Measuring Confrontation During Recovery From Addiction

Abstract

The effect of confrontation on recovery from addiction continues to be a topic of considerable debate. Although many residential treatment programs view some form of confrontation as an integral part of recovery, a number of studies have found confrontation from professional treatment staff to be counterproductive. One of the problems inherent in the current debates about confrontation is the lack of a comprehensive measure of confrontation that assesses different dimensions. This study describes the development of the “Alcohol and Drug Confrontation Subscale” (ADCS), a 72-item instrument designed to measure the quantity and frequency of confrontation that individuals receive about drug or alcohol use–related problems. Confrontation is defined as an individual being told “bad things” might happen to them if they do not make changes to address a drug or alcohol use–related problem or make changes to maintain sobriety. The instrument also measures the respondents' perceptions about their relationships with confronters (three-item alpha =. 79) and perceptions about the confrontational statements (three-item alpha =. 63). The sample included 108 individuals entering three sober living housing organizations in Northern California between 2003 and 2005. They indicated that receiving confrontational statements about alcohol or drug use–related problems was common, especially from spouses/significant others (56% of those with significant others) and family members (60%). Participants who reported receiving more confrontation reported having more positive views about their relationships with confronters and about confrontational statements than those who received less confrontation. Additional studies are necessary to establish validity, generalize results to more diverse populations, and assess confrontation at different time points during recovery.

Keywords:

• coercion
• confrontation
• denial
• recovery
• social support

Additional information

Notes on contributors

Douglas L. Polcin

Douglas L. Polcin, Ed.D., is a Research Psychologist at the Haight Ashbury Free Clinics in San Francisco. He completed his doctoral degree in Counseling Psychology from Northeastern University and postdoctoral fellowships in Public Health and Health Services Research at the University of California, Berkeley School of Public Health. His research interests include the use of coercion to enter alcohol user treatment, Motivational Enhancement Therapy, peer helping, and bridging research and community-based treatment. Doug is also a licensed Marriage and Family Therapist (MFT) and has worked in substance user and mental health programs as a therapist, supervisor, and administrator since 1979. He teaches in the Alcohol and Drug Abuse Studies Program at the University of California, Berkeley-Extension and John F. Kennedy University in Pleasant Hill, California.

Gantt P. Galloway

Gantt P. Galloway, Pharm.D., is a Research Scientist at the Haight Ashbury Free Clinics and California Pacific Medical Center, Addiction Research Unit, San Francisco, California. He is also Director of Research at New Leaf Treatment Center. His principal area of interest is developing improved pharmacologic and behavioral treatments of drug and alcohol dependencies. His other interests include HIV and other infections associated with drug use, psychiatric comorbidity, gamma-hydroxybutyrate, psychedelics, methamphetamine, and MDMA.

Thomas K. Greenfieldb

Thomas K. Greenfield, Ph.D., is Director of the Alcohol Research Group and its National Alcohol Research Center, in Berkeley, California. He trained and is licensed as a clinical psychologist (Ph.D., University of Michigan) and has an adjunct position in the Department of Psychiatry, University of California San Francisco. His research interests and grants are in the epidemiology of alcohol problems, self-report measurement, alcohol and mental health services research, and alcohol policy development and analysis. An Assistant Editor of Addiction and secretary of the Kettil Bruun Society, he earlier served on the boards of the Medical Research Institute and the International Council on Alcohol and Addiction.