Category: Sample Interpretations

The Purpose & Potential of Assessment and the Role of SASSI Screening

Engaging in assessment regularly can make it become routine; therefore, sometimes perspective is lost and the purpose forgotten. Time needs to be taken to remember the precise questions assessments are trying to answer. When forgetting the specific reasons for conducting assessments, they lose their value ­ both to the individual client and the clinician.

Screening is an important part of assessment for the purpose of triage, identification of risk factors, and referral for additional services. The basic question is whether an individual is likely to have a particular problem. If so, the subsequent assessment and treatment plan should address that problem. Since screening tools are used to identify people who are likely to have a problem or be at risk for developing a problem, they are never infallible. The key element is to use a screening tool that meets the needs of the clinician. As an example, the crucial factor in airport security screening is that the procedure be highly sensitive; they do not want to miss anyone who is a security risk. ln other words, they do not want any false negatives. However, in eliminating all false negatives, the procedure that is used produces false positives and anyone carrying metal is flagged by the airport security screening and given some degree of further scrutiny, even though most people who carry metal are not found to be a security risk. But different screening settings have different needs. ln developing and maintaining the SASSI, the researchers recognized that there are costs associated with both over and under-identification of substance use disorders (SUD). Therefore, the research and development aims were directed toward maintaining a high level of sensitivity (few false negatives) and a high level of selectivity (few false positives).

While a relatively comprehensive assessment may be needed to arrive at a diagnosis, the basic question is whether the individual meets the specific criteria (e.g., DSM-5) necessary to arrive at a diagnosis. There exists a long-standing controversy regarding the value of diagnoses. Some argue that diagnoses serve to label people unnecessarily and others argue that it is important to do whatever possible to specify an individual’s problem in a reliable and meaningful manner to ensure appropriate treatment recommendations. Regardless, most agencies require clinicians to formulate a diagnosis, and diagnoses are needed for third party payments and as part of the admission criteria for many treatment programs.

Assessments are also needed for reports. Often individuals are referred by outside agencies (e.g., other health service providers, courts, employers, schools). In these instances, the clinician is placed in the position of providing expert opinion in what may be controversial or even litigious situations. It’s vital for the clinician to have a clear understanding of the precise request being made by the referral agency – What are the questions to be answered? What are the issues that are to be addressed? What types of opinions and recommendations are requested?

In conducting the assessment and writing the report, the clinician should be clear in differentiating observations from inferences and opinions. For example, if the only information on frequency and quantity of consumption of alcohol and other drugs is the individual’s self-report, the written report should indicate that the individual reports using a certain amount, not that the individual actually consumes that amount. If the clinician has cause for concern regarding a symptom of SUD, it should be phrased as a cause for concern rather than an observation. When using the SASSI to screen it becomes possible to make a statement to the effect that the individual’s pattern of responses suggests, with a known level of certainty, that the client is or is not likely to have an SUD. (Note: In addition to screening results, supplemental clinical information is required to meet the accepted standards for a DSM-5 clinical diagnosis of an SUD). The SASSI Rx scale can also help identify individuals likely to be abusing prescription medications and the other additional scales can provide clinical insight into level of defensiveness, consequences of use, desire for change, family and social risk factors, and acknowledgement of problems.

Always present information clearly and distinguish observation from inference and opinion. It is important to help the individual become increasingly invested in the treatment process. Assessment is a critical part of the treatment process and provides an opportunity for the clinician and the individual client to mutually identify problems, set goals, and devise strategies to meet those goals. The individual client is the primary focus, and the information that’s gathered is useful to these individuals only to the extent that it helps them take action that enhances their quality of life. For information on interpreting SASSI scales, please consider completing our Clinical Interpretation training. Registration information can be found at https://sassi.com/sassi-training/.  Also, professionals can call our free clinical helpline at 800.726.0526 Option 2, M-F 1-5pm ET for help with profile interpretation.

High Probability by Subtle Scales Only

Many people know that the SASSI is possibly the best substance use disorder screening tool that exists in the behavioral health field today. The instrument can be easily administered in 15 minutes or less and manually scored in less than two minutes (or scored automatically in the online web-based version), resulting in an objective empirically-based statement of the likelihood of the client having a substance use disorder with an overall accuracy of 92% for adults and 89% for adolescents. And it achieves this kind of accuracy even in clients who are unwilling or unable to acknowledge their substance misuse or the symptoms associated with it!

