The International Journal of Psychosocial Rehabilitation
 

A Quantitative Study on Subjects with Pathological Dependence: 
A Comparison Between Two Different Rehabilitation Models

Mannino, Giuseppe 1
Milotta Simona, Maria 2
Minuto, Ilaria 3


1 Professor at LUMSA University, info, g.mannino@lumsa.it
2 LUMSA “S. Silvia” Palermo
 3 LUMSA “S. Silvia” Palermo


Citation:

Mannino G, Milotta S & Minuto I. (2019) A Quantitive Study on Subjects with Pathlogical Dependence:
A Comparison Between Two Different Rehabilitation Models.
 International Journal of Psychosocial Rehabilitation. Vol 22 (2) 32-44

 


Abstract

The drug addiction phenomenon has recently undergone a process of transformation. Its meaning has extended to the concept of dependence, covering up some cases of unsound relationships between a subject and a system of substances going far beyond traditional narcotics (Gervasi A., La Marca L., Mannino G., Schimmenti A., 2017; Granieri A., La Marca L., Mannino G, Giunta S.,Guglielmucci F., Schimmenti A 2017).

In this perspective arises the need of helping subjects to break the bond that hold them tight to their dependencies and activate useful mechanisms to promote their autonomy and self-determination ability (Johnson B, Lee M., Pagano M., Post G., 2015; Mannino G, Montefiori V., Faraci E., Pillitteri R., Iacolino C., Pellerone M., Giunta S. 2017. Subjective Perception of Time: Research Applied on Dynamic Psychology. WORLD FUTURES, vol. 73, p. 285-302, ISSN: 1556-1844, doi: 10.1080/02604027.2017.1333850; Mannino G, Caronia V. 2017. Time, Well-Being, and Happiness: A Preliminary Explorative Study. WORLD FUTURES, p. 318-333, ISSN: 1556-1844, doi: 10.1080/02604027.2017.1333849)

A lot of scientific research developed both in national and international territory relate to this matter and prove that this phenomenon is a very topical issue, which requires surveys to carry out specific measures to meet the needs of the involved users.

PURPOSE: The main aim of this work is to compare two rehabilitation models, namely the one within the therapeutic communities, to which users can spontaneously/ or through other services access and the other one within the Ser.T., which promotes people re-integration to the society through several projects.

METHOD: This quantitative study is a cross - sectional study with the aim of to deepening the generic and psychopathological properties of two different groups (Community and Ser.T).

RESULTS AND CONCLUSIONS
: The study, carried out on a sample of 105 subjects belonging to the different groups, has underlined that there are not relevant elements that could lean us toward the choice of a particular rehabilitation method. However, from this study appears that the rehabilitation phase constitutes an essential step of the drug- addicted rehabilitation to promote their autonomy and the empowerment.

KEYWORDS: Drugs addiction, Therapy, Sert, Quantitative Research, Rehabilitation.

 


Introduction:

1.2. Goals and Hypothesis

This quantitative study is a cross - sectional study with the aim of to deepening the generic and psychopathological properties of two different groups (Community and Ser.T).

The specific objectives are:

1) Analysing and differentiating the way the two groups operate;
2) Examining whether there are substantial relations between the variables subject of the research (Rosenberg Self Esteem; Inventory of Interpersonal


Problems; Outcome Questionnaire – 45; Beck Depression Inventory – II; Attachment Style Questionnaire; Traumatic Experience Checklist; The Personality Inventory for DSM – 5).

Hypothesis:

H1: we assumed that the subjects who have undergone a rehabilitation path in communities have a lower symptomatic level than those of the Ser.T group.

H2: we assumed the existence of significant relations between analysed variables (Holtyn A. F., Morrison R., Silverman K., 2016).

 

1.3 Applied Methodology
The chose method derives from the will to investigate the rehabilitation models that allow the reintegration of drug addicts to the society and the working life (Burlingame G., Di Fratello C., Giannone F., Gullo S., Lo Coco G., Mannino G. 2015, 15;  Pellerone M., Iacolino C., Mannino G., Formica I., Zabbara S., 2016).

1.3.1 Data Sample
The sample is made up of 105 subjects (age M= 37,5; ds= 10,1) with addiction issues, that have already finished the rehabilitation path; 91 are male (F%= 86,7) and 14 are female (F%= 13,3).

