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1. Substance Abuse Subtle Screening Inventory
Substance Abuse Subtle Screening InventoryOrder DescriptionAssessment Write Up –
Students will choose one assessment tool. You must choose an instrument or measure that
is ranked within the top 55 used by counselors for review.Once you have chosen your
instrument to be reviewed, access both the Tests in Print and Mental Measurement
Yearbook electronic databases through the GSU library page. You may also use articles from
Psych-Info or Psych-Articles if you like to supplement your information. If you find a more
current version of the measure that has been reviewed (e.g., BDI-2 instead of the BDI; WAIS-
IV instead of the WAIS), review the most recent version of the measure that has information
available on it.Do not use Wikipedia or other general public sources.Write up a paper in
strict APA format and style (e.g., title page, running head, abstract, reference page,
appropriate heading levels, 12 point Times New Roman font, 1 inch margins, etc.),
aIDressing the following questions in full:1. Background: Provide a brief background of
what the instrument is supposed to measure, who developed it, and when it was
developed.2. Development: Describe how the instrument was developed. What was the
sampling strategy? How many people were in the norming group? Where were they
sampled from? Was expert review, factor analysis, a pilot study, or any other method used
in the initial development of the instrument? Explain what they did and what the results of
these steps were.3. Reliability: Provide as much information as you can about the different
forms of known reliability for the instrument. What types of reliability have been obtained,
what are the reliability values, and how reliable is this instrument?4. Validity: Provide as
much information as you can about the different forms of validity known for this
instrument. What forms of validity have been obtained for it, how were these obtained, and
what does this tell you about the instrument?5. Summary: Now briefly summarize your
main findings involving the background, development, reliability, and validity of this
measure. Based on your findings, would you recommend its use? Why or why not?Text
length will depend of course on the amount of information you find for your chosen
instrument, but the body of the paper should generally run about 4-6 pages of content in
length. Include title page abstract page and reference page. Total pages for write up will be
7-9 pages.Substance Abuse Subtle Screening Inventory– 3 (The)Acronym:SASSI-
3.Authors:Miller, Glenn A.Publication Date:1983– 1997.Publisher Information:The SASSI
Institute, 201 Camelot Lane, Springville, IN, 47462, sassi@sassi.com, http://sassi.com
.Purpose:Designed to ‘ identify individuals who have a high probability of having a
substance dependence disorder.’ Test Category:Alcohol and Substance Use.Population:Ages

2. 18– 73.Scores:10 subscales: Face Valid Alcohol, Face Valid Other Drugs, Symptoms, Obvious
Attributes, Subtle Attributes, Defensiveness, Supplemental AIDiction Measure, Family vs.
Controls, Correctional, Random Answering Pattern..Administration:Individual or
group.Time:[15] minutes.Price Data:Available from publisher.Comments:May be
administered as paper-and-pencil instrument with hand scoring or scoring by optical
scanning, computer administered, or via audiotape for people with special needs regarding
vision or literacyCross References:For reviews by Ephrem Fernandez and David J. Pittenger,
see 15:252; see T5:2553 (6 references); for reviews by Barbara Kerr and Nicholas A. Vacc
of an earlier edition, see 12:381 (1 reference); see also T4:2623 (1
reference).Reviewers:Fernandez, Ephrem; Pittenger, David J..Special Editions:Foreign
Language Edition: Spanish version available..Yearbook Volume:15.Yearbook Reference:B. S.
Plake, J. C. Impara, & R. A. Spies (Eds.), The fifteenth mental measurements yearbook.
2003.Published Test Description:The Substance Abuse Subtle Screening Inventory-3.
Purpose: Designed to ‘ identify individuals who have a high probability of having a
substance dependence disorder.’ Population: Ages 18-73. Publication Dates: 1983-1997.
