Analysis Of The Tao Of Equus

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1) How did Kohanov utilize equine-assisted therapy in her practice?

2) Discuss and describe what Kohanov means in terms of “emotional resonance” and “emotional congruity.”

3) Based on your reading of The Tao of Equus and other course materials – what types of DSM 5 diagnoses do you think would be most appropriate to treat with equine-assisted therapy and why?

4) Based on your reading of The Tao of Equus and other course materials – how would you incorporate some of the information gleaned through your readings in actual practice (please give some real-life examples)?

5) Discuss and describe limitations of traditional therapy listed by Kohanov.

6) Discuss and describe what Kohanov means in terms of “sympathetic vibrations.”

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Should Labeling Play In The Addictions Assessment Process?/

Substance Use & Misuse, 43:1704–1728 Copyright © 2008 Informa Healthcare USA, Inc. ISSN: 1082-6084 (print); 1532-2491 (online) DOI: 10.1080/10826080802285489

Views and Models About Addiction: Differences Between Treatments for Alcohol-Dependent People

and for Illicit Drug Consumers in Italy

ALLAMAN ALLAMANI

Centro Alcologico, Gruppo Prevenzione e Ricerca, Florence Health Agency, Florence, Italy

Treatment of people who are alcohol-dependent and treatment of users of illicit drugs differ remarkably in Italy, in keeping with the perception of the general public that drinking alcoholic beverages is a time-honored behavior, while consumption of illicit drugs is a deviant behavior. From a clinical perspective, the treatment for alcoholism essentially stands on the principle of free choice, motivation to change, and a family approach, while the treatment of people who are illicit drug users is characterized by control, pharmacotherapy, and individual therapy approaches. From a socio-political viewpoint both were established in the 1970s, the former being a “bottom-up” movement that started as “spontaneous” responses that mutual help groups and a few clinicians and institutions gave to alcoholics and their families; while the latter was provided “top- down” as a political response of the Government confronting the increase of illegal drug consumption among youngsters.

Keywords addiction; alcohol addiction programs; illegal drug addiction units; cultural viewpoints; mutual help groups

“A te convien tenere altro viaggio” Rispose poi che lagrimar mi vide Se vuoi campar d’esto luogo selvaggio. . . . Ond’io per lo tuo me’ penso e discerno Che tu mi segui, ed io sarò tua guida E trarrotti di qui per loco eterno Ove udirai le disperate strida. . . ” (Dante Divina Commedia, Inferno, I, 91–93;112–115)

“Thee it behoves to take another road,” Responded he, when he beheld me weeping, “If from this savage place thou wouldst escape.

Thanks to editors, Alexandra Laudet and Shlomo Einstein for their patience and competence in reading the manuscript and suggesting many appropriate changes. This article is therefore luckily affected by a challenging dialogue with the editors, while its weakness is entirely due to the author. Also, thanks to Donald Bathgate for his support in the English translation, and to Ivana Pili for her help in plotting the figures.

Address correspondence to Dr. Allaman Allamani, Centro Alcologico, Gruppo Prevenzione e Ricerca, Agenzia Sanitaria Locale, Villa Basilewsky, Firenze, Italy. E-mail: allamana@gmail.com

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Views and Models About Addiction 1705

..Therefore I think and judge it for thy best Thou follow me, and I will be thy guide, And lead thee hence through the eternal place, Where thou shalt hear the desperate lamentations”

(Dante’s Comedy with the Henry W. Longfellow trans. DIGITALDANTE Institute for Learning Technologies dante@mailhub.ilt.columbia.edu Copyright 1992—97 Last Modified November, 1997)

Viewpoints on Addiction

The aim of this paper is to describe the striking differences between the treatment of people who are alcohol-dependent and the treatment of illicit drug users in Italy. In the last analysis such differences, we posit, draw on the different meanings that alcoholic beverage consumption and illegal drug use have among the general public and, more specifically, on the values that alcoholic beverages—namely wine—traditionally maintain among the Italian population and among politicians and health professionals as well. Also, in Southern Europe, alcohol beverages are mainly drunk daily or nearly daily at meals by the majority of population, and are generally endowed with the aspects of taste, pleasure, and conviviality. Intoxication, or loosening of tensions, as it is typical in Northern Europe or in United States, is not generally sought by Italian drinkers. On the other hand consumption of illicit drugs is clearly considered to be a deviant behavior, as it is the case all over the western world.

This paper discusses the different viewpoints existing in Italy regarding addictions and their treatment, how Italians and particularly clients and caregivers perceive the problems related to alcohol beverage, and drug consumption, and how programs have been created to respond to them and their various needs.

This section introduces the idea that there is no single perspective with which one can adequately understand the addiction phenomena; one needs to consider several relevant viewpoints including the clinical, the psycho-social, the moral, the socio-political, and the spiritual.

Indeed our conceptualization or view of reality, and of problems of behavior, in partic- ular, can be broadened by resorting to models of interpretation that may reflect the different aspects of human beings. These views are based on values with different cultures—specific to countries, communities, sectors, and professions, over time—attribute to activities or objects and, in the case of substances used, to the substances themselves and the behaviors by means of which people interact with them.

The Moral Viewpoint

There are certain circumstances in which these views are obviously “graded”—a substance which is acceptable in certain quantities becomes unacceptable in higher quantities, such as food, alcoholic beverages, and medicinal products. In other circumstances, by contrast, usage is not acceptable in any quantity, shape, or form such as, for example, illicit drugs. There are also considerations such as frequency of use, context of use, meanings attributed to the substance as well as its use and users or nonuse and nonusers (i.e., being a temperate person). With some minor variations, substance use in the western world can be variously perceived as being socially acceptable and good, or indicating problematic acts, behavior and even lifestyles, with medical, psychological and deviancy implications, or immoral ones.

 

 

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The Social Viewpoint

Considering the social aspects (one of the exogenous facets) of substance use and misuse with regard to the population as a whole it behooves us to ask: Why should the social side concern us when one considers the need for intervention (treatment, prevention, control, policies, research, etc.)? It can be, and is, perceived, for example, as being an improvement on the more traditional individual endogenously driven, clinical-oriented approach. Indeed the one-on-one clinical approach is still prevalent in the western world especially in the professional treatment1 of substance addiction, despite its obvious limitations in dealing with substance use and abuse2 on the one hand and on the other its rigidity and repetitiveness and consequent incapacity to produce or incorporate innovation, hemmed in as it is between the conception of biological medicine and psychological causality.3

As a point of fact, in 1970s research in the systemic, family-oriented approach in the United States, successfully diffused in Italy in the 1980s, paved the way for change of the typical clinical one-on-one approach (see Kaufman and Kaufmann 1979; Steinglass, 1987). This perspective translated the alcoholism of the individual into the “alcoholic family,” changing the individual-oriented perception of the medicalized “alcoholism” problem into a family and social issue. Indeed, the Al-Anon, or family members of alcoholics’ groups, developed in 1952 in the United States, were the first means for drawing attention to the problems and symptoms of family members being involved in and with the problems of the “tagged” alcoholic individual.

In general, contextualizing addiction behavior implies considering the parts and roles which family, environment, and society can and do play in the actual phenomenon of addiction. For example, how each of these separately and in combination are able to exert some informal control on those modes of behavior and the critical conditions which are necessary for such behaviors to operate or not to operate. The “tagged” substance, per se, is unable to define the problem, e.g., detoxifying an individual from heroin does not guarantee that relapsing into dependence on alcohol, or medications—used for nonmedical reasons and purposes—will not occur.4 A reasonable explanation for this is that whereas a detoxification process “cleans” systems of the living organisms, abstinence—however defined—harm reduction, and quality-of-life based treatment goals and models are behavioral and life- style processes and outcomes.

1Treatment can be briefly and usefully defined as a planned, goal-directed change process, of adequate quality and appropriateness, which is bounded (culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual-help-based (AA, NA, etc.), and self-help (natural recovery) models. There are no unique models or techniques used with substance users—of whatever types—and non-substance users. In the West, with the relatively new ideology of “harm reduction” and even the newer quality of life (QOL) treatment-driven model, there are now a new set of goals in addition to those derived from/associated with the older tradition of abstinence-driven models. Editor’s note.

2The journal’s style utilizes the category substance abuse as a diagnostic category. Substances are used or misused; living organisms are and can be abused. Editor’s note.

3Sir Bradford Hill published the following nine criteria in 1965 to help assist researchers and clinicians determine whether risk factors were causes of a particular disease or were outcomes or merely associated. The nine criteria include: strength of association, consistency between studies, temporality, biological gradient, biological plausibility, coherence, specificity, experimental evidence, and analogy. and are defined below (Hill, 1965). Editor’s note.

4One or few trials learning, in humans, is quite rare complex, dynamic, multidimensional, phase/level-structured, nonlinear processes/phenomenon—which are also bounded (culture, time, place, etc.). Thus a “lapse” or “relapse” may be a necessary dimension for initiating, sustaining, and integrating a change process. Editor’s note.

 

 

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According to the system approach, a family is a system of relationships which is based upon how interaction is organized among its members. In such a process, it continuously determines and implements its own characteristics, dynamics, and values. Family pathology kicks in when family interactions become and/or show up to be rigid. This means that even when some values are discovered to be inadequate in certain phases of family development, they are perceived as, and all too often are experienced as being, the only possible reality with no other viable alternatives being deemed possible.

The main conflict of an “alcoholic family” occurs in the marital arena with the actual pharmacological as well as the anticipated effects5 of alcohol consumption allowing emo- tions to be expressed. Family members often are affected by “co-dependency,” a relatively recent “diagnosis”6 which has been characterized by a pathologized addiction—like over involvement with and a continuous “caring” about and a concern for their alcoholic family member who is a patient. In a paradoxical sense the concerned family system needs the person to continue being the family alcoholic, and s/he remains in the family by playing out this role; the system remains stable with clear role and behavior definition. How- ever, if the identified and “tagged” family member, but also a so-called “healthy” mem- ber, accepts help, e.g., by attending a therapeutic group or program, a positive behavioral change can be initiated. In this case, one or more family members can be transformed into needed therapeutic resources both for the individual “alcoholic” as well as for the “sick” system.

Thus, the behavior of the identified alcoholic person and his/her family members man- ifests itself either as being dependency-driven or as a reaction to dependency.

In dependency, the individual complies with and depends on others. In reaction to dependency, the individual claims to be “dominant” or “independent.”

Dependency is experienced as a weakness to reproach and is likely to be connected to the feeling of shame. Dominance, both by the individual and of his/her family member, is experienced as strength, which, however, is also to be reproached since it is linked to the feeling of guilt. Shame (concept, process, and outcome), which in the United States is often used interchangeably as guilt, is a powerful experience that has been considered to contribute to the development of as well as to the maintenance of addiction-related problems; according to a cyclical pattern humiliation and shame, because of loss of control, are “sedated” by the use of a substance, and the addiction to the substance triggers increasing shame with consequent use of the substance (Wiechelt, 2007), Such behavior is rooted in the fact that Western culture has developed a tendency to hide shame, or to be ashamed of feeling shame (Wiechelt, 2007). The psychology of shame and its theoretical development is connected with the issues of one’s struggle for identity, that is one of the recurring problems of our age (Kaufman, 1985). The case of Italy is peculiar since while in the Italian culture the feeling of guilt appears particularly underdeveloped, the shame seems a much more diffused feeling,

5The effects of psychoactive substances in humans have been categorized as being due to the “drugs” chemical action (which has to do with a chemically active substance entering an organism, getting to a receptor, being metabolized, and then being excreted) and what has been coded a “drug experience”, which is the outcome of the interactions between the human and his expectations, the active chemical, and where this complex process is taking place. Humans do and have described “drug experiences” from nonpharmacological “drugs”. Editor’s note.

6Any diagnosis is a data gathering process designed to help make needed decisions and is based, medically, upon at least three bits of information: etiology, process, and prognosis of that which is being diagnosed. Whereas a “diagnosis” is part of a nosological system all nosologies are not diagnostic. The relatively recent diagnosis “substance use disorder” can easily be understood by “labeling theories” given its limitations of evidence-based etiology, process, and prognosis. Editor’s note.

 

 

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linked as it is to the condition of not to being perceived as being part of the social group (Battacchi and Codispoti, 1992).

It was the family-based perspective that, together with epidemiological studies in- dicating a link between the various forms of substance abuse,2 especially the use of il- legal drugs, alcohol, and food (see, e.g., Krahn, 1991; Schuckitt et al., 1996), laid the theoretical foundation for developing the concept of transmission down through the gen- erations, especially the intergenerational theory of substance use (Framo, 1992). Obvi- ously, this thesis also has to consider recent investigations about genetic alterations in- ducing addiction and their capability of being transmitted (see, e.g., Begleiter and Kissan, 1995).

If we take one step back from the more traditional medical–pharmacological approach with its classical concepts and derived processes of diagnosis and therapy, we can better appreciate and understand how medications and physicians have, in fact, been used and co-opted as a means of keeping a tight rein on behaviors related to pleasure-seeking and on posited illness outcomes chronic in nature—which have been and continue to be deemed as unchangeable over time.7 In such a “substance use disorder” illness, relapses are considered to be predictable manifestations of the underlying illness which emerge from time to time. We may reflect on how the different therapeutic communities in Italy became a means for a total, purifying re-education against the problematic behaviors of “homogenized” and all too often stigmatized individuals who are atoning for society’s problems (Picchi and Caffarelli, 1991).

From a more traditional perspective substance addiction/dependency/habituation have become a “consensualized” scapegoat of our modern family and/or globalized society and are linked to the guilt or shame feelings which are generated within our culture (Steinglass, 1979).

The Socio-Political Viewpoint

Politics and general awareness of social problems turn our attention to the task of safeguard- ing the disadvantaged. The social-political approach may therefore be used to view and give a macro-perspective to the world of addiction with its “narcoscapes,” social networks of users, and a range of stakeholders and gatekeepers.

However, the socio-political arena may not be “an appropriate domain for understanding the substances” (Kleinig and Einstein, 2006). It is much more a site of “political power and dominance” where “more or less restrictive ideologies” are enshrined in legal format and the fear of the substance consumers “leads to their disempowering, marginalization, and stereo- typing” (Kleinig and Einstein, 2006). Reflecting on the meanings that politics and society attribute to substance use, misuse, and addiction—when they place it among the objectives which they intend tackling—we can again refer to S. Einstein who, summarizing his views on the characteristics of “substance use disorder” treatment, posits that “drug treatment” and “alcohol treatment” are unethical given that (1) there are no unique and/or specific treatment models for substance users and non-substance users; (2) there are many vested interests opposed to needed change; (3) scientific veracity has been turned into slogans; (4) new and generalizable findings are generally not introduced into viable intervention efforts; and (5) substance users, representing a heterogeneous group of people and patterns

7Readers interested in either of these processes are referred to Brandt, A. M. and Rozin, P. (1997) Morality and Health Routledge NYC, particularly to their concept of secular morality as well as to the recent literature about “disease mongering” which is easily found on Google. Editor’s note.

 

 

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of use, continue to be treated in “specialized” programs which are distanced from the main- stream of the treatment of non users—“normed treatment of normed diseases”—all too often manifesting imparity in availability and delivery of needed services (Einstein, 2006).

The Recovery

The recovery may be defined as a “complex interaction of mental, physical, and spiritual actions that leads to living a conscious and sane life” (Schaub and Schaub, 1997). Such con- cept is influenced by the view of Alcoholic Anonymous (AA) and implies a process or a path that may be well described by the verses from Dante’s Divine Comedy that opens this paper, which define how to face your problems is not to escape fear—as Dante appeared to do at the moment he found himself in the deep forest—but to face it and get in touch with it, with the help of a guide, that is the Latin poet Virgil. Actually the whole Divine Comedy is a metaphor of the recovery process, as it is shown by a recent book by Schaub and Schaub (2003).

The term recovery (recupero) is not common among Italian Public Health Care Ad- diction professionals who prefer the more neutral word treatment (trattamento). This is in keeping with the usual expectation in Italy that patients—the diagnosed, chronic substance use disorder—are to be treated for the rest of their lives by health workers by means, e.g., of long-term methadone maintenance, the treatment being essentially to control clients; or that, notwithstanding the posited chronicity of their disease, they will quit “illicit drug use” completely by following the therapeutic community-based life style. . . having sufficiently matured. However, “recupero” is a usual term among Italian AA members. The issues of “natural recovery” (see Einstein, 2006) and of spontaneous remissions (see Klingemann et al., 2001) point to an as yet unresolved dilemma which continues to exist. The broad “re- covery” literature has not adequately considered and integrated the documented processes and outcomes of substance use cessation by a broad range of types of users and patterns of “drug” consumption without the use and help of tradition-based, professional-based, and/or mutual-help based treatment and support. How did they “exit” from a posited, di- agnosed, chronic disease and remain “recovered” in a field which does not use the concept “in remission?”

The “Risk”

Another aspect of “recovery” meriting consideration is the perception of “risk” and its mea- surable expression within and by society-at-large, and its health workers. Worries about risks seem to occur cyclically across years or even centuries, independently from current scientific information. For example, the report on the disasters wreaked by alcohol con- sumption in Italy that Guido Garofolini wrote about in 1887 (Garofolini, 1887) may be identical to today’s pronouncements by the Ministry of Public Health in Rome (see Italian Ministry of Health, 2005). Or, going further back, the exhortation of the Rule of St. Benedict of the sixth century A.D. which provided that monks in good health should not drink more than a hemina (quarter litre) of wine, predates the preventative recommendations of the WHO by 1300 years.

. . . bearing in mind the condition of the weakest, we believe that a quarter litre of wine a day is sufficient. (Rule of Saint Benedict, 1985)

. . . Epidemiological data suggest that the risk of alcohol-related problems grows significantly when consumption is greater than 20 grams of pure alcohol a day (World Health Organisation, 2000)

 

 

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The Spiritual Viewpoint

The spiritual aspect of substance use perceives the so-called illness of addiction as being actually a spiritual illness. In more specific terms, it is a disturbance of the relationship between body and spirit in which the individual lacks the capacity to interpret or integrate. In alcoholism, for example, this means that the individual seeks the spirit of the grape or the grain forgetting the Higher Spirit. The program of spiritual-based therapy stems from acknowledging the limits or fallacies of professional-based models of therapy. This program was established on the advice that the psychiatrist C. G. Jung gave to an alcoholic patient of his at the end of a psychotherapy process which was crowned with failure.

