SASSI - An Assessment Tool Running Head: Sassi - An Assessment Tool 1
SASSI - An Assessment Tool Running Head: Sassi - An Assessment Tool 1
SASSI - An Assessment Tool Running Head: Sassi - An Assessment Tool 1
[Course]
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SASSI – An Assessment Tool 2
Abstract
The SASSI is a brief yet highly accurate tool that works pretty effectively even when
an individual knowingly or unknowingly tries to hide the presence of any problem related to
drugs and/or alcohol. The test has been found reasonably accurate despite the differences in
gender, age, ethnicity, marital status, occupational status and education. The SASSI is
available in both Adult and Adolescent versions and is arguably the only tool with this
special set of testing capabilities and credentials.
The purpose of this article is to trace back the history of the problem of substance
abuse with a special emphasis on the development and evolution of SASSI (as the premier
tool for assessment and diagnosis of the disorder), its psychometric properties, its application
and its strength and weakness analysis.
SASSI – An Assessment Tool 3
Introduction
The term substance abuse is a very tricky one to define, most of the researchers and
counselors treat all uses of licit and illicit drugs in any way inconsistent with general
However, it should also be kept in mind that there is no definition of the term which is
dependence on a drug or other similar chemical substance causing detrimental effects to one's
The disorder usually results from persistent use of some particular medication or non-
medically indicated drug, which results in number of serious social repercussions like failure
and/or legal problems. A number of debates have been done on deciding the exact
symptoms of substance use, and on the other side defining substance abuse in relation with
should not be confused with addiction which forces a continual use of the substance despite
knowing the negative consequences. Dependence usually implies abuse, but abuse often
and intricate relationship between the person, the abused substance and the society.
SASSI – An Assessment Tool 4
disorders causing systems problems at many points (from cell and organ, to one’s family,
schools, workplaces and the society as a whole. (Alexander & Gwyther, 1995)
withdrawal may occur due to various substances, some legal and some illegal. Some of these
that could be abused (like sedatives and anxiolytes), opioids (such as morphine, heroin),
It was during the early 1950s, when the first edition of the APA's DSM (Diagnostic
and Statistical Manual of Mental Disorders) first classified alcohol and drug abuse as a
The DSM-III, in the 1980s, differentiated substance abuse and substance dependence
on the basis of tolerance and subsequent withdrawal with the former lacking both and the
later having both. The continuation in use in spite of knowing that a continuous use may
DSM-IV
use, notable tolerance or withdrawal, the DSM-IV also acknowledged substance abuse's
DSM-IV-TR, says that all of the substances named above (with nicotine and caffeine
Substance-induced disorders.
Substance use disorders encompass both abuse and dependence, whereas, substance-
induced disorders take account of intoxication, withdrawal and a range of mental states (like
dementia, anxiety, psychosis, mood disorder etc.) that may get induced as a result of the
substance’s use.
even after experiencing complex substance-related disorders. The dependent craves for the
substance and the quantity needed of the substance increases with the passage of time to
achieve the desired effect of the substance. This increase in the quantity needed is termed as
tolerance. The dependent may also experience withdrawal symptoms (like increased heart
rate, shivering, fatigue, insomnia and irritability) whenever the substance is out of reach.
On the other hand, substance abuse is continuous use of a substance despite knowing
that it is causing school, work-related or interpersonal problems, but the dependence is not
there. The substance abusers often find themselves entangled in legal problems usually due to
substances can have different effect on individuals in distinct ways. Some of the effects often
Due to confusion in the terminologies the DSM-V, planned for publication in 2010,
will most likely revisit this terminology once again. Hopefully, this time around the problem
Dr. Glenn A. Miller is credited with the development of the Substance Abuse Subtle
Screening Inventory (SASSI) as a screening questionnaire used for identifying people having
The tool is intended for collection of information, its organization and its use in
disorder, even if one does not exhibit symptoms of the problem or abuse of substances.
