Author: Kristin Kimmell, LCSW, LCAC

Kristin Kimmell, LCSW, LCAC, is a Licensed Clinical Social Worker and Licensed Clinical Addictions Counselor who is also the Director of Clinical, as well as a pivotal collaborator with the Training and Research Departments at The SASSI Institute. Kris is also a private practitioner in Bloomington Indiana that provides counseling specializing in substance use, depression and anxiety, relationship, stress management, and sexual orientation issues.

Adolescent SASSI-A3 Review: High Probability Result with a VAL of 6

This adolescent male profile presents some initial complications for the reviewer in regards to the clinical interpretation as seen on the graph. The face valid scales fall either within the norm or below the norm. One of the subtle scales is above the 85th percentile so is clinically significant, and another is below the norm. An examination of the scales produces useful information to guide the discussion of the results with the client and directing appropriate treatment considerations.

This 17-year-old male completed the FVA/FVOD side of the questionnaire for his whole lifetime.

The VAL is 6.

Rx Scale is 0.

High Probability of a Substance Use Disorder is based on Rule 6.

Rule 6: a. FVOD 7 or more. (8)

            b. FRISK or ATT or SYM is 3 or more. (SYM – 3).

            c. OAT 5 or more (7).

Clinical Discussion

The FVOD of 8 is above average and should be noted. Examining those particular questions, he endorsed will provide the groundwork for how and under what circumstance he is using drugs. With the FRISK (0) and ATT (1) scores so low, his use is not necessarily tied to his peers, nor does he have a belief or value system that supports the idea that everyone uses substances. Looking at his one ATT score will help to evaluate any beliefs he may hold around substances.

The SYM (3) score is above average and again, because it is a face valid scale, content analysis will provide information regarding the consequences that he does acknowledge.

The OAT (7) scale is significant because it is elevated above the 85th percentile. This is the subtle scale that you want elevated as it indicates someone who can acknowledge limitations and shortcomings. He can probably identify with other substance users and those behaviors represented in that population such as impatience, resentment, self-pity, or impulsiveness. This, of course, does not mean he wants to or believes that he can change. But this information can be used as a positive to recognize the insights he may have around his use.

The low SAT (1) score (below the 15th percentile) gives some clues on how best to approach this client. This score indicates he is very hypersensitive to what others think about him. He may come across as having a chip on his shoulder so tread lightly!

The DEF (8) score, though above average, is still within the norm so does not indicate significant defensiveness on the client’s part.

The SAM (3) and COR (3) have no clinical significance.

Does the VAL score of 6 impact the results? Given the outcome was High Probability based on Rule 6, the impact is nil. The VAL is significant only if the outcome was Low Probability. However, with that score, the evaluator may hypothesize that perhaps the client was trying to skew the results but failed.

Questions remain regarding the current use of substances by the client. Is he minimizing his use or is he presenting an accurate picture? He was not defensive so perhaps his overriding concern was how he was viewed by the evaluator.

Treatment Considerations

Recommendations for the level of treatment need to be considered if he does have a diagnosable disorder based on the DSM-5. Actual current use also needs to be established. The elevated OAT score does indicate he will not feel out of place in a group setting. Prior history of substance use issues also need to be considered. It would appear, however, that outpatient treatment would be a consideration with the level of intervention to be determined by the overall assessment.

We recommend administrators of the SASSI have access to The Adolescent SASSI-A3 User Guide and Manual. It contains information on scoring, interpreting profiles and includes examples of profiles. It defines all the scales, what they represent, clinical considerations and giving feedback. The Manual also contains the research and validation information. Please call our Customer Service number for more information on how to order – 800-726-0526.

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Adult SASSI-4 Review: Does the SASSI evaluate for Video Gaming?

This is an interesting profile on a 23-year-old male as it brought up the question, we get on the helpline regarding video gaming. “Does the SASSI evaluate for video gaming addiction?”, especially if the administrator believes the client was possibly including video gaming as well as substance use in his answers. The simple answer is no, it does not, so please clarify with your client not to include video gaming.  A drug that is often associated with video gaming is Adderall so the follow-up question to a client who admits to excessive video gaming is to question what drugs are they using to maintain that level of energy and concentration.

This individual was instructed to complete the FVA/FVOD side of the questionnaire for the last 12 months.

RAP was 0.

High Probability of a Substance Use Disorder.

Prescription Drug Scale result was 3 so meets the cutoff for High Probability of Prescription Drug Abuse.

