Self-Control Concerns and Drinking Loss of Control in
GeneralandClinicalPopulations* ROBINROOM,PH.D.,*^•D BARBARAC. LEIGH, PH.D.* AlcoholResearchGroup, Medical ResearchInstituteof San Francisco,2000 Hearst Avenue,Berkeley,California 94709-2176
ABSTRACT. In popularconceptions,lossof controlover drinking
ries and lossof controlover drinkingthan membersof the general population.Although controlworries were only slightly correlated with drinkinglossof control,this relationshiptendedto be conditional in the generalpopulation.The findingssuggestthat concerns aboutpersonalcontrolin generalmay be a usefulconstructto consider in conjunctionwith the drinking loss of controlconcept.(J.
involves a double loss of control, over one's life as well as over one's
drinking. A measureof "control worries," concerningthe experience of difficulties in controllingone's life, was developed.The relationshipsbetweenmeasuresof controlworries, lossof controlover drinkingandheavy-drinking behaviorwereexaminedin samplesboth of alcoholtreatmentclientsand of the generalpopulationin a Californiacounty.Alcoholtreatmentclientsreportedgreatercontrolwor-
Stud. Alcohol 53: 590-593, 1992).
"WE ADMITTED that we were powerlessover alcohol-that our lives had become unmanageable."This well-knownFirst Step of AlcoholicsAnonymousclearly containswithin it the loss of control over drinking that Jellinek(1952) identifiedas the "pathognomicsymptom" of alcoholism.But the AA's First Step extendsbeyond Jellinek'ssymptomby describingthe experienceof a double lossof control--not only over one'sdrinking, but also
judgmentsabouthow the world works--whether people get aheadby hard work or by luck, whethervoterscan controlpoliticians--rather than a personalsenseof con-
over one's life. These two losses of control, in the AA
In alcoholresearch,one responseto reconsiderations of the I-E scalehas beento focuson expectationsaboutcontrol of drinkingspecifically,ratherthan globalcontrolorientation (Donovan and O'Leary, 1978; Lettieri et al., 1985; Rohsenow, 1983). To focus more narrowly on drinkingbehavior,however,is to lose sightof the broader territory of experiencerepresented by AA's First Step-that is, the feeling that one's entire life is out of control. While the emphasisin the traditionepitomizedby the I-E constructis on expectanciesabout mastery versusfatalism, a senseof personalcontrol as an everydayconscious experiencemight well reflect a different dimension. A convincedfatalist may still believe in a duty of selfcontrol (as Weber argued about Calvinism), while an overreachingexpectationof masterymay contributeto a feeling of lack of self-control. Our interestin this investigationis to tap this dimen-
interpretation,are seen as linked: loss of control over drinkingleadsto a lossof controlover one's life. In the socialand clinical psychologicalliteratureon alcoholuse, the topicof life controlhasprimarily beenaddressedby studiesusing the conceptof locus of control (Rotter, 1966). Reviews of this literature note that alcoholics and heavier drinkers tend toward more external control
than do nonalcoholics,althoughfindings are inconsistent (Barnes, 1983; Cox, 1987; Rohsenow, 1983). However, the Internal-External(I-E) scaledoesnot tap the construct of a personalsenseof controlthat is of interestto us in this inquiry. Much of the contentof the I-E scalereflects
Received:November29, 1989. Revision:February13, 1991. *Data collectionand preparationof this paper were supportedby a National Alcohol ResearchCenter grant AA-05595 from the National Institute
on Alcohol
Abuse and Alcoholism
to the Alcohol
trol or lossof control over one's own actionsand life (see also Gurin et al., 1978). We want to draw a distinction here betweengeneralfatalism (e.g., a belief that life as a rule is mostlyluck or bad breaks)and the expression of a sense of control over one's own life.
sion of an immediate
Research
sense of self-control
maintenance
Group,MedicalResearch Instituteof SanFrancisco. Portionsof thispaper were presentedat the 24th InternationalCongressof Psychology, Sydney,Australia,August1988. *Robin Room is also affiliated with the AddictionResearchFoundation, 33 RussellSt., Toronto,Ontario M5S 2S1, Canada(correspondenceshouldbe sentto him at this address). BarbaraC. Leighis also associated with the Alcoholand Drug AbuseInstitute,Universityof
andto examinethe empiricalrelationshipbetweenexperiencesof thesetwo kindsof (drinkingand life) lossof control. To what extent are generalizedworries about life control related to the experienceof loss of control over drinking?This article exploresthis issuein two samples, one of the generaladult populationand the other of cli-
Washington,Seattle, Wash.
