Graduate Thesis Or Dissertation
 

Discursive and Psychological Processes in Project MATCH Treatment Manuals and 12-Step Program Literature

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  • Addiction is a word that represents a condition that, at best, causes minor disruptions to one’s life and, at worst, is lethal. The current definition was developed by 80 neuroscientists. It references substance use and other behaviors and includes food and sex. Addictions do not seem to be lessening but rather are increasing in terms of substances, behaviors, and lives affected. The United States opiate epidemic was fueled in part by false claims in over 600 research journal articles that pain medications were non-addictive. Language matters. In the 1930s, decades before researchers drew attention to the psychological importance of emotional tone and pronoun use, editors of the original Alcoholics Anonymous literature drew the same conclusions which informed their writing. Over 400 groups have received permission to adapt this literature for their use. Many represent behavioral addictions, which in theory, were recognized in the last diagnostic manual revision, though its authors included only gambling due to insufficient evidence to date for sex addiction, exercise addiction, and shopping addiction to name a few. In addition to a lack of research, there is a 15- to 20-year lag-time in making clinical use of research. The slow recognition of behavioral addictions by health professionals is filled in part by 12-step programs. Hence, research on 12-step programs is warranted. This dissertation covers the first of the 12 steps which addresses powerlessness and unmanageability. The concept of impaired control has been identified in each of the addictions studied. There has been an evolution of definitions of addiction from “failure of will” concepts to a “language of self-control” – the loss of which is seen as a diagnostic criterion. Rehabilitative treatment is through talk therapy. Addiction treatment manuals are often used to guide treatment; however, their language is unstudied. Leading researchers at some of the most prestigious universities in the United States and advocates for recovery are joining forces with a call to change the language of addiction. It is vital that the current language be disrupted because it induces negative implicit cognitive biases that evoke punitive attitudes and stigmatizing judgments. Globally, addictions are within the top four most stigmatized social problems. Stigma is a major barrier to treatment. For the first manuscript, three research questions were used to examine twelve-step facilitation, cognitive behavioral therapy, and motivational enhancement therapy manuals from Project MATCH. The second manuscript used the same questions to examine the first step of Alcoholics Anonymous, Debtors Anonymous, Gamblers Anonymous, Narcotics Anonymous, Overeaters Anonymous, and Sex and Love Addicts Anonymous. The research questions were: Do differences in the level of broad psycholinguistic processes exist among the texts? Do differences in specific linguistic categories exist among the texts? Do differences in specific psychological and physical processes exist among the texts? Using a synchronic corpus linguistic design, all texts were analyzed using LIWC2015. The log-likelihood ratio test was used to examine if differences in variables exist between the texts, with post hoc analysis to further examine differences. Bayesian information criterion was used to measure effect size, with effects ranging from weak to very strong. Results demonstrate that in each study, statistically significant differences exist in the broad psycholinguistic, specific linguistic, and psychological and physical process words used in the texts. For both manuscripts, differences in analytic, authentic, emotional tone, first-person singular pronouns, third-person plural pronouns, male, and biological processes words showed significance. Manuscript One also showed difference for first-person plural pronouns and third-person singular pronouns. This manuscript is the first study to compare the linguistic components of addiction treatment manuals. Manuscript Two also showed difference for second-person pronouns and negative emotion words. This second manuscript is the first study to compare linguistic components of different 12-step programs. Findings of this dissertation may have relevance to addiction treatment providers, writers of treatment manuals and of 12-step literature, researchers, and individuals with addiction issues.
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