«AN ABSTRACT OF THE DISSERTATION OF Naomi A. Mandsager for the degree of Doctor of Philosophy in Counseling presented on June 7, 2002. Title: The ...»
OF THE DISSERTATION OF
Naomi A. Mandsager for the degree of Doctor of Philosophy in Counseling
presented on June 7, 2002.
Title: The Predictive Relationship of Religiosity to Readiness to Change in
Redacted for Privacy
J. Cass Dykeman
The prevalence of addiction in society has called researchers, educators,
policy makers, and clinicians to examine and research causes and treatment approaches to address the manifold problems addictions present individuals and society alike. There are many theoretical approaches to understanding addiction and the behavior change processes that lead from addiction to recovery. Religiosity and spirituality have been identified as important factors in addiction, though the exact nature of the relationship is yet to be determined. This dissertation explores the relationship between religiosity and the known treatment outcome mediator.
The purpose of this dissertation is to inform theory, training, and practice in the area of addictions counseling.
This exploratory study investigated the relationship of religiosity to readiness to change in addictive behaviors. The database from Project MATCH was used which included participant scores from the aftercare arm of the clinical trial. A total of 772 scores were used from responses to the RBB and URICA.
Stepwise multiple regression revealed that there were no significant differences detected across variables regarding the relationship of religiosity to readiness to change.
The Predictive Relationship of Religiosity to Readiness to Change in Addiction Recovery by Naomi A. Mandsager
A DISSERTATIONSubmitted to Oregon State University in partial fulfillment of the requirements for the degree of Doctor of Philosophy Presented June 7, 2002 Commencement June, 2003 Doctor of Philosophy dissertation of Naomi A. Mandsager presented on June 7, 2002.
Redacted for Privacy Major Professor, representing Counseling Redacted for Privacy Dean of the School of Education Redacted for Privacy Dean of tITh Graduate School I understand that my dissertation will become part of the permanent collection of Oregon State University libraries. My signature below authorizes release of my dissertation to any reader upon request.
Redacted for Privacy Naomi A. Mandsager, Author
ACKNOWLEDGEMENTSThe author expresses sincere gratitude to all the members of the doctoral committee: Dr. Cass Dykeman, for his mentoring, guidance, and support, Dr. Michael Ingram, for his inspiration and thoughtful input, Dr. Gene Eakin, for his sense of humor and challenging questions, Dr. Dale Pehrsson, for her time and encouraging insight, Dr. Jim Firth, for his generosity and dedication to the profession, Dr. Stephen Giovannoni, for his good natured and uplifting presence, and Dr. Alan Brazier, for his openness and magnanimous contribution as a stand-in committee member.
This study greatly benefited from the research conducted by the Project MATCH Research Group. The field of addiction counseling has been advanced and will continue to be informed by the important work done by this group.
CHAPTER 1: Introduction
Addiction Treatment, Religiosity, and Readiness to Change............... 10 Addiction Recovery and Addiction Treatment
Religiosity and Historical Context in Addiction Recovery............. 11 Transtheoretical Model
Training and Practice
CHAPTER 2: Literature Review
Measurement of Religiosity
Readiness to Change
Project MATCH Methodology
Assessment Instruments and Procedures
Participants and Procedures
Type of Stepwise Regression Study
Human Subjects Approval
CHAPTER 4: Results
Religious Beliefs and Behaviors: Descriptive Statistics
Stepwise Multiple Regression Analysis
Summary of Findings
CHAPTER 5: Discussion
Readiness to Change
Causal Modeling and Treatment
Addictions Counseling Training Suggestions
Need to Study Treatment Process
Need to Study Treatment Context
Measure Quality of Life as Outcome
Inclusion of Multiple Sites
Need to Test Clinical Applications
The prevalence of addiction in society has called researchers, educators, policy makers, and clinicians to examine and research causes and treatment approaches to address the manifold problems addictions present individuals and society alike. There are many theoretical approaches to understanding addiction and the behavior change processes that lead from addiction to recovery. Religiosity and spirituality have been identified as important factors in addiction, though the exact nature of the relationship is yet to be determined. This dissertation explores the relationship between religiosity and a known treatment outcome mediator. The purpose of this dissertation is to inform theory, training, and practice in the area of addictions counseling.
RATIONALE The need for improvement in addictions treatment is evident given the prevalence of addiction in our society. The total cost of alcohol misuse in the United States is estimated to be approximately $98.6 billion in 1990, including $10.5 billion on funding treatment (Drummond, 1999). From this perspective, the need for research that examines alcohol treatment outcome and informs treatment development is well founded. Project MATCH was developed to meet these needs.
Specifically, Project MATCH was designed to test the general assumption that alcohol treatment matching would improve treatment outcome. Though the outcome of Project MATCH did not show matching effects, the Project MATCH Research Group (1998) noted that the project was useful beyond matching effect.
Relevant here, researchers from Project MATCH have explored variables with regard to religious beliefs and practices and treatment outcome.
