Brief Communication: Trail Making Test and Malingering among Substance Abusers

Abstract

The Trail Making Test (TMT) is often used for screening cognitive impairments in substance abusers. A possible limitation of the TMT in clinical settings is that substance abusers may malinger and give poor effort. In this study, previously validated cutting scores for malingering were applied to a sample of 7689 substance abusers (primary drug of abuse-number of subjects: Alcohol-1000, Marijuana-259, Hallucinogen-128, Cocaine/crack-4306, Heroin-1548, Narcotics/other opiates-191, Sedatives-72, Amphetamines-185) in drug abuse treatment programs. A mixed race sample was drawn from electronic files of data from the Drug Abuse Treatment Outcome Study (DATOS). The DATOS was a naturalistic, prospective cohort study that collected data from 1991-1993 in 96 programs in 11 cities in the United States. Data were analyzed to determine the number of substance abusers that fell beyond the preset malingering cutting scores on the TMT in this very large sample of substance abusing patients in treatment settings. The TMT variables of seconds to complete Part A and Part B, and the ratio score of Part B divided by Part A (B/A), ranged from no subjects beyond the preset cutting score for Part B to 2.28% (175 of 7689 subjects) for Part A to 9.74% (749 of 7689 subjects) for the ratio score. Most substance abusers fell within preset cutting score ranges, a finding that suggests that their scores are valid. Another interpretation of the data, however, is that the cutoff scores were not particularly sensitive to biased responding. Further research is indicated.