MacAndrew versus MacAndrew: the relative efficacy of the MAC and the SAP scales for the MMPI in screening male adolescents for substance misuse

MacAndrew (1965) constructed the MacAndrew Alcoholism Scale (MAC) using adult male alcoholic outpatients and male psychiatric outpatients. Later, he developed the Substance Abuse Proclivity Scale (SAP; MacAndrew, 1986), specifically for screening younger males, using adolescent and young adult substance misusing and nonmisusing males 16 to 22 years of age. Because clinicians frequently apply the MAC to adolescents, we compared the efficacy of the MAC and the SAP scales using a sample of 436 young males between the ages of 13 and 25, who were hospitalized because of substance abuse, and 770 normal young males between the ages of 13 and 25. Results suggest that clinicians should use these scales with great caution.     

Using the Millon Clinical Multiaxial Inventory's Scale B and the MacAndrew Alcoholism Scale to identify alcoholics with concurrent psychiatric diagnoses

The ability of the MacAndrew Alcoholism Scale (MAC) and Scale B of the Millon Clinical Multiaxial Inventory (MCMI) to discriminate independently defined alcoholics with psychiatric diagnoses from other psychiatric patients was examined for males and all alcoholics, using three different criteria of alcoholism. The MAC identified from 80% to 87% of male alcoholics and 76% to 82% of all alcoholics, and from 25% to 52% of male nonalcoholics and 55% to 75% of all nonalcoholics, resulting in a large number of false positives. Scale B identified from 31% to 60% of male alcoholics and 33% to 43% of all alcoholics, and from 73% to 85% of male nonalcoholics and 85% to 94% of all nonalcoholics. The operating characteristics of Scale B showed that it was not as efficient in identifying alcoholics as previous work had indicated. We suggest that Scale B should not be used and the MAC should be used cautiously to discriminate alcoholics with psychiatric disorders from patients without alcoholism.     

Using the Million Clinical Multiaxial Inventory's Scale B and the MacAndrew Alcoholism Scale to Identify Alcoholics With Concurrent Psychiatric Diagnoses

The ability of the MacAndrew Alcoholism Scale (MAC) and Scale B of the Millon Clinical Multiaxial Inventory (MCMI) to discriminate independently defined alcoholics with psychiatric diagnoses from other psychiatric patients was examined for males and all alcoholics, using three different criteria of alcoholism. The MAC identified from 80% to 87% of male alcoholics and 76% to 82% of all alcoholics, and from 25% to 52% of male nonalcoholics and 55% to 75% of all nonalcoholics, resulting in a large number of false positives. Scale B identified from 31% to 60% of male alcoholics and 33% to 43% of all alcoholics, and from 73% to 85% of male nonalcoholics and 85% to 94% of all nonalcoholics. The operating characteristics of Scale B showed that it was not as efficient in identifying alcoholics as previous work had indicated. We suggest that Scale B should not be used and the MAC should be used cautiously to discriminate alcoholics with psychiatric disorders from patients without alcoholism.     

Alcoholic Subtypes and the MacAndrew Alcoholism Scale

Forty-five alcoholics in treatment (29 males and 16 females) who reported substantial alcohol dependence but scored in the nonalcoholic range on the MacAndrew Alcoholism Scale (MAC) were matched with 45 alcoholics who reported a similar degree of alcohol dependence and obtained alcoholic-range scores on the MAC. Results reveal that high MAC alcoholics were characterized by gregariousness, social drinking, belligerence and aggression while drinking, and a high degree of alcohol-related legal problems. Low MAC alcoholics appeared to be a different or less distinctive type of alcoholic; although they were less outgoing and preferred not to drink with others, they experienced a wide range of serious alcohol-related consequences. Low MAC alcoholics were not more likely to have a history of nonsubstance use psychiatric diagnosis and treatment. Cloninger, Bohman, and Sigvardsson's (1981) alcoholic typology was related to MAC scores: There was a greater likelihood that high-MAC alcoholics were Type II and low MAC alcoholics Type I.     

Alcoholic subtypes and the MacAndrew Alcoholism Scale.