ents enteringalcoholtreatmentagencies. 59O
ROOM
AND LEIGH
Method
Subjectsand procedure General population sample. Subjects were 691 adults who were interviewedas part of an area probabilitysample of the adult (18+) householdpopulation of Costa County, California (Roizen, unpublished manuscript; Room and Weisner, 1988). Responserate was 68%. The sample was 54% female and largely (77%) white (8% black, 7% Hispanic and 8% other); 26% of the sample were aged 18-30, 35% were 31-45 and 39% were 46 years and olden
Treatmentsample. Subjectswere 381 clients (219 men and 162 women) of the county'sinpatient public alcohol treatmentagencies.The samplingframe consistedof all consecutive
admissions
to the nine
detoxication
centers
591
hadscoresof 9 or above.Controlworrieswereevenlydistributedby genderand age. In light of the great differencesin control worries between the generalpopulationand thoseenteringalcohol treatment,controlworrieswere examinedamongthosein the general populationwho reportedthat they had ever had experienceof alcoholtreatment,includingAlcoholics Anonymous, drinking-driver programsand publicor private alcohol programs.The growth of the alcohol treatment systemand the effects of its outreachefforts can be
seenin the substantial proportionof adultsin the county who haveexperienceof alcoholtreatment:altogether11% reportedsuchexperienceat sometime in their lives. Evertreated general population respondentswere somewhat less likely to report low control worries (scoresof 4-6)
thanthe never-treated (21% vs 35%; ){2= 6.1, 1 df,
and recovery homes. Subjectswere interviewed within 3
p < .05), but still contrastedstrongly with the current treatmentsample,only 1% of whom reportedlow control
daysof intake,andtheresponse ratewas67%.i Approx-
worries.
imately 50% of the samplewas white, with 6% Hispanic and 35% black; 42% were between 18 and 30 years of age, 43% were 31-45 and 14% were 46 or olden
Relationships betweenthe two lossesof control
Materials
ble loss of control" is lossof controlover drinking. A
As discussedabove, the second dimension of the "dou-
drinking loss of control score was constructedbased on The interview instrumentcoveredseveralgeneral areas, includingdrinking habits, problemsresultingfrom drinking and sociodemographic characteristics.The questionnaire includedseveralitems asking about loss of control
the sum of events indicative of loss of control over drink-
ing experienced,weightedfor frequencyof occurrence. Each item was scored3 if the experienceoccurredmore frequentlythan once a week, 2 if it occurred1-3 times a
overdrinking(Caetano,1990). 2 Respondents indicated
month and 1 if it occurred once in the last 12 months. The
whether they had ever had these experiencesand, if so, how frequently(at least once in the last 12 months,once
resultingscale could range from 0 to 15, and Cronbach's alphawas .70 for the generalpopulationsampleand .72 for the treatmentsample.As would be expected,the resultingscalediscriminatedvery stronglybetweenthe two samples:91% of the populationsamplehad a scoreof 0, while 88% of the treatmentsamplehad scoresof 2 or
in the last 6 months, 1-3 times a month, 1-2 times a
week, 3-4 times a week, 5 times a week). Four items oriented towardthe experienceof personalself-controlwere
includedin the questionnaire. 3 Theseitemswere all phrasedin the first personand refer to the respondent's concernsabout or struggleswith his or her own behavior. Four responsecategorieswere given (strongly disagree, disagree, agree and strongly agree). Becausethis study was part of a larger seriesof studies,questionnaire space was extremelylimited, and thusonly a few itemscould be
Bivariatecorrelations showedthat, in bothsamples,the relationshipbetweencontrolworriesand drinkinglossof control was modest, although strongerin the treatment sample(r = .21, p < .001) than in the generalpopulation sample (r = .13, p < .001). Control worries showed
only a smallpositivecorrelationwith heavydrinking(frequencyof drinking 12 or more drinks) in both samples
included.
Results Control
above and 57% had scores of 7 or above.
worries
A control-worriesscale was constructedby summing responsesto the four items; this scale could take values from 4 to 16 (Cronbach'salpha was .63 for the general populationsampleand .59 for the treatmentsample).The scalediscriminatedquite stronglybetweenthoseentering alcohol treatmentand the adult general population:22% of the populationsampleand92% of the treatmentsample
(general population: r = .15, p < .001; treatment: r = .05, Ns). Drinking-controlloss, on the other hand, was stronglyrelated to heavy drinking in both samples (r = .60 for generalpopulationand r = .50 for treatment samples). Correlationsof heavy drinking with demographicdimensionswere in the expecteddirections,with younger,less-educated male respondents more likely to be heavier drinkers.
