PRIME For Life ADSAP - Prevention Research Institute
Transcription
PRIME For Life ADSAP - Prevention Research Institute
PRIME For Life ADSAP Prepared by Prevention Research Institute, Inc. January 2003 PRIME For Life Executive Summary PRIME For Life (PFL) is a research-based prevention and intervention program mandated for court-referred offenders convicted of Driving Under the Influence (DUI) in South Carolina, delivered through the regional ADSAP programs. The immediate objective of PFL/ADSAP is the formation of an accurate perception of risk associated with drinking choices. The long-term objectives are to reduce consumption among the non-dependent and increase treatment seeking among dependent offenders. Research demonstrates that higher perception of risk is associated with less drinking and drug use both in adolescents and adults. (Bachman, Johnston, & O’Malley, 1988; Bachman, Johnston, & O’Malley, 1998; Feldman, Harvey, Holowaty & Shortt, 1999; Brown, Goldman, & Christiansen, 1985) Higher perception of risk is also associated with less drinking and driving (Engen, Richards, & Patterson, 1995; Nelson, et al. 1999; Greenfield and Rogers, 1999; Agostenelli and Miller, 1994) and it motivates treatment-seeking behavior in those who are alcohol or drug dependent (Hingston, Mangione, Meyers, and Scotch, 1982). This report is on 3,809 participants who completed the PFL program between April 2000 and October 2001, and for whom matched pre and post-tests were available. The pre-test was completed before attending the 16-hour PFL program and the post-test was completed after class . Participation was voluntary and confidential. Perception of Risk Analyses revealed statistically significant and desired changes on four measures of perception of risk. It is worth noting that these changes occurred in those who were not dependent, those who are dependent, and among those with indications of physiological dependence under DSM-IV. After completing the PFL program, participants: • Endorsed fewer risky beliefs regarding alcohol. • Realized that their drinking choices could affect their ability to get or keep things they valued. • Understood that their current drinking choices could result in alcoholism. • Assessed their risk for developing alcoholism significantly higher. Drinking Choices At the conclusion of the program and having learned a specific definition regarding low-risk drinking choices, participants were able to examine past drinking choices and state their intentions regarding future drinking choices: • 74% of participants intended to never make high-risk drinking choices in the future. • 67% were “very sure” that they would follow their low-risk guidelines. • 64% were in strong agreement that the things they learned in class to follow their low- risk guidelines would work in the “real” world. 1 Introduction PRIME for Life (PFL) is a research-based prevention and intervention program mandated for court-referred offenders convicted of Driving Under the Influence (DUI) in South Carolina. This report contains evaluation results for the PFL program. PFL is based on the Lifestyle Risk Reduction Model developed by Prevention Research Institute (PRI). This model holds that increasing personal perception of risk is a key step in encouraging behavior change. Personal perception of risk is a measure of the chance of loss or peril that people associate with their behavior. In other words, is the pleasure associated with the behavior worth the possible consequences associated with the behavior? The perception of how real and imminent the risk is can form a motivation for either continuing or changing that behavior. Participants in the PFL program are presented research-based content on alcohol and drugs and participate in a variety of therapeutic activities to facilitate changes in risk perception and commitment to behavior change. Participants learn to assess their personal level of risk for alcoholism and their location in the progression of alcoholism indicated by their current drinking behavior. After this assessment, participants learn how to decrease their risk for alcohol problems and/or alcoholism by making low-risk drinking choices (i.e., in terms of setting personal standards for the quantity and frequency of drinking that avoid impairment or health problems) for those who are not dependent, or abstinence and recovery for those who are dependent. Research has demonstrated that higher perception of risk is associated with less drinking and drug use, both in adolescents (Bachman, Johnston, & O’Malley, 1988; Bachman, Johnston, & O’Malley, 1998; Feldman, Harvey, Holowaty, & Shortt, 1999; Johnston, O’Malley, & Bachman, 1998) and adults (Brown, Goldman, & Christiansen, 1985; Fromme, Katz, & D’Amico, 1997; Roizen, 1983). More specific to this