This study compared the internal consistency and score levels of 7 measures of MH in SUD patients with that of the instrument development samples. These measures included optimism, reflected in the LOT measure as a mental attitude or life orientation, a life attitudes profile (LAP-R), i.e., purpose, coherence, etc., spirituality/religiousness (S/R index), social support (SPS), positive mood (PANAS), hope, operationalized as the motivation and perceived ability to achieve goals, and vitality.
Reliability, measured by Cronbach's alpha coefficient (i.e., internal consistency), was found to be as satisfactory in SUD outpatients as in the original instrument development sample for spirituality/religiousness, vitality, positive mood, hope, and optimism. It was clearly not as adequate for SUD outpatients for some of the SPS social support subscales. We would recommend using the Total score of the SPS when using this instrument with SUD patients. Although the reliability of several of the individual LAP-R subscales were slightly below 0.70, their use still appears to be justified in SUD patients. Another alternative is using a more reliable composite measure such as the PMI for SUD patients. In general, the study findings on instrument reliability supported the use of MH measures for SUD patients.
The level of spirituality/religiousness was somewhat higher in our SUD sample than in the original sample of HIV+/AIDS survivors. However, in interpreting the probability findings, it is necessary to take into account the study's large sample sizes since, as noted, the effects sizes were small on this attribute. It is important to also keep in mind that spirituality/religiousness is reinforced by self help groups that play a large role in the treatment and recovery process of SUD patients and also tends to be a significant factor in the lives of African Americans who represented 2/3 of the study sample. Hope was considerably higher and positive mood modestly higher in the study sample than in the college student comparison groups. These latter findings were somewhat surprising, although the patients' involvement in treatment may have served to enhance their motivation and perceived ability to achieve goals.
By contrast, and as might be expected, most of the LAP-R scale scores indicated poorer MH for our sample than for a community sample. The EV scale, a measure of boredom, apathy, or feelings of indifference provided a particularly telling picture of the poor MH of our study sample vis a vis the instrument development sample. Thus, despite higher self reported spirituality/religiousness and the perceived ability to achieve life goals, i.e., hope, our study sample was quite lacking in a sense of self. Social support was uniformly lower for SUD patients than for college undergraduates. Optimism, or a disposition toward seeing a positive side in life, was also lower compared to college students. The findings for these 3 measures are not surprising given the more problematic life histories and current circumstances of many SUD individuals
Finally, the study's findings that the relationships between the 7 MH measures and recent alcohol, drug, psychiatric, and family-social problems was consistently higher than that with recent legal, employment, and medical problems supports the concurrent validity of the 7 MH measures in the study's SUD outpatient sample. In this regard, it should be pointed out that while the relationship between the SPS total score and the ASI's family-social CS was not as high as one might initially anticipate, the two measures are quite different with the former assessing a number of forms of social support unrelated to the nature of the social relationship and the latter specific problems with family and friends. It is of interest also that the MH measures were most highly related (in an inverse direction) to recent psychiatric problems than to any of the measures of recent life problems. This would be anticipated since most of the MH measures tap what could broadly be considered psychological characteristics, psychological and emotional attributes. Although all of the measures of MH were inversely correlated with the severity of recent alcohol and drug problems, the findings revealed that these relationships were not high for a group of individuals in the acute phase of treatment. Whether MH bears a higher relationship to alcohol and drug problem severity in individuals in a latter stage of treatment and recovery is an important question to pursue further. In summary, the study findings revealing generally adequate reliability of the MH measures for SUD patients. The internal consistencies and levels of MH in SUD patients vis a vis the community-based groups on whom the instruments were developed, the concurrent validity evidence found in this study, as well as prior validity data on four of the study measures, appear to support the further investigation of MH measures towards understanding the characteristics of SUD patients that may have clinical utility.
In interpreting the findings, it should be kept in mind that the study's SUD patients and the community comparison groups, against which they were compared differed on a number of background and socio-demographic characteristics such as educational level, economic status, age, racial composition, additional psychopathology and so on which could have influenced the findings in addition to the substance abuse problems and associated treatment which the SUD patients were undergoing. It is also important to emphasize that while the study's SUD sample represents a large subset of those receiving treatment in the United States its findings may not generalize entirely to patients with other background characteristics or to those receiving a form of treatment that does not emphasize the self help group approach.