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An experimental study of the longitudinal effects of a methadone treatment program on the personality structure of heroin addicts

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An experimental study of the longitudinal effects of a methadone treatment program on the personality structure of heroin addicts

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Content AN EXPERIMENTAL STUDY OF THE LO N G IT U D IN A L EFFECTS
OF A METHADONE TREATMENT PROGRAM ON THE
PERSONALITY STRUCTURE OF HEROIN ADDICTS
b y
Lee Sion
A D is s e rta tio n P resented to th e
FACULTY OF THE GRADUATE SCHO OL
UNIVERSITY OF SOUTHERN CALIFORNIA
In P a rtia l F u lfillm e n t o f th e
R equirem ents fo r the D egree
DOCTOR OF PHILOSOPHY
(E ducation)
June 1978
UMI Number: DP24616
All rights reserved
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UMI DP24616
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UNIVERSITY OF SOUTHERN CALIFORNIA
THE GRADUATE SCHOOL
UNIVERSITY PARK
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f c t u C ,
? h .D .
E A .
ns
This dissertation, written by
Lee S io n
^ 5 7 s e .
under the direction of /i.A.®.............. Dissertation
Committee, and approved by all its members, has
been presented to and accepted by the Dean of The
Graduate School, in partial fulfillm ent of the re
quirements for the degree of
DOCTOR OF PHILOSOPHY
Dean
Date . . . . . .
DI^ERTATION COMMITTEE
Chairman
TABLE OF CONTENTS
C h a p te r Page
I THE PROBLEM..........................................................................................1
B ackground o f th e Problem
S tatem ent o f th e Problem S itu a tio n
Purpose o f th e S tudy
Im p o rta n ce o f th e S tudy
R esearch Q u e s tio n s to be A nsw ered
T h e o re tic a l Fram ew ork
C o n ce p tu a l and M e th o d o lo g ic a l A ssu m p tion s
D e lim ita tio n s
D e fin itio n s
O rg a n iz a tio n o f th e R em ainder o f th e S tudy
I I REVIEW OF THE LITERATURE......................................................... 12
P e rs o n a lity and P sych o p a th o lo g y Among
H e ro in A d d ic ts
F a m ily C h a ra c te ris tic s and In flu e n c e s
T reatm ent
Summary
I I I M E TH O D O LO G Y ...................................................................................34
R esearch D e sig n
S e le c tio n o f th e Sample
In s tru m e n ta tio n
E xp e rim e n ta l and T e s tin g Procedures
D ata C o lle c tio n Procedures
Data P ro ce ssin g and S ta tis tic a l A n a ly s is
L im ita tio n s
Summary
IV R E S U LTS ................................................................................................. 48
G e n e ra l Form at
S ig n ific a n t R esu lts B etw een E xp e rim e n ta l G roup
(P retest) and C o n tro l G roup (P retest)
11
Chapter Page
S ig n ific a n t R esults B etw een E xp e rim e n ta l G roup
(P o stte st) and C o n tro l G roup (P o stte st)
S ig n ific a n t R esults B etw een C o n tro l G roup (P re te st)
and C o n tro l G roup (P o stte st)
S ig n ific a n t R esults B etw een E x p e rim e n ta l G roup
(P retest) and E xp e rim e n ta l G roup (P o stte st)
D is c u s s io n o f F in d in g s
V SUMMARY AN D C O N C L U S IO N S 7 3
Summary o f Procedures
Summary o f F in d in g s
C o n c lu s io n s and R ecom m endations
REFERENCES....................................................................................................................80
APPENDIX.......................................................................................................................... 87
111
LIST OF TABLES
Table Page
M M PI P retest D ata fo r a ll S u b je cts b y G roups
(E xp e rim e n ta l v s . C o n tro l G r o u p s ) .........................................56
M M PI P o s tte s t D ata fo r a ll S u b je cts b y G roups
(E xp e rim e n ta l and C o n tro l G r o u p s ) ........................................ 59
M M PI P re te s t-P o s tte s t C om p arison (C o n tro l
G r o u p ) .................................. 61
M M PI P re te s t-P o s tte s t C om parison (E xp e rim e n ta l
G r o u p .................................. 64
IV
CHAPTER I
The Problem
T ra d itio n a l p s y c h o th e ra p e u tic m ethods have appeared to be
u n s u c c e s s fu l in th e re h a b ilita tio n o f th e n a rc o tic drug a d d ic t. D o le ,
N y s w a n d e r, and Kreek (19 66) c o n c lu d e d : "A c a re fu l se arch o f th e l it e r
a tu re has fa ile d to d is c lo s e a s in g le re p o rt in w h ic h w ith d ra w a l o f drug
and p s y c h o th e ra p y has e n a b le d a s ig n ific a n t fra c tio n o f th e p a tie n ts to
re tu rn to th e co m m u n ity and liv e as norm al in d iv id u a ls " (p. 37). D ole
and N y sw a n d e r, h a vin g a ls o noted th e fa ilu re o f le g a l m easures to curb
drug a d d ic tio n , in v e s tig a te d the p o s s ib ility o f tre a tin g drug a d d ic tio n
w ith d ru g s. T h e ir fir s t m ethadone m a in te n a n ce p ilo t program a t R ocke
fe lle r U n iv e rs ity in 1963 pro ved v e ry s u c c e s s fu l. The p ro je c t was e x -
I panded to Beth Is ra e l H o s p ita l, e v e n tu a lly g a in in g fin a n c ia l b a c k in g by
N ew York S tate in 1967, I t w as found th a t th e h e ro in a d d ic t, once
s ta b iliz e d on m ethadone and no lo n g e r c ra v in g h e ro in , coped f a ir ly w e ll
w ith r e a lity and w as a b le to le a d a n o rm a l, p ro d u c tiv e lif e . A n ti- s o c ia l
b e h a v io r d e creased s ig n ific a n tly (D ole & N ysw a n d e r, 1967).
S tatem ent o f th e Problem S itu a tio n
M u ch tim e and m oney is b e in g spent on m ethadone m a in ten a n ce
program s as a means o f co m b a tin g th e m u ltip le problem s a s s o c ia te d
w ith h e ro in a d d ic tio n . These program s have been c lo s e ly fo llo w e d and
1
e v a lu a te d from a b e h a v io ra l p e rs p e c tiv e . T hat is , th e y have fo c u s e d on
such c rite ria as e ffe c ts on em ploym ent ra te , c rim in a l b e h a v io r, and
e d u c a tio n . Such an a n a ly s is v ie w s th e problem in b e h a v io ra l term s and
is in ke e p in g w ith D o le and N y s w a n d e r's n o n -p s y c h o g e n ic , m e d ic a l
v ie w o f h e ro in a d d ic tio n .
V ie w in g h e ro in a d d ic tio n as p rim a rily a m e d ic a l d is o rd e r, w h ile
u s e fu l, is a lim ite d p e rs p e c tiv e o f th e p ro b le m . A lth o u g h h a vin g not
is o la te d a s p e c ific p s y c h ia tric d is o rd e r com m on to h e ro in a d d ic ts (G en-
dreau & G endreau, 197 0), we need to b e tte r u n d e rsta n d th e p s y c h o lo g i
c a l w o rld o f th e a d d ic t.
Purpose
T h is s tu d y w as d e sig n e d to advance kn o w le d g e o f w h e th e r m e th
adone m a in ten a n ce program s a ffe c t th e p e rs o n a lity o f th e h e ro in a d d ic t
and i f th e y do, to w ha t e x te n t. The ta s k is to v ie w th e p ro b le m — and
hence th e tre a tm e n t--fro m a p s y c h o lo g ic a l ra th e r th a n a b e h a v io ra l p e r-
I
I s p e c tiv e . E v a lu a tin g th e e ffic a c y o f m ethadone m a in ten a n ce as a tre a t-
I
m ent m o d a lity , based on p s y c h o lo g ic a l ra th e r th a n b e h a v io ra l in d ic e s ,
sh o u ld add to th e d epth o f kn o w le d g e and g iv e a- more co m p le te p ic tu re
o f w h a t happens to a p a tie n t on m ethadone d u rin g th e co urse o f h is /h e r
tre a tm e n t.
Im p o rta n ce o f th e S tudy
As p re v io u s ly s ta te d , m easures o f su cce ss o f m ethadone m a in
te n a n ce program s have fo c u s e d p rim a rily on b e h a v io ra l c rite ria and in so
I d o in g have ig n o re d th e e ffe c ts o f such program s upon p e rs o n a lity . H ope
f u lly , b y a d d in g th e p s y c h o lo g ic a l d im e n s io n , th is s tu d y w ill m ake fo r
a more h o lis tic u n d e rs ta n d in g o f th e problem and tre a tm e n t o f h e ro in
a d d ic tio n . The fin d in g s m ay in d ic a te th a t h e ro in a d d ic ts e vid e n ce a
s ig n ific a n t degree o f p s y c h o p a th o lo g y as com pared to n o n a d d ic ts , and
th a t th is d iffe re n c e does n o t decrease s ig n ific a n tly as a re s u lt o f m eth
adone tre a tm e n t. I f so, th is w o u ld le a d to a q u e s tio n in g o f th e e ffic a c y j
o f m ethadone tre a tm e n t as a v ia b le tre a tm e n t m o d a lity in and b y it s e lf .
R e h a b ilita tio n program s w ill v a ry in th e ir approach as c rite ria fo r s u c
ce ss are re d e fin e d b y s tu d y in g d iffe re n t v a ria b le s . For e xa m ple , i f th e
a lte rn a tiv e h y p o th e s is th a t h e ro in a d d ic ts do n o t e v id e n c e s ig n ific a n t
p s y c h o p a th o lo g y w as tru e , th e n tre a tm e n t g o a ls and m ethods w o u ld
d iffe r . M e th a do n e tre a tm e n t m ig h t prove s u ffic ie n t.
R esearch Q u e s tio n s to be A nsw ered
The fo llo w in g re s e a rc h q u e s tio n s w ere in v e s tig a te d :
1. Is th e re a s ig n ific a n t d iffe re n c e in th e p e rs o n a lity
o f a d d ic ts and n o n a d d ic ts before th e a d d ic ts are
exposed to a m ethadone tre a tm e n t program ?
2. Is th e re a s ig n ific a n t d iffe re n c e in the p e rs o n a lity
o f a d d ic ts and n o n a d d ic ts a fte r s ix m onths o f
tre a tm e n t?
3. Is th e re a s ig n ific a n t d iffe re n c e in th e p e rs o n a lity
o f a n o n a d d ic t group on a p re te s t as com pared to
a s ix -m o n th fo llo w -u p ?
4. Is th e re a s ig n ific a n t d iffe re n c e in th e p e rs o n a lity
o f an a d d ic t group b e fo re tre a tm e n t as com pared to
s ix m onths in to tre a tm e n t?
i T h e o re tic a l Fram ew ork
I D o le and N y s w a n d e r's a p pro ach to th e problem o f h e ro in a d d ic -
i
I tio n is based on th e ir th e o ry th a t h e ro in a d d ic tio n is d e riv e d from a
I
' m e ta b o lic d e fic ie n c y . T h is d e fic ie n c y p re d is p o s e s c e rta in in d iv id u a ls
i
I to re sp on d to the in it ia l in ta k e o f n a rc o tic s so th a t euphoria is produced
i
J ra th e r th a n th e u s u a l a v e rs iv e e ffe c ts , such as n a u se a . A c c o rd in g to
! th e s e in v e s tig a to rs , m ethadone in h ib its d ru g -s e e k in g b e h a v io r b y
c o rre c tin g th e m e ta b o lic d e fic ie n c y and th u s e lim in a tin g th e e u p h o ri-
g e n ic e ffe c ts o f h e ro in .
N orm a l c u r io s ity , not p s y c h o p a th o lo g y , prom pts in it ia l e x p e ri
m e n ta tio n w ith the d ru g. T h is is c o n tra ry to th e tra d itio n a l p s y c h o lo g i
c a l th e o rie s o f a d d ic tio n w h ic h b e lie v e th a t th e in d iv id u a l seeks th e
e u p h o rig e n ic e ffe c ts o f h e ro in as a m eans o f e s c a p in g from r e a lity .
D o le and N ysw a n d e r used as e v id e n c e a g a in s t th is p s y c h o g e n ic m odel
o f a d d ic tio n th e ir fin d in g s th a t m ethadone p a tie n ts w ere a b le to e n te r
in to the m ainstream o f s o c ie ty fa ir ly w e ll b y re tu rn in g to w ork and
s c h o o l. These m easures o f s u cce ss based on co p in g w ith o u tw a rd
r e a lity seem le s s th a n adequ ate as an argum ent a g a in s t a p s y c h o lo g ic a l
m odel o f a d d ic tio n . The p a tie n t's in n e r s u b je c tiv e r e a lity is n ot
a c c o u n te d fo r. The c la im e d s u c c e s s m ay be due to changes in the
tra d itio n a l c rite ria fo r s u c c e s s , m a kin g co m p a riso n s u n re a lis tic .
"C o p in g w e ll, " as d e fin e d by D o le and N y s w a n d e r, m ay have l it t l e
re la tio n s h ip to tr a d itio n a l m easures o f p s y c h ia tric n o rm a lc y . The so cia
a d ju s tm e n t and d e crease in a n ti- s o c ia l b e h a v io r re p o rte d in m ethadone
p a tie n ts m ay w e ll re p re s e n t s u b s titu tio n o f a le g a l n a rc o tic , m ethadone,
fo r an ille g a l drug and th e e lim in a tio n o f th e problem s a s s o c ia te d w ith
p ro c u rin g i t .
The same p s y c h o lo g ic a l p roblem s, as m easured b y c e rta in p s y
c h o lo g ic a l te s ts , m ay be id e n tifie d in th e a d d ic t b e fo re and a fte r tre a t
m e n t. T h is w o u ld in d ic a te th e need fo r a re -e v a lu a tio n o f th e scope o f
th e h e ro in a d d ic tio n problem and m ethadone tre a tm e n t program s.
H o w e ve r, in no w a y w o u ld th e e x is te n c e o f such p s y c h o p a th o -
lo g ic a l tr a its e m p iric a lly d is tin g u is h w h e th e r th e s e p e rs o n a lity d iffe r
ences e x is t because o f a p s y c h o g e n ic c a u s a l re la tio n s h ip to a d d ic tio n
(p re d is p o s in g a d d ic tiv e p e rs o n a lity ), or b e ca u se o f an o u tg ro w th o f
a d d ic tio n . The in te n tio n o f th is s tu d y is n o t to d em onstrate e tio lo g y
b u t ra th e r is to in v e s tig a te th e re la tio n s h ip b e tw e e n h e ro in a d d ic tio n ,
I m ethadone tre a tm e n t, and p e rs o n a lity .
j I f i t is fo u n d , as e xp e c te d , th a t an a d d ic tio n group dem onstrated
1 b o th b e fo re and a fte r m ethadone tre a tm e n t a g re a te r degree o f p s y c h o -
I
I
p a th o lo g y th a n a n o n a d d ic t g ro up , th is w o u ld in d ic a te th a t th e tre a tm e n t
had no e ffe c t on th is v a ria b le and th a t th e p s y c h o s o c ia l a sp e cts re la te d
to h e ro in a d d ic tio n need to be a d d re sse d in a more a g g re s s iv e m anner
th a n th a t e x is tin g w ith in m ethadone c lin ic s a t p re s e n t. A re s tru c tu rin g
I o f th e a d d ic t's p e rs o n a lity w o u ld th e re fo re be n e e d e d --th e p s y c h o th e ra -
!
I p e u tic a pproach v a ry in g w ith o n e 's p s y c h o lo g ic a l p e rs p e c tiv e ( i. e . ,
!
I F re u d ia n , R og erian, E x is te n tia l, e t c .) . W h a t th e s e v ie w s have in
I com m on is th e ir c o n v ic tio n th a t the ca u se o f a d d ic tio n lie s w ith in th e
p sych e o f th e a d d ic t; th a t th e use o f n a rc o tic s is the re s u lt o f p e rso n a l
I p roblem s p ro h ib itin g s o c ia lly a c c e p ta b le , c o n s tru c tiv e b e h a v io r. C he in
j (1964) argues a g a in s t th e prem ise th a t th e m ost im p o rta n t ta s k th a t
I
j needs to be c a rrie d o u t in th e tre a tm e n t o f a d d ic ts is to g e t them to sto p
ta k in g d ru g s . C h e in 's v ie w a c c u ra te ly re fle c ts th e p s y c h o s o c ia l m odel
o f a d d ic tio n o p p o sin g D ole and N y s w a n d e r's a p pro a ch :
The im p o rta n t ta s k is to h e lp a d d ic ts s o lv e
th e ir p ro b le m s, and th a t th e y ta k e n a rc o tic s
is , per se, th e le a s t o f th e s e . A ls o be ar in
m ind th a t n a rc o tic s a d d ic tio n d o e s, in m any
c a s e s , have an a d a p tiv e fu n c tio n ju s t as do
th e sym ptom s o f p s y c h o n e u ro s is , and th a t
e lim in a tin g re c o u rs e to such sym ptom s w ith o u t
• p ro d u cin g a n y m ore fu n d a m e n ta l change le a v e s
th e p a tie n t in d ire p e ril in d e e d , (p . 113)
In th e ir in v e s tig a tio n in to re h a b ilita tiv e a p proach es to w a rd s
drug dependence, Bow den and M a d d u x (197 3) su g ge sted s e v e ra l rea sons
fo r th e sym p to m a tic use o f h e ro in :
1. To h e lp c o n tro l c h ro n ic a n g e r.
2. To h e lp a c h ie v e in te rp e rs o n a l c lo s e n e s s
w h ic h a n x ie ty o fte n m akes d if f ic u lt .
3. To a lle v ia te c h ro n ic b o d ily p a in prom pted
b y e m o tio n a l d is tu rb a n c e .
4. To a c h ie v e a fa n ta s ie d n a r c is s is tic ,
m y s tic a l e x p e rie n c e , (p. 127)
E xp e rim e n ta l re s e a rc h re la te d to th e p s y c h o s o c ia l m odel o f
a d d ic tio n is p re se n te d in C h a p te r I I .
S tatem ent o f H yp o th e se s
The fo llo w in g h yp o th e se s are s ta te d in th e d ire c tio n o f th e ir
e xp e cte d outcom e:
1. S ig n ific a n t p e rs o n a lity d iffe re n c e s e x is t be tw e e n
a d d ic ts and n o n a d d ic ts b e fo re th e a d d ic t group is
exposed to a m ethadone tre a tm e n t program .
2. S ig n ific a n t p e rs o n a lity d iffe re n c e s e x is t be tw ee n
a d d ic ts and n o n a d d ic ts a fte r th e a d d ic t group
re c e iv e s s ix m onths o f m ethadone tre a tm e n t.
3. N o s ig n ific a n t p e rs o n a lity d iffe re n c e s e x is t in a
n o n a d d ic t group on a p re te s t as com pared to a
s ix m onth fo llo w - u p .
4. N o s ig n ific a n t p e rs o n a lity d iffe re n c e s e x is t in an
a d d ic t g roup b e fo re m ethadone tre a tm e n t as co m
pared to a fte r s ix m onths o f tre a tm e n t.
M e th o d o lo g ic a l A ssu m p tio n s
The fo llo w in g m e th o d o lo g ic a l a s s u m p tio n s w ere m ade:
1. D em o g ra ph ic and o th e r s u p p o rtiv e data on th e s u b je c ts
w ere a c c u ra te . D ata w ere a c c u ra te ly c o lle c te d , re co rd e d ,
sto re d , and a n a ly z e d .
2. The re s e a rc h d e s ig n , s u b je c t s e le c tio n p ro ce d u re s, and
data p ro c e s s in g te c h n iq u e s used in th e s tu d y w ere
a p p ro p ria te to th e in te n t o f th e in v e s tig a tio n .
3. The M in n e s o ta M u ltip h a s ic P e rs o n a lity In v e n to ry (M M P I)
is a v a lid and re lia b le m easure o f p e rs o n a lity fo r th e
p urposes o f th is in v e s tig a tio n .
4. The b a s ic s c a le s o f th e M M P I are s u ffic ie n tly in d e p e n d e n t
to ju s t if y use o f th e t - s t a t is t ic (see C ha p te r 3, In s tru m e n
ta tio n , fo r in te rc o rre la tio n s ).
5. The c o n tro l and th e e x p e rim e n ta l groups w ere a d e q u a te ly
m a tch e d, w ith th e e x c e p tio n o f a h is to ry o f drug a d d ic tio n .
6. N one o f th e s u b je c ts had p re v io u s ly ta k e n an y te s ts u t i l
iz e d in th is in v e s tig a tio n .
7. T a kin g th e M M P I in d iffe re n t e n v iro n m e n ta l s e ttin g s does
n o t s ig n ific a n tly a ffe c t s c o re s .
8. Tim e in tre a tm e n t is th e g re a te s t s in g le sou rce o f v a ria n c e
in p e rs o n a lity change o f a d d ic ts as m easured b y th e M M P I,
9. A ny e xtra n e o u s tre a tm e n t d iffe re n c e s b e tw e e n s u b je c ts in
th e e x p e rim e n ta l group are n o t c o rre la te d w ith p e rs o n a lity
change as m easured b y th e M M P I.
D e lim ita tio n s
The fo llo w in g d e lim ita tio n s serve to n a rro w th e fo c u s o f th e
s tu d y and th e e x te n t to w h ic h its re s u lts can be g e n e ra liz e d :
1. A ll s u b je c ts w ere E n g lis h -s p e a k in g a d u lts .
2. The s u b je c ts w ere a ll m a le ,
3. A ny c o n c lu s io n s re g a rd in g tre a tm e n t e ffe c t are lim ite d to
th e fir s t s ix m onths o f tre a tm e n t.
4. A lth o u g h th e to ta l num ber o f 59 s u b je c ts is s u ffic ie n t fo r
th e a n a ly s is p roced ures em plo ye d in th e in v e s tig a tio n , a
la rg e r sam ple w o u ld have in c re a s e d th e s tre n g th o f th e
c o n c lu s io n s in fe rre d and th e re co m m e n d a tion s m ade.
D e fin itio n s