Through extensive case study research, the SASSI has been found to be able to provide even more utility to clinicians in the form of clinical interpretations that go beyond just the high or low probability of a substance use disorder result. In addition to interpretations of individual scale raw scores that fall outside the boundaries of the research-based established normal distribution, we also have discovered some trends or characteristics in the specific situation in which the client scores as high probability of a substance use disorder based on SASSI decision rules that involve only subtle scales rather than face valid scales. That is the subject of our blog today.

The SASSI is made up of both face-valid scales and subtle scales. Face-valid scales such as FVA, FVOD and SYM are scales that are very obvious about what they are measuring, while subtle scales such as OAT, SAT and DEF are made up of items that do not seem to have anything at all to do with substance use. Our case study analysis showed that certain behaviors, characteristics or patterns emerge in individuals who score as high probability based only on subtle scales. Let’s take a look at an example. Byron is a 31-year-old male who was asked to be evaluated because of a child custody battle in which the mother alleges that Byron misuses drugs. Byron has not yet had a comprehensive assessment done, but has so far only admitted to some occasional use of marijuana. A SASSI was administered and the results showed that Byron met the criteria for Decision Rules 3, 4 and 7. Each of these decision rules involve only subtle scales and no face-valid scales. So, what characteristics do we tend to find in individuals with this type of scoring pattern?

One key feature of this type of scoring pattern is the fact that these individuals often have very little insight into the pervasive nature of the addictive disorder in their lives. Most of the time, this type of client actually has a very sincere delusion regarding their substance misuse. In other words, they are not trying to trick you into thinking they do not have a problem with substances; they simply do not see it. Often, every single activity this person is engaged in and every decision they make somehow involves substance use. Often, the substance misuse has become an unhealthy way to cope with emotions that are too overwhelming and so individuals with this type of scoring pattern are very emotionally avoidant. Many times, this individual has difficulty admitting their weaknesses or the personal limitations with which they struggle and instead choose to focus on very superficial things, ignoring the depth of the substance problem in their life. We can see these types of traits and behavior patterns manifested in this client’s individual face-valid scale scores such as lower than average (T-score of 50 is the mean) FVA and FVOD scores and only an average SYM score. These all indicate a client who does not acknowledge or admit to having any significant problems or negative consequences as a result of substance use. The client’s extremely high DEF score indicates a very high level of guardedness and the desire to be seen as having no weaknesses or faults. It’s even possible that the FVA, FVOD and/or SYM scale scores could be artificially low because of minimization of symptoms in the client’s answering patterns on these scales fueled by this defensiveness. However, as mentioned previously, it’s possible and even probable that this client really has very little insight into his problem with substance misuse and so he may be unable to even recognize the obvious negative consequences he is experiencing. This is especially typical of clients with high SAT scale scores as this client has. While this client does also have an equally high OAT score, which often indicates some ability to recognize negative attributes that are common in individuals with substance problems such as impulsiveness, self-pity, resentment, and impatience, it is more likely in this case that the client does not see these issues as having any relationship to his misuse of substances.

At this point, a comprehensive assessment needs to be done along with a formal diagnosis and possible treatment plan formulated. Since the SASSI does not provide an actual diagnosis and does not, by itself, indicate a need for treatment or the level of treatment, it is important to gather more information such as self-reports of the client’s current usage patterns, collateral reports, naturally occurring records, behavioral records, etc. to determine a diagnosis and course of action. Typically, clients with this scoring pattern do have a significant substance use disorder and many of them, if they need treatment, will often need a relatively intensive level of treatment which includes individual and group therapy sessions; more than just cognitive/educational programming. However, individuals with this type of scoring pattern will often be initially resistant to any treatment as they honestly do not see a problem that needs to be treated. The high level of defensiveness will require lots of time spent in developing a therapeutic alliance and positive rapport, affirming and supporting him throughout the process. Clients like this are often a high relapse risk and so it is important to provide wraparound supports and a level of intensity in the treatment regimen which allows for quicker and stronger intervention in the event the client attempts to relapse. Individuals who score as high probability of a SUD based only on subtle scales are often some of the most challenging clients, but with information gained from the client’s scoring patterns on the SASSI combined with additional information from other sources, you are in a better position to know what to address to increase the possibility of success with this client.

Don’t forget that full training on administering/scoring the SASSI and clinical interpretation of the sub-scales is available. Check out https://sassi.com/sassi-training/ to register for an upcoming training. Also, our free Clinical Helpline is available M-F from 1:00pm to 5:00pm EST to answer any questions you have about the SASSI.

