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The Journal of Psychology: Interdisciplinary and Applied Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/vjrl20
MacAndrew MMPI Alcoholism Scale: Alcoholism and Drug Addictiveness a
Henry R. Burke & Ruth Marcus
a
a
Veterans Administration Hospital, East Orange , New Jersey, New Jersey, U.S.A. Published online: 02 Jul 2010.
To cite this article: Henry R. Burke & Ruth Marcus (1977) MacAndrew MMPI Alcoholism Scale: Alcoholism and Drug Addictiveness, The Journal of Psychology: Interdisciplinary and Applied, 96:1, 141-148, DOI: 10.1080/00223980.1977.9921428 To link to this article: http://dx.doi.org/10.1080/00223980.1977.9921428
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content.
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Published as a separate and in The Journal of Psychology, 1977, 96, 141-148
MACANDREW MMPI ALCOHOLISM SCALE: ALCOHOLISM AND DRUG ADDICTIVENESS* Veterans Administration Hospital, East Orange, N e w Jersey
HENRYR. BURKEA N D RUTH MARCUS
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SUMMARY MMPI Form R answer sheets of 2 2 2 successive black and white male inpatients referred for psychological testing in a VA general medical and surgical hospital were scored on the MacAndrew Alcoholism and the Cavior Heroin Addiction Scales. The MacAndrew Scale with 74% accuracy provided a practical screening device for identifying alcoholics. It did not significantly differentiate patients with a history of drug abuse from patients with a history of alcoholism. The Cavior He Scale was not so valid a screening device for identifying drug addicted patients in our total population. Each scale in a special way seems to be measuring a “general addictive propensity.” A.
INTRODUCTION
A reliable and valid screening device that would identify alcoholics for diagnostic and treatment purposes has long been sought ( 7 , 1 2 , 13, 14). MacAndrew ( 6 ) eventually developed a 49 item scale on the MMPI which differentiated between carefully selected samples of largely white male outpatient alcoholics (N = 300) seeking treatment, and male outpatient psychiatric patients (N = 300) evaluated for treatment who were not alcoholics and had no history of drug usage. Employing a maximally effective cutoff score of 24 or greater, MacAndrew identified correctly 81.75% of the patients in his standardization samples (N = 200) and 81.5% in his cross-validation samples ( N = 200). False positives amounted to 9.5% and lo%, and false negatives amounted to 8.75% and 8.5%. Subsequent studies by Rhodes (8), Rich and Davis (9), de Groot and Adamson (3) with civilian populations, and by Whisler and Cantor ( 1 7 ) , Uecker (151, Vega (161, Rohan, Tatro, and Rotman ( l l ) , and Rohan (10)
* Received in the Editorial Office on March 2 1 , 1977, and published immediately at Provincetown, Massachusetts. Copyright by The Journal Press. 141
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142
JOLiRNAL O F PSYCHOLOGY
with veteran populations have offered cross-validation. See Table 1 for a summary. Kranitz (5) contrasted the MacAndrew Alcoholism Scale scores of five groups: ( a ) MacAndrew’s 200 alcoholics (no drug addicts), ( b ) MacAndrew’s 200 nonalcoholics (no drug addicts), ((-) 100 institutionalized heroin addicts, ( d ) 50 institutionalized nonalcoholic veteran patients, and ( c ) 50 institutionalized alcoholic veteran patients. He found significant differences between the MacAndrew Scale mean scores of VA alcoholics a n d VA nonalcoholics, no significant differences between the MacAndrew Scale mean scores of MacAndrew’s alcoholics and the VA alcoholics, and no significant differences between the MacAndrew Scale mean scores of either VA or MacAndrew alcoholics and heroin addicts. He suggested that the MacAndrew Scale identified “a general addictive propensity.” T h e purpose of the present study was to examine ( a ) the practical validity of the MacAndrew Alcoholism Scale (developed on largely white outpatients) in identifying alcoholics in a n inpatient population of black and white veterans referred for psychological testing; ( b ) the percentage of alcoholics (defined by MacAndrew Alcoholism Scale scores 2 24) in this inpatient, largely psychiatric, veteran population; a n d (0 the meaning of the overlap of measurement on the MacAndrew Scale [identified by Kranitz ( S ) ] with alcoholics and drug addicts.
B.