1. P e rs o n a lity : C o n s is ts c o n c re te ly o f a set o f v a lu e s o r des
c r ip tiv e te rm s w h ic h are used to d e s c rib e th e in d iv id u a l b e in g stu d ie d
10
a c c o rd in g to th e v a ria b le s or d im e n sio n s w h ic h o c c u p y a c e n tra l p o s i
tio n w ith in th e p a rtic u la r th e o ry u tiliz e d (H a ll & L in d z e y , 1951). In trin
s ic a lly , p e rs o n a lity is a term used fo r c la s s ific a tio n and id e n tific a tio n
o f th e in d iv id u a l w ith in a p a rtic u la r m o d el or fram ew ork fo r th e purpose
o f in te rp e rs o n a l re fe re n c e and m u tu a l c o m p re h e n s ib ility .
2. P e rs o n a lity D iffe re n c e : A s ta tis tic a lly s ig n ific a n t num erica
v a lu e o b se rve d be tw ee n c o n tro l group and e x p e rim e n ta l group, or b e
tw e e n p re - and p o s tte s ts o f e ith e r g ro u p , on s e le c te d M M P I b a s ic
c lin ic a l s c a le s .
3. H e ro in : An o p ia te n a rc o tic pro du ce d b y h e a tin g m orphine in
th e presen ce o f a c e tic a c id .
4. H e ro in A d d ic tio n : A c o n d itio n in w h ic h an in d iv id u a l dem -
I o n s tra te s c o m p u ls iv e d ru g -s e e k in g b e h a v io r, th a t is , th e procurem ent
o f drugs becom es th e d o m in a n t m o tiv a tin g need. The a b sence o f th e
n a rc o tic produces w ith d ra w a l sym ptom s w h ic h th e a d d ic t seeks to a v o id
( i . e . , a n x ie ty , re s tle s s n e s s , p e rs p ira tio n , d ila te d p u p ils , in c re a s e d
h e a rt ra te , in c re a s e d b lo o d p re s s u re , m u scle cra m ps, e t c .) . The
le n g th and fre q u e n c y o f h e ro in usage w ere n ot c r ite r ia . H ow ever, th e
a d d ic t m u st have had a h is to ry o f a t le a s t tw o p re v io u s u n s u c c e s s fu l
d e to x ific a tio n a tte m p ts to be a d m itte d to th e m ethadone program under
s tu d y .
5. M e th a d o n e : A s y n th e tic n a rc o tic re s e m b lin g m orphine and
11
h e ro in in its d e p e n d e n c y -p ro d u c in g e ffe c t, a lth o u g h i t is n o t d e riv e d
from o p iu m .
O rg a n iz a tio n o f th e R em ainder o f th e S tudy
C h a p te r I I is d iv id e d in to fo u r s e c tio n s : The f ir s t s e c tio n w ill
a tte m p t to more a d e q u a te ly d e fin e th e problem o f n a rc o tic s a d d ic tio n b y
c itin g c u rre n t tre n d s w ith in a s o c ia l-e c o n o m ic p e rs p e c tiv e . The fo llo w
in g tw o s e c tio n s exam ine lite ra tu re re la tin g p e rs o n a lity and p s y c h o p a th
o lo g y to th e c h a ra c te ris tic s and in flu e n c e s o f th e h e ro in a d d ic t's fa m ily
o f o rig in , so as to illu m in a te p o s s ib le a n te c e d e n t v a ria b le s to h e ro in
a d d ic tio n . The la s t s e c tio n d e a ls w ith tre a tm e n t m o d a litie s , n o n -m e th
adone and m ethadone.
M e th o d o lo g y is d is c u s s e d in C h a p te r I I I . I t in c lu d e s th e fo llo w
in g : 1) re s e a rc h d e s ig n , 2) sam ple c h a ra c te ris tic s , 3) in s tru m e n ta tio n
4) e x p e rim e n ta l p ro ce d u re s, 5) te s t a d m in is tra tio n and s c o rin g , 6)
data a n a ly s is , and 7) lim ita tio n s o f th e s tu d y .
C h a p te r IV p re se n ts th e re s u lts o f th e e x p e rim e n t and an a n a ly
s is and d is c u s s io n o f th e fin d in g s .
A sum m ary and c o n c lu s io n s are p re se n te d in C h a p te r V.
•CHAPTER II
R evie w o f the L ite ra tu re
The problem o f h e ro in a d d ic tio n assum ed a la rm in g p ro p o rtio n s
w ith th e h e ro in e p id e m ic o f th e la te 1 9 6 0 's . N um erous re c e n t su rve ys
have a tte m p te d to e s tim a te th e e x te n t o f h e ro in a d d ic tio n in th e U n ite d
S ta te s . B a ll, E n g la n d e r, and C ham bers (1967) e s tim a te d th a t th e re
w ere 1 0 8 ,4 2 4 kno w n o p ia te a d d ic ts in 1967. M c G lo th lin , Tabbush, and
C ham bers (197 2), in w h a t w as c o n s id e re d a c o n s e rv a tiv e fig u re , e s t i
m ated th a t th e re w ere 37 5, 000 h e ro in a d d ic ts in 1971. The Bureau o f
N a rc o tic s and D angerous D rugs (BNDD) e s tim a te d a to ta l o f 515, 000
h e ro in a d d ic ts in th e c o u n try in 197 2. C im in o , D oud, A n d im a , and
W e st (197 3), c o lle c tin g n a tio n a l d a ta , e s tim a te d th e num ber o f n a rc o tic
a d d ic ts in the U n ite d S tates to be b e tw e e n 6 9 8 ,7 82 and 8 1 9 ,9 3 2 .
A h e ro in a d d ic t m ay spend $15 to $100 a da y to su p po rt an
average h a b it. The N e w York C ity N a rc o tic s R e g iste r e s tim a te d th e re
w ere 3 1 6 ,9 1 8 n a rc o tic a d d ic ts in N ew York in 1972, e xp en d in g about
$ 3 .5 m illio n d a ily .
There is a p o s itiv e c o rre la tio n b e tw e e n h e ro in a d d ic tio n and
c rim e . M o o re (197 2) re p o rte d th a t 30% to 40% o f h e ro in is purchased
w ith fu n d s a tta in e d th ro u g h v ic tim le s s c rim e s such as b u rg la rie s , ro b
b e rie s , and s h o p liftin g . The C o m m is s io n e r o f N a r c o tic s , J. In g e rs o l,
12
13
c o n s e rv a tiv e ly e s tim a te d th e c o s t o f h e ro in de pe n d e ncy to be $ 3 .5
b illio n a n n u a lly to th e U n ite d S ta te s , co m p rise d o f p e rso n n e l and in s t i
tu tio n a liz a tio n c o s ts (197 2). There are abun d a n t s ta tis tic s te s tify in g
to th e re la tio n s h ip be tw ee n h e ro in u s e , c rim e , and governm ent e x p e n d i
tu re s .
In a d d itio n to th e re la tio n s h ip o f c rim e and re la te d e co no m ic
e x p e n d itu re s , th e num ber o f n a rc o tic -re la te d d eaths in c re a s e d d ra s tic
a lly from 1950 to 1970. In 1971, n a tio n w id e , o ve r 2 ,0 0 0 deaths
o ccu rre d from h e ro in o ve rd o se s or d is e a s e s re la te d to drug abuse (N ew
York T im e s, M a rc h 21, 197 2).
H unt (197 4) s ta te d th a t i t w o u ld be m ost m e a n in g fu l to break
dow n n a tio n a l tre n d s in to g e o g ra p h ic a re a s . W hereas in th e la te 1960's
th e h e ro in e p id e m ic peaked in th e c itie s la rg e r th a n 500, 000, th e in
cre a se in h e ro in a d d ic tio n in 197 4 w as p rim a rily in th e s m a lle r c itie s
(400, 000 p o p u la tio n or le s s ).
Bourne (197 4) trie d to e x p la in th e h e ro in e p id e m ic o f th e la te
19 6 0 's th ro u g h an a n a ly s is o f th e s o c ia l and e co n o m ic c o n d itio n s o f the
tim e s : a) tr a d itio n a l s o c ia l v a lu e s w ere c h a lle n g e d . In its extrem e
form e x is te d a "c o u n te r-c u ltu re " based upon a re v e rs e c o n fo rm ity --
w h ic h w as a lm o s t as s tiflin g as its c u ltu ra l n e m e s is . One c h a ra c te r
is t ic o f th e c h a lle n g e has been an in c re a s e d in te re s t and use o f d ru g s;
b) b la c k s had a g re a te r am ount o f m oney to b u y d ru g s; c) g re a te r b la c k -
14
w h ite c o n ta c t prom pted b y th e c iv il rig h ts m ovem ent le d to educated
w h ite yo u th s c o m m u n ic a tin g to le ra n c e fo r drug use to b la c k s ; d) drug
s a le s w ere no lo n g e r as c e n tra liz e d , a llo w in g fo r p ro fits and hence
m oney fo r p u rc h a s in g drugs b y a g re a te r num ber o f p e o p le .
In try in g to p re d ic t fu tu re tre n d s c o n c e rn in g th e in c id e n c e o f
h e ro in a d d ic tio n , D r. R obert D up o n t, D ire c to r o f th e N a tio n a l In s titu te
on D rug A buse, s ta te d th a t "w e can no lo n g e r ta lk about tu rn in g th e
c o rn e r on h e ro in a d d ic tio n " (197 5). As so urces o f s u p p ly in c re a s e ,
b o th from T u rke y and M e x ic o , use o f n a rc o tic s in th is c o u n try w ill in
a ll p ro b a b ility in c re a s e .
P e rs o n a lity and P sych o p a th o lo g y Among H e ro in A d d ic ts
A bundant re s e a rc h has been c a rrie d o u t under the th e o re tic a l
a s s u m p tio n th a t p e op le w ith d iffe re n t ty p e s o f p e rs o n a litie s are more
p re d is p o s e d to h e ro in a d d ic tio n th a n o th e rs . T h is lite ra tu re has a t
te m p te d to d iffe re n tia te th e ty p e o f p e rs o n a lity o f th e h e ro in a d d ic t from
th a t o f th e n o n a d d ic t. H en ce , th e re s e a rc h is d ire c te d to w a rd s try in g
to id e n tify th e p e rs o n a lity c h a ra c te ris tic s o f th e "d ru g -d e p e n d e n t" or
" a d d ic tiv e " p e rs o n a lity . The A m erican M e d ic a l A s s o c ia tio n C om m ittee
on A lc o h o l and D rug D ependence (1968) su p p o rte d such a lin e o f r e
sea rch w hen i t s ta te d th a t drug use re s u lts in dependence w hen th e
ro o ts o f dependence are a lre a d y p re se n t in th e in d iv id u a l; drugs m e re ly
fe e d in to th is te n d e n c y . Thus i t seem s n e c e s s a ry to lo o k fir s t a t th e
15
p s y c h o lo g ic a l m akeup o f th e d ru g -d e p e n d e n t in d iv id u a l, and th e n a t
p o s s ib le re a so n s fo r h is h a v in g a c q u ire d th o s e p a rtic u la r tr a its .
There have been e x te n s iv e s tu d ie s te s tify in g to th e presence o f
a s ig n ific a n t degree o f p s y c h o p a th o lo g y in h e ro in a d d ic ts , as e v id e n c e d
b y c lin ic a l o b s e rv a tio n s and p s y c h o lo g ic a l te s ts . By fa r th e m ost
w id e ly u se d in s tru m e n t has been th e M in n e s o ta M u ltip h a s ic P e rs o n a lity
In v e n to ry (M M P I). S utker (197 1) fou nd norm a l M M P I p ro file s in o n ly
12% o f th e h e ro in a d d ic ts she sa m p le d . In try in g to c o n tro l fo r s e le c
tio n b ia s as a p o s s ib le source o f in v a lid ity ( i. e . , c r im in a lity le v e l) ,
S u tke r and M oa n (197 2) th e n com pared fe m a le s tre e t a d d ic ts , h e ro in
a d d ic t p ris o n e rs , and n o n a d d ic t p ris o n e rs . The n o n a d d ic t p ris o n e rs
show ed b y fa r th e g re a te s t num ber o f norm a l M M P I p ro file s (48%) w h ile
th e h e ro in a d d ic t p ris o n e rs and s tre e t a d d ic ts show ed o n ly 18% and 21%,
r e s p e c tiv e ly . S heppard, F ra c c h ia , R ica , and M e rlis (1972) a d m in is te re d
M M P I's to m ale h e ro in a d d ic ts and fo und o n ly 6% o f th e sam ple to have
a c o m p le te a b sence o f s ig n ific a n t p s y c h o p a th o lo g y . G a rd n e r (1967),
u tiliz in g th e R otte r In c o m p le te S entence B la n k, a ls o fo u n d a s ig n ific a n t
le v e l o f g e n e ra l p s y c h o p a th o lo g y in h e ro in a d d ic ts . U s in g a c u t- o ff
s c o re , he c o rre c tly id e n tifie d 80% o f m ale and 100% o f fe m a le h e ro in
u s e rs .
H ill, H a e rtz e n , and G la s e r (1960), in an M M P I s tu d y o f 27 0
a d o le s c e n t and a d u lt n a rc o tic a d d ic ts , fo u n d 19% to be n e u ro tic , e v i-
16
d e n cin g a n x ie ty and d e p re s s io n . K ra ft (197 0) n o te d b o th a h ig h degree
o f s o c ia l a n x ie ty and s e x u a l d is tu rb a n c e in h is o b s e rv a tio n s o f n a rc o tic
a d d ic ts . He a ls o re p o rte d , th ro u g h case h is to rie s , th a t severe p e rs o n
a lit y d is o rd e rs e x is te d p rio r to drug a d d ic tio n and th a t drug use began
in an e ffo rt to seek r e lie f from n e u ro tic sym ptom s.
M M P I s tu d ie s have in d ic a te d th a t an even h ig h e r p ro p o rtio n o f
n a rc o tic a d d ic ts are d ia g n o se d p s y c h o tic th a n n e u ro tic ( H ill et a l. ,
1960; S utker,, 1971; S u tke r & M o a n , 1972; Sheppard e t a l. , 197 2;
B e rz in e , R oss, & M o n ro e , 1971).
G erard and K o rn e ts k y (1954) c la s s ifie d re s p o n s e s b y m ale h e ro in
a d d ic ts to th e R orschach and Hum an F ig u re D ra w in g s and found a s ig
n ific a n t p e rce n ta g e o f s u b je c ts to be s c h iz o p h re n ic . They c o n c lu d e d
th a t d ru g -ta k in g served as a d e fense a g a in s t a n x ie ty b y fa c ilita tin g
d e n ia l and a v o id a n c e .
The la rg e s t c a te g o ry o f p s y c h o p a th o lo g y lin k e d to h e ro in a d d ic
tio n is p e rs o n a lity and c h a ra c te r d is o rd e r. A u su b e l (1961) c a lle d a tte n
tio n to th e fu n c tio n a l a s p e c ts o f drug a b use , s ta tin g th a t i t seem ed to
be a v e h ic le o f a d ju s tm e n t fo r im m ature a d d ic ts . By c re a tin g a sense o f
e u p h o ria , drugs serve to d u ll s e lf - c r it ic a l a ttitu d e s . The p ro v is io n o f
im m e d ia te and e ffo rtle s s g ra tific a tio n in w h ic h e n v iro n m e n ta l dem ands
are a v o id e d , a llo w s th e a d d ic t to fe e l co n te n te d w ith h is a d ju s tm e n t to
lif e . H e has illu s o r y fe e lin g s o f s e lf-c o n fid e n c e w h ile in r e a lity he is
17
p a s s iv e and d e p e n d e n t. A u su b e l used th e re s u lts o f p s y c h o lo g ic a l te sts'
and p s y c h ia tric h is to rie s o f a d o le s c e n t h e ro in a d d ic ts a t B e lle v u e H o s
p ita l as e v id e n c e fo r h is c o n c lu s io n s . In a d d itio n , he c ite d th e fin d in g
j th a t 58% o f 318 a d u lt a d d ic ts a t B e lle v u e w ere d ia g n o se d as in a d e q u a te
I
1 p e rs o n a litie s .
G erard and K o rn e sky (1954), and C h e in , G e ra rd , Le e, and
R o se n fe ld (1964) a d m in is te re d b o th th e R orsch ach and Hum an F ig ure
D ra w in g te s ts to a d o le s c e n t h e ro in a d d ic ts and c o n tro l s u b je c ts . The
re s u lts o f th e tw o s tu d ie s co rro b o ra te d one a n o th e r: re sp o n se s b y
a d d ic ts w ere fa r more c o n s tric te d and r ig id , sh o w in g a te n d e n c y to
w ith d ra w u n de r s tre s s and le s s e m o tio n a l r e s p o n s ib ility . The a d d ic ts
appeared le s s a b le to s u s ta in c lo s e peer r e la tio n s h ip s .
S e ve ral M M P I s tu d ie s in d ic a te th a t a h ig h p ro p o rtio n o f n a rc o tic
a d d ic ts have s o c io p a th ic or p s y c h o p a th ic tr a its , as e v id e n ce d b y an
e le v a te d " 4 - 9 " code ty p e (the P s y c h o p a th ic D e v ia te and M a n ia s c a le s ,
re s p e c tiv e ly ). M a rk s and Seaman (1963) c h a ra c te riz e d a person h a v in g
such a p ro file as b e in g s o c io p a th ic , e m o tio n a lly u n s ta b le , and as fr e
q u e n tly p o s s e s s in g s e x u a l p ro b le m s. H ill e t a l. (1960), and H ill,
I H a e rtz e n , and D a v is (1962) lo o k e d a t M M P I p ro file s o f m ale n a rc o tic
a d d ic ts . They foun d p re d o m in a n tly s o c io p a th ic p ro file s in 54% o f th e
c a s e s .
An o fte n p o in te d to c ritic is m in a d d ic tio n s tu d ie s is s e le c tio n
18
b ia s . G ilb e rt and Lo m bardi (1967) a tte m p te d to re p lic a te th e above
s tu d ie s w ith th e added p re c a u tio n o f c o n tro llin g fo r th e s o c io e c o n o m ic
b a ckg ro u n d o f b o th e x p e rim e n ta l and c o n tro l s u b je c ts . The p ro file s o f
th e n a rc o tic a d d ic t sam ple w ere s ig n ific a n tly h ig h e r th a n th e n d n a d d ic t
s u b je c ts on th e fo llo w in g s c a le s o f th e M M P I: D e p re s s io n , P sych o
p a th ic D e v ia te , P s y c h a s th e n ia , S o c ia l In tro v e rs io n , and H y s te ria .
T hey c o n c lu d e d th a t th e n a rc o tic a d d ic ts show ed s ig n ific a n t p s y c h o
p a th ic tr a its . G ilb e rt and Lom bardi d e s c rib e d th e a d d ic ts as b e in g s e lf
in v o lv e d and irre s p o n s ib le , dem anding im m e d ia te g r a tific a tio n and la c k
in g p e rs is te n c e to a c h ie v e g o a ls , e v id e n c in g d is re g a rd fo r s o c ie ty 's
m o res, and as h a vin g d if f ic u lt y in fo rm in g warm and la s tin g r e la tio n
s h ip s . S im ila r re s u lts from M M P I s tu d ie s in d ic a tin g th e p re sen ce o f
s o c io p a th ic or p s y c h o p a th ic tr a its in a la rg e p e rcen ta g e o f n a rc o tic
a d d ic ts w ere fou n d b y S u tke r (1971), Sheppard e t a l. (197 2), and O v e ra ll
(1 9 73 ).
In re sp o n se to th e above s tu d ie s , B e rz in s , R oss, and M o n ro e
(1971) saw a danger in s te re o ty p in g a d d ic ts as p s y c h o p a th ic s in c e
p s y c h o p a th y is g e n e ra lly b e lie v e d to be a lm o s t im p o s s ib le to tre a t.
They lo o k e d a t e ig h t c lin ic a l s c a le s o f th e M M P I and fou nd a v a rie ty o f
d is o rd e rs o c c u rrin g w ith a lm o s t e q ua l fre q u e n c y in a s s o c ia tio n w ith
h e ro in a d d ic tio n : c h a ra c te r d is o rd e rs , n e u ro se s, and p s y c h o s e s . T h e ir
c o n c lu s io n s p a ra lle le d Sheppard et a l. (197 2), who s ta te d : "a d d ic ts
19
are a hete rog e n o us p sych o p a th o lo g ic a l p a tie n t g ro u p " (p. 54). W h ile
th e re appears to be a s ig n ific a n t degree o f p s y c h o p a th o lo g y show n by
h e ro in a d d ic ts in g e n e ra l, th e re a p p a re n tly is no s in g le p e rs o n a lity
ty p e c h a ra c te riz in g a ll h e ro in a d d ic ts . These c o n c lu s io n s w o u ld seem
to su g g e st th a t d iffe re n t tre a tm e n t a p pro a ch e s m ay be w a rra n te d fo r
d iffe re n t ty p e s o f a d d ic ts .
The ide a o f a "p re d is p o s in g a d d ic tiv e p e rs o n a lity " d iffe re n tia tin g
th e a d d ic t from th e n o n a d d ic t cam e under a tta c k b y G endreau and G e n
dreau (1970, 197 1, 197 3 ). The a u th o rs p o in te d o u t th a t in m any o f th e
s tu d ie s c ite d th e re w ere seve re m e th o d o lo g ic a l fla w s c o n fo u n d in g the
re s u lts w h ic h c o u ld have a cc o u n te d fo r th e p e rs o n a lity d iffe re n c e s founc
b e tw e e n a d d ic ts and n o n a d d ic ts . H en ce , th e e x is te n c e o f a d ru g -d e
pendent " ty p e " o f p e rs o n a lity m ay be an in v a lid c o n c lu s io n .
It is im p o rta n t to n o te th e a b sence o f ad eq u a te e x p e rim e n ta l
c o n tro ls in a d d ic tio n re s e a rc h , p a rtic u la rly th e fa ilu re to a d e q u a te ly
m a tch e x p e rim e n ta l s u b je c ts w ith e q u iv a le n t c o n tro ls . For exam ple,
G e ra rd and K o rn e ts k y (1954) d id n o t pay th e e x p e rim e n ta l s u b je c ts , b u t
d id pay th e c o n tro l g ro u p . The q u e s tio n o f m o tiv a tio n as a co n fo u n d in g
fa c to r is c e r ta in ly to be ra is e d h e re. In a d d itio n , in th e same stu d y,
th e p ro je c tiv e te s ts used w ere n o t score d b lin d , a n o th e r o b v io u s source
o f in te rn a l in v a lid ity . G ilb e rt and Lom bardi (1967), w h ile c o n tro llin g
fo r s o c io e c o n o m ic b a ckg ro u n d , fa ile d to m a tch s u b je c ts on le v e l o f
20
c rim in a l a c tiv it y . In a tte m p tin g to re p lic a te th e ir s tu d y , H ill e t a l.
(1962) used c o n tro l s u b je c ts from a m axim um s e c u rity p ris o n , c e rta in ly
i an extrem e g ro u p . The g ro up s a ls o d iffe re d in I. Q.
I
j A no th e r c r itic is m o f th e a d d ic tio n lite ra tu re is th e fa ilu re o f th e
1 in v e s tig a to rs to d e fin e a d e q u a te ly w h a t th e y m ean b y a d d ic tio n : H ow is
