Study of Self-Efficacy and Relapse to Maintain Recovery from Substance Abuse
This paper focuses on a typical analysis of the personality factors in alcohol and drug abuse. The study will consist of subjects from sober living environments who have completed at least 30 days of residential treatment or have participated on outpatient for at least 30 clinical days. The sober living environments will be selected from availability in the southern California area. The study is a mixed method quantitative and qualitative study. The quantitative will consist of a self-efficacy over relapse assessment prior to introducing the quantitative assessment. The quantitative assessment will be in the form of a momentary journaling assessment of relapse situations, selected coping skills, and effectiveness of the selected coping skill to maintain recovery from substance abuse. The sample of the study will consist of 1200 alcohol-dependent subjects and 30 controls group.
The experimental sample will be split into three ways, into a group with an alcohol disorder and relapse (n=510), a group with a drug disorder and relapse (n=480) and substance relapse only (n=210). All the participants will complete the Multidimensional Personality Questionnaire (MPQ), an instrument that is based around 3 dimensions of personality: positive emotionality (self-efficacy), negative emotionality (moodiness and negative self esteem) and constraint (caution, inhibition and morality). There are 11 scales in all: the first 4 (well-being, social potency, achievement and social closeness) represent the positive emotionality dimension; the next 3 (stress reaction, low self-esteem, alienation and aggression) represent negative emotionality: the next 3 (control, harm avoidance and traditionalism) represents constraint: and the final scale, absorption, is a separate construct.
The researchers proposed that inspection of the univariate effects to be based round some os the scales relating to negative emotionality and constraints. On all three negative scales, subjects with an alcohol disorder were given high probability scores than those without, and all the three constraint variables, participants with drug disorder were highly rated than those without. Discriminate analysis was deployed to see if functions could be identified which represented these two groups of variables. Four groups were entered as independent variable, and the 11 MPQ scales were the dependent variable.
Quantitative aspects will incorporated statistical regression and chi-test analysis. Correlations of variables such as psychological, environmental factors to the well-being of individuals who consume alcohol were also evaluated. According to previous studies, it has been determined that response to drug abuse is affected by many factors. As a result, the study will then investigate the magnitude and impact of contribution of these effects to the response of alcohol use.
The variables in the study entail the social and healthy welfare as the independent variables and the beliefs about coping mechanism as the dependent variables. A conceptual model based on these variables is provided. The proposed study will incorporate a range of score of the variables in correspondence to the independent variable.
To determine the magnitude of these variables, the study shall evaluate all variables in contribution to the independent variable. First, belief and positive attitude towards treatment and medication will be evaluated among the respondents in the score model of the belief in range score of 1 to 10. The score of self-efficacy will be evaluated on basis of a scale of 1 to 20 on impact of the response of after alcohol abuse.
A chi test will be analyzed on the variables of the studies. The confidence interval of results in this study will be 95% with an error of +/- 5%. This will determine the precision of the data to be used.
In evaluating the intuitive model of this research, scientific procedures are established to find the relationship of the relapse situations to the self-esteem as a variable that permit interference of causal precedence. With this knowledge, the research evaluates the expected causal directions: low self-esteem as a result of maltreatment; depression contributing to the engagement in substance abuse; low esteem attributing to quitting in social corporate responsibilities; and other repercussions.
In other cases, however, the logic is partly conceivable. With the realization that joblessness is involuntary, the unemployed individual end up relying on the other peoples welfare. Therefore, it would be impossible to assume that dependence is as a result of low self-esteem. Even though, one could argue that dependency is highly correlated to low self-esteem in South California area since these individuals are victimized by helplessness and subjugations.
After that, the population score is rated comparatively to self-esteem. Moreover, the behavioral changes exhibited by the subjects are analyzed based on the outcomes derived from the population with “high scores” of self-esteem. According to Najavits (2002), the investigators took an indirect tack that assumed that low self-esteem was due to disadvantaged economic and social position thus leading to relapse of the alcoholism and substance abuse. The measures by which these probable relations were tested for correlation were highly standardized. Miller & Wiley Inter-Science (2010) postulates, “The objective measure of self-esteem was tracked by directing one of the procedures developed to analyze quantitatively the hypothesized behavior under study. These measures were converted into scale (Is there any satisfaction with the behavior? What are the outcomes of taking the drugs to control relapse?), and a homogeneous determinant of the relation where the correlation coefficient were evaluated. This analysis was merged with the estimates of the performance on variances in the dependent variable such as drug taking relative to the variances of the independent variables such as determination of the low esteem.