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Use of The SASSI in Identifying Factors in Crime and Criminal Recidivism

Although there have been ample demonstrations of the value of rehabilitation programs for criminal offenders, it is important to recognize that recidivism in the criminal justice system remains a serious problem.

It would be an easy matter to greatly reduce the incarcerated population if one and only one factor caused people to have multiple arrests. Substance Use Disorder (SUD) is a strong common element among repeat offenders. However, there are numerous other factors that can also lead to habitual legal offensives – impulse control problems, personality disorders, psychiatric disorders, cognitive impairment, chronic stress, a history of trauma, childhood and other developmental issues, peer culture, poor social skills, etc.

No single factor necessarily causes criminality, but each one can contribute to a tendency toward law violation, and they can combine to produce a high-risk profile. Because there are multiple causes of criminality, one treatment program may be of value for some repeat offenders but still does not address all the issues that need to be addressed to prevent further legal difficulties. Repeat offenders do not come from one mold. Therefore, one given course of treatment is not likely to be maximally effective for all recidivists.

Screening to Identify Risk

The challenge of early intervention is to find a means of identifying and addressing risk. A first step in reducing recidivism in the criminal justice system is to screen legal offenders to identify individuals who are at greatest risk for ongoing legal difficulties and who are likely to have an SUD to provide them with appropriate and timely treatment.

SUD is strongly related to legal problems. Using SASSI screening tools can provide information on ongoing legal problems that can be helpful in treatment planning. Since there are multiple causes of habitual offending, instruments that measure a single factor are not likely to be effective in early identification of high-risk individuals. The SASSI Correctional (COR) Scale identifies individuals with a history of legal problems. While it is unclear why the COR items identify these individuals, there are many possible factors to explore, including: impulse control, anger management, high risk-taking, not responsive to consequences of behavior, low frustration tolerance, and poor social skills.

Effective Screening

Screening is a first step; but a vital and cost-effective first step, particularly in settings that process large numbers of clients. After identifying high-risk individuals, it is important to gather information that is useful in developing a treatment plan.

Client-Appropriate Treatment

There is real value in gathering information that is directly useful in planning therapeutic interventions that will address the client’s specific needs. When screening and assessment are conducted with the intent to help the professional join the client in setting effective treatment goals and planning how to achieve them, the screening and assessment becomes a vital part of the treatment process. It is important to use tools that are accurate and provide clinically useful information.

Despite the overall effectiveness of SUD treatment and despite the demonstrated cost-effectiveness or providing treatment as part of society’s response to criminality, rehabilitative diversionary programs are not maximally effective in reducing rates or recidivism. Part of the solution lies in developing interventions that are sensitive to subgroup differences and individuals’ needs. Individuals with SUD differ from one another. They therefore respond differently to different types of treatment.

Matching treatment on the basis or the nature and degree of the client’s psychopathology and sociopathy increases the effectiveness of the treatment. While it may not be possible to fulfill all the mandates, if we wish to reduce recidivism within the criminal justice system, it is necessary to identify the individuals most at risk, determine their treatment needs, and provide treatment tailored to those needs. The SASSI screening tools can be a very helpful first step in that direction.

The SASSI as a Cost-Effective Screening Tool in Criminal Justice Programs

Working with mandated clients can be challenging. Mandates are in place with goals to reduce crime, decrease recidivism in the criminal judicial system, lower the prison population, and cut back on substance use and addiction.

These are all great goals; however, achieving them can be more difficult than proclaiming them. Professionals in the fields of health care,criminal justice. and other social services are given the charge of executing the mandates and bringing the goals to fruition.

Addiction is a serious and widespread health problem: it has a devastating impact on individuals, their significant others, and society. As a health care problem, substance use disorder (SUD) is tied to issues in criminal justice. One of the common consequences of SUD is legal difficulties.

Money, a central issue underlying all mandates, is certainly a complex issue in SUD treatment. It costs money to treat SUD, but it costs more not to treat individuals suffering from them. With so many cutbacks and rising costs, professionals have been asked to do more with less. We are asked to balance the complex and often contradictory needs of our clients, referral sources, funding agencies, boards of directors, and society.