a d d ic tio n d e fin e d in term s o f ty p e o f drug (h e ro in ? ), d u ra tio n , frequency
and so on?
W h ile c r itic is m o f th e s e m e th o d o lo g ic a l fla w s is c e rta in ly w a r
ra n te d , th e re are s e rio u s d if fic u lt ie s in h e re n t in a d d ic tio n re s e a rc h .
True ra n d o m iz a tio n is o fte n p re c lu d e d b e cause c irc u m s ta n c e s dem and
th e use o f in ta c t g ro u p s . These p re s e le c te d g roups m ay be c o m p ris e d
o f v o lu n ta ry p a tie n ts w h ile o th e rs m ay be in c a rc e ra te d p a tie n ts . In
! a d d itio n , i t is v e ry d if f ic u lt to fin d c o n tro ls on w h ic h to m atch a ll
! re le v a n t d im e n s io n s .
I
In sum m ary, th e re is m uch re s e a rc h s u p p o rtin g th e v ie w th a t
th e re is a s ig n ific a n t am ount o f p s y c h o p a th o lo g y am ong a d d ic ts . The
la rg e s t c a te g o ry o f p s y c h o p a th o lo g y lin k e d to h e ro in a d d ic tio n is p e r
s o n a lity and c h a ra c te r d is o rd e r. An o fte n p o in te d to c r itic is m o f a d d ic
tio n s tu d ie s is la c k o f pro pe r e x p e rim e n ta l c o n tro ls re s u ltin g from s e l-
j e c tio n b ia s and la c k o f tru e ra n d o m iz a tio n .
21
F a m ily C h a ra c te ris tic s and In flu e n c e s
I f one does adhere to th e " a d d ic tiv e p e rs o n a lity h y p o th e s is , "
th e n one m ust n e c e s s a rily lo o k a t th o s e c o rre la te s to h e ro in a d d ic tio n
w h ic h m ay a c t as a n te c e d e n t v a ria b le s . M a n y re s e a rc h e rs have tu rn e d
to th e fa m ily in th e hope o f d is c o v e rin g p o s s ib le fa m ily and h is to r ic a l
c o rre la te s to drug a d d ic tio n and re la te d p s y c h o p a th o lo g y .
H yp o th e se s a b ou t th e re la tio n s h ip b e tw e e n a d d ic ts and th e ir
m others have fig u re d p ro m in e n tly in th e lite r a tu r e . W o lk and D is k in d
(19 61), in re v ie w in g th e ir ow n c lin ic a l e x p e rie n c e , b e lie v e th a t th e
m o th e r o f an a d d ic t fo s te rs a p a ra s itic dependence in her c h ild o u t o f
h er ow n needs to be im p o rta n t and d o m in a n t. H ill e t a l. (19 62) d e ta ile d
an in te rp e rs o n a l pro cess o rig in a tin g in th e fa m ily o f th e a d d ic t: th e
a d d ic t a g g re s s iv e ly a c ts o u t a g a in s t an a u th o rita ria n m other w ho has
I th w a rte d him in som e w a y, and a fte rw a rd s he fe e ls g u ilty and dep re sse d
I
I In agreem ent w ith th e above h y p o th e s e s , F ra z ie r (1962) c o n
sid e re d n a rc o tic s to be a m eans o f s u b lim a tin g h o s tility . He b e lie v e s
i t is m a in ly d ire c te d a g a in s t th e m o th e r, a w om an who is lo n e ly and
e m o tio n a lly is o la te d and ra is e s her c h ild to becom e lik e h e r. V a lie n t
(1966) fou nd th a t a d d ic ts v e ry o fte n re m a in w ith th e ir m others o r a n o th e r
fe m a le r e la tiv e fa r in to a d u lth o o d , som etim es beyond th e th ir tie th ye a r.
In an e x p lo ra to ry s tu d y . Tord a (1968) em plo ye d a q u e s tio n n a ire designee
to e x p la in th e p s y c h o d y n a m ic p ro ce sse s o f a d d ic ts and th e ir fa m ilie s .
22
The m o th e r c le a r ly em erged as th e d o m in a n t a u th o rity in th e hom e; th e
fa th e r w as g e n e ra lly seen as w eak and d is in te re s te d in th e fa m ily , p a r
tic u la r ly in th e a d d ic t.
In a b ro a d -b a s e d s tu d y ru n in h ig h -a d d ic tio n areas (R ichards &
L a ng e r, 1971), th e fo llo w in g c h a ra c te ris tic s o f th e a d o le s c e n t n a rc o tic
u s e r w ere in d ic a te d :
1. A b se n t or w eak fa th e r.
2. O v e rp ro te c tiv e , o v e rin d u lg e n t, d o m in
e e rin g m other.
3. In c o n s is te n t sta n d a rd s o f b e h a v io r;
la c k o f d e fin itio n o f lim its .
4. H o s t ility o r c o n flic t b e tw e e n p a re n ts .
5. U n re a lis tic a s p ira tio n s fo r c h ild re n .
M o re re c e n t s tu d ie s have a tte m p te d to fin d e m p iric a l v a lid a tio n
fo r th e above th e o re tic a l argum ents and te n ta tiv e c o n c lu s io n s , u tiliz in g
a p p ro p ria te e x p e rim e n ta l c o n tro ls . Baer and C orrado (197 4) e x p lo re d th e
ro le o f p a re n ta l in flu e n c e s on h e ro in a d d ic tio n v ia a b io g ra p h ic a l q u e s
tio n n a ire . In c o m p a riso n to a m atched c o n tro l g ro up o f n o n u se rs, th e
a d d ic ts m ore o fte n had e x p e rie n c e d an un ha p p y c h ild h o o d , in c lu d in g th e
fo llo w in g : harsh p h y s ic a l p u n ish m e n t, n e g le c t and re je c tio n , absence
o f one p a ren t from th e hom e, and le s s p a re n ta l in te re s t in th e ir s c h o o l
p e rfo rm a n ce . N e v e rth e le s s , m o st o f th e a d d ic ts in d ic a te d a g re a te r
w illin g n e s s to r e liv e p a rts o f th e ir p a s t. The a u th o rs su g ge sted th a t i t
w as e ith e r m ore a ttra c tiv e to them th a n th e ir p re s e n t o r th a t a p a s t
problem needed re s o lu tio n .
23
K aplan and M e y e ro w itz (197 0) foun d a s ig n ific a n tly h ig h e r p e r
ce n ta g e o f a d d ic ts th a n n o n a d d ic ts cam e from b ro ke n hom es:
A d d ic ts N o n a d d ic ts
1. p a ren ts liv in g to g e th e r 49% 79%
2 . b o th p a re n ts dead 2 2 % 1 2 %
3. p a ren ts se p a ra te d or d iv o rc e d 28% 9%
In sum m ary, th e re are no kn ow n fa c to rs w h ic h d e fin ite ly cause
a person to becom e an a d d ic t. A s u b s ta n tia l am ount o f re s e a rc h e v i
dences a stro n g re la tio n s h ip b e tw e e n fa m ily d yn a m ics and d ru g -ta k in g
b e h a v io r. The a d d ic t is v ie w e d as e m o tio n a lly dependent and in s e c u re ,
tu rn in g to drugs as a m eans o f c o p in g w ith r e a lity .
T re atm ent
The ra p id g ro w th o f th e d ru g -a b u s e problem proved a c h a lle n g e
to tr a d itio n a l te c h n iq u e s used in th e m e n ta l h e a lth p ro fe s s io n . The s o -
c a lle d p e rs o n a lity d is o rd e r has fa ile d to re sp o n d to th e g e n e ra l
a p pro a ches e m p lo ye d w ith o th e r p s y c h o lo g ic a l p ro b le m s . Land (1969)
a tte m p te d to c la r ify c e rta in b a s ic p o in ts w h ic h m ay a id u n d e rs ta n d in g
th e problem fa c e d w hen try in g to com e to g rip s w ith an a p p ro a ch to drug
r e h a b ilita tio n . These are h is b a s ic p o in ts :
1. There is no m ira c le c u re — d o n 't w a ste
tim e lo o k in g fo r th e m .
2, Your d o c to r ca n n o t g e t rid o f an a d d ic
tio n b y w ritin g a p re s c rip tio n .
24
3. The p s y c h o th e ra p y fa s h io n e d to cope
w ith u s u a l n e u ro s is is m e a n in g le s s ,
and th e p s y c h o a n a ly s t is g e n e ra lly
h e lp le s s .
4. M o n e y m akes no s ig n ific a n t d iffe re n c e
in s e c u rin g b e tte r tre a tm e n t; a t m o st
i t e n a b le s th e p a tie n t to e n jo y some
p h y s ic a l c o m fo rt. (Land, 1969, p. 19)
P sych o th e ra p y
T ra d itio n a l F re u d ia n p s y c h o th e ra p y has p ro ven u n s u c c e s s fu l
w ith a d d ic ts . P s y c h o a n a ly s ts e x p la in th is b y c itin g th e p re -o e d ip a l
c h a ra c te r s tru c tu re o f th e a d d ic t and h is la c k o f h a v in g e ve r e s ta b lis h e d
an e m o tio n a l tie w ith h is p a re n ts . T h is d is a llo w s fo r th e e s ta b lis h m e n t
o f a p s y c h o th e ra p e u tic re la tio n s h ip in w h ic h th e tra n s fe re n c e m ay
o c c u r, th e re b y in c re a s in g ego c o n s c io u s n e s s .
T h e ra p e u tic C o m m u n itie s
A m a jo r b re a k th ro u g h in drug tre a tm e n t o c c u rre d in 1958 w hen
Synanon w as e s ta b lis h e d . The c e n te r w as p ilo te d b y C h a rle s D e d e ric h
who c re a te d a s e lf- h e lp program w h ic h has had trem endous e ffe c t on
drug re h a b ilita tio n n a tio n w id e . Y a b io n s k y (1965) q u ote d th is speech b y
j D e d e ric h , who e x p la in e d th e Synanon te c h n iq u e as fo llo w s :
S ynanon a tte m p ts to p ro v id e a c lim a te c o n
s is tin g o f a fa m ily s tru c tu re s im ila r to a
p rim itiv e tr ib a l s tru c tu re .
The s tru c tu re a ls o c o n ta in s o v e rto n e s o f a
n in e te e n th c e n tu ry fa m ily s e t-u p o f th e
25
ty p e w h ic h p roduced in n e r d ire c te d p e r
s o n a litie s .
A more o r le s s a u to c ra tic fa m ily s tru c tu re
appears to be n e c e s s a ry as a p re c o n d itio n
e n viro n m e n t to b u y som e tim e fo r th e r e
c o v e rin g a d d ic t. The a u to c ra tic o ve rto n e
o f th e fa m ily s tru c tu re dem ands th a t th e
p a tie n ts o r m em bers o f th e fa m ily perform
ta s k s as p a rt o f th e g ro u p . D u rin g th is
tim e a c o n c e rte d e ffo rt is made b y s ig n if i
c a n t fig u re s o f th e fa m ily s tru c tu re to
im p la n t s p ir itu a l c o n c e p ts and v a lu e s
w h ic h w ill re s u lt in s e lf- r e lia n c e , (p. 29)
Form al re p o rts o f s u c c e s s ra te s a t S ynanon have been v a rie d and
m in im a l, due to S yn a n o n 's re lu c ta n c e to b e in g fo rm a lly e v a lu a te d . H o w
e v e r, one s tu d y b y S w itz e r (1974) fo u n d a 7 5% re c id iv is m ra te w ith in
tw o ye a rs a fte r le a v in g th e "c o m m u n ity " fo r th o s e a d d ic ts w ho had co m
p le te d th e program .
O th e r w e ll-k n o w n th e ra p e u tic c o m m u n itie s o f th e p a s t decade
are Da y to p , P h o en ix H ou se , O d y s s e y H ou se , and L ib e rty Park V illa g e .
j T hese program s are s im ila r in th a t th e y a tte m p t to re s tru c tu re th e
!
a d d ic t's p e rs o n a lity b y p la c in g him in a m ilie u in w h ic h h is v a lu e s and
a ttitu d e s are a c tiv e ly c o n fro n te d .
The data on th e program s are m in im a l and n o t re a d ily d is c lo s e d .
The c la im s fo r su cce ss th a t are made seem le s s th a n o b je c tiv e as th e y
re fe r a lm o s t e n tire ly to c o n tin u in g c o m m u n ity m em bers. Those who
drop o ut and th o s e who a p p ly b u t are n o t a cce p te d are fo rg o tte n a lo n g
w ith th o s e w ho d id n o t even a p p ly . T h e re fo re a th e ra p e u tic c o m m u n ity
2 6
m ay c la im a su cce ss ra te o f 60% b y d is re g a rd in g o b v io u s s e le c tio n
b ia s e s .
W hat tr a d itio n a l p s y c h o th e ra p ie s and th e th e ra p e u tic co m m u n ity
a p p ro a ch have in com m on is th a t b o th b e lie v e im m ature p e rs o n a lity
d e ve lo p m e n t is th e ro o t from w h ic h drug a d d ic tio n e n su e s. They aim a t
h e lp in g th e a d d ic t becom e d ru g -fre e and fa c e h is problem s in a more
m a tu re, re s p o n s ib le m a nne r.
M e th a d o n e T reatm ent
As s ta te d e a rlie r, D o le and N ysw a n d e r (1966) n o te d th e la c k o f
su cce ss o f th e s e a p p ro a ch e s to th e problem o f h e ro in a d d ic tio n . They
re a so n e d th a t such tre a tm e n t e ffo rts w ere u n s u c c e s s fu l b e ca u se th e y
w ere based on a p s y c h o lo g ic a l th e o ry o f drug a d d ic tio n , w h ile , in fa c t,
h e ro in a d d ic tio n is a m e d ic a l problem in w h ic h th e a d d ic t is a fflic te d
w ith a m e ta b o lic d e fic ie n c y w h ic h p re d is p o s e s him to a d d ic tio n . N orm a l
c u r io s ity , n o t a p re -e x is tin g p s y c h o p a th o lo g ic a l c h a ra c te r s tru c tu re , is
th e in it ia l im p e tu s fo r drug u s a g e . D o le and N y s w a n d e r proposed th a t
m ethadone b lo c k e d th e e u p h o rig e n ic e ffe c ts w h ic h h e ro in had upon th o se
s e le c te d in d iv id u a ls h a v in g a m e ta b o lic d e fic ie n c y :
W ith th e m ethadone b lo c k a d e . . , th e
p a tie n t is p ro te c te d a g a in s t re a d d ic tio n
to h e ro in ; n o t o n ly does m ethadone b lo c k
e uph oria from h e ro in , i t a ls o e lim in a te s
th e se co n d a ry a b s tin e n c e sym ptom s th a t
o th e rw is e fo llo w a fte r h e ro in ta k in g and
le a d th e a d d ic t b a ck to re g u la r u se .
27
I f , as i t is tru e o f m any s tre e t a d d ic ts , he
cam e from a d e p riv e d b a c k g ro u n d , w here
drugs w ere w id e ly u se d , and had becom e
a d d ic te d th ro u g h c u r io s ity , he m ay have no
re s id u a l p s y c h o p a th o lo g ic a l sym ptom s once
th e pre ssure o f h e ro in a d d ic tio n has been
re m o ve d . (D ole & N y s w a n d e r, 1967, p. 477)
H o w e ve r, in th is same re p o rt, D o le and N y s w a n d e r fa ile d to
s p e c ify any p s y c h o lo g ic a l m easures d e m o n s tra tin g th e absence o f " re s
id u a l p s y c h o p a th o lo g ic a l s y m p to m s , " In s te a d , th e y c ite d as e v id e n c e
o f n o rm a lity and s u c c e s s fu l tre a tm e n t th e fo llo w in g c rite r ia : "N o
p a tie n t in th e program has becom e re a d d ic te d w h ile b lo c k a d e d w ith
m ethadone; tw o th ird s o f th e p a tie n ts un de r tre a tm e n t fo r th re e m onths
or lo n g e r are s te a d ily em p lo ye d or a t s c h o o l" (p. 47 8 ).
I t m u st be a s k e d w h e th e r th e m easured s u c c e s s is an a r tifa c t o f
th e tre a tm e n t g o a ls e s ta b lis h e d b y D o le and N y s w a n d e r. In g e n e ra l,
th e ir tre a tm e n t g o a l is to re tu rn th e p a tie n t to th e co m m u n ity as a p ro
d u c tiv e member-— w h ile b e in g m a in ta in e d as lo n g as n e c e s s a ry , and
perhaps in d e fin ite ly , on m e th a d o n e . The k e y w ord here is p ro d u c tiv ity .
T h is g o a l is m a rk e d ly d iffe re n t from tr a d itio n a l m easures o f s u c c e s s fu l
tre a tm e n t o f th e drug a d d ic t. The la tte r aim a t h e lp in g th e a d d ic t b e
com e d ru g -fre e and to c o n fro n t h im s e lf in a m ore h o n e s t, fe e lin g w a y .
D u rin g th e p a st decade th e use o f m ethadone in tre a tin g h e ro in
a d d ic ts has in c re a s e d s h a rp ly and has becom e a m a jo r tre a tm e n t
a p p ro a ch . F o llo w in g is a b rie f lo o k a t some o f th e re s e a rc h w ork in
2 8
th is a re a .
G e a rin g (197 0) e v a lu a te d th e M e th a d o n e M a in te n a n c e U n it in
N e w York c ity . The m edia n age o f th e p a tie n ts w as 34 y e a rs , and th e
e th n ic d is trib u tio n w as a p p ro x im a te ly 40% w h ite , 40% b la c k , 19%
S p a n is h , and 1% o rie n ta l. R e su lts show ed th a t le s s th a n 1% re tu rn e d
to re g u la r h e ro in use w h ile u n de r m ethadone m a in te n a n ce tre a tm e n t,
a lth o u g h m any o f th e p a tie n ts d id use h e ro in one o r more tim e s th e fir s t
fe w m o n th s. In co m p a rin g th e p e rce n ta g e o f a rre s ts am ong p a tie n ts
p rio r to a d m is s io n in to th e tre a tm e n t program w ith th e a rre s ts o f th e s e
same p a tie n ts a fte r program e n try , a s ig n ific a n tly lo w e r p e rcen ta g e o f
a rre s ts was no te d a fte r tre a tm e n t be ga n . In a d d itio n , e m ploym ent ra te s
in c re a s e d . F in a lly , a m atched c o n tra s t gro up s e le c te d from a d e to x ifi
c a tio n u n it d id n o t show s ig n ific a n t d iffe re n c e s in p e rce n ta g e s o f
a rre s ts before and a fte r d e to x ific a tio n . T h is le n d s su p p o rt fo r m e th a
done as th e p re fe rre d tre a tm e n t m o d a lity . H o w e ve r, i t m ust be note d
th a t th e c rite ria fo r s u c c e s s fu l tre a tm e n t d id n o t in c lu d e p s y c h o lo g ic a l
fu n c tio n in g , b u t re lie d in s te a d upon such b e h a v io ra l in d ic e s as d e
cre a se d h e ro in u sage and a n ti- s o c ia l b e h a v io r and an in c re a s e d e m p lo y
m ent ra te .
R osenberg and P atch (197 2) re p o rte d th e re s u lts o f a 12-m o n th
fo llo w -u p s tu d y o f 36 m ale a d o le s c e n t a d d ic ts , ages 18 th ro u g h 2 0
y e a rs , w ho re c e iv e d m ethadone tre a tm e n t. T hey w ere com pared w ith a
29
sam ple o f 36 u n tre a te d a d d ic ts o f s im ila r d e m og ra p hic b a c k g ro u n d . U n
fo rtu n a te ly , th e re s e a rc h e rs fa ile d to re p o rt data on th e c o m p a riso n
g ro u p . H o w e ve r, th e fo llo w -u p data on th e p a tie n ts re c e iv in g m e th a
done tre a tm e n t w ere p o s itiv e : w h ile o n e -th ird o f th e p a tie n ts c o n tin u e d
to use h e ro in d u rin g th e f ir s t th re e m o n th s, th is had dropped to o n ly
o n e - fifth d u rin g th e se co nd h a lf o f th e y e a r. The abuse o f b a rb itu ra te s
and o th e r drugs a ls o d e cre a se d s ig n ific a n tly . The m o st d ra m a tic im
provem ent was in e m p lo ym e nt p a tte rn s (w o rk in g o r a t s c h o o l). F u ll
tim e em ploym ent ro se from 40% to 67%.
R osenberg and P atch ju s t if y th e use o f lo n g -te rm m ethadone
tre a tm e n t w ith ju v e n ile h e ro in a d d ic ts as fo llo w s :
R ather th a n soon g ro w in g o u t o f h is a d d ic tio n
th e young a d d ic t gro w s in to a c h ro n ic sta te
o f a d d ic tio n . I t m ay ta k e m any ye a rs b e fo re
he f in a lly g iv e s u p n a rc o tic s . In th e m ean
w h ile he u se s h e ro in , co m m its c rim e s , is
lia b le to be a rre s te d , and ru n s a m uch in
cre a se d r is k o f b e co m in g i l l o r d y in g . O ur
fin d in g s show th a t even w hen o ffe re d m e th a
done m a in te n a n c e , m any young a d d ic ts
a b ru p tly drop o u t. W e can assum e th a t m ost
re la p s e b a ck in to i l l i c i t drug u s e . Those w ho
re m a in in tre a tm e n t show a g ra d u a l im p ro v e
m e n t. T h is im p ro ve m e n t is s u ffic ie n t to
ju s t if y th e use o f m ethadone in tre a tin g
a d o le s c e n t a d d ic ts . (1972, p . 53)
A s tu d y c lo s e ly re la te d to th e p re s e n t in v e s tig a tio n was u n d e r
ta k e n b y W a d d e ll, S m ith , and S te w a rt (197 2 ). They s tu d ie d p e rs o n a lity
ch anges o f 50 b la c k h e ro in a d d ic ts m a in ta in e d on m ethadone as m e a s
30
ured b y th e M in n e s o ta M u lti p h a s ic P e rs o n a lity In v e n to ry . The M M PI
w as a d m in is te re d p rio r to a d m is s io n to th e program and a g a in fiv e
m onths la te r. O n ly th e M E, H y, and S i s c a le s w ere n o t s ig n ific a n tly
e le v a te d in co m p a riso n to th e s ta n d a rd iz a tio n g ro u p on b o th p re te s t and
p o s tte s t m e a su re s. S c a le s M a and Pd w ere m a rk e d ly above a ll o th e r
s c a le s . The a u th o rs c o n c lu d e d th a t "th e h ig h v a lu e s on th e s e s c a le s
sco re d b y h e ro in a d d ic ts b e fo re and a fte r s ta b iliz a tio n on m ethadone
c le a rly re fle c t a p o p u la tio n c h a ra c te ris tic w h ic h m ay in it s e lf p re d is
pose to d ru g -s e e k in g b e h a v io r and a d d ic tio n " (p. 435).
In te re s tin g ly , th e Ma score ro se an a d d itio n a l s ix p o in ts on th e
