Research Proposal:

Social Comparisons in Substance Abuse Recovery

James W. Threadgill

SOC6306 Spring 2012

A. G. Dworkin, Ph.D.
Introduction

November 9, 2011 in Nuevo Laredo, Mexico narcotics traffickers killed and

beheaded blogger known as Rascatripas. In Juarez Mexico, “widely believed

to be the most dangerous city on earth” as many as two dozen killings in

single day due to drug violence and gun trafficking is not uncommon (Putzel

2011).

The United Kingdom and Europe are experiencing an explosion in the

popularity of cocaine. In London cocaine is more popular than

methamphetamine, ecstasy, and heroin combined. South American

producers ship their product to Europe via West Africa where the drugs are

warehoused in Nigeria before being smuggled into southern Italy, where a

fierce turf war rages between traditional Italian mafia and newly formed

Nigerian gangs, turning a tourist destination into a slum and battlefield

(Putzel 2009).

Massachusetts has experienced a steep increase in youth addicted to

pharmaceutical pain killers containing oxycodone, a synthetic opiate. The

pills come from Florida “pill mills” in staggering numbers, on a drug pipeline

known as the “OxyContin Express.” Prescription drug overdose has exceeded

even automobile accidents as the leading cause of accidental death. The

Massachusetts Department of Health now issues Narcan—usually only

available in hospital emergency rooms—to prevent accidental deaths (Zeller

2011).

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As the above depictions of the drug war around the show interdiction is a

failed policy. In addition to failing in its mission, interdiction has caused

massive harm due to unintended consequences (Cole 2011). It has been

reported that as many as one million citizens a year are incarcerated as a

consequence of interdiction policies (Grinspoon et al 1994). Yet no progress

has been made in eradicating drug abuse and addition to illegal drugs.

Further a host of legal drugs destroy the lives of more than all illegal drugs

combined. Across the world and in the United Nations there is a growing call

to move away from interdiction and towards harm reduction strategies. But

effective substance abuse treatment needs to be the centerpiece of any

harm abuse strategy. Unfortunately, treatment efforts have been no more

successful than interdiction.

Statement of the Problem

Substance abuse results in shattered lives, lowered productivity, and an

increasingly overburdened courts and criminal justice system. Further,

alcoholism and drug abuse are accompanied by a host of well-known

secondary problems that include: poor health and extra burdens on the

health care system; various types of criminal behavior that are either a

direct result of a drug's effects (e.g. drunk driving, alcohol-related violence)

or occur as a secondary effect (e.g. According to the NIDA, one in four

accidental deaths can be attributed to drug abuse (2012). Therefore there is

clear need for new knowledge about substance abusers—especially those

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who succeed in recovery—for the development of more effective treatment

strategies.

Purpose of the Study

Though evidence indicates many substance abusers fail to benefit from

treatment, some of them are successful. The characteristics of these

individuals are especially interesting. How is it that they recover and

maintain their recovery to lead normal productive lives, while so many

others fail? What methods and mechanisms do they use to achieve and

maintain recovery? What makes them different?

The 1997 National Treatment Improvement Evaluation Study (NTIES) sought

to discover if patient characteristics or treatment units had effects on

treatment outcomes. Despite advanced research methods and statistical

analysis, the study failed to significantly correlate patient characteristics

such as age, gender, legal pressures, and problem severity to outcome. The

factors included in the study accounted for only 5% of psychiatric treatment

outcome variation and 19% of medical treatment outcome variation.

Characteristics of the treatment units explained even less treatment

outcome variation (National Clearinghouse for Alcohol and Drug

Information). Despite years of study, little is known about why some

individuals recover from substance abuse disorder while others do not. But

that is when easily quantifiable external characteristics are used as the basis

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for study. What of not so easy to quantify characteristics? What impact do

social and psychological characteristics have upon outcomes?

The purpose of this study is to investigate the social and psychological

characteristics of recovering—and not recovering—substance abusers to

ascertain if they differ from the general population and from one another

along these dimensions. It further purposes to gather information about how

these dimensions change with length of recovery. If differences exist,

understanding the characteristics and tendencies particular to recovering

and not recovering substance abusers may be useful in therapeutic settings.

Perhaps, strategies used by those in successful recoveries can be identified,

understood, and taught to those who are struggling with recovery.

