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Background and test data, including information from the Michigan Alcoholism Screening Test (MAST) and the Millon Clinical Multiaxial Inventory-III (MCMI-III), were systematically collected from four geographically distributed batterer programs as part of a multisite evaluation of batterer intervention (N = 840). The men appeared similar demographically to those in previous portrayals of courtmandated batterers, except that this sample had a greater portion of African American and Latino men than did previous studies. Several dichotomies appear among the men that might influence intervention, such as differences in living arrangements, education, employment, and drinking. Over half of the men in the sample had been arrested for offenses other than domestic violence. Over half of the men had “alcoholic” tendencies according to the MAST, and over one quarter showed evidence of severe mental disorders on the MCMI-III. The four programs reflected regional differences in demographics but had relatively similar portions of men with previous arrests, mental problems, and alcoholic tendencies.

A comparative multisite evaluation was conducted in four geographically distributed cities to examine the relative effectiveness of different approaches. The intervention systems represented a range of court-referral procedures (pretrial or postconviction), program duration (3 months to 9 months), and additional services (occasional referral or in-house alcohol treatment). 210 men at each site were recruited and tested (background, Millon Clinical Multiaxial Inventory, Michigan Alcoholism Screening Test). The batterers' partners were interviewed by phone every 3 months over a 15-month follow-up after intake, with a response rate of 77% overall. There was no significant difference in the reassault rate, portion of men making threats, and victim quality of life across the four sites. The longest, most comprehensive program did, however, have a significantly lower rate of severe reassault substantiated in a logistic regression controlling for background variables. The findings suggest that differing intervention systems that conform to fundamental standards can achieve similar outcomes.

This longitudinal study aimed at comparing aggregate measures of heavy or problem drinking and their variations across time among the same subjects. We examined middle-aged men participating in a health survey over a 5-year interval. Of the 133 consecutive men in the whole age group interviewed as 40-year-olds in 1989, 114 were reached and re-interviewed in 1994. Alcohol consumption was measured by self-report, Malmo-modified Michigan Alcoholism Screening Test (Mm-MAST), and serum carbohydrate-deficient transferrin (CDT). Self-reported alcohol consumption decreased with years (142 vs 105 g/week, P = 0.01), as did CDT (16.9 vs 14.4 U/l, P = 0.02), but there was no change in the Mm-MAST results. There was no significant difference in the number of heavy drinkers (either Mm-MAST score > or = 3, or by self-reported alcohol consumption > or = 280 g/week, or by CDT > or = 20 U/l) at 40 and 45 years of age (37 and 47% respectively). At the individual level, alcohol consumption both increased and decreased with age. At 45 years of age 5/114 (4%) of the men reported that they had increased their alcohol consumption by more than 80 g/week and 25/114 (22%) said that they had reduced their drinking by the same amount. The remaining 84 (74%) reported drinking the same amount as 5 years earlier (+/- 80 g/week). This indicates that alcohol drinking habits are not stable in middle age. Most heavy drinkers in both age groups were detected by Mm-MAST and this proportion increased with age while the proportion of positive self-reports and CDTs decreased. Thus, the social consequences, measured here by the Mm-MAST, may be more readily experienced with years even at smaller consumption levels.

Although there is general consensus that self-report measures are reliable in offspring identification of parental problem drinking, studies in which these measures are used differ in two important ways: 1) different self-report measures are used across investigations, and 2) when identical measures are used, idiosyncratic cutoff criteria are employed. The purpose of this study was to compare five self-report measures commonly used in college-age populations to identify problem-drinking parents. When the most conservative criterion was employed, each of the five measures identified similar percentages of offspring as having problem-drinking parents (10% for fathers and 4% for mothers). Interrelationships among the five measures were examined, and each method appeared to contribute both to the common and unique variance of the construct "parental problem drinking." Therefore no one measure can capture all aspects of a parent's drinking problem as reported by their offspring.

The aim of this study was to compare the validity of two direct screening questionnaires, the CAGE and MAST, in the detection of hazardous alcohol consumption with a disguised assessment by using the Trauma Scale in a poststratified general hospital sample.Surgical and medical inpatients (N = 1,379) completed the three questionnaires. Hazardous alcohol consumption was defined by criteria derived from a World Health Organization study and assessed using self-reported quantity and frequency.The sensitivity of the Trauma Scale was not significantly different compared to the CAGE and MAST, whereas the direct questionnaires were higher in specificity and overall accuracy (p.0001). In male surgical patients the detection rate of the Trauma Scale was higher compared to the CAGE (p.05). Thirteen percent of subjects with hazardous levels of alcohol consumption were detected by the Trauma Scale only. In female surgical patients, the Trauma Scale, when used as an additional tool, does not improve the detection of hazardous drinkers.Because of the low specificity, indirect assessment using a history of trauma cannot be recommended as a screening instrument in a general hospital setting. Despite a high number of false positives, the Trauma Scale may serve as an additional tool in conjunction with direct questionnaires when high sensitivity is desired.

SUMMARY This study addressed two related questions concerning screening processes for convicted drinking-drivers: first, do these individuals falsify information to avoid detection; and second, do non-obvious indicators improve the ability to detect potential recidivists? Two samples of New York State Drinking Driver Program (DDP) participants were used. The first consisted of 1,592 first-time drinking-driving offenders who completed the Michigan Alcoholism Screening Test (MAST) and RIA Self Inventory (RIASI) screening instruments under confidential conditions. The second sample of 513 first-time offenders completed these instruments under normal screening conditions. The MAST contains 25 items that are directly associated with alcohol-related problems. In contrast, the RIASI contains 15 alcohol-related items associated with alcohol beliefs, family history for alcohol problems, and drinking practices, and 31 non-obvious or more distal items that reflect areas associated with alcohol or drug problems. Rela...

