• Chatting over the fence: A qualitative study of cancer and prevention behavior in a high-risk rural area

      Plaskon, Patricia Perone; Belcher, John R. (1993)
      Poor cancer prevention practice leads to morbidity and mortality, with negative social consequences for individuals, families, and communities. The lay experience of poor prevention practice is not well understood by professionals, which limits the effectiveness of interventions to decrease the physical and social effects of cancer. Therefore, a qualitative approach was used to explore prevention behavior in a geographic region with high cancer morbidity and mortality rates. Extensive data were collected through a total of thirty interviews with ten informants over a period of six months. Field notes and transcripts were organized and sorted using the Ethnograph software package. Employing the constant comparative method of data collection and analysis, concepts and themes related to cancer and prevention were identified, systematically linked, and distilled into grounded theory. Trustworthiness was insured by triangulation of data collection methods, interview audits and debriefing. Analysis found informants had negative impressions of cancer, and little hope about cancer prevention, cancer treatment and cancer survivorship, despite accurate knowledge of prevention behavior guidelines. Hope was related to the individual's experience of five key elements: (a) the content and source of prevention guideline messages; (b) the individual's (emic) understanding of the disease; (c) experience of the disease; (d) religious/philosophical outlook; and (e) perceptions of the resources needed for prevention. The greater disparity between prevention messages and the other variables, the less hope individuals expressed for efficacy of cancer prevention, and the less likely they were to follow prevention guidelines. Significance of these findings for social work education, direct intervention, community action and public policy is that hope is as important to consider in the fight against cancer as is development of technology and access to care. An argument is made for social workers to be involved in primary prevention rather than tertiary treatment of coping with symptoms. Social workers need to be aware of opportunities to assess hope and empower persons to protect themselves, their families and communities. The role of social workers as advocates for "noncompliant" persons, interpreters/teachers to other health professionals, and lobbyists for cancer research is also discussed.
    • Compassion fatigue among adult protective services social workers

      Bergel, Dara P.; Belcher, John R. (2007)
      Compassion fatigue is a relatively new concept that describes the symptoms that are experienced by helping professionals who work with clients experiencing trauma from assault, maltreatment, and/or disaster. Little research has focused on the risk factors, effects, and experiences of social workers, specifically who work with the elderly. The purpose of this study was to qualitatively explore the experiences and perspectives of Adult Protective Services (APS) social workers related to compassion fatigue. Nine APS social workers were interviewed from six urban counties of the South Central Region of Pennsylvania. The constant comparative method of qualitative research elicited categories and themes, ultimately leading to a working hypothesis, which helped to explain why this particular sample did not experience compassion fatigue. They indicated that they developed and utilized self-protection measures to stave off any aspects of compassion fatigue. The APS social workers combined personal characteristics and professional factors to develop boundary-setting mechanisms which protected them from experiencing the symptoms and effects of compassion fatigue. The personal characteristics included the knowledge and skills developed from social work education, a personal history of dealing with crisis in their own lives, specific personality traits that APS social workers believe are inherent and needed in order to succeed in this job, the personal sense of achievement that they experience from doing this type of work, their overall fondness for this type of work, the familiarity and knowledge that they have gained from this job, and the personal strengths that these APS social workers intrinsically possess. The professional factors which have assisted APS social workers in creating boundaries are co-worker support, lack of supervisory and institutional support which fosters independence, the feeling of authority that is granted by the job, and the APS social worker's knowledge of the professional resources offered by their employer, the Area Agency on Aging. Social work education, micro practice, macro practice, and policy implications center around the elements needed to implement boundaries in order to maintain a separation between the work and home environment. Suggestions for future research are also provided.
    • An examination of Washington, D.C.'s Juvenile Curfew Act of 1995: A single-system approach

