Psychological Assessment: Copyright 1989 by the American Psychological Association, Inc.

A Journal of Consulting and Clinical Psychology 1040-3590/89/500.75

1989. Vol. l , N o . 1,61-63

Screening for Adolescent Problem Drinking: Validation of a

Multidimensional Instrument for Case Identification

Adele V. Harrell Philip W. Wirtz

Institute for Social Analysis George Washington University
Washington, DC

This research tested the thesis that adolescent problem drinking may be manifest in any of four
independent domains (measured by the 24-item screening instrument, the Adolescent Drinking
Inventory: Drinking and You): drinking-related loss of control, social indicators, psychological indi-
cators, and physical indicators. Clinical assessments of 264 adolescents referred for screening re-
vealed that more than half of the variation in clinical assessment of problem drinking severity was
captured by these four domains and that two of the four domains (loss of control and psychological
indicators) made an independent contribution to clinical assessment.

The development of screening instruments to identify adoles-
cents with drinking problems, although the focus of consider-
able research attention in recent years (e.g., KJitzner, Schwartz,
Gruenewald, & Blasinsky, 1987; Mayer &Filstead, 1979;Petch-
ers & Singer, 1987), has been largely atheoretical, characterized
by the absence of clearly specified definitions of problem drink-
ing in this age group. Conceptually, the identification of prob-
lem drinking among adolescents is somewhat more difficult
than detection among adults, because alcohol use (sometimes
heavy) by adolescents may be related to developmental tasks
(e.g., Varenhorst, 1981). As a result, recent definitions of adoles-
cent problem drinking have emphasized the harmful effects of
alcohol consumption on physical health, problem solving, and/
or social obligations, in addition to the quantity/frequency/
variability of consumption. These broader definitions, which
embody the effects of drinking across multiple domains, suggest
that instruments based on a multidimensional measurement
strategy are needed.
Previous studies of alcohol-related dysfunction (see review in
Harrell, 1985) suggested a multidimensional framework with
four primary domains of adolescent problem drinking: loss of
control of drinking, social indicators, psychological indicators,
and physical indicators. The objective of the present research
was to examine the extent to which a screening instrument in-
corporating items from these four domains would adequately
replicate clinician assessment of the severity of adolescent prob-
lem drinking.
The screening instrument used was the 24-item Adolescent
This research was supported by National Institute of Alcohol Abuse
and Alcoholism Contract ADM281-86-0002. Aspects of this study were
presented at the 1988 National Alcoholism Forum, Washington, DC.
We would like to thank Barbara Sowder, coprincipal investigator, for her
invaluable contributions to development and testing of the screening
instrument.
Correspondence concerning this article should be addressed to Adele
V. Harrell, Institute for Social Analysis, 1625 K Street, N.W., Suite
1000, Washington, DC 20036.
Drinking Inventory: Drinking and You (ADI), which was devel-
oped based on the four-domain conceptual framework. This in-
strument is a brief standardized tool designed for use by clini-
cians and counselors without specialized training in substance
abuse assessment to assist them in determining whether an ado-
lescent who is experiencing social, psychological, or behavioral
problems should be referred for further alcohol evaluation. Na-
tional field test results (Harrell, Sowder, & Kapsak, 1988) indi-
cate that the instrument exhibited excellent internal consis-
tency reliability, Cronbach's alpha = .96, and 2-week test-retest
reliability, r(43) = .78, p < .001. The instrument also was found
to have high sensitivity and specificity: ADI scores correctly
classified 88% of the adolescents who, according to independent
professional assessment, had drinking problems and 82% of
those who did not have drinking problems, for an overall accu-
racy rate of 85%.
Method
The present study was based on the responses of 264 adolescents (ages
12-17) referred for evaluation by the courts (27%), the schools (25%),
parents (21%), or others (27%) to one of six programs. The programs
included two mental health clinics (outpatient treatment), an adolescent
evaluation center (short-term counseling and referrals), two psychiatric
hospitals (inpatient treatment), and a substance abuse program (inpa-
tient and outpatient treatment). All 321 adolescents referred during the
study period were eligible; refusals were received from a parent or an
adolescent in only 18 cases. Those who completed all items on the ADI
were included in this analysis. Thirty percent of the sample were be-
tween the ages of 12 and 14,47% were between 15 and 16 years old, and
23% were 17 years old. Forty-one percent of the sample were female;
60% were White, 28% were Hispanic, and 9% were Black. The partici-
pants were diagnosed as having a variety of problems, including family
problems, school problems, and mental health problems (Harrell &
Wirtz, 1988); 59% were identified as having drinking problems.
The Criterion
Professionals trained in psychiatry, social work, clinical psychology,
or substance abuse assessment and experienced in adolescent assess-
ment evaluated the subjects using standard clinical procedures that in-

61
62 BRIEF REPORTS

Table 1
Correlations Among the Four Hypothesized Domains of Adolescent Problem
Drinking and Clinical Assessment of Severity

Domain
Clinical
severity Loss of Social Psychological Physical
Domain rating control symptoms indicators symptoms

Loss of control .71

Social symptoms .66 .79
Psychological indicators .66 .75 .75
Physical symptoms .64 .76 .75 .76

M 0.89 1.25 0.57 0.47 0.56

SD 0.86 1.03 0.68 0.53 0.68

Note.N= 264. All correlations are significant atp < .0001.

