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Increasing Moral Maturity Levels in Young Adult Patients Undergoing Substance Abuse Treatment by Marino E. Carbonell An Applied Dissertation Submitted to the Fischler School of Education and Human Services in Partial Fulfillment of the Requirements for the Degree of Doctor of Education Nova Southeastern University 2008 Approval Page This applied dissertation was submitted by Marino E. Carbonell under the direction of the persons listed below. It was submitted to the Fischler School of Education and Human Services and approved in partial fulfillment of the requirements for the degree of Doctor of Education at Nova Southeastern University.

_____________________________________ ____________________________ Anne Toth, EdD Date Committee Chair _____________________________________ ____________________________ Barbara Packer-Muti, EdD Date Committee Member _____________________________________ ____________________________ Maryellen Maher, PhD Date Executive Dean for Research and Evaluation ii Acknowledgments First, I express my deepest appreciation to the faculty members in the Child and Youth Studies at the Fischler School of Education and Human Services at Nova Southeastern University. So many teachers were instrumental in my educational success. To list just a few: Dr. Anne Toth, my applied dissertation committee chair, who guided and supported me throughout this project; Dr.

Marcia Skopp, Child and Youth Studies doctoral enrollment counselor, who convinced me that the EdD degree was an attainable goal; Dr. Tom Kennedy, program professor of applied research, who encouraged me to “just get it done”; and to all the other caring and outstanding academicians who facilitated my educational objectives. Finally, I am most grateful for my family: my wife, Karelia, and son Brenden, who have encouraged, supported, motivated, and listened for the past several years, always with compassion, love, and a sense of pride. My son Brenden’s undergraduate commencement ceremony from Yale University was on May 28, 2007.

iii Abstract Increasing Moral Maturity Levels in Young Adult Patients Undergoing Substance Abuse Treatment., 2008: Applied Dissertation, Nova Southeastern University, Fischler School of Education and Human Services. Moral Development/ Maturity (Individuals)/Substance Abuse/Cognitive Development/Outcomes of Treatment This applied dissertation was designed to test a key proposition based on Kohlberg’s Cognitive Moral Development Theory. This study attempted to answer the research question, Is there a difference in moral maturity level in young adult patients undergoing substance abuse therapy? That is, is there a difference in moral maturity level, as measured by Rest’s (1979) Defining Issues Test (DIT), between young adults undergoing substance abuse therapy and young adults not undergoing substance abuse therapy? Preliminary research into the factors that affect and gauge ethical moral maturity among young adult patients undergoing substance abuse treatment failed to uncover studies that address this particular area. The researcher implemented a questionnaire and survey to answer the research question.

A methodology for testing the research question was developed and employed for an exploratory study utilizing 20 young adults. The DIT instrument was distributed to the consenting subjects. A letter explaining the reasons for the survey, a self-administered DIT questionnaire, and instructions for completing the 5-digit identification number on the DIT was distributed at the time the study. No differences were found between cognitive moral development of the young adults undergoing substance abuse therapy and young adults not undergoing substance abuse therapy.

Although findings were not statistically significant, this study offers the potential for further research. The true value of this research is to set the stage for gathering a broader insight into moral maturity and substance abuse as a whole. iv Table of Contents Page Chapter 1: Introduction.1 Nature of Problem. 1 Purpose of Problem.5 Chapter 2: Review of Related Literature.7 History of Factors That Influence Young Adult Substance Abuse.9 Disadvantages of Exploring the Disease Concept .10 Other Factors That Influence Young Adult Substance Abuse: Peer Pressure and Self-Esteem.12 Changes in Family Structure and Parental Skills .13 Benefits of Young Adult Treatment Therapies.16 The Importance of Faith and Religion.

18 Young Adult Behaviors and Cognitive Development Strategies. 23 Participants and Subjects.23 Sample Size and Composition.23 Subject Selection, Recruitment, and Eligibility Requirements.23 Methods and Procedures.24 Measures and Administration.25 Potential Risks to Subjects. 26 Benefits to Subjects.26 Risk and Benefit Ratio. 27 Personal Health Information Use.

29 Summary of Analysis and Presentation of Findings. 33 Discussion of Results and Conclusion.33 Evaluation of the Approach.34 Limitations of the Study.34 Directions for Future Research. 36 v Appendixes A Sample Questionnaire .40 B DIT: Sample Dilemma.42 Tables 1 ANOVA Tables for Gender, Age, Education, and Therapy With Cognitive Moral Development (P Scores) Dependent.29 2 Descriptions, Means, and Standard Deviations of Variables, All DIT Indices From the Standardization Sample.30 3 Analysis of Variance Results for Young Adults Sample Group.31 vi 1 Chapter 1: Introduction Nature of Problem Young adult patients undergoing substance abuse treatment are at risk of having low moral maturity. The increase in subjectivity of moral values in American society for the past 50 years has gradually permeated to the high schools and elementary schools (Evans, 1998; Johnson, 1995).

Although experimentation with social values may be appropriate for college students, it is not necessarily beneficial to encourage younger, less experienced students to find their own morality. A review of the literature suggested the answer is that they are ingrained with a relativistic understanding of morality--a philosophic attitude that, according to Mill (as quoted in Johnson), the basic problem is that no one is wrong, just different. It is speculated that this cycle may manifest in young adult drug dependency (Murray, 2002; Power, 1997). Setting As the largest metropolitan area in the state of Florida, with a population of about 3 million, this community is a microcosm of national trends, including young adult substance abuse.

