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1. SUBSTANCE ABUSE ASSESSMENT, DIAGNOSIS, AND RELATED PROBLEMSMichigan Alcoholism Screening Test (MAST) (Selzer, 1971). The MAST is a relatively simple, inexpensive, and widely used alcoholism screening instrument that was designed principally to provide a quantifiable, structured interview instrument for the detection of alcoholism. It has been widely used with many different subject groups. These include alcoholics, persons convicted of driving while intoxicated, other social or problem drinkers, drug abusers, psychiatric patients, and general medical patients. It consists of 25 face-valid questions that require a simple "yes" or "no" answer, which can be rapidly administered. The original normative sample, used by Selzer (1971) to develop a scoring system with a cut-off score for diagnosing the subject as having an alcohol problem, consisted of 1) 41 white males admitted to the hospital for alcoholism; 2) 67 white male blue-collar employees; and 3) 36 white males visiting an allergy clinic. The age range was 19 to 73 years. The convergent validity of the MAST was assessed originally by searching the records of legal, social, and medical agencies and reviewing subjects' driving and criminal records. In the original study by Selzer (1971), of 128 diagnosed as problem drinkers, the MAST test missed only two. But Rounsaville and associates (1983) later reported that one-fourth of a group identified as alcohol dependent by the Research Diagnostic Criteria (RDC) indicated that they had no alcohol-related problems on the MAST. The accuracy of the screening of alcoholics by MAST has been found to be only "moderately satisfactory," according to Hedlund and Vieweg (1984). In a validation study, (Moore 1972), of 400 adult psychiatric inpatients, 78 percent agreement was found between the MAST and the psychiatrists' opinions on whether the patient was a "problem drinker" or "alcoholic." Its internal consistency and test-retest reliability appear to be satisfactory. Reported alpha coefficients from nine different studies ranged from .83 to .95. Zung (1982) reported test-retest reliability coefficients of .97 for 1-day retest interval, .86 for 2-day interval, and .85 for 3-day interval, when using a psychiatric population (N = 120). Skinner and Sheu (1982) obtained a test-retest reliability coefficient of .84 for an average 4.8 month retest interval, with a sample of 91 psychiatric patients. The time required to administer is approximately 7 minutes. Test items are available from the source listed below (either without cost or at nominal cost). Access:
Manson Evaluation (ME) Revised (Manson and Huba, 1987). This 72-item instrument has been administered to more than a quarter of a million individuals for use as a screening measure of alcohol abuse. It also measures anxiety, depression, depressive fluctuations, emotional sensitivity, resentfulness, aloneness, and quality of interpersonal relations. Five to 10 minutes are required for either individual or group administration. The test form is easy to use and has a unique AutoScore system, which makes it possible to score, profile, and interpret the test in just a minute or two. A Probability Index for Alcohol Abuse Proneness indicates the degree of likelihood that the subject is abuse prone. Scoring can be done by computers and interpretive reports generated. A normative sample developed in 1985 consisted of 326 applicants (147 males and 179 females) for clerical, manual labor, and professional positions at a medium-size company in Los Angeles. The age range was from 16 to 60 years; mean age, 30 years (S.D., 9 years). The mean education was 14 years of school completed (S.D. = 2 years). No race/ethnic distribution is reported. The Cronbach Alpha internal consistency reliability was .87 for this total sample. Validity was determined in a study in which each of the 71 items analyzed separately differentiated known alcoholics from known non-alcoholics to a statistically significant degree. Also, a cut-off score of 21 points for males and 26 points for females correctly diagnosed 79 percent of males and 84 percent of females as alcoholic. Costs:
Add 10% shipping and handling, plus applicable tax in California. Call for current prices and ordering information. Access: The Chemical Dependency Assessment Profile (CDAP) (Harrell et al., 1991) is a 235-item, multiple-choice, and true-false self-report instrument, to assess alcohol and drug use and chemical dependency problems. The 11 dimensions measured include quantity/frequency of use, physiological symptoms, situational stressors, antisocial behaviors, interpersonal problems, affective dysfunction, attitude toward treatment, degree of life impact, and three "use expectancies" (i.e., the client's expectation that use of the substance a) reduces tension; b) facilitates socialization; or c) enhances mood. An example of a "use expectancy" item is, "I get aggressive or violent when using alcohol." This instrument probably develops as much detailed information related to substance use, abuse, and dependency as any of the others described in this manual; there are 90 items on alcohol use and problems alone. The questionnaire covers chemical use history, patterns of use, reinforcement dimension of use, perception of situational stressors, and attitudes about treatment, self-concept, and interpersonal relations. Adequate internal consistency reliability coefficients, calculated separately for each of the 11 dimensions, ranged from .60 to .88. Test-retest reliability (after 6 to 9 days) was supported by correlations ranging from .77 to .96 separately for the 11 dimensions. The degree of validity of the CDAP (i.e., the degree to which it measured what it is intended to measure) was determined by the degree to which the 11 CDAP scores were found to correlate with 1) MAST scores, and 2) a factor score of Alcohol Use Inventory (AUI). The correlations with the MAST ranged from .33 to .77. The correlations with the AUI ranged from .35 to .79. The best correlations were with the "Use Quantity/Frequency" and "Degree of Life Impact Dimensions" of the CDAP. Normative data are available thus far on only 86 subjects, including 31 polydrug abusers, 27 alcohol abusers, and 28 social drinkers. In this sample, there were 52 males and 48 females, with mean age of 35.3 years (S.D. = 11.6), and mean years of education of 13.2 years (S.D. = 3.1). The race/ethnic distribution was 93 percent Caucasian, 4 percent Black, and 3 percent Hispanic. (A discriminant function classification analysis of the alcohol abuse group vs. polydrug abuse group yielded correct classification of 100 percent of the subjects.) This finding suggests that the normative data are useful, even for this small sample (Harrell et al., 1991). The CDAP can be administered by computer, as well as in paper and pencil format, and a three- to eight-page computerized report can be generated. This report includes the subscale scores for the 11 dimensions. Costs:
Access: The Structured Clinical Interview for Diagnosis (SCID) (Spitzer et al., 1990), and The Revised Diagnostic Interview for Children and Adults (DICA-R) (Reich et al., 1990). These two psychiatric interview forms use the DSM-III-R diagnostic criteria for enabling the interviewer to either rule out or to establish a diagnosis of "drug abuse" or "drug dependence" and/or " alcohol abuse" or "alcohol dependence." The DSM-III-R criteria for substance abuse diagnoses are the same for adolescents as for adults. The SCID can be used for adolescents as well as for adults. The questions on the DICA-R are worded somewhat more appropriately for adolescents. These diagnoses can be made by the examiner asking a series of approximately 10 questions of a client. The DSM-III-R criteria for determining a diagnosis of "Psychoactive Substance Abuse" are:
The criteria required for establishing a DSM-III-R diagnosis of "dependency" are more severe than required for "abuse." Two of these criteria, for example, are: 1) "Characteristic Withdrawal Symptoms," and 2) "Marked Tolerance" (need for at least a 50% increase in the amounts of substance used to achieve intoxication or desired effect). (There are apparently no normative data available as yet, based on a general population sample, for either adolescents or adults.) The interview time for determining the presence of a substance abuse/dependency diagnosis with the SCID is approximately 10 minutes. The SCID only is available from: A Starter Kit, Item 84S1, including a user's guide and 10 instruments, is priced at $10. The DICA-R only is available from: Kit is available for $50. The SCID and the DICA-R are available from: MHS prices for the SCID and DICA-R are as follows: Costs:
2. MEDICAL PROBLEMS AND PHYSICAL HEALTH STATUSGeneral Health Rating Index (GHRI) (Davis and Ware, 1981; Ware, 1984; Ware, 1976). This 23-item self-administered questionnaire measures "perceptions of past, present, and future health status, as well as worry about health and personal views regarding susceptibility to illness." This questionnaire, which requires approximately 7 minutes to complete, differs from other instruments for evaluating health status in that it does not include items on specific illnesses, diseases, symptoms, or components of health. It appears to assess the physical and social role limitations due to poor health and/or acute physical and psychiatric symptoms. This instrument was used in the Rand Health