Alcohol Dependence and Psychological Sense of Control: Refining the Links

Issues of psychological control feature prominently in the area of alcohol dependence (AD) and its treatment, yet the reliance on 'locus of control' (LOC) as the most common depiction of control in such research is problematic. Using a multidimensional measure to overcome such problems, this study investigates the relationship between sense of control and clinical features of AD in 50 people presenting for treatment. Severity of dependence was associated with a reduced overall sense of control. Measures of day-to-day drinking problems were significantly associated with an adverse control profile consisting of a reduced sense of control in both general and specific domains, along with reliance on negative means of gaining control. Multidimensional control inventories enable a more sophisticated functional analysis of the relationship between psychological control and features of AD, and this holds greater promise for understanding and specifying the mechanisms of action in treatments such as cognitive-behavioural therapy which explicitly employ control constructs. ********** Few psychological constructs have been so diversely applied to the study of health and illness as the construct of control (Lefcourt, 1992), and the area of alcohol dependence (AD) is no exception. Like other health fields where control constructs have been employed, there is considerable variability in the way in which these concepts have been applied in AD and conflicting empirical support for such applications. Alcohol is the most commonly used recreational drug in New Zealand (Ministry of Health, 2004), and over have of clients presenting to alcohol and drug services have AD (Adamson et al., 2006). Issues of psychological control are thought to be important in AD at a number of functional and clinical levels. First and most obviously, the diagnosis of the AD syndrome itself directly implicates issues of impaired control. In turn, the notion of 'loss of control' has been adopted extensively in self-regulation and self-efficacy models of alcohol abuse/dependence (Kahler, Epstein, & McCrady, 1995; Wills, Windle, & Cleary, 1998). Stemming from such models, control psychopathology often forms part of the wider psychological depiction of those with AD, including the characterization of such people as having 'double loss of control' (Room & Leigh, 1992) involving lost control over drinking and wider life functioning. Typically then, people with alcohol abuse/dependence have been reported as exhibiting a greater external locus of control (LOC, Rotter, 1966) than other 'normal' populations (Naditch, 1975; Nowicki & Hopper, 1974; Obitz & Swanson, 1976; Poikolainen, 1997). However this is not a uniform finding as many studies have failed to find any, or at best a partial, functional relationship between AD and LOC (Dielman, Campanelli, Shope, & Butchart, 1987; Goss & Morosko, 1970; Marchiori, Loschi, Marconi, Mioni, & Pavan, 1999). Second, issues of control are differentially embedded in the majority of AD treatment modalities and approaches. For example, as the "dominant paradigm for treating AD" (Morgenstern & Longabaugh, 2000 p.1746), one of the hypothesised mechanisms of action of cognitive-behavioural treatments (CBT) is that of mobilising self-efficacy and self-control. Though attention to control issues is commonplace in CBT, it is noteworthy that other popular treatment models imply different intentions, at least initially, with respect to psychological control. For example, motivational enhancement therapy (Miller, 1996), a widely applied treatment approach in New Zealand (ALAC, 1999), encourages clients to develop an internal LOC ("a 'can do' belief in one's ability", Yahne & Miller, 1999). By way of contrast, the disease model of Alcoholics Anonymous incorporates an explicit assumption of AD being beyond the control of the individual. Here the first goal of this treatment for the drinker is to admit powerlessness over one's situation--that is, to adopt an external LOC with respect to the AD (Sheehen & Owen, 1999). …