The Alcohol and Drug Confrontation Scale (ADCS) is a new 72-item instrument that measures a construct of confrontation specified as warnings to an individual about potential harm if she/he does not make changes to establish or maintain sobriety. Unlike most examinations of confrontation in addiction treatment, the ADCS assesses confrontation from sources beyond treatment staff, such as recovering peers, family, friends, and professionals in ancillary roles (e.g., criminal justice and social welfare staff). Published psychometric analyses of the ADCS on a sample of 177 individuals in sober living houses (SLHs) has identified two meaningful factors, shown good internal consistency of factor-based scales, and provided initial evidence of construct validity. ADCS findings to date indicate: 1) scale items were frequently endorsed, 2) participants often experienced confrontation as accurate and helpful, and 3) those being confronted frequently had positive views about their confronters. The proposed study builds on these initial promising findings and uses the full dataset of 300 SLH residents over the four data-collection time points: baseline, 6 months, 12 months, and 18 months. In addition, we will greatly expand psychometric analysis by using quantitative methods to confirm preliminary dimensional analyses over different time points, establish test-retest reliability, add to construct validity, and quantify predictive validity. Confirmatory factor analysis will verify the two factor-based scales of the ADCS: External Intensity (perceived intensity of confrontation) and Internal Support (experienced supportiveness of the confrontation). These scales will then be correlated with standardized measures of problem severity, social support, and motivation, to establish construct and predictive validity. Variation in the trajectories of these two variables over the four time points will be assessed. A qualitative study component will undertake new in-depth interviews on a targeted sample of 40 participants to help verify construct validity, add interpretability to the quantitative results, and help explain why participants' experiences of confrontation vary over time. The ADCS addresses a critically important issue in recovery from addiction because confrontation continues to be a hotly debated topic in the absence of an established method for measuring it. Current studies of confrontation lack a conceptually developed measure with established psychometric properties and an assessment of confrontation from sources beyond treatment staff. The ADCQ design addresses each of these shortcomings. Findings will help refine and further develop a research instrument to investigate when and what type of confrontations have positive versus counterproductive effects. Research will also inform treatment providers and help them maximize confrontation associated with positive outcome and minimize counterproductive confrontation. The application responds to NIDA's call for Exploratory Studies (R21) in addiction recovery. This study builds on previous Alcohol Research Group studies that describe the role of institutional and interpersonal pressure in alcohol treatment entry (e.g. Robin Room, Connie Weisner, Tom Greenfield). The research goes beyond our current studies in two ways. First, it introduces a new, multidimensional way to measure confrontation that individuals receive about their alcohol and drug use. Second, it assesses confrontation longitudinally rather than at baseline only. This will allow a description of the impact of confrontation during and after treatment in addition to treatment entry. Consistent with our previous studies, confrontation is assessed from multiple sources, including personal relationships (e.g., family and friends), treatment relationships (client peers and staff), and outside institutions (e.g., criminal justice and mental health). Findings will help clarify the types of confrontations that facilitate recovery from addiction and those that are counterproductive. ? ? ?
| Polcin, Douglas L; Mulia, Nina; Jones, Laura (2012) Substance users' perspectives on helpful and unhelpful confrontation: implications for recovery. J Psychoactive Drugs 44:144-52 |
| Polcin, Douglas L; Galloway, Gantt P; Bond, Jason et al. (2010) How do residents of recovery houses experience confrontation between entry and 12-month follow-up? J Psychoactive Drugs 42:49-62 |
| Polcin, Douglas L; Galloway, Gantt P; Bond, Jason et al. (2009) Confirmatory Factor Analysis and Test-Retest Reliability of the Alcohol and Drug Confrontation Scale (ADCS). J Drug Issues 39:931-948 |
| Polcin, Douglas L (2009) Who Receives Confrontation in Recovery Houses and when is it Experienced as Supportive? Addict Res Theory 17:504-517 |
| Polcin, Douglas L; Galloway, Gantt P; Bostrom, Alan et al. (2007) Factor analysis of the Alcohol and Drug Confrontation Scale (ADCS). Addict Behav 32:2274-80 |