Acronym: SASSI-3. Scores: 10 subscales: Face Valid Alcohol, Face Valid Other Drugs,
Symptoms, Obvious Attributes, Subtle Attributes, Defensiveness, Supplemental AIDiction
Measure, Family vs. Controls, Correctional, Random Answering Pattern. Administration:
Individual or group. Price Data: Available from publisher. Time: [15] minutes. Comments:
May be administered as paper-and-pencil instrument with hand scoring or scoring by
optical scanning, computer administered, or via audiotape for people with special needs
regarding vision or literacy. Author: Glenn A. Miller. Publisher: The SASSI Institute. Cross
References: See T5:2553 (6 references); for reviews by Barbara Kerr and Nicholas A. Vacc of
an earlier edition, see 12:381 (1 reference); see also T4:2623 (1 reference).Accession
Number:test.1982Translate Full Text:HTML Full TextSubstance Abuse Subtle Screening
Inventory– 3 (The)ListenPauseStopSelect: SettingsDownload mp3?CloseReview of the
Substance Abuse Subtle Screening Inventory-3 by EPHREM FERNANDEZ, Associate
Professor of Clinical Psychology, Southern Methodist University, Dallas, TX:DESCRIPTION.
The Substance Abuse Subtle Screening Inventory-3 (SASSI-3) is a psychometric instrument
that is designed to make inferences about substance dependence disorder. On one side, it
has 14 face valid items that are quite obvious in their relationship to substance dependence;
these are further divided into items related to alcohol and items related to other drugs. The
other side consists of 67 items that are supposed to be indirect or nonmanifest in their
relationship to substance dependence. The face valid items are to be rated on a 4-point scale
of frequency, and the other items are in a true-false format. Responses can be made with
reference to any one of four time frames: entire life, past 6 months, 6 months before, or 6
months since. The test is usually completed within 15 minutes and objectively scored within
a minute or 2. Computerized versions are available, and so are optical scanning versions as
well as an audiotaped version for those with reading difficulties.Nine subscales are
embeIDed in this instrument: Face Valid Alcohol, Face Valid Other Drugs, Symptoms,
Obvious Attributes, Subtle Attributes, Defensiveness, Supplemental AIDiction Measure,
Family vs. Controls, and Correctional. In aIDition, there is a scale to detect random
responding.Scores are interpreted with reference to a decision rule stipulating cutoffs for

3. each subscale. Exceeding any rule leads to an inference of high probability substance
dependence disorder. Only if scores are below the cutoff on all rules is an inference of low
probability made. The scores can be plotted on a profile graph. Further interpretation of
individual subscale scores is possible, though (as the authors caution) such interpretations
do not rest on empirical research and are best viewed as hypotheses and ideas for
assessment.DEVELOPMENT. This is a third edition of the adult form of the SASSI originally
developed by Miller (1985). An adolescent SASSI was developed in 1990, and a Spanish
version emerged in 1996. The SASSI-3 was developed out of data from a sample of 2,015
respondents, most of whom were in aIDiction treatment facilities, general psychiatric
hospitals including a dual diagnosis center, a vocational rehabilitation program, and a sex
offender treatment program. A subset of 839 cases had DSM diagnoses in aIDition to SASSI
scores, and this was randomly divided into roughly equal numbers of those diagnosed with
substance use disorder and those diagnosed without it. Data from the first of these
subsamples were used to formulate decision rules on SASSI scoring, and these were cross-
validated in the second subsample. There were no significant differences between these two
subsamples in terms of age, years of education, or other demographic variables.TECHNICAL.
Psychometric studies of the SASSI have been accumulating although many have been on the
adolescent version and other previous versions of the instrument. Many of the studies also
remain in the form of unpublished dissertations.Teslak (2000) found that SASSI-3 scores
correlated with scores on similar screening measures such as the Michigan Alcoholism
Screening Test (MAST) and the Drug Abuse Screening Test (DAST). However, the SASSI-3
was no more accurate than either of its counterparts and did not show incremental utility.
Pearson (2000) found that the SASSI-3 predicted psychiatric substance use disorder.
