- Email: [email protected]
Group differences in attitudes towards alcoholism
Addicrmr
Brhaoiors.
Vol
I, pp. 2X1-286.
GROUP
GLENN
Pergamon
Press 1976.
Prmted m Great Britam.
DIFFERENCES IN ATTITUDES TOWARDS ALCOHOLISM
R. CADDY*, ROY D. GOLDMAN University
of California,
and ROBERT HUEBNER
Riverside
Abstract-Attitudes toward alcoholism were assessed by questionnaires in three groups with different degrees of contact with alcohol use. The three groups were: Alcoholics Anonymous (AA), college students, and a non-drinking religious sect. Multivariate analysis of variance in a 3 x 2 (Group x Sex) design was used to compare attitudes. There were significant main effects on both factors but no interactions. Discriminant function analysis was used to further describe the nature of the attitudinal difference among groups. The results suggest that the groups differ along two independent dimensions: (1) restriction versus freedom of alcohol use. and (2) volitional control vs no control over drinking. The AA and religious groups are rather similar on the first dimension-both favoring restriction. but extremely different on the second. Men and women also differ in their attitudes toward alcoholism.
Recent investigators have considered that theoretical models of alcoholism can be conceptually clustered into the three general categories of “Physical Disease,” “Underlying Psychological Illness” and “Learned Pattern of Behavior” (Caddy, Goldman & Huebner, 1976). There is also a theoretical basis for believing that the model which a person holds, in this case a model of alcoholism, is central to that person’s whole attitudinal network regarding the condition. Aubert & Messinger (1958), Glock (1964), Parsons (1964) and Stoll (1968) for example, have all suggested that different assumptions about the causes of deviance generally underlie methods of handling the deviant individual. More specifically, Linsky (1972) employing survey methodology showed that the etiological theories of alcoholism to which individuals subscribe influence the method of social control which those individuals deem appropriate for the handling of the alcoholic. At the same time, as noted by Marconi (1967), there is a general lack of unanimity regarding the conceptualization of alcoholism. Despite the likelihood that members of special interest groups (e.g. Alcoholics Anonymous) may espouse a rather consistent view of the disorder, evidence from Linsky (1972) and Caddy, Goldman & Huebner (1976), suggests that the public holds no clear, consistent or packaged model of alcoholism. Further, the logical and empirical correspondence between the simultaneous holding of differing models of alcoholism sometimes found in the one person, makes the situation even more complex. In a comprehensive review of the relationship between attitudes and behavior, Fishbein & Ajzen (1974) concluded that attitudes are strongly related to “multiple act” behavioral criteria but not necessarily to “single-act” criteria. A single act criterion is either; (a) “the single observation of a single act,” or, (b) “repeated observations of the same single act” (Fishbein & Ajzen, 1974, p. 60) A multiple act criterion is, “ . . . based on single or repeated observations of different behaviors”. (p. 60). Behavior involving the use and abuse of alcohol clearly involves “multiple-acts”. Hence, such behavior presumably may be predictable from attitudes toward alcoholism. Any endeavor to measure attitudes must confront the issue of construct validity (Cronback & Meehl, 1955). One method of assessing construct validity involves the use of groups” which ought to differ on a construct are group difirences. Here, “criterion tested. If they differ in the expected direction then support is lent to the validity of the test under investigation. Perhaps the clearest and simplest way to employ “criterion groups” for the measurement of construct validity in attitude research on alcoholism, is to locate groups that
*Correspondence should Human
Behavior,
Jefferson
be addressed to Dr. Caddy who is now at the Department Medical College, Philadelphia, PA. 19107, U.S.A. 281
of Psychiatry
and
282
GLENN R. CADDY, ROY D. GOLDMAN and
ROBERT HUEBNER
differ along a continuum of alcohol consumption. Unfortunately such a task is difficult for it is very difficult to determine, a priori, the relative consumption of alcohol within the “normal” range of adult drinking behaviors. The present study ‘sought groups that would unequivocally differ in their histories of alcohol consumption and that could easily be ranked, a priori, along a continuum of alcohol usage. The purpose was to determine if attitudinal differences regarding alcoholism were related to alcohol usage, and at the same time to evaluate the construct validity of the Alcohol Attitude Questionnaire developed by Caddy, Goldman & Huebner (1976). The three groups surveyed comprised respectively: (1) alcoholics anonymous (AA) members, (2) college students and (3) members of a non-drinking religious sect (the subject population will be described in detail in the section entitled “Method”). These groups were considered to meet the conditions outlined previously. Basically, this research differs from previous investigations in this area because it employs two multivariate statistical methods: multivariate analysis of variance and discriminant function analysis. Multivariate analysis of variance permits the investigator. to compare group mean vectors on the dependent variables. That is, it enables a comparison of all groups simultaneously using all dependent variables (hence “mean vectors,” or row of means of all dependent variables). The alpha level of the comparison among groups is, therefore, not increased by the addition of more dependent variables. Discriminant function analysis may be used to determine which dependent variables display the greatest power to discriminate among groups. This discriminating power (called the discriminant function coefficient), is determined for all variables in the context of all the other variables. Thus, discriminant function coefficients can suggest the loci of multivariate group difference.
