Screening for alcohol and other drug (AOD) problems is a key part of any assessment of a young person's health needs. There are a number of specific youth AOD instruments available for use however most of these have drawbacks including length, cost and content. The Substances and Choices Scale (SACS) is an adolescent AOD screening and outcome measurement instrument that overcomes most of these and has high acceptability, validity and reliability.
The SACS is a one-page pencil and paper self-report questionnaire for young people aged 13-18 years. It takes about 5 minutes to complete and is free of charge. It can be completed alone or in association with the young person's health or social agency worker. It is structured in a similar format to the Strengths and Difficulties Questionnaire (SDQ) and the two instruments can be used together if a broader perspective on a young person's functioning is required. The SACS can assist in identifying young people at risk of AOD problems and guide future treatment or referral options. In addition it can measure outcome as young people progress through the treatment process.
The SACS has three sections.
- The first section records the number of occasions the young person has used a variety of substances in the last month.
- The second section measures both substance use related symptoms and substance related harm. Scoring this section yields the 'SACS difficulties score' from 0 to 20. This score can be used to screen or measure change through a treatment episode.
- The third section asks about tobacco use.
One of the principles of the SACS project was to create an instrument that was acceptable, easy to access and would be widely used.
During the development of the SACS our consultation process revealed that some agencies and clinicians may be deterred from using the SACS on account of the perception that being exposed to the names of potential illicit substances might increase a young people's interest in drugs. To address this concern we created a community version of the SACS that lists a limited number of substances.
The clinical and community version of the SACS differ only in terms of the content of Section A. The SACS difficulties score (Section B) is the same in both versions thus the psychometric properties of each version are the same.
We encourage use of the clinical version of the SACS: SACS Clinical questionnaire
The SACSclinical (clinical version) prompts the young person about their use of a wide range of substances and provides spaces for them to record "other drug use": SACS Community questionnaire
The SACScommunity (community version) prompts the young person about their use of alcohol and cannabis only, but has spaces for the young person to record "other drug use".
Health and social agency workers administering the SACS should spend some time discussing the process with their clients. This usually includes discussing the reasons for completing the SACS, issues related to confidentiality and how information from the questionnaire will be interpreted and used to plan and monitor treatment.
The information sheet can be attached to the SACS to assist with this, but it is not a substitute for provision of proper informed consent: SACS Young Person Information sheet
The SACS Clinician Guide provides information about how to score and interpret the SACS: SACS Clinician guide
The SACS has been tested in 13-18 year old males and females from a variety of ethnicities. It has very good reliability and validity, and can measure change over time. Young people report that it is easy to complete and not distressing. Clinicians like its ease of use and scoring.
The SACS Testing Overview is a brief summary of the development and testing of the SACS and results of psychometric testing.
The SACS Manual provides more in-depth information about the development and testing of the SACS and provides recommendations about how it should be used with young people.
While researching the acceptability of the SACS, the young people who participated reported (unprompted) that completing the SACS gave them an opportunity to reflect on and consider their own (drug-taking) behaviour.
What the young people reported is part of a brief intervention. Brief interventions involve gathering information about a person's substance use, giving them the opportunity to reflect on their behaviour and providing them with feedback and advice about changing. Potential outcomes from a brief intervention include increasing a young person's awareness of risks, a change in behaviour leading to harm reduction or successfully engaging a young person into longer-term treatment.
These manuals are guides to performing a brief intervention utilising the SACS. The complete version is a fairly detailed introduction to the principles of AOD treatment (and the SACS Brief Intervention) for clinicians with limited AOD experience. The abridged manual concentrates mainly on the SACSBI and is intended for clinicians with previous experience and training in AOD assessment and treatment.
With increasing familiarity and success with basic AOD treatment, hopefully clinicians will gain in confidence, develop their skills and eventually provide more (and better) AOD interventions across a range of services.
Adolescent Detoxification Guidelines
- 2017 Update - Guidelines for Management of Acute Substance Withdrawal in Adolescents
- Guidelines for the management of acute substance withdrawal in adolescents (2008)
The guidelines above were developed to for health professionals supporting young people going through withdrawal from substances.
In Partnership with
The Substances and Choices Scale (SACS) - the development and testing of a new alcohol and other drug screening and outcome measurement instrument for young people. Grant Christie, Reginald Marsh, Janie Sheridan, Amanda Wheeler, Tamasailau Suaalii-Sauni, Stella Black, Rachael Butler. Addiction, Volume 102, Number 9, September 2007, pp. 1390-1398(9)
The Substances and Choices Scale (SACS) is available for use by researchers and not-for-profit health and social agencies that provide services to enhance the health and well-being of young people. It has been designed to be used by professionals who have an active and ongoing relationship with the recipient of the questionnaire. This is so that issues around confidentiality can be discussed, and so that appropriate mental health support can be accessed if required. Werry Wharaurau and those involved in developing the SACS do not accept any responsibility or liability for any direct or indirect loss, problems or consequences of any kind arising from the use or misuse of the SACS.
Copyright - The different versions of the Substances and Choices Scale and its associated documents are copyrighted documents. The SACS may be used without charge by non-profit organizations as long as clients are not charged for its use. Electronic reproductions of the SACS are permitted if the content remains identical and formatting is similar to the paper version. Please note that the SACS is validated as a pen and paper questionnaire only.