Tag: Face Valid Scales

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.

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Notes from the Clinical Director: Clinical Interpretations

One of the trickier aspects of incorporating the SASSI results in a substance use assessment is extracting the clinical interpretation of what elevated scores mean and the relationship between the scales. If you have taken SASSI training, especially the Clinical Interpretation session, you were introduced to ‘Profile Configurations.’ This section gets more in-depth into interpreting the scales and clinically drawing on information that can better inform how to work with your client as well as consideration of treatment modalities.

Starting with the Face Valid Alcohol and Other Drug Scales versus Subtle Scales, which when one of those is elevated can make a big difference on how you approach your client with the results. A high probability result based on only Face Valid scales can indicate good treatment readiness, life-style issues (that is, how they are functioning at work, school, home, etc. and been acknowledged by the client), with behavioral consequences being greater than psychological addiction. The client can readily tell you how their life has become unmanageable. With this client, group therapy and/or support groups could be considered.

A high probability result based only on Subtle Scales is going to feel more like a brick wall. The client exhibits less awareness and may not be able to, or doesn’t want to acknowledge a problem. This could be based on having experienced only a few negative consequences so they do not feel the impact of their addiction. They could also come across as defensive. Finally, they could be ‘sincerely deluded’ and at this point, unable to connect the dots for themselves. This client will need a lot of support to become aware that their use of substances is having an impact on their life functioning. Individual therapy may be the initial therapeutic intervention working towards other modalities as needed.

If you have attended Session II of SASSI Training, you received an outline of scale interpretation. But we would like to make sure all SASSI users have access to this valuable resource. You can download a copy by clicking the following link: “SASSI Scales in Interpretation & Feedback.”

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 888-297-2774 or 800-726-0526, press 2.