audience, lower perception of risk is associated with more drinking and driving (Agostinelli, Brown, & Miller, 1995), less planning to avoid drinking and driving (Nelson, Hirsch, Pendergast, & Glavy, 1999), higher rates of injury (Cherpitel, 1993) and higher rates of recidivism among DUI offenders (Engen, Richards, & Patterson, 1995). Conversely, higher perception of risk has also been associated with increased likelihood of seeking treatment (Hingston, Mangione, Meyers, & Scotch, 1982). Such findings lend support to the program’s effort to alter personal perception of risk associated with high-risk drinking and drug use. The immediate objective of the program is the formation of an accurate perception of risk associated with drinking choices. To measure changes in perception of risk, pre-intervention and post-intervention views were compared. 2 Methodology Participants in the PFL program completed two surveys that were developed by PRI. One survey (pre-test) was completed before attending the 16-hour PFL class and a second survey (post-test) was completed after the final class. Surveys contained demographic information, measures of alcohol beliefs and perception of risk, and indicators of problem use. In addition, the post-test contained items assessing intentions for future alcohol use. Participation was voluntary and confidential. There were 4,580 participants who attended the PFL program between April 2000 and October 2001. There were 3,809 participants with a matched pre-test and post-test. Only participants with matched surveys were included in this report. Measures Risky Beliefs This measure addressed beliefs regarding alcohol and drugs. Scores ranged from 7 to 35 with lower scores indicating riskier beliefs. Risk of Losing Valued Things This measure addressed participants’ personal perception of risk for their current drinking choices interfering with getting or keeping the things they value. Responses ranged from 1 to 5 with lower scores indicating a higher perception of risk. Risk For Alcoholism at Current Drinking Level This measure addressed participants’ personal perception of risk for developing alcoholism as a result of their current drinking pattern. Responses ranged from 1 to 5 with lower scores indicating a higher perception of risk. Personal Perception of Risk For Alcoholism This item assessed participants’ overall perception of personal risk for developing alcoholism. Participants rated their risk on a 10-point scale with higher scores indicating greater risk. For further descriptions of these measures, see Appendix A. 3 Measures (cont’d) Drinking Choices After completing the class, students were asked how often they had made high-risk drinking choices in the last year. Behavioral Intentions After completing the class, participants were asked how often they intended to make high-risk drinking choices in the future. Participants were also asked to indicate their level of certainty that they would follow the low-risk guidelines and if the skills they learned in class for following the guidelines would work. For further descriptions of these measures, see Appendix A. Demographics Of 4,580 matched pre-tests and post-tests, 3,809 (83.2%) contained complete data for the demographic and outcome variables included in this report. This report contains the results for those 3,809 participants completing the PFL program between April 2000 and October 2001. 1% 17% 1% 21% 77% 83% Women Men African-American Hispanic Other Caucasian The majority, 61%, of offenders were Caucasian males which is consistent with the published research on DUI offenders. The majority of women were Caucasian, only 2% of the sample were minority women. For further descriptions of the population (education, dependency status, etc.) see Appendix B. 4 Results Changes in Perception of Risk One composite measure (risky beliefs) and three single items were used to measure change in perception of risk. A series of paired sample t-tests were performed comparing the students’ average pre-test score to the average of their post-test scores (see Table 1). These tests revealed whether or not participants showed a statistically significant change over the course of the program. Table 1. Pre-test and post-test means (with standard deviations) for the four risk perception measures: Pre-test Mean Post-test Mean t-test 29.4 30.5 -18.3 p<.001 Risk of Losing Valued Things 3.5 2.7 39.2 p<.001 Risk For Current Drinking Level 3.1 2.2 29.9 p<.001 Perception of Personal Risk 3.2 4.1 -20.2 p<.001 Risky Beliefs Key Points • Students showed statistically significant and desired changes on all four outcome measures. After completing the PFL program, participants: • • • • Endorsed fewer risky beliefs associated with high-risk drinking. Agreed that their current drinking could pose a risk for getting or keeping the things they valued. Agreed that their current drinking posed a risk for developing alcoholism. Increased their personal perception of risk for developing alcoholism. 