Substance Abuse Subtle Screening Inventory
The Substance Abuse Subtle Screening Inventory is also referred to as the SASSI. Dr. Glenn A. Miller developed the SASSI as a screening questionnaire for identifying people with a high probability of having a substance dependence disorder.
The SASSI is intended for gathering information, organizing it, and using it to help make decisions about the likelihood of an individual having a substance dependence disorder, even if the individual does not acknowledge symptoms of the disorder or misuse of substances. Guidelines are available for professionals to flag individuals with a potential substance abuse disorder for further evaluation. Interpreting the results of the SASSI helps professionals understand their clients better and plan their treatment.
When used by trained professionals, the SASSI can be an important tool in the assessment of substance use disorders. The SASSI is not intended to prove or diagnose an individual as an alcoholic or addict; it is intended to screen for a person who has a "high probability of having a substance dependence disorder." It should be kept in mind that a thorough assessment integrates other available information, such as self-report and family history, and is done by a skilled professional. This comprehensive assessment is required to determine if an individual meets the accepted standards in the mental health professional's handbook, Diagnostic and Statistical Manual of Mental Disorders , for a clinical diagnosis of a substance-related disorder.
The accuracy rate of the SASSI is 94%. Although that is very high, this means that there is a 6% probability that an individual will be misclassified based on SASSI scores. While the SASSI is a popular and widely used screening questionnaire, independent research on it has been limited. Some researchers have questions about the SASSI regarding the extent to which subscales measure what they are intended to measure and the accuracy of classification based on direct versus indirect scales. In addition, the SASSI is not to be used to discriminate against individuals, including disqualifying job applicants. It would be a violation of the Americans With Disabilities Act to eliminate a job applicant based on SASSI scores.
The SASSI is a simple, brief one-page paper-and-pencil questionnaire that can be answered in 10 to 15 minutes. The SASSI is easy to administer, to individuals or groups, and can be objectively scored by hand and interpreted, based on objective decision rules, in a minute or two. Optical scanning equipment is available for mass scoring and interpretation. The SASSI does not require a high level of reading ability. The SASSI may be used by a variety of programs and professionals, including school counselors, student assistance programs, employee assistance programs, vocational counselors, psychotherapists, medical personnel, criminal justice programs, and other human service providers.
The SASSI went through rigorous scientific development over a 16-year period before it was first published in 1988. Two new scales were added, and the SASSI-2 was published in 1994. In 1997 the SASSI-3 was published with a new scale and increased accuracy. Items on the SASSI were selected based on established research methods and statistical analysis. Items were included that identified individuals with substance dependence disorders. The selected items were consistently answered differently by individuals with a substance dependence disorder compared to individuals without a substance dependence disorder.
In 1996, a Spanish version was made available. In addition to the paper and pencil format, computer versions of the SASSI, in several formats, are available.
Some questions on the SASSI ask how frequently clients have had certain experiences directly related to alcohol and other drugs. These are answered on a four-point scale, ranging from never to repeatedly. Some items that may appear to be unrelated to substance use (indirect or subtle items) are in a true/false format. Overall, the items make up 10 subscales. The results are reported on a profile form that is discussed with the client. There are separate profile forms for males and females. The objective scoring system results in a yes or no answer about whether the client has a high probability of having a substance dependence disorder. The SASSI-3 has been empirically tested and can identify substance dependence disorder with an overall accuracy of 94%. More specifically, the SASSI identifies individuals with a substance dependence disorder with 94% accuracy, and it identifies those without a substance dependence disorder with 94% accuracy. The accuracy of the SASSI is not significantly affected by gender, age, socioeconomic status, ethnicity, occupational status, marital status, educational level, drug of choice, and general level of functioning. Research is ongoing to improve the accuracy and usefulness of the SASSI.
Since 1990 an adolescent version of the SASSI has been available. The second version of the Adolescent SASSI (SASSI-A2) has a 94% overall accuracy of identifying an adolescent with a substance dependence disorder, including both substance abuse and substance dependence. The SASSI-A2 is designed to screen individuals who are 12 to 18 years old. The accuracy of the SASSI-A2 is not affected by the respondent's gender, age, ethnicity, education, employment status, living situation, prior legal history, or general level of functioning.
A profile of the SASSI results will be reviewed with the client. The actual scores are plotted on a profile graph in comparison to a sample of people who were not being evaluated or treated for addictions or other clinical problems (also called a normative sample). Feedback is then given in terms of whether the individual has a high or low probability of having a substance dependence disorder. Individual scale scores may be used to come up with ideas or hypotheses for further evaluation and treatment. This information is based on clinical experience with the SASSI. The results may indicate issues that are important for treatment (such as difficulty acknowledging personal shortcomings, or primarily focusing on others' needs while unaware of one's own needs). The results may suggest an approach to take with the client (such as increasing awareness, or acknowledging and validating their feelings). The results may suggest a treatment plan that the client may respond to (such as addiction self-help groups or an education-focused program). Finally, the results may indicate appropriate treatment goals for the client (anger management and/or social skills, for example). The goal of providing feedback about SASSI results is to have a two-way sharing and understanding of information that is descriptive and not judgmental.
Miller, Franklin G., Ph.D., and others. SASSI-3 User's Guide: A Quick Reference for Administration and Scoring. Bloomington: Baugh Enterprises, 1997.
The SASSI Institute. The Reliability and Validity of the SASSI-3. Springville: The SASSI Institute, 1998.
The SASSI Institute. Summary of the Consistency and Accuracy of the Adolescent SASSI-A2 for Non-Statisticians. Springville: The SASSI Institute, 2001.
Gray, B. Thomas. "A Factor Analytic Study of the Substance Abuse Subtle Screening Inventory (SASSI)." Educational and Psychological Measurement 61 (2001): 102–118.
Joneis Thomas, Ph.D.
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