The Applied Psychology of Addictive Orientations:
studies in a 12-step treatment context.
Samantha Angelina Haylett B.Sc. (Hons)
Institute of Social and Applied Psychology
University of Kent at Canterbury
Thesis submitted in partial fulfilment of the requirement of the degree of Doctor of Philosophy in the Faculty of Social Science. University of Kent at Canterbury. February 2001
Abstract
The clinical data for the studies was collected at The PROMIS Recovery Centre, a Minnesota Model treatment centre for addictions, which encourages the membership and use of the 12 step Anonymous Fellowships, and is abstinence based. The area of addiction is contextualised in a review chapter which focuses on research relating to the phenomenon of cross addiction. A study examining the concept of “addictive orientations” in male and female addicts is described, which develops a study conducted by Stephenson, Maggi, Lefever, & Morojele (1995). This present study found a four factor solution which appeared to be subdivisions of the previously found Hedonism and Nurturance factors. Self orientated nurturance (both food dimensions, shopping and caffeine), Other orientated nurturance (both compulsive helping dimensions and work), Sensation seeking hedonism (Drugs, prescription drugs, nicotine and marginally alcohol),and Power related hedonism (Both relationship dimensions, sex and gambling. This concept of “addictive orientations” is further explored in a non-clinical population, where again a four factor solution was found, very similar to that in the clinical population. This was thought to indicate that in terms of addictive orientation a pattern already exists in this non-clinical population, and that consideration should be given to why this is the case. These orientations are examined in terms of gender differences. It is suggested that the differences between genders reflect power-related role relationships between the sexes. In order to further elaborate the significance and meaning behind these orientations the next two chapters look at the contribution of personality variables and how addictive orientations relate to psychiatric symptomatology. Personality variables were differentially, and to a considerable extent predictably involved with the four factors for both males and females. Conscientiousness was positively associated with “Other orientated Nurturance” and negatively associated with “Sensation seeking hedonism” (particularly for men). Neuroticism had a particularly strong association with the “Self orientated Nurturance” factor in the female population. More than twice the symptomatology variance was explained by the factor scores for females than it was for males. The most important factorial predictors for psychiatric symptomatology were the “Power related hedonism” factor for males, and “Self oriented nurturance” for females. The results are discussed from theoretical and treatment perspectives
In loving memory of my Grandparents
Harry and Winifred Reynolds
Memorandum
The research for this thesis was conducted whilst the author was a postgraduate research student on a studentship from The PROMIS Recovery Centre (October 1996 – February 2001), at the University of Kent at Canterbury.
All work in this thesis is the independent work of the author. Intellectual acknowledgements are made in the text.
The author has not been awarded a degree by this or any other University for the work included in this thesis.
Acknowledgements
The author would very much like to express her profound gratitude to Professor Geoffrey Stephenson for his inspiration and encouragement throughout.
Further thanks must also be warmly extended to PROMIS and to Dr Robert Lefever in particular whose belief and dedication in research have enabled this work to be completed.
To all the patients, whose help has been invaluable, my sincere appreciation.