5 Results Charts Depicting Changes in Perception of Risk Risky Beliefs For this outcome, participants were asked their level of agreement (on a scale of 1 to 5) with 7 beliefs regarding substance use. For Chart 1, average scores were divided by 7 to illustrate the change in agreement from pre-test to posttest. Chart 1. Pre-test and Post-test Percentages for Response Categories for Risky Beliefs 100% 63% 50% 50% Pre-test 44% Post-test 29% 25% 7% 0% Strongly Disagree Disagree 5% 1% 1% Agree Uncertain 1% 1% Strongly Agree Key Point There was an increase in the percentage of participants who strongly disagreed with beliefs such as people are born with alcoholism, getting drunk is just part of having fun and people who drink alcoholic beverages are more fun than people who don’t. 6 Results Charts Depicting Changes in Perception of Risk Perception of Risk For Losing Valued Things Chart 2. Pre-test and Post-test Percentages for Response Categories for “My current drinking choices could interfere with getting or keeping the things I value.” 50% Pre-test 34% 27% 29% 28% 25% Post-test 22% 16% 16% 10% 13% 5% 0% Strongly Disagree Disagree Uncertain Agree Strongly Agree Key Point In Chart 2, it can be seen that at pre-test, 29% of participants agreed or strongly agreed that their current drinking choices could increase their risk of losing valued things. However, at post-test, 57% agreed or strongly agreed that their current drinking choices could be risky. 7 Results Charts Depicting Changes in Perception of Risk Perception of Risk For Current Drinking Levels Chart 3. Pre-test and Post-test Percentages for Response Categories for “If I don’t change my drinking, I could develop alcoholism.” 50% 37% 36% Post-test 30% 25% 17% 21% 17% 15% 13% 8% 0% Strongly Disagree Pre-test 6% Disagree Uncertain Agree Strongly Agree Key Point Nearly half, 47%, of participants disagreed or strongly disagreed that their current drinking pattern was risky at pre-test. However, at post-test, 73% agreed or strongly agreed that their current drinking level posed a risk for developing alcoholism. 8 Results Charts Depicting Changes in Perception of Risk Personal Perception of Risk For Alcoholism For this outcome, participants were asked to estimate their overall risk for developing alcoholism on a 10-point scale with “1” being low risk and “10” being high risk. For Chart 4, response categories were collapsed to illustrate the change from pre-test to post-test. The low-risk group represents participants who rated their risk of developing alcoholism as 1-3. The medium-risk group represents participants who rated their risk of developing alcoholism as 4-7. The high-risk group represents participants who rated their risk of developing alcoholism from 8-10. Chart 4. Pre-test and Post-test Percentages for Combined Response Categories for “I think my risk for developing alcoholism.” 75% 66% 55% Pre-test 50% Post-test 23% 25% 24% 21% 11% 0% Low-Risk Medium-Risk High-Risk Key Point There was a decrease in the percentage of participants who rated their risk as low, a slight increase in the medium category and a substantial increase in the high risk category. 9 Results Impact of PFL Based on Dependence Status Does the PFL program work for participants who report symptoms of alcohol dependence? A MANOVA (Multivariate Analysis of Variance) with repeated measures was used to determine whether PFL works for clients who report symptoms of alcohol dependence. A list of the symptoms can be found in Appendix A. Based on the number of symptoms endorsed, 39% of participants were in the not dependent group, 20% were in the dependent group and 41% were in the dependent with physiological dependence group. This analysis compares the answers of three dependence groups and reveals whether the program works for some groups better than others. Dependency and Risky Beliefs The risky beliefs scale is a measure of endorsement of high-risk beliefs (e.g., people are born with alcoholism, tolerance is good, people who drink are more fun than people who don’t). The higher the score, the fewer risky beliefs the student endorsed. All groups experienced similar rates of change from pre-test to post-test as shown by the nearly parallel lines on Chart 5. Chart 5. Change in Risky Beliefs by Dependence Group 31.5 30.5 29.5 28.5 Post-test Pre-test Not Dependent Dependent Dependent with Physiological Dependence Key Point Dependency status was associated with risky beliefs. As would be expected, participants who were not dependent endorsed significantly fewer high-risk beliefs at both pre-test and posttest. Students who were dependent with physiological dependence endorsed the most high-risk beliefs. • PFL had a similarly positive impact on all groups regardless of dependence status. 