David is the Clinical Director for The SASSI Institute and has worked in the behavioral health field in Texas for over 35 years as a clinician, a manager, a division director, a trainer, an evaluator, a program developer, and a grant writer/reviewer.
The SASSI Institute’s Clinical Help Line is a free resource designed to support clinicians and professionals using the Substance Abuse Subtle Screening Inventory (SASSI). It provides assistance with clinical interpretation of scores on each of the SASSI scales; helps individuals understand typical trends seen in SASSI profiles and how to use that information in educating clients, making referrals for clients, or developing treatment plans; provides assistance in manual scoring issues; and addresses any other specific SASSI-related questions.
Typical Clinical Help Line services include:
· Clarifying how to interpret complex or ambiguous results.
· Answering questions about the SASSI tools’ methodology or scoring.
· Providing recommendations for follow-up based on screening results.
· Offering advice on integrating SASSI assessments into broader treatment planning.
This service helps clinicians maximize the effectiveness of the SASSI tools in identifying and addressing substance use issues in diverse client populations. The Clinical Help Line is staffed by experienced, licensed/certified professionals with many years of experience and expertise in the SASSI instruments, substance use disorders and screening and assessment. They are available to answer your questions Monday thru Friday from 1:00pm to 5:00pm EST. This is a totally free service so give our friendly clinicians a call and allow us to help you make your experience with the SASSI even better for you and your clients!
Alyssa (revised) is a 14-year-old female adolescent sent for evaluation by her teachers after noticing significant changes in her emotions and behavior. Her demeanor has gradually changed from a smiling, mostly compliant teen to that of a more rebellious and sullen one. She’s been caught skipping school a few times and was found to be in the company of some older adolescents who are consistently in trouble and suspected of using alcohol and drugs. The SASSI-A3 classified Alyssa with a LOW PROBABILITY of having a substance use disorder (SUD). Neither the VAL or DEF scale scores met the criteria for the possibility of a false negative. While the scale scores do not meet the criteria for classifying her as high probability of having an SUD, there are some other scale scores which could indicate some other clinical issues that may need to be addressed.
In going beyond the decision rules and looking at the individual raw scale scores, it is possible to develop a more general hypothesis regarding her level of adjustment and functioning. The fact that she scored above a zero (0) on the FVA, FVOD and SYM scales tells us that, while her scores are not high enough to indicate the probability of an SUD and are in fact very close to the mean, at 14 years old she has used both alcohol and drugs and experienced some negative consequences and/or problems as a result of that use. Based on her elevated FRISK score of 3, her slightly elevated ATT score of 3 and her elevated COR score of 6 (along with the observations made by her teachers), we can further hypothesize that Alyssa is likely to be surrounded by a close social system who are abusing substances and, as a result of this, her attitudes toward substance use lean more toward endorsing and promoting such use as a good thing. Assuming that this social system likely consists of her peers, namely the older teens mentioned earlier, this may explain her elevated COR scale score. In other words, she may have similar thinking patterns, beliefs, values and attitudes as those who are more likely to engage in rule-breaking, unlawful behaviors and/or disdain for authority. Her OAT score seems to indicate that Alyssa does not at all identify with any of the typical attributes that we would normally associate with an active substance abuser and that she firmly believes that she does not have a substance use problem. One of the most concerning scale scores on this profile is the DEF score of 2. SASSI research tells us that very low DEF scores such as this, often indicate a young woman who is experiencing a great deal of emotional pain and many of the typical symptoms associated with a syndrome of clinical depression. She may tend to engage in negative self-statements, identifying herself as a loser or misfit. She may be experiencing a sense of hopelessness, inability to enjoy positive experiences, lethargy, general bad feelings, impaired functioning in vital areas such as sleeping and eating, and sometimes even suicidal ideation.
