Tag: High ATT

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.

Reviewing an Adolescent SASSI-A3: Vaping Issue

This is an issue that may be turning up in your clinical practice. The caller wanted help with a profile interpretation on a 13-year-old male who had turned in a vaping pen. The school was mandated to do a substance use evaluation as a result. The online report indicated “inconsistencies” in the results so the counselor wanted more information. The client was instructed to complete the FVA/FVOD side for his whole lifetime.

The overall result, based on all the rules being ‘no’, came up with a Low Probability of a substance use disorder. The Prescription Drug Scale was zero. However, the Validity Check Scale was 6 so further evaluation was recommended. Elevated VAL and DEF scores coupled with a Low Probability result increases the possibility of the SASSI missing individuals with a substance use disorder.

Looking at the graph on the profile sheet helps to pull out additional information. Note the very low (below the 15th percentile) OAT and SAT scores. The low OAT can indicate someone who has a hard time acknowledging personal limitations or shortcomings. The low SAT can indicate someone who has a chip on their shoulder, feelings of rejection and hypersensitivity to others. Interestingly, the DEF score is within the norm and does not indicate the student was defensive completing the SASSI. The FRISK score is above average but within the norm and because it is a Face-valid scale, content analysis of those items may be useful. The other Face-valid scales, ATT and SYM with their scores of 1 can also be examined.

The student who turned in the vaping pen indicated it was not his. It was not clear from the caller what substances they suspected were being used. Clinically, the best thing to keep in mind is that the student has a hard time opening up and is probably very concerned about how he is viewed by teachers, counselors, etc. and very quick to feel rejected. Interacting with him in an accepting and affirming way is probably the best approach.

Substance use issues: The VAL of 6 is a red flag so further evaluation with this student is warranted. It could be on-going oversight within the school, i.e. school counselor or referral to a Substance Use counselor who could do a more formal and comprehensive assessment.

We hope this is useful for you.

As usual, don’t hesitate to call the Clinical Helpline at 800-726-0626 with any clinical questions. Live clinicians are available M-F, 11-5 pm (EST). Otherwise, feel free to leave a message and we will get back to you the next business day.

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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.

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