Evaluation of the Michigan Alcoholism Screening Test (MAST) in assessing lifetime and recent problems

Subjective social status, objective social status, and substance use among individuals with serious mental illnesses

Subjective social status (SSS) and objective socioeconomic status (OSS) may appear to be similar social determinants of mental health, but are actually independently associated with diverse health outcomes including substance use and substance use disorders (SUDs). Such associations have not been examined among individuals with serious mental illnesses (SMI) despite their high prevalence of comorbid substance use; frequent treatment and recovery complications associated with such use; and high levels of economic disadvantage, discrimination, and inequities in this marginalized population. These psychosocial adversities manifest as poor mental illness outcomes, poor physical health, and early mortality in populations with SMI. We hypothesized that both SSS and OSS would predict substance use severity and SUD diagnoses in 240 patients with SMI. SSS, measured by the MacArthur Scale of Subjective Social Status, was unassociated with a composite measure of income and education used to operationalize OSS. Additionally, SSS and OSS were differentially associated with various types of substance use disorders. Only OSS was associated with whether individuals smoked cigarettes, or the level of nicotine dependence. Conversely, only SSS was associated with drug use severity. Our results shed light on the potential for differential impacts of SSS and OSS among persons with SMI.

Do dopamine gene variants and prenatal smoking interactively predict youth externalizing behavior?

Externalizing behaviors (encompassing antisocial, impulsive, and substance use behaviors) are pervasive and impairing across a multitude of settings and developmental contexts. These behaviors, though often investigated separately, are highly comorbid. Prenatal tobacco exposure in interaction with various genetic influences has predicted later externalizing behavior, and recent evidence supports investigating sex differences in these patterns. In the current study, we extend this work by (a) examining two functional genetic markers in the dopamine system: the transporter gene (DAT1) and the dopamine receptor D4 gene (DRD4) in interaction with prenatal tobacco exposure to predict a latent composite of externalizing behavior and (b) testing whether these patterns differ by sex of youth in a community sample of adolescents (n=176). The relatively small sample is partially offset by high quality, multi-method prospective measurement. We assessed prenatal tobacco exposure using prospective repeated cotinine-corrected reports and externalizing behaviors were assessed utilizing multiple measures across three waves. The interaction between DAT1 (but not DRD4) and prenatal tobacco exposure was statistically significant in boys, and patterns appeared to differ by sex. Risk for externalizing behaviors for exposed boys increased linearly as a function of the 10r DAT1 allele. For exposed girls, there was a trend such that DAT1 heterozygotes had a marginally higher risk than homozygotes. This pattern was not explained by passive gene-environment correlation. Elucidating sex-specific pathways through which early adverse exposures and genetic susceptibilities contribute to externalizing behavior can inform early targeted prevention efforts for those children at highest risk.

A latent modeling approach to genotype-phenotype relationships: maternal problem behavior clusters, prenatal smoking, and MAOA genotype

This study illustrates the application of a latent modeling approach to genotype-phenotype relationships and gene × environment interactions, using a novel, multidimensional model of adult female problem behavior, including maternal prenatal smoking. The gene of interest is the monoamine oxidase A (MAOA) gene which has been well studied in relation to antisocial behavior. Participants were adult women (N = 192) who were sampled from a prospective pregnancy cohort of non-Hispanic, white individuals recruited from a neighborhood health clinic. Structural equation modeling was used to model a female problem behavior phenotype, which included conduct problems, substance use, impulsive-sensation seeking, interpersonal aggression, and prenatal smoking. All of the female problem behavior dimensions clustered together strongly, with the exception of prenatal smoking. A main effect of MAOA genotype and a MAOA × physical maltreatment interaction were detected with the Conduct Problems factor. Our phenotypic model showed that prenatal smoking is not simply a marker of other maternal problem behaviors. The risk variant in the MAOA main effect and interaction analyses was the high activity MAOA genotype, which is discrepant from consensus findings in male samples. This result contributes to an emerging literature on sex-specific interaction effects for MAOA.

