pursuit of this research and her dedication and love made

it possible. The family motto, from England, is Endure Fort or "Endure with

Strength." Elayne, and the children Michael, Albert, Lindsay Ann, and Jennifer did

just that and this work is dedicated to them.








TABLE OF CONTENTS


Page


ACKNOWLEDGEMENTS ............................................

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

ABSTRACT.... .................. ................... .


CHAPTER


INTRODUCTION.......................

Purpose of the study....................
The Scope of the Problem ...............
Defining Alcoholism....................
Economic Impact ......................
Drinking and Driving ...... .........
The Meyers Act .......................


The Need for the Study .......................................
Substance Abuse Programs ....................................
Program Funding .......................................... .

Rationale........................ ....................
Research Questions ......................................
Research Hypotheses.......................................
Definition of Terms .......................................
Organization of the Remainder of the Study....................

REVIEW OF THE LITERATURE............................

Perspective on Beverage Alcohol...............................
Development as a Beverage .................................
Early American Drinking.....................................
Individual Differences.................................

Alcohol Abuse Client in Florida................................
Children.................................. .................
College Students..........................................
Adults ....................................................


Treatment Concepts ............................
Early Ideas ..................................
The Alcoholic Family..........................
Treatment Services ............................
Federal Program Funding ......................
Third Party Payments .........................


Alcoholic Personality Characteristics ..........................
Ageing and the Alcoholic ...................................
Employment and the Alcoholic ................................
Super's Vocational Career Development Theory ..................


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TABLE OF CONTENTS (Continued)

Page
CHAPTER

III METHODOLOGY............................................ 52

Research Design ............................................. 53
Research Hypotheses ........................................ 53
Population and Selection of the Sampel......................... 54
Instrumentation .............................................. 56

The Minnesota Multiphasic Personality Inventory (MMPI)........... 58
MMPI Scales............................................... 60
MMPI Short Forms (Mini-Mult)............................... 63
MMPI-168 ................................................ 64
MMPI Special Alcoholism Scales .............................. 66
MAC Scale ............................................... 67

Statistical Analysis ...... .............. .......... ......... 68
Procedures ................................................. 69
Limitations of the Study ..................................... 71

IV RESULTS OF THE STUDY .................................. 72

Description of the Sample .................................... 72
Data Analysis....................... ....................... 75

V SUMMARY AND CONCLUSIONS............................... 90
Discussion................................................. 92
Conclusions of the Investigation................................ 94
Limitations........................ ......... .......... ... 95
Recommendations........................................... 96



APPENDIX .......................................................... 99
REFERENCES ....................................................... 102

BIOGRAPHICAL SKETCH............. .............................. 13












List of Tables


Page
Table I Florida Alcohol-Related Service Needs 26

Table 2 Units of Service by Component 36

Table 3 Individuals in Treatment 1979-80 37

Table 4 Family Income 38

Table 5 Means and Standard Deviations of Descriminate Function and
Percentages of Correct Classification by Age 1681 Male Alcoholics 43

Table 6 Client Characteristics of Total Sample 73

Table 7 Chi-Square Comparing Study Client Characteristics
With Estimated State Parameters 74

Table 8 Chi-Square Comparing Study Client Characteristics Within
the 3 x 2 Matrix 76

Table 9 Means and Standard Deviations of MMPI Scales by Age and
Employment 77

Table 10 Two-Way ANOVA Testing Employment and Age on Hysteria 79

Table I I Summary for Main Effects on Variable Hysteria Following
Non-Significant ANOVA Interaction 80

Table 12 Two-Way Analysis of Variance Testing Employment and Age
on Alcoholic MMPI Scale Social Introversion 80

Table 13 Summary for Main Effects on Variable Social Introversion
Following Non-Significant ANOVA Interaction 81

Table 14 Two-Way ANOVA Testing Employment and Age on Masculinity-
Feminity 81

Table 15 Two-Way ANOVA Testing Employment and Age on Masculinity-
Feminity 82

Table 16 Two-Way ANOVA Testing Employment and Age on Depression 82

Table 17 Summary for Simple Effects on Variable Depression
Following a Non-Significant ANOVA Interaction 83

Table 18 Two-Way ANOVA Testing Employment and Age on Psychasthenia 84








LIST OF TABLES (continued)


Page


Table 19 Summary for Simple Effects on Variable Psychasthenia
Following a Significant ANOVA Interaction 85

Table 20 Two-Way ANOVA Testing Employment and Age on MAC 86

Table 21 Correlation of Age and MAC 87

Table 22 Two-Way ANOVA Testing Employment and Age on Psychopathic
Deviance 88

Table 23 Correlation of Age and Psychopathic Deviance 88

Table 24 Two-Way ANOVA Testing Employment and Age on Scale L 89

Table 25 Correlation of Age and Scale L 89


Appendix

Table 26 Two-Way ANOVA Testing Employment and Age on Scale F 99

Table 27 Two-Way ANOVA Testing Employment and Age on Scale K 99

Table 28 Two-Way ANOVA Testing Employment and Age on Paranoia 100

Table 29 Two-Way ANOVA Testing Employment and Age on Schizophrenia 100

Table 30 Two-Way ANOVA Testing Employment and Age on Hypomania 101






Abstract of Dissertation Presented to the Graduate Council of the University of Florida
in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy



PERSONALITY CHARACTERISTICS OF ALCOHOLICS
RELATED TO AGE AND EMPLOYMENT



by

LINDSAY EDWARD WILSON
May 1982


Chairman: Gary Seiler
Major Department: Counselor Education

Employment has been identified as a contributing element in recovery

from drinking. This research examines the personality attributes of alcoholic

clients of different ages who are employed and unemployed. The prevention of

alcohol abuse by people ages 15-64 through job training is considered and discussed.

This study of 120 male alcoholics examines Minnesota Multiphasic Person-

ality Inventory-168 characteristics, including the MacAndrews scale of substance

abuse. The subjects were drawn from Florida Alcoholism programs and grouped

twenty to a cell in a 3 by 2 matrix. There were three levels of age, 15-24, 25-44,

and 45-64 according to the vocational development theory of Donald Super. Two

levels of work history, employed and unemployed, were determined from the

Florida Department of Health and Rehabilitative Services guidelines. Two-way

Analysis of Variance and correlational techniques were performed on the data.

The study concluded that there are differences in personality characteris-

tics of alcoholics of different age groups. The 15-24 group is lower than the oldest

on Hysteria. On Social Introversion the oldest group is higher than the other two

groups. Employment was also found to make a difference. The unemployed scored









higher on Hypochondriasis than those who work and lower on Masculinity-femi-

ninity. An interaction was found on Depression and Psychasthenia. Unemployment

raised depression in the middle age group but not the others. Employment

decreased psychasthenia scores of the middle group but not the others. Significant

differences were not found on MAC.

The study concludes that employment is an important part of the

rehabilitative plan for alcoholics. The vocational self-concept may be influential

in determining the degree of depression, guilt, worry, and hysteria in alcoholics.

The importance of work is emphasized for men in the 25-44 age bracket.

Vocational training programs might find greatest success when targeted at the 25-

44 age group. If such programs are aimed at younger people benefits may not be

demonstrable until they reach their late twenties.














CHAPTER I

INTRODUCTION

Purpose of the Study

Alcohol abuse and alcoholism are significant problems likely to be encoun-

tered by counselors in a variety of settings (Birtman, 1980). Special emphasis has

been placed on the prevention of substance abuse by young people (Andrews, 1980;

Hoefle, 1980: Florida, 1980b; Klein, 1980; Florida Drug Abuse Trust, 1979).

Community prevention efforts emphasizing the youthful stem at least in part from

the unspoken belief that older alcoholic clients are more difficult or even beyond

help (Lynn, 1978; Myerson, 1978). However, there is reason to believe that a

number of alcoholic clients do not seek serious, intensive treatment until the

middle years of life (Apfeldorf & Hunley, 1975; Hoffman & Nelson, 1971; Sutker et

al., 1979; Vosburgh, 1975; Weissback et al., 1976; Williams & Kahn, 1964). This is the

time of life Donald Super's vocational theory suggests is normally a period of

establishment of career pattern and vocational self-concept (Super, 1953).

Clopton (1973) has identified employment as a contributing element in

recovery from drinking. Work has traditionally been a part of the treatment of

alcoholism cases by self-help groups (AA, 1953, 1973, 1975; Johnson, 1980). Institu-

tions and programs accreditation groups often mandate vocational rehabilitation

with alcohol clients (Florida 1980a ; U.S., 1974). Putting substance abusers to

work is a standard component of alcoholism treatment planning.

There also appears to be a relationship between how an individual sees

himself and the level of abuse among the substance abuse population (Johnson,

1980; Medzerian, 1979). Self-concept is recognized by many theorists to be








influenced at least in part by vocational development. Super's vocational theories

have provided a framework that is commonly in use by Florida's Department of

Health & Rehabilitative Services and his ideas have been applied to vocational

projects in the substance abuse field throughout the state (Florida Drug Abuse

Trust, 1979).

The literature indicates that there are personality characteristics many

alcoholics have in common (Clopton, 1973; Hodo & Fowler, 1976; MacAndrew, 1965;

Williams & Kahn, 1964; Vosburgh, 1975). These underlying factors are stable and

resistant to change (MacAndrew, 1965). Ageing may have a way of softening the

expression of those characteristics (Apfeldorf & Hunley, 1975; Hoffman, 1970;

Hoffman & Nelson, 1971; Kratz, 1975; Sutker, 1979). Employment has been

identified as a contributing element in alcoholic recovery (Clopton, 1973, Johnson

1980). Super's developmental theory is in congruence with the question asked by

the proposed research. Working may provide structure that decreases anxiety and

reinforces a positive self-concept that is inversely correlated with alcohol abuse

(Medzerian, 1979).

Alcoholics are usually not ready to change their behaviors until they have

exhausted available alternatives (AA, 1953, 1973, 1975; Glatt, 1958). Kratz (1975)

has indicated there is a positive correlation between age and length of sobriety.

The modal age group at which change seems to occur is in the early forties

(Williams, 1964). This is the time of establishment when one normally stabilizes a

career pattern and works at maintaining an occupational position (Super, 1953;

Tolbert, 1974). Alcoholics in this age group often experience destabilization of

their career pattern and loss of vocational position Florida, 1980a). Super's theory

provides a framework for understanding age and employment factors in alcoholism

treatment.








Some counselors deemphasize work and are more concerned with their

client's intrapersonal processes and self-expression. However, most current

theorists usually place some importance on a client's need and ability to maintain

employment. Certainly the clients return to work and discontinuance of reliance

on others finds favor with administrators and others who must present substance

abuse programs to funding groups and the public (Mann, 1959).


The Scope Of The Problem

Alcohol is a drug, the most abused drug in the United States (Breecher,

1972; U.S., 1971). International comparisons rank the United States 15th in percapita

consumption of all forms of alcohol and third when consumption of distilled spirits

alone is considered. A similar pattern of a preference for hard liquor instead of

beer or wine is found in the Soviet Union and Poland. The highest levels of drinking

are in Portugal, France, and Italy where wine is a part of the everyday diet.

Although Australia and New Zealand rank 9th and Ilth respectively in overall

consumption, they lead the world in beer drinking (HEW, 1978; Keller & Gurioli,

1976).

Analysis of world and American drinking patterns must consider inter-

actions of socioeconomic variables. The high consumption rate of Nevada (#1), The

District of Columbia (#2). New Hampshire (#3), Alaska (#4), Vermont (#5), and

Florida (#11) have been attributed to several factors not easily related to each

other. Nevada and Florida have large numbers of tourists who are thought to drink

more while on vacation. Florida also ranks first in proportion of residents 65 and

over in the United States and fourth in actual number of elderly persons (Cutler &

Harootyan, 1975). Among the retired group drinking often increases from pre-

retirement rates. The District of Columbia has tourists and many people working




4

in high pressure, transient situations. Residents of states adjacent to New

Hampshire and Vermont often purchase their alcoholic beverages as well as other

goods in those states because of favorable prices due to the tax structure. Alaskan

drinking patterns may reflect a frontier life-style that traditionally has included

heavy drinking (Keller & Guirioli,1976; U.S., 1971). "Alcohol abuse" is difficult to

determine for large groups as well as individuals.

The sterotyped "skid row bum" accounts for only 3-5% of the alcoholic

group (U.S., 1971). The majority of alcoholics are people who work and lead lives

not so different from those of non-alcoholic Americans. One-third of adult

Americans drink alcoholic beverages at least once a week and another third drink

chiefly on special occasions only. Those remaining used to drink but no longer do

or have always abstained (U.S., 1978). One out of every seven to ten adult drinkers

in the United States experiences serious problems directly related to the consump-

tion of alcoholic beverages (U.S., 1971). The Department of Health, Education, and

Welfare (1978) suggests as many as 25% of those who drink are potential problem

drinkers. A 1977 National Institute of Alcohol Abuse and Alcoholism (NIAAA)

survey by Johnson et al. indicates that 36% of all those who drink could be

classified as problem drinkers.

Defining Alcoholism

There is disagreement on operational definitions in the alcoholism litera-

ture and the categories described do not always usefully differentiate between

problem drinking and alcoholic drinking (Chatham, 1979; Jellinck, 1960, 1962;

Marconi, 1959). Not every problem drinker is an alcoholic, but every alcoholic is

certainly a problem drinker (Mann, 1959). Any one individual may also drink

socially at one time in his life and alcoholically at others. "Social Drinkers" are

those whose drinking is a part of their social interactions with family, friends,

neighbors, and co-workers. Alcohol is used in this context as a beverage for







relaxation and to enhance the feelings of well-being in healthy social relationships.

The health and/or social functioning of the social drinker are not impaired.

"Problem drinkers" consume alcoholic beverage in such a way that their

drinking disrupts their interpersonal relationships with family, friends, neighbors,

or employers. Alcohol abuse or problem drinking is misuse of the drug to the point

where problems are manifested or disabilities result. Such problems include those

that are psychological in nature, such as depression and anxiety; medical illness of

an acute and chronic nature, and social problems such as default of major roles in

society. An alcohol-related disability is an impairment in the physical, mental, or

social functioning of an individual that may reasonably be inferred to be caused at

least in part by alcohol consumption (U.S., 1978).

Some problems in society are related to the excessive use of alcohol but

not necessarily alcoholism. Problem drinking is excessive but relatively controlled

drinking even to the point of psychological and physical drinking damage. Alcohol-

ism is a dependence syndrome characterized by a loss of control of alcohol intake

and is recognized as an illness that will progressively get worse if not treated

(Bowman & Jellinek, 1941; Jellinek, 1960).


Economic Impact

Economic losses are manifested in two general ways: loss of production

and an increase in health, social and criminal justice services to cope with the

consequences of heavy drinking. The Second Special Report on Alcohol and Health

indicated economic cost of 25 billion dollars in 1971, an upward revision of ten

billion dollars from losses predicted by the First Special Report by the Department

of Health, Education and Welfare. The 72% increase to 43 billion in 1971-75 is

explained by the increased costs of goods, services, and labor as well as a more

comprehensive method of analyzing cost factors; however, it does not include







unemployment compensation or welfare payments that may be related to drinking

(U.S., 1978).

Estimated lost production of goods and services was 19.64 billion dollars in

1975. This includes lost market production among males of 15.46 billion; lost

military production of .041 billion; lost future production from excess mortality of

3.77 billion dollars. The 15.46 billion estimate of lower earning is considered to be

conservative. Losses incurred by workers under 21 and over 50 are not included nor

are losses by unsalaried workers such as housewives (U.S., 1978).

The United States ranks near the median of all countries in hospital

admissions for alcohol-related mental illnesses (U.S., 1978). Among 70 thousand

first admissions to state mental hospitals in 1964, 22% of the males and 5.6% of the

females were diagnosed alcoholic. In nine states alcoholism led all other diagnoses

in mental hospital admissions. Maryland state hospital reported 40% of all male

mental health admisisons as alcoholism (Breecher, 1972).

In 1975, 12.74 billion dollars was spent for health and medical services

related to alcohol abuse. The alcoholic and problem drinking population of

approximately ten million Americans is thought to account for 8.4 billion dollars or

almost 20% of all hospital care expenses (U.S., 1978). The percentage of health

care costs that can be related to alcohol abuse may even be greater than that

reported (Ellis, 1978). Hospital and health care providers tend to diagnose

presented symptomatology and not the underlying illness, alcoholism (Hoefle, 1980;

Ramirez & Wells, 1978: Westie & McBride, 1974).

Alcohol may be implicated in illnesses, deaths, and accidents. In the

United States in 1975 between 61,034 to 95,003 deaths were reported related to

alcohol abuse. Alcohol abuse is cited as the direct cause of 18,218 to 35,295 deaths

drinking was implicated in 1975 in 6,766 to 10,013 suicides, 10,442 to 14,917

homicides; 6,614 accidental falls; 1,572 fires, and 13,756 to 22,926 motor vehicle








accidents (Day, 1977; NCHS, 1975, U. S., 1971, 1975). Alcohol is said to be involved

in as many as 64% of the homocides, 60% of the child abuse, and 56% of the

assaults in U. S. homes. (Florida, 1980 b).