METHOD
Subjects As stated previously, three groups of subjects were employed. Group (AA) comprised 31 Alcoholics Anonymous members (17 males, 14 females), ranging in age from 22 to 65 yr (mean, 44.1 yr). This group was obtained through the energetic solicitation by an active AA member of his associates. All these subjects claimed to be “succeeding in AA” with periods of abstinence ranging from 2 months to 10 yr (median 9 months). To the extent that these people were abstinent they may not have been representative of alcoholics generally. Further to the extent that half had been abstinent for longer than nine months, they may not have been representative of alcoholics anonymous members generally. The second group (college) was composed of 296 college students (146 males, 150 females) undertaking introductory and advanced psychology courses. The age range of this sample was 18-56 yr, the mean was 21.9 yr. Eighteen per cent of this sample or less than once a month”, 10% reported their alcohol consumption as “non-existent 5% failed to provide the drinking informareported regularly drinking “to intoxication”, tion and the remaining 67% were considered “moderate social drinkers”. This group was obtained by canvassing all the students in three classes (total enrollment 310) and requesting that they complete the Alcohol Attitude Questionnaire. The voluntary completion rate of this group was 95.5%. The third group (religious) comprised 46 members (26 males, 20 females) of a religious sect which forbids the use of alcohol. The ages of this group ranged between 19 and 58 yr (mean 39.4 yr). This group was contacted through the director of a university affiliated religious training institute. Questionnaire administration to this group yielded a voluntary return rate of 83.6%.
Attitudes
toward
283
alcoholism
Design
The three each group accordance Kirk, 1968,
groups differed in their personal history of alcohol usage (factor A). Within there were members of both sexes (factor B). The data were analyzed in with the model of a completely randomized 3 x 2 factorial design. (See p. 171).
Questionnaire
The instrument used in this study was the 66-item Likert-style Alcohol Attitudes Questionnaire (AAQ) previously developed by the present authors (Caddy, Goldman & Huebner, 1976). Briefly, the AAQ examines attitudinal domains which fall under the general headings of Model (reflecting the nature and origins of the disorder), Cost (reflecting the personal and national economic consequences of alcoholism) and Treatment (indicating attitudes toward the most appropriate methods of control or treatment, the most appropriate goals for such handling and the prognosis of the alcoholic). Questionnaire
administration
The AAQ was administered separately to each group. Each subject was given the questionnaire (including instruction sheet), an answer sheet and an anonymous biographical data sheet. At the completion of the administration all answer sheets were collected and the responses coded and punched onto IBM cards. RESULTS
A multivariate analysis of variance was performed using the responses to the 66 questionnaire items as dependent variables. Using the 0.01 level of significance there were significant differences among the three groups surveyed [F (132, 602) = 2.94, p < O.OOl]. There was also a significant difference between males and females [F (66, 302) = 2.32, p < O.OOOl],but not a significant sex-by-group interaction. Group differences
A discriminate function analysis was performed to compare the three groups. This analysis revealed two significant discriminate functions. The x2 values for these two discriminant functions were: x2 = 332; d.f. = 132, p < 0.0001, and x2 = 156, d.f. = 65, p < 0.0001. Since each discriminant function is uncorrelated with any other discriminant function, the differences among the three groups could be represented in two orthogonal dimensions. The meanings of the dimensions represented by the discriminant functions are implied by the loadings of the questionnaire items on those dimensions (see Table 1). The cenTable 1. Highly
discriminating
items for the composition
Item
5 6 11 12 23 24 35 41 42 45 58
Univariate
Discourage marriage Leading health problem Allergic Permitted to drink Education Social not medical Wants to be helped Public misinformed Religious involvement Percent of population Jailing Multivariate
of the AA, college and religious
F
P
11.10 9.78 8.84 11.61 2.50 5.82 3.21 2.70 23.51 6.05 2.08
0.0001 0.0001 0.001 0.0001 0.08 0.01 0.05 0.06 0.0001 0.01 0.12
F = 2.94, d.f. = 132,609, p = 0.0001.
