Substance Abuse Subtle Screening Inventory Research Articles

Mandated Treatment for Troubled Adolescents and Substance Use Disorder: Identifying and Breaking Through Defensiveness and Denial

Objective This article presents an investigation of the defensiveness demonstrated by teens who are mandated to participate in treatment as compared to their non-mandated peers. Methods The data for this study was collected as part of The Substance Abuse Subtle Screening Inventory (SASSI) Institute’s third iteration of the Adolescent SASSI-A3. A total of 164 teenagers in treatment served as the dataset for the present study. All participant cases were provided by clinicians working in service settings throughout all U.S. Census Regions and serving in a variety of venues including substance use treatment, criminal justice programs, community corrections, private clinical practices, behavioral health centers, and social service organizations. Results We present two brief de-identified treatment case studies, aptly demonstrating defensiveness and denial from a clinical standpoint. Additionally, we review cases demonstrating high-levels of defensiveness and denial in mandated teen clients, and ethical ways to break through that barrier to treatment engagement. Conclusion Working with teens can be extremely difficult given their rapid mood changes, intensely felt experiences and shifting states of compliance, openness and defiance. When teens are mandated for treatment, they may often feel their choices have been taken away and the counselor may be viewed as more of a power authority rather than a concerned and helping figure. Contingencies placed on the teen as part of the mandated treatment experience are generally the primary focus, rather than addressing their underlying substance use disorder (SUD). As a result, the teen, as well as the counselor, require greater focus than just making sure those requirements are met

Criminal Justice Alcohol and Drug Screening in Practice: Using the Substance Abuse Subtle Screening Inventory to Identify Substance Use Disorder in Offenders

Objective The substance abuse subtle screening inventory (SASSI) has been used successfully in correctional treatment settings and correctional screening since 1988. These screenings include outpatient evaluations of offenders within community settings, as well as assessments of incarcerated individuals within federal, state, city, and county correctional facilities. One key element towards reducing recidivism and reoffending, is that individuals receive treatment for substance use disorders (SUD’s) while in the correctional system. While SUD is not the only contributing factor to criminality, it does significantly increase the likelihood of legal infraction and violations, placing these individuals at a higher risk of re-offending. Thus, identifying SUD as early as possible helps provide tailored treatment to those who need it, while simultaneously reducing the risk of future legal difficulties. Now in its fourth iteration (SASSI-4), this article discusses the SASSI screening tools’ utility with criminal offenders and serving clinical needs, and reviews a case study of a young male’s clinical evaluation while incarcerated. Results For this case study, we reviewed the SASSI-4 screening results of a 24-year-old male whom we will call "Bryon". Bryon was in his 4th week of detention at a local mid-western jail in the United States. He was arrested after turning himself in for a prior domestic violence offense committed while under the influence of alcohol and for which he had fled the state. Bryon had one prior arrest (for receiving stolen property, which he subsequently traded for drugs). The intake counselor conducting Bryon’s assessment had been meeting with him at the jail for several weeks. The court was particularly interested in determining the level of risk that Bryon would again flee the area. Conclusion This case presents us with a good example of the value of early identification of substance use disorder, and potential problems in criminal justice settings. Bryon's SASSI results clearly demonstrate a well-established pattern of substance misuse that will require relatively intensive intervention. Therefore, he may be a solid candidate for diversion into an alcohol and drug treatment program as a way of reducing the risk of future offenses.

Psychometric evaluation of the Substance Abuse Subtle Screening Inventory-3 with Northern Plains American Indians.

