Robert J. Craig

Overview and Current Status of the Millon Clinical Multiaxial Inventory

The MCMI (Millon, 1983a, 1987, 1994, 1997a) was developed to operationalize Millons (1969/1983b) model of psychopathology and has been revised 2 times over the past 20 years to keep pace with changes in theory as well as the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994). Since its introduction in 1977, it has become one of the most widely used and researched clinical assessment instruments in history, generating over 500 articles and 6 books. It has been translated into several languages and is being used in cross-cultural research. This article presents a historical overview of the measure and summarizes its current status in the literature. I highlight Millons original vision for the test, changes that have been made, and its strengths and limitations. Future refinement of the MCMI is already in the planning stages and includes trait subscales for the personality disorders and linking codetypes to theory-derived interventions.

PREVALENCE OF PERSONALITY DISORDERS AMONG COCAINE AND HEROIN ADDICTS

Using the MCMI-III, we studied rates of personality disorders among 443 inpatient drug abusers (i.e., 160 opiate addicts and 283 cocaine addicts). For both samples the disorders of antisocial (60%), passive-aggressive (negativistic) (34%), and depressive personality disorders (32%) showed higher prevalence rates. Previous studies (N = 13) using different measures (e.g., SCID, SDIP, MCMI-I) reported similar findings in terms of overall prevalence of specific personality disorders, although actual rates varied by population.

Methadone maintenance. Does dose determine differences in outcome

We conducted a naturalistic study to determine if higher methadone doses were more effective than lower doses in the outcome variables of illicit drug use, treatment retention, missed medication days, and ratings of patient progress by assigned counselor among 265 patients in a Department of Veterans Affairs Methadone Maintenance Treatment Program. Results indicated no significant differences on any outcome variable by methadone dose. However, we found a significant effect by assigned therapist. Some therapists achieved better outcome results on these same variables compared to other assigned therapists independent of dose level. We conclude that, while methadone maintenance dose is an important variable, researchers need to pay more attention to the interpersonal aspects of methadone maintenance treatment.

Psychological functioning of cocaine free-basers derived from objective psychological tests

This paper reports on two separate studies that compared cocaine free-basers with opiate addicts on objective personality tests (Adjective Checklist and MMPI). Both groups showed a similar organization of needs. While opiate addicts were characterized by acting-out traits, rebelliousness, depression, anxiety, alienation, and hyperactivity, the cocaine free-basers were characterized by similar traits, but at modulated levels of severity. Implications for treatment programs and for pharmacodynamic theories, with emphasis on the relationship between underlying personality structure and drug of choice, were discussed.

A psychometric study of the prevalence of DSM-III personality disorders among treated opiate addicts.

Using the DSM-III criteria for personality disorders, prevalence rates of these disorders were evaluated, among opiate addicts in treatment, with a psychometric test--the Million Clinical Multiaxial Inventory. We found that 27% of addicts met criteria for multiple personality disorders. While all 11 DSM-III disorders were diagnosed in our sample, the disorders of antisocial (22%), narcissistic (18%), borderline (16%), and dependent (16%) were more frequent among opiate addicts. These rates were compared to two similar studies that used SADS/RDC criteria with addicts, and the similarities and differences were noted. It is suggested that future research compare rates using both structured psychiatric interviews and psychometric tests to determine the extent of instrument variance on prevalence rates estimates.

Sensitivity of MCMI-III Scales T (Drugs) and B (Alcohol) in Detecting Substance Abuse

The sensitivity and specificity of MCMI-III Scales T (drug dependence) and B (alcohol dependence) were evaluated with patients (N = 164) in an inpatient substance user treatment program. The sensitivity levels of these two scales improved significantly compared to previous research using the MCMI I and MCMI II Scales T and B, which had not achieved sensitivity values above .50. However, specificity for detecting alcoholism among drug misusers was lower compared to MCMI I and II studies. Results suggest improved diagnostic sensitivity with the MCMI-III in diagnosing substance misuse, but lowered efficiency in ruling out the disorder.

Adjectival descriptions of personality disorders : A convergent validity study of the MCMI-III

The responses to a 469-item list of adjectives (consensually validated by national experts as representing key descriptors for each personality disorder) from 202 male substance abusers in outpatient treatment were correlated with their responses to the MCMI-III (Millon, Davis, & Millon, 1997), a frequently used test for the assessment of personality disorders. Results suggested good convergent validity for the interpersonal descriptive domain for the MCMI-III scales. The Histrionic scale had extremely high convergent validity.

Assessing PTSD with the Millon Clinical Multiaxial Inventory-III.

We studied the utility of the Millon Clinical Multiaxial Inventory-III (MCMI-III) in assessing substance-abusing (n = 228), combat-related PTSD patients (n = 32). The MCMI-III produced a code type (16A) that was quite different from MCMI-I and MCMI-II code types (8A2) among similar populations. The PTSD Scale (R) successfully differentiated between a PTSD and non-PTSD substance-abusing group using mean Base Rate scores, was the best predictor of PTSD in a multiple regression equation, and the scales sensitivity and specificity in detecting and/or ruling out the disorder was above that provided by chance alone and higher than the values reported in the test manual for that scale. The MCMI-III may be used as a broad band screening instrument for PTSD, at least among patients with combat-related stress.

Testimony Based on the Millon Clinical Multiaxial Inventory: Review, Commentary, and Guidelines

Test results from the MCMI have been ruled admissible in court for a variety of clinical and forensic issues. This article addresses MCMI issues such as the tests applicability and admissibility of test results in forensic evaluations, test administration, test scoring, malingering and deception, prediction and diagnosis of behavior, reliability, validity, operating characteristics and diagnostic efficiency statistics, and use of computer-assisted interpretation of test results for forensic presentation. Recommendations are suggested for dealing with each of these issues in a forensic context.

Predicting Methadone Maintenance Treatment Outcomes Using the Addiction Severity Index and the MMPI-2 Content Scales (Negative Treatment Indicators and Cynism Scales)

We studied the ability of the Minnesota Multiphasic Personality Inventory‐2 Content Scales (Negative Treatment Indicators [TRT] and Cynicism [CYN]) and the domain scales of the Addiction Severity Index (ASI) in predicting outcome from a methadone maintenance program. Participants were 108 African American males treated in a VA health care outpatient methadone maintenance treatment program and followed for up to 1 year after admission. Dependent variables were 1) length of stay and the percentage of 2) missed medication days, 3) toxicology urine samples free from illicit drugs, 4) full‐time employment, 5) attendance at scheduled counseling sessions, and 6) counselor ratings of patient progress. A stepwise linear regression equation indicated that low drug severity scores on the ASI and low scores on percentage of missed medication predicted patients who were clean 1 year later; low scores on the psychological domain of the ASI predicted attendance at counseling sessions; a discriminant function analysis (consisting of percent of missed medication, percentage of clean urines, and ratings of patient progress) successfully predicted patient status (i.e., dropouts vs. “active patients”) with 85% accuracy. Although the TRT and CYN were related to some ASI domains, they were not associated with any outcome variable. Results suggest that some ASI scores serve as important indicators of patient progress in methadone maintenance treatment.