Sexual Addiction Screening Test SAST
Sexual Addiction Screening Test SAST overview
Creator and Context
The Sexual Addiction Screening Test (SAST) is a self report screening instrument for compulsive sexual behaviour.
It was developed by Patrick Carnes in 1989 and revised as the SAST-R by Carnes, Green and Carnes in 2010. The revised version has a 20 item core scale plus additional subscales. Copyright is held by Carnes and the International Institute for Trauma and Addiction Professionals.
Presenting Conditions
The SAST-R core scale is supported by subscales covering internet related behaviour and by four addictive dimensions:
Preoccupation
Loss of control
Relationship disturbance
Affect disturbance
Administration
Self administered in about 5 to 10 minutes. All items are answered yes or no.
Desired Audience
Adults. The original psychometrics were derived from treatment seeking samples.
Compulsive sexual behaviour is under asked about and under treated, and it frequently sits underneath presentations of shame, relationship breakdown and depression. A structured screen gives a clinician a way into a conversation that is otherwise very difficult to start.
Considerations
Sexual addiction is not a recognised diagnosis in DSM-5 or ICD-11. ICD-11 instead recognises Compulsive Sexual Behaviour Disorder as an impulse control disorder. The SAST does not diagnose an addiction.
The publisher describes the current revision as a developmental stage revision with provisional scoring that may be adjusted with further research.
Several items are culturally and morally loaded and can pathologise consensual behaviour. Some subscale naming is dated.
Copyright is held by Carnes and IITAP. There is no open licence, and commercial embedding requires permission.
How to score the Sexual Addiction Screening Test SAST
Conducting the assessment
The person answers all items yes or no. The core scale is scored separately from the subscales.
Interpretation
Scoring is based on the number of endorsed items on the core scale, with additional subscale thresholds.
The original 25 item SAST used a cut off of 13. The SAST-R core scale uses a threshold in the region of 6, although the published form and the literature differ slightly on whether the threshold is 6 or above 6. Confirm the current scoring protocol with the publisher before implementing it.
A positive screen indicates that further assessment is warranted.
Clinical Considerations
Frame the result carefully with the person. A high score describes distress and loss of control, not a moral failing, and not a diagnosis that exists in the classification systems.
Assess for the conditions that commonly sit underneath, particularly trauma, mood disorder and substance use.
Confirm the current scoring protocol with the publisher rather than relying on figures circulating online.
Sexual Addiction Screening Test SAST use cases
Screening for compulsive sexual behaviour
Opening a clinical conversation about sexual behaviour and its consequences
Identifying who warrants a fuller assessment
Category
General Well-being
Research Summary
Carnes, P. (1989). Contrary to Love: Helping the Sexual Addict. Minneapolis: CompCare Publishers.
Carnes, P., Green, B., & Carnes, S. (2010). The same yet different: Refocusing the Sexual Addiction Screening Test (SAST) to reflect orientation and gender. Sexual Addiction and Compulsivity, 17(1), 7 to 30.
Nelson, K. G., & Oehlert, M. E. (2008). Psychometric exploration of the Sexual Addiction Screening Test in veterans. Sexual Addiction and Compulsivity, 15(1), 39 to 58.
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