In Bill’s words, Jung stated that “The healing process could not be activated by further medical and psychiatric treatment, but there could be a hope only on condition that the alcoholic could become the subject of a spiritual or religious experience—in short a genuine conversion”. (Alcoholics Anonymous, 1984, p. 382)

And according to a letter that Jung wrote as a reply to Bill, “The only right and legitimate way to such an experience is that it happens to you in reality, and it can only happen to you when you walk on a path which leads you to higher understanding. You might be led to that goal by an act of grace or through a personal and honest contact with friends, or through a higher education of the mind beyond the confines of mere rationalism”. (Alcoholic Anonymous, 1984, p. 384)

Perception of Alcoholic Beverages and of Related Problems in the Italian Society

Italy, like some other Latin populations, has a certain sociological specificity compared to the other European countries, especially north European ones, in terms of family ties and family dependency, which are a major accepted fact of Italian society (see the chapter on the “Mediterranean Mother” in Bernhard, 1969). Autonomy of the individual on the other hand is not such an eagerly sought-after asset as in other cultures. This is likely to have effects in a range of “addiction” behavior manifestations, albeit in an increasingly globalized culture that tends toward uniformity with the other cultures of the western world.

The models for understanding substance addiction-dependency generally and alcohol misuse in its various categories in particular, have been developed over time, beginning with the perception, established at the end of the 1800s, that alcohol misuse had become a social issue which on the one hand was linked to the rise of the urban proletariat and on the other hand with the development of the temperance movement from its north European and north American counterparts, which in Italy was becoming fairly well known for some time (Cottino and Morgan, 1985). The onset and evolution of Fascism in the 1920s and 1930s stressed a moralistic model, that of the Italian male, strong and virtuous, and those years saw the earliest legislation sanctioning drunkenness.

In the 1970s, a well-defined, health-related perception of alcohol “abuse” emerged deriving mainly from the birth of specialization in hepatology and gastroenterology and the almost contemporary shut-down of the psychiatric hospitals by the 1978 law tabled by Franco Basaglia, to which alcoholics had been traditionally confined up to the previous decade (Cottino and Morgan, 1985). Whereas hospitalization in psychiatric wards gave a

 

 

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connotation of deviancy to the behavior of “the alcoholic,” hospitalization in a medical hospital first “normalized” the alcoholic who, here, shared equal rights with other patients. However, experience over time has adequately documented that treating liver cirrhosis did not mean treating “alcoholism” but only a few selected effects of it. The need to diversify treatment in order to tackle the issue of addiction and its medical manifestations leads to the present situation where hospital Toxicology Units, middle- or long-term hospital pro- grams, Emergency Departments have supervened with their in-patient treatment programs. Nevertheless, hospitalization in Italy is now less frequent, out-patient community services and community mutual help and volunteer resources being a more frequent option for individuals affected by alcohol addiction dependency.

AA drew Italy’s attention to the fact that alcoholism can be and is conceptualized as being an existential sickness which can be intervened with separately from the health system by group mutual help treatment support which is characterized by spiritual rebirth. The first public conference of AA in Italy was held in Palazzo Capponi, in Florence, in July 1974 when addiction to illicit drugs and their use was beginning to take root, and the television film “Silvia è sola [Sylvia is on her own]” was broadcasted some years later telling the story of alcoholism of a woman who went on to join AA. This drew Italy’s attention to the fact that alcoholism is an existential sickness and can be tackled by group treatment. In a time when Italian culture was immersed in the values of post-Fascism, post-Idealism, and Marxism, the self-generation and the spirituality-based model typical of AA took time to gain ground. However, AA has a higher profile now than it did 30 years ago, while the 12-step program brought about a turnaround in the approach to addiction treatment in Italy, too, as it became applicable to almost every posited “addiction”: food, drugs, gambling, etc.

In short, alcoholism had been perceived for years as being the problem of an unfortunate, fairly easily identifiable few in a country or neighborhood. The idea of becoming “one of them” struck one with fear or shame, a moralistic-based perception which continues to exist, but less so over time. The fact that more women as compared to those in the past are attending alcohol addiction treatment services and groups like AA is a sign that they, their husbands, fathers, and sons, and our society as a whole, are less branded by shame and are seeking ways forward rather than sticking to the traditional behavior of denial—covering up and not seeing. Today, there are even fewer program administrators and politicians getting waylaid on this issue. Alcoholism is not perceived as being “the problem” of a few, but rather is now considered to somehow be an issue of social relevance for the Italian community as a whole.

Accessible resources are now available in contemporary Italy to treat persons mani- festing problems related to their consumption of alcohol beverages as well as for those who are involved with such persons and who seek help and support. Some cities have developed needed services including alcohol addiction treatment facilities as well as mutual help and volunteer groups.

Today’s inadequacies are also visible. The media often confuses alcoholism with the misuse of alcohol by young people or members of the immigrant community, associating such use with causing road accidents or acts of violence, as well as with illegal drug use. These are surely significant problems, but information of this kind contributes to lowering concern about alcohol addiction, its consequences to and implications for individuals and systems by associating alcohol addiction and misuse to a certain age-group or culture; perceiving it as being something “separate from us” in the same way as we talk about “drugs.”

Epidemiological research, instead, tells us that alcoholism is not infrequent. Even if reliable information about the number of individuals who are affected by alcoholism in Italy does not exist, according to the observatory on smoking, alcohol, and drugs of the Italian High Institute on Health, they are estimated to be approximately 2% of the general

 

 

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Table 1 Program sources to treat substance consumers and misusers in Italy.

Professional 12-Step Voluntary Religious

Community Alcoholics Clubs for Therapeutic programs Anonymous Alcoholics in Communities Hospital beds Al-Anon Treatment University beds Narcotics

Anonymous Overeaters Anonymous

population of Italians (approaching 60,000,000), namely approximately 1 million (Scafato, 2005). Some other experts claim that they are 0.5%, and others up to 5% of the total population (cf. Voller, 2007). In two national surveys carried out on the general population by the Osservatorio Giovani e Alcool in 2000 and 2005, attempts were made to measure the dimension of alcohol dependence through the CAGE questionnaire, and the results may be considered as being consistent with the above-mentioned rates. The results of the 2005 survey revealed that the number of people who gave three or more positive answers to the four CAGE questions—that is those posited to be at potential risk8 of alcohol addiction or alcohol-consumption-related problems—increased from 0.8% (2000) to 1.9% (2005) out of all the consumers (Osservatorio Permanente Giovani e Alcool, 2000, 2007). In terms of problems involving not just alcoholic individuals, but family members as well, such figures have to be doubled, trebled, or even quadrupled.

On the other hand Italian drinkers-at-risk— individuals who are not alcohol dependent but consume more than 20 g/day of pure alcohol for females and 40 g/day for males—are estimated to represent 10–20% of the general population, that is between 5,000,000 and 12,000,000, according to international and national studies (Anderson and Baumberg, 2005; Innocenti, 2000; Voller, 2007).

Development of Italian Programs to Treat Illicit Drug Users and Alcoholic Addicts

Program sources to treat substance consumers and misusers in Italy can be divided into professional-based, 12-step mutual help based, voluntary-based, and religions-based pro- grams (see Table 1).

By and large, treatment of users of illicit drugs and of people who are alcohol-dependent differ remarkably in Italy. Both treatment resources were established in the 1970s, the former being a political “top-down” response provided by a government confronting a

8This concept is often noted in the literature, without in any way helping the reader to adequately understand its dimensions (linear, nonlinear), its “demands,” the critical necessary conditions which are necessary for it to operate (begin, continue, become anchored and integrate, change as de facto realities change, cease, etc.) or not to and whether its underpinnings are theory-driven, empirically based, individual and/or systemic stake holder-bound, based upon “principles of faith” or what. What is necessary—endogenously as well as exogenously—for the posited process to happen? This is necessary to clarify if the term is not to remain as yet another shibboleth in a field of many stereotypes. Editor’s note.

 

 

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sudden increase in illegal drug consumption among youngsters, while the latter was a “bottom-up” movement that started as “spontaneous” responses from mutual help groups and a few clinicians and institutions that begun to give help to alcoholics and their families.

Programs to Treat Illicit Drug Users

The spread of heroin consumption among young people in Italy had dramatically followed the student and young adult protest activities that pervaded Italy during the late 1960s. Consumption of heroin in Italy’s large cities began in the 1970s and subsequently spread to include smaller towns. A few politicians on the one hand, and some family doctors on the other, had provided the first attempts to treat individuals who began to present physical harm and problem behavior, and administration of morphine at the doctor’s office was then the first available program. However, formal specialized professional out-patient community services for treating illegal drug addiction, recently named as SerT (Servizi per le Tossicodipendenze) were approved by the Italian Parliament with Law N. 685, December 22, 1975. These services developed very quickly to meet such a new and for Italians a shocking phenomenon, which was experienced as being a real national emergency. These interventions and services were especially supported by left-wing governments, which footed the cost of funding the services with no contribution being asked from clients, as is traditionally the situation in Italy for Public Health Care institutions.

In general, in Italy left-wing parties have developed an approach to illegal drug user treatment that is different from the approach of right-wing parties as well as from the Catholic Church. A fourth perspective is one of the small but very active Radical Party, that for the last 20 years has been proposing the depenalization and liberalization of illicit drug use. Left-wing parties are communist and post-communist: their efforts have been to oppose the too-individualistic approach of drug consumer treatment and eventually to at- tempt a harm reduction approach which focused on methadone maintenance programs and to the reintegration of the treated drug users into the societal network. The Catholic Church also responded to the “drug problem” during the 1970s with the creation of Italian Ther- apeutic Communities (TCs). The meta-goal and ideological underpinning was to cure the addicted persons and to restore the “new man” inside. The church initiated and maintained TC movement spread in many regions in the country especially during the 1980s–1990s. More recently, they were followed by a few public or “private-public” Therapeutic Com- munities. Right-wing parties, that are represented by post-WWII fascists and a number of new political parties created during the early 1990s and have generally been sympathetic to the “law and order” approach became, somehow, closer to the ideology of Therapeutic Communities. They wanted youngsters to avoid deviant behaviors, forcing them to adapt to an “appropriate” lifestyle.

Consequences of the quick creation of the illegal drug addiction treatment services which merit concern include:

(1) the comparatively low levels of professional skill and experience of the workers in- volved;

(2) program staff who lacked the appropriate university specialization (since for years Universities did not include any aspect of “addictions” among their subjects in their faculties); and

(3) a scarcity of locally produced research.

 

 

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A social awareness and a political interest in the disadvantaged or/and the marginalized- outcasts was what was deemed to be necessary for working in this area.

This may initially have bound the professionals to the agendas and specific interests and goals of political parties and secondly contributed to fewer innovations in the created services. It may also have produced more professional turnover in the “addiction” treatment services when compared with other disciplines in the Italian health and delivery of care system.

All too often politicians and political parties tend to fund services which are mandated to tackle problems which societies’ stakeholders and gatekeepers have the greatest fear of for a variety of reasons and, in turn, the visibility of these services keeps the interest of politicians focused on them.9 The nexus between moral crusades, moral entrepreneurs, and politics is one such example. Substance use intervention remains a highly politicalized arena. The “War on Drugs,” which is a “war” on selected groups of people is a contemporary example of this.

Programs to Treat Alcoholic Addicts

By and large, alcohol-consumption-related problems have been deemed as being of lesser importance in Italy even though their associated health impact and mortality rates are higher than those relating to “drug addiction.” For example, in 2005, 603 drug addicts died from acute causes, while overall alcohol-consumption-related mortality, including from chronic consequences, were estimated to be between 17,000 and 42,000 (Italian Ministry of Health, 2005; Italian Ministry of Social Solidarity, 2006). This is additional evidence of the power that the culture of people has which enables one to fly in the face of hard numbers and data, and instead to form and to disseminate myths and misinformation. A culture in which opinions equal facts.

A reaction to alcohol misuse in Italy began a bit earlier than the treatment for drug ad- diction, especially in the Gastroenterology departments that were created in Italy during the early 1970s and which began to treat cirrhoses of the liver and their link to “alcohol abuse.” At the end of the 1970s, there were four national health system units in Italy independently experimenting with specific treatment programs for chronic alcoholics in three hospitals (the Geriatric Unit in Udine in Italy’s north-eastern Friuli-Venezia Giulia region; the Gastroen- terology Units in Florence and Arezzo, Tuscany) and the out-patient drug-addict service in Dolo in the Veneto region, cooperating with the Gastroenterology Unit in Padua (Allamani, Barbera, Calviani, and Tanini, 1994). In Florence, the out-patient Alcohol Unit of Gastroen- terology treated approximately 1,000 alcoholic patients between 1987 and 1990, who were mostly referred to the Unit by the Gastroenterology in-patient staff. AA groups and Al-Anon groups were mainly involved. The first year after the program was started in Undine (1979), 198 diagnosed “alcoholics” were treated. In addition, the voluntary groups “Club of Alco- holic in Treatment” were called in to support the patient and his/her family (Buttolo et al., 1982).

The development of programs, services, and centers for treating alcoholics in Italy during the 20-year span from the mid ’1970s to the mid ’1990s is an interesting example of

9The interested reader is referred to the large “moral panic” and “moral entrepreneur” literature as well as to books such as Bullen, R. J. et al. (eds.), Ideas into Politics (London: Croom Helm, 1984) and Brandt A. M. and Rozin, P. (1997) Morality and Health Routledge NYC; MacCoun, R. J. and Reuter, P. Drug War Heresies: Learning from Other Vices, Times and Places. (2001) London, Cambridge University Press. Editor’s note.

 

 

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how a system of treatment arose first of all from below through a creative synergy between the efforts of organized groups of alcoholics and their families, and the contemporary interest of medicine to open up to society, all within a process of transformation of values of the rural, urban, and industrial, up to post-industrial societies in the general population. In this process, the role of legislation was to subsequently institutionalize an existing pathway that was started years before.

It must, however, be acknowledged that since the beginning of the 2000s services and units for treating alcoholics in Italy have remained unevenly distributed and in some cases have even regressed. Alcohol addiction treatment programs are now more visible, but only in the context of illicit drug user programs created as a result of a concern about the use of drugs and alcohol beverages among the young. Treatment centers and services for alcoholics dedicated exclusively to alcohol-consumption-related problems may be at-risk of closure because of their quest for maintaining their own autonomy from and even being ahead of the SerTs. Lastly, the planned creation of more needed structures for the treatment of alcoholics in contemporary Italy has not taken place, probably because of financial restrictions.

By and large, the development of substance use and its intervention in Italy, from a historical perspective, may appear to be a déjà vu or a delayed replication of what happened with mental illness. The latter had been particularly stigmatized up to the 1970s as if it was related to as being an expression of a social obscenity and societal stigma. By closing asylums and fostering acts at the community level, Franco Basaglia10 and others fought vigorously to free “lunatics” from the condition of being protected/controlled/segregated in order to make the real meaning of madness known to the society which, in Basaglia’s opinion, had generated it (Basaglia, 1968). For Basaglia madness socially represents obscenity or indecency, “markers” of those deviant parts of society that society does not accept to be parts of itself. A fellow like Basaglia nowadays would draw the attention of policymakers, specialists, and the population at large to the stigmatizing, “homogenizing” labeling of “difference”—a THEM that is assigned to the addict, as we keep him/her at a distance from US and our “normed” sites of treatment. If recovery is to be a viable process and outcome—as it is and can be—one needs to be aware of and consider their ongoing levels and qualities of treatment disparity and how human diversity can be accepted in the same manner as it was in the history of responses to psychiatric illness and its treatment.

Laws

It is a truism that society is continually on the move and legislation tends to follow suit, setting the present in order and enshrining it rather than creating it. In a certain sense, therefore, the laws passed about “addictions” and their associated behaviors and planned interventions can be viewed and considered as being reliable indicators of the way in which a society, during a given period and place, perceives the phenomenon of addiction. This includes among other considerations, selected substances, their sources, their “users” of various types and categories, patterns of use, manner of use, sites of use, abstinence, etc.

The first law about illegal drugs in Italy was approved in 1923. It listed a number of substances that were considered to be illegal at that time. Additional laws followed during the 1930s, and in 1954 laws were passed which were related to the issues of health and

10Franco Basaglia (1924–1980) was an italian psychiatrist and an innovator of an important italian mental health system (reform Law N.180, in 1978) which established the abolition of the mental health facilities.

 

 

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punishment. The first comprehensive law which governed illegal drug consumption was issued on December 22, 1975, Law N. 685: “Regulation of narcotics and psychotropic substances. Prevention, treatment, and rehabilitation of drug addiction.” According to this law, consumption of moderate quantity of illegal drugs, and the possession of the amount needed by the consumer for 3–4 days, was the matter of free choice, while the user was also considered as being affected by a disease and therefore could be treated within the National Public Health System.

This law provided the driving force for developing the regional health units for treat- ing patients affected by drug addiction by means of maintenance programs based on ad- ministration of prescribed medicaments. In 1990, according to the “Jervolino–Vassalli” Law N. 162, June 26, 1990, which is known for its harsher “treatment or punishment,” the average daily amount of drug allowed to be in the user’s possession was reduced in comparison with the previous law. After a national abrogative referendum on April 1993, larger personal amounts of drugs were allowed again. Nevertheless, in 2005–2006, and in all likelihood swayed by the United States “War on Drugs”, the government in- troduced harsher measures (Fini-Giovanardi law, 49/2006). Penalties were increased as part of Italy’s “war on drug addiction.” For example, possessing substances was now pun- ished with jail sentences ranging from 1 to 6 years, and even up to 20 years in cases of serious offences. Cannabis use was made equivalent to the consumption of heroin or co- caine. Police intervention was intended to be especially relevant. At the same time, the drug user treatment programs began to be used more as a function of the penal or ad- ministrative sanctions (Italian Ministry of Social Solidarity, 2006). Such law, whose main outcome appears to be an increase of cases of imprisonment of drug users, was strongly supported by right-wing parties under the emotional popular wave of “less crime and more safety” and by religions-based Therapeutic Communities, while many arguments against it have been put forward mainly by addiction professionals and members of the left-wing parties.

A series of government measures earmarking funds for the SerTs were approved be- tween 1975 and 2005. They have mainly been used for rehabilitation and treatment initiatives while substance use prevention was essentially addressed to high school students.

A few laws about alcohol consumption and related problems have been approved, especially during the last 20 years in Italy. Indeed, already in 1889, under Zanardelli, the National Minister of Justice who was involved in the temperance movement, the first penal code resolution was passed against public drunkenness which was considered to be “offensive or dangerous to the public.” This law also punished those who caused such a state of intoxication in somebody else (Cottino and Morgan, 1985). The 1931 Penal Code, known as the Rocco Code which is still enforced, punishes public drunkenness: the punishment for crimes committed under the influence of alcohol was harsher than for the same crime committed when sober. The 1931 Penal Code also established age 16 as the minimum legal age for purchasing any kind of alcoholic beverages in both on- and off-premises (Cottino and Morgan, 1985). However, until recently this principle was rarely applied since the traditional “informal” control of consumption of alcohol beverages, as well as of caffeine a nicotine product, was under the responsibility of the families or of neighborhood. There was a long time lapse until 1988. Ten years earlier, in 1978, alcoholism had been recognized as being a medical disorder by the National Health System and could be officially treated both in hospital and in medical offices, like any other illness, without any charge of money. In 1988, a Ministerial Decree established the blood alcohol concentration (BAC) of 0.8 g/l in a driver as the threshold above which a driving license was withdrawn. In 1990 the “Jervolino– Vassalli” Law N. 162 introduced the concept of making it possible for adjudicated alcohol

 

 

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(and drug) addicts having been sentenced for a maximum of 4 years’ imprisonment to choose between prison and rehabilitation.

