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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.

 

 

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