Forty-five alcoholics in treatment (29 males and 16 females) who reported substantial alcohol dependence but scored in the nonalcoholic range on the MacAndrew Alcoholism Scale (MAC) were matched with 45 alcoholics who reported a similar degree of alcohol dependence and obtained alcoholic-range scores on the MAC. Results reveal that high MAC alcoholics were characterized by gregariousness, social drinking, belligerence and aggression while drinking, and a high degree of alcohol-related legal problems. Low MAC alcoholics appeared to be a different or less distinctive type of alcoholic; although they were less outgoing and preferred not to drink with others, they experienced a wide range of serious alcohol-related consequences. Low MAC alcoholics were not more likely to have a history of nonsubstance use psychiatric diagnosis and treatment. Cloninger, Bohman, and Sigvardsson's (1981) alcoholic typology was related to MAC scores: There was a greater likelihood that high-MAC alcoholics were Type II and low MAC alcoholics Type I.     

Prorating incomplete Wiggins and MacAndrew Scales

A table is provided for prorating the Wiggins Content Scales and MacAndrew Alcoholism Scale from the Minnesota Multiphasic Personality Inventory (MMPI) when the entire form has not been completed. Conversion factors are given in increments of 10 items for 200 to 400 completed questions. Means, standard deviations, and comparisons of the number of scales over 70 were calculated from 236 profiles, using 200, 250, 300, 350, and 400 items. Results indicate that the conversion factors tend to overestimate scale elevations for the Wiggins scale. The MacAndrew scale can be used for clinical purposes with as few as 200 MMPI items completed, but clinical interpretation of prorated Wiggins scales should be done cautiously.     

A Comparison of Primary Alcoholics,Secondary Alcoholics,and Nonalcoholic Psychiatric Patients on the MacAndrew Alcoholism Scale

The MacAndrew Alcoholism (MAC) and Sc scales of the Minnesota Multiphasic Personality Inventory (MMPI) were examined in four groups of 20 male patients. Comparisons were made among primary alcoholics, secondary alcoholics (i.e., alcoholic psychiatric patients), nonalcoholic psychiatric patients (mixed diagnoses), and conservatively defined, nonalcoholic schizophrenics. Primary alcoholics scored higher on the MAC scale than did secondary alcoholics and other groups; schizophrenics scored lower than all other groups. Primary alcoholics were lower on the Sc scale than schizophrenics but did not differ from other groups. The results support MacAndrew's (1981) distinction between primary and secondary alcoholics and suggest that the MAC scale may enhance differentiation among diagnoses other than alcoholism.     

A comparison of primary alcoholics, secondary alcoholics, and nonalcoholic psychiatric patients on the MacAndrew Alcoholism Scale

The MacAndrew Alcoholism (MAC) and Sc scales of the Minnesota Multiphasic Personality Inventory (MMPI) were examined in four groups of 20 male patients. Comparisons were made among primary alcoholics, secondary alcoholics (i.e., alcoholic psychiatric patients), nonalcoholic psychiatric patients (mixed diagnoses), and conservatively defined, nonalcoholic schizophrenics. Primary alcoholics scored higher on the MAC scale than did secondary alcoholics and other groups; schizophrenics scored lower than all other groups. Primary alcoholics were lower on the Sc scale than schizophrenics but did not differ from other groups. The results support MacAndrew's (1981) distinction between primary and secondary alcoholics and suggest that the MAC scale may enhance differentiation among diagnoses other than alcoholism.     

The Use of the MacAndrew Alcoholism Scale in Detecting Substance Abuse and Antisocial Personality

We evaluated the hypothesis that characterological factors, particularly antisocial personality, influence scores on the MacAndrew Alcoholism Scale (MAC). Using the Washington University research criteria to establish diagnoses, the following subgroups were defined: subjects who received no psychiatric diagnoses; subjects who received diagnoses other than alcoholism, drug dependence, or antisocial personality; and subjects who received a diagnosis of alcoholism, drug dependence, and/or antisocial personality, alone or in combination with other psychiatric diagnoses. The highest MAC scores were obtained by subjects diagnosed as having antisocial personality without alcoholism or drug dependence and subjects diagnosed with antisocial personality, drug dependence, and alcoholism. Alcoholics without antisocial personality or drug dependence, and subjects with other psychiatric diagnoses scored lowest. Although higher MAC scores were obtained by males, MAC scores greater than 24 correctly classified the greatest number of males and females as alcoholic, drug dependent and/or antisocial. These findings are interpreted as consistent with MacAndrew's reinterpretation of the scale as assessing a dimension of personality, rather than solely a tendency to addiction.     