10 Results Impact of PFL Based on Dependence Status Dependency and the Perception of Risk For Losing Valued Things Participants were asked if their current drinking could interfere with getting or keeping the things they valued. Higher scores indicated disagreement that current drinking was risky and lower scores indicated agreement that current drinking was risky (Chart 6). Chart 6. Change in Risk of Losing Valued Things by Dependence Group 4 3 2 Post-test Pre-test Not Dependent Dependent Dependent with Physiological Dependence Key Point At pre-test, participants who were not dependent were the least likely to agree that their current drinking choices could interfere with the things they valued whereas the participants who were dependent with physiological dependence were the most likely to agree. Participants in the dependent group fell between the non-dependent and physiologically dependent groups. • PFL had a similarly positive impact on all groups regardless of dependence status, though the change was greatest in the not dependent group. 11 Results Impact of PFL Based on Dependence Status Dependency and Perceived Risk of Developing Alcoholism This measure addressed participants’ personal perception of risk for developing alcoholism as a result of their current drinking pattern. Scores ranged from 1-5 with lower scores indicating greater agreement with the risk item. Chart 7. Change in Risk for Current Drinking Level and Alcoholism by Dependence Group 4 3 2 1 Pre-test Not Dependent Post-test Dependent Dependent with Physiological Dependence Key Point At pre-test, dependence groups differed significantly in how they perceived their risk of developing alcoholism. Students who were non-dependent were the least likely to agree that they could develop alcoholism if they didn’t change their current drinking choices whereas the participants who were dependent with physiological dependence were the most likely to agree. Participants in the dependent group fell between the non-dependent and physiologically dependent groups. • Each group changed in the desired direction at a statistically significant level. Participants in the non-dependent group and the dependent group showed greater change than the physiologically dependent group. 12 Results Impact of PFL Based on Dependence Status Dependency and Perceived Risk of Developing Alcoholism This measure assessed participants’ overall perception of risk for developing alcoholism. Scores ranged from 1-10 with higher scores indicating a greater personal perception of risk for developing alcoholism. Chart 8. Change in Personal Perception of Risk for Developing Alcoholism by Dependence Group 10 1 Pre-test Not Dependent Post-test Dependent Dependent with Physiological Dependence Key Point Participants varied at pre-test on how they perceived risk. Those who were not dependent rated their risk for developing alcoholism the lowest and the participants who were dependent with physiological dependence rated their risk the highest. Risk ratings for the participants in the dependent group fell between the non-dependent and physiologically dependent groups. All groups showed similar increases in their perception of risk for developing alcoholism regardless of dependency status. • PFL increases perception of risk regardless of dependency status. 13 Results Past Drinking Behavior and Intentions For Future Drinking Intentions After completing the class, participants were asked how often they had made high-risk drinking choices in the past and how often they intended to make high-risk drinking choices in the future. Chart 9. Participants’ Description of High-risk Drinking in the Past Year and Future Intentions 74% 80% 70% Past Year 60% 44% 50% Future 40% 30% 20% 21% 13% 18% 16% 5% 10% 0% Never Rarely Sometimes 1% A lot 4% 1% Almost Always 3% Always Key Points • In the last year, 60% of students claim to have made high-risk drinking choice sometimes or a lot. • After completing the PFL class, 74% of participants planned to make never make high-risk drinking choices in the future. • Οverall, students planned to make fewer high-risk drinking choices. 14 3% Results Past Drinking Behavior and Intentions For Future Drinking Certainty Participants were asked to indicate how sure they were about their ability to follow their low-risk guidelines. Chart 10. Participants’ Certainty of Following Low-risk Guidelines 75% 67% 50% 25% 16% 13% 1% 0% Very Sure Somewhat Sure Sure Unsure 3% Very Unsure Key Points • Two-thirds of participants were very sure that they would follow their low-risk guidelines. • A small percentage, 4%, expressed uncertainty regarding their ability to follow their low-risk guidelines. 