Insurance Study (HIS) on a sample of 4,444 adults and children at six sites in four States. Norms for various age groups and for the two genders are available based on the general populations of these four States, including representation from various minority ethnic groups. The curve of the GHRI score distribution is roughly symmetrical in a general population. The GHRI has demonstrated internal consistency reliability of .89 in a general population. Empirical evidence of validity is also favorable. Test-retest reliability coefficients, based on retesting at 2- to 6-week intervals, are "somewhat lower" than the internal consistency coefficients. Construct validity was established by a factor analysis, which confirmed the basis for the six subscales. Convergent validity for various ways to use the GHRI has been established by developing significant correlations of the GHRI summary scores with 35 different measures of health status. The summary score was also shown to discriminate between those with and without a chronic disease. Administration time is 10 minutes to complete. A copy of the GHRI form and of the norms for scoring have been available thus far for no cost. Access: 3. ACADEMIC SKILLSThe Wide Range Achievement Test Revised (WRAT-R) (Jastak and Wilkinson, 1984). This is a well-standardized test that is widely used with children, adolescents, and adults for a quick evaluation of reading, spelling, and arithmetic skills and performance. Two levels of the test are available: Level 1 (ages 5-11) and Level 2 (ages 12-adult). It is a time-limited test with approximately 5 to 10 minutes allowed for each of three sections. Reliability coefficients range from .90 to .97 for various ages. Validity is well related to external criteria, such as some longer tests of reading, spelling, and arithmetic skills. Norms based on a national, stratified sample (including varied ethnic and racial groups) are available for raw scores, grade equivalents, standard scores, and percentile ranks. The test is hand scorable. Costs:
Access: A revised edition of the WRAT-WRAT3- was released in September 1993. The WRAT3 features a new national stratified sample, new grade ratings, scaling and item analysis by the Rasch Method, and new test forms. Prices are as follows:
4. EMPLOYMENTIndex of Job Satisfaction (Brayfield and Rothe, 1951). This instrument provides a measure of how much the individual is pleased with the work in which he/she is currently employed. It is a brief test of 18 statements to which the individual responds on a 5-point scale ranging between "strongly agree" and "strongly disagree." Results with this instrument have been found to be reliable, (split half correlation of .87) as well as valid (correlation of .92 with the Hoppock Job Satisfaction scale). The scale also distinguishes between individuals placed on jobs appropriate to their training and interests from those in occupations not in line with their expressed interests. The time required to administer is 5-10 minutes. Cost: Not available. Access: Brayfield, A.H., and Rothe, H.F. (1951). Journal of Applied Psychology, 35, pp.307-311. Miller, D.C. (1991). Handbook of Research Design and Social Measurement, (5th ed.), Newbury Park, CA: Sage Publications, pp. 466-468. Note on assessment of employment: Possibly standardized employment instruments are appropriate for use with substance-abusing clients. This task can also be accomplished in a less formal, but systematic, fashion by asking the client to review his/her educational-vocational training and employment history. The combination of this background information, the client's current employment status, and expressed attitudes toward work should enable the counselor to judge whether there is any relationship between the substance abuse and job experiences. It may also identify employment history links with other social and emotional problems. This is relevant to the type of rehabilitation or treatment program most appropriate for the client. 5. SOCIAL LIFE STYLE AND PROBLEMSSocial Life Feelings Scales (SLFS) (Schuessler, 1982). This instrument consists of 12 relatively independent scales. Each scale consists of 5 to 14 statements in which the individual is asked whether he/she agrees or disagrees. For each scale, there are norms to judge the social life feelings of the individual. The examiner need not administer all 12 scales, but merely select those perceived as appropriate for the person being assessed. Some of the scales that seem most useful for evaluating a drug abuser's social adjustment are Doubt About Self-Determination; Doubt About Trustworthiness of People; Job Satisfaction/Career Concerns; People Cynicism (cynical about people's motives); Feeling Demoralized/Future Outlook.