He met Rule 1 with a FVOD score of 21.

             Rule 2 with a SYM score of 7.

             Rule 4 with a SYM score of 5 (7) or more and a SAT score of 4 (7) or more.

Looking at the graph on the Profile sheet, you will see a significant elevation on the FVOD scale score – above the 98th% so he is openly acknowledging use of drugs. By analyzing his responses, you will gain insight into what circumstances he is using, including dealing with emotional or stressful issues. And remember, he is answering the FVOD questions based on the last 12 months.

The SYM elevation is above the 85th percentile – enough to meet Rule 2. Because SYM is a face valid scale, you can do content analysis on those questions to look at the symptoms and consequences of his substance use.

The OAT score is within the norm. It would probably be the case that he does not identify with other substance abusers. This may be related to his very low-DEF score.

The SAT score is within the norm but high. The administrator may pick up some denial or lack of insight on the part of the client. And again, it may be related to the DEF score.

The DEF score is very significant because it is so low, below the 15th percentile. This individual may be in emotional distress and may be suffering from depressive symptoms. He should be evaluated for depression as he may be using substances to self-medicate. He may also believe that if he wasn’t depressed, he would not be abusing substances thus the OAT and SAT scores may reflect this perception.

The Rx score is also very significant and warrants further investigation as to what prescription drugs he may be abusing and if, in fact, are related to video gaming.

The rest of the scores are within the norm, so not clinically significant.

In summary, these clinical results are hypotheses to explore with the client to determine the depth and scope of the client’s use in order to recommend a treatment plan which fits his particular needs.

We hope this is helpful to you.

The clinical helpline line is open for your inquiries, M-F, 12- 5 (EST) at 888-297-2774 and you will be directed to a clinical consultant. If we are not available, please leave a message and we will return your call.

And as always, Thank you for your interest in the SASSI.

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Explaining Results to a Client with a High Probability Result When Scale Scores are Within the Norm

Perplexed callers periodically raise the question of how to interpret the results to their clients when all the scores fall within the norm and are only one standard deviation above or below the T-score of 50. Clinical interpretation is minimal although you can glean some useful information than just reporting a high probability.

The following profile result is of a 48-year-old female. She completed the FVA/FVOD side of the questionnaire for the last 12 months. Her RAP score was 0. Her Prescription Drug Scale score was 4 which indicates a High Probability of Prescription Drug Abuse.

As you can see, her FVA of 2 indicates below average use of alcohol, her FVOD score of 8 indicates above average use of drugs though within the norm. Her SYM score of 4 is also within the norm and although above average, she is not endorsing a lot of negative symptoms or consequences of her usage. Content analysis is useful with the Face Valid scales because they will give the context or conditions of how the client is using substances. The OAT score of 4 is within the norm so one hypothesis to explore, given the High Probability of a Substance Use disorder result, is if this client identifies with other addicted folks and those issues we often see in that population i.e. self-pity, resentment, low frustration tolerance, impatience etc. I would suspect not.

The SAT score of 3 is well below average although within the norm, this client may be concerned with what you think about her.  The DEF scale score of 7 is above average but also within the norm so you may be picking up a bit of a defensive posture with this client.

The last 3 scales, SAM, FAM and COR have no clinical impact.

Moving onto the Rules, two rules are met: Rule 9 and Rule 10.

Rule 9

  • FVA 6 or more or FVOD is 4 or more
  • SAT is 3 or more
  • DEF is 7 or more
  • All three, a,b, c ?  YES

Rule 10

  • FVA is 14 or more or FVOD is 8 or more
  • SAT is 1 or more
  • DEF is 4 or more
  • SAM is 4 or more
  • All four, a,b,c, d ? YES

The Rules are research based. Single scores within one standard deviation above or below the normative scores for each scale are not likely to indicate strong evidence of a diagnosable substance use disorder or a clinical problem. However, validation research indicated that some combinations of scores within this normative range such as in Rules 9 and 10 were evidenced by people who were diagnosed with a substance use disorder, and yet this same pattern of scores was not evidenced by those without substance use disorders. The scoring rules identify patterns of scores that accurately and reliably identify individuals with substance use disorders- even when the individual scores in the rule are not indicative of SUD on their own. Also, Table 10 in Chapter 7 in the SASSI-4 User Guide & Manual shows that both Rules 9 and 10 have a 96% accuracy rate indicating that the rules rarely identify people who do NOT have an SUD as positive on these rules.

