Alcohol Dependence Scale (ADS) User's Guide

Donna MacDonald was a nutritionist and founder of the Nutrition Information Service at Ryerson Polytechnical Institute, Toronto.

The Alcohol Dependence Scale (ADS) is a 25-item forced-choice questionnaire developed to assist clinicians in assessing severity of alcohol dependence. In order to determine treatment requirements, adequate assessment techniques are required that accurately measure dependence, and ADS attempts to provide a quantitative index of severity. As the authors point out, an estimated 5 to 7 per cent of the male population in North America may meet the criteria for alcohol dependence, and a further 15 to 35 per cent may be classified as non-dependent abusers. More sophisticated assessment tools were necessary if effective treatment planning was to be empirically based.

The Alcohol Dependence Sale User’s Guide is a useful companion to the actual ADS instrument, which is sold separately. The background section reviews the scope of alcohol dependence syndrome and provides theoretical and conceptual grounding. The ADS scale was adapted from the Alcohol Use Inventory, after 25 years of comprehensive factor analysis studies.

The second section of the guide summarizes data on measurement properties of the instrument. The authors review data from studies on ADS and conclude that reliability and predictive validity of the test are high. Factor analysis has indicated intercorrelation among items on the text. However, there are still several measurement problems with the scale. Discriminant validity has not been demonstrated; the effect of social desirability bias is high. The content of items is obvious and can therefore result in a large proportion of false answers, mainly due to underreporting. As a result, full construct validity has not been established. The authors caution those administering the test to watch for deceptive answers, but such judgments can be difficult. Since the subjects of these studies were volunteers and mostly male, further caution is warranted in generalizing results to different contexts or populations.

Guidelines for use are presented in the final section. The scale takes about 10 minutes to complete and can be self- or interviewer-administered. Scoring of the test is by summation, with the raw scone interpreted relative to a set of normative group data. A more sophisticated standard score can be computed. In this area, some question still exists as to the appropriateness of reference data from a normative group.

Despite some measurement evaluation inadequacies, the scale will no doubt be of value in providing an easy-to-administer, inexpensive research and diagnostic tool with which a quantitative index of severity can be established. There is sound theoretical grounding for the scale, and future measurement studies will lead to further refinement. As a practical application of ADS scale usage, empirically based rules for making treatment planning decisions need to be developed.