Category: Sample Interpretations

BADDS Sample Report

Mr. M. is a 38-year-old Caucasian male, presenting to the DUI Court with a second DUI offense. His first offense occurred and he was sentenced to time served (1 day), one year probation, paid a $500 fine, and his driver’s license was suspended for 90 days. Mr. M.’s probationary period from his first offense ended successfully.   

A year later, Mr. M. was arrested and entered into a no contest plea for drinking and driving under the influence. Mr. M. went before the court and asked for leniency on his conviction, yet expressed willingness to comply with any recommendations set by the court. Judge sentenced Mr. M. to 2 days served in the county jail followed by 2 years of DUI Court participation and 12 months driver’s license suspension.

Background Information: Mr. M. is a manager at a local insurance firm, where he has worked for the past nine years. Mr. M. has a bachelor’s degree in business from a state college. Mr. M. is married and has two young children. Mrs. M. is employed full-time as a teacher.

Medical and Mental Health History: Mr. M. is of average height and weight. He stated that his health is very good without significant medical problems, except for a back injury that he sustained last year that continues to cause him pain. Mr. M. does smoke cigarettes. He has a family history of cardiovascular disease and high blood pressure. Mr. M. did not report any history of mental health problems of his own or in his family.

Substance Use History: Mr. M. reported that he began drinking when he was 17 years of age during his senior year in high school. Mr. M. stated that he drank on weekends “with the guys” while in school and reported his use as “normal.”  He maintained above a 2.5 grade point average throughout college and did not report any alcohol violations during this time. He did report drinking to intoxication approximately two to four times per month.

After college, Mr. M. was hired by his current employer. He reported that during his years with the company, he received excellent evaluations and was quickly promoted to his current managerial position. Mr. M. stated that after his first DUI conviction, he has tried to maintain a “no drinking and driving” policy and limits his alcohol intake to weekends only.

Mr. M. attributed his recent absences from work to lower back pain. Mr. M. denied drinking in the morning, withdrawal symptoms such as shaking or sweating, or loss of control of his use. He denied experiencing any recent blackouts or other behavioral changes.

DUI Court Intake: The County DUI Court uses the Behaviors & Attitudes Drinking & Driving Scale (BADDS) at entry into the program and following the approximate two years of participation in drug court activities. Mr. M.’s BADDS results follow.

BADDS Pretest Results: Mr. M. has high scores on four scales: Rationalizations for Drinking and Driving (RD: 27), Lenient Attitudes (LA: 29), Likelihood of Drinking and Driving (LD: 35), and Drinking and Driving Behaviors (DB: 03). Mr. M. scored in the moderate range for Riding Behaviors with a Drinking Driver (RB: 01).

Mr. M.’s responses on the alcohol use and history items, in contrast to his stated attempts to limit his drinking to weekends, revealed that he drinks alcohol daily. Responses also showed that either he or someone significant to him has been in an alcohol-related accident. Despite his best efforts to refrain from drinking and driving, Mr. M. acknowledged that he drove under the influence and rode as a passenger in a vehicle of someone who had been drinking, within the month prior to his arrest.

Mr. M.’s high scores on the RD, LA, LD, and DB scales indicate that he has endorsed and acted upon risky beliefs and attitudes about drinking and driving. In addition, his responses on the LD scale suggest that it is acceptable to him to drive under certain circumstances after having at least three or four drinks. Mr. M.’s perception about how many drinks he can consume in one hour and drive safely and legally is just below probable legal limit based on his body weight.  Further, Mr. M.’s RB score indicates that he has recently ridden in a vehicle with an impaired driver.

Summary and Recommendations: Mr. M. enters into the DUI program as a sentencing requirement set by Judge Andrews after completing a 2-day incarceration. 

Mr. M.’s BADDS results indicate that he is a suitable candidate for a DUI program that would help him learn about the risks of drinking and driving, and examine his beliefs about safe driving behavior. In addition, an evaluation for substance use disorder will be conducted in the next session with Mr. M.  Without intervention, Mr. M.’s scores suggest that he is at high risk of recidivism. The re-administration of the BADDS prior to his completion of the DUI court program would help to assess if there has been change in his risky behaviors and attitudes that could continue to put him at risk for further problems with impaired driving, if they are not adequately addressed.