In August 1993, a Ministry of Health decree recommended some guidelines to the Italian Regions for the prevention and treatment of alcohol addiction (Decree of the Italian Ministry of Health, 1993). It recommended an interdisciplinary approach at the local level and the increase of dedicated hospital beds for alcoholics, highlighting the medical aspect of the system and indicating mutual help groups as being the rehabilitation side of treatment.

Eventually, in 2001, the Italian Parliament approved a Frame Law on alcohol and alcohol-consumption-related problems, N. 125, March 30, 2001 (Allamani, Cipriani, Voller, Rossi, and Anav, 2007). This law especially focused on re-organizing community addiction treatment services and hospital centers specializing in the treatment of alcohol-consumption- related problems and on stimulating preventive actions. It also established a maximum BAC, when driving, of 0.5 g/l; it regulated advertising of alcoholic beverages; it prohibited the supply and consumption of alcoholic beverages in work places where the effects of consumption constitute a risk for health and safety.

In conclusion, the two aims of the above-mentioned law were both to foster the de- velopment of hospital-based treatment services and to delineate and “translate” prevention principles from a control–restriction perspective.11 However, the former position is a med- icalized perspective and is probably superseded by the fact that today the problems related to alcohol consumption in Italy are essentially being responded to by public community services and mutual-help groups. The latter do not seem to adequately take into account the characteristics of drinking in Italian culture, namely a culturally anchored activity which generally occurs during the week at mealtimes and in the company of others—family, friends, colleagues, etc. Such position appears to be strongly influenced by the position ex- pressed in current Scandinavian, British, and American medical and sociological literature which primarily focuses on the toxic and inebriating outcomes that alcohol consumption has in those cultures and in which prevention takes the form of prohibition and control.

There are very few Italian studies about alcoholism and of alcohol consumption in Italy (for the latter, see Allamani, and Prina, 2007). It is to be hoped that there will be an increase in research in Italy as well as in southern Europe that focuses attention on the specific meaning(s) that alcoholic beverages and their consumption have at these latitudes and cultures and in particular about the programs and policies of prevention and their effectiveness over time.

Patients and Professionals

It is useful to raise a series of questions in order to better understand substance-use inter- vention in Italy and its implications for recovery.

What is the extent of addiction, and how many individuals using or misusing substances actually seek treatment as well as become patients, in Italy?

11Drug supply and demand reduction continues to be the underpinning for drug control efforts in many parts of the world and is exemplified by the U.S. “War on Drugs” and the ideology for United Nations intervention, among others. It is noteworthy to consider that notwithstanding increases in illegal drug seizures there also continues to be an increase in drug users of various types and ages and decreases in the prices of “street drugs.” It is useful to consider that the “supply and demand reduction” model is linear in its dimensions albeit its use to effectively intervene with processes which are dynamic, complex, nonlinear, multidimensional, and bounded (time, place, culture, etc.). Editor’s note.

 

 

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Figure 1. Types of NHS alcohol addiction services in Italy (2004). Source: Italian Ministry of Health, 2005

Who are the professionals in Italy in the area or field of alcohol, drugs, and other psychoactive substances intervention?

How are they organized? What was/is their training (types, foci, treatment ideology)? And what is the link between them and mutual-help groups?

We shall seek to answer these questions, as well as how the resources earmarked for Italian substance user therapeutic programs have been organized.

Epidemiology provides us, at best, with estimates about “addiction” in Italy, which is not an adequate description and explanation of substance use and misuse as being a dynamic, complex, nonlinear, multidimensional phenomena which is bounded (time, place, culture, etc.)12

As previously noted, reasonably accurate, generalizable knowledge about the number of individuals who are affected by alcohol dependence in Italy does not exist; estimates range between 300,000 and 2,500,000.

Given these estimates it is important to note that only a relatively small proportion of those Italians who are “diagnosed” as being alcohol-dependent are currently participating in any National Health System professional treatment program. An additional small proportion attends private health or mutual-help organization programs.

According to official Italian data, people in public treatment programs rose by more than double over 8 years: there were 21,509 in 1996 and 53,914 in 2004. Services for treating alcohol dependence rose by 64% from 280 in 1996 to 441 in 2004. More than an increase in centers and services for alcoholics dedicated to programs for alcoholics this may have been an increase in alcoholic-oriented activities within the SerT and in any case a result of the rise in territory-based out-patient activities at the cost of hospital-based in- and out-patient ones. In 2004, the national health system services for treating alcoholic patients were mainly community services (93.2%) and not hospital-based (as was the case in the 1970s); in fact in 2004 hospital units were just 4.1% and university-based clinics 2.3% (Figure 1). In 2004, there were a total of 808 educators, physicians, psychologists, nurses, and social workers who were employed full time in the treatment of alcoholic patients; they were 22% of all 3,680 professionals, including those working part-time (probably on

12In a manner similar to what the General Semanticists posited that the map is not territory; incidence and prevalence (of substance use–misuse-dependency-addiction) is not “the PROBLEM”. Editor’s note.

 

 

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Table 2 Number of NHS services, professionals employed, and clients treated according to Alcohol

and Illegal Drug Addiction treatment programs in Italy

NHS services (N ) Professionals (N ) Clients (N )

Illegal drug (2005) 535 6,692 180,000 Alcohol (2004) 404 1,344∗ 53,914

∗This figure is adjusted by adding 808 full time professionals to 736 (total of 3,680 ) part-time professionals hypothetically working in the alcohol addiction treatment program one day per week.

Sources: Ministries of Health (2005) and Ministry of Social Solidarity (2006).

an average 1 day/week) in the care of alcoholic patients (Italian Ministry of Health, 2005) (Table 2). The ratio between professionals and alcoholic clients was 1:34.9 (Figure 2).

Dealing with the issue at community level rather than in hospital departments may have contributed to lowering the hospital admission threshold especially for women. This may be so because women are more reluctant than men to take days off for the hospital, in order to remain at home. Indeed, in the 1980s, for example, the female/male (f/m) ratio of treatment was shown to be 1:4 (Allamani, Voller, Kubicka, and Bloomfield, 2000) while during the period 1996 through 2004 a ratio of 1:3.5 is reported (Italian Ministry of Health, 2005). The treatment approach for alcohol dependence in Italy is more oriented toward interaction- oriented programs than toward medication. According to a nationwide survey conducted by the Italian Health Ministry in 2004, it included individual or family counseling (for 25.6% of clients), social worker interventions (11.8%), group therapy (10.2%), and individual or family psychotherapy (11.5%) (Italian Ministry of Health, 2005). Pharmacotherapy, as a

Figure 2. Clients/professional ratio in Italy: alcohol misuser (2004) & illegal drug user (2005) treat- ment programs Sources: Ministries of Health (2005) and of Social Solidarity (2006).

 

 

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Figure 3. Alcohol misuser and illegal drug user treatment programs in Italy (2004): pharmacotherapy versus interactional approach Sources: Ministries of Health (2005) and of Social Solidarity (2006).

treatment modality was used less often by professional workers than one would expect, being carried out only with 28.9% of the identified alcoholics (Italian Ministry of Health, 2005) (Figure 3). While alcohol-consumption-related pathologies are best treated with appropriate medications, as it is usual for most medical conditions or problems, professional constraint in administering appropriate medications in order to detoxify a person affected by alcoholism may be due to the fact that pharmacotherapy can turn out to be less effective than an interactive treatment approach.

One explanation is to be found in the fact that the addiction paradigm does not fit well with the traditional medical paradigm that links symptom and medication within a causal relationship13; it rather fits the dimension of meaning. The latter perspective changes the main potential question of the individual from the “causal” questions: “Why I use a drug?” and “What I shall have to do in order to overcome such problem?” to the questions that search for meaning: “For what purposes am I using a drug?” and “What is the meaning of my life, now?” Also, the prescribed medications may not cause the cure or relief of symptoms since they are administered in a supposed and needed (by the professional) traditional medical context of a therapeutic alliance between the therapist and his/her client, where the client essentially is expected to maintain her/his autonomy; while autonomy is exactly the problem within the therapeutic relationship between an addict individual and the health professional.

Moreover, many medications can in turn induce a problem of dependence and therefore become a potential object of further treatment. This appears to be common for substance consumers and misusers treated with pharmacotherapy. It also may be an unwanted outcome for long-term treatment of originally nonaddicted patients, e.g., treatment of different kinds of pain.

13The reader is referred to Hills’s criteria for causation which were developed in order to help assist researchers and clinicians determine whether risk factors were causes of a particular disease or were outcomes or merely associated (Hill, 1965). Editor’s note.

 

 

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National epidemiological data for 2004 portray a model of treatment for alcohol addic- tion which makes relatively little use of the therapeutic communities and hospitals. Indeed, referrals by the community health services to therapeutic communities were only 2.3%, while hospitalization decreased from 10.6% in 1996 to 7.5% in 2004 (Italian Ministry of Health, 2005).

Most cooperation in the alcohol addiction treatment programs involves groups of vol- unteers and mutual-help. In 2004, 53.1% of health services referred their clients to the Clubs for Treating Alcoholics (see later) and 34.0% to AA (Italian Ministry of Health, 2005).

Obviously, the treatment that the national health system organizes for alcohol- dependent individuals has a cost—except for the 12-step mutual-help groups which tra- ditionally do not receive any economic support at all. The estimated overall social and health cost of alcohol drinking in Italy was 5,600,000 Euros in 2003 (Scafato, Allamani, Codenotti et al., 2006).

Although diversification characterizes contemporary Italian substance user treatment, a specific profile of alcohol addiction treatment can be drawn, which tends to be different from that of other drug user treatment.

The specificity of alcohol intervention draws upon the following:

� poly-professionalism and group cooperation; � minimal threshold acceptance; � minimization of delay time (waiting lists) before the first clinical visit; � a communication and motivational approach; � family involvement; � being able to give more than one therapeutic option, or a “menu” (freedom of choice); � being able to link up with local resources and mutual-help groups.

Moving to those individuals who consume illegal drugs, the prevalence in 2005 in Italy of opioid “problem user” was about 7 per 1,000 residents, while the prevalence of cocaine “problem users “ was 4 per 1,000 residents, and has been increasing every year. The estimates about the number of 15- to 54-year-old Italians who could be eligible for treatment for their psychoactive substance dependency in 2005 is posited to be 10 people per 1,000—about 300,000 individuals. About 180,000 individuals—i.e. 60%—were being treated in SerTs in 2005 (Italian Ministry of Social Solidarity, 2006). Among them, infectious diseases were quite diffused, even if at a lower rate than in 2001: Hepatitis C (61.4%), Hepatitis B (41.7%), and HIV (13.8%). Also, about 30% of SerT clients were attributed to a psychiatric diagnosis.

There were 535 SerTs during 2005. Also, there were 1,212 socio-rehabilitation centers in Italy: 766 residential, 217 semiresidential, and 229 out-patient, most of these centers being governed and supported financially through religious organizations (Italian Ministry of Social Solidarity, 2006). The majority (60%) of those centers cooperate with the SerTs.

In the last year, the SerT staff number remained the same or somehow decreased. In 2005 there were 6,692 health workers representing medical-health disciplines, and between 27% and 52% psychosocial health professionals (Table 2). The ratio of professional to patient varies between 1:20 and 1:slightly over 30. There were 6,200 caregivers in the private social arena, with a caregiver/client ratio of between 1:1 and a maximum of 1:6 (see Figure 2).

The SerT treatment system is based on prescribed medicaments and on psychosocial intervention. The former is more diffused: between 2003 and 2005, 29–40% of SerT clients were treated only with prescribed drugs—mainly methadone, naltrexone, clonidine, and buprenorphine being prescribed in fewer cases—while 23–36% with only psychosocial interventions (mainly social worker interventions, less often with psychological support or psychotherapy), the remaining drug users were treated in both types of programs. Italy’s

 

 

1722 Allamani

harm-reduction programs are still underdeveloped (Italian Ministry of Social Solidarity, 2006) (Figure 3).

Prison has now become one common outcome of illegal drug use. In 2005, 25,541 addicts were imprisoned, 25% more than the previous year, while 2,539, mostly Italians, were able to be part of a court mandated treatment program (Italian Ministry of Social Solidarity, 2006).

SerTs usually cooperate with rehabilitation centers (therapeutic communities), while they have little collaboration with hospitals. Moreover, the interaction of SerTs and Narcotics Anonymous is almost nonexisting; the latter, in Italy, consisting of a few groups and a small number of fellows (in 2006, about 50 groups and less than 1,000 people).

Communication Skills and Training Programs

Contrary to all the other medical disciplines, including psychiatry, the area of substance user treatment of people manifesting problems related to alcohol and other drug use, misuse, and dependence is characterized by minimal diagnostic procedures and therapeutic tools, and by a “poor” technology. Indeed, diagnosis often relies on the fact that a person appears at the health service eventually alleging that she/he has a problem with alcohol or with an illicit drug. No other assessment tool is administered. There are few routine medications given; psychological tests and psychological interviews are sometimes required.

However, in order to identify a “problem drinker” and his/her alcohol-consumption- related problems, to motivate him/her and his/her family to change their behavior and at least to begin treatment, alcohol or illegal substance misuse treatment professionals should be appropriately trained in communication skills, education, rehabilitation, and prevention. This is the reason why a certain number of training programs have been created during the last two decades.

One of such training programs is the Therapeutic Communication developed by Vera Maillart in the Tuscany region. It differentiates between eight communication techniques, such as “paying attention” and “reformulating.” It can be taught and learnt through feedback in a context of peer confrontation and preferably in a multidisciplinary setting. It can be learnt by and taught to any Primary Health care professional (Maillart Allamani, Marchi, and Milo, 1992).

The type of training which introduced a great innovation all over the country that stemming from the motivational theory. It has enjoyed a substantial development in Italy over the last 15 years (Spiller and Guelfi, 2000, 2007). The motivational approach is im- plemented during medical consultation, nurse counseling, and educational interventions with individuals and groups. Professionals assess the level of problem awareness of a client and/or family members, prefer the process of increasing the client awareness, and promote the client’s decision. The motivational approach has been more successful in the field of alcohol addiction treatment than in drug user treatment programs.

The ultimate aim of this approach is the voluntary change of people’s behavior. Stages and tasks of change, from precontemplation to contemplation, preparation, action, and maintenance have often been described and are well known. Readers are referred to the studies of Prochascka and DiClemente (among others, see Prochaska and DiClemente, 1992).

Another type of training program for the treatment of alcohol misusers is organized by the Clubs of Alcoholics undergoing Treatment called Territorial Alcoholism Training, which aims at developing skills especially at a volunteer level, in cooperation with professionals

 

 

Views and Models About Addiction 1723

and public organizations and institutions (Salerno, 2004). These programs have been partic- ularly beneficial in developing territorial programs for treating alcoholism throughout Italy.

Cooperation Between Mutual-Help Groups and Professionals in the Treatment of Alcoholism and Drug Dependence (or not?): A Growing Model of Cooperation

The model of cooperation between the health system with Non-Governmental Organizations (NGOs), namely mutual-help and volunteer groups in Italy, is an excellent example of modern cooperation between professionals and substance user associations. It has been an indispensable part of the treatment for many years. The groups are AA and Al-Anon (relatives or friends of alcoholics) on the one hand and the Clubs for Alcoholics undergoing Treatment (CAT) on the other.

In 2005, approximately 40,000 people, at least 0.07% of the Italian population, were estimated to be involved in either a 12-step or a CAT program.

AA in Italy, was first established in Rome in 1972, when an Italian alcoholic joined a local English-speaking group. The foundation of another group in Florence in 1974 was accompanied by the first-ever public conference held by AA in Italy (Allamani and Petrikin, 1996). It was not until the 1980s that AA started to grow. There were approximately 500 Italian groups by 2005 with at least 10,000 participants of which approximately 3,000 were women (f/m ratio 1:3). They were present in metropolitan areas and small towns, and more in the northwest of the country than in the south (Servizi Generali Alcolisti Anonimi Italia, 2004).

The other major NGO for alcohol dependency treatment is the Italian Clubs for Al- coholics undergoing Treatment (CAT), which stems from a multifamily group program established in Croatia during the 1960s by Vladimir Hudolin (Hudolin, 1991; Patussi, Tu- mino, and Poldrugo, 1996). In 1979, CAT was imported into Italy through experiences in Trieste and Udine. The clubs consist of groups of between 5 and 15 persons, wherein alco- holics and family members meet together once a week, guided by a social worker or health professional or by a “recovering alcoholic” or his/her family member. This method spread rapidly throughout many regions in Italy, especially in the late 1980s. In 2005, approxi- mately 3,000 clubs were reported with approximately 20,000 members, who generally were referred from hospitals or social services. Usually CAT actively cooperates with the public treatment systems for alcoholics and with the health authorities at the local and regional levels in supporting public-funded treatment and prevention programs.

CAT differs from AA in that meetings are led by a helper called “servant,” who is a leader certified by means of brief Territorial Alcoholism Training (Salerno, 2004). This group leader may be a health or social worker professional, or an alcoholic or family member.

In its initial stages, AA in Italy, as it had in the United States, distanced itself from health care professionals and institutions and cooperation was quite limited for a long time. On the contrary, the beginning of the movement of the Clubs for Alcoholics undergoing Treatment was quickly successful because their initially nonspiritual approach was more acceptable to the medical paradigm.

It is the usual practice that very soon after (or simultaneously with) a period of out- or in-patient clinic treatment, patients are referred to AA or to Clubs for Alcoholics undergoing Treatment (CAT).

A relevant study conducted with 480 new patients admitted to six Italian alcohol addic- tion treatment services in 1995 examined the interaction of mutual-help groups and health care system in Italy; 297 (62%) of them were also referred to AA. After 12 months, many

 

 

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(70%) of those referred to AA were still in touch both with the group and the health service, and were still abstinent. Entry into the mutual-help group does not and did not deter people from returning to their doctor (Jean et al., 2004).

Conclusion

The implication of the attitudes about drugs and alcohol and about treatment of Italy’s population at large and stakeholders, including politicians, administrators, and helping professionals, is wide.