Social Intelligence Test (Moss et al., 1990). This test, intended to evaluate the subject's social perceptions and sensitivity, consists of items to which the individual is asked to express an opinion. An examiner is required for administration. Six factors are measured: 1) judgement in social situations; 2) recognition of the mental state of another person; 3) the feelings that another person is experiencing; 4) accuracy when observing human behavior; 5) memory for names and faces; 6) sense of humor. Percentile norms are provided separately for high school, college, and adult populations, by means of which a client's social perceptions and sensitivity can be evaluated. Administration time is 50 minutes. A hand key is available for scoring. Pkg. of 25 is $12.00. Access: 6. FAMILY AND MARITAL RELATIONSHIPS AND PROBLEMSThe Family Environment Scale (FES) (Moos and Moos, 1981), is a "whole family" assessment, an instrument that measures the family environment or climate. This 90-item questionnaire includes 10 subscales, each composed of nine items, and these subscales compose three primary domains: 1) personal growth (independence, achievement orientation, intellectual-cultural orientation, active recreational orientation, moral-religious emphasis); 2) family interaction and relationships (cohesion, expressiveness, conflict); 3) system; maintenance dimensions (organization, control). Three different test booklets are available: 1) the Real Form, which measures an individual's perception of the family as it is; 2) the Ideal Form, which asks the individual how the family should be; and 3) the Expected Form, which asks the individual to predict family behavior in new situations. Administrative time of the test ranges from 15-20 minutes. Norms are available, based on 285 families of various sizes, and including adequate numbers of African-American and Mexican-American families, but low SES families are underrepresented in this original normative sample. As reported by Moos (1990), "...the FES subscales generally show adequate internal consistency, reliability, and stability over time when applied in samples that are diverse; the items also have good content and face validity. An extensive body of research supports the construct, concurrent, and predictive validity of the FES." The internal consistency reliability coefficients, based on 814 subjects, are acceptable, ranging from .64 to .79 for the 10 subscales. The test-retest reliability coefficients, based on 47 subjects, with an 8-week interval between testings, are acceptable, ranging from .73 to .86 for the 10 subscales. Discriminant validity was established by the fact that the inter-correlations between the 10 subscales scores, for the 814 subjects, range from .01 to .38, and the average inter-correlation was .20. Costs:
Access: The Family Assessment Measure (FAM-III) (Skinner et al., 1983), which was developed to provide quantitative indices of family strengths and weaknesses, is a 134-item self-report instrument that can be completed by a parent and child with adequate reading ability in approximately 45 minutes. The most recent version, FAM-III, consists of three scales, each of which provides a different perspective on the family: 1) a 50-item "General Scale" examines overall family health; 2) a 42-item "Dyadic Relationships Scale" measures how each family member views independently the dyadic relationships of each family dyad; and 3) a "Self-Scale" (42 items), which reports the family member's perception of his/her functioning in the family. FAM-III also has seven subscales to assess dimensions of family functioning and status: Task Accomplishment; Role Performance; Communication; Affective Expression; Involvement; Control; and Values and Norms (which include specific cultural influences and values handed down from earlier generations). The FAM-III also includes subscales that measure the response biases ("Denial/Defensiveness") of the individual family member completing the form "Social Desirability." Norms based on 247 normal adults and 65 normal adolescents, as well as on clinical families, are available by writing to Dr. Harvey Skinner (see address below). The statistical analyses to determine reliability and validity involved 475 families (933 adults and 502 children). Internal consistency reliability coefficients were very adequate: General Scale (.93), Dyadic Scale (.95), and Self-Rating Scale (.89). Intercorrelations between the content subscales were moderately high (.55 to .79) suggesting "that a general factor of family health or pathology underlies the content subscales" (Skinner, 1978). Discriminant validity was supported by the power of FAM-III to differentiate 133 "problem families" (defined as having one or more members receiving professional help for psychiatric, emotional, alcohol, drug, or school problems) from 342 nonproblem families. The problem families reported more dysfunction, to a significant degree, in the areas of Role Performance and Involvement (interest in each other). Only a moderate level of agreement between spouses was found in the rating of family functioning: 1) a median correlation of .36 for the profiles of the subscale scores of 74 normal couples, and 2) a median correlation of .51 for the profiles of the subscale scores of 43 clinical couples. Reliability, as measured by internal consistency estimates, is reported to be excellent. Studies on its validity are incomplete. Only the Role Performance and Involvement dimensions have been shown thus far to differentiate problem families from nonproblem families. Inquiries: Access: Costs:
Family Satisfaction Scale (Olson et al., 1982). This brief instrument consists of 14 items, each of which is a 5-point rating scale measuring the degree of satisfaction to 14 different aspects of family life. The theoretical model on which this instrument was constructed results in two underlying factors: family cohesion and family adaptability. The focus of the items is on the subject's degree of satisfaction with the amount of the cohesion dimension and the amount of adaptability dimension perceived in the family. The norms for this scale were derived from the scores obtained in it by 412 adolescents who participated in a national survey of families that were "primarily Caucasian and Lutheran." The standardization sample was 433 university students. Cronbach Alpha coefficients of reliability of .82 and .86 were obtained for the cohesion and adaptability subscale, respectively. The total scale yielded a Cronbach Alpha of .90. Access: The Family Crisis-Oriented Personal Evaluation Scales (F-COPES) (McCubbin et al., 1982) is a brief 29-item, 5 subscales inventory that measures two types of family coping mechanisms: internal ("the ways in which the family handles difficulties and problems that arise between family members"); and external ("the ways in which the family handles problems and demands which come from the social environment"). The five subscales are: Acquiring Social Support; Reframing (defined as "...the family's capability to redefine stressful events in order to make them more manageable"); Seeking Spiritual Support; Mobilizing the Family to Acquire and Accept Help; and Passive Appraisal. These five scales were derived by a factor analysis of the 49 items of a pilot instrument. The prefix for all items is, "When we face problems or difficulties in our family, we respond by [-item-]." The F-COPES can be readily completed by most subjects over 12 years of age. Norms are available separately for males and females, and for adolescents and adults. A normative sample (N = 2.692), consisting of 1,140 couples and 412 adolescents, was derived from 31 States. This sample was predominantly Lutheran and Caucasian. Cronbach's Alpha coefficients of reliability ranged from .63 for the Passive Appraisal scale to .83 for the Acquiring Social Support scale, (based on a sample of 2,582 subjects). The test-retest (over a 4- to 5-week period) reliability coefficients ranged from .61 for the Reframing scale to .95 for the Seeking Spiritual Support scale. The administration time is 1520 minutes to complete. A manual entitled Family Inventories: Inventories Used in a National Survey of Families Across the Family Life Cycle is available (see FIP Price Schedule, on the next page). The forms required for administering the F-COPES (as well as the ENRICH and the Parent-Adolescent Communicating instruments) are presented in the NIDA manual and may be photocopied with the permission of Dr. Olson. The Enrich Inventory (Fournier et al., 1983). This 125-item instrument to which the individual responds on a 5-point scale ranging between "strongly disagree" and "strongly agree," probes various aspects of a couple's relationship, such as communication, satisfaction with the relationship, roles, leisure activities and interests, financial management, and personality issues. There are 10 items to measure each of 11 content categories: Idealistic Distortion; Marital Satisfaction; Personality Issues; Communication; Conflict Resolution; Financial Management; Leisure Activities; Sexual Relationship; Children and Marriage; Family and Friends; Equalitarian Roles; and Religious Orientation. Also included are 15 items on "Idealistic Distortion," a revision of the Edmond's Social Desirability Scale. The manual presents the definitions and concepts for each of the 11 content categories, and clarifies the meaning of the individual scores. Separate norms for males and females are available for ENRICH, based on 672 couples (1,344 individuals), referred from Lutheran churches in Minnesota. Test-retest reliability coefficients, which are adequate, range between .77 and .92. It is reported (Fournier et al., 1983) that validity was demonstrated by findings. Significant correlations have been found between ENRICH scores and scores of previously established marital satisfaction tests such as the Locke-Wallace Marital Adjustment Scale. The administration time is 30-45 minutes. Dyadic Adjustment Scale (DAS) for marital and couple adjustment (Spanier, 1976). The DAS consists of 37 statements to which the individual responds. Some of the scales have five points, others have six points, and a few have seven points. Each item deals with the quality of how members of a couple relate to each other; they deal with such factors as agreement, affection, dyadic satisfaction, and cohesion. The instrument was carefully developed and has been widely used both for research and in clinical practice. Reliability coefficients for internal consistency range between .76 and .96, which are quite favorable. The scales validly discriminate between married and divorced samples, as well as between distressed and non-distressed groups of individuals. Construct validity is reported as .86 and .88, which is unusually high. The Dyadic Adjustment Scale is a self-report measure of relationship adjustment. A comprehensive manual describes the development and clinical uses of this scale. Extensive research with over 1,000 published studies has supported the use of this measure in determining the degree of relationship dissatisfaction couples are experiencing. A total score below 100 points is indicative of a relationship distress. Four factored subscales are scored that include: Dyadic Satisfaction; Dyadic Cohesion; Dyadic Consensus; Affectional Expression. The DAS can be administered using either QuikScoreTM profile forms or directly on the computer. Brief interpretive statements are also output from the computer version. Each person's responses can be saved for future reference or research purposes. The computer program allows for 50 administrations. Access: Costs:
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