The sexual behaviors of bisexually active men, defined as men having sex with a man and a woman in previous 6 months, were compared with men who had sex with men only. Differential sexual practices associated with HIV risk between the two groups of men, as well as in the bisexual men with their male and female partners, were evaluated. Cross-sectional analyses were performed on baseline data from a prospective cohort of 508 young gay men recruited from bars, college campuses, and a health center in Boston from 1993 to 1994. Odds ratios (OR) and 95% confidence intervals (CI) were calculated on categorical variables, and McNemar's chi2 was used to compare the behaviors of bisexual men with their male versus female sex partners. Six months before the interview, 47 (10%) men had male and female sex partners, and 383 men had only male sex partners during the past year or ever. Fifty-eight percent of the men in the study had a female sexual partner in their lifetime, and 18% during the past year. Bisexual men were more likely to have drinking problems as identified by the Michigan Alcoholism Screening Test (MAST; OR = 3.96, 95% CI = 1.54-10.20), and fewer male partners over their lifetime (mean +/- standard deviation [SD], 24+/-42; median, 7; versus mean +/- SD, 69+/-516; median, 12), although this difference was not statistically significant. The two groups had similar levels of unprotected anal intercourse (25.5% versus 29.5%); however, bisexual men were half as likely to have anal sex as homosexual men (OR = 0.50; 95% CI = 0.27-0.93). Bisexual men were three times as likely to have unprotected sex with their female partner as their male partner (OR = 3.0; 95% CI = 1.02-8.8). Stratified analysis revealed similar discordant behavior while sober (OR = 4.0), drinking (OR = 7.0), and while drinking with concurrent drug use (OR = 8.0). Among this cohort of men who have sex with men (MSM), a sizable proportion also had vaginal sex with female partners in the previous 6 months. Bisexually active men were more likely to have unprotected sex with their female partners compared with their male partners, potentially increasing the risk for HIV and other sexually transmitted diseases. Behavioral interventions directed toward MSM need to address bisexual behaviors.Data were collected from 508 gay men recruited from bars, 17 Boston area college campuses, and a health center in Boston during 1993-94 for use in a study comparing the sex behaviors of men who had sex with a man and a woman during the previous 6 months against men who had sex with only men. Study participants were aged 18 to over 27 years, although 85.1% were aged 18-26. 6 months before the interview, 10% of the men had both male and female sex partners, while 383 men had only male sex partners during the past year or ever. 58% of the men in the study had ever had a female sex partner, and 18% during the past year. Bisexual men were more likely to have drinking problems as identified by the Michigan Alcoholism Screening Test and fewer male partners over their lifetime. 25.5% of the bisexual men and 29.5% of the homosexuals reported having unprotected anal intercourse, but bisexual men were less likely than homosexual men to have anal sex. Bisexual men were 3 times more likely to have unprotected sex with a female partner as with their male partner. Stratified analysis revealed this same discordant behavior while sober, drinking, and drinking together with other drug use.

Objectives. To evaluate whether the CAGE, MAST-G or an abnormally high MCV are effective screening instruments for alcohol misuse and if not to devise a new instrument. Design. Questionnaire survey of randomly selected patients. Setting. Acute admission wards of two district general hospitals. Period. 9 months. Subjects. Randomly selected patients, aged 65 and over, admitted as emergencies. Main outcome measures. Excessive alcohol intake, alcohol dependence. Results. The sensitivities of the CAGE, MAST-G and an abnormally high MCV for excess alcohol intake and alcohol abuse are low, ranging from 0.13 to 0.54. Conclusion. The results confirm previous UK studies which indicate that the CAGE and an abnormally high MCV are poor screening instruments for alcohol misuse in older patients and also indicate that the MAST-G is an insensitive screening instrument. A new two-step instrument with five questions in total was generated. This requires further validation. © 1997 John Wiley & Sons, Ltd.

The objectives of this study were to determine the incidence of psychopathy among an alcoholic offender population by utilizing the Psychopathy Checklist-Revised (PCL-R), and to compare psychopathic and non-psychopathic alcoholics in relation to childhood history, demographic, alcohol dependence, violence, and suicide variables in order to determine how the groups differ, A sample of 128 alcoholic offenders (64 men and 64 women) incarcerated in the Massachusetts state prison system were interviewed and administered the Michigan Alcoholism Screening Test, the Alcohol Dependence Scale, and the PCL-R. Twenty percent of the alcoholic offenders could be classified as psychopaths according to PCL-R results. Psychopathic alcoholics were more alcohol dependent and engaged in more violent crimes. The PCL-R is thus a useful diagnostic tool to reduce the number of false positive ASPD diagnoses among acting out alcoholics. Psychopathic alcoholics require treatment aimed at reducing their severe alcohol depen...

The purpose of this study was to develop a sensitive as well as brief screening questionnaire by combining the well-known instruments CAGE and the Michigan Alcoholism Screening Test (MAST) in detecting patients with alcohol dependence or abuse in general hospitals and general practices. The number of items was reduced by means of logistic regression and item analysis based on data of 1, 167 consecutive admissions of a general hospital who completed both questionnaires. Further data were derived from a sample of 774 patients from 10 randomly selected general practices. A solution with nine items was validated in a second sample of 436 hospital inpatients. In all three samples, cases screening positive were interviewed using the Schedules for Clinical Assessment in Neuropsychiatry to provide ICD-10 and DSM-Ill-R or DSM-IV diagnosis. In addition, 103 subjects with negative screening results were interviewed in the second general hospital sample. On grounds of the data of all three samples, a solution of seven items was chosen. This instrument comprises two CAGE and five MAST questions (Luebeck Alcohol Dependence and Abuse Screening Test; LAST) and was significantly higher in sensitivity than CAGE and SMAST. Data were robust in all three samples. It is concluded that the LAST is an optimized instrument for use in general hospital and general practice.

Research on youthful drinking has shown that the greatest risks associated with alcohol abuse are related to contextual factors that may potentiate heavy drinking as well as increase risks for adverse consequences. These contextual factors include interacting psychological, interpersonal, and environmental dimensions of alcohol use. However, despite considerable college drinking research to identify these factors, few formal instruments have been produced for measuring excessive drinking in multidimensional contexts. The current study of 197 college students who were cited their first time for breaking university drinking rules focuses on the development and validation of a scale for measuring the likelihood of excessive drinking across an array of psychological, interpersonal and situational contexts resulting in the 23-item Drinking Context Scale (DCS). Three distinct factors emerged defining Convivial drinking, Private Intimate drinking, and drinking as a form of Negative Coping. These three factors explained 61.5% of the variance after principal components analysis and varimax rotation, showed excellent internal reliabilities, and were moderately intercorrelated. MANOVA analysis demonstrated concurrent validity with the Quality Frequency Index (QFI) and a modified version of the Michigan Alcoholism Screening Test (MAST). Implications for further research with the DCS are suggested.

