Increasing Moral Maturity Levels in Young Adult Patients Undergoing Substance Abuse Treatment

by Marino E. Carbonell

An Applied issertation Submitted to t!e "isc!ler Sc!ool o# Education and $uman Services in Partial "ul#illment o# t!e %e&uirements #or t!e egree o# octor o# Education

'ova Sout!eastern University

())* Approval Page T!is applied dissertation +as submitted by Marino E. Carbonell under t!e direction o# t!e persons listed belo+. It +as submitted to t!e "isc!ler Sc!ool o# Education and $uman Services and approved in partial #ul#illment o# t!e re&uirements #or t!e degree o# octor o# Education at 'ova Sout!eastern University.

,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Anne Tot!- Ed Committee C!air

,,,,,,,,,,,,,,,,,,,,,,,,,,,, ate

,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, .arbara Pac/er0Muti- Ed Committee Member

,,,,,,,,,,,,,,,,,,,,,,,,,,,, ate

,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Maryellen Ma!er- P! E1ecutive ean #or %esearc! and Evaluation

,,,,,,,,,,,,,,,,,,,,,,,,,,,, ate

ii

Ac/no+ledgments "irst- I e1press my deepest appreciation to t!e #aculty members in t!e C!ild and Yout! Studies at t!e "isc!ler Sc!ool o# Education and $uman Services at 'ova Sout!eastern University. So many teac!ers +ere instrumental in my educational success. To list 2ust a #e+3 r. Anne Tot!- my applied dissertation committee c!air- +!o guided and supported me t!roug!out t!is pro2ect4 r. Marcia S/opp- C!ild and Yout! Studies doctoral enrollment counselor- +!o convinced me t!at t!e Ed degree +as an attainable goal4 r. Tom 5ennedy- program pro#essor o# applied researc!- +!o encouraged me to 62ust get it done74 and to all t!e ot!er caring and outstanding academicians +!o #acilitated my educational ob2ectives. "inally- I am most grate#ul #or my #amily3 my +i#e- 5arelia- and son .renden+!o !ave encouraged- supported- motivated- and listened #or t!e past several yearsal+ays +it! compassion- love- and a sense o# pride. My son .renden8s undergraduate commencement ceremony #rom Yale University +as on May (*- ())9.

iii

Abstract Increasing Moral Maturity Levels in Young Adult Patients Undergoing Substance Abuse Treatment. Carbonell- Marino E.- ())*3 Applied issertation- 'ova Sout!eastern University- "isc!ler Sc!ool o# Education and $uman Services. Moral evelopment: Maturity ;Individuals<:Substance Abuse:Cognitive evelopment:=utcomes o# Treatment T!is applied dissertation +as designed to test a /ey proposition based on 5o!lberg8s Cognitive Moral evelopment T!eory. T!is study attempted to ans+er t!e researc! &uestion- Is t!ere a di##erence in moral maturity level in young adult patients undergoing substance abuse t!erapy> T!at is- is t!ere a di##erence in moral maturity level- as measured by %est8s ;?@9@< e#ining Issues Test ; IT<- bet+een young adults undergoing substance abuse t!erapy and young adults not undergoing substance abuse t!erapy> Preliminary researc! into t!e #actors t!at a##ect and gauge et!ical moral maturity among young adult patients undergoing substance abuse treatment #ailed to uncover studies t!at address t!is particular area. T!e researc!er implemented a &uestionnaire and survey to ans+er t!e researc! &uestion. A met!odology #or testing t!e researc! &uestion +as developed and employed #or an e1ploratory study utiliAing () young adults. T!e IT instrument +as distributed to t!e consenting sub2ects. A letter e1plaining t!e reasons #or t!e survey- a sel#0administered IT &uestionnaire- and instructions #or completing t!e B0digit identi#ication number on t!e IT +as distributed at t!e time t!e study. 'o di##erences +ere #ound bet+een cognitive moral development o# t!e young adults undergoing substance abuse t!erapy and young adults not undergoing substance abuse t!erapy. Alt!oug! #indings +ere not statistically signi#icant- t!is study o##ers t!e potential #or #urt!er researc!. T!e true value o# t!is researc! is to set t!e stage #or gat!ering a broader insig!t into moral maturity and substance abuse as a +!ole.

iv

Table o# Contents

Page C!apter ?3 Introduction........................................................................................................? 'ature o# Problem....................................................................................................? Setting......................................................................................................................? Purpose o# Problem..................................................................................................? %esearc! Cuestion...................................................................................................B C!apter (3 %evie+ o# %elated Literature.............................................................................9 $istory o# "actors T!at In#luence Young Adult Substance Abuse..........................9 Inclusion %esearc!...................................................................................................@ isadvantages o# E1ploring t!e isease Concept ................................................?) =t!er "actors T!at In#luence Young Adult Substance Abuse3 Peer Pressure and Sel#0Esteem............................................................................................................?( C!anges in "amily Structure and Parental S/ills ..................................................?D .ene#its o# Young Adult Treatment T!erapies......................................................?E T!e Importance o# "ait! and %eligion...................................................................?* Young Adult .e!aviors and Cognitive evelopment Strategies..........................() C!apter D3 Met!odology....................................................................................................(D Participants and Sub2ects.......................................................................................(D Sample SiAe and Composition...............................................................................(D Sub2ect Selection- %ecruitment- and Eligibility %e&uirements..............................(D Met!ods and Procedures........................................................................................(F Measures and Administration................................................................................(B Potential %is/s to Sub2ects.....................................................................................(E .ene#its to Sub2ects................................................................................................(E %is/ and .ene#it %atio...........................................................................................(E Consent "orms.......................................................................................................(9 Personal $ealt! In#ormation Use...........................................................................(9 C!apter F3 %esults..............................................................................................................(* %esearc! "indings..................................................................................................(* Comparative %esults..............................................................................................(@ Summary o# Analysis and Presentation o# "indings..............................................D( C!apter B3 iscussion........................................................................................................DD iscussion o# %esults and Conclusion...................................................................DD Evaluation o# t!e Approac!...................................................................................DF Limitations o# t!e Study.........................................................................................DF irections #or "uture %esearc!..............................................................................DB v

%e#erences..........................................................................................................................DE

Appendi1es A Sample Cuestionnaire ....................................................................................F) . IT3 Sample ilemma....................................................................................F( Tables ? ( D A'=GA Tables #or Hender- Age- Education- and T!erapy Iit! Cognitive Moral evelopment ;P Scores< ependent....................................................(@ escriptions- Means- and Standard eviations o# Gariables- All IT Indices "rom t!e StandardiAation Sample......................................................D) Analysis o# Gariance %esults #or Young Adults Sample Hroup....................D?

vi

C!apter ?3 Introduction Nature of Problem Young adult patients undergoing substance abuse treatment are at ris/ o# !aving lo+ moral maturity. T!e increase in sub2ectivity o# moral values in American society #or t!e past B) years !as gradually permeated to t!e !ig! sc!ools and elementary sc!ools ;Evans- ?@@*4 Jo!nson- ?@@B<. Alt!oug! e1perimentation +it! social values may be appropriate #or college students- it is not necessarily bene#icial to encourage younger- less e1perienced students to #ind t!eir o+n morality. A revie+ o# t!e literature suggested t!e ans+er is t!at t!ey are ingrained +it! a relativistic understanding o# morality00a p!ilosop!ic attitude t!at- according to Mill ;as &uoted in Jo!nson<- t!e basic problem is t!at no one is +rong- 2ust di##erent. It is speculated t!at t!is cycle may mani#est in young adult drug dependency ;Murray- ())(4 Po+er- ?@@9<. Setting As t!e largest metropolitan area in t!e state o# "lorida- +it! a population o# about D million- t!is community is a microcosm o# national trends- including young adult substance abuse. According to t!e ?@@* 'ational $ouse!old Survey o# rug Abusedrugs are very muc! part o# a teen8s li#e. .y t!e time t!ey !ave graduated #rom !ig! sc!ool- about B)K o# young adults !ave e1perimented +it! illegal substances. "urt!ermore- treating t!e young adult in t!ese cases is a matter o# utmost importance ;At!ealt!.com- ())?<. T!e researc!er8s private practice- located in Miami0 ade Countyis one o# a #e+ treatment #acilities available to #amilies su##ering #rom substance abuse. Purpose of the Problem

According to $anson ;())(<- a recent dramatic #inding in neurobiological researc! may greatly increase t!e understanding o# young adult decision ma/ing and t!e ability to !elp t!is age group c!oose +isely regarding drug abuse. T!is #inding suggests t!at t!e young adult brain is still developing p!ysically and #urt!er investigation can ans+er some o# t!e cognitive issues a##ecting t!e appeal o# and decision to use drugs. Most importantly- according to $anson- 6c!ronic drug abusers start e1perimenting +it! into1ication in young adult!ood7 ;p. F< and it is generally true t!at people +!o do not abuse drugs be#ore age (B are unli/ely to develop a serious drug problem. Preliminary researc! into t!e #actors t!at a##ect and gauge et!ical moral maturity among young adult patients undergoing substance abuse treatment !as #ailed to uncover studies t!at address t!is particular area. Conse&uently- it +as crucial #or t!e applied researc! to occur. T!e researc!- conducted +it!in a substance abuse treatment programserved as a precedent #or substance abuse treatment and #or ot!er recovery programs in t!e state o# "lorida and around t!e nation. T!is application can be speci#ically targeted to t!e young adult population t!at is undergoing substance abuse t!erapy. A revie+ o# t!e literature suggested t!at young adults are ingrained +it! a relativistic ;every moral c!oice is e&ually valid and t!us can moral c!oices really matter at all< understanding o# morality ;Evans- ?@@*4 Jo!nson- ?@@B< leading to drug dependency in some cases ;Murray- ())(<. Un#ortunately- t!ere are no speci#ic rules #or current generic treatment o# drug addiction. More researc! needs to be conducted to understand t!e best +ay to matc! treatment to patient. Iit!out a panacea #or t!e treatment o# t!ese comple1 substance