Drinking and Driving

The relationship of drinking and driving to traffic fatalities has been

repeatedly documented (Bako et al., 1977; Florida, J979; U. S., 1971). Economic

costs associated with driving while drunk were estimated at 5.14 billion dollars in

1975. The net percentage of alcohol related accidents of the total motor vehicle

accidents in the United States is 41.5 with the percentage increasing with the

severity of the crash (U.S. 1978). Among those age 16 to 24 the percentage of

alcohol involvement in traffic fatalities is 60% (U.S., 1971). Of those 16 to 24 years

of age, 15.9% admit to driving after having a "good bit to drink" (Florida, 1980b,

p 6). The problem drinker represents less than 10% of the general population yet may

be involved in nearly two-thirds of the related traffic fatalities in the state of New

York (New York, 1979).

Driving while intoxicated (DWI) or under the influence of alcohol (DUI)

accounted for 250 thousand arrests nationwide as early as 1965. Another 490

thousand were charged with disorderly conduct and 1,535 thousand for public

intoxication. If all drinking related arrests are considered, 40% of the reported 5

million arrests in the United States in 1965 may be linked to the excessive

consumption of alcoholic beverages (Breecher, 1972; U. S. 1971 & 1975). The

extent of the problem in the early nineteen-sixties elicited a legislative response in

the early nineteen-seventies. Although alcoholism has been decriminalized, the

behavior of those who drink excessively remains a serious problem in the nation and

State of Florida (Florida, 1980d). This is not always reflected in official reports

since drinking behaviors are no longer equated with illegal activity.








The Meyers Act

Only recently has alcohol abuse been considered an emotional or medical

disorder (Cross, 1968; Mann 1959; Public Law 91-616; Tarter & Sugarman, 1976).

During the 1960's there was a legislative movement towards dealing with alcohol

abuse that culminated in the Uniform Alcoholism and Intoxication Act drafted by

the National Conference of Commissioners on Uniform State Laws and recommen-

ded for enactment by all the states (Florida 1976, 1977; Lewis, 1955). The 1971

session of the Florida legislature passsed.the "Comprehensive Alcoholism, Preven-

tion, Control and Treatment Act" (Chapter 396 of the Florida Statutes) modeled

after the federal act. Florida Law Relating to Alcohol Offenses and the Rehabili-

tation of the Alcoholics. or "The Meyers Act" as it is commonly called, was fully

implemented January I, 1975, and amended by the 1976 legislature (Florida, 1977).

Florida statutes clearly mandate recognition of the alcoholic as an ill

individual who needs treatment and emphasizes early diagnosis and prevention.

Section 396.022 (Findings and Declaration of Purposes) includes the following

passages:

Alcohol abuse and alcoholism are increasing throughout the country
and in Florida. Alcohol abuse can seriously impair health and lead
to chronic and habitual alcoholism. Alcoholism is recognized as an
illness or disease that requires attention and treatment through health
and rehabilitative services.

The criminal law is not an appropriate device for preventing or
controlling health problems. Dealing with public inebriates as
criminals has proved expensive, unproductable, burdensome, and
futile. The recognition of this fact and the concurrent establishment
of modern public health programs for the medical management of
alcohol abuse and alcoholism will facilitate early detection and
prevention of alcoholism and effective treatment and rehabilitation
of alcoholics.

An alcoholic, except in specified instances enumerated herein,
shall be treated as a sick person and provided adequate and appropriate
medical, psychiatric, and other humane rehabilitative treatment
services for his illness. (p. I).








The Need For The Study
It has been suggested that a significant number of the American and

Floridian populations may be considered alcoholic or may demonstrate problems in

the use of alcoholic beverages in their lives. These individuals are recognized by

law as needing treatment services rather than moral chastisement or incarceration

(Florida, 1977). Treatment in cases under the supervision of federal and state

agencies includes a plan to return the person to productive work. (Florida, 1980e;

U.S., 1971, 1978).

Employment and related counseling services are viewed by policy makers

in the state and federal regulatory agencies as an integral part of the rehabili-

tation of alcoholics. Specific HRS rules require such services for state licensing as

a treatment unit. Accreditation of such programs for the receipt of third party

payments in cases where it is applicable necessitates the inclusion of vocational

rehabilitation in mandatory counseling treatment plans (U. S./JCHA, 1974; HRS,

1980a).

There are likely to be continued interest and special projects involving

vocational rehabilitation with substance abuse clients because of (I) A reported

positive correlation between unemployment and substance abuse (Andrews, 1980;

Florida Drug Abuse Trust, 1979); (2) A self-help tradition within the field

independent of professional counseling services and emphasizing "common sense"

treatment approaches (AA, 1953; Johnson, 1980); and (3) The need for greater self-

support by treatment programs in the face of dwindling federal dollars. Third

party payments by non-government entities and self-supportive cottage industries

or sheltered businesses are increasing by being looked at by program fiscal

administrators (Florida Drug Abuse Trust, 1979; Let's Make it Work, 1980, Budget,

1980).








Substance Abuse Programs

Alcohol and drug abuse programs existed prior to the 1964 Community

Mental Health Services Act outside the traditional mental health services com-

munity. Originally separate, there has been a movement towards combining

alcohol and drug services under substance abuse programs within a community

mental health center (HEW, 1979; Ozarin & Wolfe, 1979). These programs have in

the past been staffed not by professional counselors but by former abusers applying

mostly self-help methods. Many substance abuse treatment centers continue to be

staffed much the same way today.

A typical staffing pattern of a treatment unit may be drawn from data

gathered by the National Drug and Alcoholism Treatment Utilization Survey

(NDATUS) of April, 1979; social worker BA and above 9.4%; degree counselors BA

and above 16.9%; degree counselors at the AA level 4.0%; and non-degreed or

formal training are widely utilized at a full time equivalent rate of 35.4% (U.S.,

1979).

While many alcohol programs staff with recovering clients, this is not the

accepted procedure with other mental health services who generally hire college

trained counselors. Because the number of degree counselors is limited in

substance abuse programs professional techniques are usually used adjunctly to

self-help methods developed and fostered by Alcoholics Anonymous and others (AA,

1953, 1975). Such self-help methods in the field may be expected to stress common

sense ideas such as a return to work as an important step in the rehabilitation

process (Johnson, 1980).

Program Funding

Funding counseling services is expected to be increasingly difficult in the

years ahead in most areas of the field (Let's All Make It Work, 1980; Decisions,

1980). Substance abuse programs are expected to face the prospects of diminished








federal and local financial support to a perhaps greater degree that other mental

health and social service providers. A proposed federal budget for Fiscal Year 1981

would mean cutbacks of $50.9 million by NIAAA and $35.9 million by National

Institute of Drug Abuse (NIDA). Although the need for services may be real and

significant, programs view themselves in competition with other possibly more

attractive groups (Budget, 1980; Seidley, 1980). With funding becoming a problem,

it is unlikely federal, state, or local communities will give priority to alcohol and

drug programs over those programs for the handicapped or disadvantaged.

Substance abuse programs find themselves in need of demonstrable

treatment modalities and methods that can have reasonable success rates and

impact on their client population (Malfetti, 1979). Efforts that return the abuser to

productive living and remove the client from reliance on public support are popular

both with those in and outside the field (Florida Drug Abuse Trust, 1979).

Treatment services that appear frivolous or expensive while not leading to a

lifestyle that includes work are less likely to receive administrative or community

support.

Federal support in the form of Title XX, 409, 410, and other funding is not

sufficient to operate substance abuse programs at their current levels (Budget,

1980). Third party payments following accreditation is hoped for but not achieved

as yet on a large scale. The collection of client fees and funds-producing client

activities such as cottage industries are under consideration by those responsible

for the fiscal management of programs. The expectation of collection of fees for

services rendered has not met with success (Trust, 1979). The ability of clients to

produce something of value while in treatment is a necessary and traditional part

of such operations as Goodwill Suncoast, Inc. and the Pinellas Association for

Retarded Children in Florida. Whether such projects are businesses for the benefit








of the sponsoring program or part of the treatment of rehabilitation for the client

has emerged as an issue in the alcohol and drug abuse field. In any case, the trend

is towards more wide spread implementation of the cottage industry concept in the

future (Florida Drug AbuseTrust, 1979).



Rationale

Implications are expected for further research on the progressive nature

of alcoholism, treatment program planning and funding, and treatment approaches

for substance abuse clients. The findings of the study may be limited to alcoholics

among the drinking population of the state of Florida and not be applicable to

alcoholics in other areas.

Alcoholism is viewed by modern theoreticians as a progressive disease

entity (APA, 1980, Jellinek, 1960; Kissin & Begletier, 1977). There could

be expected deterioration or negative changes on personality measures and

characteristics according to the theory. The progressiveness of the illness may

justify, as presently formulated, focusing attention on the early and middle stages

of the illness and the withdrawing of limiting efforts at the end or terminal phases.

Younger clients generally receive more attention than older ones in the form of

grant monies, special projects, and publicity (Hoefle, 1980).

Directing attention to young clients does not take into consideration the

traditional theoretical curve of alcoholism recovery that predicts the individual

will "hit bottom" and then make the changes that lead to recovery (Glatt, 1958).

Another way of expressing this is that an alcoholic must reach a point where he is

willing to enter into a therapeutic relationship before he is going to change. Any

efforts towards treatment before the client reaches that motivational point are

going to have limited success (AA, 1953; Brozek, 1950; Glatt, 1958; Menninger,

1959). The effectiveness of treatment may not depend upon the age of the person








but on the clients readiness to enter a helping relationship and to change personal

behavior.

Employment would appear to have face validity as an important element

of the alcohol abuser's treatment and is supported in a general way by studies with

this population. However, more needs to be done to explain what differences

employment makes in the personalities of these clients. Research in this area is

acknowledged difficult and of uneven quality. Personality studies with this group

attempt to delve into psychological framework of clients who are skillful in

preventing others from entering their intrapersonal world (AA, 1953; Berne, 1964,

Thomas, 1980).

The federal and state regulations under which the alcohol counselor works

with the client imply values the counselor should attempt to instill in the client for

the client's own good. While this is not a new idea in counseling, it is an issue in

the substance abuse field usually not found to the same degree in other areas of

counseling practice. Control of behavior and the fostering of commonly accepted

values among alcohol and drug abusers often deals with habilitation, not rehabili-

tation counseling as traditionally formulated Hill & Blane, 1967; Malfetti, 1979;

Florida Drug Abuse Trust, 1979).

Exploratory related research was conducted regarding the conceptions of

the hypotheses and applicable research methods and materials in 1979 and 1980.

The usefulness of sheltered workshops or "cottage industries" was studied through-

out the state for the Florida Drug Abuse Education and Prevention Trust. The

Work Values Inventory (Super 1973) was used to examine intrinsic and extrinsic

work values as well as provide information about some aspects of the work self-

concept of substance abusers. The results pointed out the desirability of a

vocational training and placement component as a supplement to counseling in a

residential drug treatment center. The cottage industry project was presented at

the 1979 National Drug Abuse Conference in New Orleans.








A related examination of the Minnesota Multiphasic Personality Inventory

(MMPI) in 71 item Mini-Mult format (Kincannon, 1968) was completed in 1980 on

data gathered over a four year period at an alcoholism treatment facility in

Florida. The large sample (N = 349) yielded theoretical and practical information

concerning the application of the materials used in this research.

Participation in this study by alcoholism treatment programs in Florida

may lead to increased awareness of the characteristics of their clients and the

importance of age and employment factors in rehabilitation planning. The data

gathered may be useful to program administrators and planners for policy making

regarding substance abuse treatment procedures. The results may provide a

framework for understanding related substance abuse studies and projects in

Florida and other areas.

Research Questions

It is often alluded by those in the alcohol field that there is a progressive

degeneration of personality among alcoholics who continue to drink as they grow

older. While physiological changes associated with continued alcohol ingestion are

well known the concomitant emotional aspects are less understood. The literature

suggests that specific alcoholic personality characteristics may be constant no

matter the client's age or changes on other measures of personality.

Working has been an important part of the treatment of alcoholics by non-

professionals, often recovered drinkers themselves. Medzerian (1979), the Florida

Drug Abuse Trust (1979) and others have shown a strong relationship between self-

concept and substance abuse. That is, a poor self-concept may be highly correlated

with substance abuse.

If work is important in the formation of self-concept, then we would

expect employment to be linked with less abusive drinking levels and a more








healthy personality profile. This study examines personality characteristics of

alcoholics of different age groups suggested by Super (1953) in relation to their

recent work history.

Research Hypotheses

This study addresses the following research hypotheses:

I. There are no differences in the personality characteristics (MMPI scores) of

alcoholics of different age groups.

2. There are no differences in the personality characteristics (MMPI scores) of

alcoholics who work and those who do not work.

3. There is no interaction of age and employment related to the personality

characteristics (MMPI scores) among different age groups of alcoholics.

4. There is no difference in the potential for alcohol abuse (MAC score) among

different age groups of alcoholics.

5. There is no difference in the potential for alcohol abuse (MAC score) among

alcoholics who work and those who do not work.

6. There is no interaction of age and employment related to the potential for

alcohol abuse (MAC score).

Definition Of Terms

The following list refers to terms which are frequently referred to

throughout the study:

Alcoholic: A person determined by an alcoholism treatment program

licensed by the Department of Health & Rehabilitative Services of the State of

Florida to meet the Diagonistic and Statistical Manual of Mental Disorder

categories (DSM-III): 303.9X or 305.0X

Alcohol Abuse: (DSM Ill 305.0X A.) Pattern of pathological alcohol use

e.g., need for daily use of alcohol for adequate functioning; inability to cut down or








stop drinking; repeated efforts to control or reduce excess drinking by "going on

the wagon" (periods of temporary abstinence) or restricting drinking to certain

times of the day; binges (remaining intoxicated throughout the day for at least two

to three days); occasional consumption of a fifth of spirits (or its equivalent in

wine or beer); amnesic periods for events occurring while intoxicated (blackouts);

continuation of drinking despite a serious physical disorder that the individual

knows is exacerbated by alcohol use; drinking of non-beverage alcohol. B.)

Impairment in social or occupational functioning due to alcohol use, e. g., violence

while intoxicated, absence from work, loss of job, legal difficulties (e.g., arrest for

intoxicated behavior, traffic accidents while intoxicated), arguments or difficulties

with family or friends because of excessive alcohol use. C.) Duration of

disturbance of at least one month.

Alcoholism: Excessive dependence on or addiction to the point the

person's physical and mental health is threatened or harmed (Freedman, 1972)

characterized by a compulsion to take alcoholic beverages to experience its

psychological and physical effects and to avoid the discomfort of its absence (HEW,

1978).

Alcohol Dependence (DSM 303.9X): All of the characteristics described

as Alcohol Abuse DSM 305.0X as well as either tolerance or withdrawal. Tolerance

is the need for markedly increased amounts of alcohol to achieve the desired

effect, or markedly diminished effect with regular use of the same amount.

Withdrawal is the development of "alcohol withdrawal" (e.g., morning, "shakes" and

malaise relieved by drinking) after cessation of or reduction in drinking.

Alcohol Detoxification Center: Also known as "Alcoholism Receiving
Center," or "Detox." An inpatient setting licensed by the Department of Health

and Rehabilitative Services of the State of Florida to provide a five day medical








and counseling procedure to prevent withdrawal complication in persons who have

consumed alcoholic beverages to excess.

Department of Health & Rehabilitation Services (DHRS or HRS): The

state wide organization that provides a variety of services aimed at promoting the

health, social and economic well being of Florida residents.

Department of Vocational Rehabilitation (DRV or VR): An agency of the

Department of Health & Rehabilitative Services charged with providing vocational

rehabilitative services to vocationally hancicapped Florida residents.

Employed: The determination of employment status "employed" or

"unemployed" will be made according to Social Security Administration classifi-

cation. The 1980 DHRS Vocational Rehabilitation Counselor's Manual (HRS Manual

170-2, Chapter 10, page 2) defines employment as "substantial gain activity.

"Earnings averaging more that $230 per month deemed to demonstrate the ability

to engage in SGA." Continued work at this level for nine continuous months

demonstrates the ability to hold a job for purposes of DHRS case closure.

Unemployed: A person not meeting the requirements established under

"employed."

Florida Alcoholism Treatment Center (FATC) The 28-day intensive

alcoholism treatment program sponsored by the State of Florida located in Avon

Park. It. has served as the model for other programs of this type throughout the

state.

Minnesota Multiphasic Personality Inventory (MMPI): A 566 item person-

ality test with four validity and ten clinical scales yielding a configuration of score

plotted as a polygon.

Minnesota Multiphasic Personality Inventory Short Form (Mini-Mult): In

the interest of clinical utility, the original 66 item test has been shortened by








several different workers-beginning with Kincannon in 1968-into formats as short as

71 items in length while upholding inventory integrity.

Minnesota Multiphasic Personality Inventory Special Scales: Scales later

developed upon the original item pool that may be scored independently of the four

validity and ten clinical scales commonly in use.

National Institute of Alcohol Abuse and Alcoholism (NIAAA) The office

of the U. S. Department of Health, Education, and Welfare charged with gathering

and disseminating information on alcohol and alcoholism.