m ale p o s tte s t (T 65 to T 7 1 ), and one p o in t on th e fe m a le p o s tte s t (T 67
to T 6 8 ). T h is s u g g e s ts th a t m ethadone m a in te n a n c e causes a fu rth e r
in c re a s e in o v e rt b e h a v io r and re s tle s s n e s s . In a d d itio n , m a le s m a in
ta in e d on m ethadone so cre d h ig h e r on th e Pt s c a le (T 60 to T 56), su g
g e s tin g added in s e c u rity and a p p re h e n s io n . The a u th o rs a tte m p te d to
e x p la in th is b y th e a b sen ce o f th e c a lm in g e ffe c t o f h e ro in , w h ic h w as
o p e ra tiv e a t th e f ir s t te s tin g , b u t w h ic h w as s u b s e q u e n tly no lo n g e r
p re se n t to su ppress th e a d d ic t's b e h a v io r. By n e u tra liz in g d ru g -s e e k in g
b e h a v io r, m ethadone m a in te n a n ce m ay a c t to c re a te a gap in th e a c tiv ity
le v e l o f th e a d d ic t under tre a tm e n t: "P la n n e d c o n s tru c tiv e a c tiv it y
w o u ld th e n ap p e a r to be a n e c e s s a ry p a rt o f r e h a b ilita tio n on m ethadone
(p. 436).
31
D e m irjia n and D o w e ll (197 2) d e s c rib e d a tre a tm e n t m o d a lity fo r
h e ro in a d d ic ts th a t a tte m p te d to fa c ilita t e c o n s tru c tiv e a c tiv it y and r e
s o c ia liz a tio n b y p ro v id in g s p e c ia l r e h a b ilita tiv e s e rv ic e s w ith in a
j m ethadone m a in te n a n ce program . In d iv id u a l and g ro u p th e ra p y are r e
q u ire d . In a d d itio n , th e re are p a tie n t- s ta ff co m m itte e s and m e e tin g s
th a t in flu e n c e p o lic y ch ang es and d u rin g w h ic h g rie v a n c e s ca n be e x
p re s s e d , P a tie n ts are a ls o in v ite d to p a rtic ip a te in a c o ffe e hour tw o
m o rn in g s a w eek in o rd er to re in fo rc e in fo rm a l s o c ia liz a tio n s k ills and
g iv e p e ople an a lte rn a tiv e to th e s tre e t and s o c ia l is o la tio n . In b rie f,
th is program aim ed a t h e lp in g in d iv id u a ls d e v e lo p adequ ate s k ills fo r
s o c ia l a d a p ta tio n b y e s ta b lis h in g a s u p p o rtiv e tr a n s itio n a l e n v iro n m e n t
w h ic h ap pears a v e ry n e c e s s a ry p a rt o f h e lp in g h e ro in a d d ic ts who are
in s e c u re , re s tle s s , and s o c ia lly is o la te d .
In sum m ary, th e re are th re e m a jo r appro a ch es in th e tre a tm e n t o f
h e ro in a d d ic tio n : p s y c h o th e ra p y , th e ra p e u tic c o m m u n itie s , and m e th a
done tre a tm e n t. T ra d itio n a l p s y c h o th e ra p y a ppears to be u n s u c c e s s fu l.
R eports o f s u cce ss ra te s a t S ynanon and o th e r th e ra p e u tic c o m m u n itie s
are in c o n c lu s iv e due to la c k o f c o n tro lle d re s e a rc h . D u rin g th e p a st
decade th e u se o f m ethadone in tre a tin g h e ro in a d d ic ts has in c re a s e d
s h a rp ly . M e th a d o n e tre a tm e n t has d e m o n stra te d e ffe c tiv e n e s s in r e
d u c in g n a rc o tic use and c rim e , and in in c re a s in g th e em ploym ent ra te
am ong a d d ic ts . H o w e ve r, c rite ria fo r s u c c e s s fu l m ethadone tre a tm e n t
32
does n o t in c lu d e le s s e n in g th e degree o f p s y c h o p a th o lo g y , m aking com
p a ris o n s b e tw e e n th e s e th re e tre a tm e n t m o d a litie s d if f ic u lt .
Sum m ary
The problem o f h e ro in a d d ic tio n has assum ed a la rm in g p ro p o rtio n s
in th e U n ite d S ta te s . There has been m uch re s e a rc h e x a m in in g b o th the
ca u se s o f a d d ic tio n and it s tre a tm e n t. Two m a jo r th e o re tic a l e x p la n a
tio n s fo r a d d ic tio n and tre a tm e n t e x is t: one g ro up o f re s e a rc h is d ire c
te d to w a rd s try in g to id e n tify th o s e c h a ra c te ris tic s o f th e "d ru g -d e p e n
d e n t" or " a d d ic tiv e " p e rs o n a lity u nde r th e th e o re tic a l a s s u m p tio n th a t
p e o p le w ith d iffe re n t ty p e s o f p e rs o n a litie s are m ore p re d is p o s e d to
h e ro in a d d ic tio n . T h e re fo re , tre a tm e n t o f th e a d d ic t n e c e s s a rily in
v o lv e s p s y c h o lo g ic a l h e lp to a id th e a d d ic t in fa c in g h is problem s in a
m ore m ature m anner. In c o n tra s t to th is , D o le and N y s w a n d e r (1966)
propose th a t h e ro in a d d ic tio n is th e re s u lt o f a m e ta b o lic d e fic ie n c y and
n o t p s y c h o p a th o lo g y . T hey and th e ir fo llo w e rs are u s in g m ethadone as
a m eans o f tre a tm e n t.
M e th a d o n e tre a tm e n t has been s u c c e s s fu l in in c re a s in g s o c ia l
p r o d u c tiv ity ( i. e . , e d u c a tio n and em ploym ent) and d e c re a s in g a n ti
s o c ia l a c tiv it y . T h is is used as e v id e n c e fo r th e th e o re tic a l e x p la n a
tio n o f it s c a u s e . H o w e v e r, such m easures o f s u c c e s s fu l tre a tm e n t
d iffe r from th e c rite ria o f th e p s y c h o lo g ic a l m o d el w h ic h fo c u s e s to a
g re a te r e x te n t on th e p s y c h o lo g ic a l fu n c tio n in g o f th e a d d ic t. The
33
p re s e n t s tu d y a tte m p ts to a n a ly z e m ethadone m a in te n a n ce in te rm s o f
th is la tte r c rite rio n .
CHAPTER I I I
M e th o d o lo g y
R esearch D e s ig n
The re s e a rc h d e s ig n u tiliz e d w as th e n o n e q u iv a le n t c o n tro l
gro up as d e s c rib e d b y C a m b e ll and S ta n le y (1 963 ). The e x p e rim e n ta l
and c o n tro l groups w ere b o th g iv e n a p re te s t and p o s tte s t, b u t th e y d id
n o t have p re -e x p e rim e n ta l s a m p lin g e q u iv a le n c e . True ra n d o m iz a tio n
w as p re clu d e d b e cau se th e groups c o n s titu te d a n a tu ra lly a sse m b le d ,
in ta c t, and s e lf-s e le c te d sa m p le . The e x p e rim e n ta l s u b je c ts d e lib e r
a te ly sou gh t o u t e xp o su re to X and th e re w as no c o n tro l g ro up a v a ila b le
i from th is same p o p u la tio n . The d e s ig n is as fo llo w s :
O i X O2
0 3 0 4
w h e re : and O 3 = p re tre a tm e n t o b s e rv a tio n s (p re te s ts )
X = th e a p p lic a tio n o f th e tre a tm e n t
O 2 and 0 ^ = th e fin a l o b s e rv a tio n s (p o s tte s ts ).
The lim ita tio n o f la c k o f ra n d o m iz a tio n m akes th e a s s u m p tio n o f
)
: u n ifo rm re g re s s io n b e tw e e n e x p e rim e n ta l and c o n tro l groups le s s lik e ly
I
I and s e le c tio n in te ra c tio n s m ore p ro b a b le . In te rn a l v a lid ity is ham pered
I b y s ta tis tic a l re g re s s io n and s e le c tio n in te ra c tio n s ( i. e . , s e le c tio n -
I
I m a tu ra tio n due to sp o nta ne o u s re m is s io n o f e x p e rim e n ta l s u b je c ts ).
!
I
! 34
35
N e v e rth e le s s , a c o n tro l gro up m a tched on b a s ic d e m o g ra p h ic c rite ria
does p ro v id e in fo rm a tio n w h ic h in m any in s ta n c e s w o u ld ru le o u t th e
h y p o th e s is th a t X has an e ffe c t: "The c o n tro l g ro u p , even i f w id e ly
d iv e rg e n t in th e m ethod o f re c ru itm e n t and in mean le v e l, a s s is ts in th e
in te rp re ta tio n o f th e e ffe c t o f X" (C a m b e ll & S ta n le y , 196 3). The d e sig n
s t i l l h e lp s to c o n tro l fo r th e m a in e ffe c ts o f h is to ry , m a tu ra tio n , te s tin g
and in s tru m e n ta tio n .
The m ethadone tre a tm e n t program was th e in d e p e n d e n t in te rv e n
in g v a ria b le b e in g e v a lu a te d fo r its e ffe c t on th e p e rs o n a lity o f th e s u b
je c ts in th e e x p e rim e n ta l g ro u p .
Scores on th e M in n e s o ta M u lti p h a s ic P e rs o n a lity In v e n to ry
(M M P I) served as th e d e pend ent v a ria b le .
S e le c tio n o f th e Sam ple
The sam ple c o n s is te d o f 59 a d u lt m a le , E n g lis h -s p e a k in g su b
je c ts , d is trib u te d as fo llo w s : 33 e x p e rim e n ta l s u b je c ts w ere h e ro in
a d d ic ts p a rtic ip a tin g in a m ethadone tre a tm e n t program in an o u tp a tie n t
c lin ic in Los A n g e le s , C a lifo rn ia ; 26 s u b je c ts c o m p ris in g th e c o m p a ri
son g ro up w ere m em bers o f a Big B rothers A s s o c ia tio n g ro up in Los
A n g e le s . The s u b je c ts o f th e in ta c t gro ups w ere s e le c te d in te rm s o f
v o lu n ta ry p a rtic ip a tio n in th e s tu d y . M o n e ta ry paym ent was made to
b o th groups to c o n tro l fo r m o tiv a tio n as a p o s s ib le th re a t to in te rn a l
v a lid it y . The e x p e rim e n ta l s u b je c ts w ere p a id $5 a p ie c e a fte r com p ie -
36
tio n o f th e p re te s t and a n o th e r $5 a fte r th e p o s tte s t. A c o n trib u tio n o f
$50 w as made to th e Big B rothe r A s s o c ia tio n a fte r p re te s tin g and a n o th e r
$50 a fte r th e p o s tte s t.
The b a s ic c h a ra c te ris tic s o f th e p a rtic ip a n ts in th is s tu d y w ere
as fo llo w s :
C o n tro l
G ro up
E x p e rim e n ta l
G roup
A verage Age 28 31
E th n ic c o m p o s itio n 46% M e x -A m e ric a n 53% M e x -A m e ric a n
A verage e d u c a tio n a l
le v e l
50% W h ite
4% B la ck
1 3 .2
40% W h ite
7 % B la ck
11.0
The above data in d ic a te th a t th e e x p e rim e n ta l and c o n tro l groups
are s u ffic ie n tly s im ila r in de m og ra p hic c o m p o s itio n to h e lp c o n tro l fo r
la c k o f ra n d o m iz a tio n . W h ile e x p e rim e n ta l m o rta lity does p re se n t a
th re a t to in te rn a l v a lid ity , a v e ry h ig h p e rce n ta g e o f p o s tte s t c o m p le
tio n s o c c u rre d . O n ly 10% o f th e sam ple from b o th th e e x p e rim e n ta l and
co m p a riso n groups w ere lo s t. The e x p e rim e n te r to o k tim e to d e v e lo p
good ra p p o rt w ith b o th groups o f s u b je c ts , and in a d d itio n , m o n eta ry
paym ent a c te d as an in c e n tiv e .
In strum e n ta tio n
P e rs o n a lity in th is s tu d y w as m easured b y th e M in n e s o ta M u lt i-
p h a s ic P e rs o n a lity In v e n to ry (M M P I). The p a rtic u la r form o f th e M M PI
37
w h ic h w as s e le c te d fo r th is in v e s tig a tio n w as th e G roup Form (Form G ).
G e n e ra l D e s c rip tio n o f th e In v e n to ry
The M M P I c o n ta in s 550 s ta te m e n ts to w h ic h th e s u b je c t a n sw e rs
tru e , fa ls e , o r c a n n o t s a y . T e s tin g tim e is a p p ro x im a te ly one hour and
u s u a lly re q u ire s v e ry l it t l e in s tru c tio n and s u p e rv is io n . I f th e s u b je c t
has d if f ic u lt y w ith th e b o o k le t form o f th e te s t (Form G) as is som etim es
th e ca se w ith more d is o rie n te d p a tie n ts th e re is a ca rd s o rtin g form
a v a ila b le (H a th a w a y & M c K in le y , 1967). The b o o k le t, Form G , w as
e m p lo ye d in th is s tu d y .
The M M P I is d e s ig n e d to p ro v id e an o b je c tiv e a s s e s s m e n t o f
some o f th e m a jo r p e rs o n a lity c h a ra c te ris tic s th a t a ffe c t p e rs o n a l and
s o c ia l a d ju s tm e n t. I t is t y p ic a lly u se d to a s s e s s th o s e tr a its th a t are
co m m on ly c h a ra c te ris tic o f d is a b lin g p s y c h o lo g ic a l a b n o rm a lity . There
w ere n in e o rig in a l c lin ic a l s c a le s and th e y w ere nam ed a fte r th e c o n d i
tio n th e y w ere d e s c rib in g . The s c a le s w ere la te r a b b re v ia te d and g iv e n
num bers to a v o id m is le a d in g c o n n o ta tio n s , as th e y w ere show n to be
a p p lic a b le w ith in a no rm al range o f b e h a v io r. A te n th c lin ic a l s c a le
w as la te r in c lu d e d .
To b r ie fly fa m ilia riz e th e re a d e r w ith th e c o m p o s itio n o f th e
in v e n to ry , d e s c rip tio n s o f th e 1 0 c lin ic a l s c a le s p lu s th e v a lid ity
s c a le s ap pe a r in th e A p p e n d ix .
3 8
Ite m D e s c rip tio n o f th e In v e n to ry
The ite m s in c lu d e d have been a r b itr a r ily c la s s ifie d b y D a h ls tro m
e t a l. (197 2 ) u n d e r 26 h e a d in g s arranged as fo llo w s :
N o . o f
C a te g o ry______________C o n te n t Area_____________________________Ite m s
1 G e n e ra l h e a lth 9
2 G e n e ra l n e u ro lo g ic sym ptom s 19
3 C ra n ia l n e rves 1 1
4 M o t ilit y and c o o rd in a tio n 6
5 S e n s ib ility 5
6 V a som otor, tro p h ic , sp e e ch ,
s e c re to ry problem s
1 0
7 C a rd io re s p ira to ry syste m 5
8 G a s tro in te s tin a l syste m 1 1
9 G e n ito u rin a ry system 5
1 0 H a b its 19
1 1 F a m ily and m a rita l re la tio n s 26
1 2 O c c u p a tio n a l p ro b le m s 18
1 3 E d u c a tio n a l problem s 1 2
1 4 S exual a ttitu d e s 16
1 5 R e lig io u s a ttitu d e s 19
1 6 P o litic a l a ttitu d e s : la w and o rd e r 46
1 7 S o c ia l a ttitu d e s 72
1 8 A ffe c t, d e p re s s iv e 32
19 A ffe c t, m a n ic 24
2 0 O b s e s s iv e and c o m p u ls iv e s ta te s 15
2 1 D e lu s io n s , h a llu c in a tio n s ,
illu s io n s , id e a s o f re fe re n c e
31
2 2 Phobia s 29
2 3 S a d is tic , m a s o c h is tic tre n d s 7
2 4 M o ra le 33
2 5 Ite m s p rim a rily re la te d to
ma s c u lin ity - fe m in in ity
55
2 6 Ite m s to in d ic a te w h e th e r th e
in d iv id u a l is try in g to p la c e
h im s e lf in an im p ro b a b ly a c c e p t
a b le lig h t, (p. 5)
15
V ery fe w o f th e s e ite m s sh o w in te rc o rre la tio n s o f a n y s ig n if i-
39
c a n c e .
N orm s o f th e In v e n to ry
The o rig in a l n o rm a tiv e data w ere d e riv e d from a sam ple o f
a p p ro x im a te ly 7 00 n o rm a l in d iv id u a ls w ho v is ite d th e U n iv e rs ity H o s p i
ta ls in M in n e s o ta . The p o p u la tio n w as b o th m ale and fe m a le , ages 16
to 55. The s c a le s w ere d e v e lo p e d b y c o n tra s tin g th e n o rm a l g roup s
w ith c lin ic a l ca se s from th e p s y c h ia tric d iv is io n o f th e U n iv e rs ity H o s
p ita ls , The c rite rio n used fo r in c lu s io n o f th e s c a le s was v a lid p re d ic
tio n o f c lin ic a l ca se s as com pared w ith th e n e u ro p s y c h ia trie s ta ff d ia g
n o s is ( i. e . , th o s e sta te m e n ts w h ic h d iffe re n tia te d p s y c h ia tric p a tie n ts
from "n o rm a ls ").
S co rin g o f th e In v e n to ry
The M M P I is o fte n co m p uter s co re d , and re tu rn e d w ith a p e rs o n
a lit y d e s c rip tio n o f th e s u b je c t. I t m ay a ls o be sco re d v ia h a n d -s c o rin g
s te n c ils , as w as done in the p re s e n t s tu d y .
In p re s e n tin g th e re s u lts o f th e s c a le s , th e ra w sco re s are con
v e rte d in to sta n d a rd sco re s (T -s c o re s ) and th e n p lo tte d on a p ro file
c h a rt. The use o f num bers fo r th e s c a le s is e s p e c ia lly d e s ira b le , since|
i t p e rm its "c o d in g " o f la rg e b o d ie s o f data fo r e a s y re fe re n c e . C o d in g
a ls o h e lp s to e m p ha size th e im p o rta n c e o f c o n fig u ra i a n a ly s is in w o rk
in g w ith M M P I re s u lts , in s te a d o f b e in g lim ite d to an in te rp re ta tio n o f
40
a s u b je c t's score on each s c a le s e p a ra te ly . The re la tio n o f th e s c a le s ,
th e ir p a tte rn s , is o f g re a t im p o rta n c e (D a h lstro m e t a l. , 197 2).
R e lia b ility and V a lid ity o f th e In v e n to ry
C o n ce rn in g th e r e lia b ilit y and v a lid ity o f th e M M P I, D a h lstro m
et a l. (1972), made th e fo llo w in g sta te m e n t:
The M M P I is one o f th e m ost fre q u e n tly
s e le c te d q u e s tio n n a ire use d in th e a s s e s s
m ent o f p e rs o n a lity in re c e n t y e a rs . I t has
been p o p u la riz e d b y b e in g a d m in is te re d to
m ore th a n one m illio n p e rs o n s , and its r e li
a b ility and v a lid it y are w ith o u t q u e s tio n
fir m ly b a sed on e m p iric a lly re s e a rc h e d data
fo r m ore th a n th re e g e n e ra tio n s , (p. 8 )
The a u th o rs o f th e in v e n to ry s ta te :
The c h ie f c rite rio n o f e x c e lle n c e w as v a lid
p re d ic tio n o f c lin ic a l ca se s as com pared
w ith th e n e u ro p s y c h ia trie s ta ff d ia g n o s is ,
ra th e r th a n s ta tis tic a l m easures o f r e lia b ilit y
and v a lid ity . (H a th a w a y & M c K in le y , 1967,
P. 8 )
N e v e rth e le s s , s ta tis tic a l s tu d ie s re g a rd in g r e lia b ilit y and v a lid
i t y are o f s e rio u s c o n c e rn . R e lia b ility c o rre la tio n s o f th e s c a le s range
b e tw e e n .7 1 and .9 3 , These c o rre la tio n s w ere o b ta in e d b y te s t- r e te s t
pro ced u re s w ith b o th n o rm a ls and p s y c h ia tric p a tie n ts (H a th a w a y & M c
K in le y , 1942; M c K in le y & H a th a w a y , 1942, 1944; H o ltz b e rg & A le s s i,
1949; C o ttle , 1950).
C o n ce rn in g p re d ic tiv e v a lid ity , "a h ig h sco re on a s c a le has
been fo u n d to p re d ic t p o s itiv e ly th e c o rre s p o n d in g fin a l c lin ic a l d ia g
41
n o s is or e s tim a te in m ore th a n 60% o f new p s y c h ia tric a d m is s io n s "
(H a th a w a y & M c K in le y , 1967). E llis (1946) sum m arized 13 s tu d ie s r e
la tin g to th e v a lid ity o f th is te s t, v a lid ity c o e ffic ie n ts ra n g in g upw ards
to .8 0 .
1
I
There is o v e rla p in th e com ponent ite m s o f th e b a s ic s c a le s r e
s u ltin g in v a ry in g am ounts o f e x p e rim e n ta l d e p e n d e n ce , W h e e le r,
L it tle , and L e hn e r (1951) p u b lis h e d a se t o f c o rre la tio n s am ong th e
b a s ic s c a le s b a se d on th e am ount o f ite m o v e rla p . The in te rc o rre la tio n s
th e y re p o rt are s u ffic ie n tly lo w to ju s t if y co m p a ris o n s b e tw ee n s u b te s ts
and in d ic a te th e s u it a b ilit y o f p ro file in te rp re ta tio n (. 0 to . 46).
As fo r th e a p p ro p ria te n e s s o f th e M M P I fo r th e p re se n t s tu d y ,
th is in v e n to ry has been one o f th e m o st w id e ly used in s tru m e n ts fo r
s u rv e y in g p e rs o n a lity v a ria tio n s in a d d ic t p o p u la tio n s . I t has a ls o v e ry
o fte n been a p p lie d to q u e s tio n s in v o lv in g th e p e rs o n a lity p ro ce sse s
le a d in g to d e lin q u e n t and c rim in a l b e h a v io r. O v e r 150 M M P I s tu d ie s
s p e c ific to th is area o f re s e a rc h are c ite d b y D a h ls tro m , W e ls h , and
D a h ls tro m (197 5), m any o f w h ic h have been reported in C h a p te r II o f
th is paper (S utke r, 1971; S u tke r & M o a n , 1972; Sheppard e t a l. , 1972;
H ill et a l. , 1960; B e rzin s e t a l. , 1971; H ill, H a e rtz e n , & D a v is ,
1962; G ilb e rt & L o m b a rd i, 1967).
In sum m ary, th e M M P I has proven to be n o t o n ly a v a lu a b le c lin
ic a l in s tru m e n t b u t a re m a rk a b ly fle x ib le and in s ig h tfu l re s e a rc h to o l.
42
The v a s t q u a n tity o f re s e a rc h done b y use o f th e M M P I has stre n g th e n e d
it s v a lid ity and r e lia b ilit y to th e p o in t w here one can c la im i t is th e
m o st a c c u ra te s e lf-a d m in is te rin g p e rs o n a lity in v e n to ry a v a ila b le to th e
m e n ta l h e a lth c o m m u n ity .
E xp e rim e n ta l and T e s tin g P rocedures
E x p e rim e n ta l C o n d itio n
