British Journal of Addiction (1992) 87, 929-930
SHORT REPORT
Negative and positive expectancies in lone and group problem drinkers BARRY T. JONES & JOHN McMAHON Nurse Information Processing Group, Department of Psychology, University of Glasgow, Scotland
Abstract In this experiment we show that measuring positive expectancy of alcohol use does not discriminate between lone and group problem drinkers whereas measuring negative expectancy does. Reliably, lower measures in group drinkers is consistent with; (i) our view that negative expectancy provides the motivation for problem drinkers to quit and that anything which inhibits the translation of negative experience into negative expectancy will correspondingly inhibit motivation; and with (ii) the observations of others that social (or group) support can, indeed, often inhibit recovery. Motivation in problem drinkers both during treatment and thereafter appears to be heavily implicated in recovery from alcohol abuse. Indeed, one study has shown that as much as two-thirds of the variance in treatment outcome is accounted for by motivation and only one-third by the treatment, itself.' Where it was once interpreted as a function of 'moral fibre' or an intrinsic personality trait, motivation is now better seen as a cognitive dynamic initiated, maintained or revised by experience.^ Many see the concept of expectancy as the doorway to this subjective world, since expectancy refers to a drinker's beliefs about the outcome of alcohol use and it is these expectations that motivate drinking.-' Knowing a problem drinker's positive expectancies, should ensure that treatment is more individually tailored and, consequently, it should have a more effective outcome.'' For this reason, much effort has gone into establishing ways of measuring positive expectancies.'"' However, disproportionately little attention has been paid to problem drinkers' negative expectancies of alcohol use, yet it is most likely negative experiences that have driven them to treatment in the first place. McMahon & Jones' have developed a framework of change for alcohol abuse which incorporates a statement of the preconditions necessary for a more successful outcome of treatment and how these preconditions might be generated. In contrast to the frequent focus upon positive expectan-
cies, they target the role played by negative experiences and the learning mechanisms through which these effect (or fail to effect) negative expectancies. Within the framework of their Revised Expectancy Motivation hypothesis (REMh), problem drinkers who could be loosely described as 'poorly motivated' are those whose negative experiences (through their own faulty appraisal processes) have erroneous causes attributed to them with the consequence that these negative experiences never translate into negative expectancies of alcohol. It is this process, McMahon and Jones claim, that should be the first target of treatment (e.g. through such devices as Miller's motivational interviewing) but whereas there are highly-researched instruments for measuring positive expectancies, the same could not be said,unfortunately,ofnegative expectancies. Ways of measuring negative expectancies need to be developed comparable with the instruments available for measuring positive expectancies. Also, if the REMh is an accurate account ofchange, it is important to identify factors which both promote and inhibit the formation of negative expectancy. The work reported below begins to address these goals using a 60-item, likert-scale Negative Alcohol Expectancy Questionnaire (NAEQ) that we are currently piloting in many of the alcohol treatment centres in Glasgow. If negative experiences translate to negative expectancies through learning, then any process that reduces either the perceived frequency or intensity
929
930
Barry T. Jones & John McMahon
of negative experiences will inhibit learning and, therefore, the growth of negative expectancies. There are good reasons for believing that negative expectancy will be attenuated in group rather than lone problem drinkers. Social networks or groups (family, significant others and peers), while sometimes motivating problem drinkers to enter treatment,' can equally inhibit this by 'cushioning' them from the negative experiences that drinking will bring.'"'" When the network or group consists of like-minded individuals (such as problem drinkers) then 'buffering' from the potential effects of stressful situations (negative experiences that a problem drinker will surely generate) becomes pronounced.'