Psychological Reports, 1990, 66, 691-698.
@ Psychological Reports 1990
SUBTYPES OF SUBSTANCE ABUSERS: PERSONALITY DIFFERENCES ASSOCIATED W I T H MACANDREWSCORES ' J O H N F? ALLEN, VIVIAN FADEN, ROBERT RAWLINGS National Institute on Alcohol Abuse and Alcoholirm ANN MILLER Koala Center, Columbus, Indiana Summary.-Several earlier studies have reported clinically relevant personality correlates of high vs low scores on the MacAndmw Scale (Mac) of the MMPI. Unfortunately, these projects have not adjusted for age or nature of abuse. Also, most have assumed that the personality correlates are the same for female patients as for male patients. This study attempts to address these deficiencies. Even after correcting for age and diagnosis, high Mac patients differ from low Mac patients on major scales of the MMPI. The pattern of such differences varies considerably between men and women. Substance abuse treatment implications of these differences are discussed.
The MacAndrew Scale (Mac) consists of 49 items from the MMPI which, although they do not directly refer to drinking, have been found to distinguish alcoholic male outpatients from nonabusing male psychiatric outpatients (MacAndrew, 1965) However, MacAndrew (1979, 1981) does report that approximately '15 % of diagnosed alcoholics and drug abusers across a wide range of clinical settings score below the usual cut-off of 24 on the scale. Whde low scores on the Mac represent failures in screening, they may identify an important subtype of patients who have unique needs in substance-abuse treatment. Content analysis of the MacAndrew Scale items suggested to Finney and his colleagues (Finney, Smith, Skeeters, & Auvenshire, 1971) that low scores on the scale are indicative of greater inhibition, lower rebelliousness, lower sociability, and lower self-confidence. MacAndrew (1979, 1980, 1981) generally concurs with these personaLty descriptors. H e further describes low scoring abusers as "punishment avoidant," while he sees high scores as "pleasure seeking." Several studies, especially those by O'Neil, Giacinto, Waid, Roitzch, Miller, and Kilpatrick (1973) and Pfost, Kunce, and Stevens (1984) have formally analyzed MMPI scale differences between alcoholic male outpatients who score low on the Mac vs those who score high. Analyses of subscale differences suggest that the low scorers are less prone to acting-out, less ener'Requests for reprints should be sent to John F? Allen, Ph.D., MPA, Treatment Research Branch, NIAAA, Rm 16C03, 5600 Fishers Lane, Rockville, MD 20857.
692
J. P. ALLEN, ET AL.
getic, more depressed, and less willing to acknowledge emotional difficulties than are high scorers. Of late, particular attention has been given to how low and high scoring abusers may differ on Scale R (Repression) of the MMPI. Scale R appears to measure submissiveness, conventionality, and lack of emotionality. Cernovsky (1985) and Kennedy and McPeake (1987) report that male alcoholics who are low on Mac receive higher R scores than high Mac male patients. Cernovsky (1987) has replicated these findings for female alcoholics. The MacAndrew Scale, however, is not without detractors. Gottesman and Prescott (1989), in particular, have been critical of use of it as a screening and selection instrument, especially in populations with either low base rates of alcoholism or in populations such as adolescents, women, and ethnic groups where validational research is lacking. Despite criticism of certain uses of the MacAndrew Scale as a screening device, these researchers acknowledge that the Mac may aid in distinguishing personality subtypes among alcoholics. Our investigation was designed to cross-validate previous research on possible personality differences between substance abusing patients who score high or low on the MacAndrew Scale. We were also interested in ascertaining whether these differences were associated with sex or type of substance abuse. METHOD MMPI, demographic, and diagnostic data were collected from successive admissions to the Koala Center of Columbus, Indiana. This program largely incorporates a "Minnesota Model" (Cook, 1988) approach to treatment of substance abuse and begins with an intensive 28-day inpatient phase. Patients accepted for treatment are diagnosed as alcohol- and/or drug-dependent according to DSM-111-R diagnostic criteria. Patients are primarily referred by their employers. Testing was performed on the fifth day following admission unless the staff felt that the patient was still detoxifying, in which case the MMPI was completed as soon as possible after the patient had stabilized. The MMPI was administered individually or in small groups. Protocols