METHOD
Form R M M P I answer sheets of male patients referred to the Psychology Service for psychological testing in a VA general medical a n d surgical hospital between January 1974 and March 1975 (1%’ = 2 2 2 ) , originally scored a t the Minneapolis VA Hospital, were locally hand-scored for the MacAndrew Alcoholism Scale. No protocols were rejected, even though F in some cases exceeded 16 (cf, 4 for a discussion of the use of profiles with a n F score greater than 16). A good third, if not more, of this patient population in this general medical a n d surgical metropolitan VA hospital were black veterans [(f. the discussion on the effect of ethnic background on M M P I scores in Dahlstrom, Welsh, and Dahlstrom ( 2 , pp. 154 ff.)]. Most of the patients were referred by the Psychiatric Service.
C.
RESI‘LTS
All M M P I Form R answer sheets were also scored a t the Minneapolis VA Hospital on an MMPI Heroin Addiction Scale ( 1 ) . A summar? of the findings is presented in Table 2 .
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TABLE 1 SUMMARY OF FINDINGSWITH MACANDREW ALCOHOLISM SCALE:PERCENTAGES
Studies
MacAndrew (6) Rhodes ( 8 ) Rich and Davis (9) de Groot and Adamson (3) Whisler and Cantor (17)A Uecker (15P Vega (16P Rohan el al. ( 1 I F Rohan (IOP Burke and Marcus" a
Studies with veterans. Cutoff not 24.
Alcoholics (and no drugs) with MacAndrew scores 2 24
Nonalcoholics (and no drugs) with MacAndrew scores < 24
80
71
a9
z
M
3 Overall accuracy
False negatives
False positives
82
9 10
10 14
4
27
76 74-73b 69
?' m
C
0
x
M
55
8
37
70b 71
10
9
74
10
16
a5
86 85 85
4
>
2:
U
54 z
5 0
n
5
c
P (r
1.
drug abuse
~~~~
5 + 6 + 8 + 9
+
~-
drug abuse, nor schizophrenia 10. Total: I + 2 + 3
9 . Neither alcoholism,
i . 2 + 5 + 6 8. Schizophrenia
schizophrenia
4 . 1 + 2 + 3 5. Drug abuse only 6 Drug abuse and
schizophrenia
3. Alcoholism and
222
45
2i
i 53
13
24 130
33
i3
Alcoholism only
2. Alcoholism and
5
Diagnostic classifications
I44
15
6 46 6
108 9
15
31
62
n
13 89
65
2
3 32
10 61 10
33
86 87 22
63 83 69
19
32
85
94
n
40
29
60 7
43
l i
--
47
42
58
44
‘Z
Cavior He score 2 36
c7r
Mac Andrew score 2 24
25 3
23.0
26.2 26.8 21.2
25.8 27.0 25.5
27.5
27.1
M
2.0
5.2
3.7 3.7 4.1
3.6
4.3
4.9
3.5
4.4
SD
MacAndrew
33.6
32.7
35.2 36.0 29.5
33.i 34.4 36.3
2.9
6.0
4.5 5.7 5.4
4.7
6.1 6. 7
6.3
7.0
33.9 36.0
SD
M
Cavior He
34.2
37.0
27.5 26.7 34.2
34.4 34.2 27.6
26.2
37.8
.M
Age
SD
4 5
11.8
8.8
‘4.1
3.8
8.8 10 4 5.0
3.7
10.9
DISTRIBYTIOS OF CASESBY DIAGNOSTIC CLASSIFICATION. MACASDREWALCOHOLISM SCALE.A N D CAVIORHE SCALE. U‘ITH .M A N D SD FOR .ACANDREW..CAVIOR. A N D AGE
TABLE 2
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e
2
0
r
3 v
P 4-
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HENRY R . BURKE A N D RUTH MARCUS
145
Out of the 2 2 2 patients in this study, 73 (33%) had a diagnosis of alcoholism only, or a hospital record indicating an excessive use of alcohol, with no other psychiatric diagnosis. Of these 73, 85% had a MacAndrew Alcoholism Scale score of 24 or greater. Of the 130 patients with ( a ) a diagnosis of alcoholism only or a hospital record indicating excessive use of alcohol ( N = 73), ( b ) a diagnosis of alcoholism and drug abuse ( N = 33), and (c) a diagnosis of alcoholism and schizophrenia ( N = 24), 83% had a MacAndrew Alcoholism score of 24 or greater. Of the 27 patients (12%) with a diagnosis of schizophrenia only, six out of 2 7 (22%) had a MacAndrew Alcoholism score 24 or greater. Of the 45 patients (20%)who had neither a diagnosis of alcoholism, nor drug abuse, nor schizophrenia, 15 out of 45 (33%) had a MacAndrew Alcoholism score of 24 or greater. Of the total population of 2 2 2 , 144 (65%) had a MacAndrew Alcoholism score of 24 or greater. There are those who do not regard this as an excessive estimate of alcoholism among veterans referred for psychological testing and hospitalized on a psychiatric service [out of a sample of 78 veterans hospitalized in this institution and on renal dialysis, 43 (55%) had a score of 24 or greater on the MacAndrew Alcoholism Scale (mean age = 47.3,
SD
= 10.8)].