However, the concordance rate of the SASSI-3 with psychiatric substance use disorder was
.69 for true positive rate and .82 for true negative rate, and these figures are considerably
lower than previously observed. Arenth, Bogner, Corrigan, and Schmidt (2001) found lower
accuracy, sensitivity, and specificity for the SASSI-3 in patients with traumatic brain injury
than for a sample of disabled persons in a vocational rehabilitation program. Furthermore,
they found that blood alcohol level at the time of injury had higher specificity when
compared to SASSI-3 test classifications. More encouraging psychometric findings have
been reported by Lazowski, Miller, Boye, and Miller (1998). Working on the development
sample described earlier, these authors found a 95% concordance between SASSI-3
inferences and clinical diagnoses of substance dependence. The test had a sensitivity of 96%
and a specificity of 93%. Its retest reliability in a sample of 40 respondents assessed 2
weeks apart was in the range of .92 to 1.00. The authors also noted that as compared to
those who were test negative on the SASSI-3, those classified as test positive had higher
mean scores on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) AIDiction
Acknowledgment Scale, the MMPI-2 AIDiction Potential Scale, the MacAndrew Alcoholism
Scale-Revised, the Michigan Alcohol Screening Test, the Millon Clinical Multiaxial Inventory-
II (MCMI-II) Alcohol Dependence Scale, and the MCMI-II Drug Dependence Scale. However,
the absence of correlation coefficients in this context makes it difficult to conclude about the
concurrent validity between the SASSI-3 and these other instruments.The SASSI-3 is
portrayed as a test of substance dependence disorder, but how this differs from other

4. substance-related disorders is left unclear. This is compounded by the authors’ references
to terms such as substance use, substance abuse, and substance misuse. In an appendix to
the user’ s guide, it is stated that the SASSI-3 can be used to flag for further evaluation of
substance abuse disorder. This is misleading in that it suggests that substance dependence
is a mild precursor of substance abuse when (as defined by DSM) the latter is not associated
with tolerance, withdrawal, or compulsive use. Also, by way of definition, it would be useful
to clarify the substances that are embodied in this category of disorders. In DSM, this
extends beyond the illicit drugs (that seem to be the focus of the SASSI-3) to medications,
toxins, and even items of household consumption. DSM diagnoses of substance dependence
also come with specifiers such as with or without tolerance, and different types of
remission. In the absence of such specifiers, a SASSI-3 diagnosis is of limited clinical
utility.An even more serious handicap of the SASSI-3 is that it permits only a dichotomous
interpretation of high versus low probability of substance dependence. There are more than
80 items and nine decision rules; have the authors perhaps undersold the instrument by
ignoring the possibility that the number of decision rules satisfied might be related to the
confidence level in diagnosing a substance dependence disorder? At least, if statements
about medium probability of the disorder were possible, the instrument would be more
clinically useful.At a more minor level, some items in the SASSI-3 are phrased in common
lingo (e.g., Item 8 on the FVOD: “ Gotten really stoned or wiped out on drugs [more than just
high]“ ). Other items use technical jargon that may not be fathomed (e.g., Item 9 on the FVA:
“ Had the effects of drinking recur after not drinking for a while [e.g., flashbacks,
hallucinations, etc.]“ ). It is hard to see the purpose of a question about “ weekly family take
home income.” COMMENTARY. The SASSI-3 is laudable in its attempt to assess substance
dependence regardless of participants’ acknowledgment or denial. It does so by using a
number of subtle items that may be indirectly associated with substance use. It is also
convenient to administer, quick to score, and readily interpreted. However, the
interpretations can only take the form of high or low likelihood of the disorder in question.
This does not aID much to a DSM diagnosis of substance dependence, and it also fails to
shed light on the many qualifiers of such a diagnosis. No doubt, elaboration and illumination
of the disorder is possible with further research in this area. Further research is also needed
to quantify the psychometric features of the SASSI-3. Especially needed are factor analytic
studies of the kind done on its predecessors, the SASSI-2 and the SASSI. There is reason to
believe that such factorial validity as demonstrated for its predecessors will prevail in the
case of the SASSI-3.SUMMARY. As with many instruments that are driven exclusively by
empirical data, the SASSI-3 is methodologically commendable but conceptually less
impressive. This limits its clinical potential too. Yet, the test is widely used. With further
research and revision, it can be expected to fill a significant void in the field of assessment of
substance use disorders.REVIEWER’ S REFERENCESArenth, P. M., Bogner, J. A., Corrigan, J.