abuse disorders- t!e searc! #or additional treatment approac!es becomes e1tremely important including #uture developments in ;a< genetic identi#ication o# !ig!0ris/ individuals- ;b< identi#ication o# di##erent genetic in#luences- ;c< development o# drugs t!at in!ibit t!e dopamine transporter- and ;d< development o# a combination o# treatments to en!ance outcome in recovery. $o+ever- as t!e treatment models become more advanced and more sop!isticated- a great deal o# +or/ must be done to determine t!e optimal clinical applications o# t!ese discoveries ;Sc!uc/it- ?@@9<. Alt!oug! one treatment model mig!t +or/ best #or one sub2ect- it may not !ave positive results #or anot!er. More researc! is needed to identi#y individual addictive traits to gear treatment to a more individualistic approac!. Understanding early onset o# substance abuse !as important implications #or t!e development o# e##ective prevention programs. In recent longitudinal studies- t!e e##ects o# c!ild!ood be!aviors and #amily c!aracteristics !ave s!o+n to predict onset o# substance abuse among young adults. .asic personality dimensions are t!e underlying lin/ bet+een disruptive be!avior and substance abuse. Cloninger8s t!eory- encompassing t!ree personality dimensions00novelty see/ing- !arm avoidance- and re+ard dependence 00can be related to t!e be!avioral activation- in!ibition- and maintenance systems ;Masse L Tremblay- ?@@9<. .uilding on t!e recent #indings in neurobiological researc! may greatly increase t!e understanding o# young adult decision ma/ing adding to t!e study o# 5o!lberg8s ;?@E@< cognitive moral development ;CM < t!eory +it!in t!e young adult population. Miller ;())(<- one o# t!e aut!ors o# a study at Columbia University- concluded t!at

young adults at !ig! ris/ o# addiction mig!t be protected #rom substance abuse i# t!ey become involved in some religious community. T!e data !elp support t!e t!eory t!at young adults need some #orm o# moral or spiritual education to !elp t!em ma/e !ealt!y li#e c!oices. T!e area o# moral or spiritual education is an important piece o# t!e puAAle in young adult be!avior and may be t!e ans+er to guarding against young adult addiction or drug abuse ;Miller- ())(<. Moral education is becoming an increasingly popular topic in t!e #ields o# psyc!ology and education. Many may even go a step #urt!er and say t!ere is a moral crisis in our nation. T!ere is a gro+ing trend to+ard lin/ing t!e solutions to t!ese and related social problems to t!e teac!ing o# moral and social values ;'ucci- ?@@94 Po+er?@@9<. "inally- Miller8s ;())(< study indicated t!at morality is centered on a set o# universal concerns #or 2ustice- #airness- and !uman +el#are t!at are available even to young c!ildren. At t!e same time- t!e developmental and constructivist basis o# moral /no+ledge is commensurate +it! interactive rat!er t!an directive educational practices ;'ucci- ?@@9<. T!e goal o# moral education based on t!e t!eories o##ered by 5o!lberg ;?@E@< and Piaget ;?@D(< encourages individuals to develop to t!e ne1t stage o# moral reasoning. evelopment consists o# a se&uence o# &ualitative c!anges in t!e +ay an individual t!in/s ;'ucci- ?@@9<. T!e individual +ill- at some point- encounter in#ormation t!at does not #it into !is or !er +orldvie+- t!us #orcing t!e individual to ad2ust !is or !er vie+ to accommodate t!is ne+ in#ormation. T!is process is called e&uilibration- t!roug! +!ic!

development occurs ;'ucci<. T!is applied dissertation e1amined t!e moral maturity levels o# young adult patients undergoing substance abuse t!erapy using 5o!lberg8s ;?@E@< t!eory o# CM . T!is study used t!e e#ining Issues Test ; IT< developed by %est ;?@9@< to measure 5o!lberg8s levels o# moral reasoning. T!is researc! analyAed and evaluated t!e relations!ip bet+een treatment and t!e moral maturity level o# young adult patients undergoing substance abuse t!erapy. T!e IT #acilitates interpretation o# 5o!lberg8s stages o# CM by allo+ing #or &uantitative measurement o# moral 2udgment. T!e IT measures !o+ an individual8s concept o# 2ustice- as represented by !is or !er stage o# CM or 2udgment- in#luences decisions ;%est- ?@*F<. %est ;?@9@< believed t!at based on conte1t- individuals may e1!ibit di##erent degrees o# 2udgment4 !is IT measures moral 2udgment +it! a P ;principled< score rat!er t!an by level or stage. T!is researc! analyAed and evaluated t!e relations!ip bet+een substance abuse and moral maturity. T!is study encompassed 5o!lberg8s ;?@E@< stages in classi#ying t!e level o# moral reasoning pertinent to young adult patients undergoing substance abuse treatment. T!e results o# t!e study provided an important starting point #or ot!er researc! #ocused on analyAing t!e moral development o# young adults in general. T!e #ollo+ing outcomes +ere pro2ected3 ?. T!e #irst e1pected outcome +as t!at * o# ?) young adults undergoing substance abuse t!erapy +ould s!o+ decreased moral maturity ;P score M .()< +!en tested by t!e IT. (. T!e second e1pected outcome +as t!at * o# ?) young adults not undergoing

substance abuse t!erapy +ould s!o+ increased moral maturity ;P score N .()< +!en tested by t!e IT. Research Question T!e #ollo+ing researc! &uestion +as addressed in t!is study3 Is t!ere a di##erence in moral maturity level in young adult patients undergoing substance abuse t!erapy> T!at is- is t!ere a di##erence in moral maturity level- as measured by t!e IT- bet+een young adults undergoing substance abuse t!erapy and young adults not undergoing substance abuse t!erapy> T!e &uestion did not measure be!avior but only t!e moral reasoning levels o# t!e young adult participants. 5o!lberg ;?@E@< did not develop !is model to measure et!ical be!avior but rat!er to measure moral reasoning- +!ic! is considered as t!e #oundation o# et!ical be!avior. Conse&uently- be!avior +as not 2udged or evaluated in t!is study. T!is study encompassed 5o!lberg8s stages in classi#ying t!e level o# moral reasoning pertinent to young adult patients undergoing substance abuse treatment. T!e results o# t!e study provided an important starting point #or ot!er researc! #ocused on analyAing t!e moral development o# young adults in general.

C!apter (3 %evie+ o# %elated Literature History of Factors That Influence Young Adult Substance Abuse Addictions to alco!ol- nicotine- and cocaine involve a p!ysical or psyc!ological dependence on t!e drug4 any substance t!at can c!ange a mood or state o# mind is called a psyc!oactive or mood0c!anging drug. A p!ysical dependence is mani#ested by +it!dra+al symptoms t!at occur +!en t!e person stops using t!e drug. Several steps t!at identi#y t!e development o# addiction are as #ollo+s ;Monroe- ?@@E<3 ;a< relie# #rom boredom- ;b< increased use- ;c< preoccupation in ac&uiring drugs- ;d< dependency on drugs to #eel o/ay- and ;e< +it!dra+al. Moreover- young adults +!o are e1perimenting +it! illicit drugs may e1!ibit t!e p!ysical e##ects mentioned above. T!ey may also begin e1!ibiting ot!er negative be!aviors suc! as !iding cigarettes- alco!ol- and drugs. Additionally- t!ey may e1perience s+inging mood c!anges- temper #lare0ups- and may engage in stealing money #rom #amily and #riends to support drug use. Sc!ool attendance and grades may drop- and young adults may begin to socialiAe +it! a drug0using cro+d. Parents need to be vigilant about illicit drug use but especially vigilant about mari2uana. Mari2uana remains t!e most commonly abused drug in t!e United States ;Monroe- ?@@E< and is usually t!e #irst drug +it! +!ic! teens e1periment be#ore graduating to !arder drugs- suc! as cocaine- ecstasyand even alco!ol. .rea/ing t!e addiction cycle depends on t!e drug o# c!oice. Some addicts try to stop 6cold tur/ey-7 meaning t!e addict stops all at once +it! no treatment. T!is type o# met!od can be di##icult to sustain. Anot!er option is tapering o##- meaning t!at t!e addict

gradually stops ta/ing drugs and may need some !elp to &uit ;Hrob L de %ios- ?@@(4 Monroe- ?@@E<. Anot!er tec!ni&ue is ta/ing a substance to !elp +it! t!e addiction urge suc! as Antabuse ;#or alco!ol< or nicotine gum. A ?(0step program or ot!er support group can !elp addicts deal +it! abstinence- and- #inally- intervention treatments ;+!et!er inpatient- outpatient- community based- or private t!erapy< may be t!e only ans+er ;Monroe<. T!e long0term goal o# any treatment is to c!ange t!e person8s li#e so t!at drug use is no longer an option. $o+ever- addiction is a toug! cycle to brea/ and treatment is not a guaranteed option. Many addicts #ind t!e drug0#ree li#estyle and treatment environment !ard to cope. enial inter#eres +it! recovery. "or teens- parents need to be a+are o# t!e c!anges t!at become apparent as addiction becomes more serious. Usually c!anges in sc!ool and peer situations are indicative o# a drug problem ;Monroe<. Anot!er area to consider +!en identi#ying young adult drug use is t!e type o# substances abused ;+!et!er alco!ol- illicit drugs- or tobacco<. According to .erenson ;as cited in Monroe- ?@@E<- t!ese can be predicted by t!e type o# abuse ;p!ysical- se1ual- or bot!< as +ell as by t!e perpetrator o# t!e abuse. A study commissioned by t!e University o# Te1as Medical .ranc! #ound t!at t!e psyc!ological damage #rom p!ysical abuse may play a role in substance abuse. T!e study #ound t!at abused c!ildren !ave lo+er sel#0 esteem- less con#idence- and more mistrust o# ot!ers. .erenson ;as cited in Monroe< +ent on to say substance abuse may be an e##ort to sel#0medicate and escape emotional pain. T!e results o# t!is particular study strongly support a positive correlation bet+een drug abuse and p!ysical and se1ual abuse.