The Michigan Alcoholism Screening Test and its shortened form: a meta-analytic inquiry into score reliability

Meta-analytic methods provide a framework around which an inquiry into MAST and SMAST score reliability was completed. Of the 470 measurement opportunities observed between 1971 and 2005, 62 (13.2%) were coupled with accurate reliability information. Weighted reliability estimates centered on .80 suggesting that the MAST and SMAST generally produce scores of similar and adequate reliability for most research purposes. However, the variability of internal consistency estimates shows that at times these tools will not produce reliable scores, particularly among female and nonclinical respondents. Multiple regression equations provide practical guidelines to improve reliability estimates for the future use of these instruments.

Item characteristics of the Michigan Alcoholism Screening Test

Items of the Michigan Alcoholism Screening Test (MAST) were individually evaluated regarding disproportional responding. The item with the lowest degree of endorsement (Item 18, related to liver problems) was found to have correspondingly low relationships with other MAST items and with the total score. Weighted items concerned with drug-related arrests were found to detract from the otherwise relatively homogeneous MAST items. Traditional statistical approaches for homogeneity suggest high level internal consistency with the deletion of the aforementioned items. A factor analytic test of homogeneity was confirmed. Recommendations are presented concerning modification of the MAST scoring procedures.

Temporal stability of alcohol screening measures in a psychiatric setting

The authors evaluated the test-retest reliability of two common screening instruments administered in a psychiatric setting. The Michigan Alcoholism Screening Test (MAST; M. L. Selzer, 1971) and the CAGE (D. Mayfield, G. McLeod, & P. Hall, 1974) were administered twice, separated by a 1-week interval, to 71 people receiving outpatient psychiatric services and 64 people in the community with no reported history of psychiatric care. The MAST (r = .95) and the CAGE (r = .80) demonstrated adequate test-retest reliability and showed little evidence of variation with respect to degree or direction when administered in a psychiatric setting. Compared to a nonclinical sample, reliability estimates obtained in a psychiatric setting were only slightly lower and more variable. In the psychiatric sample, younger men who had a history of alcohol use disorder were found to be the least reliable. Overall, data suggest that people with severe and persistent mental disorders can offer reliable information about their alcohol-related problems.

Aldehyde dehydrogenase genotypes and male alcohol use disorders: a case-control study in Khon Kaen, north-east Thailand

A genetic epidemiological case-control study on aldehyde dehydrogenase 2 (ALDH2) genotype and male probable alcohol use disorders (AUD) was performed in Khon Kaen province, northeast Thailand. One hundred and twenty-four of cases (probable AUD) were obtained from male villagers aged 18-65 years using the modified Michigan Alcoholism Screening Test-Thai version. The same number of controls were selected, being matched with the cases in terms of age (+/-4 years) within the same village. Marital status, education history and past or present histories of physical illnesses were essentially the same for the cases and the controls. All of the cases and 85.5% of the controls were current drinkers, and the cases tended to drink significantly more often than the controls. Genomic DNA was extracted from fingernails and ALDH2 genotypes were determined by polymerase chain reaction technique and digested by Ksp 632I. The ALDH2 genotypes of the cases and the controls were not significantly different: 90.3% versus 91.1% normal homozygote; 8.1% versus 8.9% heterozygote; and 1.6% versus 0.0% mutant homozygote, respectively. Among the normal homozygote, the daily amount of alcohol intakes of the cases were significantly larger than that of the controls (56.2+/-40.6g vs. 8.1+/-14.1 g), the same was found among the ALDH2 deficient (55.9+/-43.4 vs. 2.2+/-5.8 g). Multivariate analysis based on the conditional logistic regression model showed no significant association of AUD with ALDH2 genotype, marital status, education history, or past history of injury, however, occupation and daily amount of alcohol intake were found to be significantly associated with AUD (OR = 10.72, 95% CI = 1.15-99.99, P = 0.037, and OR = 1.12, 95% CI = 1.06-1.18, P = 0.000, respectively). Non-farmers showed 10.7 times larger risk of developing AUD compared to farmers, and the subjects had three times more chance of developing AUD for each increase of 10 g of the daily amount of alcohol intake.