SUD treatment is intimately tied to the criminal justice system. Many of us work directly within the criminal justice system, and many more of us serve clients who are referred by colleagues from courts and correctional programs. There is an expectation that our services will address the mandates. We are expected to rehabilitate individuals, cut back on drug abuse, reduce crime, lower jail populations, and be cost-effective. We are expected to do more, do it better, and do it all with fewer resources. One way to cut back costs is by conducting early interventions. The SASSI screening tools help address the challenge of early intervention by providing a means of identifying and addressing risk. A first step in reducing recidivism in the criminal justice system is to screen legal offenders to identify individuals who are at greatest risk for ongoing legal difficulties and who are likely to have an SUD to provide them with appropriate and timely treatment.

A Common Element in Domestic Violence: Substance Misuse

The following profile is for a 38-year-old male, “Blair,” who has been mandated to counseling following an instance of spousal abuse. First, note that the scale scores do not meet the criteria for classifying Blair as High Probability of having a substance use disorder (SUD).  However, the Face-Valid Alcohol (FVA-12) and Face-Valid Other Drugs (FVOD-13) scores are moderately elevated above the mean (50th percentile) since they are more than one standard deviation from the mean and above the 85th percentile. It is important to recognize that FVA and FVOD are not just measures of frequency and quantity of consumption. Rather, they are mostly measures indicating acknowledgement of significant negative consequences as a result of substance misuse, as well as possible loss of control and using as a coping mechanism. Thus, even moderately elevated scores that do not in and of themselves lead to classifying the person as high probability of having a SUD are often indicative of some level of substance misuse. It is important to investigate this further. We not only want to establish whether substance misuse is a current or past pattern of use, but (in the context of this client’s reason for referral) further investigation is also needed to determine more about the relationship between physical abuse and substance misuse in this client’s life.

Note that the Obvious Attributes (OAT-1) score is low, i.e. it is below T40 where less than 15% of the normative sample typically scores. This type of OAT score suggests that Blair does not acknowledge the typical negative attributes or behaviors commonly associated with substance misusers such as impulse control problems, low frustration tolerance, impatience, a tendency to hold grudges, etc. An OAT score this low suggests it is not simply that he does not perceive himself as engaging in such behaviors, but that he actively (consciously or unconsciously) distances himself from any hint that he has such tendencies. In other words, he finds it difficult to acknowledge common weaknesses, personal limitations or human foibles and certainly does not see himself as being in any way similar to those who have substance problems. Often, people who come from homes that were dominated by abuse, substance misuse, or other problems are motivated to see themselves as not being like the primary abuser in their family of origin. His very elevated FAM score (FAM-14) and to some extent his somewhat elevated SYM (SYM-5) score suggest that he may have lived in an environment affected by substance misuse.

The Subtle Attributes (SAT-2) score is also significantly below average, and this can often indicate a person who may exhibit strong feelings of hypersensitivity to what others think of him stemming from his perception that others frequently reject him and unfairly judge and criticize him. This score suggests that Blair may be highly attuned to others’ opinions and may perceive slights or criticism, even when none are intended. 

The Defensiveness score (DEF-11) is very significantly elevated. This often indicates someone who has their guard up and answers the questions by endorsing only things that may make them look more positive. This is not particularly abnormal in cases like Blair’s where there are situational factors putting him at risk of losing something important to him. Since Blair is being evaluated following an accusation that he beat his spouse, he is naturally on guard. The defensiveness could also reflect a more general tendency to avoid seeing and acknowledging any personal limitations or weaknesses and is somewhat confirmed by his very low OAT score as discussed earlier. Regardless of the cause, it is important to recognize that Blair probably approached the screening process in a defensive manner and because of this there is also a higher-than-normal possibility of a false negative and potentially a possibility that Blair minimized some of his symptoms of misuse on the more face valid scales such as the FVA, FVOD and SYM.

As mentioned earlier, Blair’s score on the Family vs. Controls (FAM-14) scale is significantly elevated. The FAM scale is composed of items that tend to identify individuals who may have been involved in a family of origin in which there was significant substance misuse. People who have high FAM scores often may obsessively focus on the needs and feelings of others. It is therefore interesting to contemplate how a high FAM score might fit as a characteristic of a perpetrator of domestic violence since spousal abusers are not generally thought of as “caretakers.” The crucial element may be the tendency of individuals who score high on the FAM scale to base their happiness and their sense of well-being on the behavior of others, leading to a need to control. Violence can be an extreme expression of a profound need to control.

