Category: Sample Interpretations

What is The SASSI Institute’s Clinical Help Line?

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!

An Adolescent SASSI-A3 Profile: Low-Probability with Possible Clinical Issues

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).

PDF Version Available for Download

A SASSI-4 Profile Analysis: Drug Offender with SAT As Highest Score

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).

PDF Version Available for Download

Understanding SASSI Scales

Participants in our Clinical Interpretation (Session 2) of SASSI Training learn about screening and assessment information; giving client feedback; and practice interpretation using SASSI profiles. Upon completion of the session, participants should feel comfortable making clinical interpretations from both the adult SASSI-4 & adolescent SASSI-A3 scales and using the SASSI to engage the client in the treatment process.

Feedback to clients on SASSI profiles is useful in increasing awareness, eliciting further information, and establishing rapport. Presenting the results of the decision rules and discussing scale scores can help people come to grips with the significance of their substance usage and identify treatment goals.

The following is a link to a handout provided in the Clinical Interpretation Session that you are welcome to download for reference when interpreting profile: SASSI SCALES: CLINICAL FEEDBACK.

We encourage you to attend the Clinical Interpretation Session 2 of SASSI training if you have not already and to utilize our free Clinical phone line for consultation and help interpreting profiles at 800.726.0526 Option 2.

The Need for and Usefulness of the SASSI

Substance use disorders cause problems for countless individuals and society as a whole. Alcohol and drug abuse often underlie difficulties presented as emotional, medical, family, school, or legal problems. These problems are not likely to be resolved until the underlying substance use problem is dealt with. Yet many affected individuals are unable or unwilling to acknowledge their misuse of psychoactive substances, and many human service providers lack the resources to conduct comprehensive diagnostic assessments for substance use disorders on every client in their practices.

Dr. Glenn A. Miller developed the SASSI in response to the need for a screening measure that could identify individuals with a high probability of having a substance use disorder, even if those individuals do not acknowledge substance misuse or symptoms associated with it.

The SASSI is brief, easy to administer, and objectively scored. A client can answer the questionnaire in less than fifteen minutes. The SASSI can be scored and interpreted in a minute or two.

Thus, clients with a high probability of having a substance use disorder can be identified and helped by employee assistance programs, vocational counselors, psychotherapists, medical personnel, criminal justice programs, and other human service providers.

The SASSI is used by human service practitioners throughout the United States and Canada, as well as other countries and is used to help over a million people every year. For information on the accuracy of our screening tools please visit https://sassi.com/reliability-validity/.

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. 

An Adolescent Trying to Mix Things Up!

The message this Adolescent was trying to send is as confused as he must be. A lot of contradictions in the numbers needed to be sorted out and made sense of.

This 16-year-old male responded to the FVA and FVOD questions for his whole lifetime.

The Prescription Drug Scale result was zero.

The VAL check was 4.

He met the criteria for a High Probability of a Substance Use Disorder based on Rules 1, 5, 6 and 7. A reminder, it requires only 1 yes to the 8 rules to meet the criteria for High Probability. More “yes’s” does not mean a more severe problem. Severity of a Substance Use Disorder is determined with a diagnosis from the DSM-5.

Another reminder, content analysis of the Face Valid scales i.e. FVA, FVOD, FRISK, ATT, SYM and Rx individual items can be examined to generate information regarding under what circumstances substances are used and with whom, along with underlying emotional reasons.

The FVA of 7 is elevated enough to meet the criteria of Rule 1.  The FVOD of 2 is below average and within the norm.

The FRISK score of 0 proves to be interesting given the context of the psychosocial history of this individual. It may be he did not want to disclose information regarding his friends or family.

The ATT score of 6 is highly elevated above the 98th percentile. This indicates he has a strong value and belief system regarding the use of substances. He may believe that everyone uses and that may be the case in his world.

The SYM score of 3 is within the norm so from his perspective, he has experienced minimal symptoms or consequences of his usage.

The OAT score of 7 is elevated above the 85th percentile so clinically significant but coupled with an higher SAT score of 6 as graphed is somewhat muted. On the one hand, an elevated OAT score indicates he can acknowledge personal limitations and shortcomings and may identify with other substance users though he may not want to change. On the other hand, the elevated SAT score can indicate denial or lack of awareness and insight or detachment from feelings.