As envisionedin AA's First Step, the relationshipbetweenthe two typesof controllosswouldnot be symmetrical, so that Pearson'scorrelationsmay be an insensitive
592
JOURNAL
OF STUDIES
ON ALCOHOL
T^BLE I. Controlworriesby drinkinglossof control Drinking controlloss
Low
High
General populationsample" 34%
Low control worries
High controlworries
17%
(230)
(4)
66%
83%
(437)
(20)
(o)
(3)
Treatment sample b I%
Low control worries
High controlworries
100%
99%
(52)
(326)
Notes: Low control worries = 4-6 score. High control worries= 7-16 score. Low drinking-controlloss= 0-1 score. High drinking-control loss = 2-15
score.
"X2 = 3.28, I dr, p = .05 (Fisher's exacttest). bX2 = .023, 2 dr, •s (Yatescorrection).
measureof the association.That is, these two concepts would be relatedhierarchically,suchthat drinkinglossof control must be accompaniedby life loss of control, but not vice versa. To test this possibility,respondentswere divided into categoriesbasedon their scoreson the control worries and drinking lossof controlscales(seeTable 1). Resultsfrom contingencyanalysessuggestthat these distributionsdiffer in the two samples.There appearedto be no conditionalrelationshipbetweenthe two lossesof controlin the treatmentsample,as over 90% of the sample, whetherhigh or low in drinkinglossof control,was high in controlworries. In the generalpopulationsample, however,controlworriesdistributeddifferentlyfor respondents with high and low drinking-controlloss, with high control worries most likely to occur among those with high drinking-controlloss. Discussion
Assessingthe resultsof our explorationof the double lossof controlin two samples,we foundthat thoseentering alcoholtreatmentwere set apart from membersof the generalpopulationby high scoreson both of its dimensions:not only were they much more likely to report indicators of losing control of their drinking, but they were also muchmore likely to report feeling an inability to control their own lives. The association
of these two dimen-
sions was rather weak, but in the general populationthe experienceof a generalizedlossof controlwas somewhat preconditionedon the experienceof loss of control over drinking. The cross-sectionalnature of these data of courseprecludescausalinterpretationsor statementsabout the sequencingof thesephenomena. The very high control worries of the current treatment samplemay at leastpartly reflect the immediatesituation of enteringthe treatmentsystem,oftenin the wakeof distressinglife eventsthat may have shakenthe individual's
/ NOVEMBER
1992
senseof control (Weisner, 1988). Although clients were interviewedin the first days of entry into treatment,in order to minimize the effects of treatmentideologieson their responses,most (93% of the men and 82% of the women) had had previoustreatmentexperience(including AlcoholicsAnonymous),and high controlworriesmay be the result of ideologiescarried over from this earlier exposure. (However, general population respondentswho had had experiencewith alcohol treatmentdiffered only slightly on control worries from those who had no such experience.)It shouldbe notedthat manytherapeuticprogramstend to view an inflated senseof personalmastery as contrary to traditional treatmentphilosophies(e.g., Rohsenow, 1983). In any event, we should be cautious about interpretinga high control worries scoreas an enduring personalitycharacteristicof the respondent(see Rohsenow, 1983, for a parallel argumentabout external locusof control in treatmentsamples). The significanceof researchin the field of self-control and controlof drinkingdependsgreatlyon the socialconstructionof theseconcepts.Levine (1978) has arguedthat the idea of addiction
to alcohol
arose at a time
when
American culture was shifting towardsa heightenedexpectation of individual self-control. Addiction to alcohol becamea culturally understoodexplanationof failure of self-controland of failures in life. It has more recently been argued(Room, 1985) that alcoholismcan be viewed as a culture-boundsyndrome:only where there is a cultural expectationof individualself-controlcan one experience
a loss of control
over
either
one's
life
or one's
drinking. Although we know little about such specific controlideologiesin othercultures,hintscan be gathered from researchwith related concepts.For example, work with
the locus of control
construct
has indicated
wide
variability acrosscultures(e.g., Dyal, 1984; Strickland, 1989). Alasuutari (1986) suggeststhat Finns reject the idea that self-controlconcerningdrinking is desirable; such control is seenas "an act againstman's nature and as a limit to his internal freedom" (Koski-Jfinnesand Johansson,1989, p. 2). In support of this contention, Koski-Jannes and Johansson (1989) reporta higherexternal orientation on the drinking-relatedlocus of control scale in their sampleof Finnish alcoholicsthan has been reportedin Americanstudies.Takala(1989) hasnotedthat it is in societiesthat worry about controlover drinking, rather than in those that don't care as much, that drinkers
developanxietiesover their own drinking. There can be few terms in the alcohol field with more
different denotations than "control"
(Room,
1984;
Takala, 1989). "Controlled drinking," "self-control," and "loss of control," althoughrelated terms, each cover a wide span of behaviorand cognition. In this article we havetouchedupononly one of the possibledistinctionsto be drawnbetweenthesediversemeanings.Our findingsin this area are exploratoryand preliminary,but encourage
ROOM
AND
us to advocatetranscendingthe boundariesof disciplines and of cultures that have marked the field.