Childhood abuse and sexual revictimization in a female Navy recruit sample

To examine effects of childhood abuse on adult rape, 1,887 female Navy recruits were surveyed. Overall 35% of recruits had been raped and 57% had experienced childhood physical abuse (CPA) and/or childhood sexual abuse (CSA). Controlling for CPA, rape was significantly (4.8 times) more likely among women who had experienced CSA than among women who had not. In contrast, CPA (controlling for CSA) was unrelated to likelihood of adult rape. Alcohol problems and number of sex partners were examined as mediators. Although both variables predicted rape, their effects were independent of the effects of CSA. Finally, despite ethnic group differences in the prevalence of victimization, the predictors of rape did not differ significantly across ethnic groups.

On the behavioral characteristics of loud-music listening

To provide insight into the behavioral characteristics of people who listen excessively to loud music, the 32-item Northeastern Excessive Music Listening Survey was developed and administered to 90 subjects. Results indicate that 8 of the 90 subjects scored within a range that would suggest the presence of a maladaptive pattern of music-listening behavior similar to that exhibited by substance abusers. Implications for further research and models of treatment are discussed.

Utility of the AUDIT for identification of hazardous or harmful drinking in drug-dependent patients

We evaluated the psychometric properties of the alcohol use disorders identification test (AUDIT), a ten-item screening test for identification of hazardous drinkers, in a sample of 82 patients with DSM-III-R drug dependence. AUDIT showed good internal consistency (alpha = 0.94) and a unitary factor structure. Receiver operating characteristics analysis showed the AUDIT to be comparable to the Michigan alcoholism screening test (MAST) in identifying individuals with a current alcohol use disorder and superior to the MAST for those who are hazardous drinkers. In this patient sample, AUDIT performed well at the recommended cut-off score of > or = 8. We recommend use of the AUDIT for identification of hazardous and harmful drinking among individuals with a drug use disorder.

Validity of psychiatric diagnoses in patients with substance use disorders: is the interview more important than the interviewer?

Although structured diagnostic interviews are increasingly being used in substance abuse treatment settings, there has been limited systematic evaluation of their ability to enhance reliability and validity of psychiatric diagnoses. The present report provides data on the concurrent, discriminant, and predictive validity of current substance use disorders and common comorbid diagnoses in a sample of 100 substance abuse patients. Diagnoses formulated primarily by master's-level clinicians in the usual course of their duties were compared with diagnoses formulated by research technicians using a semistructured interview. Results indicated that the validity of clinician diagnoses was good for substance use disorders, moderate for personality disorders, and poor for anxiety disorders and major depression. Greater validity was observed for substance abuse diagnoses formulated by research technicians using the semistructured interview. Based on these findings, we conclude that psychiatric diagnosis in substance abuse patients may be improved by adding elements of structured interviews to the clinician's usual assessment.

Detection of alcoholism in three populations by the brief-MAST

The brief MAST (B-MAST) questionnaire was used to detect alcoholism in three populations, namely, alcoholics in treatment, clinical outpatients, and the general population. Nearly all the alcoholics in treatment tested positive in the B-MAST (99.2%), for lifetime as well as for current (past year) alcohol-related problems. Among the clinical outpatients and general population, 35.6% and 20.2% respectively, tested positive for lifetime alcohol problems, but only 19.6% and 7.6%, respectively, tested positive for past-year alcohol problems. The sensitivity/specificity of the B-MAST (lifetime) was 64.7%/90.0% and 48.3%/96.4% in the clinical outpatients and general population, respectively. Even lower sensitivity (28.2%) was obtained when the B-MAST was used to detect past-year alcohol problems in the general population sample. The poor sensitivity of the B-MAST in the general population was probably because most of the B-MAST questions deal with severe alcohol problems, and they are not sufficiently sensitive to detect those who drank heavily but who had not yet developed these alcohol problems. Anomalous responses to the two questions about "normal drinker" and to the question about "attendance in AA meeting" also contributed (< 3%) to inflated positive B-MAST scores. There were gender differences, and to a lesser extent, racial differences (Whites versus Blacks), in the responses to individual B-MAST questions in the three subject populations, with more males than females in each group reporting more alcohol-related problems. However, there were no gender and racial differences in the average B-MAST scores among those clinical outpatients and general population subjects who tested positive.

