We invite you to join us for a free one-hour SASSI Clinical Q&A webinar hosted by our Clinical Director, David Helton, LMSW, LCDC. The Q&A is for anyone new to using the SASSI, those considering using the SASSI, or seasoned veterans at screening with the SASSI. The Q&A is scheduled from 11 am – Noon ET on: July 14th, 2026. You can save your spot by clicking here.
We welcome you to share profiles to discuss with the group by sending them (de-identified) via email any time prior to the session to scarlett@sassi.com. These profiles will help others learn about SASSI and offer insight into the various profile configurations.
Note: Q&A sessions do not provide CEUs and are not a substitute for SASSI Training. To register for a SASSI Training webinar. please visit https://sassi.com/sassi-training-online/.
Individuals who are screened for substance use disorders often have presenting complaints related to other psychological and medical health issues, as well as difficulty in functioning and adjustment in other life domains (e.g., work, parenting, financial, and legal). It is important, therefore, that a screening instrument used to identify individuals in need of further evaluation for substance use disorders is able to discriminate between SUD and other mental health issues or poor adjustment and functioning.
Analyses were conducted to evaluate the accuracy of SASSI-4 SUD screening out-comes in a sample of individuals who had co-occurring psychiatric disorders (i.e., dual diagnoses for SUD and one or more psychiatric disorders such as depression, anxiety, post-traumatic stress disorder, etc.) and a sample of individuals who were diagnosed as not having a substance use disorder but who did have one or more non-SUD related diagnoses (i.e., were criterion negative for SUD).
Findings are presented in Table 18 and indicate excellent SASSI-4 screening sensitivity in detecting SUD in clients who had both SUD and another psychological disorder. Findings also showed high specificity in producing negative SASSI-4 screening outcomes for individuals who were diagnosed with non-SUD related disorders only. Overall SUD screening accuracy in this sample was 97%. These findings provide evidence of construct validity and the precision of the SASSI-4 in identifying likely SUD specifically, rather than identifying individuals who may be in need of treatment for life stressors, poor adjustment and functioning, or other psychological health issues.
Extracted from:
Lazowski, L. E., Kimmell, K.S., & Baker, S.L. (2016). The Adult Substance Abuse Subtle Screening Inventory-4 (SASSI-4) User Guide & Manual. Springville, IN: The SASSI Institute.
Substance use disorder is an important topic in our society. The internet, social media, and television provide us with information about new treatment programs and the ongoing political discussion of the seriousness of the problem.
The SASSI Institute gives thanks to the dedicated workers who, day-by-day, face the task of helping people who have become part of the fabric of pain that surrounds substance-related disorders. The daily efforts of practitioners, support staff, and program managers may not be newsworthy, but those efforts reflect a sense of caring and commitment that is inspiring.
We strive to make the SASSI as user friendly as possible. The following are links to download the basic Guidelines for interpreting the SASSI scales.
As always, our clinicians are available to help you with questions about administering and/or interpreting the SASSI on the Clinical Helpline at 800-697-2774 Option 2 Monday through Friday, 1 pm to 5 pm (EST).
While the core goal of identifying substance use disorders remains the same, the SASSI-4 (Adult) and SASSI-A3 (Adolescent) are tailored to the very different life stages and behavioral patterns of their respective groups.
Think of it this way: the way an adult hides a drinking problem is often very different from how a teenager masks drug use.
Comparison of SASSI-4 vs. SASSI-A3
Feature
SASSI-4 (Adult)
SASSI-A3 (Adolescent)
Age Range
18 years and older.
13 to 18 years.
Focus Area
Emphasizes long-term behavioral patterns.
Emphasizes family dynamics, peer pressure, and school behavior.
Subtle Items
Focuses on adult stressors like workplace issues and long-term social consequences.
Focuses on “acting out,” rebelliousness, and emotional regulation.
Key Differences in Approach
The Adolescent Version (SASSI-A3)
Teenagers are often in a state of natural rebellion or may be experimenting due to peer influence rather than chronic dependency. The A3 is specifically designed to:
Filter Peer Influence: It helps distinguish between a teen who is “experimenting” because of friends and one who has a burgeoning clinical dependency.