groups
Discriminant Function Coefficients I II -0.31 -0.31 -0.37 0.30 -0.33 0.30 0.48 -0.30 - 0.48 -0.34 0.34
284
GLENN
R. CADDY, ROY D. GOLDMAN
and ROBERT HUEBNER
0
cimce
Free abOut drinkrg
College
-“.5 t -10
-1.5t u
AA
.-6 t s L
-2.O-
-25Religious
I
0.5 No c0ntr0
I
I
I
I
I
I
I
1.0
15
20
25
30
3.5
40
overdrlnklq
Fig. 1. Attitude
centroids
Function
for AA, college and religious space.
Personal Control over drlnklng
II
groups
in a two dimensional
discriminate
troids of the three groups are plotted in the space of these two discriminant dimensions in Fig. 1. It can be seen from Table 1 that discriminant function I appears to reflect the dimenregarding alcohol use. At the positive pole of sion of “personal freedom-restriction” this dimension are items 12 (“People should be permitted to drink as much as they want”) and 24 (“Alcoholism is a social problem rather than a medical problem.“). Items with negative loadings are items 5 (“I would do everything in my power to discourage my children from marrying a person with a drinking problem.“), item 6 (“Alcohol abuse is now recognized as the nation’s leading health problem.“) and item 42 (“Religious involvement is a good method of handling the alcoholic.“). A person scoring high on this dimension would tend to believe that alcoholism is: (1) a social problem, (2) not the nation’s most serious health problem and (3) not best treated through religious involvement. Further, such a person would also agree with the notion that people should have freedom to drink, would not support the notion that external control measures, such as the reduction of the alcoholic concentration of beverages, is a likely long-term solution to the problem of alcoholism and finally would see drinking as a surmountable obstacle to a successful marriage. In sum, such a person sees alcoholism as a less-thanmajor problem of a social rather than medical or moral nature. As can be seen in Fig. 1, the college group scored highest on this dimension, followed respectively by the AA and religious groups. The second discriminant function seemed to reflect the volitional or willful nature of alcoholism. At the positive pole of the dimension are items 36 (“You can’t help an alcoholic unless he or she wants to be helped.“), and 58 (“Jailing is a good method of handling the alcoholic.“). These items seem to reflect the view that alcoholism is a matter of personal control and that the failure by the alcoholic to exert such control warrants the imposition of control by society. At this pole also, although of lesser Table
2. Highly
discriminating
items for the comparison
Item
Univariate F P
25 Drink to escape 45 Per cent of population 59 Change society 63 Less intelligent
Multivariate
F = 2.32,
5.65 33.98 6.13 14.41 d.f. = 66,302,
p < 0.0001.
0.05 0.01 0.05 0.01
of males and females Discriminant Function Coefficient
-0.34 - 0.43 0.35 0.30
Attitudes
toward
alcoholism
285
weighting, are items 17 (Alcoholics should all be hospitalized.“) and 3 (“Alcoholics should be treated free of charge.“). It may be implied from this association that hospitalization, like jailing, involves pressure imposed upon the individual. However, given that society is “imposing the hospitalization,” the individual should not be required to pay for such handling. At thqnegative pole of this dimension are items 11 (“The alcoholic is allergic to alcohol.“), 23 (“An educational program aimed at the youth providing factual information on the nature and recommended usage of alcohol would have long term effects on reducing the incidence of alcoholism.“), 41 (“Most of the general public is either not informed or misinformed concerning the use and abuse of alcohol.“) and 45 (“Though precise figures are not available it is likely that alcoholics and problem drinkers account for which (percentage) of the total population.“). DISCUSSION
It appears that people who have had different degrees of contact with alcohol, endorse questionnaire items which indicate that they differ in their attitudes towards alcoholism. Further, the results showed clear sex differences in attitudes towards alcoholism though no significant interaction between sex and group membership was found. The three groups which were investigated appeared to differ along two independent dimensions. The configuration of these groups, graphically depicted in Fig. 1, shows an interesting, and perhaps paradoxical finding, namely that in some ways the AA group and the religious group are quite similar. (It should of course be noted that the AA philosophy have always contained a strong nondenominational religious component). The similarities between these two groups generally reflect a restrictive attitude toward alcohol usage. Both groups seem to endorse the idea that people should be discouraged from drinking, if not prevented, by means other than self-control. This attitudinal position may possibly be the dynamic quality that motivates people to favor legal prohibition of alcohol and drug