The moderating role of substance abusers’ personal attributes in predicting relapse and partner persuasiveness

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  • Addiction Research and TheoryOctober 2006, 14(5): 493509

    The moderating role of substance abusers personalattributes in predicting relapse and partnerpersuasiveness

    CARRIE J. CROPLEY

    Department of Communication, Santa Barbara City College, Santa Barbara, CA

    (Received in final form 15 February 2006)

    AbstractIn relationships where one partner is dependent on substances, the non-dependent, orfunctional partners use a variety of strategies to stop the abuse and prevent relapse.Inconclusive research results on the effectiveness of these strategies can be partiallyexplained by the failure to consider personal characteristics of the substance abusers thatmay make them more or less receptive to their partners attempts at assisting them in theirsobriety. This work explores the substance abusers anger, over-controlled hostility, andego-strength as moderating factors influencing both the types and amounts of persuasivestrategies used by the significant other. The sample was composed of 67 married orcohabitating couples with one functional and one substance-abusing partner (as assessedby the chemical use, abuse, and dependence (CUAD) scale). Participants personalityvariables were tested using the Minnesota Multiphasic Personality Inventory (MMPI),followed by videotaped interviews where they were independently asked about theirown and their partners behavior. Contrary to predictions, as the abusers anger andego-strength increased so did their partners use of punishment and the consistency ofthe substance-abusing behavior. Finally, as the abusers ego-strength increased and over-controlled hostility decreased the partner presented more reinforcement of the substanceabuse. These findings encourage a systems approach to the treatment of substance abuse,and provide insight into appropriate and effective strategies used by the functional partnerin this system.

    Keywords: Recidivism, ego-strength, hostility, anger, inconsistent nurturing as control

    Introduction

    Past research in drug and alcohol dependence and abuse has suggested that thefamily has a significant effect on the substance abusers behavior. Researchers

    Correspondence: Carrie J. Cropley, Department of Communication, 721 Cliff Drive,Santa Barbara, CA 93109. Tel: (805) 965-0581. E-mail: cropley@sbcc.edu

    ISSN 1606-6359 print/ISSN 1476-7392 online 2006 Informa UK Ltd.DOI: 10.1080/16066350600636613

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  • conclude that the communication of the non-dependent partner may encourageor discourage the drug and alcohol use and abuse, and more optimistically, mayhave the potential to help the abuser change the patterns of use and ultimatelybecome clean (Le Poire & Cope, 1999; Le Poire, Erlandson, & Hallett, 1998;Le Poire, Hallett, & Erlandson, 2000). These findings clearly provide a rationalefor studying communication patterns in relationships that include substanceabusers. However, simply knowing which strategies are more or less effective atcurtailing substance abuse is insufficient. Specifically, it is likely that substanceabusers are self-medicating some larger psychological problem (Gawin & Kleber,1986; Khantzian, 1985). To further compound the issue, the same psychologicalvariables that caused the dependence in the first place may actually result in thesubstance abusers resistance to others strategies for curtailing the abuse.This work thus examines whether the individual level variables of anger,over-controlled hostility, and ego-strength interfere with the significant othersability to assist in reducing the substance abuse.

    Overview of INC theory

    Nurturer-controllers (commonly known as codependents) find themselves ina unique position as they attempt to maintain a relationship with their substance-abusing partner. The challenge of utilizing relational maintenance strategiesis complicated by the substance-abuse behavior, such that the functionalpartners strategies are dominated by the attempt to alter their partnersbehavioral compulsions (see Le Poire, 1992, 1995 for review). Inconsistentnurturing as control (INC) theory attempts to explain the effectiveness of thestrategies non-abusing partners utilize in attempting to control their partnerssubstance-abuse.Skinner (1971) originally examined the differential effects of consistency and