Particularly, those who contributed to the research are:

-       60 users (F%= 57,1; age M= 37, 2, ds= 10,2) who carried out their rehabilitation in therapeutic communities, both in the area of  Palermo and Trapani (M= 55, f %= 91,7; F= 5, f %= 8,3).

-       45 users (F%= 49,9; age M= 37,2, ds= 10,2) who are all treating by the Ser. T. headquarters in Palermo and Trapani (M= 36, f %= 80; F=9, f %= 20).

-       During the research, 35 subjects did not want to collaborate and abstained, 26 users turn out to be dead.

1.3.2 Tools
The tools used for the present study have been selected on the basis of their relevance among the scientific literature and the high quality of their psychometric properties. We oft have the possibility to use the Italian validated version.

All the subjects have read and signed the consent, in which each subject was informed about the measures of personal data protection, according to current regulations on personal privacy (D.Lgs. 196/2003, art. 20, art.22 of Italian constitution and D. Lgs, 196/2003, art. 7, art. 8 of Italian constitution).

Furthermore, it has been structured a questionnaire ad hoc including general information about the subject such as age, sex, level of education, civil state, profession, rehabilitation program attended, kind of addiction, how long his rehabilitation path has ended and whether there were relapses.
The tools used during the research are:

Traumatic Experience Checklist (TEC; Nijenhuis, Van der Hart, Kruger 2002):
It is a self-report tool, consisting of 29 item assessing the various types of potential traumatic experiences.
The instrument is made up of a full scale and four sub-scale:

-       Emotional tec: it realtes only to the questions from 14 to 19. These questions are designed to examine the presence of emotional abuse and the affirmative reaction of the subject to those abuse;

-       Physical tec: it involves only the questions from 20 to 23. These questions analyse the presence of physical abuse to which the subject has answered positively;

-       Sex tec: it includes only the questions from 24 to 29. These questions examine the presence of sexual abuse and harassment to which the subject has answered positively;

-       Other trauma tec: it concerns only the questions from 1 to 13 to which the subject has answered affirmatively; this instrument has shown a positive internal coherence (α= .696).

 
The Personality Inventory for DSM-5 – Brief Form (PID-5-BF) – Adult: it is used to assess the dimension of personality and includes 25 item, valued on a scale at 4 points. The unrefined marks of those 25 item must be added up in order to achieve the total unrefined mark. This latter goes from 0 to 75:  if the marks are higher, the general dysfunction of personality will be larger. The features of not adaptive personality follow five domains: negative affectivity, detachment, antagonism, disinhibition, psychoticism. This tool has shown a high internal coherence (α= .816).
 
Outcome Questionnaire OQ – 45.2: the OQ – 45 (Lambert et al., 2004; tr. It. Lo Coco, Prestano, Gullo, Di Stefano, & Lambert, 2005) is a self-report instrument that provides an assessment of the general psychological health state and consists of 45 item, evaluated on Likert scale at 5 points (from 0= never to 5= mostly). The survey is made up of a full scale and three subscales reporting the presence of pathological symptoms such as anxiety, depression, symptomatic distress and problems related to interpersonal relations as well as what concerns the social role. The marks which are higher than the cut-off indicate greater difficulties in psychological functioning. An Italian adjustment shows a high internal texture and a positive competitor validity; furthermore, it seems that the cutoff of clinical significance has been increased by 2 points (cutoff: 66 points); the Cronbach alpha is .886 (high internal coherence).
 
Inventory of Interpersonal Problems IIP – 32: the IIP -32 (Horowitz, Rosenberg, Baer, 1988; Horowitz et al., 2000; tr. it. Clementel – Jones et al., 1996) is a self-report tool that allows  the examination of problems in interpersonal relations on the basis of two dimensions:

a. affiliation, it varies from hostile to friendly behaviors;
b.dominance, it varies from submissive to dominant or control behaviors;

 
The survey consists of 32 item whose answers are given on a Linkert scale at 5 points (from 0= at all to 4= extremely). It has been identified 8 different scales:

1) Dominant/ Controlling (e.g. “I try to control people excessively”);
2) Revengeful/Focused on oneself (e.g. “it’s hard for me to put someone else’s needs above mine”);
3) Detached/ Distant (e.g. “it’s hard for me to demonstrate affection to people);
4) Socially inhibited (e.g. “it’s hard for me to introduce myself to unknown people);
5) Unassertive (e.g. “it’s hard for me to be resolute when it is necessary”);
6) Excessively obliging (e.g. “it’s hard for me to say ‘no’ to people”);
7) Protective/ who sacrifice himself (e.g. “I try to make people like me excessively); 8) Intrusive/ Needy (e.g. “it’s hard for me to keep my stuff secret to other); (α=.863).

