ASSESSING THE DIVERSITY OF PERSONAL BELIEFS ABOUT ADDICTION: DEVELOPMENT OF THE ADDICTION BELIEF INVENTORY

Abstract

Previous work in the field of substance use/misuse has suggested that client beliefs about addiction are quite diverse, and may influence the effectiveness of various treatment approaches. This paper presents an Addiction Belief Inventory (ABI) that was developed and evaluated to assess personal beliefs about addiction and substance use problems. The ABI is a 40-item instrument developed using two clinical samples: an alcohol user treatment group (N = 134) and a dual diagnosis treatment group (N = 536). Confirmatory factor analysis revealed seven stable subscales: inability to control, chronic disease, reliance on experts, responsibility for actions, responsibility for recovery, genetic basis, and coping. Multivariate analyses provided preliminary reliability and validational support. The utility of the ABI for clinical and research purposes is discussed, along with suggestions for future research and improvements to the instrument.

• Alcoholism
• Addiction
• Beliefs
• Disease model
• Confirmatory factor analysis
• Structural equation modeling

RESUMEN

Las investigaciones previas en el campo del uso y el mal uso de sustancias sugieren que las creencias del paciente en relación a la adicción son considerablemente diversas, lo que puede influir en la efectividad de los distintos acercamientos terapéuticos. Con este trabajo de investigación presentamos un inventario de creencias en torno a la adicción (“Addiction Belief Inventory” o ABI) que ha sido evaluado y desarrollado para fijar creencias personales acerca de la adicción y los posibles problemas con el uso de sustancias. El ABI es un intrumento analítico con 40 elementos que se ha desarrollado usando dos grupos clínicos: un grupo de tratamiento contra el alcoholismo (134 individuos) y un grupo de tratamiento con diagnosis dual (536 individuos). El análisis de factores confirmantes reveló siete subescalas estables: la incapacidad para controlarse, la enfermedad crónica, dependencia con respecto a los expertos, responsabilidad por las acciones, responsabilidad por la recuperación, la base genética y el enfrentamiento al problema. Los múltiples análisis variados aportaron una fiabilidad preliminar y un respaldo para la validación. Se discute la utilidad del ABI para propósitos clínicos y de investigación junto a sugerencias de investigación futuras y de mejoras del instrumento analítico.

RÉSUMÉ

De précédents travaux concernant la consommation et l’abus de produits générant une dépendance on montré que les impressions du patient quant à sa dépendance sont très diverses, et elles peuvent avoir une influence sur l’efficacité des différents traitements. Cette étude présente une “Adiction Belief Inventory” (ABI)—inventaire des impressions quant à la dépendance—outil qui a été développé et évaluée afin de mesurer les impressions individuelles quant à la dépendance et aux problèmes liés à l’abus des produits générant une dépendance. L’ABI est un outil fondé sur 40 facteurs différents qui a été développé en s’appuyant sur deux échantillons cliniques: un groupe traité pour l’abus d’alcool (n = 134) et un groupe traité pour une dépendance impliquant deux produits distincts (n = 536). L’analyse de ces facteurs a mis en lumière sept variantes stables: incapacité à se contrôler, maladie chronique, confiance accordée aux experts, responsabilité de ses actions, responsabilité de sa propre guérison, dépendance ayant une base génétique, et la tentative de faire face à la situation. Des analyses à variables multiples ont permis d’établir des données préliminaires fiables qui valident les hypothèses avancées. L’utilité de l’ABI pour un usage médical ou pour la recherche est examiné. Des suggestions pour des recherches futures et pour améliorer l’outil sont également présentées.

Notes

¹It is important to note that “addiction belief systems” refers not to beliefs about addiction as defined by professionals (i.e. DSM-IV), but rather to the set of beliefs and attitudes about addiction that any person might develop through their own experiences with alcohol and drugs or how they view “addiction,” “substance abuse” and substance dependence depicted through the media. Thus the definition of addiction used here is based on experiential and lay sources of knowledge, rather than a professional frame of reference [45]. In particular, the concept of addiction as used in the Addiction Belief Inventory is a more specific concept than the more general idea of substance misuse.

Additional information

Notes on contributors

Douglas A. Luke

Douglas Luke is Associate Professor of Community Health in Biostatistics at the Saint Louis University School of Public Health. His research interests focus on substance abuse prevention and policy, with special emphasis on teen smoking. He is currently directing a national evaluation of state-based tobacco control programs for the Centers of Disease Control & Prevention and the American Legacy Foundation. Dr. Luke also has expertise in quantitative analysis, with numerous publications on cluster analysis, survival analysis, exploratory data analysis, and geographic information systems (GIS). Dr. Luke received a Ph.D. in community and clinical psychology from the University of Illinois at Urbana-Champaign.

Kurt M. Ribisl

Kurt M. Ribisl is an Assistant Professor in the Health Behavior/Health Education department in School of Public Health at the University of North Carolina at Chapel Hill. He is also a member of the Lineberger Comprehensive Cancer Center. He received his doctorate in Community Psychology at Michigan State University and completed a postdoctoral fellowship at the Stanford Center for Research in Disease Prevention. Dr. Ribisl's research currently focuses on mass media, policy, and Internet-based tobacco control interventions. Specifically, Dr. Ribisl's research has focused on tobacco advertising in retail outlets, interventions to reduce youth access to tobacco from retail and social sources, and tobacco control policy issues on the Internet. Dr. Ribisl teaches a course at UNC entitled “The Internet and Public Health: Promises and Perils”.

Maureen A. Walton

Dr. Maureen Walton is an Assistant Research Scientist in the Substance Abuse Division of the Psychiatry Department at the University of Michigan, U.S.A. She is a community psychologist with a Masters Degree in public health promotion. Her research interests include the spectrum of treatments for alcohol and drug problems, from brief interventions to relapse prevention, with a special focus on traditionally understudied populations including women, African-Americans, and older adults. Current research investigates received and expressed violence in both Emergency Departments and substance abuse treatment settings. She is PI of the Relapse Prevention Study examining predictors of long-term substance abuse treatment outcome. She is a Co-Investigator on Project START: Stopping Alcohol-Related Trauma which is testing the effectiveness of tailored alcohol interventions for injured Emergency Department patients.

William S. Davidson

William Davidson is currently a Professor and Chair of the Ecological Psychology Graduate Program at Michigan State University in East Lansing, Michigan. He is also a Senior Scientist at the Michigan Public Health Institute and Editor of the American Journal of Community Psychology. His research efforts, extending over the past 30 years, focus on alternative treatments for offenders in the community, violence against women, and community evaluations. Dr. Davidson has published numerous articles and books, and has presented his work at conferences across the country. He holds a B.A. from Grand Valley State College and an M.A. and Ph.D. from the University of Illinois at Urbana Champaign.