Guidelines for professionals are available to label individuals with a possible substance abuse
disorder for further tests and evaluation. Interpretation of the results of a SASSI assessment
may help the professionals to understand their clients better than before and to plan their
treatment accordingly.
Necessary Precautions
If used by trained professionals, the tool can play an important part in the evaluation
of substance use disorders. It should always be kept in mind that the SASSI is not made for
the purpose of proving or diagnosing a person as an alcoholic or addict; but is intended to test
for an individual having a high possibility of having the substance dependence disorder. Also
notable is the fact that a thorough assessment incorporates some other available information
as well (like self-report and family history) and should be performed by a trained and skilled
meets with accepted standards presented in the mental health professionals’ handbook,
SASSI – An Assessment Tool 7
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), for a proper clinical
Although, the accuracy rate of the SASSI screening is 94% which is considered as
very high, but this implies the fact that still there is a probability of 6% that a person may be
diagnosed wrong on the basis of SASSI scores. Despite the fact that the SASSI is a very
popular and commonly used screening questionnaire, not enough independent research has
been done on it. Some researchers question the extent of SASSI’s sub-scaling measures to
what they are originally intended to measure and also the accuracy of categorization on the
basis of direct versus indirect scales. Furthermore, the SASSI’s purpose is not to be used for
any kind of discriminate against individuals, especially disqualification from a job, as it will
be a direct violation of the Americans with Disabilities Act to extricate a job applicant solely
The SASSI is a very simple and brief one-page paper-and-pencil questionnaire easily
answerable within 10-15 minutes. From an administrator’s point of view the tool is fairly
easy to administer, to both the individuals and the groups, and can easily yet objectively be
scored usually hand and interpreted, on the basis of objective decision rules, normally in one
or two minutes. Optical scanning equipment is also available for the purpose of mass scoring
and interpretation. One of the biggest strength the tool posses is that it does not asks for a
high level of reading ability. The tool may be used by a multitude of programs and
medical personnel and several other human service providers) with equal ease and
proficiency.
SASSI – An Assessment Tool 8
The SASSI has undergone some rigorous scientific development for a period as long
as 16-years before it was first printed in 1988. Later, two new scales were also added in its
improved version known as SASSI-2 (published in 1994). The SASSI-3 was published in
1997 with a newer scale and much improved accuracy. Items on the SASSI list were selected
on the basis of established standard research methods and proven statistical analysis. Only
those items were included that one way or other identified persons with the substance
dependence disorders. It was noted immediately that the selected items were time and again
Following the success of the tool a Spanish version was also made available in 1996.
Later on, with the increased obsession of the nation to computer-based applications computer
versions of the SASSI were also made available in several formats, in addition to the
Some questions on the tool ask the person about the frequency of having certain
experiences related directly to alcohol and other drugs. These can be answered on a scale of
four-points, from never to repeatedly. Whereas, some items that may appear (on their face
value) as completely unrelated to substance use (indirect items) are presented in a true/false
format. On the whole, the items frame 10 subscales. The results are then reported on a sort of
profile form to be discussed with the client himself later on. Keeping the gender disparity of
responses to certain questions separate profile forms are designed for male and female
respondents. The objective scoring system can only have dichotomous results a yes or a no
answer about the client’s high chances of having any substance dependence disorder. The
SASSI-3 tool has been repeatedly tested empirically and is reported to have the propensity of
the SASSI can also help in identification of individuals without a substance dependence
SASSI – An Assessment Tool 9
disorder with the same 94% accuracy. The accuracy of the tool does not gets affected
significantly by factors like gender, age, ethnicity, socioeconomic status, occupational status,
educational level, marital status, drug of choice and normal level of functioning. Research is
in progress to further improve the accuracy, reliability and usefulness of the SASSI.
