Development of MMPI-A alcohol/drug problem scales

A comparative evaluation of Korean MMPI-A and MMPI-A-RF Substance Abuse Scales

OBJECTIVE

The purpose of the present study was to compare psychometric properties of the Substance Abuse (SUB) Scale on the Korean Minnesota Multiphasic Personality Inventory-Adolescent-Restructured Form (MMPI-A-RF) with those on the Korean MMPI-A (the Alcohol/Drug Problem Acknowledgment Scale [ACK]), the Alcohol/Drug Problem Proneness Scale [PRO], and the MacAndrew Alcoholism Scale-Revised Scale [MAC-R]).

METHOD

Participants consisted of 237 Korean adolescent psychiatric patients whose scores on these measures were compared in terms of internal consistency and predictive validity.

RESULTS

Scores on SUB exhibited superior internal consistency to that of the MMPI-A substance abuse scales. Further, scores on SUB predicted substance abuse more accurately than did the optimal combination of scores on the MMPI-A substance abuse scales.

CONCLUSION

Results provide strong support for the use of the Korean MMPI-A-RF SUB scale when assessing substance abuse in Korean youth.

Correlates of MMPI-A Substance Abuse Scales

This study evaluated the correlates of 16 scales for the identification of substance abuse with the adolescent form of the Minnesota Multiphasic Personality Inventory (MMPI-A). As predicted, the scales that were previously validated with adolescents in treatment for substance abuse (i.e., the Alcohol/Drug Problem Proneness scale, or PRO; the Alcohol/Drug Problem Acknowledgment scale, or ACK; the MacAndrew scale, or MAC-R; the Substance Abuse Proclivity scale, or SAP; and the Psychopathy scale, or PSP) were reliably and positively correlated with therapists' ratings of behavioral undercontrol and substance abuse and negatively correlated with ratings of behavioral overcontrol. There were few reliable correlates for the scales that had not been previously validated with adolescents in treatment for substance abuse, and these scales were not reliably correlated with therapists' ratings of substance abuse.

A home-based prevention program for sixth-grade alcohol use: Results from project Northland

Project Northland is designed to prevent alcohol use among young adolescents. The project is ongoing in 24 school districts, randomly assigned to intervention or reference conditions. Multiple interventions begin with sixth graders and continue through eighth grade. The reference districts offer their standard health curricula. Evaluation consists of school surveys with the cohort (N = 2201) and telephone surveys of half their parents. This article describes the sixth-grade home-based intervention, the Slick Tracy Home Team. Findings of broad-based participation across sex, race, and risk status were documented, as well as some increases in knowledge and family communication about alcohol use.

Psychometric properties of the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A) Clinical, Content, and Supplementary scales in a forensic sample

In this study, we evaluated the internal psychometric properties and external correlates of scores on the Clinical, Content, and Supplementary scales in a forensic sample of 496 adolescents (315 boys and 181 girls) who were court-ordered to receive psychological evaluations. We examined Cronbach's alpha coefficients, scale intercorrelation matrices, and frequencies of scale elevations. Further, we found varying degrees of support for the convergent and discriminant validity of scores on the MMPI-A (Butcher et al., 1992 ) Clinical, Content, and Supplementary scales. This study adds to the body of literature establishing the utility of the MMPI-A in forensic evaluations.

The European Adolescent Assessment Dialogue (EuroADAD): a psychometric evaluation

BACKGROUND

The Adolescent Drug Abuse Diagnosis (ADAD) has been a gold standard for assessing drug use and associated problems in adolescents. Criticism of the instrument has been increasing. A new instrument, the European Adolescent Assessment Dialogue (EuroADAD) that builds on ADAD's strengths but seeks to address its limitations is now available, but has not been subjected to comprehensive psychometric evaluation.

OBJECTIVE

To examine the psychometric properties of the EuroADAD across various settings in adolescent populations who developed or were at a high risk of developing substance use and psychosocial adaptation problems.

