SASSI – An Assessment Tool 1

Running Head: SASSI – AN ASSESSMENT TOOL

SASSI – An Assessment Tool

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Abstract

The SASSI is an often used psychological assessment tool especially designed to

assess persons for the diagnosis of any substance abuse disorder (a problem arising from the
abuse of or dependence on substances like alcohol or drugs). The tool, devised by Dr. Glenn
Miller, (President of the SASSI Institute in Bloomington, Indiana) has the national
recognition of being the #1 assessment tool for the diagnosis of such problems. Presently it is
being used by a number of organizations together with many addiction treatment centers,
hospitals, criminal justice programs, schools, companies and EAP’s.

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.
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SASSI – An Assessment Tool

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

practices (like physician's prescription or societal norms) is classified as a substance abuse.

However, it should also be kept in mind that there is no definition of the term which is

universally accepted. Substance abuse can also be defined as one's overindulgence in or

dependence on a drug or other similar chemical substance causing detrimental effects to one's

physical and mental health.

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

to complete work, obligations from family or educational institutions, interpersonal conflicts

and/or legal problems. A number of debates have been done on deciding the exact

differentiation between substance abuse and substance dependence; presently people

differentiates the two by limiting substance dependence to behavioral and physiological

symptoms of substance use, and on the other side defining substance abuse in relation with

the social outcomes of substance use.

Substance abuse may subsequently lead to addiction or substance dependence. But it

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

happens without dependence, especially when starts abusing a substance. Dependence is a

manifestation of physiological processes whereas substance abuse is a reflection of complex

and intricate relationship between the person, the abused substance and the society.
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Substance abuse problems are often serious, complex, recurring, bio-psychosocial

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)

Substances Associated with Abuse

Substance abuse disorders like dependence, abuse, intoxication and substance

withdrawal may occur due to various substances, some legal and some illegal. Some of these

substances are alcohol, caffeine, amphetamines, nicotine, inhalants, prescription medications

that could be abused (like sedatives and anxiolytes), opioids (such as morphine, heroin),

marijuana, cocaine, phencyclidine (PCP) and hallucinogens.

History of the Disorder

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

Sociopathic Personality Disturbance, presumably symptoms of psychological disorders

and/or moral weakness.

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

exacerbate the recurrent social, psychological, occupational or physical problems in

conditions which may prove to be physically hazardous.

DSM-IV

In 1988, the DSM-IV identifies substance abuse as a condition without compulsive

use, notable tolerance or withdrawal, the DSM-IV also acknowledged substance abuse's

harmfulness and its fatality in some cases as well.

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DSM-IV-TR, says that all of the substances named above (with nicotine and caffeine

being the exceptions) may cause two types of disorders:

 Substance use disorders and

 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.

DSMIV-TR further elaborates substance dependence as a continuous use of substance

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

inability of fulfilling responsibilities like childcare.

Intoxication is a frequent direct manifestation of the substance abuse. Different

substances can have different effect on individuals in distinct ways. Some of the effects often

witnessed are emotional instability, impaired judgment, sudden increase/decrease in appetite

and/or changes in sleep patterns.

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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

will get resolved once and forever.

Development of SASSI Tool

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

a high probability of suffering from substance dependence disorder.

Intended Purpose of the Tool

The tool is intended for collection of information, its organization and its use in

making decisions regarding the probability of someone having substance dependence

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

professional. This comprehensive assessment tools is used to determine whether an individual

meets with accepted standards presented in the mental health professionals’ handbook,
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Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), for a proper clinical

diagnosis of substance-related disorder.

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

on the basis of his/her SASSI scores.

Description of the Tool

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

professionals (including school counselors, student assistance programs, vocational

counselors, employee assistance programs, psychotherapists, criminal justice programs,

medical personnel and several other human service providers) with equal ease and

proficiency.
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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

answered differently by persons with a proved substance dependence disorder as compared to

persons without any substance dependence disorder.

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

conventional paper and pencil format.

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

identifying substance dependence disorder with an accuracy of 94% generally. Particularly,

the SASSI can also help in identification of individuals without a substance dependence
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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

normal level of functioning.

Results and their Interpretations

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

substance dependence disorder.

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

disability to acknowledge personal weaknesses or only emphasizing on others' needs whilst

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).
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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

information possible that is detailed and not prejudiced.

Psychometric Properties of SASSI

The SASSI-3 questionnaire is composed of 10 scales measuring the following

dimensions:

 Face Valid Alcohol (FVA)  Face Valid Other Drugs (FVOD) 

 Symptoms (SYM)  Obvious Attributes (OAT)

 Subtle Attributes (SAT)   Defensiveness (DEF)

 Supplemental Addiction Measure (SAM)  Family vs. Control Measure (FAM)

 Correctional (COR)   Random Answering

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

substance dependence disorders.

SASSI Report 

Generally, a SASSI-3 report is composed of the following parts:

  Assessment Overview

  Graphic Presentation of Results

  Decision Rule Classification

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  Brief Interpretation

Application of the Instrument

The latest version of SASSI i.e. SASSI-3 takes about 15 minutes to complete and is

composed of 67 dichotomous questions of true-false nature along with a 26 entry self-report

portion on substance use (or abuse). 

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

is neither recommended nor encouraged. 

Evaluation of the Strengths and Weaknesses of SASSI

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

reader to decide about the efficacy of the tool

Strengths of the Tool

SASSI is an optimal diagnostic procedure used for identification of substance

use disorders. It is a complete and comprehensive screening administered by

professionals with experience relevant to the field. It includes:

 One or more interviews of the client by the professional ideally in cooperative

environment with good understanding between the two parties.

