Journal of Studies on Alcohol, Vol. 38, No. 11, 1977

Locus of Control

in Alcoholics

Treatment

and

Outcome x

David U. Caster, M.D. 2 and Oscar A. Parsons,Ph.D. s SUMMARY.Belief in external control by chance, rather than control by powerful others or internal control, appearsto be ass.ociated with unfavorable treatment outcome in male alcoholicsreceiving inpatient and outpatient therapy.

OCUSOF CONTROL(LOC)orientation in alcoholics has

beeninvestigated innumerous studies in thepast10years. Most of these studies have used the Rotter internal-ex-

ternal scale (1) to measureLOC.The resultshave not been consistent.Althoughinvestigators generallyfind that alcoholics' LOCis more internalthan the norm (2--4), severalexperimenters have found a more externalLOCin alcoholics(5-7). There have been relativelyfew studiesof the impactof treatmenton alcoholics' Lo½. Costelloand Manders(8) found increasedexternalityin successfully treatedpatients,but alsofoundthat LO½scoreswere quite stableover a 30-daytreatmentperiod.Oziel and Obitz (4) re-

portedthat alcoholics whoseekassistance fromhelpinginstitutions showincreasing internalitywith increasing contactwith helping facilities.

One factorin theseconflictingfindingsmay be the Rotter scale

(1). The scaleassumes that LOCis a unidimensional phenomenon, and doesnot makeprovision for differenttypesof control.In an • This work was conducted while

the senior author was at the Veterans

Admin-

istration Hospital, Oklahoma City. The study was accomplishedwith the help and encouragementof Pamela Parrish, M.D., director of the alcoholismtreatment program at the hospital. Financial support was provided by the Veterans Administration Research Committee, the Research Council of the Department of Psychiatry and BehavioralSciences,University of Oklahoma Health SciencesCenter, and U.S. Public Health Service (National Institute on Alcohol Abuse and Alcoholism) Grant AA

04164

to Dr.

Parsons.

• Emory JohnBrady Hospital,2135 SouthgateRoad, ColoradoSprings,CO 80906. aDepartment of Psychiatry and Behavioral Sciences,University of Oklahoma Health SciencesCenter, and Veterans Administration Hospital, Oklahoma City. Receivedfor publication: 2 June 1976. Revision: 7 March 1977. 2087

2088

D.v.

CASTER A•O O. •. •'•RSO•S

extensiveconsideration of Loc in Blacks,Gurin et al. (9) discussed the significance of distinguishing betweenmultidimensional external sourcesof control.Mirels'sfactor analysis(10) of the Rotter scale

showedthattwofactorswerepresent,oneconcerning the individual'sabilityto achievepersonalgoalsand the otherconcerning the ability to effect changein systems.Levenson(11) and Garcia and Levenson(12), using a tridimensionalLoc scale,found different typesof controlin psychiatricpatientsand in Black and White collegestudents.These studiesand others noted by Lef-

court (13) stronglysuggestthat a multidimensional approachto •oc is warranted,particularlyin the studyof specificproblems suchas the relationof •o½ to treatmentoutcomeand the changes in Loc accompanyingtreatment. For our purposes,the Levenson•oc scale (11) appearsto have

severaladvantages. The scalewas developed as a factor-analyzed measure of threedifferentaspects of •oc: locusof control-internal (Loc-•), the respondent's view of the degreeto whichhe controls hisfuturethrough personal action;locusof control-chance (Loc--c), the respondent's view of the rolethat •hanceplaysin his life; and locusof control-powerful others(•oc-Po), the respondent's view of the roleof othersin what happensto him. The questions in the Levenson scalearephrased in the firstperson; the 6-pointresponse scalepermitsa greaterrangeof •o½scores than doesthe dichotomousresponse formatof the Rotterscale. The purposes of the presentstudywereto assess the impactof treatment on the Levensonscale scoresof alcoholics;to determine whether the Levenson scale scores differentiate

between treatment

successesand failures; and to determine whether the Levenson

scalescorescorrelatedifferentiallywith depression, hopelessness andsociopathy in the treatmentsuccesses andfailures,and whether thesecorrelations changeunder the impactof treatment.The rationalefor the studyof depression, hopelessness and sociopathy in alcoholics hasbeen offeredelsewhere(14). Alcoholicsfrom two

treatmentprograms were studiedin an .attemptto ascertainthe generalizability of the findings. METHOD

Subiects.In Substudy1, the patientswere 40 consecutiveadmissions to the 90-day inpatient rehabilitativeprogramat the VeteransAdministration Hospital,OklahomaCity. All were men, their mean age was 44.1 (ranging from 22 to 63), their averageeducationallevel was 11.6 years

(rangingfrom 7 to 20), and the meannumberof yearsof heavy drink-

LOCUS OF CONTROL IN ALCOHOLICS

2089

ing was 11.3 (ranging from 1 to 30). These patients,treated with insight-orientedtherapy,were testedat the end of the 2d and 10th weeks in treatment.