LEIGH
593
DoraovAra,D.M. AND O'LEARY, M.R. The Drinking-RelatedLocus of ControlScale:Reliability,factorstructureand validity.J. Stud. Alcohol 39: 759-784, 1978. DYAL, J.A. Cross-cultural research with the locus of control construct. In: LEFCOURT,H.M. (Ed.) Research with the Locus of Control Con-
struct, Vol. 3, San Diego, Calif.: Academic Press, Inc., 1984, pp.
Acknowledgment
209-306.
This article draws on the thinking and work of several colleagues, includingRaul Caetano,Cheryl Cherpitel, Gary Collins, DeniseHerd, Mike Hilton, RhondaJones,Mary Phillips,Ron Roizen,Laura Schmidt, Marlene
Simon and Connie Weisner.
GURIN, P., GURIN, G. AND MORRISON,B.M. Personaland ideological aspectsof internaland externalcontrol. SocialPsychol.41: 275-296, 1978.
JELLINEK, E.M. Phases of alcohol addiction. Q. J. Stud. Alcohol 13: 673-684, 1952.
KOSKI-Ji•NNES, A. ANDJOHANSSON, J. Drinking after Treatmentand the Externalizationof Control among Finnish Alcoholics. Paper presentedat the FifteenthAnnualAlcohol EpidemiologySymposiumof the Kettil Bruun Societyfor Social and EpidemiologicalResearchon
Notes
Alcohol, Maastricht, Netherlands, June 1989.
1. Only 20% of the losseswere refusals;mostlossesoccurredbecause clientsleft the programbeforebeing interviewed. 2. Items were: Foundthat onceyou starteddrinking it was often impossibleto stopuntil you becameintoxicated;Promisedyourselfnot to drink alone but were not able to keep that promise;Felt that you shouldcut down on your drinking or stop altogether;Tried to cut downor controlyourdrinkingbut wereunableto do so;Gottendrunk evenwhen therewas an importantreasonto staysober. 3. Itemswere: I worry aboutkeepingcontrolof my behavior;I think of myselfas quite self-controlled(reversescored);I feel unableto control my own life; My life would go muchbetter if I could just get controlof myself.
LETTIERI, D.J., NELSON,J.E. AND SAYERS,M.A. (Eds.) Alcohol Treatment
Assessment
and
Research
Instruments.
NIAAA
Treatment
Handbook Series No. 2, DHHS Publication No. (ADM) 85-1380, Washington:GovernmentPrinting Office, 1985. LEVINE, H.G. The discoveryof addiction:Changingconceptionsof habitual drunkennessin America. J. Stud. Alcohol 39: 143-174, 1978. ORFORD,J. ExcessiveAppetites:A PsychologicalView of Addictions, New York: John Wiley & Sons, Inc., 1985. ROHSENOW,D.J. Alcoholics' perceptionsof control. In: Cox, W.M. (Ed.) Identifying and MeasuringAlcoholic PersonalityCharacteris-
tics, San Francisco:Jossey-Bass, Inc., Pubs., 1983, pp. 37-51. ROIZEN,R. ContraCostaCountyGeneral PopulationSurvey:A Technical Report, Alcohol ResearchGroup, unpublished manuscript. ROOM,R. Alcohol control and public health. Ann. Rev. publ. Hlth 5: 293-317, 1984.
References
ALASUUTARI, P. The Life Story of a Working Man: A Study on the RelationshipbetweenAlcoholismand Mother Culture. Series A., No. 9, Tampere,Finland:TampereUniversity,Departmentof Sociology and SocialPsychology,1986. BnRraES,G.E. Clinical and prealcoholicpersonalitycharacteristics.In: Kisslra,B. AraDBEGLEITER,H. (Eds.) The Biology of Alcoholism, Vol. 6, New York: Plenum Press, 1983, pp. 113-195. CAETANO,R. The factor structure of the DSM-III-R
and ICD-10 con-
ceptsof alcoholdependence. AlcoholAlcsm. 25:303-318, 1990. Cox, W.M. Personalitytheory and research.In BLANE,H.T. ANDLEOraARD,K.E. (Eds.) PsychologicalTheories of Drinking and Alcoholism, New York: Guilford Press, 1987, pp. 55-89.
