The relative efficacy of measures of adolescent substance abuse
The use of psychometric instruments in detecting problematic alcohol and drug use among adolescents has been most extensively investigated with the MacAndrew Alcoholism Scale (MAC), (MacAndrew, 1965). The MAC has been described as measuring a bipolar dimension of character, with “…high scores being indicative of a reward-seeking or `go' orientation and low scores being indicative of a punishment-avoidance or `stop' orientation” (MacAndrew, 1981). Subsequently, MacAndrew, 1985, constructed the Substance Abuse Proclivity scale (SAP) geared to the early detection of “problem engineering alcohol and drug use in younger men.” This study examined the relative efficacy of the MAC-R, as well as other currently used alcoholism scales, the PRO, SAP, and ACK in detecting substance abuse among 1051 inpatient psychiatric adolescents ranging from age 13–17 in a private psychiatric inpatient setting. The relationship between each scale and the SCID-PSUD was examined through kappa coefficients and analysis of variance. The presence of substance abuse was examined within three classifications: Reported no drug use versus any drug use, subjects reporting no use versus those who fell on the continuum of experimentation to multiple diagnoses of abuse; Reported experimentation versus severe use, subjects reporting no use or experimentation with cannabis and/or cannabis versus those who fell on the continuum of using alcohol or cannabis plus another drug to multiple diagnoses of abuse; and Reported symptoms meeting criteria for at least a single diagnosis of substance abuse versus no diagnosis, subjects reporting no symptoms indicating a diagnosis of substance abuse versus those who indicate at least a single diagnosis of substance abuse. Sensitivity and specificity values were generated as an attempt to identify MAC-R, PRO, SAP, and ACK raw cutoff scores that maximize the accurate classification of individuals (based upon level of drug use). Each scale's ability to identify substance abuse/experimentation (sensitivity) improved across the classifications. All scales demonstrated at least good sensitivity within the “Reported symptoms meeting criteria for at least a single diagnosis of substance abuse versus no diagnosis classification. With regard to specificity, the PRO and SAP scales revealed excellent specificity within the “Reported no drug use versus any drug use” classification and poor specificity within the “Reported symptoms meeting criteria for at least a single diagnosis of substance abuse versus no diagnosis.” The MAC-R and ACK scales maintained stronger specificity within the “Reported symptoms meeting criteria for at least a single diagnosis of substance abuse versus no diagnosis classification.” Additionally, the impact of gender, age, and reported symptoms of psychopathology was examined by comparing the true positives and false negatives obtained from each scale. The results were varied. Report of externalizing symptoms was revealed as the most consistent difference between true positives and false negatives. The impact of gender was less consistent and age was not revealed as a significant factor for any of the scales. The MAC-R obtained the lowest overall success rate and the ACK scale obtained the highest overall success rate. The clinical utility and limitations of all four instruments are discussed as well as the applications for school-child clinical psychologists.* *Originally published in DAI Vol. 59, No. 7. Reprinted with corrected school.
Psychotherapy|Public health|Psychological tests
Muniz, Elizabeth, "The relative efficacy of measures of adolescent substance abuse" (1998). ETD Collection for Pace University. AAI9840691.
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