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Substance Abuse Subtle Screening Inventory-3 Appears to be a Promising Screening Tool

The Question: How useful is the Substance Abuse Subtle Screening Inventory-3 as a screening tool to detect substance abuse or dependency for individuals with traumatic brain injuries?

Past Studies have found that up to 60% of traumatic brain injuries are alcohol or drug related. Studies show that over 50% of individuals that are hospitalized with traumatic brain injury have a history of substance abuse. Further, past studies indicate that individuals with more severe injuries are more likely to have substance abuse histories. Although alcohol use initially declines following traumatic brain injury, a good portion of individuals return to using alcohol at moderate to heavy levels. Alcohol and substance use is not recommended for individuals with brain injury because it can increase the risk of additional injuries, potentially slow recovery, and tends to decrease productivity, such as employment. Because of the strong relationship between substance abuse and brain injury, it is important to evaluate individuals for substance abuse and provide treatment.

Drug and alcohol screening tools typically include questioning the individual and their significant others or lab tests, such as blood or urine tests. Questioning techniques are limited by the individual’s or significant other’s willingness to tell the truth and the significant other’s knowledge of the use. Lab tests can be expensive and only record substance use at the time of the test, but do not show how substances have been used over a period of time. The Substance Abuse Subtle Screening Inventory (SASSI) is a self-report assessment used to detect chemical dependency. It is composed of “subtle” items that appear to be unrelated to substance abuse, but when the results are looked at all together, they can describe an individual’s chemical use patterns. The SASSI detects both alcohol and drug dependency, but it can only detect the possibility of substance abuse. The SASSI has been found to be a useful screening tool with the general population, but has not been tested extensively as a screening tool for individuals with traumatic brain injury.

This study’s goal was to determine if the Substance Abuse Subtle Screening Inventory, Third Edition (SASSI-3), could identify individuals with traumatic brain injuries who had a substance use disorder and those who did not. The SASSI was given to 78 participants while they were in inpatient rehabilitation. The individuals were mostly males who were 16 to 70 years old, although the majority of the participants were about 32 years old. Psychologistsalso evaluated the participants for chemical dependency. The SASSI-3’s ability to identify individuals who were and were not substance dependent or abusive and its overall accuracy was determined by comparing its results to those of the psychologists. The results were then compared to those of a former study of the SASSI-3 that included individuals with disabilities who were in a vocational rehabilitation setting. The results were additionally compared to Blood Alcohol Lab tests taken at the time of injury (for 60 participants).

Overall, the researchers found that the SASSI-3 had significantly lower accuracy rates for detecting individuals with traumatic brain injuries who had chemical dependency\ when compared to the accuracy rate of the prior SASSI-3 study. Better accuracy was obtained when trying to identify subtance abuse in addition to dependence. The SASSI-3 accuracy for indicating the possibility of substance abuse or dependence was similar to the rates of positive Blood Alcohol Level tests;however, the Blood Alcohol Level tests were better at detecting people without a substance use problem. The researchers suspect that the participants’ younger age may play a role in why the SASSI-3 was more accurate at indicating substance abuse rather than dependency. The researchers question that perhaps the participants were too young to fully establish chemical dependency patterns that could be detected by the SASSI-3.

Who May Be Affected By These Findings: Individuals with traumatic brain injuries and their significant others, chemical dependency professionals, healthcare professionals, and researchers

Caveats: It appeared that some participants had difficulty using the written forms for the SASSI-3, as 20 items were left unmarked or answered twice. The researchers suggest that the SASSI-3 would be more accessible for individuals with traumatic brain injuries if the test was shortened, the type used on the test was enlarged and if the questions were read out loud. The study results may also have been limited by the participant’s willingness to provide the psychologists with honest answers; therefore, it is possible that the SASSI-3 was more accurate than the psychologists’ diagnoses.

Bottom Line: The Substance Abuse Subtle Screening Inventory-3 (SASSI-3) shpws promise as a useful addition to the assessment of substance use with persons with traumatic brain injury, but at this time should not be used alone. p when used with The SASSI-3 may be most useful when used along with another assessment, such as a Blood Alcohol Lab Test.

Find This Study:
Arenth, P.M., Bogner, J.A., Corrigan, J.D., & Schmidt, L. (2001). The utility of the Substance Abuse Screening Inventory-3 for use with individuals with brain injury. Brain Injury, 15, 499-510.


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