With respect to the reliability of Larsen’s questionnaire, we have calculated the a coefficient of internal consistency as well as the split-half correlation for its items on this sample.

The results are satisfactory (a = 0.78, split-half correlation = 0.78). The validity of Larsen’s questionnaire is explored by examining its correlations to MCMI2 validity scales.

Patients’ confidence in recovery from addiction (“Please rate your self-confidence in remaining alcohol and drug free”) was rated on a 4-point scale (1 = very confident, 2 = confident with some concerns, 3 = unsure, 4 = little or no confidence).

Results

The average profile of this group of patients on the MCMI2 (Table 1) indicated addiction to alcohol and drugs, antisocial behaviours and conflicts with authority figures or rules and laws, aggressive behaviours, avoidant personality features, and unstable moods. The validity scales indicated a tendency to emphasize personal psychological distress.

Overall Treatment Satisfaction

The overall level of satisfaction as a single score was calculated from the ratings on the 11 items on which the patients rated their satisfaction with various aspects of the program. Those rated on the 5-point scale were algebraically converted into 4-point ratings as the common denominator, to give all items equal weight in the total score. The overall mean score for the 11 items was 3.4 (SD 0.4), that is, between “mostly satisfied” and “very satisfied,” thus indicating a high level of satisfaction with our program. No significant correlations were found (P > 0.05, 1-tailed) to any of the MCMI2 scales, including its validity scales. This suggests both that the responses to our overall measure of satisfaction with the treatment program were not biased by response styles such as social desirability and that aspects of personality and psychopathology evaluated by the MCMI2 were unrelated to the overall treatment satisfaction.

Individual Items Satisfaction

The responses to the 11 items individually demonstrated a high level of satisfaction with the various aspects of our program. For the items rated on the 5-point scale, the average values ranged from 3.6 to 4.2 (SDs 0.6–1.2), that is, from “mostly” or “very satisfied” to “above expectation/exceptional.” For items rated on a 4-point scale, the average values ranged from 3.4 to 3.7 (SDs 0.5–0.8), that is, between “mostly satisfied” and “very satisfied.”

Further analyses explored the validity of the satisfaction ratings individually for each of the 11 items of the treatment-satisfaction questionnaire. Pearson correlation coefficients were calculated between these satisfaction ratings and the 3 MCMI2 validity scales. Most importantly, no significant correlations (Pearson rs, P > 0.05, 1-tailed) were found between the desirability scale and the 11 ratings. The tendency to place oneself in a socially desirable light or to produce socially desirable responses did not unacceptably bias our program satisfaction data.

Three significant correlations (P < 0.05, 1-tailed) were found with the disclosure scale. This scale assesses the extent of personal disclosure of psychological problems. Those who more willingly discussed their personal psychological problems were more appreciative of the laboratory tests (r = 0.37, P = 0.004), and the safety and security system on the ward (r = 0.43, P < 0.001) and were more satisfied with the hospital or ward rules (r = 0.39,
P = 0.002).

The third validity scale measures self-debasement tendencies. Patients with tendencies towards self-debasement gave higher ratings for the laboratory tests (r = 0.28, P = 0.02) and the ward or hospital safety and security system (r = 0.31, P = 0.01). None of these correlations of the 3 validity scales to items on the satisfaction questionnaire poses any threat to its validity: all 5 significant relationships can be seen as meaningful personality correlates of the satisfaction ratings rather than as invalidating factors.

Further analyses examined the impact of psychopathology, age, and gender on each of the 11 items of our treatment-satisfaction scale. Pearson correlations were computed between each of the 11 ratings of program satisfaction and the 21 clinical scales of the MCMI2, age, and gender. Given the large size of the correlation matrix and the absence of specific expectations, the criterion of significance was set to P = 0.01, 2-tailed. No relationships were found except as follows. Patients who rated our laboratory and other medical tests as more helpful were those with higher scores on scale 3 (r = 0.35, P = 0.009), that is, those with an intense need to lean on others for nurturant help, supportive affection, and guidance. The subjectively perceived safety and security of the ward environment was rated as more satisfactory by patients with higher scores on the measures of borderline personality (r = 0.41, P = 0.002), those with self-defeating attitudes (r = 0.35, P = 0.008), and those with thought disorder (r = 0.37, P = 0.006), perhaps because these 3 groups and the psychiatric hospital setting were better matched (the ward is located within a psychiatric hospital that serves severely ill mental patients). An interesting correlation was found regarding satisfaction with psychological testing. Older patients rated the procedure as more helpful (r = 0.36, P = 0.004). It is possible that the older patients have been more appreciative of the feedback they obtained about their test results than their younger peers.

Confidence in Remaining Drug- and Alcohol-Free

The average level of confidence in remaining drug- and alcohol-free following discharge from our addiction treatment program was 1.6 (SD 0.6), between “very confident” and “confident with some concerns.” The majority (47.3%) indicated that they were “confident with some concerns,” another large group that they were “very confident,” and only a minority (7.3%) that they were “unsure.”

The validity of these self-ratings was examined by exploring their Pearson correlation coefficient matrix with MCMI2 validity scales. No significant relationships (P > 0.05, 1-tailed) were found except for a weak trend on the measure of self-debasement. More humble patients expressed somewhat lower self-confidence (r = 0.23, P = 0.04). The correlation matrix suggests that these ratings were not distorted by response bias tendencies such as social desirability or low self-disclosure of personal psychological problems; however, excessively humble patients might provide somewhat lower self-confidence ratings.

Further analyses examined the relationships of these confidence ratings to age and gender, to all clinical MCMI2 scales, and to the total scores based on the 11 items of the treatment satisfaction scale and also separately to each of the 11 items of the satisfaction scale. Given the large size of the correlation matrix and the absence of specific hypotheses, the criterion of significance was set to P = 0.01, 2-tailed. No significant relationships were found.

Discussion

In contrast to our previous study (2), we were unable to detect significant correlations between overall satisfaction with the treatment program and rebellious or antisocial personality traits. We note that the correlations found in our previous study using the MMPI2 were weak (r < 0.30) and it might be expected that these correlational patterns somewhat differ from sample to sample, especially if different tools to assess antisocial personality are used.

All significant correlations found in the current study involved individual aspects of the patients’ satisfaction rather than the overall satisfaction with addiction treatment. None of the correlations was high (r < 0.45). While the effects are weak, the findings indicate that some aspects of patient-satisfaction measures may be confounded by patient personality. Thus, addiction programs may benefit from individualization or modification depending on the particular personality characteristics (including psychopathology) of the patients.

Importantly, correlational patterns with MCMI2 validity scales show a lack of a biasing effect of response styles on overall ratings of satisfaction with treatment. This study thus successfully replicates our previous outcomes with MMPI2 validity indices (2).

Correlational patterns found in our study might vary with the nature of the program, the style of staff’s approach to patients, and the nature of the clientele. Each program caters to or recruits a particular clientele and, in this manner, may provide a highly biased sample. Replications are needed.

References

1. Lebow J. Consumer satisfaction with mental health treatment. Psychol Bull 1982;91:244–59.