D., & Schmidt, L. (2001). The utility of the Substance Abuse Subtle Screening Inventory-3 for
use with individuals with brain injury. Brain Injury, 15, 499-510.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.
Journal of Personality Assessment, 71, 114-128.Miller, G. A. (1985). The Substance Abuse

5. Subtle Screening Inventory (SASSI): Adult SASSI-2 manual supplement. Spencer, IN: Spencer
Evening World.Pearson, B. S. (2000). Validation of the Substance Abuse Subtle Screening
Inventory-3 (SASSI-3) with the adult chronically mentally ill population. Dissertation
Abstracts International: Section B: The Sciences and Engineering, 60 (12-B): 6418.Teslak, A.
G. (2000). The utility of the CAGE, MAST, DAST, and SASSI-3 in assessing substance
use/misuse in a psychiatric population. Dissertation Abstracts International: Section B: The
Sciences and Engineering, 61 (5-B): 2814.Review of the Substance Abuse Subtle Screening
Inventory-3 by DAVID J. PITTENGER, Head and Associate Professor, Department of
Psychology, The University of Tennessee at Chattanooga, Chattanooga, TN:Like the
proverbial better mousetrap, many clinicians and counselors will beat a path to the
developer of a better indicator of substance abuse. An inexpensive instrument that readily
identifies the presence of substance abuse is of considerable value for those working in a
variety of venues including colleges and universities, where some students evidence the
early stages of substance dependence; medical settings, where substance abuse
compromises the health and treatment of the patient; and psychological treatment facilities
where patients may exhibit psychiatric problems that mask significant substance abuse
problems. The publishers of the third edition of the Substance Abuse Subtle Screening
Inventory (SASSI-3) assure us that they have produced the better substance abuse
index.DESCRIPTION AND DEVELOPMENT. The SASSI, which was first published in 1988, is
an empirically derived inventory designed to indicate the risk of substance dependence
using items that are less likely to elicit suspicion and untruthful answers. Myerholtz &
Rosenberg (1998) reported that the SASSI is an extremely popular instrument and used in a
variety of treatment facilities as well as other settings (e.g., schools and employee assistant
programs).According to the SASSI-3 manual, the goal of the revision was to increase the
ability of the SASSI to discriminate between those who are or are not substance dependent.
The current version of the instrument contains most of the items used in the previous
edition of the inventory and is appropriate for adults (age 18 and older). The publisher also
produces an adolescent (ages 12-18) version of the SASSI.The SASSI-3 consists of two parts
that are printed on separate sides of a single paper form. The first part of the instrument
represents the subtle portion of the inventory and contains 67 true-false statements. The
vast majority (57) of the statements make no overt reference to drug and alcohol use, and
appear to be easily understood by most adults. Twenty of these items were taken from the
Psychological Screening Inventory (Lanyon, 1970).Manual scoring consists of an easy-to-
use transparent scoring template for the eight subscales of the first portion of the
instrument. Alternatives include a computer version of the instrument and answer forms
that may be machine scored. The publisher also offers an audiotape of the SASSI-3 for
clients with reading problems. Scoring the first portion of the instrument yields one validity
scale, five clinical scales, and two ancillary scales.The Random Answer Pattern (RAP) is a
measure of validity. It indicates whether the client answered randomly or had difficulty
understanding the items.There are three clinical scales that measure the presence of
symptoms of substance abuse. The Symptoms (SYM) scale is a new scale that assesses the
presence of behavioral, emotional, and social correlates of substance abuse. The Obvious
Attributes (OAT) scale is an index of the social effects substance abuse (e.g., legal problems).