 Other supportive information sources are also considered like reports of

previously conducted tests, collateral contacts and legal history.

These help in not only reducing overall assessment costs but also in reducing

the number of people receiving the diagnostic evaluations unnecessarily.

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As no single measure is available to diagnose all substance abusers, so a

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

every set of circumstances.

For this purpose not only psychometric analyses are done but also tests

involving body fluids are done to identify the existence of any psychoactive

substances in the clients’ bodies at the time of assessment.

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-

patient privilege is also there and a compromise on someone’s anonymity is never a

problem for the professionals.

The tool promotes early diagnosis of substance abuse as well as substance

dependence that eventually leads to suitable intervention and treatment followed by

recovery.

Weaknesses of the Tool

As, there is no paper and pencil instrument which is 100% accurate in

identification of substance abusers, as a result of which there is a chance of labeling

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%

possibility of SASSI going wrong in identifying or not identifying a person in his/her

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.
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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.

Some researchers (Feldstein, S. W.; Miller, W. R. 2007. Does subtle screening

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

indirect (subtle) scales to circumvent respondent denial or dishonesty.”

They further wrote in another of their article (Feldstein, S. W.; Miller, W. R.

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

below that figure.”

Conclusion

Despite some bitter criticism from some researchers, the general consensus is that

SASSI is an effective method of screening individuals potentially affected from substance

abuse or substance dependence.

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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

to the diagnosis of substance abuse and substance dependence.

Reference

Alexander, D. E., & Gwyther, R. E. (1995). Alcoholism in adolescents and their families.

Pediatric  Clinics of North America. Issue 42, p. 217-234.

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American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental

Disorders. Fourth edition, text revised. Washington DC: American Psychiatric

Association.

Feldstein, S. W.; Miller, W. R. (2007). Does subtle screening for substance abuse work? A

review of the Substance Abuse Subtle Screening Inventory (SASSI). Addiction.

January 2007. Volume 102, Number 1, p. 41-50.

Feldstein, S. W.; Miller, W. R. (2007). SASSI: A Response to Lazowski & Miller (2007).

Addiction. 2007 June 1. Volume 102, Number 6, p. 1002–1004.

Friedman, A. S.; Utada, A. (1992). The family environment of adolescent drug abusers.

Family Dynamics of Addictions Quarterly. Volume 2, Number 2, p. 32-45.

Gerstein, L.H.; Ginter, E.J.; Grazian, W. (1985). Self-monitoring, impression management,

and interpersonal evaluations. Journal of Social Psychology. Volume 125, Number 3,

p. 379-389.

Glynn, T. J.; Haenlein, M. (1988). Family theory and research on adolescent drug use: A

review. Journal of Chemical Dependency Treatment. Volume 1, Number 2, p. 39-58.

Hassin, J. (1996). After substance abuse treatment, then what? American Rehabilitation. June

1996. Copyright 1993, Gale Group.

Lazowski, L. E.; Miller, F. G.; Boye, M. W.; Miller, G. A. (1998). Efficacy of the Substance

Abuse Subtle Screening Inventory-3 (SASSI-3) in Identifying Substance Dependence

Disorders in Clinical Settings. Jornal of Personality Assessment. Volume 71, Number

1, p. 114-128. Copyright © 1998 , Lawrence Erlbaum Associates, Inc.

McClanahan, K. K.; McLaughlin, R. J.; Loos, V. E.; Holcomb, J. D.; Gibbins, A. D.; Smith,

Q. W. (1998). Training school counselors in substance abuse risk reduction

 SASSI – An Assessment Tool 16

techniques for use with children and adolescents. Journal of Drug Education. Volume

28, Number1, p. 39-51.

Miller, F. G. et al. (1997). SASSI-3 User's Guide: A Quick Reference for Administration and

Scoring. Bloomington: Baugh Enterprises.

Piercy, F. P.; Volk, R. J.; Trepper, T.; Sprenkle, D. H.; Lewis, R. (1991). The relationship of

family factors to patterns of adolescent substance abuse. Family Dynamics of

Addiction Quarterly. Volume 1, Number 1, p. 41-54.

Rokutani, L. J. (2002). A systems approach to substance abuse identification and intervention

for school counselors. Professional School Counseling. June 2002. Copyright 2002

American School Counselor Association.

Schwab, A. J. (1993). Screening for undetected substance abuse among vocational

rehabilitation clients. American Rehabilitation. March 1993. Copyright 1993, Gale

Group.

Schwarze, M.; Osburn, M. (2006). Back to school: counseling college substance abusers;

Counselors may be wise to eschew traditional treatment approaches. Addiction

Professional. March 2006. Copyright 2006 Vendome Group LLC.

The SASSI Institute. (1998). The Reliability and Validity of the SASSI-3. Springville: The

SASSI Institute.

The SASSI Institute. (2001). Summary of the Consistency and Accuracy of the Adolescent

SASSI-A2 for Non-Statisticians. Springville: The SASSI Institute.

Thomas, Gray B. (2001). A factor analytic study of the Substance Abuse Subtle Screening

Inventory (SASSI). Educational and psychological measurement. Volume 61,Number

1, p. 102-118.
 SASSI – An Assessment Tool 17

Veit, C.T.; Ware, J.E., Jr. (1983). The structure of psychological distress and well-being in

general populations. Journal of Consulting and Clinical Psychology. Issue 51, p. 730-

742.

Ware, J.E.; Sherbourne, C.D. (1992). Conceptual Framework and Item Selection. Medical

Care. Volume 30, Number 6, p. 476-483.