usage. College students, on the other hand tended to favor personal freedom of choice regarding alcohol usage. The other dimension of group differences shows a different ordering of group attitudes. This second dimension shows the AA and religious groups as most different. In general the dimension reflects a belief about personal control over drinking. Members of the AA group were found to believe that drinking behavior is not under the personal control of the alcoholic (e.g. The alcoholic is allergic to alcohol). The philosophy of AA with regard to the self-control issue in alcoholism is, in part, that the alcoholic must abstain for he is “power less over alcohol”. The religious group members hold an opposite position regarding the personal control of alcohol abuse. They tend to believe that alcohol abuse is not “compelled” by some external source but is, instead, caused by either inadequate self-control or on unwillingness to exert self-control. Thus, alcohol abuse is seen as a moral issue. College students, on the other hand, lie in between the other two groups on this dimension with a slight orientation towards the religious group end. This position might best be categorized as recommending the view that responsible drinking involves a degree of self-control and that even alcoholics should or could exert a greater degree of self-control. Interestingly, the religious group does not believe strongly in the efficacy of educational programs in reducing the incidence of alcoholism. Factual information about alcohol and its abuse would be, apparently, an inadequate substitute for the character building religious training necessary to influence the development of alcoholism. The male-female attitudes toward alcoholism are different, but the nature of this difference is difficult to interpret. One aspect of this difference may be related to a contemporary definition of masculinity involving “the ability to hold one’s liquor.” Perhaps women perceive this societal norm more clearly than men, leading women to believe that society must change in order to reduce alcoholism. Women also see alcoholism as more widespread than do men. This may be due partly to the personal control aspect of the definition of alcoholism. Women, who are more apt to perceive frequent drinking as a compulsion, are also more likely to label it as alcoholism. Men, who
286
GLENN R. CADDY, ROY D. GOLDMAN and
ROBERT HUEBNER
are more likely to see personal control over drinking, are less likely to apply the label alcoholism.
The results of this investigation lend support to the construct validity of the AAQ insofar as criterion groups’ responses differ in expectable ways. Unfortunately this study is somewhat afflicted by the problem of “surplus meaning” of the criterion groups. these groups probably differ in ways that are quite distinct from their usage of alcohol. College students are younger and socioeconomically above AA members. They are more liberal than the members of the religious group. In a sense, these differences produce a form of “confounding,” yet, this “confounding” leads to a form of external validity (Campbell & Stanely, 1963) that would be difficult to obtain from artifically created groups. Future directions would include administration of the AAQ to a more diverse set of groups including: municipal court judges, mental health professionals, physicians, social workers and to sub-populations within the community at large. By developing a clearer understanding of the diverse attitudes held toward alcohol use and alcoholism in these groups, it may be possible to introduce more effective prevention and treatment programs to the various segments of the community. REFERENCES Aubert, V., & Messinger, F., The criminal and the sick. Inquiry, 1958, 1, 137-160. Caddy, G. R., Goldman. R. D., & Huebner, R., Relationships among different domains of attitudes toward alcoholism: Model, cost and treatment. Addictive Behaviors, 1976, 1, 159-167. Cambell, D. T., & Stanley, J. C., Experimental and quasi-experimental designs fir research. Chicago: RandMcNally, 1963. Cronbach, L. J., & Meehl, P., Construct validity in psychological tests. Psychological Bulletin, 1955, 52, 281-302. Fishbein, M., & Ajzen, I., Attitudes towards objects as predictors of single and multiple behavioral criteria. Psychological Review, 1974, 81, 59-74. Glock, C. Y., Image of man and public opinion. Public Opinion Quarterly, 1964, 28, 539-546. Kirk, R. E., Experimental design procedures for the behauioral sciences. Belmont, Calif.: Brooks-Cole, 1968. Linsky, A. S., Theories of behavior and social control of alcoholism. Social Psychiatry, 1972, 7, 47-52. Marconi, J. Scientific theory and operational definitions in psychopathology with social references to alcoholism. Quarterly Journal of Studies on Alcohol, 1967, 28, 631-640. Parsons, T., Social structure and personality. New York: Free press, 1964. Stoll, C. S. Images of man and social control. Social Forces, 1968, 47, 119-127.