According to the 1998 National Household Survey of Drug Abuse, drugs are very much part of a teen’s life. By the time they have graduated from high school, about 50% of young adults have experimented with illegal substances. Furthermore, treating the young adult in these cases is a matter of utmost importance (Athealth. The researcher’s private practice, located in Miami-Dade County, is one of a few treatment facilities available to families suffering from substance abuse.

Purpose of the Problem According to Hanson (2002), a recent dramatic finding in neurobiological research may greatly increase the understanding of young adult decision making and the 2 ability to help this age group choose wisely regarding drug abuse. This finding suggests that the young adult brain is still developing physically and further investigation can answer some of the cognitive issues affecting the appeal of and decision to use drugs. Most importantly, according to Hanson, “chronic drug abusers start experimenting with intoxication in young adulthood” (p. 4) and it is generally true that people who do not abuse drugs before age 25 are unlikely to develop a serious drug problem.

Preliminary research into the factors that affect and gauge ethical moral maturity among young adult patients undergoing substance abuse treatment has failed to uncover studies that address this particular area. Consequently, it was crucial for the applied research to occur. The research, conducted within a substance abuse treatment program, served as a precedent for substance abuse treatment and for other recovery programs in the state of Florida and around the nation. This application can be specifically targeted to the young adult population that is undergoing substance abuse therapy.

A review of the literature suggested that young adults are ingrained with a relativistic (every moral choice is equally valid and thus can moral choices really matter at all) understanding of morality (Evans, 1998; Johnson, 1995) leading to drug dependency in some cases (Murray, 2002). Unfortunately, there are no specific rules for current generic treatment of drug addiction. More research needs to be conducted to understand the best way to match treatment to patient. Without a panacea for the treatment of these complex substance abuse disorders, the search for additional treatment approaches becomes extremely important including future developments in (a) genetic identification of high-risk individuals, (b) identification of different genetic influences, (c) development of drugs that inhibit the dopamine transporter, and (d) development of a combination of treatments 3 to enhance outcome in recovery.

However, as the treatment models become more advanced and more sophisticated, a great deal of work must be done to determine the optimal clinical applications of these discoveries (Schuckit, 1997). Although one treatment model might work best for one subject, it may not have positive results for another. More research is needed to identify individual addictive traits to gear treatment to a more individualistic approach. Understanding early onset of substance abuse has important implications for the development of effective prevention programs.

In recent longitudinal studies, the effects of childhood behaviors and family characteristics have shown to predict onset of substance abuse among young adults. Basic personality dimensions are the underlying link between disruptive behavior and substance abuse. Cloninger’s theory, encompassing three personality dimensions--novelty seeking, harm avoidance, and reward dependence --can be related to the behavioral activation, inhibition, and maintenance systems (Masse & Tremblay, 1997). Building on the recent findings in neurobiological research may greatly increase the understanding of young adult decision making adding to the study of Kohlberg’s (1969) cognitive moral development (CMD) theory within the young adult population.

Miller (2002), one of the authors of a study at Columbia University, concluded that young adults at high risk of addiction might be protected from substance abuse if they become involved in some religious community. The data help support the theory that young adults need some form of moral or spiritual education to help them make healthy life choices. The area of moral or spiritual education is an important piece of the puzzle in young adult behavior and may be the answer to guarding against young adult addiction or drug abuse (Miller, 2002). 4 Moral education is becoming an increasingly popular topic in the fields of psychology and education.

Many may even go a step further and say there is a moral crisis in our nation. There is a growing trend toward linking the solutions to these and related social problems to the teaching of moral and social values (Nucci, 1997; Power, 1997). Finally, Miller’s (2002) study indicated that morality is centered on a set of universal concerns for justice, fairness, and human welfare that are available even to young children. At the same time, the developmental and constructivist basis of moral knowledge is commensurate with interactive rather than directive educational practices (Nucci, 1997).

The goal of moral education based on the theories offered by Kohlberg (1969) and Piaget (1932) encourages individuals to develop to the next stage of moral reasoning. Development consists of a sequence of qualitative changes in the way an individual thinks (Nucci, 1997). The individual will, at some point, encounter information that does not fit into his or her worldview, thus forcing the individual to adjust his or her view to accommodate this new information. This process is called equilibration, through which development occurs (Nucci).

This applied dissertation examined the moral maturity levels of young adult patients undergoing substance abuse therapy using Kohlberg’s (1969) theory of CMD. This study used the Defining Issues Test (DIT) developed by Rest (1979) to measure Kohlberg’s levels of moral reasoning. This research analyzed and evaluated the relationship between treatment and the moral maturity level of young adult patients undergoing substance abuse therapy. The DIT facilitates interpretation of Kohlberg’s stages of CMD by allowing for quantitative measurement of moral judgment.

The DIT 5 measures how an individual’s concept of justice, as represented by his or her stage of CMD or judgment, influences decisions (Rest, 1984). Rest (1979) believed that based on context, individuals may exhibit different degrees of judgment; his DIT measures moral judgment with a P (principled) score rather than by level or stage. This research analyzed and evaluated the relationship between substance abuse and moral maturity. This study encompassed Kohlberg’s (1969) stages in classifying the level of moral reasoning pertinent to young adult patients undergoing substance abuse treatment.

The results of the study provided an important starting point for other research focused on analyzing the moral development of young adults in general. The following outcomes were projected: 1.