ATP - Assessment & Treatment
Planning
Bibliography & Abstracts
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Parsons, K.J.; Wallbrown, F.H.; Myers, R.W. Michigan
Alcoholism Screening Test: Evidence supporting general as well as specific
factors. Educational and Psychological Measurement, 54(2):530-536, 1994.
(124033)
The Michigan Alcoholism Screening Test (MAST) was evaluated
using Thompson's SECONDOR factor analysis. The research sample included 200
repeat driving under the influence of alcohol (DUI) offenders and nonviolent
felony offenders. The following results of the study were seen: (1) following a
SECONDOR factor analysis, a higher order general factor measuring general
alcohol dependence; and (2) several additional primary dimensions of alcohol
abuse and/or alcoholism including psychoactive substance dependence, denial,
antisocial drinker, discord, and vocational impairment. It is concluded that
Thompson's SECONDOR factor solution supports the literary controversy that the
MAST measures both unidimensional and multidimensional symptoms of alcoholism.
10 Ref.
Morse, R.M.; Flavin, D.K. Definition of alcoholism. JAMA :
Journal of the American Medical Association,, 268(8):1012-1014, 1992. (116227)
To establish a more precise use of the term alcoholism, a
23-member multidisciplinary committee of the National Council on Alcoholism and
Drug Dependence and the American Society of Addiction Medicine conducted a
2-year study of the definition of alcoholism in the light of current concepts.
The goals of the committee were to create by consensus a revised definition that
is (1) scientifically valid, (2) clinically useful, and (3) understandable by
the general public. Therefore, the committee agreed to define alcoholism as a
primary, chronic disease with genetic, psychosocial, and environmental factors
influencing its development and manifestations. The disease is often progressive
and fatal. It is characterized by impaired control over drinking, preoccupation
with the drug alcohol, use of alcohol despite adverse consequences, and
distortions in thinking, most notably denial. Each of these symptoms may be
continuous or periodic. 21 Ref Copyright 1992 - American Medical Association
Flavin, D.K.; Morse, R.M. What is alcoholism? Current
definitions and diagnostic criteria and their implications for treatment.
Alcohol Health and Research World, 15(4):266-271, 1991. (116477)
This article presents the results of a 2-year multidisciplinary
effort by the National Council on Alcoholism and Drug Dependence (NCADD) and the
American Society of Addiction Medicine (ASAM) to refine the definition of the
term alcoholism so as to reflect current clinical data and scientific evidence.
An overview of current definitions and diagnostic criteria for alcoholism is
provided. This is followed by a description of the seven components of the NCADD/
ASAM revised definition: the primary nature of alcoholism, the concept of
alcoholism as a disease, the issue of progression, the concept of impaired
control, preoccupation with alcohol use, adverse life consequences associated
with alcohol use, and denial. 26 Ref
St. Clair, H.R. Recognizing alcoholism and its effects: A
mini-guide. Basel, Switzerland: S. Karger AG, 1991. 105 p. (131613)
This small pocket-size book is a synopsis of knowledge about
alcoholism intended primarily for medical students and house staff, as well as
for other interested professionals and lay persons. Alcoholism is characterized
as the most frequently missed diagnosis in medical care, the object of the
greatest prejudice, the most frequently mismanaged illness, and the most
neglected topic in medical school and postgraduate training. Chapter topics
include epidemiology, morbidity, and mortality; diagnosis; etiology and risk
factors; taking a history; metabolism; acetaldehyde; laboratory findings;
general physiology; tolerance and dependence; organ pathology; intoxication;
indications for hospitalization; withdrawal and detoxification; interactions of
alcohol and other drugs; dynamics of denial; intervention; employee assistance
programs; dual diagnoses; treatment models of rehabilitation; a psychiatric
model of rehabilitation; psychotherapy; Alcoholics Anonymous; family; disulfiram;
other treatment modalities; children of alcoholics; alcohol and the fetus;
outcome; drinkers who are not alcoholics. The book concludes with a recommended
reading list.