Regarding Project MATCH treatments, it was anticipated that clients with higher levels of religiosity would benefit more from the Twelve Step Facilitation (TSF) treatment than would clients in lower religiosity. No relationship beyond a weak prognostic effect of religiosity on treatment outcome was predicted for clients in the Cognitive Behavioral Coping Skills Therapy or Motivational Enhancement Therapy conditions. Tests of matching hypotheses revealed no support for the predicted match among either the outpatient or aftercare samples. It was found that religiosity among TSF clients was linearly related to the degree of therapeutic task compatibility. Other analyses revealed that aftercare clients reported greater religiosity at pretreatment than did outpatient clients and that pretreatment religiosity predicted positive posttreatment drinking outcomes. Though religiosity did not present as a viable matching dimension with the treatments evaluated by Project MATCH, religiosity does appear to have a role in the predictions of the therapeutic relationship among aftercare clients and of posttreatment drinking behavior (Connors, Tonigan, & Miller, 2001).
Various Project MATCH analyses revealed a relationship between client religiosity and therapeutic alliance, and also a relationship between readiness to change and therapeutic alliance to treatment outcome. However, the antecedent variables to readiness to change have yet to be examined as proposed in Figure 1.
As religiosity has been identified as potentially significant to therapeutic relationship, this study aims to determine the place of religiosity in this causal chain.
Figure 1 contains the hypothetical causal chain guiding this study. The variables in regular print represent known relationships. The "Focus of Study" box located within Figure 1 denotes the scope of this dissertation study. The variable religiosity is italicized to represent its relationship to readiness to change is unknown. See Figure 1.
Figure 1: Focus of Study
Few would argue that addiction recovery is important to improve the quality of life for individuals and society as a whole. Improved quality of life can be conceptualized by examining those factors that contribute to increased health, wellness, and social functioning. Specifically, weilness cannot occur outside of recovery for the addicted individual. With recovery, the individual and society are afforded increased opportunity for healthy living.
Most assuredly, one of the many potential goals of addiction recovery is motivation to change addictive behavior and engage in a healthy life style. A person's
effective and on-going recovery, and ultimately a full and satisfying lifestyle.
For these reasons, addiction recovery is the key focus of addictions treatment. Due to changing trends in society, public policy, and the economy, addictions treatment requires efficient and effective approaches. Effective approaches require program evaluation, research, and training that integrates an
Treatment programs should incorporate an understanding and interventions that further contribute to the motivation of clients as motivation helps clients attain recovery goals and enhances the benefits of treatment. Achieving the goals of recovery is contingent upon clients being successful in treatment. Client readiness to change is essential for engagement in treatment and recovery behaviors.
Therefore, it is important that treatment approaches integrate readiness to change to promote addiction recovery. This outcome is the ultimate objective of treatment.
OVERVIEW This dissertation explores the relationship between client religiosity and readiness to change in addiction recovery. First, in this chapter, a description of the purpose of the current study will outline the overall objectives of this investigation.
The discussion of research goals will outline the advantages of the present study followed by an account of the potential ramifications of this research project. The reasoning for the selection of the criterion variable will be presented according to the importance of the research question. Next, an explanation of the research question and the hypothesis will be detailed, including a rationale for the background variables included in this investigation. Finally, a glossary of technical terms relevant to this study is provided.
Research Goals As an exploratory study, this dissertation seeks to provide new knowledge about the nature of the relationship between client religiosity and readiness to change in addiction recovery. Improved client readiness to change (motivation) is a step toward positive outcomes in addictions treatment, and ultimately, addictions recovery. Therefore, it is important to determine the relationship between religiosity and readiness to change as this relationship may serve to further inform the aforementioned causal chain. As will be detailed in Chapter 2, present research points to a strong link between readiness to change (motivation) and addiction recovery. Though, notably, is the addiction research on the relationship of religiosity and readiness to change is lacking.
Previous Research Problems Project MATCH was designed and implemented in response to previous research problems, particularly in the area of statistical power, and to provide a rigorous test of the most promising matching hypotheses (PMRG, 1997). Weak measures, limited sample size, infidelity of treatment, and client homogeneity have confounded past outcome research. There are many reasons for the research field to value Project MATCH. This study has taken great strides in methodological research quality (Drummond, 1999).
Power One common problem in addiction outcome research has been statistical power. This problem has occurred because of the cost and logistics involved in putting together clinical trials with a sufficient number of subjects. Large sample sizes are important as the probability of a correct rejection of the null hypothesis increases with sample size. Project MATCH addressed this research problem by recruiting a large enough samples size to provided sufficient statistical power to assess treatment matching effects on a wide range of variables (Drummond, 1999).
Measures In past addictions outcome research, the measures implemented have not been rigorously tested for reliability and validity. In addition, collateral information sources have been neglected as viable measures for informing validity of the studies. Project MATCH addressed these problems by using standardized, validated research instruments to measure outcome, by minimizing missing data by follow-up and by evaluating the validity of self-reports via collateral reports and blood specimens for analysis heavy drinking. These precautionary interventions reduced the potential for bias and increase the internal validity of the study (Drummond, 1999).