TPC-Journal-V6-Issue2

The Professional Counselor /Volume 6, Issue 2 123 substance abuse among persons with traumatic brain injury. Ashman et al. (2004) used the Structured Clinical Interview for DSM-IV (First, Spitzer, Gibbon, & Williams, 1996) as the criterion variable against which the SASSI’s results were compared. These authors concluded that while the SASSI’s overall decision and FVA scale yielded “modest accuracy, sensitivity, and specificity rates” (p. 198), the FVOD scale had high sensitivity (95%) but only moderate accuracy (83%) and specificity (82%) among persons with traumatic brain injury. The purpose of this study was to extend this line of research and examine the SASSI-3’s ability to accurately assess the presence of an SUD using DSM-5 criteria. Specifically, the authors calculated kappa statistics to estimate the degree of agreement between the SASSI-3’s overall decision rules, its individual decision rules and counselors’ DSM-5 SUD diagnoses. This analysis is important because these decision rules directly affect the SASSI-3’s final SUD classification (i.e., high probability of substance dependence disorder/low probability). Further, we examined the SASSI-3’s specificity and sensitivity using receiver operating characteristics (ROC) curves. We hypothesized that we would find good agreement between the overall SASSI-3 score and the DSM-5 SUD diagnosis. We further expected to find good agreement between the SASSI-3 face valid scales and the DSM- 5 SUD diagnosis. We expected to find a moderate to low agreement between the SASSI-3 subtle scales and the DSM-5 SUD diagnosis. Additionally, we hypothesized that the ROC analysis would provide optimal cut-off scores for each of the SASSI-3 subscales that would improve those scales’ sensitivity and specificity. Study participants were selected from an inpatient SUD treatment center, an urban university, and a community mental health center that provides court-ordered outpatient treatment for clients with substance use issues. These populations were selected in order to match the populations on which the SASSI-3 was standardized (Miller & Lazowski, 1999). Method Participants This study included participants ( N = 241) recruited between October 2013 and May 2014. There were 114 females (47.3%) and 127 males (52.7%). The participants’ average age was 33.63 ( SD = 6.83, range = 19–47). One hundred thirty-one (54.4%) were European American, 52 (21.6%) were African American, 7 (2.9%) were Hispanic, 12 (5.0%) were biracial, and 4 (1.7%) were Asian American. Thirty- five (14.5%) provided no ethnic background information. The average number of years of education completed was 12.48 ( SD = 1.79, range = 7–18). Thirty-two (13.3%) were married, 156 (64.7%) were never married, 27 (11.2%) were divorced, 16 (6.6%) were separated, 4 (1.7%) were widowed, and 6 (2.5%) did not indicate a marital status. Thirty-three (13.7%) participants listed their employment as full-time, 22 (9.1%) as part-time, 91 (37.8%) as not employed, 65 (27.0%) as student, 9 (3.7%) as home maker, 13 (5.4%) were disabled, 2 (.8%) listed retired, and 6 (2.5%) listed no employment status. The sample features fewer employed, and more unemployed and student participants than the SASSI-3 normative sample (Miller & Lazowski, 1999). Participants were recruited from three sites in Ohio. A total of 117 (48.5% of the total sample) participants were recruited from an adults-only comprehensive community mental health substance abuse treatment center. Another 61 subjects (25.3% of the total) were recruited from a private, non- profit organization specializing in court-ordered outpatient mental health treatment. Finally, 63 students (26.1% of the sample) enrolled at a large, public, urban university in Ohio were recruited to provide a sample of individuals who were less likely to be substance users. A one-way ANOVA [ F (2, 233) = 24.28, p = .000, η 2 = .172] showed that the college students’ mean age ( M = 23.86, SD = 9.04) was significantly lower than the inpatient substance abuse clients’ ( M = 35.80, SD = 11.36) and the outpatient clients’ ( M = 32.80, SD = 10.88).