Two general attitudes pervade contemporary Italian society i.e., the issues of: (1) eco- nomics and (2) security. In the case of alcohol beverages and of illegal drugs these attitudes translate into a sort of shrinkage of both economic and human resources being allocated to the addiction services and more of a police-law enforcement approach to substance user. At the same time there is the beginning of a perception among the general population of new risks coming from alcohol beverages consumption, especially those which are actually or are posited to be consumed by youngsters and immigrants. This change is mixed with a lessened worry about illegal drugs, namely cannabis, especially among the younger generations.

On the other hand, active resources and enthusiastic stakeholders fostering the recovery for users and misusers of psychotropic substances are found in the community and they are successfully cooperating with the Public Health services. Among them there are a few examples of GPs involved in the education of their clients who drink hazardously (Scafato, Allamani, Codenotti, et al., 2006), and of community-driven prevention interventions (Alla- mani et al., 2007). Twelve-step groups and CATs appear to be critical in promoting attention to the treatment programs. Narcotics Anonymous is just beginning to be known by SerT professionals.

Harm reduction programs could be further developed by health and social workers. In any case, training programs to help health and social work professionals to commu-

nicate with their client and the local population at large appear to be needed. Professionals’ interaction with their clients should go beyond the traditionally authoritative and permissive attitudes, being more focused on the individual and group needs, and on attempts to solve them.

RÉSUMÉ

Vues et modèles sur la dépendance chimique: Différences entre les traitements pour les personnes alcooliques et pour les consommateurs de drogues illicites en Italie

Le traitement des personnes qui sont alcool-dépendantes et le traitement des utilisateurs de la drogue illicite diffèrent remarquablement en Italie, en accord avec la perception du grand public selon laquelle boire des boissons alcooliques est un comportement honoré par temps, alors que la consommation des drogues illicites est un comportement déviant. D’une perspective clinique, le traitement pour l’alcoolisme se tient essentiellement selon le principe du choix libre, de la motivation pour changer, et de l’approche familiale, alors que le traitement des utilisateurs de drogue illicites est caractérisé par les approches de contrôle, la pharmacothérapie et de thérapie individuelle. D’un point de vue sociopolitique, les deux modèles ont été établis dans les années 70: l’alcoolisme étant un mouvement “de bas en haut” qui a commencé en tant que réponses “spontanées” que les groupes d’aide mutuelle et quelques cliniciens et établissements ont données aux

 

 

Views and Models About Addiction 1725

RESUMEN

Opiniones y modelos sobre la dependencia quı́mica: Diferencias entre los tratamientos para las personas alcohólicas y para los consumidores de drogas ilı́citos

en Italia

El tratamiento de las personas que es alcohol-dependiente y el tratamiento de los usuar- ios de la droga ilı́cita difieren extraordinariamente en Italia, de acuerdo con la percepción de la opinión pública según la cual beber bebidas alcohólicas es un comportamiento hon- rado por tiempo, mientras que el consumo de las drogas ilı́citas es un comportamiento que desvı́a. De una perspectiva clı́nica, el tratamiento para el alcoholismo se tiene esencial- mente según el principio de la elección libre, de la motivación para cambiar, y del enfoque familiar, mientras que el tratamiento de los usuarios de droga ilı́citos es caracterizado por los enfoques de control, del pharmacothérapie y de terapia individual. Desde un punto de vista sociopolı́tico, los dos modelos se establecieron en los años 70: el alcoholismo que es un movimiento “hacia arriba” que comenzó como respuestas “espontáneas” que los grupos de ayuda mutua y algunos médicos y establecimientos dieron al alcohólicos y a sus familias; mientras que el último se proporcionaba “de arriba abajo” como respuesta polı́tica del Gobierno que enfrentaba el crecimiento del consumo de droga ilegal entre jóvenes.

THE AUTHORS

Allaman Allamani, M.D. (Italy) Psychiatrist, Family Therapist, Researcher, since 1993 Coordinator of Cen- tro Alcologico, Florence Health Agency. Author or co- author of 140 articles, editor or co-editor of 13 books. He is a member of the Editorial Board of Substance Use and Misuse and a faculty member of the Middle East- ern Summer Institute on Drug Use. From 1973 to 1993 he worked as a gastroenterologist clinician in the Gas- troenterology Unit of Careggi Hospital in Florence. In the 1970s, he co-founded the Tuscany section of the Ital- ian Psychosomatic Society and the Centre of Interactional and Family Therapy in Prato, Italy; in the 1980s, he also co-founded the Tuscan section of the Italian Society of

Alcohology. In the same decade he contributed to a Regione Toscana project on Ther- apeutic Communication for helping professions together with Vera Maillart and others. Later on, he started a comprehensive Alcohol Problem Treatment and Prevention program in Florence, also focused on eating problems, based on low access threshold, family and motivational approach, and cooperation with mutual-help groups. He developed the first community action alcohol use intervention projects in Italy in the Florence area. Well known to the Italian 12-step movements, he was the first nonalcoholic trustee of Italian Alcoholics Anonymous from 1997 to 2003. He is trustee of the Psychosomatics Training Institute, Florence.

 

 

1726 Allamani

Glossary

Alcoholic beverage addiction: Consumption that corresponds to DSM IV criteria for alcohol dependence.

Alcoholic beverage use: Moderate daily consumption especially of wine at meals. Co-dependency: Relatively recent “diagnosis” with over involvement of a family member

with another family member who is the “identified” or “tagged” alcoholic patient or drug user.

Illicit drug use: A substance consumption pattern that is socially connoted as being deviant as well as illegal.

Models: Organised views by means of which different people or professions interpret the phenomenon of addiction and its treatment.

Non-Governmental Organizations (NGO): Twelve-step groups like Alcoholic Anonymous, Al-Anon, Narcotic Anonymous on the one hand, and the voluntary multifamily Clubs for Alcoholics in Treatment on the other hand.

Servizio Tossicodipendenze, Drug Addict Health Service (SerT): NHS treatment for illicit drug users.

References

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Allamani, A., Barbera, G., Calviani, L., Tanini, S. (1994). The treatment system for alcohol related problems in Italy. Alcologia 6(3), 247–252.

Allamani, A., Prina, F. (2007). Why the decrease in consumption of alcoholic beverages in Italy between 1970’s and the 2000’s? Shedding light on an Italian mystery. Contemporary Drug Problems, 34:187–197.

Allamani, A., Anav, S., Cipriani, F., Voller, F., Rossi, D. (2007). Italy and alcohol: A country profile. I Quarderni dell’ Osservatorio Permanente Giovani e Alcool. n.19. Casa Editrice Litos Roma.

Allamani, A., Petrikin, C. (1996). Alcoholic Anonymous and the alcohol treatment system in Italy. Contemporary Drug Problems 23(1), 43–55.

Allamani, A., Voller, F., Kubicka, L., Bloomfield, K. (2000). Drinking cultures and the position of women in Europe. Substance Abuse 21(4), 231–247.

Anderson, P., Baumberg, B. (2005). Alcohol in Europe. London: Institute of Alcohol Studies. Basaglia, F. (1968). L’istituzione negata [The denial of the institution]. Einaudi, Torino . Batacchi, M., Codispoti, O. (1992). La vergogna [The shame]. Bologna, Italy: Il Mulino. Begleiter, H., Kissan, B. (Eds.). (1995). The genetics of alcoholism. New York: Oxford University

Press. Bernhard, E. (1969). Mitobiografia [Mythobiography]. Adelphi, Milano. Buttolo, R., Di Caporiacco, F., Crasti, P., De Corato, R., Furlan, M., Gonano, C., et al. (1982).

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Cottino, A., Morgan, P. (1985). Four country profiles: Italy. In M. Grant (Ed.), Alcohol policies (pp. 83–92). WHO Regional Publications, European studies, 18.

Decree of the Italian Ministry of Health. (August 3, 1993). Linee di indirizzo per la prevenzione, la cura, il reinserimento sociale e il rilevamento epidemiologico in materia di alcool-dipendenza [Guidelines for prevention, care, social rehabilitation and epidemiological investigation in the area of alcohol-dependence] (pp. 6–7). Gazzetta Ufficiale della Repubblica a Italiana N. 197.

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Italian Ministry of Health. (2005). Relazione del ministro della salute al parlamento sugli interventi realizzati ai sensi della legge 30.3.2001 n.125 “legge quadro in materia di alcol e problemi alcolcorrelati” dati relativi all’anno 2004 [Report of Ministry of Health to Parliament on Inter- ventions implemented after the Frame Law Concerning Alcohol and Alcohol-Related Problems, 30.3.2001 n.125]. Report to Parliament, Rome.

Italian Ministry of Social Solidarity. (2006). Relazione del ministro della solidarietà sociale sullo stato delle tossicodipendenze in Italia [Report of Ministry of Social Solidarity on Drug Addiction in Italy]. Report to Parliament, Rome.

Jean, G., Cibin, M., Pini, P., Aliotta, V., Bocchia, M., Allamani, A., et al. (2004). Interazione tra servizi alcologici e Alcolisti Anonimi. In A. Allamani, D. Orlandini, G. Bardazzi, A. Quartini, A. Morettini (Eds.).Libro Italiano di Alcologia [Italian Book of Alcohology] (Vol. II, pp. 283– 288). Firenze.

Kaufman, G. (1985). Shame. The power of caring. Rochester: Shenkman Books. Kaufman, E., Kaufmann, P. (1979). Family therapy of drug and alcohol abuse. New York: Gardner

Press. Kleinig, J., Einstein, S. (2006). Introduction. In J. Kleinig, S. Einstein (Eds.). Ethical challenges for

intervening in drug use: Policy, research and treatment issues (pp. xiii–xviii). Huntsville, TX: Office of International Criminal Justice.

Klingemann, H., Sobell, L. C., Barker, J., Blomqvist, J., Cloud, W., Elllinstad, T., et al. (2001). Promoting self change form problem substance use. Practical implications for policy, prevention and treatment. Dordrecht: Kluwer Academic Publishers.

Krahn, D. D. (1991). The relationship of eating disorders and substance abuse. Journal of Substance Abuse 4, 341–353.

Law N. 685 of December 22, 1975 “Disciplina degli stupefacenti e sostanze psicotrope. Prevenzione, cura e riabilitazione dei relativi stati di tossicodipendenza [Regulation of narcotics and psy- chotropic substances. Prevention, cure and rehabilitation of drug- addiction]” Gazzetta Ufficiale della Repubblica Italiana N. 342, December 30, 1975.

Law N. 125 of March 30, 2001 “Legge quadro in materia di alcol e di problemi alcolcorrelati [Frame Law Concerning Alcohol and Alcohol-Related Problems]” Gazzetta Ufficiale della Repubblica Italiana N. 90, April 18, 2001.

Maillart, V., Allamani, A., Marchi, M. R., Milo, D. (1992). La Comunicazione terapeutica per le professioni di salute [Therapeutic communication for helping professions] (Vol. III). Firenze, Italy: Regione Toscana.

Mellody, P. (1989). Facing codependence. San Francisco: Harper & Row. Osservatorio Giovani e Alcool. (2000). Italians and alcohol. Consumption, trends and attitudes in

Italy and in the regions. 4th Doxa National Survey. Quaderno n. 14 Casa Editrice Risa, Rome. Osservatorio Permanente sui Giovani e l’Alcool. (2007). Italians and alcohol – 5th Doxa National

Survey. Quaderno n. 18, Casa Editrice Risa, Rome. Patussi, V., Tumino, E., Poldrugo, F. (1996). The development of the Alcoholic Treatment Club

System in Italy: Fifteen years of experience. Contemporary Drug Problems 23(1), 29–42. Picchi, M., Caffarelli, E. (1991). Dietro la droga un uomo (Behind the drug there is a man). Milano:

Franco Angeli.

 

 

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Prochaska, J. O., DiClemente, C. C. (1992). Stages of change in the modification of problem behaviour. In M. Hersen, R. Eisler, P. M. Miller (Eds.). Progress in behaviour modification (Vol. 28, pp. 184–214). IL: Sycamore Publishing Company.

Rule of Saint Benedict. (1981). In Latin and English. Translation by Timothy Frj. Salerno, M. T. (2004). La formazione e l’aggiornamento nell’approccio ecologico-sociale [Train-

ing and Updating acoording the ecological-social approach]. In A. Allamani, D. Orlandini, G. Bardazzi, A. Quartini, A. Morettini (Eds.). Libro Italiano di Alcologia (Vol. 2). Firenze.

Scafato, E. (2005). Country report, Italy. Document to WHO Phase IV Collaborative Study, Copen- hagen.

Scafato, E., Allamani, A., Codenotti, T., Marcomini, F., Patussi, V., Rossi, A. et al. (2006). A country- based strategy. The inplementation and integration of early detection and brief intervention in the daily GPs activities in Italy. Salute e Territorio 155, (85–119).

Schaub, B., Schaub, R. (1997). Healing addiction. The vulnerability model of recovery. Albany NY: Delmar.

Schaub, R., Schaub Gulino, B. (1997).Dante’s path. New York: Gotham Books. Servizi Generali Alcolisti Anonimi Italia. (2004). Gli Alcolisti Anonimi. In A. Allamani, D. Orlan-

dini, G. Bardazzi, A. Quartini, A. Morettini (Eds.).Libro Italiano di alcologia [Italian book of alcohology] (Vol. II). Firenze.

Shuckitt, M. A., Jayson, E. T., Anthenelli, R. M., Bucholz, K. K., Hesselbrock, V. M., Nurnberger, J. I. (1996). Anorexia nervosa and bulimia nervosa in alcohol-dependent men and women and their relatives. The American Journal of Psichiatry 153, (74–82).

Spiller, V., Guelfi, G. P.. (2000). L’approccio motivazionale: Uno stile di lavoro per aumentare la disponibilità al cambiamento [Motivational approach: A working style to increase the avalaibility to change]. In A. Allamani, D. Orlandini, G. Bardazzi, A. Quartini, A. Morettini (Eds.). Libro Italiano di Alcologia (Vol. I). Firenze.

Spiller, V., Guelfi, G. P. (2007). Motivational interviewing with illicit drug users. In G. Tober, D. Raistrick (Eds.). Motivational dialogue. London: Routledge.

Steinglass, P. (1979). Family therapy with alcoholics. A review. In E. Kaufman, P. Kaufmann (1979) Family therapy of drug and alcohol abuse. New York: Gardner Press.

Steinglass, P. (1987b). The alcoholic family. London: Hutchinson. Voller, F. (2007). Consumption of alcoholic beverages. In A. Allamani, F. Cipriani, F. Voller, D. Rossi,

S. Anav (Eds.). Italy and alcohol: A country profile. I Quaderni dell’Osservatorio Permanente Giovani e Alcool. Casa Editrice Litos, Rome.

Wiechelt, S. A. (2007). The specter of shame in substance abuse. Substance Use and Misuse,42, (399–409).

World Health Organisation. (2000). International guide for monitoring alcohol consumption and re- lated harm. Mental Health and Substance Dependence Department, Non-communicable Disease and Mental Health Cluster, World Health Organisation.

What did Stanley Milgram seek to test in his experiments at Yale University?

Social Groups and Deviance 0 unread of 0 messages https://edge.apus.edu/messageforums-tool/images/collapse.gif?sakai.tool.placement.id=6011ae23-8668-4266-8df7-746a36db5923View Full Description

Choose one of the following questions: 

1.  What did Stanley Milgram seek to test in his experiments at Yale University?  What were the results?  Do you think that the findings would be similar today?  Why or why not?  Thinking about the information shared in Chapter 2 regarding ethics in research, what are the ethical concerns of the study?

2.  Do you agree with Emile Durkheim that deviance provides certain functions for society? What functions might deviance provide?  In your answer be sure to describe Durkheim’s main thesis regarding deviance and provide examples or evidence to support your position.

 

The Week 3 Forum meets the following course objectives:

· Apply a sociological perspective to the social world.

· Analyze contemporary social issues using the sociological imagination and use sociological theories and concepts to analyze everyday life.

· Identify and describe bureaucracies and formal organizations.

· Describe deviance and social control from a sociological perspective.

 

 

Instructions for all Forums:

Each week, learners will post one initial post per week.  This post must demonstrate comprehension of the course materials, the ability to apply that knowledge in the real world.  Learners will engage with the instructor and peers throughout the learning week.  To motivate engaged discussion, posts are expected to be on time with regular interaction throughout the week.  All posts should demonstrate college level writing skills. To promote vibrant discussion as we would in a face to face classroom, formatted citations and references are not required.  Quotes should not be used at all, or used sparingly.  If you quote a source quotation marks should be used and an APA formatted citation and reference provided.

 

 

 

Points

 

Exemplary (100%)

 

 

Accomplished (85%)

 

 

Developing (75%)

 

Beginning (65%)

 

Not Participating (0%)

 

Comprehension of course materials

 

4

Initial post demonstrates rich comprehension of course materials.  Detailed use of terminology or examples learned in class.  If post includes opinion, it is supported with evaluated evidence. Initial post demonstrates clear comprehension of course materials.  Use of terminology or examples learned in class. If post includes opinion, it is supported with evaluated evidence. Initial post demonstrates some comprehension of course materials.  Specific terminology or examples learned in class may be incorrect or incomplete.  Post may include some opinion without evaluated evidence. Initial post does not demonstrate comprehension of course materials.  Specific terminology or examples learned in class are not included.  Post is opinion based without evaluated evidence. No posting, post is off topic, post does not meet minimum criteria for demonstrating beginning level of comprehension. Post may be plagiarized, or use a high percentage of quotes that prevent demonstration of student’s comprehension.
Real world application of knowledge

 

2

Initial post demonstrates that the learner can creatively and uniquely apply the concepts and examples learned in class to a personal or professional experience from their life or to a current event. Initial post demonstrates that the learner can apply the concepts and examples learned in class to a  personal or professional experience from their life or to a current event. Initial post does not clearly demonstrate that the learner can apply the concepts and examples learned in class. Unclear link between the concepts and examples learned in class to personal or professional experience or to a current event. Initial post does not demonstrate that the learner can apply the concepts and examples learned in class. No link to a personal or professional experience or to a current event is made in the post. No posting, post is off topic, post does not meet minimum criteria for demonstrating beginning level of application. Post may be plagiarized, or use a high percentage of quotes that prevent demonstration of student’s ability to apply comprehension.
Active Forum Engagement and Presence

 3

Learner posts 4+ different days in the learning week.

 

Replies to at least one response from a classmate or instructor on the learner’s initial post to demonstrate the learner is reading and considering classmate responses to their ideas.

 

Posts two or more 100+ word responses to initial posts of classmates.  Posts motivate group discussion and contributes to the learning community by doing 2+ of the following:

· offering advice or strategy

· posing a question,

· providing an alternative point-of-view,

· acknowledging similar experiences

· sharing a resource

Learner posts 3 different days in the learning week.

