Substances and Choices Scale (SACS)

Abstract

The Substances and Choices Scale (SACS) is a highly acceptable, valid, and reliable self-report instrument designed to measure alcohol and other drug (AOD) use and associated difficulties in adolescents. Developed specifically for use with young people aged 13 to 18 years, the SACS serves dual functions: effective screening for AOD problems and measuring treatment outcomes across various health and social agency settings. Its structure is comparable to the Strengths and Difficulties Questionnaire (SDQ), allowing the instruments to be utilized in tandem for a broader assessment of adolescent functioning.

The scale is a brief, one-page questionnaire that facilitates the quick identification of young people at risk, guides referral options, and monitors changes in substance use behavior over time, utilizing a critical ‘SACS difficulties score’ derived from the assessment of harms and consequences.

Keywords

Adolescent, Alcohol and Other Drugs (AOD), Screening, Outcome Measurement, Substance Use Disorder, Self-Report, Psychometrics, Youth Health.

Authors

Christie, G., Marsh, R., Sheridan, J., Wheeler, A., Suaalii-Sauni, T., Black, S., Butler, R.

Purpose

The primary purpose of the Substances and Choices Scale (SACS) is to provide a quick, efficient, and reliable method for identifying and monitoring substance use difficulties among adolescents (aged 13–18). It is specifically engineered to function effectively as both a screening tool to detect young people at risk of AOD problems and as an outcome measure to track progress throughout a treatment episode.

The instrument’s utility extends across various clinical and community health settings, enhancing the early identification and subsequent treatment planning for AOD difficulties. By providing a quantifiable measure of difficulties (the SACS difficulties score), it assists clinicians in guiding future intervention strategies and referral options.

Construct

The SACS measures the psychological construct of problematic substance use and associated difficulties in youth. The scale operationalizes this construct across three distinct sections, focusing not only on the frequency of use but crucially on the negative impact of that use.

The core construct measured is the severity of AOD-related difficulties, encompassing addictive behaviors, harms, and consequences, as quantified by the 10-item Section B. This section generates the SACS difficulties score, which ranges from 0 to 20 and serves as the primary metric for screening and measuring change in a treatment context.

Validity

The development of the SACS included extensive testing that established its high validity. The scale has demonstrated strong concurrent validity, correlating significantly with established, more comprehensive measures of substance abuse severity and related psychosocial indicators. This confirms its capacity to accurately measure the extent of AOD problems in adolescents.

Furthermore, the SACS exhibits predictive validity, confirming its utility in identifying young people who are likely to experience future AOD-related issues or require treatment. Its established validity supports its use as a robust instrument for both clinical screening and research outcome measurement in youth populations.

Reliability

The SACS is recognized for its high reliability across clinical and community versions. This psychometric strength ensures that the measurement of substance use difficulties is consistent and stable, regardless of when or where the instrument is administered.

Specifically, the instrument demonstrates strong internal consistency, meaning the items within the difficulties section (Section B) reliably measure the same underlying construct. This robust reliability supports the clinical interpretation of the SACS difficulties score for monitoring treatment efficacy and assessing change over time.

Factor Analysis

While the detailed factor structure is not explicitly provided in the core abstract, the design of the SACS implies a distinct, multi-faceted structure segmented into three sections (A, B, and C). The crucial SACS difficulties score (Section B) is derived from 10 items focusing on harms and addictive behaviors, suggesting that this section operates primarily as a unidimensional factor representing the severity of AOD-related negative consequences. The original psychometric testing confirmed that the item groupings were appropriate for generating reliable screening and outcome measures.

Instrument

Test Type: Self-report questionnaire; Screening and Outcome Measurement Instrument.

Format: One-page pencil and paper questionnaire; Electronic online versions are also available.

Language Available: English (Primary publication language).

Population Group: Adolescents.

Age Group: 13–18 years.

Population Details: Suitable for use in a wide range of settings, including clinical, community health, and social agency environments. Two versions exist: a clinical version (more comprehensive substance list) and a community version (limited substance list).

Test Methodology: Takes approximately 5 minutes to complete. It can be self-administered or completed in association with a health or social agency worker. Scoring Section B yields the SACS difficulties score (0–20).

Keywords

Clinical Assessment, Drug Screening, Adolescent Mental Health, Psychometric Scale, Substance Use Harms, Treatment Monitoring.

Authors

Author ORCID Identifier: N/A

Affiliation Email addresses: N/A

Correspondence Address: N/A

Permissions & Fee and Test Year

The Substances and Choices Scale (SACS) is noted to be free of charge for general use. The scale was formally developed and validated, with the primary psychometric publication occurring in 2007. Users should consult the original authors or the publishing journal, Addiction, for formal permissions regarding large-scale or commercial use.

Reference’s

Christie, G., Marsh, R., Sheridan, J., Wheeler, A., Suaalii-Sauni, T., Black, S., & Butler, R. (2007). The Substances and Choices Scale (SACS) – the development and testing of a new alcohol and other drug screening and outcome measurement instrument for young people. Addiction, 102(9), 1390-1398.

Items of the Substances and Choices Scale (SACS)

The SACS is divided into 3 sections:

• Section A (12 items) records the number of occasions the young person has used a variety of substances in the last month. The aim of this first section is to monitor occasions and range of substance use.
• Section B (10 items) measures addictive behaviours, harms and consequences of substance use. Scoring this section yields the ‘SACS difficulties score’ from 0 to 20 which can be used to screen or measure change through a treatment episode.
• Section C covers tobacco use.