Brhaoiors.
Vol
I, pp. 2X1-286.
GROUP
GLENN
Pergamon
Press 1976.
Prmted m Great Britam.
DIFFERENCES IN ATTITUDES TOWARDS ALCOHOLISM
R. CADDY*, ROY D. GOLDMAN University
of California,
and ROBERT HUEBNER
Riverside
Abstract-Attitudes toward alcoholism were assessed by questionnaires in three groups with different degrees of contact with alcohol use. The three groups were: Alcoholics Anonymous (AA), college students, and a non-drinking religious sect. Multivariate analysis of variance in a 3 x 2 (Group x Sex) design was used to compare attitudes. There were significant main effects on both factors but no interactions. Discriminant function analysis was used to further describe the nature of the attitudinal difference among groups. The results suggest that the groups differ along two independent dimensions: (1) restriction versus freedom of alcohol use. and (2) volitional control vs no control over drinking. The AA and religious groups are rather similar on the first dimension-both favoring restriction. but extremely different on the second. Men and women also differ in their attitudes toward alcoholism.
Recent investigators have considered that theoretical models of alcoholism can be conceptually clustered into the three general categories of “Physical Disease,” “Underlying Psychological Illness” and “Learned Pattern of Behavior” (Caddy, Goldman & Huebner, 1976). There is also a theoretical basis for believing that the model which a person holds, in this case a model of alcoholism, is central to that person’s whole attitudinal network regarding the condition. Aubert & Messinger (1958), Glock (1964), Parsons (1964) and Stoll (1968) for example, have all suggested that different assumptions about the causes of deviance generally underlie methods of handling the deviant individual. More specifically, Linsky (1972) employing survey methodology showed that the etiological theories of alcoholism to which individuals subscribe influence the method of social control which those individuals deem appropriate for the handling of the alcoholic. At the same time, as noted by Marconi (1967), there is a general lack of unanimity regarding the conceptualization of alcoholism. Despite the likelihood that members of special interest groups (e.g. Alcoholics Anonymous) may espouse a rather consistent view of the disorder, evidence from Linsky (1972) and Caddy, Goldman & Huebner (1976), suggests that the public holds no clear, consistent or packaged model of alcoholism. Further, the logical and empirical correspondence between the simultaneous holding of differing models of alcoholism sometimes found in the one person, makes the situation even more complex. In a comprehensive review of the relationship between attitudes and behavior, Fishbein & Ajzen (1974) concluded that attitudes are strongly related to “multiple act” behavioral criteria but not necessarily to “single-act” criteria. A single act criterion is either; (a) “the single observation of a single act,” or, (b) “repeated observations of the same single act” (Fishbein & Ajzen, 1974, p. 60) A multiple act criterion is, “ . . . based on single or repeated observations of different behaviors”. (p. 60). Behavior involving the use and abuse of alcohol clearly involves “multiple-acts”. Hence, such behavior presumably may be predictable from attitudes toward alcoholism. Any endeavor to measure attitudes must confront the issue of construct validity (Cronback & Meehl, 1955). One method of assessing construct validity involves the use of groups” which ought to differ on a construct are group difirences. Here, “criterion tested. If they differ in the expected direction then support is lent to the validity of the test under investigation. Perhaps the clearest and simplest way to employ “criterion groups” for the measurement of construct validity in attitude research on alcoholism, is to locate groups that
*Correspondence should Human
Behavior,
Jefferson
be addressed to Dr. Caddy who is now at the Department Medical College, Philadelphia, PA. 19107, U.S.A. 281
of Psychiatry
and
282
GLENN R. CADDY, ROY D. GOLDMAN and
ROBERT HUEBNER
differ along a continuum of alcohol consumption. Unfortunately such a task is difficult for it is very difficult to determine, a priori, the relative consumption of alcohol within the “normal” range of adult drinking behaviors. The present study ‘sought groups that would unequivocally differ in their histories of alcohol consumption and that could easily be ranked, a priori, along a continuum of alcohol usage. The purpose was to determine if attitudinal differences regarding alcoholism were related to alcohol usage, and at the same time to evaluate the construct validity of the Alcohol Attitude Questionnaire developed by Caddy, Goldman & Huebner (1976). The three groups surveyed comprised respectively: (1) alcoholics anonymous (AA) members, (2) college students and (3) members of a non-drinking religious sect (the subject population will be described in detail in the section entitled “Method”). These groups were considered to meet the conditions outlined previously. Basically, this research differs from previous investigations in this area because it employs two multivariate statistical methods: multivariate analysis of variance and discriminant function analysis. Multivariate analysis of variance permits the investigator. to compare group mean vectors on the dependent variables. That is, it enables a comparison of all groups simultaneously using all dependent variables (hence “mean vectors,” or row of means of all dependent variables). The alpha level of the comparison among groups is, therefore, not increased by the addition of more dependent variables. Discriminant function analysis may be used to determine which dependent variables display the greatest power to discriminate among groups. This discriminating power (called the discriminant function coefficient), is determined for all variables in the context of all the other variables. Thus, discriminant function coefficients can suggest the loci of multivariate group difference.