RooM, R. Dependence and society.Brit. J. Addict. 80: 133-139, 1985. ROOM,R. ANDWEISNER,C. StudyingCommunityResponseto Alcohol Problems:An Interim Report, Berkeley,Calif.: Medical ResearchInstituteof San Francisco,Alcohol ResearchGroup, 1988. ROTTER,J.B. Generalizedexpectanciesfor internal versusexternalcontrol of reinforcement.Psychol.Monogr. 80: (whole No. 609): 1-28, 1966.
STRICKLAND, B.R. Internal-externalcontrolexpectancies:From contingencyto creativity.Amen Psychologist 44: 1-12, 1989. TAKA[A, J.P. The conceptof control betweenscientific and everyday uses.In: DUCKERT,F., KOSKI-J.•NNES, A. AND RONNBERG,S. (Eds.) Perspectives on ControlledDrinking, Helsinki: Nordic Council for Alcohol and Drug Research, 1989, pp. 7-24. WEISNER,C. The role of alcohol-relatedproblematiceventsin treatment entry. Drug Alcohol Depend.26: 93-102, 1988.
GeneralandClinicalPopulations* ROBINROOM,PH.D.,*^•D BARBARAC. LEIGH, PH.D.* AlcoholResearchGroup, Medical ResearchInstituteof San Francisco,2000 Hearst Avenue,Berkeley,California 94709-2176
ABSTRACT. In popularconceptions,lossof controlover drinking
ries and lossof controlover drinkingthan membersof the general population.Although controlworries were only slightly correlated with drinkinglossof control,this relationshiptendedto be conditional in the generalpopulation.The findingssuggestthat concerns aboutpersonalcontrolin generalmay be a usefulconstructto consider in conjunctionwith the drinking loss of controlconcept.(J.
involves a double loss of control, over one's life as well as over one's
drinking. A measureof "control worries," concerningthe experience of difficulties in controllingone's life, was developed.The relationshipsbetweenmeasuresof controlworries, lossof controlover drinkingandheavy-drinking behaviorwereexaminedin samplesboth of alcoholtreatmentclientsand of the generalpopulationin a Californiacounty.Alcoholtreatmentclientsreportedgreatercontrolwor-
Stud. Alcohol 53: 590-593, 1992).
"WE ADMITTED that we were powerlessover alcohol-that our lives had become unmanageable."This well-knownFirst Step of AlcoholicsAnonymousclearly containswithin it the loss of control over drinking that Jellinek(1952) identifiedas the "pathognomicsymptom" of alcoholism.But the AA's First Step extendsbeyond Jellinek'ssymptomby describingthe experienceof a double lossof control--not only over one'sdrinking, but also
judgmentsabouthow the world works--whether people get aheadby hard work or by luck, whethervoterscan controlpoliticians--rather than a personalsenseof con-
over one's life. These two losses of control, in the AA
In alcoholresearch,one responseto reconsiderations of the I-E scalehas beento focuson expectationsaboutcontrol of drinkingspecifically,ratherthan globalcontrolorientation (Donovan and O'Leary, 1978; Lettieri et al., 1985; Rohsenow, 1983). To focus more narrowly on drinkingbehavior,however,is to lose sightof the broader territory of experiencerepresented by AA's First Step-that is, the feeling that one's entire life is out of control. While the emphasisin the traditionepitomizedby the I-E constructis on expectanciesabout mastery versusfatalism, a senseof personalcontrol as an everydayconscious experiencemight well reflect a different dimension. A convincedfatalist may still believe in a duty of selfcontrol (as Weber argued about Calvinism), while an overreachingexpectationof masterymay contributeto a feeling of lack of self-control. Our interestin this investigationis to tap this dimen-
interpretation,are seen as linked: loss of control over drinkingleadsto a lossof controlover one's life. In the socialand clinical psychologicalliteratureon alcoholuse, the topicof life controlhasprimarily beenaddressedby studiesusing the conceptof locus of control (Rotter, 1966). Reviews of this literature note that alcoholics and heavier drinkers tend toward more external control
than do nonalcoholics,althoughfindings are inconsistent (Barnes, 1983; Cox, 1987; Rohsenow, 1983). However, the Internal-External(I-E) scaledoesnot tap the construct of a personalsenseof controlthat is of interestto us in this inquiry. Much of the contentof the I-E scalereflects
Received:November29, 1989. Revision:February13, 1991. *Data collectionand preparationof this paper were supportedby a National Alcohol ResearchCenter grant AA-05595 from the National Institute
on Alcohol
Abuse and Alcoholism
to the Alcohol
trol or lossof control over one's own actionsand life (see also Gurin et al., 1978). We want to draw a distinction here betweengeneralfatalism (e.g., a belief that life as a rule is mostlyluck or bad breaks)and the expression of a sense of control over one's own life.