LITERATURE REVIEW

Self-esteem has been identified as a major factor in substance abuse from

its causes to the probability of recovery. The literature has identified low

self-esteem as one of the most important psychological issues facing

substance abusers (Babcock & Conner, 1981; Beckman, 1975; Beckman

1978; Sandmair, 1980; Wilsnack, 1984). Schlesinger, Susman, and

Koenisberg (1991), using the CooperSmith Self- Esteem Inventory (SEI),

found women and men alcoholics both suffer from low self-esteem. Using

the Crumbaugh-Mahalick Purpose in Life Test (PIL), they found women

alcoholics further suffered from a feeling that life has no meaning or purpose

(1991). Men also had lower PIL scores indicating that they may also suffer

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from reduced feelings of purpose in life in comparison to nonalcoholic men

(Schlesinger, Susman, & Koenisberg). Beckman (1975) investigated self-

esteem in women alcoholics. She hypothesizes that raising self-esteem may

be necessary to recovery from alcoholism and points out that anxiety,

depression, and clinical distress have negative effects on self-concept. The

initial questionnaire used in Beckman's study measured correlations with

other personality variables. She found that increased levels of isolation,

alienation, anxiety, neuroticism, and depression among men and women

alcoholics had negative effects on self-esteem. In her findings, Clarke

(1974), like Beckman, notes that finding effective ways of raising alcoholics'

self-esteem is critical to developing effective treatment strategies. In her

comparison study of self- esteem in men and women alcoholics, Clarke

(1974) used the Q-Sort method to measure self-esteem. She found no

significant differences in the self-esteem of men and women alcoholics. So,

regardless of gender, findings indicate that alcoholics suffer from low self-

esteem and lack of purpose in life. The same holds true for those suffering

from other forms of drug abuse and addiction.

Increasing self-esteem, then, is of vital interest to substance abusers

seeking to maintain successful recovery and to the counselors who treat

them. Yet the hurdle remains: How do we raise self-esteem? The process of

social comparison—what Wood (1996) defines as "process of thinking about

information about one or more other people in relation to the self”— may

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hold an answer (pp. 520-21). Through the process of social comparison, one

may implement methods and employ strategies of comparing to improve

self-esteem in the absence of any real improvements in one's abilities.

Social Comparison Theory

Festinger's (1954) paper "A Theory of Social Comparison Processes," though

not a new idea, provided the first fully developed theory of how and why we

compare ourselves to one another and the effects such comparisons have

upon us. Festinger hypothesized humans have a need to compare

themselves to others: "There exists, in the human organism, a drive to

evaluate his opinions and his abilities" (p. 117). He argues humans engage

in comparison activities on a daily basis—that the ability to assess one's

abilities and opinions in relation to others is critical. In many cases,

"incorrect opinions and/or inaccurate appraisals of one's abilities can be

punishing or even fatal" (p. 117). In fact, he argues it is one of the

formative forces acting upon our culture and our mode of living: Social

influence processes and some kinds of competitive behavior are both

manifestations of the same socio-psychological process and can be viewed

identically on a conceptual level. Both stem directly from the drive for self-

evaluation and the necessity for such evaluation being based on comparison

with other persons. (p. 138). This drive to evaluate ourselves extends to our

cognitive and social abilities, our physical abilities—even, says Festinger—to

our opinions. According to Festinger, in many if not most situations salient to

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everyday living—especially those involving interactions with others—there is

no objective way of measuring ability, so people rely on comparisons. In his

second hypothesis, Festinger argues the more absent objective, non-social

means are, the more people rely on comparisons with the opinions and

abilities of others. For without objective or subjective means for comparison,

assessments of abilities and opinions are unstable, and without physical or

social comparison, subjective evaluations must also be unstable. If this is so,

subjective evaluations achieve stability only when comparison to similar

others is possible. Further when similar others are not available or somewhat

dissimilar others are "tendencies to change one's evaluation of the opinion or

ability in question" manifests (Festinger, 1954, p. 122). The need, then, to

compare the self with others has many ramifications. It is part and parcel of

our daily lives, affecting our private and social lives, our opinions perhaps

even our self-image. Comparison with others informs our thinking about

ourselves.

Yet the implications of social comparison go even further. It impacts upon

whom we choose for affiliates. According to Festinger, social comparisons

are not random: We actively arrange our lives to provide us with suitable

comparison targets. Each comparison is related to a salient dimension and

comparison targets are chosen as much—perhaps more—for their similarity

on the given dimension as for their divergence. Festinger's third hypothesis

proposes that people compare less frequently as the difference between

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them and the comparison target increases. In fact we are less attracted to

affiliations and situations where we will come into contact with those who

are different from us than to situations where we will have an opportunity to

measure our abilities and opinions against the abilities and opinions of

similar others (Festinger, 1954). So, we associate ourselves with others of

similar abilities and opinions, join groups with similar interests and goals not

only to validate our own opinions and abilities but to accurately assess them

as well, for if someone is too different from us on the comparison dimension

of interest, they provide no common basis by which we can measure

ourselves. And how we measure ourselves against others ultimately affects—

perhaps dictates—how we feel about ourselves.

Since Festinger's groundbreaking paper establishing theoretical parameters,

much research has been done in the field of social comparison. Although,

this has led to a better understanding of the social comparison process, the

view has shifted only slightly; the main perspective of social comparison

research still follows Festinger. In today's outlook, researchers such as

Goethals, Messick and Allison (1991), believe comparison realities may be

subjective rather than objective; we may imagine a comparison reality that

fits our comparison purposes. Some people, according to Orive (1988), Suls

(1986), and Suls and Wan (1987) (c.f. Wood), may even invent comparison

others by distorting information. In her analysis of the literature, Wood

(1996) states the consensus definition as: (a) social comparisons may

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involve construction processes, (b) that processes that contain these

features constitute social comparisons regardless of their impact on the

individual, (c) that social comparisons may be encountered rather than

selected, (d) that they may be automatic and unconscious, and (e) that

phenomena that do not involve thinking about social information do not

constitute social comparisons. (p. 525).

