Alcohol and other drug (AOD) problems are a significant health issue for young people around the world and routine use of an AOD screening and outcome measurement instruments are recommended in all kinds of youth services. The Substances and Choices Scale (SACS) is an AOD screening and outcome measurement instrument that is simple to use, acceptable to young people and works well (is reliable and valid).
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.
There are two SACS questionnaires and they differ slightly. During the development of the SACS, consultation revealed that some agencies and clinicians may be deterred from using the SACS because they didn’t want to expose young people to the names of potential illicit substances.
For this reason 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.
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":
We recommend use of the clinical version of the SACS
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".
SACS Information sheets
If administering the SACS you should spend some time discussing the process with your 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.
The SACS Clinician Guide provides information about how to score and interpret the SACS.
The SACS as a brief intervention
Werry Workforce Whāraurau has developed a brief intervention for use in primary care settings called the SACS ABC. The SACS ABC page can be accessed here and has a number of resources and videos to support clinicians who have little or no experience in providing addiction interventions.
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.
To follow are links to detailed 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 SACS BI and is intended for clinicians with previous experience and training in AOD assessment and treatment.
Subsequent to these Guides...
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 fine print
Grant Christie, Reginald Marsh, Janie Sheridan, Amanda Wheeler, Tamasailau Suaalii-Sauni, Stella Black, Rachael Butler 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 (2007). Addiction, 102 (9) pp. 1390-1398
The SACS Manual:
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. Two links below provide further information about its validity and reliability
SACS Development and testing overview
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.
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 wellbeing of young people. It has been designed to be used by health workers 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 Workforce Whāraurau 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.
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 organisations 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.