The 38 patientsin Substudy2 were treatmentfailuresfrom the program. (There was an overlap of I patient who was included in both studies.) In a treatmentprogramdescribedelsewhere(15), thesepatientsreceived behaviorallyoriented therapy during a 2-week inpatient period and 6 months of outpatient treatment which required the use of disulfiram. Thesepatients,all men,had a meanage of 50.8 years (range, 35 to 65), had beenheavy drinkersfor a mean of 18.9 years (range, 3 to 34) and had a meaneducationallevel of 12.0years(range,8 to 18). The average number of previoustreatmentsfor patients in this group was 2, i.e., most were in their third alcoholismtreatmentprogram.In contrast,the typical patient in SubstudyI was in his first treatment program. The patientsin Substudy2 were testedat the end of the 2-week inpatient period and again at 6 months. PersonalityTests and StatisticalAnalysis.Patients in both substudies were testedwith the LevensonScale (11), the Beck DepressionInven-

tory (16), the BeckHopelessness Scale(17) and the Psychopathy Scale of the AddictionResearchCenter Inventory (ARCI,No. 60) (18). The testswere administeredby a trained male researchassistantaccording to standardinstructionsand with the informed consentof the patients. Appropriatet testswere used for between-groupand within-group comparisons, Pearsonproduct-momentcorrelationswere used to assess the relationshipsof variables,and differencesbetween correlationswere examined with the z test.

•{ESULTS

Substudy 1: The InpatientRehabilitation Group.Twenty-seven of the40 inpatients completed thetestsfollowingtheir2d and10th weeks of treatment.Their mean LOCscores(Table 1) indicate a trendtowardincreased Lo½-Iat the end of treatmentbut no change TABLE 1.-Substudy 1: Mean (_SD)

LOC Scores •

N

LOC-I

LOC-C

Program completers

27

39.2 _ 3.13

24.3 ñ

6.27

20.7 ñ

Successes Failures

17 20

39.6 _ 3.08 38.6 ___4.26

24.7 ñ 24.7 ñ

6.39 6.84

22.1 ñ 7.85 19.7 ___ 7.94

27

41.2 _ 4.17

23.8 _

6.27

20.2 _

27 165

38.6 _ 5.27 35.4 ___9.30

20.6 • 6.80 21.8 ___11.80

LOC-PO

At 2 Weeks

7.66

At 10 Weeks

Program completers Controls b

State hospital patientse

7.80

20.0 _ 7.35 23.8 ___11.70

a The range of scoresis 8-48; higher LOC-r means greater internality, and higher LOC-Cor LOC-PO means greater externality. b Peers tested at local American Legion posts.

e Schizophrenics, paranoids, depressives and neurotics studied by Levenson (11).

2090

I). 13'.CASTER AND O. A. PARSONS

in LOC--C or LOC-PO orientation.

The relation of Loc orientation

to

successes andfailuresin treatmentwasexaminedin a 1-yearfollowup of the 40 patientsin Substudy1. The treatmentteamhad per-

sonalcontactwith all but 3 patients.Of the 37 followedup, 17 were successes, workingif physicallyable and showingimprovement in living situationand generalsobriety;the 20 failures,10 of whomcompleted the programand 10 of whomdroppedout, were

doingno betterthantheywereprior to treatment.Therewereno significantdifferencesin the initial LOCscoresof the successes and failures (Table 1) or in the final scoresof the successes and the 10 failures who completedretesting. While not the focus of the presentstudy, the Loc scoresof a group of 27 veteransat local AmericanLegionpostsare includedin Table 1, and alsothe scores of 165 statehospitalpatientsreportedby Levenson(11).