While a low DEF score is not a clinical diagnosis in itself, this profile raises some questions that a counselor may wish to pursue in an interview or further ongoing assessment. For example, what is causing the significant change in emotion and behavior that was noticed by the teachers? Is it simply the normal emotional volatility of a growing and changing adolescent? Is there something happening in this teenager’s family which has caused this sudden shift in emotion and acting out? In any case, hopelessness, suicidal ideation, depressive symptoms or other psychiatric problems are important concerns to be investigated. It would also be valuable to explore the extent and context of her drinking and drug use to determine if it is just normal adolescent experimentation, a reaction to peer pressure, or an attempt to deal with emotions too overwhelming to control on her own. While the SASSI does not indicate a high probability of having an SUD currently, without some sort of intervention regarding these sudden changes in emotions and behaviors, a future SUD problem is not out of the question. It is difficult to suggest appropriate interventions without further information. However, appears that she could benefit from seeing a safe, trustworthy and empathetic counselor who could further explore the issues and immediately address her emotional pain and help her develop coping skills other than alcohol and/or drugs. Using the raw scale score interpretations described previously, in an open two-way conversation the therapist and Alyssa could use these scores to begin to collaboratively develop a plan of action that could help her confront and overcome the difficulties she is facing.
We hope you find this useful information regarding clinical issues. As always, the Clinical Helpline at 888-297-2774 is open to serve you Monday through Friday, 1 pm to 5 pm (EST).
The following profile result is of a 35-year-old male referred for screening and possible assessment after a drug-related arrest. He completed the FVA/FVOD side of the questionnaire based on his entire life timeframe. His RAP score was 0, indicating no random responding and that the result should be valid. His Prescription Drug Scale score (Rx) was 1, so he did not meet the cutoff for High Probability of Prescription Drug Abuse.
Looking at this profile, we see that he was classified as high probability of a substance use disorder based on the following Decision Rules:
Decision Rule 1 with a FVOD score of 32.
Decision Rule 3 with an OAT score of 9.
Decision Rule 4 with a SAT score of 14.
Decision Rule 5 with a SYM score of 6 (5 or more) and a SAT score of 14 (4 or more).
Decision Rule 7 with an OAT score of 9 (7 or more) and a SAT score of 14 (6 or more).
Looking at the graph on the SASSI Adult Male Profile sheet, we see an extremely high elevation on the FVOD scale score which is significantly above the 98th percentile. Individuals who score this high on the FVOD are able to acknowledge currently having or having had numerous negative consequences and problems as a result of their use of drugs. This can include loss of control of the drug use as well as using a coping mechanism. It is important to note that, since he was asked to use the “entire life” timeframe for the FVA and FVOD scales, his admission of having these consequences and problems with drugs may be related to some time in his past and not necessarily currently. For example, the client’s score on the SYM scale (which is similar to the FVA/FVOD in what it is measuring), is not nearly as elevated as his score on the FVOD even though the questions are not that dissimilar from the FVOD questions.
This suggests that he is not showing as much acknowledgement on the SYM scale of the symptoms of substance misuse that he admitted to on the FVOD scale. This could be related to the fact that the SYM scale (like all scales on the True/False side of the questionnaire) has no specific timeframe associated with it and therefore the client may have the belief that, while he has had significant problems with drugs in the past, he may not believe his current drug use is as much of a problem currently. It is highly recommended that clinicians do a content analysis of the client’s answers to the FVOD and SYM scale questions as this will provide more insight into the client’s acknowledged problems with drugs.
This client’s elevated OAT scale score, like the elevated FVOD scale score, suggests a capacity to acknowledge and identify with many of the typical negative attributes (general personality and behavioral characteristics) and personal limitations that are often common among those with substance use disorders – e.g. impatience, resentment, self-pity, impulsiveness). While the client can often see these “character defects”, they may not always feel motivated to change them or feel capable of changing. Given that the OAT score in this case is above the 98th percentile, it is highly probable that this individual may be able to closely identify with individuals in recovery from substance use disorder, such as those found at recovery support groups, and therefore may be more willing to trust these recovering individuals and follow their recovery advice.
The client’s highly elevated SAT score (the highest score on this profile), which is higher on the graph than the OAT score, suggests that despite the client’s capacity to acknowledge the more obvious problems and negative consequences associated with his use of drugs, there are subtle aspects of his behavior, personality, and addiction that are extremely hard for him to acknowledge. In other words, he may not be able recognize the pervasiveness of his addiction, how it negatively affects and rules every aspect of his life with deeply held negative thinking patterns, beliefs and negative coping patterns driving his addictive behaviors.