United States Department of Health, Education, and Welfare (HEW,

DHEW): The cabinet level department of the U. S. government that oversees

national, state, and local substance abuse programs.



Organization Of The Remainder of the Study

The remainder of the study will be presented in four additional chapters.

Chapter II provides a review of the literature directly related to the proposed

research. Chapter III describes the research design and procedures. The results of

this study and analysis of data will be reported in Chapter IV. Chapter V will

present a summary of the study, as well as a discussion of the findings, implications

and limitation of the research.











CHAPTER II

REVIEW OF THE LITERATURE
Perspective On Beverage Alcohol

The consumption of alcoholic beverages can be traced from the beginning

of recorded history in the Neolithic era to the present in most cultures. Alcohol

use in America today involves aspects of production, marketing and use in beverage

form that imply cultural variability of drinking patterns.

The term "alcohol" refers to any of the oxygen containing organic

chemical compounds with typical formulae C2H5OH (ethyl alcohol), CH2OH

(methyl alcohol), and CH3CHOHCH3 (Isopropyl alcohol). A wide variety of

industrial uses have been found for alcohols. Methyl alcohol is used in preparations

and rubbing alcohol. Only ethyl alcohol, also called ethanol or "grain alcohol," is

fit for human consumption and has the properties of euphoria, sedation, intoxi-

cation, when consumed in a limited quality. A concentration of half of one percent

of alcohol in the blood stream is within the lethal range; 0.55 is fatal in most cases.


Development as a Beverage

There are three common methods of producing alcoholic beverages that

require different levels of technological skills and parallel concomitant cultural

differences in drinking behaviors: fermentation, brewing, distillation. The source

materials for the sugar and starch include the sap of trees, wild berries, grapes,

citrus, rice, potatoes, and grains. It is presumed that fermented alcoholic drinks

were discovered, rather than invented at least 10,000 years ago during the Neolithic

period. Brewing developed along with agriculture and distillation of spirits came

into use around the tenth century A. D.








The fermentation of beverages was a time-consuming, unmanaged process

that made supply irregular. When available, alcohol would be consumed by males

only under sanction of the elders, priests, or leaders of the community to celebrate

an event of significance. In many cultures alcoholic drinks replaced other fluids in

religious ritual as a libation. Early civilizations used alcohol to impart a sanctity

to events. A drink was used to ratify compacts, complete crownings, solemnify

formal councils, confirm rights of passage, commemorate festivals and important

occasions, and to display hospitality (Florida, 1922; U. S. 1971).

Ancient peoples were characterized by simple living and general sobriety

punctuated by heavy drinking during feast days. Orginally, women did not drink at

all and drunkenness at inappropriate times was viewed as a sin or vice of the lower

classes. Concomitant with development ancient people often increased intem-

perance. An Egyptian wall painting encouraged all, including women to "Drink to

drunkenness, do not spoil the entertainment" (Florida, 1972, p. 24). The Romans ran

the gamut from moderate drinking to severe abuse.

During the Feudal period and the developing industrialization Europe

traded in agricultural products including wines and beers. Alcoholic beverages

were considered a food staple and medicinal agent. The early colonists who settled

America brought with them the cultural traits of their countries of origin,

including their drinking practices (Brown, 1966: Morrison, 1965).

Early American Drinking

The two basic social institutions of colonial America were the church and

the tavern. The taverns of the times served as a meeting house where matters of

public concern were expressed. During the revolution taverns served as court

rooms, barracks, officer's headquarters and secret meeting places of patriots. The

Green Dragon Inn, according to Daniel Webster, became the headquarters of the

revolution (Brown, 1966; Lender, 1973: Tarter & Sugarman, 1976).








As agriculture grew in the West, transportation to the Eastern markets

became a serious problem. Distillation became an integral part of farming

communities as farmers found it expedient to transform their bulky corn harvest

into corn whiskey. A horse could carry four bushels of grain or twenty-four bushels

which had been converted to whiskey. Whiskey became a medium of exchange and

an important part of the economy in the interior of our developing country. The

"Whiskey Rebellion" was one of the first crucial tests facing the administration of

George Washington and its resolution established the right of the federal govern-

ment to levy an excise and control the sale and manufacture of goods, including

alcoholic beverages (Florida, 1972).

The United States Temperance Union founded in 1833, was primarily

interested in the proper management of alcohol rather than the total abstinence

from drinking. Their position changed to denouncing drinking as a crime against

society in the late 1830's. Illustrated books graphically portrayed the decay of the

individual who indulged in drink and the "educational" campaign was highly

successful. Churches set more rigorous standards of conduct for the clergy and

laity and excessive drinking fell into disrepute.

The state was charged with the duty of protecting the morals of the

people and laws were demanded to license the liquor traffic, heavily tax it,-and to

prohibit its use. Beginning with Maine in 1848, a dozen northern states enacted

prohibition laws. During the Civil War most of the prohibition laws were repealed

largely because of the need for revenue a tax would provide. The formation of the

Anti-Saloon League in 1893 was successful in making drinking a political issue of

importance, it spent 400 thousand dollars in the year 1903 for candidates who

supported prohibition.








On October 28, 1919, the Volstead Act prohibiting sales of alcoholic

beverages containing over one-half of one percent alcohol was passed over

President Woodrow Wilson's veto.

The new law made no great change in national drinking levels and

enforcement was quite difficult. The 18th Ammendment was repealed fourteen

years later by the 21st Amendment and the "noble experiment" came to an end

(U. S., 1978).

U. S. beverage sales increased from 1850 to just after the turn of the

century and remained high until Prohibition in 1919. By the beginning of World War

II per capital sales returned to their per 1919 levels and remained there for almost

twenty years. Total per capital sales began to rise sharply about 1960 increasing

30% between 1961 and 1971. Since 1971, levels have been the highest recorded since

1850 ranging from 2.63 to 2.69 gallons of absolute alcohol per person 14 years of age

and older. Current overall drinking levels now seem stable; however, sales of

distilled spirits are down 11% from 1975-76 and sales of beer are up 8% during the

same period (U. S., 1978; Keller & Gurioli, 1976). Significant changes in the relative

proportion of abstainers to heavy drinkers have not been observed. Heavy drinkers

did increase from 15 to 20% in 1971-76 for males. Men generally drink heavily three

to six times the rate reported for women (U. S., 1978).

Individual Differences

In our society drinking to modify mood or behavior is generally accepted

as normal and appropriate under the proper circumstances. (APA, 1980). Individual

clients will consume alcoholic beverages according to their own concepts of

usefulness and morality within the framework of community standards and be-

havioral expectations. What the counselor might call problem drinking could be

seen by the client and others in his social group as acceptable activity within the

limits of normalacy. Drinking, even heavy drinking, is acceptable to some








individual and groups of people as long as the drinker maintains useful and

productive work (Jellinck, 1960: Johnson, 1980).

"You take all the drunks out of history and you take out almost all the

poets, genius....What kind of poem do you think you'd get from a glass of ice water?"

Clarence Darrow (Fincher, 1976, p. 339)

Jellinck (1960) believes there is not just one form of alcoholism, but

several: Alpha, Beta, Gamma, and Delta alcoholism. The first two are variants of

social drinking with no signs of dependence. In Gamma alcoholism both psycholog-

ical and physical dependence are observed and is characterized by "loss of control."

In Delta alcoholism the same is true except the user retains the ability to abstain

from drinking.

Because what constitutes "normal" and "heavy" drinking is not always

agreed upon it is difficult to interpert some of the data presented by various

groups, including the National Institute of Alcohol Abuse and Alcoholism (NIAAA).

A "normal" drinker in the general population is considered by Chatham (1979) to be

one who consumes the equivalent of I oz. of alcohol per day. In beverage form this

is two 12 oz. cans of beer, two 4 oz. glasses of wine, I or I 3/4 shots of hard liquor.

The new DSM III (APA, 1980) regards "occasional consumption of a fifth of spirits

or its equivalent in wine or beer" as a significant level indicating probable alcohol

abuse.

A report prepared for NIAAA by Johnson, Armor, Polich and Stambul,

(1977) under contract number ADM 281-76-0020 is often used as a resource by those

gathering data for publications and presentation, including the United States

government. Table 4 of the report, Trends in Alcohol Consumption 1971-76, defines

the "heavy" drinker as one who consumes the equivalent of I oz. of alcohol in

beverage form per day. Obviously, this narrow definition inflates the number of








those considered "heavy" drinkers in comparison to the definition of Chatham. It

also does not take into consideration individual differences as body weight, mood,

etc.

The number of drinks of an alcoholic beverages consumed during a given

time frame is usually used to describe the amount of alcohol consumption by on

individual or population. While more convenient for those who collect such data

this method is inferential and does not accurately measure an individual's level of

intoxication. When it is important to exactly determine the state of intoxication,

the most widely used practical method is measurement of blood alcohol concentration

(BAC) by breathalyzer.

A blood alcohol level of 0.03% is generally sufficient to intensify mood

and effect perception and judgment. Eight one hundreths percent lessens

inhibitions, elicits impulsive behavior and emotions, and decreases fine coordina-

tion. It is also illegal to drive in Canada and two states at this blood level. It is

illegal to drive in Florida and 41 other states at 0.10% which produces confusion,

staggering, and slurred speech. A serious impairment of physical and mental

functioning occurs at 0.15%, the legal level of intoxication in six states and

Washington, D. C. A blood alcohol level of 0.50% indicates stupor, "blind drunk"

and sometimes coma and subsequent death (U. S., 1971).

Although the exact definition of alcoholism is not precise it is necessarily

drawn by those usually charged with the responsibility in the community treatment

programs for alcoholism, the counselor. The basis for diagnosis in these programs

is or is based on The Third Edition of the Diagnostic and Statistical Manual (DSM

III) of the American Psychiatric Association (1980). The criterion for alcohol abuse

and alcohol dependence may be found in Chapter I, Definition of Terms of this

prospectus.








Alcohol Abuse Clients In Florida

An estimation of alcohol problems and related service needs in Florida

(see table I) was based on field surveys by Dr. George Warheit, Department of

Psychiatry, University of Florida and issued by HRS (Birtman, 1980). The surveys

included a series of questions regarding uses of alcohol.

The data on alcohol use and mental health showed two highly correlated

but basically independent phenomenon. T-tests and analysis of variance revealed

a statistically significant relationship between alcohol use and mental health

treatment needs. However, regression analysis indicated one could not be

predicted from the other and they emerged as related but separate conditions.

There are a sufficient number of differences between mental health and alcohol

clients to warrant separate service needs estimates.

The Florida State Plan for Alcoholism Fiscal Year 1980-81 by the Mental

Health Program Office of the Department of Health and Rehabilitative Services,

Tallahassee, is among the most current of information available concerning the

alcohol problem in the State (see Table I). HRS estimates there are now 489.903

people over 18 years of age who are in possible need of alcohol treatment services

and another 350,877 among all age groups in probable need. The total number of

individuals in need in the state of Florida Fiscal 1980-81 is considered to be 840,000

(Florida, 1980c).

Children

The Florida Center of Children and Youth, Inc. (FCCY) is a state-wide

volunteer child advocacy group concerned about the impact of alcohol abuse on the

lives of children. On February I, 1979, the Florida Department of Health and

Rehabilitative Services (DHRS) Alcoholic Rehabilitation Program contracted

FCCY to coordinate a 12 month Youth and Alcohol Abuse Project in association







Table I

Florida Alcohol-Related Service Needs


FLORIDA
1978
Population
Estimate


STATE OF FLORIDA
Alcohol-Related
Service Needs
Possible Probable


Total


Race:
White
Nonwhite

Sex:
Male
Female


Race/Sex:
White Male
White Female
Nonwhite Male
Nonwhite Female

Age:
18-19
20-29
30-39
40-49
50-59
60-69
70+

Education:
Elementary 0-4
5-8
High School -3
-4
College 1-3
4+


Marital Status:
Single
Married
Widowed
Separated
Divorced


6,620,314


5,898,757
721,557


3,085,086
3,535,228


2,759,895
3,138,862
325,191
396,366


302,562
1,301,761
1,022,134
918,524
991,515
1,056,419
1,027,399


244,952
986,427
1,105,592
2,257,527
1,125,453
1,207,399

986,427
4,323,065
642,170
225,091
443,561


489,903 350,877


448,306
44,015


330,104
173,226


289,069
160,082
32,194
14,666


38,425
165,324
75,368
63,378
68,415
42,257
19,521


12,248
45,376
72,969
248,997
119,198
19,521

147,964
289,645
19,265
22,509
31,493


318,533
34,635


277,658
88,381


248,391
81,610
29,592
8,324


33,887
123,667
47,018
61,541
44,618
14,790
7,192


9.553
32,552
55,280
101,589
105,793
7,192

138,100
159,953
13,486
24,310
35,485


Birtman, 1980








with a NIAAA Task Force. The study took place in nine communities: Pensacola,

Gainesville, Orlando, St. Petersburg, West Palm Beach, Ft. Lauderdale, Jackson-

ville, Tallahassee, and Miami (Florida, 1980b).

The project's local task forces met with resistance from school adminis-

trators when attempting to randomly survey students. Partial surveys and

previously gathered data were used in some cases. The FCCY concluded that there

is a real youth alcohol problem in Florida paralleling national proportions.

Nationally there are an estimated 3.3 million problem drinkers in the 14-17 age

group, or 19% of the total youth in this age group (U. S., 1978).

The first experience with alcoholic beverages by Florida youths is

between 12 and 13 years of age with a tendency for children to begin drinking at a

slightly younger age than in the past. Drinking to intoxication takes place with

four out of five high school seniors with no difference between males and females.

L By the senior year 40% of the boys and 21% of the girls report they have been in

trouble with family, school or police because of their excessive drinking. In

addition, young people who use alcohol to excess are also more likely to use other

drugs (Wechsler, 1976). The FCCY observes that early drinking behavior may be

predictive of drinking later in life. Those adolescents who learn to use alcoholic

beverages to cope with problems and emotional pressures may continue such

behavior or return to it at a later date.

In Pensacola a 1977 questionnaire indicated alcohol abuse in Florida high

schools is more extensive than in junior highs. Of the seniors surveyed the males

thought 30% of peers and the girls 39.6% of their peers had problems with alcohol.

Sixty-one percent of the Pensacola students said their parents know about their

drinking. Eighty percent drink alcoholic beverages, 45% on a regular basis. In

Gainesville a 1975-76 survey of 1,549 middle school students indicated 63% of these

students had their first experience with alcohol with parents or other adults.








Key informant survey information from professionals and informed

citizens was gathered from those in law enforcement, alcohol and drug counseling,

youth services, liquor stores, runaway shelters and others. These individuals

thought 50% of all adolescents drink and that the rate is increasing. As many as

30% of young people who drink are seen as problem drinkers. The main reasons for

adolescent drinking are thought to be by this group: peer pressure, to act older, to

get drunk.

A Jacksonville survey of medical and helping professionals indicates 72%

of those asked perceive a problem with young people drinking but only 18% have

been asked to directly help or make a referral. Seventy percent believe the extent

of the problem among young people is denied or not recognized by the young person

or parents. In St. Petersburg 20% of the professionals asked had ten or more

patient contacts with parents who said their adolescents were abusing alcohol.

Sixty percent know young people who drink before school and 22% said they had

contact with ten or more such individuals.

The project's specific recommendations regarding youth prevention re-

source need in Florida make direct reference to the personality factors identified

as related to alcohol abuse: low self-concept; inability to accept responsibility for

one's own behavior; lack of social coping and decision making skills; the desire to

alter reality; the need for increased stimulation; uncertainty over the future; and

rebellion.

Environmental factors identified as affecting youthful alcohol abusers

include employment opportunities, ignorance about responsible social drinking,non-

involvement in healthy community activities, media presentation of alcoholic
/
beverages in a favorable light, availability due to the lowered drinking age,

changing social morals, peer pressure, breakdown in families, schools, and

churches.








The behavior of parents and other adults can be seen as contributing to

the young abuser's problem. Implicated by the FCC the FCCY report are the lack

of responsible role models; overindulgent parents; permissive society; divorced

and/or working parents; and the legal and social acceptance of alcohol use (Florida,

1980b).



College Students

Social drinking and "partying" among the college population are con-

sidered by some to be an accepted tradition of the higher educational experience.

Increasingly the reality of students problem drinking and alcoholism is being

recognized. A 1979 survey by the Boston Medical Foundation of 7,000 students at

34 colleges and universities found that 95% of the undergraduates drink on

occasion. University of Florida Student Services Director Tom Goodale says, "1

don't think there are any more students drinking now than there were ten or twenty

years ago; they're just drinking a lot more" (Klein, 1980). T-Shirts with "UF is the

#I Party School" were sold out the first day according to the university's Alcohol

Abuse Prevention Program.