PDF Version Available for Download

A SASSI-4 Profile Analysis: Reading Aloud the Questionnaire and Interpretation of Low Scores

We regularly get inquiries about the acceptability of reading the questionnaire to a client who may have difficulty with their reading skills. We discourage the evaluator from reading the questionnaire to the client for a variety of reasons, but the primary one concerns the validity of the results. No matter how careful the reader might be, the tone of voice or emphasis on a particular part of the question may lead the client in one direction or another. Or the client may interrupt with a question regarding the meaning of a word or intention of a particular question. This is why we offer a professionally read audio CD of the SASSI-4, Adolescent SASSI-A3 and Spanish SASSI paper and pencil versions for clients who have reading difficulties. We hope in the future to be able to offer this for the online platform as well. Please contact our customer service department for ordering information.

Another frequent question is related to the clinical interpretations of the “low” scores on the profiles. These mostly relate to the subtle scales which include the OAT, SAT, DEF and SAM scales. Most callers know what a low DEF indicates. And SAM has no clinical interpretation.

So what about those low OAT and SAT scales?  What does “low’ mean? A low score is anything below the 15th percentile on the graph.  In the example to the right, the caller indicated that she was doing an assessment on a health care professional who had been arrested for her one and only DWI the previous year, had completed her alcohol education class and needed this evaluation as a final step for probation. She was not in trouble in her job and in fact, highly regarded in her profession. Given the client was at the end of her requirements, the evaluator was somewhat concerned with the results and what it meant.  The instructions were given to answer the FVA/FVOD side for the last twelve months. Her RAP is zero. Her Prescription Drug Scale is zero. She has ‘no’ on all the rules so came up with a Low Probability of having a Substance Use Disorder. However, her DEF of 9 is highly elevated. Elevated DEF scores increase the possibility of the SASSI missing individuals with a substance use disorder. Elevated DEF may also reflect situational factors. Note that the SAM is within the norm so it is probably more likely that her DEF is situational given the context. She also has an OAT score of ‘O’ and a SAT score of ‘2’. Both are below the 15th percentile.  A low OAT indicates someone has difficulty acknowledging personal limitations or shortcomings. A low SAT indicates someone who might have a ‘chip’ on her shoulder, a hypersensitivity to others or feelings of rejection.

So even though this client is nearing the completion of her probation requirements, we still get a picture of someone who is highly guarded (DEF), has a hard time acknowledging shortcomings (OAT) and may continue to exhibit resentment (SAT) for the situation she is in. Perhaps this is due to her profession, or perhaps it is her personality. What the results give the evaluator is clinical direction on how to approach the client to help reduce her defensiveness and give her permission to open up. Affirming how demanding her job is and how on top of things she must be could be a pathway to discussing her feelings of shame related to the DWI and how it might be affecting her self-esteem. Could she be minimizing her use of alcohol and drugs? Perhaps, but as we strongly express, the SASSI is only one part of a clinician’s assessment. Hopefully, with the input of all the information you have, the clinician can evaluate the results which fit the context for this client.

PDF Version Available for Download

A Review of a SASSI-4

The SASSI-4 I am reviewing is interesting for what it is not.

The client was instructed to complete the FVA/FVOD for the last 12 months.
The client is a 34 year old male with a history of drug and alcohol use. He reports that two and a half years ago he successfully completed treatment. He stopped doing drugs but continues to consume alcohol. He was being evaluated by the order of the court for an “altercation with his ex-spouse”. He does meet multiple rules and comes up with a high probability of a substance use disorder. Remember the number of Rules met does not mean a more significant disorder. The diagnosis is based on the DSM-5 with the designation of mild, moderate or severe based on the number of symptoms met.