Regardless of how social comparisons are perceived to occur—whether

based in objective or subjective realities, the effects are of primary interest,

particularly effects associated with comparison direction. Comparison

direction is inherently connected to the comparison's effects, the comparer's

purpose, and impacts upon the comparer's affect. Social comparisons can be

lateral for self-assessment, upward for self- improvement, or downward for

self-enhancement.

Upward Social Comparison (UC)

Festinger posits the majority of social comparison activity is slightly upward,

i.e., people compare themselves with others who are slightly better than

they at a given ability. He attributes the tendency to compare upward to the

natural and cultural tendency towards competition and self-improvement.

Festinger argues that when abilities are involved, people seek to reduce

discrepancies, and this interacts with a "unidirectional drive upward" (p.

124). Once an individual becomes slightly better at a given ability, the desire

to reduce discrepancies stops interacting with the "unidirectional drive."

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Because everyone cannot be slightly better, individuals are always striving to

become better and the interaction with the "unidirectional drive" is always

present. Competitive behavior and even some types of cooperative behavior

result from these forces (Festinger, 1954).

Other reasons for upward comparison exist. People may engage in upward

comparison because information gained from upward comparisons are more

useful to them (Gibbons & Gerrard, 1989). According to Radloff (1966),

comparison with persons whose abilities are somewhat better than one's

own appears to result from desire to evaluate the self. He believes this

increases the value of self-appraisals. Thornton and Arrowood (1966) posit

upward comparison furnishes a positive model for the ability being assessed.

Collins (1996) feels people make upward comparisons to feel superior and

that we may construe upward comparisons to our benefit. She argues that

by focusing on similarities with a superior comparison target, one may

vicariously associate the other's higher level of achievement with oneself and

thereby increase self-esteem. Taylor and Lobel (1989) believe comparison

with better off others is important in motivating and producing higher

achievement.

Gibbons and Gerrard (1989) found exposure to superior others may lead to

enhanced affect in those with high or normal self-esteem but not for those

low in self-esteem. Reis, Gerrard and Gibbons found similar results in a

second study in 1993. In this case, though, the subjects with low self-

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esteem experienced enhanced affect from exposure to better off others but

not as much as the high self-esteem subjects. Buunk et al found nurses with

low neuroticism experienced positive affect after exposure to better off

others and identified more with upward comparison versus downward

comparison targets. However as neuroticism increased, nurses experienced

less positive affect after exposure to better off others, identified less with the

upward comparison targets, and identified more with the downward targets,

suggesting neurotic individuals exhibit different responses to upward versus

downward comparisons (Buunk et al). In Wheeler's 1966 study—were he

was first to use the rank order paradigm—87% of subjects preferred to

compare upward. Regardless of the emotional and cognitive reasons

proposed, Collins' (1996) meta-analysis found the majority of studies

indicate that the preference of most people is to compare slightly upward. As

Collins points out, however, if one compares upward too often, negative self-

concept should result.

Downward Social Comparison (DC)

While original social comparison theory holds that most people make upward

comparisons as part of the "unidirectional drive upward," vulnerable or

threatened individuals may display a tendency to make downward social

comparisons in order to protect or boost self-esteem (Wills, 1981). Under

certain conditions, unfavorable upward comparison may cause jealousy,

hostility, frustration, and lowered self-evaluations. In these circumstances

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downward comparison may enhance self-esteem (Aspinwall & Taylor 1993).

Major, Testa, and Bylsma (1991) held that downward social comparisons are

self-enhancing—particularly when the comparison relates to self-esteem (c.f.

Wheeler & Miyake, 1992).

Wood points out research finding an individual's social environment is

related to self-evaluation (1989). Marsh and Parker examined the

relationship between school children's average ability and self-esteem. They

found that children who are surrounded by others of higher ability tend to

have lower self-esteem than children who are surrounded by others of lower

ability (1984). Wills reviewed evidence indicating that when individuals feel

threatened or experience misfortune, they tend to compare themselves with

others who are inferior or less advantaged (1981). Wheeler and Miyake

supported their hypothesis that affect and self-concept may be improved by

downward social comparison and their hypothesis that comparison direction

and self-esteem are related (1992). Studies of naturalistic threat have found

that subjects facing an imminent stressor make more downward

comparisons (Wood, Taylor, & Lictman 1985).

Further studies have found the preference for making downward

comparisons decreases as threat decreases (Gibbons & Gerrard, 1991).

Aspinwall and Taylor (1993) found low self-esteem subjects had

improvements in mood after downward comparisons. They further found

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that only low self-esteem subjects reported positive mood increases after

downward comparison.