Assess Family Environment: It includes scales that look at the teens’ perception of their home life, which is a major factor in adolescent recovery.
Evaluate “Global” Functioning: It looks at how substance use is impacting their development (school performance, legal trouble, and social skills).
The Adult Version (SASSI-4)
Adults typically have more established defense mechanisms and more to lose (jobs, marriages, custody). The SASSI-4 was recently updated to better capture:
Prescription Medication Abuse: Since the opioid crisis, the adult version has been refined to better identify those misusing legal prescription medications.
Severity Markers: It provides more nuance on the intensity of the disorder, which helps in planning for long-term recovery versus short-term intervention.
Why the Distinction Matters
Using an adult test on a teenager (or vice versa) could possibly lead to inaccurate results. A teenager’s natural impulsivity might look like a “disorder” on an adult scale, while an adult’s more calculated “denial” might not be caught by a test designed for a more impulsive adolescent.
The purpose of the SASSI is to help identify people who are likely to have substance use disorders so that early intervention and treatment can be initiated when appropriate.
The Substance Abuse Subtle Screening Inventory (SASSI) is a widely used psychological screening tool designed to identify individuals with a high probability of having a Substance Use Disorder (SUD).
Its primary value lies in its ability to look past “denial.” Many people struggling with addiction may not be ready to admit it, or they might intentionally try to minimize their usage during an evaluation. The SASSI helps by being a bit more “clever” than a strictly face-valid questionnaire.
How It Specifically Helps
1. Identifying “Hidden” Issues
Unlike many tests that ask straightforward questions (e.g., “How many drinks do you have a week?”), the SASSI includes subtle items. These are questions that don’t seem related to substance use but are statistically linked to the behavioral patterns of people with SUDs. This helps clinicians identify people who are:
In deep denial.
Intentionally hiding their use.
Unaware that their behavior constitutes a disorder.
2. Providing a Faster Path to Treatment
Because the SASSI is relatively quick to administer and score, it acts as a “triage” tool. It allows counselors to quickly decide who needs an intensive clinical interview and who might just need basic education. This efficiency ensures that resources go to the people who need them most urgently.
3. Objective Data for Referrals
Objective scoring of the SASSI yields a screening outcome – a yes-or-no answer as to whether the client has a high probability of having a substance use disorder, as well as a check on validity of the profile, a score indicating level of defensive responding, and a score indicating the possibility of prescription drug abuse. For people involved in the legal system (like DUI cases) or workplace evaluations, having objective, validated results remove personal bias from the evaluator. It provides a foundation for recommending specific levels of care, such as:
Outpatient counseling.
Intensive Outpatient Programs (IOP).
Inpatient detoxification.
What the SASSI Is Not
It is important to remember that a high probability of a substance use disorder result on the SASSI is not a final diagnosis. A licensed professional must still conduct a full clinical interview to make an official diagnosis based on the DSM-5-TR.
Overall, the SASSI provides a useful tool for healthcare providers, substance abuse professionals, criminal justice entities and others who are involved in identifying and treating substance use disorders. It can help to ensure that individuals receive appropriate care and support, which can ultimately improve their health and well-being.
In a past blog we shared an interpretation titled “SYM Scale and Environmental Factors” which discussed SASSI-4 profile scores for a Native American couple residing in Canada.
The profiles in that blog highlight a challenge that professionals face as they seek to help people overcome problems associated with substance misuse. You likely often work with individuals who consume large amounts of psychoactive substances and experience negative consequences but genuinely do not perceive that they have a substance use problem. Helping people gain awareness of such problems is a daily task for professionals. The blog demonstrates the importance of being sensitive to and respecting individuals’ realities as you endeavor to help them grow.
One reason why people may have difficulty perceiving that their substance use has a negative impact on their lives is that the substance brings immediate relief from emotional pain, even though greater pain is the ultimate consequence. Many clients face the not so easy challenge of having to recognize that their ongoing problems are attributable to an important and apparently satisfying behavior. As people confront the need to stop their misuse of psychoactive substances, they must let go of what may be a primary and valued aspect in their lives. What is recognized as a major source of their problems, they may see as the only solution. To help individuals who suffer from substance misuse, it is necessary to understand and respect the way they perceive their usage.
