Psychology of Addictive Behavior 1990. Vol. 4, No. 2.

77-81

ISSN 0893-164X. Sanely of Psychologists in Addictive Behaviors

Further Support for the Criterion Validity of the Alcohol Use Inventory
Carl E. Isenhart
Veterans Administration Medical Center Danville, Illinois
This project reports evidence for the criterion validity of the Alcohol Use Inventory (AUI; Wanberg, Horn, & Foster, 1977) by showing that the instrument accurately identifies expected differences in a specific condition (alcohol severity) in two contrasting groups of alcohol abusers. Two hundred male veterans admitted to an inpatient alcohol program were categorized as to whether or not they had a father who abused alcohol. Veterans with a father who abused alcohol scored significantly higher on AUI scales measuring alcohol abuse severity and alcohol-related problems than veterans with no such history. Differences in patterns of and benefits from alcohol use were not found. These results are consistent with the AUI literature and provide further evidence of the validity of the AUI.

A major advancement in the area of alcohol abuse assessment is the development of the Alcohol Use Inventory (AUI; Horn, Wanberg, & Foster, 1986; Wanberg, Horn, & Foster, 1977). The AUI is based on the philosophy of using multidimensional concepts and measures to assess alcohol abuse (Wanberg & Horn, 1983). Psychometric reports (Skinner and Allen, 1983; Horn et al., 1986; Wanberg et al, 1977) have been supportive of the instrument. Horn et al. (1986) provided evidence for the criterion validity of the AUI (i.e., the extent to which the instrument accurately identifies specific conditions or criteria). Using different levels of alcohol severity as the criterion, the authors reported three studies demonstrating that the AUI accurately discriminates between groups of patients with different levels of alcohol severity and alcoholrelated problems. In the first study, the AUI resulted in higher alcohol severity ratings and more alcohol-related problems in chronic-severe pa-

The author gratefully acknowledges the assistance of Pamela Marcuro for her help in reviewing articles for this project. Appreciation is also expressed to Randy Taylor, Ph.D., Michael Clayton, Ph.D., and two anonymous reviewers for their comments on a draft of this article. Correspondence concerning this article should be addressed to Carl Isenhart, Alcohol and Drug Rehabilitation Unit, Veterans Administration Medical Center, Danville, IL 61832.
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tients than inpatients who, in turn, had higher AUI severity ratings than outpatients. The second study found that readmitted patients had higher alcohol severity ratings than first-admitted patients. The third study demonstrated higher severity ratings of people in AA than those who had never attended AA (Horn et al., 1986). The present study was conducted to further investigate the criterion validity of the AUI by using two groups of alcohol abusers: those who reported their fathers had significant alcohol-related problems (Father Positive, FP), and those who reported their fathers did not have alcoholrelated problems (Father Negative, FN). The literature clearly demonstrates that, when compared to individuals who do not have an alcoholabusing parent or parents, people who had an alcohol-abusing parent or parents (as a group) drink at an earlier age and experience more social and personal problems (Penick, Read, Crowley, & Powell, 1978); have more alcoholic symptomatology, less occupational stability, and more alcohol-related physical symptomatology (Frances, Timm, & Bucky, 1980); display more symptoms of alcoholism (Alterman & Tarter, 1983); experience more severe pathology (Schuckit, 1983); exhibit higher levels of alcohol use, more symptoms of alcoholism, more incarcerations, and more sociopathy (Beardslee, Son, & Vaillant, 1986); and demonstrate more dependent problems drinking and marital disruption (Parker & Harford, 1987, 1988).

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CARL E. ISENHART they found significant negative correlations between a measure of social desirability and all but three of the AUI scales (r = - . 0 2 to -.50). That is, respondents tended to create an overly positive or negative view of themselves when responding to items related to severe alcohol abuse. As a result, Skinner and Allen (1983) suggested administering a social desirability scale along with the AUI. In that way, the AUI profiles of individuals who have high or low social desirability scores can be interpreted with special care.