The literature, then, supports Will's argument vulnerable or threatened

individuals make downward social comparisons to protect or boost self-

esteem (1981). The basic principle of downward comparison is, says Wills:

people "increase their subjective wellbeing through comparison with a less

fortunate other" (p. 245). Wills also states some factors involved in

downward comparison. Downward comparison may be likely to occur in

response to decreases in subjective wellbeing, may be passive or active, and

is more likely in those who have low self-esteem. Wheeler and Miyake

supported their hypothesis that downward social comparison enhances

subjective wellbeing and self-esteem is related to the direction of

comparison (1992). Wills cites several studies demonstrating a fear

affiliation effect, I. e., individuals facing a threat prefer to compare with

other threatened individuals and choose these persons for affiliation.

Amoroso and Walters have shown fear affiliation reduced anxiety and

arousal (1969). Major, Testa, and Bylsma also demonstrated that downward

social comparisons are self-enhancing—particularly when the comparison is

esteem-relevant (1991). Gibbons and McCoy found that low self-esteem

subjects experienced increased positive mood from passive downward

comparisons while high self-esteem subjects showed no evidence of changed

affect (1991).

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Substance abusers—recovering and not recovering—certainly comprise a

group of threatened or vulnerable individuals and the literature has

established they suffer esteem related problems. Thus it is likely these

individuals follow the established tendencies and make downward social

comparisons for self-enhancement purposes. Many characteristics displayed

by these individuals appear to point this out. The helping response, for

instance, may in part be related to the recovering substance abusers' needs

to place themselves in social contexts that make downward social

comparisons available. Recovering substance abusers also demonstrate a

tendency to maintain continual involvement in support groups such as

Alcoholics and Narcotics Anonymous—even after many years of successful

recovery. This phenomenon, too, may be related to the need to place

oneself in a social context that creates opportunities for downward social

comparisons and self-enhancement.

Operational Definitions

In current substance abuse and treatment theory, two models of recovery

are prevalent. The medical model of addiction holds that addiction is a life-

long, progressive condition and that abstinence is the only method of

recovery. Proponents of the second model—controlled use—argue that

abstinence is not necessary to recovery and may actually impede it. Rather

than a life-long, progressive disease, substance abuse, they argue, is

learned behavior and as such is subject to correction via behavior

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modification techniques. In this view, use can be controlled and abuse

patterns eliminated. Regardless, recovering substance abusers were defined

in one ways: individuals who have not met the DSM criteria for one year.

This allows for respondents in generally successful recoveries who may have

experienced a brief relapse—which are quite common—provided the relapse

did not result in meeting the DSM criteria.

Hypotheses

1. Recovering substance abusers make more downward social

comparisons than non-recovering substance abusers and those with no

history of abuse.

2. Non-recovering substance abusers make more upward

comparisons than recovering substance abusers and those with no

history of abuse.

3. Recovering and non-recovering substance abusers make more

frequent comparisons than other groups.

4. Comparison orientation and direction change in relation to recovery

state and length of time in recovery.

METHOD

Sampling

For the primary sample, the researcher will compile a list of Houston area

substance abuse. These groups in general publish member listings with

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email addresses. The researcher will visit randomly selected groups during

an open meeting, introduce himself and his work to the meeting chair, speak

to the group during announcements, obtain a club member list, solicit email

addresses from the group, and post information about the study on the club

bulletin board providing information on how to be included. In order to have

a large enough pool of samples to create up to twenty-four matched groups

for one-way ANOVA procedures. Using power analysis a priori method, given

α, power, and effect size an N of 635 is needed (See Appendix iv). This

calculation includes fifteen percent oversampling to allow for data trimming

to create well matched groups.

According to Sheehan, response rates as high as 62% are possible with a

pre-notification and follow up contact method (2001). Fincham reports rates

in excess of 70% using a pre-notification and follow up scenario (2008).

With a conservatively estimated 35% response rate and 5% failure rate, a N

of 1655 email addresses should provide a large enough sample. This

includes substantial oversampling as the researcher recognizes the non-

recovering group is harder to reach. Local treatment groups will be randomly

drawn without replacement until the desired N is reached or the scheduled

data collection period ends, whichever occurs first. Potential participants will

receive email pre-notification messages announcing the study one week in

advance of data collection. When data collection begins, a message asking

for participation and providing a coded link to the web based survey

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instrument will be sent to potential participants. Potential participants will be

sent three such invitations on a fourteen day reminder schedule. Each

invitation will offer the recipient a way to opt-out and receive no further

email messages. The web application will track the number of reminders and

whether or not there has been a response to prevent follow up messages to

those who have responded.

Upon beginning the survey respondents will be presented with the

participation information sheet which introduces the study, provides a

description of the questionnaire, contains a declaration the responses are

anonymous, explains informed consent, and lists potential benefits (See

Appendix I). Only after acknowledging they have read and understand the

participant information will the survey begin. Once a response set has been

submitted, no further responses will be accepted from that email address.

Responses will be anonymous with no identification key linking the email

address to the response set. Each response set will receive unique IDs for

sample and response set identification purposes only.