 

Posts two 100+ word responses to initial posts of classmates.  Posts motivate group discussion and contribute to the learning community by doing  2+ of the following:

 

· offering advice or strategy

· posing a question,

· providing an alternative point-of-view,

· acknowledging similar experiences

· sharing a resource

Learner posts 2 different days in the learning week.

 

Posts one 100+ word response to initial post of classmate.  Post motivates group discussion and contributes to the learning community by doing 1 of the following:

 

· offering advice or strategy

· posing a question,

· providing an alternative point-of-view,

· acknowledging similar experiences

· sharing a resource

Learner posts 1 day in the learning week.

 

Posts one 100+ word response to initial post of classmate.  Post does not clearly motivate group discussion or clearly contribute to the learning community.

 

Responses do not:

· offering advice or strategy

· posing a question,

· providing an alternative point-of-view,

· acknowledging similar experiences

· sharing a resource

Learner posts 1 day in the learning week, or posts are not made during the learning week and therefore do not contribute to or enrich the weekly conversation.

 

No peer responses are made.  One or more peer responses of low quality (“good job, I agree”) may be made.

Writing skills

 1

Post is 250+ words.  All posts reflect widely accepted academic writing protocols like using capital letters, cohesive sentences, and no texting language. Dialogue is also polite and respectful of different points of view. Post is 250+ words.  The majority of posts reflect widely-accepted academic writing protocols like using capital letters, cohesive sentences, and no texting language. Dialogue is polite and respectful of different points of view. Post is 175+ words.  The majority of posts reflect widely-accepted academic writing protocols like using capital letters (“I am” not “i am”), cohesive sentences, and no texting language. Dialogue may not be respectful of different points of view. Post is 150+ words.  The majority of the forum communication ignores widely-accepted academic writing protocols like capital letters, cohesive sentences, and texting; Dialogue may not be respectful of different points of view. No posting, post is off topic and does not meet minimum criteria for demonstrating beginning level of comprehension.

 

 

READING CHAPTER 2

2 DISCOVER SOCIOLOGICAL RESEARCH

 

© Marianna Day Massey/ZUMA/Corbis

Media Library

CHAPTER 2 Media Library

AUDIO    

Fallout from a contemporary experiment based on the Milgram study.

Facebook’s Newsfeed Study

VIDEO    

Milgram’s Experiment

Qualitative v. Quantitative Research Methods

Steven Colbert on Validity Research

Asch Conformity Experiment

Ethnography in Context

The Tuskegee Syphilis Experiment

CQ RESEARCHER    

Sentencing Reform for Drugs

PACIFIC STANDARD MAGAZINE    

Survey v. Public Opinion

The Organ Detective

JOURNAL    

Validity and Reliability homicide studies

Field Work Methods

Unobtrusive Research in Criminal Justice

Participatory Research Methods in Skid Row Los Angeles

 

 

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IN THIS CHAPTER

Sociology and Common Sense

Research and the Scientific Method

Doing Sociological Research

Doing Sociology: A Student’s Guide to Research

Sociology and You: Why Learn to Do Sociological Research?

 

 

WHAT DO YOU THINK?

1.   What kinds of research questions could one pose in order to gain a better understanding of sociological issues like bullying, long-term poverty, gang violence, or the high dropout rate in some high schools? What kinds of research methods would be appropriate for studying these issues?

2.   What factors do you think affect the honesty of people’s responses to survey questions?

3.   What makes a sociological research project ethical or unethical?

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RESEARCHING THE CONSEQUENCES OF THE U.S. PRISON BOOM

REUTERS/Lucy Nicholson

 

The United States imprisons more of its people than any other modern country on the planet. About 3% of U.S. adults are in the correctional system: “2.2 million people in prisons and jails, and an additional 4.8 million on probation or parole” (Goffman, 2014, p. xi). Data show that the climb in the prison population began in the 1970s and rose steeply in the 1980s, with significant numbers of poor men and women of color pulled into the criminal justice system, many for minor drug crimes and other nonviolent offenses. The effects of this “prison boom” are not only individual; mass incarceration has also had consequences for already struggling neighborhoods in urban America (see Figures 2.1a and 2.1b).

In On the Run: Fugitive Life in an American City (2014), sociologist Alice Goffman writes that her work is an on-the-ground account of the U.S. prison boom: a close-up look at young men and women living in one poor and segregated Black community transformed by unprecedented levels of imprisonment and by the more hidden systems of policing and supervision that have accompanied them. Because the fear of capture and confinement has seeped into community members’ basic activities of daily living—work, family, romance, friendship, and even much-needed medical care—it is an account of a community on the run (p. xii).

Goffman explores the norms and practices that govern life in a neighborhood ravaged by economic and social marginality and the pervasive effects of the reality and threat of imprisonment. For example, in the absence of opportunities for legitimate employment, she notes the birth of a shadow economy that caters to the “fugitive life” she describes: Some wily entrepreneurs peddle “clean” urine to neighbors who are on parole and subject to drug testing. Goffman’s work is significant because it carefully examines the effects of the mass incarceration phenomenon on personal lives and relationships and the daily life of a community.

Goffman conducted research in the city of Philadelphia for six years, combining interviews with individuals working in the criminal justice system, including police and prison guards, and regular interactions with residents of her adopted neighborhood. She utilized participant and nonparticipant observation in gathering information about the social environment. Goffman’s work is a good example of qualitative sociological research, and she recognizes its potential significance to academic and policy debates. Utilizing a scientific approach and rigorous field research, Goffman is able to cast light on how neighborhoods and their residents, whether or not they are involved in criminal activity, understand and experience the powerful consequences of mass imprisonment.

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FIGURE 2.1A Imprisonment Rates in Selected Philadelphia Neighborhoods, 2008

 

SOURCE: Based on data from the The Justice Mapping Center.

 

FIGURE 2.1B Percentage of Non-Whites in Selected Philadelphia Neighborhoods, 2008

 

 

In this chapter, we examine the ways sociologists like Alice Goffman study the social world. First, we distinguish between sociological understanding and common sense. Then we discuss the key steps in the research process itself. We examine how sociologists test their theories using a variety of research methods, and, finally, we consider the ethical implications of doing research on human subjects.

SOCIOLOGY AND COMMON SENSE

Science is a unique way of seeing and investigating the world around us. The essence of the scientific method is straightforward: It is a process of gathering empirical (scientific and specific) data, creating theories, and rigorously testing theories. In sociological research, theories and empirical data exist in a dynamic relationship (Figure 2.2). Some research begins from general theories, which offer “big picture” ideas about social life: Deductive reasoning starts from broad theories but proceeds to break them down into more specific and testable hypotheses. Sociological hypotheses are ideas about the world that describe possible relationships between social phenomena. Some research begins from the ground up: Inductive reasoning starts from specific data, such as interviews or field notes, which may focus on a single community or event, and endeavors to identify larger patterns from which to derive more general theories.

p.32

FIGURE 2.2 The Relationship Between Theory and Research

 

 

 

Sociologists employ the scientific method in both quantitative and qualitative research. Quantitative research, which is often done through methods such as large-scale surveys, gathers data that can be quantified and offers insight into broad patterns of social behavior (for example, the percentage of U.S. adults who use corporal punishment with their children) and social attitudes (for example, the percentage of U.S. adults who approve of corporal punishment) without necessarily delving into the meaning of or reasons for the identified phenomena. Qualitative research, such as that conducted by Alice Goffman, is characterized by data that cannot be quantified (or converted into numbers), focusing instead on generating in-depth knowledge of social life, institutions, and processes (for example, why parents in particular social groups are more or less likely to use spanking as a method of punishment). It relies on the gathering of data through methods such as focus groups, participant and nonparticipant observation, interviews, and archival research. Generally, population samples in qualitative research are small because they focus on in-depth understanding.

Personal experience and common sense about the world are often fine starting points for sociological research. They can, however, mislead us. In the 14th century, common sense suggested to people that the earth was flat; after all, it looks flat. Today, influenced by stereotypes and media portrayals of criminal behaviors, many people believe Black high school and college students are more likely than their White counterparts to use illegal drugs such as marijuana, cocaine, crack, and heroin. But common sense misleads on both counts. The earth is not flat (as you know!), and Black high school and college students are slightly less likely than White students to use illegal drugs (Table 2.1).

Consider the following ideas, which many believe to be true, though all are false:

Common Wisdom:

I know women who earn more than their husbands or boyfriends. The gender wage gap is no longer an issue in the United States.

Sociological Research:

Data show that men as a group earn more than women as a group. For example, in the first quarter of 2014, men had a weekly median income of $872 compared to $722 for women for all full-time occupations (U.S. Bureau of Labor Statistics, 2014f). According to statistical data, women earn about 82% of what men earn. This statistic compares all men and all women who work full-time and year-round. Reasons for the gap include worker characteristics (such as experience and education), job characteristics (such as hours required), devaluation of “women’s work” by society, and pay discrimination against female workers (Cabeza, Johnson, & Tyner, 2011; Reskin & Padavic, 2002). So while some women, of course, earn more than some men, the overall pattern of men outearning women remains in place today. This topic is discussed in greater detail in Chapter 10.

Common Wisdom:

Homeless people are poor and lack adequate shelter because they do not work.

Sociological Research:

Some of the homeless cannot find work or are too disabled by mental or physical problems to work. Many, however, do work. Research suggests that about 44% of homeless adults work for pay (National Coalition for the Homeless, 2009b), and the U.S. Conference of Mayors (2011) reports that 15% of the homeless are regularly employed full- or part-time. However, low wages and poor benefits in the service industry, where many less educated people work, as well as a shortage of adequate housing options for low-income families, can make finding permanent shelter a challenge even for those who work for pay. To under stand how declining wages magnify the strain on low-income families, consider this: In many U.S. cities, to make ends meet, a household needs more than one full-time minimum-wage employee to afford the fair market rent price for a two-bedroom apartment (National Low Income Housing Coalition, 2009). The contemporary reality is that wages are not keeping up with the rate of inflation, which further adds to the economic hardships that low-income families endure. These topics are discussed in fuller detail in Chapter 7.

 

TABLE 2.1   Annual Prevalence Rate of Drug Use by 12th Graders, 2013.

 

Johnston, L. D., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E. & Miech, R.A. (2014). Demographic subgroup trends among adolescents in the use of various licit and illicit drugs, 1975–2013. Monitoring the Future Occasional Paper No. 81. Ann Arbor, MI: Institute for Social Research.

 

  Milgram’s Experiment CLICK TO SHOW
  Fallout from a contemporary experiment based on the Milgram study. CLICK TO SHOW

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© Bettmann/CORBIS

The Metropolitan Washington Council of Governments distinguishes between the “permanently supported homeless,” who have housing but are at risk due to extreme poverty and/or disability, and the “chronically homeless,” who are continually homeless for a year or more or at least four times in three years. Do you think that these categories fully encompass the homeless population?

Common Wisdom:

Education is the great equalizer. All children in the United States have the opportunity to get a good education. Low academic achievement is a personal failure.

Sociological Research:

Public education is free and open to all in the United States, but the quality of education can vary dramatically. Consider the fact that in many U.S. states and localities, a major source of public school funding is local property taxes, which constitute an average of about 44% of funding (state and federal allocations make up the rest). As such, communities with high property values have richer sources of funding from which to draw educational resources, while poor communities—even those with high tax rates—have more limited pools. As well, high levels of racial segregation persist in U.S. schools. In fact, Latino and Black students are more likely to be in segregated schools today than were their counterparts in earlier decades. Research shows a relationship between academic performance and class and racial segregation: Students who are not isolated in poor, racially segregated schools perform better on a variety of academic measures than those who are (Condron, 2009; Logan, Minca, & Adar, 2012). The problem of low academic achievement is complex, and no single variable can explain it. At the same time, the magnitude and persistence of this problem suggests that we are looking at a phenomenon that is a public issue rather than just a personal trouble. We discuss issues of class, race, and educational attainment further in Chapter 12.

Even deeply held and widely shared beliefs about society and social groups may be inaccurate—or more nuanced and complex than they appear on the surface. Until it is tested, common sense is merely conjecture. Careful research allows us to test our beliefs to gauge whether they are valid or merely anecdotal. From a sociological standpoint, empirical evidence is granted greater weight than common sense. By basing their decisions on scientific evidence rather than personal beliefs or common wisdom, researchers and students can draw informed conclusions and policy makers can ensure that policies and programs are data driven and maximally effective.

RESEARCH AND THE SCIENTIFIC METHOD

Scientific theories answer questions about how and why scientific observations are as they are. A good scientific theory has the following characteristics:

•    It is logically consistent. One part of the theory does not contradict another part.

•    It can be disproved. If the findings contradict the theory, then we can deduce that the theory is wrong. While we can say that testing has failed to disprove the theory, however, we cannot assume the theory is “true” if testing confirms it. Theories are always subject to further testing, which may point to needed revisions, highlight limitations, or strengthen conclusions.

  Sentencing Reform for Drugs CLICK TO SHOW
  Qualitative v. Quantitative Research Methods CLICK TO SHOW

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© Martin Ruetschi/Keystone/Corbis

Some research on bullying relies on self-reports, while other data come from peer reports. Recent research (Branson & Cornell, 2009) suggests that more than twice as many students (11%) were labeled bullies in peer reports than in self-reports (5%), highlighting the fact that any method of data collection has limitations.

Theories are made up of concepts, ideas that summarize a set of phenomena. Concepts are the building blocks of research and prepare a solid foundation for sociological work. Some of the key concepts in sociology are social stratification, social class, power, inequality, and diversity, which we introduced in the opening chapter.

In order to gather data and create viable theories, we need to define concepts in ways that are precise and measurable. A study of social class, for example, would need to begin with a working definition of that term. An operational definition of a concept describes the concept in such a way that we can observe and measure it. Many sociologists define social class in terms of dimensions such as income, wealth, education, occupation, and consumption patterns. Each of these aspects of class has the potential to be measurable. We may construct operational definitions in terms of qualities or quantities (Babbie, 1998; Neuman, 2000). In terms of qualities, we might say, for instance, that the “upper-middle class” is composed of those who have completed graduate or professional degrees, even though there may be a broad income spread between those with master’s degrees in English and those with master’s degrees in business administration. This definition is based on an assumption of class as a social position that derives from educational attainment. Alternatively, using quantity as a key measure, we might operationally define “upper class” as households with annual income greater than $150,000 and “lower class” as households with annual income of less than $20,000. This definition takes income as the preeminent determinant of class position, irrespective of education.

Consider a social issue of contemporary interest—bullying. Imagine that you want to conduct a research study of bullying to determine how many female middle schoolers have experienced bullying in the past academic year. You would need to begin with a clear definition of bullying that operationalizes the term. That is, in order to measure how many girls have experienced bullying, you would need to articulate what constitutes bullying. Would you include physical bullying? If so, how many instances of being pushed or punched would constitute bullying? Would you include cyberbullying? What kinds of behaviors would be included in that category? To study a phenomenon like bullying, it is not enough to assume that “we know it when we see it.” Empirical research relies on the careful and specific definition of terms and the recognition of how definitions and methods affect research outcomes.

RELATIONSHIPS BETWEEN VARIABLES

In studying social relationships, sociologists also need variables. A variable is a concept that can take on two or more possible values. For instance, sex can be male or female, work status can be employed or unemployed, and geographic location can be inner-city, suburbs, or rural area. We can measure variables both quantitatively and qualitatively. Quantitative variables include factors we can count, such as crime rates, unemployment rates, and drug use frequency. Qualitative variables are variables that express qualities and do not have numerical values. Qualitative variables might include physical characteristics, such as gender or eye color, or attitudinal characteristics, such as a parent’s preference for a private or public school or a commuter’s preference for riding public transportation or driving to work.

Sociological research often tries to establish a relationship between two or more variables. Suppose you want to find out whether more education is associated with higher earnings. After asking people about their years of schooling and their annual incomes, both of which are quantitative variables, you could estimate the degree of correlation between the two. Correlation—literally, “co-relationship”—is the degree to which two or more variables are associated with one another. Correlating the two variables “years of education” and “annual income” demonstrates that the greater the education, the higher the income (Figure 2.3). (Do you see the exception to that relationship? How might you explain it?)

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© Ed Kashi/VII/Corbis

Getting enough sleep is one factor that can help students maintain good grades in college. How would you design a research study to examine the question of which factors correlate most strongly with solid grades?

When two variables are correlated, we are often tempted to infer a causal relationship, a relationship between two variables in which one is the cause of the other. However, just because two variables are correlated, we cannot assume that one causes the other. For example, ice cream sales rise significantly during the summer, as does the homicide rate. These two events are correlated in the sense that both increase during the hottest months. However, because the sharp rise in ice cream sales does not cause rates of homicide to increase (nor, clearly, does the rise in homicide rates cause a spike in ice cream consumption), these two phenomena do not have a causal relationship. Correlation does not equal causation.

Sometimes an observed correlation between two variables is the result of a spurious relationship—that is, a correlation between two or more variables caused by another factor that is not being measured. In the example above, the common factor missed in the relationship is, in fact, the temperature. When it’s hot, more people want to eat ice cream. Studies also show that rising temperatures are linked to an increase in violent crimes—though after a certain temperature threshold (about 90 degrees), crimes wane again (Gamble & Hess, 2012). Among the reasons more violent crimes are committed in hot weather is the fact that people spend more time outdoors in social interactions when it is hot, which can lead to confrontations.

 

FIGURE 2.3 Correlation Between Education and Median Weekly Earnings in the United States, 2013

 

SOURCE: Bureau of Labor Statistics. (2013). Education pays. Employment projections. Washington, DC: U.S. Government Printing Office.

 

Let’s take another example that is close to home: Imagine that your school newspaper publishes a study concluding that coffee drinking causes poor test grades. The story is based on a survey of students that found those who reported drinking a lot of coffee the night before an exam scored lower than did their peers who had consumed little or no coffee. Having studied sociology, you wonder whether this relationship might be spurious. What is the “something else” that is not being measured here? Could it be that students who did not study in the days and weeks prior to the test and stayed up late the night before cramming—probably consuming a lot of coffee as they fought sleep—received lower test grades than did peers who studied earlier and got adequate sleep the night before the test? The overlooked variable, then, is the amount of studying students did in the weeks preceding the exam, and we are likely to find a positive correlation and evidence of causation in looking at time spent studying and grade outcomes.

Sociologists attempt to develop theories systematically by offering clear operational definitions, collecting unbiased data, and identifying evidence-based relationships between variables. Sociological research methods usually yield credible and useful data, but we must always critically analyze the results to ensure their validity and reliability and to check that hypothesized relationships are not spurious.