=t!er studies e1amining drug abuse and c!ild abuse are ma/ing advances. A 'ational Institute on rug Abuse0#unded revie+ at $arvard Medical Sc!ool e1amined F@ cases involving drug0abusing +omen +it! posttraumatic stress disorder. Most +omen reported c!ild abuse trauma. T!is study reported t!at D)K to E)K o# +omen in drug abuse treatment also !ave +it! posttraumatic stress disorder- t+o to t!ree times !ig!er t!an t!e rate among men in treatment ;Manisses Communication Hroup- ?@@B<. =verallalt!oug! t!e studies connecting drug abuse and c!ild abuse !ave made some impact in t!is area o# researc!- t!e di##iculty in validating t!e data ;S+an- ?@@*< !as !indered development o# treatment and prevention approac!es addressing t!e needs o# c!ild abuse victims. Inclusion Research %ecent developments !ave improved t!e general understanding o# genetic #actors t!at contribute to t!e ris/ #or alco!olism and drug addiction. T!e process o# development and perpetuation o# dependence on a substance is !ig!ly comple1. Additional social #actors mi1ed +it! biological #actors contribute to dependence ;Sc!uc/it- ?@@9<. Addiction is a brain disease and ris/ o# addiction can be in!erited ;.rody- ())D<. $eredity accounts #or about F)K o# t!e ris/ ;.rody<. Cami and "arrO ;())D< observed t!at personality traits suc! as ris/0ta/ing and novelty0see/ing tendencies are ma2or conditioning #actors in drug addiction. Additionally- because prolonged e1posure to abused drugs results in long0lasting c!anges in t!e brain- addiction s!ould be considered a c!ronic medical illness ;.rody4 elong- ?@@94 Peele- ?@*Eb<. =ne o# t!e +ays to treat young adult drug abuse is to modi#y t!e cultural climate

?)

;Pic/ler- ?@@@<- #ocusing c!ildren to value and ac!ieve independence- adventureintimacy- consciousness- activity- and commitment to community among many ot!er t!ings. Moreover- Peele ;?@*Ea< dismissed t!e disease concept o# addiction but used Gaillant8s disease t!eory to support !is o+n conclusions t!at addiction is a +!ole li#e0 style issue and needs to be e1plored under t!e conte1t o# be!avioral modi#ication- not 2ust genetics. T!ere is an ongoing struggle to understand better t!e root o# addiction +!et!er biological or situational ;Peele- ?@*Ea<. =t!er aut!ors noted problem drug use is a symptom- not a cause o# personal and social malad2ustment and t!at t!e meaning o# drug use can best be understood in t!e conte1t o# an individual8s personality structure and development !istory ;Hrob L de %ios- ?@@(<. Hrob and de %ios !ypot!esiAed t!at current e##orts at drug prevention are misguided to t!e e1tent t!at t!ey #ocus on symptoms rat!er t!an on t!e psyc!ological syndrome underlying drug abuse. isad!antages of "#ploring the isease $oncept T!e American Academy o# Pediatrics- Committee on C!ild $ealt! "inancing- and Committee on Substance Abuse identi#ied t!at t!e numbers o# c!ildren- young adults- and #amilies a##ected by substance abuse !ave s!arply increased since t!e ?@@)s. Un#ortunately- t!e availability o# and #inancing #or substance abuse preventionassessment- and treatment !ave not /ept pace +it! t!e needs o# t!e young people009BK to *)K o# c!ildren +!o are in need o# mental !ealt! treatment #ail to receive it ;Committee on C!ild $ealt! Financing and Committee on Substance Abuse, 2001). T!e conse&uences o# #ailing to intervene early and #ailing to provide age0appropriate

??

substance abuse and mental !ealt! treatment are substantial and long0term. $o+evert!ere is gro+ing evidence t!at success#ul early intervention and treatment carries a signi#icant bene#it #or t!e individual and society ;American Academy o# PediatricsCommittee on C!ild $ealt! "inancing and Committee on Substance Abuse- ())?<. espite t!e #act t!at t!ere is no single treatment approac! t!at +or/s #or all patients- standard treatment !as s!o+n to produce signi#icant decreases in drug use ;Les!ner- ())?<. Standard substance abuse treatment programs in t!e United States are rooted in t!e disease concept- consisting mostly o# t!e spiritual ?(0step Alco!olics Anonymous program. T!e problem is t!at researc! designed to assess t!ese programs8 e##ectiveness in controlling alco!olism and drug addiction !as not been reassuring ;Peele?@@)<. Certain c!aracteristics o# t!e patient- not treatment- are crucial to t!e outcome o# t!e addiction treatment. People +!o succeed t!roug! treatment or on t!eir o+n do so #or similar reasons. %esearc! supported t!at certain c!aracteristics o# t!e patient and not treatment itsel# is responsible #or t!e outcome. Patients +it! stable #amily and +or/ succeed at a !ig!er rate ;Peele- ?@@)<. A recent dramatic #inding in neurobiological researc! may greatly increase t!e understanding o# young adult decision ma/ing and t!e ability to !elp t!is age group c!oose +isely regarding drug abuse. T!is #inding suggests t!at t!e young adult brain is still developing p!ysically and #urt!er investigation can ans+er some o# t!e cognitive issues a##ecting t!e appeal o# and decision to use drugs. Most importantly- c!ronic drug abusers start e1perimenting +it! into1ication in adolescence or young adult!ood and it is

?(

generally true t!at people +!o do not abuse drugs be#ore age (B are unli/ely to develop a serious drug problem ;$anson- ())(<. Prevention programs o#ten are designed to en!ance protective #actors and to reduce ris/ #actors. Some protective #actors are ;a< strong and positive #amily bonds- ;b< clear rules o# content en#orced +it!in #amily- ;c< success in sc!ool per#ormance- ;d< strong bond +it! institutions suc! as sc!ool- and ;e< adoption o# conventional norms about drug use. Some ris/ #actors are ;a< c!aotic !ome environments- ;b< inappropriately s!y or aggressive be!avior in classroom- ;c< #ailure in sc!ool per#ormance- and ;d< poor social coping s/ills ;$anson- ())(<. $anson8s ris/0and0protective strategy !as opened an area o# interest #or continuing researc! in young adult addiction prevention- treatmentand recovery. .uilding on t!e recent #indings in neurobiological researc! may greatly increase t!e understanding o# young adult decision ma/ing- adding to t!e study o# 5o!lberg8s ;?@E@< CM ;discussed in a later c!apter< +it!in t!e young adult population. %ther Factors That Influence Young Adult Substance Abuse& Peer Pressure and Self' "steem Many studies stressed t!at t!e #irst e1perience +it! drugs usually occurs during adolescence. Iol# et al. ;?@@B< noted t!e !ig! incidence o# t!e use o# !as!is! and mari2uana by young adults !as led to a considerable amount o# scienti#ic literature on t!e sub2ect. In t!is conte1t- Jessor et al. ;as cited in Iol# et al.< claimed t!at t!e p!enomenon o# t!e use o# !as!is! and mari2uana by young adults s!ould be e1amined against t!e bac/ground o# psyc!ological processes t!at typi#y adolescence. $uba- .entler- and Iingard ;as cited in Iol# et al.< proposed a model t!at attempted to e1plain !o+ interactions among a +ide range o# sets o# #actors ;personal and environmental< lead to

?D

drug use. T!is model paved t!e +ay #or studies t!at e1amined connections bet+een di##erent relevant variables and drug use in young adults. Anot!er t!eory is t!e in#ormation integration t!eory proposed by Anderson ;as cited in Iol# et al.- ?@@B<+!ic! assumes t!at t!e individual integrates in#ormation #rom di##erent relevant sources in order to generate a valid response. Among young adults- t!e t!eory !as been used to e1amine t!e development o# moral 2udgment. In ot!er +ords- individuals interpret reality as relevant to t!eir o+n e1periences ;Iol# et al.<. Pressure #rom t!e re#erence group ;or peer group< plays a central role in t!e c!oices made by any individual. Moreover- t!e term adolescence represents a stage in t!e development o# t!e individual and +as #irst suggested in ?9E( by %ousseau to represent an e1perience o# second birt! ;Iol# et al.- ?@@B<. Eri/son ;as cited in Iol# et al.< postulated t!at adolescence is c!aracteriAed by c!allenge o# identity #ormation. According to Gictor et al. ;as cited in Iol# et al.<- t!is c!allenge #or middle0class yout! +!o !ave no !istory o# pat!ology and +!o do not use drugs is associated +it! curiosityris/ ta/ing- and searc! #or ne+ e1periences. Curiosity is accepted as t!e most common motive #or embar/ing on drug use. Puc/erman ;as cited in Iol# et al.< also #ound t!at users perceive curiosity as a motive #or t!eir initiation into drug use. $hanges in Family Structure and Parental S(ills In e1amining American young adult drug abuse issues- t!ere is an implicit presumption or bias in #avor o# sel#0contained individualism as an un&uestioned value. An analysis o# contemporary American society as it impacts t!e sel# is important #or t!e

?F

discussion o# young adult drug abuse. Cus!man ;?@@)< maintained t!at since Iorld Iar II- t!e con#iguration o# an empty sel# !as emerged in American middle classes- empty in part because o# t!e loss o# #amily- community- and tradition. T!e sel# !as to be #illed by consuming goodse1periences- and emp!atic t!erapists attempting to #ig!t t!e gro+ing alienation and #ragmentation o# its era. Inner emptiness can be e1pressed in many +ays- including lo+ sel#0esteem and drug abuse. Conse&uently- drug abuse is t!e compulsion to #ill t!e emptiness +it! c!emically induced emotional e1periences as +ell as t!e absence o# personal meaning and t!e !unger #or spiritual guidance ;Hrob L de %ios- ?@@(<. C!anges t!at !ave evolved among t!e #amily !ave also a##ected today8s sc!ools and may be one o# t!e contributing #actors #or an increase in c!emical dependency in t!e young adult population. Sc!oolteac!ers complain t!at parents are more an1ious about t!eir c!ildren8s success- yet less available to support and guide t!em- and are more demanding and critical o# t!e sc!ool ;Evans- ?@@*<. Additionally- parents !ave become ine##ective in setting limits on t!eir c!ildren ;Cus!man- ?@@)<. A decline in civilitysocial responsibility- and institutional a##iliation adversely a##ects sc!ools t!ese days ;Evans4 Cus!man<. Evans ;?@@*< described !o+ t!e #amily !as been trans#ormed over t!e past F) years. T!e modern #amily structure is more #luid- less stable- and more vulnerable to outside pressures t!an its predecessor ;t!e traditional #amily<. T!e traditional #amily8s central value +as toget!erness. "amily +as placed be#ore sel#. Parental aut!ority- i# not absolute- +as unilateral. Parents +ere to provide protection- guidance- and discipline. T!e