6. According to the user’ s guide, persons diagnosed with substance abuse are likely to
endorse this item when answering honestly. The Subtle Attributes (SAT) scale complements
the OAT scale as it consists of statements endorsed by substance dependent patients
attempting to hide their dependence as well as those who answered honestly.The
Defensiveness (DEF) scale assesses willful attempts to deny substance dependence as well
as a personality trait or reaction to stressful personal circumstances. The Supplemental
AIDiction Measure (SAM) scale purports to differentiate between defensive clients hiding
substance abuse and other defensive individuals.The Family vs. Controls (FAM) scale
identifies individuals who may live with or have a significant relationship with a substance
abuser. This scale is not used in determining substance dependence, but may be used to
assess the needs of those close to a substance dependent person. Similarly, the Correctional
(COR) is not a clinical measure as it serves as an indication of abusers who have had a
record of legal/criminal entanglements.The second portion of the instrument consists of 12
questions that identify the extent of alcohol use and 14 questions that identify the extent of
other drug use. Clients may be instructed to answer the questions within the time frame of
their entire life, during the past 6 months, or 6 months before or after a critical event.
Although the instrument offers these options, the manual warns that the 6-month time
frames may increase the proportion of false positives. Consequently the manual encourages
users to use the entire lifetime unless circumstances dictate otherwise. The scale for these
questions is a Likert scale ranging from 0 (never) to 4 (repeatedly).There are separate
normative data for male and females. Interpreting the results begins by plotting each
subscale score on a graph that creates a client profile and then completing a checklist for
nine “ decision rules.” Each rule determines whether the client scored at or above a critical
score for one or a combination of the scales. A positive response to any one of the rules is
evidence of a high probability of substance dependence. An extensive user’ s guide, which is
separate from the manual, provides detailed accounts of different profiles that may emerge
and their clinical significance.TECHNICAL. The promotional material and manual for the
SASSI-3 make extensive reference to the predictive validity of scores from the instrument.
Specifically, the claim is that the SASSI-3 has a 94% correspondence rate with clinical
assessments of substance abuse. Independent research examining the utility of the SASSI-3
also suggests that the instrument is an extremely useful tool (Horrigan & Piazza, 1999;
Horrigan & Katz, 2000; Horrigan, Schroeder, & Schaffer, 2000) that should be used during
the initial screening for substance abuse. Although these results are encouraging, they need
to be interpreted with due caution. Striking features of the manual are the data and
statistical information that are not reported. Those familiar with the Standards for
Educational and Psychological Testing (AERA, APA, & NCME, 1999) will be disappointed by
the notable absence of information that would allow one to make a more informed decision
regarding the utility of the instrument.The sample used to create the norms for this version
of the instrument were 848 patients drawn from aIDiction treatment centers, general
psychiatric hospitals, dual diagnosis hospitals, vocational rehabilitation programs, and sex
offender treatment programs. All participants had completed the SASSI-3 and had been
independently evaluated for substance abuse using the criteria established in the Diagnostic
and Statistical Manual of Mental Disorders (DSM-III-R; American Psychiatric Association,

7. 1987; DSM-IV, American Psychiatric Association, 1994). There is no indication of the
credentials of the persons rendering the diagnosis of substance abuse. Within the sample,
80% were diagnosed as substance dependent.COMMENTARY. Although the reported
accuracy rate of the SASSI-3 is high, the data should be interpreted with some caution. Using
the test with populations for which there is a high proportion of substance abuse may
inflate its criterion validity. Stated from a different perspective, using the instrument as a
screening instrument for populations with a lower base rate of substance dependence (e.g.,
college students, employee assistance programs) may produce lower criterion validity
estimates (Lilienfeld, Wood, & Garb, 2000). Using the data presented in the manual, I
determined LB, an asymmetric measure of association, to be LB = .70. In other words, using
the SASSI-3 reduces by 70% the error in predicting the criterion of substance dependence.
