Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

46 II. ASSESSMENT OF ADDICTIONby severity of the predisposing liability (Vanyukov et al., 2003). In effect, thefactors contributing to the risk for one type of drug abuse largely apply to allother abusable drugs.The onset of use of each type of substance needs to be documented todescribe fully the natural history of consumption. As each type of substanceemerges in the person’s history, it is essential to ascertain whether it hasreached problematic severity to warrant a diagnosis of abuse or dependence. Inaddition, the occurrence of remission and number of lifetime episodes should bedescribed. Moreover, polydrug use should be investigated because of the substantiallethal risk posed by the combined use of psychoactive drugs. For example,conjointly using alcohol and benzodiazepines is especially dangerousbecause of the risk of respiratory arrest.To date, no single assessment measure evaluates all aspects of consumptionbehavior and its psychological manifestations. Certain instruments measurequantity and frequency, others measure severity, and yet others measure patternsof current and lifetime abuse. Several rating scales quantifying severity ofalcohol problems in adults are, however, routinely used. The Michigan AlcoholismScreening Test (MAST; Selzer, 1971) is best known for this purpose.The MAST is easy to administer, because it consists of only 25 true–false statements.Paralleling the MAST, the Drug Abuse Screening Test (DAST; Skinner,1982) is a self-report measure that is brief (20 items) and easy to score.Alcohol problems can also be evaluated within a multivariate perspectiveemploying the Alcohol Use Inventory (AUI; Wanberg & Horn, 1985). Thisinstrument captures primarily the motivational aspects of alcohol use. TheAUI, consisting of 228 items in a self-report format, can be administered toindividuals or groups. A limiting characteristic of the AUI is that the questionsare not phrased to inform about a specific time frame.A frequently used instrument to assess problem severity is the AddictionSeverity Index (McLellan, Luborsky, Woody, & O’Brien, 1980). This interviewwas designed to assist treatment planning. A homologous version has also beendeveloped for adolescents. Referred to as the Teem Addiction Severity Index(T-ASI; Kaminer, Bukstein, & Tarter 1991), this semistructured interviewinforms about problem severity in multiple spheres of health and psychosocialfunctioning.A subscale of the Minnesota Multiphasic Personality Inventory (MMPI)—the MacAndrew Alcoholism Scale (MAC)—consists of 49 items that differentiatepersons with psychiatric disorders from those with substance use disorders.Another important feature of the MAC is that it assists in the assessment ofparticular characteristics associated with addiction, such as impulsivity, poorjudgment, and sensation-seeking behavior. Also, when analyzed within thecontext of the MMPI validity scales, the MAC can identify persons who mightbe minimizing their substance abuse by endorsing socially desirable responses. It