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Patients with medical or social problems related to alcohol abuse or alcohol dependence frequently are seen in the health care delivery system. Direct and indirect screening methods are available, but contemporary data describing their combined effectiveness have not been reported. We determined the sensitivity of (a) an empirically derived, item-weighted, relatively 'indirect' screening measure for alcohol misuse (the Common, Alcohol, Logistic [CAL] scale for the MMPI), (b) a 'direct' approach to screening for alcohol misuse (the Self-Administered Alcohol Screening Test [SAAST]), and (c) their combined application. We obtained the responses to both measures from an archival sample of 361 medical patients (89 women, 272 men) who had been diagnosed with alcohol dependence by DSM-III-R criteria. The CAL scale and the SAAST both demonstrated high sensitivity. However, results favored the simultaneous use of a direct-in this study, the SAAST-and an indirect-in this study, the CAL scale-screening procedure. [ABSTRACT FROM AUTHOR]

Objective: To measure a 1-day point prevalence of alcohol dependence among hospitalized patients and to assess practices of detection, evaluation, and diagnosis of alcohol problems., Patients and Methods: On April 27, 1994, a total of 795 adult inpatients at 2 midwestern teaching hospitals were asked to complete a survey that included the Self-administered Alcoholism Screening Test (SAAST). The records of SAAST-positive patients were reviewed to determine the numbers of patients receiving laboratory screening for alcoholism, addiction consultative services, and a discharge diagnosis of alcoholism., Results: The survey response rate was 84% (667/795). Of the 569 patients who provided SAAST information, 42 (7.4%) had a positive SAAST score and thus were identified as alcohol dependent. Thirteen (31%) of the 42 alcoholic patients received addiction or psychiatric consultative services during their hospitalization. Serum gamma-glutamyltransferase was measured in 4 (11%) of the 38 actively drinking alcoholic patients. Three (7%) of 42 alcoholic patients received a discharge diagnosis of alcohol abuse or dependence., Conclusions: The alcoholism prevalence rate was lower than those observed in several other US hospitals. Laboratory testing may be underutilized in identifying hospitalized patients who may be addicted to alcohol. Physician use of consultative services and diagnosis of alcohol dependence had not improved from similar observations more than 20 years earlier. These findings may indicate persistent problems in physician detection, assessment, and diagnosis of alcoholism.

Recent studies have revealed differences between men and women alcoholics in symptoms, consequences, and help-seeking behavior related to alcohol usage. Based on these findings, it was hypothesized that gender differences also would appear on alcohol screening instruments. The Self-Administered Alcoholism Screening Test (Colligan, Davis, & Morse, 1988: SAAST: Swenson & Morse, 1975) of 1,920 men and 1,775 women was subjected to a within-gender, principle-components, factor analysis with a varimax rotation. Gender differences at the component level were revealed. Men endorsed the "help-seeking for alcohol-related problems" component while women endorsed the "help-seeking for emotional problems" component. In addition, men expressed concern about receiving a psychiatric label while women expressed concern about receiving a drinker label. The results suggest that different items need to be used in screening women for alcohol-related problems.

Objective: To determine the prevalence of prescription drug dependence among elderly persons in an inpatient treatment setting, to identify apparent risk factors for drug dependence, and to ascertain what factors led to admission of these patients., Design: We reviewed the medical records of 100 elderly patients dependent on prescription drugs who were admitted to the Mayo Inpatient Addiction Program between 1974 and 1993., Material and Methods: Demographic features, chronic medical disorders, categories of substance dependence, diagnoses of mental disorders, and Minnesota Multiphasic Personality Inventory data were compiled and analyzed., Results: The mean annual admissions rates for three substance use disorder groups among all elderly persons treated during the 20-year period of study were as follows: alcohol only, 72%; prescription drugs, 16%; and both alcohol and drugs, 12%. The group as a whole was socially intact. Female gender seemed to be a risk factor for drug dependence. By several measures, these elderly patients were characterized as a psychiatric population. The most frequent drug dependence involved sedatives or hypnotics. General medical data did not suggest that these elderly persons were more physically impaired than the general population., Conclusion: In elderly patients, awareness of coexistent diagnoses is essential in avoiding the inappropriate administration of multiple pharmaceutical agents and the possible risk of associated drug abuse and dependence.

The Self-Administered Nicotine-Dependence Scale (SANDS) is a questionnaire to assist in the determination of the most appropriate intervention for the nicotine-dependent individual. Six content domains included are: (1) self-efficacy; (2) social skills deficit; (3) loss of control; (4) consequences of use; (5) social support for smoking; and (6) concern for healthy life-style. A preliminary set of 79 items was reduced to a 32-item scale, which, in turn, was divided into two non-overlapping subscales of 16 items each. Logistic regression analyses of an additional sample of subjects indicated that the SANDS added predictive power to knowledge of sex and transdermal-patch status for predictions of smoking status 6 months later.