METHOD
Subjects As stated previously, three groups of subjects were employed. Group (AA) comprised 31 Alcoholics Anonymous members (17 males, 14 females), ranging in age from 22 to 65 yr (mean, 44.1 yr). This group was obtained through the energetic solicitation by an active AA member of his associates. All these subjects claimed to be “succeeding in AA” with periods of abstinence ranging from 2 months to 10 yr (median 9 months). To the extent that these people were abstinent they may not have been representative of alcoholics generally. Further to the extent that half had been abstinent for longer than nine months, they may not have been representative of alcoholics anonymous members generally. The second group (college) was composed of 296 college students (146 males, 150 females) undertaking introductory and advanced psychology courses. The age range of this sample was 18-56 yr, the mean was 21.9 yr. Eighteen per cent of this sample or less than once a month”, 10% reported their alcohol consumption as “non-existent 5% failed to provide the drinking informareported regularly drinking “to intoxication”, tion and the remaining 67% were considered “moderate social drinkers”. This group was obtained by canvassing all the students in three classes (total enrollment 310) and requesting that they complete the Alcohol Attitude Questionnaire. The voluntary completion rate of this group was 95.5%. The third group (religious) comprised 46 members (26 males, 20 females) of a religious sect which forbids the use of alcohol. The ages of this group ranged between 19 and 58 yr (mean 39.4 yr). This group was contacted through the director of a university affiliated religious training institute. Questionnaire administration to this group yielded a voluntary return rate of 83.6%.
Attitudes
toward
283
alcoholism
Design
The three each group accordance Kirk, 1968,
groups differed in their personal history of alcohol usage (factor A). Within there were members of both sexes (factor B). The data were analyzed in with the model of a completely randomized 3 x 2 factorial design. (See p. 171).
Questionnaire
The instrument used in this study was the 66-item Likert-style Alcohol Attitudes Questionnaire (AAQ) previously developed by the present authors (Caddy, Goldman & Huebner, 1976). Briefly, the AAQ examines attitudinal domains which fall under the general headings of Model (reflecting the nature and origins of the disorder), Cost (reflecting the personal and national economic consequences of alcoholism) and Treatment (indicating attitudes toward the most appropriate methods of control or treatment, the most appropriate goals for such handling and the prognosis of the alcoholic). Questionnaire
administration
The AAQ was administered separately to each group. Each subject was given the questionnaire (including instruction sheet), an answer sheet and an anonymous biographical data sheet. At the completion of the administration all answer sheets were collected and the responses coded and punched onto IBM cards. RESULTS
A multivariate analysis of variance was performed using the responses to the 66 questionnaire items as dependent variables. Using the 0.01 level of significance there were significant differences among the three groups surveyed [F (132, 602) = 2.94, p < O.OOl]. There was also a significant difference between males and females [F (66, 302) = 2.32, p < O.OOOl],but not a significant sex-by-group interaction. Group differences
A discriminate function analysis was performed to compare the three groups. This analysis revealed two significant discriminate functions. The x2 values for these two discriminant functions were: x2 = 332; d.f. = 132, p < 0.0001, and x2 = 156, d.f. = 65, p < 0.0001. Since each discriminant function is uncorrelated with any other discriminant function, the differences among the three groups could be represented in two orthogonal dimensions. The meanings of the dimensions represented by the discriminant functions are implied by the loadings of the questionnaire items on those dimensions (see Table 1). The cenTable 1. Highly
discriminating
items for the composition
Item
5 6 11 12 23 24 35 41 42 45 58
Univariate
Discourage marriage Leading health problem Allergic Permitted to drink Education Social not medical Wants to be helped Public misinformed Religious involvement Percent of population Jailing Multivariate
of the AA, college and religious
F
P
11.10 9.78 8.84 11.61 2.50 5.82 3.21 2.70 23.51 6.05 2.08
0.0001 0.0001 0.001 0.0001 0.08 0.01 0.05 0.06 0.0001 0.01 0.12
F = 2.94, d.f. = 132,609, p = 0.0001.