It is hypothesized that the FP group would score higher than the FN group on scales measuring alcohol abuse and alcohol-related problems. That is, criterion validity would be demonstrated if the AUI identifies different levels of alcohol severity in these two groups.

Method Subjects
The subjects were 200 male veterans (127 FNs and 73 FPs) admitted to a cognitive-behavioral alcohol and drug rehabilitation unit in a Midwestern Veterans Affairs Medical Center. Approximately 72% of the veterans abused alcohol only, whereas 28% had a concurrent drug abuse problem. The average age of the subjects was 44.2 (SD - 11.61). Table 1 displays other relevant demographic characteristics. For two logistical reasons, the study was limited to males with fathers who were alcohol abusers. First, the percentage of veterans whose mothers or both parents abused alcohol was less than 10%. Second, less than 3% of the veterans in the program are female. It was believed that the low incidence of these two groups of veterans would not allow for an adequate number of subjects of which to collect and analyze data.

Procedures
Every participant admitted to the program routinely received a psychological evaluation that consisted of completing a test battery that included the AUI. Also, each participant completed a "Family History Questionnaire." This questionnaire asked the individual to indicate whether his father, mother, brothers), sister(s), step-father, step-mother, maternal grandfather or grandmother, or paternal grandfather or grandmother "has or had an alcohol abuse problem to the extent that it has resulted in medical, legal, family, job, or emotional problems for that individual." Nobody was admitted to the unit and therefore did not participate in this study if there were any signs of intoxication, impending withdrawal, severe cognitive impairment, an active psychiatric disorder, or an acute medical condition. The AUI test data and the Family History Questionnaire results were retrospectively collected from the records of veterans who had been admitted to the program.

Measures
Alcohol Use Inventory (A VI). The AUI (Wanberg et al., 1977) is a 147-item questionnaire that measures 16 primary factors, four secondary factors, and one broad measure ofgeneral alcoholism. The primary scales assess the individual's alcohol use pattern (e.g., gregarious vs. isolated drinking), benefits from alcohol use (e.g., mood change), and negative consequences (e.g., delirium and hangover). The secondary scales assess the extent that alcohol enhances the individual's performance, and the extent that the individual's drinking is obsessive, compulsive, and sustained. Other secondary scales provide estimates of alcohol-related disruption experienced by the individual (two scales) and the amount of anxiety and concern the individual experiences about his or her alcohol abuse. Wanberg et al. (1977) reported internal consistency reliability coefficients ranging from .38 to .93, testretest reliability coefficients ranging from .54 to .94 over a 1-week period, and interscale correlation coefficients for the primary scales ranging from .00 to .62. Skinner and Allen (1983) reported internal consistency reliability coefficients ranging from .48 to .92 and correlation coefficients with the Michigan Alcoholism Screening Test (MAST; Selzer, 1971) ranging from .01 to .72. They found minimal correlations with a measure of defensive responding (r .03 to .30), but

Results
Table 1 displays the demographics of the two groups. Analysis shows that the FP group was significantly younger (40.14) than the FN group (46.51; t = 3.86, p < .001). Further examination of Table 1 reveals no other significant demographic differences between these groups. Because of the significant age difference, an analysis of covariance was performed using age as the covariate. Because of the increased probability of making Type I errors when conducting multiple comparisons, the level of significance was set at .0025 (.05/20) as suggested by Hays (1981). Table 2 displays the results of this analysis. There were no significant differences between these groups on scales measuring benefits from or patterns of alcohol use. However, there were significant differences on three primary scales measuring negative consequences associated with alcohol abuse. The FP group scored significantly higher on the following scales: Loss of Control

