TPC-Journal-V6-Issue2

The Professional Counselor /Volume 6, Issue 2 131 treatment. The unfortunate trade-off is that persons with an SUD who might benefit from assessment and treatment would otherwise be sent home without an appropriate recommendation. The health, social, psychological and legal implications of misdiagnosing clients with SUDs have been documented (Brown, Suppes, Adinoff, & Thomas, 2001; Horrigan, Piazza, & Weinstein, 1996; McMillan et al., 2008). Therefore, SUD counselors would benefit from a screening instrument with high sensitivity and specificity (Tiet, Finney, & Moos, 2008). When that goal cannot be achieved, SUD counselors and agencies may want to consider which of these two is more important. Counselors and their agencies might consider their patient population and setting. Among populations likely to have an SUD, specificity might be less important than sensitivity. Conversely, a counselor working at a community mental health agency or college counseling center may benefit from a highly sensitive instrument to identify clients with dual diagnosis treatment needs. In sum, this study represents the first investigation of the SASSI-3’s agreement with the new DSM-5 SUD criteria. Past research (e.g., Laux et al., 2012) has demonstrated that the SASSI-3’s subtle scales improve the instrument’s diagnostic accuracy over that which is obtained using face valid approaches only. As such, we are cautious about drawing strong conclusions about the SASSI-3’s agreement with the DSM-5 criteria until a larger sample of research is available. Limitations and Suggestions for Future Research ROC curve analysis allows for the examination of one scale at a time. Consequently, we were unable to use these methods to examine the SASSI-3 decision rules that use more than one scale (Rules 6, 7, 8 and 9). These decision rules include data from the instrument’s subtle and obvious questions and are important contributors to the overall instrument’s sensitivity and specificity. Thus, the inability to examine these decision rules excludes results that may impact the SASSI-3 sensitivity and specificity. This study collected data from three different locations: a university campus, an inpatient SUD treatment center and an outpatient mental health counseling center. The participants from the college sample were significantly younger, by 9 and 11 years respectively, than those from the other collection sites. Because SUDs are progressive in nature, we recommend that subsequent researchers conduct sample-specific SASSI-3 analyses to determine whether or not population-specific, rather than universal, cut-offs would be useful. Additionally, because there were very few persons in this sample whose use of drugs other than alcohol was categorized as mild, it is not clear whether the FVOD’s lower kappa value was due to the instrument itself or the sample’s homogeneity. Finally, the DSM-5 ’s SUD diagnosis is on a continuum and includes severity specifiers (mild, moderate or severe). It may be more diagnostically useful to expand the SASSI-3 to address these specifiers, rather than rely solely on the current dichotomous likely/not likely dependent conclusion. Future researchers are encouraged to determine what decision rule cut scores would be associated with each of the three levels of SUD severity. Conflict of Interest and Funding Disclosure The authors reported no conflict of interest or funding contributions for the development of this manuscript.