The efficacy of the Substance Abuse Subtle Screening Inventory-3 (SASSI-3) was assessed among northern plains American Indians (AIs). The current study examined the efficacy of the SASSI-3 for identification of substance abuse in AIs. Northern plains AIs from 7 reservations participated in the study. The participants were either a clinical sample receiving substance abuse (SA) or mental health diagnoses from behavioral health clinicians and receiving outpatient treatment services or a community sample that had no substance abuse or mental health diagnoses and were not currently in treatment (no diagnosis). The internal consistency for Face Valid Alcohol (FVA), Face Valid Other Drugs, and Symptoms (SYM) subscales were excellent, and the consistency for the other subscales was moderate, ranging from .21 to 73. The results of the study suggest that the SASSI-3 has good positive predictive power (PPP) and negative predictive power (NPP), particularly when the criterion group substance abuse is larger in the sample. Additionally, the PPP and NPP varied depending on the decision rules. For the analysis that included individuals with just SA, the clinical group scored significantly higher than the no diagnosis group on all measures of the SASSI-3, except for Defensiveness. When the SA group included all individuals with the diagnosis (regardless of the comorbid diagnosis), the clinical group scored significantly higher than the no diagnosis group for all the SASSI-3 subscales. A discriminant examination of the standardized function coefficients indicated that the FVA and SYM subtests contributed the most to the function. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Alcohol and Substance Use Symptom Differences Between Classes of Perfectionists

We examined how multidimensional perfectionism is associated with the Substance Abuse Subtle Screening Inventory–3 (SASSI‐3; Miller & Lazowski, 1999) among a sample of 428 undergraduate students. Latent profile analysis based on measures of perfectionism and perceived stress supported a four‐class model (i.e., adaptive perfectionists, mixed perfectionists, nonperfectionists, and maladaptive perfectionists). Overall, adaptive perfectionists reported fewer alcohol and substance use–related symptoms, whereas maladaptive perfectionists reported higher alcohol and substance use–related symptoms. In addition, according to the SASSI‐3 overall classification rule screening for low or high risk of an alcohol or substance use disorder, adaptive perfectionists were the least likely to be classified in the high‐risk category, whereas maladaptive perfectionists were the most likely to be classified in the high‐risk category.

Mental Health and Substance Use Disorder Co-Morbidities Among Teens in Treatment: SASSI-A3 Correlations in Screening Scores

This article presents an overview of a study investigating the co-occurrence of teen mental health and substance use disorders. These co-morbidities have proven problematic and difficult to treat and/or identify in this population. The data for this study was collected as part of The SASSI Institute’s third iteration of the Adolescent Substance Abuse Subtle Screening Inventory (SASSI-A3). A total of 515 teenagers in treatment, whose cases consisted of a valid and complete SASSI-A3, DSM-5 diagnostic evaluation, and client demographics, served as the dataset for the present study. Specifically, we focused on the frequencies of mental health diagnoses alongside a DSM-5 diagnosis of substance use disorder for teens who were seeking treatment for substance misuse issues. All participant cases were provided by clinicians working in service settings throughout the U.S. Census Regions (Northeast, Midwest, South, West). These professionals served in a variety of venues including substance use treatment and criminal justice programs, community corrections, private clinical practices, behavioral health centers, and social service organizations. All clinicians were qualified SASSI users who administered the SASSI-A3 via the SASSI Institute’s SUD web-based screening application. Substance abuse in teens can often be a sign of an attempt to self-medicate an untreated mental health disorder. Identifying possible correlations between SASSI-A3 scale scores and diagnosed mental health disorders, depression and anxiety in particular, can enable clinicians to direct the course of subsequent clinical interviews, and further assessments needed early in the counseling relationship.

Vaping and Edibles: Self-Reported Usage Patterns Among Teens In and Out of Treatment

Objective This article examines one key aspect of the Substance Abuse Subtle Screening Inventory (SASSI) Institute’s forthcoming third iteration of the Adolescent Substance Abuse Subtle Screening Inventory (SASSI-A3). Overall project aims were to revise the second version of the adolescent SASSI (SASSI-A2), and to update new symptom-related identifiers of substance use disorders in adolescents according to the diagnostic and statistical manual of mental disorders, Fifth Edition (DSM-5) guidelines. Methods We added new questions regarding cannabidiol (CBD) edible consumption and the extent of vaping to review and subsequently address these dangers in teens. Identifying these patterns will inevitably direct the course of subsequent clinical interviews and treatment planning. Early intervention is a critical component towards preventing possible negative outcomes for substance misusing teens. Results This aspect of the research demonstrated a connection between a higher acknowledged usage pattern of teens in treatment versus teens not in treatment. Correlations between beliefs associated with marijuana legalization, marijuana usage by family and friends, tobacco use, connection between age at first use, and the onset of regular usage patterns were also shown to be significantly higher among teens in treatment. Conclusions Teens that begin using alcohol, drugs, and tobacco early in adolescence are more likely to engage in vaping and edible usage. They are also more likely to use at a more frequent rate. In addition, teens who are surrounded by family and friends who engage in marijuana use are more likely to be supportive of its recreational use and legalization. This acknowledged information on the SASSI-A3 can help direct treatment planning early in the counseling relationship and provide a gateway for bringing family in the treatment and education process.