You can see for Rules 1-4, the cutoff scores are outside the standard deviation which allows for both meeting the rule criteria and allows for easier clinical interpretation as well.

It is also important to note that the cutoff scores for each scale in any rule are specific to the rule. Being close doesn’t count.

Giving feedback to this client, the administrator needs to be aware of the bit of defensiveness and sensitivity of the client and perhaps the reluctance to identify as an addict. Using the information, she did endorse in the FVA, FVOD and SYM scales along with the Prescription Drug Scale results. It may help her to connect the dots and thus become open to whatever treatment considerations are discussed.

As always, if you have any questions about your SASSI results, please contact us through the free Clinical Helpline. We are available M-F, 12 – 5 EST at 888-297-2774 or 800-726-0526.

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Adolescent A3 – Emphasis on COR Scale

This profile is a good example of needing to be careful with assumptions.

Overview of CORRECTIONAL (COR) SCALE

The COR scale provides information pertaining to the possibility that the client may have a relatively high risk of experiencing legal problems. It is composed of items that differentiated between people who had a history of involvement in the juvenile justice system and those who did not.

It is very important not to over-interpret elevated COR scores. Teens who have elevated COR scores are responding similarly to individuals who have violated the law. This does not mean that all clients with elevated COR scores have broken laws. Also, there is no empirical evidence that these clients are at risk for future offenses.

If a client has an elevated COR score, it is worth exploring those behaviors which may be leading the client to make poor choices, especially after using substances and magnifying the tendency to exhibit those behaviors. These include anger management issues, impulsivity, risk taking behaviors, low frustration tolerance or poor social skills. The task of the clinician is to help the client see the relationship of their behavior to the consequences they have experienced and introduce alternatives to regulate their emotions and behavior.

The SASSI A3 was administered on a 15-year-old male and the time frame for the FVA/FVOD was for the past 6 months. The caller explained this time frame was used as the client identified that his substance use became problematic during this time. He indicated he had initially started smoking marijuana but in the last 6 months started abusing Percocet.

There is a lot to look at in this profile below.

He meets Rules 1, 3, 4, 5, 6 and 8 so met the criteria of a High Probability of having a Substance Use Disorder. A reminder that more “yeses” does not necessarily mean a more severe problem or meets the DSM-5 criteria for severity.

His Rx scale score was 1.

The FVA (2) is below average and within the norm.

The FVOD (18) is highly elevated and close to the 98th percentile so he is very open about his use and under what circumstances he is using.

As seen on the profile graph, both the FRISK (2) and ATT (3) are within the norm though above average.  These scores indicate he is not necessarily using due to peer pressure nor does he have a strong belief or value system that endorses substance use.

The SYM (9) is off the chart. He is endorsing negative consequences and symptoms of his use as well as loss of control.

It is worth taking the time to look at how he has answered his face valid scales and do content analysis of his answers because these will generate a lot of information for clinical insight and discussion on how and why he is using substances. As a reminder, the face valid scales are the FVA, FVOD, FRISK, ATT, SYM and Rx scales. You cannot do content analysis on the subtle scales.

Both the OAT (8) and SAT (7) are above the 85th percentile. Although the OAT indicates he can acknowledge personal limitations, the higher SAT score indicates a level of denial or lack of awareness or detachment from feelings and may present himself functioning well.

The DEF (4) score is very significant as it is below the 15th percentile. This indicates severe emotional pain, and he may be exhibiting depressive symptoms so it is suggested a mental status exam should be conducted.

As usual, there is no individual clinical interpretation to SAM (4).

The last scale, COR (10) is highly elevated above the 98th percentile. He is identifying with those issues that are normally seen in juveniles with legal issues.

This is where one must be careful with assumptions because this client has had no legal issues for any reason. It is more productive to explore those issues he is identifying with and affecting his choice making.

It is also curious that one can be very open (based on the FVOD and SYM) yet have an elevated SAT score as well. This may be due to the DEF score and the emotional pain he is in. Hypothetically, he may believe that if he was not “depressed” he would not be abusing drugs.

Another aspect of the profile is to explore his Rx result. According to the client’s report, he is primarily abusing Percocet. His score may reflect he is getting it illicitly and not through a doctor.

Finally, regarding treatment considerations, the caller reported he has tried to quit using the Percocet for a week but relapsed. A treatment plan including inpatient should be considered considering his reported relapse.

We hope this is helpful to you.

The clinical helpline line is open for your inquiries, M-F, 12- 5 (EST) at 888-297-2774 and you will be directed to a clinical consultant. If we are not available, please leave a message and we will return your call.

And as always, Thank you for your interest in the SASSI.

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A SASSI-4 Profile: When the Drug Use is Marijuana

It is no news that the use of marijuana is viewed by many, no matter what the demographic, as innocuous and far less than alcohol and certainly any other drugs. It has become increasingly difficult to convince users of the harm associated with marijuana use when the legal status ranges from fully illegal, to medicinal and/or decriminalized to fully legal. Users often describe marijuana as simply a plant so it is a natural and therefore a healthy alternative to alcohol and other drugs. This, along with the misconception that marijuana is not addictive, creates an inherent struggle for both the evaluator and evaluatee. As an aside, when writing this, I came across an article in the New York Times by Dana G. Smith (April 10, 2023), titled “How Do You Know If You Are Addicted to Weed?” The article itself gives good basic information but the most interesting part was the comments from readers which were all over the map.

Substance use evaluations for marijuana use become problematic when the client comes in with that strong point of view which may be reflected in the results of the SASSI and in the scales.

The question of diagnosis based on the DSM-5’s 11- symptom criteria and whether the client meets either mild, moderate or severe must be answered before any treatment considerations can be raised.

The following is a good example of what a profile looks like when the drug use in question is marijuana.

The client is a 19 year old female and the FVA/FVOD questions were answered for the last 12 months. The RAP and Prescription Drug Scale scores are 0.

CLINICAL INTERPRETATION

The client’s FVA is average but her FVOD of 13 is elevated above the 85th percentile so clinically significant. Her SYM score of 9 is above the 98th percentile so she is endorsing significant symptoms and consequences. It also indicates she is associating with either family or friends who are heavy users. This gives important information regarding her environment and the difficulty of a social system that supports recovery.

The OAT scale score of 5 is neither elevated nor extremely low. It would be plausible to say she does not identify with or see herself as a substance abuser. This is reinforced by both the SAT(6) and DEF(6) falling in the normative range. She is not in denial because she believes there is nothing wrong with smoking marijuana and so was non-defensive when completing the questionnaire. The only other clinically significant scale is COR with a score of 7, also above the 85th percentile. Whether or not she has legal problems, she has answered in a similar way to others with legal issues. Anyone looking at that result can evaluate impulsivity, anger management issues, low frustration tolerance, poor social skills or risk taking behaviors, all of which impacts choice-making abilities.

THE RULES

Out of the 10 rules evaluating for either a high or low probability of a substance use disorder, she meets 4 of them:

          Rule 2 (SYM=7+)

          Rule 5 (SYM=5 + and SAT=4+)

          Rule 6 (SYM=6+ and DEF OR SAM=7+)

          Rule 10 (FVA=14+ or FVOD =8+ and SAT=1+ and DEF= 4+ and SAM 4+)

To meet the criteria of a High Probability of a Substance Use disorder requires meeting only ONE rule. Meeting more than one rule does not necessarily mean a more severe disorder. The DSM-5 evaluates for severity ranging from mild, moderate to severe based on the number of diagnosable criteria met.

CLINICAL ISSUES TO CONSIDER

Giving clinical feedback to this client or any client for that matter, is to use the information they have given you from the questionnaire. Pulling information from this client’s questionnaire, the FVOD and the SYM responses can help start the conversation regarding how she is using drugs, under what circumstances and consequences of her use. For online users wanting access to the SYM questions, go to sassionline.com, log-in: go to ‘my clients’ tab; then ‘support materials’ tab. Under Adult SASSI-4 Online User’s Guide go to the SYM section, Pg.19. You will find a list of the SYM questions you can coordinate with your client’s completed questionnaire. A reminder: only with face valid scales i.e FVA, FVOD, SYM and Rx scales can you do content analysis of the questions.

The purpose of feedback is not trying to convince her that marijuana is a drug and she has a disorder but to use the information she, herself, has given you to explore how her drug use is impacting her in a negative way or in some ways interfering in her life.

TREATMENT CONSIDERATIONS

The OAT score result implies group treatment intervention would not be the first choice for this client. Information specifically regarding marijuana’s addictive qualities and impact on the body could be included in individual motivational counseling. Establishing a goal regarding her use, including reduction or abstinence is part of treatment planning no matter the context. Even though she is not defensive, establishing rapport and trust may be instrumental in facilitating this client to take a closer look at her drug use and eventually be open to group experiences.

If you have any clinical questions, be sure to call our free helpline to talk to our clinicians. We are available M-F, 12-5 EST at 800-726-0526.

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SASSI-4 Profile of Adult Male Involved in a Custody Suit with ex-Spouse

A substance use evaluation administered on an individual involved in a custody suit can reliably be fraught with issues. This one presents a number of them.

This 39-year-old client was instructed to complete the FVA/FVOD questions for his whole lifetime.

A significant issue was his history of 4 DUI’s from 2020 – 2021 while in the process of separation and divorce. He denies his current use is anything like it was during that period.

The SASSI result indicated a Low Probability of a substance use disorder.

His RAP was 1 but not enough to flag the results and his Prescription Drug Scale was zero.

Looking at how his scores compare on the graph; we first see the average scores of his FVA and FVOD scales which may be suspect given his DUI history. His average SYM score suggests he does not acknowledge significant symptoms or consequences of his use despite 4 DUI’s. Face Valid Scales are easy to manipulate or minimize if the client chooses as they directly relate to substance use.

Moving on to the subtle scales starting with OAT, we see it is very low but within the norm. If it were any lower, it would indicate he has a hard time acknowledging personal limitations and shortcomings so there may be a hint of that going on. It is the next two subtle scales which contribute the most. The SAT scale is below the 15th percentile and when it is this low can indicate the client is hypersensitive to what others think of him, maybe experiences feelings of rejection so comes across as having a chip on his shoulder.

The extremely high-DEF score (above the 98th percentile) questions the Low Probability Result.  As suggested, If the DEF is 8 or more, that increases the possibility of the SASSI missing individuals with a substance use disorder. It does not invalidate the result. There are many reasons for a high DEF – it could be situational – and it is not unusual in custody disputes to see a high DEF. It could be the client was defensive around their substance use. It could be that he has a defensive personality in general. The administrator is tasked with determining the meaning of the DEF scale score. It also tells you how to clinically approach a client who has difficulty opening up, is hypersensitive to others and is defensive.

The SAM score, though low, is the only scale which does not have an individual clinical interpretation. It is used in the decision rules to increase the validity and accuracy of the other scales it is paired with. It is also used to ascertain if the client is defensive around their substance use if both the DEF and SAM are elevated.

The FAM and COR results are not clinically significant.

In this kind of a case, the question of what timeframe to use with the FVA and FVOD scales comes up. It depends on several factors. Lifetime does give you an overall baseline of substance use but if you want a more “focused” timeframe, the last twelve months should be considered. Sometimes there is the issue of missing someone who had a significant issue in the past but is not currently using it, so a high probability result becomes a risk statement. A reminder:  the SASSI cannot determine what a client is currently doing. This inventory is part of the information gathered by the administrator which is incorporated into the whole assessment.

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SAMSHA Survey 

June is National Pride month so we thought we would bring attention to the just released SAMSHA survey on Lesbian, Gay and Bisexual Results from the 2021 and 2022 National Surveys on Drug Use and Behavioral Health. The results point to the heavy societal stressors of this minority population in regards to mental health and the overall use of substances as a significant coping response. 

The behavioral survey looks at any mental illness, serious mental illness, major depressive episodes, co-occurring AMI and SUD, suicidal thoughts, plans and attempts. 

The substance use survey covers cigarette smoking, alcohol use, binge drinking, heavy alcohol drinking, illicit drug use, marijuana use, CNS, stimulants, cocaine, Rx stimulants, meth, opioids, inhalants, etc. 

Women often remain under the radar in terms of substance use even now, but the stats on Lesbians and Bisexual women might surprise you so take a look. 

The report is straight forward which means an easy and fast read. 

Elevated RAP/ High Probability Results on an Adult SASSl-4

This profile on a 21-year-old female with the FVA and FVOD, based on the last 12 months, is interesting primarily because it is so unusual.

As you look at the profile graph, all the scale scores are within the norm, i.e., between the 15th and 85th percentiles except for the SYM score which is above the 85th percentile. This tells you that she is acknowledging symptoms and consequences of her use and indicates she is associating with friends or family who are also heavy users. This is a bit of a contrast to her FVA and FVOD scores, both of which are above average but not above the 85th percentile.

The SAT score of 5 is within the norm which is a positive – no denial or lack of awareness or insight is indicated. However, with the OAT score within the norm, it is a possibility that she does not identify with other substance users and those characteristics we associate with substance users such as impatience, self-pity, resentment, or impulsivity. If marijuana is her primary drug, she may not see it as a problem so the high probability of a substance use disorder may be an unexpected result for the client.

Another positive is the DEF score, which is above average but not clinically significant since it is below the 85th percentile.

The client meets decision rules 5, 6 and 9 and 10 thus meeting the criteria for a high probability of a substance use disorder. As a reminder, more rules that are met does not mean a more severe problem. As we often mention on the clinical helpline, the diagnosis and severity of a substance use disorder is based on the criteria in the DSM-5.

Note the Prescription Drug Scale score of 2. It does not meet the cut-off criteria for prescription drug abuse, but it is worth a look at those items she endorsed.

The caller was puzzled by the RAP score of 2 and how it affected the result of the SASSI.

A RAP score of 2 or more always needs to be explored, preferably with the client. The two items which posed the problem were ‘I never have been picked on and I have never been sad’.
Cultural and language contexts need to be considered for possible reasons the client answered as she did. The possibility of her deliberately trying to ‘skew’ the questionnaire is low given the high probability result. More likely, the client answered accurately for her based on her life experience.

The clinician can now safely accept the overall result as valid.

As a reminder, the free clinical helpline, (800-726-0526) is available M-F, 12- 5 pm (EST) for any questions you may have. We also offer a free Q&A zoom meeting once a month for an hour as well. Please check the blog notice for dates and time to register. And finally, if you have additional inquiries, please contact the Clinical Director, Kristin Kimmell, LCSW, LCAC at kristin@sassi.com.

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Pre-employment Screening / A Profile Review on the Proper Use of the SASSI-4

A recent caller wanted help in interpreting a profile completed by a 33-year-old male. He was instructed to complete the FVA/FVOD side of the questionnaire for the last 12 months. The administrator revealed during the call that the assessment was a pre-employment screening for the Department of Transportation. The helpline does receive regular calls from counselors who administer the SASSI-4 for the Department of Transportation after a driver has failed a drug or alcohol test for substances, but not for pre-employment screening.

In review, the client comes up with a high probability of a substance use disorder based on Rules 2,5,6 and 9. The RAP is 0 and the Rx Prescription Drug Scale is 0.

The FVA is below average use, the FVOD is on the 50th percentile. The SYM scale of 7 is above the 85th percentile, considered elevated and thus Rule 2 meets the criteria of a High Probability of a Substance Use Disorder. The rest of the scale scores are within the norm (between 15-85th percentiles) so clinically are not significant but are significant in meeting the criteria of a Substance Use Disorder if accounting for the additional rules of # 5, 6 and 9. The SAT of 5, being in the norm indicates the client was not in denial about his usage.

Considerations

Although the results do not account for current or actual use, further assessment may include urine screens that would give a more accurate representation of current use of substances. He does come up with a high probability of a Substance Use Disorder, so deeper inquiry is necessary.

The administration of this SASSI was part of a pre-employment screening and our position on the proper use of the SASSI in this regard, is very explicit:

From our User’s Guide and Manual: *

“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.”

“To use the SASSI to discriminate against individuals violates the intent of the authors and may even violate the law.”

“SASSI results should not be used to abridge the rights of individuals or to disqualify applicants for positions, such as jobs or benefits, such as public assistance programs.”

Thus, it is extremely important to use the results in the most therapeutic way possible with the best intentions of helping individuals with a substance use disorder.

If you have any questions, please contact the Clinical Director, Kristin S. Kimmell, LCSW, LCAC at kristin@sassi.com.

*SASSI -4 User Guide & Manual – Chapter 1 (overview), pg.7
SASSI-4 Online User Guide – Proper Use of the SASSI. pg. 8

LGBTQA issues: What side of the Profile Sheet to use in cases where gender is in question?

We receive regular phone inquiries regarding which side of the Profile Sheet to use in scoring either the Adolescent or Adult SASSI when the client identifies as transgender or neither male nor female. This comes up whether one is using the paper and pencil or the online version.

To affirm one’s self-identity can be powerful and empowering so a discussion with a client who is either questioning their gender identification or sexual orientation or is very clear about either one can be a very supportive encounter. The message given is one of sensitivity, respect, and validation for their choices.

