anti-Causality


Thursday, June 9, 2011

wiki Self- and Group-Dynamics in Mutual Support Recovery

This wiki is represented as a APA sytle paper in the article following this one (click).

Abstract
Self-efficacy in those attempting to recover from substance abuse disorders is believed to contribute to abstinence. Participation in mutual support groups is believed to reinforce self-efficacy by giving participants the opportunity to help others. Self-efficacy, as a component of the conceptual "system of self" works in conjunction with self-esteem to help goal achievement, or self-agency, which, for those with substance disorders, is abstinence. To reinforce research from previous largely qualitative studies, this study proposes to correlate self-efficacy and self-esteem as predictors of the rate of abstinence, or self-agency, of a group 30 men with a mean age of 30 who attend mutual support substance abuse programs. It is hypothesized that increases in self-efficacy and self-esteem will predict self-agency in terms of higher abstinence and lower drug craving, but that self-efficacy will be a greater predictor. The study also proposes to explore innovative data collection and statistical methodologies that leverage cell phones, the internet, and continuous online statistical analysis for the benefit of other researchers and those who want to manualize self-efficacy and self-esteem concepts in the group context for substance abuse recovery.

Statement of Problem
Substance abuse is growing
  • alcohol (National Institute on Alcohol Abuse and Alcoholism, 2004)
  • hard drugs (Terry-McElrath, 2005)
  • substance abuse services are declining in many places
Quitting substance abuse is difficult
  • abstinence is difficult (Groh, et al. 2009)
  • relapse is common (DeFulio & Silverman, 2011).
Mutual support groups (MSGs) are (Groh, et al. 2009).
  • effective for those who are not abstinant
  • cost-effective
  • long history

Self-efficacy
  • explains effectiveness of MSGs (Bogenschutz, Tonigan, & Miller, 2006; Stevens, et al., 2010).
  • perception of the ability to reach goals and mediates more goal-reaching (Bandura, 1982)
  • part of the "system of self" (Epstien, 1982, August)
  • self-esteem -- good feelings about oneself
  • self-agency (Bandura, 1982)

Group-efficacy
  • group's perception about reaching goals, group agency (Whiteoak, Chalip, & Hort, 2004)
  • group process (Truneckova, & Viney, 2008)
  • self-esteem of group members

Literature Review
Group process (Bracke, Christiaens, & Verhaeghe, 2008).
  • self-efficacy
    • giving support
    • leadership role
  • self-esteem
    • receiving support
    • beneficial self-feelings
    • may also feel dependent
      • low self-agency
      • detriment to self-efficacy
Group attendance (Groh, et al., 2009)
  • rate predicts abstinence
    • far beyond average
    • cannot be group efficacy
  • double attendees highest
  1. 12-step
  2. mutual support community
  • attendee may be providing support (Bracke, Christiaens, & Verhaeghe, 2008)
    • self-efficacy

Hypotheses to be Tested


1) Clients who participate in MSGs by contributing support and suggestions to other group participants (self-efficacy), and who receive this kind of support (self-esteem) will have abstinence rates that are higher than those who have low measures on these variables.

  • Correlation bet s-eff and abst

2) Clients who have high abstinence will show higher self-efficacy than self-esteem.

  • Greater correlation between s-eff and abst than s-est and abst
3) Clients with high self-efficacy will have lower cravings; cravings will be negatively correlated with abstinence (or self-agency).
  • Correlation (negative) between s-eff and craving
  • Correlation (negative) between cravings and abst
Sample:
one group
  • referred clients
  • attending group regularly
  • male
    • recent addiction
      • heroin
      • cocaine
      • methedrine
      • similar
    • testing criteria
      • agree to confidential testing
      • not in system for long term
  • female (future study)
    • different self-esteem valuing
  • attending group regularly

Variables

Independent
(predictor)
  • self-efficacy
    • perception of reaching goals
  • self-esteem
    • feelings about oneself
  • group process
    • to assure that group is not failing (g-proc)
    • data for future group-related research
  • attendance
    • criteria for client