A Prospective Study of Service Use in the Year After Birth by Women at High Risk for Antenatal Substance Use and Mental Health Disorders

Maternal substance use (SUD) and mental health disorders commonly co-occur and require complex treatment. Information on women’s use of appropriate services in the perinatal period is limited. Data from the New Zealand Infant Development, Environment and Lifestyle Study were used to examine the characteristics of women with high probability of substance use and/or psychiatric disorder and rates of service use at 1 and 12 months following birth (n = 221). The Substance Abuse Subtle Screening Inventory-3 and the Brief Symptom Inventory were used to identify risk of disorder. Despite a high proportion of mothers with disorder risk, rates of specialist treatment remained low across SUD and psychiatric groups at 1 (27–39%) and 12 months postnatal (25–42%). Very low rates of women with comorbid disorder received both mental health and substance use treatments (1 month, 4.5%; 12 months, 7.3%). There was no association between service use and risk for psychiatric disorder at 12 months after birth. The findings suggest that even when services are publicly funded, they may be under-utilised or under-resourced to provide effective treatment, despite the high and complex needs of this population.

Detecting “Faking good” with the Adolescent Substance Abuse Subtle Screening Inventory-SASSI-A3: A Clinical Response to Alcohol & Other Drug Use Minimization among Teens

ABSTRACT This article reviews one aspect of the clinical findings of a “fake-good data set” of the SASSI Institute’s forthcoming third iteration of the Adolescent Substance Abuse Subtle Screening Inventory (SASSI-A3). We are evaluating new items for inclusion in the SASSI-A3 to address emerging issues and contemporary trends; comparison of honest and “fake” responses from participants with known Substance Use Disorders (SUDs), and in order to validate the instrument’s efficacy identifying likely SUD profiles when respondents do not fully acknowledge substance misuse. Such respondent drug use pattern minimization is known as “faking-good.” This is the first in a series of reports comprising a validation study by the SASSI Institute to monitor the concordance and accuracy of the adolescent SASSI substance use screening measure against DSM-5 criteria for diagnosing SUDs. Providing screening and assessment professionals appropriate scale scores to identify defensive client responses, or attempts to minimize disclosure of substance abuse, can inform subsequent clinical interviews. These scale scores will assist professionals with treatment planning, enhancing treatment placement and related conditions.

Subtle scales: An avenue for identification of prescription drug abuse

Prescription drug abuse and diversion behavior is sustained by overprescribing of abuse-liable substances. Individuals who intend to abuse or divert prescriptions can feign symptoms easily and effectively. Efforts to identify such faking behavior have been lacking because most drug abuse screening tools and self-reported symptom inventories are known to have poor sensitivities to faking. This paper makes the case for the potential of subtle scales in the identification of faking behavior. Subtlety in scale development is the degree to which the psychopathological meaning of an item can be determined in an a priori fashion. Scales containing subtle items, such as the Minnesota Multiphasic Personality Inventory and the Substance Abuse Subtle Screening Inventory, have traditionally shown only moderate sensitivity to faking due to the lack of a tailored and focused approach. This paper provides a guide for the development of a subtle scale that is tailored to a specific condition and using sound measurement theory, a theoretical framework, and knowledge derived from literature. The Accuracy of Knowledge framework proposed by Lanyon is presented along with its application to the development of a subtle scale. Further, specific recommendations have been provided for the various steps involved in the development of a subtle scale including item development, sample selection, item refinement, and scale scoring. Use of well-developed subtle scales can present opportunities to reduce overprescribing, over-diagnosis, and help in the early identification of abuse behavior for targeted interventions. We conclude by presenting opportunities, scope, and possible avenues for research within the cultural context of the United States.