The hit rate in this study for identifying alcoholics among a group of already self-identified inpatient hospitalized alcoholics seeking treatment was a t least as good as in the MacAndrew study (6) of outpatients: 85% or 83% as opposed to MacAndrew’s 82%. The overall percentage of accuracy in identifying alcoholics in this study for the MacAndrew Alcoholism Scale with a cutoff score of 24 or greater was 74% with 16% false positives and 10% false negatives, not quite as good as the accuracy in MacAndrew’s study, probably due to the presence in this sample of 53 patients (24%) with histories of drug abuse. Of the 13 patients (6%) who had a diagnosis of drug abuse only, nine out of 13 (69%) had a MacAndrew Alcoholism score of 24 or greater. Of the 53 patients (24%) who had a drug abuse diagnosis only, a diagnosis of drug abuse with alcoholism, or a diagnosis of drug abuse with schizophrenia, 46 out of 53 (87%) had a MacAndrew Alcoholism score of 24 or greater. Of the 33 patients (15%) who had a diagnosis of drug abuse and alcoholism, 31 out of 33 (94%) had a MacAndrew Alcoholism score of 24 or greater. There was accordingly considerable overlap of measurement with alcoholics and drug abuse patients by the MacAndrew Scale.
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146
JOURNAL O F PSYCHOLOGY
Of the 13 patients with a drug abuse only diagnosis, 10 (77%) had a Cavior Heroin (He) Addiction Scale score 36 OY above. Of the 72 patients with no drug nor alcohol abuse diagnosis or history, 5 7 (79%) had He scores below the cutoff score of 36, 15 ( 2 1 % ) above. The percentage of accuracy of identification by the He Scale with these 85 patients was 79%. There was also overlap of measurement of alcoholics and drug abuse patients by the Cavior Heroin Addiction Scale: 32 (44%) of the 73 alcoholic patients had Cavior He scores 2 36. In our total sample ( N = 2 2 2 ) 89 (40%) had Cavior He scores b 36, an improbable number or percentage of drug abuse patients for our sample. Comparisons by t tests of the differences between proportions in our sample show that the MacAndrew Alcoholism Scale did not identify alcoholics among alcoholics, (85%, il! = 73) significantly better than the He Scale identified drug abuse patients among drug abuse patients (77%, N = 13, t = .64). The He Scale did not identify drug abuse patients among drug abuse patients (77cT0, N = 13) significantly better than the MacAndrew Alcoholism Scale identified them (6976, t = .46). Yet the MacAndrew Alcoholism Scale significantly identified alcoholics among alcoholics (85 96, N = 73) better than the He Scale identified them (44%, t = 6.4). In spite of the overlap in measurement by the two scales, there was little relationship between scores on the MacAndrew Scale and the Cavior He. The coefficient of correlation' for scores on the two scales was .30 (N = 2 2 2 ) . Among alcoholics only ( N = 73), the coefficient of correlation was .23. The phi coefficient for MacAndrew scores 24 or greater, and less than 2 4 , z's. Cavior He scores 36 and greater, and less than 36, was . 2 5 . Comparisons by t tests of mean scores on the MacAndrew Alcoholism Scale for the diagnostic classes in our population are given in Table 3 . The MacAndrew Alcoholism Scale differentiated significantly between dcoholics and other groups of patients with no history of drug abuse; it differentiated significantly between drug abuse patients and schizophrenics, but not between drug abuse patients and a group of patients not schizophrenics. The MacAndrew Scale did not differentiate significantly between alcoholics and drug abuse patients. The Cavior He Scale did not differentiate between alcoholics only and drug abuse patients only (t = 1.20, n. s.). Yet the Cavior He Scale did differentiate between drug abuse patients only and schizophrenics (t =
' The number of items the two scales have in common may even account for some of this correlation. The MacAndrew with 49 items and the Cavior with 5 7 items have seven items scored the same: # 61T, 149F, 224T. 283T, 3783, 472T, 529T.