      Cole, Ralph Daniels; Belcher, John R. (2002)
      There is a major concern among the American people that juvenile crime is escalating out of control. Juvenile curfew laws have been the fastest growing intervention to combat youth violence and juvenile crime. A single-system experimental replication design, ABAB, was used to examine whether the Juvenile Curfew Act of 1995 is effective in reducing juvenile crime in the District of Columbia. The sample for the study was the District of Columbia (N = 1). Archival data were obtained from the Information Technology Division of the Metropolitan Police Department for the time period of October 1, 1993 to September 30, 2001 of persons arrested under age 18. The data were analyzed using statistical software, SINGWIN, designed for single-system research. A five-step procedure was used to analyze each variable of the data: (1) visual analysis of the data, (2) calculation of descriptive statistics, (3) check for autocorrelation, (4) check for a significant trend, and (5) determination of whether a two-standard-deviation-band approach (Shewart chart) and/or t-test can be used to analyze the data. The findings from this research study showed the Juvenile Curfew Act of 1995 effective in reducing part 2 (non-violent) juvenile crime arrests in Washington, D.C. The possible reasons why juvenile curfew laws are not effective in reducing all types of juvenile crime (e.g., violent crimes) or appropriate as the only method of intervention are discussed. For example, curfew laws exclude the hours when juveniles are most likely to commit crimes, they do not include the entire juvenile population, there is inconsistent enforcement of the law by police, they do not fully incorporate the theories and research related to juvenile delinquency, and they do not address the major correlates of delinquency (e.g., individual, family, peers, and school factors). Future research on juvenile curfew laws needs to be completed to ascertain why these laws are ineffective in reducing certain types of crime (e.g., violent crime) and to determine whether they can be made more effective. Until such research is conducted, curfew laws may continue to be a popular but seemingly ineffective intervention when used alone in the fight against youth violence and juvenile crime.
    • Holy ground, common ground: Perspectives of Christian clergy on their mental health role

      Smith, Peter Joseph; Belcher, John R. (1999)
      Persons experiencing emotional problems, including serious mental illness, often turn to clergy as their first choice for help. Past studies show that pastors reported feeling inadequately trained to deal with the types of problems they encountered. In spite of this, pastors referred infrequently to secular mental health professionals (MHPs). This qualitative field study explored-the perspectives of clergy on their mental health role and developed "grounded theory" that addresses the clergy understanding of their role. Data were collected through ten field observations, and twenty-seven semi-structured interviews with nine informants (n = 9) from a range of Christian churches (Non affiliated Evangelical, Denominationally affiliated Evangelical, and Mainline) throughout central Maryland. The constant comparative method was used as categories and themes were identified from the data, and collapsed into working hypotheses at each of three rounds of data collection. Grounded theory was developed from the final working hypotheses. Analysis revealed that pastors' mental health activities were related to their role definition, which was in turn shaped by their religious beliefs, experience of God, experience in ministry, and expectations of help seekers. Similarities were found among all pastors regarding types of problems seen, value and limits of their role, the desire to help, and the role of trust in selecting a referral resource. Evangelical pastors differed from Mainline pastors in the use of religious language and symbols, preference for type of referral resource, and familiarity with secular MHPs. Charismatic pastors differed from other Evangelicals by the degree to which they saw mental health in religious terms, sought to import mental health technology, and had limited ties to the mental health system. These findings are significant for professional social work in the following areas. Diversity training in social work education should include a treatment of religious belief systems and their language and symbols. Direct micro practice would be enhanced by building trust with local pastors, and expanding the social work role from referral terminus to providing consultation and support for the pastor's role. On the level of macro practice, mental health outreach and education for local pastors would magnify the benefits of social work training and expertise.
    • Perspectives among mental health providers regarding rehospitalization of the chronically mentally ill

      Anderson, Denise Lynn; Belcher, John R. (1995)
      Rehospitalization of persons diagnosed with chronic mental illnesses has been a problem since deinstitutionalization. While there has been little agreement among researchers, practitioners, families and consumers as to what is needed to improve this problem, it has been addressed frequently in mental health literature. The purpose of this qualitative 'grounded theory' field study was to explore perspectives of different levels of community mental health providers (i.e., directors, supervisors and direct service providers) (n = 15) from different community agencies regarding rehospitalization of persons diagnosed with chronic mental illnesses. Semi-structured interviews were conducted with each participant in three rounds of data collection. The data was coded and categories were collapsed into themes. As themes reached saturation, they were negotiated and refined into the working hypotheses. This method of constant comparative analysis allowed for negotiation of the final working hypotheses to develop 'grounded theory'. The results indicate there are differences and similarities among levels of community mental health providers regarding rehospitalization. Similar perspectives among participants included their view of needs for new and improved programs and increased education to decrease rehospitalizaton. Participants view multiple community mental health agencies as having strengths and limitations. Lack of perceived influence by persons in direct hierarchical line of authority was another commonalty. Differences were related to the scope of the providers' view, providers' perceived significance of impact on consumers, and level of openness regarding views and opinions. The results also reveal that different perspectives exist among agencies related to awareness of outside influences impact on their work with consumers. Implications of these findings include recommendations for both practice and research within this community mental health setting, as well as, to the social work profession. Recommendations for the setting in which the research was conducted include to further explore the findings of the study, specifically, the reported frustration regarding lack of team work among different agencies within the mental health system. Finally, social work research is encouraged to build knowledge and address problems from a social work perspective. It is recommended that further research be conducted from a social work perspective in the area of mental health.
    • Perspectives of battered women regarding the criminal justice system