As seen on the profile sheet, he has a number of elevated scales including the FVA, SYM, OAT, SAT and COR. What is interesting, is that his DEF is not elevated and is below average staying within the norm. For domestic violence cases, this is fairly unusual. Often we see an elevated DEF above the 85th percentile. The FVA and SYM scores indicate an openness and acknowledgment of his use as well as symptoms and consequences. The elevated SYM also indicates he is either hanging out with or from a family of heavy users. In this case, he disclosed his family has a history of alcohol abuse.

The elevated OAT score indicates that he can probably identify with other substance users and those behaviors we often see with substance abusers i.e. impatience, resentment, self-pity and impulsiveness. On the other hand, his elevated SAT indicates a lack of awareness or insight or simple denial of the impact alcohol is having on him. He readily acknowledges his past drug issues but has put alcohol in a separate category. His final elevated scale is COR. Regardless of any past or present legal issues, we encourage evaluating for those behaviors that impact the ability to make good choices. These behaviors can range from poor social skills, low frustration tolerance, risk-taking behaviors to impulse control or anger management issues.

Utilizing the results: The evaluation started out as a domestic violence case but transitioned to also include substance use. The fact that the client was open about his alcohol use, not defensive and has a successful treatment history suggests he may be willing to take a look at his alcohol use and its impact on his behavior. His elevated OAT score does indicate treatment readiness and he is not going to feel out of place in a group setting. The emphasis will be to help him connect the dots between his alcohol use and any impulsive behaviors. This does not take the place of any recommended intervention for anger management issues he may have. The administrator has a good opportunity to facilitate the client to continue the work needed on his recovery and deal with all his issues.

We hope this is helpful for you in your work with your clients. As usual, the free clinical helpline is open for your questions M-F, 11-5, (EST). Don’t hesitate to call us whether you are new to the SASSI or an old hand.

PDF Version Available for Download

The “Unaware” Client

The client, Carol, is a 43-year-old married female, a successful business woman and mother of two children. She recently was arrested and charged with her first DWI after leaving a business dinner with sales associates. This is the first significant consequence related to her drinking. She claims that she does not have a drinking problem; however, she characterizes her mother as an alcoholic.

As we take a look at her scores, first notice that Carol appears to have responded in a meaningful way to the items on the SASSI-4 (RAP=0). However, there is some evidence that she may have approached the assessment process in a defensive manner (DEF=8). Despite her apparent defensiveness, the SASSI results indicate that she has a high probability of having a moderate to severe substance use disorder (SAT=7 leading to a positive on decision rule 4).

Given the elevations on the SAT and DEF, we get the sense that Carol may have some difficulty recognizing (high SAT) and acknowledging (high DEF) the nature of her substance-related problems. Yes, it is true that she reports significant problematic use of alcohol (FVA=10). However, it will be important to review with her the content of her responses on the face valid alcohol scale in order to gain some understanding of how she views these consequences. Our experience with the SASSI and our knowledge of the nature of the addictive process suggest to us that individuals who have elevated SAT and DEF scores (especially when OAT is average or below, as is the case here) often have difficulty seeing the manner in which their drinking has pervaded other areas of functioning. Therefore, it is reasonable to expect that much of what she has reported on the FVA may be flavored with a theme of, “I’m so embarrassed about these things, but thank God I don’t have a problem.”

Carol’s FAM score is elevated (13), suggesting that her responses are similar to individuals who have a history of being in relationships with others who are substance dependent. This is often related to a tendency to focus on others and a need to try to control the external environment. Elevated scores on SAT, DEF, and FAM suggest that Carol is likely to have an exceptionally strong tendency to deflect attention away from any suggestion that it is important for her to make significant changes in her life. Carol’s lack of awareness and insight may not only be rooted in her own addictive disorder but may also be fostered by a long history of trying to cover up for her mother and feeling responsible for the family’s welfare.

Despite Carol’s inability to see her substance misuse as a serious problem in her life, the SASSI results clearly indicate that she is likely to meet the diagnostic criteria of a substance use disorder. Therefore, effective treatment planning will need to include some form of addictions therapy, most likely at the outpatient level of care. The therapeutic challenge for the treatment provider will be to establish a working relationship with Carol that is conducive to helping her explore the substance abuse issues in her life. This usually means starting where the client is and moving her in a direction of increased awareness and insight regarding the nature of her own substance use problems and the changes that can help her begin a process of healing and recovery.