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 ( α = 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 ≥ 8. We recommend use of the AUDIT for identification of hazardous and harmful drinking among individuals with a drug use disorder.

Alcohol abuse and dependency remain a serious problem among incarcerated offenders. Successful treatment requires specific interventions that augment generic substance abuse treatment. The purpose of this study is to delineate areas for intervention with alcoholic inmates. One hundred twenty-eight alcoholic inmates (64 men and 64 women) from the Massachusetts state prison system were randomly selected and interviewed. Measures included the Michigan Alcoholism Screening Test (MAST), the Alcohol Dependence Scale (ADS), and Hare's Psychopathy Checklist-Revised (PCL-R). The data suggests that, along with substance abuse treatment, interventions should be directed at: (a) early intervention; (b) physical, sexual, and emotional trauma issues; (c) depression and suicide potential; (d) occupational skills; (e) safe sex education; (f) violent behavior; and (g) psychopathic characterological issues, when warranted.

We studied the relationship of D2 and D1 receptor gene polymorphisms and alcoholism in male Finnish alcoholics and assessed male controls. Seventy alcoholics entering a detoxification programme and 50 control individuals were recruited. Forty-three per cent of the alcoholic patients, but only 22% of controls, had the D2 receptor gene TaqI A restriction fragment length polymorphism A1 allele. The frequency of the A1 allele was significantly higher in alcoholics (p = 0.039). In comparison, no association between alcoholism and the D1 receptor gene EcoRI restriction fragment length polymorphism alleles was found. A logistic regression analysis of the alcoholic population failed to support the idea that the presence of the A1 allele would be linked to estimates of alcohol dependence severity rated with the Severity of Alcohol Dependence Questionnaire or the Michigan Alcoholism Screening Test. In conclusion, allelic association between the D2 but not D1 receptor gene and alcoholism in a genetically relatively homogenous population of male Finns was found. The results are in agreement with the view that the D2 receptor locus is involved in genetic susceptibility to alcoholism but does not give support to a special association of severe alcohol dependence and the A1 allele of the D2 receptor gene.

A sample of 315 nursing students in yearly cohorts (1988-1992) completed the Michigan Alcoholism Screening Test (MAST). A simple and quick instrument with established reliability and validity, the MAST had a reliability coefficient of .78 with this sample. The MAST scores of the nursing students indicated that 21.5% had probable alcoholism or were alcoholic. Drinking problems among these nursing students were similar to those of other nursing students and college students in general. Implications for nurse educators include recognition that nursing students need continuing self-assessment and monitoring to avoid drinking problems as a student and future practitioner. Alcoholism self-screening is an excellent introduction to client assessment for drinking problems. Implications for future research include identifying correlates and determinants of problem drinking behaviors and ultimately developing and testing educational interventions to eliminate the problem.

Background : Despite recognition of the high prevalence of alcoholism among patients with head and neck cancer, the prognostic importance of alcoholism has not been evaluated adequately. Previous investigators have speculated that alcoholic patients may have a poorer prognosis than nonalcoholic patients because of more advanced stage of cancer, the immunosuppressive effects of alcohol, and an increased rate of death due to other alcohol-related diseases. Purpose : The goal of this population-based study was to identify the features of alcoholism that are associated with survival for patients with head and neck cancer and to develop an alcoholic severity staging system from a composite of the independent features of alcoholism. Methods : This prospective study included 649 patients who were diagnosed with cancer of the oral cavity, oropharynx, hypopharynx, or larynx during the period from September 1, 1983, through February 28, 1987, in a three-county area of western Washington state that participates in the Surveillance, Epidemiology, and End Results Program of the U.S. National Cancer Institute. Details on lifetime alcohol consumption, treatment for alcoholism, abstinence from alcohol prior to the diagnosis of cancer, and alcohol-related health problems were ascertained through in-person interviews near the time of diagnosis. Patients were classified as either nonalcoholics or alcoholics according to their responses to questions from the Michigan Alcoholism Screening Test. The measures of alcohol consumption and abuse that were found to be independently associated with 5-year survival by logistic regression analysis were combined using conjunctive consolidation to create a final composite variable, called an alcoholic severity stage. Cox proportional hazards regression analysis was done to estimate the relative risk (RR) of death within 5 years due to specific causes of death for each of the alcoholic severity stages. Results : Alcoholism (RR = 2.06 ; 95% confidence interval [CI] = 1.43-2.98) and a history of alcohol-related systemic health problems (i.e., liver disease, pancreatitis, delirium tremens, or seizures) (RR = 2.76 ; 95% CI = 1.69-4.49) were associated with an increased risk of death, whereas abstinence (i.e., the consumption of fewer than one drink per week at 1 year prior to the diagnosis of cancer) (RR = 0.62 ; 95% CI = 0.39-0.97) was associated with a decreased risk of death. These associations were independent of age, site of cancer, anatomical stage, histopathologic grade, smoking, and type of antineoplastic treatment. Patients in the two worst alcoholic severity stages had an increased risk of dying not only of head and neck cancer but also of cardiovascular disease, pulmonary disease, and other alcohol-related causes. Conclusions : Alcohol abuse, measured by alcohol consumption, functional impairment, a history of alcohol-related health problems, or abstinence, can provide important prognostic information for patients with head and neck cancer. Our results suggest that sobriety among alcoholic patients can lead to prolonged survival.

Current trends in conceptions of alcohol problems and provision of health care put increased emphasis on identifying individuals whose alcohol use and problems cover a range of severity. The purpose of this study is to begin to provide information on the relative utility of self-report measures designed to identify (screen for) individuals with alcohol problems. To achieve this goal, the empirical literature on contrasts of self-report screening measures was reviewed, and 13 relevant studies across diverse settings and subject populations were identified. The review showed that the CAGE, the Michigan Alcoholism Screening Test (MAST), and the short MAST (sMAST) have been the most widely studied self-report instruments to screen for alcohol problems. Direct comparisons show the MAST to be more sensitive than the CAGE, but with elderly patients the CAGE may perform better than the MAST. Furthermore, available data suggest that the CAGE and the sMAST perform comparably. Finally, the CAGE, MAST, and sMAST all perform best when predicting criteria most similar to those the instruments were designed to reflect. The study concludes with a discussion of priorities for research on screening instruments.