PARTICIPANTS AND SETTINGS

Three of the samples were collected in Hungary, including: institutionalized youths from juvenile residential facility (n = 295); adolescents from outpatient psychiatry facility (n = 278), and controls (n = 59). An additional sample was collected in the Netherlands, and consisted of adolescent boys from an independent residential institution for youth with severe behavioral problems (n = 51).

PROCEDURE

The EuroADAD was administered by trained interviewers. Data were collected through face-to-face interviews and self-report questionnaires.

RESULTS

Reliability: the intraclass correlation was high for all domains of the EuroADAD; reliability analyses indicated good test-retest reliability, and internal consistency.

VALIDITY

difference among study samples was significant (p < 0.05) for the majority of the domains, with juvenile institution and psychiatric outpatient subjects exhibiting higher severity in most areas compared to controls. The Hungarian and Dutch samples were comparable, expect for the legal domain, due to the higher severity of behavioral problems in the Dutch sample. Several domains of the instrument, including 'alcohol', 'drugs' and 'legal' showed an association with trait aggression as measured by the Buss-Perry Aggression Questionnaire and with Novelty Seeking on the Cloninger Temperament and Character Inventory.

CONCLUSION

Based on the pattern and significance of group differences, and correlations with other measures, the scale has good criterion, and convergent and discriminant construct validity. The EuroADAD is a reliable and valid tool for the assessment of alcohol and drug use, and related psychosocial problems in adolescents.

Practitioner review: adolescent alcohol use disorders: assessment and treatment issues

BACKGROUND

Alcohol use disorders in adolescents are associated with significant morbidity and mortality. Over the past decade, there has been a burgeoning of research on adolescent alcohol use disorders.

METHODS

A summary of the alcohol assessment tools is provided, and randomized studies reviewed and synthesized to provide an overview of state of the art knowledge of treatment of adolescent alcohol use disorders. Animal models of addiction are also briefly reviewed, and the value of translational research approaches, using findings from basic studies to guide the design of clinical investigations, is also highlighted.

RESULTS

Comorbidity is the rule, not the exception in adolescent alcohol use disorders. Comprehensive assessment of psychiatric and other substance use disorders, trauma experiences, and suicidality is indicated in this population to optimize selection of appropriate clinical interventions. In terms of available investigated treatments for adolescents with alcohol use disorders, Multidimensional Family Therapy and group administered Cognitive Behavioral Therapies have received the most empirical support to date. There is a paucity of research on pharmacological interventions in this patient population, and no firm treatment recommendations can be made in this area.

CONCLUSIONS

Given the high rate of relapse after treatment, evaluation of combined psychosocial and pharmacological interventions, and the development of novel intervention strategies are indicated.

The Impact of Project Northland on Selected MMPI-A Problem Behavior Scales

Project Northland was a randomized community trial to prevent or delay alcohol use among adolescents. Students in the intervention communities were exposed to a multi-component prevention program in early adolescence and high school. This paper examines the impact of Project Northland on the trajectories of four scales of the adolescent form of the Minnesota Multiphasic Personality Inventory (MMPI-A). Students in the intervention communities demonstrated lower rates of growth of family problems and alcohol/drug use proneness than students in the delayed-program control communities. The results were more robust for baseline non-drinkers. EDITORS' STRATEGIC IMPLICATIONS: This experimental study extends the scope of the impact of Project Northland, already recognized as a model substance abuse prevention program by the Substance Abuse and Mental Health Services Administration. The results suggest that focused prevention programs have the potential to impact young adolescents' lives more broadly. Replication and further examination of the mechanisms by which risk factors and outcomes are modified is necessary, but school administrators and public health officials could learn from this promising program and evaluation.

Ability of substance abusers to escape detection on the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A) in a juvenile correctional facility

The ability of respondents to underreport successfully on substance abuse and validity scales of the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A; Butcher et al., 1992) was evaluated. Incarcerated teens (67 substance abusing, 59 non-substance abusing) completed the MMPI-A twice: once under standard instructions (SI) and once under instructions to fake good (FG). Under SI, substance scales correctly classified about 60% to 85% of adolescents. Under FG, substance- and non-substance-abusing juveniles produced lower scores on substance scales. However, the Lie Scale (L) was able to detect more than 75% of deceptive profiles and about 77% of honest profiles. When scale L and the best substance scale were used in combination, only about 18% of faking substance abusers were not identified as either substance abusers or as underreporting. For feigning substance abusers, only about 10% of substance abusers were detected, with about 72% being categorized as faking and needing further assessment.