This study assessed the effect of treating nicotine dependence in smokers undergoing inpatient treatment for other addictions. It was a prospective, nonrandomized, controlled trial with a 1-year outcome. The subjects were smoking patients (50 controls, 51 in intervention group) in an inpatient addictions treatment unit in a medical center. The enrollment of subjects was sequential: controls were enrolled first; after a 6-week washout period, intervention subjects were enrolled. Controls received usual care, and the intervention group received nicotine dependence treatment consisting of a consultation, 10 intervention sessions, and a structured relapse prevention program. Smoking cessation rate and abstinence from alcohol or other drug use were the main outcome measures. The confirmed smoking cessation rate at 1 year was 11.8% in the intervention group and 0.0% in the control group (p = 0.027). Nicotine dependence intervention did not seen to interfere with abstinence from alcohol or other drugs (1-year relapse rate was 31.4% in the intervention group and 34.0% in controls). In this study, nicotine dependence treatment provided as part of addictive disorders treatment enhanced smoking cessation and did not have a substantial adverse effect on abstinence from the nonnicotine drug of dependence.

Khantzian (1985) hypothesized that the drug of choice of patients with substance-dependence disorders reflects an attempt at self-medication. Cocaine- and marijuana-dependent inpatients were compared using the MMPI to test this hypothesis. These two groups of patients did not differ on the standard validity and clinical scales of the MMPI, and their scores were basically similar to a group of alcohol-dependent inpatients and a group of psychiatric patients of similar age. There was no single MMPI code type that was characteristic of either group of substance-dependent patients. It appears that drug of choice had little effect on the MMPI scores of these two groups of substance-dependent patients. These results are not consistent with the theory of self-medication.

The effects of benzodiazepine dependence on the ability to learn and remember new material (determined with the Auditory-Verbal Learning Test) were studied in 20 detoxified, benzodiazepine-dependent patients who were 55 years of age or older and in a drug-dependence rehabilitation program. The patients were matched approximately for age, sex, and IQ with 20 detoxified, alcohol-dependent patients in the same rehabilitation program and 22 control subjects from a community sample. Neuropsychologic testing was performed a mean of 6 to 10 days after the patients had been completely detoxified from the addicting substance. The benzodiazepine-dependent patients had more difficulty with tests of learning and short-term and delayed recall than did the alcohol-dependent or control group. The difference between the benzodiazepine-dependent patients and the control group was statistically significant. The results suggest that benzodiazepine dependence in older people can cause memory impairment that persists into the early drug-free period.

In order to evaluate the equivalence of interviewer-administered and computer-administered forms of the substance use disorder diagnostic schedule (SUDDS), both forms were presented to 100 substance-dependent inpatients. An additional 101 psychiatric outpatients were administered one form or the other. For patients who received both forms of the SUDDS, the percentage agreement ranged from 96% for the classification of a lifetime diagnosis of alcohol abuse/dependence to 88% for the classification of current diagnosis of alcohol abuse/dependence (kappa coefficients ranged from 0.709 to 0.865). Overall agreement with a clinician diagnosis (validity) and the two forms of administration varied from 100% for computer-generated diagnosis of current alcohol abuse/dependence to 71% for computer-generated lifetime diagnosis of drug abuse/dependence, when stratified by number of symptoms reported. No consistent differences were found in the performances of the two forms of the SUDDS, and we conclude that they may be used interchangeably.

We developed a MMPI alcoholism scale based on adult medical patient samples. Our criterion group consisted of 736 inpatients (525 males; 211 females) diagnosed as having alcoholism according to DSM-III criteria. Three contrast samples that totaled 13,120 individuals were used for control purposes. MMPI items were chosen by means of logistic regression. The 33 items yielded by this procedure formed a provisional scale (CAL, for common alcoholism logistic) that worked equally well for males and females. With new cross-validation samples, with sensitivity (proportion of alcoholics correctly identified) set at 90%, the specificity (proportion of nonalcoholics correctly identified) ranged from 90% to 96% for selected contrast samples. We conclude that this scale shows promise as a screening device in similar populations.