 
Beck Depression Inventory – II BDI – 2: it has been developed as index  of the occurrence and intensity of depressive symptoms according to the criteria listed in DSM – IV. This survey consists of 21 assertions groups corresponding to 21 areas of investigation. These latter indicate the nosographic clusters defined for depressive syndrome.

Depression is defined through a way of thinking marred by a general tendency to interpret the events negatively. Therefore, alterations of the tone in the mood are secondary to those that Beck defines “cognitive distortions”. Negative patterns and cognitive distortions lead to the so-called “bad triad” that includes a negative perception of oneself, of the world and the future. A useful completion to understanding the total mark is given by focusing on two sub-scales. The first one is Cognitive – Affective (includes item from 1 to 13) and collects the somatic and affective signs of depression (such as loss of interest, lack of energy, changes in  sleep and appetite, agitation, wept and so on). The second one concerns the somatic and performance symptoms (includes item from 14 to 21). This sub-scale refers to the cognitive demonstrations of depression (such as pessimism, guilt, self-criticism, self-confidence and so on). This instrument has shown a high internal coherence (α=.876).
 
Attachment Style Questionnaire ASQ: the aim of this survey is to evaluate the individual differences in adult attachment and it is made up of 40 item. After the normal inclusion of marks, the file provides marks over three dimensions that gives information about the kind of attachment for each subject (which is defined by the dimension with the highest score):
 

-       Secure attachment: subjects with this style of attachment are characterized by confidence in themselves and others;
-       Anxious attachment: this dimension and style of attachment is marked by the need of approval. It reflects the need of acceptance and confirmation by others and the worry about relations, namely the inclination of individuals at seeking others in order to fill their needs of dependency;
-       Avoidant attachment: this kind of attachment is characterized by experiences of discomfort in intimate relations and a particular tendency in putting emphasis on independence as well as living relations as an unimportant thing. In this way individuals try to protect themselves from possible wounds and vulnerability;

-       The instrument has demonstrated a high internal coherence (α=.842)


Rosenberg Self Esteem Scale RSES: (Rosenberg, 1979); this is a 10 item scale and measures the personal self-confidence level; higher marks indicate greater self-awareness. The Cronbach alpha is .482.
 
1.3.3 Process
The users involved in the survey have been contacted in the period from October 2016 to January 2017. The research has been carried out in the areas of Palermo, Bagheria, Alcamo, Castelvetrano, Mazara del Vallo and Marsala.

There were some difficulties in getting in touch with some users because they did not want to join the research probably because they finished their rehabilitation path long time ago, they began a new life and did not remember their past sufferings. Others, who were eligible to our research died prematurely probably for reasons related to the drug use. Finally, the remaining part, who initially agreed to join the research, did not show up for the scheduled meeting.

In spite of this initial problems, the meetings with the remainder subjects have been held either at Ser.T. Centers or within therapeutic communities where participants carried out their programs.

1.3.4 Data analysis
The analysis of data and the subsequent statistical treatment was carried out through the SPSS program. It is a statistical analysis software which provides the basic functionalities useful to manage the whole analytical process. Considering the aims and the assumptions of the research, preliminary and comparison analysis has been carried out through the use of descriptive statistics as the frequency, the average and the standard deviation (F, M and DS). In order to examine whether there were any differences relating to the symptomatic aspects in the two different rehabilitation models, it has been realized an analysis of the differences between averages for independent samples (test t of student).


Finally, the presence of statistically significant associations between the variables object of the research has been checked by the use of the Pearson correlation coefficient. By the contrast, the alpha index of Cronbach has been adopted for the analysis of reliability of the tools used in the study.
 