Sex differences on the MMPI-2 substance abuse scales in psychiatric inpatients.

Sex differences on the MMPI-2 addiction scales (MacAndrew Alcoholism Scale-Revised, Addiction Acknowledgement Scale, Addiction Potential Scale) and their ability to distinguish between substance-abusing and nonabusing psychiatric inpatients were examined. Men obtained higher mean raw scores than women on the MacAndrew Alcoholism Scale-Revised and the Addiction Acknowledgement Scale, and substance abusers scored higher on all three scales. Even relatively low cutoff scores, however, on the MacAndrew Alcoholism Scale-Revised resulted in false negative rates of 37 to 39%. The results support the utility of the MMPI-2 substance abuse scales; however, lower cutoff scores should be used with women and within a psychiatric population.     

The use of the MacAndrew Alcoholism Scale in detecting substance abuse and antisocial personality

We evaluated the hypothesis that characterological factors, particularly antisocial personality, influence scores on the MacAndrew Alcoholism Scale (MAC). Using the Washington University research criteria to establish diagnoses, the following subgroups were defined: subjects who received no psychiatric diagnoses; subjects who received diagnoses other than alcoholism, drug dependence, or antisocial personality; and subjects who received a diagnosis of alcoholism, drug dependence, and/or antisocial personality, alone or in combination with other psychiatric diagnoses. The highest MAC scores were obtained by subjects diagnosed as having antisocial personality without alcoholism or drug dependence and subjects diagnosed with antisocial personality, drug dependence, and alcoholism. Alcoholics without antisocial personality or drug dependence, and subjects with other psychiatric diagnoses scored lowest. Although higher MAC scores were obtained by males, MAC scores greater than 24 correctly classified the greatest number of males and females as alcoholic, drug dependent and/or antisocial. These findings are interpreted as consistent with MacAndrew's reinterpretation of the scale as assessing a dimension of personality, rather than solely a tendency to addiction.     

Subtypes of substance abusers: personality differences associated with MacAndrew scores

Several earlier studies have reported clinically relevant personality correlates of high vs low scores on the MacAndrew Scale (Mac) of the MMPI. Unfortunately, these projects have not adjusted for age or nature of abuse. Also, most have assumed that the personality correlates are the same for female patients as for male patients. This study attempts to address these deficiencies. Even after correcting for age and diagnosis, high Mac patients differ from low Mac patients on major scales of the MMPI. The pattern of such differences varies considerably between men and women. Substance abuse treatment implications of these differences are discussed.     

Application of the MacAndrew alcoholism scale to alcoholics with psychiatric diagnoses

The MacAndrew Alcoholism scale scores of 140 male patients from a large VA hospital were examined to assess whether the MAC scale can detect alcoholism among patients with psychiatric diagnoses. There were five diagnostic groups, each with 28 patients: alcoholics, alcoholics with neurotic disorders, alcoholics with personality disorders, nonalcoholic patients with neurotic disorders, and nonalcoholic patients with personality disorders. The MAC scale was able to differentiate alcoholics and nonalcoholic psychiatric patients, but was unable to differentiate either of the alcoholic psychiatric groups from its nonalcoholic psychiatric counterpart. Thus, it appears that the MAC scale may be unable to identify alcoholism among patients with combined alcoholic-psychiatric diagnoses.     

The use of the MMPI special scales in the assessment of delinquent personality.

The MMPI was administered to 401 adjudicated male juvenile offenders, ages 13 to 17, who had been referred to a juvenile court mental health unit for recommendations in court disposition. Mean T scores generated by 86 MMPI clinical and supplementary scales were tabulated and analyzed as to their relationships with completed court offense histories. Twenty-eight of these scales that best described and discriminated between high and low levels of recidivism, crime severity, assault, and property offenses were identified, profiled, and discussed. Data were analyzed by a suggested T-score cutoff of 1.5 standard deviations, univariate, and multivariate (discriminant) analysis. Scales that best discriminated between high and low levels of recidivism and property offenses were Pd (Psychopathic Deviance), Ma1 (Amorality), Pd2 (Authority Problems), Re (Social Responsibility), and MAC (MacAndrew Alcoholism). Low scores on Re (Social Responsibility), Es (Ego Strength), Cn (Control), and St (Social Status) best discriminated between high and low levels of crime severity. High and low levels of assault were best differentiated by Ma3 (Imperturbability), Scale 5 (Masculinity-Femininity), and Pa2 (Poignancy). Although the linear combination of Scales F, 4, 8, and 9 has some utility in the areas of recidivism and property offenses, its discriminative ability is extremely poor for levels of assault and crime severity.     

