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Assessment of Classification Instruments Designed to Detect Alcohol Abuse

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Assessment of Classification Instruments Designed to Detect Alcohol Abuse US Deportment of Transportc'!on National Highway Traffic Safety Administration DOT HS 807 475 December 1988 Final Report Assessment of Classification Instruments Designed to Detect Alcohol Abuse This document is available to the public from the National Technical Information Service, Springfield, Virginia 22161. J r II The United States Government does not endorse products ,A or manufacturers. Trade or manufacturers' names appear only because they are considered essential to the object of this report. f '^ Tecltelcol Report Docon,.wtation P99. 1. Report No. 2. Government Accession No. 3. Recipient's C.t.les He. DOT HS 807 475 4. Title and Subtitle S. Report Dot. December 1988 Assessment of Classification Instruments Designed 6. Performing Organisation cod, to-Detect Alcohol Abuse s I. P.,fer.tin9 Organisation Report No. 7. Autt..t$) C.L. Ponkin, C.H, Kannenberg, J.H. Lacey and P.F. Waller 1' 9. Performing Organization Name and Address 10. Work Unit No. (TRAIS) University of North Carolina Highway Safety Research Center 11. Contrect or Grant Me. 134 1/2 E. Franklin Street, CB #3430 DTNH22-87-R-07328 Chanel Hill, NC 27599-3430 13. Tn. of Repo and Period Covered 12. Sponseeing Agency N. osd Address U.S, Department of Transportation National Highway Traffic Safety Administration Washington, DC 20590 14. Spenaarimg Agency C.d. 15. Supplementary Notes The contracting officer's technical representative on this project was Dr. James Frank of the Office of Driver and Pedestrian Research. 16. Abstract This report summarizes an effort to identify and evaluate instruments currently in use to assess substance abuse problems in driving while impaired (DWI) offenders. The results of a national survey of DWI assessment practices in the United States are reported, including a more detailed examination of procedures in five states.' Operational constraints and needs of jurisdictions are described, with special consideration given to factors within each setting which influence the•selection of particular instruments and their use within that setting: Several instruments are reviewed and evaluated. .our. study of currently available instruments indicated that there were few which appeared to have been developed in a methodologically sound way; and, some of these are older instruments which have not bee modified to accommodate changes in the population served. The newer instruments, with automated scoring, synthesize a large amount of information, have a truthfulness scale, and provide the assessor, judge, and treatment provider with a brief overview of the nature of the individualls problem. However, these instruments still have not been adequately validated by independent investigators, even though they appear to have potential. Therefore, widespread adoption cannot now be recommended. The newer and the most widely used assessment instruments are evaluated and the operational needs of various types of jurisdictions are discussed. Based on information obtained through the national survey, individual site visits, and discussions with persons actively involved in DWI assessments, suggestions are offered for refining the assessment process and assuring greater accuracy in the identification and appropriate referral of those individuals with drinking problems. I* 17. Key Words 18. Distribution Statement Substance abuse assessment instrument Document is available to the U.S. public Alcohol assessment instrument through the National Technical Informatior Drunken driving Service, Springfield, VA 22161 Drunk driving DWI 19. Security Classif. (.f this report) 20. Security Ciesslf. (of this pose) 21. No. of Pogo* 22. Price Unclassified Unclassified Form DOT F 1700.7 (6-72) Reproduction of completed page outh.riuod i ACKNOWLEDGMENTS This project covered a broad area and the information gathered was obtained from a large number of people who spent a considerable amount of time talking with us or writing to us about the procedures which they followed in their states. In each of the sites which we visited, state level coordinators, personnel from departments of motor vehicles, substance abuse assessors, judges and other judicial personnel actively involved with DWI offenders were generous with their time helping us to understand how assessments were conducted and used in their states. We are indebted to all these people. We wish to give special acknowledgment to several people who kindly gave of their time and knowledge. Special thanks to Mr. Pete Martin, Chief, DWI/Criminal Justice Branch, North Carolina Department of Human Resources for his assistance in allowing us to use the results of the national survey as well as the pilot study of DWI assessment in North Carolina. Thanks also are extended to Mr. Gary Cole of Mr. Martin's office who helped us in identifying many instruments available nationwide. Mrs. Peggy James and Ms. Teresa Parks assisted in the preparation of this manuscript. Mrs. Jane Stutts and Mr. Jeff Lowrance kindly reviewed the report. To these persons we offer our thanks. I-I ii i TABLE OF CONTENTS Page 1. INTRODUCTION .................................................. 