Fall quarter, 1978, 1823 students were surveyed from four different

institutions of higher learning in Florida: Florida State University, Tallahassee:

University of Florida, Gainesville; University of South Florida, Tampa; and Florida

Atlantic University, Boca Raton. This group represents a cross section of higher

education facilities in Florida. Gonzalez & Conover (1979) reported in this state-

wide study that 81% of the students said they drink. School level at time of first

drink was Elementary 16.1%; middle 34.7%; high school 42.2%; and

college 7.0%. They had their first drink at home (44.3%) or at a friend's home

(25.3%). Now they drink less at home (27.4%) and more at bars (51.3%) usually

with friends (63.6%). Mainly the students drink to relax (88.7%) and prefer








highballs (48%) over beer (37.7%) and wine (18.9%). They most often report

drinking once a week or less (63.6%) with 36.4 drinking two times a week or more.

There were significant sex differences in the responses with males drinking a

greater quantity more often (p .001).

The use of alcohol by 483 students at the University of Florida was

reported by Gonzalez (1980) separate from the larger state-wide study. Eighty-

four percent of the students said they drink. The school level of first time drinkers

was also similar to the larger study: elementary, 19.1%, middle, 40.3%, high

school, 35.0% and college, 5.5%. First drink was also at home and nearly half

(47.8%) prefer bars. Highballs (53.9%) were favored over beer (32.0%) and wine

(11.1%). They drink to relax (89.8%) with 61.9% drinking one time per week or

less. Slightly more than in the overall study drank two or more times per week

(38.1%).

The two reports acknowledge a significant amount of student problem

drinking and alcoholism in higher education in the State of Florida. They

recommend such action as incorporating alcohol information into orientation

programs for incoming students; education and training programs for university

staff; and a substantial commitment by Student Mental Health to provide specific

treatment modalities for alcohol abuse. Working against this effort is the fact that

the majority of students who drink learned to drink at home with the full

knowledge of their parents. Parents and university staff are aware of heavy

student drinking on campus. Drinking, even heavy drinking, within the context of

college life is acceptable behavior.


Adults

The Florida Alcoholism Treatment Center, the State's inpatient treatment

center at Avon Park, no longer has the mission of gathering research data and is








primarily a treatment facility. A 1964 study of all 941 alcoholics admitted during

a sixteen month period in 1962-63 attempted to present a description of the

characteristics of that sample (Williams & Kahn, 1964). It remains the most

complete description of alcohol sample description available from FATC (Thomas,

1980). More recent material by Vosburgh (1975) and others indicate the character-

istics appear to be stable over time and different sample groups.

Seventy-two percent of the clients were male and 28% were female.

Most of the clients were in their middle years with the average age 45. They were

either lower-middle class or upper-lower class (78%) on the McGuire-White Index

of Value Orientation. Almost all (93%) came from urban centers as defined by the

United States census of 1960. Forty-six percent were married and 27% divorced,

15% separated, and 6% were widowed or never married. Thirty-nine percent

reported they were employed just before entering the 28 day treatment program

and 61% said they were unemployed. Regarding the occupational level of their last

job, 30% listed professional, managers, officials, or proprietors as their occu-

pational level, while 24% reported craftsmen, foremen. Twenty-two percent listed

service or unskilled labors as their last occupational level. They worked an average

of 5 months on their last job for an average of 49 hours per week during the year

proceeding treatment. They held an average of two jobs and worked 34 weeks.

The age of first drink was 17 with frequent drinking at the age of 30. The

first blackouts or loss of consciousness occurred with regularity at the age of

thirty-five. They became uncontrolled drinkers at 37, experienced their first

delirium tremens at 39 and first seriously sought alcoholism treatment at age 42.

Treatment Concepts

In 1971 the American Medical Association stated that alcoholism is a

"complex disease" with biological, psychological components" (Kissin & Betleiter,

1977, p. I) Alcoholism, as distinct from common or even heavy drinking has only








recently been recognized as proper subject matter for academic and therapeutic

inquiry rather than the clergy or criminal justice system (Cross, 1968; U. S., 1971;

Mann, 1959; Public Law 91-616; Tarter & Sugerman, 1976).

Early Ideas

It was not until Benjamin Rush published Inquiry into the Effects of

Ardent Spirits on the Human Body and Mind in 1785 (Rush, 1943) that the idea of

"addiction" and "disease" became associated with problem drinking. Rush

conceptualized alcoholism as a progressive disease that develops slowly and was

aware of the phenomenon of tolerance. Therapeutic measures- recommended by

Rush included compassion and whippings, bleeding, and shaming. "The association

of the idea of ardent spirits, with a painful or disagreeable impression of some sort

upon the body, has sometimes cured the love of strong drink" (Tarter et al. p. 17;

Lender, 1973; Rush, 1943).

In 1838 Esquirol saw drunkenness as a mental illness. In 1852 Magnus Huss

observed that there was not a definite boundary between the symptoms of

alcoholism and mental illness in general and made use of the term "chronic

alcoholism." The work of Esquirol and Huss opened the door to physicians who had

in the past felt the subject was not properly within the realm of medicine. Magnan

believed in 1891 the causative factor was an underlying psychoses. Gaupp in 1901

identified the periodic depression of an epileptic origin as the most important

clinical feature. Gaupp postulated damage to the hypothalamas. In 1901 Kurtz and

Kraepelin applied the term "alcohol addiction." Medical doctors of the era

suspected central nervous system causative factors which are no longer believed to

be of significant importance in the majority of alcoholism cases (Marconi, 1959).

The most important contribution of the 19th and early 20th century theories was

the utilization of the medical model for the treatment of the "disease" of

alcoholism (Tarter & Sugerman, 1976; U. S., 1971).








The Laboratory of Applied Physiology was established at Yale University

in 1923 for collecting scientific information on the effects of alcohol and searching

for causes. By 1930 Yale had organized archives of the world literature on

alcoholism. In 1944, two clinics called the Yale Plan Clinics for alcoholics were

established in New Haven and Hartford, Connecticut. They provided models for

other rehabilitation centers throughout the country. In 1962 with the help of

National Institute of Health and private funding the Yale Center of Alcohol Studies

were moved to Rutgers--The State University of New Jersey in New Brunswick

(Tarter &Sugerman, 1976). A National Committee on Education emerged from the Yale

Center supported by a five year grant. This committee became The National

Council on Alcoholism; independent of the university since 1950 (Cross, 1968).

In 1935 the fellowship of Alcoholics Anonymous was formed through the

efforts of a New York stockbroker and an Akron, Ohio, physician known as "Dr.

Bob." Alcoholics Anonymous (AA) and its derivitive programs AI-Anon and Ala-

Teen is now a world wide organization with as many as one million members. It

believes that alcoholic must admit his life is unmanageable; must rely on a power

greater than himself; pray for strength to the power; and follow a set program of

"steps" in order to recover from illness. These twelve steps include taking a moral

inventory of one's self and rescuing other alcoholics by getting them involved in the

AA program (AA, 1953, 1973, 1975).

The AA literature states the alcoholic must reach a point where there is a

willingness to take the first step, admission of a need for help (Glatt, 1958). This

is commonly referred to as "hitting bottom" before beginning to get well. Not

everybody goes down to the depths of alcoholism that are often stereotyped but

every alcoholic must reach a point that is bottom for them (Brozek, 1950). This

point is independent of age, status and other variables.

This concept is important in the treatment of alcoholism within the








medical model. In sincerely seeking help alcoholics identify themselves as patients

with an illness who will follow the doctor's instructions (Menninger, 1959).

Psychotherapy within the medical model has generally been considered unsuccess-

ful with alcoholic clients. The psychotherapeutic model is based on a treatment

model for neurotics and may not be appropriate for those alcoholic clients who may

have character disorder traits (Hill & Blane, 1967; Siddons, 1978). The treatment

of alcoholism may not mean just abstinence. Clients may show continued

deterioration in their lives even though they no longer drink. There is evidence

for a relatively stable underlying personality trait in alcoholism that persists after

treatment (Apfeldorf, 1974; Larchar, et al, 1976).

Bowman and Jellinek (1941) distinguished between two types of alcoholism,

chronic alcoholism and alcohol addiction. The former covers all the physical and

psychological changes resulting from the prolonged use of the drug. The latter is

characterized by an urgent craving for alcohol. These addicted individuals have

lost control of the situation and are not able to give up drinking even with a sincere

desire to do so. Jellinek later revised his theory recognizing two main patterns:

Alcohol addiction which is a progressive disorder accessible to medical-psychiatric

treatment and other forms of excessive drinking which can best be managed

through social control including law enforcement (Jellinek, 1960, 1962).

Jellinek's ideas were popular and were assimilated by the public and lay

self-help groups such as AA. The common understanding of his work is that a

heavy drinker drinks by choice, an alcoholic does not; alcoholism is a progressive

disease, which left untreated grows worse; if left untreated alcoholism leads to

either insanity or death; and alcoholism can be arrested (Mann, 1959).
The Alcoholic Family

The effect of the early environment has been examined to determine

possible influences on later behavior. Family conditions that negatively influence








the emotional bonding between parent and child are implicated. An inordinate

number of alcoholics are believed to have experienced disrupted childhoods related

to the death, separation, or instability of the parents. The male alcoholic is often

closer to his dominant mother and has a poor relationship with his openly uncaring

father. Children of alcoholics have a greater than expected number of incidents of

alcohol abuse, hyperactivity, psychopathic deviant behaviors, and neurotic sympto-

matology (U. S., 1978).

Goodwin (1971) has suggested hereditary factors among some alco-

holic patients. Children of alcoholic parents may react to alcohol differently than

children of nonalcoholic parents. That is, physiological responses to a stimulus of a

measured dosage of alcohol are different among the children of alcoholics and the

children of non-alcoholics. Onset of problem drinking for alcoholics' children may

be more immediate and the progression to alcoholism more rapid. Jones and Smith

(1973) have reported a "fetal alcohol syndrome" characterized by neurological

dysfunction in infants caused by excessive alcohol use by the mother. Infants of

addicted mothers are sometimes born with withdrawal symptoms demonstrating

physical dependence on alcohol in the womb. Animal studies have suggested an

increased potential to reactivate such a dependency at a later time (Branchey et

al., 1971; Goodwin & Guze, 1974; Kissin & Begleiter, 1977).

Family treatment of the alcoholic conceptualizes the alcoholic family

with a marriage highly resistant to change. The parental behavior is complimentary

and any attempt to change the behavior of one partner threatens the equilibrium of

the marriage and elicits resistance from the other person. Traditionally, the

family as well as significant others such as friends, employers, and co-workers are

includedin the client's treatment whenever possible. Not only is the alcoholic ill,

but the illness pervades the style of relations with others (AA, 1953, 1973; Berne,

1964; Janzen, 1978).








Treatment Services
A series of reports called the National Drug Abuse Treatment Utilization

Survey (NDATUS) by the National Institute of Drug Abuse (NIDA) measures the

scope and use of treatment services in the United States and its territories. The

April 1979, Series F, Number 7 NADTUS report is the first of the series to reflect

a joint NIDA and National Institute of Alcohol Abuse and Alcoholism Treatment

Utilization Survey (NIAAA) effort. This survey included 9,101 facilities consisting

of 6,411 treatment units and 2,690 other units providing services such as preven-

tion, education, administration. Of the treatment oriented facilities, 2,821 were

alcohol, and 1,398 were combined drug and alcohol abuse treatment (U. S., 1979).

Service utilization studies measure one service unit as one person in

treatment one day. In Florida Fiscal Year 1979-80 the following rates were

reported by the HRS Mental Health Program Office, July, 1980:


Table 2

Units of Treatment Service by Component

Detoxification 117,419
Residential 299,638
Day-Night 6,689
Outpatient 187,750


NOTE: The numbers are higher than the reported number of client in the state
(70,449) because of some clients' high rates of multiple treatment experiences.

Alcoholism treatment is being increasingly associated with drug abuse

treatment in a substance abuse department within a community mental health

program (Ferguson, 1979; Wynne, 1975). Drugs and Alcohol treatment modalities

parallel each other and have similar program rules for detoxification, outpatient

and residential treatment services. Detoxification, is a five day procedure for

alcohol, 21 days for opiate drugs, whereby an individual is medically withdrawn








from the addicting chemical. Outpatient treatment is individual and group

counseling one or more times per week with or without supportive chemotherapy

for an unspecified duration. Residential treatment is an inpatient treatment

modality lasting from three to eighteen months.

There are more than seventy thousand people in treatment in Florida for

alcohol abuse and alcoholism by 271 publicly supported programs in eleven HRS

districts (Florida, 1977, 1980b). Fiscal 1979-80 ending July I, 1980, supplies the

most recent period for which data are available on treatment services in Florida

(see table 3).


Table 3

Individuals in Treatment 1979 1980
Males 57,052
Females 13,742


White 58,742
Black 9,661
Spanish 1,787
American Indian 161
Other 98


Under 18 906
18-24 6,903
25-44 30,437
45-54 17,528
55-64 11,528
65 and over 3,449


TOTAL 70,449

Florida, 1980c

Those in treatment in the State of Florida for Alcohol problems are

largely male, white, and between the ages of 25 to 54. The reported family income

of Florida Alcoholism Clients is decidedly low. (See Table 4).






TABLE 4

Family Income
No Income 28,816
$1 2,999 10,476
$3,000- 5,199 9,066
$5,200 7,800 7,825
7,800 10,399 5,713
10,400 15,599 4,679
$15,600 + 3,875

Florida/HRS, July, 1980b

It should be remembered that publicly supported treatment programs

provide services based on a sliding scale for fees and some clients may not present

their income level in a favorable light. It is certainly not true that alcoholism only

troubles poor people. However, alcoholic drinking progressively deteriorates job

effectiveness. Alcoholics in treatment in Florida seem to be middle aged men in

Super's Establishment stage who have not solidified their career pattern or self-

concept. It may be that male alcoholics who appear to be firmly established in

their careers do not really feel that way and are not successfully implementing their

vocational self-concept. Treatment invariably includes employment and improve-

ment in self-esteem.

The real, general lack of vocational stability and financial security by

many alcohol clients has implications other than theory and treatment. The future

support of community alcohol treatment programs is unlikely to come from client

fees since many of the most seriously ill clients are unable to pay more than a

nominal amount.

Federal Program Funding

The National Institute on Alcohol Abuse and Alcoholism was established in

1970 (NIAAA). It funds program services through federal formula grants to the

states totaling $126,030,000 in 1976. In 1974, special funds were made available to

serve as incentives to individual states to adopt the Uniform Alcoholism Treatment








Intoxication Act. Additional monies from agencies such as the Department of

Defense, $2,693,000, the Veterans' Administration, $14,109,000, and the Depart-

ment of Transportation, $62,286,000, bring the total of federal expenditures for

Alcoholism treatment to $206,587,000 to 1976 (U. S., 1978).

Third Party Payments

The average financial resources available to alcoholism programs are

formula grants 13%, other NIAAA funding 17%, local funds 17% and state and

other federal monies 53%. Third party payments are seen as important for the

fiscal management of alcoholism programs in the future. In the past, those with

drinking problems received treatment for symptomatology of their illness, alco-

holism, via third party payors indirectly. As part of efforts to curb rising health

care costs in the late 1960's, payors moved to limit coverage of patients whose

chief problem was alcoholism.

In 1976, Blue Cross-Blue Shield undertook a nation wide study concerning

the feasibility of offering direct benefits for alcoholism treatment. Some

individual Blue Cross-Blue Shield plans have implemented such coverage. Begin-

ning in 1974, Capital Blue Shield of Maryland pays benefits of non-hospital

residential settings and out-patient treatment (U. S., 1978).

American labor unions such as the AFL-CIO, United Mine Workers and

United Auto Workers have sought health insurance coverage for treatment of

alcoholism and drug abuse. Blue Cross-Blue Shield of Michigan now offers benefits

for alcohol and other drug abuse treatment to one million United Auto Workers

Union members and their families. The major commercial insurance carriers

appear to be dropping their exclusions on coverage of alcoholism treatment with

specified limitations dropping from 16.5 in 1972 to 13 percent of all policies in

1975 (U. S., 1978).








The Social Security Administration Medicare program for those age 65

and above views alcohol and drug abuse treatment as mental health services and

pays less than for physical illness. Medicaid, for lower income persons age 21-64,

leaves it up to individual states to decide if alcoholism treatment should be

included. Most states reimburse for inpatient treatment of physical illnesses

related to alcoholism and 85% will pay for out-patient treatment. Reimbursement

is lower for direct treatment of alcoholism; 66% for treatment at a community

health center; 33% for treatment at an alcoholism center; 10% for half-way house

residency (U. S., 1978).

Title XX, the 1975, amendment to the Social Security Act may include

alcoholism services depending on the state's required comprehensive plan. Ten

states provide direct alcohol services, another eleven related services, and 16

specific mental health services with Title XX funding. In 1975, Title XX

contributed 2.7 billion dollars to the states.

The Civilian Health and Medical Program of the Uniformed Service

(Champus) insurance program for active and retired military personnel and their

dependents covers in patient and outpatient care for alcoholism. Inpatient

treatment beyond detoxification is limited to three admissions for any one person.

Out patient treatment is limited to psychiatric services. Civilian Health and

Medical Programs of the uniformed Services Veteran's Administation (CHAMPVA)

is a similar program available to dependents and survivors of disabled veterans.

The NIAAA has worked with different interested groups including the

third party payors to demonstrate the practicality of alcoholism treatment benefit

insurance. Standards have been developed that lead to accreditation and concom-

mittant increase in likelihood of third party reimbursement for treatment services.

