Application of the MacAndrew alcoholism scale to alcoholics with psychiatric diagnoses

The MacAndrew Alcoholism Scale (MAC: MacAndrew, 1965) has demonstrated significant discriminative power in separating male alcoholics from male psychiatric patients, but there are two different interpretations of MAC scale scores. Apfeldorf and Hunley (1981) have proposed that high MAC scores measure an alcoholic response pattern and low scores measure a psychiatric response pattern. In contrast, MacAndrew (1981) has proposed that high MAC scores measure a reward seeking orientation, and low scores measure an orientation to avoid punishment. These researchers concur, however, in questioning the MAC'S ability to detect alcoholism which coexists with psychiatric diagnosis. Therefore, the present study examined the MAC's performance with alcoholic psychiatric patients.

Subjects were 140 male V. A. Hospital patients assigned to one of five diagnostic groups (Alcoholics, Alcoholic Personality Disorders, Alcoholic Neurotics, Personality Disorders, or Neurotics) based on DSM-III diagnoses. All patients completed a valid MMPI which was used to determine MAC scores.

MAC scale scores successfully differentiated the Alcoholic group from the combined psychiatric groups which was consistent with previous research. However, the MAC scale did not effectively discriminate alcoholics from patients with character disorder diagnoses.

The MAC scale failed to differentiate either of the alcoholicpsychiatric groups from its psychiatric counterpart. The alcoholicvi psychiatric groups did not obtain intermediate MA£ scores as Apfeldorf and Hunley's ideas would suggest. In fact, the Alcoholic Personality Disorder group scored significantly higher than the Alcoholic Neurotic group, which would suggest that these psychiatric diagnoses influence the MAC scale in different ways.

Further investigation revealed that the majority of patients in the highest scoring group did not appear to possess a reward seeking orientation. At present, MacAndrew's theory has not been tested adequately. Specifically, future research needs to assess whether high and low scorers actually possess the characteristics proposed by MacAndrew. Recommendations for other research and for the clinical application of the MAC scale are discussed.