John P. Allen, Ph.D., M.P.A.
Scientific Consultant to the National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD
The first edition of Assessing Alcohol Problems: A Guide for Clinicians and Researchers has proved extremely popular and helpful for clinicians and researchers concerned with treatment of alcohol–dependent patients. This revision differs from the first edition in several ways.
Many of the instruments it presents have become available only since the publication of the first edition. Each of the chapters has been updated based on the most current research. Perhaps most noteworthy, the revision includes several new sections of chapters dealing with emerging topics, such as assessment of alcohol craving and new uses of biomarkers in treatment and research. In addition, a new chapter has been written dealing with adolescent assessment issues and instruments. Finally, the format of the Guide has been changed from a bound volume to a looseleaf format, which will allow users to add additional pages on new instruments, and the revised Guide will be accessible to users of the Internet.
We are confident that this new version of the Guide will also prove beneficial to the alcoholism treatment and research communities.
Initial examination of potential scales for inclusion in this Guide yielded more than 250 candidates. Final selection of instruments entailed careful review and extensive deliberation by the expert panel who developed this Guide. Decisions were based on the following criteria:
- The instrument must be specific to alcoholism treatment, with the exception of instruments to be included in the new chapters dealing with collateral addictive problems.
- The instrument must be available in English.
- The instrument must be identifiable by name, not simply by description in an article.
- The instrument must yield quantitative scores.
- Psychometric characteristics of the instrument must be described in at least one published source.
- The instrument must be appropriate for use beyond the original study for which it was developed.
- Research on or research using the instrument must have been published in 1995 or later.
- The instrument must merit broad dissemination to the treatment community.
The review panel generally adhered quite closely to these criteria. Certain exceptions were made, however. For example, in important domains in which instrumentation remains scarce, such as adolescent assessment and alcohol craving, some measures are included that are too new to meet all criteria. Such instruments are provided to avoid leaving the clinician and researcher without evaluation options within the less developed domains of alcoholism treatment assessment.
To identify instruments appropriate for inclusion, relevant databases were searched, panel members were queried, and letters asking for additional instruments for consideration were sent to representatives of the alcoholism treatment community. Despite these efforts, some high–quality treatment assessment instruments may be missing. The editors do not presume total comprehensiveness.
ORGANIZATION OF THE GUIDE
The Guide is designed to allow even those new to the field to understand the critical issues involved in formal evaluation of alcohol treatment and in planning treatment for individuals and to select instruments best suited to their purposes.
The Guide begins with a general overview summarizing salient features of formal alcoholism assessment. Fundamental psychometric, methodological, and applied issues and suggested directions for future research are addressed. The overview is followed by a "Quick–Reference Instrument Guide" listing most of the instruments included in this Guide. By providing at–a–glance comparisons of instrument usage, this table may assist researchers and clinicians in identifying instruments and in comparing measures appropriate for use within each domain of treatment assessment. In that we were unable to obtain up–to–date fact sheets on some of the instruments mentioned in the chapters of the Guide, readers are urged to also review the appropriate chapters when selecting instruments to meet their needs.
The Guide is organized into the following assessment domains:
- Screening. Measures identifying individuals likely to satisfy diagnostic criteria for an alcohol use disorder and for whom further assessment seems warranted. Biochemical and self–report measures are addressed in separate chapters within this section.
- Diagnosis. Instruments that yield a formal alcohol–related diagnosis or that quantify symptoms central to the alcohol dependence syndrome. Also covered in this chapter are instruments designed to evaluate craving and urge to drink.
- Assessment of Drinking Behavior. Instruments to delineate the "topography" of drinking behavior, including quantity, frequency, intensity, and pattern of alcohol consumption.
- Adolescent Assessment. Because of the unique differences associated with assessment of adolescents with alcohol problems, this revision of the Guide includes a chapter specific to the needs of this group.
- Treatment Planning. Scales to assist the clinician in developing client–specific treatment plans.
- Treatment and Process Assessment. Measures that assist in understanding the process of treatment such as treatment atmosphere, degree of treatment structure, and the immediate goals or proximal outcomes of treatment.
- Outcome Evaluation. Instruments designed to assess the end results of treatment.
Each assessment domain is addressed by a chapter written by a member of the review panel, and most chapters also include tables for comparing instruments within the domain. Each chapter describes salient issues and provides a discussion of the state of research and practice within the particular stage or topic of the treatment process. It offers guidance on the clinical utility of particular instruments for assessing the domain and identifies specific issues on which additional research is especially needed. The tables contain information on instruments that have been identified as potentially appropriate for use in the relevant stage or topic of the treatment assessment process. Administrative characteristics of each instrument are noted, including populations for whom the measure might be particularly appropriate, time required for administration and scoring, and availability of computerized formats.
Because the chapter authors based their discussions of instruments on a review of the literature as well as on the actual instruments and fact sheets (as described in the next section), there may be some discrepancies in the information presented in the chapters versus the information presented in the fact sheets. Readers should contact the instrument author or source if they have questions.
The appendix includes fact sheets about the instruments listed in the "Quick–Reference Instrument Guide" and copies of the instruments, if available; they are arranged alphabetically. The fact sheets synopsize administration, scoring, and interpretation and note copyright status and how to obtain copies of the instruments. Although most details in the fact sheets were obtained directly from the instrument's author or an expert on the measure, minor editing was done by the panel members to ensure consistency in tone and format across scales as well as to elaborate on items not fully addressed by the instrument's proponent. In a few instances, the reviewer independently prepared the fact sheet.
The instruments are reproduced in their entirety when possible, but length and copyright concerns prohibited full reproduction of some. In most cases, sample items are provided when the full instrument is not available in order to convey the "flavor" of the instrument's content and format. Users are reminded to secure the permission of the authors or copyright holders before using any instrument.
The opinions expressed in the fact sheets are intended to faithfully represent views of the instrument authors. Neither the National Institute on Alcohol Abuse and Alcoholism (NIAAA) nor members of the panel certify accuracy of the data provided. Details on the fact sheets should be considered in conjunction with information obtained from original sources and the user's particular needs to determine the suitability of an instrument for a particular task.
ONLINE AVAILABILITY AND UPDATES
This Guide will be available online at the NIAAA Web site, www.niaaa.nih.gov, and instrument information on the Web site will be updated regularly. We also would like users' assistance in identifying new instruments and offering suggestions to make the material more helpful. You can reach us at the following address:
National Institute on Alcohol Abuse and Alcoholism
TREATMENT ASSESSMENT INSTRUMENTS
6000 Executive Boulevard, Suite 505
Bethesda, MD 20892–7003
Prepared: August 2004