?B

central value o# t!e ne+ modern #amily structure is autonomy4 individual #amily members pursue t!eir o+n #ul#illment. Parental aut!ority !as +ea/ened and is o#ten at best mutual- a matter o# renegotiation +it! c!ildren. Parents are less li/ely to set #irm guidelines and more li/ely to negotiate decisions ;Evans4 Mac/- ?@@F<. Moreover- adults !ave become more s/eptical +it! a greater mistrust o# institutions- ma/ing parents less li/ely to respect t!e sc!ool8s aut!ority. Today8s permeable #amily centers on t!e +ell being o# adults- denying c!ildren t!e basics o# !ealt!y gro+t! on +!ic! psyc!ological !ealt!- e##ective learning- and civility and community depend. Toget!er- t!ese basics are essential to development o# sel#0esteemand to +!at Holeman ;as &uoted in Evans- ?@@*< called 6emotional intelligence7 ;p. F<. T!ese c!anges in t!e #amily structure are a##ecting t!e educational systemt!reatening and over+!elming sc!ools. In t!e ?@B)s- institutional aut!ority +as strong00 t!e sc!ool8s +ord +as generally t!e la+. T!e abdication o# c!ild rearing tas/s by t!e #amily and ot!er social institutions- and criticism t!at sc!ools !ave #ailed to prepare students- !ave contributed to t!e brea/do+n o# moral education- leading to a decrease or loss o# civility among students and parents ;Evans- ?@@*<. $o+ever- t!e greatest in#luence parents can e1ert on t!eir c!ildren8s +ell0being and emotional development- as +ell as t!eir sc!ool8s success- is in t!e +ay t!ey parent t!roug! t!e t!ree #actors o# !ealt!y gro+t! ;nurture- structure- and latitude< coupled +it! understanding and respecting t!e sc!ool8s values. Conse&uently- t!e c!anges t!at !ave evolved +it!in t!e #amily !ave a##ected t!e cognitive development o# c!ildren ;Evans?@@*4 Murray- ())(4 'ucci- ?@@9<.

?E

At t!e source o# t!e gentle c!ild0rearing et!os +as "reud- +!ose discoveries gave rise to t!e idea t!at parental mista/es could +rea/ li#elong damage upon a c!ild. In ?@FBSpoc/ introduced t!e t!eory t!at t!e /ey to raising !appy c!ildren +as to relin&uis! t!e biblical model o# parent!ood and relieve c!ildren o# t!ose pressures o# parental po+er and aut!ority t!at supposedly created dependent and in!ibited adults ;Mac/- ?@@F<. 'ot too long ago- parents +ere loo/ed upon as repositories o# +isdom and rectitude and unc!allenged custodians o# t!eir c!ildren. Today- parents are assailed as abusive and un+ort!y o# t!eir aut!ority over c!ildren. According to Mac/- Spoc/ and !is disciples stood t!e ideal o# good parent!ood on its !ead. "or t!em- 6good7 parents +ere not t!ose +!o got t!eir c!ildren to be!ave but t!ose +!o understood +!y t!eir c!ildren misbe!aved. uring t!e last #e+ decades- ot!er aut!ors !ave contributed to t!e literature on parent:c!ild relations!ips. In t!e late ?@E)s and early ?@9)s- Hinott ;?@9?< and Hordon ;?@9B< advised +eary parents to use t!erapeutic and counseling tec!ni&ues to deal +it! t!eir c!ildren. $o+ever- t!is permissive sc!ool o# t!oug!t +as criticiAed. Parents +!o !ad granted t!eir c!ildren 6voting rig!ts7 and po+er to negotiate !ouse!old rules +ere t!e same parents +!o +ere rescuing t!eir c!ildren #rom embarrassing drug busts. .y t!e ?@*)s- #aced +it! statistical evidence o# rising drug use- violence- and delin&uency- a ne+ +ave o# c!ild0rearing e1perts called #or a return to more aut!ority and discipline in raising c!ildren. S+iss psyc!oanalyst- A. Miller ;?@@?< insisted t!at parent!ood +as not a rational- conscious process dictated by a set o# belie#s about !o+ c!ildren s!ould be raised. It +as an unconscious po+er struggle bet+een adults and t!eir

?9

c!ildren. .rads!a+ ;as cited in Mac/- ?@@F< touted t!at 6soul murder7 +as t!e most basic problem in t!e +orld. .rads!a+8s r!etoric espoused t!e t!eory t!at even t!e most enlig!tened modern parents resorted to aut!oritarian roles in times o# stress and crisis and it +as at t!ese times t!at t!ey crus!ed t!e souls o# t!eir c!ildren ;Mac/<. T!e underlying impetus o# movements suc! as .rads!a+8s ;as cited in Mac/?@@F< to 6liberate7 c!ildren #rom parental control and impositions +as seen as !aving little to do +it! concern #or t!e +el#are o# c!ildren. 'e+ #amily styles ma/e it ne1t to impossible #or t!e ma2ority o# parents to provide t!e /ind o# c!ild rearing t!at goes along +it! t!e image o# c!ildren as in need o# parental nurture ;Evans- ?@@*4 Mac/<. .y assuming t!e competency o# sc!ools and communal institutions to raise c!ildren- or +orse o# c!ildren to raise t!emselves- parents also imagine t!at t!ey are doing t!e rig!t t!ing in #ailing or re#using to accept #ull responsibility #or t!e p!ysical care and t!e moral education o# t!eir o+n c!ildren. Parents today are more li/ely to neglect t!eir c!ildren t!an to abuse t!em ;Mac/- ?@@F<. Conse&uently- t!e greatest in#luence parents can e1ert on t!eir c!ildren8s +ell0being and emotional development00as +ell as t!eir sc!ool8s success00is in t!e +ay t!ey parent. 'eglecting to parent can be considered a type o# c!ild abuse ;Mac/<. )enefits of Young Adult Treatment Therapies eciding to send a young adult to a residential treatment #acility is a #amily decision. C!ildren8s problems include be!avior- substance abuse- and learningsuggesting t!at t!e e##ects on t!e #amily +it! drug0abusing c!ildren !ave an enormous strain on marriage- sibling tension- and parents8 o+n emotional scars. ecisions are made

?*

best +!en problems are identi#ied because by t!e time parents consider residential treatment- t!ey !ave probably tried ot!er met!ods. According to one study- predictors suggest t!at early parental involvement is /ey to success#ul treatment outcomes ; a/o#Te2eda- L Liddle- ())?<. Conse&uently- parents need to become in#ormed participants in t!eir c!ild8s recovery ; a/o# et al.<. =t!ers e1plore t!e possibility t!at teen centers !ave been #ocusing on t!e age rat!er t!an t!e addiction. Abstinence rates posttreatment #or young adults are dismal at centers t!at #ocus on t!e age o# t!e abuser instead o# t!e addiction. T!ere is no standard rate o# success in addiction treatment outcome studies- and a metarevie+ o# outcome studies #rom ?@*)0?@@D reported t!at only DD.EK o# studies used abstinence as an outcome variable. An earlier study #ound t!at young adults +ere F to B times more li/ely to maintain abstinence posttreatment going t!roug! a multigenerational setting t!an a young adult0only center ;Mars!all- ())?<. Among t!e negative e##ects #ound in young adult0only treatment centers is t!e lo+er ratio o# recovering sta##- t!e di##erential treatment o# younger patients by sta##- t!e emp!asis on #amily t!erapy over community ?(0step support- t!e deviant peer in#luencesand lo+ e1pectations in general #or abstinence and recovery. Also- treatment #or teens is more e1pensive and does not !ave su##icient data to s!o+ positive results ;Mars!all())?4 Petracca- ())(<. T!e lo+ opinion o# treatment values !eld by young adults !as been s!o+n to be a ma2or cause o# resistance to t!eir treatment and t!is resistance is being constantly rein#orced +!en young adults are placed in same0age settings ;Petracca- ())(<.

?@

Additionally- +!en assessing young adult treatment #acilities- one o# t!e #irst issues an individual con#ronts in caring #or t!e young adult patient is t!e issue o# con#identiality. T!e con#identiality rules t!at deal +it! minors vary #rom state to state- and many state la+s mandate con#identiality #or young adults +!en it comes to issues o# se1uality and substance abuse. "irst- an individual must be a+are t!at teenagers are &uic/ to overreact to perceived criticism. Second- cooperation must be promoted by e1plaining to t!e teen +!y t!e &uestions are being as/ed. T!ird- every opportunity must be used to praise teens #or !ealt!y be!aviors. Teenagers respond better t!an older patients to positive rein#orcement ;%oye- ?@@B<. Educating teenagers in !ospitals and ot!er settings about ris/y be!aviors is o# paramount importance. $o+ever- young adults do not !ave mature t!in/ing processes and many !ave trouble t!in/ing about #uture outcomes. Teens o#ten live entirely in t!e !ere and no+. As Jo!nson ;?@@B< indicated- satis#ying t!eir immediate needs is more important to t!em t!an delaying grati#ication to prevent #uture problems. T!ey +ant to be li/e t!eir peers. Young adults pre#er to be +it! /ids t!eir o+n age and are li/ely to be uncom#ortable s!aring a room +it! younger c!ildren or adults. T!us- young adults s!ould be grouped toget!er +!enever possible. =verall- privacy is o# t!e utmost importance to t!e young adult. Trusting and allo+ing teens to e1press individuality may also add to better treatment outcomes ;%oye- ?@@B<. The Importance of Faith and Religion T!e researc! revealed t!at teens +it! a !ig!er degree o# personal devotion-