      Noone, Diana Colombo; Belcher, John R. (2000)
      New laws and policies in the domestic violence arena have been implemented without any input from the women who survived domestic violence. The perspectives of the survivors are not well documented or understood by policymakers and criminal justice personnel. Therefore, a qualitative approach was used to explore the perspectives of the women who survived domestic violence and what initiatives can make the criminal justice system more amenable to their needs. Extensive data were collected through a total of thirty interviews with a total of ten informants over a 9-month period of time. The constant comparative method of data collection and analysis was utilized. Concepts and themes related to the survivors' perspectives of the criminal justice system and what helped them through the ordeal were identified, linked and developed into grounded theory. The use of triangulated data collection methods, interview audits and peer debriefing insured the trustworthiness of the study. The results indicate that participants became involved in the criminal justice system to protect their children from the emotional and physical effects of the abuse. The survivors also indicated they received the necessary support to survive the ordeal from family and/or friends, the courthouse domestic violence advocate, and judges who mandated counseling. However, they did not believe the police provided adequate information and support during the initial arrest. Therefore, they suggested a female advocate would be beneficial on the scene at the time of arrest. Implications of these findings include recommendations for practice, research and policy within the criminal justice community and the social work community. Recommendations for the setting in which the research was conducted include to further explore the findings of the study especially the reported frustration at the lack of support from the police. Also, social work research is suggested to build knowledge and address the problems from the survivors' perspectives.
    • Protective factors for inner city adolescents at risk: Family factors and social support

      Lagana, Maureen Theresa; Belcher, John R. (1998)
      The national estimated school dropout rate is 25%. A wide variety of variables have been associated with the occurrence of school dropout. This study compared three groups of adolescents on a continuum of risk for school dropout: adolescents in the mainstream school program (n = 91); adolescents in an at risk program (n = 78); and adolescents in an alternative evening program (n = 25). Participants were low-income, inner-city, African-American youth from the same high school. The purpose of this study was to develop a model that could discriminate between the groups identified. The study focused on family variables and social support variables. Measures included the Family Adaptability and Cohesion Evaluation Scale (FACES II), a subscale of the Perceived Social Support Scale (PSSS) which measured peer support, a direct adaptation of the PSSS which measured support from adults outside the immediate family, and a questionnaire that gathered demographic information and information previously associated with school dropout. A discriminant function analysis was performed. Participants in the at risk program could be discriminated from participants in the mainstream and alternative programs in that they were more likely to repeat a grade, be older, be a parent or parent to be, have a higher grade point average and come from less cohesive families. Students in the alternative program were more likely than students in the mainstream to be males, be at a lower current grade, have lower intelligence scores, and lack adult and peer support. Interestingly, they were more likely to be satisfied with family cohesion and adaptability, and come from more adaptive families. Results suggest that adolescents at the highest level of risk experience more educational difficulties, including interactions with peers and adults, and adolescents at a lower continuum of risk are more likely to experience difficulties in the home environment. Classification rates for the three groups were as follows: 40% for the alternative program, with a prior probability of only 12%; 68.7% for the risk program, with a prior probability of 40%; and 82.7%, with a prior probability of 48%. The model greatly increased correct classification of membership into each group over that of chance.
    • Protective factors to resilience in maltreated children: A developmental view

