Journal of Studies on Alcohol, Vol. $6, No. I, 1975
BRIEF
REPORTS
Control Orientation Extent
in Alcoholics Related to
Treatment
L. JeromeOzieP and FrederickW. Obitz2 StrMMAnV. The self-perceived locusof controlof three groupsof alcoholics who had had varyingamountsof exposureto treatmentwas measuredon the InternalExternal(I-E) scale.Alcoholicswho had had more treatmentperceivedthemselves in greatercontrolof their behaviorin generaland of their drinkingin particularthan those who had had less treatment.
Severalrecentinvestigations have shownthat alcoholicsreport that they perceivethemselves as beingin controlof their own behavior(1, 2, 3). Oziel et al. (3) reportedthat alcoholics not only statethat they are in control of their behavior in general but also of their drinking behavior.This finding appearsparadoxicalsince drinking was creating major problemsin their day-to-dayfunctioning. Gossand Morosko(1) were surprisedto find that a majorityof the
alcoholics they studiedscoredas internallycontrolledon the InternalExternalControl (I-]•) Scale (4). They suggested that the alcoholics' belief in personalcontrolmight be a contributingfactor in the guilt and self-blamecommonlyfound in alcoholics.Gozali and Sloan (2) suggestedthat the alcoholics'internalcontrolorientationwas at leastpartly responsiblefor their excessivedrinking and contributedto a proclivity to become an addict.
The data substantiating the perceivedinternallocusof controlof alcoholicshave been derivedfrom alcoholicswho were activelyparticixUniversityof SouthernCalifornia Schoolof Medicine, Departmentof Psychiatry, 1934 Hospital Place, Los Angeles,CA 90033. • VeteransAdministrationHospital, Phoenix,AZ 85012. AC•OWLV.DCMV.•T.--Wethank Dr. Peter Berwick, SouthernArizona Mental Health Center, Tucson, who assistedin data collection. Reprint requeststo: L. Jerome Oziel, Ph.D., Department of Psychiatry, 1934 Hospital Place, Los Angeles,CA 90033. Receivedfor publication:27 January1974. Revision:4 September1974. 158
BRIEF REPORTS
159
patingin a treatmentprogram.Many programsstressthe importance of alcoholics' motivationto stop drinking (e.g., 3). It is possiblethat, as a resultof their exposureto treatmentprograms, theylearnto believeor reportthat they are in controlof their behavior and that the consequence of thislearningis their self-reportedperceived internal orientation.By samplinggroupsof alcoholicswho have had differentdegreesof exposureto treatmentprograms,we hopedto answer this question.We hypothesizedthat as alcoholicsexperiencedgreater exposure to treatmentprogramsthey wouldreportperceivingthemselves in greatercontrolof their behaviorin generaland of their drinkingbehavior in particular. METHOD
One hundred alcoholicsparticipatingin 3 different treatmentprogramsin Arizona (the Veterans AdministrationHospital and St. Luke's Hospital in Phoenixand West Center Recovery,Rehabilitation,and ResearchCenter in Tucson)were dividedinto 3 groupsaccordingto the total time they had spent in treatment: (1) 25 alcoholics(18 men and 7 women) who were currently in a detoxicationprogramfor the first time and had not receivedprior treatment, (2) 25 alcoholics(17 men and 8 women) who were currentlyin a detoxication programand had beenin a detoxicationprogram3 or more times but had not takenpart in systematic rehabilitationprograms,and (3) 50 alcoholics(37 men and 13 women) who were participating in an ongoing postdetoxication rehabilitativeprogramof 2 months'or greater duration.The mean age of group I was 45.2 years (range, 23-62); group II, 40.0 (range, 23-66); and group III, 45.0 (range, 17-70). The patientswere recruitedon a voluntarybasisand were not askedto identify themselvesby name on the testing material. All volunteerscompleted the x-•. scale (4) and a scalespecificallydesignedto measureperceived locus of drinking control. The drinking control scale was patterned after the x-•. scale with regard to number of items, forced choice format and the type of scoring. a In essence,the scale translatedgeneralizedperceivedlocusof controlinto specifiedperceivedlocusof controlwith regard to drinkingbehavior.Items suchas the followingwere included: (a) There is no suchthing as an irresistibletemptationto drink. (b) Many times there are circumstances that forceyou to drink. (On both scalesa low scoreindicatesinternalcontrolorientation.) •{ESULTS