()

personal conservatism- and institutional conservatism +ere less li/ely to engage in alco!ol consumption and ot!er drug use. T!is revelation is particularly signi#icant because t!e onset o# alco!olism and drug addiction usually occurs in adolescence. Unli/e adults in Alco!olics Anonymous- Miller ;())(< concluded in !er study t!at young adults +ere not !elped by a rigid or #orced ad!erence to religion. Young adults bene#ited by attaining a spiritual #oundation rat!er t!an a dogmatic religious education. I# teens !ave made a personal c!oice to pursue a spiritual li#e- t!ey are muc! less li/ely to drin/ or to abuse drugs ;Miller- ())(<. Miller8s ;())(< study also revealed t!at young adults at !ig! ris/ o# addiction mig!t be protected #rom substance abuse i# t!ey become involved in some religious community. T!is study also !elps support t!e t!eory t!at young adults need some #orm o# moral or spiritual education to !elp t!em ma/e !ealt!y li#e c!oices. T!e area o# moral or spiritual education is an important piece o# t!e puAAle in young adult be!avior and may be t!e ans+er to guarding against young adult addiction or drug abuse ;Miller- ())(<. $o+ever- t!e greatest in#luence parents can e1ert on t!eir c!ildren8s +ell0being and emotional development- as +ell as t!e student8s success at sc!ool- is in t!e +ay t!ey parent t!roug! t!e t!ree #actors o# !ealt!y gro+t! ;nurture- structure- and latitude<coupled +it! understanding and respecting t!e sc!ool8s values. Conse&uently- t!e c!anges t!at !ave evolved among t!e #amily !ave a##ected c!ildren8s cognitive development ;Evans- ?@@*<. As t!e analysis in t!e previous section discovered- moral education is becoming an increasingly popular topic in t!e #ields o# psyc!ology and education. Many may even

(?

go a step #urt!er and say t!ere is a moral crisis in our nation. T!ere is a gro+ing trend to+ard lin/ing t!e solutions to t!ese and related social problems to t!e teac!ing o# moral and social values in public sc!ools ;'ucci- ?@@94 Po+er- ?@@9<. Piaget ;?@D(< t!eoriAed t!at all development emerges #rom action- meaning t!at individuals construct and reconstruct t!eir /no+ledge o# t!e +orld as a result o# interactions +it! t!e environment- determining t!at morality could be considered a developmental process. "urt!ermore- moral sel#0relevance !as been s!o+n to play an important role in moral be!avior. Arnold ;as cited in 'ucci- ?@@9< #ound t!at in adolescence- moral sel#0relevance correlated positively +it! teac!er reports o# et!ical be!avior. Young adults +!o demonstrated altruism +ere more li/ely to describe t!emselves in terms o# moral personality traits. Hiven t!at relatively !ig! moral sel#0 relevance is associated +it! et!ical and altruistic be!avior- it seems reasonable to e1pect t!at moral sel#0relevance s!ould inversely relate to antisocial be!avior ;'ucci<. Young Adult )eha!iors and $ogniti!e e!elopment Strategies T!e goal o# moral education based on t!eories o##ered by 5o!lberg ;?@E@< and Piaget ;?@D(< encourages individuals to develop to t!e ne1t stage o# moral reasoning. evelopment consists o# a se&uence o# &ualitative c!anges in t!e +ay an individual t!in/s. T!e c!ild +ill at some point encounter in#ormation t!at does not #it into !is or !er +orldvie+- t!us #orcing t!e c!ild to ad2ust !is or !er vie+ to accommodate t!is ne+ in#ormation. T!is process is called e&uilibration- t!roug! +!ic! development occurs. T!e most common tool #or developing and stimulating moral development is to present a moral dilemma and re&uire students to determine and 2usti#y +!at course t!e actor in t!e

((

dilemma s!ould ta/e ;Murray- ())(<. 5o!lberg ;?@E@< !eld t!at moral education re&uires more t!an individual re#lection and also needs to include e1periences #or students to operate as moral agents +it!in a community. $is model to gauge CM and t!us t!e ability to teac! moral education !as become more important in today8s sc!ools and education system. Un#ortunately- sc!ool teac!ers are teac!ing a type o# relative morality +!ere t!ere are no rig!t or +rong actions but only toleration o# divergent vie+s t!at impede setting conse&uences and accountability not only to t!e respective students but to t!eir parentsspilling over to t!e community at large ;Evans- ?@@*<. T!e ma2ority o# parents e1pect teac!ers and ot!er sc!ool aut!orities to contribute to c!ildren8s moral development ;Evans- ?@@*4 'ucci- ?@@9<. $o+ever- t!ere is considerable discord and con#usion about +!at is meant +!en teac!ers and ot!er sc!ool aut!orities tal/ about morality. C!ildren in any society s!ould learn to con#orm to a number o# social rules and e1pectations i# t!ey are to become participants in t!e culture. C!ildren must learn t!e social conventions o# t!eir society. Conventions are s!areduni#orm be!aviors determined by t!e social system in +!ic! t!ey are #ormed ;Turiel as cited in 'ucci<. Yet- alt!oug! conventions are important- t!ey are arbitrary. In contrast +it! convention- moral considerations stem #rom #actors intrinsic to actionsconse&uences suc! as !arm to ot!ers- violations o# rig!ts- and e##ects on general +el#are. Moral issues are neit!er arbitrary nor determined by cultural precepts or by consensus ;'ucci<. Anot!er common vie+ is t!at building sel#0esteem #osters good c!aracter ;Po+er-

(D

?@@9<. T!is vie+ presupposes t!at a !ig! sense o# sel#0esteem can inoculate c!ildren and young adults #rom !aving to #ind alternative- antisocial means o# gaining approbation. C!ildren appear to resort to antisocial be!avior i# t!ey are denied approval by parentsteac!ers- coac!es- and popular peers ;Sc!e##- %atAinger- L %yan as cited in Po+er<. $o+ever- empirical data indicate t!at t!ere is no necessary relations!ip bet+een sel#0 esteem and morality. Individuals +ill not derive a sense o# sel#0esteem #rom acting morally ;Po+er<. Yet- sel#0esteem does play a signi#icant role in moral li#e. .uilding sel#0esteem is an important part o# c!aracter development because building sel#0esteem involves t!e construction o# moral standards o# evaluation. Moral sel#0esteem appears to depend upon 2udging one8s actual sel# to be at least directed to+ard one8s ideal sel# and a+ay #rom one8s dreaded sel#. Colby and 5o!lberg8s analysis indicated t!at t!e ideal- dreaded- and real selves develop in a se&uential pattern o# cognitive levels +it! similarities to t!e moral 2udgment stages ;Po+er- ?@@9<. T!ese levels indicate t!at individuals do not develop an a+areness o# t!emselves as !aving a c!aracter o# a uni#ied sel# until !ig! sc!ool at t!e earliest. %esearc! suggested t!at c!aracter education must begin +it! an understanding o# !o+ c!aracter develops. S!aring data +it! ot!er t!erapists in t!e #ield allo+s #or t!e understanding o# t!e program and t!erapeutic bene#its ;'ation- .ens!o##L Mal/in- ?@@E<.

(F

C!apter D3 Met!odology Participants and Sub*ects T!e sub2ects o# t!is applied dissertation study +ere patients ?* years old and older- undergoing substance abuse t!erapy- and same0aged nonpatients serving as a control group. T!e population used to e1tract a purposive sample consisted o# residents o# Miami0 ade County- "lorida. T!e participating group under+ent a controlled researc! e1periment in +!ic! eac! individual too/ t!e e#ining Issues Test ; IT4 %est- Turiel- L 5o!lberg- ?@E@<. T!is applied researc! gauged t!e impact o# substance abuse t!erapy and its relations!ip to increasing moral maturity in young adults. Sample Si+e and $omposition A ma1imum o# () sub2ects bet+een t!e ages o# ?* and ?@ years old ;male and #emales<- ?) sub2ects undergoing substance abuse treatment and ?) sub2ects not undergoing substance abuse treatment- participated in t!e study. Eac! sub2ect +as as/ed to ta/e t!e IT and to #ill out a &uestionnaire ;see Appendi1 A<. Eac! sub2ect signed a consent #orm. Sub*ect Selection, Recruitment, and "ligibility Re-uirements A #lyer +as posted outside t!e medical comple1 to allo+ t!e sub2ects to approac! t!e researc!er i# t!ey +ere interested in participating. A p!one number +as listed on t!e #lyer. T!e interested participant called and +as given in#ormation about t!e date- timeplace- and a brie# e1planation about t!e researc!- survey instrument- and t!e time commitment ;no more t!an ? !our<. I# a sub2ect c!ose to participate in t!e program- !e or s!e +as in#ormed t!at a signed consent #orm +as needed be#ore enrolling in t!e study.

(B

T!e consent #orms +ere available t!e day t!e survey +as administered. Time +as given to revie+ t!e consent #orm. Anyone +!o- at t!at point- c!ose not to sign t!e consent #orm +as e1cused #rom t!e researc! study. T!e #lyer invited sub2ects ;a ma1imum o# () bet+een t!e ages o# ?* and ?@ years o# age<- ?) patient sub2ects and ?) !ealt!y control sub2ects- to participate in a researc! study in +!ic! eac! individual too/ t!e IT survey instrument. T!e eligibility re&uirements to participate in t!e researc! study +ere as #ollo+s3 ?. Sub2ects +ere bet+een t!e ages o# ?* and ?@ years old ;male and #emales< +!o +ere undergoing substance abuse treatment. (. Sub2ects +ere bet+een t!e ages o# ?* and ?@ years old ;male and #emales< +!o +ere not undergoing substance abuse treatment. D. Sub2ects +ere +illing to commit no more t!an ? !our to complete t!e survey. F. Sub2ects +ere +illing to complete t!e IT. T!e e1clusionary criteria t!at !indered participation in t!e researc! study included t!at sub2ects could not be past or current clients o# t!e researc!er. .ethods and Procedures T!e met!odology employed a cross0sectional approac! in +!ic! t!e population o# interest +as young adult patients undergoing substance abuse t!erapy and nonpatients. T!e data #or t!is study +ere ta/en #rom a nonrandom- purposive sample. .abbie ;?@*D< made t!e observation t!at a purposive sample is appropriate to use +!en a large population e1ists t!at cannot be easily sampled but yet a +ell0de#ined subset o# t!e population can be targeted.

