A cluster analysis of Million Clinical Multiaxial Inventory (MCMI) profiles: more about a taxonomy of alcoholic subtypes

Personality, problem solving, and adolescent substance use

The major aim of this study was to examine the role of social problem solving in the relationship between personality and substance use in adolescents. Although a number of studies have identified a relationship between personality and substance use, the precise mechanism by which this occurs is not clear. We hypothesized that problem-solving skills could be one such mechanism. More specifically, we sought to determine whether problem solving mediates, moderates, or both mediates and moderates the relationship between different personality traits and substance use. Three hundred and seven adolescents were administered the Substance Use Profile Scale, the Social Problem-Solving Inventory-Revised, and the Personality Experiences Inventory to assess personality, social problem-solving ability, and substance use, respectively. Results showed that the dimension of rational problem solving (i.e., effective problem-solving skills) significantly mediated the relationship between hopelessness and lifetime alcohol and marijuana use. The theoretical and clinical implications of these results were discussed.

Substance abuse problems, psychiatric symptoms, and post-treatment status in MCMI psychopathology subgroups of cocaine dependent males

This study involved cluster analysis of Millon Clinical Multiaxial Inventory-II (MCMI-II) records of 304 cocaine dependent males and examined differences among personality-based clusters in medical, legal, employment, drug, alcohol, family, and psychiatric problem severity at treatment intake and in outcome status during the 12 months after completion of residential drug treatment. A hierarchical cluster analysis (Ward's method) was used to identify 4 cluster subgroups: antisocial, subclinical, neurotic, and high psychopathology. MANOVA revealed that membership in Neurotic and High Psychopathology Cluster subgroups was linked with more severe family and psychiatric problems at treatment intake than found in the Subclinical Cluster Subgroup (all ps < .05). The High Psychopathology Cluster Subgroup also had more severe drug problems at intake than did the Subclinical Subgroup (p < .05). Logistic regression analysis revealed that membership in the High Psychopathology Subgroup predicted relapse/loss to follow-up status after controlling for age, education, ethnicity, treatment program attended, and pretreatment cocaine use frequency (X(2) = 21.25, df = 3, p < .001).

Millon Clinical Multiaxial Inventory-III subtypes of opioid dependence: validity and matching to behavioral therapies

The concurrent and predictive validity of 2 different methods of Millon Clinical Multiaxial Inventory-III subtyping (protocol sorting, cluster analysis) was evaluated in 125 recently detoxified opioid-dependent outpatients in a 12-week randomized clinical trial. Participants received naltrexone and relapse prevention group counseling and were assigned to 1 of 3 intervention conditions: (a) no-incentive vouchers, (b) incentive vouchers alone, or (c) incentive vouchers plus relationship counseling. Affective disturbance was the most common Axis I protocol-sorted subtype (66%), antisocial-narcissistic was the most common Axis II subtype (46%), and cluster analysis suggested that a 2-cluster solution (high vs. low psychiatric severity) was optimal. Predictive validity analyses indicated less symptom improvement for the higher problem subtypes, and patient treatment matching analyses indicated that some subtypes had better outcomes in the no-incentive voucher conditions.

Persönlichkeitstypen und Persönlichkeitsstörungen bei stationär behandelten Alkoholabhängigen