The mean scoreon the I-E scalewas 11.48 (range, 4-18--*-_ 3.47, SD) in groupI; 7.92 (range, 1-17--+-_ 4.02) in group II; and 6.10 (range, 1-21--*-_ 3.50) in group III. Comparisons of group meansindicatedthe following:Patientsin groupI were significantlylessinternalthan those in groupII (t = 4.75,48 dr, p • .001,one-tailed),and patientsin group 8For a copy of the locusof drinking control scale,order NAPS DocumentNo. 02504 from ASIS/NAPS, c/o MicrofichePublications,440 Park Ave., South,New York, NY 10016; remit with order $1.50 for microfiche or $5.00 for full-size
photocopy. Outsidethe U.S. and Canada,postageis $2 for a photocopyor $.50 for a microfiche.
160
JOURNALOF STUDIESON ALCOHOL
II weresignificantly lessinternal thanthose in groupIII (t -- 9.44,73dr, p • .001).All comparisons fromthe •-v, scaledatasupported the hypothesis of increased internalcontrolorientation withincreased exposure to treatment
programs.
The meandrinkingcontrolscoreof groupI was9.00 (range,3-20 ñ 4.02); groupII, 5.00 (range,0-12 ñ 2.93); and groupIII, 5.60 (range,
0-22ñ 4.80). The patients in groupI weresignificantly lessinternal thanthosein groupII (t ----5.71,48 dr, p • .001,one-tailed);but patientsin groupII were not significantly differentfrom thosein group
III (t • 0.92,73 dr); patients in groupI weresignificantly lessinternal thanthosein groupIII (t -- 4.72,73 dr, p • .001). Two of thesethree comparisons supported the hypothesis of increased internalitywith increasedexposureto treatment programs. DXSCUSSION'
The hypothesis was stronglysupportedby the data. Scoreson the x-v,scalewereprogressively and reliablymorein the internaldirection as length of exposureto treatmentprogramsincreased.As a group, patientsbeingdetoxicated for the first time had a meanx-v,scorethat classifiedthem as externallycontrolled.Alcoholicswho had been detoxicated three or more times had a mean x-v, score that classified them
as beingneitherinternallynor externallycontrolled.Finally,alcoholics who were in a rehabilitativeprogramhad a mean•-v, scorethat classified them as internallycontrolled. With oneexceptionthe datafrom the drinkingcontrolscalesupported the hypothesis. Alcoholicsbeing detoxicatedfor the first time were significantly less internal than thosewho had been detoxicatedthree or more times and significantlyless internal than those who were in a rehabilitativetreatment program. It might be expectedthat alcoholicswho voluntarilyentereda pro-
longedpostdetoxication treatmentprogramwould be more internally orientedthan thosewho did not. Hence, it might be argued that there is a selectionfactorwhich accountsfor theseresults.Suchan hypothesis is not totally consistent, however,with the data presentedhere. Granted that there may be a selectionfactor concomitantwith the decisionto participatein a rehabilitativeprogram, it is improbablethat such a selectionfactor is concomitantwith the decisionto undergodetoxication. The decisionto undergodetoxicationwould certainlyseemto be made under different conditionsthan the decisionto participate in a rehabilitativeprogram.Yet the changetoward internalitywas consistent from the group undergoingdetoxicationfor the first time to the group beingdetoxicatedfor at leastthe third time. A selection-factor hypothesis, therefore,could possiblyaccountfor the changeobservedin the
rehabilitationgroup,but it doesnot accountfor the changeobserved in the multiple detoxicationgroup. A treatment-exposure hypothesis, on the other hand, is consistentwith the shift toward internal control
orientationobservedacrossall three groupsof alcoholics.