groups
Discriminant Function Coefficients I II -0.31 -0.31 -0.37 0.30 -0.33 0.30 0.48 -0.30 - 0.48 -0.34 0.34
284
GLENN
R. CADDY, ROY D. GOLDMAN
and ROBERT HUEBNER
0
cimce
Free abOut drinkrg
College
-“.5 t -10
-1.5t u
AA
.-6 t s L
-2.O-
-25Religious
I
0.5 No c0ntr0
I
I
I
I
I
I
I
1.0
15
20
25
30
3.5
40
overdrlnklq
Fig. 1. Attitude
centroids
Function
for AA, college and religious space.
Personal Control over drlnklng
II
groups
in a two dimensional
discriminate
troids of the three groups are plotted in the space of these two discriminant dimensions in Fig. 1. It can be seen from Table 1 that discriminant function I appears to reflect the dimenregarding alcohol use. At the positive pole of sion of “personal freedom-restriction” this dimension are items 12 (“People should be permitted to drink as much as they want”) and 24 (“Alcoholism is a social problem rather than a medical problem.“). Items with negative loadings are items 5 (“I would do everything in my power to discourage my children from marrying a person with a drinking problem.“), item 6 (“Alcohol abuse is now recognized as the nation’s leading health problem.“) and item 42 (“Religious involvement is a good method of handling the alcoholic.“). A person scoring high on this dimension would tend to believe that alcoholism is: (1) a social problem, (2) not the nation’s most serious health problem and (3) not best treated through religious involvement. Further, such a person would also agree with the notion that people should have freedom to drink, would not support the notion that external control measures, such as the reduction of the alcoholic concentration of beverages, is a likely long-term solution to the problem of alcoholism and finally would see drinking as a surmountable obstacle to a successful marriage. In sum, such a person sees alcoholism as a less-thanmajor problem of a social rather than medical or moral nature. As can be seen in Fig. 1, the college group scored highest on this dimension, followed respectively by the AA and religious groups. The second discriminant function seemed to reflect the volitional or willful nature of alcoholism. At the positive pole of the dimension are items 36 (“You can’t help an alcoholic unless he or she wants to be helped.“), and 58 (“Jailing is a good method of handling the alcoholic.“). These items seem to reflect the view that alcoholism is a matter of personal control and that the failure by the alcoholic to exert such control warrants the imposition of control by society. At this pole also, although of lesser Table
2. Highly
discriminating
items for the comparison
Item
Univariate F P
25 Drink to escape 45 Per cent of population 59 Change society 63 Less intelligent
Multivariate
F = 2.32,
5.65 33.98 6.13 14.41 d.f. = 66,302,
p < 0.0001.
0.05 0.01 0.05 0.01
of males and females Discriminant Function Coefficient
-0.34 - 0.43 0.35 0.30
Attitudes
toward
alcoholism
285
weighting, are items 17 (Alcoholics should all be hospitalized.“) and 3 (“Alcoholics should be treated free of charge.“). It may be implied from this association that hospitalization, like jailing, involves pressure imposed upon the individual. However, given that society is “imposing the hospitalization,” the individual should not be required to pay for such handling. At thqnegative pole of this dimension are items 11 (“The alcoholic is allergic to alcohol.“), 23 (“An educational program aimed at the youth providing factual information on the nature and recommended usage of alcohol would have long term effects on reducing the incidence of alcoholism.“), 41 (“Most of the general public is either not informed or misinformed concerning the use and abuse of alcohol.“) and 45 (“Though precise figures are not available it is likely that alcoholics and problem drinkers account for which (percentage) of the total population.“). DISCUSSION
It appears that people who have had different degrees of contact with alcohol, endorse questionnaire items which indicate that they differ in their attitudes towards alcoholism. Further, the results showed clear sex differences in attitudes towards alcoholism though no significant interaction between sex and group membership was found. The three groups which were investigated appeared to differ along two independent dimensions. The configuration of these groups, graphically depicted in Fig. 1, shows an interesting, and perhaps paradoxical finding, namely that in some ways the AA group and the religious group are quite similar. (It should of course be noted that the AA philosophy have always contained a strong nondenominational religious component). The similarities between these two groups generally reflect a restrictive attitude toward alcohol usage. Both groups seem to endorse the idea that people should be discouraged from drinking, if not prevented, by means other than self-control. This attitudinal position may possibly be the dynamic quality that motivates people to favor legal prohibition of alcohol and drug usage. College