There are a number of methodological considerations concerning the evaluation of screening scales that, independent of the assessment criteria, need to be further elucidated. First, the choice of an optimal cut-off largely depends on the context of the study and the specific task at hand [34]. For example, using the SDS as a screening tool for cannabis dependence in a clinical setting, it may be preferable to maximize the ability to detect people who are at risk for dependence (i. e. use a lower cut-off) at the expense of decreased specificity. On the other hand, it may be more important to minimize costs, i.e. to avoid selecting people for treatment who do not need it. In this case, it may be more appropriate to use a higher cut-off with increased specificity and decreased sensitivity. In research settings, where the main interest is to estimate prevalence, the optimal approach would be to take a value that offers the best balance between sensitivity and specificity.