The m et ha done tre a tm e n t program served as th e in d e p e n d e n t
v a ria b le . I t c o n s is te d o f th e fo llo w in g p ro c e d u re s :
1. I n it ia l m e d ic a l c h e c k -u p .
2, M e d ic a l e v a lu a tio n as to in it ia l m ethadone dosage le v e l.
3, M e th a d o n e is a d m in is te re d once d a ily b y a n u rs e . I t is
g iv e n o r a lly , m ixe d w ith an orgnge s o ft d rin k ,
4. The p a tie n t is supposed to see a c o u n s e lo r once a w e e k.
In r e a lity , in th e p a s t p a tie n ts have on th e a verage reported
to th e ir c o u n s e lo rs a p p ro x im a te ly tw ic e a m o n th , o fte n o n ly
to sa y " h e llo " and "c h e c k in " w ith th e ir c o u n s e lo r. The
c o u n s e lo r fu n c tio n s to fa c ilita te th e p a tie n t's s u c c e s s fu l
a c h ie v e m e n t o f th e p ro g ra m 's lo n g itu d in a l g o a ls . That is ,
he p rom otes th e a b s tin e n c e o f h e ro in usage and encourages
s o c ia l p ro d u c tiv ity ( i. e . , re tu rn to s c h o o l or w o rk ). In no
w a y is he tra in e d n o r does he fu n c tio n as a p s y c h o th e ra
p is t co n cern e d w ith th e p s y c h o lo g ic a l d e ve lo p m e n t o f h is
43
c lie n t. The c o u n s e lo r is e ith e r a para p ro fe s s io n a l (o fte n an
e x -a d d ic t) or in th e p ro ce ss o f re c e iv in g some a ca d e m ic
tra in in g as a c o u n s e lo r.
5. The p a tie n t is m e d ic a lly fo llo w e d to in s u re p rope r s ta b iliz a
tio n on m e th a do n e . A d ju s tm e n ts in dosage are made as
seen f i t b y a p h y s ic ia n ,
6 . P a tie n ts a re re q u ire d to g iv e u rin e sp e cim e n s a t th e c lin ic
once a w e e k . The te s ts are a n a ly z e d fo r o p ia te s and o th e r
n a rc o tic s . The d a y o f th e u rin e te s t is s e le c te d ra n d o m ly
and is n o t announce d to th e p a tie n ts b e fo re h a n d .
C o n tro l C o n d itio n
The c o n tro l c o n d itio n c o n s is te d o f a c o n tro l group com posed o f
s u b je c ts w ho w ere n o t drug a b use rs and d id n o t unde rgo an y e x p e ri
m e n ta l tre a tm e n t.
T e s tin g P rocedures
The M M P I is a s e lf-a d m in is te rin g te s t th a t re q u ire s l it t l e i f a n y
in s tr u c tio n . The c o n tro l s u b je c ts w ere te s te d as a group a t th e Big
B ro th e r A s s o c ia tio n m e e tin g s a t its u s u a l m e e tin g p la c e . The e x p e ri
m e n ta l s u b je c ts w ere te s te d in d iv id u a lly as th e y e n te re d th e m ethadone
p rogram , b e fo re m ethadone tre a tm e n t b e g a n . The e x p e rim e n ta l s u b je c ts
w ere te s te d a t th e c lin ic .
44
D ata C o lle c tio n P rocedures
B efore e xp osu re to th e in d e p e n d e n t v a ria b le , th e fo llo w in g data
w ere g a th e re d from c lin ic in ta k e re c o rd s fo r each a d d ic t s u b je c t p a r tic i
p a tin g in th e s tu d y :
1. L a s t nam e, f ir s t nam e,
2. C h ro n o lo g ic a l a g e.
3. E th n ic g ro u p .
The d ate o f program e n try was n o te d . The data w ere k e p t on 3 x 5 in d e x
c a rd s .
The de pe n d e nt v a ria b le m easure w as a d m in is te re d and th e e x p e r
im e n ta l tre a tm e n t began s h o rtly th e re a fte r. P o s tte s ts on th e d e pe n dent
v a ria b le w ere g a th e re d on each s u b je c t a fte r he had been in tre a tm e n t
fo r s ix m o n th s .
D e m o g ra ph ic data fo r th e c o n tro l gro up w as g a th e re d on 3 x 5
in d e x ca rd s a t th e tim e o f a d m in is te rin g th e p re te s t. T e s tin g o f th e con
t r o l g ro u p to o k p la c e a t a m e e tin g h e ld b y th e B ig B ro th e r A s s o c ia tio n a t
it s u s u a l m e e tin g p la c e . P o s tte s ts on th e d e p ende nt v a ria b le w ere
a d m in is te re d a fte r a p e rio d o f s ix m o n th s, fo llo w in g th e same p ro cedure
D ata A n a ly s is
The M M P I sco re s fo r a ll s u b je c ts w ere h a n d -s c o re d th ro u g h use
o f te m p la te s p ro v id e d w ith th e te s t. S ta tis tic a l a n a ly s e s w ere p erfo rm ed
th ro u g h u se o f a hand c a lc u la to r and a co m p u te r program m er d e ta ile d in
45
Chapter IV.
The fo llo w in g h yp o th e se s have been s ta te d in n u ll fo rm :
1. N o s ig n ific a n t d iffe re n c e s e x is t b e tw e e n th e m ean p re te s t
sco re s o f th e c o n tro l and e x p e rim e n ta l gro up on a n y o f th e
in d iv id u a l 13 m a jo r M M PI s c a le s .
2 . N o s ig n ific a n t d iffe re n c e s e x is t b e tw e e n th e m ean p o s tte s t
sco re s o f th e c o n tro l and e x p e rim e n ta l group on a n y o f th e
in d iv id u a l 13 m a jo r M M PI s c a le s .
3. S ig n ific a n t d iffe re n c e s do e x is t b e tw e e n th e mean p re te s t
and p o s tte s t sco re s o f th e c o n tro l gro up on a n y o f th e
in d iv id u a l 13 m a jo r M M PI s c a le s .
4. S ig n ific a n t d iffe re n c e s do e x is t b e tw e e n th e m ean p re te s t
and p o s tte s t sco re s o f th e e x p e rim e n ta l g ro up on a n y o f th e
in d iv id u a l 13 m a jo r M M PI s c a le s .
For th e s ta tis tic a l a n a ly s is , th e fo llo w in g te c h n iq u e s w ere
a p p lie d to a ll o f th e h y p o th e s e s :
1. An F ra tio w as use d to te s t fo r h o m o g e n e ity o f v a ria n c e
b e tw e e n th e e x p e rim e n ta l and co m p a ris o n g ro u p . A ssu m ing
v a ria n c e s are co m p a ra b le , th e n any d iffe re n c e s fo u n d b e
tw e e n m eans are m e a n in g fu l.
2. The s tu d e n t t te s t fo r in d e p e n d e n t sa m p le s w as used to
te s t h y p o th e s e s 1 th ro u g h 4.
46
3. The M a n n -W h itn e y U te s t w as pe rform ed to m ake c o m p a ri
sons w hen th e F fo r h o m o g e n e ity o f v a ria n c e n e c e s s ita te d
o b v ia tio n o f th e t - t e s t .
L im ita tio n s
The fo llo w in g lim ita tio n s w ere e v id e n t:
1. G e n e ra liz a tio n s m ay be lim ite d b y th e p a rtic u la r e th n ic
ra tio s and s o c io e c o n o m ic s ta tu s o f th e p o p u la tio n b e in g
s tu d ie d ,
2. True random nes.s in s a m p lin g d id n o t o c c u r b e ca u se o f th e
c o n s tra in ts in v o lv e d in th e use o f s e lf-s e le c te d in ta c t
g ro u p s .
3. To th e e x te n t th a t a n y one o f th e a s s u m p tio n s w as n o t m et,
a lim ita tio n in th e in v e s tig a tio n d id e x is t.
Sum m ary
In sum m ary, th e re s e a rc h d e s ig n u tiliz e d w as th e n o n e q u iv a le n t
c o n tro l group as d e s c rib e d b y C a m b e ll and S ta n le y (1963). The e x p e ri
m e n ta l and c o n tro l gro ups w ere b o th g iv e n a p re te s t and a p o s tte s t, b u t
tru e ra n d o m iz a tio n w as p re c lu d e d as a re s u lt o f th e g roups b e in g in ta c t
and s e lf- s e le c te d . S cores on th e M in n e s o ta M u lti p h a s ic P e rs o n a lity
In v e n to ry (M M P I) se rve d as th e d epe n d e nt v a ria b le . D iffe re n c e s w ere
m easured w ith in and b e tw e e n g roups on p re te s t and p o s tte s t m e a su re s.
47
The sam ple c o n s is te d o f 59 a d u lt, m a le , E n g lis h -s p e a k in g s u b je c ts ,
d is trib u te d as fo llo w s : 33 e x p e rim e n ta l s u b je c ts w ere h e ro in a d d ic ts
p a rtic ip a tin g in a m ethadone tre a tm e n t program in an o u tp a tie n t c lin ic
in Los A n g e le s ; 26 s u b je c ts c o m p ris in g th e co m p a riso n g ro up w ere
m em bers o f a Big B rothers A s s o c ia tio n g ro u p in Los A n g e le s . I t w as
h y p o th e s iz e d th a t a s ig n ific a n t am ount o f p s y c h o p a th o lo g y is p re s e n t
am ong h e ro in a d d ic ts and th a t m ethadone tre a tm e n t does n o t e ffe c t
p e rs o n a lity ch a ng e .
CHAPTER IV
R e su lts
G e n e ra l Form at
T h is c h a p te r c o n ta in s th e p re s e n ta tio n and a n a ly s is o f th e data
c o lle c te d and a th o ro u g h d is c u s s io n o f th e s e fin d in g s . The data in th is
e x p e rim e n t w ere s u b je c t to th e fo llo w in g k in d s o f a n a ly s e s .
A fte r th e ra w sco re data w ere ta b u la te d fo r th e M in n e s o ta M u lt i-
p h a s ic P e rs o n a lity In v e n to ry , th e t - t e s t w as used to com pare m ean d if
fe re n ce s b e tw e e n th e a d d ic t and n o n a d d ic t g roups b o th b e fo re and a fte r
im p le m e n ta tio n o f th e in d e p e n d e n t v a ria b le , and to com pare p re te s t and
p o s tte s t d iffe re n c e s w ith in each g ro u p . A to ta l o f 42 t - t e s t s w ere p e r
fo rm e d .
Ten a d d itio n a l c o m p a riso n s w ere pe rform ed w hen th e F ra tio fo r
h o m o g e n e ity o f v a ria n c e w as s ig n ific a n t; th is s ig n ific a n c e d ic ta te s th e
use o f a c o rre c tio n fo rm u la . These c o m p a riso n s w ere p e rfo rm ed b y
m eans o f a n o rm a l a p p ro x im a tio n b a sed on th e M a n n -W h itn e y U te s t.
T h is n o n p a ra m e tric te s t u ses ra n k s as i f in te r v a l d a ta , ra th e r th a n
u tiliz in g ra w s c o re s . W ith an N o f 8 o r g re a te r, i t is safe to assum e
th e ra n k s are d is trib u te d n o rm a lly (G u ilfo rd & F rue ht e r, 197 3).
The le v e l o f s ig n ific a n c e e m p lo ye d th ro u g h o u t fo r m aking in fe r
e n tia l s ta te m e n ts a b ou t a c o m p a riso n w as th e . 05 le v e l o f s ig n ific a n c e ;
48
49
th is le v e l is g e n e ra lly re c o g n iz e d as s u ita b le w ith in th e fie ld o f
re s e a rc h p s y c h o lo g y as a v a lu a b le p re d ic tiv e s ta n d a rd . H o w e ve r,
w here s ig n ific a n c e e xce ed e d th is le v e l o f c o n fid e n c e , th e e x p e rim e n te r
n o te d th e . 0 1 le v e l o f s ig n ific a n c e to fu rth e r stre n g th e n a n y d e c la ra tiv e
s ta te m e n ts p re se n te d b y th e fin d in g s . To re in fo rc e th e re je c tio n c r i
te rio n o f th e n u ll h y p o th e s e s , a tw o - ta ile d te s t o f s ig n ific a n c e w as
u s e d , w h ic h p ro te c ts a g a in s t th e Type II e rro r (the fa ilu re to re je c t a
n u ll h y p o th e s is w hen i t is tr u ly fa ls e ).
A ll c a lc u la tio n s w ere perform ed b y m eans o f a hand c a lc u la to r,
w ith th e e x c e p tio n o f th e M a n n -W h itn e y U te s ts fo r w h ic h an A PL p ro
gram and co m p uter w as used to a n a ly z e th e d a ta .
The ra w score m eans, sta n d a rd d e v ia tio n s , degrees o f freed om ,
F te s t, and co m p uted t- v a lu e s o r z -s c o re s fo r th e above data are p re
se n te d in T ab les 1 th ro u g h 4. In a d d itio n , th e t score m eans d e riv e d
from c o n v e rte d ra w sco re s appear in C h a rts 1 th ro u g h 4, w here th e y
have been p lo tte d in to a p ro file so as to enhance in te rp re ta tio n and
v is u a l in s p e c tio n . A lth o u g h m any o f th e data a ppear more th a n once,
i t is p re se n te d in th is fo rm a t to m ake th e c o m p a riso n s m ore re a d ily
u n d e rs to o d ,
j The p ro file s have been co d ed b y m eans o f th e W e ls h c o d in g
I
I syste m (H a th a w a y & M c K in le y , 1967) and a ppear in th e a n a ly s is o f th e
fin d in g s . In c lin ic a l u se o f th e M M P I i t has c o n tin u a lly been em pha-
50
s iz e d th a t th e e xa m in e r m u st n o t e v a lu a te th e in d iv id u a l s c a le in a p ro
f ile b u t sh o u ld , in s te a d , lo o k a t th e p a tte rn a ffo rd e d by th e w h o le group|
o f s c a le s . To m ake p a tte rn s u s a b le , c o d in g syste m s w ere d e v e lo p e d to
re d u ce th e la rg e num ber o f p o s s ib le p ro file s to a m ore p ra c tic a l s iz e
(H a th a w a y & M c K in le y , 1967), T h e re fo re , in a n a ly z in g th e re s u lts o f
th e p re se n t s tu d y , b o th in d iv id u a l s c a le d iffe re n c e s and p ro file d iffe r
en ces w ill be g iv e n .
The a n a ly s is o f th e fin d in g s w ill be p re ceded b y a d is c u s s io n
o f th e re s u lts in te rm s o f th e ir s ig n ific a n c e to th e o rig in a l in te n t o f th e
in v e s tig a tio n , th e ir im p lic a tio n s to th e fie ld o f drug abuse tre a tm e n t,
and th e ir re le v a n c e and u s e fu ln e s s to o th e r re s e a rc h e rs w ho m ay be
c o n s id e rin g d o in g fu rth e r in v e s tig a tio n s in th e area o f m ethadone tre a t
m e n t. The d is c u s s io n w ill in c lu d e in te rp re ta tio n s o f th e fin d in g s ,
w hereas th e a n a ly s is o f th e fin d in g s w ill be a s tra ig h tfo rw a rd a tte m p t
b y th e in v e s tig a to r to te s t th e re s e a rc h h y p o th e s e s d is c u s s e d in C h a p
te r 1 .
E x p e rim e n ta l G rou p - P re te st
The fo llo w in g is a sum m ary fo r th e p re te s t fo r th e e x p e rim e n ta l
g ro u p . The code ty p e (H a th a w a y & M c K in le y , 1967) d e s c rib in g th e
g ro up is p re se n te d , fo llo w e d b y an a n a ly s is and d is c u s s io n o f th is
code ty p e . T h is m ethod o f p re s e n tin g each g ro u p , fo llo w e d b y an
a n a ly s is o f th e re s u lts , w ill be c o n tin u e d fo r a ll th e g ro u p s , b o th c o n -
51
tr o l and e x p e rim e n ta l, th ro u g h o u t th e c h a p te r.
Code T ype 4 2 ^ 7 8 - 6 3 1 5 O /F -K /1 :
The fo llo w in g p ro file is g ra p h ic a lly p o rtra y e d in C h a rt 1. W ith
a T sco re o f 7 5, s c a le 4 p ro v id e s th e m o st re le v a n t in s ig h t in to th is
p e rs o n a lity ty p e . T h is s c a le w as d e v e lo p e d to m easure the p e rs o n a lity
c h a ra c te ris tic s o f th e a m o ra l and a s o c ia l su b gro ups o f p ersons w ith
p s y c h o p a th ic p e rs o n a lity d is o rd e rs (M c K in le y & H a th a w a y , 1944). The
m a jo r fe a tu re s o f th is p e rs o n a lity p a tte rn in c lu d e a fla g ra n t d is re g a rd
fo r s o c ia l cu sto m s and m o res, an in a b ilit y to p r o fit from p u n is h in g
e x p e rie n c e s as show n in re p e a te d d if fic u lt ie s o f th e sam e k in d , and an
e m o tio n a l s h a llo w n e s s in re la tio n to o th e rs , p a r tic u la r ly in s e x u a l and
a ffe c tio n a l d is p la y (D a h ls tro m e t a l. , 197 2). The c o n te n t o f s c a le 4
ra n ge s w id e ly , r e fle c tin g th e a lie n a tio n o f th e p e rso n from h is fa m ily ,
and d if fic u lt ie s in s c h o o l and w ith a u th o ritie s in g e n e ra l. G ough,
M cK e e , a n d Y a n d e ll (1955) d e s c rib e d a gro up o f h ig h 4 m a le s as h o s tile
and a g g re s s iv e in th e ir in te rp e rs o n a l re la tio n s h ip s , s a rc a s tic and c y n i
c a l, te n s e , m oody, and re s e n tfu l.
The second h ig h p o in t in th e code is s c a le 2, a t T65. T his
s tro n g ly in d ic a te s a g e n e ra l p e s s im is m , fe e lin g s o f h o p e le s s n e s s or
w o rth le s s n e s s , m o o d in e s s , s o c ia l a lie n a tio n , and s e n s itiv ity . W ith
p s y c h ia tric p o p u la tio n s , s c a le 2 is o fte n a c le a r in d ic a tio n o f g e n e ra l
s e lf- d is s a tis fa c tio n and fa u lty a d ju s tm e n t. D a h ls tro m e t a l. (197 2)
52
d e s c rib e th e 42 code ty p e as fo llo w s :
The p s y c h o p a th ic fe a tu re s o f th is code ty p e are
p ro m in e n t and c o rre s p o n d to lo n g -s ta n d in g b e
h a v io ra l p a tte rn s su ch as a lc o h o lis m ; on th e
o th e r hand, th e d e p re s s iv e fe a tu re s a ppe ar to
be s itu a tio n a lly p ro d u ce d and s h o r t- liv e d .
W h ile g u ilt and s e lf-d e p re c ia tio n m ay be p a rt
o f th e p re s e n tin g p ic tu re o f th e s e p e rs o n s ,
such m a n ife s ta tio n s are n o t u s u a lly v e ry c o n
v in c in g or s in c e re , (p. 27 0)
S ince th e p s y c h o p a th ic p e rs o n a lity a ppears r e la tiv e ly fre e o f
c o n flic ts and does n o t show a n x ie ty u n til a c tu a lly in s e rio u s d if fic u lt y ,
th e d is tre s s o f th e s e p e rs o n s , w h ile g e n u in e , does n o t r e fle c t in te rn a l
c o n flic ts so m uch as s itu a tio n a l p re s s u re s from le g a l c o n fin e m e n t, p s y
c h ia tr ic c o m m itm e n t, o r o th e r c lo s e s u p e rv is io n and s c ru tin y .
The th ird h ig h p o in t is s c a le 9, a t T 64. T h is e le v a tio n re fle c ts
a g g re s s iv e n e s s , re b e llio u s n e s s , and im p u ls iv ity . P eople w ith 49 p ro
f ile p a tte rn s te n d to be o v e ra c tiv e , irre s p o n s ib le , and s h a llo w and
s u p e rfic ia l in th e ir re la tio n s h ip s (D a h ls tro m et a l. , 197 2).
In sum m ary, th e a d d ic t gro up m ay be d e s c rib e d as h o s tile , re
b e llio u s , e m o tio n a lly s h a llo w , la c k in g in s e lf-e s te e m , and d e p re sse d
a b o u t th e ir im m e d ia te s itu a tio n .
C o n tro l G roup - P re te st
C ode Type 5 9 4 8-7 6 2 3 10 /P K L /
The fo llo w in g a n a ly s is is g ra p h ic a lly p o rtra y e d in C h a rt 1.
In th e b a s ic a n a ly s is o f th e c o m p a ris o n g ro up , one sees a d e f-
54
in ite s h ift in p ro file p a tte rn . N o lo n g e r is th e p s y c h o p a th o lo g ic a l
te rm in o lo g y used fo r th e drug gro up a p p ro p ria te . An e le v a tio n on s c a le
4 o f 60 is m oderate and w e ll w ith in a n o rm a l fra m e w o rk . I t in d ic a te s
th a t th e m em bers o f th e g ro up have a m uch m ore c o n v e n tio n a l p e rs o n a l
it y th a n th a t p re se n te d b y th e m em bers o f th e e x p e rim e n ta l g ro u p , a l
th o u g h th e y are s t i l l in d iv id u a lis t ic , o u ts p o k e n , a d v e n tu ro u s , and
prone to w o rry (H a th a w a y & M e e h l, 19 52).
The h ig h p o in t in th e p ro file is s c a le 5 a t 64. T h is is n o t u n e x
p e cte d as th e co m p a riso n gro up was d ra w n from a s o c ia l s e rv ic e o rg a n
iz a tio n , c o m p ris e d o f fa ir ly w e ll-e d u c a te d m em bers co n ce rn e d w ith
s o c ia l v a lu e s . Those re g is te rin g a t s c a le 5 are d e s c rib e d b y H a th a w a y
and M e e h l (1952) as s e n s itiv e , p e a c e a b le , prone to w o rry , and h a v in g
a e s th e tic in te re s ts . H ig h 5 's are d e s c rib e d b y G ough (1965) as ca p a b le ,
s e n s itiv e , s u b m is s iv e , to le ra n t, and c a u tio u s .
S cale 9, a t T 61, is th e second h ig h p o in t. W h ile i t is n o t s ig
n ific a n tly lo w e r th a n th e s c a le 9 T sco re fo r th e e x p e rim e n ta l g ro u p , i t
needs to be u n d e rs to o d in te rm s o f th e p ro file in w h ic h i t lie s . The
m o d e ra te ly e le v a te d a c t iv it y le v e l in d ic a te d m ay le a d to a g re a t d e a l o f
a c c o m p lis h m e n t b y a m b itio u s , v ig o ro u s , e n th u s ia s tic , e n e rg e tic
n o rm a ls . Some o f th e b e h a v io r re s u ltin g from hypom ania m ay be c o n
fu s e d w ith p s y c h o p a th ic p a tte rn s . H a th a w a y and M o n a c h e s i (19 5 3,
1963) n o te d th e ro le o f s c a le 5 as an in h ib ito r o f m a n ife s te d d e lin q u e n t
55
b e h a v io r. They fo u n d th e c o m b in a tio n 59 in th e p ro file s o f n in th grade