      Henry, Darla Lynn; Belcher, John R. (1996)
      The costs of child maltreatment to children, families and society have been extensively documented for the past 30 years. Children who have been maltreated by a primary caregiver respond with various behaviors to coping with living in an abusive environment. It was the intent of this qualitative research study to explore the protective factors that indicate resilience in a group of adolescents, maltreated as children, who have demonstrated competence and mastery towards independent living. The grounded theory method was chosen for this study because the research questions focused on the exploration and explanation of coping methods used by children who were maltreated. Seven adolescents (ages 13 to 20) and six professional child care workers were interviewed on three occasions to obtain their perceptions of their reactions to the abuse. These perceptions were then categorized into common patterns and themes, using the constant comparative method, towards working hypotheses indicative of the protective factors of resilience. Adolescents and child care professionals, all associated with the York County Children and Youth Services, York, Pennsylvania, were the participants in this study. Descriptive results of this study indicated the emergence of five themes that showed a progression of skills used by children to adapt to and cope with an abusive caregiver. These themes were: the child's perceptions of the abusing parent(s), normalizing the abusive environment, establishing a sense of safety through a perception of invisibility, developing a positive self value and having a future orientation. The successful progression through each of these themes resulted in a more resilient adolescent who demonstrated competency and mastery of adolescent tasks. These themes comprised a developmental perspective of resilience in maltreated children. The findings suggest that those children who were able to cope with maltreatment through these perceptions gained a sense of control in their lives. The more their actions minimized the impact of the abusive episodes, the more their value of self increased. As they began to discover pride in surviving and overcoming difficulties, more and more of their capabilities came into the work and play of daily life. Competency and mastery were reinforced through the reliance of self through the developing years. Resilience is a product of this adaptation to the abuse.
    • A qualitative study of parenting by incest survivors

      O'Brien, Daryl Wardzinski; Belcher, John R. (1998)
      The devastating issue of childhood sexual abuse has been well documented in the literature. The vast majority of the research, however, has focused on an individualistic view of the victim, perpetrator, and non-offending spouse. The rationale for this study was based on the failure of the existing literature to address the relationships between members of the incestuous family system. In particular, the research is limited in its investigation of the role of the incest survivor as a parent. The purpose of this study was to systematically discover, describe, and analyze the beliefs, practices, and values of nine female incest survivors related to parenting. A qualitative methodology combined with symbolic interaction theory was used to describe the meaning of parenting in the lives of nine female incest survivors. Three rounds of semi-structured interviews were conducted. Interactions between the mother and child, the life experience of the mother that impacted on this relationship, and the behaviors, attitudes, and beliefs that developed were systematically explored. Three major themes were discovered that identified and explained the parenting role of the mother/survivor. These themes support the final hypothesis: The meaning attached to the abuse in the family of origin influences the parenting in the family of procreation. Incest survivors recognize what they do not want their parenting to be, however, because they have no model for healthy functioning there is difficulty implementing this desire in actual parenting situations. In an attempt to be a better parent, a deficit model is utilized which is more self-focused than child-focused. This study provided preliminary information that can be useful in understanding the transmission of child maltreatment across generations. These mothers indicated a desire to be better parents than their own parents were, however, it was in the application of parenting behaviors that difficulties continue. It was also evident that the sexual abuse was only part of their experience and that the unavailability of their own parents was most influential in showing them how to parent.
    • Raising an autistic child: Subjective experiences of fathers

      Collins, Renee; Belcher, John R. (2008)
      Using the grounded theory approach, this study examines fathers' experiences of raising a child diagnosed with autism. Fathers identified specific concerns and needs of their children as well as discussed their personnel methods of coping and providing care. Fathers in this study see themselves as very "hands-on" in providing care for their child and school needs. Fathers attributed their ability to accept and cope with the day-to-day struggles to the strength of their marriage. Fathers also expressed a desire to have a male support group enabling them to have others to confide in as well as to be able to mentor other fathers entering the world of autism. Although worried about the future of their children when they are no longer able to provide care, the fathers' immediate concern is advocating for current services that are known to all families caring for a child diagnosed with autism.
    • Rural Veterans: Pathways to Homelessness

