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Resurrecting the ICAS: a competitor for the MAC in screening medical patients for alcoholism?
R C Colligan1, L J Davis, R M Morse
1Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota 55905.
Abstract:
Although the MacAndrew scale (MAC) is the most widely used of the MMPI alcoholism screening scales, evidence to support its continued use is equivocal, and recent data raise serious questions about its efficacy in the screening of medical patients. In comparison, the Institutionalized Chronic Alcoholic Scale (ICAS), an 8-item scale, has an equivalent correct classification rate among male alcoholics and is significantly better than the MAC scale at identifying female alcoholics. Furthermore, misclassification rates among medical patients and normal persons are substantially lower for the ICAS than for the MAC scale, although the ICAS overidentifies potential alcoholism among normal women and female medical patients. However, reliability coefficients across the criterion and contrast samples are disappointingly low, and the use of the ICAS cannot be defended on that basis.
Insights
The Institutionalized Chronic Alcoholic Scale (ICAS) shows promise for screening alcoholism, especially in women, but its reliability is questionable. The MacAndrew scale (MAC) may be less effective for medical patients.
Area of Science:
- Psychological Assessment
- Clinical Psychology
- Substance Abuse Research
Background:
- The MacAndrew scale (MAC) is a widely used MMPI alcoholism screening tool.
- Recent evidence questions the efficacy of the MAC scale in screening medical patients.
- The Institutionalized Chronic Alcoholic Scale (ICAS) offers an alternative screening method.
Purpose of the Study:
- To compare the efficacy of the Institutionalized Chronic Alcoholic Scale (ICAS) against the MacAndrew scale (MAC) for alcoholism screening.
- To evaluate the performance of both scales in identifying alcoholics within medical patient populations.
- To assess misclassification rates and reliability of both screening tools.
Main Methods:
- Comparative analysis of the MAC and ICAS scales.
- Evaluation of correct classification rates for male and female alcoholics.
- Assessment of misclassification rates in medical patients and normal individuals.
- Reliability analysis using criterion and contrast samples.
Main Results:
- The ICAS demonstrated an equivalent correct classification rate for male alcoholics compared to the MAC scale.
- The ICAS was significantly more effective than the MAC scale in identifying female alcoholics.
- The ICAS exhibited substantially lower misclassification rates among medical patients and normal persons than the MAC scale.
- The ICAS showed a tendency to overidentify potential alcoholism in normal women and female medical patients.
- Reliability coefficients for the ICAS were disappointingly low across samples.
Conclusions:
- The ICAS presents a potentially more accurate screening tool for alcoholism, particularly for female patients, compared to the MAC scale.
- Despite improved classification accuracy, the low reliability of the ICAS raises concerns about its defensible use in clinical settings.
- Further research is needed to address the reliability issues of the ICAS before widespread adoption for alcoholism screening.