TESTING THEORIES AND HYPOTHESES

Once we have defined concepts and variables with which to work, we can endeavor to test a theory by positing a hypothesis. Hypotheses enable scientists to check the accuracy of their theories. For example, consider state-level data on obesity and poverty (Figures 2.4 and 2.5). Data from the U.S. Census Bureau for 2012 show that some positive correlation exists between obesity and poverty rates at the state level. A positive correlation is a relationship showing that as one variable rises or falls, the other does as well. The variables’ common trajectory suggests a possible relationship between poverty and obesity (Table 2.2), although, as we noted above, sociologists are quick to point out that correlation does not equal causation. Researchers are interested in creating and testing hypotheses to explain cases of positive correlation—they are also interested in explaining exceptions to the pattern of correlation between two (or more) variables.

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FIGURE 2.4 Self-Reported Obesity Rates by State, 2012

 

SOURCE: Centers for Disease Control. (2011). Prevalence of self-reported obesity among U.S. adults. Behavior risk factor surveillance system. Washington, DC.

 

In fact, researchers have explored and hypothesized the relationship between poverty and obesity. Among the conclusions they have drawn is that living in poverty—and particularly living in poor neighborhoods—puts people at higher risk of obesity, though the risk is greater for women than for men (Centers for Disease Control and Prevention, 2012d; Hedwig, 2011; Smith, 2009). Among the factors that researchers have identified as contributing to a causal path between poverty and obesity are the lack of access to healthy food choices, the lack of access to safe and nearby spaces for physical exercise, and a deficit of time to cook healthy foods and exercise. They have also cited the stress induced by poverty. While the data cannot lead us to conclude decisively that poverty is a cause of obesity, research can help us to gather evidence that supports or refutes a hypothesis about the relationship between these two variables. We look at this issue in greater depth in Chapter 16.

In the case of a negative correlation, one variable increases as the other decreases. As we discuss later in Chapter 11, which focuses on the family and society, researchers have found a negative correlation between male unemployment and rates of marriage. That is, as rates of male unemployment in a community rise, rates of marriage in the community fall. Observing this relationship, sociologists have conducted research to test explanations for it (Edin & Kefalas, 2005; Wilson, 2010).

 

FIGURE 2.5 Poverty Rates by State, 2012

 

SOURCE: U.S. Census Bureau, “American FactFinder,” 2010 American Community Survey.

 

Keep in mind that we can never prove theories to be decisively right—we can only prove them wrong. Proving a theory right would require the scientific testing of absolutely every possible hypothesis based on that theory—a fundamental impossibility. In fact, good theories are constructed in a way that makes it logically possible to prove them wrong. This is Karl Popper’s (1959) famous principle of falsification, or falsifiability, which holds that to be scientific, a theory must lead to testable hypotheses that can be disproved if they are wrong.

VALIDITY AND RELIABILITY

For theories and hypotheses to be testable, both the concepts used to construct them and the measurements used to test them must be accurate. When our observations adequately reflect the real world, our findings have validity—that is, the concepts and measurements accurately represent what they claim to represent. For example, suppose you want to know whether the crime rate in the United States has gone up or down. For years sociologists depended on police reports to measure crime. However, researchers could assess the validity of these tallies only if subsequent surveys were administered nationally to victims of crime. If the victim tallies matched those of the police reports, then researchers could say the police reports were a valid measure of crime in the United States. The National Crime Victimization Survey (NCVS) enables researchers to assess validity because it offers data on victimization, even for crimes that have not been reported to authorities.

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TABLE 2.2   Top 10 States: Obesity and Poverty, 2012

 

SOURCES: U.S. Census Bureau. (2013). Poverty: 2000 to 2012, American Community Survey Briefs; Centers for Disease Control and Prevention. (2014). Prevalence of self-reported obesity among U.S. adults, 2012.

 

Sociologists are also concerned with the reliability of their findings. Reliability is the extent to which the findings are consistent with the findings of different studies of the same phenomenon, or with the findings of the same study over time. Sociological research may suffer from problems of validity and reliability because of bias, a characteristic of results that systematically misrepresent the full dimensions of what is being studied. Bias can creep into research due to the use of inappropriate measurement instruments. For example, suppose the administrator of a city wants to know whether homelessness has risen in recent years. She operationally defines “the homeless” as those who sleep in the street or in shelters and dispatches her team of researchers to city shelters to count the number of people occupying shelter beds or sleeping on street corners or park benches. A sociologist reviewing the research team’s results might question the administrator’s operational definition of what it means to be homeless and, by extension, her findings. Are the homeless solely those spending nights in shelters or on the streets? What about those who stay with friends after eviction or camp out in their cars? In this instance, a sociologist might suggest that the city’s measure is biased because it misrepresents (and undercounts) the homeless population by failing to define the concept in a way that captures the broad manifestations of homelessness.

Bias can also occur in research when respondents do not tell the truth (see Table 2.3). A good example of this is a study in which respondents were asked whether they used illegal drugs or had driven while impaired. All were asked the same questions, but some were wired to a machine they were told was a lie detector. The subjects who thought their truthfulness was being monitored by a lie detector reported higher rates of illegal drug use than did subjects who did not. Based on the assumption that actual drug use would be about the same for both groups, the researchers concluded that the subjects who were not connected to the device were underreporting their actual illegal drug use and that simply asking people about drug use would lead to biased findings because respondents would not tell the truth. Do you think truthfulness of respondents is a general problem, or is it one researchers are likely to encounter only where sensitive issues such as drug use or racism are at issue?

OBJECTIVITY IN SCIENTIFIC RESEARCH

Even if sociologists develop theories based on good operational definitions and collect valid and reliable data, like all human beings they have passions and biases that may color their research. For example, criminologists long ignored the criminality of women because they assumed that women were not disposed toward criminal behavior. Researchers therefore did not have an accurate picture of women and crime until this bias was recognized and rectified.

  Steven Colbert on Validity Research CLICK TO SHOW

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INEQUALITY MATTERS

 

HOW MANY PEOPLE SUFFER FROM HOMELESSNESS?

 

The Washington Post/Contributor/Getty Images

Understanding of research methods will help you recognize the challenges in gathering reliable statistics on populations that are outside the mainstream. In this photo, a volunteer conducts an interview with a homeless man, which helps local authorities assess how many homeless people are in the city and why they lack shelter.

Homelessness is a social problem in the United States. But how extensive is it? The National Law Center on Homelessness and Poverty (2012) estimates that more than 3 million people experience homelessness over the course of a year across the United States. Of these, 1.3 million are children; more than one-third of the entire homeless population is made up of families. While the majority of the homeless have access to transitional housing or emergency shelters, approximately 4 out of 10 are unsheltered, living in improvised conditions that are not suited for human habitation. Despite a decrease in the homeless population nationally, the rates for 24 individual states and the District of Columbia increased between 2009 and 2011 (National Alliance to End Homelessness, 2012).

Statistics vary, however, depending on the definitions and counting methodologies employed. In the early 1980s, the U.S. government was under pressure to provide services and assistance to a population of homeless that some claimed was large and growing. In response, the U.S. Department of Housing and Urban Development (HUD) conducted a study to determine the number of homeless people in cities and towns across the country. After analyzing all existing studies, government researchers called providers of services to the homeless and other experts in 60 cities and asked them to estimate the numbers of homeless people in their communities. Based on this research, the government concluded there were 250,000 to 350,000 homeless people in the United States. This figure was considerably lower than the estimate of 2 million that came from other sources outside the government (Burt, 1992).

Politicians used the HUD figures extensively, although some sociologists were skeptical (Appelbaum, 1986; Appelbaum, Dolny, Dreier, & Gilderbloom, 1991). First, HUD’s operational definition of homelessness included only people sleeping on the streets and in shelters; it effectively excluded homeless people living in cars or abandoned buildings or taking temporary shelter with friends. Second, HUD based its figures on the estimates of shelter providers, police officers, and other local experts who admitted they were often only guessing. Finally, the HUD figures were based almost entirely on estimates of the homeless in the downtown areas of big cities, a methodological bias that excluded the numerous homeless people who lived in surrounding towns and suburbs. As a result of these problems, HUD’s estimate of the national homeless population lacked validity.

THINK IT THROUGH

Subsequent research has confirmed that by the early 1990s there were as many as 1 million homeless in the United States—three to four times the estimate produced by the government study. An axiom of sociological research is that it is not what you think you know that matters, but how you came to know it. The homeless represent a transient population that is challenging to count. The homeless have no fixed addresses, no consistent billing statements, and no easy way for researchers to locate them. What methods might you employ to attempt to systematically count the homeless people in your community? What kinds of resources do you think you would need?

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TABLE 2.3   How Truthful Are Survey Respondents? (in percentages)

 

SOURCE: Adams, J., Parkinson, L., Sanson-Fisher, R. W., & Walsh, R. A. (2008). Enhancing self-report of adolescent smoking: The effects of bogus pipeline and anonymity. Addictive Behaviors, 33(10), 1291–1296.

 

Personal values and beliefs may affect a researcher’s objectivity, or ability to represent the object of study accurately. In the 19th century, sociologist Max Weber argued that in order for scientific research to be objective it has to have value neutrality—that is, the course of the research must be free of the influence of personal beliefs and opinions. The sociologist should acknowledge personal biases and assumptions, make them explicit, and prevent them from getting in the way of observation and reporting.

How can we best achieve objectivity? First, recall Karl Popper’s principle of falsification, which proposes that the goal of research is not to prove our ideas correct but to find out whether they are wrong. To accomplish this, researchers must be willing to accept that the data they collect might contradict their most passionate convictions. Research should deepen human understanding, not prove a particular point of view.

A second way we can ensure objectivity is to invite others to draw their own conclusions about the validity of our data through replication, the repetition of a previous study using a different sample or population to verify or refute the original findings. For research to be replicated, the original study must spell out in detail the research methods employed. If potential replicators cannot conduct their studies exactly as the original study was performed, they might accidentally introduce unwanted variables. To ensure the most accurate replication of their work, researchers should archive original materials such as questionnaires and field notes and allow replicators access to them.

Popper (1959) described scientific discovery as an ongoing process of “confrontation and refutation.” Sociologists usually subject their work to this process by publishing their results in scholarly journals. Submitted research undergoes a rigorous process of peer review, in which other experts in the field of study examine the work before the results are finalized and published. Once research has been published in a reputable journal such as the American Sociological Review or the Journal of Health and Social Behavior, other scholars read it with a critical eye. The study may then be replicated in different settings.

DOING SOCIOLOGICAL RESEARCH

Sociological research requires careful preparation and a clear plan that guides the work. The purpose of a sociological research project may be to obtain preliminary knowledge that will help formulate a theory or to evaluate an existing theory about society and social life. As part of the strategy, the researcher selects from a variety of research methods—specific techniques for systematically gathering data. In the following sections, we look at a range of research methods and examine their advantages and disadvantages. We also discuss how you might prepare a sociological research project of your own.

SOCIOLOGICAL RESEARCH METHODS

Sociologists employ a variety of methods to learn about the social world (Table 2.4). Since each has strengths and weaknesses, a good research strategy may be to use several different methods. If they all yield similar findings, the researcher is more likely to have confidence in the results. The principal methods are the survey, fieldwork (either participant observation or detached observation), experimentation, working with existing information, and participatory research.

  Validity and Reliability homicide studies CLICK TO SHOW

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TABLE 2.4   Key Sociological Research Methods

 

 

SURVEY RESEARCH

A survey relies on a questionnaire or interviews with a group of people in person or by telephone or e-mail to determine their characteristics, opinions, and behaviors. Surveys are versatile, and sociologists often use them to test theories or simply to gather data. Some survey instruments, such as National Opinion Research Center questionnaires, consist of closed-ended questions that respondents answer by choosing from among the responses presented. Others, such as the University of Chicago’s Social Opportunity Survey, consist of open-ended questions that permit respondents to answer in their own words.

An example of survey research conducted for data collection is the largest survey in the nation, the U.S. Census, which is conducted every 10 years. The census is not designed to test any particular theory. Rather, it gathers voluminous data about U.S. residents that researchers, including sociologists, use to test and develop a variety of theories.

Usually, a survey is conducted on a relatively small number of people, a sample, selected to represent a population, the whole group of people to be studied. The first step in designing a survey is to identify the population of interest. Imagine that you are doing a study of behavioral factors that affect grades in college. Who would you survey? Members of a certain age group only? People in the airline industry? Pet owners? To conduct a study well, we need to identify clearly the survey population that will most effectively help us answer the research question. In your study you would most likely choose to survey students now in college, because they offer the best opportunity to correlate grades with particular behaviors.

Once we have identified a population of interest, we will usually select a sample, as we seldom have the time or money to talk to all the members of a given population, especially if it is a large one. Other things being equal, larger samples better represent the population than smaller ones. However, with proper sampling techniques, sociologists can use relatively small (and therefore inexpensive) samples to represent large populations. For instance, a well-chosen sample of 1,000 U.S. voters can be used to represent 100,000 U.S. voters with a fair degree of accuracy, enabling surveys to make election predictions with reasonable confidence. Sampling is also used for looking at social phenomena such as drug or alcohol use in a population: CNN reported recently that 17% of high schoolers drink, smoke, or use drugs during the school day, based on a 1,000-student sample polled by the National Center on Addiction and Substance Abuse at Columbia University (Azuz, 2012).

  Survey v. Public Opinion CLICK TO SHOW

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© James Marshall/Corbis

Since it is often impossible to sample every person in a target population, being well versed in research methodology enables a researcher to produce empirically rigorous data with a representative population sample.

Ideally, a sample should reflect the composition of the population we are studying. For instance, if you want to be able to use your research data about college students to generalize about the entire college student population of the United States, you would need to collect proportional samples from 2-year colleges, 4-year colleges, large universities, community colleges, online schools, and so on. It would not be adequate to survey only students at online colleges or only female students at private 4-year schools.

To avoid bias in surveys, sociologists may use random sampling, whereby everyone in the population of interest has an equal chance of being chosen for the study. Typically, they make or obtain a list of everyone in the population of interest. Then they draw names or phone numbers, for instance, by chance until the desired sample size is reached (today, most such work is done by computers). Large-scale random sample surveys permit researchers to draw conclusions about large numbers of people on the basis of relatively small numbers of respondents. This is an advantage in terms of time and money.

In constructing surveys, sociologists must take care to ensure that the questions and their possible responses will capture the respondents’ points of view. The wording of questions is an important factor; poor wording can produce misleading results, as the following example illustrates. In 1993, an American Jewish Committee/Roper poll was taken to examine public attitudes and beliefs about the Holocaust. To the astonishment of many, results indicated that fully 22% of survey respondents expressed a belief the Holocaust had never happened. Not immediately noticed was the fact that the survey contained some very awkward wording, including the question “Does it seem possible or does it seem impossible to you that the Nazi extermination of the Jews never happened?” Can you see why such a question might produce a questionable result? The question’s compound structure and double-negative wording almost certainly confused many respondents.

The American Jewish Committee released a second survey with different wording: “Does it seem possible to you that the Nazi extermination of the Jews never happened, or do you feel certain that it happened?” The results of the second poll were quite different. Only about 1% of respondents thought it was possible the Holocaust never happened, while 8% were unsure (Kagay, 1994). Despite the follow-up poll that corrected the mistaken perception of the previous poll’s results, the new poll was not as methodologically rigorous as it could have been; a single survey question should ask for only one type of response. The American Jewish Committee’s second survey contained a question that attempted to gauge two different responses simultaneously.

A weakness of surveys is that they may reveal what people say rather than what they do. Responses are sometimes self-serving, intended to make the interviewee look good in the eyes of the researcher. As we saw in an earlier example, a respondent may not wish to reveal his or her drinking or drug habits. A well-constructed survey, however, can overcome these problems. Assuring the respondent of anonymity, assigning interviewers with whom respondents feel comfortable, and building in questions that ask for the same information in different ways can reduce self-serving bias in survey research.

FIELDWORK

Fieldwork is a method of research that uses in-depth and often extended study to describe and analyze a group or community. Sometimes called ethnography, it takes the researcher into the “field,” where he or she directly observes—and sometimes interacts with—subjects in their social environment. Social scientists, including sociologists and anthropologists, have employed fieldwork to study everything from hoboes and working-class gangs in the 1930s (Anderson, 1940; Whyte, 1943) to prostitution and drug use among inner-city women (Maher, 1997) and Vietnam veterans motorcycling across the country to the Vietnam Veterans Memorial in Washington, D.C. (Michalowski & Dubisch, 2001). Alice Goffman’s (2014) work on the underground economy is another example of the use of fieldwork in sociological research.

  Field Work Methods CLICK TO SHOW

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Most fieldwork combines several different methods of gathering information. These include interviews, detached observation, and participant observation.

An interview is a detailed conversation designed to obtain in-depth information about a person and his or her activities. When used in surveys, interview questions may be either open-ended or closed-ended. They may also be formal or informal. In fieldwork, the questions are usually open-ended to allow respondents to answer in their own words. Sometimes the interviewer prepares a detailed set of questions; at other times, the best approach is simply to have a list of relevant topics to cover.

Good researchers guard against influencing respondents’ answers. In particular, they avoid the use of leading questions—that is, questions that tend to elicit particular responses. Imagine a question on attitudes toward the marine environment that reads “Do you believe tuna fishing with broad nets, which leads to the violent deaths of dolphins, should be regulated?” The bias in this question is obvious—the stated association of broad nets with violent dolphin deaths creates a bias in favor of a yes answer. Accurate data depend on good questions that do not lead respondents to answer in particular ways.

Sometimes a study requires that researchers in the field keep a distance from the people they are studying and simply observe without getting involved. The people being observed may or may not know they are being observed. This approach is called detached observation. In his study of two delinquent gangs (the “Saints” and the “Roughnecks”), William J. Chambliss, coauthor of this text, spent many hours observing gang members without actually being involved in what they were doing. With the gang members’ permission, he sat in his car with the window rolled down so he could hear them talk and watch their behavior while they hung out on a street corner. At other times, he would observe them playing pool while he played at a nearby table. Chambliss sometimes followed gang members in his car as they drove around in theirs and sat near enough to them in bars and cafés to hear their conversations. Through his observations at a distance, he was able to gather detailed information on the kinds of delinquencies the gang members engaged in. He was also able to unravel some of the social processes that led to their behavior and observe other people’s reactions to it.

Detached observation is particularly useful when the researcher has reason to believe other forms of fieldwork might influence the behavior of the people to be observed. It is also helpful for checking the validity of what the researcher has been told in interviews. A great deal of sociological information about illegal behavior has been gathered through detached observation.

One problem with detached observation is that the information gathered is likely to be incomplete. Without actually talking to people, we are unable to check our impressions against their experiences. For this reason, detached observation is usually supplemented by in-depth interviews. In his study of the delinquent gang members, Chambliss (1973, 2001) periodically interviewed them to complement his findings and check the accuracy of his detached observations.