SlUrX•ae•oa•s
161
We are not attemptingto challengethe finding that alcoholicsin
treatmentprogrgms reportthat they perceivethemselves as being in controlof their•behaviorin generaland of their drinkingbehaviorin particular;thesefindingshave been amply demonstrated. What is suggestedis that this perceivedinternal controlon the part of alcoholics may be a consequence of exposureto treatmentmodalitiesthat stress the importanceof self-motivation,self-controland a "you-can-do-itif-you-want-to"attitude,rather than a consequence of a predisposing personalitydimension.It may be, then, that internallycontrolledalcoholicsare simplyalcoholicswho have been reinforcedfor behavingas an "external"("unable"to controldrinking)but verbalizingan "internal" attitude (I "can"controlmy drinking). This would be a simple but plausibleexplanationthat would accountfor past and presentfindings regardingthe puzzling discrepancybetween alcoholics'attitudes and behavior.
REFERENCES
1. Goss, A. and MoaosKo, T. E. Relation between a dimensionof internal-external
controland the MMrXwith an alcoholicpopulation.J. cons.olin. Psychol.34: 189-192, 1970.
2. Goz.•LI, J. and SLOAN,J. Controlorientationas a personalitydimensionamong alcoholics.Quart. J. Stud. Ale. 32: 159-161, 1971. 3. OZ•EL,L. J., OB•, F. W. and I•tSON, M. Generaland specificperceivedlocus of control in alcoholics.Psychol.Rep. 30: 957-958, 1972. 4. ROTTEa,J. B., LIVF-at,tNT, S. and CaOWNE,D. P. The growth and extinctionof expectancies in chancecontrolledand skilled tests.J. Personality52: 161-177, 1961.
BRIEF
REPORTS
Control Orientation Extent
in Alcoholics Related to
Treatment
L. JeromeOzieP and FrederickW. Obitz2 StrMMAnV. The self-perceived locusof controlof three groupsof alcoholics who had had varyingamountsof exposureto treatmentwas measuredon the InternalExternal(I-E) scale.Alcoholicswho had had more treatmentperceivedthemselves in greatercontrolof their behaviorin generaland of their drinkingin particularthan those who had had less treatment.
Severalrecentinvestigations have shownthat alcoholicsreport that they perceivethemselves as beingin controlof their own behavior(1, 2, 3). Oziel et al. (3) reportedthat alcoholics not only statethat they are in control of their behavior in general but also of their drinking behavior.This finding appearsparadoxicalsince drinking was creating major problemsin their day-to-dayfunctioning. Gossand Morosko(1) were surprisedto find that a majorityof the
alcoholics they studiedscoredas internallycontrolledon the InternalExternalControl (I-]•) Scale (4). They suggested that the alcoholics' belief in personalcontrolmight be a contributingfactor in the guilt and self-blamecommonlyfound in alcoholics.Gozali and Sloan (2) suggestedthat the alcoholics'internalcontrolorientationwas at leastpartly responsiblefor their excessivedrinking and contributedto a proclivity to become an addict.