students, on the other hand tended to favor personal freedom of choice regarding alcohol usage. The other dimension of group differences shows a different ordering of group attitudes. This second dimension shows the AA and religious groups as most different. In general the dimension reflects a belief about personal control over drinking. Members of the AA group were found to believe that drinking behavior is not under the personal control of the alcoholic (e.g. The alcoholic is allergic to alcohol). The philosophy of AA with regard to the self-control issue in alcoholism is, in part, that the alcoholic must abstain for he is “power less over alcohol”. The religious group members hold an opposite position regarding the personal control of alcohol abuse. They tend to believe that alcohol abuse is not “compelled” by some external source but is, instead, caused by either inadequate self-control or on unwillingness to exert self-control. Thus, alcohol abuse is seen as a moral issue. College students, on the other hand, lie in between the other two groups on this dimension with a slight orientation towards the religious group end. This position might best be categorized as recommending the view that responsible drinking involves a degree of self-control and that even alcoholics should or could exert a greater degree of self-control. Interestingly, the religious group does not believe strongly in the efficacy of educational programs in reducing the incidence of alcoholism. Factual information about alcohol and its abuse would be, apparently, an inadequate substitute for the character building religious training necessary to influence the development of alcoholism. The male-female attitudes toward alcoholism are different, but the nature of this difference is difficult to interpret. One aspect of this difference may be related to a contemporary definition of masculinity involving “the ability to hold one’s liquor.” Perhaps women perceive this societal norm more clearly than men, leading women to believe that society must change in order to reduce alcoholism. Women also see alcoholism as more widespread than do men. This may be due partly to the personal control aspect of the definition of alcoholism. Women, who are more apt to perceive frequent drinking as a compulsion, are also more likely to label it as alcoholism. Men, who
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ROBERT HUEBNER
are more likely to see personal control over drinking, are less likely to apply the label alcoholism.
The results of this investigation lend support to the construct validity of the AAQ insofar as criterion groups’ responses differ in expectable ways. Unfortunately this study is somewhat afflicted by the problem of “surplus meaning” of the criterion groups. these groups probably differ in ways that are quite distinct from their usage of alcohol. College students are younger and socioeconomically above AA members. They are more liberal than the members of the religious group. In a sense, these differences produce a form of “confounding,” yet, this “confounding” leads to a form of external validity (Campbell & Stanely, 1963) that would be difficult to obtain from artifically created groups. Future directions would include administration of the AAQ to a more diverse set of groups including: municipal court judges, mental health professionals, physicians, social workers and to sub-populations within the community at large. By developing a clearer understanding of the diverse attitudes held toward alcohol use and alcoholism in these groups, it may be possible to introduce more effective prevention and treatment programs to the various segments of the community. REFERENCES Aubert, V., & Messinger, F., The criminal and the sick. Inquiry, 1958, 1, 137-160. Caddy, G. R., Goldman. R. D., & Huebner, R., Relationships among different domains of attitudes toward alcoholism: Model, cost and treatment. Addictive Behaviors, 1976, 1, 159-167. Cambell, D. T., & Stanley, J. C., Experimental and quasi-experimental designs fir research. Chicago: RandMcNally, 1963. Cronbach, L. J., & Meehl, P., Construct validity in psychological tests. Psychological Bulletin, 1955, 52, 281-302. Fishbein, M., & Ajzen, I., Attitudes towards objects as predictors of single and multiple behavioral criteria. Psychological Review, 1974, 81, 59-74. Glock, C. Y., Image of man and public opinion. Public Opinion Quarterly, 1964, 28, 539-546. Kirk, R. E., Experimental design procedures for the behauioral sciences. Belmont, Calif.: Brooks-Cole, 1968. Linsky, A. S., Theories of behavior and social control of alcoholism. Social Psychiatry, 1972, 7, 47-52. Marconi, J. Scientific theory and operational definitions in psychopathology with social references to alcoholism. Quarterly Journal of Studies on Alcohol, 1967, 28, 631-640. Parsons, T., Social structure and personality. New York: Free press, 1964. Stoll, C. S. Images of man and social control. Social Forces, 1968, 47, 119-127.