The Joint Commission on Accreditation of Hospitals (JCAH) has accredited more

than 200 programs across the country (U. S., 1978).








Florida Statute 627, 669 effective January I, 1980, stipulates that group

health insurance carriers in the state must offer as an option coverage for

treatment of alcoholism. This has been interpreted by HRS in administrative rule

IOE-3.60 State Approval for insurance eligibility and the revised Definitions Rule

IOE-3.

HRS Rule No. IOE-714 implementing Florida Statutes 397 concerns

residential services to drug clients. It specifies "The following supportive services

must be made available: a. Educational; b. Vocational Counseling, and c. Job

Development." HRS Rule No. 0IE-3.46 implementing Florida Statute 396.062

regarding alcoholism services specifies, "Rehabilitation services shall be provided

to every client. These services may include vocational counseling. ." Out-

patient alcohol services must include rehabilitative services "related to preparing

to training a person to function within the limits of a disability or disabilities by

the acquisition of skills." Under this directive "Vocational rehabilitation and

counseling.... shall be provided."

The Joint Commission on Accreditation for Hospitals accreditation man-

ual for alcoholism programs specifies:


"The intermediate care component shall be
designed to facilitate the rehabilitation of
the alcoholic person by placing him in an
organized therapeutic environment in which he
may receive diagnostic services, counseling,
vocational rehabilitation and/or work therapy
while benefitting from the support which a full
or partial residential setting can provide
(Human Service Horizons, 1978, p. 7)

Alcoholic Personality Characteristics

Alcoholism research with the MMPI generally approaches alcoholism in

one of two ways. Either it is seen as a major disorder in itself with distinctive

personality characteristics and pattern or alcoholism is subsumed under the








psychological symptomatology of other mental disorders (Uecker, 1969). Many

diagnose neuroses or psychoses rather than alcoholism as the primary problem

(Apfeldorf, 1974; Hoefle, 1980).
When alcoholic MMPI scores are grouped, the highest scores are usually on

Scale 2 Depression and 4 Psychopathic deviance (MacAndrew & Gertsma, 1963).

While other distinct highpoint pairs are common either scale 2 or 4 will usually be

included in the profile peaks (Clopton, 1973; MacLachlan, 1975; Williams, 1974;

Vosburgh, 1975). The 2-4 and 4-2 codetypes account for about 21% of all alcohol

cases with 73% of the cases involving either 2 or 4 according to a study by

Hodo & Fowler (1976). There was also a relative frequent occurrence of 4-9/9-4

and 2-7/-2 codetypes reported.

Hodo and Fowler's study of 1,009 Caucasian inpatient alcoholics concluded

that a primary or consistent alcoholic profile does not exist and fails to support the

concept of an alcoholic personality. Clopton (1973) makes the point that alcoholics

are a heterogeneous group and that grouping the data may obscure important

differences and relationships. It has been suggested that there may be two basic

groups of alcoholics: one of psychopathic individuals with poor impulse control

whose unconventional behavior gets them into trouble when drinking even moder-

ately; and another group of neurotic-depressive persons who use alcohol with much

greater control and so are able to regularly consume large amounts of alcohol.

Clopton (1973) suggests that there is a great similarity in group average

MMPI profiles of alcoholics and drug abuses with both groups having essentially the

same personality characteristics. Neither group is homogeneous in personality

traits, he says, but in general drug abusers seem to be more sociopathic and less

depressed and anxious than alcoholics. A 1979 study by Sutker et. al. of 175 male

alcoholics and 135 male heroin addicts found more neurotic symptomatology such

as depression, anxiety, guilt, emotional liability, and somatic preoccupation among








the alcoholics. The addicts were higher on defensiveness, activity, ego strength,

and seemed more self-confident, energetic and free of neuroses. Both groups

shared sociopathic characteristics of impulsivity, restlessness, and nonconformity

with addicts scoring the highest. Alcoholics combined neurotic characteristics of

impulsivity, restlessnes, and nonconformity with addicts scoring the highest.

Alcoholics combined neurotic characteristics with social deviance whereas the

heroin addicts were simply social deviants. Alcoholics, speculated Sutker et al., abuse

alcohol for tension reduction and heroin addicts are motivated by pleasure seeking.

Overall et al. 1973 computed a descriminant function to separate alcoholics

from narcotics addicts with 85% accuracy. MacLachlan (1975) replicated the study

and found the two groups could be distinguished from each other with 65%

accuracy. Overall descriminant function (DF) is calculated by weighing the MMPI

scales in a simple formula. The formula was computed from a sample of 1681

males and 519 females of average age 45.6 years admitted from 1968 to 1972 to an

inpatient alcoholism treatment center. A product-moment correlation of .78

between first and second admission scores suggests the DF is stable.

Ageing and The Alcoholic

The value of Overall's descriminant function decreased with age (F=l 1.5,

p .001) as indicated in the following abridged table from McLahlan, 1975, page

164:

Means and Standard Deviations of Discriminant Functions and Percentage of

Correct classifications by age of 1681 Male Alcoholics

Table 5

Age N Mean SD Percentage
Group Correctly
Classified
Under 30 83 17.08 3.80 74
30 39 375 16.31 3.59 64
40-49 647 15.88 3.70 62
50-59 449 15.68 3.24 61
Above 50 128 15.49 2.96 59








As the value of the function decreases with age concomitant misclassi-

fication increases. There appears to be a decline in symtomatological personality

characteristics associated with ageing in alcoholic persons (Apfeldorf & Hunley,

1975). Apfeldorf and Hunley (1975) refute MacAndrew's contention that the MAC

scale has no correlation with age. They found a correlation of -.61 in their sample

of alcoholics with no comparable correlation in the control group. They state, "The

findings of a negative correlation of the MacAndrew scale with age in alcoholics

suggests that the personality traits and symptoms identified by the MacAndrew

may diminish with advancing age" (p. 652).

The 1969 work of Goodwin and Schai demonstrated decreasing anxiety

and increasing introversion as a function of age as measured by the 16PF (in

Hoffman, 1970). The Personality Research Form was given by Hoffman (1970) to

337 hospitalized male alcoholics one week after admission. Change, Dominance,

Exhibition, Impusliveness and Play decreased with increasing age. In scales relating

to employment such as Achievement, Endurance, and Play the alcoholics scored

lower than a control group of nonalcoholics. "They appear to function at a lower

level of aspiration or activity in terms of maintaining high standards, willingness to

work for distant goals, being persistent, and enjoying activities just for fun"

(Hoffman, 1970, p. 170).

Hoffman and Nelson (1971) studied 148 alcoholic patients with a mean age

of 43 years ranging from 18 to 67 administering the MMPI, EPPS, and Shipley-

Hartford Intelligence scale one week after admission. They found fewer dif-

ferences between alcoholics and nonalcoholics than between alcoholics of different

ages. There also was indication that alcoholics and non-alcoholics may be more

alike than alcoholics of different intelligence levels. "Alcoholics show a significant

decrease in abstract reasoning with an increase in age. Also, with an increase in

age, alcoholics show an increase in Deference, Order, Nurturance, and Endurance,








and a decrease in Dominance, Change, Heterosexuality, Psychopathic Deviance, and

Psychastenia" (p. 145).

Sutker et al. (1979) have succinctly stated the concept of personality

changes in alcoholics related to age: "The motives for drug or alcohol use could be

significantly related to life stages defined by age. Covarying for age eliminated

unadjusted mean differences between alcoholics and opiate addicts on the Pd scale,

and age was clearly the most powerful predictor of group classification (pp.

642,633).

Psychosocial stress related to age such as retirement, loss of family and

friends, a change in identity and living patterns as well as organic changes

contribute to problem drinking with some clients. The functional loss of neuro-

logical tissues in older people has been hypothesized to make them more sensitive

to drugs in the sedative-hypnotic class such as alcohol. It is known that many

drugs, including alcohol, do have prolonged clinical and toxic effects on older

persons (Myerson, 1978; Zimber, 1978).

Men and women appear to differ in the relationship of age to excessive

drinking. Women 35 to 49 show a trend towards increased consumption to a

moderate level. Women in this age group are often reentering the labor force and

are more likely to be employed. There are more drinkers and more moderate and

heavy drinkers among younger women. The drinking peak for women is 21 to 34

and declines thereafter. Men display an age-specific trend although not as well

defined. Among men drinking peaks in the 21 age range and declines steadily

thereafterwards. After the age of 50 heavy drinking and alcohol related physical

and mental problems seen to decline rapidly for both sexes and there is an attrition

of older alcoholics from treatment (Lynn, 1978; U. S., 1978; Westie & McBride,

1979).








Kratz (1975) found length of sobriety was positively correlated with age.

It has been suggested that there may be a greater feeling of internal control

associated with ageing among alcoholics (Weissback et al., 1976). The early forties

appear to be a time of life when an alcoholic person may decide to seek serious,

intensive treatment (Apfeldorf & Hunley, 1975; Hoffman & Nelson,

1971; Kratz, 1975; Sutker et al., 1979; Vosburgh, 1975; Weissback et al., 1976;

Williams & Kahn, 1964).

Employment and the Alcoholic

Not only is the alcoholic ill, but the illness pervades the style of

interpersonal relationships. Traditionally the family as well as significant others

such as friends, employers and co-workers are included in the client's treatment

(AA, 1953, Berne, 1964; Janzen, 1973; Johnson, 1980). Work is seen as important

in the formation and maintenance of self-concept by most development and needs

theorists including Holland, 1963, 1973; Roe 1954, 1956, 1957; Samler, 1954; Super,

1953; and Tiedeman and O'Hara 1963 (Tolbert, 1974). The theory of Super (1953)

has been utilized in this study because of the importance he places on vocational

self-concept and vocational life stages.

Poor self-concept as measured by the Tennessee Self-Concept Scale, has

been shown by Medzerian (1979) to be highly correlated with increased levels of

medication requested by substance abusers. The Flordia Drug Abuse Education and

Prevention Trust utilized the Work Values Inventory, a vocational develop-

ment instrument by Super, in a 1979 study of substance abusers in sheltered

workshops. Positive changes in the work self-concept were linked to rehabilitative

success Both Studies by Medzerian and The Trust indicate poor self-concept are

related to a desire for licit and/or illicit medication by substance abusers.

Employment as an integral part of the treatment of alcoholics has been

supported by the U.S. Department of Labor Employment and Training Administra-








tion in such projects as a vocational resource center in Olympia, Washington, under

contract 82-51-70-09 completed in 1973. Community resources were utilized to

ensure jobs for alcoholics after MDTA training. The project reported a rate of

rehabilitation five times greater than other efforts with comparable clientele (4-

030, ETA, 1979). A supported employment project by the Vera Institute of Justice

in New York City under grants 92-36-72-02 and 92-36-72-12 was completed in

1978. This effort examined the feasibility and potential of such projects to make

an impact on individuals with addiction, alcoholic and offender backgrounds (3-196,

ETA, 1979).

Drug treatment programs such as Synanon, Daytop Delancey Street, and

Phoenix House were the forerunners in the attempt to incorporate in-the-

community skills activity with their treatment activity. The early attempts by

these therapeutic communities demonstrated that not only was it possible to

provide opportunities for clients to practice their newly acquired life-skills in the

community, but it was vital to provide these activities for effective treatment

(Florida Drug Abuse Trust, 1979).

During 1977 the Florida Drug Abuse Education and Prevention Trust

conducted national site visits to existing drug abuse treatment and vocational

training programs with supportive work programs (i.e., "cottage industries"). These

site visits, which studied programs from New York to Hawaii, led the Trust to the

conclusion that it would be beneficial to existing substance abuse treatment

programs if similar training work environments were provided to clients undergoing

treatment within the residential treatment programs in Florida. Funding was

provided to Village South in Miami for a picture framing project and Disc Village in

Tallahassee for a greenhouse project. The one year project concluded that if

substance abuse treatment is to be effective, it should provide the client with

those skills necessary to function in the day-to-day world. Traditional residential








treatment was found not to be as effective as residential treatment plus job

training and placement (Florida Drug Abuse Trust, 1979).

Super's Vocational Career Development Theory

The vocational career development theory of Donald Super (1953) is

widely utilized by the Department of Health and Rehabilitative Services and has

been applied by HRS, CETA, and the Florida Drug Abuse Trust to the study of

substance abusers. The importance of his theory in this study is Super's linkage of

self-concept to employment. Self-concept has been shown to be associated with

substance abuse. A positive employment experience may contribute to the

recovery and continued abstinence of alcoholic clients. There are four main points

to Super's theory: vocational life stages, vocational maturity, vocational self-

concept, and career patterns. A person masters specific development behaviors as

vocational and personal maturity are acquired.

Super (1953) envisions four life stages of vocational development and

concomitant personal maturity. In the Growth stage from birth to age 14, the self-

concept develops through identification with key figures in the family unit and

school. Although needs and fantasy are most important in the beginning, interests

and capacities of the individual become more dominant with increased social

participation and reality testing. There are three substages: A) Fantasy from age

4 to 10 when the child's needs are dominant and role-playing in fantasy is

prevalent; B) Interest from age II to 12 when personal tastes determine activities;

and C) Capacity from age 13 to 14 when individual abilities are given weight and

job requirements are considered.

The second main stage is Exploration from age 15 to 24. Self examination

in occupational exploration in school, leisure, and part-time work takes place.

There are three substages: A) Tentative from 15 to 17 when needs, interests, as








well as capacities, values and opportunities are considered. Tentative occupational

choices are made and tried out in discussion, school courses, and work; B)

Transition from age 18 to 21 when reality is given more weight as the person

actually enters the world of work or post high school training in an attempt to

implement a self-concept; C) Trial from age 22 to 24 when a choice is made and

tried out in the real world.

The third main stage is Establishment from age 25 to 44 when the person

makes an effort to find a place in the chosen field wifh some trial and error. There

are substages: Trial from age 24 to 30 when changes may be made before a

vocational area is determined; Stabilization from age 30 to 44 when the career

pattern becomes clear and an effort is made to solidify one's position. Main-

tenance continues from age 45 to 64 with few changes in career pattern or

vocational self-concept.

It is within the stabilization and maintenance substages of Super's estab-

lishment period that many alcohol clients seriously seek treatment for the first

time (Appeldorf & Hunley, 1975; Hoffman & Nelson, 1971; Sutker et al, 1979;

Vosburgh, 1975; Weissback et al., 1976; Williams & Kahn, 1964. At a time others

have theoretically solidified their position in the world, alcoholics may find

themselves much less secure in their careers and self-concept. The reported

family income of Florida alcohol clients is very low (See Table 4) suggesting low

vocational attainment for middle aged men. Medzerian (1979) has shown a high

positive correlation between low self-concept and increased levels of substance

abuse.

Super's fourth stage is Decline from age 64 on when physical and/or

mental capacities of ten decrease and occupational activity changes and eventually

ceases. There is one substage, Deceleration from age 65 to 70 which is basically the








transition into retirement when work demands decrease with declining capacity to

work (Tolbert, 1974).

Of the coping behaviors Super discusses, three are positive: trial,

instrumental, and establishing; and two are negative: floundering and stagnating.

This study suggests that behaviors viewed by the alcoholic individual as frustrating

and given inordinate significance because of the personality characteristics of the

person may lead to increased rates of alcohol consumption.

Super's development theory is in congruence with the question asked by

the proposed research. The literature indicates that there are personality

characteristics many alcoholics have in common (Clopton, 1973; Hodo & Fowler,

1976; MacAndrew, 1965; Williams & Lewis, 1973; Vosburgh, 1975). These under-

lying factors are stable and resistant to change (MacAndrew, 1965). Ageing may

have a way of softening the expression of those characteristics (Apfeldorf &

Hunley, 1975; Hoffman, 1970; Hoffman & Nelson, 1971; Kratz, 1975; Sutker et al.,

1979). Employment has been identified as a contributing element in alcoholic

recovery (Clopton, 1973, Johnson, 1980). Working may provide structure that

decreases anxiety and reinforces a positive self-concept that is inversely cor-

related with alcohol abuse (Medzerian, 1979).

Alcoholics are usually not ready to change their behaviors until they have

exhausted available alternatives (AA, 1953, 1973, 1975; Glatt, 1958). The modal

age group at which this seems to occur is in the early forties (Williams & Kahn,

1964). This is the time of establishment when one normally stablizes a career

pattern and works at maintaining an occupational position (Super, 1953; Tolbert,

1974). Alcoholics in this age group often experience destabilization of their career

pattern and loss of vocational position (Florida, 1980). Super's theory provides a

framework for understanding age and employment factors in alcoholism treatment.








The review was conducted with the help of the University of South Florida

Library Computer Searches Center in Tampa. A comprehensive effort was made to

retrieve previous studies in English related to the topic appearing in professional

journals, government publications, and other resources. The data collections and

time frames of search were Educational Resources Information Center (ERIC)

1966 to May 1, 1980; Dissertation Abstracts 1861 to May 1, 1980; Psychological

Abstracts 1967 to January 1980: Sociological Abstracts 1963 to December 1979:

Social Science Citation Index 1972 to May 1980; The Monthly Catalog of Govern-

ment Publications 1976 to May I, 1980; and the National Clearinghouse for Mental

Health Information.