(E

T!e participants too/ t!e IT survey instrument. T!e researc! &uestion and t!e procedural met!odology are discussed belo+. T!e researc! &uestion addressed +as- Is t!ere a di##erence in moral maturity level in young adult patients undergoing substance abuse t!erapy> T!at is- is t!ere a di##erence in moral maturity level- as measured by t!e IT- bet+een young adults undergoing substance abuse t!erapy and young adults not undergoing substance abuse t!erapy> T!e researc! &uestion +as analyAed using t!e IT. Studies suggested t!at t!e most reliable +ay to measure group di##erences in CM using t!e IT +as to #ocus on t!e P score ;or principled score< t!at measures CM describing- according to %est ;?@*E<- t!e relations!ip bet+een t!e signi#icance an individual gives to moral values +!en #aced +it! a decision about a moral dilemma. I!en t!e data +ere analyAed #or t!is study- t!e P score +as used to assess group means and di##erences- correlation- and ot!er analyses. T!e score could #all +it!in t!e range o# ) to @B. An A'=GA evaluated group di##erences in P scores lin/ed to t!e researc! &uestion. .e#ore distributing t!e instrument to t!e selected population- it +as necessary to obtain a signed consent #orm t!at addressed suc! issues as ;a< voluntary participation- ;b< anonymity and con#identiality- and ;c< t!at t!e study +ould involve ?) patient sub2ects and ?) !ealt!y control sub2ects. T!e IT survey instrument +as distributed at t!e time o# administering t!e survey to t!e consenting sub2ects. A letter e1plaining t!e reasons #or t!e survey- a sel#0 administered &uestionnaire ;see Appendi1 A<- and instructions #or completing t!e B0digit identi#ication number on t!e IT +as distributed at t!e time t!e study. Instructions +ere

(9

read out loud and time +as allotted #or &uestions. T!e identi#ication numbers on t!e survey +ere 6bubbled7 be#ore!and to rein#orce t!e con#identiality #actor o# eac! survey instrument. T!e researc!er mailed t!e completed IT surveys to t!e University o# Minnesota #or scoring. .easures and Administration T!e IT survey instrument is comprised o# multiple0c!oice &uestions administered in a group or individual #ormat- is computer0scored- and is available in t+o #ormats3 t!ree0 and si10scenario &uestionnaires. T!is study used t!e t!ree0scenario #ormat ;%est- ?@9@<. T!e ob2ective #or t!e participant +as to evaluate t!e &uestions by raising t!e most important considerations in responding to ans+ering t!e dilemma. T!e surveys +ere con#idential and anonymous ;clear instructions +ere given to participants to insure t!at t!eir survey instruments remain anonymous<. T!e data t!at +ere collected consisted o# demograp!ic data- measurement o# cognitive moral maturity as per t!e IT instrument ;Center #or t!e Study o# Et!ical evelopment- ())F4 see Appendi1 .<- and correlation analyses bet+een t!e patients and nonpatients groups. Cost implications +ere based on t!e number o# surveys ordered and scored. T!e researc!er +as t!e coordinator o# t!e actual testing. Potential Ris(s to Sub*ects T!e ris/ to participants +as minimal. In#ormation obtained during t!e participation o# t!is program +as strictly con#idential. 'o names or identi#ying in#ormation +ere used in any o# t!e survey instruments. In addition- a researc! number +as used to identi#y all o# t!e participant8s in#ormation. T!e list lin/ing t!e sub2ect to

(*

t!eir researc! number +as /ept separately #rom t!e data and consent #orms- and t!e list +as /ept in a loc/ed #iling cabinet. )enefits to Sub*ects T!ere +ere no direct bene#its to patients #or ta/ing part in t!is study. Patients +ere not compensated #or t!eir participation. Ris( and )enefit Ratio T!e in#ormation gained in t!is study is !elp#ul to t!e t!erapists in substance abuse treatment programs. T!e ris/ to participants +as minimal. $onsent Forms I# a sub2ect c!ose to participate in t!e researc! study- !e or s!e +as in#ormed t!at a consent #orm +as needed to be signed be#ore t!ey +ere able to enroll in t!e study. T!e consent #orms +ere available t!e day t!e survey +as administered. Time +as given to revie+ t!e consent #orm. Sub2ects +!o c!ose not to sign t!e consent #orm +ere e1cused #rom t!e researc! study. Personal Health Information /se 'o personal !ealt! in#ormation +as collected on t!e &uestionnaires.

(@

C!apter F3 %esults Research Findings "or a more compre!ensive understanding o# t!e researc! #indings- several items are revie+ed. According to Pee/ ;?@@@<- 5o!lberg8s Stages o# CM are as #ollo+s3 6STAHE ?3 Punis!ment and =bedience =rientation- STAHE (3 Instrumental %elativist =rientation- STAHE D3 Hood .oy0'ice Hirl =rientation- STAHE F3 La+ and =rder =rientation- STAHE B3 Social0Contract Legalistic =rientation- STAHE E3 Universal Et!ical Principle =rientation7 ;p. F*<. T!e P score is t!e score upon +!ic! t!e IT analysis is based. T!e P score is interpreted as a #actor t!at is comparable to t!e c!aracteristics o# t!e !ig!est t+o CM stages- Stages B and E ;Pee/- ?@@@<. %est ;?@9@< e1plained t!at t!e P score is a representation o# t!e degree to +!ic! a person8s t!in/ing is most li/e t!e t!in/ing o# moral p!ilosop!ers. An e1ample #ollo+s illustrating !o+ t!e P score is used to compare stages3 Junior !ig! students generally earn an average score in t!e ()s- senior !ig! students score in t!e D)s- college students score in t!e F)s- graduate students score in t!e B)s- and moral p!ilosop!ers score in t!e E)s. Adults ;in general< average in t!e F)s. T!e P score can range #rom ) to @B. T!e mean level o# t!is particular sample is ?9.9) ;S Q ?(.@E<- t!ere#ore #alling close to t!e 2unior !ig! score ;()s<. "or more t!an ( decades- t!e Cronbac!8s alp!a inde1 o# internal consistency o# t!e IT !as been in t!e .9)8s ;%est- ?@9@<. T!ere#ore- based upon #indings o# t!is studyt!e results o# t!is researc! +ere use#ul #or e1amining t!e CM o# t!e sub2ects in t!e study.

D)

T!e data analyses to e1amine t!e CM and t!e testing o# t!e researc! &uestion +ere conducted on () responses. Table ? presents t!e results o# #our- one0+ay A'=GA analyses ;corresponding to t!e researc! &uestion< using t!e P score as t!e dependent variable. T!ere +ere no di##erences in P score #or gender- age- education- and t!erapy based on t!e F statistics- ).@@- ).*B- ?.(?- and ).9D- respectively. T!e di##erences are not statistically signi#icant. Table ? AN%0A Tables for 1ender, Age, "ducation, and Therapy 2ith $ogniti!e .oral e!elopment 3P Scores4 ependent ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Sum o# Mean

Gariable s&uares df s&uare F Sig. ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Hender bet+een groups Iit!in Hroups Age bet+een groups Iit!in Hroups Education bet+een groups Iit!in Hroups In t!erapy bet+een groups Iit!in Hroups *.DFB (?.@E@ ).9() (.()@ E.E*@ ??.E9F E.9)D ?@.F** DB @? DB @? DB 9F DB 9F .(D* .(F? .)(? .)(F .?@? .?B* .?@( .(ED ).@** ).*F9 ?.(?? ).9(9 .B)? .9)F .(F( .*B)

,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Table ( provides t!e in#ormation to determine i# an individual8s samples are relatively !ig! or lo+ on Stages ( to E ;%est L 'arvaeA- ?@@*<. Conclusions o# t!e respondents8 et!ical maturity levels can be dra+n #rom studying t!e P scores #ound in Table D.

D?

$omparati!e Results Table ( compares t!e results o# previous studies including Pee/ ;?@@@< and =sgood ;as cited in Pee/< +it! t!ose o# t!e present study. T!e results ta/e into account a select #e+ studies to better understand t!e present #indings. avison ;as cited in Pee/< scores o# a larger population sample #acilitated t!e comparison bet+een more recent results.
Table ( escriptions, .eans, and Standard e!iations of 0ariables, All IT Indices From the Standardi+ation Sample ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Stage Stage D Stage Stage Stage Stage P

Hroup Statistic ( F BA B. E score ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Junior !ig! students Senior !ig! students College students Hrad students All Pee/ studyHeneral services administration employees =sgood studymunicipal elected o##icials . S . S . S . S . S . S E.D) D.?) B.?B D.FF D.)B (.*? (.(F (.B? F.?@ D.D@ (.*( (.*E ?B.)) B.D? ??.*F B.ED *.E) B.?F 9.@E B.EE ?).*B E.?D @.)F 9.BE ().(F B.9F ?@.?9 9.(* ?9.)? *.)9 ?9.@9 *.E9 ?*.E) 9.E( (B.B) @.F* *.)? F.E? ?D.?) E.FE ?B.*? E.D? ?B.)@ E.?? ?D.)) E.EE ??.E E.@? (.B*)) (.F@)) D.)@)) (.9*)) B.())) D.F))) B.(E)) D.B()) F.)F)) D.D?)) (.)E)) (.*F)) ?.F? ?.*@ (.F( (.FB F.*@ D.DF E.BE D.DB D.*( D.F* F.@( F.() ().)) @.)F D?.)D ?D.@) FD.?@ ?F.D( FF.*B ?B.)E DF.99 ?E.E9 D).@) ?F.B)

. S

).*E ?.)9

?D.9? *.)F

().)) @.(F

?).B9 B.E(

D.?F)) D.(F))

D.?F (.(9

F?.@) ?B.()

D(

issertation . ?.(? DB.9@ D9.D* F.)@ ).FEDE ?.BF ?9.9) study- young S ?.@( ?9.DB ?D.(E D.9? ?.)*)) ?.@B ?(.@E adults in t!erapy ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Note. IT Q e#ining Issues Test4 data #rom t!e #irst B ro+s are #rom a large sample o# ?-)*) sub2ects used as a standardiAation sample in some early studies by Mar/ avison. Pee/ and =sgood studies #rom The 1ood, the )ad, and the .isunderstood ;p. F*<- by 5. Pee/- ?@@@. Unpublis!ed doctoral dissertation- 'ova Sout!eastern University- "ort Lauderdale- "L.