The DEF score of 6 is within the norm and below average which can indicate self-esteem issues. It is a bit surprising the DEF score, in this case, is not elevated. The client was not defensive completing this questionnaire.

The SAM score, by itself, has no clinical interpretation.

The COR score of 5 is within the norm so there is no clinical interpretation.

What the psychosocial interview revealed: The client had a history of vaping nicotine with friends and had completed a Substance Use Education course. However, the client was smoking pot at home and minimizing his use. He was described as lying and manipulative. It was also disclosed his father is in recovery. As we all know, attitudes around Marijuana not being addictive or even a “drug” have been rapidly changing along with the legalization of Marijuana. However, the client’s risk of developing a significant risk of a substance use disorder is escalated by a family history of addiction.

Addressing the VAL score of 4:  With the High Probability of a Substance Use Disorder result, the VAL check score does NOT come into play. It would only be impactful if he had come up with a LOW Probability of a SUD. However, this score is quite high, and the administrator would rightly suspect the client was trying to skew the results even if it had no impact on the result.

Adolescent FRISK, ATT, & SYM Scale FAQ

In our last blog post we discussed a frequent question we get regarding the web-based version of the SASSI-4 and how to identify the SYM (Symptoms) scale items on a client’s completed questionnaire. This week we discuss identifying the FRISK (Family-Friends Risk), ATT (Attitudes), and SYM scale items on the web-based version of the Adolescent SASSI-A3. Because these scales are face valid, they can give you information concerning the client’s substance use and it may be worthwhile to do a content analysis of the items comprising them as they are directly related to substance use.

While logged into your sassionline.com account, click on the tab ‘My Clients’ and then click on ‘Support Materials.’ On the Support Materials page click on ‘SASSI-A3 User Guide.’ Go to pages 15-18 for the information on these scales. There you will see the 6 FRISK items, 8 ATT items, and the 19 SYM items listed. We suggest you print these pages out to assist in identifying these items on your clients’ completed questionnaires.

As always, we encourage you to call our free clinical help line for interpretation assistance M-F 1-5 pm EST at 800.726.0526 Option 2.

A Good Assessment is Key to a Good Use of the SASSI

This SASSI-4 profile is an excellent example of why the comprehensive assessment is a crucial part of the evaluation process.

This 33-year-old male completed the FVA/FVOD side of the questionnaire for his whole lifetime.

His RAP is 0 as is his Prescription Drug Scale.

His profile graphs most of his scores within the norm, between the 15th and 85th percentiles. The one standout is the SAT score of 0. That score indicates someone who is hypersensitive to what others think about him and may harbor feelings of resentment coming across as having a chip on his shoulder. Although the DEF score of 7 is not quite high enough to trigger looking at the possibility of SASSI missing individuals with a substance use disorder, it is significantly above average so there may be a “hint” of him exhibiting defensiveness.

Based on the face of it and on the SASSI alone, he comes up with a Low Probability of a Substance Disorder.

So, what is missing? The information gathered from the rest of his evaluation.

This individual has a history of 3 DUI’s – one in 2013, 2020 and the last in 2023.

As you can see, he does not indicate in his FVA or SYM any issues with alcohol or negative consequences of his usage. From his perspective, he has not had negative consequences. It could be that what he was required to do historically was minimal i.e. an alcohol education class. As these offenses are spread over 10 years, it may mean that he has a problem with drinking and driving. What is his current usage? Does he have a diagnosable disorder based on the DSM-5? Knowing about his extensive history requires the Clinician to dig deeper into this client’s use history and question his perspectives.

A useful tool we offer for both individual administration and for alcohol-related education and treatment interventions is the BADDS – Behaviors & Attitudes Drinking and Driving Scale.

It identifies drinking and driving and riding behaviors, history of impaired driving, the likelihood of riding or driving with an impaired driver, rationalizations for drinking and driving and intervention effectiveness.

The BADDS can be used in Driver’s education classes, Impaired driving prevention, DUI courts and DUI programs, Colleges and Universities and Counseling and treatment programs.

The BADDS can be used as a pre-test or be re-administered to measure behavioral and/or attitudinal change in multiple intervals. The post-test can also assess overall program effectiveness.

The BADDS is available in a paper and pencil version only for those 18 years or older with a third grade reading level and takes about 15 minutes to administer. We do offer on-demand webinar training. For more information go to www.thebadds.com.

PDF Version Available for Download

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.

PDF Version Available for Download

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.

PDF Version Available for Download