147
HENRY R. BURKE A N D RUTH MARCUS
DIFFERENCES AMONGMEANSON
TABLE 3 MACANDREW ALCOHOLISM SCALE:I Tests
THE
Comparison Alcoholics us. schizophrenics Alcoholics us. neither alcoholics, drug abusers, nor schizophrenics Drug abuse patients only us. schizophrenics only Drug abuse patients only us. neither alcoholics, drug abusers, nor schizophrenics Alcoholics only us. drug abuse patients only
*p
.05, not quite significant). Finally in this study it is not surprising to find the alcoholics were significantly older than the drug abuse patients (t = 2.97, p < .01).
3.74, p
D. CONCLUSIONS The MacAndrew Alcoholism Scale, for all practical purposes, provides a valid screening device for identifying alcoholics in an inpatient (largely psychiatric) population. It does not, however, significantly differentiate patients with a history of drug abuse from patients with a history of alcoholism. In our sample 65% of patients were alcoholics (with use of a MacAndrew Scale score of 2 24 as a criterion). The Cavior Heroin Addiction Scale successfully differentiates between patients with a history of drug abuse and patients with no history of drug or alcoholic abuse, but it is not so valid a screening device for practical purposes in identifying drug addicted patients in our total patient population. I t is not clear why or how the MacAndrew Alcoholism Scale and the Cavior Heroin Addiction Scale commonly identify alcoholics and drug abuse patients, but have scores for the patients in this study that show little intercorrelation. They seem both to be measuring, but differently, what Kranitz ( 5 ) called “a general addictive propensity.”
REFERENCES 1.
CAVIOR, N . , KURTZBERG, R. L . , & LIPTON,D. S. The development and validation of a heroin addiction scale with the MMPI. Internal. 1.Addictions, 1967, 2, 129-137.
148 2. 3 4.
5. 6.
JOURNAL O F PSYCHOLOGY
DAHLSTROM, W. G . , WELSH, G . S., & DAHLSTROM, L. E . An MMPI Handbook: Volume 11. Research Applications. Minneapolis: Univ. Minnesota Press, 1975. DE GROOT, W . G . , & ADAMSON,J. D . Responses of psychiatric inpatients to the MacAndrew Alcoholism Scale. Quart. J. S f u d . Alrohol, 1973, 34, 1133-1139. GYNTHER,M. D., ALTMAN,H . , & WAREIIN,R. Interpretation of uninterpretable Minnesota Multiphasic Personality Inventory profiles. 1. Consirlt. l7 Clin. Psychol., 1973, 40, 78-83. KRANITZ,L. Alcoholics. heroin addicts and nonaddicts: Comparisons on the MacAndrew Alcoholism Scale of the MMPI. Quart. J . Stud. A k o h o l , 1972, 33. 807-809. MACANDREW.C. The differentiation of male alcoholic outpatients from nonalcoholic psychiatric patients by means of the MMPI. Quart. J. S t u d . Alcohol, 1965, 26. 238-246.
MACANDREW, C . , & GEERTSMA, R. H . A critique of alcoholism scales derived from the MMPI. Quart. 1.Stud. Alcohol, 1964, 25, 68-76. 8 . RHODES,R. J . The MacAndrew alcoholism scale: A replication. J . Clin.Psyc-hol., 1969, 25, 181-191. 9 . RICH,C . C . . & DAVIS,H . G . Concurrent validity of MMPI alcoholism scales. J . Clin. Psyrhol., 1969, 25. 425-426. 10. ROHAN,W . P. MMPI changes in hospitalized alcoholics. Quart. J . S t u d . A l r o h l , 1972,
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I.
33, 65-76.