eluded interview data on the adolescent's social and family history as
well as items on substance abuse. Because we deliberately selected the
clinicians for heterogeneity in training and specialty to represent the
different types of professionals that assess adolescents, the methods they
used to reach a diagnostic judgment varied but were assumed to reflect
high standards of accuracy based on the clinicians' level of training and
experience. The clinicians' ratings of the severity of the adolescents'
drinking problems (significant problem, moderate problem, or minor/
no problem) served as the criterion for evaluating the screening instru-
ment.
The ADI
Independently of the clinical assessment, subjects completed the ADI
screening instrument. Loss of control of drinking during the past year
was reflected in four items (on frequent intoxication, drinking at inap-
propriate times or places, and excessive consumption) scored on a 4-
point frequency scale of never, only once, 2-3 times, and 4 or more limes
in the past year (Cranbach's alpha = .86). Social indicators—difficulties
in interpersonal relationships and role fulfillment reflected in drinking-
related problems with friends, family members, and school and legal
authorities—were measured by 11 items scored on the same four fre-
quency categories (Cronbach's alpha = .91). Psychological indicators—
drinking to cope with feelings such as loneliness and depression or to
enhance mood—were measured by subject ratings of seven statements
about reasons for drinking on a 3-point scale of like me a lot, like me
some, and not like me at all (Cronbach's alpha = .88). Physical indica-
tors—memory problems and increased tolerance—were measured by
subject ratings of two statements about the effects of drinking on the
same 3-point scale, r(283) = .60.
mains. The coefficient of determination relating the entire set
of four domains to the clinician assessment rating was .55.
In a separate series of hierarchical multiple regression analy-
ses performed to explore the nature of the overlap among the
four domains, we found that the social indicator domain and
the physical indicator domain each made an independent con-
tribution to clinical assessment of severity when the other was
deleted from the model.
Discussion
The results indicate that it is possible with a brief, easy-to-
administer checklist such as the ADI to measure domains asso-
ciated with clinician ratings of the severity of adolescent drink-
ing problems. The results further point to the effectiveness of
indicators from multiple symptom domains in identifying ado-
lescents who should be referred for a comprehensive alcohol
evaluation. On a bivariate level, all four domains are correlated
with clinician assessment of problem drinking, confirming re-
search findings of the significance of problems in these areas in
case identification.
The correlations among the domains are highly significant
and indicate that, generally, adolescents with problems in one
domain will have problems in other domains. However, two of
the domains—loss of control and psychological indicators—
make independent contributions to the severity rating, and the
estimated regression coefficients for the other two domains are
positive. Moreover, when the social domain is eliminated from

Results

Correlations among each of the four domains of alcohol-re- Table 2

lated dysfunction ranged from .75 to .79 (p < .0001), and all Regression of Clinically Assessed Problem Drinking Severity
four domains showed significant positive correlations with the on Four Domains of Symptomatology
clinician severity rating that ranged from .64 to .71 (p < .0001;
Domain b t P 0
see Table 1). The results of regressing clinician severity rating
on the set of four domains are presented in Table 2. Two of the Intercept 0.17 3.08 .0023 0.00
four domains (loss of control and psychological indicators) were Loss of control 0.32 5.00 .0001 0.39
found to be independently related to clinician assessment in the Social symptoms 0.17 1.73 .0853 0.13
Psychological indicators 0.29 2.47 .0143 0.18
expected direction at the p < .05 level. The domains of social
Physical symptoms 0.14 1.55 .1217 0.11
indicators and physical indicators were not found to be signifi-
cantly related to assessment independently of the other two do- Note. RltoMt, - .55; df= 259.
 BRIEF REPORTS
the model, the physical domain contributes to the severity rat-
ing independently of loss of control and psychological indica-
tors, and when the physical domain is eliminated, the social do-
main makes an independent contribution. These results suggest
that measuring problems in multiple domains, especially in the
areas of loss of control and psychological indicators, should in-
crease the reliability and accuracy of screening results as op-
posed to relying on consumption measures alone. The four do-
mains as a group explained over half the variation (55%) in clin-
ically assessed severity. The unexplained variation may reflect
the existence of untapped domains, imperfect measures of the
four domains, and/or error in the clinical ratings, which were
assumed to be the superior measure but were not necessarily
error free.
The apparent overlap between the social and physical indica-
tors of adolescent problem drinking raises practical questions
about whether both domains are needed during screening. It
should be noted that the findings reported here are based on a
heterogenous group of adolescents referred for assessment of a
wide variety of social, psychological, and behavioral problems.
Additional research should be conducted to determine the con-
tribution of various domains in case identification among ado-
lescents with selected demographic and clinical characteristics,
especially in view of the evidence that all four domains are re-
lated to clinical assessments, if not independently. In addition
to possible increases in instrument accuracy among subgroups,
the use of items from four domains offers some advantages. In-
dicators from multiple domains span a variety of symptoms ex-
perienced by adolescents with alcohol-related problems, are
consistent with the scale items (as shown by the ADI's internal
consistency), add to the reliability of the instrument, and pro-
vide information on the type of problems an adolescent is expe-
riencing.
63
Although the ADI was designed primarily as a tool for those
referring adolescents experiencing difficulties to the type of pro-
grams used in the study, research to develop instrument norms
for adolescents in school is currently under way. The findings
are expected to provide additional information on the preva-
lence of drinking-related indicators and the relationship among
the domains of problem drinking in a general population of ad-
olescents and among adolescents in alcohol treatment.
References
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and findings. Washington, DC: Royer Cook, Inc.
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Received September 7, 1988
Revision received November 23,1988
Accepted December 6, 1988 •