An adolescent version of the tool has also been available since 1990. Its second
version (SASSI-A2) reportedly, has an overall accuracy of 94% to identify any adolescent
with any substance dependence disorder (encompassing both substance abuse and substance
dependence). The SASSI-A2 is intended to assess youths within an age bracket of 12-18
years. The accuracy of this tool also does not gets affected by the respondent's gender,
ethnicity, age, education, living situation, employment status, prior legal history and/or
A summary of the SASSI results is usually reviewed with the client. Then the actual
scores gets plotted on a profile graph in contrast with a sample of people (also known as
normative sample) not being assessed for addictions or other similar problems. Results are
then drawn declaring if the person under discussion has high or low chances of having any
Individual scale scores could be used to drill up hypotheses or ideas for further
assessment and treatment. This information is primarily plowed from clinical exposure to the
SASSI.
The results may point towards issues of importance regarding the treatment (like
remaining oblivious to one's own needs). These results can guide about an approach to pursue
with the client (like increasing the awareness or recognizing and confirming their feelings).
SASSI – An Assessment Tool 10
The results may also help in suggesting a course of treatment specifically designed for the
client to whom he/she may respond to (like addiction self-help groups or a program focusing
on education). Lastly, the results may also point toward suitable treatment objectives for the
client (e.g. anger management and social skills). The basic objective of providing any
feedback about the results of SASSI is to make a two-way sharing and comprehension of
dimensions:
On the basis of the arrangement of these scales, decision rules are then used to gauge
the extent to which an individual’s response profile is similar to individuals with proven
SASSI Report
Assessment Overview
Brief Interpretation
The latest version of SASSI i.e. SASSI-3 takes about 15 minutes to complete and is
As mentioned before, the tool is exclusively designed for clinical screening and
treatment only. Its use for any purpose outside this context like for pre-employment screening
Like every other tool this tool also has some inherent advantages and shortfalls, but it
is its strengths that clearly outweigh its weaknesses. We will present the most obvious of the
advantages and shortcomings of the tool in the next few paragraphs and then leave it to the
These help in not only reducing overall assessment costs but also in reducing
comprehensive and complex system of measurement is devised for the purpose. The
biggest strength of the tool is its universality and applicability to every individual in
For this purpose not only psychometric analyses are done but also tests
involving body fluids are done to identify the existence of any psychoactive
The tool’s biggest benefit is that it does not infringe on the client’s dignity and
neither abridges their rights, its confidentiality is its biggest advantage. The doctor-
recovery.
some individuals who are actually not substance abusers but get identified as abusers,
and similarly the probability of missing some abusers is also there. There is 6%
true context.
The body fluid screening may misidentify some persons for having a disorder
only because of having a substance in their body at the time of the screening.
SASSI – An Assessment Tool 13
Despite claiming that the tool is not intended for any discrimination against
persons, like disqualification from a job or denying public assistance and that it is a
violation of the Americans with Disabilities Act, no one can ensure that the
companies and job providers will abstain themselves for using this tool for their own
personal agendas.
for substance abuse work?) claim that “No empirical evidence was found for the
SASSI's claimed unique advantage in detecting substance use disorders through its
2007. SASSI: A Response to Lazowski & Miller. 2007.) that “of the 36 studies we
reviewed, only 10 included a criterion measure against which SASSI accuracy could
be judged, and that only three of these used the SASSI-3. This is because, to the best
of our knowledge, that is the entire peer-reviewed literature on the validity of the
SASSI. The fact remains that no peer-reviewed study has replicated the sensitivity
rate of 0.94 claimed in the test manual and the average, however computed, is well
Conclusion
Despite some bitter criticism from some researchers, the general consensus is that
Like every other man made system, SASSI also possess some flaws or shortcomings
but researchers are working very diligently for the removal of these problems, as a result of
which we have witnessed three versions of SASSI and a different version for adolescents and
Hispanics.
But presently nobody can deny the fact that SASSI is the best we have when it comes
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