In addition to the primary sample, a secondary sample will be gathered

using the snowballing technique in two methods. In the first method,

individuals who respond to the club bulletin announcements will be directed

to a registration page where they will be able to add their email address. In

the second method, respondents will be offered a chance to invite others

they know who may be interested upon completion of the survey

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instrument—a typical feature of web based data collection devices. Again

potential respondents will be contacted via email using the same method

and schedule as with the primary participants. Responses will be anonymous

with no identification key linking the email address to the response set. Each

response set will receive unique IDs for sample and response set

identification purposes only. Upon completion, each respondent will receive a

follow up message which thanks them for their participation. The message

will contain a coded link to the snowball sampling application and offer a last

chance to submit email addresses of others they may know who may be

interested in the study. The researcher feels the secondary sample provides

a method to reach more in the non-recovering group.

The purpose of the website extends beyond merely collecting data. The web

site will provide information about the study in particular and substance

abuse issues in general. The mailing list will also be used to keep list

members up to date on the study’s progress as well as providing information

about how to access the results in lay and academic versions. While those

with no history of substance abuse will not be included in the survey,

interested parties are invited to join the mailing list in order to receive news

about the study. Every effort will be made to make the study participants

stakeholders and part of the study’s online community. The researcher has

also considered making a mobile version of the web site available for those

without computer access in order to reach more of the non-recovering group

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as well as a community forum for participants and interested parties to

discuss the study and experiences.

Individuals who reported a history of substance abuse and have not met the

DSM criteria for more than a year are defined as recovering those who have

met the DSM criteria in the past year are defined as not recovering. Due to

the fluidity of the construct of interest, comparison orientation, and its

sensitivity to situational factors, well-matched groups seem the best method

for obtaining meaningful data regarding the population of interest. It is

recognized equally matched groups may require data trimming and the

sample size has been calculated with this in mind.

Instrument

The questionnaire consists of a three part self-report survey. Part I consisted

of demographics and substance use, abuse, and recovery history. Part I also

contains the DSM criteria for a substance abuse diagnosis for respondents

who may not have been sure if they had a problem, and to act as aid in

defining recovery. Part II consists of the Iowa-Netherlands Comparison

Orientation Measure (INCOM) and one of two directional subscales (Gibbons

& Buunk, 1999). Part III consists of a series of Likert format questions

modeled after the Gibbon and Buunk instrument which ask about in group

comparison orientation (five questions), two parallel comparison directional

subscales modeled after the Gibbons and Buunk subscales (1999), and three

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open ended questions about substance abuse and recovery related

experiences (See Appendix I).

The INCOM was designed and tested by Dr. Frederick Gibbons of Iowa State

University and Dr. Bram Buunk of the University of Gronigen. The INCOM

demonstrates good reliability in its development by Gibbons and Buunk. The

internal consistency has a Cronbach's alpha that ranges from .78 to .85 in all

the samples. It also showed good temporal stability given the construct's

fluidity in response to changes in situation. The INCOM has been shown to

possess good construct validity in known-groups validation (Gibbons &

Buunk, 1999). Scale validation testing revealed that culture and sex affect

INCOM means. In a comparison of Dutch and American samples, Gibbons

and Buunk found that Americans made significantly more comparisons (p <

.001). They also discovered that women reported a moderately higher social

comparison orientation (SCO) than men. Age, too, was associated with social

comparison orientation scores. High school students in the U. S. had a mean

CO of 40.19 compared to adult males with a mean CO of 35.33, and adult

females at 36.96 (Gibbons & Buunk, 1999).

The INCOM consists of eleven items graded on a five point Likert scale with

anchors at I strongly agree and I strongly disagree and measures the

frequency or tendency of one to make social comparisons. The questions

refer to general social comparison orientation (SCO) rather than specific

comparison experiences. In accord with Festinger (1954), the instrument

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measures two constructs of social comparison: abilities, opinions. Schneider

and Schupp, who conducted exploratory and confirmatory factor analysis on

the INCOM, state the instrument has “proven to be valid and reliable,” citing

its validity as being tested in 22 questionnaires in the United States and the

Netherlands (2011, pg. 55). Additionally one of two sub-scales, each

consisting of six items graded on a five point Likert scale, measures social

comparison direction (SCD). The sub-scales are parallel in form, i. e., the

items are identical except for the use of "better or worse" and "less or

more."

Form A: Downward Comparison Sub-scale

When I consider how I am doing socially e.g., social skills, popularity),

I prefer to compare with others who are less socially skilled than I am.

Form B: Upward Comparison Sub-scale

When I consider how I am doing socially (e.g., social skills,

popularity), I prefer to compare with others who are more socially

skilled than I am.

The INCOM was published in the January 1999 issue of the Journal of

Personality and Social Psychology. Dr. Gibbons allowed the researcher in the

present study to use the INCOM and provided a copy of the sub-scales.

Part III of the instrument consists of newly devised questions relating to in

group social comparison behavior. New questions will be subjected to

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reliability testing for Cronbach’s alpha with inter-item correlations and alpha

if missing. Factor analysis will be performed on the in group SCO scale to

look for two dimensional model fit for the underlying abilities and opinions

constructs.