Part one Background to the research
1 The origins of 12 step methodology, Anonymous Fellowships and the Minnesota method
1.1. Historical background of Twelve step methodology
1.2. The Minnesota Model and AA
1.3. Some assumptions of MM and the Fellowships
1.3.ii. The religious nature of the Steps and Spirituality
1.4. Usefulness of fellowships
1.5. The spread of the philosophy to embrace other addictive behaviours
1.6. Research investigating the effectiveness of Twelve-steps
1.7. Positive impact of the fellowships
2 Philosophy and organisation of the PROMIS recovery Centre
2.2. Treatment method (Twelve Step Facilitation, linked with Anonymous Fellowships)
3 Addiction, behavioural inclusion and co-variation in addictive behaviours
3.2 The development of the concept of addiction
3.2.i. Historical and moral approaches
3.3. DSM IV (Diagnostic and Statistical Manual of Mental Disorders, 1994)
3.4 Other behaviours being considered
3.5. Criteria for further behavioural inclusion
3.6. Addiction and its association with crime
3.8. Mechanisms relevant to the explanation of cross addiction
3.9 Different levels of analysis that may help unify diverse addictive modalities
3.10. Studies that have attempted to look at a wider cross section of addictive areas
4 The validity of the Shorter PROMIS Questionnaire
4.2. The Development of the PROMIS Questionnaire
4.3. Results from Stephenson et al’s (1995) Factor analytic study
4.4. Problems with Stephenson et al’s (1995) study; the need for replication
4.5. The Shorter PROMIS Questionnaire
4.6. The dimensions of the SPQ
4.6.ii. Process related addictions (Relationships and Compulsive helping)
4.6.iii. Food related addictions
4.6.iv. Behavioural addictions
Part two The exploration of addictive orientation
5 The Shorter PROMIS questionnaire in an addicted clinical population
5.3.i. Principal Component Analysis (PCA)
6 The Shorter PROMIS questionnaire in a non treatment population
6.4.i. Principal components analysis
6.4.ii. 4 Factor Model for the Non-addict sample
6.4.iii. Cluster Analysis for Non treatment group
7 Investigation of gender differences in addictive orientation
7.3.i. Factor analysis in the Treatment population. Gender differences
7.3.ii Factor analysis in the Non-treatment population: Gender differences
7.3.iii. MANOVA. Combined Analysis
Part three The contribution of personality and psychiatric symptomatology to addiction
8 The contribution of personality to addiction
8.2. Why still pursue the possible involvement of personality
.3.i. Model of personality and addiction
8.3.ii. Physiological model of personality in relation to addiction
8.3.iii. Self-medication model: Relating personality and addiction
8.4. Biochemical, behavioural demands
8.5. Anti-social personality disorder
8.6. Possible structure of personality variables which may link with addiction
8.7. Personality in relation to addictive behaviour in non-addicts
8.9 Summary and conclusions of the review
9 The involvement of personality characteristics with addictive orientation
10 A comparison of psychiatric symptomatolgy in addicts over the course of treatment
10.4.i. Level of symptom reporting in males and females
10.4.ii. Reduction of BSI scores after 6 weeks of treatment
10.4.iii. Regression analyses of BSI scores on Factor scores on entry
10.4.iv. Regression analyses of BSI scores on Factor scores after 6 weeks of treatment
Part four Summary, discussion and implications
11 Summary, discussion and implications
11.1 Main purpose of the research
11.2 Part one: Background of the research
11.3 Part two: The exploration of addictive orientation
11.4 Part three: The contribution of personality and psychiatric symptomatology
11.5 Further implications and future research
Preface
During the period of the studentship at PROMIS, I continued the routine collection of questionnaire and personality data used in the empirical studies reported in this thesis.
The general approach to the thesis was, in part, determined by the nature of the clinical context within which the work was to be conducted. One primary aspect of the clinical context was the interpretation of what was to be considered as addictive behaviour at the treatment centre where the work was conducted. So, an initial starting point was the exploration of literature which was relevant to the clinical setting of the PROMIS Recovery Centre, and its philosophy of treatment, and the contextualisation and exploration of these parameters within formal psychological theory.
A further determinant, which was to serve as a starting point, was a piece of work conducted by Stephenson, Maggi, Lefever, & Morojele, (1995) that had suggested a two factor solution of the behaviours considered by PROMIS as addictive. These results needed to be replicated and verified, and so the first study constitutes this replication and formed the foundational work from which further studies of the thesis emanate.
In addition to the work contained in the thesis two further studies to which I contributed were conducted whilst at PROMIS. The validation of the Shorter PROMIS Questionnaire appears in appendix 1 and is discussed in chapter four of the thesis. This paper has now been accepted for publication in Addictive Behaviours. The second study of a quasi experimental treatment intervention appears in appendix 6 as published in The Journal of Constructivist Psychology.