Based on his SASSI scores, the Decision Rules result indicates a low probability of Blair being diagnosed as having a SUD. However, the significantly elevated DEF score cautions that there is an increased possibility of a false negative result (i.e. test-miss). His FVA and FVOD scores, while not high enough by themselves to provide a “high probability of a SUD” result, were clear indicators of acknowledged negative consequences from misuse of substances. Given the fact that many people with DEF scores as high as Blair’s often minimize some or a lot on the face valid scales to make themselves look better, there is still a possibility that Blair may suffer from a substance use disorder. Substance misuse is a common ingredient in domestic violence.

Domestic abusers often do not assume responsibility for their behavior, claiming that the victim “made me do it.” Blair’s SASSI profile corroborates and expands on this. The low SAT score suggests that Blair may have this victim mentality, and the low OAT score suggests that he is indisposed to see in himself the very tendencies that are likely to lead to spousal abuse such as low frustration tolerance, poor impulse control, anger management problems, a tendency to hold grudges, etc. The high-DEF score suggests a broader proclivity not to acknowledge personal limitations and to only endorse positives; and an extreme focus on others, as suggested by the high FAM score, could lead to an inability to deal effectively with interpersonal conflict. Ongoing comprehensive assessment should be directed toward determining more precisely the role of substance misuse in Blair’s spousal abuse. Treatment should also be directed toward helping Blair perceive and act in accord with appropriate personal boundaries. He is likely to need help in learning to accept and deal with interpersonal conflict and to assume greater responsibility for his behavior. As it stands, his extreme need to control others may lead to poor social judgment that allows him to construe violent acts as mature behavior and provides him with a rationale for excusing the inexcusable.

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).

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Supporting the SASSI Mission Through Story: Introducing The Addict’s Wake Film Series

As a filmmaker dedicated to exploring substance use disorder and recovery, I created The Addict’s Wake film series to deepen understanding, spark dialogue, reduce stigma, and break down the silo mentality. It’s an honor to share this work with the SASSI community, whose tools and research have helped so many professionals respond to addiction with precision and compassion.

Like SASSI’s evidence-based screening instruments, the films are designed to support professionals across treatment, education, justice, and first response systems—bringing the human stories behind the data into clear and powerful focus.

What is The Addict’s Wake Film Series?

The Addict’s Wake is a three-part documentary film series that explores the impact of substance use disorder and declining mental health from multiple angles—community, education, and first response—offering distinct tools for professionals working in treatment, prevention, and recovery support.

  1. The Feature-Length Film – The Addict’s Wake
    This award-winning documentary follows the story of Brown County, Indiana—a rural community overwhelmed by addiction—and its journey toward recovery. Through intimate interviews with individuals in active use and recovery, their families, and community leaders, the film reveals the deep-rooted effects of addiction and the resilience of those fighting back.
  2. The Educational Film
    Designed specifically for use in high schools, colleges, treatment centers, and community groups, this version featurescompletely different footage from the feature-length film. It focuses on education, prevention and the connection between mental health and addiction, offering a practical, age-appropriate resource to spark discussion and awareness among youth, families, and professionals.
  3. The Law Enforcement & First Responder Film
    Tailored for professionals on the front lines—police, EMTs, firefighters, and correctional staff—this film uses original footage to explore the toll addiction takes on public safety; while also highlighting ways law enforcement and emergency personnel can play a compassionate, constructive role in the recovery ecosystem.

How the Film Series Supports the Work of the SASSI Institute:

  1. Humanizing the Data:
    • SASSI tools uncover patterns of substance use—our films show what those patterns look like in real lives, families, and communities.
    • The personal narratives help viewers move beyond statistics to a fuller understanding of SUDs.
  2. Enhancing Training & Engagement:
    • Whether you’re training clinicians, probation officers, educators, or first responders, these films add emotional impact and real-world relevance to technical instruction.
    • When used alongside SASSI assessments, the films help professionals interpret data with greater insight and compassion.
  3. Reducing Stigma in Practice:
    • Viewers often report a shift in mindset after seeing the films, becoming more aware of the complexity and humanity behind addiction.
    • This aligns with SASSI’s mission to support treatment, not punishment, and care over judgment.
  4. Improving Communication:
    • The film series serves as an effective conversation starter with clients, families, and teams—opening the door to honest dialogue about substance use and recovery.
    • Ideal for intake sessions, classroom discussions, or community forums.
  5. Flexible Use Across Settings:
    • With tailored content for general audiences, students, and first responders, the film series can be adapted to support many of the sectors SASSI already serves—from justice systems to education and public health.