1.3.5 Results
The results of the descriptive analysis are listed below:
Table 1 Bar chart frequency distribution of the sex sample



By this chart appears that 86, 67% of the sample are men while 13, 33% are women.
 
Table 2 Bar chart frequency distribution of civil status



By this chart it appears that 39, 05% of the sample are unmarried (both men and women) 36, 10% are married, 23, 81% are divorced and the remaining are widowed.
 
Table 3 Bar chart frequency distribution of profession


This chart highlights that most of the sample (44, 76%) are unemployed people.
 
Table 4 Pie chart rehabilitation modality


This chart shows the proportion of the sample according to which rehabilitation path they were following, namely within the therapeutic communities or Ser. T. Centres. It is possible to notice that the sample belonging to therapeutic communities (57, 14%) is higher than the one in Ser. T. Centres (42.86%).
 
        Table 5 Pie chart relapsed                                                                         
                                  
         
Table 6 Pie chart medicines        

These last two charts show the frequency percentage relating to possible phases of subjects’ relapse and medicines consumption. In both charts prevails the answer ‘no’, then among the people taken into examination, most of them did not have relapse and did not take medicines.
The table below instead shows values corresponding to selected variables and sample.

 

Table 7. Descriptive statistics of variables analysed by group Community and Ser. T.

 

COMMUNITY

 (N = 60)

SERT (N = 45)

VARIABLES

 

Mean

SD

Mean

SD

 

 

 

 

 

 

1. ROS_TOT

22,1

4,5

21,7

3,4

2. IIP_TOT_raw_score

29,6

16,2

31,1

16,7

3. OQ_TOT

54,9

25,4

53,7

20,6

4. BDI_TOT

12,7

10,5

13,3

8,3

5. ASQ_safe

34,1

5,7

34,4

5,9

6. ASQ_anxiety

23,8

7,4

23,4

6,2

7. ASQ_avoidance

29,6

6,8

28,8

7

8. TEC_TOT

4,0

3,4

4,5

2,6

9. TEC_EMOTIONAL

1,0

1,2

1,2

1,2

10. TEC_PHYSICAL

0,2

0,5

0,2

0,4

11. TEC_SEX

0,2

0,6

0,2

0,5

12. TEC_OTHER_TRAUMA

2,7

2

3,0

2,1

13. PID_5_TOT

29,6

13,1

29,3

13,7

14. PID_NEGATIVE _AFFECTIVITY

6,9

3,7

6,8

3,3

15. PID_DETACHMENT

5,4

3,4

5

2,9

 

16. PID_ANTAGONISM

5,2

2,9

4,4

2,7

17. PID_DISHINIBITION

6,3

3,4

6,3

3,6

18. PID_PSYCHOTICISM

5,9

3,6

6,8

6,1

NOTE: ROS_TOT=Rosenberg Self Esteem Scale Total; IIP_TOT_raw_score= Inventory of Interpersonal Problems Total; OQ_TOT=Outcome Questionnaire Total; BDI_TOT= Beck Depression Inventory-II Total; ASQ_safe- ASQ_anxiety- ASQ_avoidance= Attachment Style Questionnaire  secure attachment- anxious attachment- avoidant attachment;TEC_TOT-TEC_EMOTIONAL- TEC_PHYSICAL- TEC_SEX.- TEC_OTHER_TRAUMA= Traumatic Experience Checklist Total- emotional- physical- sex- other trauma;PID_5_TOT- PID_NEGATIVE_AFFECTIVITY- PID_DETACHMENT- PID_ANTAGONISM-  PID_DISHINIBITION- PID_PSYCHOTICISM= The Personality Inventory for DSM-5 – Brief Form Total- negative affectivity- Detachment- Antagonism- Dishinibition- Psychoticism.

In this table are listed means (M) and standard deviations (D) of both groups compared with the tools used in this research.

By the results, neither of the two groups show problematic levels. Confidence (ROS_tot), indeed, seems to be adequate either in the group of subjects in Community (M=22, 1, DS= 4,5) and in Ser. T. group (M= 21,7, DS= 3,4).

The level of general psychological functioning seems to be under the cut-off problems in both groups (Community: M=54, 9, DS= 25, 4; Ser. T: M= 53, 7, DS= 20,6).