ROHAN.W . P . , TATRO. R. L.. & ROTMAN.S. R. MMPI changes in alcoholics during hospitalization. Quart. J. S t u d . Alrohol, 1969. 30, 389-400. 1 2 . ROSEN,A. G. A comparative study of alcoholic and psychiatric patients with the MMPI. Quart. J . S f t r d . Alruhol. 1960. 21, 253-266. SUTHERLAND, 13 E. H . , SCHROEDER, H . G . , & TORDELLA. C . L. Personality traits and the alcoholic. Qitart. J . S t i t d . Alrohol, 1950, 11, 547-561. SYME,L. Personality characteristics and the alcoholic. Quart. J. S f i t d . Alrohol, 1957, 14 18. 39-54. 1 5 . UECKER,A. E. Differentiating male alcoholic from other psychiatric inpatients. Quart. J . S t u d . Akohol, 1970, 31, 379-383. 16. VEGA,A. Cross-validation of four MMPI scales for alcoholism. Q u a r t . J . S t u d . Alcuhol,
11.
1971. 32. 191-797. 17.
WHISLER,R. H.. & CANTOR.J. M. The MacAndrew Alcoholism Scale: A crossvalidation in a domiciliary setting J Clin. P s y r - h o l . . 1966. 22. 31 1-312.
Veterans Administration Hospital East Orange, New J e r s e y 07019
The Journal of Psychology: Interdisciplinary and Applied Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/vjrl20
MacAndrew MMPI Alcoholism Scale: Alcoholism and Drug Addictiveness a
Henry R. Burke & Ruth Marcus
a
a
Veterans Administration Hospital, East Orange , New Jersey, New Jersey, U.S.A. Published online: 02 Jul 2010.
To cite this article: Henry R. Burke & Ruth Marcus (1977) MacAndrew MMPI Alcoholism Scale: Alcoholism and Drug Addictiveness, The Journal of Psychology: Interdisciplinary and Applied, 96:1, 141-148, DOI: 10.1080/00223980.1977.9921428 To link to this article: http://dx.doi.org/10.1080/00223980.1977.9921428
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content.
Downloaded by [Monash University Library] at 06:20 01 February 2015
This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
Published as a separate and in The Journal of Psychology, 1977, 96, 141-148
MACANDREW MMPI ALCOHOLISM SCALE: ALCOHOLISM AND DRUG ADDICTIVENESS* Veterans Administration Hospital, East Orange, N e w Jersey
HENRYR. BURKEA N D RUTH MARCUS
Downloaded by [Monash University Library] at 06:20 01 February 2015
SUMMARY MMPI Form R answer sheets of 2 2 2 successive black and white male inpatients referred for psychological testing in a VA general medical and surgical hospital were scored on the MacAndrew Alcoholism and the Cavior Heroin Addiction Scales. The MacAndrew Scale with 74% accuracy provided a practical screening device for identifying alcoholics. It did not significantly differentiate patients with a history of drug abuse from patients with a history of alcoholism. The Cavior He Scale was not so valid a screening device for identifying drug addicted patients in our total population. Each scale in a special way seems to be measuring a “general addictive propensity.” A.
INTRODUCTION
A reliable and valid screening device that would identify alcoholics for diagnostic and treatment purposes has long been sought ( 7 , 1 2 , 13, 14). MacAndrew ( 6 ) eventually developed a 49 item scale on the MMPI which differentiated between carefully selected samples of largely white male outpatient alcoholics (N = 300) seeking treatment, and male outpatient psychiatric patients (N = 300) evaluated for treatment who were not alcoholics and had no history of drug usage. Employing a maximally effective cutoff score of 24 or greater, MacAndrew identified correctly 81.75% of the patients in his standardization samples (N = 200) and 81.5% in his cross-validation samples ( N = 200). False positives amounted to 9.5% and lo%, and false negatives amounted to 8.75% and 8.5%. Subsequent studies by Rhodes (8), Rich and Davis (9), de Groot and Adamson (3) with civilian populations, and by Whisler and Cantor ( 1 7 ) , Uecker (151, Vega (161, Rohan, Tatro, and Rotman ( l l ) , and Rohan (10)
* Received in the Editorial Office on March 2 1 , 1977, and published immediately at Provincetown, Massachusetts. Copyright by The Journal Press. 141
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142
JOLiRNAL O F PSYCHOLOGY
with veteran populations have offered cross-validation. See Table 1 for a summary. Kranitz (5) contrasted the MacAndrew Alcoholism Scale scores of five groups: ( a ) MacAndrew’s 200 alcoholics (no drug addicts), ( b ) MacAndrew’s 200 nonalcoholics (no drug addicts), ((-) 100 institutionalized heroin addicts, ( d ) 50 institutionalized nonalcoholic veteran patients, and ( c ) 50 institutionalized alcoholic veteran patients. He found significant differences between the MacAndrew Scale mean scores of VA alcoholics a n d VA nonalcoholics, no significant differences between the MacAndrew Scale mean scores of MacAndrew’s alcoholics and the VA alcoholics, and no significant differences between the MacAndrew Scale mean scores of either VA or MacAndrew alcoholics and heroin addicts. He suggested that the MacAndrew Scale identified “a general addictive propensity.” T h e purpose of the present study was to examine ( a ) the practical validity of the MacAndrew Alcoholism Scale (developed on largely white outpatients) in identifying alcoholics in a n inpatient population of black and white veterans referred for psychological testing; ( b ) the percentage of alcoholics (defined by MacAndrew Alcoholism Scale scores 2 24) in this inpatient, largely psychiatric, veteran population; a n d (0 the meaning of the overlap of measurement on the MacAndrew Scale [identified by Kranitz ( S ) ] with alcoholics and drug addicts.