Some people do not recognize the impact that substance misuse has on their lives because they do not see an alternative. This phenomenon is not limited to small, geographically isolated communities like Mary and John’s (see SYM Scale and Environmental Factors). Many people who live in larger towns are members of sub-communities in which substance misuse is the norm, “everybody drinks and drugs, everybody has family fights, everybody has hangovers, everybody has money problems, everybody has legal problems.” As a service provider, there is a responsibility to recognize and deal effectively with the realities that confront individuals. It is disrespectful to expect people to easily reject a central aspect of their social milieu and readily embrace a lifestyle that is completely foreign to them.
Providing clients with feedback on the SASSI can promote a collaborative relationship in which you can join the client in the process of exploring their world and seeking ways in which to enhance the quality of their lives. Consider Mary & John’s profiles; an outstanding scale are the elevated SYM scores. SYM provides a measure of clients’ acknowledgment of being involved in a pattern of heavy usage and associated negative consequences. Since it is composed of items that directly address substance misuse, it is valuable to review the endorsed items with clients and ask them for elaboration. For example, an elevated SYM score may indicate a history of parental substance misuse, early onset of substance misuse, and associated family problems. During the process of providing feedback, it is important to promote discussion to help clients gain a greater understanding of the role of substance use in their lives and to help them increase perspective and insight into the way substance use has affected their lives.
Professionals expect clients to be receptive to the process of change; so too professionals must endeavor to understand the world in which they live. The act of change is an act of courage. As an addiction professional you are privileged to stand witness to courage shown by clients as they open themselves to new ways of seeing and being in the world. Through patience and understanding, you can hopefully be a source of encouragement and support along the way.
(Please note that The SASSI Institute recommends examining specific items on the FVA, FVOD, SYM, Rx and on the RAP scale, but NOT on the other (subtle) scales – OAT, SAT. DEF, SAM, FAM, and COR)
Please be sure to utilize our free clinical consultation line for assistance interpreting SASSI profiles M-F 1-5 pm EST at 800.726.0526 Option 2.
In my conversations with SASSI users on our free Clinical Helpline, I often run into people who have never participated in an official training led by a SASSI-certified trainer. Some of them have never been trained by anyone and are just trying to figure it out on their own or using the SASSI User Guide & Manual. Others have had a co-worker show them what they know about the instrument, sometimes inadvertently receiving misinformation or information lacking in important details. Thankfully, the SASSI was originally designed to be a simple and easy to use screening instrument that doesn’t necessarily require one to have a specific credential or college degree in order to successfully administer and score the instrument. So, anyone can easily learn to use the SASSI effectively and accurately with proper training.
I remember several years ago I was doing a training on the SASSI for a probation department and one of the attendees, who had been using the SASSI for over 10 years and who wasn’t sure why he had to be at the training, came up to me at the break and told me he had already learned several things in the first 1 ½ hours that he hadn’t known for the past ten years! He had never been to an official SASSI training done by a SASSI certified trainer until that day. For him, he was now glad he had been required to go to the training that day!
While the basics of administering and scoring the instruments are quite simple, the SASSI also has additional utility in the form of Clinical Interpretation of the Sub-Scales that can be used to help us in treatment planning, educating the client, making referrals for clients and just understanding our clients better. Like most things involving humans though, clinical interpretation can be rather complex and not as straight forward as the basics of administration and scoring. Getting good training by a SASSI-certified trainer is a first step to learning to master the interpretation of individual sub-scales on the instruments. The second step after training is to regularly utilize the free Clinical Helpline service offered by the SASSI Institute weekly M-F from 1:00pm-5:00pm EST. Through this service, callers are able to essentially extend their training on the SASSI for free and practice their clinical interpretation with SASSI clinical experts as often as they want or need each week.