Validation of the Adult Substance Abuse Subtle Screening Inventory-4 (SASSI-4)

Abstract. The study objective was to develop a revision of the adult Substance Abuse Subtle Screening Inventory-3 to include new items to identify nonmedical use of prescription medications, as well as additional subtle and symptom-related identifiers of substance use disorders (SUDs) and to evaluate its psychometric properties and screening accuracy against a criterion of DSM-5 diagnoses for SUD. Clinical professionals throughout the nine US Census Bureau regions and two Canadian provinces who used the SASSI Online screening tool submitted 1,284 completed administrations of the provisional SASSI-4 along with their independent DSM-5 diagnoses of SUD. Validation sample findings demonstrated SASSI-4 sensitivity of 93% and specificity of 90%, AUC = .91. Items added to identify respondents who were abusing prescription medications showed 94% overall screening accuracy. Logistic regression showed no significant effects of client demographic characteristics or type of screening setting on the accuracy of SASSI-4 screening outcomes. In Study 2, 120 adults in recovery from SUD completed the SASSI-4 under instructions to fake good. Sensitivity of 79% was demonstrated for the full scoring protocol and was 47% when only face valid scales were utilized. Clinical utility is discussed.

Screening Drug, Alcohol and Substance Abuse the Psychometric Measures

Urinalysis was used in previous studies among higher institution students (n=16252) in Malaysia to answer the question of whether university students are involved in drug abuse. However, the use of urinalysis had faced some problems. The problems were related to human rights issues and the cost to perform the urinalysis was expensive and quite impossible to be implemented to a large population of university students. To overcome this problem, this study was conducted to examine the effectiveness of psychometric measures in screening drug, alcohol and substance abuse. The Substance Abuse Subtle Screening Inventory A2 (SASSI-A2) was used for this purpose. SASSI-A2 is a brief screening tool designed to identify individuals who have a high probability of having a substance use disorder, including both substance abuse and substance dependence. SASSI-A2 comprises of 72 items that are rated on a two point scale with response; true and false. SASSI-A2 was translated into Malay language and it was refined through a back-translation technique and focus group approach. Psychometric testing was undertaken on a sample of 750 university students from five public universities in Malaysia. All participants were aged between 19 and 20 years. Internal consistency coefficients were calculated for the total scale and its subscales. Chronbach's alpha obtained for SASSI-A2 was 0.72. This relatively high level of Chronbach's alpha showed relatively high level of reliability. The results demonstrated that the whole SASSI-A2 meets the fundamental measurement properties and can discriminate groups of higher institution students from high to low on the substance dependency variable. The accuracy of the test has been found to be unaffected by gender, ethnicity, age and years of education. Although more rigorous validation studies are needed, it is recommended that SASSI-A2 be considered for usage to higher institution students populations when a brief, objective, and accurate screening tool for chemical dependency is needed.

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

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). …

Exploring the Value of the Substance Abuse Subtle Screening Inventory–3 for Predicting Attrition and Recidivism Among Perpetrators of Intimate Partner Violence

This study explored the potential value of the Substance Abuse Subtle Screening Inventory–3 (SASSI‐3; F. G. Miller & Lazowski, ) as a means of predicting program attrition and recidivism among perpetrators of intimate partner violence, concluding that the SASSI‐3 is not an adequate predictor.

Women Reentering the Community: Understanding Addiction and Trauma-Related Characteristics of Recidivism

Women represent 26% of those arrested for serious crimes; many have posttraumatic stress and co-occurring substance use disorders, which may influence recidivism. This study examined 57 women residing in a community re-entry program after exiting prison. Participants completed the Trauma Symptom Inventory and Substance Abuse Subtle Screening Inventory. A discriminant function analysis accounted for 34% of between-group variability and provided a profile of women who recidivated. Women who recidivated had greater alcohol dependence and lower rates of sexual dysfunction and sexual concerns. Practitioners should consider potential links between substance abuse, trauma, and sexual behavior in treatment settings.

