Author: The SASSI Institute

From Addiction to Hope: A Recovery Story Worth Sharing

The following is a message to individuals in need of recovery from a family member & friend of mine. Please share it with those who you feel may benefit from it so they can see there is hope for a better way. ~ Scarlett (SASSI Training Director)

“I know there are some very special people out there still struggling with addiction so I’m going to put this out there for you all to see.

I loved doing meth. And I am not going to rewrite my story and pretend that I did not. Meth made everything quiet. The pain, the fear, the memories, the shame. Meth gave me the energy to keep going when my entire life was falling apart. Until eventually, I was not getting high to feel good anymore. I was getting high because I did not know how to exist without meth or other drugs. My entire life revolved around them.

Where I was going to get them.

How I was going to pay for them.

Where I was going to sleep.

How long until I got sick.

How was I going to get more meth to get back up again (Already thinking about that before I even ran out ~ if you know, you know).

I lived in my car. I slept on sidewalks and trap house floors, and I was totally content with that ~ because it was normal, right?~.  I put myself in dangerous situations and let people treat me in ways I never thought I would tolerate. I even left the hospital while critically sick because getting high felt more important than staying alive.

That is ADDICTION!

Watching your entire life burn to the ground and still choosing the thing that lit the darn match.

But on January 5th, 2015, I stopped running. Recovery did not magically give me a beautiful life. I had to build one. I learned how to feel without getting high. How to survive bad days without destroying myself. How to love and be loved. How to become someone I actually wanted to be.

So to addicts from an addict, the woman who once slept on sidewalks and trap house floors now helps other women get sober.  I went back to school. I built a career. I built a life I never thought I would live long enough to have. And in 5 months I will have TWELVE YEARS clean. And of course, my GOD gets all the glory.

I loved meth for what it made me forget. For the billions and trillions of dopamines that it gave me and for the energy it gave me to get through my everyday life. Let’s not forget the 5am energy that it gave us to sort tiny little objects like paperclips, coins, or beads by shades of color or size for hours on end (we don’t ask why and we don’t judge over here). Meanwhile over there somehow, we have no energy to put back any of the 50,000 projects we’ve tore apart and started knowing we’ll never finish them (but hey, sounded like a good idea at the time) again ~ if you know, you know.

But I love who I am without it so very much more.

I see you, I love you, and I am rooting for you!”

Amy Jo Korvela Canfield

CelebrateRecovery.com

Finding the Path Forward: How Objective Screening Supports National Recovery Month

Every September, National Recovery Month serves as a vital reminder that prevention works, treatment is effective, and people do recover. Across schools, healthcare facilities, and justice systems, professionals work tirelessly to help individuals overcome substance use disorders. However, early detection and clear insight remain two of the biggest hurdles to starting that journey.

Identifying substance use issues early—and without bias—is critical to guiding individuals toward appropriate care.

The Role of Objective Assessment in Recovery

Recovery is never a one-size-fits-all process. Effective support relies on accurate, evidence-based tools that help practitioners see past defensiveness, denial, or fear.

  • Bypassing Resistance: Individuals who are hesitant to disclose substance use often minimize their symptoms. Standardized screening instruments provide objective data that helps clinicians start honest conversations.
  • Informing Targeted Interventions: By distinguishing between low or high probability of a substance use disorder, practitioners can route individuals to the exact level of care they need.
  • Supporting Early Identification: In settings like high schools, employee assistance programs (EAPs), and community corrections, identifying early warning signs allows for proactive help before crises escalate.

Moving Forward Together

National Recovery Month is a time to honor the resilience of individuals in recovery and recognize the dedication of the professionals who support them. Having the right tools in place ensures every individual gets a fair, accurate start on their path toward lasting health and independence.

Recovery Begins with Being Seen

Recovery is rarely a straight line, and it almost never starts in the same place for any two people. It begins in quiet moments—a decision to seek help, a conversation with someone who listens without judgment, or the realization that a different future is possible.

During National Recovery Month, we celebrate the courage it takes to step onto that path and honor the strength of those walking it every day.

  • Healing starts with understanding: Before treatment, coping strategies, or support networks can take root, an individual needs to be seen clearly and met right where they are.
  • Hope is a shared effort: Recovery doesn’t happen in isolation. It thrives in communities, families, and spaces where people feel supported rather than defined by their struggles.
  • Every step counts: Whether it is day one or year ten, every effort toward wellness and stability is a victory worth recognizing.

To anyone currently on the journey, supporting a loved one, or helping others find their way: recovery is real, it is achievable, and your story matters.

