Short Michigan Alcoholism Screening Test Research Articles

Computerized Screening for Alcohol and Drug Use Among Adults Seeking Outpatient Psychiatric Services

Computerized Screening for Alcohol and Drug Use Among Adults Seeking Outpatient Psychiatric Services

Diagnostic and Other Correlates of HIV Risk Behaviors in a Probability Sample of Homeless Adults

Diagnostic and Other Correlates of HIV Risk Behaviors in a Probability Sample of Homeless Adults

Alcohol Problems and the Differentiation of Partner, Stranger, and General Violence

To explore the relationship between alcohol problems and physical violence with partners and strangers, 457 college men and 958 college women with low, intermediate, or high scores on the Short Michigan Alcohol Screening Test reported conflict tactics on the Conflict Tactics Scale in the past year to and by partners and strangers. More men than women had high alcohol problems scores. Men with alcohol problems were more likely than other men to commit violence toward strangers or to partners and strangers. However, men with alcohol problems were not more likely than other men to commit violence toward partners only. Among women, alcohol problems had little relationship to committing violence or being the victim of violence.

Effects of Gender, Ethnicity, and Medical Illness on Drinking Cessation in Older Primary Care Patients

This study examined the effects of gender, ethnicity, and medical illness on cessation of alcohol consumption in late life by analyzing characteristics that distinguish current drinkers from former drinkers. Participants were 211 medical patients aged 55 to 91 years, recruited from four urban public sector primary care clinics. Respondents completed the Short Michigan Alcohol Screening Test and provided health and demographic data. A subset (n = 139) reported drinking history. Of these participants, 40% reported cessation of alcohol consumption at least 1 year prior to their participation in the study. Older age, hypertension, and heart problems were associated with drinking cessation among women but not among men. In a logistic regression model, drinking cessation was predicted by being unmarried, being a member of an ethnic minority group, heart problems, and diabetes. Physical illnesses may contribute to drinking cessation, especially in older women. Results have implications for alcohol interventions with older adults.

Validation of the Alcohol Use Disorders Identification Test (AUDIT) in urban community outreach and de-addiction center samples in north India.

The Alcohol Use Disorders Identification Test (AUDIT) developed by the World Health Organization for screening disorders related to alcohol use has been shown to have robust psychometric properties. This study compared the performance of AUDIT with that of the Short Michigan Alcoholism Screening Test (SMAST) in a region of North India. A total of 297 consecutive subjects who had used alcohol in the past year were recruited from a de-addiction center (DAC) (n = 97) and a community outreach setting (n = 200) in West Delhi. Using International Classification of Diseases, Tenth Edition (ICD-10) criteria, the relative effectiveness of the AUDIT and the SMAST in identifying alcohol-use-related disorders was assessed and compared. Internal consistency and interscale correlations were evaluated, along with sensitivity, specificity and ROC curve analyses. The AUDIT had very high internal reliability (alpha 0.92) in this Indian sample. There was, in general, good correlation between the total and factor scores of the AUDIT and SMAST (ranging from 0.28 to 0.97), which were higher in the community than in the DAC sample. The AUDIT (area under the curve [AUC] = 0.883) and SMAST (AUC = 0.870) were similar in detecting harmful use of alcohol. The AUDIT optimal cutoff score was 16 (sensitivity 85.3, specificity 89.4) for ICD-10 harmful use and 24 (sensitivity 69.4, specificity 87.5) for ICD-10 alcohol dependence. The AUDIT and SMAST seem to be comparable in their ability to screen subjects with alcohol use disorders. The AUDIT score for screening harmful use in the sample appears to be higher than previously reported. The utility of such high cutoff for screening subjects for intervention is obvious, but it is quite likely that some positive cases might be missed.

Elevated plasma and lung endothelial selectin levels in patients with acute respiratory distress syndrome and a history of chronic alcohol abuse.