A Rasch Analysis of the Substance Abuse Subtle Screening Inventory–3

Rasch analysis of the Substance Abuse Subtle Screening Inventory–3 (SASSI‐3; F. G. Miller & Lazowski, 1999) indicated that the SASSI‐3 meets fundamental measurement properties; however, the authors of the current study recommend the elimination of nonfunctioning items and the improvement of response options for the face valid scales to increase functioning and ease of use.

Commentary on Ondersma et al. (2012): Beyond the quest for the perfect test—drug use screening in pregnancy

Unchanged since its articulation in 1968 by the World Health Organization, the object of screening remains ‘to discover among the apparently well who are in fact suffering from disease’ 1. Guidelines for a good screening test remain the following: the availability of treatment, latent disease state, patient acceptability and a balance of benefits to harms on the population level. Ondersma et al. 2 propose a novel screening instrument for drug use in the prenatal period. The authors are to be commended in approaching the subject area with an understanding of the shame and stigma that often accompanies drug use during pregnancy. To overcome what they term ‘hesitancy in disclosure’, the authors propose and validate an indirect screening method (Wayne Indirect Drug Use Screener: WIDUS). Using both urine and hair toxicology as the gold standard, the indirect screening instrument performed similarly to other published screening instruments and better than a direct screener, the Drug Abuse Screening Test (DAST), in their sample. As an obstetrician gynecologist who provides care to pregnant women with drug problems, I understand the importance of this topic. However, I am uncertain as to the benefit of a new screening instrument in general, and have reservations about the clinical utility of indirect methods in particular. From the 4Ps Plus to the Zuckerman–Kuhlman Personality Questionnaire (ZKPQ), the Substance Use Screening and Assessment Instruments Database managed by the Alcohol and Drug Abuse Institute at the University of Washington currently catalogues 904 unique instruments, of which 15 have been developed specifically for or validated in pregnant women 3. To my knowledge, there is a single systematic review of substance screening during pregnancy. Bradley et al. investigated seven alcohol screening instruments and failed to demonstrate any large differences in test characteristics between them 4. To date, no single method is recommended by professional societies in the United States 5, 6 or Canada 7. The overall absence of any evidence privileging one screening method over another begs the question as to whether additional instruments need to be developed. One of the problems with screening for drug use during pregnancy is the inconsistent uptake of screening among providers. Although universal screening is recommended 8, it is far from achieved 9. More common in the United States is selective screening based on race, poverty and poor pregnancy outcomes 10. This selective screening is highly discretionary 11, and betrays a disturbing bias among providers of women's health care towards the legal coercion of pregnant women with drug problems 12. A new screening instrument is unlikely to change these realities. Unlike direct screening methods which rely on self-report, indirect methods attempt to capture use without using a tool that refers to drug use. The concept and appeal of indirect screening has existed for several decades 13. However, the evidence to support its superiority is lacking. For example, a recent review of one of the most used indirect screeners (Substance Abuse Subtle Screening Inventory: SASSI) showed no benefit in detecting substance use correctly compared with direct methods 14. Screening only makes public health sense if linked to evidence-based interventions. Clinically, a positive screen invites the opportunity to discuss drug problems and provide brief interventions based upon the individual's readiness to change. Ondersma et al. note that the primary motivation for indirect screening is that under-reporting leads to missed opportunities for interventions. However, non-disclosure reflects a lack of readiness to change (a context in which brief interventions are not indicated) or a mistrust of the provider/clinical encounter (a context in which brief interventions may be harmful), or both. Therefore, it is difficult to see how indirect screening would lead to brief interventions without confrontation, an approach that Ondersma et al. describe correctly as ‘inaccurate, unethical and counterproductive’ 2. In this regard, the clinical utility of indirect screening appears more similar to toxicology testing than to direct screening and therefore raises similar ethical questions 15, specifically the potential harms of false positive results. Using the data from Ondersma et al.'s Table 3, I calculate a false positive rate of at least 7% (cut score 4) to as high as 34% (cut score 2) in the WIDUS screen, which is higher than the DAST-10 in their sample (range 2–10%). This is concerning, as one of the consequences of a positive screen may be a report to Child Protective Services. In conclusion, I believe that we need to move beyond the quest for the perfect test and focus instead on educating providers and empowering mothers such that the complex issues of drug use in pregnancy can be addressed safely and with compassion. None.

