The effects of early negative events on self-esteem and treatment outcomes of participants in a drug abuse outcome study.

摘要

The developmental age-chronological stage discrepancy is a phenomenon noted by addictions and other mental health professionals for some time yet it is poorly explained and under-researched. According to developmental age-chronological stage discrepancy theory, an individuals cognitive development will stall or slow significantly as a result of abuse, neglect, or substance abuse. This stage-age discrepancy results in behaviors that are congruent with the developmental stage the individual was in when the events occurred but are not congruent with the expectations of a person at the individual's chronological age. The discrepancy presents as a dramatic-erratic personality disorder. A method of promoting cognitive development, deliberate psychological education (DPE) is discussed as well as the 12 Steps commonly used in addictions treatment milieus. Loevinger's cognitive-developmental theory is presented and is paralleled to the 12 Steps in an attempt to merge the accepted 12 Step practice with a sound theoretical model for improved understanding and intervention. Using archival data from the Drug Abuse Outcome Study (DATOS), a 10-year, 10,100 subject longitudinal survey of substance abuse treatment client characteristics and outcomes, responses from participants present at both intake and the 12-month follow-up (N = 2,897) were analyzed. The primary focus of this study was to examine how early negative environmental events and age of first use impacted self-esteem, what treatment modality resulted in the greatest improvement in self-esteem, and what events had the greatest impact on self-esteem. Further, treatment outcomes in terms of relapse rates for the four treatment modalities (short-term inpatient, outpatient drug-free, long-term residential, and methadone maintenance) were reviewed and compared to the previous findings. Overall, the results showed that while self-esteem did improve with treatment, it was only weakly correlated with any variable associated with early traumatic or negative events or age of onset of substance abuse. Further, it was shown that different treatment modalities will affect self-esteem differently. Self-esteem by age/ethnicity and gender were found to have a statistically significant relationship but not a functional difference.