The data substantiating the perceivedinternallocusof controlof alcoholicshave been derivedfrom alcoholicswho were activelyparticixUniversityof SouthernCalifornia Schoolof Medicine, Departmentof Psychiatry, 1934 Hospital Place, Los Angeles,CA 90033. • VeteransAdministrationHospital, Phoenix,AZ 85012. AC•OWLV.DCMV.•T.--Wethank Dr. Peter Berwick, SouthernArizona Mental Health Center, Tucson, who assistedin data collection. Reprint requeststo: L. Jerome Oziel, Ph.D., Department of Psychiatry, 1934 Hospital Place, Los Angeles,CA 90033. Receivedfor publication:27 January1974. Revision:4 September1974. 158
BRIEF REPORTS
159
patingin a treatmentprogram.Many programsstressthe importance of alcoholics' motivationto stop drinking (e.g., 3). It is possiblethat, as a resultof their exposureto treatmentprograms, theylearnto believeor reportthat they are in controlof their behavior and that the consequence of thislearningis their self-reportedperceived internal orientation.By samplinggroupsof alcoholicswho have had differentdegreesof exposureto treatmentprograms,we hopedto answer this question.We hypothesizedthat as alcoholicsexperiencedgreater exposure to treatmentprogramsthey wouldreportperceivingthemselves in greatercontrolof their behaviorin generaland of their drinkingbehavior in particular. METHOD
One hundred alcoholicsparticipatingin 3 different treatmentprogramsin Arizona (the Veterans AdministrationHospital and St. Luke's Hospital in Phoenixand West Center Recovery,Rehabilitation,and ResearchCenter in Tucson)were dividedinto 3 groupsaccordingto the total time they had spent in treatment: (1) 25 alcoholics(18 men and 7 women) who were currently in a detoxicationprogramfor the first time and had not receivedprior treatment, (2) 25 alcoholics(17 men and 8 women) who were currentlyin a detoxication programand had beenin a detoxicationprogram3 or more times but had not takenpart in systematic rehabilitationprograms,and (3) 50 alcoholics(37 men and 13 women) who were participating in an ongoing postdetoxication rehabilitativeprogramof 2 months'or greater duration.The mean age of group I was 45.2 years (range, 23-62); group II, 40.0 (range, 23-66); and group III, 45.0 (range, 17-70). The patientswere recruitedon a voluntarybasisand were not askedto identify themselvesby name on the testing material. All volunteerscompleted the x-•. scale (4) and a scalespecificallydesignedto measureperceived locus of drinking control. The drinking control scale was patterned after the x-•. scale with regard to number of items, forced choice format and the type of scoring. a In essence,the scale translatedgeneralizedperceivedlocusof controlinto specifiedperceivedlocusof controlwith regard to drinkingbehavior.Items suchas the followingwere included: (a) There is no suchthing as an irresistibletemptationto drink. (b) Many times there are circumstances that forceyou to drink. (On both scalesa low scoreindicatesinternalcontrolorientation.) •{ESULTS
The mean scoreon the I-E scalewas 11.48 (range, 4-18--*-_ 3.47, SD) in groupI; 7.92 (range, 1-17--+-_ 4.02) in group II; and 6.10 (range, 1-21--*-_ 3.50) in group III. Comparisons of group meansindicatedthe following:Patientsin groupI were significantlylessinternalthan those in groupII (t = 4.75,48 dr, p • .001,one-tailed),and patientsin group 8For a copy of the locusof drinking control scale,order NAPS DocumentNo. 02504 from ASIS/NAPS, c/o MicrofichePublications,440 Park Ave., South,New York, NY 10016; remit with order $1.50 for microfiche or $5.00 for full-size
photocopy. Outsidethe U.S. and Canada,postageis $2 for a photocopyor $.50 for a microfiche.
160
JOURNALOF STUDIESON ALCOHOL
II weresignificantly lessinternal thanthose in groupIII (t -- 9.44,73dr, p • .001).All comparisons fromthe •-v, scaledatasupported the hypothesis of increased internalcontrolorientation withincreased exposure to treatment
programs.