Assessing contemporary substance abusers with the MMPI MAC Andrews Alcoholism Scale: a review

We reviewed 71 United States-based MacAndrew Alcoholism Scale (MAC), as revised (MAC-R) studies totaling almost 32,000 Ss, with adolescent and adult substance abusers, from studies published since the last MAC reviews (1989) through 2001. Results suggest that the MAC, and to some extent, the MAC-R, significantly correlates with measures of alcohol and substance abuse in both male and female adolescents and adults, across a diverse spectrum of the use-abuse continuum. Nonclinical groups (100%) scored below the clinical ranges on the MAC/MAC-R, while 79% of adolescent substance abusing groups scored > R 23, indicative of problems with substance abuse. Persons who abused alcohol, drugs, and polydrugs had mean MAC/MAC-R scores > 23, which ranged from 77% to 100% of the cases. The MAC/MAC-R does well in discriminating persons who abuse substances compared to nonclinical, nonabusing groups, but appears to lose diagnostic efficiency with psychiatric patients, and especially with medical patients with seizure disorders. Using R > 25 seems to improve diagnostic accuracy with this population. Meaning of false positives and false negatives were explored and discussed.

Adolescent substance-use assessment: methodological issues in the use of the ADAD (Adolescent Drug Abuse Diagnosis)

During the past twenty years, various instruments have been developed for the assessment of substance use in adolescents, mainly in the United States. However, few of them have been adapted to, and validated in, French-speaking populations. Consequently, although increasing alcohol and drug use among teenagers has become a major concern, the various health and social programs developed in response to this specific problem have received little attention with regard to follow-up and outcome assessment. A standardized multidimensional assessment instrument adapted for adolescents is needed to assess the individual needs of adolescents and assign them to the most appropriate treatment setting, to provide a single measurement within and across health and social systems, and to conduct treatment outcome evaluations. Moreover, having an available instrument makes it possible to develop longitudinal and trans-cultural research studies. For this reason, a French version of the Adolescent Drug Abuse Diagnosis (ADAD) was developed and validated at the University Child and Adolescent Psychiatric Clinic in Lausanne, Switzerland. This paper aims to discuss the methodological issues that we faced when using the ADAD instrument in a 4-year longitudinal study including adolescent substance users. Methodological aspects relating to the content and format of the instrument, the assessment administration and the statistical analyses are discussed.

Accuracy of MMPI-A scales ACK, MAC-R, and PRO in detecting comorbid substance abuse among psychiatric inpatients

This study investigated the accuracy of various indices involving the MMPI-A scales, ACK, MAC-R, and PRO in diagnosing substance abuse in a sample of 79 psychiatric inpatients. In the full sample, 89.9% of the cases were accurately classified by at least one of the three scales. The overall accuracy of classification was similar among males, females, Caucasians, and African Americans, although there was a tendency for more false positive misclassifications among males. Profile code type moderated the accuracy of classification with greatest accuracy for code types including Scales 1, 2, 3, 5, or 0 and least accuracy for code types including Scales 4, 6, or 9. ACK, MAC-R, and PRO were better at screening out cases of substance abuse than in accurately identifying those adolescents who were using substances.

Use of the MMPI-A to detect substance abuse in a juvenile correctional setting

In this study, we examined the ability of the MMPI-A (Butcher et al., 1992) to detect substance abuse problems in a juvenile correctional setting. Specifically, we evaluated the Alcohol/Drug Problem Acknowledgment scale (ACK; Weed, Butcher, & Williams, 1994), the Alcohol/Drug Problem Proneness scale (PRO; Weed et al., 1994), and the MacAndrew Alcoholism Scale-Revised (MAC-R; Butcher et al., 1992) in the prediction of substance abuse. In addition, the incremental validity of ACK in comparison to PRO was evaluated, as was the incremental validity of PRO in comparison to ACK. The sample consisted of 123 boys and girls from ajuvenile correctional facility in Northeastern Ohio. Results indicate that ACK and PRO, but not MAC-R, were related to interviewer ratings of substance abuse. Results point to the superiority of ACK over PRO in substance abuse identification.