Why It Matters to SASSI Users:

By pairing SASSI’s evidence-based screening tools with The Addict’s Wake film series, professionals gain a more holistic approach to addressing substance use—one that honors both the science and the story.

To explore licensing options or learn how to integrate the films into your SASSI training, programming, or community outreach visit TheAddictsWake.com or contact Lisa at lhall@glorygirlproduction.com

Lowering Defensiveness in Clients

In our last blog we discussed a profile with defensive responding on the SASSI. In this blog, we would like to discuss strategies for handling clients who respond in this manner and the steps that might be taken to reduce defensiveness prior to administration of the SASSI.

The two factors most frequently related to defensive responding are 1) the purpose of the evaluation – i.e. to determine if there is a high probability of a substance use disorder and 2) the context or setting in which the evaluation is taking place – i.e. situational factors that may result in serious consequences for the individual such as jail time, loss of a job or loss of child custody. While there may be little that can be done to change the reason for a SASSI screening, there are a few things you can do to reduce the effect of the stigma and fear that many individuals feel in legal, EAP, or child welfare settings. Research suggests that professionals working with a client in any setting are more likely to have positive successful results with that person if they are able to develop a positive rapport with them. Specifically, you can help the client view your role as one of a helping professional who values them as an individual, recognizes and is empathetic to the difficulty they are currently facing and desires not to punish or demean them, but to assist in getting them any help they may need.

Building rapport with a client before presenting the SASSI to them can be as simple as meeting them in the lobby, smiling at them genuinely, asking about their well-being, and spending some time talking to them in a manner that you would use with anyone you were interested in getting to know better, rather than immediately “getting to the business” of the trouble that brought them there. Talking to the client in this friendly, engaging and empathetic way can be useful in helping the client to develop a higher level of trust in you, to lower their defensiveness, and to be more forthright and honest in their answers on the SASSI questionnaire. Using this procedure gives you a chance to put the client at ease and reduce any perceived threat by beginning to develop a trusting and empathic relationship. Letting clients know that you understand their pain and acknowledging how scary it must be to go through this process will also help to reduce the fear and apprehension that often leads to defensive responding.

Additionally, clinical experience has shown that clients tend to respond less defensively when told in advance that they will have a chance to talk over their answers to the questionnaire with you after they’ve finished. Letting the client know upfront that you will discuss their responses with them after they finish gives clients the message that you view them as important and value their input and perspective. One very common fear among mandated clients is that they will be mistakenly or unfairly judged by a system that doesn’t care much about their well-being. If clients know that you are someone who will not jump to conclusions and are willing to listen to their point of view, they will usually have less of a reason to feel threatened. Letting them know that the questionnaire is simply a way for you to get to know them better and to find out what problems, if any, you can help them with, as well as telling them that there are no right or wrong answers increases the likelihood that they will respond in a more open and forthright manner. It is also often useful to refer to the SASSI in terms that are not perceived as negative such as “questionnaire” rather than “test”; “survey” rather than “screening instrument.” Taking these steps will help to ensure that clients will be more open to hearing your feedback and comments when it is time to review the SASSI results.

In short, the two most effective ways to reduce the likelihood of defensive responding on the SASSI are to 1) spend some time building a positive trusting rapport with the client before ever introducing the SASSI or talking about why the client is seeing you, and 2) administer the SASSI in the context of an empathic and trusting relationship and let the clients know that they will have a chance to review the results with you.

If you would like to discuss any of your clients screening results, feel free to call the free clinical helpline at 800-726-0526, option 2.

Young Parent in Custody Evaluation: Low Probability with High DEF

The profile being discussed is for Julia, a 21-year-old single parent female, who is participating in mandated counseling following an allegation that she has been neglecting her child. The child was removed from her care and placed with family members temporarily. This counseling will play a major role in her being allowed to resume custody of her child.

There is probably no circumstance more likely to evoke feelings of defensiveness in a person than revealing the details of personal, family life, and private attitudes for others to scrutinize, particularly when other people are given the power to determine an individual’s parenting abilities and possibly remove one’s child from custody. It is no surprise then that Julia’s DEF score is elevated, given the difficult situation she is in. In reviewing Julia’s SASSI scores, she does not meet the criteria for classification as High Probability of having a substance use disorder (SUD). While elevated DEF scores, when coupled with a Low Probability result, can potentially imply an increased possibility of the SASSI missing an individual with an SUD (a false negative), an elevated DEF may also reflect serious and difficult situational factors facing Julia with custody of her child at risk.

