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.

Drug Use Disorder Identification Test – Extension (DUDIT-E)

The DUDIT-E is an extension of the DUDIT, which previously only consisted of 11 items, whereas the extended version has 54 items. It is important to note that the DUDIT-E is an assessment tool, rather than a diagnostic tool. The assessment test is based on the idea that it is a behavioural choice to use drugs, and that that reflects positive outcome expectancies. For active drug users, the choice to use substances does not necessarily reflect a perceived sense of low self-efficacy, but rather, the use of drugs can be perceived as an adequate and self-efficacious response to legitimate existential needs.

A benefit from using the DUDIT-E, involves the use of motivation, as motivation is a widely used concept in substance use treatment, and is commonly seen as a premise for change during treatment (Sletteng et al., 2011). The short assessment tool is divided into four sections: frequency of drug use, positive aspects of drug use, negative aspects of drug use, and treatment readiness and aspects of motivation. In the section that focuses on treatment readiness, it asks the individual for their thought about drugs, which help indicate whether or not they are ready for change. Questions include, “have you been worried about your drug use…?” and “are you ready to work to change your drug use?”. Another benefit includes the assessment tool being available online, and in different languages from different countries, if there is no available copy in a specific language then the assessor can apply to get it translated, or translate it themselves. Identified substances that the DUDIT-E (drug list) covers include: cannabis, amphetamines, cocaine, opiates, hallucinogens, thinner and other drugs, GHB, sleeping/calming pills, pain relievers and tobacco.

The DUDIT-E has also been tested and examined psychometrically across various countries, such as Sweden and Norway, and using populations such as prison inmates and inpatients. Reliability analyses indicate good internal consistency, and high intraclass correlations indicate good test-retest reliability. The Cronbach’s Alpha Values indicate that the subscales range from 0.73 to 0.93, and for the online version, it was reported that the Cronbach’s Alpha was greater than 0.73 for all subscales (Berman et al., 2007).

Limitations involve gender distributions in past studies showing a preponderance of males. Another limitation is that the tool has only been studied in detoxification settings and criminal justice settings, therefore, there may be biased responses as individuals can be affected by perceived pressure to answer questions in a socially desirable manner. This may occur more frequently when the expression of negative attitude towards continued drug use is connected to possible benefits for the respondent, such as within the criminal justice setting before sentencing, or in an employment setting where scores may be invalid due to fears regarding possible sanctions following admitted drug use (Matuszka et al., 2014). Therefore, future research should be made to contribute to treatment admission among female drug users and young drug users in an outpatient addiction treatment setting, where treatment is clearly defined and follows a specified placement procedure. Overall, the DUDIT-E is a reliable and valid assessment tool, which is internationally appropriate as it can be translated to many different languages in different settings, and is available to use on both females and males.

References

Berman, A. H., Palmstierna, T., Källmén, H., & Bergman, H. (2007). The self-report Drug Use Disorders Identification Test—Extended (DUDIT-E): reliability, validity, and motivational index. Journal of substance abuse treatment, 32(4), 357-369.

Matuszka, B., Bácskai, E., Berman, A. H., Czobor, P., Sinadinovic, K., & Gerevich, J. (2014). Psychometric characteristics of the drug use disorders identification test (DUDIT) and the drug use disorders identification test-extended (DUDIT-E) among young drug users in Hungary. International journal of behavioral medicine, 21(3), 547-555.

Sletteng, R., Harnang, A. K., Hoxmark, E., Aslaksen, P. M., Friborg, O., & Wynn, R. (2011). A Psychometric Study of the Drug Use Disorders Identification Test—Extended in a Norwegian Sample. Psychological reports109(2), 663-674.