The Substance Abuse Subtle Screening Inventory–3 and Stages of Change: A Screening Validity Study

The sensitivity of the Substance Abuse Subtle Screening Inventory—3 (SASSI‐3) was examined among substance‐dependent adults enrolled in a family drug court. The SASSI‐3 had a high sensitivity rate with this population, even across varying levels of motivation to change.

Co-morbidity of substance use disorder and psychopathology in women who use methamphetamine during pregnancy in the US and New Zealand

BackgroundMethamphetamine (MA) abuse is a worldwide problem. Little is known about the co-morbidity of substance use disorders (SUD) and other psychiatric disorders of mothers who use MA prenatally. The Infant Development, Environment and Lifestyle (IDEAL) Study is a prospective, investigation of prenatal MA use and child outcome in the United States (US) and New Zealand (NZ). This study examined prenatal MA use and the co-morbidity of SUD and psychiatric disorders at 1-month postpartum. MethodMothers who used MA (US=127, NZ=97) were compared to a matched comparison group (US=193, NZ=110). The Substance Abuse Subtle Screening Inventory-3 was used to measure the probability of a SUD. The Brief Symptom Inventory (BSI) was used to measure the likelihood of a positive diagnosis of a psychiatric disorder. ResultsIn the US and NZ, MA groups had lower SES, increased single parenting, delayed prenatal care, and increased polydrug use. In the US only, MA mothers had lower income than the comparison group. MA users were 10 times more likely to have a SUD and twice as likely to meet BSI criteria for a diagnosable psychiatric disorder. In NZ, but not the US, MA users were five times more likely to have co-morbidity of both. This disparity may be due to higher quantities of prenatal alcohol use associated with increased psychiatric symptoms. ConclusionThese findings suggest that addressing both substance abuse and psychiatric disorders in mothers who use MA may be required to effectively treat maternal MA use.

The Effectiveness of Substance Use Measures in the Detection of Full and Partial Denial of Drug Use

Appraisals of substance abuse often constitute a key component of psychological assessments affecting both diagnostic and treatment issues. Because of negative consequences, many substance users engage in outright denials and marked minimization regarding their drug use. Psychological measures, especially those with transparent items, are highly vulnerable to this denial. To address this response style, indirect items are often included on substance use measures to identify those who deny their use. The purpose of this study was to examine the effects of complete and partial denial on the Drug Abuse Screening Test-20, Substance Abuse Subtle Screening Inventory-3, and Drug Use Screening Inventory-Revised. Partial denial refers to the disacknowledgement of drug-related impairment interfering in multiple domains of a client's functioning. The study used a mixed within- and between-subjects design with 102 inpatient substance users. Each participant completed the study under two conditions: a disclosing condition and an experimental condition (either complete denial or partial denial). Results show partial denial is distinctly different from complete denial across three self-report substance use measures. Importantly, substance users engaging in these denial conditions were often undetected by these measures. Contrary to expectations, subtle scales with indirect item content were only minimally more effective than the face valid scales alone for the assessment of denied drug use.

Screening for Adolescent Substance‐Related Disorders Using the SASSI‐A2: Implications for Nonreporting Youth

In this study (N = 137), although 70.8% of participants reported no current substance use and 42.3% reported never using, the Adolescent Substance Abuse Subtle Screening Inventory (SASSI‐A2; Miller & Lazowski, 2001) screened 39.41% of the participants for a high level of probability of having a substance‐related disorder. SASSI‐A2 classified more females in our sample as having a high probability of substance‐related disorder than males. Among African American participants, male adolescents had substantially higher levels of drug use and significantly lower levels of alcohol use than did female adolescents. Implications, limitations, and future directions are provided.