Analysis

Response set data will be coded and the ready for import into statistical

analysis software directly from the web survey application database server.

In the initial analysis, descriptive statistics will be run against both sample

sets and the sample sets examined for homogeneity. The data will then be

subjected to two-way analysis of variance procedures (ANOVA). First the

primary and secondary samples are split according version of the

questionnaire, form A or B, and the two recovery dimensions, creating four

groups in each sample: Form A recovering/not recovering; Form B

recovering/not recovering. Form A measures social comparison orientation

(SCO), downward comparison tendencies, and in group comparison

behavior, and form B measures SCO, upward comparison tendencies, and in

group comparison behavior. Following ANOVA procedures the data will be

subjected to non-parametric tests. Wald-Wolfowitz Runs tests will be

performed to determine if the center of the distributions differ and describe

the shape of the distributions. The two samples and the subgroups of each

sample will be compared. Provided no statistically significant differences are

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found, data from the snowballing sample will be aggregated with the primary

sample for further procedures.

The data file will then be split into four groups based on the survey form A/B

and recovery attribute recovering/not recovering (A/B, R/N). The results will

be analyzed for between group differences on SCO, SCD, in group SCO

scale, in group SCD sub-scale, and combined scores. Because age plays such

a large role in social comparison processes, the groups will be divided into

age groups for a more precise comparative analysis. In addition the four

groups (A/B, R/N) will be split on the sex attribute to analyze differences

between the sexes. The researcher is also interested in ethnicity effects, so

the file will be split by ethnicity for ANOVA procedures. The recovering group

will then be split by four time in recovery intervals—which may be

manipulated by the researcher—and subjected to ANOVA procedures which

will examine the data on the SCO, SCD, in group SCO scale, in group SCD

sub-scale, and combined scores across time in recovery. Bonferroni post hoc

multiple comparisons will be performed following all ANOVA procedures.

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Correlation & Linear Regression

Pearson r calculations will be performed to ascertain the relationship

between SCO and SCD for each group, recovering/not recovering, and form,

A/B. Additionally both groups recovering/non-recovering SCO and SCD

scores for forms A and B will composited for SCO and SCD and multivariate

linear regression performed on the time in recovery dimension to determine

if a linear relationship exists between SCO, SCD, and length of recovery. The

object here will be to examine the relationship between the constructs of

interest from the shortest non-recovering to the longest recovering lengths

of time. Further multivariate linear regression will be performed with one to

multiple factors to examine the relationship of the constructs of interest with

age, ethnicity, and sex.

t-Test

A series of single sample t-tests using weighted means will be performed to

measure the data collected in the present study against the data gathered

by Gibbons and Buunk (1999). Further analysis using t tests with groups

split by ethnicity will seek to determine if ethnicity plays a role in SCO, SCD,

and recovery.

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REFERENCES

Amoroso, D. M., & Walters, R. H. (1969). Effects of anxiety and socially

mediated anxiety on paired associate learning. Journal of Personality and
Social Psychology, 11,388-396.
Aspinwall, L. G., & Taylor, S. E. (1993). Effects of social comparison
direction, threat, and self-esteem on affect, self-evaluation, and expected
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Appendix I: Sample Size Calculations

Threadgill 30
Sample Size*

Effect size f = 0.25

α err prob = 0.05

Power (1-β err prob) = 0.95
Number of groups = 24
Noncentrality parameter λ = 34.5000000
Critical F = 1.5497617
Numerator df = 23
Denominator df = 528
Total sample size = 552
Actual power = 0.9578973

* Calculated using power analysis a priori method, given α,

power, and effect size using G*Power.

Sampling Distribution

calculated using a priori method, given α, power, and effect

size:

Threadgill 31
Appendix II: The Survey Instrument

Threadgill 32
Introduction to the Study: Participant Information

The purpose of this study is to investigate the social comparison

characteristics—the process of thinking about information about other
people in relation to the self—of recovering substance abusers.
Knowledge gained through this study could assist substance abuse
treatment professionals in the design and implementation of more
effective treatment strategies for individuals suffering from
substance abuse problems and benefit society as a whole.

The questionnaire consists of a three part self-report survey. Part I

asks questions about demographics and substance use, abuse, and
recovery history. Part II asks a series of questions about the social
comparisons you make in your everyday life. Part III asks about your
group therapy experience.

Your confidentiality will be protected. Email address will be used

only for the purposes of the study and will be kept confidential.
Whether or not the survey was completed and submitted will also be
kept confidential. No other information about you beyond and email
address will be collected. IP address logging will be disabled on the
study web server to protect anonymity.

The surveys will be returned anonymously, with no way to identify your

responses. The only information associated with any given email
address is whether or not the survey has been completed. This is done
to discourage multiple submissions.

This information sheet contains all the information you need to make
an informed decision about whether to participate or not. You have the
right to withdraw at any time. Return of the completed questionnaire
signifies consent to be included.