were scored for the validity scales (L, and K), the clinical scales, and the commonly analyzed "research scales" (A, R, ES, and Mac). Of the 396 eligible participants, 318 men and 59 women had complete information and had MMPIs with standard L-scores 5 70, F-scores 5 80, and K-scores 5 7 0 . (These inclusion criteria are admittedly somewhat conservative but were purposely selected since a major goal of the present study was to replicate prior research on the Mac-R relationship. Kennedy and McPeake (1987) used these validity criteria. (The other studies by Schwartz and Graham (1977), and by Cernovsky (1785, 1987) did not report MMPI validity scale inclusion criteria. Abuse diagnosis was coded as pure alcohol dependence,
673
SUBSTANCE ABUSE AND PERSONALITY
pure drug dependence, or simultaneous dependence on alcohol and at least one other drug. Subjects were distinguished as High Mac (MacAndrew score of 24 or higher) or as Low Mac (MacAndrew score of 23 or 1ower)I Two hundred eighty-eight men were classified as high Mac and 30 as low Mac. Forty women were scored as high Mac and 19 as low Mac. Raw scores on the MMPI validity and clinical scales were standardized to Tscore form by using the means and standard deviations provided for adult men and women by Colligan, Osborne, Swenson, and Offord (1983). Tscores on Scales A, R, and ES were derived based on data contained in Dahlstrom, Welsh, and Dahlstrom (1972). RESULTS Wilks lambdas were computed for Mac (high vs low), diagnosis, and the Mac-by-diagnosis relationship with the rest of the MMPI. Separate multivariTABLE 1
SUMMARY OF UNIVARIATE ANALYSESOF VARIANCEBETWEEN MALE GROUPS HIGH AND Low O N MACANDREW SCALE MMPI Scale
L F
K 1
2 3 4 5 6 7 8 9 0 A
R ES
High MacAndrew M SD
47.8 61.0 44.2 55.4 60.8 55.4 65.8 52.6 62.7 60.2 60.2 63.1 50.8 57.6 49.0 45.5
8.3 11.6 9.7 13.2 12.5 11.7 10.7 9.4 10.7 13.5 12.3 10.7 10.3 11.0 7.1 10.9
Low MacAndrew M SD
51.5 51.8 50.0 55.1 61.1 56.3 60.2 54.0 58.2 58.3 55.4 52.4 53.7 52.2 53.7 51.0
9.9 10.0 11.7 13.6 13.4 12.0 12.0 10.3 9.0 11.7 12.1 7.9 11.7 12.0 6.3 8.3
F,,,,, 1.21 9.90t 4.66 1.37 .27 .17 7.09* .51 4.97 .93 4.77 20.767 .72 3.69 5.50 10.35t
*p
@ Psychological Reports 1990
SUBTYPES OF SUBSTANCE ABUSERS: PERSONALITY DIFFERENCES ASSOCIATED W I T H MACANDREWSCORES ' J O H N F? ALLEN, VIVIAN FADEN, ROBERT RAWLINGS National Institute on Alcohol Abuse and Alcoholirm ANN MILLER Koala Center, Columbus, Indiana Summary.-Several earlier studies have reported clinically relevant personality correlates of high vs low scores on the MacAndmw Scale (Mac) of the MMPI. Unfortunately, these projects have not adjusted for age or nature of abuse. Also, most have assumed that the personality correlates are the same for female patients as for male patients. This study attempts to address these deficiencies. Even after correcting for age and diagnosis, high Mac patients differ from low Mac patients on major scales of the MMPI. The pattern of such differences varies considerably between men and women. Substance abuse treatment implications of these differences are discussed.
The MacAndrew Scale (Mac) consists of 49 items from the MMPI which, although they do not directly refer to drinking, have been found to distinguish alcoholic male outpatients from nonabusing male psychiatric outpatients (MacAndrew, 1965) However, MacAndrew (1979, 1981) does report that approximately '15 % of diagnosed alcoholics and drug abusers across a wide range of clinical settings score below the usual cut-off of 24 on the scale. Whde low scores on the Mac represent failures in screening, they may identify an important subtype of patients who have unique needs in substance-abuse treatment. Content analysis of the MacAndrew Scale items suggested to Finney and his colleagues (Finney, Smith, Skeeters, & Auvenshire, 1971) that low scores on the scale are indicative of greater inhibition, lower rebelliousness, lower sociability, and lower self-confidence. MacAndrew (1979, 1980, 1981) generally concurs with these personaLty descriptors. H e further describes low scoring abusers as "punishment avoidant," while he sees high scores as "pleasure seeking." Several studies, especially those by O'Neil, Giacinto, Waid, Roitzch, Miller, and Kilpatrick (1973) and Pfost, Kunce, and Stevens (1984) have formally analyzed MMPI scale differences between alcoholic male outpatients who score low on the Mac vs those who score high. Analyses of subscale differences suggest that the low scorers are less prone to acting-out, less ener'Requests for reprints should be sent to John F? Allen, Ph.D., MPA, Treatment Research Branch, NIAAA, Rm 16C03, 5600 Fishers Lane, Rockville, MD 20857.
