International Journal of the Addictions
ISSN: 0020-773X (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/isum19
Trail Making Test Performance of Alcoholics Abstinent at Least a Year Donald I. Templer, Carol F. Ruff & Kathleen Simpson To cite this article: Donald I. Templer, Carol F. Ruff & Kathleen Simpson (1975) Trail Making Test Performance of Alcoholics Abstinent at Least a Year, International Journal of the Addictions, 10:4, 609-612, DOI: 10.3109/10826087509026738 To link to this article: http://dx.doi.org/10.3109/10826087509026738
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The International Journal of the Addictions, 10(4), pp. 609-612, 1975
Trail Making Test Performance of Alcoholics Abstinent at Least a Year Donald I. Templer Pleasant Grove Hospital Anchorage, Kentucky
Carol F. Ruff Kathleen Simpson Western State Hospital Hopkinsville, Kentucky
The purpose of the present research was to compare the Trail Making Test performance of alcoholics who have not consumed any alcohol for at least a year with that of normal control subjects. The Trail Making Test is a two-part instrument that assesses organic impairment. Part A consists of 25 circles distributed over a sheet of paper and numbered from 1 through 25. The subject is required to connect the circles in numerical sequence with a pencil line as quickly as possible. Part B consists of 25 circles numbered from 1 through 13 and from A to L. The subject is required to connect the circles, alternating between numbers and letters and taking both series in ascending sequence. The Trail Making Test was 609 Copyright 0 1975 by Marcel Dekker, Inc. All Rights Reserved. Neither this work nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
TEMPLER, RUFF, AND SIMPSON
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chosen for the present research because it has a rather high degree of validity (Reitan, 1955, 1958) and because in three previous investigations alcoholics had significantly inferior performance on it than control subjects. Table 1 summarizes the relevant data for these three studies. Fitzhugh, Fitzhugh, and Reitan (1960, 1965) and Goldstein and Chotlos (1965) found alcoholics to be inferior to control subjects on the Trail Making Test. However, in the two Fitzhugh et al. studies the alcoholics had been sober only a mean of 12 days. In the Goldstein and Chotlos research the alcoholics were tested in their second week in the hospital. It is the opinion of many clinicians that recovery of cognitive deficits in alcoholics sometimes takes several months. Furthermore, in research of Smith and Layden (1972) it was found that measures of cognitive, perceptual, and motor ability were significantly improved after 6 weeks of sobriety as compared to test performance with 1 week sobriety. The present investigation was conducted not only to focus upon the Trail Making Test performance of long-term abstinent alcoholics, but to provide greater perspective to the more general question of permanent psychological deficit in alcoholics. In a comprehensive review of psychological deficits in alcoholics by Tarter (in preparation), the period of sobriety before testing in the vast ma,jority of the studies cited was less than Table 1 Summary of Previous Studies Using Trail Making Test with Alcoholics No. Study Fitzhugh et al. (1960) Alcoholics Controls Fitzhugh et al. (1965) Alcoholics Controls Goldstein and Chotlos (1965)' Alcoholics Controls a
Ss
Sex
Mean age
Mean education
Mean days abstinence
17 17
M M
44.41 44.35
10.76 11.00
12.00
35 35
M M
40.57 39.77
11.00 11.71
11.94
50 50
M M
44.76 41.84
10.98 12.72
t14.00
Trail Making Test superiority
X
X
Alcoholic and control means adjusted by analyses of covariance
X
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TRAIL MAKING TEST PERFORMANCE OF ALCOHOLICS
61 1
2 weeks after the gross effects of intoxication had subsided, or else was not specified (although presumably not long since the alcoholics employed were in acute treatment programs). Among the longer intervals were a mean of 42 days (Jones, 1971), 42.43 days (Jones and Parsons, 1971), 40.18 days (Kish and Cheney, 1969), during their second month (Pishkin, Pishkin, and Stahl, 1972), and for at least 60 days (Edelberg, 1970). The only study with a sobriety interval comparable to that of the present research is that by Plumean, Machover, and Puzzo (1960). They administered the Wechsler-Bellevue Intelligence Scale to 22 active AA members with a minimum of 2 years sobriety, 23 alcoholics who never had more than 6 months sobriety, and 23 normal control subjects appropriately matched with the other two groups. The IQs of the three groups were not statistically different. However, the Plumeau et al. findings with an intelligence test are not different from those of similar investigations with short-term sobriety alcoholics reviewed by Tarter (in preparation) who concluded, “The reports are virtually unanimous in rejecting the notion that alcoholics suffer from a generalized or global intellectual deteriorati on .”