Another type of fieldwork is participant observation, a mixture of active participation and detached observation. Participant observation can sometimes be dangerous. Chambliss’s (1988b) research on organized crime and police corruption in Seattle, Washington, exposed him to threats from the police and organized crime network members who feared he would reveal their criminal activities. Goffman’s (2014) work also included participant observation; she spent significant amounts of time with the residents of the Philadelphia neighborhood she studied, seeking to carefully document their voices and experiences.

EXPERIMENTATION

Experiments are research techniques for investigating cause and effect under controlled conditions. We construct experiments to measure the effects of independent or experimental variables, variables we change intentionally, on dependent variables, which change as a result of our alterations to the independent variables. To put it another way, researchers modify one controllable variable (such as diet or exposure to violent movie scenes) to see what happens to another variable (such as willingness to socialize or the display of aggression). Some variables, such as sex, ethnicity, and height, do not change in response to stimuli and thus do not make useful dependent variables.

In a typical experiment, researchers select participants who share characteristics such as age, education, social class, or experiences that are relevant to the experiment. The participants are then randomly assigned to two groups. The first, called the experimental group, is exposed to the independent variable—the variable the researchers hypothesize will affect the subjects’ behavior. The second group is assigned to the control group. These subjects are not exposed to the independent variable—they receive no special attention. The researchers then measure both groups for the dependent variable. For example, if a neuroscientist wanted to conduct an experiment on whether listening to classical music affects performance on a math exam, he or she might have an experimental group listen to Mozart, Bach, or Chopin for an hour before taking a test. The control group would take the same test but would not listen to any music beforehand. In this example, exposure to classical music is the independent variable, and the quantifiable results of the math test are the dependent variable.

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Daniel Hurst/Stock Connection Worldwide/Newscom

When looking at the relationship between violent video games and violent behaviors, researchers must account for many variables. What variables would you choose to test?

To study the relationship between violent video game play and aggression, researchers took a longitudinal approach by examining the sustained violent video game play and aggressive behavior of 1,492 adolescents in grades 9 through 12 (Willoughby, Adachi, & Good, 2012). Their results showed a strong correlation between playing violent video games and being more likely to engage in, or approve of, violence. This body of literature represents another example of the importance of research methodology; the same researchers, in a separate study, found that the level of competitiveness in a video game, and not the violence itself, had the greatest influence on aggressive behavior (Adachi & Willoughby, 2011). More research on this topic may help differentiate between the effects of variables and avoid conclusions based on spurious relationships.

WORKING WITH EXISTING INFORMATION

Sociologists frequently work with existing information and data gathered by other researchers. Why would researchers choose to reinterpret existing data? Perhaps they want to do a secondary analysis of statistical data collected by an agency such as the U.S. Census Bureau, which makes its materials available to researchers studying issues ranging broadly from education to poverty to racial residential segregation. Or they may want to work with archival data to examine the cultural products—posters, films, pamphlets, and such—used by an authoritarian regime in a given period to legitimate its power or disseminated by a social movement like the civil rights movement to spread its message to the masses.

Statistical data include quantitative information obtained from government agencies, businesses, research studies, and other entities that collect data for their own or others’ use. The U.S. Bureau of Justice Statistics, for example, maintains a rich storehouse of information on a number of criminal justice social indicators, such as prison populations, incidents of crime, and criminal justice expenditures. Many other government agencies routinely conduct surveys of commerce, manufacturing, agriculture, labor, and housing. International organizations such as the United Nations and the World Bank collect annual data on the health, education, population, and economies of nearly all countries in the world. Many businesses publish annual reports that yield basic statistical information about their financial performance.

Document analysis is the examination of written materials or cultural products: previous studies, newspaper reports, court records, campaign posters, digital reports, films, pamphlets, and other forms of text or images produced by individuals, government agencies, private organizations, and others. However, because such documents are not always compiled with accuracy in mind, good researchers exercise caution in using them. People who keep records are often aware that others will see the records and take pains to avoid including anything unflattering. The diaries and memoirs of politicians are good examples of documents that are invaluable sources of data but that must be interpreted with great caution. The expert researcher looks at such materials with a critical eye, double-checking with other sources for accuracy where possible.

This type of research may include historical research, which entails the analysis of historical documents. Often such research is comparative, examining historical events in several different countries for similarities and differences. Unlike historians, sociologists usually identify patterns common to different times and places; historians tend to focus on particular times and places and are less likely to draw broad generalizations from their research. An early master of the sociological approach to historical research was Max Weber (1919/1946, 1921/1979), who contributed to our understanding of—among many other things—the differences between religious traditions in the West and those in East Asia.

Content analysis is the systematic examination of forms of documented communication. A researcher can take a content analysis approach by coding and analyzing patterns in cultural products like music, laws, tweets, blogs, and works of art. An exciting aspect of social science research is that your object of curiosity can become a research question. In 2009, sociologists conducted a content analysis of 403 gangsta rap songs to assess whether rap’s reputation of being misogynistic (hostile to women) was justified (Weitzer & Kubrin, 2009). The analysis found that the songs did contain significant misogynistic undertones, reflecting larger stereotypical views of male and female characteristics.

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TECHNOLOGY & SOCIETY

 

DOES TECHNOLOGY AFFECT STUDYING?

 

© Sam Bloomberg-Rissman/Blend Images/Corbis

Has technology helped or hindered your studying in college? Does it mostly offer research help—or additional distractions?

In 2011, as it has every year since 2000, the National Survey of Student Engagement (NSSE) surveyed about 416,000 U.S. students at 673 institutions of higher education, asking about student relationships with faculty, note taking and study habits, and hours spent studying. One of the 2011 findings, consistent with the results of other recent surveys, was that students were spending far fewer hours studying than did their counterparts in previous decades. If in 1961 the average student reported studying about 24 hours per week, by 2011 the average student reported about 14 hours of study time (Babcock & Marks, 2010; NSSE, 2012). Within this figure are variations by major, ranging from about 24 hours per week for architecture majors to 10 for speech majors. Sociology majors reported studying an average of 13.8 hours per week (de Vise, 2012).

This study presents a number of interesting research questions, few of which are answered by the NSSE, which collected quantitative data but did not analyze the results. What factors might be behind the precipitous decline in self-reported hours spent studying?

Some existing hypotheses implicate modern technology for at least two reasons. First, it has been suggested that students study less because they are spending substantial time using social media such as Facebook. One pilot study at Ohio State University concluded that students who used Facebook had poorer grades than those who did not (Karpinski & Duberstein, 2009). These data suggest that another study could profitably look for correlations between social media use and study time.

Second, students may be reporting less study time because technology has cut the hours of work needed for some tasks. While preparing a research paper in the past may have demanded hours in the library stacks or in pursuit of an expert to interview, today an online search engine can bring up a wealth of data earlier generations could not have imagined. Far fewer students consult research librarians or use library databases today. Notably, however, a recent study suggests that the quality of data students have the skills to find in their searches is mixed and often low (Kolowich, 2011).

Technology is only one possible factor in the decline in the time U.S. students spend studying. Two economists, for instance, suggest that studying time has decreased as achievement standards have fallen (Babcock & Marks, 2010). But there is no denying that one of the most dramatic differences between the 1960s and today is the proliferation of technology, which suggests that an explanatory relationship may exist.

THINK IT THROUGH

Imagine that your final paper for this semester involves answering the research question, “What is the impact of technology on studying and learning?” How would you go about answering this question? How would you collect data for your project?

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PARTICIPATORY RESEARCH

While sociologists usually try to avoid having an impact on the people they study, one research method is employed specifically to foster change. Participatory research supports an organization or community trying to improve its situation when it lacks the necessary economic or political power to do so by itself. The researcher fully participates by training the members to conduct research on their own while working with them to enhance their power (Freire, 1972; Park, 1993; Whyte, 1991). Such research might be part of, for instance, empowering a community to act against the threat of HIV/AIDS, as has been done in places like San Francisco and Nairobi, Kenya. Participatory research is an effective way of conducting an empirical study while also furthering a community or organizational goal that will benefit from the results of the study.

DOING SOCIOLOGY: A STUDENT’S GUIDE TO RESEARCH

Sociological research seldom follows a formula that indicates exactly how to proceed. Sociologists often have to feel their way as they go, responding to the challenges that arise during research and adapting new methods to fit the circumstances. Thus, the stages of research can vary even when sociologists agree about the basic sequence. At the same time, for student sociologists, it is useful to understand the key building blocks of good sociological research. As you read through the following descriptions of the stages, think about a topic of interest to you and how you might use that as the basis for an original research project.

FRAME YOUR RESEARCH QUESTION

“Good research,” Thomas Dewey observed, “scratches where it itches.” Sociological research begins with the formulation of a question or questions to be answered. Society offers an endless spectrum of compelling issues to study: Does exposure to violent video games affect the probability of aggressive behavior in adolescents? Does religious faith affect voting behavior? Is family income a good predictor of performance on standardized college entrance tests such as the SAT? Beyond the descriptive aspects of social phenomena, sociologists are also interested in how they can explain relationships between the variables they examine.

Formulating a research question precisely and carefully is one of the most important steps toward ensuring a successful research project. Research questions come from many sources. Some arise from problems that form the foundation of sociology, including an interest in socioeconomic inequalities and their causes and effects, or the desire to understand how power is exercised in social relationships. Sociologists are also mindful that solid empirical data are important to public policies on issues of concern such as poverty, occupational mobility, and domestic violence.

 

FIGURE 2.6 Sociological Research Formula

 

 

Keep in mind that you also need to define your terms. Recall our discussion of operationalizing concepts. For example, if you are studying middle school bullying, you need to make explicit your definition of bullying and how that will be measured. The same holds true if you are studying a topic such as illiteracy or aggressive behavior.

REVIEW EXISTING KNOWLEDGE

Once you identify the question you want to ask, you need to conduct a review of the existing literature on your topic. The literature may include published studies, unpublished papers, books, dissertations, government documents, newspapers and other periodicals, and, increasingly, data disseminated on the Internet. The key focus of the literature review, however, is usually published and peer-reviewed research studies. Your purpose in conducting the literature review is to learn about studies that have already been done on your topic of interest so that you can set your research in the context of existing studies. You will also use the literature review to highlight how your research will contribute to this body of knowledge.

  Unobtrusive Research in Criminal Justice CLICK TO SHOW
  Ethnography in Context CLICK TO SHOW

 

  Participatory Research Methods in Skid Row Los Angeles CLICK TO SHOW

 

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SELECT THE APPROPRIATE METHOD

Now you are ready to think about how your research question can best be answered. Which of the research methods described earlier (1) will give the best results for the project and (2) is most feasible for your research circumstances, experience, and budget?

If you wish to obtain basic information from a relatively large population in a short period of time, then a survey is the best method to use. If you want to obtain detailed information about a smaller group of people, then interviews might be most beneficial. Participant observation and detached observation are ideal research methods for verifying data obtained through interviews, or, for the latter, when the presence of a researcher might alter the research results. Document analysis and historical research are good choices for projects focused on inaccessible subjects and historical sociology. Remember, sociological researchers often use multiple methods.

WEIGH THE ETHICAL IMPLICATIONS

Research conducted on other human beings—as much of sociological research is—poses certain ethical problems. An outpouring of outrage after the discovery of gruesome experiments conducted by the Nazis during World War II prompted the adoption of the Nuremberg Code, a collection of ethical research guidelines developed to help prevent such atrocities from ever happening again (Table 2.5). In addition to these basic guidelines, scientific societies throughout the world have adopted their own codes of ethics to safeguard against the misuse and abuse of human subjects.

Before you begin your research, it is important that you familiarize yourself with the American Sociological Association’s Code of Ethics (www.asanet.org/about/ethics.cfm), as well as the standards of your school, and carefully follow both. Ask yourself whether your research will cause the subjects any emotional or physical harm. How will you guarantee their anonymity? Does the research violate any of your own ethical principles?

Most universities and research institutes require researchers to complete particular forms before undertaking experiments using human subjects, describing the research methods to be used and the groups of subjects who will take part. Depending on the type of research, a researcher may need to obtain written agreement from the subjects for their participation. Today, a study like that conducted by Philip Zimbardo in the 1970s at Stanford University (described in the Private Lives, Public Issues box) would be unlikely to be approved because of the stress put on the experiment’s subjects in the course of the research. Approval of research involving human subjects is granted with an eye to both fostering good research and protecting the interests of those partaking in the study.

 

TABLE 2.5   The Nuremberg Code

 

SOURCE: U.S. Department of Health and Human Services.

 

COLLECT AND ANALYZE THE DATA

Collecting data is the heart of research. It is time-consuming but exciting. During this phase, you will gather the information that will allow you to make a contribution to the sociological understanding of your topic. If your data set is qualitative—for example, open-ended responses to interview questions or observations of people—you will proceed by carefully reviewing and organizing your field notes, documents, and other sources of information. If your data set is quantitative—for example, completed closed-ended surveys—you will proceed by entering data into spreadsheets, comparing results, and analyzing your findings using statistical software.

  The Tuskegee Syphilis Experiment CLICK TO SHOW
  Facebook’s Newsfeed Study CLICK TO SHOW

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Galerie Bilderwelt/Contributor/Getty Images

During the Nuremberg Trials, which brought key figures of the Nazi Party of Germany to justice, the practices of some Nazi medical personnel were found to be unethical and even criminal. The Nuremberg Code, which emerged from these trials, established principles for any type of human experimentation.

Your analysis should offer answers to the research questions with which you began the study. Be mindful in interpreting your data and avoid conclusions that are speculative or not warranted by the actual research results. Do your data support or contradict your initial hypothesis? Or are they simply inconclusive? Report all of your results. Do your findings have implications for larger theories in the discipline? Do they suggest the need for further study of another dimension of the issue at hand? Good research need not have results that unequivocally support your hypothesis. A finding that refutes the hypothesis can be instructive as well.

SHARE THE RESULTS

However fascinating your research may be to you, its benefits are amplified when you take advantage of opportunities to share it with others. You can share your findings with the sociological community by publishing the results in academic journals. Before submitting research for publication, you must learn which journals cover your topic areas and review those journals’ standards for publication. Some colleges and universities sponsor undergraduate journals that offer opportunities for students to publish original research.

Other outlets for publication include books, popular magazines, newspapers, video documentaries, and websites. Another way to communicate your findings is to give a presentation at a professional meeting. Many professional meetings are held each year; at least one will offer a panel suited to your topic. In some cases, high-quality undergraduate papers are selected for presentation. If your paper is one, relevant experts at the meeting will likely help you interpret your findings further.

SOCIOLOGY AND YOU: WHY LEARN TO DO SOCIOLOGICAL RESEARCH?

The news media provide us with an immense amount of round-the-clock information. Some of it is very good; some of it is misleading. Reported “facts” may come from sources that have agendas or are motivated by self-interest, such as political interest groups, lobbying groups, media outlets, and even government agencies. Perhaps the most problematic are “scientific” findings that are agenda driven, not scientifically unbiased. In particular because we live in a time of information saturation, it is important that we learn to be critical consumers of information and to ask questions about the quality of the data presented to us. Carefully gathered and precise data are important not only as sources of information but also as the basis of informed decision making on the part of elected officials and others in positions of power.

Because you now understand how valid and reliable data are gathered, you can better question the veracity and reliability of others’ claims. For example, when a pollster announces that 80% of the “American people” favor Joe Conman for Congress, you can ask, “What was the size of the sample? How representative is it of the population? How was the survey questionnaire prepared? Exactly what questions were asked?” If it turns out that the data are based on the responses of 25 residents of a gated Colorado community or that a random sample was used but the survey included leading questions, you know the results do not give an accurate picture.

Similarly, your grasp of the research process allows you to have greater confidence in research that was conducted properly. You should put more stock in the results of a nationwide Centers for Disease Control and Prevention survey of college students’ drug use or safe-sex choices that used carefully prepared questionnaires tested for their validity and reliability and less stock in data gathered by a reporter untrained in scientific methods who interviewed a small, nonrandom sample of students on a single college campus.

You have also taken the first step in learning how to gather and evaluate data yourself. Realizing the value of theories that can be tested and proven false if they are wrong is the first step in developing your own theories and hypotheses. By using the concepts, processes, and definitions introduced in this chapter, you can conduct research that is valid, appropriate, and even publishable.

In short, these research tools will help you be a more critical consumer of information and enhance your understanding of the social world around you. Other benefits of learning sociology will become apparent throughout the following chapters as you discover how the research process is applied to cultures, societies, and the institutions that shape your life.

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PRIVATE LIVES, PUBLIC ISSUES

 

ZIMBARDO’S EXPERIMENT: THE INDIVIDUAL AND THE SOCIAL ROLE

 

Stanford University archives

Despite questions about the ethics of Philip Zimbardo’s experiment, sociologists still study his work. Is it wrong to use research data gathered by means we now consider unethical? Do the results of research ever justify subjecting human beings to physical or psychological discomfort, invasion of privacy, or deception?

Social psychologist Philip Zimbardo (1974; Haney, Banks, & Zimbardo, 1973) wanted to investigate how role expectations shape behavior. He was intrigued by the possibility that the frequently observed cruelty of prison guards was a consequence of the institutional setting and role, not the guards’ personalities.

In an experiment that has since become well known, Zimbardo converted the basement of a Stanford University building into a makeshift prison. A newspaper ad seeking young men to take part in the experiment for pay drew 70 subject candidates, who were given a battery of physical and psychological tests to assess their emotional stability and maturity. The most mature 24 were selected for the experiment and randomly assigned to roles as “guards” or “prisoners.” Those assigned to be prisoners were “arrested,” handcuffed, and taken to the makeshift prison by the Palo Alto police. The behavior of the guards and the prisoners was filmed. Within a week, the prison setting took on many of the characteristics of actual prisons. The guards were often aggressive and seemed to take pleasure in being cruel. The prisoners began planning escapes and expressed hostility and bitterness toward the guards.

The subjects in the experiment so identified with their respective roles that many of them displayed signs of depression and anxiety. As a result, some were released early, and the experiment was canceled before the first week was over. Since the participants had all been screened for psychological and physical problems, Zimbardo concluded that the results could not be attributed to their personalities. Instead, the prison setting itself (the independent variable) appeared to be at the root of the guards’ brutal behavior and the prisoners’ hostility and rebelliousness (the dependent variable). Zimbardo’s research shows how profoundly private lives are shaped by the behavioral expectations of the roles we occupy in social institutions.

THINK IT THROUGH

Zimbardo’s experiment could not be repeated today, as it would violate guidelines for ethical research with human subjects. How might a researcher design an ethical experiment to test the question of the circumstances under which apparently “normal” individuals will engage in violent or cruel acts?

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WHAT CAN I DO WITH A  SOCIOLOGY DEGREE?