MMPI substance abuse scales on drug addicts with and without concurrent alcoholism

The range and utility of the MMPI-derived MacAndrew Alcoholism Scale (MAC) and the Heroin Addiction Scale (He) was assessed with a large sample of drug addicts with and without concurrent alcoholism. Results indicated that addicts with a co-existing alcohol problem obtained higher MAC scores than addicts without a current alcohol problem. Opiate abusers scored higher on the MAC than non-opiate abusers. No such effects were observed with the He scale. The MAC is a particularly robust scale that taps generic substance abuse and may even be sensitive enough to detect alcoholism in drug addicts.     

Validity of the Substance Abuse Scales of the MMPI-2 in a College Student Sample

This study assessed the validity of three Minnesota Multiphasic Personality Inventory-2-based (MMPI-2: Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) substance abuse scales. The scales were the MacAndrew Alcoholism Scale-Revised (MAC-R; Butcher et al., i989) and the recently developed Addiction Acknowledgment Scale and Addiction Potential Scale (AAS & APS; Weed, Butcher, McKenna, & Ben-Porath, 1992), Study participants were 308 male and female college students who completed the MMPI-2 and the substance use disorder modules of the Diagnostic Interview Schedule. The MAC-R and the APS had a nonsignificant-to-weak relationship with substance dependence as defined by the Diagnostic and Statistical Manual of Mental Disorders' (3rd ed., rex. [DSM-III-R]; American Psychiatric Association, 1980). The AAS had a moderate ability to identify the 33 study participants who met DSM-HI-R criteria for a substance use disorder, primarily alcoholism, Broadening the definition of substance abuse to a continuum of alcohol/drug problems did not alter the character of findings, These results highlight the relative superiority of direct (AAS) versus subtle (APS, MAC-R) scales to detect substance dependence and support studies that question the overall utility of traditional MMPI scales to identify substance abuse.     

The Relationship of MMPI and Sensation Seeking Scales to Adolescent Drug Use

This study examined the relationship of Minnesota Multiphasic Personality Inventory (MMPI) measure, including the MacAndrew alcoholism (MAC) scale, and the Sensation Seeking Scales (SSS) to adolescents drug use across nine drug categories. Subjects were 51 male and 72 female high school students between the ages of 14 and 18 (mean age = 16 years, 5 months). The drug use/abuse measure consisted of adolescents' self-reports on the Segal (1973) Alcohol-Drug Use Research Survey. Drug categories included for investigation were alcohol amphetamines, barbiturates, caffeine, cocaine, hallucinogens, marijuana, narcotics, and tobacco. Scores from standard MMPI scales, the MAC scale, and the SSS were examined in relation to individual drug use outcomes, and multivariate procedures were used to predict polydrug versus single drug use patterns. Results demonstrated significant and meaningful relationships between personality measures and drug use among adolescents, with consistently strong findings for the SSS.     

The relationship of MMPI and Sensation Seeking Scales to adolescent drug use

This study examined the relationship of Minnesota Multiphasic Personality Inventory (MMPI) measures, including the MacAndrew alcoholism (MAC) scale, and the Sensation Seeking Scales (SSS) to adolescents' drug use across nine drug categories. Subjects were 51 male and 72 female high school students between the ages of 14 and 18 (mean age = 16 years, 5 months). The drug use/abuse measure consisted of adolescents' self-reports on the Segal (1973) Alcohol-Drug Use Research Survey. Drug categories included for investigation were alcohol, amphetamines, barbiturates, caffeine, cocaine, hallucinogens, marijuana, narcotics, and tobacco. Scores from standard MMPI scales, the MAC scale, and the SSS were examined in relation to individual drug use outcomes, and multivariate procedures were used to predict polydrug versus single drug use patterns. Results demonstrated significant and meaningful relationships between personality measures and drug use among adolescents, with consistently strong findings for the SSS.