The most striking and important feature of her profile is that most of her individual scale scores are rather “flat”, not really deviating very far from the mean (T Score of 50), which is where most average people would score. Besides the DEF scale score, only the COR score is significantly elevated. This suggests that overall she responded in a generally “average” way (answering similarly to people not in treatment for SUD). The two exceptions are DEF and COR.

Her high DEF score indicates a possible tendency to endorse only things that make her look good to others, to have her guard up so as to not reveal anything about herself that may be viewed as negative. Again, when one is being accused of child neglect and one’s child could be removed from the parent, it is quite normal for that parent to have their defenses, their guard way up and not want to show any weakness or negative traits, even though all humans have weaknesses with which they struggle. Therefore, this high level of defensiveness could be seen as entirely situational or perhaps even a personality trait. In addition, it is noted that while Julia’s DEF scale score is very high, her SAM scale score is not at all high. Prior case studies reveal to us that often when a person has a high DEF scale score and also has a high SAM score, this could be an indicator that the person’s defensiveness may be related to substance abuse. That is not the case here though. It is therefore most likely that her defensiveness is more general and situational rather than being specifically related to substance misuse.

Julia also had a very high score on the COR scale. While this score has nothing to do with the SASSI decision rules leading to a result of high or low probability of a substance use disorder, our experience with high COR scores indicates that a person with high COR scores is answering the questions on that scale very similarly to the way a person with a long history of criminal justice involvement would answer. Therefore, a person with a high COR scale score could be at greater risk of engaging in behavior that may get them arrested. Sometimes certain personality traits of the individual can be found in clients with high COR scores that may contribute to their risk of acting out and being arrested. Therefore, it is often recommended that the therapist explore for signs of low frustration tolerance, anger management problems, poor social skills, poor impulse control or being one who enjoys engaging in high risk behaviors and add these to the treatment plan to try to lower risk.

In summary: While Julia is alleged to have engaged in child neglect, there can be many reasons why a parent may engage in this behavior, with substance abuse being only one of them. As the SASSI is not designed to be a measure of a wide variety of pathologies, but is limited to the role of determining the likelihood of a substance use disorder, the results indicate that substance use disorder is not likely.

It is important to acknowledge the reality of the fear and pain underlying defensive responding on the SASSI. In order to do so, it is valuable to have a good understanding of the nature of your client’s defensiveness. There is no clear evidence in this case that defensiveness is an ongoing characterological feature or personality characteristic of Julia. Her defensiveness therefore is likely to stem from situational factors. Having said that, her high COR score indicates potential risk of engaging in behaviors that could cause her to get in trouble which may be fueled by difficulty controlling her anger and frustration and may cause her therefore to display poor judgement and act impulsively. These potential issues could indeed put her child at risk as well as herself and so should be explored carefully.

Be sure to read our next blog which will discuss tips for reducing defensiveness.

As always, feel free to call our free clinical helpline M-F 1-5 pm ET for assistance in administering, scoring, and/or interpretation of profile results at 800-726-0526 Option 1.

How Telehealth Is Expanding Access to Substance Use Screening with the SASSI

As telehealth continues to reshape the healthcare landscape, behavioral health professionals are finding new opportunities to reach clients in innovative ways. One powerful example is the integration of the Substance Abuse Subtle Screening Inventory (SASSI) into telehealth practices. This trusted tool for identifying individuals who may have a substance use disorder is now more accessible than ever—thanks to digital delivery.

Breaking Barriers with Telehealth and SASSI

The SASSI was designed to help clinicians detect substance use issues, even in individuals who may not acknowledge their struggles. In a telehealth setting, this becomes especially valuable. Clients can complete the inventory from the privacy of their own homes, which may reduce defensiveness and increase the accuracy of results.

But the benefits go well beyond convenience.

Key Benefits of Using SASSI Online in Telehealth

1. Increased Accessibility
Telehealth removes geographic and logistical barriers, giving clients in rural or underserved communities access to screening tools they might otherwise miss. With SASSI Online, clinicians can send a secure link, and clients can complete the assessment from anywhere with internet access.

2. Client Comfort and Honesty
The privacy of a remote setting often helps clients feel more relaxed—especially when discussing difficult topics like substance use. This comfort can lead to more genuine responses, enhancing the SASSI’s effectiveness.

3. Immediate Results for Informed Care
SASSI Online provides instant scoring and interpretation, allowing clinicians to discuss results in real time during a telehealth session. This supports faster clinical decisions and more seamless integration into treatment planning.