METHOD Both the 22 recovered alcoholic and 20 control subjects to whom the Trail Making Test was administered are White males from various localities in western Kentucky who volunteered for t h s research. All of the recovered alcoholics are members of A.A. They have been abstinent from 1 to 18 years with a mean of 5.77 years. They had previously been uncontrolled alcoholics from 2 to 45 years with a mean of 15.55 years. The alcoholic and control subjects are very similar with respect to mean age, 50.09 and 50.60, respectively, and they are very similar with respect to mean education, 10.72 and 1 1 .OO, respectively.
RESULTS AND DISCUSSION The alcoholic and control subjects took means of 58.32 and 55.35 seconds ( t = 0.34, NS), respectively, to complete Part A of theTrail Making Test; 116.23 and 133.30 seconds ( t = 1.34, NS) for Part B, 174.55 and 179.67 seconds ( t = 0.28, NS) for Part A plus Part B. It is apparent that the Trail Making Test did not demonstrate any deficit in recovered alcoholics. It appears likely that the alcoholics’ inferior
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TEMPLER, RUFF, AND SIMPSON
performance in the studies of Fitzhugh et al. (1960, 1965) and Goldstein and Chotlos (1965) was a function of their mean sobriety being less than 2 weeks. The present findings have implications beyond those for the performance of alcoholics upon the Trail Making Test. These findings suggest that a large percentage of the studies upon psychological deficits in alcoholics may have to be viewed with a different perspective, and that the inferences based upon such literature are now unclear. It certainly cannot be denied that some alcoholics, such as those with Korsakoff’s syndrome, have permanent organic impairment. However, it would probably now be unwarranted to maintain that the “typical” alcoholic, or those like the subjects in the present study who are functioning in the community and members of A.A., definitely have psychological deficits. REFERENCES EDELBERG, R. Inhibitory Function in the Alcoholic. NIMH Progress Report, Grant Number 14702, 1970, pp. 220-239. FITZHUGH, L., FITZHUGH, K., and REITAN, R. Adaptive abilities and intellectual functioning in hospitalized alcoholics. Quart. J. Studies Alc. 21 : 414-423, 1960. FITZHUGH, L., FITZHUGH, K., and REITAN, R. Adaptive abilities and intellectual functioning of hospitalized alcoholics: Further considerations. Quart. J. Studies Alc. 26: 402-411, 1965. GOLDSTEIN, G., and CHOTLOS, J. Dependency and brain damage in alcoholics. Percept. Motor Skills, 21: 135-150, 1965. JONES, B. Verbal and spacial intelligence in short and long-term alcoholics. J . Nervous Mental Disease. 153: 292-297, 1971. JONES, B., and PARSONS, 0. Impaired abstracting ability in chronic alcoholics. Arch. Gen. Psychiat. 24: 71-75, 1971. KISH, G., and CHENEY, T. Impaired abilities in alcoholism measured by the General Aptitude Test Battery. Quart. J . Studies Alc. 30: 384-388, 1969. PISHKIN, V., PISHKIN, S., and STAHL, M. Concept learning in chronic alcoholics: Psychophysiological and set functions. J . Clin. Psychol. 28 : 328-334, 1972. PLUMEAU, F., MACHOVER, S., and PUZZO, F. Wechsler-Bellevue performances of remitted alcoholics and their normal controls. J . Consult. Psychol. 24: 240-242, 1960. REITAN, R.M. The relation of the Trail Making Test to organic brain damage. J . Consult. Psychol. 19: 393-394, 1955. REITAN, R.M. Validity of the Trail Making Test as a n indicator of organic brain damage. Percept. Motor Skills 8: 271-276, 1958. SMITH, J.W., and LAYDEN, T.A. Changes in psychological performance and blood chemistry in alcoholics during and after hospital treatment. Quart. J. Studies Alc. 33: 379-394, 1972. TARTER, R.E. Psychological deficit in chronic alcoholics, in preparation.