Knowledge gained through this study could assist substance abuse

treatment professionals in the design and implementation of more
effective treatment strategies for individuals suffering from
substance abuse problems.

This study has been approved by The University of Houston

Institutional Review Board, 4800 Calhoun Road, Houston, Texas 7700.
(713) 743-2255. Researcher: James W. Threadgill, jwthreadgill@uh.edu

Threadgill 33
Survey Questionnaire Form A

Instructions: Please read carefully before beginning the

questionnaire. The questionnaire consists of two sections. Part I
gathers demographic information and asks about substance use, abuse,
and recovery history. The Diagnostic and Statistical Manual (DSM IV)
criteria for Substance Abuse and Substance Dependence are provided at
the end of Part I for reference. Please consult them if you feel a
need to do so. Part II asks questions about the social comparisons you
make in everyday life.

Definitions

DSM Criteria for Substance Abuse:

A. A maladaptive pattern of substance use leading to clinically

significant impairment or distress, as manifested by one (or more) of
the following, occurring within a 12-month period:

(1) recurrent substance use resulting in a failure to fulfill

major role obligations at work. school or home (e.g., repeated
absences or poor work performance related to substance use:
substance-related absences. suspensions, or expulsions from
school: neglect of children or household)

(2) recurrent substance use in situations in which it is

physically hazardous (e.g., driving an automobile or operating a
machine when impaired by substance use)

(3) recurrent substance-related legal problems (e.g., arrests for

substance-related disorderly conduct)

(4) continued substance use despite having persistent or

recurrent social or interpersonal problems caused or exacerbated
by the effects of the substance (e.g., arguments with spouse
about consequences of intoxication, physical fights).

Successful Recovery: For the purposes of this study, successful

recover means you met the criteria at some point the past but have not
in the past 12 months.

Part I

Circle response or fill in corresponding blanks.

Demographics:

Sex: Male___ Female_____

Age: ____

Race/Ethnicity (Circle more than one if needed.): Caucasian, African-

American, Latino/a, Asian, American Indian, ________.

Threadgill 34
History:

1. Do you now have or have you ever had a Substance Abuse or Substance
Dependence problem as defined above?

Yes, No? If no, display message informing participant the study only
includes those with a history of substance abuse.

2. Do you currently have one year or more of successful recovery?

Yes, No?

a. If yes, how long? _____years ______months ______days.

b. If no, how long do you have? ______months ______days.

4. Do you have one year or more of controlled use—that is you have not
met the DSM IV criteria for Substance Abuse or Substance Dependence in
the past year or more? Yes, No. If no, go to Part II of the
questionnaire.

Part II
Strongly Disagree | Disagree | No Opinion | Agree | Strongly Agree

1. I often compare how my loved

ones (boy or girlfriend, family

members, ect.) are doing with how

others are doing. ( ) ( ) ( ) ( ) ( )

2. I always pay a lot of attention

to how I do compared with how others

do things. ( ) ( ) ( ) ( ) ( )

3. If I want to find out how well

I have done something, I compare

what I have done with how others

have done. ( ) ( ) ( ) ( ) ( )

4. I often compare how I am

doing socially (e.g. social

skills, popularity) with other

people. ( ) ( ) ( ) ( ) ( )

Threadgill 35
5. I am not the type of person

who compares often with others. ( ) ( ) ( ) ( ) ( )

6. I often compare myself with

others with respect to what I

have accomplished in life. ( ) ( ) ( ) ( ) ( )

7. I often like to talk with

others about mutual opinions

and experiences. ( ) ( ) ( ) ( ) ( )

8. I often try to find out what

Others think who face similar

problems as I face. ( ) ( ) ( ) ( ) ( )

9. I always like to know what

others in a similar situation

would do. ( ) ( ) ( ) ( ) ( )

10. If I want to learn more about

something, I try to find out what

others think about it. ( ) ( ) ( ) ( ) ( )

11. I never consider my situation

in life relative to that of other

people. ( ) ( ) ( ) ( ) ( )

12. When it comes to my personal

Life, I sometimes compare myself

With others who have it worse

than I do. ( ) ( ) ( ) ( ) ( )

13. When I consider how I am

doing socially (e.g., social

skills, popularity), I prefer to

compare with others who are

less socially skilled than I am. ( ) ( ) ( ) ( ) ( )

Threadgill 36
14. When evaluating my current

Performance (e.g., how I am doing

at home, work, school, or wherever).