CHAPTER III

METHODOLOGY

The review of the literature indicates much remains to be learned about

alcohol abuse and alcoholism counseling. There is a long history of alcohol use

in the United States and its present use is entrenched as an acceptable social

behavior. It becomes unacceptable when the individual loses control of alcohol intake

and/or fails to be able to continue productive functioning such as work. Counseling

such clients has traditionally centered on the struggle for control, improvement

in self-concept, and a return to work.

Limited research has been conducted regarding the relationship between

age, employment and personality patterns of alcoholics (Apfeldorf & Hunley, 1975;

Hoffman, 1970; Hollman & Nelson, 1971; Kratz, 1975; MacLachlan, 1975; Sutker et

al., 1979; Vosburgh, 1975; Williams & Kahn, 1964). More research would be useful

in this area since program planning for the treatment of alcohol abuse and

alcoholism makes assumptions regarding age and employment as factors in rehabili-

tative treatment. The study will also serve to add to the body of literature on

Minnesota Multiphasic Personality Inventory applications to this important aspect

of rehabilitation counseling.

Previous work and related research has been completed by the researcher

to develop testing concepts and materials used in this study (Florida Drug Abuse

Trust, 1979). This study involves a comparison of clients diagnosed alcoholic and

currently in treatment in the State of Florida by publicly supported programs.

Three levels of age are compared with two levels of employment. The design of








the study, hypotheses, population and selection of sample, instrumentation, re-

search procedures and timeline, statistical analyses and limitations of the study are

discussed in this chapter.


Research Design

The development research design is a 3 x 2 table of three levels of age

and two levels of work history as independent variables. Age is divided into three

groups, 15-24 Exploration; 25-44 Establishment; and 45-64 Maintenance according

to Super's theory of career development (Super, 1953; Tolbert, 1974). Work history

of the previous nine months is separated into two categories termed employed and

unemployed as determined by the HRS Department of Vocational Rehabilitation
(1980). The dependent variables are the validity and clinical scales of the

Minnesota Multiphasic Personality Inventory in 168 item format (Overall & Gomez-

Mont, 1974) and the MacAndrew (1965) special scale of substance abuse. The MMPI

clinical scales will be examined for nomothetic or absolute scale level differences

and group configurational differences as suggested by Clopton (1973) so that

important relationships due to the diversity of alcoholic profiles are not obscured.

Attention with this type of research is necessary so that differences

among the cells on the dependent variables are not overlapped with other

differences between the groups (Campbell & Stanley, 1966; Isaac & Michael, 1977).

In order to control for this a "Client Characteristics" form will be collected. The

groups will be compared with the Chi-Square Test of Independence and the data used

for a descriptive comparison of the groups.

Research Hypotheses
This study addresses the following hypothses and tests them at the

.05 level of significance (C= .05).








I. There is no significant difference in the personality characteristics (MMPI

scores) of alcoholics of different age groups.

2. There is no significant difference in the personality characteristics

(MMPI scores) of alcoholics who are employed and those who are

unemployed.

3. There is no significant interaction of age and employment in relation

to the personality characteristics (MMPI scores) of alcoholics.

4. There is no significant difference in the potential for alcohol abuse (MAC)

score among alcoholics who are employed and those who are unemployed.

6. There is no significant interaction of age and employment in relation to

potential for alcohol abuse (MAC score.



Population and Selection of Sample

The population addressed in this study consists of Florida alcoholic clients

with primary diagnosis of DSM III categories 303.0X Alcohol Abuse or 303.9x

Alcohol Dependence (APA, 1980). The diagnosis will be determined by staff

charged with the responsibility by licensed alcoholism treatment facilities under

the supervision of the Department of Health and Rehabilitative Services of the

State of Florida.

The subjects are drawn from those currently in treatment in outpatient,

residential and detoxification modalities. No one known to be under the influence

of alcohol or the effects of alcohol withdrawal was admitted to the study. Those

clients in treatment at a detoxification center were in the final day of treatment

and determined by medical personnel to have successfully completed detoxification

and be pending discharge (Ramirez & Wells, 1978; Williams, 1966).

The sample is further limited to English speaking males between the ags

of 15 and 64 inclusive with at least six years of formal education. Most of the








research and normative data available is based on males who outnumber women in

treatment nearly four to one (U. S., 1980). The role of women in the world of work

has changed greatly in recent years. The inclusion of females in this study might

lead to differences on the dependent variables attributable to sex or other actors

and not the independent variables age and employment. Fifteen years of age is

about the lower limit of the MMPI as is a sixth grade education and knowledge of

the English language (Dahlstrom, et al., 1972).

The determination of employment status will be made according to Social

Security Administration classification. The 1980 Florida Department of HRS

Vocational Rehabilitation Counselor's Manual (HRS Manual 170-2), Chapter 10,

page 2, defines employment as "substantial gain activity (SGA)." "Earnings

averaging more than $230 per month are deemed to demonstrate the ability to

engage in SGA." Continued work at this level for nine months demonstrates ability

to hold a job according to the Department of Health and Rehabilitation Services.

(Florida, 1980d)

For the purpose of this study, an "employed" person will be someone

who has engaged in work for an unspecified number of hours for nine continuous

months previous to admittance to the study at a pay of at least $230 per month.

This is understood to have three criterion elements: I. the subject must have

worked; 2. the work must have been for nine consecutive months; and 3. the rate

of pay must have been $230 per month (or $2,760 annually) or greater. Those

not meeting these criterion will be considered "unemployed."

Two Florida alcoholism programs regulated by the state have agreed

to participate in the study: The Alcohol and Substance Abuse Program of the

Human Development Center of Pasco, Inc. and the Pinellas Comprehensive Alcoholism

Services. Both programs are located in the Tampa Bay area and draw clients








from their respective catchment areas. Pasco County is rural, Pinellas County

is urban.

The participants were informed of the general nature of the research.

Alcohol clients have been know to give socially desirable responses to MMPI

questions (Dahlstrom et al., 1962; Newton, 1971; Thomas 1980). The participants

were told that the study is on drinking patterns and that it is voluntary. Few

clients declined to participate since MMPI testing and data collection are an

established part of program procedures at many facilities. Each participant was

given a "Consent to Research" form. A two dollar gratuity was given to each

person when the materials were returned to the program staff.

The sample for this study consists of a minimum of 120 members of the

total population pool of alcoholism clients meeting the previously specified

criteria. A table of random numbers and "Participant List" was used by the

coordinator at each site to admit approximately 60 clients, or 10 for each cell of

the 3 x 2 table. When the data from the two programs were combined the sample size

per cell was 20 or more.

The study participants are compared on age, race, education, and income

with the latest date published by the Mental Health Program Office or HRS,

Tallahassee. Similarity was considered to further indicate representatives of the

sample to the state population of alcohol clients (Medzerian, 1979). Significant

differences (.05) on the comparison variables may limit the extent the study can be

generalized. A second comparison was made within the matrix as a check on

internal validity. The data for the basis of the two comparisons were collected on a

"client characteristics" form with the information filled out by the staff coordin-

ating the study at each field setting.

Instrumentation

The Minnesota Multiphasic Personality Inventory has an extensive history








of use by alcohol treatment programs nationally and in Florida. The MMPI is the

standardized testing instrument of personality characteristics in this study. The

MMPI has four validity scales "L", "F", "K", and ?. The ten clinical scales are

Hypochondriasis, Depression, Hysteria, Psychopathic Deviance, Masculinity-Femin-

inity, Paranoia, Psychastenia, Schizophrenia, Hypomania, and Social Introversion.

The MMPI scales contain different numbers of items to be marked "yes"

or "no" with a pencil according to whether or not they apply to the person at the

time of test administration. It is permissible to not answer at all, so long as a

large number of responses are not left incomplete. The scales may be plotted

together or a profile form with mean values of each scale established at fifty with

raw score deviations equivalent to a standard deviation of ten on T-score values.

There are several different presentations currently available. This

study used the MMPI Mini-Mult 168 Form R matched to the hardboard step-down

board copyrighted in 1948 by The Psychological Corporation. The Mini=Mult

format of only the first 168 items is administered by instructing the client to stop

at the bottom of page seven (Overall & Gomez-Mont, 1974). This version is

considered most appropriate for use with an alcohol population (Hoffman &

Butcher, 1975; Newmark, Newmark & Cook, 1975; Overall, Higgins & De

Schweinitz, 1976). It is anticipated that clients will be able to complete the MMPI

168 in thirty minutes or less.

In addition to the MMPI 168 validity and clinical scales a special measure

of substance abuse proneness was administered. The MAC scale (MacAndrew,

1965) is the most widely used special scale of the MMPI for the detection of

substance abuse in general and is noted for its stability over time (Burke & Marcus,

1977; DeGroot & Adamson, 1973; Rhodes, 1969; Rhodes & Chany, 1978; Rosen-

berg, 1972. As usually administered the MAC consists of fifty-one items ranging








from item number 6 to number 562 (Dahlstrom et al., 1975, p. 284). MacAndrew

(1979) says it correctly identifies alcoholics approximately 84.6% of the time.

Test-retest differences are one to two points, smaller differences than for the

regular MMPI scales (MacAndrew, 1979). In his 1979 study, MacAndrew demonstra-

ted the efficacy of administering the MAC scale independent from the full scale

MMPI.

The Minnesota Multiphasic Personality Inventory (MMPI)

Alcoholism treatment programs are encouraged by federal and state

authorities to evaluate their clients and prescribe and appropriate individualized

treatment plan. Evaluation and screening usually includes some psychological

testing. The Minnesota Miltiphasic Personality Inventory (MMPI) was selected for

use in this study because it is one of the most widely used personality inventories

and it is common usage in alcoholism treatment programs throughout the United

States (Apfeldorf, 1974; Clopton, 1973; Huber & Danahy, 1975; Sukerman & Sola,

1975; Vosburgh, 1975; Williams & Kahn, 1964). The instrument has drawn some

controversy. (Bavernfeind, 1956; Butcher & Tellesen, 1966; Fiske, 1968; Green-

spoon & Gursten, 1967). This is to be expected of a test in use by

a variety of workers in different settings for forty years. The widely accepted

MMPI remains a useful, well studied assessment of personality characteristics and

tool of research (Dahlstrom et al., 1972, 1975; Marks & Seeman, 1974).

The MMPI was originally published in 1943. In 1939 Starke R. Hathaway

and J. Charnley McKinley began development of an empirical criterion keyed

diagnostic objective aid and measure of therapeutic change over time. A set of

504 items was selected of 1000 statements from clinical reports, manuals, forms,

case histories and other sources. A sample of 299 men and 425 women adult

medical patients and visitors at the University of Minnesota Hospital was admin-
istered the early form of the instrument. This sample corresponded to the










Minnesota population according to the 1930 census on age, sex, and marital status.

The performance of this normative group is the basis for comparison of any

individual taking the test.

In 1940, such a Minnesota normal adult was about thirty-five
years old, was married, lived in a small town or rural area,
had had eight years of general schooling, and worked at a
skilled or semi-skilled trade (or was married to a man with
such an occupational level. (Dahlstrom et al., 1972, p.8).


In 1957 Hathaway and Briggs used a revised sample of 266 males and 315

females to add additional scales to the original instrument.

Theoretical concerns regarding personality inventories may be reduced by

the use of special instructions (Fink, 1972) or examination of the instrument by

factor analysis (Astin, 1959; Eichman, 1962). When the MMPI is properly used in

conjunction with psychosocial information that can support the projections of the

clinical code-types (Kostlan, 1954). It is particularly important to be familiar with

the instrument in the setting and client populations to which it will be applied

(Erickson & O'Leary, 1977; Gaines et al., 1974; Thomas, 1980).

The test is available in three forms: individual or card form, group or

paper and pencil, and audiotape. The most common is a form of the standard

booklet published in 1947 by the Psychological Corporation and suitable for

individual or group administration. Form R is a step-down, hardboard format with

566 items presenting the basic clinical and validity scales within the first 399

statements.

Test subjects must be sixteen years of age or older with at least six years

of formal education. An IQ score below 80 on either the Verbal or Full-Scale

Wechsler Adult Intelligence Scale (WAIS) suggests the client will not be able to

successfully complete the MMPI in booklet form. Those with IQ's 65 or less or with








less than three years formal .education have great difficulty completing any form

of the test including oral. Sixty to ninety minutes is the amount of time it takes

most people to complete the test.

MMPI Scales

The scales of the MMPI contain different numbers of items to be marked

yes or no according to whether they apply to the person at the time of test

administration. Scores are profiled so that each scale may be viewed in context to

other scales. The scales may be interpreted nomethically (absolute scale level) or

idiographically (configural pattern. The latter analysis is preferred for clinical use.

The following description of the MMPI scales is drawn chiefly from

Dahlstrom et al., 1972, and Gilberstadt & Duker, 1965. The basic clinical scales are

# I Hypochondriasis (Hs), #2 Depression (D), #3 Hysteria (Hy), #/4 Psychopathic

deviance (Pd), #5 Masculinity-femininity (Mf), #6 Paranoia (Pa), #7 Psychasthernia

(Pt), #8 Schizophrenia (Sc), #9 Hypomania (Ma), #10 Social introversion (Si).

Scale # I Hyponchondriasis indicates an abnormal concern for bodily

functions. Worries and preoccupations with physical symptomatology persists

despite evidence to the contrary. The 33 items concern themselves with general

aches and pains and specific complaints about digestion, breathing, thinking, vision,

sleep, and sensation.

Scale #2: Depression is characterized by feelings of hopelesness, a

slowing of thought and movement, and frequently thoughts of suicide. The sixty

items deal with apathy, unsatisfactory work performance, sleep disturbances,

appetite, and mood.

Scale #3: Hysteria identifies those clients using physical symptoms as a

means of avoiding responsibility under stress. The sixty items include twenty in

common with the hypochondriases scale that make reference to somatic com-

plaints.









Scale #4: Psychopathic deviance measures a personality pattern whose

characteristics include repeated disregard for community standards, shallow and

unstable relationships with others, and an inability to profit from experience. The

fifty items tap alienation from family, difficulty and authority figures and social

maladaption.

Scale #5: Masculinity-femininity was designed to measure male sexual

inversion or feminine personality characteristics, values, interests, and style of

expression in interpersonal relationships. The Fm scale is an unsuccessful attempt

to develop a corresponding scale more appropriate for women covering social

activities, personal sensitivities, and sexual material.

Scale #6: Paranoia involves suspicious delusional beliefs and overly

sensitive misinterpretations of personal situations out of proportion with the

client's ability and intelligence. The thirty-nine items are about delusional and

referential ideas in relationships with others.

Scale #7: Psychasthenia is an out-of-date term for obsessive-compulsive

personality characteristics such as difficulty in concentration, rumination, and

working. The forty-eight items include reference to anxiety, immobilization and

low self-confidence.

Scale #8: Schizophrenia refers to bizzare or unusual thoughts or

behavior. The seventy-eight items reflect lack of deep interests, poor family

relationships, and bizzare ideation.

Scale #9: Hypomania features overactivity, emotional liability, and flight

of ideas in conjunction with a lack of concommitant productivity. The forty-six

items search activity levels, sociability and agiation.

Scale #10: Social introversion examines withdrawal from contact with

others and responsibilities. The seventy items indicate the degree to which a client









withdraws from others in response to emotional needs and related patterns of

behavior.

There are three validity scales on the MMPI: "?', "L", "F". Validity in the

sense that it is reported by these scales indicates the acceptability of anyone

administration of the test. These built in checks also imply sources of any

invalidity by elevation and configuration of pattern.

The Cannot Say or "?' score is the number of items placed in that

category by client as well as those skipped or deliberately omitted. This allows the

client to skip items that seem inappropriate and decreases the restrictiveness of

the instrument. A continuum of test evasiveness is not presumed. The most likely

reason for an elevated Cannot Say score is inability to comprehend the question or

confusion (Brown, 1950).

The "L" score is a fifteen item scale designed to identify dishonesty

in answering the test questions. It is often called "the lie scale." As one would

expect, high scores on L tend to suppress elevation on the clinical scale profile.

The sixty four item "F" scale detects unusual reponses to certain

questions. It is often called "the validity scale" as if it alone were sufficient to

measure invalidity. It picks up pervasive personality disorganization,the presence

of current drug effects on the client, and an inability to understand and reliably

answer the test questions.

The "K" scale was added to the other three validity scales after workers

had gained experience with the test in the field. Experience suggested the original

indicators were measuring gross protocol invalidation while not detecting sources

of invalidity. In 1947 the MMPI was supplemented with the K scale and corrections

for K on the clinical scales. This suppressor factor was incorporated by The

Psychological Corporation into the scoring procedures to improve the discrimin-

ation of normal form abnormal records.








MMPI Short Forms (Mini-Mult)

The full scale MMPI format of 566 items takes about one and one-half

hours to complete for the average client. This length of time makes administration

of the test difficult in clinical situations with some clients, including many

substance abusers. They may see little face validity to the MMPI questions and

doubt the efficacy of such psychological testing. Resistance and defensiveness to

what may be perceived as unwarranted personal intrustion are encountered with

regularity. The poorly motivated client sometimes rushes through the test or even

randomly completes it. (Erickson & O'Leary), 1977; Hoffman & Butcher, 1975;

Newmark, Newmark & Cook, 1975). As many as 25% of alcohol client full scale

MMPI test reports may be invalid for this reason (Overall, Higgins & DeSchweinitz,

1976).

