Psychology ETDs


Megan Kirouac

Publication Date



Alcohol problems are a serious public health concern but few individuals with alcohol problems and alcohol use disorders (AUDs) ever receive formal treatment (SAMHSA, 2009). To understand and address this phenomenon, it is important to understand why individuals decide to seek treatment, which may help clinicians facilitate treatment entry and completion among individuals with AUDs. Research on reasons individuals cite for seeking treatment and their success in recovering from AUDs suggests that hitting bottom' may be important (e.g., Sobell, Sobell, Toneatto, & Leo, 1993). Accordingly, evaluating the concept of 'hitting bottom' may provide insight into why individuals seek and complete treatment; however, 'hitting bottom' has never been operationally defined. Consequently, the goal of this multi-phase study was to address this gap in the field by developing a measure of 'hitting bottom. Literature review and both qualitative and quantitative data analyses informed the development of a preliminary measure of 'hitting bottom. Feedback about the measure was obtained from experts in the field (N = 9; 11% Female). The final, 114 item measure, called the Noteworthy Aspects of Drinking Important to Recovery (NADIR) measure, was administered via web-based survey to individuals self-identified as moderate to heavy drinkers across the United States (N = 402; 46.6% Female, 24.6% Hispanic, average Alcohol Use Disorders Identification Test (AUDIT) 16.3 (SD = 8.3)). Exploratory factor analyses, item response theory, and confirmatory factor analyses were performed to analyze the factor structure of the NADIR. The final confirmatory factor model of the NADIR measure included 60 of the original 114 items, provided an adequate fit to the data, and consisted of four domain specific factors (social network, health problems, situational and environmental circumstances, and existential issues domains) and two higher order factors (cognitive appraisal and importance/influence). The factors of the NADIR measure showed concurrent validity with measures of drinking quantity and frequency, as well as drinking consequences and the AUDIT. Future research should empirically evaluate the predictive validity of the NADIR and identify if and for whom 'hitting bottom,' as measured by the NADIR, may be important for facilitating treatment entry or self-change.

Degree Name


Level of Degree


Department Name


First Advisor

Witkiewitz, Katie

First Committee Member (Chair)

McCrady, Barbara

Second Committee Member

Tonigan, J. Scott




alcohol, alcohol problems, alcohol treatment, hitting bottom

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Included in

Psychology Commons