Zusammenfassung. Theoretischer Hintergrund: In der Literatur werden bestimmte Persönlichkeitseigenschaften oder Persönlichkeitstypen mit der Entstehung und Aufrechterhaltung des Alkoholismus in Beziehung gebracht. Fragestellung: Es soll ein Beitrag zur Beantwortung der Frage geleistet werden, in welchen Persönlichkeitseigenschaften und Persönlichkeitsstörungen sich Alkoholabhängige von Kontrollpersonen aus der allgemeinen Bevölkerung unterscheiden und ob das Konzept einer begrenzten Anzahl von Alkoholabhängigentypen fruchtbar ist. Methode: In einer Querschnittstudie wurden 95 männliche und 56 weibliche stationär behandelte Alkoholabhängige mit den 42 Skalen des Trierer Integrierten Persönlichkeitsinventars (TIPI-Version 1) und dem Strukturierten Klinischen Interview zur Erfassung von Persönlichkeitsstörungen (SKID-II) untersucht und mit einer Kontrollgruppe von 199 Personen aus der allgemeinen Bevölkerung verglichen. Ergebnisse: Eine logistische Regressionsanalyse mit Kreuzvalidierung zeigte, dass 14 von 42 TIPI-Skalen eine gute Prädiktion der Gruppenzugehörigkeit (Alkoholabhängige vs. Kontrollpersonen) ermöglichen. Auf clusteranalytischem Weg konnten vier Persönlichkeitstypen identifiziert werden, die bei Alkoholabhängigen signifikant häufiger auftreten als in der normalen Bevölkerung. Bei 41% der Patienten wurden Persönlichkeitsstörungen diagnostiziert. Schlussfolgerung: Die Kenntnis von vier Typen von Alkoholabhängigen, die sich in ihrer Persönlichkeit und in Persönlichkeitsstörungen unterscheiden, kann zur ätiologischen Hypothesenbildung und zur Therapieplanung beitragen.

Exploring the diversity of dual diagnosis: utility of cluster analysis for program planning

This study demonstrates the utility of using cluster analysis to explore the heterogeneity of dual diagnosis populations so as to facilitate planning and implementation of individualized treatment programs. A sample of 467 persons admitted to a state psychiatric hospital with DSM-III-R psychiatric diagnoses and substance abuse problems were interviewed on the Addiction Severity Index (ASI) and other measures to assess psychological, social, and community functioning. Scores on seven ASI severity ratings (medical, employment, alcohol, drug, legal, family, and psychiatric functioning) were used to group patients into seven homogeneous subgroups using cluster analysis: best functioning, unhealthy alcohol abuse, functioning alcohol abuse, drug abuse, functioning polyabuse, criminal polyabuse, and unhealthy polyabuse. Cluster reliability and validity were demonstrated using split-half tests as well as cross-sectional and longitudinal analyses. Results illustrate the extreme heterogeneity of dual diagnosis and are suggestive of how individualized treatment programs can be matched to the particular needs of patients with dual diagnoses.

MCMI-III-derived typological analysis of cocaine and heroin addicts

A sample of 441 African American men who were either inpatient heroin or cocaine addicts, or both; were assessed with the MCMI-III. The modal codetype showed primary elevations on the Antisocial Personality Disorder Scale (6A), consistent with previous research using the MCMI-I and MCMI-II with substance abusers. The data were subjected to 3 independent clustering procedures that resulted in general consistency among procedures. The solutions were validated on a randomly selected half of the sample. Three subtypes were variants of the antisocial parent codetype, whereas another subtype was characterized by a Within Normal Limits profile suggesting no personality disorder. These 4 subtypes were also associated with different external correlates with significant clinical import. The results suggest that findings from previous research with substance-abusing patients, using the MCMI-I and MCMI-II, should be applicable to the MCMI-III as well.

Structured interview versus self-report test vantages for the assessment of personality pathology in cocaine dependence

The study compared structured interview (SCID-II) and self-report test (MCMI-II) vantages for the detection and characterization of personality pathology among 144 urban, poor, cocaine-addicted individuals seeking outpatient treatment. Diagnostic agreement was inadequate for most disorders, and the instruments at best shared only modest common variance. Positive predictive power was poor for all MCMI-II scales, though negative predictive power was good to excellent. This lends support for the use of the MCMI-II as a screening measure to rule out Axis II disorders; however, confirmation of positive diagnoses will require follow-up interview assessment. Future development of self-report personality inventories for substance abusers should focus on controlling for the acute dysphoric effects of drug use and related dysfunction, expanding attention to Cluster B content domains, and incorporating more objective criteria for assessing paranoia and "odd/eccentric" traits.