Carol comes to the treatment setting with recognition of her mother’s alcoholism. She has a desire to disclose information about her life growing up with an alcoholic mom. This gives the treatment provider a naturally occurring place to begin. As Carol bonds with her therapist in the work of resolving the pain of her childhood, the therapist can help her examine the significance of her own alcohol usage. The therapy can be augmented by support groups in which Carol can learn from the experiences of others who come from similar home environments and from other people who have had to struggle with the reality of their own addiction problems. Ongoing assessment will be helpful during this process to monitor her progress and make adjustments in the treatment plan as necessary. For example, if she is unable to refrain from using, has additional alcohol-related social or legal consequences, or becomes non-compliant in the treatment process, it may be necessary to move to a more intensive level of care.

The emotional impact of growing up in an environment that is dominated by the pain and shame of addiction takes many forms and can exert its influence throughout a person’s life. Carol’s DWI can be a gift. With appropriate intervention, Carol can begin a process of self-examination and growth that will lead to a freer, richer life.

PDF Version Available for Download

Interpreting the Spanish SASSI

Carlos C. is a 36-year-old Mexican-American male who’s Spanish SASSI results indicate that he has a high probability of having a substance use disorder based on “yes” answers to Rules 1, 2, 3, 4 and 6 and because his FPOS score is 5 or less (FPOS=2). Validation studies indicate that 86% of the people who have substance use disorders are correctly classified by the Spanish SASSI based on the Decision Rule (High Probability) and the False Positive Check (5 or less).

In addition, Carlos has an SCS score of 8 or more (SCS=9) indicating that he is more likely to have a substance dependence disorder than substance abuse. In validation studies, the majority of people (77%) who are test positive on the Spanish SASSI and have SCS scores of 8 or more have a substance dependence disorder rather than substance abuse or no disorder.

The Administration and Scoring Instructions and Development and Validation of the Spanish SASSI provide detailed information on interpreting the Decision Rule results, the False Positive and False Negative Check (FPOS and FNEG) and the Supplementary Classification Scale (SCS).

Three of the Spanish SASSI scales, FVA, FVOD and SYM, are composed of “face valid” items that address substance misuse in an apparent or obvious manner. Some questions address inability to control usage. For example, on one of the FVA items, Carlos acknowledged that on several occasions he has had more to drink than he intended to. Other items on these scales reflect usage in order to better cope with negative feelings or other problems. Carlos, for example, reported on one of the SYM items that when he is anxious, he feels the need to drink. The face valid scales also include items that address negative consequences of substance misuse, such as physical, emotional and relationship problems. Carlos indicated on an FVA item that on several occasions his drinking has led to problems with friends and family members, and on a SYM item he acknowledged that he has had a drink first thing in the morning to steady his nerves or get rid of a hangover.

As you can see, by reading clients’ answers to specific questions on the FVA, FVOD, and SYM scales, it is possible to gain greater understanding of the types of problems they may be having with alcohol and other drug usage. Also, providing feedback to clients on the types of problems they have identified on the face valid items of the Spanish SASSI may be useful in the process of establishing treatment goals.

The remaining scales, OAT, SAT, DEF and SAM are subtle scales — i.e., the items that comprise these scales do not address substance misuse in an obvious or apparent manner. Therefore, Carlos’ responses to questions on those scales cannot be readily interpreted. The SASSI Institute provides guidelines for interpreting four similar scales as they appear on the English versions of the SASSI. However, the subtle scales on the Spanish SASSI are not identical to the English scales, and there is not enough information available to formulate guidelines for interpreting them for clinical purposes. The SASSI Institute, therefore, does not recommend interpreting scores on the subtle scales for clinical purposes. We will however, be delighted to help you with scoring or administering the questionnaire.

PDF Version Available for Download

Interpreting the Results of an Adolescent SASSI-A3 with a High OAT Score

Happy New Year everyone!