ISSN: 0020-773X (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/isum19
Trail Making Test Performance of Alcoholics Abstinent at Least a Year Donald I. Templer, Carol F. Ruff & Kathleen Simpson To cite this article: Donald I. Templer, Carol F. Ruff & Kathleen Simpson (1975) Trail Making Test Performance of Alcoholics Abstinent at Least a Year, International Journal of the Addictions, 10:4, 609-612, DOI: 10.3109/10826087509026738 To link to this article: http://dx.doi.org/10.3109/10826087509026738
Published online: 03 Jul 2009.
Submit your article to this journal
Article views: 5
View related articles
Citing articles: 2 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=isum19 Download by: [RMIT University Library]
Date: 10 April 2016, At: 01:23
Downloaded by [RMIT University Library] at 01:23 10 April 2016
The International Journal of the Addictions, 10(4), pp. 609-612, 1975
Trail Making Test Performance of Alcoholics Abstinent at Least a Year Donald I. Templer Pleasant Grove Hospital Anchorage, Kentucky
Carol F. Ruff Kathleen Simpson Western State Hospital Hopkinsville, Kentucky
The purpose of the present research was to compare the Trail Making Test performance of alcoholics who have not consumed any alcohol for at least a year with that of normal control subjects. The Trail Making Test is a two-part instrument that assesses organic impairment. Part A consists of 25 circles distributed over a sheet of paper and numbered from 1 through 25. The subject is required to connect the circles in numerical sequence with a pencil line as quickly as possible. Part B consists of 25 circles numbered from 1 through 13 and from A to L. The subject is required to connect the circles, alternating between numbers and letters and taking both series in ascending sequence. The Trail Making Test was 609 Copyright 0 1975 by Marcel Dekker, Inc. All Rights Reserved. Neither this work nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
TEMPLER, RUFF, AND SIMPSON
Downloaded by [RMIT University Library] at 01:23 10 April 2016
610
chosen for the present research because it has a rather high degree of validity (Reitan, 1955, 1958) and because in three previous investigations alcoholics had significantly inferior performance on it than control subjects. Table 1 summarizes the relevant data for these three studies. Fitzhugh, Fitzhugh, and Reitan (1960, 1965) and Goldstein and Chotlos (1965) found alcoholics to be inferior to control subjects on the Trail Making Test. However, in the two Fitzhugh et al. studies the alcoholics had been sober only a mean of 12 days. In the Goldstein and Chotlos research the alcoholics were tested in their second week in the hospital. It is the opinion of many clinicians that recovery of cognitive deficits in alcoholics sometimes takes several months. Furthermore, in research of Smith and Layden (1972) it was found that measures of cognitive, perceptual, and motor ability were significantly improved after 6 weeks of sobriety as compared to test performance with 1 week sobriety. The present investigation was conducted not only to focus upon the Trail Making Test performance of long-term abstinent alcoholics, but to provide greater perspective to the more general question of permanent psychological deficit in alcoholics. In a comprehensive review of psychological deficits in alcoholics by Tarter (in preparation), the period of sobriety before testing in the vast ma,jority of the studies cited was less than Table 1 Summary of Previous Studies Using Trail Making Test with Alcoholics No. Study Fitzhugh et al. (1960) Alcoholics Controls Fitzhugh et al. (1965) Alcoholics Controls Goldstein and Chotlos (1965)' Alcoholics Controls a
Ss
Sex
Mean age
Mean education
Mean days abstinence
17 17
M M
44.41 44.35
10.76 11.00
12.00
35 35
M M
40.57 39.77
11.00 11.71
11.94
50 50
M M
44.76 41.84
10.98 12.72
t14.00
Trail Making Test superiority
X
X
Alcoholic and control means adjusted by analyses of covariance
X
Downloaded by [RMIT University Library] at 01:23 10 April 2016
TRAIL MAKING TEST PERFORMANCE OF ALCOHOLICS
61 1
2 weeks after the gross effects of intoxication had subsided, or else was not specified (although presumably not long since the alcoholics employed were in acute treatment programs). Among the longer intervals were a mean of 42 days (Jones, 1971), 42.43 days (Jones and Parsons, 1971), 40.18 days (Kish and Cheney, 1969), during their second month (Pishkin, Pishkin, and Stahl, 1972), and for at least 60 days (Edelberg, 1970). The only study with a sobriety interval comparable to that of the present research is that by Plumean, Machover, and Puzzo (1960). They administered the Wechsler-Bellevue Intelligence Scale to 22 active AA members with a minimum of 2 years sobriety, 23 alcoholics who never had more than 6 months sobriety, and 23 normal control subjects appropriately matched with the other two groups. The IQs of the three groups were not statistically different. However, the Plumeau et al. findings with an intelligence test are not different from those of similar investigations with short-term sobriety alcoholics reviewed by Tarter (in preparation) who concluded, “The reports are virtually unanimous in rejecting the notion that alcoholics suffer from a generalized or global intellectual deteriorati on .”