How the SASSI Fills the Gaps of Toxicology: Addressing Denial in Addiction

The Substance Abuse Subtle Screening Inventory (SASSI) is an essential clinical tool for identifying substance use disorders (SUD). While toxicology tests only detect recent drug presence, the SASSI penetrates denial and hidden use to evaluate the underlying psychological probability of an SUD with up to 92% accuracy.

When determining the most effective method for identifying a substance use disorder (SUD), many healthcare providers and criminal justice professionals weigh biological drug testing (toxicology) against psychological screening tools. While both methods have their place in both healthcare and criminal justice, the SASSI often proves to be the superior clinical tool for identifying a SUD.

The SASSI screener stands out as a more effective, comprehensive solution than a standard toxicology screen because of the limitations of toxicology screening. Toxicology screening—typically done via urine, blood, or hair—is highly effective at identifying the biological presence of specific substances or their metabolites. However, it has distinct limitations:

  • The Detection Window: Toxicology only provides a snapshot of very recent use (usually a few days to a week). A drug test tells you if a substance is in the system only.
  • Misses Alcohol Use: Standard 5-panel or 10-panel drug screens often do not test for alcohol or fail to give a full profile of alcohol misuse.
  • Does Not Account for Denial: Many individuals who struggle with addiction will alter their usage before a test or intentionally attempt to “pass” otherwise positive drug screens.

Rather than testing the body, the SASSI assesses behavioral patterns, psychological symptoms, and the consequences of substance use.

While toxicology confirms the presence of a chemical, the SASSI provides a comprehensive clinical picture of a substance use disorder:

1. Identifies Hidden Use and Denial : Because the SASSI includes indirect, subtle items, it can flag individuals with a high probability of having a SUD even if they are intentionally lying or minimizing their habits on face-value questionnaires. You cannot “cheat” the SASSI by simply abstaining from drugs for 24 hours prior to a test.

2. Profiles Alcohol Use Effectively: Alcohol remains one of the most widely abused substances, yet it has a very short biological detection window. Studies have shown that the SASSI is highly selective in pinpointing alcohol misuse profiles that are completely missed by urine toxicology.

3. Assesses the Probability of an SUD: A negative drug test does not mean a person is free from addiction. The SASSI categorizes the probability of a SUD, helping professionals in their determination of the possible type of treatment needed (e.g., outpatient counseling, intensive outpatient programs, or inpatient detox).

4. More Cost-Effective – Research evaluating substance abuse screening methods found that relying on the SASSI combined with patient history is more cost-effective and clinically accurate than relying solely on toxicology screening.

Toxicology testing is excellent for verifying immediate chemical presence, but it falls short in identifying the presence of an addiction. By looking beyond recent biological usage and diving into psychological and behavioral patterns, the SASSI screener offers a far more accurate, reliable way to help individuals on the path to recovery.

Coming soon – Clinical Q&A Webinar– Register Now/No Cost!

We invite you to join us for a free one-hour SASSI Clinical Q&A webinar hosted by our Clinical Director, David Helton, LMSW, LCDC. The Q&A is for anyone new to using the SASSI, those considering using the SASSI, or seasoned veterans at screening with the SASSI. The Q&A is scheduled from 11 am – Noon ET on: July 14th, 2026. You can save your spot by clicking here.

We welcome you to share profiles to discuss with the group by sending them (de-identified) via email any time prior to the session to scarlett@sassi.com. These profiles will help others learn about SASSI and offer insight into the various profile configurations.

Note: Q&A sessions do not provide CEUs and are not a substitute for SASSI Training. To register for a SASSI Training webinar. please visit https://sassi.com/sassi-training-online/.

Screening Accuracy in Dual Diagnosis Clients and Clients with Diagnoses other than SUD

Individuals who are screened for substance use disorders often have presenting complaints related to other psychological and medical health issues, as well as difficulty in functioning and adjustment in other life domains (e.g., work, parenting, financial, and legal). It is important, therefore, that a screening instrument used to identify individuals in need of further evaluation for substance use disorders is able to discriminate between SUD and other mental health issues or poor adjustment and functioning.

Analyses were conducted to evaluate the accuracy of SASSI-4 SUD screening out-comes in a sample of individuals who had co-occurring psychiatric disorders (i.e., dual diagnoses for SUD and one or more psychiatric disorders such as depression, anxiety, post-traumatic stress disorder, etc.) and a sample of individuals who were diagnosed as not having a substance use disorder but who did have one or more non-SUD related diagnoses (i.e., were criterion negative for SUD).