^ Not only does this group provide support, it also provides a norm'^'" against which a member of the group can compare his own negative experiences. By contrast, therefore, otherwise substantially negative experiences are perceived as 'normal', an intuitive defense that has not escaped the heavy drinker for as negative experiences worsen with increased consumption and begin to contrast unfavourably with the group's, new companions are sought in an effort to reduce the contrast.'"*''^ The whole process of support, contrast reduction and decline is exacerbated by the fact that individuals within such groups tend to mistakenly perceive themselves as more favourably adjusted than their peers.'^-" Consequently, drinking in groups should reduce the perception of negative experiences and inhibit their translation to negative alcohol expectancies. Within the framework of REMh, therefore, negative expectancies, as measured by the NAEQ, should discriminate between lone and group drinkers and provide a test of the discriminatory power of the pilot NAEQ. The NAEQ and Brown et al.'s (positive) Alcohol Expectancy Questionnaire* were given to two groups of patients admitted to Gartnavel Royal Hospital's Alcohol and Drug Detoxification Unit. Group L comprised 25 lone drinkers and Group G 25 group drinkers. Reliably higher negative expectancy scores were found in Group L than Group G (f = 2.5, d f = 4 8 , p = 0.016, 2-tail) whereas no reliable difference was found for positive expectancy (£ = 0.19, df = 48, p = 0.86, 2-tail). Within an approach such as that of the REMh, that addresses motivation to stop drinking rather than motivation to drink and within the confines of the current experiment, a pilot negative expectancy measure discriminates between two quite different types of problem drinker whereas a substantiallyvalidated positive measure does not. If these results can be generalized and negative expectancy has clinical utility, then it points to a need to pay more attention to: (1) the concept of negative expectancy
itself; (2) its relationship with negative experiences; and (3) researching its measurement. Acknowledgements This work was supported by a Scottish Office Home and Health Department Nursing Research Fellowship to the second author supervised by the first. References 1. PROCHASKA, J. O . & DICLEMENTE, C . C . (1985)
Common processes of self-change in smoking, weight control and psychological distress, in: SHIFTMAN, S. & WILLS, T . (Eds) Coping and Substance Abuse: a conceptual framework, pp. 345-363 (New York, Academic Press). 2. MILLER, W . R . (1983) Motivational interviewing with problem drinkers. Behavioural Psychotherapy, 11, pp. 147-172. 3. MARLATT, G . A . & GORDON, J. R. (1985) Relapse
Prevention: maintenance strategies in the treatment of addictive behaviours (New York, Guilford). 4. BROWN, S. A. (1985) Reinforcement expectancies and alcoholism treatment outcome after a one-year followup. Journal of Studies on Alcohol, 46, pp. 304-308. 5.
SotJTHWiCK,
L.,
STEELE,
C,
MARLATT,
A. &
LiNDELL, M. (1981) Alcohol-related expectancies: defined by phase of intoxication and drinking experience. Journal of Consulting and Clinical Psychology, 49, pp. 713-721. 6. BROWN, S. A., CHRISTIANSEN, B . A. & GOLDMAN,
M. S. (1987) The alcohol expectancy questionnaire: an instrument for the assessment of adolescent and adult alcohol expectancies. Journal of Studies on Alcohol, 48, pp. 483-491. 7. LEIGH, B . C . (1989) Attitudes and expectancies as predictors of drinking habits: a comparison of three scales. Journal of Studies on Alcohol, 50, pp. 432-440. 8. MCMAHON, J. & JONES, B . T . (1992) The change
process in alcoholics: client motivation and denial in the treatment of alcoholism within the context of contemporary nursing. Journal of Advanced Nursing, 17, pp. 173-186. 9. AMODEO, M . & KURTZ, N . (1990) Cognitive processes and abstinence in a treated alcoholic population. The International Journal ofAddictions,25,pp. 9S3-IOO9. 10. WEISNER, C . (1990) The alcohol treatment-seeking process from a problems perspective: responses to events, British Journal of Addiction, 85, pp. 561-569. 11. LEIPMAN, M . R . , NIRENBERG, T . D . & BEGIN, A. M.
(1989) Evaluation of a program designed to help family and significant others to motivate resistant alcoholics into recovery, American Journal of Drug and Alcohol Abuse, 15, pp. 209-221. 12.
SARASON, B . R . , PIERCE, G . R . , SHEARIN, E . N . , SARASON, I. G., WALTZ, J. A. & POPPE, L . (1991)
Perceived social support and working models of self and actual others. Journal of Personality and Social Psychology, 60, pp. 273-287. 13. FESTINGER, L . (1954) A theory of social comparison processes. Human Relations, 7, pp. 117-140. 14. CAHALAN, D . (1970) Problem Drinkers: a national survey (San Francisco, Josey-Bass). 15. ARMOR, D . J., POLICH, J. M. & STAMBtn,, H. B. (1978)
Alcoholism and Treatment (New York, Wiley). 16. HOY, R. M . (1973) The meaning of alcoholism for alcoholics: a repertory grid study, British Journal of Clinical Psychology, 12, pp. 98-99.