Brief substance use screening instruments for primary care settings: a review

Chemical dependence, including nicotine, alcohol, prescription drugs, and illicit drugs, is one of the leading causes of morbidity and mortality in the United States. Primary care physicians and nurses routinely provide preventive health care and rely on routine screening to detect diseases and promote wellness. These primary care practitioners are in a unique position to assess and detect such dependence at its earliest stages. However, previous research indicates that little such screening is actually conducted. This literature review gathered and examined substance use screening instruments in four categories to assess their feasibility for use in primary care settings. Although substance use screening tools are available, most are not appropriate for screening in a primary care setting. There clearly remains a need for the development of a valid, reliable screening instrument that can be easily incorporated into the practices and procedures found in primary care settings.

Project Northland high school interventions: community action to reduce adolescent alcohol use

Project Northland is a randomized community trial initially implemented in 24 school districts and communities in northeastern Minnesota, with goals of delaying onset and reducing adolescent alcohol use using community-wide, multiyear, multiple interventions. The study targets the Class of 1998 from the 6th to 12th grades (1991-1998). The early adolescent phase of Project Northland has been completed, and reductions in the prevalence of alcohol use at the end of 8th grade were achieved. Phase II of Project Northland, targeting 11th- and 12th-grade students, uses five major strategies: (1) direct action community organizing methods to encourage citizens to reduce underage access to alcohol, (2) youth development involving high school students in youth action teams, (3) print media to support community organizing and youth action initiatives and communicate healthy norms about underage drinking (e.g., providing alcohol to minors is unacceptable), (4) parent education and involvement, and (5) a classroom-based curriculum for 11th-grade students. This article describes the background, design, implementation, and process measures of the intervention strategies for Phase II of Project Northland.

Adolescent substance abuse: a review of the past 10 years

OBJECTIVE

To review and synthesize the recent scientific literature on adolescent substance abuse, covering natural history, epidemiology, etiology, comorbidity, assessment, treatment, and prevention, and to highlight areas for future research.

METHOD

Studies of adolescent substance abuse were reviewed with the focus on substance abuse and dependence rather than substance use.

RESULTS

There has been a sharp recent resurgence in adolescent drug use. Biological factors, including genetic and temperament characteristics, as well as family environment factors, are emerging as important etiological variables. Comorbidity with other psychiatric disorders, particularly with conduct disorder, is frequent and complicates treatment. New assessment instruments are available for clinical and research use. Among treatment modalities, family-based interventions have received the most study.

CONCLUSIONS

The past decade has seen growth in the volume and sophistication of research on adolescent substance abuse and in the conceptualization of this problem. Further research is needed, particularly on the significance of comorbid conditions and on individualized and effective treatment approaches.

Alcoholism in adolescents and their families. Family-focused assessment and management

A family-focused approach is the most effective clinical method in the assessment and management of substance abuse in adolescents and their parents. The impact of alcoholism and substance abuse on parents and children, psychosocial risk factors, and indicators of alcoholism are important considerations when using this approach. Education regarding the family-focused approach to the treatment of substance abuse deserves a high priority in the training of pediatricians and other primary care physicians. As Doherty and Baird suggest," . . . the key to this training will not be . . . the development of a more sensitive liver function test, . . . but (rather) will be to help primary care physicians view individual patients as a part of a social context. The challenge will be to train the physicians to evaluate the patient in his or her social and family system for significant disturbances that commonly occur with chemical dependency. By evaluating the presenting patient in a family context, the primary care physician has the means to discover chemical dependency in early stages, when treatment options are less disruptive; when outcome is improved; and when the emotional and economic losses to patient, family and community are reduced."