The Adolescent Substance Abuse Subtle Screening Inventory-A2 (SASSI-A2)

Abstract

The Adolescent Substance Abuse Subtle Screening Inventory-A2 (SASSI-A2) is a specialized, self-report clinical instrument designed for the efficient screening of adolescents aged 12 to 18 for potential Substance Use Disorders (SUDs). Developed to mitigate the effects of adolescent denial and attempts at deception, the SASSI-A2 utilizes a dual approach: incorporating questions with obvious face validity regarding substance use, alongside subtle items that detect clinical contexts associated with problematic use.

The instrument generates 12 distinct scales, which clinicians use in conjunction with nine decision rules to determine the high or low probability and severity of a substance use disorder. The results are converted to standard scores using separate gender-based norms, providing a measure of similarity to diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR and DSM-5).

Keywords

SASSI-A2, Substance Use Disorders, adolescent screening, psychological assessment, subtle screening, substance abuse, clinical instrument, DSM-5

Authors

F. G. Miller, L. E. Lazowski, G. A. Miller

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Purpose

The primary purpose of the SASSI-A2 is to serve as a rapid, structured screening measure to identify adolescents aged 12 to 18 who are likely to meet the diagnostic criteria for a substance use disorder (SUD). A crucial secondary purpose is to overcome common obstacles inherent in adolescent self-reporting, specifically the tendency toward denial or minimization of substance use behaviors.

The instrument is designed for maximum utility in clinical, treatment, and correctional settings where professional assessment of substance abuse severity and risk factors is critical. The scoring mechanism provides information regarding not only the probability of an SUD diagnosis but also the severity level and key environmental factors associated with substance misuse.

Construct

The SASSI-A2 measures the construct of similarity to diagnostic criteria for substance-related and substance-induced disorders. It is fundamentally built on the assumption that individuals who meet diagnostic criteria for an SUD exhibit specific patterns of behavior, attitudes, and environmental risk factors that can be detected through both direct and indirect questioning, even when they attempt to conceal their use.

The inventory accomplishes this by assessing multiple dimensions through its items, including: substance misuse symptoms; family and social environment risks; attitudes and beliefs concerning alcohol and drug use; and subtle items specifically constructed to identify individuals with substance use problems who may be deceptive. The resulting 12 scales are interpreted based on their alignment with criteria specified in the DSM nomenclature.

Validity

Validity evidence for the SASSI-A2 is primarily reported in terms of concurrent validity, establishing that instrument results align accurately with clinical substance use disorder diagnoses. In combined development and cross-validation samples, the instrument demonstrated a high overall accuracy rate of 94% in correctly identifying individuals both with and without an SUD diagnosis.

Further validity evidence is provided through psychometric indicators related to diagnostic accuracy. The scale reported a 95% sensitivity rate (correctly identifying respondents with an SUD who tested positive) and an 89% specificity rate (correctly identifying respondents without an SUD). The positive predictive power was exceptionally high at 98%, while the negative predictive power was 75%. Data also suggest that the instrument’s accuracy is not significantly compromised by demographic variables or overall functional level. However, it is noted that the SASSI-A2 is a screening tool and does not predict future substance use problems.

Reliability

The reliability of the SASSI-A2 is supported by evidence drawn from both test-retest and internal consistency metrics, though the latter must be interpreted cautiously due to the scale’s design. For test-retest reliability, administered over a two-week interval, the correlation coefficients for the nine scales used in determining the probability of an SUD ranged from .81 to .92, yielding a strong overall coefficient of .89.

Internal consistency (alpha) coefficients across the nine scales ranged from .63 to .95, with an overall alpha coefficient of .75 (N = 2,145). It is important to note that internal consistency is not the central measure of reliability for the SASSI-A2 because the scale was specifically designed to measure a complex, non-unitary construct (substance use disorder similarity) via multiple, distinct scales rather than a single, homogeneous trait.

Factor Analysis

Formal, detailed information regarding the factor structure or factor analysis of the SASSI-A2 is not explicitly detailed in the summary of technical information provided. The instrument’s construction relies on 12 distinct scales derived through clinical criterion-based development and decision rules, rather than solely relying on exploratory or confirmatory factor analysis to define its core constructs.

Instrument

Test Type: Self-report questionnaire, clinical screening instrument

Format: Mixed item types, including True/False and four-choice Likert-type responses.

Language Available: English (Other languages not specified in source material).

Population Group: Adolescents suspected of or diagnosed with Substance Use Disorders (SUDs).

Age Group: 12–18 years old.

Population Details: The scale development was based on a diverse sample (N=1,470) encompassing varying gender, ethnic classifications, age, employment status, clinical settings, residential circumstances, and prior involvement with legal systems. The normative sample (N=856) was drawn from school and community youth programs. A minimum reading level of 4.4 is required, though an audio administration version is available for those with lower reading skills.

Test Methodology: The inventory consists of 72 True/False items and 28 four-choice Likert-type items, totaling 100 scored items. Additionally, six items assess background information (current/past substance use, school, legal involvement) but are not used in scoring. Scoring utilizes a gender-based profile document and template, applying nine specific decision rules to the 12 resulting scale scores to determine the probability and severity of an SUD.

Keywords

screening inventory, adolescent psychology, clinical assessment, substance abuse treatment, psychometrics, test-retest reliability, concurrent validity, denial, subtle items

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Authors

Author ORCID Identifier: Information not available in source material.

Affiliation Email addresses: Information not available in source material.

Correspondence Address: Correspondence generally handled via The SASSI Institute.

Permissions & Fee and Test Year

The Adolescent SASSI was originally developed in 1990. The research edition of the SASSI-A2 was initiated in 1998, and the final standardized form was published in 2001. The instrument and its related materials (e.g., user’s guide, manuals, scoring templates) are commercially available through The SASSI Institute, which requires purchase and appropriate professional qualifications for administration and interpretation.

The most recent updated user’s guide was published in 2013, confirming continued professional support and alignment with modern diagnostic standards, including the DSM-5 criteria.

Reference’s

• American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Author.
• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Author.
• Lazowski, L. E., & Miller, G. A. (2013). The adolescent SASSI-A2 updated user’s guide. The SASSI Institute.
• Miller, F. G., & Lazowski, L. E. (2001). The adolescent SASSI-A2 manual. The SASSI Institute.
• Perera-Diltz, D. M., & Perry, J. C. (2011). Screening for adolescent substance-related disorders using the SASSI-A2: Implications for nonreporting youth. Journal of Addictions & Offender Counseling, 31, 66–79.

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Items of the The Adolescent Substance Abuse Subtle Screening Inventory-A2 (SASSI-A2)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The SASSI-A2 consists of 106 items total. The inventory includes 72 true/false items and 28 four-choice Likert-type items assessing frequency, extent, and nature of substance abuse. Six additional items assess current and past substance use, school information, and legal involvement, but are not used in scoring.

The specific, proprietary items of the SASSI-A2 are not available in the public domain source content provided. The scored items assess the following general categories:

• Substance misuse symptoms
• Family and social environment risks
• Attitudes and beliefs regarding alcohol and drug use
• Subtle items designed to identify individuals with substance use problems