b oys w as a s s o c ia te d w ith a lo w e r d e lin q u e n c y ra te th a n an o v e ra ll ra te
fo r th e e n tire sa m p le .
A re a s o n a b le h y p o th e s is is th a t m o d e ra te ly e le v a te d 4 and 9
j s c a le s in th e p re sen ce o f a h ig h s c a le 5 re s u lts in th e c h a n n e liz a tio n
o f v ig o ro u s e n e rg y to w a rd s s o c ia lly a c c e p ta b le , c o n s tru c tiv e a c tiv itie s
ra th e r th a n th e d e s tru c tiv e , a n ti- s o c ia l b e h a v io r c h a ra c te ris tic o f a
h ig h e r 49 c o m b in a tio n and th e a b sen ce o f an e le v a te d s c a le 5. T h is is
v a lid a te d b y th e s ig n ific a n tly lo w e r c o n tro l g ro u p sco re on s c a le 2 , a t
T 55, in d ic a tin g m uch le s s s e lf-d e p re c ia tio n and fe e lin g s o f w o rth le s s
n e ss th a n p re s e n t in th e e x p e rim e n ta l g ro up .
In sum m ary, th e m em bers o f th e c o n tro l g ro u p p re s e n t a p ic tu re
o f b e in g s o c ia lly re s p o n s ib le , a c tiv e and s e n s itiv e . There are no
1 a p p a re n t in d ic a to rs o f m e a n in g fu l p s y c h o p a th o lo g y in th e ir gro up p ro file
In fe re n tia l S ta tis tic s A lo n g W ith R e la te d D e s c rip tiv e
S ta tis tic s fo r th e E x p e rim e n ta l G ro up (P re te st) and C o n tro l
G ro u p (P re te st)
The n u ll h y p o th e s is is as fo llo w s :
There are no s ig n ific a n t d iffe re n c e s b e tw e e n th e
mean p re te s t sco re s o f th e c o n tro l and e x p e rim e n ta l
groups on a n y o f th e in d iv id u a l 13 m a jo r M M P I s c a le s .
The re s u lts o f th e s ta tis tic a l c o m p u ta tio n s in T able 1 e n a b le s
th e re s e a rc h e r to s ta te th a t th e re are s ig n ific a n t d iffe re n c e s b e tw e e n
M M P I P re te st D ata
(E xp e rim e n ta l
TABLE 1
fo r A ll S u b je c ts b y G roup
v s . C o n tro l G roup)
56
1
1
M e a n
Score
(E .G .)
M ean
Score
( C .G .)
S tandard
D e v ia tio n
(E .G .)
S tandard
D e v ia tio n
( C .G .)
F T e st T T e st Z Score
L 3 .8 5 4. 15 2 . 12 1 .8 3 1.34 -0.583
F 8.30 6.50 4.65
4.32 1 . 16
1.52
K 12.91 14.42 6.48 4.92 1 . 6 8
- 1 . 0 0
1 14.36 12. 58 3.86 2.50 2.38 2.08*
2 23.30 18.77 4.53 4.69 1.07 3 .6 7 **
3 21.45 19.23 4.80 3.99 1. 45 1.90
4
29. 18 23. 12 3.68 4.66 1.60 5 .5 9 **
5
23.24 27.50 6 . 14 5.01 1. 50 - 2 . 8 6 * *
6 10.91 1 0 . 0 0 3. 00 3.31 1 . 2 2 1 . 1 0
7 28.48 27.04 5. 58 4.40 1.61 1.08
8 27.73 27.35 6 . 43 4.80 1.79 0.25
9 22,64 21. 19 3.98 3.90 1. 04 1.40
0 27.76 24. 65 7.31 8.45 1. 34 1. 51
d e gre es o f freedom = 57
* * in d ic a te s th e . 0 1 le v e l o f s ig n ific a n c e
* in d ic a te s th e .0 5 le v e l o f s ig n ific a n c e
E.G. = E x p e rim e n ta l G roup
C.G. = C o n tro l G ro up
57
th e c o n tro l gro up p re te s t and e x p e rim e n ta l g ro u p p re te s t on a t le a s t one
o f th e m a jo r v a lid it y o r c lin ic a l s c a le s o f th e M M P I. T h e re fo re , h y p o
th e s is 1 w as re je c te d . In th is p a rtic u la r case th re e s c a le s in d ic a te d
; d iffe re n c e s a t th e . 01 le v e l o f s ig n ific a n c e and one s c a le a t th e , 05
le v e l, (H o w e ve r, as m andated b y th e m e th o d o lo g ic a l s tru c tu re s o f th is
pa pe r o n ly one s c a le need be s ig n ific a n t a t th e . 05 le v e l to re je c t th e
n u ll h y p o th e s is . )
In fe re n tia l S ta tis tic s A lo n g w ith R ela ted
D e s c rip tiv e S ta tis tic s fo r th e E x p e rim e n ta l G roup (P o s tte s t)
and C o n tro l G roup (P o s tte s t) C o m p a riso n s
E x p e rim e n ta l G ro u p (P o s tte s t) C ode Type 4 2 9 1 8 7 3 5 -5 0 /F -K /L :
C o n tro l G roup (P o s tte s t) C ode Type 5 8 9 - 4 7 6 2 3 0 / l: F K L /
T a b le 2 e n a b le s th e in v e s tig a to r to a n sw e r th e m andates o f
h y p o th e s is 2 w h ic h s ta te d th e re are no s ig n ific a n t d iffe re n c e s be tw e e n
th e mean p o s tte s t sco re s o f th e c o n tro l and e x p e rim e n ta l gro up s on any
o f th e in d iv id u a l 13 m a jo r M M P I s c a le s .
The t-te s t re s u lts on T a b le 2 a cco m p a n ie d b y C h a rt 2 in d ic a te s
th a t th e re are s ig n ific a n t d iffe re n c e s b e tw e e n th e c o n tro l g ro u p p o s tte s t
and e x p e rim e n ta l gro up p o s tte s t on a t le a s t one o f th e m a jo r v a lid ity or
c lin ic a l s c a le s o f th e M M P I. T h e re fo re , h y p o th e s is 2 w as re je c te d .
In th is c o m p a ris o n th re e s c a le s in d ic a te d d iffe re n c e s a t th e .0 1 le v e l
o f s ig n ific a n c e and th re e a d d itio n a l s c a le s in d ic a te d d iffe re n c e s a t th e
. 05 le v e l.
58
Profile and Case Summary
The Minnesota M ultiphasic Personality Inventory Name_
Starke R. Hathaway and J . Charnley McKinley Address
Scorer's Initials_______________
2 34 5 6 7 8 9 0
For Recording
TotTc Pa Pt+1K Sc + IK Ma+.2K Si ToiTc Additional Scales
1 2 0 — 120
55 -
115 115
Male
3 0 -
5 5 -
50— 45 — .3 5 -
11 0- 110
105 5 0 - 105
5 0 -
100 ■25--
3 0 -
3 5 -
45—
3 5 - 4 5 -
4 0 -
9 0 —
3 5 - 4 0 -
20 - 4 0 - 2 5 - 85 -
3 0 -
3 5 -
3 0 -
13 0 -
120- 3 0 -
3 0 - 3 5 -
3 5 - 2 5 -
2 0 - 110-
'10 — -15 — 70—' 25— '25—
1 0 0 - 3 0 -
9 0 -
25 - 3 0 -
20- 3 0 - 2 5 -
2 0- \
20- 5 0 -
'5 - 2 5 -
2 5 -
20 - 4 0 -
50 — — 30 — '
20—
15- 10-
2 0 - 1 0 - 1 5 -
45 - 1 5 - 2 0 -
0- 2 0 -
15 -
40 — — 40
10-
0 - 1 5 - 5-
10- 1 5 - 5 -
1 0 -
30 — •10 —
1 0 -
0 - 0 -
1 0 -
2 5 -
1 0 -
0 —
0 —
PH-IK Sc+IK Ma+.2K TorTc Hy Pd+.4K Mf TorTc
Raw Score
(?)
Printed in U.S.A.
K to be added _ _ _
Raw Score with K .
Copyright 1948 by The Psychological Corporation
All rights reserved as stated in the manual and Catalog.
The Psychological Corporation, New York, N.Y.
Occupation.
Education__
JDate TestecL
.Age.
Marital Status.
NOTES
.Referred by.
Fractions el K
.CHART- 2
P osttest, Experim ental v s . C ontrol
K .5 .4 .2
30
29
15
15
12
12
6
6
Scale T Score T Score
28 14 11 6
Experim ental C ontrol
26 13 10 5
25 13 10 5
L 49 51
24
23
12
12
10
9
5
5
F 62 58
22
21
4
K 51 53
20 10
4 1 63 49
19
18
10
9 7 4
2 66 53
17
16
9
a
7
6
3
3
3 60 53
4 71 58
14 7 6 3
5 56 63
12 6 5 2
6 60 56
7 61 58
10
9
5
5 4
2
2
8 63 61
8
7
4
4
3
3
9 66 60
6
5
3
3
2
2 1
0 55 50
3
2
1
0
2
1
0
2
1
1
0
1
0
0
0
Experim ental
C ontrol
77-1178 Signature. .Date.
TABLE 2
M M P I P o s tte s t D ata fo r a ll S u b je c ts b y G rou ps
(E xp e rim e n ta l and C o n tro l G roup s)
59
M e a n
Score
(E.G.)
M e a n
Score
(C .G .)
S tandard
D e v ia tio n
(E.G.)
S tandard
D e v ia tio n
(C .G . )
F T est T T est Z Score
L 3.77 4.24 2.62 1.76 2 . 2 2 1.42
F 8 . 27 6 . 2 0 6 . 1 1 2.84 4.63 -0.91
K 13. 13 14.08 5.62 5.05 1. 24 -0. 65
1 16.43 12.04 5. 39 2 . 8 6 3.55 - 3 .2 2 * *
2 23. 53 18.12 6.33 3.91 2.62 -3 .3 5 * *
3 21.97 18.32 5.31 3.70 2 . 06 -2 .4 5 *
4 28.03 2 2 . 2 0 4.50 4.26 1 . 12 4 .9 0 **
5 23.67 27.32 6.39 5. 14 1.55 -2 .3 0 *
i
i ^
1 1 . 2 0 10.04 4.06 3.81 1. 14 1.08
1 7
1
28. 57 27.28 5.47 4.50 1.48 0.94
1
i®
29.00 29.24 8.06 4.54 3. 15 — 0 . 0 2
9 23. 30 21.04 4.51 3.84 1. 38 1.98
0 29.77 24.64 8.64 9.42 1. 19 2 . 1 0 *
d e grees o f freedom = 53
* * in d ic a te s th e . 0 1 le v e l o f s ig n ific a n c e
* in d ic a te s th e ,0 5 le v e l o f s ig n ific a n c e
E.G. = E x p e rim e n ta l G roup
C. G . = C o n tro l G roup
60
In fe re n tia l S ta tis tic s A lo n g w ith R ela te d D e s c rip tiv e S ta tis tic s
fo r th e C o n tro l G ro u p (P re te st) and C o n tro l G ro u p (P o s tte s t)
C o n tro l G roup (P re te st) C ode Type 5 9 4 8 -7 6 2 3 1 O /F K L /
C o n tro l G roup (P o s tte s t) Gode Type 5 8 9 - 4 7 6 2 3 0 / 1 : F K L /
T a b le 3 e n a b le s th e re s e a rc h e r to re sp o n d to th e m andates o f
h y p o th e s is 3 w h ic h s ta te d th e re are s ig n ific a n t d iffe re n c e s b e tw e e n th e
m ean p re te s t and p o s tte s t sco re s o f th e c o n tro l gro u p on a n y o f th e i n
d iv id u a l 13 m a jo r M M P I scales.
The t - t e s t re s u lts on T able 3 a c c o m p a n ie d by C h a rt 3 in d ic a te s
th a t th e re are no s ig n ific a n t d iffe re n c e s b e tw e e n th e c o n tro l g ro u p 's
p re te s t and p o s tte s t sco re s on a n y o f th e m a jo r v a lid it y o r c lin ic a l
s c a le s o f th e M M P I. T h e re fo re , h y p o th e s is 3 w as re je c te d .
T h is w as e x p e c te d in v ie w o f th e h ig h r e lia b ilit y c o e ffic ie n ts
fo u n d in M M P I re s e a rc h (see C h a p te r I I I ) . T e s t-re te s t r e lia b ilit y does
h e lp to c o n tro l fo r th e m a in e ffe c ts o f h is to ry , m a tu ra tio n , te s tin g , and
in s tru m e n ta tio n , th e re b y a s s is tin g in th e in te rp re ta tio n o f th e in d e p e n
d e n t v a ria b le (C a m b e ll & S ta n le y , 196 3). R e te st r e lia b ilit y show s th e
e x te n t to w h ic h sco re s on a test can be g e n e ra liz e d o v e r d iffe re n t
o c c a s io n s ; th e h ig h e r th e r e lia b ilit y , th e le s s s u s c e p tib le th e scores
are to random d a ily changes in th e c o n d itio n o f th e s u b je c t or o f th e
te s tin g e n v iro n m e n t (A n a s ta s i, 1968).
The a lte ra tio n in th e p ro file c o n fig u ra tio n is n o n s ig n ific a n t and
does n o t re q u ire a d d itio n a l e x p la n a tio n b e yo n d th a t o f e rro r v a ria n c e .
61
TABLE 3
M M P I P re te s t-P o s tte s t C o m p a riso n
(C o n tro l G roup)
M e a n
Score
(P re)
M e a n S tand ard
S core D e v ia tio n
(Post) (P re te st)
S tandard
D e v ia tio n
(P o s tte s t)
F T e st T T e st Z Score
L 4. 15 4.24 1.83 1.76 1 . 08 - 0 , 18
F 6 . 50 6 . 2 0 4.32 2.84 2. 31 0.04
K 14. 42 14. 08 4 .92 5. 05 1. 05 0 . 24
1 12. 58 12.04 2 .50 2 . 8 6 1. 31 0 . 70
2 18.77 18. 12 4.69 3.91 1. 44 0 . 53
3 19.23 18.32 3.99 3.70 1 . 16 0 . 83
4 23.12 2 2 . 2 0 4.66 4.26 1 . 2 0 0 , 72
5 27.50 27.32 5.01 5. 14 1.05 0 , 12
6 1 0 . 0 0 10.04 3 . 31 3.81 1. 32 - 0 . 04
7 27.04 27.28 4 . 40 4. 50 1. 05 “ 0 . 19
8 27.35 28.24 4.80 4. 54 1 . 12 - 0 . 67
9 21. 19 21.04 3 .9 0 3.84 1. 03 0 . 14
0 24.65 24.64 8 .45 9.42 1. 24 0 . 0 0
degrees o f freedom = 49
* * in d ic a te s th e . 0 1 le v e l o f s ig n ific a n c e
* in d ic a te s th e .0 5 le v e l o f s ig n ific a n c e
62
Profile and Case Summary
The Minnesota M ultiphasic Personality Inventory Name_
Starke R. Hathaway and J . Charnley McKinley Address.
Scorer's Initials_______ ________
For Recording
Raw Score.
ToiTc HS+.5K Hy Pd + .4K Ml Pa Pl+IK Sc + IK Mq+.2K ToiTc Additional Scales
12 0— - 1 2 0
5 5 -
115 - 115
Male
3 0 -
5 5 -
11 0 —
110
4 0 -
105 105 - 5 0 -
5 0 -
45—
10 0' 100 25-----
3 0 - 4 5 -
45—
3 5 -
4 0 -
3 5 - 4 0 -
60-
2 0 - 2 5 - 8 5 -
40 — 3 5 -
3 0 -
3 0 -
13 0 -
15 - 3 5 -
120- 3 0 -
3 0 - 3 5 -
2 5 - 3 5 -
2 0 -
25— •15 — '2 5 -
3 0 -
9 0 - 10-
25 - 65 — 3 0 -
2 0 - 3 0 - 2 5 -
1 5 -
2 0 - 6 0 -
5 0 - 20-,
5 - 2 5 - 55 T
2 5 -
2 0 - 4 0 -
50 — — 30 — '
20—
1 5 -
10 - 15 - 2 0 -
45 — 1 5 -
2 0 -
5 -
40 — 1 5 --
1 5 -
1 0 -
0 - 5 - 1 5 -
35 -
5 - 10- 1 5 -
1 0 -
30 — ■10 —
1 0 -
0 - 0 -
1 0 -
25 -
1 0 -
5 -
20 —
0 —
TorTc PH-IK Sc+IK Ma+.2K
7 8 9
Pa
6
Hy Pd+.4K Mf
3 4 S
TorTc
0 2
( ? )
Printed in U.S.A.
K to be added
Raw Score with K
Copyright 1948 by The Psychological Corporation
All rights reserved as stated in the manual and Catalog.
The Psychological Corporation, New York, N.Y.
Occupation.
Education__
JDate Tested.
.Age.
Marital Status.
NOTES
.Referred by.
Fractions oi K
CHART 3
P rete st-P o stte st Com parison
Pretest _
P osttest
K .5 .4 .2
30
29
15
15
12
12
6
6
27 14 11 5
Scale T Score T Score
Pretest Posttest
25 13 10 5
24
23
22
12
12
11
10
9
9
5
5
4
L 50 51
21 11 8 4
F 58 58
20 10 8 4
K 54 53
18 9 7 4
1 53 52
16 8 6 3
2 55 53
15. 8 6 3 3 55 53
14
13 7
3
3 4 60 58
12
11
6
6
2
2 5 64 63
6 56 56
9 5 4 2
7 58 58
7 4 3 1
8 59 61
9 60 60
5
4
3
2
2
2
1
1 0 50 50
3
2
2
1
2
1
1
0
1
0
1
0
1
0
0
0
77-117S Signature. .Date.
63
In fe re n tia l S ta tis tic s A lo ng w ith R elated D e s c rip tiv e S ta tis tic s
fo r th e E x p e rim e n ta l G ro u p (P re te st) and E x p e rim e n ta l G ro u p (P o s tte s t)
E x p e rim e n ta l G ro u p (P re te st) C ode Type 4 2 9 7 - 8 63 15 0 /F - K /L :
E x p e rim e n ta l G ro up (P o s tte s t) C ode Type 4 2 9 1 8 7 3 6 - 5 O /F -K /L :
T a b le 4 e n a b le s th e re s e a rc h e r to re sp o n d to th e m andates o f
h y p o th e s is 4 w h ic h s ta te d th e re are s ig n ific a n t d iffe re n c e s b e tw e e n th e
m ean p re te s t and p o s tte s t score s o f th e e x p e rim e n ta l g ro up on any o f
th e in d iv id u a l 13 m a jo r M M P I s c a le s .
The t-te s t re s u lts on T a b le 4 a cco m p a n ie d b y C h a rt 4 in d ic a te
th a t th e re are no s ig n ific a n t d iffe re n c e s b e tw e e n th e e x p e rim e n ta l
g ro u p 's p re te s t and p o s tte s t sco re s on a n y o f th e m a jo r v a lid ity or
c lin ic a l s c a le s o f th e M M P I. T h e re fo re , h y p o th e s is 4 w as re je c te d .
In sum m ary, th e above data s e rio u s ly q u e s tio n th e e ffic a c y o f
m ethadone tre a tm e n t and th e th e o re tic a l fo u n d a tio n upon w h ic h i t rests.
The data in d ic a te th a t a s ig n ific a n tly g re a te r degree o f p s y c h o p a th o lo g y
is p re s e n t in a d d ic ts th a n n o n a d d ic ts , and th a t m ethadone tre a tm e n t
does n o t h e lp to le s s e n th is g a p . C o n c lu s io n s and re co m m e n d a tio n s
a p p e a r in th e fo llo w in g c h a p te r.
D is c u s s io n o f F in d in g s
There w as a d e lib e ra te a tte m p t on th e p a rt o f th e re s e a rc h e r to
a v o id le n g th y d e s c rip tio n s o f th e s ig n ific a n c e o f th e n u ll h y p o th e s e s in
th e fir s t s e c tio n o f th is c h a p te r in o rd e r to p re s e n t th e s e in te rp re ta tio n s
TABLE 4
M M P I P re te s t-P o s tte s t C o m p a riso n
(E x p e rim e n ta l G roup)
M e a n
Score
(Pre)
M e a n
Score
(Post)
S tandard
D e v ia tio n
(P re te st)
S tand ard
D e v ia tio n
(P o s tte s t)
F T est T T e st
L 3.85 3.77 2 . 1 2 2.62 1.53 0.14
F 8.30 8 . 27 4 .6 5 6 . 11 1.73 0.03
K 12.91 13. 13 6.38 5.62 1.29 -0. 15
1 14.36 16.43 3.86 5.39 1.95
2 23.30 23.53 4.53 6.33 1.95
3 21.45 21.97 4.80 5. 31 1 . 2 2 -0 .4 0
1 4
29.18 28.03 3 .6 8 4. 50 1.50 1 . 1 1
5 23.24 23.67 6.14 6.39 1.08 -0.27
6 10.91 1 1 . 2 0 3 . 00 4. 06 1.83 -0.32
7 28.48 28. 57 5 . 58 5.47 1.04 -0.06
8 27.73 29. 0 0 6 .43 8 . 06 1.57 - 0 . 6 8
9 22.64 23. 30 3 .9 8 4. 51 1.28 -0 .62
0 27.76 29.77 7 . 31 8.64 1.40 -0 .98
1.49
0.34
degrees o f freedom = 51
I
I * * in d ic a te s th e . 0 1 le v e l o f s ig n ific a n c e
I * in d ic a te s th e .0 5 le v e l o f s ig n ific a n c e
65
Profile and Case Summary
The Minnesota M ultiphasic Personality Inventory
Starke R. Hathaway and J . Charnley McKinley
Scorer's Initials_______ ________
Address.
For Recording
TorTc Pa Pt+1K Sc+IK Mg+.2K Si ToiTc Addiiional Scales
120 120
45 —
5 5 -
115 115
Male
5 5 -
50— 45 — .3 5 -
110- — 110
5 0 -
4 0 -
- 105 105 5 0 -
45—
4 0 - -- 100 1 0 0 - 2 5 -
3 0 -
3 5 -
95 T
3 5 - 4 5 -
4 0 -
3 5 - 4 0 -
60-
2 0 - 4 0 - 85 - 2 5 -
4 0 - 35 -
3 0 -
130-
1 5- 3 5 -
120- 3 0 -
3 0 - 3 5 -
3 5 - 2 5 -
2 0 - 110- 4 5 -
10 — 7 0 - ' '25— 25—
1 0 0 -
9 0 - 1 0-
3 0 - 65 —
2 0 - 2 5 - 3 0 -
60 —
2 0 -
2 0 - 1 0 - 5 0 -
0 5 - 2 5 - - 55
2 5 -
2 0 - 4 0 -
50 — — 30 — '
20—
10- 1 5 -
10 - 2 0 - 15-
45 - 1 5 - 2 0 -
2 0 -
5 - 1 5-
40 —
1 5 -
10-
0 - 1 5 - 5 -
35 -
10- 1 5 - 5 -
1 0 -
30 — ■10 —
1 0 -
0 - 0 -
1 0 -
25 -
1 0 -
5 -
20 —
0 —
Pt+IK Sc+IK Ma+.2K TorTc Hy Pd+.4K Mf TorTc
R aw Score
(?)
Printed in U.S.A.
K to be added
Raw Score with K
Copyright 1948 by The Psychological Corporation
All rights reserved as stated in the manual and Catalog.
The Psychological Corporation, New York, N.Y.
Occupation.
Education__
JDate Tested.
.Age.
Marital Status.
NOTES
.Referred by.
Fractions ol K
■CHART 4
P retest-P osttest Comparison
(Experim ental Group)
P osttest
g g 4
30 15 12 6
Scale T Score T Score
28 14 11 6
Pretest Posttest
26 13 10 5
25 13 10 5 L 50 49
24
23
12
12
10
F
62
62
22
21
11
11
9
K 51
51
1 57 63
19 10
4
2 65
66
17 9 7 3
3 59
60
4 74 71
15
14
8
7
6
6
3
3 5 55
56
13
12 6
-5
5
3
2 6 59 60
11 6 4 2
7 61 61
10 5 2
8 60
63
8 4 3 2
9 64 66
6 3 2 1
0 53 55
5 3 2 1
4 2 2 1
3 2 2 1
2
1
i
1
1 0 Pretest
0 0 0 0
77-1178 Signature. .Date.
6 6
in a more e x te n s iv e w a y in th e d is c u s s io n . The d is c u s s io n w ill re v ie w
fin d in g s p re se n te d in th is c h a p te r and a tte m p t to e x p la in th e s e fin d in g s
in te rm s o f g e n e ra l th e o re tic a l p o s itio n s c o n c e rn in g th e e ffe c ts o f m e th
adone tre a tm e n t on th e p e rs o n a lity s tru c tu re o f a d d ic ts . T h is s e c tio n
w ill c o n c lu d e w ith s p e c ific re co m m e n d a tio n s to o th e r re s e a rc h e rs to
e x p lo re o th e r areas o f th is problem in o rder to exp and o u r c u rre n t u n d e r
s ta n d in g o f m ethadone tre a tm e n t and g e n e ra l drug a b use issues.
H y p o th e s is one a d d re sse d th e is s u e o f w h e th e r o r n o t s ig n if i
c a n t d iffe re n c e s e x is te d b e tw ee n th e e x p e rim e n ta l g ro up and c o n tro l
g ro up on th e ir M M P I g ro up p e rs o n a lity p r o file . The re s u lts on th e t -
tests in d ic a te d s ig n ific a n t d iffe re n c e s e x is te d b e tw e e n th e s e groups on
th e fo llo w in g s c a le s : 1 (H y p o c h o n d ria s is ), 2 (D e p re s s io n ), 4 (P sych o
p a th ic D e v ia n c y ), and 5 ( M a s c u lin ity -F e m in in ity ) . The fo llo w in g is a
b rie f sum m ary o f th e s c a le s and a d e s c rip tio n o f w h a t th e re p o rte d d if
fe re n c e s m ean in te rm s o f p e rs o n a lity a ttrib u te s .
S ca le 1, t 2.08 - S ca le 1 is com posed p rim a rily o f ite m s w h ic h
d e s c rib e p h y s ic a l c o m p la in ts and b o d ily fu n c tio n s . The drug g ro up
e v id e n c e d s ig n ific a n tly g re a te r co n c e rn a b o u t h e a lth and b o d ily fu n c
tio n s th a n th e c o n tro l g ro u p . E le v a te d sco re s on th is in d e x are in d ic a
tiv e o f in d iv id u a ls w ho te n d to be more e g o c e n tric , ir r ita b le and c o m
p la in in g .
S ca le 2, t 3.67 - S ca le 2 w as d e v e lo p e d to id e n tify p a tie n ts
67
w ho e x h ib ite d d e p re s s io n . The drug g ro up sco re d s ig n ific a n tly h ig h e r,
in d ic a tin g p e s s im is m and s e lf-d e p re c ia tio n .
S cale 4, t 5.59 - The h ig h 4 in th e e x p e rim e n ta l g ro up in d ic a te s
th a t th e y are h o s tile , u n d e p e n d a b le and have d if fic u lt ie s o p e ra tin g
w ith in th e norm s o f s o c ie ty . T h is s c a le fre q u e n tly appears in drug
a b u s e rs ' p ro file s and is e m b le m a tic o f th e ir in a b ilit y to fin d adequate
e m o tio n a l s a tis fa c tio n w ith in th e m a in stre a m o f o u r c u ltu re .
S ca le 5, t 2.86 - The e le v a te d s c a le 5 in th e c o n tro l is fre q u e n t
am ong m ales w ho are s o c ia lly co n ce rn e d and s e n s itiv e . T h is w as c h a r
a c te r is tic o f th e co m p a riso n g ro u p as th e s u b je c ts w ere d ra w n from a