The concurrent validities of five self-report alcoholism measures were compared in a psychiatric hospital population using Diagnostic Interview Schedule (DIS) alcohol dependence module outputs as criterion. The Michigan Alcohol Screening Test was the most accurate identifier of alcohol dependence at some point in the subjects' life, while the CAGE interview best identified alcohol dependence in the previous year. The correlations of a quantity-frequency measure, the Clinical Signs checklist, and the Medical History questionnaire with DIS alcohol dependence module outputs were generally weaker. The data also suggested that cutting scores based on local norms may offer better hit rates in psychiatric settings than those proposed by the instruments' authors, but additional cross-validations are needed to confirm that possibility.

The transition to parenthood has been occurring within the context of the increasing labor force participation of women and potential stress-related costs of "nontraditional" as well as "traditional" gender role choices of new parents. This study addressed the extent to which gender role-related stressors lead to increased problem drinking across the transition to parenthood.Fifty-five married couples expecting their first child were obtained from seven Chicago area hospitals and surveyed with a mailed questionnaire at two points in time: (1) during the second trimester of pregnancy and (2) at 6 months following childbirth. The study examined both wives' and husbands' changes in problem-related drinking by comparing problem drinking during the 6 months prior to pregnancy (retrospectively assessed at Time 1) with drinking during the 6 months following childbirth using a modified form of the Michigan Alcoholism Screening Test. In addition, the study contrasted problem drinkers with nonproblem drinkers following parenthood with regard to role overload (overwhelming demands from work and family roles), role deprivation (loss of work role following parenthood) and role deterioration (decreased support from role relationships).The data show increased problem drinking for both mothers and fathers but fail to support either role overload or role deprivation hypotheses. However, the data are congruent with the role deterioration perspective.If these findings are replicated, future studies of gender roles and alcohol abuse should focus greater attention on the perceived quality of social roles beyond noting their presence or absence.

This study assessed the extent of alcohol use among six classes of freshman medical students over an 8-year period to provide actuarial feedback about drinking patterns to these students. A total of 278 freshman medical students was anonymously surveyed in class using the Michigan Alcoholism Screening Test (MAST). Students were given subsequent group feedback about these data with ample time for discussion. Signs of clinical detection and community resources were highlighted. Of all students 11.7% were nondrinkers, 51% were nonproblematic drinkers, 7% were borderline, 23% were 80% likely to be alcoholic, and 7% were 100% likely to be alcoholic based on the MAST score. No time trends were evident in substance use patterns. The 13-item Short MAST (SMAST) compared to the MAST had a sensitivity of 52% and a specificity of 98%. The need for better education, detection, and intervention regarding alcohol abuse among medical students was evident. Fortunately, no time trends are evident in this school's freshmen classes in contrast to national trends in college students. Teaching about problem drinking based on the administration of the MAST and from drinking norms of the class appears to increase awareness, relevance, and concern about alcohol abuse among freshmen medical students.

Prior reports have indicated that the prevalence of alcohol-related problems in VA patients is significantly higher than that found in the general population. Prevalence rates, however, are likely to be affected by the screening instrument employed. A sample of 722 VA outpatients awaiting general medical and urgent care treatment was asked to complete two screening questionnaires: the World Health Organization's AUDIT and the brief MAST. Of 508 completed AUDITs, 55 (11%) scored above the cut-offs of 11 for harmful consumption, and 85 (17%) above the more liberal cut-off score of 8; whereas of 501 completed MASTs, 104 (21%) scored above the cut-off. Differences in identification rates are discussed.

Carbohydrate-deficient transferrin (CDT) was analyzed by a modified radioimmunoassay test in a random population sample of 400 individuals, and results were compared with reported alcohol intake derived from a structured questionnaire. Among the 180 men, the test was found to be acceptable with respect to detecting harmful alcohol intake (

Alcohol use and associated factors were studied in 124 consecutive cocaine-dependent admissions to an outpatient substance abuse clinic. Two analyses were conducted: First, those who did and did not meet criteria for current alcohol dependence were compared on sociodemographic and drug use characteristics. Second, patients who reported simultaneous cocaine and alcohol use on50% vs.or = 50% of the occasions that they used cocaine were compared using the same dependent measures. Fifty-seven percent of patients met criteria for current alcohol dependence. Those with and without alcohol dependence did not differ on any sociodemographic characteristics, but those with dependence scored higher on the alcohol and family subscales of the Addiction Severity Index, the Michigan Alcoholism Screening Test, and measures of alcohol use, and were more likely to use cocaine and alcohol simultaneously, to use cocaine with friends and in social settings, and were more likely to report financial difficulties and unwanted sexual relations as adverse consequences of their cocaine use. Sixty-four percent of patients reported50% simultaneous cocaine and alcohol use. The two groups did not differ on any sociodemographic characteristics, but those reporting greater simultaneous use were more likely to be alcoholic, scored higher on most measures of alcohol use, and were more likely to report using cocaine with friends and in social settings. The only other differences observed between the two groups were fewer reports of seizures or difficulty concentrating in the group reporting greater simultaneous use. The present results confirm prior reports on the widespread prevalence of alcohol dependence among cocaine-dependent patients and extend them by providing new information on the prevalence and other characteristics of simultaneous cocaine and alcohol use.

This study examined the accuracy of the Diagnostic Interview Schedule (DIS) for indicating alcohol use disorder in a sample of patients hospitalized for depression. The Michigan Alcoholism Screening Test (MAST), with its established validity, was considered a good criterion against which to evaluate the DIS, and preferable to the clinician-assigned diagnosis in this regard. The rates of alcoholism in the sample were 31, 33, and 22.5% as yielded by the DIS, MAST, and physician's diagnosis of alcohol disorder, respectively. (The lower rate for physician's diagnosis may be due to the physician's not applying this diagnosis to recovered or currently abstinent alcohol patients.) Using the MAST's standard cutoff of five points as indicative of alcoholism, agreement with the DIS occurred in 91% of the cases, corresponding to a product moment coefficient of .79. It was concluded that the DIS alcoholism scale could be used, with reasonable confidence in its validity, for assessing alcoholism in psychiatric settings.