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Table 2 Table 1 Demographic Characteristics and Comparison Mean Scores (and Standard Deviations) of the FP and FN Groups for Each of the A VI Scales of the FN and FP Groups
FP Demographic Age Race White Black Other Marital status Single Married Separated Divorced Widowed Education College 13-15 years High school 9-11 years <9 years Occupation Professional Administrative Clerks/techs Skilled labor Semi/unskilled *p < .001. Secondary scales Self-enhancement Total 73) FN 127) Statistic X2 = 0.5839 163 36 1 32 34 26 102 6 12 53 108 14 13 1 15 23 87 74 60 13 0 13 8 13 37 2 2 25 39 4 3 0 6 3 33 31 103 23 1 4.775 19 26 13 65 4 X = 6.037 10 28 69 10 10 1 9 20 54 43 Help before Loss of control Role maladaptation Delirium Hangover Drug abuse Quantity
2

FP
Primary scales Social benefit Mental benefit Gregarious drinking Obsessive drinking Sustained drinking Guilt and worry Mood change 5.55 (2.54) 1.63 (1.58) 5.08 (2.68) 3.59 (2.36) 6.84 (3.01) 5.85 (2.29) 5.63 (2.21) 3.08 (2.23) 9.15 (3.77) 6.67 (2.91) 3.89 (3.36) 5.74 (2.60) 2.25 (2.12) 6.03 (2.59) 8.49 (4.08) 10.16 (4.30) 14.59 (5.05) 21.16 (8.20) 8.44 (2.49)

FN
1.088 5.00 (2.67) 0.017 1.47 (1.56) 0.014 4.76 (2.52) 3.661 2.92 (2.39) 0.504 6.93 (3.37) 3.383 5.03 (2.71) 1.272 5.10 (2-39) 1.273 2.94 (2.23) 7.00 10.56 (4.13) 9.893 5.34 (2.83) 5.800 2.91 (3.19) 4.29 10.53 (3.14) 2.756 1.29 (1.79) 2.988 5.28 (2.90) .2986 .8641 .8721 .0540 .4855 .0639 .2597 .2594 .0018* .0023* .0161 .0018* .0944 .0816

44.2 40.1

46.5 x" = 0.3860*

(a history of causing harm to self and/or others, experiencing blackouts and passing out, or staggering or stumbling when drinking), Role Maladaptation (a history of unemployment or difficulties at work, residential instability, legal problems, or incarcerations), and Hangover (a history of shakes, nausea and vomiting, tachycardia, convulsions, or chills while sobering up). There was also a significant difference on one secondary scale (Deterioration-1), suggesting that the FP group experiences a greater level of alcohol-related deterioration and disruption than the FN group. Finally, the FP group scored significantly higher than the FN group on the tertiary scale (General Alcoholism) measuring the extent to which a person may be experiencing symptoms consistent with problematic drinking. The General and Deterioration-1 scales consist of, but are not limited to, items from the primary scales, including the Loss of Control, Role Maladaptation, and Hangover scales.

Obsessive/sustained Anxious concern Deterioration-1 Deterioration-2 Tertiary scale General alcoholism

0.482 .4954 7.52 (3.83) 0.415 .5277 9.47 (4.62) 12.54 4.055 .0427 (5.69) .0021* 16.99 10.09 (9.38) 3.854 .0481 7.31 (3.69) .0016*

36.45 29.17 10.76 (12.29) (15.24)

*p < .0025. Note. A 0 score on two scales. Using Alcohol to Cope With Marital Conflict and Alcohol Use Resulting in Marital Conflict, has two interpretations: first, the person does not use alcohol to cope with marital conflict and/or alcohol use does not result in marital conflicts; or second, the person did not answer the scales's items because the respondent was not married or was not in a "marriage-type" situation for 6 months. Because of this "dual interpretation" of a 0 score, these scales were not included in the data analysis to prevent any misinterpretation.