I received my first Adolescent A-3 call on the helpline and was so excited and when I heard the numbers, I knew exactly why the clinician was calling.

As you look at the profile, you can see most of the numbers are within the norm. He meets Rule 6 so comes up with a High Probability of a Substance Use Disorder and no Prescription Drug Abuse.  So, what clinical information can the scale scores give you with so few scales outside the norm?

Although the FVOD is within the norm, it is above average and as recommended, you can do content analysis of his Face Valid scales. Another scale to pay attention to is the OAT score of 7 which is elevated. This suggests the client can acknowledge personal limitations and shortcomings and identify with other substance abusers. However, he may not want to or think he can change. The other significant score is SAT with a score of 1 which is below the 15th percentile. This suggests he may be hypersensitive to others and comes across as having a chip on his shoulder. This gives you good information on how to approach this client, especially when giving him feedback as you process the results with him because he is not giving you a whole lot of direct information regarding his use.

A word about the VAL of 6. If the numbers had resulted in a Low Probability of a Substance Use Disorder, you would question the results and do further investigation. Because he met Rule 6, there is no need to address the VAL. That said, with the VAL being so high, was this individual trying to manipulate the questionnaire and didn’t succeed?

Finally, users of the older version will notice that the SCS has been eliminated. This will require your use of the DSM-5 to determine the diagnosis and level of severity from your assessment.

Hope this information is instructive and assists you in your practice. And remember, as usual, we are here to help, so give the clinical line a call at 800-726-0526, press 2.

PDF Version Available for Download

Client’s High SAT Score Indicates Lack of Awareness

Bob is a 43-year old male who was referred by his attorney for a substance evaluation following a traffic fatality in which he was driving under the influence. Bob seems to have understood the items and responded in a meaningful way (RAP = 0). There is no significant evidence that Bob was defensive (DEF = 7).

The most salient feature of the profile is the significantly elevated SAT score, which is a key feature in both decision rules that lead to a test positive on the SASSI (Decision Rules 4, 5, 6, and 7). His responses were highly similar to substance dependent individuals regardless of their ability or willingness to report symptoms relevant to substance misuse. Given the lack of evidence of defensive responding, it’s likely that Bob falls in the category of those who are unaware of the full impact of substance use problems in their lives.

Individuals with this configuration of scores are often willing to acknowledge some behavioral problems related to their substance use. Bob demonstrates this by acknowledging significant current and/or past alcohol (FVA=14) and drug (FVOD=12) use. His pattern of responding also indicates some awareness of behavioral problems that are commonly associated with individuals with substance use disorders: low frustration tolerance, self-centeredness, grandiosity, etc. (OAT=7). However, given the elevated SAT, he will most likely not be able to make any connection between his acknowledged use and behavioral problems and their impact on other areas of his life.

He also responds in a fashion similar to individuals who live in an environment dominated by substance abuse (SYM=6). Although the SYM is not extremely elevated, it does tend to support the notion that Mr. B. may view his substance use as normal. Further content analysis may reveal additional factors about his life circumstances that might be important to consider in treatment planning.

Bob may be relatively well presented. He may also appear to be emotionally detached while maintaining a sense of pragmatism regarding his situation. Relatively poor insight and self-awareness are commonly present in these types of profiles. It’s not that Bob refuses to understand or is intentionally resistant; he literally doesn’t grasp that his substance use may be a problem that requires further exploration. In his mind, external factors or stressors may be to blame for his current predicament. The possibility that this tragic incident may be directly related to a substance use problem would be quite difficult for Bob to understand at this time.

PDF Version Available for Download

Differentiating between Substance Use and a Substance Use Disorder in Teens Using the SASSI-A3

This sample case is based in part on SASSI-A3 scale scores that were called into our clinical help desk. The client, Josh (not his real name), is a 17-year-old male who was a senior in high school at the time of the assessment.

Josh was referred to the school counselor after he was caught drinking beer on the school campus with some of his friends during a school-sponsored activity. Josh, an above-average student with no prior history of alcohol or drug-related problems, plans to attend college in the fall. His parents reported that Josh had been staying out later than usual on some weeknights and that they confronted him once about alcohol on his breath.