In the field of substance use, cultural considerations when assessing Hispanic clients include issues regarding the availability of translated and validated instruments in Spanish and interpretation of the data collected. The objective of this chapter is to describe the major assessment instruments used in the field of substance abuse, with a special focus on screening and multidimensional instruments that examine alcohol or drug using patterns, as well as associated problems. In particular, the Addiction Severity Index (ASI), CAGE questionnaire, Alcohol Use Disorders Identification Test (AUDIT), Michigan Alcoholism Screening Test (MAST), Drug Abuse Screening Test (DAST), and Substance Abuse Subtle Screening Inventory (SASSI) will be discussed. We summarize the psychometric evidence of each assessment instrument, provide information about the availability of each instrument in the Spanish language and its psychometric properties, and present information on translated versions and adaptations of each assessment instrument for use with younger populations.

Spirituality and forgiveness have been shown to be associated with psychological well-being, while guilt has been associated with poor health. Little is known, however, about the relationship between forgiveness, spirituality, guilt, posttraumatic stress (PTSD) and psychological co-morbidity among people in recovery from addiction. Eighty-one people (F = 36, M = 45) in recovery from drug and alcohol addiction were recruited from two residential units and two drop-in centres in a city in the United Kingdom. They completed the Posttraumatic Stress Diagnostic Scale (PDS), the General Health Questionnaire-28 (GHQ-28), the Spiritual Involvement and Beliefs Scale (SIBS), the Heartland Forgiveness Scale (HFS), the Traumatic Guilt Inventory (TGI), the Michigan Alcoholism Screening Test (MAST-22) and the Drug Abuse Screening Test (DAST-20). The control group comprised of 83 (F = 34, M = 49) individuals who confirmed that they did not have addiction and completed the PDS & GHQ-28. 54 % of the addiction group met the criteria for full PTSD and reported anxiety, somatic problems and depression. They described themselves as spiritual, had strong feelings of guilt associated with their addiction, and had difficulty in forgiving themselves. Controlling for demographics, number of events and medication management, regression analyses showed that spirituality predicted psychological co-morbidity, whilst feelings of guilt predicted PTSD symptoms and psychological co-morbidity. Unexpectedly, forgiveness did not predict outcomes. This study supports existing literature, which shows that people with drug and alcohol addiction tend to have experienced significant past trauma and PTSD symptoms. Their posttraumatic stress reactions and associated psychological difficulties can be better understood in the light of guilt and spirituality. Meanwhile, their ability to forgive themselves or others did not seem to influence health outcomes.

Bu araştırmada ülkemizdeki romatizmal hastaların alkol kullanım alışkanlıkları değerlendirildi.Hastalar ve yöntemler: Romatoid artrit (RA), ankilozan spondilit (AS) hastalarından ve sağlıklı kontrollerden oluşan toplam 332 denek [185 erkek, 147 kadın; yaş ortalamaları sırası ile 41.2 (%95 GA 39.5-43.0) ve 45.2 (%95 GA 43.4-47.1) yıl], alkol kullanım alışkanlığı olup olmadığına yönelik olarak sorgulandı. Alkol kullanım alışkanlığı olanlardan Michigan Alkolizm Tarama Testi'nin (MATT) Türkçe versiyonunu yanıtlamaları istendi.Bulgular: Deneklerin toplam %37.3'ü alkol kullanıyordu. Erkeklerin yaklaşık %50'si, kadınların ise %20'si alkol tüketim alışkanlığına sahipti. En düşük alkol kullanım oranı RA grubunda (%23.0), en yüksek oran ise sağlıklı kontrol grubunda (%45.6) idi. Ortalama MATT skoru, RA ve AS grupları için sırasıyla 3.02 (%95 GA: 2.36-3.69) ve 3.13 (%95 GA: 1.76-4.5) olarak bulundu ve her iki değer de kontrol grubuna ait değerden istatistiksel olarak anlamlı oranda küçüktü [4.94 (95% GA: 4.14-5.73) p, In this study, we aimed to evaluate alcohol consumption of Turkish rheumatic patients. Patients and methods: A total of 332 subjects [185 males and 147 females; mean ages of 41.2 (95% CI 39.5- 43.0) and 45.2 (95% CI 43.4-47.1) years, respectively] with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and healthy controls were questioned regarding their alcohol habits. Alcohol consumers were asked to fill out the Turkish version of the Michigan Alcoholism Screening Test (MAST). Results: A total of 37.3% of all subjects were alcohol consumers. Nearly 50% of males and 20% of females drank alcohol. Rheumatoid arthritis group had the lowest rate of alcohol consumption (23.0%), while healthy controls had the highest rate (45.6%). The mean MAST scores were 3.02 (95% CI: 2.36-3.69) and 3.13 (95% CI: 1.76-4.5) for the AS and RA groups, respectively, indicating statistically lower rate compared to the healthy controls [4.94 (95% CI: 4.14-5.73) (p

The Michigan Alcoholism Screening Test (MAST) and the Drug Abuse Screening Test (DAST) are instruments designed to detect alcohol and drug abuse, respectively. Short versions (20 self-report items) of each instrument were administered to a sample of 615 women who were in jail or on probation. Principal-components analysis (PCA) was applied to the items of each instrument. Four factors similar to those found in previous research were identified, however the instruments were essentially found to be unidimensional. Subjecting pooled MAST and DAST items to PCA did not result in the identificatio of an underlying factor.

One hundred and forty-eight U.S. college students from a small southwestern university were asked to provide or complete the following: the Michigan Alcoholism Screening Test (MAST), a structured alcohol-use interview, and a 10-ml blood sample to be assayed for carbohydrate-deficient transferrin (CDT) levels and gamma-glutamyl-transpeptidase (GGTP) activity. Using the data obtained in the interview, only 2 females and 5 males were identified as heavy drinkers. Conclusions regarding the efficacy of the biochemical markers are therefore limited. It was found that CDT levels were significantly and positively correlated with various measures of alcohol consumption among males. There was no similar association between CDT, or GGTP, and alcohol consumption within the female sample.