Activation of endothelial cells is a critical step in the pathogenesis of acute respiratory distress syndrome (ARDS). Soluble endothelial selectin (sE-selectin), an endothelial cell-specific molecule that mediates leukocyte-endothelial cell adhesion has never been measured in the bronchoalveolar lavage fluid of critically ill patients. Based on the effects of alcohol on endothelial cell and alveolar-capillary barrier function, we hypothesized that chronic alcohol exposure may be associated with increased sE-selectin in ARDS patients. Prospective observational cohort study. Medical and surgical intensive care units; an inpatient alcohol detoxification unit within university-affiliated hospitals. A total of 20 ARDS patients (50% with chronic alcohol abuse); seven individuals with a history of chronic alcohol abuse. Patients underwent bronchoalveolar lavage within 72 hrs of ARDS diagnosis. Individuals with a history of chronic alcohol abuse underwent bronchoalveolar lavage within 7 days of their last alcoholic beverage. A history of chronic alcohol abuse was determined by a Short Michigan Alcohol Screening Test score of > or =3 or a history of an alcohol-related diagnosis. sE-selectin was measured in plasma and bronchoalveolar lavage. Neither severity of illness nor at-risk diagnosis differed by alcohol history. sE-selectin levels in the plasma of ARDS patients who abused alcohol chronically were significantly elevated compared with nonalcoholic ARDS patients (181 ng/mL [56-328] vs. 32 ng/mL [14-55], p <.01). The bronchoalveolar lavage sE-selectin levels from the patients with ARDS and alcohol abuse were also significantly elevated compared with nonalcoholic ARDS patients (1.51 ng/mL [1.09-3.11] vs. 0.69 ng/mL [0.33-0.94], p <.002) and were higher than those measured in individuals with a history of chronic alcohol abuse but without ARDS (0.46 ng/mL [0.12-2.75], p =.15). ARDS patients who chronically abuse alcohol have elevated concentrations of sE-selectin in both the plasma and epithelial lining fluid consistent with altered endothelial cell and alveolar-capillary barrier function.

Validity of the SMAST in Two American Indian Tribal Populations

The standardized evaluation of alcoholism and other psychopathologies in minority populations, particularly American Indians, has long been questioned. This study investigated the validity of one of the most commonly applied assessments for alcoholism—the Short Michigan Alcohol Screening Test (SMAST)—in two distinct American Indian tribal groups. We analyzed data collected from 1989 to 1995 from largely community representative samples of 456 Southwestern and 214 Plains Indians ages 21 or older. For comparison, alcohol dependence was diagnosed using Diagnostic and Statistical Manual of Mental Disorders, Third Edition–Revised (DSM-III-R) criteria from a detailed, modified version of the Schedule for Affective Disorders and Schizophrenia—Lifetime (SADS-L). Accuracy of the SMAST was quantified as sensitivity, specificity, likelihood ratios, and the area under the curve for receiver operating characteristics, using the DSM-III-R diagnosis as the reference. The standard SMAST cutoff score of ≥3 had a demonstrated sensitivity 86% to 95%, but did not perform well in terms of specificity (23%–47%). Significantly higher cutoff scores (≥5 for both genders in the Southwestern tribe and 8 and ≥6 for men and women in the Plains tribe) were required to demonstrate acceptable levels of specificity in both tribes. The findings suggest that the SMAST is not a valid tool to screen for alcohol misuse in these two tribal populations. The highly elevated and different thresholds required from one population to the next and from one gender to the next constitute a significant obstacle to the use of the instrument.

Screening for Paternal Alcoholism: Reliability of a German Version of the F-SMAST

The development of screening instruments for the detection of paternal alcoholism is of both clinical and research interest. F-SMAST, an adapted version of the Short Michigan Alcoholism Screening Test (SMAST), has proven to be a reliable and valid instrument for the assessment of an individual’s father’s drinking history. The present investigation examines the reliability of a German version of the F-SMAST. Internal consistency and test-retest stability (Pearson correlation coefficients on unweighted total scores; ĸ statistics and Yule’s Y of the individual items) are evaluated in a sample of undergraduates (n = 202). Internal consistency of the F-SMAST is re-evaluated in a second study by analysing the responses of alcohol-dependent in-patients (n = 205). The German version of the F-SMAST exhibited excellent reliability in terms of internal consistency and test-retest stability of the unweighted total scores. Test-retest agreement of the individual items was in the acceptable range. Taking into account the lifetime prevalence of alcoholism and several background variables (e.g. marital status and number of real children) a cut score of 6 or 7 on the F-SMAST seems appropriate for the detection of paternal alcoholism.