SHORT REPORT
Negative and positive expectancies in lone and group problem drinkers BARRY T. JONES & JOHN McMAHON Nurse Information Processing Group, Department of Psychology, University of Glasgow, Scotland
Abstract In this experiment we show that measuring positive expectancy of alcohol use does not discriminate between lone and group problem drinkers whereas measuring negative expectancy does. Reliably, lower measures in group drinkers is consistent with; (i) our view that negative expectancy provides the motivation for problem drinkers to quit and that anything which inhibits the translation of negative experience into negative expectancy will correspondingly inhibit motivation; and with (ii) the observations of others that social (or group) support can, indeed, often inhibit recovery. Motivation in problem drinkers both during treatment and thereafter appears to be heavily implicated in recovery from alcohol abuse. Indeed, one study has shown that as much as two-thirds of the variance in treatment outcome is accounted for by motivation and only one-third by the treatment, itself.' Where it was once interpreted as a function of 'moral fibre' or an intrinsic personality trait, motivation is now better seen as a cognitive dynamic initiated, maintained or revised by experience.^ Many see the concept of expectancy as the doorway to this subjective world, since expectancy refers to a drinker's beliefs about the outcome of alcohol use and it is these expectations that motivate drinking.-' Knowing a problem drinker's positive expectancies, should ensure that treatment is more individually tailored and, consequently, it should have a more effective outcome.'' For this reason, much effort has gone into establishing ways of measuring positive expectancies.'"' However, disproportionately little attention has been paid to problem drinkers' negative expectancies of alcohol use, yet it is most likely negative experiences that have driven them to treatment in the first place. McMahon & Jones' have developed a framework of change for alcohol abuse which incorporates a statement of the preconditions necessary for a more successful outcome of treatment and how these preconditions might be generated. In contrast to the frequent focus upon positive expectan-
cies, they target the role played by negative experiences and the learning mechanisms through which these effect (or fail to effect) negative expectancies. Within the framework of their Revised Expectancy Motivation hypothesis (REMh), problem drinkers who could be loosely described as 'poorly motivated' are those whose negative experiences (through their own faulty appraisal processes) have erroneous causes attributed to them with the consequence that these negative experiences never translate into negative expectancies of alcohol. It is this process, McMahon and Jones claim, that should be the first target of treatment (e.g. through such devices as Miller's motivational interviewing) but whereas there are highly-researched instruments for measuring positive expectancies, the same could not be said,unfortunately,ofnegative expectancies. Ways of measuring negative expectancies need to be developed comparable with the instruments available for measuring positive expectancies. Also, if the REMh is an accurate account ofchange, it is important to identify factors which both promote and inhibit the formation of negative expectancy. The work reported below begins to address these goals using a 60-item, likert-scale Negative Alcohol Expectancy Questionnaire (NAEQ) that we are currently piloting in many of the alcohol treatment centres in Glasgow. If negative experiences translate to negative expectancies through learning, then any process that reduces either the perceived frequency or intensity
929
930
Barry T. Jones & John McMahon
of negative experiences will inhibit learning and, therefore, the growth of negative expectancies. There are good reasons for believing that negative expectancy will be attenuated in group rather than lone problem drinkers. Social networks or groups (family, significant others and peers), while sometimes motivating problem drinkers to enter treatment,' can equally inhibit this by 'cushioning' them from the negative experiences that drinking will bring.'"'" When the network or group consists of like-minded individuals (such as problem drinkers) then 'buffering' from the potential effects of stressful situations (negative experiences that a problem drinker will surely generate) becomes pronounced.'^ Not only does this group provide support, it also provides a norm'^'" against which a member of the group can compare his own negative experiences. By contrast, therefore, otherwise substantially negative experiences are perceived as 'normal', an intuitive defense that has not escaped the heavy drinker for as negative experiences worsen with increased consumption and begin to contrast unfavourably with the group's, new companions are sought in an effort to reduce the contrast.'"