15 Results Past Drinking Behavior and Intentions For Future Drinking “Real World Application” Participants were asked to indicate their agreement with the statement “The things I learned to do in class to meet the low-risk guidelines that apply to me will work in the real world.” Chart 11. Participants’ agreement with “The things I learned to do in class to meet the low-risk guidelines that apply to me will work in the real world.” 75% 64% 50% 31% 25% 3% 1% 1% Uncertain Disagree Strongly Disagree 0% Strongly Agree Agree Key Points • 64% of participants strongly agreed that the things they learned in class would apply in the real world. • Over 90% agreed or strongly agreed that the things they learned in class would apply in the real world. 16 Summary and Conclusion After completing the PFL program, participants: • • • • • • Endorsed fewer high-risk beliefs. Increased their perception of risk for their current drinking for both losing things they valued and for developing alcoholism. Increased their perception of risk for developing alcoholism. Intended to make fewer high-risk drinking choices in the future Expressed certainty about their ability to follow their low-risk guidelines Strongly agreed that the skills they had learned in class would work The immediate changes in participants’ risky beliefs and perception of risk were specifically assessed in this report. After exposure to the 16-hour PFL ADSAP curriculum, participants showed statistically significant and desirable changes in their risky beliefs and perception of risk. Participants endorsed fewer beliefs associated with high-risk drinking choices and increased their perception of risk for alcoholism and alcohol-related problems. Differences in risky beliefs were found between groups of participants at pretest, based on alcohol dependence status. Participants who were not dependent on alcohol held the fewest high-risk beliefs at pretest. In contrast, participants who endorsed enough DSM-IV symptoms to indicate alcohol dependence with physiological dependence endorsed the most high-risk beliefs. Participants who were alcohol dependent without physiological dependence fell in-between the non-dependent and physiologically dependent groups. These differences in risky beliefs were not unexpected as these beliefs should be associated with increased alcohol use. In other words, participants who hold the riskiest beliefs would be expected to be making the riskiest drinking choices. Results indicate that regardless of dependence status, participants showed statistically significant decreases in risky beliefs over the course of the intervention. The same pattern between dependence groups was found for the remaining three measures that focused on personal perception of risk. These risk measures were specific to the participant and the participant’s drinking choices. Non-dependent participants held the lowest perception of risk, dependent with physiological dependence participants held the highest perception of risk and dependent participants fell between the two. Overall, participants came to see that their drinking choices could affect their ability to get or keep things they valued and that their drinking choices could result in alcoholism. However, there were some differential patterns of change based on dependence status. Nondependent participants started out with less awareness of, and subsequently showed a greater increase in perception of risk for losing the things they valued compared to either dependent or physiologically dependent participants. Both non-dependent and dependent participants showed greater increases in perception of risk for developing alcoholism as a result of their current drinking choices. The PFL curriculum defines a series of phases in the progression towards alcoholism. The characteristics of these phases are defined for participants and it may be that participants in the earlier phases are just beginning to experience alcohol-related problems (such as a DUI) and may not have viewed their drinking choices as risky until the links between problems and drinking were elucidated in class. The more seriously dependent clients entered with greater awareness of these risks and this awareness increased with exposure to the program. 