Work outcomes for female liver transplant recipients with alcohol-related liver disease.

The purpose of this retrospective survey was to describe post-liver transplant work outcomes for female liver transplant recipients with histories of alcohol-related liver disease. The theoretical framework guiding the study was Laffrey's conception of health. The Short Michigan Alcohol Screening Test was used to measure alcohol-related liver disease. Forty-seven female liver transplant recipients whose Short Michigan Alcohol Screening Test scores were indicative of alcohol-related liver disease comprised the convenience sample. Using a mailed questionnaire, post-transplant work and daily activities were assessed. Work was operationally defined as including either employment or household work. Results revealed that 59% of the female recipients were working post-transplant and that working recipients had higher conception of health scores than did non-working recipients.

Parental problem drinking and anxiety disorder symptoms in adult offspring: examining the mediating role of anxiety sensitivity components.

Preliminary studies have implicated childhood exposure to parental problem drinking as a possible factor in the development of anxiety sensitivity (AS). The present retrospective study was designed to examine the role of exposure to distressing parental problem drinking behaviors, over and above the role of parental alcoholism, in the development of various AS components (psychological, physical, and social concerns) in the offspring. We also examined the possible mediating role of AS components in explaining relations between parental drinking problems and anxiety-related symptoms in the adult offspring. A sample of 213 university students provided retrospective reports of both distress related to parental drinking [Children of Alcoholics Screening Test (CAST)] and parental alcoholism [maternal and paternal forms of the Short Michigan Alcoholism Screening Test (SMAST)]. Participants also reported on their own current AS levels [AS Index (ASI)], general anxiety symptoms [State-Trait Anxiety Inventory-Trait subscale (STAI-T)], and lifetime history of uncued panic attacks [Panic Attack Questionnaire-Revised (PAQ-R)]. Scores on the CAST predicted AS psychological and physical concerns (but not social concerns) over and above participant gender and parental alcoholism measured by the SMASTs. Moreover, AS psychological concerns proved a consistent modest mediator of the relations between parental problem drinking on the CAST and both general anxiety and uncued panic outcomes in the offspring. Thus, exposure to distressing parental problem drinking behavior may be one factor that contributes to elevated AS psychological concerns in the child, which in turn may contribute to the development of anxiety disorder symptoms in the offspring.

Comparing the alcohol-related problems survey (ARPS) to traditional alcohol screening measures in elderly outpatients

Older drinkers may incur alcohol-related risks at low consumption levels, but commonly used screening measures do not address alcohol's effects among persons with declining health and increased medication use. We compared the newly developed Alcohol-Related Problems Survey (ARPS) to three validated alcohol screens: the Cut down, Annoyed, Guilty, Eye-opener (CAGE), Short-Michigan Alcohol Screening Test (SMAST), and Alcohol-Use Identification Test (AUDIT). The ARPS classifies drinking as non-hazardous, hazardous or harmful. Non-hazardous drinking is defined as consumption with no known risks for adverse physical or psychological health events. Hazardous drinking is consumption with such risks. Harmful drinking results in adverse events. The AUDIT screens for hazardous and harmful drinking; the CAGE and SMAST identify abusive (e.g. failure to fulfill social obligations) and dependent (e.g. having withdrawal symptoms) drinkers. In this study of 574 current drinkers 65 years and older who completed the ARPS and AUDIT in primary care clinics, half were randomly assigned to complete the CAGE and half, the SMAST. Drinkers who screened positive on the CAGE, SMAST or AUDIT were correctly classified by the ARPS as hazardous or harmful drinkers 91, 75, and 100% of the time, respectively. The majority of ARPS-identified hazardous or harmful drinkers did not screen positive on the CAGE, SMAST or AUDIT. These drinkers had medical conditions or used medications that placed them at risk for adverse health events, none of which was addressed in these three screens. In this study, the ARPS identified nearly all drinkers detected by the CAGE, SMAST, and AUDIT and detected hazardous and harmful drinkers not identified by these measures.