 

 

 

 

 

CAREER DEVELOPMENT: GETTING STARTED AND ASSESSING YOUR INTERESTS, VALUES, AND SKILLS

The skills and knowledge of career development and your job search are learned, practiced, and mastered over time. You will learn about yourself, make career decisions, manage workplace expectations, and pursue new opportunities throughout your professional life. Your career success starts with self-reflection, exploration, the effective implementation of career and job search action plans, and a personal and professional commitment to your career. The basic activities linked to these processes are shown in the career development wheel.

In this chapter, we focus on your assessment of career interests and preferences and your exploration of career and job options.

Assessment of Individual Career Interests and Preferences

Self-knowledge is an important element of career assessment and development. Learning about your career identity—the values, aspirations, interests, talents, skills, and preferences related to careers—is fundamental to your career success.

Careful self-assessment will help you determine what you do well and enjoy, what skills and talents you possess, how you prefer to work, what interests you actively pursue, what values drive your choices, and where your strengths and weaknesses lie. By matching your characteristics to careers and occupations, you will establish a basis for identifying your career options and a guide to further research and exploration.

Assessments may be completed individually, online, in a group setting, and/or with a career professional. Assessments often include information linking your career interests to potential academic majors. You may want to access the following online assessment resources to research your career identity:

•    www.jobhuntersbible.com (What Color Is Your Parachute?)

•    www.focuscareer.com (Focus 2 Online Career Planning System)

•    www.humanesources.com/products /program/do-what-you-are (Do What You Are)

•    www.careerinfonet.org/occupations (CareerOneStop)

THINK ABOUT CAREERS

Consider the components of a career identity noted above. What characteristics of your career identity can you identify at this point? How will you begin to establish the key aspects of your career identity?

 

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SUMMARY

•    Unlike commonsense beliefs, sociological understanding puts our biases, assumptions, and conclusions to the test.

•    As a science, sociology combines logically constructed theory and systematic observation in order to explain human social relations.

•    Inductive reasoning generalizes from specific observations; deductive reasoning consists of logically deducing the empirical implications of a particular theory or set of ideas.

•    A good theory is logically consistent, testable, and valid. The principle of falsification holds that if theories are to be scientific, they must be formulated in such a way that they can be disproved if wrong.

•    Sociological concepts must be operationally defined to yield measurable or observable variables. Often, sociologists operationally define variables so they can measure these in quantifiable values and assess validity and reliability, to eliminate bias in their research.

•    Quantitative analysis permits us to measure correlations between variables and identify causal relationships. Researchers must be careful not to infer causation from correlation.

•    Qualitative analysis is often better suited than quantitative research to producing a deep understanding of how the people being studied view the social world. On the other hand, it is sometimes difficult to measure the reliability and validity of qualitative research.

•    Sociologists seek objectivity when conducting their research. One way to help ensure objectivity is through the replication of research.

•    Research strategies are carefully thought-out plans that guide the gathering of information about the social world. They also suggest the choice of appropriate research methods.

•    Research methods in sociology include survey research (which often relies on random sampling), fieldwork (including participant observation and detached observation), experiments, working with existing information, and participatory research.

•    Sociological research typically follows seven steps: framing the research question, reviewing the existing knowledge, selecting appropriate methods, weighing the ethical implications of the research, collecting data, analyzing data, and sharing the results.

•    To be ethical, researchers must be sure their research protects the privacy of subjects and does not cause them unwarranted stress. Scientific societies throughout the world have adopted codes of ethics to safeguard against the misuse and abuse of human subjects.

KEY TERMS

scientific method, 31

deductive reasoning, 31

hypotheses, 31

inductive reasoning, 31

quantitative research, 32

qualitative research, 32

scientific theories, 33

concepts, 34

operational definition, 34

variable, 34

quantitative variables, 34

qualitative variables, 34

correlation, 34

causal relationship, 35

spurious relationship, 35

negative correlation, 36

principle of falsification, 36

falsifiability, 36

validity, 37

reliability, 37

bias, 37

objectivity, 39

value neutrality, 39

replication, 39

research methods, 39

survey, 40

sample, 40

population, 40

random sampling, 41

fieldwork, 41

interview, 42

leading questions, 42

experiments, 42

independent or experimental variables, 42

dependent variables, 42

statistical data, 43

document analysis, 43

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DISCUSSION QUESTIONS

1.   Think about a topic of contemporary relevance in which you may be interested (for example, poverty, juvenile delinquency, teen births, or racial neighborhood segregation). Using what you learned in this chapter, create a simple research question about the topic. Match your research question to an appropriate research method. Share your ideas with classmates.

2.   What is the difference between quantitative and qualitative research? Give an example of each from the chapter. In what kinds of cases might one choose one or the other research method in order to effectively address an issue of interest?

3.   Sociologists often use interviews and surveys as methods for collecting data. What are potential problems with these methods of which researchers need to be aware? What steps can researchers take to ensure that the data they are collecting are of good quality?

4.   Imagine that your school has recently documented a dramatic rise in plagiarism reported by teachers. Your sociology class has been invited to study this issue. Consider what you learned in this chapter about survey research and design a project to assess the problem.

5.   In this chapter, you learned about the issue of ethics in research and read about the Zimbardo prison experiment. How should knowledge collected under unethical conditions (whether it is sociological, medical, psychological, or other scientific knowledge) be treated? Should it be used just like data collected under ethically rigorous conditions?

 

 

Sharpen your skills with SAGE edge at  edge.sagepub.com/chambliss2e

A personalized approach to help you accomplish your coursework goals in an easy-to-use learning environment.

 

CHAPTER 4

4 SOCIALIZATION AND SOCIAL INTERACTION

 

Will & Deni McIntyre/Photo Researchers, Inc.

Media Library

CHAPTER 4 Media Library

AUDIO    

Careers & Self-Identity

Gender and Self-Talk

VIDEO    

Wild Child: The Story Of Feral Children

South park and Gender Socialization

Teen Shaming

Advertising Invades the Classroom

Virtual Identities

CQ RESEARCHER    

Deprivation of Social Interaction

Socialization and Education

PACIFIC STANDARD MAGAZINE    

Socialization and Men

Parenting and Empathy

JOURNAL    

Socialization and Teenage Activism

Media Socialization, Kids and Food

Social Roles in Total Institutions

REFERENCE    

Total Institutions

 

 

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IN THIS CHAPTER

The Birth of the Social Self

Agents of Socialization

Socialization and Aging

Total Institutions and Resocialization

Social Interaction

Why Study Socialization and Social interaction?

 

 

WHAT DO YOU THINK?

1.   Is the personality of an individual determined at birth?

2.   Are the media today as important in a child’s socialization as the child’s family? Might the media be more important?

3.   Do people adjust the presentation of their personalities in interactions in order to leave particular impressions? Might we say that we have different “social selves” that we present in different settings?

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GIRLS, BOYS, AND TOYS

REUTERS/Aly Song

 

We can find a box (or several boxes) of toys in most U.S. homes with children. Many of us can look back on our childhoods—whether they are a recent or distant memory—and recall a favorite toy. It might have been a smiling doll, a stuffed animal, a hardy truck or tank, or a set of colorful blocks. If we were lucky, we had an array of toys from which to choose our fun. In this chapter, we talk about agents of socialization, that is, the entities (like families, peers, and schools) that teach us the norms, rules, and roles of society. From a sociological perspective, toys are not just toys—rather, they too are agents of socialization, contributing to children’s early ideas of who they are and who they can be in society.

Like other key agents of socialization—families, peers, the media, school, and organized sports, among others—toys may contribute to a child’s sense of socially accepted roles, aspirations for the future, and perceptions of opportunities and limitations. If we as social beings are made not born, as sociologists argue, then toys contribute to the construction of boys and girls in ways that can be both predictable and surprising.

In 2014, two researchers at Oregon State University published a study with some attention-getting results. In this research, 37 girls ages 4 to 7 were each given one of three toys with which to play: a Mrs. Potato Head, a glamorous Barbie doll, or a doctor Barbie doll. After a short period of play, each subject was shown pictures depicting 10 female- and male-dominated professions, like librarian, teacher, and flight attendant (“female” jobs) and pilot, doctor, and firefighter (“male” jobs). With each picture, the subject was asked, “Could you do this job when you grow up?” and “Could a boy do this job when he grows up?” (see Figure 4.1). Notably, girls who played with either of the Barbie dolls identified fewer jobs that they could do than did the girls who played with Mrs. Potato Head—and all of the girls in the study thought that a boy would be able to do a greater number of both the male- and female-dominated jobs (Sherman & Zurbriggen, 2014). Other research has shown that young girls exposed to Barbies express a stronger desire to be thin and have lower body self-esteem than do girls exposed to dolls with more realistic body proportions (Dittmar, Halliwell, & Ive, 2006).

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FIGURE 4.1 Number of Jobs Girls Think They Can Do Better or Worse Than Boys Based on Occupation Type

 

SOURCE: Sherman, A.M. and Zurbriggen, E.L. (2014). “‘Boys Can Be Anything’: Effect of Barbie Play on Girls’ Career Cognitions.” Sex Roles, online publication, March 5. Copyright © 2014 Springer Science + Business Media New York. Reprinted with permission.

 

 

TOSHIFUMI KITAMURA/Staff/Getty Images

A young girl prays for blessings in the New Year on the shoulders of her father at the Meiji shrine in Tokyo. Many components of one’s culture are seamlessly passed down through habit, observational learning, and family practices.

These findings are provocative and raise some interesting questions: What is the power of toys? Do toys affect children’s aspirations and perceptions? And why did all of the girls in the 2014 study judge themselves less capable than boys of doing a variety of jobs? Efforts have been made to expose young girls to more career options through toys; for instance, the popular Lego brand has introduced female Lego scientist figures, including an astronomer, a paleontologist, and a chemist, complete with a beaker (Gambino, 2014). Might such changes encourage greater future interest among girls in the STEM (science, technology, engineering, and mathematics) fields, where women are underrepresented? Do “boyish” toys already do that for boys? What do you think?

In this chapter, we examine the process of socialization and the array of agents that help shape our social selves and our behavioral choices. We begin by looking into the “nature versus nurture” debate and what sociology says about that debate. We then discuss the key agents of socialization, as well as the ways in which socialization may differ in total institutions and across the life course. We then examine theoretical perspectives on socialization. Finally, we look at social interaction and ways in which sociologists conceptualize our presentation of self and our group interactions.

THE BIRTH OF THE SOCIAL SELF

Socialization is the process by which people learn the culture of their society. It is a lifelong and active process in which individuals construct their sense of who they are, how to think, and how to act as members of their culture. Socialization is our primary way of reproducing culture, including norms and values and the belief that our culture represents “normal” social practices and perceptions.

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Nina Leen/Contributor/Getty Images

Given the choice in an experiment between a wire mother surrogate and a surrogate covered with cloth, the infant monkey almost invariably chose the cloth figure. How are human needs similar to and different from those we find in the animal kingdom?

The principal agents of socialization—including parents, teachers, religious institutions, friends, television, and the Internet—exert enormous influence on us. Much socialization takes place every day, usually without our thinking about it: when we speak, when others react to us, when we observe others’ behavior—even if only in the movies or on television—and in virtually every other human interaction.

Debate has raged in the social sciences over the relative influence of genetic inheritance (“nature”) and cultural and social experiences (“nurture”) in shaping people’s lives (Coleman & Hong, 2008; Ridgeway & Correll, 2004). If inborn biological predispositions explain differences in behaviors and interests between, say, sixth-grade boys and girls, or between a professional thief and the police officer who apprehends him, then understanding socialization will do little to help us understand those differences. On the other hand, if biology cannot adequately explain differences in attitudes, characters, and behaviors, then it becomes imperative that we examine the effects of socialization.

Almost no one today argues that behavior is entirely determined by either socialization or biology. There is doubtless an interaction between the two. What social scientists disagree about, however, is which is more important in shaping a person’s personality, life chances, philosophy of life, and behavior. In this text we lean toward socialization because we think the evidence points in that direction.

Social scientists have found little evidence to support the idea that personalities and behaviors are rooted exclusively in “human nature.” Indeed, very little human behavior is actually “natural.” For example, humans have a biological capacity for language, but language is learned and develops only through interaction. The weight of socialization in the development of language, reasoning, and social skills is dramatically illustrated in cases of children raised in isolation. If a biologically inherited mechanism alone triggered language, it would do so even in people who grow up deprived of contact with other human beings. If socialization plays a key role, however, then such people would not only have difficulty learning to speak like human beings, but they would also lack the capacity to play the social roles to which most of us are so accustomed.

One of the most fully documented cases of social isolation occurred more than 200 years ago. In 1800, a “wild boy,” later named Victor, was seen by hunters in the forests of Aveyron, a rural area of France (Shattuck, 1980). Victor had been living alone in the woods for most of his 12 or so years and could not speak, and although he stood erect, he ran using both arms and legs like an animal. Victor was taken into the home of Jean-Marc-Gaspard Itard, a young medical doctor who, for the next 10 years, tried to teach him the social and intellectual skills expected of a child his age. According to Itard’s careful records, Victor managed to learn a few words, but he never spoke in complete sentences. Although he eventually learned to use the toilet, he continued to evidence “wild” behavior, including public masturbation. Despite the efforts of Itard and others, Victor was incapable of learning more than the most rudimentary social and intellectual skills; he died in Paris in 1828.

Other studies of the effects of isolation have centered on children raised by their parents, but in nearly total isolation. For 12 years, from the time she was 1½ years old, “Genie” (a pseudonym) saw only her father, mother, and brother, and only when one of them came to feed her. Genie’s father did not allow his wife or Genie to leave the house or have any visitors. Genie was either strapped to a child’s potty-chair or placed in a sleeping bag that limited her movements. Genie rarely heard any conversation. If she made noises, her father beat her (Curtiss, 1977; Rymer, 1993).

When Genie was 13, her mother took her and fled the house. Genie was unable to cry, control her bowels, eat solid food, or talk. Because of her tight confinement, she had not even learned to focus her eyes beyond 12 feet. She was constantly salivating and spitting, and she had little controlled use of her arms or legs (Rymer, 1993).

  Wild Child: The Story Of Feral Children CLICK TO SHOW

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Gradually Genie learned some of the social behavior expected of a child. For example, she became toilet trained and learned to wear clothes. However, although intelligence tests did not indicate reasoning disability, even after 5 years of concentrated effort on the part of a foster mother, social workers, and medical doctors, Genie never learned to speak beyond the level of a 4-year-old, and she never spoke with other people. Although she responded positively to those who treated her with sympathy, Genie’s social behavior remained severely underdeveloped for the rest of her life (Rymer, 1993).

Genie’s and Victor’s experiences underscore the significance of socialization, especially during childhood. Their cases show that however rooted in biology certain capacities may be, they do not develop into recognizable human ways of acting and thinking unless the individual interacts with other humans in a social environment. Children raised in isolation fail to develop complex language, abstract thinking, notions of cooperation and sharing, or even a sense of themselves as people. In other words, they do not develop the hallmarks of what we know as humanity (Ridley, 1998).

Sociologists and other social scientists have developed a number of theories to explain the role of socialization in the development of social selves. What these theories recognize is that whatever the contribution of biology, ultimately people as social beings are made, not born. Below, we explore four approaches to understanding socialization: behaviorism, symbolic interactionism, developmental stage theories, and psychoanalytic theories.

BEHAVIORISM AND SOCIAL LEARNING THEORY

Behaviorism is a psychological perspective that emphasizes the effect of rewards and punishments on human behavior. It arose during the late 19th century to challenge the then-popular belief that human behavior results primarily from biological instincts and drives (Baldwin & Baldwin, 1986, 1988; Dishion, McCord, & Poulin, 1999). Early behaviorist researchers such as Ivan Pavlov (1849–1936) and John Watson (1878–1958), and later B. F. Skinner (1904–1990), demonstrated that even behavior thought to be purely instinctual (such as a dog salivating when it sees food) can be produced or extinguished through the application of rewards and punishments. Thus, a pigeon will learn to press a bar if that triggers the release of food (Skinner, 1938, 1953; Watson, 1924). Behaviorists concluded that both animal and human behavior can be learned, and neither is just instinctive.

When they turned to human beings, behaviorists focused on social learning, the way people adapt their behavior in response to social rewards and punishments (Baldwin & Baldwin, 1986; Bandura, 1977; Bandura & Walters, 1963). Of particular interest was the satisfaction people get from imitating others. Social learning theory thus combines the reward-and-punishment effects identified by behaviorists with the idea that we model the behavior of others; that is, we observe the way people respond to others’ behavior.

Critical Thinking / Errors In Reasoning

Errors in Reasoning

In this assignment, you will select one of the claims listed below. Using what you know about the topic, describe at least four claims that might commonly be made that display some of the errors in reasoning covered in this module’s readings. You may have to do a bit of research to find popular positions on these topics.

For example, if the claim is: Children should not be allowed to play violent video games.

Then four common claims about the subject might be:

1. Children have always played violent games and they turned out okay.

2. Dr. Dre says that violent video games are okay.

3. Everybody knows that violent video games don’t cause problems.

4. Many countries banned violent video games and they have higher crime rates than we do.

And the errors they represent might be:

1. Children have always played violent games and they turned out okay (appeal to tradition and false analogy).

2. Dr. Dre says that violent video games are okay (argument by mistaken authority).

3. Everybody knows that violent video games don’t cause problems (appeal to common belief).

4. Many countries banned violent video games and they have higher crime rates than we do (post hoc ergo propter hoc).

Because

1. Any sentence that talks about how we have always done something as a way to justify doing it is an appeal to tradition.

2. The claim looks like it comes from an authority, but Dr. Dre is a musician, not a doctor.

3. Any claim that says that everyone knows something as a way to justify doing it is an appeal to common belief.

4. Showing that two things happened (that video games are accepted and crime is up) does not prove that the two things are related or that the first caused the second; this is called post hoc ergo propter hoc, which means after this, so because of this.

Select one of these topics. Using what you know about the topic and additional research you conduct, describe at least four claims that might commonly be made that display some of the errors in reasoning covered in this module’s readings.

1. Should people under 18 be subjected to legal curfews or restricted driving privileges?

2. Should libraries be required to install filtering software or otherwise censor the materials that they provide?

3. Should insurance companies be required to pay for breast reconstruction, birth control pills, or Viagra?

4. Should the use of camera phones be banned in gymnasiums or other locations?

Write your 600-word response in the Microsoft Word document format.

Assignment 2 Grading Criteria
Maximum Points
Provided at least four commonly made claims about your selected topic (four common claims).
40
Named the errors found in each common claim (the errors represented).
30
Explained what factors show that the error is present (definitions).
20
Applied current APA standards for editorial style, expression of ideas, and format of text, citations, and references. Professionally presented the response by using good grammar, spelling, and punctuation.
10
Total:
100