4. Streamlined Practice Management
Digitally administering the SASSI reduces paperwork and helps clinicians maintain more organized and efficient records. Results can be securely stored or integrated into electronic health records, improving documentation and continuity of care.

Practical Applications Across Fields

The flexibility of SASSI Online makes it a great fit for a wide range of telehealth services, including:

  • Mental Health Therapy: Screening for co-occurring substance use issues during virtual sessions.
  • Primary Care and Chronic Pain Management: Identifying patterns of misuse that may complicate treatment.
  • School Counseling: Using the Adolescent SASSI (SASSI-A3) in remote appointments to catch early signs of substance use in teens.
  • Employee Assistance Programs (EAPs): Conducting screenings during remote wellness check-ins.

Tips for Telehealth Providers

To make the most of the SASSI in a remote care setting:

  • Walk clients through the process clearly—what to expect, how long it will take, and what the results mean.
  • Integrate the SASSI results into a broader conversation about mental health, support systems, and next steps.
  • Follow up with resources, referrals, or treatment recommendations tailored to the client’s needs.

Looking Ahead

Telehealth is here to stay—and tools like the SASSI are evolving alongside it. By combining clinical insight with the power of technology, providers can offer thoughtful, early intervention for substance use—without waiting for an in-person visit.

Whether you’re a therapist, nurse practitioner, school counselor, or case manager, SASSI Online makes it easier than ever to offer this critical screening tool in the digital age.

Interested in learning more about integrating the SASSI into your telehealth practice?
Visit www.sassi.com or contact our team for a demo of SASSI Online.

SASSI Supporting Community Corrections

The SASSI Institute supports community corrections by providing tools, training, and resources to help probation officers, case managers, and other professionals identify substance use issues among individuals in the criminal justice system. Our tools can enhance decision-making, reduce recidivism, and support successful rehabilitation efforts.

Key Ways the SASSI Institute Supports Community Corrections:

1. Validated Screening Tools:

  • The Adult SASSI-4 and Adolescent SASSI-A3 are effective tools for identifying substance use disorders, even in individuals who may deny or minimize their use.
  • The Correctional (COR) scale may be useful in promoting discussion of the basis of clients’ legal difficulties, if any, and behavioral patterns that prompt other types of sanctions. Discussions focused on ways to avoid future problems can be valuable for the client.

2. Efficient Assessment Process:

  • SASSI tools are quick and easy to administer, typically taking 15 minutes to complete, which minimizes disruption to case management workflows.
  • Scoring can be completed manually or through online software, allowing for rapid scoring, interpretation and integration into case plans.

3. Objective Decision-Making:

  • The SASSI provides objective scoring to support probation and parole decisions and help in identifying high-risk behaviors.
  • Can help in determining appropriate levels of intervention based on the likelihood of substance use disorders and scale scores.

4. Treatment Matching and Referral:

  • The SASSI can offer insights into individuals’ substance use patterns and behaviors, aiding in referrals to suitable treatment programs.

5. Training for Community Corrections Professionals:

  • The SASSI Institute provides workshops to train professionals in using SASSI tools effectively.
  • Training ensures probation officers and case managers can confidently interpret results and apply them in their work.

6. Reducing Recidivism:

  • By identifying substance use issues early, SASSI tools help community corrections professionals intervene before substance use leads to further criminal behavior.
  • The SASSI can supports rehabilitation efforts by addressing substance use as a contributing factor to criminal activity.

7. Resources for Special Populations:

  • Offers tools and guidance for working with diverse populations, including adolescents, monolingual Spanish speakers and IAmerican Sign Language.

8. Ongoing Support:

  • Access to our Free Clinical Help Line for assistance with interpreting results and addressing case-specific questions.
  • Updates and resources to keep community corrections professionals informed about best practices in substance use screening and assessment.

Benefits of using the SASSI in Community Corrections:

  • Enhances the ability to identify and address substance use issues in justice-involved individuals.
  • Improves treatment outcomes and supports long-term rehabilitation.
  • Efficient and reliable screening tools reduces workload.
  • Strengthens the link between corrections, treatment providers, and community resources.

The SASSI Institute can help community corrections professionals make informed decisions, improve client outcomes, and contribute to public safety. Large volume SASSI users in federal, state, and local correctional centers can reach out to us about the development of customized reports on a contractual basis to meet specific program needs