Dependent (criterion)
  • self-agency
    • abstinence: time since last use

Operational definitions

"System of self" (self-system)
  • self-efficacy (s-eff)
    • perception of reaching goals
  • self-esteem (s-est)
    • good feelings about oneself
  • self-agency (s-agen)
    • achieving goals
  • group process (g-proc)
    • group provides self-esteem
    • future study
  • rate of abstinence (abst)
    • time since last drug use
  • cravings (craving)
    • involuntary desire to do drugs
    • causes relapse
Group process
  • group efficacy
  • group esteem
  • other-efficacy
    • confidence by group members about the potential success of an individual
Method
types of measures
  • self-system
    • Likert-type scale
    • ordinal
  • time
    • since last drug use
    • interval
  • attendance
    • participant inclusion criteria
    • yes/no
    • nominal
Participants
Group sample
  • Recovering clients (clients) n~=100
    • referred for "hard" drugs
    • measures
      • s-eff
      • s-est
      • s-agen
      • craving
      • attendence
  • male
    • present study
  • female
    • future study

Facilitators
  • Group leaders
    • reliable, drug free (inclusion criteria)
    • data
      • group process n=~10
      • client attendance

No control group
  • study will test for correlations between self-efficacy and abstinence in referred clients
Tests (statistical input)
ordinal
  • s-eff
  • s-est
  • craving
interval
  • drug use (relapse)
    • length of time since last use (will always be greater than zero as use while reporting is impossible)
    • tested for (examples_
      • heroin
      • cocaine
      • methedrine
      • oxycodone
      • methadone
    • not tested for (examples)
      • alcohol
        • not reliable after a few hours (Dupont, ??
      • marijuana
        • previous use may cause a positive (Goldberg, 2010)
Materials
Instruments
Self-created reated test (gleaned for questions to create a specific efficacy and esteem scale such as Gambling Abstinence Self-efficacy Scale)

Ask different questions to obtain same information at different times
  • Alcohol Abstinence Self-Efficacy Scale (DiClemente & Carbonari, 1994) high levels of validity and reliability
  • Rosenberg Self-esteem Scale (Greenberger, Chen, Dmitrieva, & Farruggia, 2003)
  • Group efficacy (consensual questionarie asking "how the group went" based on Whiteoak, Chalip, and Hort's (2004) suggestions; this can be expanded into a group-wide test in preparation of whole group efficancy testing and other-efficacy testing for abstinence)
Information system
  • cell phone "app" self-report system (tiny web page)
  • smart phones
  • secure online web server
  • statistical software continuous service
Reward for self-report honesty
  • restaurant coupon
    • donated by business community (community involvement project)
    • restaurant coupon is social-oriented which will mediate the group process
Drug testing problem
  • low honesty about testing (Tourangeau & Yan, 2007)
  • testing mediates abstinence (Sánchez-Hervás, et al., 2010)
Procedure
Participants register anonymously
Clients' self-report
support group sessions (before and after)
  • self-efficacy
  • self-esteem
at any time
  • cravings
  • drug use (relapse)
Test groups
  • group of individuals (groups not part of hypothesis)
  • group material is for future research

Group leaders
  • group processes
  • client attendence
Proposed Statistics
Strength of each s-eff and s-est correlation between and the DV (abst)
When abst is hightest, s-eff will be highest
The test measures are self-efficacy, self-esteem, and group process (independent/predictor variables), and abstinence (dependent criterion). As the relationship between the variables is expected to be linear, multiple regressions will be used to create the "r" value that will indicate the level of association between variables (Meyers, 2006).
Ethical Considerations
Informed Consent
is developed from federal government and APA guidlines (Kitchener, 2000)