    inconsistency in reinforcement and punishment of behavior. INC theory expandson Skinnerian behaviorism by outlining certain dynamics that are unique to thecontext of relationships that include one afflicted partner. Le Poire (1995) arguesthat several paradoxical injunctions exist in relationships that include afflictedpartners (e.g., drug abusers, aggressive individuals, depressed individuals, andeating disordered individuals) and that these paradoxes ultimately impactexpressions of control by the functional family member (i.e., the partner withno problem interfering with day-to-day functioning) in the relationship. In thecontext of a relationship where one person is functional and the other afflicted,the functional person is very likely to intermittently reinforce behaviors theyactually want to extinguish. This reinforcement occurs when functional familymembers first nurture the substance-dependent individual when they arein crisis, thus ultimately reinforcing the behavioral compulsion. Then, ascaregivers become resentful, as is likely to happen (Asher, 1992; Wiseman, 1991),they may fail to nurture the afflicted individuals, thus failing to reinforce thebehavior. The lack of care giving by the functional partner not only communicatesresentment, but also is likely an attempt to punish, or extinguish the undesirable

    494 C. J. Cropley

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  • behavior of the dependent partner. However, INC theory argues thatthe intermittent nature of this punishing behavior will actually increase thebehavioral compulsion. Thus, functional family members unintentionallystrengthen the likelihood of the substance-abuse behavior through intermittentreinforcement and intermittent punishment.

    Application of INC theory to the substance abuser-significant other relationship

    Research on INC theory thus far indicates that family members of substance-abusive individuals are indeed inconsistent in their use of reinforcement andpunishment. In an investigation of drug users and their functional partners,Le Poire et al. (2000) found that partners typically cycled from reinforcing topunishing communication strategies following labeling of their partners assubstance abusive. This first study of INC theory hypothesized and found thatfunctional partners changed their strategy usage over time, such that (a) theyreinforced substance-dependent behavior more before their determination that thebehavior was problematic than after; (b) they punished substance-dependentbehavior more after they labeled the drinking/drugging behavior as beingproblematic, than before; and (c) they reverted to a mix of reinforcing andpunishing strategies, resulting in an overall pattern of inconsistent reinforcementand punishment. This cycling is central to the inconsistent nature of reinforcingor punishing communication strategies postulated by INC theory. In addition tothe findings afore-mentioned, a qualitative analysis of the strategies used byfunctional partners of substance abusers (Le Poire & Addis, 2000) also supportsthe cycling pattern. Functional partners used several macro-level strategies whichincluded both reinforcement and punishment including verbal abuse, makingrules pertaining to the addiction, punishment, getting a third party involved,threats, avoidance, ending the relationship, expressing personal feelings, with-holding something from the partner as a punishment, supporting abuseby participation, demanding the partner stop/active involvement, and confront-ing. The use of these strategies will strengthen the tendency to engage in alcoholor drug use, according to the hypotheses posited by INC theory and theconfirmatory research. Although this patterning in and of itself was not found tobe more predictive of greater relapse, patterns of reinforcement and punishmentwere linked to persuasive outcomes. Specifically, partners who were moreconsistent in punishing substance abuse and reinforcing alternative behaviors(e.g., encouraging attendance at AA meetings) had substance-abusive partnerswho relapsed less. Moreover, more successful partners also reported lessdepression than those with partners who relapsed more (Le Poire et al., 2000).This is important for two reasons. First, partners of substance-abusing individualscan help reduce their partners recidivism. Second, this assistance can alsotranslate into better mental health outcomes for the partners.The findings thus far have clearly supported the underlying principles of

    INC theory. However, the utility of the theory extends beyond describing thebehavioral patterns of the functional family member. INC theory makes specific

    Personal attributes and persuadability 495

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  • recommendations that will allow the family members of substance-abusingindividuals to engage in communication behaviors that will assist in recovery.Specifically, INC theory asserts that to make a difference in the recovery of thenon-functioning partner, the functioning partner should adopt consistent com-munication strategies in the form of consistent punishment of substance abuse.Furthermore, functional members should refrain from the behaviors thatintermittently reinforce the substance abuse between punishments. The key tosuccessfully implementing these strategies requires that the functioning partnerprovide reinforcement of alternative behaviors for the non-functioning partner(Le Poire et al., 2000). Marlatt (1985) concurs, writing social factors areinvolved both in the initial learning of the addictive habit, and in the subsequentperformance of the activity once the habit has become firmly established (p.10).It appears, however, that in viewing the relationship and the addiction holistically,there are a multitude of other variables to consider. Although the communicationpatterns of the functioning partner play a significant role in aiding recovery andpreventing relapse, the personal attributes of the substance abuser may mediatethe success of these strategies.

