Substances and Choices Scale (SACS)

The Substances and Choices Scale (SACS) is an adolescent alcohol and other drug (AOD) use measurement instrument with high acceptability, validity and reliability. It has utility in screening and measuring outcome and can be used to enhance the identification and treatment of AOD difficulties in adolescents across a range of health settings.

The SACS a one-page pencil and paper self-report questionnaire for adolescents aged 13 -18 years. It takes about 5 minutes to complete and is free of charge. It can be completed alone or in association with the young person’s health or social agency worker. It is structured in a similar format to the Strengths and Difficulties Questionnaire (SDQ) and the two instruments can be used together if a broader perspective on a young person’s functioning is required. The SACS can assist in identifying young people at risk of AOD problems, guide future treatment or referral options and can measure outcomes as young people progress through the treatment process. Electronic online versions are also available.

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.

There are clinical and community versions of the SACS which differ only in terms of the content of Section A, with the community version listing a limited number of substances. The SACS difficulties score (Section B) is the same in both versions thus the psychometric properties of each version are the same. The use of the clinical version is encouraged where possible to get a clearer perspective of a young person’s substance use.

References

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.

Alcohol Use Disorder Identification Test (AUDIT)

The AUDIT is a screening instrument to detect excessive and harmful patterns of alcohol use. It was developed by the World Health Organization (WHO) in an initiative to develop a reliable and valid measure in identifying alcohol abuse. The AUDIT was developed to be used by General Practitioners and other professionals in the primary health care industry and is easy to use and interpret. It comprises of a 10-item questionnaire appropriate for adolescents and adults of all ages. It can be completed by clients as a self-report, or used in an interview by the practitioner. It takes approximately 2 to 3 minutes to be completed and clients are invited to ask for clarification on any items. The 10 items address three areas of drinking behaviour; Hazardous Alcohol use (items 1,2,3), Dependence symptoms (items 4,5,6) and harmful alcohol use (7,8,9,10).

Two examples of items on the AUDIT questionnaire are;

  1. How often do you have a drink containing alcohol?

(0) Never [Skip to Qs 9-10] (1) Monthly or less (2) 2 to 4 times a month (3) 2 to 3 times a week (4) 4 or more times a week

  1. Have you or someone else been injured as a result of your drinking?

(0) No (2) Yes, but not in the last year (4) Yes, during the last year

To interpret the AUDIT sum each item score to get an overall score which can be interpreted as per the guideline cut off points; 8-15 hazardous, 16-19 harmful and >20 is dependent. The guidelines should be considered tentative and subject to clinical judgement. Important information can be obtained by interpreting which items received the high scores (harmful, hazardous or dependence items).

The AUDIT has been found to have good reliability and consistency with ICD-10 definitions of alcohol dependence and harmful alcohol use (Babor, Higgins-Biddle, Saunders &  Monterio, 2001). Meneses-Gaya et al (2009) systematic review of psychometric properties found a mean Cronbach’s alpha of .80 across 10 studies investigating internal consistency. The AUDIT presented excellent sensitivity and specificity values (Menese-Gaya et al 2009). In the initial comparative study across 6 countries a cut off point of 8 yielded sensitivities in mid .90’s and specificities averaged in the .80’s.

The AUDIT is free to use and does not require specific training to administer, the manual is available on Turning point website http://www.turningpoint.org.au/Treatment/Online-Self-Assessment.aspx. Turning point have developed ‘The Adult AOD Screening and Assessment Instrument” Clinical Guide that list instructions and advice for the AUDIT along with other AOD screening tools. The AUDIT is a screening tool to assist to interpret levels of hazards drinking. A clinical interview and other assessments are required for a formal diagnosis.

 

References

Menese- Gaya, C., Zuardi, A., Loureiro, S., & Crippa, J. (2009). Alcohol use disorders identification test (AUDIT): An updated systematic review of psychometric properties. Psychology & Neuroscience, 2(2), 83-97 DOI: 10.3922/j.psns.2009.1.12

Heather, N. (2006). WHO collaborative project on identification and management of Alcohol-related problems in primary health care. Retrieved from http://www.who.int/substance_abuse/publications/identification_management_alcoholproblems_phaseiv.pdf?ua=1

Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., Monterio, M. G. (2001). AUDIT: The Alcohol Use Disorders Identification Test Guidelines for Use in Primary Care (second edition) Retrieved from http://www.who.int/substance_abuse/publications/audit/en/