I often compare with others who

are doing worse than I am. ( ) ( ) ( ) ( ) ( )

15. When I wonder how good I am at

something, I sometimes compare myself

with others who are worse at it than

I am. ( ) ( ) ( ) ( ) ( )

16. When things are going poorly,

I think of others who have it

worse than I do. ( ) ( ) ( ) ( ) ( )

17. I sometimes compare myself

With others who have accomplished

Less in life than I have. ( ) ( ) ( ) ( ) ( )

Directional Comparison Sub-scale B

12. When it comes to my personal

life, I sometimes compare myself

with others who have it better

than I do. ( ) ( ) ( ) ( ) ( )

13. When I consider how I am

Doing socially(e.g., social

skills, popularity), I prefer to

compare with others who are more

socially skilled than I am. ( ) ( ) ( ) ( ) ( )

14. When evaluating my current

Performance (e.g., how I am doing

at home, work, school, or

Threadgill 37
wherever), I often compare with

others who are doing better than

I am. ( ) ( ) ( ) ( ) ( )

15. When I wonder how good I am

At something. I sometimes compare

Myself with others who are better

at it than I am. ( ) ( ) ( ) ( ) ( )

16. When things are going poorly,

I think of others who have it

better than I do. ( ) ( ) ( ) ( ) ( )

17. I sometimes compare myself with

others who have accomplished more

in life than I have. ( ) ( ) ( ) ( ) ( )

Gibbons, F. X. & Buunk, B. P. (1998-2012).

Part III
Strongly Disagree | Disagree | No Opinion | Agree | Strongly Agree

SCO Questions (5)

1. In group I often compare my

Experiences with the experiences

Of other group members. ( ) ( ) ( ) ( ) ( )

2. I find it helpful to gauge

the severity of my disease by

the severity of other members

disease. ( ) ( ) ( ) ( ) ( )

3. In group, I often ask the

opinions of others for managing

my recovery. ( ) ( ) ( ) ( ) ( )

Threadgill 38
4. In group, I often gauge my

recovery progress by the progress

of other group members. ( ) ( ) ( ) ( ) ( )

5. I never consider other group

members situation in life relative

to my own. ( ) ( ) ( ) ( ) ( )

CD Questions (Subscale A)

6. The stories most group

members tell about their

addictive behavior sound

worse than mine. ( ) ( ) ( ) ( ) ( )

7. I often compare the severity

Of my disease to others whose

disease is worse than mine ( ) ( ) ( ) ( ) ( )

8. When I feel in danger of relapse

I think of others who have it

worse than I. ( ) ( ) ( ) ( ) ( )

9. In group I often compare

My progress to the progress

of others who are doing worse

than I. ( ) ( ) ( ) ( ) ( )

10. In group I often compare my

life situation to others who

are doing worse than I. ( ) ( ) ( ) ( ) ( )

Subscale B

Threadgill 39
6. The stories most group

members tell about their

addictive behavior sound

better than mine. ( ) ( ) ( ) ( ) ( )

7. I often compare the severity

Of my disease to others whose

disease is better than mine ( ) ( ) ( ) ( ) ( )

8. When I feel in danger of relapse

I think of others who have it

better than I. ( ) ( ) ( ) ( ) ( )

9. In group I often compare

My progress to the progress

of others who are doing better

than I. ( ) ( ) ( ) ( ) ( )

10. In group I often compare my

life situation to others who

are doing better than I. ( ) ( ) ( ) ( ) ( )

Open Ended Questions:

The worst thing about my substance abuse is

______________________________________________________________________
______________________________________________________________________
_________________________.

Before I entered therapy, I often felt my life was

______________________________________________________________________
______________________________________________________________________
________________.

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The best thing to happen to me since beginning group therapy is
______________________________________________________________________
______________________________________________________________________
____.

Threadgill 41
Appendix III: Timeline

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Social Comparisons & Substance Abuse Treatment
Event Name Start Date End Date

Graphic Design Sep 03 2012 Sep 10 2012

Promotional item Design Sep 10 2012 Sep 17 2012

Web Site UX Design Sep 10 2012 Sep 12 2012

Web Development Phase I (Mailing List) Sep 12 2012 Sep 17 2012

Compile Pool of Treatment Groups Sep 17 2012 Sep 24 2012

Printing Sep 17 2012 Sep 24 2012

Sampling Sep 24 2012 Dec 10 2012

Web Development Phase II (Survey) Nov 26 2012 Dec 17 2012

Data Collection (mail pre- notifications 12/10/12) Dec 17 2012 Feb 25 2013

Data Analysis Feb 25 2013 Apr 08 2013

Write Up Results (Academic) Apr 08 2013 Apr 22 2013

Write Up Results (Lay Audience) Apr 15 2013 Apr 29 2013

Threadgill 44
Appendix IV: Budget
Web Site Cost Estimates
UX Design $250.00
Application Development $1,500.00
Database Design $250.00
Hosting/Domain Registration $75.00
Total $2,075.00

Sampling
Travel Expenses .50/mile $750.00
Labor Data Collection (25.00 per hour) $2,000.00
Data Entry (15.00 per hour) $150.00
Total $2,750.00

Publicity
Logo Design $250.00
Photocopying/Printing $250.00
Total $500.00

Data Collection
Draft email notifications $250.00
manage mailing list $500.00
Total $750.00

Data Analysis
SPSS Data Analysis 30 hours $750.00
Total
$750.00
Reporting Results
Write Up Results with lay version (40 hrs) $1,000.00
Publish results web site $150.00
Total $1,150.00

Miscellaneous office Expenses

Office Supplies $75.00
Paper $50.00
Total $125.00

Total Expenses $8235.00

Threadgill 46