The SASSI-A3 was administered as part of the assessment to rule out the possibility of a Substance Use Disorder. The scores are illustrated in the accompanying profile. The results indicate that Josh has a Low Probability of having a Substance Use Disorder (Rule 1-8 answered “no”). The VAL and DEF scales arenot elevated, suggesting that there is not a particularly high likelihood that the SASSI incorrectly missed identifying Josh as having a Substance Use Disorder. He appears to have responded to the instrument in a forthright manner and therefore probably provided a reasonably accurate account of his alcohol and drug-related experiences (DEF=4). On the FVA items he reports using to cope with problems, moderate loss of control (drinking more than he intended to once or twice), and negative consequences including the current incident and confrontation with his parents. Both the FRISK and ATT are elevated so some attention should be given to who Josh is associating with along with his beliefs and values regarding substance use.

Given the Low Probability outcome, it is reasonable to infer from this result that Josh is most likely involved in a pattern of substance use that is experimental/recreational in nature. However, given that he has begun to experience some issues of loss of control and negative consequences, he may be at risk for developing a substance use problem if he does not receive adequate assistance and support for behavioral change. This may be a particularly important consideration when he goes to college and is likely to be exposed to peer groups in which regular substance use is the norm.

The SASSI-A3 results indicate that Josh is not likely to have a Substance Use Disorder at this time. Additional assessment information did not indicate that Josh has been experiencing risk factors over and above what was already indicated on the SASSI-A3. He will most likely benefit from a cognitively based educational/ prevention program geared towards increasing his awareness of the harmful effects of alcohol use. Values clarification and exploring alternate means of peer group support may also be effective in helping Josh make healthier social choices.

PDF Version Available for Download

SASSI Results Highlight Excessive Drug Use Including Rx Abuse

Angela T. illustrates a profile often seen in people who acknowledge that they use drugs excessively and have come to rely on them as a coping resource.

Angela’s scores on the SASSI-4 meet the criteria for classifying her as having a high probability of a substance use disorder. Angela’s score on the Rx scale also indicates a high probability of prescription drug abuse.

Reviewing her scale scores reveals openness in disclosing her use of drugs and alcohol. On FVOD and SYM, Angela acknowledges extensive use of drugs and many negative consequences and symptoms of abuse. Examining her answers to specific items on these scales may help you counsel Angela, and may suggest good starting points for a more detailed history of her use of alcohol, drugs and prescription medications.

On SYM Angela acknowledges serious substance misuse that she acknowledges resulted in making her problems worse, increased tolerance, excessive use, and wishing she could cut down her use of substances. Her OAT score is in the average range, which can indicate that Angela does not necessarily align herself with those characteristics associated with substance abusers and she may not see herself as a ‘drug addict.’

With her Prescription Drug scale (Rx) score of 6, it is useful to look at those individual items as well.

Angela’s moderate DEF score suggests she can be open and realistic in acknowledging her difficulties and substance misuse. The rest of her scores fall within the normal range, between the 15th and 85th percentiles.

Given Angela’s high level of drug use and consequences, you might consider a more comprehensive evaluation to determine whether she can maintain sobriety and function well enough to benefit from a treatment program. She may need supervised detoxification or other intensive intervention.

You may find Angela able to acknowledge that she uses drugs frequently and perhaps that she drinks to excess. However, she may not see that her behavior varies dramatically from others who don’t have a substance use disorder. Feedback on where her scores fall on the profile sheet may help her see that her behaviors are not typical. Examining the items that Angela endorsed on the FVA, FVOD, SYM, and Rx scales may provide useful insight into her motivations for using and help her see the consequences that result from her use. Angela may need your help to acknowledge her pain and to recognize that there are alternatives to her current lifestyle.

The SASSI-4 screens for Substance Use Disorder (SUD) along the full DSM-5 continuum of severity: mild, moderate, and severe. A brief scale, Prescription Drug (Rx), was added to accurately identify individuals likely to be abusing prescription medications. Read a full sample assessment report on Angela T. in the SASSI-4 User Guide & Manual.