A SECONDOR factor analysis was performed on the Michigan Alcoholism Screening Test (MAST) items endorsed by 200 repeat driving under the influence of alcohol (DUI) offenders and nonviolent felony offenders. The result of the factor analysis showed a higher-order general factor measuring general alcohol dependence as well as several more primary dimensions of alcohol abuse and/or alcoholism such as (a) psychoactive substance dependence, (b) denial, (c) antisocial drinker, (d) discord, and (e) vocational impairment. Thompson's SECONDOR factor solution provides empirical support for the literary controversy that the MAST measures both unidimensional and multidimensional signs and symptoms of alcoholism.

Objectives: To determine whether rates of addressing alcohol use differed between family medicine and internal medicine residents, and to determine whether attitudes, confidence, and perceptions affected these relationships. Setting: Two university outpatient clinics, one staffed by family medicine and the other by primary care and categorical internal medicine residents. Design: Cross-sectional study of consecutive patients who had been followed by second- and third-year residents for at least one year. Measurements: Alcohol abuse was determined using the Michigan Alcoholism Screening Test (MAST), with a score a 5 considered positive. Rates of addressing alcohol use in the preceding year were determined by patient report and chart review. Attitudes were assessed using the Substance Abuse Attitude Survey (SAAS). Results: 334 patients of 49 residents completed the MAST. Rates of alcoholism among the patient groups were: family medicine, 8.3%; primary care, 29.1%; and categorical medicine, 18.0% (p

Alcohol consumption is a well-known risk factor for laryngeal cancer. To determine whether alcoholism, as measured by responses to the Michigan alcoholism screening test (MAST), is a risk factor for laryngeal cancer independent of alcohol consumption, we analyzed data from a population-based case-control study. Personal interviews were conducted with 235 patients (81 percent response rate) with laryngeal cancer diagnosed from September 1983 through February 1987, who were residents of the Seattle metropolitan area. A total of 547 controls frequency-matched by age and gender, selected by random-digit dialing, were interviewed (75 percent response rate). When considered in a multivariate model, independent risk factors for laryngeal cancer included: alcohol consumption (42 or more drinks/wk compared with seven or less drinks/wk: odds ratio [OR] = 3.1, 95 percent confidence interval [CI] = 1.2-7.9); cigarette use (40 or more cigarettes/day compared with never-smoked: OR = 23.1, CI = 9.4-52.6); and weighted positive responses to the MAST (score of five or more compared with score of zero: OR = 1.9, CI = 1.1-3.4). Possible explanations for the association between alcoholism and laryngeal cancer are that a measure of alcoholism improves the accuracy of assessment of alcohol consumption, that alcoholism is associated with a pattern of alcohol consumption that increases the risk of laryngeal cancer, or that alcoholism may be a marker for host susceptibility to the carcinogenic effects of alcohol.

Objective: To assess the validity of the CAGE (cut down, annoyed, guilty feelings, eye-opener) questionnaire and the Michigan Alcoholism Screening Test (MAST) in distinguishing between elderly patients with and without alcohol abuse or dependence disorders. Design: A cross-sectional study, in which patients were interviewed with a “gold standard,” the alcohol module of the Revised Diagnostic Interview Schedule (DIS-III-R), and two screening questionnaires: the CAGE and the MAST. Setting: The study was conducted in the outpatient medical practice of a university teaching hospital. Patients: All English-speaking continuity patients 65 years of age or older able to participate were eligible; complete data were available for 154 (91%) of the 170 people who agreed to participate. Results: Sixty-seven patients (44%) were active drinkers, whereas 87 (56%) reported abstinence. Twenty-five patients (16%) metDiagnostic and Statistical Manual ofMental Disorders-III-Revised (DSM-III-R) criteria for alcohol abuse or dependence. A CAGE score of 2, the conventional cutoff point, had a sensitivity and a specificity of 48% and 99%, respectively. A MAST score of 5, the originally recommended cutoff point, had a sensitivity and a specificity of 52% and 91%, respectively. The areas under the receiver operating characteristic (ROC) curves were 0.91 for the CAGE and 0.61 for the MAST. Conclusion: The CAGE and the MAST were both characterized by low sensitivities at conventional cufoff points, but the CAGE was significantly more effective than the MAST in discriminating between elderly medical outpatients with and without alcohol abuse or dependence.

The efficacy of the CAGE questions, the Malmö modification of the MAST questionnaire (Mm-MAST) and Skinner's five-item trauma score were used as a part of a larger health questionnaire in a sample of 1,663 female and 707 male first-year university students in Finland. The Mm-MAST correlated well (0.51-0.66) to reported alcohol intake and drinking for intoxication, the correlation (0.30-0.39) to CAGE was not as high but significant (p.001). The trauma score did not correlate significantly to reported alcohol intake. Sensitivity and specificity for Mm-MASTor = 3 in detecting heavy drinking, defined as a reported consumption of pure ethanol per year of at least 10 kg for women and at least 15 kg for men, was 63.8% and 87.1%, respectively, for female students and 86.3% and 87.4% for male students. Mm-MAST can be recommended as a useful screening tool for heavy drinking and alcohol-related problems in young university students. It is more specific and more sensitive than the CAGE questionnaire in this population. Skinner's trauma score was not useful for the screening of heavy drinking among young university students.

This article examines alcohol-related problems of Employee Assistance Program (EAP) Populations as related to parental alcohol problems. Data is analyzed according to self-referral and employer-referral clients. Using the Michigan Alcoholism Screening Test and the Children of Alcoholism Screening Test a population of 206 clients of an EAP were screened for self-reported drinking patterns of themselves and their parents. A strong correlation exists between alcohol problems in the family of origin, and personal alcohol problems. While only 6% of the total variance can be explained by family history, it is likely that it is displayed as a part of other "causes" of the personal problems. Employer-referrals were more likely to grow up in homes where alcohol was abused (77.5%) compared to only about 33.7% of the self-referrals.

