This article presents analyses on psychometric properties of a recent revision of the Substance Abuse Subtle Screening Inventory (SASSI-3). Participants were 772 individuals from a range of clinical settings who were independently diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association [APA], 1987) or DSM-IV (APA, 1994) criteria regarding the presence or absence of a substance-dependence disorder. A development sample (n = 391) was used to formulate SASSI-3 decision rules that yielded 95% agreement with clinical diagnoses of substance dependence. Correspondence with the criterion variable was shown to be 97% in a cross-validation sample (n = 381) from the same clinical settings. Convergent relations were demonstrated with a variety of other indexes of substance misuse, including clinical assessments of substance abuse history, alcohol and drug-related arrests, self-reported use of illicit drugs, and other instruments designed to screen for substance misuse. Further, logistic regression analyses indicated no significant differences in the overall accuracy of the SASSI-3 as a function of respondents' demographic characteristics or clinical ratings of respondents' level of adjustment and functioning (Global Assessment of Functioning ratings; APA, 1987, 1994).

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Likely SUD as measured by the SAVR-S was most predictive of depression symptom severity in this sample of persons with traumatic SCI. Drug and alcohol screening are important for identifying individuals at risk for depression, but screening for both may be optimal. Further research is needed on risk and protective factors for depression, including psychosocial characteristics.

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Abstract. The study objective was to develop a revision of the adult Substance Abuse Subtle Screening Inventory-3 to include new items to identify nonmedical use of prescription medications, as well as additional subtle and symptom-related identifiers of substance use disorders (SUDs) and to evaluate its psychometric properties and screening accuracy against a criterion of DSM-5 diagnoses for SUD. Clinical professionals throughout the nine US Census Bureau regions and two Canadian provinces who used the SASSI Online screening tool submitted 1,284 completed administrations of the provisional SASSI-4 along with their independent DSM-5 diagnoses of SUD. Validation sample findings demonstrated SASSI-4 sensitivity of 93% and specificity of 90%, AUC = .91. Items added to identify respondents who were abusing prescription medications showed 94% overall screening accuracy. Logistic regression showed no significant effects of client demographic characteristics or type of screening setting on the accuracy of SASSI-4 screening outcomes. In Study 2, 120 adults in recovery from SUD completed the SASSI-4 under instructions to fake good. Sensitivity of 79% was demonstrated for the full scoring protocol and was 47% when only face valid scales were utilized. Clinical utility is discussed.