Assessment of alcohol and drug use

JOHN G. KUNA, PSY.D. AND ASSOCIATES COUNSELING

Assessment of Alcohol and Drug Use: MMPI-2 and MCMI-

III

MMPI-2 sub scales

Addiction Admission Scales (AAS) 13 Items Significantly different than MAC scale

Focus on simple acknowledgement or denial of substance abuse problems

Addiction Potential Scale (APS) 39 Item scale To identify personality features and lifestyle patterns

related to substance abuse Constructed by contrasting item responses from normative

group, psychiatric populations, and alcoholic populations Cross validated in Greene et al. (1992). Near identical

results as Weed et al. (1992)

AAS and APS Limited research AAS seems to perform better than the less direct APS

or MAC-R scales APS may discriminate better between psychiatric

patients and substance abuse than MAC-R Sensitive to substance abuse in general, may not be

able to delineate SA from Alcohol abuse

MCMI-III

Scale B Alcohol Dependence Scale 46 items Assesses Hx of drinking that has caused problems at

home /workScale T

Drug dependence Scale 58 items Assesses drug abuse as problematic in either home or

work

MCMI-III

Both scales Numerous indirect items helpful at identifying

psychiatric patients not eager to admit substance abuse

Again, only a few studies on these sub scales Correlation, validation to MAC

One study (Millon) MAC – B scale, .44 MAC – T scale, .51

MCMI performance weak when used with SA population

Miller and Streiner (1990): Scale B is inaccurate, should not be used

Additional Screening Scales

TWEAK 5 items Variation on the CAGE Purports increased sensitivity to identify alcohol problems in

pregnant womenAUDIT

10 items Refer to my presentation

RAP Rapid Alcohol Problems Screen (1998) RAPS4 (2000) Combined items from TWEAK, MAST, CAGE and AUDIT Low sensitivity in ethnically diverse populations

Timing of Psychological Assessment

Timing of Psychological Assessment Early intervention crucial for effective treatment

planning/outcomes Early assessment: results may be distorted by

withdrawal Clear guidelines for timing of assessment lacking

10 days (Sherer, Haygood & Alfano, 1984) 4-6 weeks (Nathan, 1991)

Mitigating factors Type of drug abused Severity and length of abuse Type of psych testing (neuropsychological or personality)

Future research needed

Objective tests used D/A programs

MMPI-2 Research focused on Alcoholic populations (as

compared to SA) Research:

No unitary ‘alcoholic’ personality (duh) But some distinct sub-groups

For both Male and Females: 2-4, 2-7, 4-9 Females: 3-4, 4-6, 4-8 Males: 1-2 Cluster analysis: 2-7-8-9, 4-9, 1-2-3-4


MMPI-2 Limited research on if the above subgroups have

different treatment outcomes/drinking history Data not ethnically diverse (mostly tested on white

males)Substance Abuse (SA)

Not much research until recently* Research asked:

Is there a poly-drug personality? Difference from Alcoholic population? Some personalities have a drug of choice?


Substance Abuse Comparison to alcoholic population:

SA experienced more emotional distress* No unitary SA personality (duh) But subgroups: 4-8, 4-9 (men and women) African American SA report less emotional distress (than

Caucasian) Again, limited research on if the above subgroups have

different treatment outcomes/drinking history


MCMI-III No specific studies with D/A populations Surprising as in patient psychiatric pop often present

with dual diagnosis of SA Primary research identified clusters of alcoholic

patients Typically elevated on the following scales

Narcissistic, Avoidant-Dependent, Passive-Aggressive/ Negativistic, and Compulsive


Alcohol Use Inventory Created in 1969 (Horn & Wanberg), revised 1987 24 Heterogeneous scales Developed from the way in which people described drinking

problems Does not screen for SA Classifies individuals based on

Age of onset of drinking Dx Family Hx Gender Level of impairment Locus of control Reason for referral


Alcohol Use Inventory, cont. “The diverse nature of the groupings…precludes any

real generalizations about drinking patterns as assessed by the AUI.”

“No studies have used the AUI to assess treatment process…or outcome. [This] would seem to be the logical next step in the use of the AUI (Butcher, 500).”

Dual Diagnosis

Dual Dx 84% of patients in SA facility had lifetime prevalence

of another disorder (Ross, Glasser & Germanson, 1988).

Most commonly Anti-social Personality Disorder Schizophrenia GAD Phobias

Dual Diagnosis

Issues Additional Dx can affect SA/Alcohol treatment Likelihood of relapse increased significantly with

personality disorder present Assessment complicated by possible neurological

deficits due to prolonged SA Impairments in abstract thinking, motor skills, problem

solving Impairments in concentration, memory and attention may

increase after 2 weeks of abstinence Alcoholic individuals over 40 less neurological recovery

than their younger counterparts

Summary

Significant progress with objective tests over two key areas

Screening Low prevalence of SA make meaningful research

difficult* Gender and ethnic differences in reporting SA must be

considered in the design and implementation of screening measures

Summary

Treatment planning and Outcomes Factors that enhance treatment planning

Explicit reporting of individual’s SA Social and interpersonal aspects of SA Factors leading person enter treatment SES and education

Research should examine differences w/in specific MMPI code types and MCMI profiles

Timing of assessment after intake and DT needs further investigation

Clear explication of the role of Dual Dx

Contact

Questions, comments, concerns? Contact us! 570-961-3361

[email protected]

http://johngkunapsydandassociates.com/

www.facebook.com/JohnGKuna.PsyD.Associates

https://www.youtube.com/watch?v=leAjo7ZxxcY


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Assessment of alcohol and drug use