Development of a "Steps Questionnaire"

Alcoholics Anonymous (AA) promotes a "12-Step" program to foster recovery from alcoholism. The program intends to facilitate the maintenance of abstinence and remove the obsession to drink or use drugs, so that the individual becomes "happily and usefully whole." Francis S. Gilbert (Journal of Studies on Alcohol, 1991, 52/4, 353-360) develops an instrument to measure attitudes and beliefs relating to the first 3 Steps. He also examines the relationship between degree of belief in these Steps and sobriety.

Gilbert accomplishes his aim with guidance from Andrich's "Rasch Models for Measurement" (Sage, 1988) and Cohen's "PROX" paper (Brit. J. Math. Stat. Psych. 32, 113-120, 1979). He constructs 42 items from AA literature. 17 items indicate Step 1, 12 Step 2 and 13 Step 3. The response mechanism is a 7 point rating scale from "disagree strongly" to "agree strongly" with "neither agree nor disagree" as the mid-point. 10 negative items are reverse scored. The questionnaire is administered to 183 male subjects in an alcohol treatment program.

To simplify analysis, responses are transformed from their 7-point Likert form into dichotomies with the 3 categories of agreement scored "1" and the other 4 categories "0". Item difficulty calibrations are estimated for the 42 items with the PROX algorithm. These calibrations are used to select 5 items to represent each of the three Steps [see Table].

Person raw scores are accumulated for the 5 dichotomously scored items of each Step, but only the raw scores for Step 1 items prove useful predictors of sobriety. In contrast, frequency of attendance at AA meetings does not predict sobriety. Gilbert concludes that it is belief in "powerlessness and unmanageability" that predicts abstinence.

-------------------------------------------------------------------------
Logit  Step  Item
-------------------------------------------------------------------------
"Beginner"  "Easiest to Agree with"
-1.43  1    I surrender to the fact that I can never drink again
-1.35  1    My life has become unmanageable because of alcohol
-1.24  1    I admit I am powerless over alcohol

-1.07  1    I can never drink again, not even one
-0.94  1    No matter what I do, when I drink things get worse

-0.53   2   A Power greater than myself can restore me to sobriety
-0.42   2   My recovery lies in a Power greater than myself

  .27    3  Consciousness of God is the most important fact of sobriety
  .35    3  Higher Power must run my life, with no strings attached
  .55    3  I do not need to understand a Power to let it take over

  .68   2   Personal willpower is the only thing that is needed (Reverse)
  .76   2   Trying, without believing in a Power, was a waste of time
  .82   2   All I need is to understand myself (Reverse)

  .90    3  Belief in myself is all I need (Reverse)
 1.32    3  Learning to have faith in a Power seems impossible (Reverse)
"Advanced"  "Hardest to Agree with"
-------------------------------------------------------------------------
Step 1:     Powerlessness over alcohol
Step 2:    A Higher Power is needed
Step 3:    Decision to turn to that Power
-------------------------------------------------------------------------


Development of a "Steps Questionnaire", F Gilbert … Rasch Measurement Transactions, 1992, 6:2 p. 220


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