Identification of alcoholism and depression in a geriatric medicine outpatient clinic

OBJECTIVE

To examine the utility of brief screening instruments for alcoholism and depression in the frail elderly medical outpatient.

DESIGN

Cross-sectional examination.

SETTING

Coffey Geriatric Outpatient Clinic, The Mount Sinai School of Medicine, New York City.

SUBJECTS

Convenience sample of 84 consenting male and female outpatients over 62 years of age.

MEASUREMENTS

The Michigan Alcohol Screening Test (MAST), CAGE questionnaire, and the Geriatric Depression Scale (GDS).

RESULTS

Four subjects (5%) scored positive for alcoholism on the MAST, all of whom had been previously identified by the geriatric clinic staff. In contrast, the CAGE only identified 1 (1.4%) alcoholic subject. Thirty-two percent of subjects scored positive for depression on the GDS, yet only one-third of these depressed patients had been previously identified by the geriatric team as depressed. Among the depressed outpatients, 19% were labeled anxious and received anxiolytics from the geriatric medical staff.

CONCLUSIONS

Whereas brief alcohol screening instruments to detect alcoholism did not augment the geriatrician's clinical assessment, screening for depression with the GDS may be an important adjunct to the identification of depression in geriatric medical patients.

Relative performance of the MAST, VAST, and CAGE versus DSM-III-R criteria for alcohol dependence

A number of instruments have been developed to screen for alcoholism. With the advent of DSM-III and lay administered psychiatric diagnostic instruments, a test of the performance of these screens relative to diagnostic instruments is critical. In this paper, we document the relative effectiveness in a general medical clinic of the Michigan Alcoholism Screening Test (MAST), the Veterans Alcoholism Screening Test (VAST), and the CAGE questions in comparison to the DSM-III-R criteria for alcohol dependence as measured in the Composite International Diagnostic Interview (CIDI). All of the screens performed at acceptable levels, but the MAST and VAST tended to have higher performance characteristics. At the recommended cut points, they had higher sensitivity for lifetime alcohol dependence (VAST 95.1%, MAST 90.2%, CAGE 78.0%) as well as higher specificity (VAST 80.3%, MAST 81.7%, CAGE 76.1%). For present alcohol dependence only, at the recommended cut points the MAST and CAGE had sensitivity of 100% but specificity of 62.0 and 61.0% respectively. The VAST had sensitivity of 83.3% and specificity of 89.0%. We conclude that all three perform well relative to DSM-III-R criteria.

A possible genetic association between PROP-tasting and alcoholism

Fifty-five young adult subjects and their parents were classified as alcoholic or nonalcoholic based on a standardized questionnaire (the MAST) filled out by the subjects. Subjects' thresholds for detection of 6-n-propylthiouracil (PROP; a PTC-like compound) were determined with the experimenter blind to MAST responses. There was a significantly higher proportion of nontasters of PROP among children of alcoholics than among children of nonalcoholics. There was no relationship between the child's alcoholism status and ability to taste PROP. These results are inconsistent with the view that excessive use of alcohol causes the association between nontasting and alcoholism and are consistent with the view that there is a genetic association between PROP/PTC-tasting and alcoholism.

Utility of the Self-Administered Alcoholism Screening Test (SAAST) in schizophrenic patients

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 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% (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% 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.

Female alcoholics. III. Some clinical associations of the Michigan Alcoholism Screening Test and diagnostic implications

In an age-matched sample of male and female inpatient alcoholics of the same ethnic background, the mean Michigan Alcoholism Screening Test (MAST) score declined significantly with age group and was lowest in elderly people. Females and first-admission subjects recorded lower mean MAST scores. A correlation was noted in both sexes between reported alcohol consumption and MAST scores. Although screening tests such as MAST have been found of value in detecting alcoholism in high-risk populations, this study of some of the MAST parameters in a clinical population suggests that some of the "invisible" and older alcoholics might not be grossly disturbed persons and that other more subtle behavioural clues to diagnosis should be determined. Despite the limitations inherent in any diagnostic technique, the ultimate detection of invisible alcoholics lies at the interface of clinical judgement, the use of screening tests, community awareness and the development of personal responsibility.