sion of an immediate
Research
sense of self-control
maintenance
Group,MedicalResearch Instituteof SanFrancisco. Portionsof thispaper were presentedat the 24th InternationalCongressof Psychology, Sydney,Australia,August1988. *Robin Room is also affiliated with the AddictionResearchFoundation, 33 RussellSt., Toronto,Ontario M5S 2S1, Canada(correspondenceshouldbe sentto him at this address). BarbaraC. Leighis also associated with the Alcoholand Drug AbuseInstitute,Universityof
andto examinethe empiricalrelationshipbetweenexperiencesof thesetwo kindsof (drinkingand life) lossof control. To what extent are generalizedworries about life control related to the experienceof loss of control over drinking?This article exploresthis issuein two samples, one of the generaladult populationand the other of cli-
Washington,Seattle, Wash.
ents enteringalcoholtreatmentagencies. 59O
ROOM
AND LEIGH
Method
Subjectsand procedure General population sample. Subjects were 691 adults who were interviewedas part of an area probabilitysample of the adult (18+) householdpopulation of Costa County, California (Roizen, unpublished manuscript; Room and Weisner, 1988). Responserate was 68%. The sample was 54% female and largely (77%) white (8% black, 7% Hispanic and 8% other); 26% of the sample were aged 18-30, 35% were 31-45 and 39% were 46 years and olden
Treatmentsample. Subjectswere 381 clients (219 men and 162 women) of the county'sinpatient public alcohol treatmentagencies.The samplingframe consistedof all consecutive
admissions
to the nine
detoxication
centers
591
hadscoresof 9 or above.Controlworrieswereevenlydistributedby genderand age. In light of the great differencesin control worries between the generalpopulationand thoseenteringalcohol treatment,controlworrieswere examinedamongthosein the general populationwho reportedthat they had ever had experienceof alcoholtreatment,includingAlcoholics Anonymous, drinking-driver programsand publicor private alcohol programs.The growth of the alcohol treatment systemand the effects of its outreachefforts can be
seenin the substantial proportionof adultsin the county who haveexperienceof alcoholtreatment:altogether11% reportedsuchexperienceat sometime in their lives. Evertreated general population respondentswere somewhat less likely to report low control worries (scoresof 4-6)
thanthe never-treated (21% vs 35%; ){2= 6.1, 1 df,
and recovery homes. Subjectswere interviewed within 3
p < .05), but still contrastedstrongly with the current treatmentsample,only 1% of whom reportedlow control
daysof intake,andtheresponse ratewas67%.i Approx-
worries.
imately 50% of the samplewas white, with 6% Hispanic and 35% black; 42% were between 18 and 30 years of age, 43% were 31-45 and 14% were 46 or olden
Relationships betweenthe two lossesof control
Materials
ble loss of control" is lossof controlover drinking. A
As discussedabove, the second dimension of the "dou-
drinking loss of control score was constructedbased on The interview instrumentcoveredseveralgeneral areas, includingdrinking habits, problemsresultingfrom drinking and sociodemographic characteristics.The questionnaire includedseveralitems asking about loss of control
the sum of events indicative of loss of control over drink-
ing experienced,weightedfor frequencyof occurrence. Each item was scored3 if the experienceoccurredmore frequentlythan once a week, 2 if it occurred1-3 times a
overdrinking(Caetano,1990). 2 Respondents indicated
month and 1 if it occurred once in the last 12 months. The
whether they had ever had these experiencesand, if so, how frequently(at least once in the last 12 months,once
resultingscale could range from 0 to 15, and Cronbach's alphawas .70 for the generalpopulationsampleand .72 for the treatmentsample.As would be expected,the resultingscalediscriminatedvery stronglybetweenthe two samples:91% of the populationsamplehad a scoreof 0, while 88% of the treatmentsamplehad scoresof 2 or
in the last 6 months, 1-3 times a month, 1-2 times a
week, 3-4 times a week, 5 times a week). Four items oriented towardthe experienceof personalself-controlwere
includedin the questionnaire. 3 Theseitemswere all phrasedin the first personand refer to the respondent's concernsabout or struggleswith his or her own behavior. Four responsecategorieswere given (strongly disagree, disagree, agree and strongly agree). Becausethis study was part of a larger seriesof studies,questionnaire space was extremelylimited, and thusonly a few itemscould be
Bivariatecorrelations showedthat, in bothsamples,the relationshipbetweencontrolworriesand drinkinglossof control was modest, although strongerin the treatment sample(r = .21, p < .001) than in the generalpopulation sample (r = .13, p < .001). Control worries showed
only a smallpositivecorrelationwith heavydrinking(frequencyof drinking 12 or more drinks) in both samples
included.