      Jorden, Brenda J.; Belcher, John R.; DeForge, Bruce R. (2018)
      Veterans are overrepresented in homeless populations compared to non-veterans (Gamache, Rosenheck, & Tessler, 2001; Perl, 2015). Most homeless individuals live in urban centers and as a result most research studies have focused on urban homelessness leaving the rural homeless less studied and understood (Knopf-Amelung, 2013). The purpose of the current qualitative study was to explore the pathways to homelessness for a sample of rural homeless veterans. Fifteen veterans and 16 staff/administrators were interviewed to determine the causes of homelessness for veterans living in a rural area. A limited grounded theory approach was used to develop themes identified as causing homelessness. The primary pathway according to both groups was chronic substance abuse. Mental health and economic problems, and adverse childhood events were also major factors in veterans experiencing homelessness. Social support appeared to delay the onset of homelessness for some individuals. Not all veterans qualify for VA services, which leaves a segment of the population without access to VA services. Overcoming barriers to substance abuse and mental health services for rural homeless veterans is an area to focus research efforts. Creative ways to provide outreach to the hidden homeless are needed.
    • Selected factors affecting utilization of social services by women clients of two domestic violence shelters

      Horner, Douglas Charles; Belcher, John R. (1992)
      Utilizing a model based on ecological theory and feminism, the major research question for this study was: What factors in the experience of women victims of couple violence who request assistance from shelters are associated with the use of shelter services? The dependent variable for this research, the use of shelter services, was measured by two constructs; the length of shelter stay and the use of referrals by clients for additional services. The use of referrals was operationalized constructing a ratio of the number of referrals completed by a client and the number of referrals provided. Two primary independent variables were identified for analysis; clients' perception of social support and clients' identification with feminist/egalitarian values for couple relationships.;Six control variables were employed to test if spurious relationships existed between variables or offer alternative explanations to relationships suggested. These are frequency and intensity of abuse, length of the couple relationship, age of the victim, educational incompatibility of the partners, employment status of the victim, and risk of abuse to womens' children by the partner. A fourth variable set, type of referral provided, was employed to test what additional explanation of variance in the dependent variable constructs may be determined.;Interviews were completed with women clients of two domestic violence shelters (50 women from each shelter) yielding a total sample of 100. The statistical analysis was accomplished using a linear hierarchical multiple regression model. The results obtained for the completion ratio dependent variable indicated that 42% of the variance was explained at a statistically significant level for the total model. Four variables significant in the model included perceived social support, age of the clients, perceived risk to children, and referrals for protective services. No statistical relationships were found concerning total days of shelter stay. Social workers in shelter settings should evaluate further the importance of these and other variables, during the intake phase for sheltering, to have information concerning clients' potential utilization of services within the shelter and from the social service community. This information may assist service planning and funding.
    • Sexual risk behavior among African American college women: Understanding socio-cultural factors in the context of HIV/AIDS

      Gibbons, Maya; Belcher, John R. (2010)
      African American women are at the center of the discussion on health disparities, specifically disparities regarding HIV/AIDS and Sexually Transmitted Infections (STIs). Though there has been substantial research examining sexual risk behavior among low-income African American women, little has been done to understand sexual behavior decision-making among African American women who are not disadvantaged. The purpose of this qualitative study was to explore social and cultural influences on the sexual attitudes and behaviors of African American college women. Ten African American undergraduate college women, between the ages of 20 - 24 years, were individually interviewed for this study. Grounded theory methodology was used to elicit themes, ultimately leading to the working hypotheses, which helped to describe the factors influencing safe and risky sexual behavior in this sample. The first working hypothesis indicated that there are specific individual, social, and cultural factors that influence both risky and safe sexual behavior among the African American college women in the study. The individual factors include self-esteem, perceived power in a relationship, substance use, and perceived risk of contracting HIV/STIs. The social factors were peer norms, media/education exposure, and past sexual experiences. The cultural factors consisted of religion and spirituality as well as parental messages regarding sex, intimacy, and relationships. The second working hypothesis suggested that trust in a romantic partner tends to override protective factors and lead to risky sexual behavior. The findings from this study indicate that African American women in college are at risk for contracting HIV/AIDS and STIs, though there are protective influences that can minimize their risk. This research highlights that prevention programs aimed at eradicating HIV/AIDS and STI disparities for African American women should include the sub-group specific realities such as those found in this study. Implications for social work education and practice center on elevating the understanding of behaviors and attitudes that can put people at risk for HIV/STIs and infusing information about socio-cultural influences on sexual risk behavior in work with young adults. Future research suggestions include further exploring trust and intimacy as a salient influence on the sexual behavior decisions of African American college women.
    • Social drift among primary alcohol abusers