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CARL E. ISENHART

Therefore, the differences on the General and Deterioration-1 scales are expected given the significant differences between the groups on the three primary scales. Although not statistically significantly different at the alpha level used here, there were noteworthy differences between the two groups on other scales that are consistent with the hypothesis being tested in this study. For example, the FP group scored higher on the following scales: Delirium (a history of visual, auditory, or tactile hallucinations; frightening and unusual sensations; and clouded thinking), Anxious Concern (feelings of worry, tension, depression, guilt, and shame surrounding alcohol abuse; and concern that alcohol abuse is becoming worse), and Deterioration-2 (a measure of alcohol-related deterioration that is a more indirect and subtle measure than Deterioration-1). Discussion This project used two contrasting groups to demonstrate criterion validity for the AUI. Consistent with the literature, the AUI scales reflected more severe alcohol-related life-style problems in the FP group than in the FN group. Specifically, the FP group was found to have higher levels of alcohol-related loss of behavioral control, greater social role maladaptation, and more severe hangovers than the FN group. Also, there were indications that the FP group experienced more severe alcohol-related delirium and higher levels of anxiety surrounding their alcohol consumption than the FN group. Overall, the FP group was found to have more alcohol-related deterioration and more indicators of problematic drinking than the FN group. The lack of differences on the scales measuring benefits from and patterns of alcohol abuse are consistent with Horn et al.'s (1977) observation that severity is unrelated to benefits and patterns. That is, more or less severe drinkers may drink for similar benefits and in similar patterns. In addition to having higher severity ratings, the FP group was also significantly younger than the FN group. Thisfindingsuggests that, because of the severity of their alcohol-related problems, the FP group may become involved with an inpatient program at an earlier age than the FN group. Although this was not a hypothesis of this study, this age difference is consistent with the

literature and supports findings that individuals raised by an alcohol-abusing parent(s) may themselves develop an alcohol problem at a younger age than individuals not raised by an alcohol-abusing parent(s). There are limitations to this study. First, the population was all male, predominantly white, and from lower SES levels. Also, only the father's drinking history was considered. It is possible that other demographic groups would yield different results (see Horn et al., 1986, for a discussion on the scoring patterns of different racial groups and females). Also, consideration of the mother's drinking history separately and in addition to the father's drinking history may produce different results. Despite these considerations, however, these results are consistent with the AUI literature and further support the validity of this instrument.

References
Alterman, A. I., & Tarter, R. E. (1983). The transmission of psychological vulnerability. The Journal of Nervous and Mental Disease, 171, 147-154. Beardslee, W. R., Son, L., & Vaillant, G. E. (1986). Exposure to parental alcoholism during childhood and outcome in adulthood: A prospective longitudinal study. British Journal of Psychiatry, 149, 584591. Frances, R. J., Timm, S., & Bucky, S. (1980). Studies of familial and nonfamilial alcoholism. Archives of General Psychiatry, 37, 564-566. Hays, W. L. (1981). Statistics (3rd ed.). New York: CBS College Publishing. Horn, J. L., Wanberg, H. W., & Foster, F. M. (1986). The alcohol use inventory (AUI). Minneapolis, MN: National Computer Systems, Inc. Parker, D. A., & Harford, T. C. (1987). Alcoholrelated problems of children of heavy-drinking parents. Journal of Studies on Alcohol, 48, 265-268. Parker, D. A., & Harford, T. C. (1988). Alcoholrelated problems, marital disruption and depressive symptoms among adult children of alcohol abusers in the United States. Journal of Studies on Alcohol, 49. 306-313. Penisk, E C , Read, M. R., Crowley, P. A., & Powell, B. J. (1978). Differentiation of alcoholics by family history. Journal of Studies on Alcohol, 39, 19441948. Schuckit, M. A. (1983). Alcoholic men with no alcoholic first-degree relatives. American Journal of

Psychiatry, 140, 429-443.

Selzer, M. L. (1971). The Michigan alcoholism screening test: The quest for a new diagnostic in-

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strument American Journal'of'Psychiatry, 127,1653of alcohol use with multidimensional concepts and 1658. measures. American Psychologist, 38, 1055-1069. Skinner, H. A., & Allen, B. A. (1983). Differential Wanberg, K. W., Horn, J. L., & Foster, F. M. (1977). assessment of alcoholism. Journal of Studies on AlA differential assessment model for alcoholism. cohol, 44, 852-862. Journal of Studies on Alcohol, 38, 512-543. Wanberg, K. W., & Horn, J. L. (1983). Assessment