Results Control
above and 57% had scores of 7 or above.
worries
A control-worriesscale was constructedby summing responsesto the four items; this scale could take values from 4 to 16 (Cronbach'salpha was .63 for the general populationsampleand .59 for the treatmentsample).The scalediscriminatedquite stronglybetweenthoseentering alcohol treatmentand the adult general population:22% of the populationsampleand92% of the treatmentsample
(general population: r = .15, p < .001; treatment: r = .05, Ns). Drinking-controlloss, on the other hand, was stronglyrelated to heavy drinking in both samples (r = .60 for generalpopulationand r = .50 for treatment samples). Correlationsof heavy drinking with demographicdimensionswere in the expecteddirections,with younger,less-educated male respondents more likely to be heavier drinkers.
As envisionedin AA's First Step, the relationshipbetweenthe two typesof controllosswouldnot be symmetrical, so that Pearson'scorrelationsmay be an insensitive
592
JOURNAL
OF STUDIES
ON ALCOHOL
T^BLE I. Controlworriesby drinkinglossof control Drinking controlloss
Low
High
General populationsample" 34%
Low control worries
High controlworries
17%
(230)
(4)
66%
83%
(437)
(20)
(o)
(3)
Treatment sample b I%
Low control worries
High controlworries
100%
99%
(52)
(326)
Notes: Low control worries = 4-6 score. High control worries= 7-16 score. Low drinking-controlloss= 0-1 score. High drinking-control loss = 2-15
score.
"X2 = 3.28, I dr, p = .05 (Fisher's exacttest). bX2 = .023, 2 dr, •s (Yatescorrection).
measureof the association.That is, these two concepts would be relatedhierarchically,suchthat drinkinglossof control must be accompaniedby life loss of control, but not vice versa. To test this possibility,respondentswere divided into categoriesbasedon their scoreson the control worries and drinking lossof controlscales(seeTable 1). Resultsfrom contingencyanalysessuggestthat these distributionsdiffer in the two samples.There appearedto be no conditionalrelationshipbetweenthe two lossesof controlin the treatmentsample,as over 90% of the sample, whetherhigh or low in drinkinglossof control,was high in controlworries. In the generalpopulationsample, however,controlworriesdistributeddifferentlyfor respondents with high and low drinking-controlloss, with high control worries most likely to occur among those with high drinking-controlloss. Discussion
Assessingthe resultsof our explorationof the double lossof controlin two samples,we foundthat thoseentering alcoholtreatmentwere set apart from membersof the generalpopulationby high scoreson both of its dimensions:not only were they much more likely to report indicators of losing control of their drinking, but they were also muchmore likely to report feeling an inability to control their own lives. The association
of these two dimen-
sions was rather weak, but in the general populationthe experienceof a generalizedlossof controlwas somewhat preconditionedon the experienceof loss of control over drinking. The cross-sectionalnature of these data of courseprecludescausalinterpretationsor statementsabout the sequencingof thesephenomena. The very high control worries of the current treatment samplemay at leastpartly reflect the immediatesituation of enteringthe treatmentsystem,oftenin the wakeof distressinglife eventsthat may have shakenthe individual's
/ NOVEMBER
1992
senseof control (Weisner, 1988). Although clients were interviewedin the first days of entry into treatment,in order to minimize the effects of treatmentideologieson their responses,most (93% of the men and 82% of the women) had had previoustreatmentexperience(including AlcoholicsAnonymous),and high controlworriesmay be the result of ideologiescarried over from this earlier exposure. (However, general population respondentswho had had experiencewith alcohol treatmentdiffered only slightly on control worries from those who had no such experience.)It shouldbe notedthat manytherapeuticprogramstend to view an inflated senseof personalmastery as contrary to traditional treatmentphilosophies(e.g., Rohsenow, 1983). In any event, we should be cautious about interpretinga high control worries scoreas an enduring personalitycharacteristicof the respondent(see Rohsenow, 1983, for a parallel argumentabout external locusof control in treatmentsamples). The significanceof researchin the field of self-control and controlof drinkingdependsgreatlyon the socialconstructionof theseconcepts.Levine (1978) has arguedthat the idea of addiction
to alcohol
arose at a time
when
American culture was shifting towardsa heightenedexpectation of individual self-control. Addiction to alcohol becamea culturally understoodexplanationof failure of self-controland of failures in life. It has more recently been argued(Room, 1985) that alcoholismcan be viewed as a culture-boundsyndrome:only where there is a cultural expectationof individualself-controlcan one experience
a loss of control
over
either
one's
life
or one's
drinking. Although we know little about such specific controlideologiesin othercultures,hintscan be gathered from researchwith related concepts.For example, work with
the locus of control
construct
has indicated
wide
variability acrosscultures(e.g., Dyal, 1984; Strickland, 1989). Alasuutari (1986) suggeststhat Finns reject the idea that self-controlconcerningdrinking is desirable; such control is seenas "an act againstman's nature and as a limit to his internal freedom" (Koski-Jfinnesand Johansson,1989, p. 2). In support of this contention, Koski-Jannes and Johansson (1989) reporta higherexternal orientation on the drinking-relatedlocus of control scale in their sampleof Finnish alcoholicsthan has been reportedin Americanstudies.Takala(1989) hasnotedthat it is in societiesthat worry about controlover drinking, rather than in those that don't care as much, that drinkers
developanxietiesover their own drinking. There can be few terms in the alcohol field with more
different denotations than "control"
(Room,
1984;
Takala, 1989). "Controlled drinking," "self-control," and "loss of control," althoughrelated terms, each cover a wide span of behaviorand cognition. In this article we havetouchedupononly one of the possibledistinctionsto be drawnbetweenthesediversemeanings.Our findingsin this area are exploratoryand preliminary,but encourage
ROOM
AND
us to advocatetranscendingthe boundariesof disciplines and of cultures that have marked the field.