Utility of a composite measure to detect problematic alcohol use in persons with traumatic brain injury

Cherner M, Temkin NR, Machamer JE, Dikmen SS. Utility of a composite measure to detect problematic alcohol use in persons with traumatic brain injury. Arch Phys Med Rehabil 2001;82:780-6. Objectives: To examine factors complicating the study of alcohol-related effects in traumatic brain injury (TBI) patients and to evaluate a composite measure to categorize such patients according to degree of alcohol-related problems. Design: Inception cohort. Setting: Level I trauma center. Patients: Consecutively hospitalized adult TBI patients (n = 156; 73% men; 87% Caucasian; mean age, 30yr; mean education, 12yr). Selection criteria required objective evidence of brain trauma; minimum survival of 1 month postinjury; age 15 years or older; and English speaking. Main Outcome Measures: An index of problematic drinking based on a measure created by combining blood-alcohol level, quantity-frequency of consumption, and the Short Michigan Alcoholism Screening Test. Preinjury characteristics were obtained through structured interview. Results: Participants with highly problematic drinking showed poorer premorbid psychosocial functioning, including lower educational attainment, greater likelihood of problems with the law, lower perceived social support, and greater prevalence of other substance abuse. Conclusion: The composite index is useful in identifying problematic drinkers among TBI patients. Results have implications for interpreting and planning research on the role of alcohol in TBI outcomes.

The prevalence of psychiatric disorders and subsyndromal mental illness in low-income, medically ill elderly.

This study estimated the past and current prevalence of psychiatric illness and subsyndromal mental illness (both pre-relapse and new onset) in a sample of low-income, medically ill older adults. A convenience sample of 95 public sector medical patients aged 55 and older were assessed for the presence of psychiatric diagnosis and symptoms using the Geriatric Depression Scale, Beck Anxiety Inventory, the Short Michigan Alcohol Screening Test, and the Computerized Diagnostic Interview Schedule (DIS-C). Dysthymia and Major Depression were the most prevalent current disorders and Alcohol Dependence the most prevalent past disorder. Overall, 25 percent met criteria for at least one Axis I disorder. An additional 44 percent of patients had subsyndromal mental illness: 14 percent had subsyndromal depression, 17 percent were significantly anxious, and 30 percent were problem drinkers. A prior model predicting current Axis I disorder in younger people was found to be predictive of current Axis I but did not predict to subsyndromal disorder. The rates of psychiatric disorders and symptoms in this older, low-income population were similar to those in other samples of older medical patients. The findings from this research suggest the need for larger epidemiological studies of the prevalence of psychiatric disorders in this disadvantaged aging population. The complexities of this type of research are also discussed.

Detection of acute alcohol intoxication and chronic alcohol dependence by trauma center staff.

Trauma patients with acute alcohol intoxication or chronic alcohol dependence are at greater risk for morbidity and mortality. We hypothesized that relying on clinical suspicion to detect acute alcohol intoxication and chronic alcohol dependence in trauma patients is inaccurate, influenced by injury factors, and biased by race, gender, age, and socioeconomic status. Trauma patients were screened with a blood alcohol concentration and with the Short Michigan Alcohol Screening Test and CAGE questionnaire. Before screening, physicians and emergency department nurses were asked whether the patient was acutely intoxicated (blood alcohol concentration > 100 mg/ dL) or had a chronic alcohol problem. Sensitivity, specificity, positive, and negative predictive values were determined by comparing responses with blood alcohol concentration, Short Michigan Alcohol Screening Test, and CAGE questionnaire results, stratified by injury and demographic factors. Clinical evaluations were obtained on 462 patients. Overall, 23% of acutely intoxicated patients were not identified by physicians. The miss rate increased to one third in severely injured, chemically paralyzed, or intubated patients. Specificity was also poor. Patients with a negative blood alcohol concentration were more likely to be falsely suspected of intoxication if they were either young, male, perceived as disheveled, uninsured, or having a low income (p < 0.05). Staff identified < 50% of patients with a positive Short Michigan Alcohol Screening Test or CAGE, and falsely identified 26% of patients as alcoholic. Formal alcohol screening should be routine because clinical detection of acute alcohol intoxication and dependence is inaccurate. Screening should also be routine to avoid discriminatory bias attributable to patient characteristics.