Although this is an extremely high value, it may be substantially lower for different
populations. Unfortunately, the manual provides no normative data for populations not
directly associated with treatment for a psychopathology.There are other notable absences
in the supporting materials. As stated previously, the SASSI-3 contains several important
clinical scales. Indeed, the user’ s guide describes several examples of patients who
represent different clinical symptom profiles. Unfortunately, there are no data to verify the
appropriateness of making these distinctions among profile patterns. Similarly, there has
been no attempt to confirm the factor structure of the instrument. Indeed, Gray (2001) was
unable to confirm a factor model implied by the subscales.There is also limited information
regarding the temporal stability of the instrument. The manual reports high test-retest
reliability for a 2-week interval with only 40 respondents who were part of the substance
abuse treatment population. Myerholtz and Rosenberg (1997, 1998) reported much lower
reliabilities for the binary diagnosis of substance dependence for the 2-week interval (phi =
.68) and the 4-week interval (phi = .36), and that SASSI scores are susceptible to
instructions for fake good or bad.Finally, there are no data to indicate the utility of the
SASSI-3 relative to other measures of substance abuse. Myerholtz and Rosenberg (1998)
reported moderate to large coefficient Kappas between the SASSI and other indicators of
substance abuse, some of which are in the public domain. Given the availability of a number
of alternative screening instruments, one would hope to have data that illustrate the
incremental validity of using the SASSI-3 at the exclusion of other instruments.SUMMARY.
The SASSI-3 may well serve as a quick and ready triage instrument for the presence of
substance abuse. Users should not be sanguine in assuming the SASSI-3 is as accurate as its
publisher claims. Consequently, one hopes that the publishers of the instrument will expand
their analysis of the psychometric properties of the instrument.REVIEWER’ S
REFERENCESAmerican Educational Research Association, American Psychological
Association, & National Council on Measurement in Education. (1999). Standards for
educational and psychological testing. Washington, DC: American Educational Research
Association.American Psychiatric Association. (1987). Diagnostic and statistical manual of
mental disorders: DSM-III-R. Washington, DC: Author.American Psychiatric Association.
(1994). Diagnostic and statistical manual of mental disorders: DSM-IV. Washington, DC:
AuthorGray, B. T. (2001). A factor analytic study of the Substance Abuse Subtle Screening
Inventory (SASSI). Educational & Psychological Measurement, 61, 102-118.Horrigan, T. J., &

8. Katz, L. (2000). Ohio’ s Bill 167 fails to increase prenatal referrals for substance abuse.
Journal of Substance Abuse Treatment, 18, 283-286.Horrigan, T. J., & Piazza, N. (1999). The
Substance Abuse Subtle Screening Inventory minimizes the need for toxicology screening of
prenatal patients-A post partum assessment. Journal of Substance Abuse Treatment, 17,
243-248.Horrigan, T. J., Schroeder, A. V., & Schaffer, R. M. (2000). The triad of substance
abuse, violence, and depression are interrelated in pregnancy-National survey findings.
Journal of Substance Abuse Treatment, 18, 55-58.Lanyon, R. I. (1970). Development and
validation of a psychological screening inventory. Journal of Consulting & Clinical
Psychology, 35, 24-37.Lilienfeld, S. O., Wood, J. M., & Garb, H. N. (2000). The scientific status
of projective techniques. Psychological Science in the Public Interest, 1, 27-67.Myerholtz, L.
E., & Rosenberg, H. (1997). Screening DUI offenders for alcohol problems: Psychometric
assessment of the Substance Abuse Subtle Screening Inventory. Psychology of AIDictive
Behaviors, 11, 155-165.Myerholtz, L., & Rosenberg, H. (1998). Screening college students
for alcohol problems: Psychometric assessment of the SASSI-2. Journal of Studies on
Alcohol, 59, 439-446.The Board of Regents of the University of Nebraska and the Buros
Center for Testing. All rights reserved. Any unauthorized use is strictly prohibited. Buros
Center for Testing, Buros Institute, Mental Measurements Yearbook, and Tests in Print are
all trademarks of the Board of Regents of the University of Nebraska and may not be used
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