  • informed consent agreement will be presented in terms that the clients understand
  • all rights will be protected and individual concerns will be accommodated
  • participants will be informed about the
  • content of the study,
  • its duration
  • how confidentiality will be protected
  • contact persons within the research group
  • that they are volunteers and they can withdraw at any time without consequences
  • there are no deceptions

2nd Cycle
true wiki style

Gender differences

Female "system of self" in group process and especially abstinence
  • self-esteem
  • self-efficacy
  • social cohesiveness
    • group-esteem

Group-oriented agency model
self-system within the group process as it applies to society

  • other-efficacy (Jowett, S. & Lavallee, D. 2007)
    • views by individual group members of the likely hood of success
    • how that will affect agency
      • self-efficacy
      • self-esteem
  • group-efficacy measures
    • consensual
    • individual aggregate
    • individual view of group
  • group-agency measures
    1. group success
    2. success of individuals within group
      • ability of the group to create agency in individuals (irrespective of the group agency)
    3. societal success model
    • what does the model contribute?
      • group volume
      • comparison to other models
        • CBT
        • behavioral
        • psychoeducation
        • psychodyamics
      • material comparisons
        1. benefit to society
        2. cost to society
        3. low cost of research
    • variety of environments
      • countries
      • national groups
        • socio-economic
        • ethnic

Methodology model: Abstinence vs. relapse

Scale

  • time
Variables

Abstinence

explicit
group

  • attendance
  • efficacy (three measures)
individual
  • self-efficacy
  • self-agency
  • self-esteem
  • etc

implicit (anticipated)
  • honesty
    • rewards
    • group reinforcement (self- and group-esteem)
Relapse varibales
  • craving
  • relapse
  • drug-use cohort
  • comorbidities
    • anxiety
      • panic attacks
    • depression
    • etc
Question development
  • open-end questions at end of questionnaire session
  • comments
Software development

Priorities

  • replace drug screening with "soft screening"
    • predict abstinence honesty
  • resolve security/privacy issues
    • delete data as it is processed
  • determine questions that are most predictive

visual inspection

  • charts with respect to
    • time (primary)
    • variables (design factor modeling)

regression model

  • determine significance

factor analysis
develop therapeutic strategies

  1. cluster questions
  2. find clusters that are significant
  3. define them within the "self- and group-system"
  4. facilitate group development based on clusters

Implement "success" model

  • general support

diverse testing

  • nations
  • socio-economic levels
  • ethnicities

new question development

  • native-speaking question-makers
Illustration
  • Future research hypothesized graph (below)
    • Charting of relationship between self-efficacy and self-esteem
    • Help predict relapse (low self-agency)




References

Bandura, A. (1982). Self-efficacy mechanism in human agency. American Psychologist, 37(2), 122-147. doi:10.1037/0003-066X.37.2.122

Berry, W. (1985). Multiple regression in practice. Beverly Hills, CA: Sage Publications.

Bogenschutz, M. P., Tonigan, S., & Miller, W. R. (2006). Examining the effects of alcoholism typology and AA attendance on self-efficacy as a mechanism of change. Journal of Studies on Alcohol, 67(4), 562-567.

Bracke, P., Christiaens, W., & Verhaeghe, M. (2008). Self-esteem, self-efficacy, and the balance of peer support among persons with chronic mental health problems. Journal of Applied Social Psychology, 38(2), 436-459. doi:10.1111/j.1559-1816.2008.00312.x

DeCoster, J. (1998). Overview of factor analysis. Retrieved from http://www.stat-help.com/notes.html

DeFulio, A., & Silverman, K. (2011). Employment-based abstinence reinforcement as a maintenance intervention for the treatment of cocaine dependence: post-intervention outcomes. Addiction, 106(5), 960-967. doi:10.1111/j.1360-0443.2011.03364.x

DuPont, R. (2005). Drug testing in schools: guidelines for effective use. Center City, MN: Hazelden.

Figueira-McDonough, J. & Sarri, R. (2002). Women at the Margins: Neglect, Punishment, and Resistance. New York: Routledge

Goldberg, R. (2010). Drugs across the spectrum. Belmont, CA: Wadsworth, Cengage Learning.