Prevalence and occupational covariates of mood, anxiety disorders, and alcohol dependence in a French ancillary staff population

The aim of this study was to confirm the high prevalence of three frequent psychiatric disorders : anxiety, depressive illnesses, and alcohol dependence among ancillary staff, and to examine for occupational risk factors. Two hundred and forty-six women were randomly selected from the ancillary staff of the regional hospital centre of Bordeaux, and 186 subjects were interviewed between June 1996 and October 1997. First, a self-administrated questionnaire was completed concerning socio-economic status, lifestyle, health, and working conditions. Second, the two sections of the composite international diagnosis interview (CIDI), devoted to explore anxiety and depression, and the short Michigan alcoholism screening test (S-MAST) were used. Mean age of the subjects was 40.8 years (SD = 8.3 years). During the year preceding the interview, 77 (42.5 %) subjects had stopped their job because of illness. Prevalence of the psychiatric disorders studied was 33.9 % (95 % confidence interval, 27.1-40.7 %). These disorders were related to sickness absence. This is why the use of drugs raises questions for work physicians. Two protective factors associated against depression in logistic regression analysis were found : training at the time of employment, and the task 'cleaning sickroom'. A high prevalence of psychiatric disorders was confirmed and occupational risk factors for the prevalence of increased psychiatric disorders were isolated that could have practical consequences, such as for the training at time of employment.

Prospective analysis of the relation between DSM-III anxiety disorders and alcohol use disorders.

Cross-sectional studies show a robust association between anxiety disorders and alcohol use disorders (comorbidity); however, this methodology does not allow for the testing of causal models. The authors attempted to overcome this limitation by examining comorbid relationships prospectively. Male and female college students were assessed as freshmen (year 1), and then again at years 4 and 7, for selected 12-month anxiety disorders (generalized anxiety disorder, agoraphobia, and social phobia or panic) diagnosed according to the National Institute of Mental Health Diagnostic Interview Schedule (DIS) and DSM-III and for 12-month DIS/DSM-III alcohol use disorders (alcohol dependence alone and alcohol abuse or dependence). Cross-sectionally, the odds of having either an anxiety disorder or an alcohol use disorder were two- to fivefold greater when the other condition was present. Prospectively, the odds of developing a new alcohol dependence diagnosis at year 7 increased from 3.5 to five times for those diagnosed with an anxiety disorder at years 1 or 4. Conversely, the odds of developing a new anxiety disorder at year 7 increased by about four times for those diagnosed with alcohol dependence at years 1 or 4. When alcohol abuse and dependence were combined, the pattern of findings was similar, albeit weaker. Multivariate path models provide similar results and highlight the reciprocal influence of alcohol use disorders and anxiety disorders. Alcohol use disorders (especially alcohol dependence) and anxiety disorders demonstrate a reciprocal causal relationship over time, with anxiety disorders leading to alcohol dependence and vice versa.

DIAGNOSIS AND MANAGEMENT OF ALCOHOL PROBLEMS

Approximately 14 million Americans suffer from alcohol abuse and dependen~e,’~ and drinking remains the most common cause of liver-related mortality in the United States. Forty-four percent of the 26,000 annual deaths from liver cirrhosis are attributed to alcohol use. Even this is likely to be an underestimate because certifying physicians may not be familiar with the decedent’s drinking history or may desire to protect the family from the stigma of a family member being an alcoholic.10 Alcoholic liver disease is also an important cause of morbidity. It has been estimated that between 15% and 30% of heavy drinkers develop advanced liver disease.I9 In 1990, cirrhosis was listed as a diagnosis on approximately 1% of discharges from nonfederal short-stay hospitals for those 15 years and older and was the principal diagnosis for 0.2% of the discharges. Underestimation of alcoholic liver disease on hospital discharge records may exceed that for death certificate^.^^ Because of the adverse effects of alcohol on the liver, alcoholdependent and alcohol-abusing patients commonly are seen in many hepatologists’ practices. Although findings on the physical examination and laboratory tests may provide clues, the diagnosis of alcoholism depends on the history provided by patients and their relatives. The two most commonly employed sets of criteria are the American Psychiatric Association‘s Diagnostic and Statistical Manual of Mental Disorders, ed 4 (DSM-IV)’ and in the World Health Organization’s International Classification of Diseases, 10th rev (ICD-10).36 Both are based on symptoms of alcohol dependence and abuse rather than specific thresholds of drinking frequency, quantity, or patterns. The term alcoholism has been dropped in favor of two distinct categoriesalcokol abuse and alcohol dependence. Alcoholic liver