692
J. P. ALLEN, ET AL.
getic, more depressed, and less willing to acknowledge emotional difficulties than are high scorers. Of late, particular attention has been given to how low and high scoring abusers may differ on Scale R (Repression) of the MMPI. Scale R appears to measure submissiveness, conventionality, and lack of emotionality. Cernovsky (1985) and Kennedy and McPeake (1987) report that male alcoholics who are low on Mac receive higher R scores than high Mac male patients. Cernovsky (1987) has replicated these findings for female alcoholics. The MacAndrew Scale, however, is not without detractors. Gottesman and Prescott (1989), in particular, have been critical of use of it as a screening and selection instrument, especially in populations with either low base rates of alcoholism or in populations such as adolescents, women, and ethnic groups where validational research is lacking. Despite criticism of certain uses of the MacAndrew Scale as a screening device, these researchers acknowledge that the Mac may aid in distinguishing personality subtypes among alcoholics. Our investigation was designed to cross-validate previous research on possible personality differences between substance abusing patients who score high or low on the MacAndrew Scale. We were also interested in ascertaining whether these differences were associated with sex or type of substance abuse. METHOD MMPI, demographic, and diagnostic data were collected from successive admissions to the Koala Center of Columbus, Indiana. This program largely incorporates a "Minnesota Model" (Cook, 1988) approach to treatment of substance abuse and begins with an intensive 28-day inpatient phase. Patients accepted for treatment are diagnosed as alcohol- and/or drug-dependent according to DSM-111-R diagnostic criteria. Patients are primarily referred by their employers. Testing was performed on the fifth day following admission unless the staff felt that the patient was still detoxifying, in which case the MMPI was completed as soon as possible after the patient had stabilized. The MMPI was administered individually or in small groups. Protocols were scored for the validity scales (L, and K), the clinical scales, and the commonly analyzed "research scales" (A, R, ES, and Mac). Of the 396 eligible participants, 318 men and 59 women had complete information and had MMPIs with standard L-scores 5 70, F-scores 5 80, and K-scores 5 7 0 . (These inclusion criteria are admittedly somewhat conservative but were purposely selected since a major goal of the present study was to replicate prior research on the Mac-R relationship. Kennedy and McPeake (1987) used these validity criteria. (The other studies by Schwartz and Graham (1977), and by Cernovsky (1785, 1987) did not report MMPI validity scale inclusion criteria. Abuse diagnosis was coded as pure alcohol dependence,
673
SUBSTANCE ABUSE AND PERSONALITY
pure drug dependence, or simultaneous dependence on alcohol and at least one other drug. Subjects were distinguished as High Mac (MacAndrew score of 24 or higher) or as Low Mac (MacAndrew score of 23 or 1ower)I Two hundred eighty-eight men were classified as high Mac and 30 as low Mac. Forty women were scored as high Mac and 19 as low Mac. Raw scores on the MMPI validity and clinical scales were standardized to Tscore form by using the means and standard deviations provided for adult men and women by Colligan, Osborne, Swenson, and Offord (1983). Tscores on Scales A, R, and ES were derived based on data contained in Dahlstrom, Welsh, and Dahlstrom (1972). RESULTS Wilks lambdas were computed for Mac (high vs low), diagnosis, and the Mac-by-diagnosis relationship with the rest of the MMPI. Separate multivariTABLE 1
SUMMARY OF UNIVARIATE ANALYSESOF VARIANCEBETWEEN MALE GROUPS HIGH AND Low O N MACANDREW SCALE MMPI Scale
L F
K 1
2 3 4 5 6 7 8 9 0 A
R ES
High MacAndrew M SD
47.8 61.0 44.2 55.4 60.8 55.4 65.8 52.6 62.7 60.2 60.2 63.1 50.8 57.6 49.0 45.5
8.3 11.6 9.7 13.2 12.5 11.7 10.7 9.4 10.7 13.5 12.3 10.7 10.3 11.0 7.1 10.9
Low MacAndrew M SD
51.5 51.8 50.0 55.1 61.1 56.3 60.2 54.0 58.2 58.3 55.4 52.4 53.7 52.2 53.7 51.0
9.9 10.0 11.7 13.6 13.4 12.0 12.0 10.3 9.0 11.7 12.1 7.9 11.7 12.0 6.3 8.3
F,,,,, 1.21 9.90t 4.66 1.37 .27 .17 7.09* .51 4.97 .93 4.77 20.767 .72 3.69 5.50 10.35t
*p
