This document summarizes research on objective psychological tests used to assess substance abuse and dual diagnoses. It discusses the MMPI-2, MCMI-III, and other screening tools. Key findings include: (1) the MMPI-2 and MCMI-III identify some personality subgroups related to substance abuse but research is limited, especially for diverse populations; (2) most patients in substance abuse facilities have dual diagnoses, commonly including antisocial personality disorder or schizophrenia; and (3) accurate assessment is complicated by potential neurological impairments from substance abuse and the timing of testing after starting treatment.

1. J O H N G . K U N A , P S Y . D . A N D A S S O C I A T E S
C O U N S E L I N G
Assessment of Alcohol and Drug
Use: MMPI-2 and MCMI-III

2. MMPI-2 sub scales
 Addiction Admission Scales (AAS)
 13 Items
 Significantly different than MAC scale
 Focus on simple acknowledgement or denial of substance abuse
problems
 Addiction Potential Scale (APS)
 39 Item scale
 To identify personality features and lifestyle patterns related to
substance abuse
 Constructed by contrasting item responses from normative group,
psychiatric populations, and alcoholic populations
 Cross validated in Greene et al. (1992). Near identical results as
Weed et al. (1992)

3.  AAS and APS
 Limited research
 AAS seems to perform better than the less direct APS or MAC-
R scales
 APS may discriminate better between psychiatric patients and
substance abuse than MAC-R
 Sensitive to substance abuse in general, may not be able to
delineate SA from Alcohol abuse

4. MCMI-III
 Scale B
 Alcohol Dependence Scale
 46 items
 Assesses Hx of drinking that has caused problems at home
/work
 Scale T
 Drug dependence Scale
 58 items
 Assesses drug abuse as problematic in either home or work

5. MCMI-III
 Both scales
 Numerous indirect items helpful at identifying psychiatric
patients not eager to admit substance abuse
 Again, only a few studies on these sub scales
 Correlation, validation to MAC
 One study (Millon)
 MAC – B scale, .44
 MAC – T scale, .51
 MCMI performance weak when used with SA population
 Miller and Streiner (1990): Scale B is inaccurate, should not be
used

6. Additional Screening Scales
 TWEAK
 5 items
 Variation on the CAGE
 Purports increased sensitivity to identify alcohol problems in
pregnant women
 AUDIT
 10 items
 Refer to my presentation
 RAP
 Rapid Alcohol Problems Screen (1998)
 RAPS4 (2000)
 Combined items from TWEAK, MAST, CAGE and AUDIT
 Low sensitivity in ethnically diverse populations

7. Timing of Psychological Assessment
 Timing of Psychological Assessment
 Early intervention crucial for effective treatment
planning/outcomes
 Early assessment: results may be distorted by withdrawal
 Clear guidelines for timing of assessment lacking
 10 days (Sherer, Haygood & Alfano, 1984)
 4-6 weeks (Nathan, 1991)
 Mitigating factors
 Type of drug abused
 Severity and length of abuse
 Type of psych testing (neuropsychological or personality)
 Future research needed

8. Objective tests used D/A programs
 MMPI-2
 Research focused on Alcoholic populations (as compared to
SA)
 Research:
 No unitary ‘alcoholic’ personality (duh)
 But some distinct sub-groups
 For both Male and Females: 2-4, 2-7, 4-9
 Females: 3-4, 4-6, 4-8
 Males: 1-2
 Cluster analysis: 2-7-8-9, 4-9, 1-2-3-4

9. Objective tests used D/A programs
 MMPI-2
 Limited research on if the above subgroups have different
treatment outcomes/drinking history
 Data not ethnically diverse (mostly tested on white males)
 Substance Abuse (SA)
 Not much research until recently*
 Research asked:
 Is there a poly-drug personality?
 Difference from Alcoholic population?
 Some personalities have a drug of choice?

10. Objective tests used D/A programs
 Substance Abuse
 Comparison to alcoholic population:
 SA experienced more emotional distress*
 No unitary SA personality (duh)
 But subgroups: 4-8, 4-9 (men and women)
 African American SA report less emotional distress (than
Caucasian)
 Again, limited research on if the above subgroups have different
treatment outcomes/drinking history

11. Objective tests used D/A programs
 MCMI-III
 No specific studies with D/A populations
 Surprising as in patient psychiatric pop often present with dual
diagnosis of SA
 Primary research identified clusters of alcoholic patients
 Typically elevated on the following scales
 Narcissistic, Avoidant-Dependent, Passive-Aggressive/
Negativistic, and Compulsive

12. Objective tests used D/A programs
 Alcohol Use Inventory
 Created in 1969 (Horn & Wanberg), revised 1987
 24 Heterogeneous scales
 Developed from the way in which people described drinking
problems
 Does not screen for SA
 Classifies individuals based on
 Age of onset of drinking
 Dx
 Family Hx
 Gender
 Level of impairment
 Locus of control
 Reason for referral

13. Objective tests used D/A programs
 Alcohol Use Inventory, cont.
 “The diverse nature of the groupings…precludes any real
generalizations about drinking patterns as assessed by the
AUI.”
 “No studies have used the AUI to assess treatment process…or
outcome. [This] would seem to be the logical next step in the
use of the AUI (Butcher, 500).”

14. Dual Diagnosis
 Dual Dx
 84% of patients in SA facility had lifetime prevalence of
another disorder (Ross, Glasser & Germanson, 1988).
 Most commonly
 Anti-social Personality Disorder
 Schizophrenia
 GAD
 Phobias

15. Dual Diagnosis
 Issues
 Additional Dx can affect SA/Alcohol treatment
 Likelihood of relapse increased significantly with personality
disorder present
 Assessment complicated by possible neurological deficits due
to prolonged SA
 Impairments in abstract thinking, motor skills, problem solving
 Impairments in concentration, memory and attention may
increase after 2 weeks of abstinence
 Alcoholic individuals over 40 less neurological recovery than their
younger counterparts

16. Summary
 Significant progress with objective tests over two key
areas
 Screening
 Low prevalence of SA make meaningful research difficult*
 Gender and ethnic differences in reporting SA must be
considered in the design and implementation of screening
measures

17. Summary
 Treatment planning and Outcomes
 Factors that enhance treatment planning
 Explicit reporting of individual’s SA
 Social and interpersonal aspects of SA
 Factors leading person enter treatment
 SES and education
 Research should examine differences w/in specific MMPI code
types and MCMI profiles
 Timing of assessment after intake and DT needs further
investigation
 Clear explication of the role of Dual Dx

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