So, if you’ve never been to an official SASSI-certified training or it’s been many years ago and you need to go to training again to get a “refresher,” let me encourage you to take that step in improving your knowledge base to get more out of this amazing screening instrument to better assist your clients. You can go to the Training section of the SASSI website by going here: https://sassi.com/sassi-training/. From there, you can click on United States or Canada to see if there are any trainings scheduled by state, province or region by our certified trainers; or you can click “Online” to view and register for any of our upcoming live public webinar trainings which are separated by those that are specifically for the Online/Web-based version of the SASSI and those for the traditional paper/pencil version of the SASSI. On this page you can also register for “On-Demand” recorded SASSI trainings if you don’t want to wait for a live training. The live trainings offer you the advantage of being able to interact in real time with the trainer and other participants and ask any questions you might have on the spot. The “on-demand” recordings offer the convenience of immediate viewing. Choose what works best for you but please consider getting training in an official SASSI-certified session. Who knows? You might find out some things about the SASSI you never knew that can help you use the instruments more effectively.
Many people know that the SASSI is possibly the best substance use disorder screening tool that exists in the behavioral health field today. The instrument can be easily administered in 15 minutes or less and manually scored in less than two minutes (or scored automatically in the online web-based version), resulting in an objective empirically-based statement of the likelihood of the client having a substance use disorder with an overall accuracy of 92% for adults and 89% for adolescents. And it achieves this kind of accuracy even in clients who are unwilling or unable to acknowledge their substance misuse or the symptoms associated with it!
Through extensive case study research, the SASSI has been found to be able to provide even more utility to clinicians in the form of clinical interpretations that go beyond just the high or low probability of a substance use disorder result. In addition to interpretations of individual scale raw scores that fall outside the boundaries of the research-based established normal distribution, we also have discovered some trends or characteristics in the specific situation in which the client scores as high probability of a substance use disorder based on SASSI decision rules that involve only subtle scales rather than face valid scales. That is the subject of our blog today.
The SASSI is made up of both face-valid scales and subtle scales. Face-valid scales such as FVA, FVOD and SYM are scales that are very obvious about what they are measuring, while subtle scales such as OAT, SAT and DEF are made up of items that do not seem to have anything at all to do with substance use. Our case study analysis showed that certain behaviors, characteristics or patterns emerge in individuals who score as high probability based only on subtle scales. Let’s take a look at an example. Byron is a 31-year-old male who was asked to be evaluated because of a child custody battle in which the mother alleges that Byron misuses drugs. Byron has not yet had a comprehensive assessment done, but has so far only admitted to some occasional use of marijuana. A SASSI was administered and the results showed that Byron met the criteria for Decision Rules 3, 4 and 7. Each of these decision rules involve only subtle scales and no face-valid scales. So, what characteristics do we tend to find in individuals with this type of scoring pattern?
One key feature of this type of scoring pattern is the fact that these individuals often have very little insight into the pervasive nature of the addictive disorder in their lives. Most of the time, this type of client actually has a very sincere delusion regarding their substance misuse. In other words, they are not trying to trick you into thinking they do not have a problem with substances; they simply do not see it. Often, every single activity this person is engaged in and every decision they make somehow involves substance use. Often, the substance misuse has become an unhealthy way to cope with emotions that are too overwhelming and so individuals with this type of scoring pattern are very emotionally avoidant. Many times, this individual has difficulty admitting their weaknesses or the personal limitations with which they struggle and instead choose to focus on very superficial things, ignoring the depth of the substance problem in their life. We can see these types of traits and behavior patterns manifested in this client’s individual face-valid scale scores such as lower than average (T-score of 50 is the mean) FVA and FVOD scores and only an average SYM score. These all indicate a client who does not acknowledge or admit to having any significant problems or negative consequences as a result of substance use. The client’s extremely high DEF score indicates a very high level of guardedness and the desire to be seen as having no weaknesses or faults. It’s even possible that the FVA, FVOD and/or SYM scale scores could be artificially low because of minimization of symptoms in the client’s answering patterns on these scales fueled by this defensiveness. However, as mentioned previously, it’s possible and even probable that this client really has very little insight into his problem with substance misuse and so he may be unable to even recognize the obvious negative consequences he is experiencing. This is especially typical of clients with high SAT scale scores as this client has. While this client does also have an equally high OAT score, which often indicates some ability to recognize negative attributes that are common in individuals with substance problems such as impulsiveness, self-pity, resentment, and impatience, it is more likely in this case that the client does not see these issues as having any relationship to his misuse of substances.