PDF Version Available for Download

Enhancing Your Clients’ Insight and Motivation Using the SASSI

Through the years, we have had the opportunity to share inspirational stories with our colleagues about their experience using the SASSI. One such story came recently from a psychologist who uses the SASSI in his practice. This was a gratifying story for us to hear and we are pleased that he has allowed us to share it with you.

The mother of a 22-year-old woman called me because she felt very strongly that her daughter Aimee (not client’s actual name) had an alcohol problem. But Aimee was adamant, no question about it, “I don’t have a problem.”

After some persuasion, Aimee agreed to come into my office, and I invited her mother to stay in the office during the interview, with Aimee’s permission. I really think Aimee was very certain that there wasn’t a problem, and that having Mom there during the process would convince her mother of this, too. I said, “You know, Mom can be a bit of a reality check here, but I’m listening to what YOU are saying.” Aimee’s mother agreed to just listen, since she had had her say when making the referral.

We talked about it, and Aimee restated that she didn’t have a problem. She was just not aware of any bad consequences coming from drinking. Aimee really seemed to believe what she was saying, “My friends and I, we don’t have any consequences; we just enjoy drinking.” I told her that was fine and asked, “Would you like to find out if you, in fact, do have a problem, or would you rather not know?” Of course, this is right in front of Mom. And she thought about it, seeing herself as being free to say “no.” But she did say, “Yeah, I think I would want to know.” When asked about each of the DSM diagnostic criteria for substance use disorders, Aimee answered no to all symptom questions.

Then, I brought out the SASSI-4, and told her a little bit about how it would compare her responses to two known groups of people: those who have a problem and know it, own it, and the other group that is just as aware that they do not have a problem, and own that. And we will see how your responses go. She agreed that that sounded good. She took the SASSI-4, and her responses showed a high probability of having a substance use disorder. This was very surprising to her. Then I went back and showed Aimee her scores on the FVA and the SYM.

When she looked at those scores, she could see by the profile that the consequences she was getting were way out of line compared to ordinary people who drink. She runs with folks whose norm is to drink a lot, and there is a history in her family of substance use issues. She just said, “It’s almost like thinking about it and realizing that you are surrounded, and your best bet is to give up!” She surrendered to the idea that, “Yes, I’ve got a problem.” From there on she was willing to do something about it. Aimee made an appointment to see me again, and we went on from there.

Let’s say that the SASSI did not exist, and I would have had only the DSM criteria and her history. I would have had her mother’s reflections and thoughts and observations, and—I don’t feel certain, but I’m guessing—she would have walked away with the understanding that she did not have a problem. She would have gone on as she had been—because I would not have been able to make a case that she did have a problem, because there would have been no data to base that on. She may well have been one of those who left the interview, and for the rest of her life said, “No, I don’t have a problem, so get off my back.” In a sense, I really believe that the SASSI saved this young woman’s life, or at least spared her significant pain. I have always been impressed by the accuracy of the SASSI. It picks up on people who really are “sincerely deluded.” It’s interesting that her score on the Defensiveness (DEF) scale was not particularly elevated, so it was not that she was being defensive, she was just unaware of how her drinking and symptoms associated with it were beyond the norm. Her elevated SAT score – at the 98th percentile – supports the interpretation that Aimee has little insight into what may be motivating her to drink with her friends, or the negative consequences that follow from spending time that way. I am very grateful for the SASSI, and I wouldn’t do an assessment or a screening without it. I literally would refuse, because just the verbal reports can be so misleading, although not intentionally misleading, necessarily. Clients will compare themselves with the people they know who are much further along in the addiction process, and not really understand that their own behavior is a problem, just because their own behavior is not yet as severe as what they see in others. The SASSI can put a client’s use into a broader, and often more realistic context.

Original depiction, written by Nancy Winningham, M.A. based on an actual experience a clinician had using the SASSI with a client.  Adapted to reflect SASSI-4 information.

PDF Version Available for Download