*''^ The whole process of support, contrast reduction and decline is exacerbated by the fact that individuals within such groups tend to mistakenly perceive themselves as more favourably adjusted than their peers.'^-" Consequently, drinking in groups should reduce the perception of negative experiences and inhibit their translation to negative alcohol expectancies. Within the framework of REMh, therefore, negative expectancies, as measured by the NAEQ, should discriminate between lone and group drinkers and provide a test of the discriminatory power of the pilot NAEQ. The NAEQ and Brown et al.'s (positive) Alcohol Expectancy Questionnaire* were given to two groups of patients admitted to Gartnavel Royal Hospital's Alcohol and Drug Detoxification Unit. Group L comprised 25 lone drinkers and Group G 25 group drinkers. Reliably higher negative expectancy scores were found in Group L than Group G (f = 2.5, d f = 4 8 , p = 0.016, 2-tail) whereas no reliable difference was found for positive expectancy (£ = 0.19, df = 48, p = 0.86, 2-tail). Within an approach such as that of the REMh, that addresses motivation to stop drinking rather than motivation to drink and within the confines of the current experiment, a pilot negative expectancy measure discriminates between two quite different types of problem drinker whereas a substantiallyvalidated positive measure does not. If these results can be generalized and negative expectancy has clinical utility, then it points to a need to pay more attention to: (1) the concept of negative expectancy
itself; (2) its relationship with negative experiences; and (3) researching its measurement. Acknowledgements This work was supported by a Scottish Office Home and Health Department Nursing Research Fellowship to the second author supervised by the first. References 1. PROCHASKA, J. O . & DICLEMENTE, C . C . (1985)
Common processes of self-change in smoking, weight control and psychological distress, in: SHIFTMAN, S. & WILLS, T . (Eds) Coping and Substance Abuse: a conceptual framework, pp. 345-363 (New York, Academic Press). 2. MILLER, W . R . (1983) Motivational interviewing with problem drinkers. Behavioural Psychotherapy, 11, pp. 147-172. 3. MARLATT, G . A . & GORDON, J. R. (1985) Relapse
Prevention: maintenance strategies in the treatment of addictive behaviours (New York, Guilford). 4. BROWN, S. A. (1985) Reinforcement expectancies and alcoholism treatment outcome after a one-year followup. Journal of Studies on Alcohol, 46, pp. 304-308. 5.
SotJTHWiCK,
L.,
STEELE,
C,
MARLATT,
A. &
LiNDELL, M. (1981) Alcohol-related expectancies: defined by phase of intoxication and drinking experience. Journal of Consulting and Clinical Psychology, 49, pp. 713-721. 6. BROWN, S. A., CHRISTIANSEN, B . A. & GOLDMAN,
M. S. (1987) The alcohol expectancy questionnaire: an instrument for the assessment of adolescent and adult alcohol expectancies. Journal of Studies on Alcohol, 48, pp. 483-491. 7. LEIGH, B . C . (1989) Attitudes and expectancies as predictors of drinking habits: a comparison of three scales. Journal of Studies on Alcohol, 50, pp. 432-440. 8. MCMAHON, J. & JONES, B . T . (1992) The change
process in alcoholics: client motivation and denial in the treatment of alcoholism within the context of contemporary nursing. Journal of Advanced Nursing, 17, pp. 173-186. 9. AMODEO, M . & KURTZ, N . (1990) Cognitive processes and abstinence in a treated alcoholic population. The International Journal ofAddictions,25,pp. 9S3-IOO9. 10. WEISNER, C . (1990) The alcohol treatment-seeking process from a problems perspective: responses to events, British Journal of Addiction, 85, pp. 561-569. 11. LEIPMAN, M . R . , NIRENBERG, T . D . & BEGIN, A. M.
(1989) Evaluation of a program designed to help family and significant others to motivate resistant alcoholics into recovery, American Journal of Drug and Alcohol Abuse, 15, pp. 209-221. 12.
SARASON, B . R . , PIERCE, G . R . , SHEARIN, E . N . , SARASON, I. G., WALTZ, J. A. & POPPE, L . (1991)
Perceived social support and working models of self and actual others. Journal of Personality and Social Psychology, 60, pp. 273-287. 13. FESTINGER, L . (1954) A theory of social comparison processes. Human Relations, 7, pp. 117-140. 14. CAHALAN, D . (1970) Problem Drinkers: a national survey (San Francisco, Josey-Bass). 15. ARMOR, D . J., POLICH, J. M. & STAMBtn,, H. B. (1978)
Alcoholism and Treatment (New York, Wiley). 16. HOY, R. M . (1973) The meaning of alcoholism for alcoholics: a repertory grid study, British Journal of Clinical Psychology, 12, pp. 98-99.