Findings are presented in Table 18 and indicate excellent SASSI-4 screening sensitivity in detecting SUD in clients who had both SUD and another psychological disorder. Findings also showed high specificity in producing negative SASSI-4 screening outcomes for individuals who were diagnosed with non-SUD related disorders only. Overall SUD screening accuracy in this sample was 97%.  These findings provide evidence of construct validity and the precision of the SASSI-4 in identifying likely SUD specifically, rather than identifying individuals who may be in need of treatment for life stressors, poor adjustment and functioning, or other psychological health issues.

Extracted from: 

Lazowski, L. E., Kimmell, K.S., & Baker, S.L. (2016). The Adult Substance Abuse Subtle Screening Inventory-4 (SASSI-4) User Guide & Manual. Springville, IN: The SASSI Institute. 

Supporting Your Practice: Interpretation Guidelines and a Thank You

Substance use disorder is an important topic in our society. The internet, social media, and television provide us with information about new treatment programs and the ongoing political discussion of the seriousness of the problem.

The SASSI Institute gives thanks to the dedicated workers who, day-by-day, face the task of helping people who have become part of the fabric of pain that surrounds substance-related disorders. The daily efforts of practitioners, support staff, and program managers may not be newsworthy, but those efforts reflect a  sense of caring and commitment that is inspiring.

We strive to make the SASSI as user friendly as possible. The following are links to download the basic Guidelines for interpreting the SASSI scales.

                                             Adult SASSI-4 Guidelines

                                             Adolescent SASSI-A3 Guidelines

As always, our clinicians are available to help you with questions about administering and/or interpreting the SASSI on the Clinical Helpline at 800-697-2774 Option 2 Monday through Friday, 1 pm to 5 pm (EST).

Notable Differences between the SASSI-4 and SASSI-A3

While the core goal of identifying substance use disorders remains the same, the SASSI-4 (Adult) and SASSI-A3 (Adolescent) are tailored to the very different life stages and behavioral patterns of their respective groups.

Think of it this way: the way an adult hides a drinking problem is often very different from how a teenager masks drug use.

Comparison of SASSI-4 vs. SASSI-A3

FeatureSASSI-4 (Adult)SASSI-A3 (Adolescent)
Age Range18 years and older.13 to 18 years.
Focus AreaEmphasizes long-term behavioral patterns.Emphasizes family dynamics, peer pressure, and school behavior.
Subtle ItemsFocuses on adult stressors like workplace issues and long-term social consequences.Focuses on “acting out,” rebelliousness, and emotional regulation.

Key Differences in Approach

The Adolescent Version (SASSI-A3)

Teenagers are often in a state of natural rebellion or may be experimenting due to peer influence rather than chronic dependency. The A3 is specifically designed to:

  • Filter Peer Influence: It helps distinguish between a teen who is “experimenting” because of friends and one who has a burgeoning clinical dependency.
  • Assess Family Environment: It includes scales that look at the teens’ perception of their home life, which is a major factor in adolescent recovery.
  • Evaluate “Global” Functioning: It looks at how substance use is impacting their development (school performance, legal trouble, and social skills).

The Adult Version (SASSI-4)

Adults typically have more established defense mechanisms and more to lose (jobs, marriages, custody). The SASSI-4 was recently updated to better capture:

  • Prescription Medication Abuse: Since the opioid crisis, the adult version has been refined to better identify those misusing legal prescription medications.
  • Severity Markers: It provides more nuance on the intensity of the disorder, which helps in planning for long-term recovery versus short-term intervention.

Why the Distinction Matters

Using an adult test on a teenager (or vice versa) could possibly lead to inaccurate results. A teenager’s natural impulsivity might look like a “disorder” on an adult scale, while an adult’s more calculated “denial” might not be caught by a test designed for a more impulsive adolescent.

The purpose of the SASSI is to help identify people who are likely to have substance use disorders so that early intervention and treatment can be initiated when appropriate.

How the SASSI Improves Lives of those Suffering

The Substance Abuse Subtle Screening Inventory (SASSI) is a widely used psychological screening tool designed to identify individuals with a high probability of having a Substance Use Disorder (SUD).

Its primary value lies in its ability to look past “denial.” Many people struggling with addiction may not be ready to admit it, or they might intentionally try to minimize their usage during an evaluation. The SASSI helps by being a bit more “clever” than a strictly face-valid questionnaire.

How It Specifically Helps

1. Identifying “Hidden” Issues

Unlike many tests that ask straightforward questions (e.g., “How many drinks do you have a week?”), the SASSI includes subtle items. These are questions that don’t seem related to substance use but are statistically linked to the behavioral patterns of people with SUDs. This helps clinicians identify people who are:

  • In deep denial.
  • Intentionally hiding their use.
  • Unaware that their behavior constitutes a disorder.