As a way of addressing this issue the adult SASSI-4, adolescent SASSI-A3, and Spanish SASSI ask for ‘gender’ in the demographics rather than ‘sex.’ This allows the client to indicate their self-identity. What side of the profile sheet used for scoring purposes should either (1) conform most closely to what the client indicates or (2) after discussion with the client, what they feel most comfortable with given the gender limitations of M/F on the SASSI.  The research is based on binary identification and as such, we are limited in adding additional categories. Future research will undoubtedly be more inclusive. Regardless, the results are valid. The overall goal of the inventory is to give both the administrator and the client a compass to follow with useful information regarding the extent that substance use may or may not be a problem.

To be clear, score the side of the profile sheet that the transgender client self-identifies with. Not when or if they started hormones, or in a current state of transitioning, or they identified as a different gender when the legal offense happened.

A client may express a preference to not identify in any way and decline any gender identification. In that case, the administrator may want to score both sides of the SASSI to see if there is any difference in the result. More often than not, the result will be the same. The primary differences in M/F are in the FVA/FVOD scales which impact Rule 1 and Rule 10 in SASSI-4. There are no differences in the SASSI-A3.

The following is a list of LGBTQA terminology and definitions provided from the Prism Youth Community, part of Bloomington PRIDE here in Indiana:

These definitions were borrowed and adapted from several sources including the University of California- LA LGBT Campus Resource Center, the University of California Berkeley Gender Equity Resource Center, the University of Michigan Spectrum Center, and the University of Wisconsin Milwaukee LGBT Resource Center.

Definitions may vary with location, era, and culture. It is very important to respect people’s desired self-identifications. One should never assume another person’s identity based on that person’s appearance. It is always best to ask people how they identify, including what pronouns they prefer and to respect their wishes.

Ally – Typically any non-LGBT person who supports and stands up for the rights of LGBT people, though LGBT people can be allies, such as a lesbian who is an ally to a transgender person.

Androgyne – A person appearing and/or identifying as neither man nor woman, presenting a gender either mixed or neutral.

Asexual – A person who is not sexually attracted to any gender or does not have a sexual orientation. Asexuality is not the same as celibacy.

Bisexual or Bi – A person emotionally, physically, and/or sexually attracted to males/men and females/women. This attraction does not have to be equally split between genders and there may be a preference for one gender over others.

Cisgender – A person who feels comfortable with the gender identify and gender expression expectations assigned to them based on their physical sex.

Gender Expression – The way in which a person expresses their gender identity through clothing, behavior, posture, mannerisms, speech patterns, activities, and more.

Gender Identity – A person’s sense of being masculine, feminine, or other gendered.

Genderqueer A gender variant person whose gender identity is neither male nor female, is between or beyond genders, or is some combination of genders.

Homosexual or Gay – A person primarily emotionally, physically, and/or sexually attracted to members of the same sex.

Intersex – A person whose sexual anatomy or chromosomes do not fit with the traditional markers of “female” and “male”. For example: people born with both “female” and “male” anatomy (penis, testicles, vagina, uterus); people born with XXY.

Lesbian – A female-identified person attracted emotionally, physically, and /or sexually to other female-identified people.

LGBTIQA+  – Lesbian, gay, bisexual, transgender, intersex, queer, asexual or ally, and other identities.

Pansexual – A person who is sexually attracted to all or many gender expressions.

Partner – A significant other in an intimate relationship; a gender-neutral alternative to boyfriend/girlfriend, husband/wife, or other binary-based relationships terms.

Queer – 1. An umbrella term for people who are not heterosexual or cisgender. 2. A reclaimed word that was formerly used solely as a slur but that has been semantically overturned by some members of the LGBTIQA+ community, who use it as a term of defiant pride.

Sex – A medical term designating a certain combination of gonads, chromosomes, external gender organs, secondary sex characteristics and hormonal balances.

Sexual Orientation – The desire for intimate emotional and/or sexual relationships with people of the same gender/sex, another gender/sex, or multiple genders/sexes.

Sexuality – A person’s exploration of sexual acts, sexual orientation, sexual pleasure, and desire.

Trans – An abbreviation that is sometimes used to refer to a gender variant person. This use allows a person to state a gender variant identity without having to disclose hormonal or surgical status/intentions.

This term is sometimes used to refer to the gender variant community as a whole.

Transgender – An umbrella term for a person whose gender identity, expression or behavior is different from those typically associated with their assigned sex at birth.