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The Substance Abuse Proclivity Profile (SAP)

Appx. B: The Substance Abuse Proclivity Profile (SAP)
The Substance Abuse Proclivity Profile (SAP)

The SAP is an excellent example of the use of an extremely useful tool, the MMPI, to “prove” AA doctrine and gain acceptability for AA language. The SAP successfully discriminates between young male substance abusers, putative normals and non substance abusing psychiatric outpatients. It is useful for those between the ages of 13 and 26. Validity falls off rapidly afterward.

The scale is divided into three “factors:” “Extroversion,” “Rebelliousness” and “Self Pity.” While there is room for criticism of designer MacAndrew’s analysis of the first two factors, the third is most interesting.

AA doctrine asserts that the alcoholic is guilty of self pity. The SAP scale proves it. Substance abusers score high on “Self Pity.” A look at the 10 questions which make up the self pity factor, however, shows more ideology (or perhaps theology) than “Self Pity.”

My Webster’s defines self pity as “pity for oneself.” It defines pity as “sympathy with the grief or misery of another.” The dictionary definition does not discriminate what we may find “distasteful” or “pathological” from what is expected and considered “normal and natural.”

What MacAndrew means is related to a distastful or pathological “pity for oneself.” This is made clear in his statement, “Since it is Self Pity that unifies this ‘litany of lamentations,’ that is how I have labeled this factor.”

Three of the self pity factor questions deal with vague fears.

#543: Several times a week I feel as if something dreadful is about to happen.

#494: I am afraid of finding myself in a closet or small closed place.

#365: I feel uneasy indoors.

Substance abusers are more likely to answer “True” to the three questions. MacAndrew holds this as the substance abusers inclination to “portray themselves as victims.”

If young substance abusers have these vague fears in disproportion to other groups, which apparently they do, they have two choices when asked if they do. They can either tell the truth and prove “self pity” by marking these questions “True” or they can prove another doctrinal point about alcoholics. They can lie.

#202: I believe I am a condemned person.

#484: I have one or more faults which are so big that it seems better to accept them and try to control them rather than to try to get rid of them.

MacAndrew holds the tendency to respond “True” to these as again “portray[ing] themselves as victims.” It seems much more accurate under the situation of taking the MMPI that they were merely expressing honest beliefs about themselves based in learned helplessness. There are also other possibilities. The sample is in treatment where they are being pressured to admit “I am powerless over alcohol.” They are constantly being pressured to admit the flaws which prove their disease. They are also learning they can’t change these faults and must wait until Step Seven, “Humbly asked God to remove our shortcomings,” for the program to change them. Rather than “self pity,” perhaps this is a sign of treatment success.

Since those abuse alcohol and drugs more often come from disordered homes and have a higher frequency of one or both parents being alcohol or drug abusers, “accurate estimation of circumstances” may well be a better interpretation of the “True” response given by young substance abusers to the following questions.

#157: I feel that I have often been punished without cause.

#338: I have certainly had more than my share of things to worry about.

It would seem that just being in treatment for substance abuse is more than most people have to worry about. To state such when asked is hardly part of a “litany of lamentations.”

Answering “True” to the remaining three questions can be viewed as evidence of “self pity.” They can also, however, be seen as the result of growing up (or being half grown up) in a family in which there was intense competition between siblings for limited parental attention, approval and affection.

#469: I have often found people jealous of my good ideas, just because they had not thought of them first.

#331: If people had not had it in for me I would have been much more successful.

#507: I have frequently worked under people who seem to have things arranged so that they get credit for good work but are able to pass of mistakes onto those under them.

MacAndrew sums up the information provided by the SAP scale,

“From a remedial perspective it would seem, ... that when this sort of mordant self absorption is detected, ‘treatment’ might profitably focus upon its radical transformation.”

No doubt many young substance abusers would benefit from therapy in which they learned to clearly recognize their fears and put them in a proper perspective. Anything which counteracted their pervasive sense of helplessness, their lack of self efficacy, would be helpful. They would benefit from support for their rightness in a wrong environment. They could learn that whatever jealousy and competition exists in their home environment is far from universal and that as they grow up they have increasing power to choose their associates.

MacAndrew’s analysis leads to a diagnosis of substance abuse with a definition of the substance abuser as more or less a self pitying wretch. This logically leads to “treatment” for learned helplessness which begins with confessing “I am powerless” and to “treatment” for vague fears which is learning that fear is “an evil and corroding thread.” Success at suppressing fear would make the young substance abuser more like his adult addict and alcoholic counterparts. He would be more likely to respond “True” to the MMPI’s “Evil spirits possess me at times.”

Young male substance abusers do differ from the “putative normal” college student. It is questionable how much they differ from the average young person. The “Self Pity Factor” shows they are having difficulties growing up but longitudinal studies show they do grow up. That is, of course, unless they get what MacAndrew himself need to use quotes for, “treatment.”

Regardless of how high young substance abusers score on the Self Pity Factor, “self pity” is a gross misnomer of scant value as diagnosis or as a guide in treatment. The grouping of these questions under the title “Self Pity Factor” only serves to lend an air of respectability to AA doctrine and give respectability to AA language.