In 1968 Kincannon introduced his 71 items which were chosen as

representative of the content clusters of the standard validity and clinical scales.

Kincannon's "Mini-Mult" was estimated to lose only 9% reliability and 14% corres-

pondence in comparison with readministration of the standard length instrument.

The mean scale values correspond well with the standard test but underestimated

extreme scores and yielded narrower score ranges (Dahlstrom et al., 1972).

Although scales F, I, and 9 tend to be underestimated by the Mini-Mult

the product-moment correlatons between the short and long forms ranged from .80

to .93 for the validity and clinical scales with a median correlation of .87

(Kincannon, 1968). Correlations of initial Mini-Mult scores retested with the

standard MMPI ranged from .60 on F to .89 on scale seven. Correlations on two

administrations of the long form ranged from .62 to .91 with the same two scales

being lowest and highest (Dahlstrom et al., 1972).

Armentrout and Rouzer (1974) have pointed out a weakness of some Mini-








Mult formats with character disorder and psychotic clients. They stressed the

importance of experience with short forms of the MMPI in the context in which

they are to be used. Newton (1971) investigated Kincannon's early Mini-Mult

format with male alcoholics. His findings do not support more optimistic

suggestions that the 71 item short form closely approximates the long form of the

MMPI. Correlations ranged from .28 on scale 9 to .63 on L. Newton also found

that on a second administration alcoholic clients gave more socially desirable

answers.

After the initial appearance of Kincannon's short form other Mini-Mults

were developed by Hugo in 1971, Graham and Schroeder in 1972, Fachingbaurer in

1973, and others. A study of these short forms by Hoffman and Butcher (1975)

found all of them to correlate highly with the standard length test (.74 to .96). The

success in predicting code type was not considered acceptable, however. The 168

item format was judged the better of the studies examined although the authors

preferred the full scale MMPI.

MMPI-168

Overall and Gomez-Mont (1974) devised an abbreviated MMPI form

utilizing the first 168 items of the test, or up to the last item on the bottom of

page seven of Form R. Correlations between scales on the short form and

traditional long form ranged from .79 on scale 9 to .96 on scale three with a mean

of .88 for all scales. Newmark, Newmark and Cook (1975) found the 168 to:

Correspond fairly accurately to the standard MMPI
for psychiatric patients as a group. The only
apparent difficulty occurs with the MMPI-168
tendency to underestimate significantly the Si scale
for both sexes. It should be emphasized that the
correlation obtained in this study are as high as
any that have been obtained with abreviated MMPI
scales to date. The MMPI-168 proved to be a
remarkably accurate substitute for the MMPI. (pp. 63-64)








Overall, Higgins and DeSchweinitz (1976) strongly support the MMPI-168.

In fact they mention the tendency to accept the standard form of the instrument

as an infallible criterion and to find fault with the short form when there are

discrepancies. They maintain:

The fact that the diagnostic group discrimination
based on the abbrevitated MMPI-168 was equal
to that for the longer MMPI seems to confirm that,
in fact, an extra element of unreliability, is intro-
duced, at least for some Ss. by the excessive length
of the standard form. This can be reasoned from the
fact that the shorter test length should be expected
to produce less reliable scores if the item reliabilities
remain constant throughout A less reliable instrument
also would be expected to be less valid. On the other
hand, if fatigue, boredom, resentment, or distractability
changes the quality of responses in latter portions of
the test, an increase in scale score reliability might
not result from use of the longer form. (p. 243).

Gaines, Abrams, Toel, and Miller (1974) as well as Erickson and O'Leary (1977)

stress the importance of being familiar with a particular setting when applying the

Mini-Mult. This is good advice for applying any instrument to a clinical setting but

takes on particular significance in the substance abuse population. Almost by

definition substance abusers demonstrate the behaviors and personality character-

istics that decrease the quality of the responses during a lengthy test administra-

tion. The two programs participating in this study went to Mini-Mult formats,

several years ago for precisely the reasons discussed in this section. The Mini-Mult

MMPI is a reasonably accurate substitute for the full-scale instrument that is more

practical in clinical use with an alcoholic client population.

There is a possibility of withdrawal effects influencing the test responses

of alcohol clients who are or have recently been drinking. From the time of last

ingestion, five full days are necessary before the client who has been drinking

heavily may be considered detoxified. Administration of any instrument during the

first five days following an alcoholic drinking episode could be invalid. Theoreti-
cally a case can be made that much longer periods of time are necessary for








sufficient recovery from drinking to warrant valid psychological testing; perhaps up

to one year (Brozek, 1950; Libb & Taulbee in Clopton, 1973; Mayer & Garcia-Mullin,

1972; Williams, 1966).

MMPI Special Scales

Three special scales of significance have been developed upon the body of

MMPI items as aids in the diagnosis of alcoholism. (Atsaides et al., 1977;

Rosenberg, 1972; MacAndrew & Gerstma, 1964). Hampton attempted in 1954 to

develop an instrument to differentiate not only alcoholics from non-alcoholics but

different levels within the alcoholic category. Hampton drew a sample of men who

were members of Alcoholics Anonymous in Minnesota, Iowa, Kentucky, and Ohio

who had been determined to be "alcoholic" by medical personnel or the criminal

justice system. A later scale constructed by Holmes is chiefly concerned with

prealcoholic states and was based on 72 men hospitalized for "chronic alcoholism

without psychosis" in a California state mental institution. The Hoyt and Sedlacek

(1958) scale drew 98 Caucasian "chronic alcoholic" men from the Mental Health

Institute in Independence, Iowa. It is designed to identify the personality

characteristics of alcoholics which separate them from nonalcoholics. All the

scales contrasted a diagnosed alcoholic group with a normal sample.

MacAndrew and Gertsma (1964) have taken the position that these three

alcoholism scales based on the MMPI are not measures of alcoholism so much as

measures of general maladaption. Of the 191 items included in the three scales

only seven were common to all three scales. MacAndrew's conclusion is "The

manifest content of these seven items indicated that relative to normals, people

diagnosed as alcoholics describe their alcohol intake as excessive rather than

moderate, tend to accept the responsibility for their past failures and transgres-

sions, and while not consistent church-goers, profess to believe in miracles"









(MacAndrew, 1964, p. 76). Alcoholism scales based on MMPI items, including the

MAC Scale to some degree, seem to tap traits alcoholics share with offenders in

the criminal justice system (Apfeldorf & Hunley, 1975). This suggests that there is

an aspect to alcoholism that is simply social maladaption.

MAC SCALE

MacAndrew's MAC Scale (1965) remains the most widely used special

scale of the MMPI for the detection of substance abuse in general whether alcohol

or drug abuse (Burke & Marcus, 1977; DeGroot & Adamson, 1973; Rhodes, 1969;

Rhodes & Chany, 1978; Rosenberg, 1972). It was designed to distinguish between

a general psychiatric sample and alcoholics rather than between normals and

alcoholics. The 49 item scale (together with MMPI items 215 and 460) appears to

measure a relatively stable personality configuration independent of current

behaviors or levels of functioning. That is, it is common for MAC scores to remain

the same whether an alcoholic is drinking or not drinking. This is true even if

sustained abstinence is accompanied by a decrease in score elevation on the other

MMPI scales (Apfeldorf, 1974; Lachar et al., 1976).

This is particular important in this study since there is no interest in

measuring the potential for substance abuse independent of other personality

characteristics.

In 1976 Lachar studies the MAC scale in relation to alcohol and drug

abuse with 165 male alcohol and drug abuse cases and 165 male control patients.

Each group of abusers scored significantly higher than the controls at the .05 level

for alcoholics and the .01 level for the polydrug abusers. The cutting score of 23

correctly classified 86 percent of the self-identified addicts. Apparent errors in

classification may be attributed in part, according to Lachar, in that the MAC

scale identified a potential for substance misuse among those who have not yet

expressed that potential in abusive behaviors.








Test-retest administration of the MAC average 1.02 points mean difference

which compares favorably with test-retest differences on the MMPI clinical

scales of 1.49 points with a range of 0.3 to 2.5 in a 1979 study by Mac Andrew.

Originally it was recommended that MMPI protocals with an F scale

score of 15 or more should be considered to invalidate the MAC. MacAndrew

(1979) and Apfeldorf & Hunley (1975) now indicate an L scale of 9 or more may

be considered as the invalidation criterion.


Statistical Analysis

After administration the data were prepared for statistical analysis. The

"Client Characteristics" form was used to describe the sample with mean and

standard deviation of the groups of the 3 x 2 matrix will be reported. This form

was compared with the most recently published HRS Mental Health Program data

on age, race, education, and income to ensure representativeness of the sample.

The comparison is of the total sample collected to the state data through the

means of the chi-square test for goodness of fit. The requirements for this test are

that the data be in the form of frequencies; observations are independent of each

other; and a minimum of five expected observations per cell (Isaac & Michael,

1977; Roscoe, 1975). This serves as an indicator of external validity and

generalizability of the data.

As an indicator of internal reliability a second comparison of client

characteristics will be made between the cells of the 3 x 2 matrix. The chi-square

test of independence will be used to determine if there are significant differences

among the cells. The requirements are the same as for other chi-square tests

(Isaac & Michael, 1977; Roscoe, 1975).

The statistical procedure used for determining significant differences of

the MMPI validity, clinical, and MAC scales is the two-factor analysis of variance








(ANOVA). The underlying assumptions of ANOVa are randomly selected subjects

from normally distributed populations, approximately equal variances, and indepen-

dence of observations (Issac & Michael, 1977; Roscoe, 1975). The assumptions

have been taken into consideration and the proper allowances made.

To insure information was not lost by partitioning the variable age, it was

also treated as continuous. An overall age to MMPI scale and within groups

correlation was made when ANOVA failed to reach significant alpha levels.

Procedures

I. The researcher contacted responsible administrative personnel at the

participating treatment programs to explain and discuss the purpose and

intended procedure of the study. The researcher met with the staff at

each facility who collected the data and administered the research

materials. The procedures were discussed in detail.Anonymity of client

records and adherence to ethical principles were given particular atten-

tion. The "Participant List" form in the Appendix was developed for use

by the programs to protect the client's right to privacy.

2. The sample selection and collection of data began: a) Client

Characteristics form; b) MMPI-168; c) MAC scale.

3. The researcher contacted the coordinator to determine the status of

the data collection at each facility.

4. The collection of data was completed and the materials mailed to the

researcher in the provided stamped envelopes.

5. The MMPI-168 was scored by hand and individual profiles returned to

the programs. All materials were screened for errors such as the

inclusion of inappropriate participants or misunderstanding of the admin-

istration of the instruments. Those records with an L score of 9 or more








or an F score of 16 or greater were invalidated as recommended by the

MMPI Revised Manual (1967) and Mac Andrew (1979). The data were

grouped along the lines of the 3 x 2 matrix.

6. The data were prepared for computer analysis. The analysis includes:

a) Descriptive statistics of the sample drawn from the "Client

Characteristics" form.


b) Chi-square goodness of fit test comparing client characteristics of

U. S. state-wide alcohol population data with the sample on age, race,

education, and income. This allows more precise discussion on the

extent the data may be generalized.


c) Chi-square test of independence on client characteristics within

the cells of the 3 x 2 matrix to aid the examination of internal

validity.

d) A two-factor ANOVA with three levels of one independent

variable (age) and two levels of a second (work history) was computed

on MMPI T-scores on validity and clinical scales. The absolute scale

value and the most common two point code type configural patterns

will be examined.

e) A two factor ANOVA with three levels of one independent variable

(age) and two levels of a second (work history) was computed on MAC

scale scores.

f) Treating age as a continuous variable product moment correlations

within and between groups was made on MMPI and MAC scales.


g) The hypotheses were tested.









7. The report of the results of the study and analysis of data may be

found in Chapter IV. A summary of the study, discussion of findings,

implications and limitations of the study are in Chapter 5.


Limitations of the Study

An important factor in developmental research mentioned by Isaac and

Michael (1977) is that the subjects at each age level should be comparable.

Differences between the cells on the dependent variable should be attributed to the

independent variable, not some other factor. The use of the "Client Character-

istics" form as a descriptor of each cell attempts to address this issue.

In regards to the external validity and generalizability of the study,

reasonable attempts are made to insure the participating programs are represen-

tative of alcoholism treatment programs throughout the state and perhaps the

country. Florida U. S. rules are based on state statutes formulated on federal

regulations issued by the U.S. Department of Health, Education, and Welfare, the

National Institute of Mental Health, and the National Institute on Alcohol Abuse

and Alcoholism. Health and Rehabilitative Services requirements ensure minimum

standards in eight areas of substance abuse programs operation. The data

pertaining to client characteristics will be used to compare the total sample to

HRS alcohol population estimates for the State of Florida.

The study is designed to examine the importance of employment with

different age groups of men and not both sexes. The issue may be more clear-cut

with men than women whose role in the world of work has undergone great

changes. Any differences between the sexes in this area might make it more

difficult to determine effects attributable to the variables under study. Extrapola-

tion of the data to individuals or groups not adequately represented in the study

should be done with care, if at all.











CHAPTER IV

RESULTS OF THE STUDY

In this chapter the results of the study are presented based on the

methodology and statistical procedures described in Chapter III. The chapter is

divided into two sections. The first is a description of the sample with comparisons

to the estimated state alcohol population and within the design matrix. The second

is the data analysis determining relationships among variables and testing the

hypotheses.

Description of the Sample

The 120 subjects were selected randomly from the client populations of

two alcoholism treatment programs in west central Florida. Three levels of age

based on the vocational theory of Donald Super (1953) and two levels of employ-

ment determined by Florida HRS standards were used as independent variables.

The design is a 3X2 matrix with an n of 20 subjects in each cell.

The characteristics of the total sample are presented in Table 6.

Participants were diagnosed by the programs as Alcohol Dependent (93%) or

Alcohol Abuse (7%) cases. The sample is similar to the state population on age,

race, and educational level. Regarding income, there are discrepancies between

how much the clients tell the programs they make and what they tell a researcher,

as anticipated in Chapter Two. If the entire range of income reported to the

researcher is compared to state estimates, a significant difference is found. If the

lowest and highest are disregarded as inaccurate, there is no significant difference

(See Table 7). It is believed that the clients in this study are representative of the

male alcoholic population in the State of Florida.
72










Table 6

Client Characteristics of the Total Sample


Demographic


I. Age: X = 44.9. Range = 17-64 s.d. = 13,986

2. Race: White = 99%, Black = 1%, Other 0%

3. Marital Status: Single = 37%, Married = 10%
Separated = 10%, Divorced = 38%


Educational/
Vocational Hx


Alcohol HX


4. Client's Usual Type of Work:

Unskilled Labor = 37%

Skilled Labor = 42%

White Collar = 21%

5. Last school grade completed: X = 12.03

6. Last year family income from all sources:

$ 0 2,999 26.6%
3,000- 5,199 18 %
5,200 7,799 9.4%
7,800 10,399 14.6%
10,400 15,599 7 %
15,600+ 24.4%


7. Alcohol Abuse (DSM I I 305.OX) = 7%


7. Alcohol Abuse (DSM 11 305.0X) = 7%
Alcohol Dependence (DSM III 303.9X) = 93%

8. Number of years drinking a serious problem:

Less than 5 years = 20%

5 to 10 years = 26%

More than 10 years = 54%












Table 7

Chi-Square Goodness of Fit Test Comparing Study Client Characteristics With
Estimated State Parameters


Characteristic


Age

Race


Sample

44.9

99% White


Estimated State Paramaters


44.4

90% White


Educational Level

Income 0 2,999

3,000 5,199

5,200 7,799

7,800 10,399

10,400 15,000

15,600


12.03

26%


18%


9.4%

14.4%


12.54

56%


13%

I1%


24.4%


NOTE: Chi-Square equals 98.14, significant at = .001. Chi-Square for Age,
Race, and Eduation Level alone is .929 which is not significant. Chi-Square
disregarding lowest and highest levels of income is 8.94 which is not
significant.









The internal validity of the study was examined by applying the Chi-

Square Test to client characteristics within the matrix (See Table 8). Differences

on two areas of work history and three areas of marital status were found due

to the structured differences in age and employment built into the research design.

Fewer young people may be expected to hold white collar jobs than those middle-

aged or older. The same is true for marital status; the young clients are more

likely to be single and less likely to have yet separated or divorced. There were no

differences on race, diagnosis, or education. The cells are considered to be similar

allowing a test of hypotheses to reflect real differences on the research variables.


Data Analysis

The MMPI-168 and MAC protocols were graded and grouped according to

the research design. The means and standard deviations of scores may be found in

Table 9. The scores are corrected for K and put in correspondence with full scale

scoring according to Overall and Gomez-Mont (1975).

