Alcohol and Drug

Consumption of alcohol and other drugs is closely linked to developmental processes. Not surprisingly, therefore, it unfolds in a more or less regular order. Typically, consumption begins with licit compounds (alcohol, tobacco) and progresses, if at all, to the use of illicit drugs. Although much has been written about the gateway hypothesis, in which drug use staging is presumably influenced by prior history of drug use (Kandel, 1975), the evidence to support this speculation is at best equivocal (Morral, McCaffrey, & Paddock, 2002). Rather, the progression across stages of substance use is most parsimoniously explained by severity of the predisposing liability (Vanyukov et al., 2003). In effect, the factors contributing to the risk for one type of drug abuse largely apply to all other abusable drugs.

The onset of use of each type of substance needs to be documented to describe fully the natural history of consumption. As each type of substance emerges in the person's history, it is essential to ascertain whether it has reached problematic severity to warrant a diagnosis of abuse or dependence. In addition, the occurrence of remission and number of lifetime episodes should be described. Moreover, polydrug use should be investigated because of the substantial lethal risk posed by the combined use of psychoactive drugs. For example, conjointly using alcohol and benzodiazepines is especially dangerous because of the risk of respiratory arrest.

To date, no single assessment measure evaluates all aspects of consumption behavior and its psychological manifestations. Certain instruments measure quantity and frequency, others measure severity, and yet others measure patterns of current and lifetime abuse. Several rating scales quantifying severity of alcohol problems in adults are, however, routinely used. The Michigan Alcoholism Screening 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 perspective employing the Alcohol Use Inventory (AUI; Wanberg & Horn, 1985). This instrument captures primarily the motivational aspects of alcohol use. The AUI, consisting of 228 items in a self-report format, can be administered to individuals or groups. A limiting characteristic of the AUI is that the questions are not phrased to inform about a specific time frame.

A frequently used instrument to assess problem severity is the Addiction Severity Index (McLellan, Luborsky, Woody, & O'Brien, 1980). This interview was designed to assist treatment planning. A homologous version has also been developed for adolescents. Referred to as the Teem Addiction Severity Index (T-ASI; Kaminer, Bukstein, & Tarter 1991), this semistructured interview informs about problem severity in multiple spheres of health and psychosocial functioning.

A subscale of the Minnesota Multiphasic Personality Inventory (MMPI)— the MacAndrew Alcoholism Scale (MAC)—consists of 49 items that differentiate persons with psychiatric disorders from those with substance use disorders. Another important feature of the MAC is that it assists in the assessment of particular characteristics associated with addiction, such as impulsivity, poor judgment, and sensation-seeking behavior. Also, when analyzed within the context of the MMPI validity scales, the MAC can identify persons who might be minimizing their substance abuse by endorsing socially desirable responses. It is important to note that individuals with substance abuse disorders who are court-ordered to receive a drug and alcohol evaluation are often motivated to hide or minimize their substance abuse (Shaffer, 1992).

Psychometric tests designed specifically for adolescent drug users have also been validated. The Personal Experience Inventory (PEI; Henly & Winters, 1988) and the Chemical Dependency Assessment Survey (Oetting, Beauvais, Edwards, & Waters, 1984) are two examples. The PEI, suitable for a clinical population, assesses multiple psychosocial domains that may be adversely affected by substance abuse.

The Drug Use Screening Inventory (DUSI; Tarter, 1990) is the most recently developed self-report that is in widespread use. This inventory has homologous forms for adolescents and adults. It profiles frequency of substance use behavior in conjunction with severity of disturbance in 10 spheres of functioning that are integral to both the etiology and sequelae of substance abuse. Each scale quantifies problem severity from 0 to 100%. The measurement domains are (1) substance use consequences, (2) psychiatric disorder, (3) health status, (4) behavior disorder, (5) school performance, (6) work adjustment, (7) social competence, (8) peer relationships, (9) family adjustment, and (10) leisure and recreation. The revised DUSI-R also contains a Lie scale as a validity check. The reliability and validity of the DUSI-R, as well as cutoff scores for diagnosis, are documented (Kirisci, Hsu, & Tarter, 1994; Tarter & Kirisci, 1997). Importantly, the overall problem density score in early adolescence is predictive of substance use disorder by young adulthood (Tarter & Kirisci, 2001).

It is readily apparent that psychological inventories that measure the mul-tifaceted topology of alcohol and drug use have not been developed. The previously described procedures only clarify current use patterns and problem severity. Other information that can most easily be gathered in the course of an interview is also important to obtain. Questioning should therefore be directed at determining the following: (1) patterns of substance use (e.g., episodic vs. continuous), (2) context of substance use (solitary vs. social consumption), (3) availability of drugs and opportunity to access drugs in the social environment, (4) perceived importance of drugs, (5) expected and experienced effects of drugs on mood and behavior, and (6) family history of drug and alcohol abuse.

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