Substance Abuse: Screening and Assessment Tools

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Table of Contents

Introduction
Substance Abuse Subtle Screening Inventory (SASSI-3)
Composite International Diagnostic Interview Substance Abuse Module (CIDI-SAM)
Comparison
Interpreting results
Effectiveness of each assessment tool
The assessment tool with a clearer application of measurement concepts
Conclusion
References

Introduction

Substance abuse has become a major public health problem as most users become addicted, which may lead to severe social implications or death at times. Therefore, different screening and assessment tools have been developed to be used when dealing with substance users and abusers. This paper compares two tools, viz. the Substance Abuse Subtle Screening Inventory (SASSI-3) and the Composite International Diagnostic Interview Substance Abuse Module (CIDI-SAM).

The comparison majors on the key measurement constructs of reliability and validity for the two tools. The paper also describes the different methods for acquiring the key measurement constructs coupled with highlighting how the results of each assessment are interpreted.

Substance Abuse Subtle Screening Inventory (SASSI-3)

SASSI is a short self-report developed by Dr. Glenn Muller to be used as a psychological screening tool. The current version is in the third edition, and it has interfaces for adolescents and adults. The adult SASSI-3 tool is used to gather, organize, and use information when making decisions concerning the probability of substance dependence disorder in an individual, “with an overall empirically tested accuracy of 93 percent” (Feldstein & William, 2007, p. 44).

On the other hand, the Adolescent SASSI-A2 is “designed to identify individuals who have a high probability of having a substance use disorder, including both substance abuse and substance dependence, with its decision rules yielding an overall accuracy of 94 percent” (Laux, Salyers, & Kotova, 2005, p. 46). Besides, this tool has subtle items, which are not related to substance use. These subtle items are useful when dealing with individuals with substance use problems, but they live in denial, and thus, they cannot admit having such issues. The target population for the tool includes adults and teenagers between 12 to 18 years. The tool is useful in both outpatient and inpatient set ups.

Composite International Diagnostic Interview Substance Abuse Module (CIDI-SAM)

CIDI-SAM is a structured and standardized interview, which is used in the assessment of substance use and abuse. The interview has five sections with each having a set of different questions on the user. Section A “contains demographic questions, Section B is for tobacco, Section C is for alcohol, Section D is for drugs, and Section E covers caffeine” (Cottler, 2000, p. 83). The structured CIDI-SAM interview questions allow even non-clinicians to ask questions, which prompt answers that can be used to highlight a certain drug abuse trend. This trend can then be used for diagnosis by combining the results with published information on the available diagnostic criteria.

Comparison

The reliability construct of both SASSI-3 and CIDI-SAM involve test-reset measures. Test-retest reliability is defined “as the degree to which an assessment yields similar results from one testing instance to another” (Robins et al., 1991, p. 656). In both SASSI-3 and CIDI-SAM, individuals undertake the tests for the first time before being invited to retake it for a second time. During the second interview, the respondents are put in a different environment from that of the first interview.

Besides, different interviewers are used in the second one. In essence, the second interview is conducted independently. The retest interviewers are blind to the findings of the first interview. The interviewees are informed that they do not necessarily have to repeat what they said in the first interview, and thus, they should answer the second interview questions to the best knowledge and judgement at that point.

If the results from the two interviews used in the retest method are the same, then the reliability coefficient is said to be 1. In SASSI-3, the reliability of the instrument is confirmed if a coefficient of 93% is obtained for adults and 94% for adolescents. Similarly, the reliability of the tool in CIDI-SAM is accepted when the Kappa values are above 0.93 in an agreement between the interviewer and observers. Besides, the available symptoms for the substance abuse have to yield a Kappa score of over 0.94.

Validity is “the extent to which scores derived from reliability measure what an instrument is designed to evaluate” (Vacha-Haase, Henson, & Caruso, 2002, p. 563). In SASSI-3, validity is established using measures of criterion. In the measures of criterion, the presence or absence of given criterions used to represent a given construct is determined. For instance, if one is measuring alcohol dependency using SASSI-3, the validity of the tool can be determined by using the following procedure. A large group of individuals of alcohol users is identified. A panel of experts then selects some individuals who are suspected to be alcohol dependent.

Then a set of questions is given to all the respondents and answers analyzed. The questions that are answered differently are taken to be valid for individuals with alcohol dependency problem. The validity of SASSI-3 has been established in previous studies. Therefore, instead of undertaking a validity study, individuals using SASSI-3 can get that information from previous studies.

On the contrary, the validity of CIDI-SAM is determined using measures of content. The content validity measures “the degree to which the test items represent the domain or universe of the trait or property being measured” (Vacha-Haase et al., 2002, p. 563). In this approach, the researcher identifies the overall content, which needs representation. The researcher then picks certain items randomly from the overall content to represent accurate information in all given areas. For instance, using the example used in the SASSI-3 case above, the researcher may use experts in the field of alcohol dependency to identify the content of the test. However, the validity of the CIDI-SAM tool has been determined in previous studies and thus, researchers can refer to the available literature on the same.

Interpreting results

In CIDI-SAM, the scores are interpreted based on the Kappa scores. The Kappa values run from 0 to 1, whereby values of 0.75 are excellent while those ranging from 0.40 to 0.75 are fair or good. On the other side, any Kappa value below 0.40 is said to be poor. Therefore, the results for CIDI-SAM scores are evaluated based on this scale. The higher the Kappa value, the higher the reliability and validity of the scores.