A Two-Way Analysis of Variance was performed on the MMPI validity

(L,F,K) clinical (Hs, D, Hy, Pd, Mf, Pa, Pt, Sc, Hy, Si) and MAC scales. In all cases

0.05 was used as the significant alpha level. A significant interaction was found on

Depression (p = .001) and Psychasthenia (p = .002). Significant main effect

emerged on Hyponchondriasis (employment, p = .05), Hysteria (age, p = .01),

Masculinity-Feminity (employment, p = .038), and Social Introversion (age, p = .008).

Of interest but not statistically significant at alpha equals .05 were the validity

scale L (employment, p = .057) and MAC (interaction, p = .056).

The significant F ratios were tested for simple effects in the case of

interaction and main effects in cases where there was no interaction. Scale L and

MAC because of their near significance on ANOVA were further examined by the











Table 8

Chi-Square Test of Independence Comparing Participant Characteristics Within
the 3 x 2 Matrix



Characteristic Chi-Square Significance


Race .421

Diagnosis

303.0X Alcohol Abuse 11.04

303.9X Alcohol Dependence 1.12

Education .330

Work History

Unskilled 57.91 .001

Skilled 3.24

White Collar 42.74 .001

Marital Status

Single 12.515 .05

Married 7.998

Separated 17.18 .01

Divorced 56.12 .001











Table 9

Means and Standard Deviations of Alcoholic Scores on MMPI Scales by Age and
Employment



Employed

MMPI Age 15-24 Age 24-44 Age 45-64
Scale X S.D. X S.D. X S.D.



L 2.815 1.814 4.860 2.501 3.295 2.006
F 8.865 3.869 8.140 3.056 9.150 4.601
K 11.010 4.154 12.330 5.538 12.215 4.184
Hs 14.505 6.543 14.770 7.514 15.045 4.269
D 25.170 5.810 20.235 5.565 26.895 6.270
Hy 22.840 6.267 22.700 6.450 26.620 6.757
Pd 29.175 4.708 25.350 3.792 28.355 5.279
Mf 28.055 3.622 28.045 7.047 27.970 7.148
Pa 13.890 2.529 11.260 3.653 12.300 3.045
Pt 32.020 6.724 24.410 10.055 33.935 6.618
Sc 32.535 8.762 28.785 10.045 35.280 8.972
Hy 24.270 4.839 22.995 4.268 22.915 5.629
Si 24.870 7.581 21.755 9.437 33.365 13.247
MAC 29.950 5.306 29.100 3.810 29.100 4.553














Table 9 continued


Unemployed

MMPI Age 15-24 Age 25-44 Age 45-64
Scale X S.D. X S.D. X S.D.


L
F
K
Hs
D
Hy
Pd
Mf
Pa
Pt
Sc
Hy
Si
MAC


4.320
10.720
11.140
15.505
24.570
24.075
26.680
24.739
11.580
29.810
34.750
20.850
23.885
29.650


2.2674
4.325
4.097
6.224
7.243
7.039
5.126
5.936
3.294
7.839
8.617
5.364
9.395
4.283


3.595
8.525
10.050
18.025
28.915
25.295
28.160
26.045
14.043
35.080
32.125
22.725
27.660
28.200


2.262
4.654
4.378
7.405
4.405
6.188
4.664
4.934
2.677
6.678
8.649
7.141
9.932
5.207


4.835
8.820
13.110
18.025
24.460
28.407
28.915
25.845
12.720
34.525
32.855
22.865
28.965
28.800


3.345
3.685
5.206
7.405
6.646
8.130
5.821
9.127
6.716
10.899
12.947
8.229
13.742
4.336






application of a product-moment correlation within the cells of the design.


The results of the analyses were then used in the consideration of the research

hypotheses.



Hypothesis I. There are no differences in the personality characteristics of

alcoholics of different age groups. The data analysis indicated there is a

difference on Hysteria (< = .01) and Social Inversion ( o( = .08). Hypothesis I was

therefore rejected. Tables 10, I 12 and 13 provide information about this

analysis.


Table 10

Two-Way Analysis of Variance Testing Employment and Age on Alcoholic MMPI Scale
Hysteria



Source of Sum of Mean F
Variation D.F. Squares Squares Ratio P


Employment I 103.324 103.324 2.210 .136

Age 2 390.118 195.059 4.173 .018

Interaction 2 8.659 4.325 .093

Error 114 5329.178 46.757

Total 119 5831.270







Table II

Summary Table for Main Effects on Variable Hysteria Following Non-Significant
ANOVA Interaction


Source of Sum of Mean F
Variation D.F. Squares Squares Ratio P


Age 2 371.702 185.851 3.978 .021

Error 117 5466.639 46.723

Total I19 5838.341


Table 12

Two-Way Analysis of Variance Testing Employment and Age on Alcoholic MMPI Scale
Social Introversion


Source of Sum of Mean F
Variation D.F. Squares Squares Ratio P


Employment 1 .901 .901 .008

Age 2 1171.712 585.856 5.037 .008

Interaction 2 551.091 275.546 2.369

Error 114 13259.656 116.313

Total 119 14983.360







Table 13

Summary Table for Main Effects on Variable Social Introversion Following Non-
Significant ANOVA Interaction


Source of Sum of Mean F
Variation D.F. Squares Squares Ratio P


Age 2 1500.506 750.253 6.563 .002

Error 117 13373.984 114.308

Total I19 14874.490



Hypothesis 2. There are no differences in the personality characteristics

of alcoholics who work and those who do not work. The analysis determined

a difference on Hypochondriasis (o< = .05) Masculinity -Feminity ( Q< = 0.38).

Hypothesis 2 was rejected. Tables 14 and 15 show the ANOVA on the two variables.


Table 14

Two-Way Analysis of Variance Testing Employment and Age on Alcoholic MMPI
Scale Hypochondriasis


Source Sum of Mean F
Variation D.F. Squares Squares Ratio P


Employment I 174.484 174.484 3.841 0.50

Age 2 57.318 28.659 .631

Interaction 2 30.270 15.135 .333

Error 114 5178.426 45.425

Total I19 5440.498







Table 15

Two-Way Analysis of Variance Testing Employment and Age on Alcoholic MMPI
Scale Masculinity-Feminity


Source of Sum of Mean F
Variation D.F. Squares Squares Ratio P


Employment I 185.008 185.008 4.324 .038

Age 2 9.465 4.733 .111

Interaction 2 10.705 5.353 .125

Error 114 4977.922 42.789

Total I19 5083.100



Hypothesis 3. There is no interaction of age and employment related to
personality characteristics among different age groups of alcoholics. Significant

interaction was found on Depression (-o= .001) and Psychasthenia ( o( = .002).

Hypothesis 3 is therefore rejected. Tables 16, 17, 18, and 19 provide more

information.


Table 16


Two Way Analysis of Variance Testing
MMPI Scale Depression


Employment and Age on Alcoholic


Source of Sum of Mean F
Variation D.F. Squares Squares Ratio P


Employment I 106.220 106.220 2.896 .088

Age 2 26.061 13.031 .355

Interaction 2 710.096 355.048 9.680 .001

Error 114 4181.473 36.680

Total 119 5023.850






Table 17

Summary Table for Simple Effects on Variable Depression Following A Significant
ANOVA Interaction


Source Sum Mean F
Variation D.F. Squares Squares Ratio P.


Age Groups

Employed 2 477.903 238.912 6.890 .002

Error 47 1976.897 34.682

Total 59 2454.800


Unemployed 2 281.637 140.819 3.411 0.39

Error 57 2353.232 41.285

Total 59 2634.869


Employment:

15-24
Age Group I 3.600 3.600 0.84

Error 38 1638.124 43.109

Total 39 1641.724


24-45
Age Group I 589.824 589.824 21.454 .001

Error 38 1044,691 27.492

Total 39 1634.515


45-64
Age Group I 59.292 59.292 1.420 .239

Error 38 1586.257 41.744

Total 39 1645.550









Table 18


Two Way Analysis of Variance Testing Employment and Age on Alcoholic
MMPI Scale Psychasthenia


Source of Sum of Mean F
Variation D.F. Squares Squares Ratio P


Employment I 273.008 273.008 3.948 .047

Age 2 432.978 216.489 3.13 .046

Interaction 2 917.003 458.902 6.63 .002

Error 114 7884.063 69.158

Total I19 9507.852







Table 19

Summary Table for Simple Effects on Variable Psychasthenia. Following a Significant
ANOVA Interaction


Source of Sum of Mean F
Variation D.F. Squares Squares Ratio P

Age Groups:
Employed 2 1015.366 507.683 8.011 .001

Error 57 3612.436 63.736

Total 59 4627.802


Unemployed 2 334.749 167.375 2.234 .115

Error 57 4270.575 74.922

Total 59 4605.324



Employment:

15-24 Age Group I 48.620 48.620 .912

Error 38 2025.477 53.302

Total 39 2074.098


25-44 Age Group I 1107.756 1107.756 15.707 .001

Error 38 2680.041 70.527

Total 39 3787.798


45-64 Age Group I 3.481 3.481 .043

Error 38 3089.103 81.292

Total 39 3092.584








Hypotheses 4, 5, and 6 all involve tests of the MacAndrews (MAC) scale of

substance abuse and are accordingly considered as follows:

Hypothesis 4. There is no difference in the potential for alcohol abuse

among different age groups of alcoholics. Age was not found to be a significant

variable in terms of interaction or main effects on the MAC scale. Hypothesis 4

was therefore retained. More information may be found in Tables 20 and 21.

Hypothesis 5. There is no difference in the potential for alcohol abuse

among alcoholics who work and those who do not work. Employment was not found

to be a significant variable in terms of interaction of main effects on the MAC

scale. Hypothesis 5 was therefore retained. More information may be

found in Tables 20 & 21.

Hypothesis 6. There is no interaction of age and employment related

to the potential for alcohol abuse. No significant interaction was found with

the variables age or employment on the MAC scale by the analysis and Hypothesis

6 was retained. Table 20 describes the ANOVA. A product-moment correlation

was computed for the cells of the matrix and may be found in Table 21.
Table 20
Two-way Analysis of Variance Testing Employment and Age on Alcoholic MMPI
Scale MAC


Source of Sum of Mean F
Variation D.F. Squares Squares Ratio P


Employment I 7.500 7.500 .353

Age 2 28.467 14.234 .669

Interaction 2 2.400 1.200 .056

Error 114 2425.500 21.276

Total I19 2463.867









Table 21

Correlation of Age and MAC score


Age Group Employed Unemployed

15-24 .157 .398
25-44 .280 .572
45-64 .221 .671



The MMPI Psychopathic Deviance scale (Pd) is associated with maladaptive

behavior. It is not as clear a measure of addictive proneness as the MAC scale.

The ANOVA of Pd may be found in Table 22. No interaction of age and employment

is proved. A correlational matrix (See Table 23) indicates that the employed

men's Pd score may be related to age in a curvilinear way. A second-degree

polynomial describing a single bend in the regression curve yielded polynomial

coefficients of A (0) = 52.894, A (I) = 1.507, A (2) = .020. The determination

coefficient was R = .222, the correlation coefficient R = .471, and the standard

estimated error 4.373.

The information collected in this study on scales Pd and L does not

reach statistical significance and does not directly bear on the research hypotheses.

It is presented in Tables 22 and 23 for Pd and Tables 24 and 25 for Scale L. It

is of interest to note a simliar pattern regarding these two scales: a curvilinear

relationship on the scale with age among employed males. A tendency for employed

males to be more truthful about their socially unacceptable feelings may be found

in further research.








Table 22

Two-Way Analysis of Variance Testing Employment and Age on Alcoholic MMPI
Scale Psychopathic Deviance


Source of Sum of Mean F
Variation D.F. Squares Squares Ratio P


Employment 1 2.552 2.552 .105

Age 2 72.129 36.065 1.480 .231

Interaction 2 141.796 70.898 2.909 .057

Error 114 2778.422 24.372

Total I19 2994.699




Table 23

Correlation of Age and Pd Score



Age Groups Employed Unemployed


15-24 .395 .084

25-44 .073 .163

45-64 .431 .056



The differences on the lie scale are not statistically significant (o( = .057)
but seem worthy of further research. (See Table 24). The employed men's L score
appears to be related to their age in a curvilinear fashion. (See Table 25.) A
second-degree polynominal describing a single bend in the regression curve found








polynominal coefficients of A (0) = 4.864, A (I) = 4.72, A (2) = 6.288. The

determination coefficient was R = .129, the correlation of coefficient R = .360, and

the standard estimated error 1.915.

Table 24

Two-Way Analysis of Variance Testing Employment and Age on Alcoholic MMPI
Scale L


Source of Sum of Mean F
Variation D.F. Squares Squares Ratio P



Employment I 22.188 22.188 3.596

Age 2 4.954 2.477 .401

Interaction 2 26.340 13.170 2.134 .121

Error 114 703.539 6.171

Total I19 757.012



Table 25

Correlation of Age and L Score



Age Group Employed Unemployed


15-24 .375 .124
15-44 .275 .176
45-64 .404 .123


Data collected on MMPI scales F, K, Paranoia, Schizophrenia, and

Hypomania were not found to be of signifance and did not bear on the research

hypotheses. The data may be found in the Appendix.












CHAPTER V

Summary and Conclusions


The review of the literature in Chapter II suggests that alcohol abuse and

alcoholism are significant problems likely to be encountered by counselors in a

variety of settings. Community prevention efforts emphasizing the youthful stem

at least in part from the unspoken belief that older alcoholics are beyond help.

However, there is some reason to question this as pointed out in several studies

that indicate it is the middle aged alcoholic who seeks serious treatment and wants

to change his behaviors. The importance of employment has been recognized by

self-help groups and professionals in the field. The relationship between work and

self-concept has been theorized by Super (1953) in his vocational theories. The

linkage between self-concept and substance abuse has been documented by

Medzerian (1979) and others.

In October, 1981, 120 alcoholics in Pasco and Pinellas counties in the

State of Florida completed questionnaires regarding their background, the MMPI -

168, and the MacAndrews scale of substance abuse. These people were clients

participating in community agency programs licensed and supervised by the

Department of Health and Rehabilitative Services of the State of Florida. All

were diagnosed alcoholic by the program staff according to DSM III categories 305.Ox

alcohol abuse or 303.9x alcohol dependence.

The subjects responses were statistically examined by the Chi-Square

Tests of Independence to check internal validity of the study. It was determined

that the cells of the design were equivalent and statistical analysis should indicate









differences attributable to the research variables. The Chi-Square Test of Goodness

of Fit compared the study sample to state estimates of the alcohol population

and found the sample to be representative of alcoholic men in Florida.

A Two-Way Analysis of Variance with two levels of employment (employed

and unemployed) and three levels of age (15-24, 25-44, 45-64) was performed

on MMPI validity and clinical scales as well as the special scale MAC. A statistical

analysis of the data yielded significant F ratios for the variable age on Hysteria

and Social Introversion. There were significant F ratios for the variable employment

on Hypochrondriasis and Masculinity-Feminity. Significant interaction of age

and employment was determined on Depression and Psychasthenia. Correlations

were done following ANOVA on the MAC and L scales.

In summary, the results obtained from the study hypotheses are:

(I) There are significant differences in the personality character-

istics of alcoholics of different age groups. The youthful age group is lower than

the oldest on Hysteria. On Social Introversion the oldest group is higher than the

young and middle groups.

(2) There are significant differences in two of the measured MMPI

characteristics of alcoholics who work and those who do not work. Those who are

unemployed score higher on Hypochondriasis than those who work and lower on

Masculinity-Femininity.

(3) There is a significant interaction of age and employment related to

personality chacteristics among alcoholics, on Depression and Psychasthenia.

Unemployment raises depression in the middle age group, but not the youngest and

oldest. Employment decreases Psychasthenia scores of the middle age group but

not the others.

(4) There is no significant difference in the potential for alcohol abuse

among different age groups of alcoholics as measured by the MacAndrews scale.








(5) There is no significant difference in the potential for alcohol abuse

among alcoholics who work and those who do not as measured by the MAC scale.

(6) There is no significant interaction of age and employment related to

the potential for alcohol abuse as measured by the MAC scale. Increases in

Depression and Psychasthenia associated with unemployment as well as corre-

lational data on the MAC qualify this finding.


Discussion

Differences were found between the youngest alcoholics and the oldest on

Hysteria. These differences should not necessarily indicate a change in physical

well-being related to ageing. It may represent a real difference in the use of a

neurotic conversion defense by the older clients by giving physical symptomatology

as a means of dealing with conflicts or avoiding responsibilities. The Hy MMPI

scale is designed to measure the inordinate use of such a defense distinguishable

from use in a normal population. Not making excuses and meeting responsibilities

is a cornerstone of traditional alcohol treatment.

Older alcoholics are socially introverted. They tend to withdraw from

social contacts and responsibilities. Isolation and self-depreciation are associated

with higher scores on the Social Introversion scale of the MMPI. It is understand-

able that self-help groups and professionals in the field stress the need for group

and family counseling. Until fairly recently it has been largely middle-aged and

older alcoholics who have sought help through lay support groups. It may be that a

prime contribution of such groups is the fellowship and sense of belonging that new

members find that enables them to turn their attention to others and relationships

instead of themselves. It is understandable that many find they must maintain

contact with the groups in order to preserve their sobriety.




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