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.

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.

Alcohol consumption (quantity, frequency, and pattern) and alcohol-related problems were determined in endometriosis patients (n = 137), patients with other gynecological disorders (n = 91), and normal control subjects (n = 98). Participants completed a self-administered questionnaire, including the Michigan Alcoholism Screening Test (MAST), questions to determine the quantity and frequency of alcohol use, and questions regarding the relationship between gynecological symptoms and alcohol intake. The percentage of endometriosis patients with MAST scores greater than five or seven was significantly greater than that of normal control subjects (p = 0.045 and p = 0.009, respectively), but did not differ from that for patients with other gynecological disorders. Endometriosis patients with high MAST scores (> or = 5) tended to consume more alcohol on a yearly basis than normal control subjects with high MAST scores (p = 0.07). Among participants who experienced gynecological symptoms and were not abstainers, 31% of endometriosis patients, 9.5% of normal control subjects, and 14.3% of patients with other gynecological disorders reported increasing their alcohol consumption when experiencing gynecological symptoms. Endometriosis patients tended to differ in this regard from normal control subjects (p = 0.058) and were significantly different from patients with other gynecological disorders (p = 0.039). The evidence suggests that the gynecological problems of endometriosis may be a major medical correlative of alcoholism in women.

Alcoholism is a prevalent problem encountered during the methadone treatment of opioid dependence. The unique feature of examining alcoholism in methadone clinics is the ability to objectively measure alcohol consumption on a frequent basis. The present study examined how blood alcohol level (BAL) relates to clinic absenteeism and whether any paper and pencil tests predict BAL in alcoholic methadone patients. Thirty-eight alcoholic methadone patients receiving outpatient treatment had their BALs assessed over consecutive 5-day periods for a period of 2 months. The relationship of these BALs to several measures, including the Michigan Alcohol Screening Test (MAST), Beck Depression Inventory (BDI), clinic absenteeism and methadone dose was assessed. Significant positive correlations between mean BAL and admission MAST, mean BAL and clinic absenteeism, and MAST and BDI were observed. Methadone dose tended to be inversely correlated with mean BAL. These findings demonstrate that the MAST predicts mean BAL and that mean BAL is an objective predictor of clinic absenteeism in alcoholic methadone patients. Moreover, the results illustrate the usefulness of methadone clinics as a setting to investigate alcohol abuse and dependence.

Available data on the nutritional status of alcoholics is controversial. The present study was conducted to assess the frequency of malnutrition in alcoholic inpatients. The objectives were to (1) compare anthropometric data of hospitalized alcoholic and nonalcoholic patients and (2) evaluate the association between alcoholism and protein-energy malnutrition. It was a cross-sectional comparative study including a stratified analysis to control for potential confounding factors. Alcoholics were identified as patients with a score from the Michigan Alcoholism Screening Test > or = 8 among patients admitted consecutively to the general wards of a department of internal medicine; they were matched for sex, age, and time of admission with nonalcoholic patients (Michigan Alcoholism Screening Test score < or = 4). Nutritional status was assessed using weight, height, midarm circumference, and tricipital skinfold thickness values, which were then used to determine the Quetelet body mass index and the mid-arm muscle circumference. The study took place in general wards of internal medicine in a 1000-bed city and teaching hospital in Lausanne, Switzerland. The participants were 93 alcoholic patients and 93 controls aged 20 to 75 years, admitted from September 1, 1988, to March 18, 1989. Alcoholics were characterized by a low rate of severe protein-energy malnutrition (< 5%); their average body weight was normal, similar to the weight of nonalcoholic inpatients, and not greatly influenced by the presence or severity of concomitant liver disease. However, tricipital skinfold thickness was lower in alcoholics than in nonalcoholics (8 mm vs 10 mm, p < .05, and 13 mm vs 20 mm, p < .01, in men and women, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Background: A burgeoning clinical and empirical literature has provided incontrovertible evidence that combat operations exact a heavy toll in terms of human suffering not only on combatants but also military support personnel. Though the Indian army is engaged in low intensity conflict (LIC) operations for over five decades, the psychological effects of LIC deployment on soldiers have not been adequately studied. Aims: To evaluate the psychological effects of deployment in LIC operations on service personnel. Methods: Five hundred and sixty-eight servicemen engaged in LIC operations and equal number of age- and rank-matched personnel in adjoining peace areas were evaluated with a self-made questionnaire, General Health Questionnaire (GHQ), Carroll Rating Scale for Depression (CRSD), State-Trait Anxiety Inventory (STAI), Michigan Alcoholism Screening Test (MAST), Impact of Events Scale (IES), Perceived Stress Questionnaire (PSQ), Multidimensional Fatigue Inventory (MFI), Hindi PEN inventory, Satisfaction With Life Scale (SWLS) and Locus Of Control (LOC) scale. Results: Respondents from LIC area had significantly higher scores on CRSD, MAST, GHQ, IES, and general fatigue, physical fatigue, and mental fatigue subscale of the MFI in comparison to those located in other areas. Significantly higher number of respondents from highly active LIC and with more than one-year service in LIC scored above cut-off levels on CRSD, MAST and GHQ. Conclusions: The psychological status of troops was directly related both to the duration of stay and the nature of LIC area.

Aim: Alcohol abuse and dependence is an important public health concern in most countries. It is also a big problem among the hospitalized patients. Method: This study was undertaken to determine the number of the patients with alcohol related problems in a general hospital sample, to compare the prevalence rate among clinics, to determine the sensitivity and specificity of MAST (Michigan Alcoholism Screening Test) for an inpatient sample. The data were collected from 13 inpatient clinics of Ankara Numune Research and Training Hospital. Result: A sample of 800 patients was enrolled in the study. 60 patients were (%7,5) diagnosed alcohol addiction and 11 were (%1,4) diagnosed as alcohol abuse. Alcohol addiction was most common in gastroenterology clinic. MAST sensitivity and specificity were found 0,74 and 0,98 respectively. Conclusion: MAST might be a useful instrument for screening alcohol related problems in a general hospital setting.