Goodwin, C. J. (2010). Research in psychology: Methods and design (6th ed.). Hoboken, NJ: John Wiley and Sons, Inc.

Gossop, M., Stewart, D., & Marsden, J. (2008). Attendance at Narcotics Anonymous and Alcoholics Anonymous meetings, frequency of attendance and substance use outcomes after residential treatment for drug dependence: A 5-year follow-up study. Addiction, 103(1), 119–12

Greenberger, E., Chen, C., Dmitrieva, J., & Farruggia, S. P. (2003). Item-wording and the dimensionality of the Rosenberg Self-Esteem Scale: Do they matter?. Personality & Individual Differences, 35(6), 1241. doi:10.1016/S0191-8869(02)00331-8

Groh, D. R., Jason, L. A., Ferrari, J. R., & Davis, M. I. (2009). Oxford House and Alcoholics Anonymous: The impact of two mutual-help models on abstinence. Journal of Groups in Addiction & Recovery, 4(1/2), 23-31. doi:10.1080/15560350802712363

Hasin, D. S., Stinson, F. S., Ogburn, E., & Grant, B. F. (2007). Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and cependence in the United States. Archives of General Psychiatry, 64(7), 830-842.

Hojat, M. (2007). Empathy in patient care: antecedents, development, measurement, and outcomes. New York: Springer.
Jowett, S. & Lavallee, D. (2007). Social psychology in sport. Champaign, IL: Human Kinetics.

Kitchener, K. (2000). Foundations of ethical practice, research, and teaching in psychology. Mahwah, N.J: L. Erlbaum Associates.

Matto, H. C., Strolin, J. S., & Mogro-Wilson, C. (2008). A pilot study of a dual processing substance user treatment intervention with adults. Substance Use & Misuse 43(3-4), 285-294.

Meyers, L. (2006). Applied multivariate research: Design and interpretation. Thousand Oaks, CA: Sage Publication

Phan, H. (2010). Students' academic performance and various cognitive processes of learning: an integrative framework and empirical analysis. Educational Psychology, 30(3), 297-322. doi:10.1080/01443410903573297

Sánchez-Hervás, E., Romaguera, F., Santonja Gòmez, F., Secades-Villa, R., García-Rodríguez, O., & Yanez, E. (2010). Urine testing during treatment predicts cocaine abstinence. Journal of Psychoactive Drugs, 42(3), 347-352.

Schmitt, D. P., & Allik, J. (2005). Simultaneous administration of the Rosenberg Self-Esteem Scale in 53 nations: exploring the universal and culture-specific features of global self-esteem. Journal of Personality and Social Psychology, 89(4), 623-642. doi:10.1037/0022-3514.89.4.623

Stevens, E. B., Jason, L. A., Ferrari, J. R., & Hunter, B. (2010). Self-efficacy and sense of community among adults recovering from substance abuse. North American Journal of Psychology, 12(2), 255-264.

Terry-McElrath, Y. M., Johnston, L. D., O'Malley, P. M., & Yamaguchi, R. (2005). Substance abuse counseling services in secondary schools: A national study of schools and students, 1999-2003. Journal of School Health, 75(9), 334-341. doi:10.1111/j.1746-1561.2005.00047.x

Tourangeau, R., & Yan, T. (2007). Sensitive questions in surveys. Psychological Bulletin, 133(5), 859-883. doi:10.1037/0033-2909.133.5.859

Truneckova, D., & Viney, L. L. (2008). Small-group counselling with primary school children. Personal Construct Theory & Practice, 5, 139-148.


NOTES

"Self-esteem, when viewed as a basic construct in an individual's implicit conceptual system of self, is of such fundamental importance in understanding human behavior that it warrants a great deal of creative effort in establishing better ways to measure it." (Epstein, 1982, August, p. 1)

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