17 Summary and Conclusion Taken together, the results of the analysis by dependence groups indicate that participants exit the class with a higher perception of risk and that the perception of risk corresponds with the alcohol-related symptoms they report at pre-test. Put simply, participants appear to be not only be increasing their perception of risk overall, but also increasing the accuracy of the perceived risk. Both traditional wisdom in the addictions field and a number of previous studies indicate that educational interventions may not be effective with those who are dependent. Yet the above findings demonstrate that PFL is effective in changing perception of risk even with the dependent and the physiologically dependent population. This supports the use of PFL as therapeutic education for those needing out patient services or as the educational component of a larger therapeutic experience. With a specific definition regarding what constitutes low-risk drinking choices, participants were able to examine past drinking choices and state their intentions regarding future drinking choices. Almost threefourths of the participants intended to never make high-risk drinking choices and two-thirds expressed confidence regarding their ability to follow their low-risk guidelines. 18 Appendix A - Measures Family History Participants who reported a parent, sibling or grandparent with alcoholism or a serious “drinking problem” were grouped as having a positive family history for alcohol problems. Participants were grouped as having a negative family history, if they indicated no knowledge of any relatives with alcohol problems. Alcohol Dependence Seven questions were asked at pre-test to identify symptoms of alcoholism or increased risk for alcoholism. The DSMIV criterion for substance dependence is the presence of 3 or more symptoms of 7 in a 12-month period. The symptoms follow: (a) tolerance (b) withdrawal (c) use of alcohol in larger amounts of over a longer period of time than was intended (d) persistent desire or unsuccessful efforts to cut down or control use (e) great deal of time spend in activities to obtain or recover from its effects (f) important social, occupational, or recreational activities given up or reduced due to use and (g) substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem likely to have been caused or exacerbated by the substance. Three groups were formed based on number of symptoms that were coded positive and whether tolerance or withdrawal was indicated. If participants indicated experiencing less than three symptoms, they were classified as not dependent. Participants who endorsed three or more symptoms but did not endorse the tolerance or withdrawal items were classified as dependent. If three items or more were marked and any one of them was tolerance or withdrawal, the classification was physiologically dependent. In other words, it is not necessary to have both tolerance and withdrawal identified to get a physiologically dependent categorization. These groups represented the three categories called dependence status. Perception of Risk Four measures of risk perception were used in the analysis. There was one composite risky beliefs measure and three measures of personal perception of risk. Risky beliefs.This measure addressed participants’ general beliefs regarding substance use. This scale was comprised of the following seven items: 1. 2. 3. 4. 5. 6. 7. Only people born with alcoholism can get it. It is okay to use drugs if you can handle it. It is good to be able to drink more than other people before getting drunk. Getting drunk is just part of having fun. It is okay to drive after smoking marijuana. People who drink alcoholic beverages are more fun than people who don’t. People are not really drinking if they have only 1 or 2 drinks. Responses were measured on a 5-point Likert scale ranging from strongly agree (1) to strongly disagree (5). Items were summed to produce a score ranging from 7 to 35 (Cronbach’s alpha= .73). Risk of losing valued things. This measure addressed participants’ personal perception of risk regarding possible consequences associated with their current drinking choices. Responses ranged from strongly agree (1) to strongly disagree (5). Risk for current drinking level and alcoholism. This measure addressed participants’ personal perception of risk for developing alcoholism as a result of their current drinking pattern. Responses ranged from strongly agree (1) to strongly disagree (5). 19 Appendix A - Measures Personal perception of risk for alcoholism. This item assessed participants’ overall perception of personal risk for developing alcoholism. In response to the item “I think my risk for developing alcoholism is:” participants rated their risk on a 10-point scale anchored at the endpoints as low (1) and high (10). Drinking choices in the past year. After completing the class, participants were asked to respond to the item “In the past year, I made high-risk drinking choices.” Participants chose from six responses: never, rarely, sometimes, a lot, almost always and always. Behavioral intentions. After completing the class, students were asked to respond to the item “Based on everything I have learned about risks and what is important to me, I have decided to make high-risk drinking choices.” Students chose from six responses: never, rarely, sometimes, a lot, almost always and always. Participants were asked “How sure are you that you will follow the low-risk guidelines that apply to you?” Participants chose from five responses: very sure, somewhat sure, sure, unsure and very unsure. Participants were asked to indicated their level of agreement from strongly agree (1) to strongly disagree (5) with the statement: “ The things I learned to do in class to meet the low-risk guidelines that apply to me will work in the real world.” 