T!e mean P score o# young adults undergoing substance abuse treatment in t!e present study ;. Q ?9.9)- S Q ?(.@E< is lo+er t!an t!e results o# Pee/8s ;?@@@< and =sgood8s ;as cited in Pee/< analyses o# a normative composite sample. T!e means in t!e present study #all belo+ Pee/8s means #or Heneral Services Administration employees ;. Q D).@. S Q ?F.B< and =sgood8s municipal elected o##icials ;. Q F?.@- S Q ?B.(<. T!e sample mean #alls belo+ t!e P score o# ()- t!e 2unior !ig! student level. An A'=GA +as completed to measure t!e ratio o# t+o variances. Table D presents t!e signi#icance o# t!e P scores by gender- age- education levels- and t!erapy. I# t!e probability is less t!an .)B- t!ere is evidence t!at t!ere is a signi#icant di##erence bet+een t!e t+o groups being compared. I# t!e probability is greater t!an .)B- t!ere is evidence t!at t!ere is no di##erence bet+een t!e t+o groups. T!e null !ypot!esis is re2ected +!en F is larger t!an .)B. Table D Analysis of 0ariance Results for Young Adults Sample 1roup ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Sum o# Mean

Hroup s&uares F s&uare F Sig. " ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Hender *.DFB DB .(D* ).@** .B)?

DD

Age ).9() DB .)(? ).*F9 .9)F Education E.E*@ DB .?@? ?.(?? .(F( In t!erapy E.9)D DB .?@( ).9(9 .*B) ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Note. N Q () respondents.

Summary of Analysis and Presentation of Findings T!is c!apter presented t!e CM #indings based on statistical analyses o# data gat!ered #rom comparing ?) sub2ects undergoing substance abuse treatment and ?) sub2ects not undergoing substance abuse treatment. T!e results o# t!e #indings do not support t!e !ypot!esis. T!e null !ypot!esis cannot be re2ected. T!is analysis and presentation o# t!e #indings neit!er addressed t!e practical implications o# t!ese #indings nor a normative assessment o# t!e results.

DF

C!apter B3 iscussion T!e main ob2ective o# t!is researc! +as to e1plore t!e moral maturity levels o# young adult patients undergoing substance abuse t!erapy. A recent dramatic #inding in neurobiological researc! may greatly increase t!e understanding o# young adult decision ma/ing and t!e ability to !elp t!is age group c!oose +isely regarding drug abuse. T!is #inding suggests t!at t!e young adult brain is still developing p!ysically and #urt!er investigation can ans+er some o# t!e cognitive issues a##ecting t!e appeal and decision to use drugs. T!is c!apter presents a discussion o# t!e researc! &uestion- Is t!ere a di##erence in moral maturity level in young adult patients undergoing substance abuse t!erapy> T!at isis t!ere a di##erence in moral maturity level- as measured by t!e IT- bet+een young adults undergoing substance abuse t!erapy and young adults not undergoing substance abuse t!erapy> iscussion of Results and $onclusion T!e statistical results s!o+n in Tables (- D- and F +ere applied to t!e researc! &uestion. In t!is segment- t!e statistical results o# t!e researc! &uestion are e1plored. A summary o# t!e #indings as discussed in c!apter F is listed belo+. T!e researc! &uestion +as not supported by data and t!e null !ypot!esis cannot be re2ected. T!e results o# t!e statistical analyses do not support any signi#icant di##erence in moral maturity levels by gender- age- education- or t!erapy. $o+ever- as displayed in Table D- young adult patient0sub2ects8 and nonpatient sub2ects8 CM range ;?9.9)< +as lo+er t!an t!e 2unior !ig! students CM range ;().)<. .uilding on t!e recent #indings in

DB

neurobiological researc!- t!is lo+er CM #inding ;?9.9)< among study participants adds to #urt!ering t!e understanding o# young adult decision ma/ing. "!aluation of the Approach Alt!oug! #indings +ere not statistically signi#icant +it! t!e #indings t!at %est8s ;?@9@< met!ods !ave yielded- t!e approac! and measuring instrument ; IT< used to assess moral reasoning in t!is study o##ers t!e potential #or #urt!er researc!. $o+ever- it is recommended t!at t!is study be replicated +it! a larger population. T!e true value o# t!is researc! +as gat!ering in#ormation about moral maturity and t!e substance abuse t!erapeutic treatment. T!is researc! approac! o##ers an invaluable 62umping o##7 point #or #urt!er studynot only #or t!e substance abuse t!erapeutic community but also #or t!e larger addictions sector. %ecommendations #or #urt!er researc! possibilities +ill be e1plored in t!e #inal section o# t!is c!apter. 5imitations of the Study T!e study8s limitations can be attributed to t!e small siAe o# t!e sample population. Also- contributing to t!e limitations o# t!e study +ere t!e eligibility re&uirements to participate in t!e researc!- as #ollo+s3 ?. T!e sub2ects +ere bet+een t!e ages o# ?* and ?@ years old ;male and #emales<+!o +ere undergoing substance abuse treatment. (. T!e sub2ects +ere bet+een t!e ages o# ?* and ?@ years old ;male and #emales< +!o +ere not undergoing substance abuse treatment. D. T!e sub2ects +ere +illing to commit no more t!an ? !our to complete t!e

DE

study. F. T!e sub2ects +ere +illing to complete t!e IT. T!e e1clusionary criteria t!at !indered participation in t!e researc! study included t!at sub2ects could not be past or current clients o# t!e researc!er. Alt!oug! t!e return ratio and accuracy o# t!e IT +as !ig! due to t!e met!ods o# distribution ;e.g.- ITs +ere distributed and collected in person<- t!e sample siAe contributed to a restriction o# range t!at led to a lac/ o# variation or diversity among t!e respondents. T!e researc! &uestion +as e1amined in an associative manner. Causality neit!er could be in#erred nor con#irmed in t!is study. Also- in order to allocate reasonable time #or sub2ect participation in t!e surveyst!e t!ree0scenario IT #ormat +as c!osen rat!er t!an t!e si10scenario #ormat. According to t!e University o# Minnesota8s Huide #or t!e IT ;%est L 'arvaeA- ?@@*<- t!e s!ort #orm8s reliability is decreased by B to ?) points4 t!ere#ore- t!ere is a possibility t!at t!e t!ree0scenario #ormat also contributed to limited assessment o# t!e participants. irections for Future Research Several possibilities can be suggested #or #uture researc! in t!is area. T!e areas revealed as limitations o# t!is study must be ta/en into consideration in any #uture researc!. It +ould be bene#icial to eit!er e1pand t!e IT to include t!e si10scenario #ormat or conduct posttest intervie+s to gat!er &ualitative in#ormation to con#irm causality o# be!avior. T!e researc! s!ould include a larger number o# participants in a longitudinal study in order to accurately assess and evaluate t!e IT as a measuring tool #or t!is particular sample population.

D9

E1pansion o# t!e current study is recommended t!at +ould #urt!er t!e /no+ledge in t!e #ield o# substance abuse t!erapy- relative morality- and et!ics education in general. Additionally- instead o# #ocusing solely on t!e moral development aspect- studies can incorporate a person8s moral p!ilosop!y lin/ing it to et!ical attitudes and decision ma/ing.

%e#erences

American Academy o# Pediatrics- Committee on C!ild $ealt! "inancing and Committee on Substance Abuse. ;())?<. Improving substance abuse prevention- assessmentand treatment #inancing #or c!ildren and adolescents. Pediatrics, 678, ?)(B0?)(@. At!ealt!.com. ;())?<. 1etting the facts about young adult substance abuse and treatment. %etrieved 'ovember ((- ())?- #rom !ttp3::+++.at!ealt!.com: consumer:youngadultsu#acts.!tm .abbie- E. ;?@*D<. The practice of social research ;Drd ed.<. .elmont- CA3 Iads+ort!. .rody- J. ;())D- September D)<. Addiction3 A brain ailment- not a moral lapse. The Ne9 Yor( Times .aga+ine- p. *. Cami- J.- L "arrO- M. ;())D<. rug addiction. The Ne9 "ngland :ournal of .edicine, ;<=- @9B0@*E. Center #or t!e Study o# Et!ical evelopment. ;())F<. IT''sample dilemma> %etrieved 'ovember @- ())9- #rom !ttp3::+++.center#ort!estudyo#et!icaldevelopment.net: ITK()00SampleK() ilemma.!tm Committee on C!ild $ealt! Financing and Committee on Substance Abuse. ;())?<. Improving substance abuse prevention- assessment- and treatment #inancing #or c!ildren and young adults. Pediatrics, 678, ?)(B0?)(@. Cus!man- P. ;?@@)<.I!y t!e sel# is empty. To+ard a !istorically situated psyc!ology. American Psychology, <?- B@@0E??. a/o#- H. A.- Te2eda M.- L Liddle- $. A. ; ;())?<. Predictors o# engagement in

D*

adolescent drug abuse treatment> :ournal of the American Academy of $hild and Adolescent Psychiatry, <7, (9F0(*?. eLong- J. G. ;?@@9<. ealing 9ith drug abuse& A report to the Ford Foundation> The rug Abuse Sur!ey Pro*ect. %etrieved January ??- ?@@9- #rom !ttp3:: ()E.E?.?*F.FD:sc!a##er:library.!tml Evans- %. ;?@@*- Iinter<. C!anging #amilies c!anging sc!ools. Independent School, ?0 ?F. Hinott- $. ;?@9?<. )et9een parents and teenagers. 'e+ Yor/3 Avon .oo/s. Holeman- . ;?@@B<. "motional intelligence. 'e+ Yor/3 .antam .oo/s. Hordon- T. ;?@9B<. Parent effecti!eness training. 'e+ Yor/3 Peter $. Iyden. Hrob- C.- L de %ios- M. ;?@@(<. Adolescent drug use in cross0cultural perspective. :ournal of rug Issues, @@, ?((0?D*> $anson- H. %. ;())(- "ebruary<. 'e+ vistas in drug abuse prevention. NI A Notes, 6A, D0 B. Jo!nson- P. E. ;?@@B<. Reason in the balance. o+ns Hrove- IL3 InterGarsity Press. 5o!lberg- L. ;?@E@<. Stage and se&uence3 T!e cognitive0developmental approac! to socialiAation. In . A. Hoslin ;Ed.<- Handboo( of sociali+ation theory and research ;pp. DF0DB<. C!icago3 %and Mc'ally. Les!ner- A. ;())?- January<. .lending drug abuse researc! and practice to improve treatment. NI A Notes, 6?, D0F. Mac/- . ;?@@F- Marc!<. Are parents bad #or c!ildren> $ommentary, B=, D)0DE. Manisses Communication Hroup. ;?@@B<. I!en substance abusing teens ac!ieve abstinence- it roc/s t!e #amily boat. The )ro9n /ni!ersity $hild and Young Adult )eha!ior 5etter, 66, S?0S(. Mars!all- S. ;())?<. Young adults may respond better in adult treatment. %etrieved August ()- ())?- #rom !ttp3::substanceabuse.about.com Masse- L.- L Tremblay- %. ;?@@9<. .e!avior o# boys in /indergarten and t!e onset o# substance use during adolescence. Archi!es of 1eneral Psychiatry, ?<, E(0E*. Miller- A. ;?@@?<. The ne9ly recogni+ed, shattering effects of child abuse. 'e+ Yor/3

