Identification of alcohol problems among health maintenance organization patients, using the MacAndrew Alcoholism Scale.

Exploratory research was conducted with 178 men and 321 women (aged 18-69), patients of FHP Utah, to test the relationship between alcoholism as measured by the MacAndrew Alcoholism Scale (MAC) and various life-problems. Problem areas included physical, emotional, job/legal/economic, and family/social. Patients were also questioned about their drinking practices. Cut-off scores on the MAC of 24 for males and 27 for females operationally defined patients as having an alcohol problem. The following hypotheses were tested: (1) sex differences would be shown in the number of individuals diagnosed; (2) individuals diagnosed as alcoholic would exhibit a greater number of life problems than nonalcoholics; (3) problems exhibited would not be confined to the physical area, but would include two or more problem areas; and (4) no sex differences would be shown between the life problems shown by alcoholic males vs females. The MAC identified 31.5% of the males and 7.2% of the females as alcoholic. This was a significant difference (p < .001) and supported Hypothesis 1. Possible reasons for the abnormally high number of male alcoholics are discussed, as well as a number of ways of determining the true meaning of this finding. Individuals diagnosed as alcoholic exhibited many more problems identified by the patient (7.0 vs 3.9 for males, and 9.2 vs 5.8 for females, for alcoholics vs nonalcoholics). These results were significant (p < .001). Problems identified by the physician for alcoholics vs nonalcoholics was .45 vs .22 for males (p < .05) and .48 vs .17 for females (p < .08). In sum the results supported Hypothesis 2. Hypothesis 3, that problems shown would reflect two or more problem areas was supported. Life-problems from all four areas were significantly associated with a diagnosis of alcoholism. Proportionately fewer physical problems were seen despite the test instrument being saturated with physical problems diagnostic of alcohol problems in early to middle stages of problem alcohol use. Significant sex differences were found among the signs and symptoms diagnostic of alcohol problems. Thus Hypothesis 4 was not supported. The literature in the alcoholism field has not so far addressed this issue. Cautions on the interpretation of the data are discussed as well as implications for future research.