s o c ia l s e rv ic e g ro u p .
E s s e n tia lly , th e drug g ro u p in d ic a te d s tro n g te n d e n c ie s to w a rd
a n ti- s o c ia l b e h a v io rs as w e ll as d e fin ite v u ln e r a b ility to w a rd d e p re s
s io n and s o m a tic c o m p la in ts . These fin d in g s are in harm ony w ith th e
fin d in g s o f S u tke r (1971), S heppard et a l. (197 2 ), and O v e ra ll (197 3)
w h ic h a ll co n c u rre d th a t n a rc o tic a d d ic ts sh o w stro n g in d ic a tio n s o f
b e in g c h a ra c te r d is o rd e rs as w e ll as n e u ro tic s and p s y c h o tic s .
H y p o th e s is tw o a tte m p te d to d e te rm in e w h e th e r th e d iffe re n c e s
re p o rte d b e tw e e n th e e x p e rim e n ta l g ro up and th e c o n tro l group on the
p re te s t w ere s t ill a p p a re n t s ix m onths la te r a fte r th e m ethadone p a tie n ts
had sp e n t th a t p e rio d o f tim e in th e re h a b ilita tio n p rogram . The re s u lts
on th e t- t e s t s in d ic a te d s ig n ific a n t d iffe re n c e s e x is te d b e tw e e n th e
6 8
g ro up s on th e fo llo w in g s c a le s : 1 (H y p o c h o n d ria s is ), 2 (D e p re s s io n ),
3 (H y s te ria ), 4 (P s y c h o p a th ic D e v ia n c y ), 5 ( M a s c u lin ity -F e m in in ity ) ,
and 0 (S o c ia l In tro v e rs io n ). The fo llo w in g is a b rie f re c a p itu la tio n o f
th e s e s c a le s and th e ir s ig n ific a n c e in te rm s o f p e rs o n a lity v a ria b le s .
As in th e p re te s t c o m p a ris o n , s ig n ific a n t d iffe re n c e s w ere foun d
in th e p o s tte s t c o m p a ris o n on s c a le 1 (t - 3 .2 2 ) , s c a le 2 (t - 3 .3 5 ) ,
s c a le 4 (t 4 .9 0), and s c a le 5 (t - 2 .3 0 ) , th e a d d ic t gro up s c o rin g h ig h e r
th a n th e n o n a d d ic t g ro up on s c a le s 1, 2, and 4, and lo w e r on s c a le 5.
In a d d itio n , s ig n ific a n t d iffe re n c e s w ere fo u n d on s c a le s 3 (t 2 .4 5 ) and
s c a le 0 (t 2 . 1 0 ) in d ic a tin g more s o c ia l in tro v e rs io n and p s y c h o n e u ro tic
fa c to rs in our drug p o p u la tio n . A m o d e ra te ly e le v a te d s c a le 3 in d ic a te s
im m a tu rity , e m o tio n a l lia b ilit y , and s u s c e p tib ility to s u g g e s tio n . Phys
ic a l sym ptom s m ay be u se d as a m eans o f a v o id in g r e s p o n s ib ilitie s
(D a h lstro m et a l. , 197 2 ). E le v a tio n s in s c a le 0 are in d ic a tiv e o f in d i
v id u a ls w ho are h ig h -s tru n g , s e lf- e ffa c in g and s u b m is s iv e . N e v e rth e
le s s , th e e le v a tio n on s c a le 0 am ong th e drug g ro up w as w e ll w ith in th e
n o rm a l ra n g e .
E s s e n tia lly , no m e a n in g fu l ch ang es o c c u rre d in th e co m p a riso n s
I b e tw e e n th e s e group s d u rin g th e s ix m onth p e rio d and th is su g g e sts th a t
I
I th e b a s ic p e rs o n a lity o f th e a d d ic ts d id n o t change in a n y s ig n ific a n t
m anners d u rin g th e s ix m o n th s. T h is in fe re n c e w as v a lid a te d b y th e
re s u lts o f h y p o th e s is 4.
69
H y p o th e s is 3 w as d e s c rib e d e a rlie r in th e c h a p te r and in d ic a te d
th a t no s ig n ific a n t ch a n g e s o c c u rre d in th e p ro file ty p e o f th e c o n tro l
g ro up d u rin g th e s ix m onth p e rio d . The s t a b ilit y o f p e rs o n a lity tr a its
am ong a gro up o f h ig h fu n c tio n in g n o rm a ls w o u ld in d ic a te th a t th e c o n
tr o l g ro u p d id p ro v id e a c o n s ta n t and re lia b le co m p a ris o n g ro u p .
H y p o th e s is 4 is p ro b a b ly th e k e y fin d in g p re se n te d b y th e s tu d y .
M e th a d o n e tre a tm e n t had no s ig n ific a n t e ffe c t on p e rs o n a lity change in
th is a d d ic t g ro u p and no m e a n in g fu l re d u c tio n in th e ir a s s e s s e d p s y c h o
p a th o lo g y w as a p p a re n t d u rin g th e s ix m onth tre a tm e n t p ro g ra m . The
o b v io u s in te rp re ta tio n o f th e re s u lts o f h y p o th e s is 4 w o u ld be th a t th e
m ethadone a p pro a ch is p ro b a b ly in e ffe c tiv e in a s s is tin g th e a d d ic t in
d e v e lo p in g m ore adeq u a te ego b o u n d a rie s . H o w e v e r, re a c h in g th is
c o n c lu s io n h a s tily m ay in fa c t be in a p p ro p ria te o r in a c c u ra te . T h e re
fo re i t is n e c e s s a ry to p re s e n t a num ber o f th e o re tic a l p o s s ib ilitie s to
in te rp re t th is re s u lt.
In re e v a lu a tin g th e p ro je c t i t m ay be th a t th e o rig in a l e x p e c ta
tio n s o f th e in v e s tig a to r w ere u n re a s o n a b le . H ow lik e ly is i t th a t an
a c u te ly d is tu rb e d a d d ic t p o p u la tio n w o u ld in d ic a te spo nta ne o u s em o
tio n a l re a d ju s tm e n t in s ix m o n th s? P o s s ib ly an e xte n d e d lo n g itu d in a l
in v e s tig a tio n o f 18 m onths to 36 m onths w o u ld ha ve p ro v id e d s ig n ific a n t;
re s u lts n o t a p p a re n t in th is in v e s tig a tio n .
A n o th e r p o s s ib le e x p la n a tio n fo r th e fin d in g s w as th a t th e i n i t i a l
70
e ffe c ts o f m ethadone tre a tm e n t do n o t o c c u r d u rin g th e In c e p tio n o f th e
d e to x ific a tio n p ro ce ss b u t b e fo re i t . W hen th e a d d ic t f in a lly c o n c lu d e s
he w a n ts to e n te r a m ethadone program he has a lre a d y undergone som e
m e a n in g fu l p e rs o n a lity a lte ra tio n s w h ic h have le a d him to seek h e lp and
th is a c c e p ta n c e o f tre a tm e n t is th e k e y ,v a r ia b le , n o t the m ethadone i t
s e lf. T h is p o in t does in fa c t shed d oub t on D o le and N y s w a n d e r's
m e ta b o lic d e fic ie n c y th e o ry , as i t in fe rs th a t m ethadone it s e lf is not
th e k e y fa c to r in th e p s y c h o lo g ic a l r e h a b ilita tio n o f th e a d d ic t.
The s tu d y d o e s, h o w e ve r, m andate p ro fe s s io n a ls in th is fie ld to
c o n tin u e to e xam ine th e lo n g -te rm e ffe c ts o f m ethadone tre a tm e n t.
P o s s ib ly th e c o n c lu s io n s o f h y p o th e s is 4 are m e a n in g fu l and in d ic a te
th a t m ethadone in it s e lf has l i t t l e or no e ffe c t on th e a d d ic t's p ro fo u n d
p s y c h o lo g ic a l d is tu rb a n c e s . The fin d in g s o f G e a rin g (197 0) and o f
R osenberg and P atch (197 2), do in d ic a te th a t h e ro in a d d ic ts do e x h ib it
le s s p s y c h o s o c ia l d is tu rb a n c e s in te rm s o f c r im in a lity and e m p lo ym e n t
in s t a b ilit y , b u t is th is s o c ia l a d ju s tm e n t due to m ethadone or th e fa c t
th a t th e a d d ic t no lo n g e r is fo rc e d to d e a l w ith u n d e rw o rld drug d e a le rs
and s o c io p a th s to p ro cu re h is needed f ix . P o s s ib ly i f h e ro in w as le g a l
and a v a ila b le to a d d ic ts in m ethadone ty p e c lin ic s , h e ro in a d d ic ts
w o u ld a ls o in d ic a te lo w le v e ls o f a n ti- s o c ia l b e h a v io rs and in c re a s e d
e m p lo ym e nt ra te s . T h is q u e s tio n s t i l l re m a in s u n re s o lv e d and w o u ld
need to be a n sw e re d e m p iric a lly b e fo re a n y a ffirm a tiv e s ta te m e n ts
71
c o u ld be m ade c o n c e rn in g th e e ffe c ts o f m ethadone tre a tm e n t.
R ecom m endations fo r F uture In v e s tig a tio n s
A fte r c o n s id e rin g th e re s u lts o f th is p ro je c t and re v ie w in g th e
c u rre n t s ta tu s o f m ethadone re s e a rc h th e in v e s tig a to r deem s i t a p p ro p ri
a te to s u g g e st needed fu tu re s tu d ie s in th is a re a . The m o st a p p a re n t
q u e s tio n o ffe re d b y th is in v e s tig a to r is , w o u ld have th e re s u lts have
been th e sam e i f th e s tu d y had been c o n d u c te d o ve r a lo n g e r p e rio d .
There is d e fin ite ly a need fo r a lo n g -te rm lo n g itu d in a l s tu d y to in v e s t i
g a te p e rs o n a lity and a ttitu d e ch anges o f th e h e ro in a d d ic t. T h is s tu d y
s h o u ld be co n d u c te d on an expan d e d sa m p le and w o u ld p ro b a b ly need to
be fu n d e d b y a m a jo r p riv a te o r fe d e ra l g ra n t. S in ce n o t a ll s o c io e c o n
o m ic g ro ups w ere in c lu d e d in th is s tu d y i t w o u ld be a p p ro p ria te to s u b
d iv id e th is sam ple on a b a s is o f ra c e and s o c io e c o n o m ic fa c to rs to
d e te rm in e w h e th e r th e s e is s u e s are in flu e n tia l in th e p e rs o n a lity re a d
ju s tm e n t o f th e a d d ic t.
A n o th e r in te re s tin g and u n a n sw e re d q u e s tio n is w h a t is th e m ost
a p p ro p ria te tre a tm e n t m o d a lity to in c re a s e th e lik e lih o o d o f e m o tio n a l
re h a b ilita tio n o f th e a d d ic t? W o u ld an a d d ic t re c e iv in g b o th m ethadone
and p s y c h o th e ra p y show g re a te r e m o tio n a l re a d ju s tm e n t th a n som eone .
m e re ly in v o lv e d in a m ethadone m a in te n a n ce a p p ro a ch ? W o u ld group
th e ra p y be m ore e ffe c tiv e w ith a d d ic ts in v o lv e d in re h a b ilita tio n p ro
gram s th a n in d iv id u a l p s y c h o th e ra p y ? These q u e s tio n s c o u ld be
72
a n sw e re d b y c re a tin g a lo n g -te rm m u ltip le g ro up re s e a rc h in v e s tig a tio n
w h ic h w o u ld in v o lv e o ffe rin g d iffe r e n tia l tre a tm e n t m o d a litie s fo r the
a d d ic t. S in ce th e ra d ic a l a p p ro a ch e s o f S ynanon and o th e r com m unal
program s have s t i l l fa ile d to e m p iric a lly v a lid a te th e ir s u cce ss ra te s in
an a c c e p ta b le , s c ie n tific m anner, i t becom es th e r e s p o n s ib ility o f th e
re s e a rc h p s y c h o lo g is t to a s su re th is s o re ly needed area re c e iv e s c o n
c e n tra te d s tu d y .
CHAPTER V
Sum m ary and C o n c lu s io n s
The purpose o f th is s tu d y w as to d e te rm in e th e e x is te n c e o f
I
'p e rs o n a lity d iffe re n c e s b e tw e e n h e ro in a d d ic ts and n o n a d d ic ts , and to
e v a lu a te th e e ffe c t o f a m ethadone tre a tm e n t program on th e p e rs o n a lity
o f a d d ic ts . Is th e re a g re a te r degree o f p s y c h o p a th o lo g y am ong n a rc o tic
u se rs th a n n o n u s e rs , and can th is be s u c c e s s fu lly tre a te d th ro u g h m e th
adone m a in te n a n c e ?
A re v ie w o f th e lite ra tu re re v e a le d a c o n tro v e rs y as to th e ca u se
o f a d d ic tio n and its s u b se q u e n t tre a tm e n t. O ne arg um e n t is th a t in d iv i
d u a ls seek n a rc o tic s b e ca u se o f an in h e re n t m e ta b o lic d e fic ie n c y and
! th a t m ethadone h e lp s to a lle v ia te th is (D o le & N y s w a n d e r, 1966, 1967).
1
I The o th e r s id e argues th a t th e re e x is ts a p re d is p o s in g p e rs o n a lity to
I h e ro in usage and th a t th e p s y c h o lo g ic a l p ro ble m s c a u s in g th e in d iv id u a l
to seek o u t drugs need to be c o n fro n te d (B e rz in s , R oss, & M o n ro e , 1971;
H ill, H a e rtz e n , & G la s e r, 1960; S heppard, F ra c c h ia , R ica , & M e r lis ,
1972; S u tk e r, 1971; S u tk e r & M o a n , 1972).
The th e o re tic a l p re s u p p o s itio n s o f th e re s e a rc h e r w ere based on
th e a rgum e nts p re s e n te d b y th e re s e a rc h e rs w ho s ta te d th a t th e re is a
p re d is p o s in g p e rs o n a lity w h ic h is m ore lik e ly to in itia te h e ro in abuse in
o rd e r to d e a l w ith u n re s o lv e d p s y c h o lo g ic a l c o n flic ts . T h is p o s itio n
73
74
w as d e s c rib e d b y th e d e a rth o f re s e a rc h e rs c ite d a t th e c o n c lu s io n o f
th e la s t p a ra g ra p h . The in te n t o f th is in v e s tig a tio n w as to d e te rm in e
w h e th e r in fa c t th e D o le and N ys w a n d e r (1966, 1967) p o s itio n w o u ld
prove a d eq u a te in e x p la in in g th e a b ilit y o r in a b ilit y o f a d d ic ts to show
s ig n ific a n t p s y c h o lo g ic a l re c o v e rie s w hen th e ir m e ta b o lic d e fic ie n c ie s
w ere re m ove d .
In o rd e r to re a s o n a b ly a tte m p t to a n s w e r th is q u e s tio n th e in v e s
tig a to r te s te d a sam ple o f h e ro in a d d ic ts b e fo re th e in c e p tio n o f tr e a t
m ent in a m ethadone c lin ic to e s ta b lis h a g ro u p p e rs o n a lity p ro file on
th e M M PI. T h is g ro up p ro file w as com pared to a c o n tro l g ro u p m atched
on a b a s is o f b a ckg ro u n d and s o c io e c o n o m ic fa c to rs . The a d d ic ts w ere
re te s te d s ix m onths la te r a fte r a c tiv e in v o lv e m e n t in a m ethadone p ro
gram and th e g ro up p ro file o f th e p re te s t w as s t a t is t ic a lly com pared to
th e g ro up p ro file re c e iv e d on th e p o s tte s t b y m eans o f th e t - t e s t p a ra
m e tric s ta tis tic . T h is a p p ro a ch a llo w e d th e in v e s tig a to r w ith in a lim
ite d fra m e w o rk, to in fe r w h e th e r or n o t th e p e rs o n a lity s tru c tu re o f th e
a d d ic ts s t i l l in d ic a te d s ig n s o f m e a n in g fu l p a th o lo g y once th e "in h e re n t
m e ta b o lic d e fic ie n c y " w as re m o ve d . T e s tin g th e D o le and N y s w a n d e r
th e o ry w as a lo g ic a l s te p to "d e te rm in e w h e th e r or n o t th e m e ta b o lic
d e fic ie n c y w as th e p rim a ry c a u se o f p s y c h o p a th o lo g y n o te d in a ll s tu d
ie d a d d ic t g ro u p s.
T h is c h a p te r p re s e n ts a sum m ary o f th e p ro ce d u re s u se d in th is
75
s tu d y as w e ll as a b r ie f re v ie w o f th e fin d in g s . In a d d itio n , im p lic a
tio n s fo r tre a tm e n t and re co m m e n d a tio n s fo r fu rth e r re s e a rc h are c ite d .
I Sum m ary o f P rocedures
I T h irty -th re e h e ro in a d d ic ts p a rtic ip a tin g in a m ethadone m a in
te n a n c e program in Los A n g e le s c o m p ris e d th e e x p e rim e n ta l g ro u p . They
w ere a d m in is te re d th e M in n e s o ta M u ltip h a s ic P e rs o n a lity In v e n to ry
(M M P I) as th e de pe n d e nt v a ria b le b o th b e fo re im p le m e n ta tio n o f m e th a
done tre a tm e n t and s ix m on th s a fte r tre a tm e n t b e g a n . A c o m p a riso n
gro up c o n s is tin g o f 26 m em bers o f a Big B ro th e rs A s s o c ia tio n g ro u p in
Los A n g e le s w ere a ls o a d m in is te re d th e M M PI d u rin g th e same tim e
in te r v a ls .
The fo llo w in g n u ll h y p o th e s e s w ere te s te d a t th e . 05 le v e l o f
s ig n ific a n c e :
There are no s ig n ific a n t d iffe re n c e s b e tw e e n th e
mean p re te s t sco re s o f th e c o n tro l and e x p e rim e n ta l
groups on a n y o f th e in d iv id u a l 13 m a jo r M M P I s c a le s .
2
H There are no s ig n ific a n t d iffe re n c e s b e tw e e n th e
m ean p o s tte s t sco re s o f th e c o n tro l and e x p e rim e n ta l
groups on a n y o f th e in d iv id u a l 13 m a jo r M M P I s c a le s .
3
H S ig n ific a n t d iffe re n c e s do e x is t b e tw e e n th e mean
p re te s t and p o s tte s t sco re s o f th e c o n tro l gro up on
any o f th e in d iv id u a l 13 m a jo r M M P I s c a le s .
76
4
H S ig n ific a n t d iffe re n c e s do e x is t b e tw e e n th e m ean
p re te s t and p o s tte s t sco re s o f th e e x p e rim e n ta l
g ro u p on a n y o f th e in d iv id u a l 13 m a jo r M M P I s c a le s .
I A to ta l o f 42 t - t e s t s w ere p e rform ed to com pare m ean d iffe re n c e s
Ten a d d itio n a l c o m p a ris o n s w ere pe rform ed u tiliz in g th e non para m e tric
M a n n -W h itn e y U te s t w here th e F ra tio fo r h o m o g e n e ity o f v a ria n c e
n e c e s s ita te d o b v ia tio n o f th e t - t e s t , as v a ria n c e s w e re n 't s u ffic ie n tly
co m p a ra b le .
Sum m ary o f F in d in g s
A fte r p e rfo rm in g th e above s ta tis tic a l te s ts on th e M in n e s o ta
M u ltip h a s ic P e rs o n a lity In v e n to ry i t w as fo und th a t s ig n ific a n t d if fe r
en ces d id e x is t b e tw e e n th e e x p e rim e n ta l and c o n tro l g ro u p s on b o th
p re te s t and p o s tte s t a lo n g s e v e ra l d im e n s io n s . M o s t n o tic e a b le w as
th e s ig n ific a n tly h ig h e r s c a le s 1, 2, and 4, and lo w e r s c a le 5 c h a ra c
te r is t ic o f th e a d d ic t g ro u p . In s h o rt, w hen com pared to n o n a d d ic ts ,
a d d ic ts e v id e n c e d s ig n ific a n tly m ore s ig n s o f h y p o c h o n d ria s e s , d e p re s
s io n , and p s y c h o p a th ic d e v ia n c y , and le s s s e n s itiv ity and fe m in in ity
o f in te re s ts .
P re te s t-p o s tte s t w ith in g ro up c o m p a ris o n s o f th e c o n tro l and
e x p e rim e n ta l g roups y ie ld e d no s ig n ific a n t d iffe re n c e s . The ind e p e nd e n t
v a ria b le , m ethadone tre a tm e n t, d id n o t a ffe c t p o s itiv e p e rs o n a lity
cha ng e in th e a d d ic t g ro u p .
77
In sum m ary, th e fin d in g s o f th is in v e s tig a tio n in d ic a te d th a t:
1 ) th e h e ro in a d d ic t show s a m a rk e d ly d iffe re n t p e rs o n a lity p ro file w hen
com pared to a n o n -a b u s in g g ro u p ; 2 ) a s ix m onth in v o lv e m e n t in a m e th
adone m a in te n a n ce program in d ic a te d no s ig n ific a n t a lte ra tio n s in th e
p e rs o n a lity s tru c tu re o f th e a b u se r. M a n y o f th e b a s ic s ig n s o f p s y c h o
p a th o lo g y p e rs is te d .
These re s u lts in d ic a te th a t a t le a s t on th e b a s is o f M M P I p ro
file s o b ta in e d in th is s tu d y th e u n d e rly in g e m o tio n a l d is tu rb a n c e s o f th e
h e ro in a d d ic t are n o t s ig n ific a n tly a lte re d b y m ethadone m a in te n a n c e .
T h is fin d in g is s ig n ific a n t in th a t i t m ay s tim u la te p ro fe s s io n a ls i n
v o lv e d in th e tre a tm e n t o f h e ro in a d d ic ts to re c o n s id e r w h e th e r or not
m ethadone is in it s e lf an a d eq u a te or s u ffic ie n t th e ra p e u tic program to
r e h a b ilita te drug a b u s e rs .
C o n c lu s io n s and R ecom m endations
The g e n e ra l c o n c lu s io n s th a t m ust be draw n from th is s tu d y are
th a t th e re are p e rs o n a lity d iffe re n c e s b e tw e e n a d d ic ts and n o n a d d ic ts ,
and th a t m ethadone tre a tm e n t is n o t an a d eq u a te m ethod to re d u ce p s y
c h o p a th o lo g y am ong a d d ic ts . These c o n c lu s io n s have b o th im p lic a tio n s
and q u a lific a tio n s .
The m ost a p p a re n t im p lic a tio n is th e n e c e s s ity fo r m ore co m p re
h e n s iv e tre a tm e n t fa c ilit ie s fo r th e drug a d d ic t. As d e m o n stra te d by th e
d a ta , he is s e rio u s ly d is tu rb e d p s y c h o lo g ic a lly , irre g a rd le s s o f c a u s e .
The need fo r p s y c h o th e ra p e u tic a s s is ta n c e b y tra in e d p ro fe s s io n a ls is
im p e ra tiv e .
From a th e o re tic a l p e rs p e c tiv e i t w o u ld appear th a t th e fin d in g s
are c o n tra d ic to ry to th e m e ta b o lic d e fic ie n c y m o d e l o f D o le and N y s w a n
