Confirmatory Factor Analysis and Test-Retest Reliability of the Alcohol and Drug Confrontation Scale (Adcs)

Article excerpt

The addiction field lacks an accepted definition and reliable measure of confrontation. The Alcohol and Drug Confrontation Scale (ADCS) defines confrontation as warnings about the potential consequences of substance use. To assess psychometric properties, 323 individuals entering recovery houses in U.S. urban and suburban areas were interviewed between 2003 and 2005 (20% women, 68% white). Analyses included test-retest reliability, confirmatory factor analysis, and measures of internal consistency. Findings support the ADCS as a reliable way of assessing two factors: internal support and external intensity. Confrontation was experienced as supportive, accurate and helpful. Additional studies should assess confrontation in different contexts.


Interpersonal interactions have been hypothesized to influence substance use (Beattie, Longabaugh, Elliott, & Stout, 1993; Matzger, Kaskutas, & Weisner, 2005), the probability that an individual will enter treatment (George & Tucker, 1 996; Hasin, 1 994) and how those who enter treatment respond to it (Goehl, Nunes, Quitkin, & Hilton, 1993; Gogineni, Stein, & Friedmann, 2001; Marlowe, Merikle, Kirby, Festinger, & McLellan, 2001). These interactions can take the form of encouraging substance use, but they can also discourage substance use by expressing concern about negative consequences, requesting the individual change their use, or threatening consequences if changes are not made. Findings on attempts to get others to decrease or stop their use are mixed. Matzger, Kaskutas, and Weisner (2005) found pressure from family members to change drinking was associated with more drinking and decreased probability of treatment entry. In contrast, Hasin (1994) and George and Tucker ( 1 996) found social pressure to change drinking was related to increased treatment entry. Brown, O'Grady, Battjes, and Katz (2004) developed a measure to assess community support to enter treatment, called the Community Assessment Inventory. Support and encouragement from family, extended family, friends and the community were viewed as facilitative of treatment entry by outpatient clients. In terms of treatment outcome, Polcin and Beattie (2007) found that individuals who received pressure to enter treatment from interpersonal sources (e.g., friends and family) and institutions (e.g., criminal justice and social welfare) had outcomes that were similar to other clients. However, Marlowe et al. (2001) found that clients who reported non-familial coercive pressure related to financial problems (e.g., serious debt) had better outcome, than other clients.

It is important to sort out the effects of various types of pressure on substance use, treatment entry, and treatment outcome because pressure is commonly reported among individuals entering treatment (Marlowe et al., 2001; Polcin & Weisner, 1 999). In particular, threatened consequences from the legal system have been found to be common précipitants to treatment entry (Farabee, Prendergst, & Anglin, 1 998; Miller & Flaherty, 2000; Polcin, 2001). McLellan (2006) reported that the majority of individuals entering substance abuse treatment in the U.S. do so under some form of institutional coercion. Approximately 59% enter treatment as a result of a mandate from the criminal justice system. Despite being coerced into treatment, outcomes for criminal justice mandated clients are comparable to voluntary clients (Farabee et al., 1998; Miller & Flaherty, 2000; Polcin, 2001).

Less studied among illicit drug users are the effects of pressure from family, friends, and peers. However, alcohol studies using general population samples have found that individuals frequently give and receive pressure designed to decrease drinking. For example, Room, Bondy, and Ferris (1996) found that 35% of the general public in Ontario, Canada had commented on a friend's or relative's drinking within the past year, and 1 5% had suggested the person get help. …