CROSS-VALIDATION OF AN MMPI SCALE OF DIFFERENTIAL DIAGNOSIS 271

of three forms with differential item weights (depending upon significance level). It was found that the brain-damaged patients scored significantly higher on each of the three forms of the Sc-0 scale than did the schizophrenics. I n addition, i t was found that the suggested cutting scores successfully identified a high per- centage of the patients.

REFERENCES 1. HOVEY, H. B. Brain lesions and 5 MMPI items. J . consult. Psychol., 1964, 28, 78-79. 2. UPPER, I). and SEICMAN, W. Brain damage, schizophrenia, and five MMPI items. J . clin.

3. WATSON, C . G. An MMPI scale to separate brain-damaged from schizophrenic men. J . coiasult.

4. WATSON, 6. G. and THOMAS, R. W. MMPI profiles of brain-damaged and schizophrenic pa-

Psychol., 1968, 24, 444.

elin. Psychol. 1971, 36, 121-125.

tients. Percept. mot. Skills, 1968, 27, 567, 573.

T H E USE OF T H E MMPI (MINI-MULT) TO PREDICT ALCOHOLICS’ RESPONSE TO A BEHAVIORAL TREATMENT PROGRAM

Sioux Trails Mental Health Center AND

SHARON R. WEEKS JAMES A. POWELL

Baylor University

ALLAN G. HEDBERG’ LOWELL M. CAMP BELL^

PROBLEM I n the investigation of alcoholism and its treatment much use has bcen made

of various measures of personality and psychopathology. Perhaps the Minncsota Multiphasic Personality Inventory (MMPI) has been the most wisely used in- strument. It has been the basis for the construction of numerous alcoholism scales(4* 6 * lo* 14). Other research efforts have focused on the classification of alco- holics according to various personality profiles (3, le) and the evaluation of profile changes that occur over treatment“, 8 p y , 11,

A neglected area of research has been the possible use of thc MMPI to dif- ferentiate between those alcoholics who will succeed or fail in specific treatment programs. Therefore, the present study investigated the utility of this instrument as a predictor of success or failure of an alcoholic sample in a bchavioral outpatient alcoholism treatment program.

METHOD

1 3 ) .

Subjects. Twenty-eight male alcoholics wcre referrcd to the community Mental Health Centcr for treatment of alcoholism. Thc mean age of the patients was 38.2 years, range from 22 years to 65 years. Their average level of education was grade 11. Their mean years of drinking was 17, and their avcragc length of abstinence at any one time prior to treatment was 3 months.

Measure. The Mini-Mult form of the MMPI was selected for the study. The Mini-Mult‘’) is a 71-item short form of the MMl’I and has an advantagcous usc in research projects when only brief time is available for data collection. Further, i t was standardizcd on a patient population very similar to the patients in this study.

‘Current address: 1676 N. Van New Ave., Fresno, Calif. 93728. 2Current address: Department of Psychology, Baylor University, Waco, Tex. 76703

272 A. G. HEDBERG, L. M. CAMPBELL, S. R. WEEKS AND J. A. POWELL

Procedures. Treatment scheduling for all patients consisted of three l-hour therapy sessions per week for the first 3 weeks of the treatment program. There- after, treatment sessions were held once each week for the next 5 weeks, every other week for the next 8 weeks, and once monthly for the next 2 months.

The first three sessions were concerned with an explanation of the treatment program, a behavioral analysis of the patient’s drinking patterns, and the ad- ministration of the Mini-Mult. Treatment commenced at the time of the third session. After an average of 12 treatment sessions (approximately 7 weeks after the initial appointment) the Mini-Mult again was administered to assess the change that had occurred during the first half of the treatment program.

Each patient was seen individually on a rotating basis by each of the four treatment staff members. The patients were assigned randomly to one of four behavioral treatment conditions: systematic desensitization, covert sensitization, behavioral family counseling, or faradic stimulation.

Six months after the termination of treatment a follow-up contact was made with each patient, and an evaluation was made of the patient’s current drinking behavior. Additionally, interviews were conducted with the patient’s spouse or a close friend to verify the patient’s present drinking behavior. The treatment staff, in addition to the patient and those interviewed, jointly determined the extent to which the patient achieved success in therapy. A detailed description of the treatment program and methodology is given elsewhere ( 5 ).