The equivalence of paper-and-pencil-administered and computer-administered versions of the Self-Administered Alcoholism Screening Test (SAAST) was investigated with alcoholic inpatients and nonalcoholic psychiatric outpatients. When the two formats were administered in counterbalanced order, total score mean differences were nonsignificant. In addition, mean differences on a short-form version were also nonsignificant. Equivalence was also determined by comparing the two formats in terms of classification agreement (i.e., classification of subjects into alcoholic and nonalcoholic categories). Agreement between the two formats was 95% in both the total score and short-form versions. Implications of these results as well as the advantages and disadvantages of using computer-administered alcoholism screening tests are discussed.

Equations are provided for the calculation of age-corrected standard scores with a mean of 10 and a standard deviation of 3 for the Mental Control, Logical Memory, Visual Reproduction, and Associate Learning subtests of the Wechsler Memory Scale. Use of the standard scores is expected to facilitate intersubtest comparisons.

For a sample of 1156 patients (520 alcoholics and 636 nonalcoholics), discriminant function analyses were performed on the total score, a nine-item version, and a two-item version of the Self-Administered Alcoholism Screening Test (SAAST). With sensitivities set at 90 and 95%, specificities for the total score and nine-item versions ranged from 96.4 to 99.4%. Cross-validation of the nine-item version with the "jackknife" procedure resulted in only one additional misclassification of the 1156 subjects. Separate analyses of the male and female samples revealed that more items entered the discriminant function for women than for men and resulted in a higher, although clinically nonsignificant, percentage of correct classification for women. The results strongly support the use of either the total score or the nine-item version of the SAAST in large-scale screening for alcoholism in a medical patient population.

Results of stepwise discriminant analyses of the Self-Administered Alcoholism Screening Test (SAAST) administered to 181 alcoholics and 123 nonalcoholics in Mexico City were compared with results of a similar analysis of a sample in the United States (Rochester, MN). With sensitivities of 90% and 95%, specificities were 91.1% to 99.2% in the Mexican sample for total score and a nine-item version derived from the Mexican sample gave specificities between 95.1% and 99.2% at 90% and 95% sensitivities, as with the Rochester sample. The two items with greatest predictive power were the same in both cultures.

The medical records of 216 elderly persons, admitted to the hospital for treatment of alcoholism, were reviewed. Concern of family and friends was the most common factor motivating patients for admission. Patients with late-onset alcoholism reported an association between a life event and problem drinking more frequently than did the early-onset alcoholics. The most common associated psychiatric disorders were tobacco dependence (67%), organic brain syndrome (25%), atypical or mixed organic brain syndrome (19%), and affective disorder (12%). Fourteen percent of patients also had a drug abuse or dependence problem, all using legally prescribed drugs. Psychiatric diagnoses and results of psychologic testing did not differ between early-onset and late-onset alcoholism groups. In a 60-patient cohort studied for correlation of outcome of treatment for alcoholism with major psychiatric diagnoses, no associations were found.

Because investigators have expressed concern about the validity of alcoholism self-report measures, attention has been focused on the use of spouse or other collateral ratings of patient drinking behaviors. Previous studies have shown that spouse ratings of alcoholics on the Self-Administered Alcoholism Screening Test (SAAST) were reliable and a valid means of screening for alcoholism. In the current study, our objectives were to attempt to replicate the earlier findings in a new and larger sample and to determine whether the various content dimensions of the SAAST show similar patient-spouse agreement. The SAAST results of 240 patient-collateral pairs showed that the mean percentage agreement over the 35 items of the SAAST was 76.5%. Patient-spouse agreement ranged from 84.7% on the component "family alcohol problems" to 68.5% on "loss of control." When patients were classified as alcoholic or nonalcoholic on the basis of spouse ratings on the SAAST, correct classification occurred 98% of the time. Correct conjoint classification by both patient and spouse occurred 95.4% of the time. Thus, we found a high level of agreement between patient and spouse on the SAAST ratings and confirmed that spouse SAAST ratings of drinking behavior of patients provide a reliable diagnosis of alcoholism.

The Minnesota Multiphasic Personality Inventory (MMPI) was scored for the MacAndrew (MAC) Scale in a series of samples totaling 14,789 subjects. These samples included 1077 substance-dependent patients (739 men), 7090 selected medical outpatients (2853 men), 5000 unselected medical outpatients (2500 men), 214 psychiatric inpatients (92 men) and 1408 contemporary normal (646 men). Overall, the MAC Scale correctly classified only 70.7% of the men and 37.9% of the women alcoholics. However, when samples of men and women alcoholics were broken down into four age groups, the MAC Scale correctly identified 90% of men alcoholics in the 18- to 24-year age group but only 41% of women alcoholics in the same age group. In addition, the predicted rate of alcoholism in the samples that were not substance-dependent, using the MAC Scale, was approximately 1.5 to 4 times the estimated lifetime prevalence rate (this was also true in the 18- to 24-year age group). MMPI item 215 ("I have used alcohol excessively") correctly identified 95% of the men and 94% of the women alcoholics. It was concluded that, except for men less than 24 years old, the MAC Scale is not an appropriate screening test for substance dependence in a predominantly middle-class medical population.