Michigan Alcoholism Screening Test (MAST)--its possibilities and shortcomings as a screening device in a pre-selected non-clinical population

A statistical analysis of the MAST scores obtained by its administration to industrial workers, hospitalized alcoholics and persons arrested driving while intoxicated has been performed. The author discusses the modalities and possibilities of improving the test reliability which will increase its efficiency in the screening of alcohol related disabilities. A further study of the inconsistencies in the administration of the MAST along with its validation is planned.

Early detection of harmful alcohol consumption: comparison of clinical, laboratory, and self-report screening procedures

This report describes the conceptual and empirical basis for the development of a screening instrument to identify persons with potentially harmful alcohol consumption. As part of a larger project sponsored by the World Health Organization (WHO), alcoholic (N = 65) and nonalcoholic (N = 187) research volunteers completed a battery of assessments that included laboratory tests, a physical examination, a diagnostic interview, personality measures, and two standard self-report screening questionnaires. The data were analyzed to evaluate the validity of diagnostic measures that could subsequently be used to develop a briefer screening test. The results of a construct validity analysis indicated that the new diagnostic measures correlated well with generally accepted alcoholism screening tests (the MAST and MacAndrew scales) and with measures of hypothetical vulnerability (e.g., sociopathy and childhood problems). Analysis of discriminant validity indicated that alcohol-specific self-report measures differentiated well between male risk groups, but were less effective in identifying high risk females. In general, alcohol-specific measures differentiated best, followed by clinical and laboratory tests and vulnerability assessments. It is concluded that no single procedure is universally suitable for the early identification of harmful drinkers. The design of a screening test will depend on the purpose of screening, the groups to be identified, the resources available and the level of cooperation to be expected from the population screened.

Diagnosis of alcoholism

Alcoholism is among the most prevalent of the difficult diseases to establish diagnoses in medicine. This article outlines a number of steps to help in identifying the alcoholic patient. These include: a careful history, several laboratory blood tests, simple paper-and-pencil tests, and recognition of alcohol-related medical disorders.

Correlates of the Michigan Alcoholism Screening Test (MAST) among DWI offenders

Examined the relationship between scores on the Michigan Alcoholism Screening Test (MAST), Psychological Screening Inventory (PSI) and Locus of Control Scale (LOC) in a selected sample of 156 apprehended drunken drivers. About 90% were identified as problem drinkers on the MAST, and 15% were screened by the PSI as requiring more intensive psychological assessment. Scores on the MAST were independent of LOC, but positively related to results on PSI scales that assess antisocial acting-out and neurotic anxiety and also to general maladjustment (mean scale elevation). A weighted composite of three PSI scales was related significantly to MAST scores, but explained only a modest proportion of variance in them. The MAST and PSI can be used to supplement one another in screening DWI offenders.

Reliability and validity of the short mast among psychiatric inpatients

Examined the reliability and empirical validity of the Short Michigan Alcoholism Screening Test (SMAST) orally administered as an embedded scale to a sample of 120 male and female psychiatric inpatients, who reported a broad spectrum of current and lifetime drinking problems. Test results showed substantial reliability within and across administrations that spanned 1 to 3 days, but they were related only moderately to the psychiatric diagnosis.

Brief assessment of drinking problems in male and female psychiatric inpatients

Used discriminant function analysis to identify and cross-validate a subset of items on the Michigan Alcoholism Screening Test (MAST) that in combination maximally distinguish between male and female psychiatric inpatients (N = 120) diagnosed as having alcohol-related and non-alcohol-related disorders. Classification of Ss by use of the composite variate showed 88% overall accuracy with an 83% valid positive rate in the validation sample, but only 65% overall accuracy and a 10% valid positive rate in an independent cross-validation group. The reliability of the MAST interview did not decline at higher levels of alcohol involvement.