RESULTS At the time of the 6-month follow-up interview 17 of the patients were classi-

fied unequivocally as successful in treatment, whereas the remaining 11 were considered to be treatment failures.

Table 1 presents the obtained mean scores for the initial and interim ad- ministrations of the Mini-Mult for the successfully and the unsuccessfully treated alcoholic patients. The initial profile reflects greater psychopathology for the suc- cess group; the profile is elevated from scale 2 through scale 8. In comparison to the failure group, the success group obtained a significantly lower Lie (L) score ( p < .05) and a significantly higher Paranoia (PA) score ( p < .03) and a higher, but nonsignificant Psychasthenia (PT) score ( p < .03). The failure group obtained a significantly elevated mean score on the Psychopathic Deviate (PD) scale only.

Significant differences between the groups at the time of the interim testing were obtained on the paranoia (PA) scale (2 = 2.35; p < .03) and the Schizophrenia (Sc) scale ( p < .03), and the Hypomania (MA) scale approached significance ( p < .06). In each case the success group obtained higher mean scores than the failure group.

A step-wise discriminant analysis (2) was performed to calculate a linear equation on the initial and interim scores to predict a patient’s membership in the success or failure group. After two steps the L (initial) and PA (interim) scores were found to predict the success or failure of a patient based on the two obtained formulae as noted below:

Success (L, initial) X (1.24) + (PA, interim) X (.54) - 47.73 =

Failure (L, initial) x (1.34) + (PA, interim) X (.47) - 48.92 =

Table 1 also includes the interim T-values for the two groups.

When the resulting two values are obtained, the larger value determines a patient’s classification as a success or failure in treatment. When these formulae were applied to the present sample, 73% of the failures and 71% of the successes were predicted correctly.

THE USE OF THE MMPI (MINI-MULT) TO PREDICT ALCOHOLICS’ RESPONSE 273

T.4BLE 1. MEAN MINI-MULT T SCORES BEFORE THERAPY A N D AT AN INTERIM TESTINQ PERIOD OF SUCCESSFULLY AND UNSUCCESSFULLY TREATED ALCOHOLICS

Success Failure Mini-mult Mean SD Mean SD

Pretherapy : -

(L) 48.59 5.70 53.91 8.03 2.05* (F) 65.24 16.65 60.27 9.00 .91 (K) 48.29 7.16 50.00 6.29 .65 (Hs) 63.59 17.18 57.55 17.10 .91 (D) 73.29 21.03 65.91 17.86 .96 (HY) 67.06 12.04 64.36 14.72 .53 ( P D ) 75.18 12.44 70.64 9.38 1.03 ( P A ) 70.53 13.06 60.36 8.97 2.25* (PT) 74.76 15.44 63.00 15.83 1.96** (SC) 75.71 23.13 61 .OO 17.35 1.80 (MA) 64.24 13.06 60.73 10.53 .75

(L) 53.76 10.18 55.18 6.26 .41 Interim :

(F) 61.06 9.45 58.27 5.31 .89 (K) 51.65 7.66 54.55 5.37 1.09 (Hs) 55.65 8.77 53.27 7.25 .75 (D) 65.41 14.67 63.36 11.94 .39

(w 70.53 9.32 68.36 11.89 -54 (HY) 60.76 9.74 59.73 8.09 .30

(PA) 65.71 14.43 54.55 7.70 2.35* (PT) 63.82 13.33 55.18 13.98 1.64 (SC) 66.35 11.26 55.00 15.03 2.28* (MA) 59.47 7.90 52.36 11.25 1.97**

* p < .05; **p < .10

DISCUSSION In the assessment of an alcoholic population a fairly common finding is an

elevated MMPI profile with the psychotic scales slightly more elevated than the neurotic scales. The present results suggest that the elevations on the psychotic scales, indicative of marked pathology, should not be the basis to exclude a patient from a treatment program. Rather, it may serve as a predictor of an alcoholic patient’s responsiveness to treatment. The presence of greater pathology possibly may facilitate increased motivation for change and. a more serious approach to treatment. It is suggested that further inquiry be directed toward the identifica- tion and classification of alcoholics based on their response to treatment and the way in which this responsiveness interacts with personality traits and psycho- pathology.