The meandrinkingcontrolscoreof groupI was9.00 (range,3-20 ñ 4.02); groupII, 5.00 (range,0-12 ñ 2.93); and groupIII, 5.60 (range,
0-22ñ 4.80). The patients in groupI weresignificantly lessinternal thanthosein groupII (t ----5.71,48 dr, p • .001,one-tailed);but patientsin groupII were not significantly differentfrom thosein group
III (t • 0.92,73 dr); patients in groupI weresignificantly lessinternal thanthosein groupIII (t -- 4.72,73 dr, p • .001). Two of thesethree comparisons supported the hypothesis of increased internalitywith increasedexposureto treatment programs. DXSCUSSION'
The hypothesis was stronglysupportedby the data. Scoreson the x-v,scalewereprogressively and reliablymorein the internaldirection as length of exposureto treatmentprogramsincreased.As a group, patientsbeingdetoxicated for the first time had a meanx-v,scorethat classifiedthem as externallycontrolled.Alcoholicswho had been detoxicated three or more times had a mean x-v, score that classified them
as beingneitherinternallynor externallycontrolled.Finally,alcoholics who were in a rehabilitativeprogramhad a mean•-v, scorethat classified them as internallycontrolled. With oneexceptionthe datafrom the drinkingcontrolscalesupported the hypothesis. Alcoholicsbeing detoxicatedfor the first time were significantly less internal than thosewho had been detoxicatedthree or more times and significantlyless internal than those who were in a rehabilitativetreatment program. It might be expectedthat alcoholicswho voluntarilyentereda pro-
longedpostdetoxication treatmentprogramwould be more internally orientedthan thosewho did not. Hence, it might be argued that there is a selectionfactorwhich accountsfor theseresults.Suchan hypothesis is not totally consistent, however,with the data presentedhere. Granted that there may be a selectionfactor concomitantwith the decisionto participatein a rehabilitativeprogram, it is improbablethat such a selectionfactor is concomitantwith the decisionto undergodetoxication. The decisionto undergodetoxicationwould certainlyseemto be made under different conditionsthan the decisionto participate in a rehabilitativeprogram.Yet the changetoward internalitywas consistent from the group undergoingdetoxicationfor the first time to the group beingdetoxicatedfor at leastthe third time. A selection-factor hypothesis, therefore,could possiblyaccountfor the changeobservedin the
rehabilitationgroup,but it doesnot accountfor the changeobserved in the multiple detoxicationgroup. A treatment-exposure hypothesis, on the other hand, is consistentwith the shift toward internal control
orientationobservedacrossall three groupsof alcoholics.
SlUrX•ae•oa•s
161
We are not attemptingto challengethe finding that alcoholicsin
treatmentprogrgms reportthat they perceivethemselves as being in controlof their•behaviorin generaland of their drinkingbehaviorin particular;thesefindingshave been amply demonstrated. What is suggestedis that this perceivedinternal controlon the part of alcoholics may be a consequence of exposureto treatmentmodalitiesthat stress the importanceof self-motivation,self-controland a "you-can-do-itif-you-want-to"attitude,rather than a consequence of a predisposing personalitydimension.It may be, then, that internallycontrolledalcoholicsare simplyalcoholicswho have been reinforcedfor behavingas an "external"("unable"to controldrinking)but verbalizingan "internal" attitude (I "can"controlmy drinking). This would be a simple but plausibleexplanationthat would accountfor past and presentfindings regardingthe puzzling discrepancybetween alcoholics'attitudes and behavior.
REFERENCES
1. Goss, A. and MoaosKo, T. E. Relation between a dimensionof internal-external
controland the MMrXwith an alcoholicpopulation.J. cons.olin. Psychol.34: 189-192, 1970.
2. Goz.•LI, J. and SLOAN,J. Controlorientationas a personalitydimensionamong alcoholics.Quart. J. Stud. Ale. 32: 159-161, 1971. 3. OZ•EL,L. J., OB•, F. W. and I•tSON, M. Generaland specificperceivedlocus of control in alcoholics.Psychol.Rep. 30: 957-958, 1972. 4. ROTTEa,J. B., LIVF-at,tNT, S. and CaOWNE,D. P. The growth and extinctionof expectancies in chancecontrolledand skilled tests.J. Personality52: 161-177, 1961.