      Tovar, Daniel David; Belcher, John R. (1992)
      Research relevant to the pathways of becoming homeless (social drift) are few, particularly those that pertain to primary alcohol abusers. The author explored the plight of these individuals within the context of an urban city substance abuse treatment center located within the Johns Hopkins Medical System. By using a qualitative research design, the testimonies from the subjects developed the central themes through a sequence of interviews. In addition, the ongoing analysis of data and the emerging hypotheses were continually reconstructed by a constant comparative method involving the review of case files, revising observations, and the negotiation of the emerging themes with the subjects. The data was also continually tested for its trustworthiness using a set of systematic procedures. Findings that emerged indicated that there were five prevalent clusters of life events and factors that led to social drift of the respondents. They were in the categories of predispositional factors, the lack of intervention during the formative years, the life-cycle and progression of the alcohol and subsequent poly-drug abuse itself, non-productive and refuge-seeking related behaviors and by the clients' own inability to successfully negotiate with the social support systems and treatment chances even when made available to them.
    • The socialization of the urban, black, male delinquent in a low-income, single parent, female-headed household

      Neverdon-Merritt, Michal; Belcher, John R. (1996)
      Juvenile delinquency has been declared a widespread social problem. Statistics show that low-income, black male juveniles have higher rates of involvement in delinquent activities than white male, white female and black female juveniles. Family structure (i.e., one parent vs two parent families) has been related to juvenile delinquency. Some researchers have argued that juveniles from single parent families (specifically families headed by females) are more vulnerable to delinquent activities than those of two parent families. There are limited entries, past and current, that directly relate to single parenting and its influence on juvenile recidivism. The purpose of this qualitative "grounded" theory field study was to explore and describe the effects of mother son interaction patterns on the black male delinquent (ages 10-17). Open ended interviews were conducted with each mother son dyad (N = 11) in three rounds of data collection. Interviews were conducted in the homes of the families. The constant comparative method of data collection and analysis was used, concepts and themes were identified, systematically linked, negotiated and refined into working hypotheses. The working hypotheses were negotiated to develop "grounded" theory. The results indicate that black male juveniles who are continuously encouraged by their single mothers to be "independent" tend to exhibit aggressive behavior and have a pessimistic outlook on life. The mothers' expectations of independence for their sons are based on the following factors: (a) mothers' own childhood experiences and socialization process; (b) mothers' interactions with male partners; (c) mothers' perceptions of sons; and (d) mothers' emotional well-being and religious/philosophical outlook on life. The sons' aggressive behaviors and pessimistic outlook on life are related to: (a) their perceptions of their parents and interactions with mothers; and (b) their support from their extended family and community. Implications of these findings include recommendations for policy, research and direct practice within the social work profession and various helping professions in the community. Significant findings indicated that "juvenile delinquency is a community problem." The educational system, the juvenile justice system, mental health centers and others need to coordinate their services for youth. All agencies would benefit from having social workers develop and implement programs.
    • Socio-demographic and Psychological Characteristics of Sub-types of Alcoholism: An Analysis of the Type A/Type B and Five-Factor Models

      Thiel, Mindy; Belcher, John R. (2010)
      The characteristics of individuals with alcoholism have been depicted as sets of socio-demographic variables, psychological variables, drinking and other drug use variables, personality variables, and a conceptual model, known as the Type A/Type B typology. The utility of a Type A/Type B approach has been criticized by some researchers; however, these critics still concede that alcoholism is a heterogeneous diagnostic category. Potentially, other approaches to the creation of types of alcoholism can respond to these criticisms and still reflect the heterogeneous nature of the population of persons who abuse alcohol. Throughout the past two decades, the Five-Factor Theory of Personality has emerged as a widely accepted theory of personality. Researchers have only begun to link these dimensions of personality with alcoholism. Rather than replacing the Type A/Type B approach to creating types of alcoholism, by using the Five-Factor Theory of Personality along with the Type A/Type B approach, researchers may be able to develop typologies of alcoholism that further validate these two frameworks. This study used a secondary data analysis to test the utility of the Type A/Type B conceptual typology on a population of 421 adult males and females who had abused alcohol and were under treatment at the National Institute of Alcohol Abuse and Alcoholism (NIAAA). The study then analyzed differences between Type A and Type B alcoholism on each of the dimensions of the Five-a Factor Theory of Personality to determine whether this combined approach resulted in a categorization of sub-types of alcoholism that was conceptually clear, and clinically meaningful for social work.