D@

oubleday. Miller- L. ;())(<. "arly spirituality deters alcohol abuse. %etrieved May ?(- ())(- #rom !ttp3::alco!olism.about.com Monroe- J. ;?@@E- January<. I!at is addiction> $urrent Health @, ?E0?@. Murray- M. ;())(<. An o!er!ie9 of moral de!elopment and moral education. %etrieved April ?(- ())(- #rom Studies in Moral evelopment and Education Ieb site3 !ttp3::tigger.uic.edu:Rlnucci:MoralEd:overvie+.!tml 'ation- J. M.- .ens!o##- J. J.- L Mal/in- M. M. ;?@@E<. T!erapeutic recreation programs #or young adults. :ournal of Rehabilitation, A@, ?)0?E. 'ucci- L. ;?@@9<. Synthesis of research on moral education. %etrieved July ?- ())(- #rom Studies in Moral evelopment and Education Ieb site3 !ttp3::tigger.uic.edu: Rlnucci:MoralEd:articles:nuccisynt!esis.!tml Pee/- 5. ;?@@@<. The good, the bad, and the misunderstood> Unpublis!ed doctoral dissertation- 'ova Sout!eastern University- "ort Lauderdale- "L. Peele- S. ;?@*Ea<. T!e 6cure7 #or young adult drug abuse3 Iorse t!an t!e problem> :ournal of $ounseling and e!elopment, A?, (D0(F. Peele- S. ;?@*Eb<. T!e implications and limitations o# genetic models o# alco!olism and ot!er addictions. :ournal of Studies on Alcohol, <=, ED09D. Peele- S. ;?@@)<. Cures depend on attitudes- not programs. ;?@@)- Marc! ?F<. 5os Angeles Times- pp. ?0D. Petracca- M. ;())(<. Treatment for teens& Young adults may respond better in adult treatment. %etrieved June ?9- ())(- #rom !ttp3::alco!olism.about.com Piaget- J. ;?@D(<. The moral *udgment of the child ;M. Habain- Trans.<. London3 5egan Paul. ;original +or/ publis!ed ?@D(< Po+er- ". C. ;?@@9<. /nderstanding the character in character education. %etrieved July ?- ())(- #rom Studies in Moral evelopment and Education Ieb site3 !ttp3:: tigger.uic.edu:Rlnucci:MoralEd:aotm:article?(.!tml %est- J. %. ;?@9@<. e!elopment in *udging moral issues> Minneapolis3 University o# Minnesota Press. %est- J. %. ;?@*F<. T!e ma2or components o# morality. In I. M. 5urtines L J. L. Her+itA

F)

;Eds.<- .orality, moral de!elopment and moral beha!ior ;pp. (F0D*<. 'e+ Yor/3 Jo!n Iiley and Sons. %est- J. %. ;?@*E<. .oral de!elopment& Ad!ances in research and theory> 'e+ Yor/3 Praeger. %est- J. %.- Turiel- E.- L 5o!lberg- L. ;?@E@<. %elations bet+een levels o# moral 2udgment and pre#erence and compre!ension o# t!e moral 2udgment o# ot!ers. :ournal of Personality, ;=, ((B0(B(. %est- J. %.- L 'arvaeA- . ;?@@*<. 1uide for the efining Issues Test. Minneapolis- M'3 University o# Minnesota- Center #or t!e Study o# Et!ical evelopment. %oye- C. ;?@@B<. .rea/ing t!roug! to t!e adolescent patient. American :ournal of Nursing, B?;?(<- ?@0(D. Sc!uc/it- M. ;?@@9<. Science- medicine- and t!e #uture3 Substance abuse disorders. The )ritish .edical :ournal, ;6<, ?0@. S+an- '. ;?@@*- July<. E1ploring t!e role o# c!ild abuse in later drug use3 %esearc!ers #ace broad gaps in in#ormation. NI A Notes, 6;, ?0E. Iol#- Y.- =lenic/0S!emes!- .- Addad- M.- Hreen- .- L Ialters- J. ;?@@B<. Personal and situational #actors in drug use as perceived by /ibbutA yout!. Adolescence, ;7, @)@0@D?. Pic/ler- P. ;?@@@- September<. Et!nic identi#ication and cultural ties may !elp prevent drug abuse. NI A Notes, 6<, 90@.

F?

Appendi1 A
Sample Cuestionnaire

F(

Sample Cuestionnaire ear Participant3 To obtain an accurate re#lection o# t!is researc!- your participation is crucial. T!ere#ore- it is re&uested t!at you provide ans+ers #or a con#idential &uestionnaire t!at s!ould ta/e about D) minutes to complete. 'o responses can be trac/ed to an individual. I am interested only in t!e average responses #or a group o# people +!o are completing t!is #orm. Accompanying t!is letter is an ;?< an Ans+er S!eet and ;(< an Instructional .oo/let. "irst- to gat!er general demograp!ical in#ormation- please complete ;by circling<3 I# you are #emale3 I# you are male3 I# you are ?*3 I# you are ?@ or over3 I# you are in !ig! sc!ool I# you are in college I# you are undergoing treatment I# you are not undergoing treatment ? ( ? ( ? ( ? (

Second- read t!e first three stories in t!e Instructional .oo/let3 $einA and t!e rug- Escaped Prisoner- and 'e+spaper. T!ird- use a S( pencil ;+ill be provided i# needed< on t!e Ans+er S!eet to bubble in your !onest opinion o# !o+ you +ould !andle eac! o# t!e t!ree social situations T!ere are t!ree sections on t!e Ans+er S!eet t!at must be completed3 ;?< I!at +ould you do about t!e situation> ;(< $o+ important +ould eac! o# t!e ?( statements be in !elping you ma/e a decision> ;D< %an/ t!e #our statements t!at +ere t!e most important> T!an/ you #or ta/ing t!e time to complete t!e IT. Marino E. Carbonell- MS- LM$C- CAP 'ova Sout!eastern University

FD

Appendi1 . IT3 Sample ilemma

FF

DIT --Sample Dilemma

$einA and t!e rug In Europe a +oman +as near deat! #rom a special /ind o# cancer. T!ere +as one drug t!at doctors t!oug!t mig!t save !er. It +as a #orm o# radium t!at a druggist in t!e same to+n !ad recently discovered. T!e drug +as e1pensive to ma/e- but t!e druggist +as c!arging ten times +!at t!e drug cost to ma/e. $e paid T()) #or t!e radium and c!arged T(-))) #or a small dose o# t!e drug. T!e sic/ +omanUs !usband- $einA- +ent to everyone !e /ne+ to borro+ t!e money- but !e could only get toget!er about T?-)))- +!ic! is !al# o# +!at it cost. $e told t!e druggist t!at !is +i#e +as dying- and as/ed !im to sell it c!eaper or let !im pay later. .ut t!e druggist said- V'o- I discovered t!e drug and IUm going to ma/e money on it.V So $einA got desperate and began to t!in/ about brea/ing into t!e manUs store to steal t!e drug #or !is +i#e. S!ould $einA steal t!e drug> Please rate the follo9ing statements in terms of their importance in ma(ing a decision about 9hat to do in the dilemma> 36C1reat importance, @C.uch importance, ;CSome Importance, <C5ittle importance, ?CNo importance4 ?. I!et!er a communityUs la+s are going to be up!eld. (. IsnUt it only natural #or a loving !usband to care so muc! #or !is +i#e t!at !eUd steal> D. Is $einA +illing to ris/ getting s!ot as a burglar or going to 2ail #or t!e c!ance t!at stealing t!e drug mig!t !elp> F. I!et!er $einA is a pro#essional +restler- or !ad considerable in#luence +it! pro#essional +restlers. B. I!et!er $einA is stealing #or !imsel# or doing t!is solely to !elp someone else. E. I!et!er t!e druggistUs rig!ts to !is invention !ave to be respected. 9. I!et!er t!e essence o# living is more encompassing t!an t!e termination o# dying- socially and individually. *. I!at values are going to be t!e basis #or governing !o+ people act to+ards eac! ot!er. @. I!et!er t!e druggist is going to be allo+ed to !ide be!ind a +ort!less la+ +!ic! only protects t!e ric! any!o+. ?). I!et!er t!e la+ in t!e case is getting in t!e +ay o# t!e most basic claim o# any member o# society. ??. I!et!er t!e druggist deserves to be robbed #or being so greedy and cruel. ?(. Iould stealing in suc! a case bring about more total good #or t!e +!ole society or not. No9 please ran( the top four most important statements> Put the number of the statement in the blan(& ,,,, Most important item ,,,, Second most important item ,,,, T!ird most important item ,,,, "ourt! most important item

Note. "rom IT''Sample ilemma- by Center #or t!e Study o# Et!ical evelopment- ())F> %etrieved 'ovember @- ())9- #rom !ttp3::+++.center#ort!estudyo#et!icaldevelopment.net: ITK()00Sample

FB

K() ilemma.!tm. Copyrig!t ())F by Center #or t!e Study o# Et!ical evelopment. %eprinted +it! permission.