    Personal attributes of the substance-abusing

    partner affecting recidivism

    Anger, over-controlled hostility, and ego-strength

    A consistent finding is that between 30 (Sheehan, 1993), and over 50% ofsubstance-dependent individuals are susceptible to dual-diagnoses (e.g., Bryant,Rounsaville, Spitzer, & Williams, 1992) including antisocial personality disorder(Lehman, Myers, Thompson, & Corty, 1993). Thus, it is important to considerthe impact such personality disorders may have on communication behavior andon communication outcomes in the relationship. Specifically, it is likely that thereare personal characteristics that make it less likely that substance abusers will bepersuaded by their significant others. This work, therefore, focuses on personalcharacteristics with interpersonal ramifications. It is highly likely that substanceabusers with problematically high levels of anger and expressions of over-controlled hostility are likely to be less susceptible to their significant otherspersuasive attempts. Moreover, this anger and over-controlled hostility mayactually lessen the amount of attempts a significant other may communicate thefirst place. Further, those same individuals with greater ego-strength are also lesslikely to be persuaded by their significant others as their opinions are rated asmore important than their partners. Thus, there are several personal attributevariables that may make it less likely that an individual would be persuaded bytheir significant other to use less alcohol/substances. In addition, met withresistance from their substance-abusing partners, functional partners may noteven present their substance-abusing significant others with the same amounts ofstrategies had their partners been less hostile and angry. Thus, it is possible thatfunctional partners may present less punishment (and consequently more

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  • reinforcement) of substance abuse, and less consistency of strategies when theirpartners report more anger, over-controlled hostility, and ego-strength. Thus, it ispossible to hypothesize that:

    H1: As anger, over-controlled hostility, and ego-strength of the substance-abusing partner increase, the amounts of punishment of the substance-abusebehavior by the functional partner will decrease.H2: As anger, over-controlled hostility, and ego-strength of the substance-

    abusing partner increase, so too will the amounts of reinforcement of thesubstance-abuse behavior by the functional partner.H3: As anger, over-controlled hostility, and ego-strength of the substance-

    abusing partner increase, the amount of reinforcement of alternative behaviorby the functional partner will decrease.H4: As anger, over-controlled hostility, and ego-strength of the substance-

    abusing partner increase, the amounts of consistency in the functional partnerspunishment of the substance-abuse behavior will decrease.

    Given that the existence of anger, over-controlled hostility, and ego-strength ofthe substance-abusing partner may lessen the types of strategies used by theirfunctional partner, it is also possible that functional partners will be rated as lesspersuasively effective by their non-functional partners. This, in combination withthe fact that substance abusers with anger, hostility, and ego-strength should bemore resistant to the strategies that are presented by their functional partnerswould seem to indicate that it is even more likely that substance abusers will ratetheir functional partners as less effective the more they report anger, over-controlled hostility, and ego-strength.

    H5: The effectiveness of the functional partners persuasive strategies will bemoderated by the anger, over-controlled hostility, and ego-strength of the non-functioning partner, such that substance-abusing partners who are high in anger,over-controlled hostility, and ego-strength will report that their partners are lesspersuasively effective.

    To take this one logical step further, it is similarly unlikely that a substanceabuser with anger, over-controlled hostility, and ego-strength will be successfulin their recovery as a result of their significant others help. In addition, since theymay be attempted to self-medicate their issues wit...