Empirical Groupings of Perceptions of Alcohol Use Among Alcohol Dependent Persons: A Cluster Analysis of the Alcohol Use Inventory (AUI) Scales

Scales of the Alcohol Use Inventory (AUI) for 217 consecutive admissions (174 men, 43 women; 178 white, 39 black) to a substance abuse treatment program were cluster analyzed to empirically identify patterns of subjective perceptions regarding benefits of use, deleterious consequences of use, and styles of use. Five groupings emerged which were cross-validated by randomly splitting the total sample in half and applying the K-Means procedure to each half. Differences among these groups were found on age, education, and the personality and symptom scales of the Millon Clinical Multiaxial Inventory-II (MCMI-II). The implications of these clusters for understanding and treating alcohol abuse/dependence are discussed.

An MCMI cluster typology of obsessive-compulsives: a measure of personality characteristics and its relationship to treatment participation, compliance and outcome in behavior therapy

The two-fold purpose of this investigation was to (a) define personality subtypes among patients diagnosed with obsessive-compulsive disorder (OCD) and (b) examine the relationship between the resulting typology and treatment participation, compliance and outcome of OCD patients treated with behavior therapy, using exposure and response prevention. A hierarchical agglomerative cluster analysis was performed on the Millon Clinical Multiaxial Inventory (MCMI) scale scores of 137 OCD patients seeking outpatient treatment; four cluster types emerged. Patients' OCD symptom severity was assessed at pretreatment, posttreatment, and 6-month follow-up using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Patients with no evident personality pathology and those with dependent qualities demonstrated the best overall outcome. Patients whose personalities indicated particular difficulties with interpersonal interaction were most likely to refuse behavior therapy and, among these patients who engaged in treatment, evidenced no reduction in OCD symptoms at posttreatment and follow-up. Patients with histrionic/borderline traits showed symptom reductions at posttreatment, but did not maintain their treatment gains at follow-up. The clinical implications of these findings are discussed.

Personality characteristics of alcohol dependent inpatients: relationship of MCMI subtypes to self-reported drinking behavior

Recent cluster analytic research with alcoholic inpatients has demonstrated the existence of several Millon Clinical Multiaxial Inventory (MCMI) clusters that appear to be consistent across different subject samples. The validity of these data would be strengthened by a statistical demonstration of the similarity of attained clusters across studies--a demonstration of concordance of subject classification across different clustering techniques on the same data set- and the inclusion of external, independent measures against which to evaluate the predictive validity of the cluster typology. We found a high level of concordance in subject classification across different clustering methods on the same data set and a high level of agreement with cluster typologies attained in previous studies. Subsequent multivariate analyses employing independent scales measuring various aspects of alcohol use confirmed differences among cluster members on perceived benefits of alcohol use and deleterious effects of alcohol use. The prominent differences in alcohol use along with a rationale for their development are discussed.

The relationship between personality type and style of alcohol use

Two hundred fifty male, alcoholic VA inpatients were administered the Millon Clinical Multiaxial Inventory (MCMI) and the Alcohol Use Inventory (AUI). A cluster analysis, based on the scales of the MCMI, yielded three clusters: Cluster 1 was the smallest and was described by the least overall psychopathology. Cluster 2 had significant elevations on Antisocial, Narcissistic, Paranoid, Drug and Alcohol Abuse scales. Cluster 3 was the largest and had significant elevations on Avoidant, Schizoid, Dependent, Passive-Aggressive, Anxiety, Dysthymia, and Alcohol Abuse scales.

An update of the Millon Clinical Multiaxial Inventory (MCMI)

Reviews, commentary, and recent research on the MCMI are examined. There has been controversy over the impact on research of delayed availability of hand scoring materials, the discrepancies between Millon's diagnostic conceptualizations and DSM-III, and MCMI construction idiosyncrasies. MCMI use for clinical diagnosis continues to be suspect, but clinicians now have an augmented awareness of DSM limitations as a result of this version of the Millon instrument.