der (1966), upon w h ic h m ethadone tre a tm e n t w as fo u n d e d . H o w e ve r, th e
p re s e n t s tu d y w as n o t a b le to is o la te th e e ffe c t th a t a d d ic tio n m ig h t have
on p e rs o n a lity . T h e re fo re a d e fin itiv e s ta te m e n t as to th e e tio lo g y o f
n a rc o tic a d d ic tio n c a n n o t be made b a se d s o le ly on th e fa ilu re o f m e th a
done to a ffe c t p e rs o n a lity c h a n g e . N e v e rth e le s s , th e data p o in t to w a rd s
th e " a d d ic tio n -p ro n e " p e rs o n a lity th e o ry w h ic h s ta te s th a t th e n a rc o tic
s a tis fie s some p s y c h o lo g ic a l w e a kn e ss in th e a d d ic t.
In c o n d u c tin g fu rth e r re s e a rc h in th e area o f n a rc o tic a d d ic tio n ,
th e a d e q u a cy o f e x p e rim e n ta l c o n tro ls is im p e ra tiv e . As G endreau and
G e n d reau (197 3) p o in te d o u t, th e re are a b un d a n t m e th o d o lo g ic a l fla w s in
p a s t s tu d ie s done in th is a re a . W h ile m e th o d o lo g y is ham pered b y i n
ta c t groups p ro h ib itin g a tru e e x p e rim e n ta l d e s ig n , m a tch in g a lo n g such
d im e n s io n s as s o c io e c o n o m ic s ta tu s , e d u c a tio n , and c rim in a l b e h a v io r
is in d ic a te d . In a d d itio n , th e problem o f c o lle c tin g data upon s h rin k in g
s a m p le s, p a r tic u la r ly in th e a d d ic t g ro u p , p re s e n ts a th re a t to v a lid ity .
An a d e q u a te c o m p a ris o n am ong d iffe re n t tre a tm e n t m o d a litie s fo r
th e n a rc o tic a d d ic t needs to be p e rfo rm e d — and th is n e c e s s ita te s a
s ta n d a rd iz e d o u tco m e c r ite r ia . I t is th e a u th o r's o p in io n th a t a n y a g ree d
79
u pon c rite ria s h o u ld encom pass a m easure o f p s y c h o lo g ic a l fu n c tio n in g ,
as e v id e n c e d b y s ig n ific a n t p s y c h o p a th o lo g y am ong a d d ic ts .
F in a lly , th e re is a d e fin ite need fo r in -d e p th s tu d y o f th e e ffe c t
iv e n e s s o f m ethadone p ro g ra m s. The lite ra tu re has in d ic a te d th a t th e
m ethadone a d d ic t is le s s s o c io p a th ic th a n he w as as a h e ro in a d d ic t;
h o w e ve r, th is fin d in g in it s e lf is in a d e q u a te to ju s t if y o r s ta te th a t m e th
adone tre a tm e n t is s ig n ific a n t in ch a n g in g th e b a s ic c h a ra c te r d is tu rb a n c e
o f th e a d d ic t. The m e n ta l h e a lth fie ld is m andated to go b e yo n d s u p e r
f ic ia l c rite ria in u n d e rs ta n d in g p e rs o n a lity d y n a m ic s and to c o n s ta n tly
seek m ore c o m p le te m ethods o f tre a tin g and n o t m e re ly m a in ta in in g th e
h e ro in a d d ic t.
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o f In te rn a l M e d ic in e , 1966, 1 1 8 , 3 0 4 -3 0 9 . |
I D u P o n t, R. The h e ro in p ro b le m . T im e , 197 5, 11, 1 5 -1 8 . I
I
E llis , A . The v a lid it y o f p e rs o n a lity q u e s tio n n a ire s . P s y c h o lo g ic a l |
I B u lle tin , 1946, 43, 3 8 5 -4 4 0 . |
I j
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!
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I
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(G e a rin g , F. S u ccess and fa ilu re in m ethadone m a in te n a n ce tre a tm e n t o f ;
83
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H ill, H . , H a e rtz e n , C . , & D a v is , H , An M M P I fa c to r a n a ly tic s tu d y o f
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H o lz b e rg , J, , & A le s s i, S. R e lia b ility o f th e s h o rte n e d M M P I. Journal i
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H u n t, L . R ecent sp re ad o f h e ro in a d d ic tio n in th e U n ite d S ta te s : U n a n
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1974, I
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j H ouse o f R e p re s e n ta tiv e s , Part I I , 1 9 7 1 , W a s h in g to n , D . C . : ; |
; G o ve rn m en t P rin tin g O ffic e , 1971, |
I I
lln s titu te o f P e rs o n a lity A s s e s s m e n t and R esearch (IPAR), S p e c ia l co m -
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j P ress, 1952, !
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j drug a b u s e : A c o m p a ris o n o f a d d ic t and n o n a d d ic t p o p u la tio n s i
I from th e p e rs p e c tiv e o f s e lf th e o ry . S o c ia l S cie n ce and M e d ic in e ,
j 1970, 2 0 3 -2 2 5 . ;
< 1
(K ra ft, T , D rug a d d ic tio n and p e rs o n a lity d is o rd e r, B ritis h Jo urnal o f
85
A d d ic tio n , 1970, 64, 4 0 3 -4 0 8 .
L a n d , H . D rugs and yo u r c h ild . N e w Y o rk: M c G r a w - H ill, 1969.
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a lit y . B a ltim o re : W illia m s & W ilk e n s , 19 63.
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o p ia te a d d ic tio n c o n tro l: C o s ts , b e n e fits , and p o te n tia l. F in a l
R eport BN D D C o n tra c t N o . J -7 0 -3 3 . B ureau o f N a rc o tic s and
D angerous D ru g s , W a s h in g to n , D . C . , 1972.
M c K in le y , J. , & H a th a w a y , S. A m u ltip h a s ic p e rs o n a lity sc h e d u le
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"p s y c h o p a th " : Im p lic a tio n s fo r c o m m u n ity c a re . In te rn a tio n a l
Journal o f th e A d d ic tio n s , 1971, 2 ^ , 6 0 1 -6 0 8 .
M o o re , M . P o lic y c o n c e rn in g drug abuse in N e w York s ta te --V o lu m e I I I :
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1974.
N a rc o tic s R e g is te r S ta tis tic a l R eport. N e w Y o rk: C ity o f N e w York
I H e a lth D e p a rtm e n t, 1972. i
O v e ra ll, J. M M P I p e rs o n a lity p a tte rn s o f a lc o h o lic s and n a rc o tic a d d ic ts
I Q u a rte rly Journal o f S tu d ie s on A lc o h o l, 1973, 2 1 ' 1 0 4 -1 1 1 .
!
I R ic h a rd s , L . , & L a n g e r, J. D rug ta k in g in y o u th . W a s h in g to n : U .S .
I D e p a rtm e n t o f J u s tic e , 1971.
I I
I R osenberg, C . , & P atch, V. T w e lv e -m o n th fo llo w - u p o f a d o le s c e n t I
a d d ic ts tre a te d w ith m e th a do n e . F ourth N a tio n a l C o n fe re n ce on
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! S heppard, C . , F ra c h ia , J. , R ic c a , E. , & M e r lis , S. In d ic a tio n s o f j
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I 3 5 1 -3 6 0 , ;
(
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'----- -2 4 7 -2 5 6 . - -
8 6
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APPENDIX
87
8 8
The M M P I S ca les
The M M P I s c a le s w ere c o n s tru c te d b y an e m p iric a l m ethod.
The 550 te s t ite m s w ere a d m in is te re d to g ro ups o f c a re fu lly
s tu d ie d c lin ic a l c a s e s and to g roups o f in d iv id u a ls ju d g e d
to be n o rm a lly a d ju s te d . Those ite m s w h ic h d iffe re n tia te d
th e c lin ic a l group (fo r in s ta n c e , d e p re sse d p a tie n ts ) from
th e n o rm a l g ro up c o m p ris e d a s c a le ; in th is c a s e , S ca le 2
(D ). The o r ig in a l s ta n d a rd iz a tio n y ie ld e d n in e c lin ic a l
s c a le s . I t has becom e in c re a s in g ly a p p a re n t, h o w e ve r,
th a t th e aim o f id e n tify in g an in d iv id u a l as a m em ber o f a
d ia g n o s tic g ro u p on th e b a s is o f s in g le s c a le e le v a tio n is
n e ith e r p ra c tic a l n or u s e fu l. The c u rre n t fo c u s in th e
c lin ic a l u tiliz a tio n o f th e M M P I is upon th e c o n fig u ra i re
la tio n s h ip s am ong th e s c a le s , and upon th e use o f th e te s t
data fo r p e rs o n a lity d e s c rip tio n .
The m o st w id e ly used s c a le s o f th e M M P I a t th e p re s e n t
tim e are fo u r v a lid it y s c a le s and te n c lin ic a l s c a le s . There
a re , in a d d itio n , a v a s t num ber o f " s p e c ia l s c a le s " w h ic h
are le s s kn o w n and le s s w id e ly used (and w ill n o t be d is
c u s s e d in th is s tu d y ).
A . The V a lid ity S c a le s
U n lik e m any o f th e p a pe r and p e n c il te s ts o f p e rs o n a lity ,
th e M M P I p ro v id e s s c a le s d e s ig n e d to a s s e s s th e v a lid ity
o f th e te s t. These s c a le s p ro v id e a c h e c k on su ch te s t -
ta k in g a ttitu d e s as d e s ire to e xa g g e ra te o r m in im iz e sym p
tom s and on fa c to rs w h ic h w o u ld in te rfe re w ith th e in te r
p re ta tio n o f th e te s t re s u lts such as in a b ilit y to re a d or
u n d e rs ta n d th e q u e s tio n s and a fa ilu re to a n s w e r an a d e
q u ate num ber o f ite m s . In a d d itio n , th e v a lid it y s c a le s
have c lin ic a l im p lic a tio n s .
? S ca le The ? o r "C a n n o t S ay" sco re is a c o u n t o f
th e num ber o f ite m s le f t u n a n s w e re d . The
in s tru c tio n s re q u e s t th e p a tie n t to c o m p le te
a ll o f th e ite m s , and th e te s t a d m in is tra to r
is a ske d to re tu rn th e te s t to th e p a tie n t fo r
c o m p le tio n i f m ore th a n 30 have been o m itte d .
H IG H s c o re s , i f re a d in g d if f ic u lt y can be
ru le d o u t, m ay in d ic a te 1 ) a r e s is tiv e , u n
c o o p e ra tiv e p a tie n t, or 2 ) o b s e s s io n a lis m ,
in te lle c tu a liz a tio n and in d e c is io n .
89
L S ca le The L s c a le c o n s is ts o f 15 ite m s w h ic h d e
s c rib e r e la tiv e ly m in o r fa u lts or fa ilin g s to
w h ic h m ost p e o p le w o u ld re a d ily a d m it. A
H IG H score on L s u g g e s ts th a t th e s u b je c t,
in h is e a ge rn e ss to appea r s o c ia lly a c c e p t
a b le , has c o n c e a le d o r m is re p re s e n te d some
th in g s a b o u t h im s e lf on th e te s t. P eople
w ith h ig h L sco re s m ay be te n s e , s te re o ty p e d ,
and la c k in g in in s ig h t. They te n d to be r ig id ,
n a iv e ly d e fe n s iv e , and u n c o m p re h e n d in g .
Low sc o re rs te n d to be in d e p e n d e n t, s o c ia lly
re s p o n s iv e p e o p le w ho are c o m fo rta b le in
a d m ittin g fa u lts .
F S ca le The F s c a le is made up o f 64 ite m s w h ic h are
ra re ly a n sw e re d in th e sco re d d ire c tio n . H IG H
F s c a le sco re s (over 80) s u g g e st th a t th e s u b
je c t has been in v a lid a te d b e ca u se th e s u b je c t:
1. W as u n a b le to re a d o r u n d e rs ta n d th e te s t
ite m s or m ade e rro rs in f illin g o u t th e
a n s w e r s h e e t.
2. W as s e rio u s ly c o n fu s e d , d is o rg a n iz e d ,
or d e lu s io n a l.
3. A tte m p te d to m ake h im s e lf lo o k e x tre m e ly
d is tu rb e d fo r some re a s o n .
4. D id n o t c o o p e ra te , and p u rp o s e ly re s
ponded in a random o r irre le v a n t m anner.
; Ù L o w F s c a le sco re s s u g g e s t th a t th e te s t ite m s
w ere u n d e rs to o d and th e te s t ta k e n a c c o rd in g
to in s tr u c tio n s . P eople w ith lo w sco re s are
o fte n d e s c rib e d as c a lm , c o n v e n tio n a l and
d e p e n d a b le , and as h a v in g n a rro w in te r e s ts .
F sco re s te n d to be re d u ce d a fte r th e ra p y .
K S ca le The K s c a le is com p ose d o f 3 0 ite m s w h ic h
m easure th e te s t- ta k in g a ttitu d e s o f th e
s u b je c t.
90
H IG H K s c a le sco re s s u g g e s t th a t th e s u b je c t
is d e fe n s iv e and h e s ita n t to a d m it p s y c h o lo g i
c a l p ro ble m s o r w e a k n e s s e s . T hey m ay a ls o
su g g e s t th a t he is r e la tiv e ly c o n te n t w ith h is
p re s e n t s ta tu s , and th a t he w o u ld be re s is ta n t
to th e ra p e u tic c h a n g e . M o d e ra te e le v a tio n s
(T = 5 5 -6 5), h o w e ve r, m ay s u g g e s t a d a p tiv e
n e ss and ego s tre n g th .
L o w K s c a le sco re s su g g e st th a t th e s u b je c t
is s e lf - c r it ic a l, d is s a tis fie d , and w illin g to
a d m it to sym ptom s and fa ilin g s . T hey m ay
r e fle c t in a d e q u a c y o f c u rre n t d e fe n s e s and a
re a d in e s s fo r p ro fe s s io n a l h e lp .
B. The C lin ic a l S ca le s
S ca le 1 S cale 1 is com posed p r in c ip a lly o f ite m s
(H s) w h ic h d e s c rib e p h y s ic a l c o m p la in ts and
b o d ily fu n c tio n s .
H IG H S ca le 1 sco re s a re a s s o c ia te d w ith
undue c o n c e rn a b o u t h e a lth o r b o d ily fu n c
tio n s . W here re a l p h y s ic a l d is o rd e rs are
p re s e n t, th e sym ptom s are lik e ly to be
e x a g g e ra te d . H ig h s c o re rs te n d to be e g o
c e n tric , ir r ita b le , and c o m p la in in g .
LO W S ca le 1 sco re s s u g g e s t an a m b itio u s ,
e n e rg e tic p e rson w ho is fre e o f in h ib itio n s
and n o t o v e rly co n ce rn e d w ith p h y s ic a l
c o m p la in ts .
S ca le 2 S ca le 2 w as d e v e lo p e d to id e n tify p a tie n ts
(D) w ho e x h ib ite d d e p re s s io n .
H IG H S ca le 2 sco re s s u g g e s t d e p re s s io n ,
w o rry and p e s s im is m . M o d e ra te e le v a tio n s
m ay be a s s o c ia te d w ith good p s y c h o th e ra p y
re s p o n s e . S ca le 2 is s e n s itiv e to tra n s ito ry
flu c tu a tio n s o f m ood.
LO W S ca le 2 sco re s are a s s o c ia te d w ith
c h e e rfu ln e s s , s p o n ta n e ity and th e a b se n ce
91
o f d e p re s s io n . T hey te n d to o c c u r in
yo u n g e r p e o p le and in p e o p le w ith a la c k
o f in h ib itio n . They are ty p ic a l o f p o s t
th e ra p y p r o file s .
S cale 3 S ca le 3 w as b a se d upon a g ro up o f p a tie n ts
(H y) s u ffe rin g from c o n v e rs io n h y s te ria .
H IG H S ca le 3 sco re s s u g g e s t im m a tu rity ,
re p re s s io n , e m o tio n a l la b ilit y and s u s c e p t
i b i l i t y to s u g g e s tio n . U nder s tre s s , p h y s ic a l
sym ptom s m ay be used as a m eans o f s o lv in g
c o n flic ts o r a v o id in g r e s p o n s ib ilitie s ,
LO W S ca le 3 sco re s s u g g e s t a c o n s tric te d ,
g uarded and s o c ia lly n o n p a rtic ip a tin g p e r
s o n a lity . They m ay a ls o o c c u r in e m o tio n
a lly w e ll a d ju s te d and in te lle c tu a lly above
a ve ra g e in d iv id u a ls .
S ca le 4 S ca le 4 w as b a se d upon p a tie n ts w ho e x h ib -
(Pd) ite d a d is re g a rd fo r s o c ia l v a lu e s , an in a b il
i t y to p r o fit from e x p e rie n c e and a d if f ic u lt y
in m a in ta in in g s a tis fa c to ry p e rs o n a l r e la tio n
s h ip s ,
H IG H S ca le 4 sco re s s u g g e s t an in d iv id u a l
w ho is im p u ls iv e , re s e n tfu l and la c k in g in
deep e m o tio n a l re s p o n s e s . M o d e ra te e le v a
tio n s m ay be c h a ra c te ris tic o f n o rm a ls w ho
are a d v e n tu ro u s , s o c ia b le and v e rb a l,
L O W S ca le 4 sco re s su g g e st a c o n fo rm in g ,
u n a ssu m in g p e rso n w ho is o v e rly a c c e p tin g
o f a u th o rity . They m ay a ls o in d ic a te a p e r
son la c k in g in h e te ro s e x u a l in te re s ts .
S ca le 5 S cale 5 m e asures a te n d e n c y to w a rd th e
(M f) a ttitu d e s and in te re s ts o f th e o p p o s ite s e x .
H IG H S ca le 5 sco re s s u g g e s t, in m a le s ,
s e n s itiv ity and fe m in in ity o f in te re s ts and,
in fe m a le s , a m a s c u lin e , a c tiv e , a g g re s s iv e
o rie n ta tio n . E d u ca te d , c u ltu r a lly o rie n te d
92
m a le s te n d to have e le v a te d s c o re s ,
LO W S ca le 5 sco re s s u g g e s t, in m a le s , an
a d v e n tu ro u s p e rson w ho p re fe rs a c tio n to
c o n te m p la tio n a n d , in fe m a le s , a s tro n g fe m
in in e in te re s t p a tte rn , p a s s iv ity , a n d , in th e
e xtre m e , a m a s o c h is tic w illin g n e s s to a c c e p t
b u rd e n s .
S ca le 6 S ca le 6 w as b a se d upon p a tie n ts w ho show ed
(Pa) s u s p ic io u s n e s s , fe e lin g s o f p e rs e c u tio n and
o th e r p a ra n o id sym p to m s.
H IG H S ca le 6 sco re s su g g e s t a s u s p ic io u s ,
o v e rly s e n s itiv e p e rson w ho u tiliz e s p ro je c
tio n as a d e fe n s e . H ig h sc o re rs te n d to be
s e lf-c e n te re d , and to fe e l d is c rim in a te d
a g a in s t. j
I
LO W S ca le 6 sco re s are o fte n a s s o c ia te d I
w ith tr a its s im ila r to th o s e o f h ig h S ca le 6 ]
s c o re s . The s u s p ic io u s n e s s is lik e ly . t o be |
a c c o m p a n ie d b y a la c k o f co n c e rn w ith |
s o c ia l c o n ta c t and b y stu b b o rn n e ss and |
e v a s iv e n e s s . I
I
1
S ca le 7 S ca le 7 w as b a se d upon a gro up o f p a tie n ts ;
(Ft) tro u b le d b y p h o b ia s , o b s e s s io n s and c o m - |
p u ls io n s , I
I
H IG H S ca le 7 sco re s are a s s o c ia te d w ith |
a n x ie ty , r ig id it y , te n s io n , fe a rs and e x - 1
c e s s iv e d o u b t. !
LO W S ca le 7 s c o re s s u g g e s t a w e ll o rg a n iz e d , !
p e rs is te n t and r e a lis tic p e rso n w ho is a b le to j
m o b iliz e h is re s o u rc e s e a s ily and e ffe c tiv e ly . '
S ca le 8 S ca le 8 w as d e v e lo p e d from a g ro u p o f p a tie n ts
(Sc) s h o w in g th e b iz a rre and u n u s u a l th o u g h ts a nd
b e h a v io r ty p ic a l o f s c h iz o p h re n ia .
H IG H S ca le 8 sco re s s u g g e s t s o c ia l w ith d ra w a l,
u n u s u a l th o u g h t p ro c e s s e s and n o n c o n fo rm ity ,
93
a lth o u g h n o t n e c e s s a rily a s c h iz o p h re n ic
c o n d itio n .
LO W S cale 8 sco re s s u g g e s t a c o n v e n tio n a l,
c o n tro lle d and som ew hat c o m p lia n t pe rson
lik e ly to be seen b y o th e rs as fr ie n d ly and
a d a p ta b le .
S ca le 9 S ca le 9 w as d e riv e d from a g ro up o f p a tie n ts
(M a) w ho show ed h y p o m a n ia , e m o tio n a l e x c ite
m e n t, flig h t o f id e a s and o v e r a c tiv ity .
H IG H S cale 9 sco re s su g g e st h ig h e n e rg y
le v e l, re s tle s s n e s s , e n th u s ia s m and im
p a tie n c e , and h y p e ra c tiv ity .
LO W S ca le 9 sco re s su g g e st lo w e n e rg y
le v e l, n o n c o m p e titiv e n e s s , and a la c k o f
s e lf-c o n fid e n c e .
S cale 0 S ca le 0 w as d e v e lo p e d to id e n tify s o c ia l
(Si) p a rtic ip a tio n .
H IG H S cale 0 sco re s s u g g e s t a s h y , s e n
s itiv e pe rson w ho is h e s ita n t to becom e
in v o lv e d in s o c ia l s itu a tio n s .
LO W S ca le 0 sco re s s u g g e s t a s o c ia b le
p erson w ho is o u tg o in g a n d a s s e rtiv e in
h is re la tio n s h ip s w ith o th e rs . (F o w le r,
1966, p. 6 -1 0 )

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Asset Metadata

Creator Sion, Lee (author)

Core Title An experimental study of the longitudinal effects of a methadone treatment program on the personality structure of heroin addicts

Degree Doctor of Philosophy

Degree Program Education

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag OAI-PMH Harvest,Psychology, clinical

Language English

Contributor Digitized by ProQuest (provenance)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c26-471231

Unique identifier UC11245905

Identifier usctheses-c26-471231 (legacy record id)

Legacy Identifier DP24616.pdf

Dmrecord 471231

Document Type Dissertation

Rights Sion, Lee

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA