Psychological Reporb, 1992, 70, 913-914.
O Psychological Reports 1992
PREVALENCE OF UNDETECTED ALCOHOL DEPENDENCE IN T H E MENTAL HEALTH DIAGNOSTIC INTERVIEW' BETH MENEES RIENZI California State University, Bakersfield Summary.-The prevalence of undetected alcohol dependence was examined utilizing the Michigan Alcohol Screening Test for 118 (68 women) users of community mental health services as part of a Quality Assurance Review. Clinicians did not uniformly request information about substance abuse in the diagnostic interview and did not uniformly address alcohol abuse i n the treatment plan when alcohol dependence was diagnosed. Other programs may have similar problems.
Clinicians should routinely inquire about substance abuse in the mental health diagnostic interview as alcohol dependence often coexists with other psychiatric symptoms, both as primary and secondary diagnoses to complicate treatment (Schaefer, Sobieraj, & Hollyfield, 1987). A Quality Assurance Review assessed the conformity of community mental health outpatient clinicians to this ideal. The Michigan Alcoholism Screening Test (MAST), a direct alcohol inventory, was used to assess diagnostic accuracy. Its predictive validity suffers when alcoholics are motivated to avoid detection, so the scores are believed to underpredict alcoholism in a general population (Otto & Hall, 1988). The test does not distinguish the time when alcohol-abuse symptoms occur, but a history of this problem should be considered prior to treatment planning or prescription of psychotropic medication. Method.-The Michigan Alcoholism Screening Test was administered to 118 (68 women) patients admitted to a county out-patient mental health clinic only after the clinicians' diagnostic assessment was complete. Ages ranged from 18 to 85 years, with a mean age of 37.6. Sixteen clinicians (2 licensed psychologists, 5 Licensed Clinical Social Workers, 2 licensed Marriage Family Child Counselors, and 7 master's level interns) were given one day of training on dual diagnosis prior to this study and were not aware of data collection. The test protocols, identified only by case number, were not scored until data collection was complete. Screening test scores were compared to each patient's chart by case number. The intake evaluation, diagnosis, treatment plan, and case notes were assessed for each clinician's awareness of potential alcohol problems and consideration of alcohol dependence in diagnosis and treatment planning by a licensed clinician. Each clinician's diagnostic evaluations were read to as-
'The author is indebted to Marsha Maslan for assistance in data collection. Address r uests for , reprints to Beth Rienzi, Department of Psychology, California State University, ~ a k e 2 i e l d CA 9331 1-1099.
914
B. M. RIENZI
sess accuracy of diagnosis for the 35 identified dual diagnosis cases. Diagnostic classification was reviewed for all cases. Results.-Michigan Alcoholism Screening Test scores averaged 11.10 (SD = 13.02) for men and 1.29 (SD = 2.53) for women. Ten of the women (15%) and 25 of the men (50%) scored alcohol-dependent on the test. Twenty of the 35 MAST-identified patients were diagnosed as secondary alcohol dependence on Axis I of DSM-111-R (American Psychiatric Association, 1987). Only 14 of the 35 MAST-identified patients were given treatment plans that addressed the issue of alcohol dependence. Alcohol consumption was noted somewhere in the clinical chart for 29 of the 35 MAST-identified patients. Six of the MAST-identified patients had no mention of alcohol use in the diagnosis, treatment plan, or clinical notes. No patients were diagnosed as alcohol-dependent who were not identified by scores on the screening test. Discussion.-The clinicians in this study did not uniformly request information about substance abuse during the diagnostic interview, and they did not uniformly provide an adequate treatment plan when a substance abuse problem was identified. The one-day training was not sufficient to provide for an acceptable level of diagnostic accuracy among these clinicians. The use of a substance abuse screening device similar to the Michigan Alcoholism Screening Test, if made available to the clinicians at the diagnostic interview, could serve as a reminder. Quality Assurance investigation of diagnostic accuracy is recommended for other community mental health programs. REFERENCES AMERICANPSYCHIATRIC ASSOCIATION. (1987) Diagnostic and statistical manual of mental disorders. (3rd ed., Rev.) Wash~ngton,DC: Author. OTO, R. K., & HALL, E. (1988) The utility of the Michigan Alcoholism Screening Test in the detection o!kcoholrs and problem driiers. Journal of Pmonaljty Assessment, 52. 499-505.
SCHAEFER, M. R., SOBIERAJ, K., & HOLLYFIELD, R. L. (1987) Additional ps chiatric symptoms , 435-447. in male alcoholic inpatients. American Journal of Drug and ~ k o h o ~l l u I e 13, Accepted April 6, 1992.
O Psychological Reports 1992
PREVALENCE OF UNDETECTED ALCOHOL DEPENDENCE IN T H E MENTAL HEALTH DIAGNOSTIC INTERVIEW' BETH MENEES RIENZI California State University, Bakersfield Summary.-The prevalence of undetected alcohol dependence was examined utilizing the Michigan Alcohol Screening Test for 118 (68 women) users of community mental health services as part of a Quality Assurance Review. Clinicians did not uniformly request information about substance abuse in the diagnostic interview and did not uniformly address alcohol abuse i n the treatment plan when alcohol dependence was diagnosed. Other programs may have similar problems.
Clinicians should routinely inquire about substance abuse in the mental health diagnostic interview as alcohol dependence often coexists with other psychiatric symptoms, both as primary and secondary diagnoses to complicate treatment (Schaefer, Sobieraj, & Hollyfield, 1987). A Quality Assurance Review assessed the conformity of community mental health outpatient clinicians to this ideal. The Michigan Alcoholism Screening Test (MAST), a direct alcohol inventory, was used to assess diagnostic accuracy. Its predictive validity suffers when alcoholics are motivated to avoid detection, so the scores are believed to underpredict alcoholism in a general population (Otto & Hall, 1988). The test does not distinguish the time when alcohol-abuse symptoms occur, but a history of this problem should be considered prior to treatment planning or prescription of psychotropic medication. Method.-The Michigan Alcoholism Screening Test was administered to 118 (68 women) patients admitted to a county out-patient mental health clinic only after the clinicians' diagnostic assessment was complete. Ages ranged from 18 to 85 years, with a mean age of 37.6. Sixteen clinicians (2 licensed psychologists, 5 Licensed Clinical Social Workers, 2 licensed Marriage Family Child Counselors, and 7 master's level interns) were given one day of training on dual diagnosis prior to this study and were not aware of data collection. The test protocols, identified only by case number, were not scored until data collection was complete. Screening test scores were compared to each patient's chart by case number. The intake evaluation, diagnosis, treatment plan, and case notes were assessed for each clinician's awareness of potential alcohol problems and consideration of alcohol dependence in diagnosis and treatment planning by a licensed clinician. Each clinician's diagnostic evaluations were read to as-
'The author is indebted to Marsha Maslan for assistance in data collection. Address r uests for , reprints to Beth Rienzi, Department of Psychology, California State University, ~ a k e 2 i e l d CA 9331 1-1099.
914
B. M. RIENZI
sess accuracy of diagnosis for the 35 identified dual diagnosis cases. Diagnostic classification was reviewed for all cases. Results.-Michigan Alcoholism Screening Test scores averaged 11.10 (SD = 13.02) for men and 1.29 (SD = 2.53) for women. Ten of the women (15%) and 25 of the men (50%) scored alcohol-dependent on the test. Twenty of the 35 MAST-identified patients were diagnosed as secondary alcohol dependence on Axis I of DSM-111-R (American Psychiatric Association, 1987). Only 14 of the 35 MAST-identified patients were given treatment plans that addressed the issue of alcohol dependence. Alcohol consumption was noted somewhere in the clinical chart for 29 of the 35 MAST-identified patients. Six of the MAST-identified patients had no mention of alcohol use in the diagnosis, treatment plan, or clinical notes. No patients were diagnosed as alcohol-dependent who were not identified by scores on the screening test. Discussion.-The clinicians in this study did not uniformly request information about substance abuse during the diagnostic interview, and they did not uniformly provide an adequate treatment plan when a substance abuse problem was identified. The one-day training was not sufficient to provide for an acceptable level of diagnostic accuracy among these clinicians. The use of a substance abuse screening device similar to the Michigan Alcoholism Screening Test, if made available to the clinicians at the diagnostic interview, could serve as a reminder. Quality Assurance investigation of diagnostic accuracy is recommended for other community mental health programs. REFERENCES AMERICANPSYCHIATRIC ASSOCIATION. (1987) Diagnostic and statistical manual of mental disorders. (3rd ed., Rev.) Wash~ngton,DC: Author. OTO, R. K., & HALL, E. (1988) The utility of the Michigan Alcoholism Screening Test in the detection o!kcoholrs and problem driiers. Journal of Pmonaljty Assessment, 52. 499-505.
SCHAEFER, M. R., SOBIERAJ, K., & HOLLYFIELD, R. L. (1987) Additional ps chiatric symptoms , 435-447. in male alcoholic inpatients. American Journal of Drug and ~ k o h o ~l l u I e 13, Accepted April 6, 1992.