Neither of two groups (Community: M=12,7, DS=10,5; Ser.t: M=13,3, DS=8,3) have depressive content (BDI-II), or experienced clinically relevant trauma (TEC_tot; Community: M=4, DS=13,4; Ser.t: M=4,5, DS=2,6) or no adaptive personality traits (PID 5_tot; Community: M=29,6, DS=13,1; Ser.t: M=29,3, DS=13,7).

Table 8 shows means, standard deviations and differences between the two groups relating to the tools used. By the results above listed there are no significant differences between the groups. The level of general psychological functioning closely approximates to the level of statistical significance (t=.257, p=.053). The community group highlights highest marks in problems concerning the general psychological functioning. According to these latter information, an extension of the sample could lead to statistically significant results.

            Table 8. Descriptive statistics and differences between groups in Community (N=60) and Ser.t (N=45)

 

Community

SERT

Differences between groups

Variables

Media

DS

Media

DS

t

P

ROS_TOT

22.1

4.5

21.7

3.4

.513

.191

IIP_tot_raw_sc

29.6

16.2

31.1

16.7

-.476

.859

OQ_TOT

54.9

25.4

53.7

20.6

.257

.053

BDI_ tot (T)

12.7

10.5

13.3

8.4

-.284

.134

PID_TOT

29.6

13.1

29.3

13.7

.131

.930

PID_neg._affect.

6.8

3.7

6.8

3.2

.105

.296

PID_Detachment

5.4

3.5

4.9

2.9

.687

.179

PID_Antag.

5.2

2.9

4.4

2.7

.436

1.4

PID_Dishinib.

6.3

3.4

6.3

3.6

.000

.810

PID_Psychot.

5.9

3.6

6.8

6.1

-.997

.424









NOTE: ROS_TOT=Rosenberg Self Esteem Scale Total; IIP_TOT_raw_score= Inventory of Interpersonal Problems Total; OQ_TOT=Outcome Questionnaire Total; BDI_TOT= Beck Depression Inventory-II Total; PID_5_TOT- PID_NEGATIVE_AFFECTIVITY- PID_DETACHMENT- PID_ANTAGONISM-  PID_DISHINIBITION- PID_PSYCHOTICISM= The Personality Inventory for DSM-5 – Brief Form Total- negative affectivity- Detachment- Antagonism- Disinhibition- Psychoticism.

As for the other variables, results show that there aren’t relevant differences between groups concerning the confidence level (Ros_tot; t= .513, p= .191) as well as the stress level perceived in interpersonal relations (IIP_tot t = -.476; p = .859). However, the level of general psychological functioning closely approximates to the level of statistical significance (OQ_tot t = .257, p= .053). The community group highlights highest marks in problems concerning the general psychological functioning. The variable related to depressive symptoms doesn’t reveal significant differences between the groups (BDI_ tot (T) t = -.284; p = < .134) as well as the variables concerning dimensions of personality (PID_TOT t = .131; p = .930).

In the following tables are listed links between variables examined in Communities and Ser.T groups.

Values are marked with stars and point out significant correlations, particularly:

*(p = < .05) means that it is at 95% significance

** (p = < .01) means that it is at 99% significance

 

If the value is close to 1 the variables are positively linked, namely with the increasing of one also increases the other.

If the value is close to -1 the variables are negatively linked, namely with the increasing of one decreases the other.



The results of the analysis of the correlations for a community group, show that the general psychological functioning is linked with the stress factor related to interpersonal relations in a positive way (r = .574 p < .01). Furthermore, the high frequency of depressive symptoms is related positively to problems in interpersonal relations (r = .413 p < .01) with highest score in the general psychological functioning (r = 718 p < .01). Secure attachment and challenges in interpersonal relations, instead, have a negative correlation (r = -.287 p = > .05) concerning both secure attachment and general psychological functioning level (r = -.518 p = >.01) and secure attachment and depressive symptoms (r = -.434 p = >.01). Conversely, there is a positive correlation between the anxious attachment and challenges in interpersonal relations (r = .465 p = < .01), the anxious attachment and the general psychological functioning level (r =.447 p = <.01) and the anxious attachment and depressive symptoms (r =.343 p = <.01). Another positive correlation concerns the avoidant attachment and challenges in interpersonal relations (r = .451 p = < .01), the avoidant attachment and the general psychological functioning level (r = .431 p = <.01), as well as the avoidant attachment and depressive symptoms (r =.330 p = <.01), the avoidant attachment and the anxious attachment (r = .701 p = < .05) and at last the anxious attachment and personality dimensions (r = .701 p = <.01). The high presence of trauma in subjects of community groups matches with the increasing of challenges in interpersonal relations in a positive way (r = .503p < .01). Lastly, the variable of personality dimensions is linked to more difficulties in interpersonal relations (r = .573 p < .01), general psychological functioning level (r = .686 p < .01), depressive symptoms (r = .456 p < .01), anxious attachment (r = .518 p = < .01) and avoidant attachment (r = .472 p = < .01) in a positive way.