B.
METHOD
Form R M M P I answer sheets of male patients referred to the Psychology Service for psychological testing in a VA general medical a n d surgical hospital between January 1974 and March 1975 (1%’ = 2 2 2 ) , originally scored a t the Minneapolis VA Hospital, were locally hand-scored for the MacAndrew Alcoholism Scale. No protocols were rejected, even though F in some cases exceeded 16 (cf, 4 for a discussion of the use of profiles with a n F score greater than 16). A good third, if not more, of this patient population in this general medical a n d surgical metropolitan VA hospital were black veterans [(f. the discussion on the effect of ethnic background on M M P I scores in Dahlstrom, Welsh, and Dahlstrom ( 2 , pp. 154 ff.)]. Most of the patients were referred by the Psychiatric Service.
C.
RESI‘LTS
All M M P I Form R answer sheets were also scored a t the Minneapolis VA Hospital on an MMPI Heroin Addiction Scale ( 1 ) . A summar? of the findings is presented in Table 2 .
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TABLE 1 SUMMARY OF FINDINGSWITH MACANDREW ALCOHOLISM SCALE:PERCENTAGES
Studies
MacAndrew (6) Rhodes ( 8 ) Rich and Davis (9) de Groot and Adamson (3) Whisler and Cantor (17)A Uecker (15P Vega (16P Rohan el al. ( 1 I F Rohan (IOP Burke and Marcus" a
Studies with veterans. Cutoff not 24.
Alcoholics (and no drugs) with MacAndrew scores 2 24
Nonalcoholics (and no drugs) with MacAndrew scores < 24
80
71
a9
z
M
3 Overall accuracy
False negatives
False positives
82
9 10
10 14
4
27
76 74-73b 69
?' m
C
0
x
M
55
8
37
70b 71
10
9
74
10
16
a5
86 85 85
4
>
2:
U
54 z
5 0
n
5
c
P (r
1.
drug abuse
~~~~
5 + 6 + 8 + 9
+
~-
drug abuse, nor schizophrenia 10. Total: I + 2 + 3
9 . Neither alcoholism,
i . 2 + 5 + 6 8. Schizophrenia
schizophrenia
4 . 1 + 2 + 3 5. Drug abuse only 6 Drug abuse and
schizophrenia
3. Alcoholism and
222
45
2i
i 53
13
24 130
33
i3
Alcoholism only
2. Alcoholism and
5
Diagnostic classifications
I44
15
6 46 6
108 9
15
31
62
n
13 89
65
2
3 32
10 61 10
33
86 87 22
63 83 69
19
32
85
94
n
40
29
60 7
43
l i
--
47
42
58
44
‘Z
Cavior He score 2 36
c7r
Mac Andrew score 2 24
25 3
23.0
26.2 26.8 21.2
25.8 27.0 25.5
27.5
27.1
M
2.0
5.2
3.7 3.7 4.1
3.6
4.3
4.9
3.5
4.4
SD
MacAndrew
33.6
32.7
35.2 36.0 29.5
33.i 34.4 36.3
2.9
6.0
4.5 5.7 5.4
4.7
6.1 6. 7
6.3
7.0
33.9 36.0
SD
M
Cavior He
34.2
37.0
27.5 26.7 34.2
34.4 34.2 27.6
26.2
37.8
.M
Age
SD
4 5
11.8
8.8
‘4.1
3.8
8.8 10 4 5.0
3.7
10.9
DISTRIBYTIOS OF CASESBY DIAGNOSTIC CLASSIFICATION. MACASDREWALCOHOLISM SCALE.A N D CAVIORHE SCALE. U‘ITH .M A N D SD FOR .ACANDREW..CAVIOR. A N D AGE
TABLE 2
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e
2
0
r