Smith, C.M.; Pristach, C.A. Utility of the Self-Administered
Alcoholism Screening Test (SAAST) in schizophrenic patients. Alcoholism:
Clinical and Experimental Research, 14(5):690-694, 1990. (109276)
The utility of the Self-Administered Alcoholism Screening Test
(SAAST) in determining alcohol abuse and alcoholism was assessed in a
preliminary study of 21 schizophrenic patients during their hospitalization in
an acute care psychiatric unit; on admission all met Diagnostic and Statistical
Manual of Mental Disorders-III Revised (DSM- III-R) criteria for schizophrenia
and none were detected to have any alcohol-related diagnosis. SAAST scores
ranged from 2 to 26 with a mean score of 10.8. Forty-eight percent (10/21) had
SAAST scores greater than or equal to 10, indicating "probable
alcoholism"; 62 percent (13/ 21) scored 8 or higher. Every patient with a
SAAST score of 8 or higher also met DSM-III-R criteria for alcohol abuse or
dependence on the basis of patient interview, independent chart reviews, and
interviews of significant others. In contrast, only half (5/10) of the high
SAAST scorers would actually admit to a problem with drinking during the
extensive study interviews. Six SAAST items were found to be highly predictive
of abuse or alcoholism; the SAAST had greater sensitivity than the interviews.
Sixty-two percent (8 of 13) of the schizophrenic patients who met the DSM-III-R
criteria for alcohol abuse reported a first degree relative with an
alcohol-related problem, in contrast to only 25 percent of the
"nonalcoholic" patients. The patterns of the alcoholic schizophrenic
patients' responses on the different SAAST items revealed even greater denial
and lack of insight than those of nonschizophrenic alcoholic subjects. 20 Ref.
Copyright 1990 - The Research Society on Alcoholism
Mowbray-A; Kessel-N. Alcoholism and the general practitioner.
British Journal of Psychiatry, 148:697-700, 1986. (087929)
General practitioners (GP's) were interviewed to determine
their knowledge of alcoholism and their alcoholic patients, their attitudes, and
their skills and practices. Of 53 GP's (62 percent of those available), 45 had
learned from their experience in dealing with alcoholics, 39 had gained
knowledge by reading, and 31 had received postgraduate training. The majority
did not differentiate alcoholics from problem drinkers. The most common rate of
alcoholism among patients was between 2 and 3 per 1000. Respondents regarded
social problems associated with alcoholism as predominating (68 percent),
followed by somatic problems (45 percent), denial or relapse (28 percent), and
psychiatric and emotional problems (25 percent). It was the rule for alcoholics
to consult ostensibly for other reasons. GP's considered a diagnosis of
alcoholism when presented with certain somatic and social factors: 75 percent
always considered alcoholism in instances of family violence, while about half
did so when faced with other factors, such as presenting complaints or signs
observed during a consultation. About half became aware of alcoholism when told
by the family. To confirm the diagnosis, about a third asked only about
consumption; most sought evidence of dependence; half inquired about other
harms; and just less than half asked about the complete trio of consumption,
dependence, and other harms, while 75 percent approached a family member for
confirmation. Ninety percent said they were not embarrassed in dealing with
alcoholic patients, but 38 percent said that sometimes they did not take a
drinking history, even when they thought they should. Forty-five referred at
least some alcoholic patients to the hospital, while 37 sent patients to
Alcoholics Anonymous. An overwhelming majority believed alcoholics to be as
deserving of help as any other patient and considered family support important
for treatment. A high proportion preferred their patients' gastritis not to be
due to alcoholism, but only because alcoholic gastritis was viewed as more
intractable. It is concluded that GP's have a reasonably good knowledge of
alcoholism, are prepared to treat alcoholics, and are tolerant and sympathetic
toward alcoholics and their families. 4 Ref.
Wood-M-E. Alcoholism: Assessment of chronic alcoholism by
medical examination. New Zealand Medical Journal, 99(801):326-330, 1986.
(087819)
The accumulated data from a defined medical examination of 561
male alcoholics are reported and analyzed using a simple artificial index of the
severity of alcohol injury that describes each patient in a single parameter:
the alcohol related toxicity quotient (ARTq). The results indicate that after an
average of 12 days of sobriety, the clinical assessment of ataxia is a more
consistent guide to chronic alcoholism than a previous history of intervention
by a therapeutic agency or the more complex tests of mean cell volume (MCV) or
gamma glutamyl transpeptidase (GGT). However, the ARTq correlates with each of
these indices better than they intercorrelate between themselves. The data
indicate that the ARTq is quantitatively related to the severity and duration of
alcoholic injury and is thus a scalar index of the severity of alcoholism. It is
also likely that it is related to the probability of chronic alcoholism but this
was not specifically explored because its expense and diagnostic ambiguity make
it unsuitable as a general screening test. The ARTq was also particularly useful
in following progress from admission to admission and in demonstrating continued
improvement despite setbacks and continued deterioration despite denial.