METHOD Both the 22 recovered alcoholic and 20 control subjects to whom the Trail Making Test was administered are White males from various localities in western Kentucky who volunteered for t h s research. All of the recovered alcoholics are members of A.A. They have been abstinent from 1 to 18 years with a mean of 5.77 years. They had previously been uncontrolled alcoholics from 2 to 45 years with a mean of 15.55 years. The alcoholic and control subjects are very similar with respect to mean age, 50.09 and 50.60, respectively, and they are very similar with respect to mean education, 10.72 and 1 1 .OO, respectively.
RESULTS AND DISCUSSION The alcoholic and control subjects took means of 58.32 and 55.35 seconds ( t = 0.34, NS), respectively, to complete Part A of theTrail Making Test; 116.23 and 133.30 seconds ( t = 1.34, NS) for Part B, 174.55 and 179.67 seconds ( t = 0.28, NS) for Part A plus Part B. It is apparent that the Trail Making Test did not demonstrate any deficit in recovered alcoholics. It appears likely that the alcoholics’ inferior
Downloaded by [RMIT University Library] at 01:23 10 April 2016
612
TEMPLER, RUFF, AND SIMPSON
performance in the studies of Fitzhugh et al. (1960, 1965) and Goldstein and Chotlos (1965) was a function of their mean sobriety being less than 2 weeks. The present findings have implications beyond those for the performance of alcoholics upon the Trail Making Test. These findings suggest that a large percentage of the studies upon psychological deficits in alcoholics may have to be viewed with a different perspective, and that the inferences based upon such literature are now unclear. It certainly cannot be denied that some alcoholics, such as those with Korsakoff’s syndrome, have permanent organic impairment. However, it would probably now be unwarranted to maintain that the “typical” alcoholic, or those like the subjects in the present study who are functioning in the community and members of A.A., definitely have psychological deficits. REFERENCES EDELBERG, R. Inhibitory Function in the Alcoholic. NIMH Progress Report, Grant Number 14702, 1970, pp. 220-239. FITZHUGH, L., FITZHUGH, K., and REITAN, R. Adaptive abilities and intellectual functioning in hospitalized alcoholics. Quart. J. Studies Alc. 21 : 414-423, 1960. FITZHUGH, L., FITZHUGH, K., and REITAN, R. Adaptive abilities and intellectual functioning of hospitalized alcoholics: Further considerations. Quart. J. Studies Alc. 26: 402-411, 1965. GOLDSTEIN, G., and CHOTLOS, J. Dependency and brain damage in alcoholics. Percept. Motor Skills, 21: 135-150, 1965. JONES, B. Verbal and spacial intelligence in short and long-term alcoholics. J . Nervous Mental Disease. 153: 292-297, 1971. JONES, B., and PARSONS, 0. Impaired abstracting ability in chronic alcoholics. Arch. Gen. Psychiat. 24: 71-75, 1971. KISH, G., and CHENEY, T. Impaired abilities in alcoholism measured by the General Aptitude Test Battery. Quart. J . Studies Alc. 30: 384-388, 1969. PISHKIN, V., PISHKIN, S., and STAHL, M. Concept learning in chronic alcoholics: Psychophysiological and set functions. J . Clin. Psychol. 28 : 328-334, 1972. PLUMEAU, F., MACHOVER, S., and PUZZO, F. Wechsler-Bellevue performances of remitted alcoholics and their normal controls. J . Consult. Psychol. 24: 240-242, 1960. REITAN, R.M. The relation of the Trail Making Test to organic brain damage. J . Consult. Psychol. 19: 393-394, 1955. REITAN, R.M. Validity of the Trail Making Test as a n indicator of organic brain damage. Percept. Motor Skills 8: 271-276, 1958. SMITH, J.W., and LAYDEN, T.A. Changes in psychological performance and blood chemistry in alcoholics during and after hospital treatment. Quart. J. Studies Alc. 33: 379-394, 1972. TARTER, R.E. Psychological deficit in chronic alcoholics, in preparation.
