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The Simple Screening Instrument for Substance Abuse (SSI-SA) is a 16-item scale designed to encompass a broad spectrum of signs and symptoms for substance use disorders, and particularly to screen patients in mental health settings for co-occurring substance abuse disorders. These conditions are characterized by substance use that leads to negative physical, social, and/or emotional consequences and loss of control over one's pattern and amount of consumption of the substance(s) of abuse. The SSI-SA was developed by the consensus panel of Treatment Improvement Protocol (TIP) 11, Simple Screening Instruments for Outreach for Alcohol and Other Drug Abuse and Infectious Diseases (Center for Substance Abuse Treatment 1994c).
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The SSI-SA is a 16-item scale, although only 14 items are scored so that scores can range from 0 to 14. Items 1 and 15 are not scored. Items 2-14 are scored as 1 (yes) or 0 (no). These 14 items were selected by the TIP 11 consensus panelists from existing alcohol and drug abuse screening tools.
A score of 4 or greater has become the established cut-off point for warranting a referral for a full assessment.
SSI-SA Score and Degree of Risk for Substance Abuse
| SSI-SA Score | Degree of Risk for Substance Abuse |
|---|---|
0 – 1 | None to low |
2 – 3 | Minimal |
≥ 4 | Moderate to high |
A score of less than 4 does not necessarily indicate the absence of a substance abuse problem.
Questions 1 and 15 are not scored, because affirmative responses to these questions may provide important background information about the respondent but are too general for use in scoring. The observational items are also not intended to be scored, but the presence of most of these signs and symptoms may indicate a substance abuse problem.
PsyPack can automatically score the SSI-SA assessment and prepare corresponding tables and graphs.
Substance Use
The purpose of the evaluation is to:
Self-administered
Clinical
Questionnaire
15 years and above
10 to 15 minutes
Use of the screening instrument should be accompanied by a careful discussion about confidentiality issues. The interviewer should also be clear about the instrument’s purpose and should make it understood that the information elicited from the instrument will be used to benefit, not to punish, the individual being screened.
Some of the items in the screening instrument may trigger emotional distress or a crisis. Reactions may sometimes include anxiety or depression, which may be accompanied by sui- cidal thoughts and behaviors.
Since the questionnaire relies on client self-report, all responses should be verified by the clinician, and a definitive diagnosis is made on clinical grounds taking into account how well the client understood the questionnaire, as well as other relevant information from the client.
The five domains measured by the instrument are substance consumption (questions 1, 10, and 11), preoccupation and loss of control (questions 2, 3, 9, 11, and 12), adverse consequences (questions 5–9, 12, and 13), problem recognition (questions 2–4 and 13–16), and tolerance and withdrawal (questions 5 and 10).
It is expected that people with a substance abuse problem will probably score 4 or more on the screening instrument. A score of less than 4, however, does not necessarily indicate the absence of a substance abuse problem. A low score may reflect a high degree of denial or lack of truthfulness in the subject’s responses. The scoring rules have not yet been validated, and thus the substance abuse screening instrument needs to be used in conjunction with other established screening tools when making referrals.
Observation Checklist
The following signs and symptoms may indicate a substance abuse problem in the individual being screened:
Consensus panel of Treatment Improvement Protocol (TIP) 11, Simple Screening Instruments for Outreach for Alcohol and Other Drug Abuse and Infectious Diseases (Center for Substance Abuse Treatment 1994c).