Overall, the data reflect the protean manifestations of ethanol' s toxicity and
indicate that lesser known features such as chronic myopathy,
hypercorticosteroidism, and a specific respiratory lesion are characteristic of
chronic alcoholism rather than rare accompaniments. 11 Ref.
Carroll-J-F-X. Substance abuse problem checklist: A new
clinical aid for drug and/or alcohol treatment dependency. Journal of Substance
Abuse Treatment, 1(1):31-36, 1984. (074180)
The Substance Abuse Problem Checklist (SAPC) is a self-adaministered
inventory designed specifically to facilitate the counseling of drug and alcohol
dependent patients. The SAPC contains 377 specific problems grouped into eight
categories: (1) problems associated with motivation for treatment; (2) health
problems; (3) personality problems; (4) social relationship problems; (5)
job-related problems, (6) problems associated with the misuse of leisure time;
(7) religious or spiritual problems; and (8) legal problems. One of several
patient benefits from taking the SAPC is the patient's assumption of the role of
active collaborator in the treatment process. Furthermore, the SAPC is an
instrument that aids the clinician in diagnosing and treating drug abusers, and
also has potential use in research. The results of a study of 114 SAPC's
completed by Eagleville Hospital patients reflect the contribution of suppressed
and repressed feelings to the evolution of chemical dependency, and also provide
a clear indication of the importance of the ecological perspective. Problems
with the SAPC include: (1) the unsuitability for administration to patients with
limited English speaking or reading ability, and (2) the conscious or
unconscious denial or concealment of problems when responding. 7 Ref.
Allen-B-A; Skinner-H-A. Differential assessment of
alcoholism: Evaluation of the Alcohol Use Inventory. Journal of Studies on
Alcohol, 44(5):852-862, 1983. (069496)
Results are presented from an evaluation of the Alcohol Use
Inventory (AUI). This evaluation was designed to: (1) determine the
internal-consistency reliability of each of the AUI scales; (2) evaluate the
degree to which AUI scales are influenced by three response styles (social
desirability, denial, and carelessness); (3) examine the concurrent validity of
the AUI scales with respect to the widely used Michigan Alcoholism Screening
Test (MAST), as well as indices of alcohol consumption; and (4) evaluate the
correlations of the AUI scales with demographic characteristics, intellectual
functioning, and psychopathology. Subjects were 274 patients (77 percent men)
who had voluntarily sought help at the Addiction Research Foundation (Toronto,
Canada) for a problem with alcohol (71 percent) or with alcohol and other drugs
combined (29 percent). On the basis of these results, it is concluded that the
AUI holds considerable promise as a differential assessment instrument. 22 Ref.
Krupski-A-M. Inside the adolescent alcoholic. Center City,
MN: Hazelden, 1982. 66 p. (067907)
The adolescent alcoholic's behavior and pain and that of the
parents is described through a description of one adolescent alcoholic's
intrapsychic world. It is hoped that this book will enable the reader to
perceive in depth the adolescent alcoholic's intrapsychic world and therefore
understand more about the consuming anguish and the destructive behaviors which
flow from the unresolved pain of addiction. The processes of confrontation and
diagnosis, including denial, anger, bargaining, depression, and acceptance, are
briefly discussed.
Skinner-H-A. Drug abuse screening test. Addictive Behaviors,
7(4):363-371, 1982. (067652)
The Drug Abuse Screening Test (DAST) was designed to provide a
brief instrument for clinical screening and treatment evaluation research. It
consists of 28 self-report items used to determine various consequences that are
combined in a total DAST score to yield a quantitative index of problems related
to drug misuse. Measurement properties of the DAST were evaluated using a
clinical sample of 256 drug and alcohol abuse clients who sought help at the
Clinical Institute of the Addiction Research Foundation (Toronto, Canada). Of
the total sample, 58.6 percent were referred for alcohol problems, 25. 4 percent
for drug abuse, and 16.0 percent for both alcohol and drug problems. The
internal consistency reliability estimate was found to be substantial at 0.92,
and a factor analysis of item intercorrelation indicated an unidimensional
scale. With respect to response style biases, the DAST was only moderately
correlated with social desirability and denial. Concurrent validity was examined
by correlating the DAST with background variables, frequency of drug use during
the past 12 months, and indices of psychopathology. It is concluded that,
although these findings support the usefulness of the DAST for quantifying the
extent of drug involvement within a help-seeking population, further validation
work is needed in other populations and settings. 22 Ref.