Alcohol use and readiness to change after spinal cord injury

Objective: To describe alcohol use and motivation to change drinking among persons with recent spinal cord injury (SCI). Design: Survey Setting: Acute inpatient rehabilitation program Patients: Subjects were 58 patients with recent SCI assessed during inpatient rehabilitation. Main Outcome Measures: Short Michigan Alcoholism Screening Test (SMAST), Readiness to Change questionnaire (RTC), and alcohol use questions. Results: Subjects were on average 39 years old, 88% were male, and 86% were Caucasian. Thirty-five percent of the total sample scored in the “alcoholic” range on the SMAST. Twenty-nine (50%) of the sample were considered “at-risk” drinkers. Of these, 6 (21%) were in the precontemplation phase, 13 (45%) were in the contemplation phase, and 10 (34%) were in the action phase with respect to modifying their drinking habits. Multivariate analyses indicated that a positive history of alcoholism and higher daily consumption were associated with greater readiness to change. Conclusions: Soon after SCI, most at-risk drinkers are at least considering changes in their alcohol use. This situation may represent an underutilized window of opportunity to implement interventions designed to reduce postinjury alcohol abuse and related impairments.

Paternal alcoholism, paternal absence and the development of problem behaviors in boys from age six to twelve years.

The purpose of this study was to examine the association between paternal alcoholism, paternal absence, and the development and stability of behavioral problems in boys, from kindergarten to the end of elementary school. A sample of 642 boys originating from low socioeconomic status (SES) families was used. Paternal alcoholism was established using the Short Michigan Alcohol Screening Test. Behavioral problems (opposition, hyperactivity, inattention, physical aggression and anxiety) were assessed by teachers' reports when the boys were 6 and 12 years old. Four groups of boys were created on the basis of paternal alcoholism (nonalcoholic, alcoholic) and family structure (intact families, nonintact/father-absent families). Consistent with personality theories of alcoholism, results showed that a propensity for physical aggression and low anxiety best distinguished sons of male alcoholics (SOMAs) from non-SOMAs at both ages (6 and 12 years), even when SES was controlled. In addition, SOMAs were more oppositional and hyperactive than non-SOMAs at both ages. No significant effects were observed for family structure or age, or an interaction between these factors and paternal alcoholism in the multivariate analysis. The results suggest that problem behaviors in SOMAs begin early and persist over time, and that paternal alcoholism and family structure are not associated with changes in boys' behaviors between kindergarten and the end of elementary school in this population, at least in the sample used.

Prevalence of Alcohol Dependence and Abuse in General Practice

The aim of this study is to deliver representative epidemiological data about the prevalence of alcohol abuse and dependence in general practices in an urban area. In 12 general practices at Luebeck, a Northern German city with 220,000 inhabitants, a total of 929 patients (aged between 14 and 75 years) were screened using the CAGE and the Short Michigan Alcoholism Screening Test. If one of these screening questionnaires or the General Practitioners' assessment of the patient indicated an alcohol problem, the patient underwent a standardized diagnostic interview using the alcohol section of the Schedules for Clinical Assessment in Neuropsychiatry. The prevalence rates according to ICD-10 or DSM-III-R were 3.5% for alcohol abuse and 7.2% for alcohol dependence, the sex ratio was 1:2.8 (female:male). These results are compared with previous findings, and general epidemiological implications of this study are discussed.