 Table 10 Correlations (Pearson’s ‘r’) between the variables examined in Ser. T. groups

 

NOTE: ROS_TOT=Rosenberg Self Esteem Scale Total; IIP_TOT_raw_score= Inventory of Interpersonal Problems Total; OQ_TOT= Outcome Questionnaire Total; BDI_TOT= Beck Depression Inventory-II Total; ASQ_secure- ASQ_anxiety- ASQ_avoidance= Attachment Style Questionnaire  secure attachment- anxious attachment- avaoidant attachment; TEC_TOT-TEC_EMOTIONAL- TEC_PYSICAL- TEC_SEX.- TEC_OTHER_TRAUMA= Traumatic Experience Checklist Totale- emotional- physical- sex- other trauma; PID_5_TOT- PID_NEGATIVE_AFFECTIVITY- PID_DETACHMENT- PID_ANTAGONISM-  PID_DISHINIBIZION- PID_PSYCHOTICISM= The Personality Inventory for DSM-5 – Brief Form Total- negative affectivity- Detachment- Antagonism- Disinhibition- Psychoticism.



The results of the analysis carried out in the table above (tab.10) show that the general psychological functioning matches the stress related to interpersonal relations in a positive way (r = .719 p < .01). In addition, a higher frequency of depressive symptoms is linked positively to problems concerning interpersonal relations (r = .474 p < .01) with highest score in the general psychological functioning (r = 594 p < .01). Conversely, secure attachment and the general psychological functioning level have a negative correlation (r = -.340 p = > .05), as well as the anxious attachment and confidence level (r = -.377 p = >.05). It is possible to find positive correlations between the anxious attachment and difficulties in interpersonal relations (r = .456 p = <. 01), the anxious attachment and the general psychological functioning level (r = .392 p = <01) and the anxious attachment and depressive symptoms (r = .377 p = .05). The avoidant attachment, indeed, is linked to difficulties in interpersonal relations (r = .381 p = <.01), general psychological functioning level (r =. 440 p = < .01), the increasing of depressive symptoms (r = .309 p= <.05) and the anxious attachment (r= .682 p = <.01) in a positive way. A higher presence of trauma correlates positively with the anxious attachment (r = .561 p < .01).
 
1.3.6 Findings
The aim of this study was to investigate in depth the general and psychopathological characteristics of two different groups (Community and Ser.T.). In particular, it aimed to highlight possible significant differences in the psychological functioning and to draw attention to the presence of significant relationships between the variables that were the object of the research.
The preliminary hypothesis was that the subjects that have performed a rehabilitation program in communities could have a lower symptomatic level than the subjects in Ser.T. groups.

The study, carried out on a sample of 105 subjects belonging to the different groups, has underlined that there are no relevant elements that can make us lean toward the choice of a particular rehabilitation method.

The results of this study should be considered taking into account some limitations.  The first aspect concerns the cross-sectional nature of the study. This limits what from results it could be stated at the causality level.

Comparing this study to others in scientific literature, it is possible to realize that all the researchers pay a special attention to the psychosocial and rehabilitation phase of the subject with dependency problems.

The interest is aimed at creating empowerment and autonomy in order to improve the subject’s quality of life and subsequently his social reintegration.

(Mannino G., 2013; Mannino G., Giunta S., La Fiura G., 2017; Mannino G, Schiera M., 2017; Mannino G., Giunta S., Buccafusca S., Cannizzaro G, Lo Verso G., 2015; Mannino G., Giunta S., 2015.)


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