Royce-J-E. Patterns and progressions. In: J. E. Royce,
Alcohol Problems and Alcoholism: A Comprehensive Survey, New York: The Free
Press, 1981, vol. xiii. 383 p. (pp.87-102). (065056)
Types of alcoholics, their common characteristics and the
progression of alcoholism are discussed. The characteristics of confusion,
common feelings, and coping devices (rationalization, projection of blame,
denial) are detailed. The development of the illness is presented based on
Jellinek's work and include the early signs (prodromal phase), middle stage
(basic or crucial) and the late stage (chronic).
Skinner-H-A. Benefits of sequential assessment. Social Wk
Res. Abst., 17 (No. 1): 21-28, 1981. (061153)
The benefits of a model of 3 levels of assessment are explored
for the benefit of social workers, focusing on the use of the model with alcohol
and drug abusers. A 66-item Intake Questionnaire was administered to a group of
social workers which elicited data about demographic and family characteristics
and alcohol and drug use. The Michigan Alcoholism Screening Test, the Alcohol
Use Inventory, and the Lifetime Drinking History were the other instruments used
in the assessment. The 3 measures of the validity of assessment used included
the Denial Scale of the Basic Personality Inventory, the Desirability Scale of
the Personality Research Form, and the Infrequency Scale of the Personality
Research Form.
Skinner-H-A. multivariate evaluation of the MAST. J. Stud.
Alc., 40:831-844, 1979. (042980)
A self-administered format of the Michigan Alcoholism Screening
Test ( MAST) was completed by 418 inpatient alcoholics; half of the responses
were used to examine internal properties of the MAST and half to determine
external correlates. The 2 groups did not differ significantly in sex (164 and
160 were men) or age (mean, 33.9 and 34. 3). Internal consistency reliability
estimates were .90 for the regular scoring, .93 for a simpler unit weighting
strategy, and .99 for both. An item analysis revealed that all items except 1
(concerning " liver trouble") contributed significantly to the total
MAST score. Five factors were identified among the items: (1) recognition of
alcohol problem by self and others; (2) legal, work and social problems; (3)
help seeking; (4) marital-family difficulties; and (5) liver pathology. The MAST
scores were only moderately correlated with social disability (-.32) and were
not significantly correlated with response styles of denial or carelessness. The
interpretation of MAST scores as a continuum of severity of alcoholic
involvement was stressed, as opposed to using it to make a diagnosis of
alcoholism.
Zung B.J. Factor Structure Of The Michigan Alcoholism
Screening Test. J. STUD. ALC., 39: 56-67, 1978. (033569)
The Michigan Alcoholism Screening Test (MAST) was administered
to 1000 motorists (mean age 42; 67 women) arrested for driving while intoxicated
(dwi). The mast item scores of the entire sample and of subgroups of alcoholics
(mast scores of 5 or above) and nonalcoholics were factor analyzed. A
principal-components analysis of the entire sample yielded 4 independent
dimensions of alcoholic symptomatology which accounted for a maximal proportion
of the individual differences on the mast: help-seeking, discord, alienation and
denial. Six independent factors were found for the alcoholic subgroup (54
percent of the entire sample): denial, debilitation, marital discord, work
problems, help-seeking and social discord. No consistent patterns were found in
the nonalcoholic subgroup. The multidimensionality of the mast in the sample as
a whole and in the alcoholic subgroup indicates the wide variety of drinking
problems in the DUI population which must be taken into account in diagnosis and
treatment.
SELZER-MELVIN; VINOKUR-AMIRAM; ROOIJEN-LOUIS.
SELF-ADMINISTERED SHORT MICHIGAN ALCOHOLISM SCREENING TEST (SMAST). JOURNAL OF
STUDIES ON ALCOHOL, 36(1):117-126, 1975. (018982)
The reliability and validity of self-administration of the Michigan
alcoholism screening test (mast) and a shortened 13-item version was
investigated. Based on results from 501 male drivers and 228 alcoholic
outpatients, reliability and validity coefficients of the mast were .95 and .79,
respectively. It is concluded that a self-administered mast questionnaire has
substantial reliability and validity with the scores relatively unaffected by
age and the denial of socially undesirable characteristics. Test results for
reliability and validity of the short Michigan alcoholism screening test (SMAST)
implied that the SMAST may be as effective as the mast in screening for
alcoholism. Use of the mast and smast as screening devices rather than final
diagnostic instruments is discussed. 12 ref.