At this point, a comprehensive assessment needs to be done along with a formal diagnosis and possible treatment plan formulated. Since the SASSI does not provide an actual diagnosis and does not, by itself, indicate a need for treatment or the level of treatment, it is important to gather more information such as self-reports of the client’s current usage patterns, collateral reports, naturally occurring records, behavioral records, etc. to determine a diagnosis and course of action. Typically, clients with this scoring pattern do have a significant substance use disorder and many of them, if they need treatment, will often need a relatively intensive level of treatment which includes individual and group therapy sessions; more than just cognitive/educational programming. However, individuals with this type of scoring pattern will often be initially resistant to any treatment as they honestly do not see a problem that needs to be treated. The high level of defensiveness will require lots of time spent in developing a therapeutic alliance and positive rapport, affirming and supporting him throughout the process. Clients like this are often a high relapse risk and so it is important to provide wraparound supports and a level of intensity in the treatment regimen which allows for quicker and stronger intervention in the event the client attempts to relapse. Individuals who score as high probability of a SUD based only on subtle scales are often some of the most challenging clients, but with information gained from the client’s scoring patterns on the SASSI combined with additional information from other sources, you are in a better position to know what to address to increase the possibility of success with this client.
Don’t forget that full training on administering/scoring the SASSI and clinical interpretation of the sub-scales is available. Check out https://sassi.com/sassi-training/ to register for an upcoming training. Also, our free Clinical Helpline is available M-F from 1:00pm to 5:00pm EST to answer any questions you have about the SASSI.
At The SASSI Institute, our mission has always been to provide you with tools that make your work easier, more accurate, and more effective. SASSI Online has grown into an important resource for clinicians, educators, and professionals in the field of substance use screening — and that growth is thanks to the support and feedback of our valued customers.
Now, we’d like to hear directly from you.
What features would make SASSI Online even more useful in your daily work?
Are there tools or functions that could save you time?
Are there any enhancements to reporting, data management, or integrations that would make your workflow smoother?
Is there something you’ve always wished SASSI Online could do?
No suggestion is too small or too big. Whether it’s a streamlined way to organize client assessments, a new type of dashboard, or a feature you’ve seen in other platforms that you’d love to have here—we want to know.
Your input will help guide our development team as we continue to improve SASSI Online and ensure it remains a tool that truly supports your practice.
Early identification: The SASSI’s screening tools (the SASSI) can help identify students who may be struggling with substance use disorders, even if they are not openly acknowledging the issue.
Targeted interventions: The SASSI can provide valuable insights for tailoring interventions and treatment plans to individual student needs.
Reduced stigma: The SASSI is a tool for understanding and supporting students, rather than a judgmental “test.”
2. Training and education
Accessible training: We offer workshops and webinars (live or recorded) for counseling center staff on the proper administration, scoring, and interpretation of the SASSI.
Free resources: Staff can utilize our free clinical helpline and free clinical Q&A webinars to address questions and concerns related to using the SASSI.
Collaboration with academic programs: We welcome partnerships with university departments to integrate SASSI training into relevant courses (e.g., counseling, social work, psychology).
3. How to integrate SASSI into existing practices
Part of intake: Incorporate the SASSI as a routine part of the intake process for all students seeking counseling services.
Utilize online options: Online administration is convenient and SASSI Online can be used for telehealth and remote screening, including increased accessibility, client comfort, immediate results, and streamlined record-keeping.
Referral protocols: Clear protocols for referring students based on their SASSI results to appropriate internal or external resources, including addiction counseling, or specialized treatment programs can be developed.
By implementing these strategies, University Counseling Centers can effectively use the SASSI and provide crucial support to students struggling with substance use concerns.