2. Providing a Faster Path to Treatment

Because the SASSI is relatively quick to administer and score, it acts as a “triage” tool. It allows counselors to quickly decide who needs an intensive clinical interview and who might just need basic education. This efficiency ensures that resources go to the people who need them most urgently.

3. Objective Data for Referrals

Objective scoring of the SASSI yields a screening outcome – a yes-or-no answer as to whether the client has a high probability of having a substance use disorder, as well as a check on validity of the profile, a score indicating level of defensive responding, and a score indicating the possibility of prescription drug abuse.  For people involved in the legal system (like DUI cases) or workplace evaluations, having objective, validated results remove personal bias from the evaluator. It provides a foundation for recommending specific levels of care, such as:

  • Outpatient counseling.
  • Intensive Outpatient Programs (IOP).
  • Inpatient detoxification.

What the SASSI Is Not

It is important to remember that a high probability of a substance use disorder result on the SASSI is not a final diagnosis. A licensed professional must still conduct a full clinical interview to make an official diagnosis based on the DSM-5-TR.

Overall, the SASSI provides a useful tool for healthcare providers, substance abuse professionals, criminal justice entities and others who are involved in identifying and treating substance use disorders. It can help to ensure that individuals receive appropriate care and support, which can ultimately improve their health and well-being.

Showing Respect for the Realities of Peoples’ Worlds

In a past blog we shared an interpretation titled “SYM Scale and Environmental Factors” which discussed SASSI-4 profile scores for a Native American couple residing in Canada. 

The profiles in that blog highlight a challenge that professionals face as they seek to help people overcome problems associated with substance misuse. You likely often work with individuals who consume large amounts of psychoactive substances and experience negative consequences but genuinely do not perceive that they have a substance use problem. Helping people gain awareness of such problems is a daily task for professionals. The blog demonstrates the importance of being sensitive to and respecting individuals’ realities as you endeavor to help them grow.

One reason why people may have difficulty perceiving that their substance use has a negative impact on their lives is that the substance brings immediate relief from emotional pain, even though greater pain is the ultimate consequence. Many clients face the not so easy challenge of having to recognize that their ongoing problems are attributable to an important and apparently satisfying behavior. As people confront the need to stop their misuse of psychoactive substances, they must let go of what may be a primary and valued aspect in their lives. What is recognized as a major source of their problems, they may see as the only solution. To help individuals who suffer from substance misuse, it is necessary to understand and respect the way they perceive their usage.

Some people do not recognize the impact that substance misuse has on their lives because they do not see an alternative. This phenomenon is not limited to small, geographically isolated communities like Mary and John’s (see SYM Scale and Environmental Factors). Many people who live in larger towns are members of sub-communities in which substance misuse is the norm, “everybody drinks and drugs, everybody has family fights, everybody has hangovers, everybody has money problems, everybody has legal problems.” As a service provider, there is a responsibility to recognize and deal effectively with the realities that confront individuals. It is disrespectful to expect people to easily reject a central aspect of their social milieu and readily embrace a lifestyle that is completely foreign to them.

Providing clients with feedback on the SASSI can promote a collaborative relationship in which you can join the client in the process of exploring their world and seeking ways in which to enhance the quality of their lives. Consider Mary & John’s profiles; an outstanding scale are the elevated SYM scores. SYM provides a measure of clients’ acknowledgment of being involved in a pattern of heavy usage and associated negative consequences. Since it is composed of items that directly address substance misuse, it is valuable to review the endorsed items with clients and ask them for elaboration. For example, an elevated SYM score may indicate a history of parental substance misuse, early onset of substance misuse, and associated family problems. During the process of providing feedback, it is important to promote discussion to help clients gain a greater understanding of the role of substance use in their lives and to help them increase perspective and insight into the way substance use has affected their lives.

Professionals expect clients to be receptive to the process of change; so too professionals must endeavor to understand the world in which they live. The act of change is an act of courage. As an addiction professional you are privileged to stand witness to courage shown by clients as they open themselves to new ways of seeing and being in the world. Through patience and understanding, you can hopefully be a source of encouragement and support along the way. 

(Please note that The SASSI Institute recommends examining specific items on the FVA, FVOD, SYM, Rx and on the RAP scale, but NOT on the other (subtle) scales – OAT, SAT. DEF, SAM, FAM, and COR)

Please be sure to utilize our free clinical consultation line for assistance interpreting SASSI profiles M-F 1-5 pm EST at 800.726.0526 Option 2.