3 v
P 4-
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HENRY R . BURKE A N D RUTH MARCUS
145
Out of the 2 2 2 patients in this study, 73 (33%) had a diagnosis of alcoholism only, or a hospital record indicating an excessive use of alcohol, with no other psychiatric diagnosis. Of these 73, 85% had a MacAndrew Alcoholism Scale score of 24 or greater. Of the 130 patients with ( a ) a diagnosis of alcoholism only or a hospital record indicating excessive use of alcohol ( N = 73), ( b ) a diagnosis of alcoholism and drug abuse ( N = 33), and (c) a diagnosis of alcoholism and schizophrenia ( N = 24), 83% had a MacAndrew Alcoholism score of 24 or greater. Of the 27 patients (12%) with a diagnosis of schizophrenia only, six out of 2 7 (22%) had a MacAndrew Alcoholism score 24 or greater. Of the 45 patients (20%)who had neither a diagnosis of alcoholism, nor drug abuse, nor schizophrenia, 15 out of 45 (33%) had a MacAndrew Alcoholism score of 24 or greater. Of the total population of 2 2 2 , 144 (65%) had a MacAndrew Alcoholism score of 24 or greater. There are those who do not regard this as an excessive estimate of alcoholism among veterans referred for psychological testing and hospitalized on a psychiatric service [out of a sample of 78 veterans hospitalized in this institution and on renal dialysis, 43 (55%) had a score of 24 or greater on the MacAndrew Alcoholism Scale (mean age = 47.3,
SD
= 10.8)].
The hit rate in this study for identifying alcoholics among a group of already self-identified inpatient hospitalized alcoholics seeking treatment was a t least as good as in the MacAndrew study (6) of outpatients: 85% or 83% as opposed to MacAndrew’s 82%. The overall percentage of accuracy in identifying alcoholics in this study for the MacAndrew Alcoholism Scale with a cutoff score of 24 or greater was 74% with 16% false positives and 10% false negatives, not quite as good as the accuracy in MacAndrew’s study, probably due to the presence in this sample of 53 patients (24%) with histories of drug abuse. Of the 13 patients (6%) who had a diagnosis of drug abuse only, nine out of 13 (69%) had a MacAndrew Alcoholism score of 24 or greater. Of the 53 patients (24%) who had a drug abuse diagnosis only, a diagnosis of drug abuse with alcoholism, or a diagnosis of drug abuse with schizophrenia, 46 out of 53 (87%) had a MacAndrew Alcoholism score of 24 or greater. Of the 33 patients (15%) who had a diagnosis of drug abuse and alcoholism, 31 out of 33 (94%) had a MacAndrew Alcoholism score of 24 or greater. There was accordingly considerable overlap of measurement with alcoholics and drug abuse patients by the MacAndrew Scale.