Additional test was carried to estimate the potency of the occurrence of relapse by chance, taken as 8% of the actual period. “From this assessment, unswerving connections emerged indicating that alcohol and substance abuse are positively linked with low self-esteem” (Bellack, 2004). In other cases, however, the correlation runs unpredictably. Hunsley & Mash (2008) states, “The consumption of psychoactive drugs created affirmative impressions on the effects of self esteem, and this connection remains incontestable since drug usage is believed to interfere with the consciousness” (145).
From the previous research studies, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) found a 32% lifetime prevalence of alcohol use disorders (AUDs) in Southern California area of United States.
“The lifetime prevalence for alcohol dependence was 12.7%, while lifetime prevalence of alcohol abuse was 17.9%” (Garcia, 2010). Over three months’ period, the prevalence of alcohol dependence will be around 3.9%, and the prevalence of the alcohol abuse at 5.2%. In this research, the prevalence for AUDs was taken as 19.6%for women and 42.0% for men. Women are more likely to abstain from alcohol than man in this population. “Ethnicity and culture are critical factors in determining levels of alcohol consumption” (Grilo & Mitchell, 2009). The data collected by the research group indicated that in Southern California area, African Americans, Hispanics, and Asians all had a lower risk for past-year incidence of AUDs than whites. For the Asian Americans, genes that affect the metabolism of alcohol act as protective factor and may be responsible for lower AUD rates. “At 12.7%, Native Americans have significantly higher rates of past-year AUDs than other ethnic groups” (In Miller, 2013).
“The impacts of therapeutic alliance on drinking outcomes were varying across treatment settings and modalities” (Grilo & Mitchell, 2009). From the modest predictor of drinks per drinking day, r= -0.102 and percent abstinent days (r= 0.169) for outpatients, but not aftercare clients in the Project MATCH (Matching Alcoholism Treatment to Client Heterogeneity), was correlated to alcohol-use outcomes among inpatients and day-patients receiving CBT (Grilo & Mitchell, 2009). These results were supported by evidence that therapeutic alliance was related to alcohol-use outcomes in medication-compliance interventions but not in CBT plus medication, psychodynamic, or multimodal behavior treatments (In Miller, 2013).
In light of these variable findings, it was suggested that therapeutic alliance might play a less prominent role in substance-use outcomes with treatments that are more structured and more prominent role in treatment built on common therapy elements.
Typically, in randomized studies of multiple treatments, it was appropriate to assure the subjects that all the treatments in the study were expected to succeed equally. The Randomized controlled trials on the RP model supported the hypothetical claims on efficacy of combined CBT-like therapies and naltrexone for alcohol-dependent individuals. Moreover, the RP model of meta-analysis determined whether the medical management of the relapse on alcohol-dependent patients was as effective as using CBT (Perfas, 2003). The design was structured in 1200 alcohol-dependent subjects and randomly assigned therapists with partially effective drugs, with or without what is referred as cognitive-behavioral interventions (CBI). Even if no one would guarantee the subjects that a particular treatment would work, it was good to encourage the clients to try it for the planned period as a course of coping with relapse. “Self efficacy could be considered if the subject drinking habits shows some improvements” (Najavits, 2002). The discussed treatment methods could also apply if the new problems emerge.
Putting it more into clinical implications, the percentage of subjects with good medical outcome was 60% for those who received only medical management and placebo, 72% for those who received medical management with naltrexone and 70% those who received medical treatment with CBI (Garcia, 2010).
In the Project MATCH, a limit of no more than two additional sessions may be provided at therapist discretion. A plan to provide a specific referral and help the client make contact was devised in Project MATCH in case all attempts to keep the client in treatment failed. Additional treatment would not be provided by any project therapist. Referral was made to an outside agency or to a therapist within the same agency who had no involvement in Project MATCH.
Recommendations and Conclusions
Often than not, the linkage between self-esteem and the association between self-esteem and its performance implications does not surface since the variables on self-esteem are undetermined. “This tendency is very common especially when conducting a study on substance abuse to small minority groups (Miller, 2013). Moreover, representation of psychological factors such as self-esteem rarely brought to bear in the analysis of inveterate welfare dependency.
The traits of the variable being investigated may also lead to unconvincing results of the associations in question. “Self-esteem is depicted as a decisive variable that brings a platform for varied outcomes ranging from substance abuse to withdraw tendency of crime and violence (Garcia, 2010). Due to compound implications, it remains that self-esteem will be connected with many behavioral changes but the outcomes will stands as weak in many cases. Accordingly, it would be implausible to anticipate high correlation while focusing on self-esteem alone.
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