The scores for this assessment correlate strongly with those from the DSM-IV and ICD-10 diagnostic criteria. In a research by Compton, Cottler, Dorsey, Spitznagel, and Mager (1996), it was established that DSM-IV and CIDI-SAM “dependence diagnoses indicated good agreement for alcohol and cocaine, and fair agreement for opiates and cannabis” (183). This realization underscores the reliability of CIDI-SAM as a psychological assessment tool.

On the other side, SASSI-3 uses a standardized scale with different scales including “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. Controls (FAM), and Correctional (COR)” (Miller, Woodson, Howell, & Shields, 2009, p. 1099). Each scale is given standardized numbers, which have a particular score on a t-score expressed as a percentile. Based on the results, any rule answered “yes” is an indication of high chances of having a substance dependence disorder.

On the other side, all rules with a “no” answer indicate a low probability of having such a disorder. The scores of SASSI-3 compare with DSM-IV results. In a study conducted by Lazowski, Miller, Boye, and Miller (1998), the obtained SASSI-3 scores yielded “95% agreement with clinical diagnoses of substance dependence” (p. 124). Therefore, it suffices to conclude that SASSI-3 is a reliable psychological screening tool for individuals with substance dependence disorder.

Effectiveness of each assessment tool

The SASSI-3 tool offers an easy and direct way that professionals can use when screening individuals suspected to have substance dependence disorder. The questions provided are simple and direct, and thus, the respondent is only required to take a short period to give satisfactory results. Besides, the view that the reliability and validity scores have been developed in the past gives the interviewer easy time because one is only needed to enter the data and generate scores, which are then analyzed and interpreted based on set standards.

Moreover, the availability of the computer version gives the interviewer the chance to record results personally, thus, eliminating the probability of making errors, which is common in the paper-pencil version of the tool (Miller et al., 2009). However, this tool has some shortcomings. First, SASSI-3 is not a diagnostic tool, and thus, it has to be used together with other tools like DSM-V for a full diagnosis. Second, given that the accuracy rate of 94% is accepted in SASSI-3, it highlights the 6% probability of misclassifying an individual. Finally, some researchers have raised issues about the validity of the subscales used in this screening tool.

On the other side, CIDI-SAM offers an effective and quick way of assessing the presence of the substance use disorder. Additionally, the abuse and dependence questions are separated, which gives refined information for each side (Robins et al., 1991). However, given that this tool is developed for different cultures, reliability and validity in one set up may not be replicated in another. Besides, the Kappa values used to generate the scores have not been validated and accepted internationally.

The assessment tool with a clearer application of measurement concepts

SASSI-3 tool has a clearer application of measurement concepts as compared to CIDI-SAM. The 93 and 100 items for adults and adolescents respectively in SASSI-3 give the interviewer the opportunity to sample different characteristics before drawing conclusions (Miller et al., 2009). Moreover, the tool has 10 and 12 subscales for adults and adolescents respectively. On the contrary, the CIDI-SAM tool has 38 items and 3 subscales, which are fewer as compared to the numbers in SASSI-3. Besides, SASSI-3 offers 9 scales each with different scores, thus, improving the applicability of the measurement concepts.

Conclusion

Substance abuse is a serious public health concern in the contemporary times. Unfortunately, most individuals with substance dependence disorder live in denial, and this aspect poses a challenge to health practitioners using the conventional assessment tools like DSM-V. However, the SASSI-3 screening tool solves this problem by assessing individuals to point out the ones with the highest probability of having the substance dependence disorder.

On the other side, CIDI-SAM offers a set of interview questions to indicate if an individual abuses drugs. The validity and reliability of the two tools have been determined in past researches. However, SASSI-3 has a clearer application of measurements concepts as compared to CIDI-SAM. In conclusion, it suffices to observe that further research is needed to address the different shortcomings associated with each tool.

References

Compton, W., Cottler, B., Dorsey, K., Spitznagel, L., & Mager, D. (1996). Comparing assessments of DSM-IV substance dependence disorders using CIDI-SAM and SCAN. Drug and Alcohol Dependence, 41(3), 179-187.

Cottler, B. (2000).Composite International Diagnostic Interview—Substance Abuse Module (SAM). St. Louis, MO: Department of Psychiatry, Washington University School of Medicine.

Feldstein, W., & William, M. (2007). Does SASSI work? A review of the SASSI. Addiction, 102(1), 41-50

Laux, M., Salyers, K., & Kotova, E. (2005). A psychometric evaluation of the SASSI-3 in a college sample. Journal of College Counseling, 8(1), 41-51.

Lazowski, L., Miller, G., Boye, M., & Miller, 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(1), 114-128.

Miller, S. C., Woodson, J., Howell, R. T., & Shields, A. L. (2009). Assessing the reliability of scores produced by the Substance Abuse Subtle Screening Inventory. Substance Use and Misuse, 44(8), 1090-1100.

Robins, N., Cottler, B., Grant, B., Blaine, J., Towle, L., Wittchen, H., & Sartorius, N. (1991). The CIDI-core substance abuse and dependence questions: cross-cultural and nosological issues. The WHO/ADAMHA field trial. British Journal of Psychiatry, 159, 653-658.

Vacha-Haase, T., Henson, R., & Caruso, J. C. (2002). Reliability generalization: Moving Toward improved understanding and use of score reliability. Educational and Psychological Measurement, 62, 562-569.

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