Detection, assessment, and diagnosis of alcoholism. Current techniques

The need for a continuing evolution in methods of detection, assessment, and diagnosis of alcohol abuse and alcohol dependence disorders is emphasized as a necessary step toward altering the stagnating effects of several static and outdated constructs and practices which, despite their humanitarian benefits, may actually be impediments to progress in prevention and treatment. Distinctions are drawn among the purposes and techniques of detection, assessment, and diagnosis; although all three activities are vital, it is the last that must provide a logical basis for understanding causes, courses, and treatment for health problems. Thus far, there has been little genuine progress beyond simply naming the problems we attempt to treat. To illustrate the promising directions that progress might take and to recommend research advances, recent developments in detection, assessment, and diagnosis over the past 5 years are reviewed and critiqued. Special attention is paid to the NCA Diagnostic Criteria and its newest modifications, the Michigan Alcoholism Screening Test and its derivatives, the MacAndrew Scale, the Mortimer-Filkins test, the Essential-Reactive Alcoholism Interview Schedule, and the Alcohol Use Inventory. All of these approaches have demonstrated their utility, but none has yet fulfilled its potential. Their relative advantages are discussed, their flaws are identified, and suggestions are given as to how researchers and clinicians might better use the available tools.