Little is known about alcohol consumption and the efficiency of alcohol questionnaires among women. In the present study 40-year-old (n = 90) and 45-year-old (n = 75) women participating in a health screening gave a self-report about their alcohol consumption and filled out the Malmo modified Michigan Alcoholism Screening Test (Mm-MAST) and the CAGE questionnaires. Teetotallers comprised 11% of the 40-year-old group and 8% of the 45-year-old women. CAGE, but not Mm-MAST worked with the traditional cut-off point of two recommended for men. When the criterion for heavy drinking was a self-reported consumption > or = 140 g of absolute alcohol per week or a positive (> or = 2) finding in the CAGE or > or = 4 'yes' answers in the Mm-MAST, 20% of the 40-year-old and 17% of the 45-year-old group (together 19%) proved positive. Neither of the two questionnaires nor self-report alone worked perfectly for identifying the heavy drinker group (n = 31) screened. Using the three above criteria; of the heavy drinkers 52% were detected by self-report, 55% by CAGE, and 45% by Mm-MAST. CAGE in combination with self-report detected 90% and this combination, being short and simple, can be recommended for clinical practice.

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.

In previous research adapted versions of the Short Michigan Alcoholism Screening Test (SMAST) have been employed to assess an individual's father's (F-SMAST) and mother's alcohol abuse (M-SMAST). However, to date psychometric information on these forms has been limited. In order to more broadly assess the psychometric properties of these forms, several critical issues in five related studies were addressed. The samples for the five studies were drawn from a college population at a large midwestern university. Overall, the reliability and validity of the adapted SMASTs appears to be quite good. The F-SMAST demonstrated high reliability (from the standpoint of internal consistency, temporal stability, and reliability across siblings) as well as validity (both in respect to convergence with an interview measure and with father's own report on a parallel instrument). Furthermore, shortening both of these instruments to nine-item versions appears to improve their reliability and validity. For researchers and clinicians interested in assessing parental history of alcoholism, the F-SMAST and M-SMAST would appear to be a reliable and valid paper-and-pencil measure.

The role of alcohol as a risk factor for cerebral infarction and hemorrhage has been assesed in 200 middle-aged and elderly stroke patients and 200 controls matched for age, sex and hospital admission date. Computed tomographic brain scans were done in all but 10 of the stroke patients. Alcohol intake was reckoned on the 12 months preceding hospitalization and expressed in grams daily according to a standard nomogram. The Michigan Alcoholism Screening Test was used for the diagnosis of alcoholism. Cerebral infarction was present in 59% of the stroke patients and cerebral hemorrhage in 9%. The role of alcohol as risk factor for stroke proved to be small (Odds Ratio 1.86) and was practically lost after adjustement for the most common risk factors for cerebrovascular disorders (previous strokes, arterial hypertension, diabetes, obesity and hyperlipidemia). Our findings seem to suggest that alcohol is not an independent risk factor for stroke in the middle-aged and elderly. The data are, however, preliminary and are discussed in the light of methological problems.

A procedure for overcoming denial in problem drinking college students is presented. Based on research suggesting that negative consequences due to drinking are a reflection of alcohol misuse, the paper recommends an assertive intervention strategy. By using a standardized assessment device, the Michigan Alcoholism Screening Test, explicitly extracted from a compendium of psychological tests, students are confronted with an objective measure of the students' alcohol use.

This study addresses the course of alcohol-related problems in future physicians from the perspectives of occupational stress versus selection and life-span developmental frameworks. A cohort of medical students was surveyed at medical school entrance and during the early fall of the second training year. Self-report questionnaires assessed: alcohol-related problems (using a modified time-linked version of the MAST), pretraining psychosocial and psychopathological characteristics and experiences (symptomatic distress, motivations for drinking, personality attributes/deficits, familial history of problem drinking, family disruption and earlier parental bonding) and medical-training characteristics (perceived stressors and levels of social support). On the basis of MAST scores, respondents manifested the following drinking patterns: consistent nonproblem drinking (67.4%), problem exit or remission during medical training (19.4%), problem entrance or onset during medical training (6.3%) and problem chronicity involving problems before and during medical training (6.9%). Female students were overrepresented in the consistent nonproblem group. The major predictors of Time 2 problem onset and chronicity as opposed to problem remission involved pretraining factors: familial history of alcohol problems, Time 1 symptomatic distress and escape motives for drinking. Future reports will depict the prevalence and etiology of problem drinking manifested during the clinical portion of medical training.

The aim of this study was to investigate the relationship between self-mutilation (SM) and posttraumatic stress disorder (PTSD) in male alcohol-dependent inpatients, and to examine whether there is something unique about self-mutilaters with the PTSD/alcohol-dependence co-morbidity, compared with self-mutilaters without PTSD in this population. Participants were 156 consecutively admitted male alcohol-dependent inpatients. Patients were investigated with the Self-mutilative Behaviour Questionnaire (SMBQ), the Traumatic Experiences Checklist (TEC), the Clinician Administered PTSD Scale (CAPS), the Symptom Checklist-Revised (SCL-90-R) and the Michigan Alcoholism Screening Test (MAST). Among alcohol-dependent inpatients, 34.0% (n=53) were considered as group with SM. Rate of being unemployed, history of any trauma, history of suicide attempt and lifetime PTSD diagnosis were higher, whereas being married, current age, age at onset of regular alcohol use and duration of education were lower in the group with SM. Mean scores of SCL-90 subscales, TEC and MAST were higher in the SM group. Although SM might be related with PTSD among male alcohol-dependent inpatients, predictors of SM were age at onset of regular alcohol use, history of suicide attempt, anxiety, depression and hostility. Age at onset of regular alcohol use, history of suicide attempt, anxiety, depression and somatisation predicted SM in the subgroup of patients without PTSD, whereas hostility predicted SM alone in the subgroup of patients with PTSD. Results support the anti-suicide and the affect-regulation models of SM in the non-PTSD group, whereas they support the hostility model of SM in the subgroup with PTSD in alcohol-dependent inpatients. Thus, to reduce self-mutilative behaviour (SMB)among alcohol-dependent patients, clinicians must address different subjects in different subgroup patients; that is, focussing hostility in those with PTSD co-morbidity.