The Self-Administered Alcoholism Screening Test (SAAST) was completed by 583 inpatients (437 men; 146 women) who were undergoing evaluation and treatment for alcoholism. Endorsement frequencies were computed separately for men and women, and a principal components analysis was performed on the item intercorrelation matrix. Six components (or factors) were retained for interpretation. Men were significantly more likely to engage in occupationally and socially disruptive behaviors (component II) and to elicit concern on the part of others (component V). Women were significantly more likely to admit to loss of control (component I), to experience emotional consequences and request help (component IV), and to report alcohol problems in their families (component VI). Younger alcoholics were more likely to admit to a loss of control, to have occupational and social disruption, to experience emotional consequences and request help, and to obtain higher total scores on the SAAST. Older alcoholics were more likely to report physical consequences of drinking (component III). Twenty-two alcoholics who scored in the nonalcoholic range (6 or below) were likely to be initially resistant and unaccepting of treatment.

Twelve patients (6 men and 6 women), ages 21-79 years, who, as far as it could be determined from their case histories, began to stutter for the first time in adulthood were classified by examining physicians and speech-language pathologists as having psychogenic stuttering. The case histories of these patients were examined to determine the details of their speech and allied complaints, the course and duration of stuttering, and if any psychologically stressful events surrounded the onset and development of the disorder. Minnesota Multiphasic Personality Inventory (MMPI) data on 10 of the 12 patients were analyzed independently. The main findings were (a) stuttering was the chief complaint of 11 patients; (b) all 12 patients had additional neurologic-like complaints that turned out to be nonorganic; (c) duration of stuttering from onset to examination ranged from 4 hr to 1.5 years; (d) the stuttering of most patients was variable in severity and returned to normal either spontaneously or as a result of speech therapy or psychotherapy; (e) psychologic stress was associated with the onset in 10 patients: the stress was chronic in 4 patients and acute in 6; (f) MMPI profiles of 9 of 10 patients were abnormal, with four profiles reflective of a conversion reaction; (g) differentiating neurologic from psychogenic stuttering and the need for interdisciplinary collaboration were essential in all 12 cases; and (h) speech therapy and psychotherapy are justified when psychogenic stuttering is diagnosed.

Seven alcoholism scales for the MMPI were evaluated for effectiveness in screening medical patients. Sensitivity and specificity were assessed by use of five contrast samples: (1) 736 inpatients from an alcohol and drug dependence unit; (2) 4,923 unselected medical outpatients; (3) 7,044 selected medical outpatients; (4) 214 psychiatric inpatients; and (5) 1,408 contemporary normal persons. None of these scales can be recommended for use in screening medical patients. However, endorsement of MMPI item 215 should lead to further evaluation because classification was more accurate with this single item than with any of the scales evaluated.

We describe 216 elderly patients (65 years of age or older) who were treated for alcoholism in an inpatient treatment program. Emphasis is placed on the demographics, medical characteristics, results of laboratory tests, outcome of treatment, and various comparisons of early- and late-onset alcoholism. The frequency of serious medical disorders among these patients was higher than would be expected for the overall population of a similar age. Elderly alcoholics have more abnormal results of commonly used laboratory tests than do younger alcoholics. Our data show that the elderly alcoholic can be successfully treated in a medically oriented inpatient treatment program. The concept of less-intensive treatment for the elderly alcoholic is generally not supported. More-intensive treatment may be necessary for some of these patients because of the high frequency of accompanying major medical and psychiatric problems. Early-onset alcoholism predominated, but we found no major differences between the two groups.

Although the MacAndrew scale (MAC) is the most widely used of the MMPI alcoholism screening scales, evidence to support its continued use is equivocal, and recent data raise serious questions about its efficacy in the screening of medical patients. In comparison, the Institutionalized Chronic Alcoholic Scale (ICAS), an 8-item scale, has an equivalent correct classification rate among male alcoholics and is significantly better than the MAC scale at identifying female alcoholics. Furthermore, misclassification rates among medical patients and normal persons are substantially lower for the ICAS than for the MAC scale, although the ICAS overidentifies potential alcoholism among normal women and female medical patients. However, reliability coefficients across the criterion and contrast samples are disappointingly low, and the use of the ICAS cannot be defended on that basis.