Clients with a pattern of scores like this client who tend to be able to acknowledge heavy usage, negative consequences and problem behaviors, may still be convinced, sincerely deluded into thinking that they are not truly addicted. They will often present as more “superficial” saying things like “well, I go to work every day and do my job so I couldn’t be addicted”. Clients with elevated SAT scores (especially higher on the graph than their OAT score) tend to be more initially resistant to the need for treatment and are more likely to relapse. These clients tend to be detached from their feelings and have relatively little insight into the basis and causes of their problems (namely substance addiction). These clients typically need a more intensive level of treatment where they can receive constant support for their recovery efforts and can get the kind of group processing therapy needed to help them connect with their feelings and learn how to cope with them without drugs.
In providing treatment to this type of client it is important to recognize that underneath the many excuses (other than substance addiction) for their problems, there is an individual with a substance use disorder who is likely in pain and scared. Individuals with high SAT scores may not be in touch with the pain and fear, largely because they immediately numb any negative feelings with substances as soon as they appear, but the pain and fear. In this case, intensive treatment and group work has to be accompanied by sensitive and skillful clinical intervention that lets the individual know that somebody is aware of their fear deep within and that it will be a relief to let it out to begin healing.
We hope you find this useful information regarding clinical issues. As always, the Clinical Helpline at 888-297-2774 is open to serve you Monday through Friday, 9 am to 5 pm (EST).
This has been an interesting year hasn’t it? I’ve worked in the behavioral health field, primarily substance use disorder, since 1989. During those 31 years I’ve never come across the types of challenges I’ve seen this year, for those struggling with substance addiction and for those healthcare providers trying to help them.
“Social isolation” is the new mantra in the culture and yet it is the very thing that is anathema to behavioral health counselors trying to help individuals coping with addiction. Resources are going out of business and events which once brought enjoyment, support, solidarity and an alternative to substances for having fun are being cancelled one after another. Fear is paramount, and it’s drastically shaping the face of addiction and recovery. We are seeing more initiation of substance abuse, more cycles of relapse and overdose, and more barriers to successful recovery in order to cope with a world in chaos. While outpatient treatment programs have successfully used technology to transition to online counseling groups, this has presented a barrier for those without the resources to purchase the technology needed to participate. For the last 10 years, I’ve worked for a local non-profit treatment center for women and adolescent girls here in Dallas, Texas called Nexus Recovery Center. Recently, the Executive Director, Heather Ormand, wrote the following in a blog post:
“COVID-19 has stripped so many sober women of our community. Twelve-step meetings are no longer being held in churches. Churches are closed or access is limited and people are afraid to sit shoulder to shoulder right now. For those with long-term sobriety and a strong support system, we can probably get by with Zoom twelve-step meetings, reading literature and connecting with other sober women via text or calls. But what about the woman struggling in her disease? The woman isolated in an unsafe home without the resources to leave and get treatment? The woman without a place for her children to go while she tries to piece together continuous days of sobriety and start rebuilding their lives?”
But there is hope. Treatment staff have proven that they are indeed essential, and programs like those at Nexus Recovery Center are showing that recovery staff are willing to risk getting sick themselves in order to help another human being break the cycle of addiction. They are showing that empathy and compassion and hope can still be conveyed through a mask or through a live, online group or individual counseling session. We can still find innovative ways to connect and share our experience, strength and hope with those who are struggling to find someone who cares.
I’ve also been associated with The SASSI Institute as a trainer for the past 25+ years and have found them to be an organization that strives hard to give agencies effective and easy to use resources for helping identify individuals struggling with a substance use disorder and guiding them to the most appropriate path for their recovery journey. I’m also proud to have been allowed to help people on The SASSI Institute’s Clinical Helpline for the past few years. One consistent thing I hear from callers is how much they appreciate the fact that they can reach out in frustration or puzzlement over a client they are working with, and how those on the Clinical Helpline are always there to help them work through a SASSI screening result, craft how to phrase the results to the client or in a report, and guide them in helping clients discover things about themselves, in order to initiate their recovery process. The SASSI Institute, though at a “social distance,” is there for me like a warm blanket on a cold night and for many other behavioral health workers in the US and in other countries who sometimes just need a willing ear to process some of their cases and SASSI results. Working together we can get through 2020 and beyond, despite any obstacles.