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Of the 13 patients with a drug abuse only diagnosis, 10 (77%) had a Cavior Heroin (He) Addiction Scale score 36 OY above. Of the 72 patients with no drug nor alcohol abuse diagnosis or history, 5 7 (79%) had He scores below the cutoff score of 36, 15 ( 2 1 % ) above. The percentage of accuracy of identification by the He Scale with these 85 patients was 79%. There was also overlap of measurement of alcoholics and drug abuse patients by the Cavior Heroin Addiction Scale: 32 (44%) of the 73 alcoholic patients had Cavior He scores 2 36. In our total sample ( N = 2 2 2 ) 89 (40%) had Cavior He scores b 36, an improbable number or percentage of drug abuse patients for our sample. Comparisons by t tests of the differences between proportions in our sample show that the MacAndrew Alcoholism Scale did not identify alcoholics among alcoholics, (85%, il! = 73) significantly better than the He Scale identified drug abuse patients among drug abuse patients (77%, N = 13, t = .64). The He Scale did not identify drug abuse patients among drug abuse patients (77cT0, N = 13) significantly better than the MacAndrew Alcoholism Scale identified them (6976, t = .46). Yet the MacAndrew Alcoholism Scale significantly identified alcoholics among alcoholics (85 96, N = 73) better than the He Scale identified them (44%, t = 6.4). In spite of the overlap in measurement by the two scales, there was little relationship between scores on the MacAndrew Scale and the Cavior He. The coefficient of correlation' for scores on the two scales was .30 (N = 2 2 2 ) . Among alcoholics only ( N = 73), the coefficient of correlation was .23. The phi coefficient for MacAndrew scores 24 or greater, and less than 2 4 , z's. Cavior He scores 36 and greater, and less than 36, was . 2 5 . Comparisons by t tests of mean scores on the MacAndrew Alcoholism Scale for the diagnostic classes in our population are given in Table 3 . The MacAndrew Alcoholism Scale differentiated significantly between dcoholics and other groups of patients with no history of drug abuse; it differentiated significantly between drug abuse patients and schizophrenics, but not between drug abuse patients and a group of patients not schizophrenics. The MacAndrew Scale did not differentiate significantly between alcoholics and drug abuse patients. The Cavior He Scale did not differentiate between alcoholics only and drug abuse patients only (t = 1.20, n. s.). Yet the Cavior He Scale did differentiate between drug abuse patients only and schizophrenics (t =
' The number of items the two scales have in common may even account for some of this correlation. The MacAndrew with 49 items and the Cavior with 5 7 items have seven items scored the same: # 61T, 149F, 224T. 283T, 3783, 472T, 529T.
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HENRY R. BURKE A N D RUTH MARCUS
DIFFERENCES AMONGMEANSON
TABLE 3 MACANDREW ALCOHOLISM SCALE:I Tests
THE
Comparison Alcoholics us. schizophrenics Alcoholics us. neither alcoholics, drug abusers, nor schizophrenics Drug abuse patients only us. schizophrenics only Drug abuse patients only us. neither alcoholics, drug abusers, nor schizophrenics Alcoholics only us. drug abuse patients only
*p
.05, not quite significant). Finally in this study it is not surprising to find the alcoholics were significantly older than the drug abuse patients (t = 2.97, p < .01).
3.74, p
D. CONCLUSIONS The MacAndrew Alcoholism Scale, for all practical purposes, provides a valid screening device for identifying alcoholics in an inpatient (largely psychiatric) population. It does not, however, significantly differentiate patients with a history of drug abuse from patients with a history of alcoholism. In our sample 65% of patients were alcoholics (with use of a MacAndrew Scale score of 2 24 as a criterion). The Cavior Heroin Addiction Scale successfully differentiates between patients with a history of drug abuse and patients with no history of drug or alcoholic abuse, but it is not so valid a screening device for practical purposes in identifying drug addicted patients in our total patient population. I t is not clear why or how the MacAndrew Alcoholism Scale and the Cavior Heroin Addiction Scale commonly identify alcoholics and drug abuse patients, but have scores for the patients in this study that show little intercorrelation. They seem both to be measuring, but differently, what Kranitz ( 5 ) called “a general addictive propensity.”
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DAHLSTROM, W. G . , WELSH, G . S., & DAHLSTROM, L. E . An MMPI Handbook: Volume 11. Research Applications. Minneapolis: Univ. Minnesota Press, 1975. DE GROOT, W . G . , & ADAMSON,J. D . Responses of psychiatric inpatients to the MacAndrew Alcoholism Scale. Quart. J. S f u d . Alrohol, 1973, 34, 1133-1139. GYNTHER,M. D., ALTMAN,H . , & WAREIIN,R. Interpretation of uninterpretable Minnesota Multiphasic Personality Inventory profiles. 1. Consirlt. l7 Clin. Psychol., 1973, 40, 78-83. KRANITZ,L. Alcoholics. heroin addicts and nonaddicts: Comparisons on the MacAndrew Alcoholism Scale of the MMPI. Quart. J . Stud. A k o h o l , 1972, 33. 807-809. MACANDREW.C. The differentiation of male alcoholic outpatients from nonalcoholic psychiatric patients by means of the MMPI. Quart. J. S t u d . Alcohol, 1965, 26. 238-246.
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WHISLER,R. H.. & CANTOR.J. M. The MacAndrew Alcoholism Scale: A crossvalidation in a domiciliary setting J Clin. P s y r - h o l . . 1966. 22. 31 1-312.
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