The discriminant analysis performed on the data indicates that it is possible to distinguish between successful and unsuccessful patients on the basis of the MMPI Mini-Mult scores. Further, it appears possible that a formula can be constructed to predict a patient’s success or failure. Apparently such a prediction about treatment outcome requires both initial and interim test data when scores from the Mini-Mult are used. Although it would be desirable to make such a pre- diction before therapy commences, it may not be possible to do so with the measure-

274 A. G. HEDBERG, L. M. CAMPBELL, S. R. WEEKS AND J. A. POWELL

ment instruments currently available. At least the obtained formula would help a therapist to decide whether a particular patient or a therapy program should continue after a specified interim period of time.

Caution should be used when the obtained formula is applied because the results are ba.sed upon a specific population of alcoholics in a clinical setting. The fact that the two groups differed on their initial testing, with the failure group within the normal limits, questions the view that an abnormal pretreatment profile is due to a state of intoxification rather than the presence of pathology. Although the present study was not designed to assess this issue, the findings suggest that some change well may result from detoxification and some due to the treatment program. Future research needs to assess this issue directly.

It has been asserted that a common error is made when an alcoholic is assessed prior to treatment. This error is the failure to delay test administration until the effects of excessive alcohol consumption have dissipated. Therefore it is difficult to attribute the resulting posttreatment behavioral change to the treatment pro- cess because it merely may reflect the dissipation of an intoxicated 1 3 ) .

Although the present study was not designed to assess this issue, the fact that the two groups differed significantly on their initial test results questions the view that an abnormal pretreatment profile is due to a state of intoxication rather than to thc prcsencc of pathology. Intoxication does not appear to account for the pre- treatment profile, for the sample of this study, since testing was not done until the second session, which was scheduled after a 4- to 5-day period in which no drinking had occurred.

SUMMARY The study was designed to predict the response of alcoholics to behavior

therapy and to assess MMPI profile changes during the initial phase of treatment. Four MMPI scales discriminated between the successfully treated alcoholics and the failures. The MMPI profiles for both groups of patients fell within normal limits early in treatment; the successful group yielded an overall profile of greater pathology at both the initial and the interim testing periods. The implications for prediction and treatment evaluation are discussed.

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2. DIXON, W. J. UMD, Biomedical Computer Programs. Berkeley: University of California Press, 1971.

3. GOLDSTICIN, S. G. and LINDE, J. D. Multivariate classification of alcoholics by means of the MMPI. J. abn. Psychol., 1969, 74, 661-669.

4. HAMPTON, P. J. The development of a personality questionnaire for drinkers. Genet. psychol. Monog., 1953, 48, 55-115.

fi. IIEDBERG, A. G. and CAMPBICLL, L. M. A comparison of four behavioral treatment approaches to alcoholism. J . behav. ther. erper. Psychiat., 1974, 5, 251-256.

6. HOYT, D. P. and SKDLACK, ( i . M. Differentiating alcoholics from normals and abnormals with the MMPI. J. clin. Ps?/chol., 1958, 14, 69-74.

7. KINCANNON, J. C. Prediction of the standard MMPI scale scores from 71 items: The mini- mult. J. consult. cliu. Psychol., 1968, Sb, 319-325.

8. K~ZOFT, T. and WIJI~SINGHE, N. Systematic desensitization of social anxiety in the treatment of alcoholism: A psychometric evaluation of change. Brit. J . Psychiat., 1970, 117, 443-444.

9. Lmn, J. W. and TAULBEE, E. S. Psychotic-appearing MMPI profiles among alcoholics. J. din . Psychol., 1971, 127, 101-102.

MACANDRXW, C. The differentiation of male alcoholic outpatients from non-alcoholic psychiatric outpatients by means of the MMPI. Quart. J . Stud. Ale., 1965, 26, 238-246.

ROHAN, W. P. MMPI changes in hospitaiked alcoholics. Quart. J. Stud. A&., 1972, 33, 65-76. I~OHAN, W. P., TATRO, It. L. and ROTMAN, S. It. MMPI changes in alcoholics during hospitali-

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chopathology by means of two MMPI scales. J. c h . Psychol., 1969, $6, 287-289. VKGA, A. Cross-validation of four MMPI scales for alcoholism. Quart. J . Stud. Alc., 1971, 32,

791 -797. WALTON, H. J. Personality as a determinant of the form of alcoholism. Brit. J. I’sychiai.,

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