Proper Use of The SASSI:

• The purpose of the SASSI is to help people with substance use disorders. To use the SASSI to discriminate against individuals, such as disqualifying job applicants or to deny public assistance, violates the purpose of the SASSI and is illegal under the Americans With Disabilities Act.
  
• Remember, no screening measure is 100% accurate, and specific clinical information is required to meet the accepted standards for a DSM-IV clinical diagnosis of a Substance Use Disorder. The SASSI can be a valuable tool for professionals making assessments when it is used properly and in conjunction with supplemental information.
• We encourage you to look over the following information regarding use of the SASSI in public assistance programs. Always feel free to contact us personally should you have any questions regarding appropriate use of the SASSI.

The typical substance abuse screening procedure that is used in conjunction with applications for public assistance entails screening all qualified applicants for substance abuse. Those that are determined likely to be substance abusers are referred for a more comprehensive assessment. If they are then found to have a significant substance abuse problem, they are referred for treatment as part of the services they receive from the public assistance agency. Those who attend such treatment and comply with requirements continue to receive general assistance funds.

The SASSI Institute supports substance abuse screening in the context of the provision of general assistance, as long as the process is beneficial for recipients and does not infringe on their dignity or abridge their rights. It is our mission to promote early identification of substance dependence that ultimately leads to appropriate intervention, treatment, and ongoing recovery. In so doing, we hope to lessen the personal suffering and societal costs that accompany substance abuse. We accomplish our mission by providing assessment instruments for human service practitioners to use in developing screening programs in a broad range of human service settings, e.g., medical, counseling, criminal justice, vocational. We see our responsibility to develop valid and useful measures, to describe their reliability and validity, and to distribute them to qualified counselors. It is the responsibility of the counselors to establish policies regarding the use of assessment instruments in their settings according to appropriate legal, ethical and professional guidelines. In response to continuing inquires from agencies considering use of the SASSI in general assistance programs, the Institute desires to provide information that counselors and agencies may find useful in consideration of adoption and application of the SASSI and other assessment tools.

The optimal diagnostic procedure for identifying substance use disorders is a comprehensive assessment conducted by a professional with relevant expertise. The assessment should include one or more interviews, ideally with good rapport between client and professional. It should also take into account a range of other supportive information sources such as collateral contacts, test reports and legal history. However, such comprehensive assessments are costly; and they may be seen as an imposition on individuals who are applying for general assistance who are not substance abusers. Screening programs can be of value in reducing the overall cost of assessments and in avoiding subjecting some people to unnecessary evaluations. However, no screening measure is able to identify all substance abusers. Body fluid screens identify individuals who have psychoactive substances within their bodies at the time of the screening. They do not necessarily identify all people with substance-related disorders, especially alcoholics; and they misidentify some individuals who do not have a disorder but have a substance in their bodies at the time of the screening. Also, no paper and pencil instrument is 100% accurate in identifying substance abusers. Invariably, some individuals who are not substance abusers will be identified as abusers, and some abusers will be missed. Also, some people whose substance abuse is in remission and who do not need help in maintaining sobriety will be referred unnecessarily for the subsequent comprehensive evaluation.

Therefore, it appears vital for a program to pilot its screening procedures to determine the proportion of individuals who do not have a substance abuse disorder who are identified as high risk by the measure and subsequently referred for more thorough assessment. It is also important to determine the proportion of substance disordered individuals referred for further assessment that are actually already in recovery and would not profit from help in maintaining their recovery. The recovery group becomes a focal point because of protection under the Americans with Disabilities Act - under which the inconvenience of further assessment could be construed as discriminatory. Also, public assistance agencies that institute a screening procedure may wish to be aware of the percentage of substance dependent clients who are missed by the screening tool and consequently are not identified as needing additional help.

The assessment and treatment-referral that is conducted subsequent to the screening is crucial in determining the ethical propriety of mandated substance abuse screening, assessment and treatment. Does the assessment constitute an unnecessary burden on applicants? Does it constitute an unnecessary burden on substance abusers that are in remission? Does it provide some benefit to substance abusers that are in remission? Is it free from conflicts of interest such as the assessment agent also serving as the treatment provider? Does it conform to state of the art standards?

It is also important to recognize that two programs appearing to be identical on paper can differ significantly in their impact. In one, applicants may be treated respectfully, be informed of the purpose of each step in the process, and referrals for further assessment and treatment conducted in such a way as to value the person and protect their dignity. In another program, the clients may not be treated with adequate respect, and referrals may be made in a critical rather than supportive fashion. These issues and others pertaining to the assessment, referral and treatment process are beyond the control of The SASSI Institute.

The SASSI Institute would be pleased to provide whatever information we have available to help all human service providers, including public assistance agencies, develop screening programs that further a shared mission of identification and treatment of substance abuse.