Assessing the Accuracy of the Substance Abuse Subtle Screening Inventory-3 Using DSM-5 Criteria

Abstract

The Substance Abuse Subtle Screening Inventory-3 (SASSI-3; Miller & Lazowski, 1999) is a substance use screen that uses logically derived, or obvious questions, as well as subtle, or empirically derived questions. The SASSI-3 can be completed, scored and interpreted in 15 minutes. Side one consists of 67 true-false items selected for their ability to statistically differentiate between a criterion group of persons with substance dependence and a control group of non-substance dependent persons. The 67 empirically derived items are used in an effort to defeat dissimulation and are similar in nature and purpose to items found on the MacAndrew Alcoholism Scale-Revised (MAC-R; MacAndrew, 1965). As such, these empirically derived items are useful with individuals who are either intentionally or unintentionally denying a substance use (Laux, Piazza, Salyers, & Roseman, 2012). These comprise the Symptoms scale (SYM), which assesses the symptoms and consequences of drug and alcohol use; the Obvious Attributes scale (OAT), a measure of the obvious symptoms of substance dependence; the Subtle Attributes scale (SAT), an indirect measure of substance use that employs items with non-substance-related content; the Defensiveness scale (DEF), which measures denial or minimization; the Supplemental Addiction Measure scale (SAM), which discriminates general defensiveness from defensiveness related to substance use; the Family Versus Control Subjects scale (FAM), which identifies those who are likely to focus on the thoughts and feelings of others to their own neglect; the Correctional scale (COR), used to detect response patterns similar to those produced by persons with a history of criminal behaviors; and the Random Answering Pattern scale (RAP), designed to identify haphazard answering. Side one also includes questions about respondents' marital status, employment status, education, ethnicity and income.Side Two consists of 12 items specific to alcohol use and 14 items regarding use of other substances. Response options to these 26 items are never, once or twice, several times, and repeatedly. These 26 items comprise the Face Valid Alcohol (FVA) and Face Valid Other Drugs (FVOD) scales and are similar to items found on the Michigan Alcoholism Screening Test (MAST; Selzer, 1971) and the CAGE (Ewing, 1984). The SASSI-3 is interpreted using nine decision rules. The first five decision rules are based solely on the unique contributions of individual scales. The remaining four decision rules involve a combination of two or more scales. A decision rule is coded yes if the associated SASSI-3 scale or scales' raw score is equal to or greater than the decision rule's cut score. Otherwise, the decision rule is coded as no. The respondent is determined to have a high probability of having a substance dependence disorder if any of the decision rules are met (Miller & Lazowski, 1999, p. 10).Not only does the SASSI-3 do a better job of identifying alcohol use disorders than the MAST, CAGE and MAC-R (Laux, Perera-Diltz, Smirnoff, & Salyers, 2005; Laux, Salyers, & Kotova, 2005), it provides the added benefit of screening for drug use other than alcohol. The most recent inquiry into substance use screens indicated that the SASSI-3 is the substance use screen most frequently used by Master Addictions Counselors certified by the National Board for Certified Counselors (Juhnke, Vacc, Curtis, Coll, & Paredes, 2003).The SASSI-3 Manual (Miller & Lazowski, 1999) reported a sensitivity (true positive) rate of 94.6% and specificity (true negative) rate of 93.2%. Subsequent field research produced results consistent with the psychometric claims made in the SASSI-3 Manual (Burck, Laux, Harper, & Ritchie, 2010; Burck, Laux, Ritchie, & Baker, 2008; Calmes et al., 2013; Hill, Stone, & Laux, 2013; Laux, Perera-Diltz, Smirnoff, & Salyers, 2005; Laux, Salyers, & Bandfield, 2007; Laux, Salyers, & Kotova, 2005; Wright, Piazza, & Laux, 2008). …