One question we field often on the clinical helpline is what does it mean when either the OAT (Obvious Attributes) is higher than the SAT (Subtle Attributes) or when the SAT is higher than the OAT when both are elevated above the 85th percentile? We are comparing how they are plotted on the graph – not the raw scores. The position of these subtle scales in relation to each other can give you important clinical information regarding treatment readiness. It also gives the administrator important clues on how to approach the client with the results of the SASSI – especially if the results indicate a high probability of a substance use disorder.
An elevated OAT score reflects acknowledgment of behavioral or attitudinal tendencies common among practicing substance abusers. These center around impatience, resentment, self-pity or impulsiveness. They are able to identify with other substance abusers and the higher the OAT, the more likely someone will acknowledge these traits cause them problems. An elevated OAT score often decreases following treatment.
An elevated SAT score is an indicator of poor insight, lack of self-awareness and not in touch with feelings. It is an indicator of denial – the client sincerely believes they do not have a substance use problem.
When the OAT is greater than the SAT it can indicate good treatment readiness, the client is aware of their pain and can admit to feeling distressed over their substance use. They are aware of their personal limitations and shortcomings. They are relatively non-defensive and will probably need less intensive treatment.
When the SAT is greater than the OAT it is more likely the client uses emotional avoidance as a coping mechanism. There is greater focus on appearance and they exhibit a lack of insight into their problems. The clinician will initially run into high resistance and the risk for relapse is high. This client will need relatively intensive treatment but will find group participation difficult. The client may benefit from affective work – not just cognitive and educational programs.
An elevated OAT can be viewed as a clinical guide for treatment readiness. The client may not believe they have a substance use disorder or want to change, but it is more likely they are candidates for group interventions.
With an elevated SAT, the client will clinically be more challenging. These clients often present themselves well, detached from their feelings and initially very resistant to treatment. They will need more help in “connecting the dots” on the impact substances are having on their lives. Treatment interventions should be carefully considered. If feasible, starting out with individual sessions moving the client into a more treatment ready stage could be helpful. And a client suffering from a co-occurring disorder like depression will certainly need therapeutic help on multiple levels.
As usual, the Clinical Helpline is available with a real, live clinician Monday-Friday, 11 – 5pm (EST) to help with any clinical questions you may have. Please leave us a message if you call after hours and a good time to reach you. We will get back to you the very next day. Call 800-726-0526.
SAMHSA – The Substance Abuse and Mental Health Services Administration is a source of up-to-date research, articles and information on prevention and treatment that is readily available through downloading for free. The site is samhsa.gov.
IRETA – Institute for Research, Education and Training in Addictions – The is a public health
nonprofit group located in Pittsburgh, PA. They send out a newsletter on a regular but not obnoxious frequency and offer research, information and webinars related to prevention, treatment and recovery. Their website is www.ireta.org.
Happy Holidays and a very Happy and Safe New Year!