LEIGH
593
DoraovAra,D.M. AND O'LEARY, M.R. The Drinking-RelatedLocus of ControlScale:Reliability,factorstructureand validity.J. Stud. Alcohol 39: 759-784, 1978. DYAL, J.A. Cross-cultural research with the locus of control construct. In: LEFCOURT,H.M. (Ed.) Research with the Locus of Control Con-
struct, Vol. 3, San Diego, Calif.: Academic Press, Inc., 1984, pp.
Acknowledgment
209-306.
This article draws on the thinking and work of several colleagues, includingRaul Caetano,Cheryl Cherpitel, Gary Collins, DeniseHerd, Mike Hilton, RhondaJones,Mary Phillips,Ron Roizen,Laura Schmidt, Marlene
Simon and Connie Weisner.
GURIN, P., GURIN, G. AND MORRISON,B.M. Personaland ideological aspectsof internaland externalcontrol. SocialPsychol.41: 275-296, 1978.
JELLINEK, E.M. Phases of alcohol addiction. Q. J. Stud. Alcohol 13: 673-684, 1952.
KOSKI-Ji•NNES, A. ANDJOHANSSON, J. Drinking after Treatmentand the Externalizationof Control among Finnish Alcoholics. Paper presentedat the FifteenthAnnualAlcohol EpidemiologySymposiumof the Kettil Bruun Societyfor Social and EpidemiologicalResearchon
Notes
Alcohol, Maastricht, Netherlands, June 1989.
1. Only 20% of the losseswere refusals;mostlossesoccurredbecause clientsleft the programbeforebeing interviewed. 2. Items were: Foundthat onceyou starteddrinking it was often impossibleto stopuntil you becameintoxicated;Promisedyourselfnot to drink alone but were not able to keep that promise;Felt that you shouldcut down on your drinking or stop altogether;Tried to cut downor controlyourdrinkingbut wereunableto do so;Gottendrunk evenwhen therewas an importantreasonto staysober. 3. Itemswere: I worry aboutkeepingcontrolof my behavior;I think of myselfas quite self-controlled(reversescored);I feel unableto control my own life; My life would go muchbetter if I could just get controlof myself.
LETTIERI, D.J., NELSON,J.E. AND SAYERS,M.A. (Eds.) Alcohol Treatment
Assessment
and
Research
Instruments.
NIAAA
Treatment
Handbook Series No. 2, DHHS Publication No. (ADM) 85-1380, Washington:GovernmentPrinting Office, 1985. LEVINE, H.G. The discoveryof addiction:Changingconceptionsof habitual drunkennessin America. J. Stud. Alcohol 39: 143-174, 1978. ORFORD,J. ExcessiveAppetites:A PsychologicalView of Addictions, New York: John Wiley & Sons, Inc., 1985. ROHSENOW,D.J. Alcoholics' perceptionsof control. In: Cox, W.M. (Ed.) Identifying and MeasuringAlcoholic PersonalityCharacteris-
tics, San Francisco:Jossey-Bass, Inc., Pubs., 1983, pp. 37-51. ROIZEN,R. ContraCostaCountyGeneral PopulationSurvey:A Technical Report, Alcohol ResearchGroup, unpublished manuscript. ROOM,R. Alcohol control and public health. Ann. Rev. publ. Hlth 5: 293-317, 1984.
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