1 1.1 Background .................................................. 1 1.2 Overview of Research Effort .................................... 4 V 2. AN APPROACH TOWARD IDENTIFYING THE PROBLEM DRINKER .. 7 2.1 Medical Information ......................................:.... 9 2.1.1 Biological Markers of Alcoholism ........................ 9 2.1.2 Medical Records ........................................ 11 2.2 Driving History ............................................... 11 2.3 Reports of Social Agencies ...................................... 14 2.4 Individual Responses to Clinical Interviews and Assessment Instruments ................................................. 14 2.5 Patterns of Alcohol Consumption .............................. 16 2.6 Sociological and Psychological Factors ............................ 16 2.7 Adolescent Problem Drinking .................................. 17 2.8 Summary .................................................... 18 3. REVIEW OF SELECTED SUBSTANCE ABUSE SCREENING INSTRUMENTS ................................................... 20 3.1 Approach to Instrument reviews ................................ 21 3.1.1 Norms ................................................. 24 3.1.2 Reliability .............................................. 24 3.1.3 Validity ............................................... 25 3.2 Reviews of Instruments for Adults ............................. 27 3.2.1 Addiction Severity Index (ASI) ........................... 28 3.2.2 Alcohol Use Inventory (AUI) ............................ 31 V TABLE OF CONTENTS Page 3.2.3 CAGE (Cut down, Annoyed, Guilty, Eye-opener) .......... 33 3.2.4 Craig Analysis of the Substance Abuse Syndrome (CASAS) 35 rr 3.2.5 Driver Risk Inventory (DRI) ............................ 37 3.2.6 Hopkins 20 - Questions Test ............. , .............. 39 3.2.7 Life Activities Inventory (LAI) .......................... 41 3.2.8 MacAndrew Scale of MMPI (MAC Scale) ................. 43 3.2.9 Minnesota Assessment of Chemical Health (MACH) ...... 46 3.2.10 Michigan Alcoholism Screening Test (MAST ............. 49 3.2.11 Modified Criteria - National Council on Alcoholism Diagnosis (MOD-CRIT) ................................ 51 3.2.12 Mortimer-Filkins Test (Court Procedures for Identifying Problem Drinkers) ..................................... 54 3.2.13 Substance Abuse Like Circumstances Evaluation (Automated Drinking Evaluation (SALCE/ADE) ...................... 56 3.3 Reviews of Instruments for Adolescents ........:................. 58 3.3.1 Adolescent Alcohol Involvement Scale (AAIS) ............ 59 3.3.2 Adolescent Chemical Dependency Inventory (ACDI) ....... 62 3.3.3 Juvenile Automated Substance Abuse Evaluation (JASAE) .. 63 3.3.4 Personal Experience Inventory (PEI) ....................... 64 3.3.5 Personal Experience Screen Questionnaire (PESQ) ........... 66 3.4 Evaluation of Assessment Instruments .......................... 68 3.5 Considerations in Instrument Selection .......................... 71 4. REQUIREMENTS AND NEEDS OF THE COURTS AFFECTING INSTRUMENT SELECTION .......................................... 76 4.1 National Survey ............................................... 76 vi TABLE OF CONTENTS Page 4.2 Summaries of Site Visits ........................................ 77 4.2.1 Alaska Assessment Procedures ............................. 78 4.2.2 Arizona Assessment Procedures ........................... 79 `. 4.2.3 Florida Assessment Procedures ............................ 83 4.2.4 Minnesota Assessment Procedures ......................... 86 4.2.5 North Carolina Assessment Procedures .. ................ 89 4.3 Considerations in Instrument Selection and Use .................. 92 4.3.1 State Philosophy .......................................... 92 4.3.2 Legislated Constraints ..................................... 93 4.3.3 Needs of Special Populations .............................. 94 4.3.4 Instrument Modification .................................. 94 4.3.5 Financial Considerations ................................... 95 4.3.6 Training and Certification Requirements for Assessors ....... 96 4.3.7 The Assessor as Treatment Provider ........................ 97 4.3.8 Caseload of the Jurisdiction and Assessors ................... 97 4.3.9 Attitude toward the Use of Computers ...................... 98 4.4 Benefits of Automated Assessment Instruments ................... 98 4.4.1 Ability of Computerized Programs to Generate
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