20 Appendix B - Demographics Age Age ranged from 16 years to 75 years of age with an average age of 36.2 and a standard deviation of 10.9. Approximately 50% of the sample was 36 or younger and 90% of the sample was under the age of 50. Education High school graduates were the largest educational category. Approximately one-fourth of students had less than a high school education. Less than 10% of the sample held a college or advanced degree. Chart A1. Percentage of Participants by Education 60% 40% 36% 22% 20% 22% 7% 6% 5% 2% 0% Grade 1-8 (n=194) Some HS (n=194) HS Grad (n=1377) Some College Votech Grad (n=833) (n=232) College Grad (n=277) Grad Degree (n=194) Additional points Analysis revealed that women were more likely to hold an advanced degree and less likely to report a grade school education than men, χ2 (6, N = 3,809) = 23.9, p < .001. Only 1.6% of the male participants held a graduate degree compared to 3.5% of female participants. In contrast, 5.5% of men reported a grade school education compared to 3.1% of women. Marital Status Chart A2 reveals the percentage of participants by marital status. Never married participants were the largest marital status group with 32% of the sample. Approximately one-third, or 30%, of participants were married and 21.1% were divorced. Chart A2. Percentage of Participants by Marital Status 40% 32% 30% 30% 21% 20% 6% 9% 2% 0% Never Married (n=1218) Married (n=1144) Divorced (n=803) Co-habitating (n=224) Separated (n=343) Widowed (n=77) Additional points Analysis revealed differences in marital status by gender, χ2 (5, N = 3,809) = 49.4, p < .001. Women were more likely to be separated or divorced than men; 38.5% of women fell into these two groups as compared to 28.4% of men. Men were more likely to be single than women; 33.2 % of men reported having never been married as compared to 26.0% of women. 21 Appendix B - Demographics Dependence Status Based on data taken at pre-test (before the intervention), there were 1,493 (39.2%) participants in the non-dependent group, 752 (19.7%) in the dependent group and 1,564 (41.1%) in the physiologically dependent group (Chart A3.). These groupings are based on the answers to seven questions covering DSM-IV symptoms and are an approximation, not an actual diagnosis. Chart A3. Percentage of Participants, Male and Female Participants by DUI Offender Status 60% 40% 41% 39% 20% 20% 0% Nondependent (n=1493) Dependent (n=752) Dependent with Physiological Dependence (n=1564) Additional points Analysis revealed differences in dependence status by gender, χ2 (2, N = 3,809) = 74.2, p < .001. Women endorsed significantly fewer DSM-IV type symptoms than men. Half of the women in the sample fell into the nondependent group as compared to 37% of men. While 44% of men were in the dependent with physiological dependence group, only 26% of women were in this group. Family History Half of participants indicated that they had at least one biological family member who they believed had alcoholism or a serious “drinking problem.” There were 1,933 (50.7%) participants who reported relatives with alcohol problems and 1,876 (49.3%) participants who reported no relatives with alcohol problems. Figure A1. Percentage of Participants by Family History of Alcohol Problems 49% 51% No Family History 22 Positive Family History Appendix B - Demographics Family History Additional points The relationship between dependence status and family history is shown in Chart A4. Participants with a positive family history were significantly more likely to be in the dependent with physiological dependence category and less likely to be in the not dependent category, χ2 (2, N = 3,809) =111.9, p < .001 Chart A4. Percentage of Students in the Family History Categories within Dependence Groups 60% 49% 47% 40% 33% 32% 20% 20% 20% 0% Not Dependent (n=1493) Dependent (n=752) Dependent with Physiological Dependence (n=1564) Negative (n=1876) Positive (n=1933) 23 References Agostinelli, G., Brown, J.M., & Miller, W.R. (1995). Effects of normative feedback on consumption among heavy drinking college students. Journal of Drug Education, 25:1, 31-40. Bachman, J. G., Johnston, L. D., & O’Malley, P. M. (1988). 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