Table2 presents the meanscores on the personality variablesat initialandfinaltestings of the patientswhocompleted the program. There were no significantdifferencesbetweenthe successes and failureson the initial scoresof the threepersonality variablesor on the amount of change from initial to final score, suggesting

that any differencein correlations betweenLOCvariablesand personalitymeasures is attributableto differentpsychological constellationsof relationships asopposed to magnitude of personality score. Althoughthereweretwo significantcorrelations betweenLoc scores and personalityvariablesin the initial scoresof the successes (+.488 betweenDepressionand •.oc-Po,p < .05, and +.561 betweenHopelessness and LOC-VO, p < .01), Z testsfor significanceof differences between

correlations

indicated

that the successes and

failuresdid not differ in the magnitudeof any of' the correlations. In the final scoresof the successes, there was a significantcor-

relation(r- +.666) betweenLOC-•and Hopelessness (p < .01) andtwo significant correlations appearedin the failures:Loc-• and

Sociopathy (r -- +.603,p < .05) and•.oc-candHopelessness (r : +.731,p • .01). All threerelationships achieved significance by TABLE2.-Substudy1: Mean (+SD) Scoreson PersonalityVariables SUCCESSES

FAILURES

(N -- 17)

(N -- 10)

Initial

Depression Hopelessness Sociopathy

11.7 ___5.67 3.6 q- 2.81 42.1 '+ 3.15

Final

5.5 ___ 6.65 2.1 q- 2.33 40.2 ___ 3.03

Initial

Final

10.4 +__ 7.10 2.7 +__ 2.18 42.7 '+ 6.00

2.3 +__ 2.79 2.1 +__ 2.33 42.3 +__ 4.16

LOCUS OF CONTROL IN ALCOHOLICS

2091

becoming morepositive.In the successes, therewas a shift from a positive initial correlationbetween LOC--Cand Hopelessness (,4,.446) to a negativecorrelation(--.263) which was significant, aswastheshiftin LOC--PO andHopelessness froma positive( -4-.561 ) to a negative(--.596) correlation. Thesefinal negativecorrelations in the successes (LOC--C and Hopelessness, r----.263; Loc-•'o and Hopelessness, r = --.596) alsodifferedfromthe corresponding rela-

tionships (,4,.731and-4-.429)in thefailures:Loc-candHopelessness,z -- 2.59,p < .02;•.oc-•,oandHopelessness, z ----2.47,p < .02. There were no significantshiftsfrom initial to final scoresin the failures.It seemsclearthat the changeswhich occurredwere largely in the successes.

Substudy 2: The OutpatientRecidivistGroup.Loc scoresat 2 weeksand 6 monthswere availablefor 18 to 20 patientstreated successfully. There were no significantchangesbetweentestings (Table 3). The initial scoresof 20 successful patientswere com-

paredwiththoseof 16of the 18 failures(Table3) asa meansof assessing the valueof LO½scores in predictingtreatmentoutcome. (Dataon2 of thesuccesses and2 of thefailureswereincomplete. ) Successful patients weredefinedasthosewhocontinued in group therapy, weredrinking lessthan10%of the timeandmanifested improvement intheirlifeadaptation. Failures weredefined asthose whodropped outoftreatment, drankcontinually ormadenochange in theirlifestyle.Failuresweresignificantly morechance-oriented (t = 2.46,p < .05) thanwerethesuccesses. Alsoreported in Table 3 are the initial Loc scoresof the alcoholicsin both substudies. TABLE3.-Substudy 2: Mean ( 4-SD) LOC Scores N

LOC-•

LOC-C

18 20 16

39.9 ___3.24 39.9 4- 3.14 38.5 4- 4.64

23.0 4- 5.91 22.8 ___5.63* 27.8 ___6.61'

23.2 4- 9.20 23.6 ___8.88 23.6 4- 7.74

18

40.4 _____ 3.74

22.4 --4-__ 6.11

19.1 --4-__ 7.40

73

39.17 4- 3.78

24.8 4- 6.37

22.18 _____ 8.10

LOC-PO

At 2 Weeks

Programcompleters Successes

Failures

At 6 Months

Program completers Patients in substudies i and 2 •

a Comparedwith the controls(Table 1) the alcoholicsdiffered significantlyonly in LOC-C(t • 2.43, l0< .01). Comparedwith the statehospitalpatients(Table 1), the alcoholics scoredsignificantlyhigheron LOC-I(t -: 4.47, 236 dr, P < .001) and LOC-C(t • 2.54, 236 dr, l0< .01) but not on LoC-PO (t z 0.76,236 df). Thesedata suggest that t.oc-cmay differentiatealcoholics from other psychiatric patients as well as from the norm. * P

Locus of control in alcoholics and treatment outcome.

Journal of Studies on Alcohol, Vol. 38, No. 11, 1977 Locus of Control in Alcoholics Treatment and Outcome x David U. Caster, M.D. 2 and Oscar A...
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